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Isodon xiaoluzhiensis, a new species of the tribe Ocimeae in family Lamiaceae, is described and illustrated. The new species is known only from the type locality, Xiaoluzhi village in Luzhijang dry-hot valley of Yimen County, central Yunnan, southwest China. It is characterized by having a procumbent habit, gracile stems and branches, relatively small leaves and flowers, and the phenology of flowering in winter. The morphological comparisons with its putative closest relatives (I. adenanthus and I. hsiwenii) are also presented. [ABSTRACT FROM AUTHOR]

The indumentum of nutlets is shown to be of phylogenetic importance in previous molecular phylogenetic studies of Paraphlomis, a genus of Lamiaceae with approximately 30 species distributed mainly in southern China and Southeast Asia. Nearly half the species of Paraphlomis are known from limestone areas. In this study, we described and illustrated a new species, P. hsiwenii, from the karst mountain forests in Guangxi Zhuang Autonomous Region, China. Our molecular phylogenetic analyses revealed that P. hsiwenii is recovered in a clade consisting of species with hairy nutlets. The new species is morphologically most similar to P. pagantha from the same clade, but they differ in the morphology of lamina bases, length of pedicels and calyces, as well as the morphology of upper corolla lips. [ABSTRACT FROM AUTHOR]

Most species of Paraphlomis are distributed in the south of the Yangtze River in China. In this study, a new species, P. nana, from northeast Chongqing in the north of the Yangtze River is described and illustrated. Bayesian inference and maximum likelihood analyses based on two nuclear ribosomal DNA regions (ITS and ETS) and three plastid DNA markers (rpl32-trnL, rps16, and trnL-trnF) were carried out to explore the phylogenetic position of the new species within Paraphlomis. Though the nuclear and plastid trees reveal incongruent placements of P. nana in Paraphlomis, which may be caused by chloroplast capture, a close relationship between the new species and P. albiflora is supported by molecular phylogenetic, morphological, and geographic evidence. However, the two species can be clearly distinguished from each other by the plant height and lamina and calyx morphology. [ABSTRACT FROM AUTHOR]

This paper addresses the significant challenges faced by distribution system operators (DSOs) in competitive electricity markets due to uncertainties arising from electricity markets, electric vehicles (EVs), and conventional loads. To tackle these challenges, this paper proposes a pseudo-local reserve market between the DSO and EVs, which enables the DSO to integrate EV flexibility into the overall market framework while compensating for deviations in the conventional load across the wholesale electricity market. Furthermore, a two-stage framework is developed to facilitate the participation of EVs in electricity markets. In the first stage, the reserve capacity of EVs is integrated into the decision-making process for day-ahead bidding, taking into account uncertainties of the load and electricity. In the second stage, the day-ahead results are coordinated to enable the efficient dispatch of EVs for real-time market participation. To assess the efficacy of the proposed framework, a case study is conducted within a 31-node distribution system situated on a university campus located in Guangdong, China. This paper investigates the economic impact of load deviation constraints on EV reserves, revealing a penalty reduction of 3100 CNY for a daily reservation of 1000 EVs and a net profit increase of 1300 CNY for DSOs utilizing reserves. It further introduces a method for quantifying reserve capacity, enhancing DSO decision-making accuracy. • A pseudo-local reserve market is established considering EV's reserve potential. • Optimal bidding strategy for DSO in China's electricity markets is constructed. • A framework for EV coordinated V2G operation is developed. • The proposed method can limit load deviation cost for more profits. [ABSTRACT FROM AUTHOR]

Mazus lanceifolius (Mazaceae) is a perennial herb with opposite leaves and endemic to central China that has not been collected for 130 years. Rediscovery of this enigmatic species in the wild allows for determination of its phylogenetic position within Mazaceae. Phylogenetic reconstruction of Mazaceae based on DNA sequences from four plastid markers (matK, rbcL, rps16 and trnL-trnF) and nuclear ribosome ITS consistently showed that Mazus was not monophyletic. Mazus lanceifolius is in the most basal clade within Mazaceae, as sister to the remaining species of three recognized genera Dodartia, Lancea and Mazus. These results support the separation of M. lanceifolius from Mazus as a new genus, which was established here as Puchiumazus Bo Li, D.G. Zhang & C.L. Xiang. Meanwhile, a collection from Shennongjia Forestry District of Hubei Province, China, misidentified as "M. lanceifolius" in previous molecular study, is here revealed to represent an undescribed species of Mazus, i.e., M. fruticosus Bo Li, D.G. Zhang & C.L. Xiang, sp. nov. Morphologically, Puchiumazus is clearly distinct from the other three genera by having quadrangular to somewhat ribbed stems, and obviously opposite leaves. In addition, we provide a taxonomic key to the four genera of Mazaceae. [ABSTRACT FROM AUTHOR]

