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Purpose: To determine the impact of visual impairment (VI) on health-related quality of life (HRQoL) and to compare the health burden of VI in different areas in mainland China. Methods: A cohort of 6830 people from rural villages and a cohort of 3251 people from an urban city were included to receive comprehensive ophthalmologic examinations and complete the European Quality of Life-5 Dimensions 3 Levels (EQ-5D-3L) questionnaire. For urban and rural populations, a unified VI grouping standard was adopted: the eyes were classified into normal group, mild–moderate group, and severe group according to WHO standards, and then divided into 6 groups considering both eyes. We estimated the effects of VI on the EQ-5D index score using linear regression models and the association between VI and self-reported EQ-5D health problems using logistic regression models. Associations were assessed by the Spearman correlation coefficient. Results: The prevalence of VI and the index scores of EQ-5D-3L for each subgroup of VI were higher for the rural cohort. In these two cohorts, the severity of VI in rural population (Spearman r = 0.205; p < 0.0001) and urban population (Spearman r = 0.164; p < 0.0001) is correlated with the EQ-5D index score. In the rural cohort, the difference in index scores with bilateral severe VI compared to those without VI, after adjusting for covariates, was − 0.053 for the rural cohort and − 0.084 for the urban cohort, respectively. In the rural cohort, the odds ratio for bilateral severe VI was 4.39 for mobility, 6.33 for self-care, and 5.88 for usual activities. The incidence of anxiety or depression and pain or discomfort in the urban cohort was greater; the OR for bilateral severe VI in the urban cohort was 4.75. Conclusions: VI has a negative impact on HRQoL in the rural and urban areas of China, especially in urban population. It is also more likely to cause anxiety or depression among the urban cohort, which deserves special attention. [ABSTRACT FROM AUTHOR]

As a result of the continuous global warming in recent years, the average annual number of rain days in China has been on the decline, while the number of rainstorm days has gradually increased. These conditions make it extremely easy to form a waterlogging environment, which has an adverse impact on plant growth and development. In many apple-producing areas in China, apples are subject to severe flooding during planting. In this study, two-year-old apple rootstock M9T337 was used to explore the effects of interval water stress on the morphological and physiological parameters of apple leaves. The purpose was to determine the plant’s adaptability to waterlogged environments and provide theoretical reference for management and maintenance after waterlogging. The results showed that the effect on flooded (T2) on apple stock was greater than that of waterlogged (T1), Short-term (7 d) waterlogging (T1) did not affect the growth of seedlings but was conducive to the accumulation of dry matter. Furthermore, the initial stress was be imprinted on the plants, which could directly affect their response to later stress. The results of principal component analysis (PCA) revealed that PC1, PC2, and PC3 explained 26.92%, 17.46%, and 13.03% of the physiological changes under water stress, respectively. By calculating the weight of each indicator, we concluded that high-frequency resistance r, relative chlorophyll content (SPAD) and maximum photochemical efficiency Fv/Fm are important parameters for apple rootstocks affected by water stress. [ABSTRACT FROM AUTHOR]

Lycium fruits (Lycium barbarum, Lycium chinense) are mainly cultivated and distributed in Northwest China. The fruits and root bark have been used in Chinese traditional medicine for centuries. In this study, Lycium dry fruit extracts from the main cultivation areas in China together with a sample from Nepal were subjected to a comparative metabolic profiling, including total carbohydrate content, total phenolic content, vitamin C content, carotenoid content, and mineral contents. Results showed that there was a slight difference in contents of nutrients and phytochemicals among samples from different areas. The total carbohydrate content was higher in the sample from Guazhou, Gansu province (69.47%), with an average value of total carbohydrate content of 61.59%, while the highest total phenolic content value was 14.13 mgGAE/g from Nepal. Data concerning vitamin C content ranged between 33.15 and 113.8 mg/100 g, with an average value of 55.29 mg/100 g. Zeaxanthin dipalmitate content in Lycium dry fruits ranged from 419.34 to 1008.90 μg/g among the different samples, with the highest content (1008.90 μg/g) observed in Tianjing. It appeared that we could not clearly differentiate Lycium samples in terms of their metabolic and mineral profile. The quantitative difference observed among samples might be linked to soil composition and environmental aspect of the harvest place. Our results were somehow in the same range as those reported in the literature. Therefore, Lycium fruits could be used as a dietary source of natural function foods and be worthy of development and utilization. [ABSTRACT FROM AUTHOR]

Background People with physical disability (PWPD) is the largest subgroup of people with disability (PWD) in China, but few studies have been conducted among this vulnerable population. The objective of this study was to investigate the level of quality of life (QoL), self-perceived quality of care and support (QOCS), severity of disability and personal attitude towards disability among people with physical disability in China, as well as to identify how QoL can be affected by severity of disability through QOCS and personal attitude towards disability among PWPD. Methods A cross-sectional study was conducted among 1,853 PWPD in Guangzhou, China. Data were collected on participants' QoL, QOCS, personal attitude towards disability and severity of disability. Structural equation modeling was used to examine the effects of the other variables on QoL. Results Even with a mild disability (mean score:1.72), relatively low levels of QoL (mean score: 2.65- 3.22) and QOCS (mean score: 2.95 to 3.28), as well as unfavorable personal attitude towards disability (mean score: 2.75 to 3.36) were identified among PWPD. According to SEM, we found that the influence of severity of physical disability on QoL is not only exerted directly, but is also indirectly through QOCS and their personal attitudes towards disability, with QOCS playing a more important mediating role than PWPD's attitudes towards their own disability. Conclusions Unfavorable health status was identified among PWPD in China. Focusing on improvement of assistance and care services has the potential to substantially improve PWPD's QoL. Further research should focus on understanding the needs and their current state of health care of PWPD in China thus being able to develop better interventions for them. [ABSTRACT FROM AUTHOR]

