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The aim of this study was to apply complexity theory to explain and understand how risk factors combined in complex ways, eventually leading to a high prevalence of depressive symptoms among pregnant women. We also aimed to evaluate whether depressive symptoms affected delivery approach. The study had a longitudinal design and was conducted between May and September 2017. A total of 481 pregnant women were recruited to participate and completed closed-end surveys at two distinct times: during prenatal care at the hospital after 26 weeks of pregnancy and 1 to 4 weeks after delivery. This study identified eleven different pathways that led to an increase in depressive symptoms. Each pathway differentiated the effects of different influencing factors. Among the 481 pregnant women, 128 (26.6%) had cesarean deliveries without medical indications. Although depressive symptoms could affect delivery approach, it was not the most important factor. Surprisingly, the first production emerged as the key factor determining delivery mode. This study was innovative in that it examined which factors and which combinations of factors were necessary for the development of depressive symptoms. Additionally, this study provided a better understanding of the mechanisms underlying the choice of cesarean section without medical indications.

A multi-objective optimization method based on an injury prediction model is proposed to address the increasingly prominent safety issues for e-bike riders in Chinese road traffic. This method aims to enhance the protective effect of vehicle front-end for e-bike riders by encompassing a broader range of test scenarios. Initially, large-scale rider injury response data were collected using automated Madymo simulations. A machine learning model was then trained to accurately predict the risk of rider injury under varied crash conditions. Subsequently, this model was integrated into a multi-objective optimization framework, combined with multi-criteria decision analysis, to effectively evaluate and rank various design alternatives on the Pareto frontier. This process entailed a comparative analysis of the design in a baseline scenario before and after optimization, focusing on both kinematic and injury responses of riders. Through detailed injury mechanism analysis, key design variables such as the height of the hood front and the width of the bumper were identified. This led to the proposal of specific optimization strategies for these structural parameters. The results from this study demonstrate that the proposed optimization method not only guides the design process accurately and efficiently but also balances the injury risks across different body parts. This approach significantly reduces the injury risk for riders in car-to-e-bike collisions and provides actionable insights for vehicle design enhancements., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

In recent years, as the abundance of residual mulch film (RMF) in agricultural soil continues to increase, whether the adsorption capacity of its surface affects the migration of heavy metals is a topic of current interest for scholars. Herein, this study investigated the distribution of RMF abundance and metal concentration in different soil layers of 75 plastic-mulching croplands in subtropical China; meanwhile, we also explored the associations of RMF characteristics with metal concentration. The results showed that land type, film mulching amount, and film mulching time were the main factors affecting RMF abundance, distribution, and particle size composition. The highest abundance of RMF was found in the garden soils (910 n·kg -1 ) with more than 15 years mulching period and more than 19.5 kg hm -2 of annual mulch amount. The lowest abundance of RMF was occurred in the group of field and conservation agricultural land (237 n·kg -1 ). Moreover, the concentrations of metals in soil, especially Cd, Cr, Cu, and Pb, were closely related to the extent of RMF contamination in the soil environment. In the 0-10 cm and 10-20 cm soil layers, microplastic abundance exhibited a negative correlation with Cr and Cu concentrations and a positive correlation with Pb concentration. Based on the above findings, it is demonstrated that RMF significantly influences the mobility of metals in soil via adsorption processes, with potential synergistic effects between RMF and heavy metals posing a heightened risk to the soil environment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Pesticides have been frequently detected in global freshwater ecosystems, but attempts to document changes in population dynamics of organisms upon exposure to pesticides, establish a causal relationship between exposure and population effects, and identify the key toxic events within individuals under natural field conditions remain rare. Here, we used a field survey, a reciprocal cross-transplant experiment, and a laboratory toxicity experiment to build a compelling case that exposure to the insecticide chlorpyrifos was responsible for differences in snail ( Bellamya aeruginosa ) densities in eastern (ELL) and western basins of Liangzi Lake in China. Our field survey and reciprocal cross-transplant experiment revealed significant differences in snail densities, juvenile percentage, survival, and relative telomere length (RTL) in the two basins. The insecticide chlorpyrifos detected in snail tissues was negatively correlated with snail densities, the percentage of juvenile snails, and RTL and had an extremely high risk quotient in ELL. In the laboratory experiment, tissue concentrations of chlorpyrifos detected in ELL were associated with reduced RTL and increased juvenile mortality in B. aeruginosa . These results support the hypothesis that chlorpyrifos exposure in ELL reduced the density of snails by reducing juvenile survival and, consequently, recruitment to the adult population.

Background: Brain-derived neurotrophic factor (BDNF) is crucial for neuronal survival and may be implicated in the pathophysiological process of depression. This study aimed to prospectively investigate the association between serum BDNF and post-stroke depression (PSD) at 3 months in a multicenter cohort study., Methods: A total of 611 ischemic stroke patients with serum BDNF measurements from the China Antihypertensive Trial in Acute Ischemic Stroke were included in this analysis. We used the 24-item Hamilton Depression Rating Scale to assess depression status at 3 months after ischemic stroke, and PSD was defined as a score of ≥8., Results: Baseline serum BDNF was inversely associated with the risk of depression after ischemic stroke. The multivariable-adjusted odds ratio of PSD for the highest tertile of BDNF was 0.53 (95 % confidence interval, 0.34-0.82; P for trend = 0.004) compared with the lowest tertile. Multivariable-adjusted spline regression model also showed a linear does-response association between serum BDNF levels and PSD at 3 months (P for linearity = 0.006). In addition, adding serum BDNF to conventional risk factors significantly improved the risk reclassification of PSD (net reclassification improvement: 16.98 %, P = 0.039; integrated discrimination index: 0.93 %, P = 0.026)., Limitations: All patients in this study were Chinese, so our findings should be applied to other populations cautiously., Conclusions: Higher serum BDNF levels at baseline were significantly associated with a decreased risk of PSD at 3 months, suggesting that BDNF might be a valuable predictive biomarker and potential therapeutic target for PSD among ischemic stroke patients., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: In this study, we aimed to validate the performance of the PAX1 and JAM3 methylation (PAX1 m /JAM3 m ) test as a triage tool for detecting cervical intraepithelial neoplasia grade 3 or worse (CIN3 +) in non-16/18 high-risk human papillomavirus-positive patients (non-16/18 hrHPV +)., Methods: The triage performance of liquid-based cytology (LBC) and the PAX1 m /JAM3 m test for detecting CIN3 + were compared., Results: In total, 1851 participants had cervical histological outcomes and were included in the analysis. The sensitivity/specificity of the LBC test results with atypical squamous cells of undetermined significance or worse (LBC ≥ ASCUS) and the PAX1 m /JAM3 m test were 90.1%/26.7% and 84.8%/88.5%, respectively. PAX1 m /JAM3 m ( +) had the highest diagnostic AUC (0.866, 95% confidence interval (CI) 0.837-0.896) in the whole cohort. All cancers (n = 20) were detected by PAX1 m /JAM3 m (+). Compared with LBC ≥ ASCUS, PAX1 m /JAM3 m (+) reduced the number of patients who needed referral for colposcopy by 57.21% (74.66% vs. 17.45%). The odds ratios for detecting CIN3 + by LBC ≥ ASCUS and PAX1 m /JAM3 m (+) were 3.3 (95% CI 2.0-5.9) and 42.6 (27.1-69.6), respectively (p < 0.001). The combination of LBC ≥ ASCUS or PAX1 m /JAM3 m (+) slightly increased the diagnostic sensitivity (98.0%, 95% CI: 95.8-100%) and referral rate (77.09%) but reduced the diagnostic specificity (24.8%, 22.7-26.8%)., Conclusions: In non-16/18 hrHPV(+) women, PAX1 m /JAM3 m was superior to cytology for detecting CIN3 + . Compared with LBC ≥ ASCUS, PAX1 m /JAM3 m (+) reduced the number of significant referrals to colposcopy without compromising diagnostic sensitivity., (© 2024. The Author(s).)