Hanceola is a genus of eight herbaceous species previously thought to be endemic to southern China. However, H. suffruticosa, a new species described here from China and Vietnam, differs from all other species of Hanceola by its subshrubby habit. It is also distinct in its shallowly bicrenate laminae and densely purplish glandular puberulent inflorescences. The morphological description, illustrations, and distribution of the new species are presented. A key to all species of Hanceola is also provided. [ABSTRACT FROM AUTHOR]

This paper proposes a novel management scheme, namely, the distribution system operator (DSO) as a key player participating in China's electricity markets owing to its high value-added capability, high customer loyalty and robust risk resistance. In light of this, this paper discusses the maximal marginal revenue for DSO in uncertain electricity markets with vehicle-to-grid operation incorporated. Initially, considering different benefit expectations of electric vehicles (EVs) owners, DSO could provide preferential contracts, including the discount price contract (DPC) and revenue-sharing contract (RSC), in exchange for the management rights of EVs. Then, the stochastic optimization model considering the spatiotemporal uncertainties of EVs and electricity markets is built up, and the optimal bidding and coordinating strategy are proposed to maximize the marginal revenue of DSO. Comprehensive case studies are conducted in a 31-node distribution system of a university campus under the electricity markets in Guangdong, China. Results reveal that different distribution of EVs parking lots has a significant impact on the profit of DSO, and the revenue for DSO is 13,477 yuan more than that for EVA by scheduling 1400 EVs' charging/discharging behavior properly. Additionally, the DSO with RSCs is exposed to 25% less market volatility risk than that with DPCs. • Comparing EV aggregator(EVA) and distribution system operator(DSO) characteristics. • Discount price contracts and revenue-sharing contracts are compared. • The advantages of DSO over EVA in market participation are analyzed. [ABSTRACT FROM AUTHOR]

• A novel carbon emission reduction(CER) methodology is proposed. • The Black-Scholes mode is introduced to measure carbon emission option pricing. • Case studies of campus grid CER assessment are conducted in Shenzhen. • Methods and policy suggestions of CER are given for grid integration of EVs. China, as the world's largest emitter of carbon emissions, has implemented carbon markets to reduce carbon emissions, but the economic feasibility of integrating electric vehicles (EVs) into these markets remains uncertain. To address this challenge, we propose a novel methodology for grid integration of EVs based on the Shenzhen carbon inclusive management measures. Our proposed methodology can optimize EV charging schedules based on carbon emission prices and improve the economic feasibility of low-carbon transitions through EVs in China. We incorporate the Black-Scholes model to measure carbon emission option pricing and develop an optimal bidding strategy that considers spatiotemporal uncertainties of EVs and electricity markets. We use numerical simulations with real-world data from Shenzhen carbon emission market and Guangdong electricity market to demonstrate the effectiveness of our proposed methodology. Results reveal that scheduling 100 EVs' charging/discharging behavior properly can generate a revenue of 2379.4 yuan for the distribution system operator, while the revenue for carbon emission reduction (CER) is only 9.35 yuan. This paper demonstrates that the potential revenue of CER may be substantially based on the future scenario for the carbon emission market. These findings provide valuable insights for policymakers and stakeholders seeking to reduce carbon emissions in China's electricity sector. [ABSTRACT FROM AUTHOR]