Caspase-8 and caspase-10 play crucial roles in both cancer development and chemotherapy efficacy. In this study, we aimed to comprehensively assess single nucleotide polymorphisms (SNPs) of the caspase-8 (CASP8) and caspase-10 (CASP10) genes in relation to toxicity outcomes with first-line platinum-based chemotherapy in patients with advanced non-small cell lung cancer (NSCLC). We genotyped 13 tag SNPs of CASP8 and CASP10 in 663 patients with advanced NSCLC treated with platinum-based chemotherapy regimens. Associations between SNPs and chemotherapy toxicity outcomes were identified in a discovery set of 279 patients and then validated in an independent set of 384 patients. In both the discovery and validation sets, variant homozygotes of CASP8 rs12990906 and heterozygotes of CASP8 rs3769827 and CASP10 rs11674246 and rs3731714 had a significantly lower risk for severe toxicity overall. However, only the association with the rs12990906 variant was replicated in the validation set for hematological toxicity risk. In a stratified analysis, we found that some other SNPs, including rs3769821, rs3769825, rs7608692, and rs12613347, were significantly associated with severe toxicity risk in some subgroups, such as in nonsmoking patients, patients with adenocarcinoma, and patients treated with cisplatin combinations. Consistent results were also found in haplotype analyses. Our results provide novel evidence that polymorphisms in CASP8 and CASP10 may modulate toxicity outcomes in patients with advanced NSCLC treated with platinum-based chemotherapy. If validated, the findings will facilitate the genotype-based selection of platinumbased chemotherapy regimens. [ABSTRACT FROM AUTHOR]

The article discusses a study on the association between polymorphisms in CASP7 with the risk of lung cancer, esophageal adenocarcinoma and endometrial cancer and between the loss of CASP7 expression to resistance to anticancer drugs. Six hundred sixty three patients with inoperable 3A-4 non-small cell lung cancer (NSCLC) in Shanghai, China were included. It suggests an association between platinum-based chemotherapy efficacy and variants of CASP7 in Chinese patients with advanced NSCLC.

To identify susceptibility variants for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), we conducted a genome-wide association study by genotyping 440,794 SNPs in 355 chronic HBV carriers with HCC and 360 chronic HBV carriers without HCC, all of Chinese ancestry. We identified one intronic SNP (rs17401966) in KIF1B on chromosome 1p36.22 that was highly associated with HBV-related HCC and confirmed this association in five additional independent samples, consisting of 1,962 individuals with HCC, 1,430 control subjects and 159 family trios. Across the six studies, the association with rs17401966 was highly statistically significant (joint odds ratio = 0.61, P = 1.7 × 10−18). In addition to KIF1B, the association region tagged two other plausible causative genes, UBE4B and PGD. Our findings provide evidence that the 1p36.22 locus confers susceptibility to HBV-related HCC, and suggest that KIF1B-, UBE4B- or PGD-related pathways might be involved in the pathogenesis of this malignancy. [ABSTRACT FROM AUTHOR]

Apurinic/apyrimidinic endonuclease 1/redox effector factor-1 (APE1/Ref-1) is a ubiquitous multifunctional protein that possesses both DNA-repair and redox regulatory activities. Although it was originally identified as a DNA-repair enzyme, accumulating evidence supports a role of APE1/Ref-1 in tumor development. To investigate association between APE1/ Ref-1 polymorphisms and lung cancer risk in Chinese populations, we first genotyped three variants of APE1/ Ref-1 and found a -141 T-to-G variant (rs1760944) in the promoter associated with decreased risk of lung cancer [odds ratio (OR) = 0.62 for GG; P=0.043]. Similar results were obtained in a follow-up replication study. Combined data from the two studies comprising a total of 1072 lung cancer patients and 1064 cancer-free control participants generated a more significant association (P=0.002). We observed lower APE1/Ref-1 mRNA levels in the presence of the protective G allele in human peripheral blood mononuclear cells and normal lung tissues. The -141G-allele-promoter construct exhibited decreased luciferase reporter gene expression. Electrophoretic mobility shift assays and surface plasmon resonance analysis showed that the -141G allele impaired the binding affinity of some transcription factor, accounting for lower APE1/Ref-1-promoter activity. Supershift assays further revealed that the protein of interest was octamer-binding transcription factor-1 (Oct-l). Chromatin immunoprecipitation reconfirmed binding of Oct-1 to the APE1/Ref-1-141-promoter region. We also found that Oct-1 conferred attenuated transactivation capacity toward the -141G variant by exogenously introducing Oct-1. These data indicate that genetic variations in APE1/Ref-1 may modify susceptibility to lung cancer and provide new insights into an unexpected effect of APE1/Ref-1 on lung carcinogenesis. [ABSTRACT FROM AUTHOR]

