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Objectives: To summarize the clinicopathological and genetic features of malignant paragangliomas in head and neck cancer and to explore the appropriate treatment options for this rare lesion. Methods: Six patients harboring head and neck malignant paraganglioma from Beijing Tongren Hospital were retrospectively reviewed. The clinicopathological characteristics, gene mutations, and prognosis of these patients were analyzed. Results: Of these 6 patients, 3 were male and 3 were female; 4 patients harbored malignant carotid body tumors, and two had malignant vagal paragangliomas. Three patients had cervical lymph node metastasis, two presented with lung and bone metastasis, and 1 had lung and liver metastasis. Of the 6 patients, four underwent surgical resection, and the other two patients denied surgery and instead received chemotherapy with paclitaxel, ifosfamide, and dacarbazine. These 2 patients with vagal paraganglioma received postoperative radiotherapy. All 6 patients are still alive at the present time, with a median follow-up time of 66 months. Positive Ki-67 expression in tumor tissue ranged from 1% to 40%. Genetic mutations in SDHD, SDHB, ATR, and MAP3K13 were identified in 4 patients. Conclusions: After comprehensive treatment, head and neck malignant paraganglioma can attain a favorable prognosis. Genetic mutations are commonly detected in patients with malignant paragangliomas. This study also identified mutations in ATR and MAP3K13 in these patients. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article is to discuss the effective management of mandibular fractures in pediatric patients during the growing phase of the mandible using splint fiber and ligature wire. Methods: A retrospective study examined pediatric patients with mandibular fractures who were treated using the splint (Quartz) fiber and ligature wire technique at the Stomatology Hospital of Xi'an Jiaotong University from August 2021 to January 2023. Data on gender, age, location or site of the fracture, and development of tooth stage were collected from the patient's medical records. Descriptive statistics were used to analyze the data and evaluate the effectiveness of the splint (Quartz) fiber technique for treating mandibular fractures in pediatric patients. Results: Out of 256 subjects, 6 pediatric patients with mandibular fractures were selected, resulting in an incidence rate of 2.34% with an equal sex ratio. Mental or symphysis fracture was the most common site for fracture in children, accounting for 100% of cases. Right mandibular angle fracture was observed in 16.7% of patients, while 50% of the group (3 individuals) suffered from left condylar fracture and 16.7% had a bilateral condylar fracture. Treatment with Quartz splint fiber and circumdental arch wiring using ligature wire was successful with no observed post-treatment complications or malocclusion. The splint fiber was worn for 30 days and the circumdental arch wiring was for the same. Healing of bone fracture yields good results after 12 weeks. Follow-up care is crucial to monitor for complications, in this study, no post-treatment complications were observed. Conclusion: The treatment of pediatric mandibular fractures is complex and requires careful consideration of various factors. Conservative management should be the first choice, with open reduction and internal fixation reserved for specific cases. The use of quartz splint fiber and ligature wire is an effective treatment option for stabilizing the mandible and providing occlusal stability in growing children. A fiber splint along with ligature wire can also be used as an alternative treatment to avoid any adverse effects on the growth and development of the mandible and permanent teeth. A multidisciplinary approach is essential to achieving the best outcomes for pediatric patients with mandibular fractures. [ABSTRACT FROM AUTHOR]

This paper presents the failure analysis of the crack and leakage accident of a crude oil pipeline under CO2-steam flooding in the western oilfield of China. To analyze the failure behavior and cause, different testing, including nondestructive testing, chemical composition analysis, tensile property testing, metallographic analysis, and microanalysis of fracture and chloride stress corrosion cracking (SCC) testing, are applied in the present study. The obtained results showed that the pipeline under the insulation layer of high humidity, high oxygen content, and high Cl− environment occurred pit corrosion, and the stress concentration area at the bottom of the corrosion pit sprouted cracks. Besides, it is demonstrated that the cracks were much branched, mostly through the crystal, and the fracture showed brittle, which is consistent with the typical characteristics of chloride SCC. Meanwhile, the insufficient Ni content of the pipeline material promoted the process of chloride SCC, and the high-temperature working conditions also aggravated the rate of chloride SCC. In addition, efficient precautions were provided to avoid fracture. [ABSTRACT FROM AUTHOR]