Background: At present, diabetes is a chronic disease of great cost and heavy burdens. The International Diabetes Federation has repeatedly warned that by 2025, the global number of diabetics would rise to 333 million from 194 million in 2003. Although the occurrence of diabetes in developing countries is lower, China has a large population, so that the number of cases is increased. At the same time, more people have prediabetes, a growing health concern where a large percentage of the patients develop full type 2 diabetes. In addition, the patients of diabetes easily incur complications such as blindness, kidney failure, and cardiovascular diseases that can seriously affect the patients' quality of life and cause great economic burdens to family and society. Therefore, effective interventions for prediabetes are needed to prevent or delay the occurrence and development of diabetes.Methods: A randomized controlled trial that was assessed with pharmacoeconomic methods was undertaken in this study. The study term was 24 months (12 months for the intervention and 12 months for follow up). Four hundred participants, recruited from four cities in China: Beijing, Tianjin, Xian, and Naning, were randomized to the treatment group (JQJT tablets) and the control group (placebo). Participants included in this study had been diagnosed with prediabetes according to the criteria for western medicine and Traditional Chinese Medicine (TCM). The end-point effectiveness indexes included the incidence of diabetes and the reversion rate. The drug costs and lifestyle intervention costs were included in the total costs. The study used the cost-effectiveness analysis to discuss the economic advantage of the JQJT tablets.Results: The outcomes of the study contained 2 sections,namely clinical outcomes and cost-effectiveness analysis outcomes. The clinical outcomes: the treatment group and control group had no significant statistical difference P> 0.05) on the baseline of situation; Jinqi Jiangtang tablet effectively reduced the incidence of diabetes mellitus and enhanced reversion rate. compared with the control group (p< 0.05); the scores of SF-36 of two groups had no significant difference P> 0.05); finally the compliance of participants between the two groups had no significant difference. The cost-effectiveness analysis outcomes:in the intervention period of 12 months,on the aspect of reversion rate, the treatment group had better economic advantage by using cost-effectiveness ratio and the incremental cost-effectiveness ratio;on the aspect of the incidence of diabetes, the control group had better economic advantage by using cost-effectiveness ratio and the incremental cost-effectiveness ratio; in the follow-up period of 24 months, on the aspect of reversion rate, the treatment group had better economic advantage by using cost-effectiveness ratio and the incremental cost-effectiveness ratio, on the aspect of the incidence of diabetes, the control group had better economic advantage by using cost-effectivenes ratio and the incremental cost-effectiveness ratio.At the same time, these outcomes remained the same by sensitivity analysis. Assuming that prices and resident incomes rose 5%, the sensitiveness analysis shows that the two group affected by the paremeters changed little.Conclusion: The importance and effectiveness of lifestyle education and JinQi Jiangtang tablets was proven. In both the intervention period and follow-up, JinQi Jiangtang tablets combined with lifestyle education had a greater cost advantage effect than the lifestyle education alone on the reversion rate; the lifestyle education had a greater cost advantage effect than the JinQi Jiangtang tablets combined with lifestyle education on the incidence of diabetes.Trial Registration: Chinese Clinical Trials ChiCTR-TRC-09000401 ) , registered on 25 May 2009. [ABSTRACT FROM AUTHOR]

Background Suboptimal health status (SHS) is the intermediate health state between health and disease, refers to medically undiagnosed or functional somatic syndromes, and has been a major global public health challenge. However, both the etiology and mechanisms associated with SHS are still unclear. Breakfast eating behavior is a dietary pattern marker and previous studies have presented evidence of associations between failure to consume breakfast and increased diseases. Accordingly, in view of the significance of breakfast eating behaviors with respect to health status, the associations between breakfast eating habits and healthy lifestyle, SHS require further elucidation. Methods A cross-sectional survey was conducted within a clustered sample of 24,159 individuals aged 12-80 years in 2012-13 within the population of Southern China. Breakfast eating habits were categorically defined by consumption frequency ('scarcely, sometimes or always'). Health-promoting lifestyle was assessed via the health-promoting lifestyle profile (HPLP-II). SHS was evaluated using the medical examination report and Sub-health Measurement Scale V1.0 (SHMS V1.0). Results Of the 24,159 participants, the prevalence rates for the 'health', 'SHS', and 'disease' were 18.8%, 46.0%, and 35.2%, respectively. Overall, 19.6% of participants reported 'scarce' breakfast eating habits, with frequent breakfast eaters scoring higher on both HPLP-II and SHMS V1.0. After demographic adjustment, regression analyses revealed a significant association between breakfast eating habits and healthy lifestyle (p <0.001). There were lower levels of breakfast consumption regularity amongst individuals with SHS than those with disease. Categorically 'scarce' breakfast eaters were approximately three times more likely to be assigned SHS (OR: 2.745, 95% CI: 2.468-3.053), while infrequent breakfast eaters ('sometimes') were just less than twice as likely to be assessed as being of SHS (OR: 1.731, 95% CI: 1.595-1.879). Conclusions Breakfast eating habits are significantly associated with a healthy lifestyle, and appear to be a useful predictor of a healthy lifestyle. Irregular breakfast eating habits are related to an increased risk of SHS; increased breakfast eating frequency may contribute to lowering the prevalence of SHS in Southern China. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the morphology of a new species of Isodon from Vunnan Province, Southwest China. The study made used of micrometer under a microscopes to measure the new species. The result of the study shows that the new species differed pertaining to leaf size, plant stature, inflorescence, pollen, and indumentum.