The significance of mangroves in carbon storage is widely acknowledged. However, the potential role of carbon enhancement driven by mangroves in mitigating the risk of metal exposure remains unclear. In this study, a natural mangrove reserve located in Futian was selected to investigate the potential role of autochthonous organic carbon on metal bioavailability. The presence of mangroves seemed to have little effect on the accumulations of Cu(II), Zn(II), Cr(VI/III), Pb(II), and Ni(II) in surface sediments. Metal mobility and bioavailability, however, were found to be directly influenced by the presence of mangroves. Compared with mudflat, mangrove sediments exhibited an obvious in the bioavailability of Cu(II), Zn(II), Cr(VI/III), Pb(II), and Ni(II) by 19-79 %, with the highest reduction occurring in the interior of mangroves dominated by K. obovata. Mangroves also significantly enhanced the accumulation of organic carbon in sediments, regardless of carbon components. Moreover, the results from random forest analysis further showed that autochthonous organic carbon was the most important carbon component that negatively related to metal bioavailability. In summary, this is the first study to provide a linkage between mangrove cover and increased autochthonous organic carbon input, which decreases metal bioavailability. The present data also suggest that mangroves are an efficient natural barrier to alleviate the risk of metal exposure in intertidal regions., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The problem-based learning (PBL) is increasingly used in undergraduate education. However, the application of integrated PBL to medical undergraduate education has not been well assessed. An observational study was designed to compare integrated PBL combined with lecture-based classroom (LBC) with traditional LBC teaching in 2 semesters of a Medical School in China. This study was conducted from March 2021 to July 2022. A total of 118 undergraduates majoring in clinical medicine were randomly allocated in 2 groups, 1 group receiving the integrated PBL + LBC teaching (experimental group, n = 60) and another group receiving LBC teaching (control group, n = 58). The experimental group attended the integrated PBL courses for the basic and clinical medicine conducted in the 6th and 8th semesters, respectively, as well as taking the LBC courses. The experimental group was required to preview the course materials before class, make presentations in class and take online feedback questionnaires after class, while the control group was required to preview the textbooks and listen to the traditional LBC courses. The students' scores of these 2 groups were compared, and feedback questionnaires were performed to evaluate the effectiveness of the experimental group over the control group. Results showed that the experimental group scored significantly higher than the control group in Clinical Skills (95% confidence interval [CI] 4.19-5.89), Internal Medicine I (95% CI: 1.85-9.93), Internal Medicine II (95% CI: 8.07-15.90), Introduction to Surgery (95% CI: 5.08-10.25), Surgery (General Surgery) (95% CI: 7.82-12.72), Surgery (Specialty) (95% CI: 6.47-9.97), and Clinical Medical Level Test (95% CI: 1.60-5.15) (all P < .01). In the feedback questionnaires of integrated PBL, up to 80% and 90% of students were satisfied with the teaching methods and lecturers, respectively. More than 80% of students agreed that the integrated PBL improved their abilities to learn independently, understand knowledge, and to raise, analyze and solve problems. In terms of stress in and out of class, a small number of students, <36.7%, felt stressed. The integrated PBL combined with LBC is an effective teaching approach, which may provide new ideas for teaching research and reform on undergraduate medical education in clinical medicine specialty and other medical majors., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Co-existence of colistin, β-lactam and carbapenem in multidrug-resistant Enterobacteriaceae isolates poses a serious threat to public health. In this study, we investigated and characterized the co-occurrence of bla CTX-M-65 , bla OXA-1 , and mcr-1.1 strain isolated from a clinical extensively-drug-resistant Escherichia coli ST744 in Shanghai., Methods: Antimicrobial susceptibility test was carried out by agar dilution methods. Whole genome sequencing was conducted, and resistance genes, and sequence types of colistin in E. coli isolates were analyzed. Plasmid stability and amino acid mutations were assessed in E. coli isolates., Results: A colistin resistant E. coli ST744, named ECPX221, was identified out of 145 fecal samples collected. The strain carries a 60,168 IncI2 plasmid with the mcr-1.1 gene. The strain also has bla CTX-M-65 , bla OXA-1 , dfrA 14, qnrS1 , cmlA5 , arr2 , ampC , aph(4)-Ia , sul1 , and aadA5 resistance genes. The plasmid pECPX221 was capable of conjugation with an efficiency of 2.6 × 10 -2 . Notably, 45% of the transconjugants were determined as mcr-1.1 -harboring in the colistin-free environment after 60 generation of passage. No mutations occurred in pmrB , mgrB , and phoPQ gene in the mcr-1.1 -harboring transconjugants. Bioinformatic analysis indicated pECPX221 shared highly similar backbone with the previously reported mcr-1.1 -harboring pAH62-1, pMFDS1339.1, pSCZE4, and p2018-10-2CC. Furthermore, sequencing and phylogenetic analyses revealed a similarity between other MCR-1-homolog proteins, indicating that ECPX221 was colistin resistant., Conclusion: The stable transferable mcr-1.1 -harboring plasmid found in the E. coli ST744 strain indicated the high risk to disseminate the extensively-drug-resistance phenotype among Enterobacteriaceae ., 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 Feng, Wu, Zhuang, Luo, Chen, Wu, Fei, Shen, Yuan and Chen.)

China is rich in antimony, boron, and vanadium mineral resources, which have been detected in environmental water bodies and drinking water. During the revision process of the "Standards for Drinking Water Quality (GB5749-2006)", research and evaluation are focused on three indicators: antimony, boron and vanadium. Vanadium is added and the limit value of boron is adjusted. This study reviews and discusses the technical contents related to the revision of the antimony, boron and vanadium, including the environmental presence levels, exposure status, health effects, and the revision of the standard limits of these three indicators. Suggestions are also made for the implementation of this standard.

Dietary intake is a crucial pathway of organophosphate esters (OPEs) exposure for human. However, information about the exposure risk of OPEs via rice consumption is still largely unknown. In the present study, a total of 234 rice samples from 25 provinces or city of China were collected and the concentrations of 24 OPEs were determined. Sixteen OPEs were detected in these rice samples and each rice sample was contaminated with at least 5 OPEs, indicating a ubiquitous occurrence of OPEs in Chinese rice. Moreover, the concentrations of Σ 16 OPEs ranged from 1.46 to 552.65 μg/kg dry weight (dw), with a mean value of 64.74 μg/kg dw. For the composition profile of OPEs, three Cl-OPEs, including tris(2-chloroethyl) phosphate (TCEP), tri(2-chloroisopropyl) phosphate (TCIPP) and tris(1,3-dichloro-2-propyl) phosphate (TDCIPP), accounted for the highest proportion of Σ 16 OPEs. For the spatial distribution of OPEs, although obvious spatial variations were observed among the 25 provinces or city, no obvious variations were found among the six rice-cultivating regions of China. Additionally, estimated dietary intakes (EDI) values of the 16 OPEs for adults and children were 1105.24 and 1399.13 ng/kg bw/day, respectively, under the high intake scenario. The hazard indexes of the 10 OPEs were 0.108 and 0.137 for adults and children, respectively. The risk assessment results indicated that Chinese adults and children did not suffer significant adverse effects from OPEs via rice intake., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Rice cultivation regions have a high density of open water networks to meet the requirements of rice growth and production. These open water networks have a significant risk of carbon (C) emissions due to agricultural production, but the C emissions from these waters are not clearly recorded in previous studies. Therefore, this study aimed to explore the pattern and internal mechanism of methane (CH 4 ) and carbon dioxide (CO 2 ) emissions from multiple types of waters (i.e., river, fish pond, reservoir, and ditch) in a typical rice cultivation region in southwestern China. The annual CH 4 and CO 2 fluxes were higher in the downstream river (2.79-94.89 and 39.39-1699.98 mg m -2 h -1 ) and ditch (8.80-74.99 and 123.43-542.65 mg m -2 h -1 , respectively) and lower in the reservoir (-0.67 to 3.45 and -239.15 to 141.50 mg m -2 h -1 ) (P < 0.05). The monthly trends of CH 4 and CO 2 fluxes from the middle river and ditch were driven by interactive reactions of rice cultivation practices and precipitation. In contrast, the emission patterns of CH 4 and CO 2 from the lower river, upper river, and fish pond were mainly driven by domestic sewage discharge, precipitation, and aquaculture practices, respectively. This study suggested that river and ditch were more sensitive to C emissions than other waters, and the rice production period was the critical period for controlling C emission. Although rice paddy soils yield more cumulative emissions of CH 4 , water networks in rice cultivation regions were possible hotspots for C emissions due to the higher emission intensities, which were largely overlooked before. Thus, it is necessary to refine and promote practices to better mitigate C emissions from waters in rice cultivation regions in the future., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Ouping Deng reports financial support was provided by National Natural Science Foundation of China. Rong Huang reports financial support was provided by National Natural Science Foundation of China. Ouping Deng reports financial support was provided by Department of Science and Technology of. Sichuan Province, China. Jianbo Fei reports financial support was provided by Department of Science. and Technology of Sichuan Province, China., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Using the data from a large-scale Chinese national survey, this study aimed to explore the underlying mechanisms between Chinese adults' self-assessments of family social status in childhood and depression., Methods: The research data was from the China Family Panel Studies (CFPS) in 2020. We selected 13,430 Chinese adults aged 16-60 as participants, and used the PROCESS macro program to conduct moderated mediation analysis., Results: Chinese adults' self-assessments of family social status in childhood had a statistically significant negative predictive effect on depression. The sharing frequency of WeChat Moments played a partial mediating role in the relationship between self-assessment of family social status in childhood and depression. Furthermore, social trust moderated the direct effect of mediation model. Age moderated the second half of the mediation model, and the effect was statistically significant in the younger population (young people), but not in the older population (middle-aged people)., Limitations: This was a cross-sectional study and no causal conclusions could be drawn., Conclusions: Chinese adults' self-assessment of family social status in childhood could affect depression in adulthood through sharing frequency of WeChat Moments. People with higher social trust can effectively buffer the adverse effect of self-assessed low family social status in childhood on depression. Age moderated the relationship between sharing frequency of WeChat Moments and depression, but this moderating effect was only significant in the younger population., Competing Interests: Conflict of interest The authors declare that they have no conflict of interest., (Copyright © 2022 Elsevier B.V. All rights reserved.)