Background: Longevity is a multifactorial trait with a genetic contribution, and mitochondrial DNA (mtDNA) polymorphisms were found to be involved in the phenomenon of longevity. Methodology/Principal Findings: To explore the effects of mtDNA haplogroups on the prevalence of extreme longevity (EL), a population based case-control study was conducted in Rugao - a prefecture city in Jiangsu, China. Case subjects include 463 individuals aged ≥95 yr (EL group). Control subjects include 926 individuals aged 60-69 years (elderly group) and 463 individuals aged 40-49 years (middle-aged group) randomly recruited from Rugao. We observed significant reduction of M9 haplogroups in longevity subjects (0.2%) when compared with both elderly subjects (2.2%) and middleaged subjects (1.7%). Linear-by-linear association test revealed a significant decreasing trend of N9 frequency from middleaged subjects (8.6%), elderly subjects (7.2%) and longevity subjects (4.8%) (p = 0.018). In subsequent analysis stratified by gender, linear-by-linear association test revealed a significant increasing trend of D4 frequency from middle-aged subjects (15.8%), elderly subjects (16.4%) and longevity subjects (21.7%) in females (p = 0.025). Conversely, a significant decreasing trend of B4a frequency was observed from middle-aged subjects (4.2%), elderly subjects (3.8%) and longevity subjects (1.7%) in females (p = 0.045). Conclusions: Our observations support the association of mitochondrial DNA haplogroups with exceptional longevity in a Chinese population. [ABSTRACT FROM AUTHOR]

Background: Rapid economic growth in China in the past decades has been accompanied by dramatic changes in lifestyle and environmental exposures. The burdens of non-communicable diseases, such as cardiovascular diseases, diabetes and cancer, have also increased substantially. Methods/design: We initiated a large prospective cohort-the Taizhou Longitudinal Study-in Taizhou (a medium-size city in China) to explore the environmental and genetic risk factors for common non-communicable diseases. The sample size of the cohort will be at least 100,000 adults aged 30-80 years drawn from the general residents of the districts of Hailin, Gaogang, and Taixing (sample frame, 1.8 million) of Taizhou. A three-stage stratified sampling method will be applied. Baseline investigations include interviewer-administered questionnaire, anthropometric measurements, and collection of buccal mucosal cells and blood specimens. DNA will be extracted for genetic studies and serum samples will be used for biochemical examinations. A follow-up survey will be conducted every three years to obtain information on disease occurrence and information on selected lifestyle exposures. Study participants will be followed-up indefinitely by using a chronic disease register system for morbidity and cause-specific mortality. Information on non-fatal events will be obtained for certain major categories of disease (e.g., cancer, stroke, myocardial infarction) through established registry systems. Discussion: The Taizhou Longitudinal Study will provide a good basis for exploring the roles of many important environmental factors (especially those concomitant with the economic transformation in China) for common chronic diseases, solely or via interaction with genetic factors. [ABSTRACT FROM AUTHOR]

The ability to extract mitochondrial and nuclear DNA from ancient remains has enabled the study of ancient DNA, a legitimate field for over 20 years now. Recently, Y chromosome genotyping has begun to be applied to ancient DNA. The Y chromosome haplogroup in East Asia has since caught the attention of molecular anthropologists, as it is one of the most ethnic-related genetic markers of the region. In this paper, the Y chromosome haplogroup of DNA from ancient East Asians was examined, in order to genetically link them to modern populations. Fifty-six human remains were sampled from five archaeological sites, primarily along the Yangtze River. Strict criteria were followed to eliminate potential contamination. Five SNPs from the Y chromosome were successfully amplified from most of the samples, with at least 62.5% of the samples belonging to the O haplogroup, similar to the frequency for modern East Asian populations. A high frequency of O1 was found in Liangzhu Culture sites around the mouth of the Yangtze River, linking this culture to modern Austronesian and Daic populations. A rare haplogroup, O3d, was found at the Daxi site in the middle reaches of the Yangtze River, indicating that the Daxi people might be the ancestors of modern Hmong-Mien populations, which show only small traces of O3d today. Noticeable genetic segregation was observed among the prehistoric cultures, demonstrating the genetic foundation of the multiple origins of the Chinese Civilization. [ABSTRACT FROM AUTHOR]