Background: Up to 85% of hepatocellular carcinoma (HCC) cases in China can be attributed to infection of hepatitis B virus (HBV). Lipid metabolism performs important function in hepatocarcinogenesis of HBV–related liver carcinoma. However, limited studies have explored the prognostic role of lipid metabolism in HBV–related HCC. This study established a prognostic model to stratify HBV–related HCC based on lipid metabolisms. Methods: Based on The Cancer Genome Atlas HBV–related HCC samples, this study selected prognosis-related lipid metabolism genes and established a prognosis risk model by performing uni- and multi-variate Cox regression methods. The final markers used to establish the model were selected through the least absolute shrinkage and selection operator method. Analysis of functional enrichment, immune landscape, and genomic alteration was utilized to investigate the inner molecular mechanism involved in prognosis. Results: The risk model independently stratified HBV-infected patients with liver cancer into two risk groups. The low–risk groups harbored longer survival times (with P < 0.05, log–rank test). TP53, LRP1B, TTN, and DNAH8 mutations and high genomic instability occurred in high–risk groups. Low–risk groups harbored higher CD8 T cell infiltration and BTLA expression. Lipid–metabolism (including "Fatty acid metabolism") and immune pathways were significantly enriched (P < 0.05) in the low–risk groups. Conclusions: This study established a robust model to stratify HBV–related HCC effectively. Analysis results decode in part the heterogeneity of HBV–related liver cancer and highlight perturbation of lipid metabolism in HBV–related HCC. This study's findings could facilitate patients' clinical classification and give hints for treatment selection. [ABSTRACT FROM AUTHOR]

In recent years, the Dongbei suancai industry in China had been developing continuously, however, the flavor of suancai fermented by inoculating with lactic acid bacteria needed to be improved. The effects of Chinese Baijiu on the flavor compounds of Chinese Dongbei suancai were investigated, and the quality evaluation model of volatile flavor components of suancai was established in this study. Results showed that although Baijiu had negative effects on the microbial growth, it could decrease the total titratable acid content and prevent excessive acidification of suancai. In addition, Baijiu increased the amount of the flavor compounds in inoculated fermented suancai. The contents of aldehydes showed a higher value in suancai fermented with 2% Baijiu concentration, while acids, esters, ketones and thiocyanates/isothiocyanates were higher at 5% and 8% Baijiu concentrations. Furthermore, the esters, ketones and sulfur compounds became the characteristic flavor of suancai fermented with Baijiu, simultaneously, the comprehensive scores of flavor components showed that 2% Baijiu could improve the flavor quality of suancai. The results of the study could contribute to the flavor quality improvement of Chinese Dongbei suancai, and also could provide the theoretical basis for understanding the flavor formation mechanism of Dongbei suancai. Practical applications: The results of this study determined an emerging fermentation method to obtain suancai products with intense aromatic flavor, simultaneously, provided a scientific basis for the improvement of the flavor quality of Chinese Dongbei suancai. [ABSTRACT FROM AUTHOR]

In the Taihang Mountain areas, known as the "esophageal cancer zone" in China, the incidence of esophageal cancer (ESCA) ranks the first in the country and shows a familial and regional clustering trend. Taihang Mountain areas are located in a mountainous area, with inconvenient transportation, limited living conditions, unbalanced diet, and poor nutrition. Ninety percent of the pathological types of ESCA in Taihang Mountain areas are squamous cell carcinoma, among which the risk factors have not been well understood. These areas are usually remote villages and mountains with low population mobility, large family members, similar environmental factors, and a clear and stable genetic background. Therefore, according to the current situation, second-generation sequencing and multigroup analysis technology are used to analyze the familial ESCA patients; disease-related genetic variation are located; and then disease-related susceptibility genes associated with ESCA are screened and analyzed. Health education, tobacco control, endoscopic screening, and other health management projects for suspected and high-risk patients in areas with a high incidence of ESCA can be carried out for screening and early diagnosis, and the incidence of ESCA in Taihang Mountain areas can be reduced. A comprehensive continuous care pattern based on traditional medical nursing to track, monitor, evaluate, and intervene with patients diagnosed with ESCA to facilitate them with medications guidance, dietary guidance, and timely health problem-solving is established. Furthermore, statistical analysis of epidemiology, gene sequencing, and family genetics information can be performed on patients with ESCA in the Taihang Mountains areas to clarify the relationship between genetic phenotype and genotype during the occurrence of ESCA. [ABSTRACT FROM AUTHOR]

This study revealed the modulation of the impacts of Madden–Julian Oscillation (MJO) on winter rainfall in China by El Niño‐Southern Oscillation (ENSO) using reanalysis data and statistical analysis. When MJO is active over the Indian Ocean, its impacts are strengthened by El Niño, leading to enhanced positive rainfall anomalies in eastern China. However, the effects of MJO are counteracted by La Niña; thus, significant positive rainfall anomalies exist only in Zhejiang Province and adjacent areas. MJO activity over the western Pacific induces opposite rainfall anomalies in South China between El Niño and La Niña winters; rainfall in South China increases (decreases) in El Niño (La Niña) winters. Such differences in rainfall anomalies are closely related to anomalous circulation and moisture transport. Anomalous southwesterlies in eastern China are enhanced in El Niño winters when MJO is active over the Indian Ocean, which leads to increased moisture transport towards China and stronger ascending motion in eastern China. But the anomalous southwesterlies are weakened in La Niña winters, thereby resulting in less moisture transport and convergence. When MJO is active over the western Pacific, anomalous northeasterlies in mainland China are enhanced (weakened) in La Niña (El Niño) winters, which strengthens (weakens) the moisture divergence and descending motion in China. Moisture convergence anomalies that explain the rainfall anomalies in ENSO winters are mainly attributed to the effects of low‐frequency background state (LFBS) moisture and meridional winds. It was found that ENSO modulates the impacts of MJO by two main ways. First, ENSO can regulate the intensity and distribution of MJO activity. Therefore, MJO in the same phase will lead to different circulation and moisture transport anomalies in China. Second, ENSO‐induced LFBS circulation and moisture anomalies can also influence the moisture convergence in China, which will strengthen or weaken the effects of MJO. [ABSTRACT FROM AUTHOR]