• Climate-sensitive additive stand biomass models were developed. • The difference in biomass estimations when using the new models at a large scale was quantified. • Forecast combination method reduced the uncertainty from the biomass models. • About $8.3 million carbon services were underestimated using traditional models. • Climate-sensitive stand biomass models were recommended for carbon service accounting. Accurate forest carbon service accounting is essential for climate change mitigation. At present, the knowledge about whether and how climate-sensitive stand biomass models could reduce the uncertainty of forest biomass/carbon estimation is lacking. Hence, the aim of this study is to develop climate-sensitive stand biomass models and quantify their differences. Data containing 539 sample plots of larch plantations in northern and northeastern China were utilized to develop two basic and the corresponding climate-sensitive stand biomass models. Owing to the uncertainty from predictors, the forecast combination method was used to combine the two basic models (FCMs) and the two climate-sensitive models (CS-FCMs) and to quantify the difference in biomass estimations at the plot and regional scales. Results showed that the adjusted R 2 values of the stand biomass models were greater than 0.85 and the relative root mean square errors ranged from 5.51% to 22.62%. The CS-FCMs produced more accurate biomass estimates than the FCMs. The difference in biomass estimations derived from biomass models with and without climatic variables was 411,549 tons or 0.27% at the regional scale, but the carbon value difference amounted to about $8.3 million. This study underlined the importance of accurate carbon accounting based on climate-modified stand biomass models for forest carbon management. [ABSTRACT FROM AUTHOR]

Lectotypes of Paraphlomis albiflora (Hemsl.) Hand.-Mazz. and Paraphlomis gracilis (Hemsl.) Kudô are designated. The name Paraphlomis javanica (Blume) Prain var. angustifolia C. Y. Wu & H. W. Li ex C. L. Xiang, E. D. Liu & H. Peng is validated by a type designation. [ABSTRACT FROM AUTHOR]

Vitis yunnanensis C. L. Li, originally described from Yunnan, southwestern China, was not validly published in 1997, because two type specimens were simultaneously designated. To enable formal use of the name, it is validated here. [ABSTRACT FROM AUTHOR]

Nitrate (NO 3 −) pollution in irrigation canals is of great concern because it threatens canal water use; however, little is known about it at present. Herein, a combination of positive matrix factorization (PMF), isotope tracers, and Mixing Stable Isotope Analysis in R (MixSIAR) was developed to identify anthropogenic impacts and quantitative sources of NO 3 − in a rural-urban canal in China. The NO 3 − concentration (0.99–1.93 mg/L) of canal water increased along the flow direction and was higher than the internationally recognized eutrophication risk value in autumn and spring. The inputs of the Fuhe River, NH 4 + fertilizer, soil nitrogen, manure & sewage, and rainfall were the main driving factors of canal water NO 3 − based on principal component analysis and PMF , which was supported by evidence from δ15N/δ18O–NO 3 -. According to the chemical and isotopic analyses, nitrogen transformation was weak, highlighting the potential of δ15N/δ18O–NO 3 - to trace NO 3 − sources in canal water. The MixSIAR and PMF results with a <15% divergence emphasized the predominance of the Fuhe River (contributing >50%) and anthropogenic impacts (NH 4 + fertilizer plus manure & sewage, >37%) on NO 3 − in the entire canal, reflecting the effectiveness of the model analysis. According to the MixSIAR model, (1) higher NO 3 − concentration in canal water was caused by the general enhancement of human activities in spring and (2) NO 3 − source contributions were associated with land-use patterns. The high contributions of NH 4 + fertilizer and manure & sewage showed inverse spatial variations, suggesting the necessity of reducing excessive fertilizer use in the agricultural area and controlling blind wastewater release in the urban area. These findings provide valuable insights into NO 3 − dynamics and fate for sustainable management of canal water resources. Nevertheless, long-term chemical and isotopic monitoring with alternative modeling should be strengthened for the accurate evaluation of canal NO 3 − pollution in future studies. [Display omitted] • NO 3 − source of canal water was assessed by PMF and MixSIAR with δ15N/δ18O–NO 3 -. • NH 4 + fertilizer and manure & sewage were the main anthropogenic NO 3 − sources. • The NO 3 − source contribution was controlled by land-use patterns with season. • Nitrification and denitrification were not significant in canal water. [ABSTRACT FROM AUTHOR]