Background: The nucleotide excision repair (NER) protein, xeroderma pigmentosum C (XPC), participates in recognizing DNA lesions and initiating DNA repair in response to DNA damage. Because mutations in XPC cause a high risk of cancer in XP patients, we hypothesized that inherited sequence variations in XPC may alter DNA repair and thus susceptibility to cancer. Methods: In this hospital-based case-control study, we investigated five XPC tagging, common single nucleotide polymorphisms (tagging SNPs) in 1,010 patients with newly diagnosed lung cancer and 1,011 matched cancer free controls in a Chinese population. Results: In individual tagging SNP analysis, we found that rs3731055AG+AA variant genotypes were associated with a significantly decreased risk of lung adenocarcinoma [adjusted odds ratio (OR), 0.71; 95% confidence interval (CI), 0.56-0.90] but an increased risk of small cell carcinomas [adjusted OR, 1.79; 95% CI, 1.05-3.07]. Furthermore, we found that haplotype ACCCA was associated with a decreased risk of lung adenocarcinoma [OR, 0.78; 95% CI, 0.62-0.97] but an increased risk of small cell carcinomas [OR, 1.68; 95% CI, 1.04-2.71], which reflected the presence of rs3731055A allele in this haplotype. Further stratified analysis revealed that the protective effect of rs3731055AG+AA on risk of lung adenocarcinoma was more evident among young subjects (age ≤ 60) and never smokers. Conclusion: These results suggest that inherited sequence variations in XPC may modulate risk of lung cancer, especially lung adenocarcinoma, in Chinese populations. However, these findings need to be verified in larger confirmatory studies with more comprehensively selected tagging SNPs. [ABSTRACT FROM AUTHOR]

The root of Phragmites australis can often be used as the Chinese herb in China. In this paper, the complete chloroplast genome of P. australis was studied for more genetic information. The chloroplast genome was 137,561 bp in length as the circular and typical quadripartite structure, which contained a large single-copy region (LSC) of 82,328 bp, a small single-copy region (SSC) of 12,699 bp, and a pair of inverted-repeat regions (IRs) of 21,267 bp. The overall nucleotide composition of chloroplast genome is: 42,300 bp A (30.7%), 42,090 bp T (30.6%), 26,500 bp C (19.3%), 26,671 bp G (19.4%) and the total G + C content of 38.7%. However, 134 genes were found that included 87 protein-coding genes (PCGs), 39 transfer RNA (tRNAs), and 8 ribosome RNA (rRNAs). The Maximum-Likelihood (ML) method phylogenetic relationship with the reported chloroplast genomes showed that Phragmites australis is closely related to Setaria viridis and Setaria italic of the family Poaceae. [ABSTRACT FROM AUTHOR]

The article focuses on the treatment of SARS with glucosteroids in severe acute respiratory syndrome patients in Guangdong Province, China. Several studies have been conducted on the use of corticosteroids in SARS management in terms of efficacy, duration, dose and severe adverse events. It revealed that the proper use of corticosteroid in critical SARS resulted in lower mortality and shorter hospitalization stay.

To determine the prevalence of inapparent infection with severe acute respiratory syndrome (SARS) among healthcare workers, we performed a serosurvey to test for immunoglobulin (Ig) G antibodies to the SARS coronavirus (SARS-CoV) among 1,147 healthcare workers in 3 hospitals that admitted SARS patients in mid-May 2003. Among them were 90 healthcare workers with SARS. As a reference group, 709 healthcare workers who worked in 2 hospitals that never admitted any SARS patients were similarly tested. The seroprevalence rate was 88.9% (80/90) for healthcare workers with SARS and 1.4% (15/1,057) for healthcare workers who were apparently healthy. The seroprevalence in the reference group was 0.4% (3/709). These findings suggest that inapparent infection is uncommon. Low level of immunity among unaffected healthcare workers reinforces the need for adequate personal protection and other infection control measures in hospitals to prevent future epidemics. [ABSTRACT FROM AUTHOR]

To determine the prevalence of inapparent infection with severe acute respiratory syndrome (SARS) among healthcare workers, we performed a serosurvey to test for immunoglobulin (Ig) G antibodies to the SARS coronavirus (SARS-CoV) among 1,147 healthcare workers in 3 hospitals that admitted SARS patients in mid-May 2003. Among them were 90 healthcare workers with SARS. As a reference group, 709 healthcare workers who worked in 2 hospitals that never admitted any SARS patients were similarly tested. The seroprevalence rate was 88.9% (80/90) for healthcare workers with SARS and 1.4% (15/1,057) for healthcare workers who were apparently healthy. The seroprevalence in the reference group was 0.4% (3/709). These findings suggest that inapparent infection is uncommon. Low level of immunity among unaffected healthcare workers reinforces the need for adequate personal protection and other infection control measures in hospitals to prevent future epidemics. [ABSTRACT FROM AUTHOR]

A new Chinese Quality of Life Instrument (ChQOL) based on the principles of diagnosis and practice in Chinese medicine has been developed. This paper describes the development of the ChQOL instrument using factor analysis and structural equation modeling. An initial pilot version of the 78 items instrument was field tested in a sample 273 subjects recruited from different areas in China. The objective of this study was to determine the factor structure and latent constructs of the ChQOL based on factor analysis. A series of confirmatory factor analysis and structural equation models were used to determine the final model of the ChQOL. The results showed that the application of factor analysis and structural equation modeling is an effective method to develop the new health-related quality of life instrument, ChQOL, even though the practice of Chinese medicine is quite different from the practice of conventional western medicine. [ABSTRACT FROM PUBLISHER]