This study aimed to explore the combination of different conditional variables that led to depressive symptoms among frontline nurses who were fought against COVID-19 during the outbreak in Wuhan City, Hubei Province of China. The study was conducted in August 2020, which included 331 frontline clinical nurses who supported Wuhan's fight against COVID-19. The age range was 21-57 years and included 315 female nurses and 16 male nurses. This study used the fuzzy-set qualitative comparative analysis research method to explore the path of depression among frontline nurses. This study generated nine different configurations for the path of depression among frontline nurses, and had a detailed demonstration for each configuration. Each configuration distinguishes the different effects of influencing factors. For example, in the first configuration, gender, sleep disorder and PTSD exist as core conditions, while social support exists as a core condition lack. This study was presented results which was different what linear regression model reports. It takes into consideration the combined effect of each conditional variable on the development of depression. Nurse managers should pay attention to the combination of multiple influencing factors, instead of focus on single factors., (© 2022 John Wiley & Sons Australia, Ltd.)

Objectives: Previous studies revealed a positive association between neuroticism and depression. This study further extended the previous findings by exploring the psychological processes underlying this association among Chinese postgraduates. Guided by theoretical models and empirical research, we proposed a multiple mediation and moderated mediation model to investigate the roles of dispositional mindfulness and cognitive reappraisal in the relationship between neuroticism and depression. Methods: Using the NEO Five-Factor Inventory, Beck Depression Inventory, Mindfulness Attention Awareness Scale, and Emotion Regulation Questionnaire, 1103 first-year postgraduates at a comprehensive university in China were surveyed. Path analysis was adopted to test the models. Results: The results showed that dispositional mindfulness mediated the association between neuroticism and depression. Further, this mediating effect was moderated by cognitive reappraisal, with this effect being stronger in individuals with low engagement in cognitive reappraisal. Conclusion: The results support interrelations among neuroticism, depression, dispositional mindfulness, and cognitive reappraisal as moderated mediation rather than multiple mediation. The results enhance our understanding of psychological mechanisms between neuroticism and depression and provide suggestions for interventions to prevent or reduce depression in highly neurotic postgraduates., 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 Hou, Chang, Chen, Fei and Zhou.)

The study aimed to investigate the level of life satisfaction (LS) among Chinese female workers after resuming work during the COVID-19 epidemic, and to further explore the potential mediating and moderating roles in the association between family stress and LS. Self-reported questionnaires were completed by 10,175 participants. Results showed that the level of LS decreased. The family stress had a negative effect on LS, and the effect was mediated by anxiety symptoms. Additionally, age moderated the direct and indirect effects within this relationship. Interventions aiming to improve LS should consider these aspects and younger workers should be given special attention.

With the increasing severity of environmental regulations, Chinese enterprises are gradually transforming from the profit growth pattern of "growth with pollution" to green development. However, this paper finds that this transformation is not complete. While catering to the national environmental protection governance requirements, some enterprises still persist the profit growth pattern of "growth with pollution." How to solve this problem? By attracting government subsidies, reducing tax burdens, and increasing the proportion of technical personnel employed, we theoretically and empirically demonstrate that the positive effect of "new infrastructure" in accelerating enterprises' transformation away from the profit growth pattern of "growth with pollution" to sustainable development. In the heterogeneity analysis section, we found that in enterprises with higher political correlation, more technical personnel, and lower labor cost, the "new infrastructure" has a stronger restraining effect on the "growth with pollution" pattern., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The study was to compare the performance of the regression models and fuzzy set qualitative comparative analysis (fsQCA) models in analyzing the possible effects of sociodemographic variables (age and sex) and lifestyle behaviors (physical activity, sedentary time, sleep duration, physical education class and screen time) on depressive symptoms in adolescents. This cross-sectional surgery was conducted among 726 adolescents in Jilin Province of China, selected by random cluster sampling. The regression model showed that age, physical education (PE) class and sleep duration were associated with depressive symptoms. Meanwhile, the fsQCA models showed that shorter physical activity, PE class and sleep duration as well as longer sedentary and screen time were related to higher levels of depressive symptoms. Both regression and fsQCA models indicated that promoting lifestyle behaviors could affect depressive symptoms. Considering the differences between the two methods, they are not superior to the other method, but complementary and should be used in other studies at the same time., 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 Mei, Lv, Ren, Guo, Meng, Fei, Yuan, Yue, Gao, Song, Zhao, Ao and Li.)

Considering the inhomogeneity of plastisphere and surrounding soil, it is plausible that the microbial community colonizing it also varies, affecting soil services and sustainability. Herein, we analyzed the soil and film residue from fifty-five plastic-mulching croplands in the subtropical areas of China. Based on the outcomes of this analysis, we explored the diversity and functions of the associated bacterial communities. Alpha-diversity and phylogenetic diversity of the plastisphere bacterial community was significantly lower than the surrounding soil. The average net relatedness and net nearest taxa indices of samples were less than zero. Four phyla and twenty genera were enriched in the plastisphere compared to the surrounding soil. Ecological networks of the plastisphere community showed multiple nodes, but fewer interactions, and the members of Bradyrhizobium, Rhodospirillaceae, and Bacillus were indicated as the hub species. Predicted pathways related to human disease, as well as the metabolisms of cofactors, vitamins, amino acids, and xenobiotic biodegradation, were reinforced in the plastisphere, and meanwhile, accompanied by an increase in abundance of genes related to carbon, nitrogen, and phosphorus cycles. These results demonstrated the diversity and functions of the plastisphere microbiome and highlighted the necessity for exploring the ecological and health risks of plastic residue in croplands., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Marine spatial planning (MSP) is to manage incompatible functional use for achieving spatial homogeneity in sea. However most MSP strategies focus on single-target sea use demand ignoring multiple-conflicts of different demands. Thus, this study develops a spatial management model and quantitatively recognizes two types of spatial conflicts among eight sea use functions in the Zhejiang coasts, China. Under the simulation of three different management scenarios including independent, joint and overall-value managements respectively, we further propose a conflict optimization scheme in the scenarios of sea uses with different intensities, different types of sea use combinations, and different site selection. Most importantly, this study demonstrates the spatial management model is a powerful and efficient tool for spatial multiple-conflicts trade-off and matching sea use demands under the practical approach of marine functional zoning (MFC) in China., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