Previous studies of the end-Permian mass extinction have established that it was geologically rapid, but condensed sections have made it difficult to establish the exact timing of the extinction relative to fluctuations in the ocean carbon cycle, oxygen levels, and temperature. Integrated high-precision U-Pb geochronology, biostratigraphy, and chemostratigraphy from a highly expanded section at Penglaitan, Guangxi, South China reveal a sudden end-Permian mass extinction that occurred at 251.939 ± 0.031 Ma, which is temporally coincident with the extinction recorded in Bed 25 of the Meishan section. Despite the significantly expanded nature of the section and extensive collecting of more than ten major marine fossil groups, there is no evidence of a decline of biotic diversity prior to the extinction interval and no Permiantype species survive the extinction at this location. Fossil range data suggest a nearly instantaneous extinction at the top of a narrow stratigraphic interval limited to 31 ± 31 k.y. The extinction was preceded by and/or accompanied by fluctuations in δ13Ccarb and δ13Corg of 2-3‰, and 3-5 °C in seawater temperature. A larger, more rapid seawater temperature rise of 6-8 °C immediately followed the extinction level at Penglaitan. The extinction is spatially associated with a thick unit of tuff and tuffaceous sandstones (Bed 141) indicating massive pyroclastic input. It is correlative with an ash layer (Bed 25) in the deeper water setting at Meishan, where some Permian-type organisms survived the extinction. Our study reveals that the survivability of Permian taxa after the major extinction pulse is variable and dependent upon the severity of environmental perturbation in different sedimentary settings. The sudden extinction may fit a scenario in which the onset of Siberian Traps and South China intensive volcanism ~420 k.y. before the extinction may have diminished the ecological resilience of communities and reduced ecological functions with little change in diversity. In such an environmentally stressed condition, a single environmental disturbance could trigger the sudden collapse of global ecosystems. [ABSTRACT FROM AUTHOR]

Extreme weather/climate events increased significantly because of global warming. Based on daily records from 16 meteorological stations in the Poyang Lake Basin (PLB) from 1959 to 2019, we comprehensively investigated the temporal-spatial and non-stationarity characteristics of extreme precipitation from three dimensions (intensity, frequency and duration) using PreWhite-ning Mann-Kendall (PWMK), extreme-point symmetric mode decomposition method (ESMD) and the generalized additive models for location, scale and shape (GAMLSS). The results showed that the intensity and frequency of extreme precipitation increased significantly in the PLB, while the duration of extreme precipitation decreased from 1959 to 2019. The extreme precipitation had features of high intensity, high frequency, and short duration in the PLB. There was a clear distinction between flood season and non-flood season for extreme precipitation. Extreme precipitation was concentrated in the northern and central PLB during the flood season and in the central PLB during the non-flood season. The increasing trend of extreme precipitation amount was 2.10 mm·a -1 in the Xinjiang basin, which had the largest increment over the PLB. In the flood season, the extreme precipitation had longer duration but weaker intensity and smaller range, contrasting with the status during the non-flood season. The intensity and frequency of extreme precipitation showed stationarity characteristics in the PLB. However, the duration of extreme precipitation showed non-stationarity characteristics. With the continuous increase of extreme precipitation amount, the risk of related disasters would increase.

