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The timing of autism spectrum disorder detection in research and clinical practice is characterised by substantial heterogeneity ranging from infancy to school age. In this study, we examined the age of diagnosis and its associated individual and socio-familial factors in Chinese children diagnosed with autism spectrum disorder. A sample of 1235 autism spectrum disorder children from 132 rehabilitation organisations in Shenzhen was investigated in 2021. We found a mean age of diagnosis of 31.4 ± 12.7 months and a median of 30.0 months. Although 71.7% of the children received their diagnosis between 25 and 36 months of age, and 13.3% were diagnosed early (?24 months), 15.1% did not have their symptoms detected until preschool or later years (>36 months). The diagnosis was likely delayed (>36 months) if the children were older, were less severe and presented with no intellectual impairment. The odds of delayed autism spectrum disorder diagnosis were more than 9 times higher among migrant autism spectrum disorder children than those with local household registrations. The study underscores the importance of identifying culturally sensitive socio-economic determinants in autism spectrum disorder detection in addition to clinical factors, as the former are likely to affect the quality of life of many autism spectrum disorder children and their families.

Background: Coronavirus disease 2019 (COVID-19) has been a great concern since 2019. Patients with myasthenia gravis (MG) may be at higher risk of COVID-19 and a more severe disease course. We examined the associations between COVID-19 and MG. Methods: This single-center retrospective cohort study involved 134 patients who were diagnosed with MG from June 2020 to November 2022 and followed up until April 2023. They were divided into a COVID-19 group and non-COVID-19 group. Logistic regression analysis was used to detect factors potentially associating COVID-19 with MG. Results: Of the 134 patients with MG, 108 (80.6%) had COVID-19. A higher number of comorbidities was significantly associated with an increased risk of COVID-19 (p = 0.040). A total of 103 patients (95.4%) had mild/moderate COVID-19 symptoms, and 4 patients (3.7%) were severe/critical symptoms (including 2 deaths). Higher age (p = 0.036), use of rituximab (p = 0.037), tumors other than thymoma (p = 0.031), Hashimoto's thyroiditis (p = 0.011), more comorbidities (p = 0.002), and a higher baseline MG activities of daily living (MG-ADL) score (p = 0.006) were risk factors for severe COVID-19 symptoms. The MG-ADL score increased by ≥ 2 points in 16 (15.7%) patients. Dry cough and/or expectoration (p = 0.011), use of oral corticosteroids (p = 0.033), and use of more than one kind of immunosuppressant (p = 0.017) were associated with the increase of the post-COVID-19 MG-ADL score. Conclusion: Most patients with MG have a mild course of COVID-19. However, patients with older age, many comorbidities, a high MG-ADL score, and use of a variety of immunosuppressants during COVID-19 may be more prone to severe symptoms. [ABSTRACT FROM AUTHOR]

The timing of autism spectrum disorder detection in research and clinical practice is characterised by substantial heterogeneity ranging from infancy to school age. In this study, we examined the age of diagnosis and its associated individual and socio-familial factors in Chinese children diagnosed with autism spectrum disorder. A sample of 1235 autism spectrum disorder children from 132 rehabilitation organisations in Shenzhen was investigated in 2021. We found a mean age of diagnosis of 31.4 ± 12.7 months and a median of 30.0 months. Although 71.7% of the children received their diagnosis between 25 and 36 months of age, and 13.3% were diagnosed early (⩽24 months), 15.1% did not have their symptoms detected until preschool or later years (>36 months). The diagnosis was likely delayed (>36 months) if the children were older, were less severe and presented with no intellectual impairment. The odds of delayed autism spectrum disorder diagnosis were more than 9 times higher among migrant autism spectrum disorder children than those with local household registrations. The study underscores the importance of identifying culturally sensitive socio-economic determinants in autism spectrum disorder detection in addition to clinical factors, as the former are likely to affect the quality of life of many autism spectrum disorder children and their families. Timely detection is an issue of paramount importance in the care of children with autism spectrum disorder. Whether the delayed autism spectrum disorder diagnosis can be explained by children's clinical presentations and socio-familial status in China is a question to be addressed. We investigated 1235 autism spectrum disorder children from 132 rehabilitation organisations in Shenzhen, China. These children were found to have a mean age of diagnosis of 31.4 ± 12.7 months and a median age of diagnosis of 30.0 months. The majority of these children were able to receive their diagnosis during toddlerhood. However, about one in six were not diagnosed until they entered preschool or later, thus missing the golden window of opportunity for early intervention. The age of diagnosis was likely to be late if the children were older, were less severe and presented with no intellectual impairment. The odds of having a delayed autism spectrum disorder diagnosis were more than 9 times higher among migrant autism spectrum disorder children than among those with local household registrations, thus underscoring the importance of identifying culturally sensitive socio-economic determinants in autism spectrum disorder detection, as these factors are likely to affect the quality of life of many autism spectrum disorder children and their families. [ABSTRACT FROM AUTHOR]