To determine the impact of depressive symptoms on health service use and catastrophic health expenditure, and whether it varied by per-capita household consumption, health insurance schemes, and physical comorbidities. Population-based panel data analysis. Participants were 8585 adults aged 45 years and older in 2011, and had completed a follow-up survey in 2013, 2015, and 2018 from the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed using the short form of the Center for Epidemiologic Studies Depression Scale. The number of outpatient visits and inpatient hospital days were used as proxies for health service use. When households' out-of-pocket spending on health was 40% or above its total expenditure, it was defined as a catastrophic health expenditure. With the panel data approach, random-effects negative binomial regression and logistic regression were used to analyze the effect of depressive symptoms on health service use and health care expenditure, respectively. Depressive symptoms were associated with increased number of outpatient visits (incidence rate ratio 1.52; 95% CI 1.44–1.60) and days spent in the hospital as an inpatient (1.52; 1.43–1.62). Depressive symptoms were also associated with a significantly increased likelihood of catastrophic health expenditure (odds ratio 1.54; 95% CI 1.43–1.66). Their effect on outpatient visits, inpatient hospital days, and catastrophic health expenditure persisted in different age, per-capita household consumption, and physical comorbidities groups, and across all health insurance programs. Depressive symptoms were risk indicators that can drive health service use and household financial stress. Given the rapidly aging population in China, there is an urgent need to integrate mental health care into routine physical examinations to alleviate the economic impacts of depressive symptoms on individuals in China. specifically for individuals with physical comorbidities and in poorer socioeconomic conditions. [ABSTRACT FROM AUTHOR]

Conclusion:From aspect of fluid dynamics, expanding patients’ nasopharyngeal coronal-sectional area to 48.3–54.7% of normal area will bring the airflow velocity back to normal in adenoidal hypertrophy children. It might provide a suggestion for adenoidectomy range selection and whether total resection is necessary. Objectives:To evaluate the nasopharyngeal airflow characteristics in pediatric OSA patients with adenoidal hypertrophy, and to explore the proper resection range for adenoidectomy Method:Nine OSA patients and four normal children were recruited. The CT scans of their upper airway were collected and used to construct three dimensional models for fluid dynamics analysis. Using computational fluid dynamics, indices such as velocity, pressure, and coronal-sectional area were calculated. Results:Compared with the normal, the OSA children showed three characteristics in nasopharyngeal: the airflow velocity was significantly higher (p < 0.05), the coronal-sectional area was significantly smaller (p < 0.01), while pressure showed no difference (p > 0.05). In a study of the relationship between velocity and coronal-sectional area, this study investigates different coronal-sectional areas from 30–300 mm2. It was found that, when patients’ nasopharyngeal coronal-sectional area was expanded over 155–170 mm2, namely 48.3–54.7% of normal area, airflow velocity in nasopharyngeal showed no difference than normal. [ABSTRACT FROM PUBLISHER]

Since 2013 the occurrence of human infections by a novel avian H7N9 influenza virus in China has demonstrated the continuing threat posed by zoonotic pathogens. Although the first outbreak wave that was centred on eastern China was seemingly averted, human infections recurred in October 2013 (refs 3, 4, 5, 6, 7). It is unclear how the H7N9 virus re-emerged and how it will develop further; potentially it may become a long-term threat to public health. Here we show that H7N9 viruses have spread from eastern to southern China and become persistent in chickens, which has led to the establishment of multiple regionally distinct lineages with different reassortant genotypes. Repeated introductions of viruses from Zhejiang to other provinces and the presence of H7N9 viruses at live poultry markets have fuelled the recurrence of human infections. This rapid expansion of the geographical distribution and genetic diversity of the H7N9 viruses poses a direct challenge to current disease control systems. Our results also suggest that H7N9 viruses have become enzootic in China and may spread beyond the region, following the pattern previously observed with H5N1 and H9N2 influenza viruses. [ABSTRACT FROM AUTHOR]

The mass movement was an unconventional political technique adopted by the Chinese Communist Party. Because it was superior to regular administrative means, it was used extensively for many years after the founding of the People’s Republic of China as a convenient and effective tool of mobilization and governance. The key features of the Chinese Communist mass movement included the mobilized political participation of the broad rural masses, state power’s direct intervention in rural society, class categorization, and class struggle. Continuous mass movements helped the Party-state effectively mobilize the rural masses and implement rural governance, but the results of the mobilization and governance were poorly institutionalized and had to be maintained by new and incessant movements. Subsequently, unsolvable tensions appeared between the dynamics of social transformation and the norms of social governance. [ABSTRACT FROM PUBLISHER]