It is widely accepted that the cytotoxicity and genotoxicity of benzene results from the action of reactive metabolites. Therefore, genetic variation in metabolic enzyme genes may contribute to susceptibility to chronic benzene poisoning (CBP) in the exposed population. Using a case–control study that included 268 benzene-poisoned patients and 268 workers occupationally exposed to benzene in South China, we aimed to investigate the association between single-nucleotide polymorphisms in genes with phase I and II of metabolism and risk of CBP. The TaqMan technique was used to detect polymorphisms of CYP1A1, CYP1A2, CYP1B1, ADH1B, EPHX1, EPHX2, NQO1, MPO, GSTP1 and UGT1A6 genes. We also explored potential interactions of these polymorphisms with lifestyle factors such as cigarette smoking and alcohol consumption. A weak positive association was found between glutathione S-transferase pi-1 (GSTP1) rs1695 polymorphism and the risk of CBP (P = 0.046), but this association was not statistically significant (P = 0.117) after adjustment for potential confounders. Further analysis showed that the risk of CBP increased in the subjects with EPHX1 GGAC/GAGT diplotype (P = 0.00057) or AGAC/GAGT diplotype (P = 0.00086). In addition, we found that alcohol drinkers with the EPHX1 rs3738047 GA  AA genotypes and non-alcohol drinkers with the GSTP1 rs1695 AA genotype tended to be more susceptible to benzene toxicity. Our results suggest that genetic polymorphisms in EPHX1 may contribute to risk of CBP in a Chinese occupational population. [ABSTRACT FROM AUTHOR]

The Uyghur (UIG) population, settled in Xinjiang, China, is a population presenting a typical admixture of Eastern andWestern anthropometric traits. We dissected its genomic structure at population level, individual level, and chromosome level by using 20,177 SNPs spanning nearly the entire chromosome 21. Our results showed that UIG was formed by two-way admixture, with 60% European ancestry and 40% East Asian ancestry. Overall linkage disequilibrium (LD) in UIG was similar to that in its parental populations represented in East Asia and Europe with regard to common alleles, and UIG manifested elevation of LD only within 500 kb and at a level of 0.1 < r² < 0.8 when ancestry-informative markers (AIMs) were used. The size of chromosomal segments that were derived from East Asian and European ancestries averaged 2.4 cM and 4.1 cM, respectively. Both the magnitude of LD and fragmentary ancestral chromosome segments indicated a long history of Uyghur. Under the assumption of a hybrid isolation (HI) model, we estimated that the admixture event of UIG occurred about 126 [107∼146] generations ago, or 2520 [2140∼2920] years ago assuming 20 years per generation. In spite of the long history and short LD of Uyghur compared with recent admixture populations such as the African-American population, we suggest that mapping by admixture LD (MALD) is still applicable in the Uyghur population but ∼10-fold AIMs are necessary for a whole-genome scan. [ABSTRACT FROM AUTHOR]

Abstract A lipidomics study using liquid chromatography-tandem mass spectrometry and multivariate statistics was conducted in this work to discriminate raw pork meat. A total of 1180 lipid species were identified in the studied pork samples. Four, three and eight lipids were determined as potential discriminatory markers for the five cuts (shoulder, rump, loin, shank and belly) of Tibetan, Jilin and Sanmenxia black pigs, respectively. Distinct lipidomic fingerprints of Tibetan, Jilin and Sanmenxia pork were obtained and they were clearly separated into three clusters by partial least squares discriminant analysis (PLS-DA). The developed PLS-DA model (R2X = 0.603, R2Y = 0.861 and Q2 = 0.752) enables a 91.1% correct classification of pork samples. One-hundred variables, including 61 glycerolipids, 17 glycerophospholipids, 4 sterol lipids, 2 sphingolipids, 3 polyketides, 7 fatty acyls and 6 prenol lipids, were found to have high potential (variable importance in projection value > 1, p -value<0.05) to differentiate Tibetan, Jilin and Sanmenxia pork meat. The current data set will facilitate a better understanding of the nutritional values of the investigated pork and can be expanded to a larger sample size for lipid marker validation. Our findings demonstrate that lipidomic analysis together with multivariate statistics is a promising approach for the differentiation of China's domestic pork. Graphical abstract Image 1 Highlights • More comprehensive lipidomic profiles were established for TP, JL and SMX pork. • Five pork cuts were differentiated based on comparative lipidomic profiling. • PLS-DA model classifies the TP, JL and SMX pork with a correct rate of 91.1%. • 100 potential lipid markers were identified for discriminating TP, JL and SMX pork. • LC-MS-based lipidomics proves to be a powerful tool for raw pork authentication. [ABSTRACT FROM AUTHOR]