In this study, Illumina MiSeq sequencing of the 16 S rRNA gene was used to describe the bacterial communities in the South China Sea (SCS) during the southwest monsoon period. We targeted different regions in the SCS and showed that bacterial community was driven by the effects of the river, upwelling, and mesoscale eddy through changing the environmental factors (salinity, temperature, and nutrients). Distinct bacterial communities were observed among different chemical conditions, especially between the estuary and the open sea. The abundance of Burkholderiales, Frankiales, Flavobacteriales, and Rhodobacterales dominated the estuary and its adjacent waters. Bacteria in cyclonic eddy were dominated by Methylophilales and Pseudomonadales, whereas Prochlorococcus, SAR11 clade, and Oceanospirillales had relatively high abundance in the anticyclonic eddy. Overall, the abundance of specific phylotypes significantly varied among samples with different chemical conditions. Chemical conditions probably act as a driver that shapes and controls the diversity of bacteria in the SCS. This study suggests that the interaction between microbial and environmental conditions needs to be further considered to fully understand the diversity and function of marine microbes., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Most previous studies focused on the associations of depression and anxiety with Internet addiction (IA) have used variable-centered approaches. This study aims to explore the distinct developmental trajectories of depression and anxiety, and their association with IA based on person-centered approaches., Methods: A total of 437 Chinese high school freshmen at the baseline were followed across one year. Latent class growth analysis (LCGA) and growth mixture modeling (GMM) were used to identify the heterogeneity of individual trajectories of depression and anxiety., Results: For depression, there were three distinct trajectories identified, namely, the escalating group (n=60, 13.7%), recovery group (n=31, 7.1%), and the low-stable group (n=346, 79.2%). For anxiety, the subgroups consisted of the escalating group (n=50, 11.4%), the recovery group (n=34, 7.8%), and the low-stable group (n=353, 80.8%). The probability of IA in the depression low-stable group was significantly smaller compared to those in either the recovery group (χ 2 =10.794, P=0.001) or the escalating group (χ 2 =19.314, P<0.001). The probability of IA in the anxiety low-stable group was found to be significantly smaller than that in the recovery group (χ 2 =17.359, P<0.001) and the escalating group (χ 2 =7.752, P=0.005)., Limitations: The sample was limited to students from one specific high school and had a one-year follow-up., Conclusions: The findings of the study suggest the necessity of early prevention and intervention strategies for those students with depression and anxiety, which are at elevated risk of developing IA., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objectives: This study aimed to evaluate the nutrition risk profile of hospitalized children with electronic health record-based nutrition risk screening. Additionally, this study analyzed the association between high nutrition risk and clinical outcomes., Methods: Children discharged from Shanghai Children's Medical Center between 2017 and 2018 were enrolled and nutritionally screened. Nutrition risk scores using the Screening Tool for Assessment of Malnutrition in Pediatrics (STAMP), length of stay (LOS), and costs of hospitalization were recorded. Enrolled patients were categorized into two groups: the low and medium nutrition risk (LMNR) group, with scores ranging from 0 to 3, and the high nutrition risk (HNR) group, with scores ≥4., Results: Out of 62 408 subjects, 17.4% were at HNR. Patients with congenital heart diseases (83.9%), hematology-oncology diseases (26.0%) and gastroenterological diseases (21.4%) were affected most. Infants had the highest HNR rates (35.5%) of any age group. Surgical patients (20.7%) had a higher rate of HNR than non-surgical patients (9.5%). The HNR group had longer LOS (10.0 d versus 3.0 d, P < 0.001), higher total hospital costs (53 680.1 Chinese yuan [CNY] versus 8810.1 CNY, P < 0.001), and higher costs of antibiotics (441.0 CNY versus 0.0 CNY, P < 0.001) compared to the LMNR group. As STAMP score values increased, growing LOS and costs of hospitalization, medications, and antibiotics were observed., Conclusions: A high prevalence of HNR was found in patients of Shanghai Children's Medical Center. Surgeries, specific disease, and infancy were important HNR risk factors. HNR scores using STAMP might predict prolonged LOS and higher medical costs., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: Increasing evidence indicate that coronavirus disease 2019 (COVID-19) is companied by renal dysfunction. However, the association of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)-induced renal dysfunction with prognosis remains obscure., Materials and Methods: All 154 patients with COVID-19 were recruited from the Second People's Hospital of Fuyang City in Anhui, China. Demographic characteristics and laboratory data were extracted. Renal dysfunction was evaluated and its prognosis was followed up based on a retrospective cohort study., Results: There were 125 (81.2%) mild and 29 (18.8%) severe cases in 154 COVID-19 patients. On admission, 16 (10.4%) subjects were accompanied with renal dysfunction. Serum creatinine and cystatin C were increased and estimated glomerular filtration rate (eGFR) was decreased in severe patients compared with those in mild patients. Renal dysfunction was more prevalent in severe patients. Using multivariate logistic regression, we found that male gender, older age and hypertension were three importantly independent risk factors for renal dysfunction in COVID-19 patients. Follow-up study found that at least one renal function marker of 3.33% patients remained abnormal in 2 weeks after discharge., Conclusion: Male elderly COVID-19 patients with hypertension elevates the risk of renal dysfunction. SARS-CoV-2-induced renal dysfunction are not fully recovered in 2 weeks after discharge.

Background: Increases in the levels of serum C-reactive protein (CRP) and creatinine (Cr) and decreases in those of albumin (Alb) are commonly observed in acute pancreatitis (AP). We aimed to evaluate the efficacy of the Cr/Alb and CRP/Alb ratios in the prediction of surgical treatment effect in AP patients., Methods: This study retrospectively analyzed clinical data obtained from 140 AP patients who underwent debridement from January 2008 to November 2018 in Shanghai Ruijin Hospital. The Cr/Alb and CRP/Alb ratios at admission and before surgery were assessed in the analysis of clinical statistics, prediction of prognoses, and logistic regression analysis., Results: The admission Cr/Alb had the best predictive value of the four ratios. This value was significantly higher in patients with re-operation and those who died (P < 0.05) and was correlated with the Acute Physiology and Chronic Health Evaluation (APACHE II) score, admission CRP/Alb, preoperative Cr/Alb, and post-operative complications. The admission Cr/Alb could predict the risk of AP-related re-operation and mortality with sensitivities, specificities and areas under the curve of 86.3%, 61.7% and 0.824, and 73.4%, 81.3% and 0.794, respectively. At a cut-off value of 3.43, admission Cr/Alb values were indicative of a worse clinical state, including impaired laboratory test values, APACHE II scores, rates of post-operative complications and re-operation, and mortality (P < 0.05). In the logistic regression analysis, admission Cr/Alb values were independently related to the APACHE II score, post-operative renal failure, and mortality., Conclusion: Cr/Alb is a novel but promising, easy-to-measure, reproducible, non-invasive prognostic score for the prediction of the effect of debridement in AP patients.