A novel H7N9 influenza A virus first detected in March 2013 has since caused more than 130 human infections in China, resulting in 40 deaths. Preliminary analyses suggest that the virus is a reassortant of H7, N9 and H9N2 avian influenza viruses, and carries some amino acids associated with mammalian receptor binding, raising concerns of a new pandemic. However, neither the source populations of the H7N9 outbreak lineage nor the conditions for its genesis are fully known. Using a combination of active surveillance, screening of virus archives, and evolutionary analyses, here we show that H7 viruses probably transferred from domestic duck to chicken populations in China on at least two independent occasions. We show that the H7 viruses subsequently reassorted with enzootic H9N2 viruses to generate the H7N9 outbreak lineage, and a related previously unrecognized H7N7 lineage. The H7N9 outbreak lineage has spread over a large geographic region and is prevalent in chickens at live poultry markets, which are thought to be the immediate source of human infections. Whether the H7N9 outbreak lineage has, or will, become enzootic in China and neighbouring regions requires further investigation. The discovery here of a related H7N7 influenza virus in chickens that has the ability to infect mammals experimentally, suggests that H7 viruses may pose threats beyond the current outbreak. The continuing prevalence of H7 viruses in poultry could lead to the generation of highly pathogenic variants and further sporadic human infections, with a continued risk of the virus acquiring human-to-human transmissibility. [ABSTRACT FROM AUTHOR]

• Established an evaluation index of tidal flat ecological stability (ECO-CSI). • Urbanization and the traffic road were the key negative artificial factors. • The sediment discharge, the precipitation, etc. were the key guarantee factors. • The threshold value of the Liaohe River sediment discharge was 792.91×104t y−1. • The threshold value of the scale of traffic roads was 770.9244 hm2. The tidal flat, located at the forefront of the coastal estuary wetland, serves as a peripheral defense line to maintain the stable ecological function of the estuary wetland. Therefore, the accurate identification of the stable state of a tidal flat is rendered as the decision-making basis for the restoration and management of estuary wetland ecosystems. Conducted at the tidal flat of the Liaohe Estuary Wetland, the study established a comprehensive evaluation index of tidal flat ecological stability (ECO-CSI) based on the Pressure-State-Response model and Rough Set theory. The driving factors and threshold values which affected the stability of the tidal flat were identified. The results showed that the average ECO-CSI value of the tidal flat during the past 30 years was 0.44 indicating, in general, a relatively stable state of the tidal flat. On the other hand, in 2017 the ECO-CSI value was 0.25, pointing that the tidal flat is in an unstable state currently. Among the factors affecting the tidal flat ecological stability, the artificial development activities were the major driving factors, and the urbanization and the traffic road scale were the key driving factors leading to the instability of the tidal flat. Of the natural factors, the sediment discharge, the flow in flood season, and the precipitation in the upstreams were the key guarantee factors for maintaining the material supply of the tidal flat. The threshold values for maintaining the ecological stability of the tidal flat in the Liaohe Estuary wetland were determined that the sediment discharge of the Liaohe River should be not less than 792.91 × 104t⋅y-1 and the scale of traffic roads in the tidal flat should be less than or equal to 770.9244 hm2. Hence, in the development and utilization of tidal flats and coastal wetlands, unreasonable human development activities should be minimized to avoid damage to the integrity and natural dispositions of the tidal flat. In this way, the stability of the tidal flat could be improved, contributing to the ecological security for the overall stability of the estuary wetland ecosystem. [ABSTRACT FROM AUTHOR]

The extensive use of neonicotinoids (NEOs) has caused the release of wide-ranging of residues to the environment and food, and their potential health risks are now receiving more attention. In this study, three surveys were conducted to obtain the overall profiles of NEO residue levels (seven NEOs and one metabolite) in Chinese tea over a period of seven years. A total of 726 tea samples were tested, and nearly 87% of the samples were found to have detectable NEO residues. The overall average detection frequency of acetamiprid was the highest, reaching 73%. Imidacloprid residues in 4.6% of the samples exceeded the Chinese maximum residue limits, whereas clothianidin and nitenpyram had been detected in Chinese tea samples since 2014. The applications of thiacloprid and thiamethoxam gradually increased, and some tea samples with high residue levels appeared in China. These findings signal the replacement of new and old varieties of NEOs in China. Both long- and short-term cumulative exposures to NEOs were calculated based on optimistic and pessimistic models recommended in the EFSA guidelines. In the three survey periods, the average total imidacloprid-equivalent concentrations were 484.63, 1713.36, and 1148.34 μg/kg, respectively. Combined with the refined point estimates and probabilistic models used in this study, the hazard quotients of NEO residues in tea for Chinese tea consumers were found to be low and within the bounds of safety. Image 1 • The temporal variation of NEOs in tea samples collected in China was analyzed. • A signal of the replacement of new and old varieties of NEOs was observed in China. • Point estimates and probabilistic models were used to evaluate the risk of NEOs. • HQs of NEOs for Chinese tea consumers were low and within the bounds of safety. The temporal variation of NEOs in tea signals the replacement of new and old varieties of NEOs in China, and tea is an important cause of human exposures to NEOs. [ABSTRACT FROM AUTHOR]