Although coal has made a huge contribution to the development of the economy and socie-ty and its economic benefits have often attracted much attention, little research has focused on the ecosystem services of coalfields. Based on remote sensing data, meteorological data, and soil data in Shanxi coalfields during 1986, 2000, and 2015, we estimated soil conservation and water yield using the InVEST model, assessed the net primary productivity of vegetation using the CASA mo-del, and estimated sand fixation using the RWEQ model. Further, we simulated the spatial patterns of ecosystem services (ESs) using the k-means cluster analysis method and analyzed the influence factors of ESs using the Geodetector model in Shanxi coalfield areas. The results showed that soil conservation service, water yield service, and sand fixation service increased continuously. The high-value area of soil conservation service was mainly concentrated in the north of Hedong coalfield and the northeast of Qinshui coalfield, while the low-value area was distributed in the southwestern edge of Datong coalfield. The high-value area of water yield service was mainly concentrated in the northeast of Qinshui coalfield, while the low-value area was distributed in the northeast of Qinshui coalfield, Xishan coalfield and northwestern Qinshui coalfield. The high-value area for vegetation production service was mainly concentrated in the southeast of Qinshui coalfield, while the low-value area was distributed in Datong coalfield, Ningwu coalfield, Xishan coalfield, and northern Hedong coalfield. The distribution of low- and high-value areas of sand fixation service was unfixed. Ecosystem service bundles could be divided into four categories. The first category belonged to soil conservation service bundle, mainly distributed in the northern Ningwu coalfield, the northern Hedong coalfield, and the northern Qinshui coalfield. The second was water yield service bundle, mainly distributed in Huoxi coalfield and southern Qinshui coalfield. The third category belonged to vegetation production service bundle, mainly distributed in parts of Qinshui coalfield. The fourth category belonged to sand fixation service bundle, mainly distributed in the southern part of Hedong coalfield and Qinshui coalfield. Soil conservation service was greatly affected by temperature, digital elevation model (DEM), and industrial output value, with q values of 0.5, 0.3, and 0.2, respectively. Water yield service was greatly affected by precipitation, temperature, and DEM, with q values of 0.8, 0.3, and 0.2, respectively. The industrial output value, precipitation, and temperature q values of vegetation production service were 0.7, 0.6, and 0.2, respectively. The main influen-cing factors of sand fixation service were precipitation, temperature, and DEM, while the q values were 0.7, 0.3, and 0.3, respectively. The spatial distribution of coalfields ESs and the relationship between multiple ESs were closely related to natural and human factors. Therefore, maintaining the coordination relationship between natural-human factors and ecological services would be helpful to the management of the land reclamation, ecological reconstruction, and the sustainable development of coalfields ecosystem.

Objective: To evaluate the implementation effect of the optimization strategy for the use and management of malaria rapid diagnostic testing (RDT) technology in Jiangsu Province, so as to provide the empirical evidence and suggestions for promoting the standardized use of RDT technology., Methods: Questionnaire surveys of primary-level health professionals' RDT-related knowledge, attitude, and practice (KAP) and work satisfaction were conducted in 4 pilot cities in Jiangsu Province before and after the intervention., Results: After the implementation of the intervention, 13.9% of surveyed laboratory technicians, 21.9% of surveyed clinicians and 4.1% of surveyed staff of the centers for disease control and prevention (CDCs) had significant improvements in RDT-related knowledge. About 10.9% of the surveyed laboratory technicians and 25.6% of the surveyed CDC staff improved their attitudes toward RDT technology. About 38.4% of the surveyed laboratory technicians and 10.0% of the surveyed clinicians improved the standardized use of RDT technology. All types of primary-level health professionals had high evaluation in the satisfaction and effectiveness of the optimization strategy. However, the evaluation of the surveyed clinicians was slightly lower than that of the laboratory technicians and CDC staff., Conclusions: The optimization strategy in this project can effectively improve the knowledge, attitude and behavior of all types of primary-level health professionals and help to promote the standardized use of RDT technology.

Objective: To analyze the situation of malaria elimination, identify the current main challenges and difficulties of maintaining the achievements of malaria elimination, and find out feasible solutions in Jiangsu Province., Methods: Through randomized grouping, the subject discussion and questionnaires were conducted by malaria control staffs from centers for diseases control and prevention of 13 cities of Jiangsu Province and Jiangsu Institute of Parasitic Diseases. The basic characteristics of participants and the effect of the discussion were analyzed through questionnaires., Results: Twenty-seven professional participants were randomly divided into 3 groups. Totally 27 questionnaires were released and 24 valid questionnaires were retrieved. Among the 24 participants, 79.1% (19/24) of them were with mid-level and senior professional titles, and 66.7% (16/24) of them had worked for more than 10 years. Before the group discussion, only 16.7% (4/24) of the participants were aware of the current main challenges and difficulties in Jiangsu Province. After the discussion, 87.5% (21/24) of them thought the discussion increased their understanding of the challenges and difficulties. Through the subject discussion, the expert group summarized the current challenges and difficulties as well as the solutions in malaria prevention in Jiangsu Province in 4 aspects, namely the management guarantee of prevention work, diagnosis and treatment of the cases, field epidemiological investigation and others. Finally, a framework about these discussion results was established., Conclusions: During the post-stage of malaria elimination, Jiangsu Province still faced many challenges and difficulties, such as management guarantee, case diagnosis and treatment, epidemiology survey and focus disposals, and malaria surveillance sustainability. The feasible solutions of these challenges may provide examples for other provinces and regions which are undergoing malaria elimination or in post-stage of malaria elimination.