China needs to balance between current population pressures and a vulnerable marine environment, creating a national, political outline or management strategy dubbed an ecological civilization construction. The nation's effort to protect and maintain a sustainable ocean and address the relevant economic, resource and environmental issues relies on Marine Ecological Civilization (MEC) construction. The quantification of MEC progress is essential to track the management performance and guide the subsequent development and implementation. This study evaluates the performance of China's MEC from 2006 to 2016 based on a comprehensive index system. Our findings are as follows: During 2006-2016, the overall MEC performance score increased from 0.3426 to 0.4850 nationwide. Large space-time variations exist among the eleven coastal regions. The Shandong and Guangdong regions showed relatively good performances, whereas the Jiangsu, Guangxi and Shanghai regions had low scores. A decade long change in MEC scores showed that Hebei achieved the largest increase ratio. Marine management was improved by implementing various conservation strategies by China's government. Marine education and human talent introduction deserve more attention in less developed areas such as Hainan and Guangxi, and poor marine environmental quality was an urgent issue of the Yangtze river estuary economic zone. More accessible marine monitoring dataset are needed to track future space-time progress dynamics towards MEC construction. Our results provide a decade long retrospect of China's MEC achievements, and the quantified evaluation for each coastal region can provide valuable insight to policy-makers., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Cave dwelling is an ancient and unique type of residence in the Loess Plateau of Northern China, where the economics are less-developed. The majority of the local dwellers rely on traditional solid fuels for cooking and heating, which can emit large amounts of particles into both indoor and outdoor environments. In this study, we measured the real-time household concentrations of PM 2.5 and explored the association between personal daily PM 2.5 exposure and blood pressure (BP). Cooking and heating activities with different energies made a great variation in the household PM 2.5 air pollution, and residents using biomass had the highest personal PM 2.5 exposure. Temperature and relative humidity are both significantly linear correlated with household PM 2.5 air pollution. Besides, systolic blood pressure (SBP) was demonstrated to be positively associated with personal PM 2.5 exposure: with each 10-μg/m 3 incremental PM 2.5 concentration when controlling all the other factors, SBP will increase by 0.36 mmHg (95% confident interval (CI) 0.05-0.0.77 mmHg). If solid fuels could be replaced with clean energies, personal PM 2.5 exposure and SBP would reduce by more than 21% and 3.7%, respectively, calling for efficient intervention programs to mitigate household air pollution of cave dwellings and protect health of those residents.

Background: COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has threatened every civilian as a global pandemic. The immune system poses the critical interactive chain between the human body and the virus. Here, we make efforts to examine whether comorbidity with type 2 diabetes (T2D) affects the immunological response in COVID-19 patients., Methods: We conducted a retrospective pilot study investigating immunological characteristics of confirmed cases of COVID-19 with or without comorbid T2D. Two subcohorts of sex- and age-matched participants were eligible for data analysis, of which 33 participants were with T2D and the remaining 37 were nondiabetic (NDM). Cellular immunity was assessed by flow cytometric determination of surface markers including CD3, CD4, CD8, CD19, CD16, and CD56 in peripheral blood. Levels of C reactive protein, immunoglobulin (IgG, IgM, IgA, and IgE), and complements (C3, C4) were detected by rate nephelometry immunoassay. And Th1/Th2 cytokines (IL-2, IL-4, IL-6, IL-10, TNF- α , and IFN- γ ) were detected by Cytometric Bead Array., Results: Neutrophil counts were found to be significantly higher in the T2D group than in the NDM group and had a significant relevance with clinical severity. Lymphocyte frequencies showed no significant differences in the two groups. However, the proportions and absolute counts of T, Tc, Th, and NK cells decreased in both groups to different degrees. An abnormal increase in neutrophil count and a decrease in lymphocyte subpopulations may represent risk factors of COVID-19 severity. The level of IgG, IgM, IgA, C3, and C4 showed no significant difference between the two groups, while the IgE levels were higher in the T2D group than in the NDM group ( p < 0.05). Th1 cytokines including IFN- γ , TNF- α , and IL-6, as well as CRP, appeared significantly higher in the T2D group., Conclusions: The COVID-19 patients comorbid with T2D demonstrated distinguishable immunological parameters, which represented clinical relevancies with the predisposed disease severity in T2D., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2020 Ruxing Zhao et al.)

Daya Bay is facing the influence of human activities and nature changes, which result in phytoplankton adjusting to the changing environment. The data about environmental changes and phytoplankton were obtained from four seasonal cruises in 2013 in the bay. It is helpful to explore seasonal succession of phytoplankton driven by the determining environmental factors in this bay. Temperature is a significant indicator of season change. The limiting factor of phytoplankton growth totally changed from P (PO 4 -P) limiting during the southwest monsoon to Si (SiO 3 -Si) limiting during northeast monsoon. The order of diatoms and dinoflagellates was the dominant phytoplankton groups in Daya Bay. The dominant species included chain-forming diatoms (Skeletonema, Pseudo-nitzschia, Thalassionema, Chaetoceros and Rhizosolenia) were found all the year round and filamentous cyanobacteria (Trichodesmium) in spring and autumn. Partial least square regression (PLS) found that salinity, temperature and nutrients were important driving force for phytoplankton seasonal succession.

Sediment quality caused by heavy metals was investigated in the Mirs Bay and Tolo Harbor, Hong Kong, China. Samples were collected in January and July, 2010. One-way analysis of variance showed that sediment quality variables (Fe, Zn, Mn, Pb, V, Cu, Cr, Ba, Ni and As) were significantly different (p < 0.05) among the sampling areas, whereas the average concentration of V, Eh and Ba exhibited the significant seasonal variations (p < 0.05) between January and July. The spatial pattern of heavy metals (Pb, Zn and Cu) can probably be attributed to anthropogenic and tidal flushing influence in the harbor. Both geo-accumulation index (I geo ) and enrichment factor (EF) were used to identify the metal pollution level and its related source. Pb, Zn, and Cu are considered as "polluted metal" in Tolo Harbor. Cluster analysis (CA) identified three distinct clusters with the Tolo Habor and Shatou Jiao, the inner bay and the south part of the bay. Principal component analysis (PCA) identified the spatial patterns and their affected parameters in the studying area. Results showed metals distribution in Mirs Bay and its adjacent area is principally affected by human activities such as marineculture, dumping, located mostly in Tolo Harbor and Shatou Jiao, where was closely related with anthropogenic influence. While the monitoring stations including MS13-MS16 and MS8 locating in the south part of the studying area might be corresponded to natural influence.

Kandelia obovata is one of the cold tolerant mangrove plants along the China coast. To reveal the cold tolerant mechanism of K. obovata, the present work isolated two CBF/DREB1 genes (designated KoCBF1 and KoCBF3) from cold-stressed K. obovata and characterized their expression profiles in various organs and in response to multiple abiotic stresses. The deduced proteins of KoCBF1 and 3 all contain specific features of CBFs, and show high similarity to AmCBF1 and 3 from Avicennia marina, respectively. Different expression patterns of the two CBF orthologous under various abiotic stresses and exogenous hormone suggested that they may have different regulators and be involved in different regulatory pathway. The high basal and cold induced expression of the two genes indicated that they may all play important roles in growth and cold resistance of plants. The significant induction of KoCBF3 after salt and lead (Pb 2+ ) treatments suggested that this CBF gene may also participate in response to salinity and heavy metal stresses. This study will provide a better understanding of CBF-regulated stress-resistant mechanism, which may be benefit in mangrove biotechnological breeding, high-latitude transplanting, and bioremediation of heavy metal pollutions.

Lead smelting slag (LSS) has been identified as general industrial solid waste, which is produced from the pyrometallurgical treatment of the Shuikoushan process for primary lead production in China. The LSS-based geopolymer was synthesized after high-energy ball milling. The effect of unconfined compressive strength (UCS) on the synthesis parameters of the geopolymer was optimized. Under the best parameters of the geopolymer (modulus of water glass was 1-1.5, dosage of water glass (W(SiO 2 +Na 2 O)) was 5% and water-to-binder ratio was 0.2), the UCS reached 76.09 MPa after curing for 28 days. The toxicity characteristic leaching procedure (TCLP) leaching concentration of Zn from LSS fell from 167.16 to 93.99 mg/L after alkali-activation, which was below the limit allowed. Meanwhile, C-S-H and the geopolymer of the hydration products were identified from the geopolymer. In addition, the behavior of iron was also discussed. Then, the hydration process characteristics of the LSS-based geopolymer were proposed. The obtained results showed that Ca 2+ and Fe 2+ occupied the site of the network as modifiers in the glass phase and then dissociated from the glass network after the water glass activation. At the same time, C-S-H, the geopolymer and Fe(OH) 2 gel were produced, and then the Fe(OH) 2 was easily oxidized to Fe(OH) 3 under the air curing conditions. Consequently, the conclusion was drawn that LSS was an implementable raw material for geopolymer production.