(1) Background: To reveal the intrinsic relationship between the tidal flat sediments in an estuary wetland and the runoff from the upstream river. This research was conducted in the tidal flats of the Liaohe estuary wetland. (2) Methods: The 137Cs and 210Pb dating technique was used to reconstruct the time correspondence between tidal flat sediments and runoff, and the periodic response was explored between the changes in the tidal flat sediments and runoff based on the spectrum analysis method. (3) Results: The average sedimentation rate in the tidal flat was 2.24 cm·year−1 during the past 50 years. The amount of fine sediment particles deposited on the estuary tidal flat was directly related to the amount of sediments transported by the river and inversely proportional to the ability of rivers to transport fine matter. The high frequency reproduction cycle of 14–15 years in the flood season flow and 5–6 years in the annual sediment discharge of the Liaohe River correspond to the high and low frequency reproduction cycles of the median size of sediments in Liaohe estuarine wetland tidal flats. (4) Conclusions: The research clarified the hydrological constraints of the action law between Liaohe River runoff and the estuarine sediments. The periodic response between Liaohe River runoff and the sediment was established. [ABSTRACT FROM AUTHOR]

• The formation of pipe dent is related to the extruding deformation from a rock during pipeline laying. • The operating inner pressure has a small effect on the dent recovery of the pipeline. • The micro-cracks form at the deepest part of the dent region because of stress concentration. • The pipeline dent leak is a type of fatigue failure. Natural gas pipeline leaks may cause considerable damage to people, properties, and the surrounding environment. This study investigates a dent leak in a gas pipeline in China that has operated for six years. The failure pipe section meets American Petroleum Institute (API) specification 5L-2012 standard for carbon steel pipelines. The cause of leakage is evaluated not only through visual examination, micromorphology observation, structural deformation analysis, and residual stress measure of the dented region near the leak point of the pipe body, but also through finite element analysis on the deformation and stress of the pipe under different loads. The dent formation is related to rocks during pipeline laying. Under the combined effect of external load and internal pressure, the maximum equivalent stresses of the dented edge at the outer wall, bulge top of the inner wall, and dented edge of the inner wall are greater than the yield stress of the material. Moreover, micro-crack formation occurs due to the maximum deformation at the bottom of the dent and the maximum equivalent stress on top of the inner surface bulge. Under alternating stress, microcracks gradually expand until they penetrate the wall thickness, and thereby cause pipeline leakages. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the occurrence of fipronil and its three metabolites in tea samples collected from 2011 to 2018 in China, where the use of fipronil in agriculture had been banned since 2009. Among the 726 tea samples, the total fipronils (∑FIPs, non-detected (ND)− 140 µg/kg) were dominated by the parent compound fipronil (ND-80.6 µg/kg) and its major metabolites fipronil desulfinyl (ND-36.9 µg/kg) and fipronil sulfone (ND-24.2 µg/kg), while fipronil sulfide (ND-6.78 µg/kg) contributed little to the total. A total of 20.0 % and 30.7 % of the tea samples detected ∑FIPs residues exceeded the maximum residue limits of 0.005 and 0.002 mg/kg set by the European Union and Japan, respectively. The average concentration of ∑FIPs decreased by 22 times during the three survey periods. By the probabilistic model, the chronic exposure risk of Chinese tea consumers was less than 25 % of the acceptable daily intake of fipronil, and a ten-fold decrease was observed within eight years. The ∑FIPs residues in tea were within a low health risk for Chinese tea consumers. This was the first study to provide the basic information on the occurrence and the temporal variation of fipronil in tea samples from China. • Fipronil and its metabolites widely occurred in tea samples for a long time. • The temporal variation of fipronil and its metabolites in tea were provided. • The residue level and detection frequency of ∑FIPs decreased year by year. • The ∑FIPs residues in tea were within a low health risk for Chinese tea consumers. [ABSTRACT FROM AUTHOR]