Although the relationship between biodiversity and ecosystem functioning has been extensively studied, it remains unclear if the relationships of biodiversity with productivity and its spatial stability vary along productivity gradients in natural ecosystems. Based on a large dataset from 2324 permanent forest inventory plots across northeastern China, we examined the intensity of species richness (SR) and tree size diversity (Hd) effects on aboveground wood productivity (AWP) and its spatial stability among different productivity levels. Structural equation modeling was applied, integrating abiotic (climate and soil) and biotic (stand density) factors. Our results demonstrated that both SR and Hd positively affected AWP and its spatial stability, and the intensity of these positive effects decreased with increasing productivity. At low productivity levels, SR and Hd increased spatial stability by reducing spatial variability and increasing mean AWP. At high productivity levels, stability increased only through mean AWP increase. Moreover, temperature and stand density affected the AWP directly and indirectly via biodiversity, and the strength and direction of these effects varied among different productivity levels. We concluded that biodiversity could simultaneously enhance productivity and its spatial stability in temperate forests, and that the effect intensity was uniform along productivity gradients, which provided a new perspective on relationships within biodiversity-ecosystem functioning., 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 © 2021 Elsevier B.V. All rights reserved.)

Purpose: To evaluate the performance of an AI-based diabetic retinopathy (DR) grading model in real-world community clinical setting., Methods: Participants with diabetes on record in the chosen community were recruited by health care staffs in a primary clinic of Zhengzhou city, China. Retinal images were prospectively collected during December 2018 and April 2019 based on intent-to-screen principle. A pre-validated AI system based on deep learning algorithm was deployed to screen DR graded according to the International Clinical Diabetic Retinopathy scale. Kappa value of DR severity, the sensitivity, specificity of detecting referable DR (RDR) and any DR were generated based on the standard of the majority manual grading decision of a retina specialist panel., Results: Of the 193 eligible participants, 173 (89.6%) were readable with at least one eye image. Mean [SD] age was 69.3 (9.0) years old. Total of 321 eyes (83.2%) were graded both by AI and the specialist panel. The κ value in eye image grading was 0.715. The sensitivity, specificity and area under curve for detection of RDR were 84.6% (95% CI: 54.6- 98.1%), 98.0% (95% CI: 94.3-99.6%) and 0.913 (95% CI: 0.797-1.000), respectively. For detection of any DR, the upper indicators were 90.0% (95% CI: 68.3-98.8), 96.6% (95% CI: 92.1-98.9) and 0.933 (95% CI: 0.933-1.000), respectively., Conclusion: The AI system showed relatively good consistency with ophthalmologist diagnosis in DR grading, high specificity and acceptable sensitivity for identifying RDR and any DR., Translational Relevance: It is feasible to apply AI-based DR screening in community., Precis: Deployed in community real-world clinic setting, AI-based DR screening system showed high specificity and acceptable sensitivity in identifying RDR and any DR. Good DR diagnostic consistency was found between AI and manual grading. These prospective evidences were essential for regulatory approval.

Accurate exposure estimate of the air pollutant PM 2.5 is required to evaluate its health impacts in epidemiological studies, due to its adverse effects on human's respiratory and cardiovascular systems. However, traditional personal sampling is time and cost consuming. Thus, modeling techniques are needed to accurately predict the personal exposure level to PM 2.5 . In this study, a total of 117 older adults over 60 were recruited in Tianjin, a heavily polluted city in northern China, for indoor, outdoor and personal PM 2.5 sampling. Eighteen variables which may increase the exposure level of older adults were recorded for artificial neural network (ANN) simulation. Four modeling techniques, including time-integrated activity modeling, Monte Carlo simulation, ANN modeling, and combined use of principal component analysis (PCA) and ANN model, were used to evaluate their ability for predicting real exposure values of PM 2.5 . The results of traditional time-weighted activity modeling showed the lowest correlation with measured values with R 2 of 0.57 and 0.42 in winter and summer, respectively. For Monte Carlo simulation, high correlation was obtained (R 2 of 0.93 and 0.92 in winter and summer, respectively) between percentiles of the predicted and the real exposure values. Compared with the simple ANN models, the combined use of PCA and ANN produced the most accurate results with R 2 of 0.99 and RMSE lower than 15. Since the information of the input variables for the PCA-ANN model can be obtained from the questionnaire and fixed air quality monitoring sites, this technique shows a great potential in predicting personal exposure level to the air pollutant because no additional concentration measurement is needed., 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 © 2020 Elsevier B.V. All rights reserved.)