Background: Non-obstructive azoospermia (NOA), a serious phenotype of male spermatogenesis failure, is a multifactorial disease which is regulated by genetic, epigenetic, and environmental factors. Some gene structural variants have been demonstrated to be related to NOA. Loss-of-function mutations of KISS1R cause normosmic idiopathic hypogonadotropic hypogonadism (IHH) which result in azoospermia at the pre-testicular level. The objective of this research was to investigate genetic variants of KISS1R in NOA patients., Methods: The entire coding region of 52 spermatogenesis-associated genes (KISS1R included) was sequenced from 200 NOA patients. Mutation screening was performed to identify genetic variations of these genes by targeted exome sequencing. Sequencing data analysis was carried out by a series of bioinformatics tools. Candidate variants confirmation was performed by Sanger sequencing. Functional analysis of candidate variants was evaluated using SIFT and PolyPhen-2., Results: Three heterozygous missense variants in KISS1R were identified in three patients, respectively. No deleterious variations in other candidate genes were found in the three patients. Two of these three variants, p.A211T and p.G186E, had been reported in the ExAC and dbSNP database, respectively, while the other variant p.A301D was novel. These variants were all predicted to be likely pathogenic by in silico analysis., Conclusion: Our study revealed three heterozygous missense variants in KISS1R which expanded the mutation spectrum of KISS1R in infertile men with NOA in the northeast of China., (© 2019 The Authors. Journal of Clinical Laboratory Analysis published by Wiley Periodicals, Inc.)

Background: Dehydration due to insufficient fluid intake (IFI) is detrimental to health. This cross-sectional study aimed to assess the fluid intake of urban adults in Wuxi, China, and to identify potential risk factors contributing to IFI., Methods: Adults were selected from the urban area of Wuxi, China, using a multiple-stage random sampling method. The fluid intake information was obtained with a 24-h self-reported diary over seven consecutive days in both summer and winter of 2015. A classification and regression tree (CART) analysis was conducted to detect the potential risk factors associated with IFI. CART is a machine-learning algorithm that portions the data into subsets by threshold., Results: A total of 584 adults aged 18-87 years were included. The results showed that the median (P25-P75) values of daily fluid intake of the participants were 1100 (800-1550) mL in summer and 1000 (750-1300) mL in winter. Women had a higher prevalence of IFI than men in both summer (odds ratio (OR) = 2.683, 95% confidence interval (CI): 1.830-3.934) and winter (OR = 2.636, 95% CI: 1.677-4.142). The results of CART analysis showed that, in summer, BMI < 25 kg/m 2 (probability: 64.2%) and age < 64 years (probability: 67.4%) were main risk factors of IFI for men, and BMI < 29 kg/m 2 (probability: 81.6%) and living in C Community (probability: 86.7%) were main risk factors for women. In winter, age < 40 years (probability: 81.8%) and BMI < 20 kg/m 2 (probability: 94.5%) were identified as main risk factors of IFI for men and women, respectively., Conclusions: Most of the participants living in the study site had IFI. The fluid consumption varied by gender, age, location, and BMI. The findings could be useful for the implementation and optimization of intervention programs by identifying the individuals who may at greater risk of dehydration.

Preterm birth (PTB) can give rise to significant neonatal morbidity and mortality, as well as children's long-term health defects. Many studies have illustrated the associations between ambient air pollution exposure during gestational periods and PTB risks, but most of them only focused on one single air pollutant, such as PM 2.5 . In this population-based environmental-epidemiology study, we recruited 6275 pregnant mothers in Zhejiang Province, China, and evaluated their gestational exposures to various air pollutants during 2013-2017. Time-to-event logistic regressions were performed to estimate risk associations after adjusting all confounders, and Quasi-AQI model and PCA-GLM analysis were applied to resolve the collinearity issues in multi-pollutant regression models. It was found that gestational exposure to ambient air pollutants was significantly associated with the occurrence of PTB, and SO 2 was the largest contributor with a proportion of 29.4%. Three new variables, prime factor (a combination of PM 2.5 , PM 10 , SO 2 , and NO 2 ), carbon factor (CO), and ozone factor (O 3 ), were generated by PCA integration, contributing 63.4%, 17.1%, and 19.5% to PTB risks, respectively. The first and third trimester was the most crucial exposure window, suggesting the pregnant mothers better to avoid severe air pollution exposures during these sensitive periods., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In the past two decades, neonicotinoid insecticides have been widely used in agricultural activities in China. Many previous studies have investigated the neonicotinoid pollution in aquatic ecosystems, but the status of water safety of neonicotinoid uses in China is very scarce. The present study aims to reveal the spatial and temporal distribution of neonicotinoids in rivers, and then evaluate the ecological risks to aquatic animals. Water samples were collected from all sixteen rivers along the east coast of China during the dry and wet seasons in 2016, and nine individual commercialized neonicotinoids were quantified. Higher concentrations were found during the dry season (343 ± 210 ng/L) compared to those during the wet season (174 ± 162 ng/L). The concentration of neonicotinoid insecticides in river water is mainly affected by the intensity of agricultural activities. The spatial and temporal pollution patterns we discovered suggested the use of neonicotinoids has shifted from old types (i.e., imidacloprid and acetamiprid) to new types (i.e., dinotefuran and nitenpyram) in some areas. The estimated annual quantity of neonicotinoids released into the adjacent seas totaled 1256 ± 780 tons, most of which (95%) ran into the East China Sea due to heavy agricultural use in the Yangtze River Basin. Using the species sensitive distribution (SSD) method, the thresholds for aquatic animals were determined (acute: 362 ng/L; chronic: 58 ng/L). Under current agricultural practices, 27% and 84% of the river water samples exceeded the thresholds for acute and chronic ecological risks, suggesting intervention programs are in urgent need to ensure river water safety for aquatic life in China., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Neonicotinoid insecticides have been widely consumed worldwide, particularly in China. There is a growing interest in the environmental research community about the occurrence, fates, sources, and risks of neonicotinoids. Nine neonicotinoids in river/lake water were measured at 12 sites along the Yangtze River Basin during the dry and wet seasons in 2016, and nonpoint sources were also identified based on a modified mass balance method. A significantly higher concentration of neonicotinoids was found during the dry season probably due to the dilution effect and insecticide consumption. The high pollution levels are due to posing high ecological risks compared with the recommended thresholds. In 2016, 1190 (95% confidence interval (CI) = 822-1690) tons of neonicotinoids were transferred into the adjacent sea. Nonpoint source pollution (1700 (CI = 1200-2370) tons) was the major contributor (91.3%) to the total input of neonicotinoids into the system. Composition profiles identifying specific neonicotinoid sources indicated some changes in usage patterns from old to new types of neonicotinoids. This spatial and seasonal field study and source identification is expected to fill the data gap regarding the limited information on neonicotinoid use patterns and to inform further effective policy-making and intervention programs in China that should be urgently promoted in the near future.

Background and Objectives: Lactation is a time of increased nutritional requirements for mothers, and inadequate nutrient intake may have a detrimental effect on a woman's nutritional status. To investigate the dietary intake of two groups of women in Shanghai during the traditional confinement period., Methods and Study Design: Two groups of women (1) a community dwelling sample (n=92); (2) residents in a Maternity Care Centre (MCC) (n=30), kept a prospective dietary record which was complemented by photographing. This data collection was done on a single day on three occasions in the community group, and for three days on five occasions in the MCC one. The mean nutrient intakes of the two groups were compared at common time points to dietary reference intakes, and the food intake was compared to dietary guidelines., Results: Over half of this population had high body mass indices (BMIs) which reported that an excessive proportion of calories had come from fat intake. The mean intakes of sodium were higher than the recommended. Fruit, vegetable, bean, tuber, and milk intakes were lower than the recommendations. Over 70% of the women failed to meet the Estimated Average Requirement (EAR) for calcium. A notable proportion of all women failed to meet the EAR for vitamin C, thiamin, and riboflavin. Dietary fiber intakes were low, with a group mean intake value less than half the Adequate Intake (AI)., Conclusions: This study on dietary intakes indicates nutritional intake issues may exist among lactating women in Shanghai, particularly in community-dwelling women.