The Northeast is one of the regions with the most extensive wetland area in China, which provides important environmental support for social development. However, agricultural reclamation and socio-economic development have changed the land use of wetland ecosystems, resulting in the continuous loss of natural wetland area and affecting the sustainable development of wetlands. In this study, an emergy accounting approach was used to evaluate the sustainable development status of the wetland ecosystem in Northeast China from 1980 to 2015. The results showed that the purchased resources (P) replaced the local renewable resources (R) and the local non-renewable resources (N) as the largest emergy flow after 2000. This change led to a negative development of the emergy indicators. The emergy yield ratio (EYR) decreased from 5.63 to 2.04, the environmental load ratio (ELR) increased from 1.90 to 3.58, and the emergy sustainability indicator (ESI) decreased from 2.96 to 0.57, indicating that the sustainable development of wetlands deteriorated during the study period. Next, the Logarithmic Mean Divisia Index decomposition analysis (LMDI) was applied to decompose the change of the ESI (ΔESI) into 5 driving factors. The results showed that the external pressure factor (A w /P) had a decisive impact on sustainable development, and the other four factors indicated that renewable resources had a positive contribution to improving sustainable development. Therefore, this study proposes to improve sustainable development from three aspects: firstly, restore or expand the wetland area; secondly, reduce the input of purchased resources; and thirdly, increase the application of renewable resources. Such findings can provide valuable suggestions for the government to better manage wetlands. • Externally purchased resources became the most important part of the total emergy used in the study area. • The three emergy indicators were negatively developed. • The sustainability index of wetland fell from 2.96 to 0.57. • The external pressure factor (A w /P) had a decisive impact on the sustainable development of the wetlands. • Renewable resources have a positive contribution to improving the sustainable development of the wetland. [ABSTRACT FROM AUTHOR]

Background/purpose: As a major causative pathogen of community-acquired pneumonia, Mycoplasma pneumoniae (M. pneumoniae) can cause both upper and lower respiratory tract inflammation as well as extrapulmonary syndromes, especially in infants and the elderly. The emergence of macrolide-resistance has significant effects on the treatment of relevant diseases in children. This study aimed to analyze the genotypes and the macrolide resistance-associated mutations in M. pneumoniae sampled from the pediatric patients in Henan, China., Methods: A segment of gene on the 23S rRNA was amplified and sequenced to detect the mutations related to macrolide resistance. Molecular typing was performed by the method named multiple locus variable-number tandem repeat analysis (MLVA) for macrolide-susceptible and macrolide-resistant specimens., Results: Among the M. pneumoniae-positive samples, 95.7% (111/116) had macrolide-resistant mutation, and all of them consisted of the A2063G mutation. There were only two MLVA types identified in this study, type 4-5-7-2 (51/92, 55.4%) and type 3-5-6-2 (41/92, 44.6%)., Conclusion: There was no correlation between MLVA types and macrolide resistance (P ​> ​0.05)., (Copyright © 2023 Indian Association of Medical Microbiologists. Published by Elsevier B.V. All rights reserved.)

Although influenza A viruses of several subtypes have occasionally infected humans, to date only those of the H1, H2, and H3 subtypes have led to pandemics and become established in humans. The detection of two human infections by avian H3N8 viruses in April and May of 2022 raised pandemic concerns. Recent studies have shown the H3N8 viruses were introduced into humans from poultry, although their genesis, prevalence, and transmissibility in mammals have not been fully elucidated. Findings generated from our systematic influenza surveillance showed that this H3N8 influenza virus was first detected in chickens in July 2021 and then disseminated and became established in chickens over wider regions of China. Phylogenetic analyses revealed that the H3 HA and N8 NA were derived from avian viruses prevalent in domestic ducks in the Guangxi-Guangdong region, while all internal genes were from enzootic poultry H9N2 viruses. The novel H3N8 viruses form independent lineages in the glycoprotein gene trees, but their internal genes are mixed with those of H9N2 viruses, indicating continuous gene exchange among these viruses. Experimental infection of ferrets with three chicken H3N8 viruses showed transmission through direct contact and inefficient transmission by airborne exposure. Examination of contemporary human sera detected only very limited antibody cross-reaction to these viruses. The continuing evolution of these viruses in poultry could pose an ongoing pandemic threat. IMPORTANCE A novel H3N8 virus with demonstrated zoonotic potential has emerged and disseminated in chickens in China. It was generated by reassortment between avian H3 and N8 virus(es) and long-term enzootic H9N2 viruses present in southern China. This H3N8 virus has maintained independent H3 and N8 gene lineages but continues to exchange internal genes with other H9N2 viruses to form novel variants. Our experimental studies showed that these H3N8 viruses were transmissible in ferrets, and serological data suggest that the human population lacks effective immunological protection against it. With its wide geographical distribution and continuing evolution in chickens, other spillovers to humans can be expected and might lead to more efficient transmission in humans., Competing Interests: The authors declare no conflict of interest.