Identifying the geographical origins of white tea is of significance because the quality and price of white tea from different production areas vary largely from different growing environment and climatic conditions. In this study, we used near-infrared spectroscopy (NIRS) with white tea (n = 579) to produce models to discriminate these origins under different conditions. Continuous wavelet transform (CWT), min-max normalization (Minmax), multiplicative scattering correction (MSC) and standard normal variables (SNV) were used to preprocess the original spectra (OS). The approaches of principal component analysis (PCA), linear discriminant analysis (LDA) and successive projection algorithm (SPA) were used for features extraction. Subsequently, identification models of white tea from different provinces of China (DPC), different districts of Fujian Province (DDFP) and authenticity of Fuding white tea (AFWT) were established by K-nearest neighbors (KNN), random forest (RF) and support vector machine (SVM) algorithms. Among the established models, DPC-CWT-LDA-KNN, DDFP-OS-LDA-KNN and AFWT-OS-LDA-KNN have the best performances, with recognition accuracies of 88.97%, 93.88% and 97.96%, respectively; the area under curve (AUC) values were 0.85, 0.93 and 0.98, respectively. The research revealed that NIRS with machine learning algorithms can be an effective tool for the geographical origin traceability of white tea. [ABSTRACT FROM AUTHOR]

When using maps to study China's historical concept of itself, we find that the research can be divided into two schools: the "Map of the Traces of Yu" (Yu ji tu 禹跡圖) system and the "Unification Map" (yitong tu 一統圖) system. There are also two major classifications for the type of map used: the "China Proper" type and the type that includes the outlying areas. These competing concepts of what constitutes China reflect the different modes of life that have existed alongside each other throughout China's long history, namely the agrarian and the nomadic lifestyles. The relationship between these two economic modes has alternated between peaceful and hostile and this tumultuous relationship has influenced who are considered "real" Chinese and who are the outsiders. This paper explores the evolution of what is considered China's territory and what is not. [ABSTRACT FROM AUTHOR]

The 18th National Congress of the Communist Party of China put forward the optimization of territorial space development patterns as the primary measure of ecological civilization construction, and put forward the goal of "promoting intensive and efficient production space, livable and moderate living space, and beautiful (picturesque scenery) ecological space". Through literature research and summing induction, this paper combs the research progress of the overall optimization of "Production–Living–Ecological" space (PLES) systematically. It is found that the existing work mainly focuses on the overall optimization of PLES from the perspectives of land-use quality, land-use suitability evaluation, resource and environmental carrying capacity, and comparative advantages. However, due to the lack of understanding of the scientific connotation of PLES, and the imperfect construction of quantitative identification methods and classification system, there are many problems in the technical approaches of the overall optimization of PLES, which remain to be clarified. In the future, the technological approach to the overall optimization of PLES should be guided by the vision of building a beautiful China, with the theory of a human–Earth coupling system as the core, and systematically build a theoretical system and technical framework to identify and optimize territorial space. [ABSTRACT FROM AUTHOR]

Since agricultural cooperatives have developed rapidly under the farmland transfer policy in China, they play an important role in the new operation pattern for China's fresh agricultural product supply chains. To enhance current agricultural supply chains' stability, we consider a three-level (farmer-cooperative-retailer) fresh agricultural product supply chain, conduct quantitative analysis of the impact of the quantity flexibility contract, and compare the impact of the relational contract with that of the quantity flexibility contract on the freshness and the profit. Our results show that a suitable relational contract can improve the freshness and increase the profit of the three-level supply chain, but cannot fully guarantee its stability. Furthermore, the government's subsidy policy can improve the relational contract stability of the fresh agricultural product supply chain by providing the protection price contract mechanism of the agricultural product and the cold chain facility subsidy contract. [ABSTRACT FROM AUTHOR]

Power distribution networks are in a transformation active distribution networks with distributed energy resources. However, the widely adopted distribution test networks were established many years ago, which are untimely and cannot reflect the characteristics of high penetration renewable energy. Therefore, in this study, a distribution network with high penetration renewable energy is established based on the real data of a renewable-energy-rich radial rural distribution network in China. The proposed radial distribution network includes three types of loads and two types of renewable energy distributed generations. The evaluation indexes are designed to assess the proposed system and compare with the existing distribution networks. In addition, the topical high/low voltage problem of distribution network caused by high penetration of renewables is discussed. Furthermore, based on the measured time series characteristics of load and renewable resources, the effectiveness of the proposed system is validated by power flow analysis and dynamic characteristic criterion. [ABSTRACT FROM AUTHOR]

A large amount of wastewater is discharged in the course of preventing and controlling water inrush in China's coal mines. We investigated the role of mine water in coal production and associated ground subsidence problems at the prefecture-level, and analyzed their spatial characterization and regional differences using coal mine production data. The results indicate that ≈ 5310 million m3 of such mine water were produced in China in 2018. Five clusters of coal mine water production were identified; spatial analysis suggests that the cities in these areas should pay more attention to mine water reuse and comprehensive control of ground subsidence to alleviate water resource pressures and aid the environment. [ABSTRACT FROM AUTHOR]