Objectives: This study aimed to identify factors that influence people's willingness to volunteer and participation in emergency volunteering in northern China., Design/setting: This study was conducted in Heilongjiang province in September and October 2014 using a mixed methods approach, which included a cross-sectional questionnaire survey on community residents and in-depth interviews with community residents and relevant organisational managers and officials in relation to emergency responses. A stratified cluster sampling strategy was employed to select questionnaire respondents., Participants: 2686 respondents completed the questionnaire survey; 19 key informants were interviewed., Primary and Secondary Outcome Measures: Willingness to volunteer was the major concern of this study. Self-reported past experience of the participants in emergency volunteering served as a secondary outcome., Results: 65.7% of respondents were willing to volunteer in emergencies. 24.3% of respondents had participated in emergency actions. Higher levels of willingness to volunteer and participation in volunteering were found in those who resided in rural areas (OR=1.308 (1.064 to 1.608) for willingness; OR=1.518 (1.208 to 1.908) for participation), had stronger community attachment (OR=1.720 (1.429 to 2.069) for willingness; OR=1.547 (1.266 to 1.890) for participation), had higher recognition of responsibility (OR=1.981 (1.498 to 2.619) for willingness; OR=1.517 (1.177 to 1.955) for participation), demonstrated preparedness behaviour (OR=1.714 (1.424 to 2.064) for willingness; OR=1.391 (1.151 to 1.681) for participation) and were covered by injury insurance (OR=1.335 (1.102 to 1.619) for willingness; OR=1.822 (1.500 to 2.214) for participation). The in-depth interviews revealed that an inappropriate policy environment and poor volunteer organisational management were major barriers for converting willingness into actions., Conclusion: A relatively high level of willingness to volunteer in emergencies in northern China is associated with a range of individual, community and institutional factors. Efforts should be made to translate willingness into effective contributions to the emergency response system. This can be done through improving policies, regulations, coordination mechanisms and volunteer training and support., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Niemann Pick Type C1 Like 1 (NPC1L1) protein plays a key role in intestinal and hepatic cholesterol metabolism in humans. Genetic variation in NPC1L1 has been widely studied in recent years. We analyzed NPC1L1 single nucleotide polymorphisms in Chinese gallstone disease patients to investigate their association with gallstone disease. NPC1L1 mRNA expression was also measured in liver biopsies from patients with cholesterol gallstone disease and compared between genotypes. The G allele of the g1679C>G (rs2072183) polymorphism was significantly more prevalent in patients with gallstones compared with gallstone-free subjects. Moreover, patients carrying the G allele had lower hepatic NPC1L1 mRNA expression and higher biliary cholesterol (molar percentages) and cholesterol saturation index. Our study suggests that the G allele of the NPC1L1 polymorphism g1679C>G may be a positive marker of gallstone formation risk.

Daya Bay is one of the largest and most important gulfs in the southern coast of China, in the northern part of the South China Sea. The phylogenetic diversity and spatial distribution of phytoplankton from the Daya Bay surface water and the relationship with the in situ water environment were investigated by the clone library of the large subunit of ribulose-1, 5-bisphosphate carboxylase (rbcL) gene. The dominant species of phytoplankton were diatoms and eustigmatophytes, which accounted for 81.9 % of all the clones of the rbcL genes. Prymnesiophytes were widely spread and wide varieties lived in Daya Bay, whereas the quantity was limited. The community structure of phytoplankton was shaped by pH and salinity and the concentration of silicate, phosphorus and nitrite. The phytoplankton biomass was significantly positively affected by phosphorus and nitrite but negatively by salinity and pH. Therefore, the phytoplankton distribution and biomass from Daya Bay were doubly affected by anthropic activities and natural factors.

Mangrove is a special coastal forest along tropical and subtropical intertidal shores. However, how mangroves adapt to tidal flooding and the mechanisms involved in mangrove zonation are still poorly understood. In this study, a pot trial with different tide treatments was conducted to investigate the differences in root anatomy, porosity, radial oxygen loss, iron plaque formation and waterlogging tolerance among six mangroves along a continuous tidal gradient. The index of waterlogging tolerance illustrated that Sonneratia apetala possessed the highest index, followed by Aeguceras corniculatum/Kandelia, Rhizophora stylosa, Heritiera littorlis and Thespesia populnea. Waterlogging tolerances of the mangroves were found to be positively correlated with their root porosity, radial oxygen loss and iron plaque formation. Waterlogging-sensitive species such as landward semi-mangroves exhibited small root porosity and ROL, while waterlogging-tolerant species such as seaward pioneer and rhizophoraceous mangroves exhibited extensive porosity, ROL and iron plaque formation. Nevertheless, grater root porosity and iron plaque formation were detected in permanent waterlogged plants when compared to drained plants. In conclusion, The present study proposes a structural adaptive strategy to tidal flooding in mangroves, such that the mangroves with higher root porosity, ROL and iron plaque appeared to exhibit higher waterlogging tolerance and adaptability in anaerobic foreshores.

Objective: To assess whether single nucleotide polymorphisms of HSD17B5 (AKR1C3) (rs1937845 and rs12529) and HSD17B6 (rs898611) are associated with polycystic ovary syndrome (PCOS) in a Chinese population., Design: A case-control study was conducted to investigate the relation between HSD17B5 and HSD17B6 polymorphisms and PCOS., Methods: In this study, 335 patients with PCOS and 354 controls were recruited. The genotypes of HSD17B5 (rs1937845 and rs12529) and HSD17B6 (rs898611) were detected by the TaqMan method., Results and Conclusions: We found that the genotypic frequencies of the rs1937845 polymorphism were different in subjects with PCOS compared with control, with the CT genotype being more commonly found in patients with PCOS than in controls (P=0.005). We observed a significantly 1.74-fold higher risk of CT genotype in the polymorphism rs1937845 in women with PCOS vs the control group (adjusted odds ratio (OR), 1.74; 95% CI=1.19-2.54; P=0.005). A similar, significant 1.47-fold higher risk (adjusted OR, 1.47; 95% CI=1.07-2.03; P=0.018) was demonstrated for T allele of polymorphism rs1937845 associated with PCOS. In patients with PCOS, the rs12529 (G>C) and rs1937845 (C>T) polymorphisms were strongly associated with the high level of testosterone. The TT carriers of polymorphism rs1937845 had a significantly increased homeostatic model assessment-B% (HOMA-B%) (P=0.045) and that might be associated with the high risk of insulin resistance. However, no significant difference was found in genotype or allele distributions of the polymorphisms rs12529 of HSD17B5 and rs898611 of HSD17B6 between patients with PCOS and controls. Additionally, the two polymorphisms of HSD17B5 are associated with hyperandrogenemia in patients with PCOS. In conclusion, our findings showed a significant statistical association between HSD17B5 rs1937845 and PCOS risk in Chinese women. The CT genotype and T allele frequency are influenced significantly to a higher extent in patients with PCOS than controls. Further studies are needed to confirm the results and find out the exact molecular mechanism of the polymorphism on the risk of hyperandrogenemia and PCOS., (© 2015 European Society of Endocrinology.)