Background: Few studies focused on the general situation of telemedicine in China., Objectives: The purpose of this review is to investigate telemedicine in China, from the aspects of necessity, history, scale, and operation procedure, to improve the further development and implementation of telemedicine service., Methods: A literature search for peer-reviewed studies was conducted using the primary electronic databases. Additional documents from the official websites of Chinese government departments involved telemedicine was also collected. We extracted telemedicine related information focused on China from the final retrieved materials, and the general situation of telemedicine was drawn., Results: In China, telemedicine offers a feasible solution to the unequal allocation of healthcare resources, which makes telemedicine increasingly become an important alternative to close the gap between rural and urban in the capability and quality of medical services. China initiated telemedicine in the late 1980s. In 2018, China's telemedicine network has covered more than 3,000 hospitals across the country. As of 2019, almost all of the 31 provinces and municipalities in mainland have established regional telemedicine centers, and the market size of telemedicine reached about USD 2.68 billion. Based on the telemedicine network, remote rural patients can apply for healthcare services of top-tier urban hospitals through local county-level medical institutions., Conclusions: Through improving the capacity, quality, and efficiency of healthcare in underserved areas, and reducing the unequal distribution of medical resources, telemedicine can help solve the problems of the difficulty and high cost to access to medical services in China., 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 Gao, Fan, Chen, Fan, Li, Wang, Ma, He, Zhai and Zhao.)

Importance: The nasal bone is one of the most commonly fractured bones of the midface. However, the frequency of coincident fractures of adjacent bones such as the frontal process of the maxillary bone, nasal septum, and medial or inferior orbital walls has not been fully evaluated. Objective: The purpose of this study was to investigate the incidence of fractures of adjacent structures in the setting of a nasal bone fracture. Second, we propose a new classification system of nasal bone fractures with involvement of adjacent bony structures. Design, Setting, and Participants: One thousand, one hundred ninety-three patients with midfacial fractures were retrospectively reviewed. The characteristics of fractures of the nasal bone and the incidence of coincident fractures of the frontal process of maxilla, bony nasal septum, medial, or inferior orbital walls were analyzed. Exposure: All patients included in the study presented with nasal trauma. Main Outcomes and Measures: The coincident fractures of adjacent midfacial structures were assessed, and a new classification of midfacial fractures based on computed tomography (CT) scan images was proposed. Results: Among the 1193 cases, bilateral fractures of the nasal bone were most common (69.24%), and coexistent fracture of the frontal process of the maxilla and bony nasal septum was 66.89% and 42.25%, respectively. Coincident fracture of the orbital walls was observed in 16.51% of cases. The major etiology of fracture for the younger and elderly groups was falls, compared with assault as the most common etiology in the adult group. A classification scheme was generated in which fractures of the nasal bone were divided into five types depending on coexisting fractures of adjacent structures. Conclusions and Relevance: External force applied to the nasal bone can also lead to coexistent fracture of adjacent bony structures including the frontal process of the maxilla, nasal septum, and orbital walls. The proposed classification of nasal fracture based on CT imaging helps to incorporate coincident disruption of adjacent structures.

Aim: To investigate the upstream therapeutic effects of fluvastatin and valsartan on hypertensive patients with non-permanent atrial fibrillation (AF)., Methods: A total of 189 patients who were admitted to outpatient and inpatient department from eight medical centers in China, diagnosed as hypertension with non-permanent AF, were divided into four groups randomly: the CCBs group (group A, n = 45); CCB + fluvastatin group (group B, n = 48); valsartan group (group C, n = 46); valsartan + fluvastatin group (group D, n = 50). The four groups were followed up for 24 months. The blood routine, biochemical examination, echocardiography, high sensitive C-reactive protein (hs-CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP), the maintenance rate of sinus rhythm, and the recurrence of paroxysmal AF or persistent AF incidence were observed in these groups before and after 24 months' treatment., Results: After 24 months of follow-up, there were 178 cases of patients who have completed the study. (a) There was no significant difference in blood routine, liver, and renal function in each group (P > 0.05). (b) The blood lipids level in groups B and D was significantly reduced after treatment (P < 0.01). There was no significant difference of hs-CRP level in group A (P > 0.05). The left ventricular remodeling was significantly alleviated in group C and group D (P < 0.05). The NT-ProBNP level was significantly decreased in group D (P < 0.05). (c) The sinus rhythm maintenance rate of group B, group C, and group D was higher than group A (77.78%, 70.45%, 79.17% vs 43.90%), the occurrence of persistent AF was significantly lower than group A (11.11%, 14.29%, 8.33% vs 31.71%; P < 0.05)., Conclusions: CCB plus fluvastatin and valsartan can reduce the recurrence rate of non-permanent AF and to delay the progression from non-permanent AF to permanent AF in patients with hypertension. The combined application of valsartan and fluvastatin is more effective than valsartan or CCB alone in the upstream therapies of AF., (© 2018 John Wiley & Sons Ltd.)