Background: At present, diabetes is a chronic disease of great cost and heavy burdens. The International Diabetes Federation has repeatedly warned that by 2025, the global number of diabetics would rise to 333 million from 194 million in 2003. Although the occurrence of diabetes in developing countries is lower, China has a large population, so that the number of cases is increased. At the same time, more people have prediabetes, a growing health concern where a large percentage of the patients develop full type 2 diabetes. In addition, the patients of diabetes easily incur complications such as blindness, kidney failure, and cardiovascular diseases that can seriously affect the patients' quality of life and cause great economic burdens to family and society. Therefore, effective interventions for prediabetes are needed to prevent or delay the occurrence and development of diabetes., Methods: A randomized controlled trial that was assessed with pharmacoeconomic methods was undertaken in this study. The study term was 24 months (12 months for the intervention and 12 months for follow up). Four hundred participants, recruited from four cities in China: Beijing, Tianjin, Xian, and Naning, were randomized to the treatment group (JQJT tablets) and the control group (placebo). Participants included in this study had been diagnosed with prediabetes according to the criteria for western medicine and Traditional Chinese Medicine (TCM). The end-point effectiveness indexes included the incidence of diabetes and the reversion rate. The drug costs and lifestyle intervention costs were included in the total costs. The study used the cost-effectiveness analysis to discuss the economic advantage of the JQJT tablets., Results: The outcomes of the study contained 2 sections,namely clinical outcomes and cost-effectiveness analysis outcomes. The clinical outcomes: the treatment group and control group had no significant statistical difference P> 0.05) on the baseline of situation; Jinqi Jiangtang tablet effectively reduced the incidence of diabetes mellitus and enhanced reversion rate. compared with the control group (p< 0.05); the scores of SF-36 of two groups had no significant difference P> 0.05); finally the compliance of participants between the two groups had no significant difference. The cost-effectiveness analysis outcomes:in the intervention period of 12 months,on the aspect of reversion rate, the treatment group had better economic advantage by using cost-effectiveness ratio and the incremental cost-effectiveness ratio;on the aspect of the incidence of diabetes, the control group had better economic advantage by using cost-effectiveness ratio and the incremental cost-effectiveness ratio; in the follow-up period of 24 months, on the aspect of reversion rate, the treatment group had better economic advantage by using cost-effectiveness ratio and the incremental cost-effectiveness ratio, on the aspect of the incidence of diabetes, the control group had better economic advantage by using cost-effectivenes ratio and the incremental cost-effectiveness ratio.At the same time, these outcomes remained the same by sensitivity analysis. Assuming that prices and resident incomes rose 5%, the sensitiveness analysis shows that the two group affected by the paremeters changed little., Conclusion: The importance and effectiveness of lifestyle education and JinQi Jiangtang tablets was proven. In both the intervention period and follow-up, JinQi Jiangtang tablets combined with lifestyle education had a greater cost advantage effect than the lifestyle education alone on the reversion rate; the lifestyle education had a greater cost advantage effect than the JinQi Jiangtang tablets combined with lifestyle education on the incidence of diabetes., Trial Registration: Chinese Clinical Trials ChiCTR-TRC-09000401 ) , registered on 25 May 2009.