Background: People with physical disability (PWPD) is the largest subgroup of people with disability (PWD) in China, but few studies have been conducted among this vulnerable population. The objective of this study was to investigate the level of quality of life (QoL), self-perceived quality of care and support (QOCS), severity of disability and personal attitude towards disability among people with physical disability in China, as well as to identify how QoL can be affected by severity of disability through QOCS and personal attitude towards disability among PWPD., Methods: A cross-sectional study was conducted among 1,853 PWPD in Guangzhou, China. Data were collected on participants' QoL, QOCS, personal attitude towards disability and severity of disability. Structural equation modeling was used to examine the effects of the other variables on QoL., Results: Even with a mild disability (mean score:1.72), relatively low levels of QoL (mean score: 2.65- 3.22) and QOCS (mean score: 2.95 to 3.28), as well as unfavorable personal attitude towards disability (mean score: 2.75 to 3.36) were identified among PWPD. According to SEM, we found that the influence of severity of physical disability on QoL is not only exerted directly, but is also indirectly through QOCS and their personal attitudes towards disability, with QOCS playing a more important mediating role than PWPD's attitudes towards their own disability., Conclusions: Unfavorable health status was identified among PWPD in China. Focusing on improvement of assistance and care services has the potential to substantially improve PWPD's QoL. Further research should focus on understanding the needs and their current state of health care of PWPD in China thus being able to develop better interventions for them.

Objective: To investigate the clinical database of severe acute respiratory syndrome (SARS) in Guangdong province and evaluate the efficacy and safety of corticosteroid in the treatment of severe SARS from December 2002 to December 2003., Methods: The detail data of 1 278 SARS patients and borderline cases were collected. Four hundred and two confirmed SARS cases were recruited in our study. Out of them, 358 cases were assigned to the severe SARS group based on the criteria issued by Ministry of Health. Subjects who received steroid (which was converted into methylprednisolone) treatment were further divided into three groups: small dose group (<80 mg/day); moderate dose group (80-320 mg/day); high dose group (>or=320 mg/day). A Logistic regression model was applied to investigate the outcome variables:death, complications, subsequent lung infection and other infections and COX regression was made., Results: (1) Small dose of steroid seemed to have protective effect, but it did not reach significant level. (2) COX regression revealed that steroid was not related to instant mortality rate. (3) Length of stay in hospital of patients steroid usage in medium dosage seemed to be 0.619 time less risky than in patients without steroid usage (chi (2)=7.262, P=0.007), and that in patients with immunomodulator (including gamma globulin, thymic peptide and interferon) was 0.671 time less risky than in patients without immunomodulator (chi (2)=10.252, P=0.001). (4)Incidence of infections in patients with steroid was 3.095 times higher than in patients without steroid (chi (2)=4.289, P=0.038)., Conclusion: There is no significant difference in mortality, instant death incidence between steroid treatment and non-steroid treatment group of SARS patients diagnosed with the diagnostic criteria issued by Ministry of Health. However, steroid seem to shorten the length of hospital stay. But attention should be paid that infection rate could be increased in such cases.

Objective: To analyze the clinical diagnostic criteria for serious severe acute respiratory syndrome (SARS) in Guangdong retrospectively discriminant with SARS database, and to screen out the sensitive warning factors in predicting the outcome., Methods: Four hundred and two SARS patients were selected based on the diagnostic criteria for SARS from Ministry of Health, China. Of them, 358 SARS patients were selected as their clinical manifestations conformed to the diagnostic criteria of serious SARS. The study subjects were divided into two groups. One group consisted of the patients with serious SARS (358 patients), and they either underwent invasive or non-invasive mechanical ventilation or died of the disease. The remaining 44 SARS patients constituted the non-serious SARS group. Taking the lowest value of oxygen index (OI) as the main index, the OI was categorized into 3 classes, namely< or =200 mm Hg (1 mm Hg=0.133 kPa) as 1,200-300 mm Hg as 2, and >300 mm Hg as 3. According to this index, the seriousness and the prognosis were analyzed., Results: OI less than 300 mm Hg were identified as the unequivocal serious SARS patients, and the mistake judgement rate was 6.800%. Furthermore mortality and complications were compared with Logistic regression, and questionable SARS patients were excluded. The results showed that the patients identified with OI less than 300 mm Hg had worse outcome than the original ones diagnosed with criteria of Ministry of Health., Conclusion: OI less than 300 mm Hg in patients with ALI meet the diagnostic criteria of serious SARS better, and it can be taken as a prognostic criterion in clinic.