Unlabelled: The cases of human infections with H10N8 viruses identified in late 2013 and early 2014 in Jiangxi, China, have raised concerns over the origin, prevalence, and development of these viruses in this region. Our long-term influenza surveillance of poultry and migratory birds in southern China in the past 12 years showed that H10 influenza viruses have been introduced from migratory to domestic ducks over several winter seasons at sentinel duck farms at Poyang Lake, where domestic ducks share their water body with overwintering migratory birds. H10 viruses were never detected in terrestrial poultry in our survey areas until August 2013, when they were identified at live-poultry markets in Jiangxi. Since then, we have isolated 124 H10N8 or H10N6 viruses from chickens at local markets, revealing an ongoing outbreak. Phylogenetic analysis of H10 and related viruses showed that the chicken H10N8 viruses were generated through multiple reassortments between H10 and N8 viruses from domestic ducks and the enzootic chicken H9N2 viruses. These chicken reassortant viruses were highly similar to the human isolate, indicating that market chickens were the source of human infection. Recently, the H10 viruses further reassorted, apparently with H5N6 viruses, and generated an H10N6 variant. The emergence and prevalence of H10 viruses in chickens and the occurrence of human infections provide direct evidence of the threat from the current influenza ecosystem in China., Importance: After the outbreak of avian-origin H7N9 influenza viruses in China, fatal human infections with a novel H10N8 virus were reported. Utilizing data from 12 years of influenza surveillance in southern China, we showed that H10 viruses were regularly introduced by migratory ducks to domestic ducks on Poyang Lake, a major aggregative site of migratory birds in Asia. The H10 viruses were maintained and amplified in domestic ducks and then transmitted to chickens and reassorted with enzootic H9N2 viruses, leading to an outbreak and human infections at live-poultry markets. The emergence of the H10N8 virus, following a pathway similar to that of the recent H7N9 virus, highlights the role of domestic ducks and the current influenza ecosystem in China that facilitates influenza viruses moving from their reservoir hosts through the live-poultry system to cause severe consequences for public health., (Copyright © 2015, American Society for Microbiology. All Rights Reserved.)

Unlabelled: Two-way transmission of influenza viruses between humans and swine has been frequently observed, and the occurrence of the 2009 H1N1 pandemic influenza virus (pdm/09) demonstrated that swine-origin viruses could facilitate the genesis of a pandemic strain. Although multiple introductions to and reassortment in swine of the pdm/09 virus have been repeatedly reported in both Eurasia and the Americas, its long-term impact on the development of swine influenza viruses (SIVs) has not been systematically explored. Our comprehensive evolutionary studies of the complete genomes of 387 SIVs obtained from 2009 to 2012 by influenza virus surveillance in China revealed 17 reassortant genotypes with pdm/09-origin genes. Even though the entire 2009 pandemic virus and its surface genes cannot persist, its internal genes have become established and are now the predominant lineages in pigs in the region. The main persistent pdm/09-origin reassortant forms had at least five pdm/09-origin internal genes, and their surface genes were primarily of European avian-like (EA) or human H3N2-like SIV origin. These findings represent a marked change in the evolutionary patterns and ecosystem of SIVs in China. It is possible that the pdm/09-origin internal genes are in the process of replacing EA or triple-reassortant-like internal genes. These alterations in the SIV gene pool need to be continually monitored to assess changes in the potential for SIV transmission to humans., Importance: Shortly after the emergence of the 2009 pandemic H1N1 (pdm/09) influenza virus, it was transmitted from humans to pigs and this continues to occur around the world. Many reassortants between pdm/09-origin viruses and enzootic swine influenza viruses (SIVs) have been detected. However, the long-term impact of pdm/09-origin viruses on the SIV gene pool, which could lead to the generation of influenza viruses with the potential to infect humans, has not been systematically examined. From extensive surveillance of SIVs over a 38-month period in southern China, it was found that although neither complete pdm/09 viruses nor their surface genes could persist in pigs, their internal genes did persist. Over the survey period, these internal genes became predominant, potentially replacing those of the enzootic SIV lineages. The altered diversity of the SIV gene pool needs to be closely monitored for changes in the potential for SIV transmission to humans., (Copyright © 2014, American Society for Microbiology. All Rights Reserved.)

Domestic ducks in southern China act as an important reservoir for influenza viruses and have also facilitated the establishment of multiple H6 influenza virus lineages. To understand the continuing evolution of these established lineages, 297 H6 viruses isolated from domestic ducks during 2006 and 2007 were genetically and antigenically analyzed. Phylogenetic analyses showed that group II duck H6 viruses had replaced the previously predominant group I lineage and extended their geographic distribution from coastal to inland regions. Group II H6 virus showed that the genesis and development of multiple types of deletions in the neuraminidase (NA) stalk region could occur in the influenza viruses from domestic ducks. A gradual replacement of the N2 NA subtype with N6 was observed. Significant antigenic changes occurred within group II H6 viruses so that they became antigenically distinguishable from group I and gene pool viruses. Gene exchange between group II H6 viruses and the established H5N1, H9N2, or H6N1 virus lineages in poultry in the region was very limited. These findings suggest that domestic ducks can facilitate significant genetic and antigenic changes in viruses established in this host and highlight gaps in our knowledge of influenza virus ecology and even the evolutionary behavior of this virus family in its aquatic avian reservoirs.