Metal pollution has been widely reported in mangrove wetlands; however, the mechanisms involved in metal detoxification by mangroves are still poorly understood. This study aimed to investigate the possible function of root anatomy and lignification/suberization on metal uptake and tolerance in seedlings of six species of mangroves. The results revealed that the three rhizophoraceous species (Bruguiera gymnorrhiza (L.) Poir, Kandelia obovata Sheue, Liu & Yong and Rhizophora stylosa Griff) consistently exhibited higher metal tolerances than the three pioneer species (Aegiceras corniculatum (Linn.) Blanco, Acanthus ilicifolius L. and Avicennia marina (Forsk.) Viern.). Moreover, metal-tolerant species often exhibited a thick exodermis with high lignification and suberization. The tolerance indices of the mangroves were found to be positively correlated with the amounts of lignin and suberin deposition within the exodermal cell walls. The observed metal uptake by the excised roots further illustrated that a lignified/suberized exodermis directly delayed the entry of metals into the roots, and thereby contributed to a higher tolerance to heavy metals. In summary, the present study proposes a barrier property of the lignified/suberized exodermis in dealing with the stresses of heavy metals, such that the mangroves which possessed more extensive lignification/suberization within the exodermis appeared to exhibit higher metal tolerance., (© The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Objectives: To evaluate whether the outcomes of renal grafts from living related donors more than 60 years old are acceptable, in terms of renal function and patient/graft survival., Material and Methods: Twenty-one patients who received kidneys from donors older than 60 years constituted the study group (Group 1). The control group (Group 2) consisted of 110 patients who received renal transplants from ideal donors, aged 18 to 45 years. The recipients were analyzed for posttransplantation serum creatinine, the number of acute rejection episodes and delayed graft function, and patient/graft survival., Results: The mean age of donors was 62.6 ± 2.2 years in Group 1 and 32.8 ± 7.0 years in Group 2. Recipient serum creatinine was higher on postoperative day 1, year 1, year 5 in Group 1 than that in Group 2 (536.8 ± 203.3 vs. 409.8 ± 213.8, 142.4 ± 38.2 vs. 100.3 ± 22.9, 152.6 ± 42.7 vs. 107.1 ± 22.1, respectively; all p < 0.05). Acute rejection was seen in 4 cases in Group 1 (19.0%) and in 15 cases in Group 2 (13.6%; p = 0.759). Delayed graft function was seen in two cases in Group 1 (9.5%) and in four cases in Group 2 (3.6%; p = 0.540). One-, 3- and 5-year patient survival was 100%, 100% and 100% for Group 1, and 97%, 97% and 97% for Group 2. Corresponding death-censored graft survival was 100%, 100% and 100% for Group 1, and 98%, 98% and 96% for Group 2. No significant difference was observed in terms of patient/graft survival., Conclusions: Although compromising renal function, donor age did not affect patient and graft survival in the 5-year follow-up in our study. Age alone seems not to be an exclusion criterion to living kidney donation.

Introduction: Early and normative surgery is the only curative method for multiple endocrine neoplasia type 2 (MEN 2)-related medullary thyroid carcinoma (MTC)., Aims: To study the timing of prophylactic total thyroidectomy (TT) for MEN 2-related MTC with different RET mutations in a Chinese population, and to compare the sensitivity and accuracy of fully-automated chemiluminescence immunoassay (FACLIA) and radioimmunoassay (RIA) for serum calcitonin (Ct)., Methods: We collected 24 asymptomatic individuals from 8 unrelated Chinese families with MEN 2, and analyzed RET mutation and Ct levels. Then we performed TT on 17 of the 24 individuals, including TT (2/17), TT with bilateral level VI lymph-node dissection (B-LND(VI); 12/17) and TT with B-LND(VI) + modified unilateral/bilateral/local neck dissection (3/17)., Results: Histopathology revealed bilateral/unilateral MTC in 15/17 (88.2%; median diameter, 1.0 cm) and bilateral C-cell hyperplasia in 2/17 (11.8%; p.V292M/R67H/R982C and p.C618Y). Lymph-node metastasis/fibro-adipose tissue invasion (p.C634R) or solely fibro-adipose tissue invasion (p.C634Y) were found in 2/17 (11.8%). Elevated pre-surgical Ct (pre-Ct) was identified by FACLIA in 17/17 (median age, 24.0), while pre-Ct by RIA was found in only 6/15 (P < 0.001). The median follow-up was 22.0 months, during which 16/17 had no abnormality (one p.C634R individual had elevated Ct), and another 7 carriers still had consistently undetectable Ct by FACLIA., Conclusions: Our study highlights the importance and feasibility of individualized prophylactic TT for MEN 2-related MTC, based on predictive integrated screening of RET and pre-Ct levels. Besides, we recommend FACLIA to measure Ct for earlier diagnosis, treatment and follow-up monitoring of MTC., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: To report clinical outcomes of kidney transplantation from cardiac death donors (DCD) in China, and to investigate its feasibility to expand the organ donor pool., Patients and Methods: We retrospectively studied clinical data of 46 DCD kidneys from 31 donors from February 2007 to August 2011. Recipients were followed for patient and graft survival., Results: We discarded the organs from 3 of 29 (10.3%) DCD donors and 7 of 42 (16.7%) kidneys that displayed renal thrombosis. Of the 39 recipients engrafted with DCD kidneys successfully, the mean follow-up was 16 months, (range = 50 days to 43 months). Delayed graft function (DGF) occurred in 15 (38.5%) recipients, who except one recovered within 3 months. Three biopsy-proven acute rejection episodes were observed in two recipients (5.1%). All patients survived through the follow-up. The graft survival rate was 97.4% at 12 months and 94.9% at 24 months. A 45-year-old male recipient who received a pair of grafts from a 6-year-old child survived with good renal function., Conclusion: Although kidney transplantations from DCD donors showed a higher rate of DGF with a longer duration of graft recovery, we achieved favorable short-term clinical outcome in terms of graft survival and function. Donation after cardiac death can expand the organ donor pool in China., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Studies on the safety of older living renal donors are lacking in China., Methods: We observed 142 consecutive living renal donors before and early after (7 days) the operation. There were no prisoners used as donors or recipients. Subjects were divided into 2 groups: older than 50 years of age (n = 40) or younger age (n = 102). We compared differences in early safety between the 2 groups., Results: There were no significant differences in 8 aspects of the predonation quality of life using the SF-36 questionnaire, except for physical function (P < .001). Zero hour biopsies performed on 52 kidneys showed 15 to display abnormal renal tissues (28.85%), which was significantly greater among the older age group (P = .034). The perioperative indexes were similar between the 2 groups; however, the hospital stay was longer in the older group (P = .034). Compared with the younger group, the older group generally showed a lower creatinine clearance (CCr; P < .001), higher cystatin c (P = .006), and similar serum creatinine (Scr) preoperatively, conditions that persisted at 7 days postoperatively. Although the increased Scr and reduced CCr were present in all donors, the changes in Scr and CCr were similar between the 2 groups. Differences in urinary micro-albumin and proteinuria before and after operation were not significantly different for both groups., Conclusions: Increased use of older living kidney donors in China may be a safe strategy to meet the demand for transplantation. However, long-term outcomes need further follow-up., (2010 Elsevier Inc. All rights reserved.)

Background: It has been identified that human epididymal protease inhibitor (EPPIN) plays a critical role in sperm function and male fertility. The aim of this study was to determine whether variants of the EPPIN gene are risk factors for idiopathic male infertility., Methods: All subjects, including 473 idiopathic infertile men and 198 fertile controls, underwent complete historical and physical examinations. Each subject donated 5 ml of peripheral blood for genomic DNA extraction and serum testosterone evaluation and an ejaculate for semen analysis. The semen analysis was performed by computer-assisted semen analysis system. The serum testosterone level was evaluated by radioimmunoassay. Four tagging single-nucleotide polymorphisms were analyzed by polymerase chain reaction-restriction fragment length polymorphism., Results: We have demonstrated a significant decreased risk of idiopathic infertility with abnormal semen parameters in association with the variant rs2231829, and an increased risk of idiopathic infertility with abnormal semen parameters in association with the variant rs11594. However, among men with normal semen parameters, there were no differences in risk for these genotypes. Furthermore, no significant differences were found for the other variants, rs6124715 and rs2227290, on the risk of male infertility with normal or abnormal semen parameters. Similar serum testosterone levels among different EPPIN genotypes were observed for each group., Conclusions: These results suggest that different variants in the EPPIN gene may have different relationships with idiopathic male infertility and men carrying these variants have a decreased or increased risk of abnormal semen parameters associated with male infertility.