Study Objective: To investigate the efficacy and safety profiles of corticosteroid therapy in severe acute respiratory syndrome (SARS) patients., Design: Four hundred one of 1,278 SARS cases treated in Guangzhou China between December 2002 and June 2003 fulfilled the diagnostic criteria issued by the World Health Organization for confirmed identification of SARS. Among them, the diagnosis of critical SARS was defined by criteria of SARS guidelines incorporated with a low oxygenation index (OI) [< 300 mm Hg]. Data of these patients retrieved from a database were retrospectively analyzed by logistic regression and Cox regression for the effect of corticosteroid therapy on death, hospitalization days, and complication presentation., Results: Among the 401 SARS patients studied, 147 of 249 noncritical patients (59.0%) received corticosteroids (mean daily dose, 105.3 +/- 86.1 mg) [+/- SD], and all survived the disease; 121 of 152 critical patients (79.6%) received corticosteroids at a mean daily dose of 133.5 +/- 102.3 mg, and 25 died. Analysis of these 401 confirmed cases did not show any benefits of corticosteroid on the death rate and hospitalization days. However, when focused on 152 critical SARS cases, factors correlated with these end points indicated by univariate analysis included use of corticosteroid, age, rigor at onset, secondary respiratory infections, pulmonary rales, grading of OI, and use of invasive ventilation. After adjustment for possible confounders, treatment with corticosteroid was shown contributing to lower overall mortality, instant mortality, and shorter hospitalization stay (p < 0.05). Incidence of complications was significantly associated with the need for invasive ventilation but not with use of corticosteroids., Conclusion: This Guangzhou retrospective study revealed that proper use of corticosteroid in confirmed critical SARS resulted in lowered mortality and shorter hospitalization stay, and was not associated with significant secondary lower respiratory infection and other complications.

Mental retardation (MR) is one of the most frequent handicaps among children. Fetal iodine deficiency disorder (FIDD) is the commonest cause of preventable MR. However, not everyone in the iodine-deficient areas is affected and familial aggregation is common. This suggests that genetic factors may play an important role. Thyroid hormone (TH) plays an important role in fetal and early postnatal brain development. The thyroid-stimulating hormone (TSH, or thyrotropin) receptor (TSHR) is located on the surface of thyroid cells and binds TSH. It results in the production of thyroid hormones via the activation of adenylate cyclase and phospatidylinositol-dependent signaling pathways. Some researchers formulated the hypothesis that TSH receptor expression in the brain may be involved in local thyroid homeostasis through TSH stimulating the DIO2 activity. In the previous study, we have proposed that DIO2 may protect against FIDD in the iodine-deficient areas of China. The TSHR gene, which located on chromosome 14q31 is a potential candidate gene for susceptibility to FIDD. To investigate the potential genetic contribution of TSHR gene, we performed a case-control association study in Chinese Han population from the Qin-Ba mountain regions using four common SNPs in the gene (rs2284716, rs917986, rs2075173 and rs2075179). Pairwise linkage disequilibrium (LD) analysis showed that LD was observed between rs2284716 and rs917986 and between rs2075173 and rs2075179. Single-locus analysis found that all four SNPs in TSHR gene showed no association after correction for multiple testing. Haplotype analysis showed no significant differences in frequency for three sets of haplotypes based on the pariwise LD results. In conclusion, our association results suggest that TSHR gene is not a susceptibility gene for FIDD in the iodine-deficient areas of China.

Background: This paper describes the development of the Chinese Quality of Life Instrument (ChQOL) which is a self-report health status instrument. Chinese Medicine relies very much on asking subjective feelings of patients in the process of diagnosis and monitoring of treatment. For thousands of years, Chinese Medicine practitioners have accumulated a good wealth of experiences in asking questions about health of their patients based on the concept of health in Chinese Medicine. These experiences were then transformed into questions for the ChQOL. It is believed that ChQOL can contribute to the existing Patient Report Outcome measures. This paper outlines the concept of health and disease in Traditional Chinese Medicine, the building of the conceptual framework of the ChQOL, the steps of drafting, selecting and validating the items, and the psychometric properties of the ChQOL., Methods: The development of the ChQOL was based on the concept of health in Traditional Chinese Medicine with a theory driven approach. Based on the results of literature review, the research team developed an initial model of health which encompassed the concept of health in TCM. An expert panel was then invited to comment and give suggestions for improvement of the initial model. According to their suggestions, the model was refined and a set of initial items for the ChQOL was drafted. The refined model, together with the key domains, facets and initial items of the ChQOL were then mailed to a sample of about 100 Chinese medicine practitioners throughout Mainland China for their comments and advice. A revised set of items were developed for linguistic testing by a convenience sample consisting of both healthy people and people who attended Chinese Medicine treatment. After that, an item pool was developed for field-testing. Field test was conducted on a convenience sample of healthy and patient subjects to determine the construct validity and psychometric properties of the ChQOL., Results: Construct validity was established by various methods, i.e. the internal consistency in all facets and domains were good; the correlation between facets to domain, and domains to overall ChQOL correlation were high; confirmatory factor analysis showed that the structure fitness of all facets, domain and overall structure were good with CFI > 0.9. Test-retest reliability was also good, especially in the domain scores with ICC value ranging from 0.83 to 0.90. No ceiling or floor effect was noted which indicated that ChQOL can be applied to subjects with a wide range of health status. Most facet scores, domain scores and the overall CHQOL scores were able to discriminate groups of subjects with known differences in health status. The ChQOL had mild positive convergence with the other generic health related QOL measures, i.e. the WHOQOL-100 and the SF-36, with moderate correlations., Conclusion: In conclusion, the study indicated that the ChQOL is conceptually valid with satisfactory psychometric properties. It can provide additional information on health and QOL on top of the existing generic health related QOL measures. Furthermore, it forms basis for further testing and applications in clinical trials.