Introduction: Traditional Chinese medicine (TCM) has accumulated some experience in curing stable angina pectoris (SAP) and efficacy has been demonstrated. Chinese patent medicines, known as modern dosage forms of TCM, can attain the desired effect in clinical application only with the guidance of TCM syndrome theory. However, due to their use by a large number of persons with little knowledge of TCM theories and practices, their efficacy and reputation have been seriously affected., Method and Analysis: Two common syndrome types of SAP in TCM, 'qi deficiency and blood stasis' and 'qi stagnation and blood stasis', will be studied in 144 subjects from four TCM hospitals in Tianjin in China using a partial crossover design. The two syndromes will be broken down into six symptom combinations; patients will select a combination of the most distressing to them, and then will be randomised into two groups. Each group, on the basis of routine medication, will be administered one kind of Chinese patent drug: Qishenyiqi Dripping Pills or Compound Danshen Dripping Pills. The treatment characteristics of the two medicines will be evaluated with the COME-PIO method developed by our research team., Ethics and Dissemination: This protocol has been approved by the medical ethics committee of Tianjin University of TCM (registration number TJUTCM-EC20130005). The study is safe and reliable., Trial Registration Number: Chinese clinical trials register ChiCTR-TTRCC-14004406., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Fast-track surgery (FTS), which combines various techniques with evidence-based adjustments, is aimed to reduce postoperative morbidity, attenuate surgical stress response, thereby accelerating recovery and shorting length of stay. To further investigate the effectiveness of fast-track surgery, we compared the short-term outcomes of laparoscopic radical cystectomy and ileal conduit diversion for Chinese bladder cancer patients with FTS or with CS in our hospital. Patients with bladder cancer were included and divided into two consecutive groups: CS group and FTS group. Duration to first flatus and regular diet, postoperative hospital days, hospital expense, incidence of complications and postoperative surgical stress response were compared. There was no significant difference between the two groups in age, sex, BMI and postoperative TNM classification. Compared with the CS group, the FTS group had significantly shorter duration to first flatus, time to regular diet, postoperative hospital days and hospital expense, less complications, lower white blood count (WBC) and serum of C-reactive protein (CRP) on postoperative day 5 and 7. Our study indicates that FTS program is safe and efficacious for Chinese patients undergoing laparoscopic radical cystectomy and ileal conduit diversion. It can accelerate recovery, reduce stress action, shorten postoperative hospitals days and reduce hospital expenses.

Veregen™ and Fulyzaq are the first two botanical drug products that were approved by the Food and Drug Administration (FDA) to market in the US in recent years. Additional herbal medicines, including Compound Danshen Dripping Pills, Fuzheng Huayu Tablets, Xuezhikang Capsule, Guizhi Fuling Capsule, Kanglaite Capsule and Kanglaite Injection, have filed the investigational new drug (IND) application to the FDA and are in phase II or phase III clinical development. In order to gain better understanding of the process of botanical drug approval in the US, this article examines the aforementioned drugs by looking at their composition, indication, prior clinical experience and clinical development process, and summarizes key features that enabled IND filing and marketing approval by the FDA.

Background: The practice of traditional Chinese medicine (TCM) has a profound history in many Asian countries. TCM syndrome is a set of characteristic physical signs and symptoms shared by a group of patients. Syndrome diagnosis and treatment assignment according to the identified TCM syndrome is a long-held practice of Chinese medicine. Owing to its distinctive way of interpreting illness and administering care, medical practitioners not well educated in TCM theories and practices are generally incapable of giving out prescriptions for Chinese patent drugs. Currently, the existence of a multitude of Chinese patent drugs marked with largely identical indications is further complicating this situation., Methods: In this multicenter, randomized, controlled, double-blind, double-dummy clinical trial, in which we will use the comparative effectiveness research method, we will compare the efficacy of two commonly used Chinese patent medicines for angina patients diagnosed with qi deficiency and blood stasis syndrome. A total of 160 patients will be recruited and randomly assigned to receive either (1) QiShenYiQi dripping pills, Tongxinluo placebo and routine medication or (2) Tongxinluo capsules, QiShenYiQi placebo and routine medication. These treatment regimens will be carried out for 4 weeks, followed by a 10-day washout period and a 4-week crossover phase in which the treatments in the two patient groups will be exchanged. Patients will be allowed to choose symptoms that matter most to them and will be grouped accordingly. Patient-reported outcomes such as the Seattle Angina Questionnaire score and the 15-point Likert scale score will be measured and reported. The minimally clinical important difference will be calculated and used for efficacy assessment, and correspondence analysis will be performed to identify the best indications for each drug., Discussion: The goal of the study is to establish a methodology for the precise identification of the characteristic indications for which a Chinese patent drug is most effective. The findings of this study will inform the practicality of the proposed evaluation method., Trial Registration: Chinese clinical trials register Chi CTRTTRCC13003732.