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Beijing’s new strategies toward Taiwan are informed by neo-functionalism derived from European experiences, assuming that economic integration will eventually lead to political accommodation and integration. Despite the surprising Sunflower Movement and the fiasco of the Chinese Nationalist Party (KMT) in the 2014 local elections, Beijing will try its best to maintain the momentum of peaceful development of cross-Strait relations. Facing a brand new Taiwan that seems an oddity to the mainland, however, Beijing has adapted to ‘the new normal’ with a slower pace, refocusing on the economic and cultural issues. Whether or to what degree Beijing will change its asymmetric engagements with the two main parties on the island, however, is contingent upon whether the KMT and the Democratic Progressive Party (DPP) can reach a balance of power domestically and whether their policies toward the mainland converge rather than diverge. At any rate, Beijing is likely to pay more attention to ordinary people’s feelings about cross-Strait economic and cultural exchanges and consider quality of cross-Strait exchange as more important than quantity of activities. [ABSTRACT FROM PUBLISHER]

Bioethanol will play a significant role in energy structure adjustment and greenhouse gas mitigation in the future, especially in the transport sector. As bioethanol production with grain crops may become obsolete due to food security concerns, the Chinese government has advocated the development of non-grain bioethanol. According to the current actual situation of bioethanol development and China's Liquid Biofuel Development Roadmap, we defined three stages of bioethanol development. We focused on the assessment of bioethanol feedstock resources and bioethanol yield potential in different stages using a comprehensive evaluation system integrating statistical methods, crop growth process models, and geographic information system (GIS) techniques. The considered feedstocks included corn, sweet sorghum, cassava, switchgrass, crop straw, and forest residues. The spatial–temporal characteristics of the regional bioethanol distribution were discussed. The results indicate that the total resources of corn, sweet sorghum, cassava, switchgrass, crop straws, and forest residues were about 257.17, 2083.55, 44.36, 357.56, 1031.62, and 924 million tons at different time points, respectively. In the first stage, the year 2020, the potential bioethanol totaled 21.55 million tons. An advantage in bioethanol development was demonstrated by Northeast China. A positive development situation was also identified in East China, such as in Tianjin. In the second stage, from 2020 to 2030, the potential bioethanol production is estimated to be 145.42 million tons. The bioethanol development potential will increase in South China, in areas such as Yunnan, Guangxi, and Guizhou. In the third stage, the potential bioethanol based on switchgrass is estimated to be 92.99 million tons. The potential bioethanol based on crop straws and forest residues will be 14.76 million tons if 5% of these feedstocks are fully used for producing bioethanol. Regions with a large development potential will be further expanded. Interregional bioethanol flows and international cooperation will help meet the whole nation's requirement. [ABSTRACT FROM AUTHOR]

With the diplomatic warming of US-China relations, the recent resumption of the Koo-Wang meeting and Taiwan's elections for legislators, mayors, and city councilors, cross-Taiwan Strait relations are at another historical turning point. While the improvement of US-China relations tends to relieve both sides from rhetoric exchanges of 'China threat' and 'US-Taiwan conspiracy', Clinton's oral declaration of the 'Three No's' has raised serious concerns in Taiwan. With such a background, a group of experts and policy-making participants from the US, Taiwan and Mainland China gathered again at a conference on 'US-China Relations and the Taiwan Factor' in Washington, DC in mid-October 1998. This was the second episode in a series of symposia on US-China relations sponsored by the Association of Chinese Political Studies (ACPS). The symposium attempts to provide a free, intimate, and long-term forum for a group of influential experts with different perspectives from the US, Taiwan and Mainland China. As a result, a deep understanding of common interests has been reached and clear differences have also been recognized through direct dialogue and frank exchange of ideas. [ABSTRACT FROM AUTHOR]

The objective of this paper is to investigate CO2 emissions in the production of coal sources at the prefecture level and to analyze their spatial distribution and regional differences based on the spatial autocorrelation and standard deviational ellipse analysis. The results indicate that Chinese coal production from 2018 will most likely generate 485.23 million tons of CO2 emissions, and there still exists an obvious gap between the five coal development districts in terms of their CO2 emissions. A significant clustering pattern and positive spatial autocorrelation are revealed in the coal production-based carbon emissions in China. In addition, the spatial pattern of coal production-based CO2 emissions has an obvious central tendency and directional trend, and the ellipse direction is quite consistent with the Aihui–Tengchong Line. Our findings suggest that energy policy-makers should be concerned about the carbon emission effect when implementing regional coal development plans and actively guide the formation of a low-carbon spatial strategic pattern of coal production with a directional distribution of CO2 emissions perpendicular to the Aihui–Tengchong Line. [ABSTRACT FROM AUTHOR]

Although discrimination has gained increasing attention in research and practice intervention for family caregivers of children with disabilities, little is known about the social determinants that associate with the perceived discrimination among caregivers, especially in non-Western contexts. This study aims to examine the socio-familial and child-level determinants of perceived discrimination among family caregivers of children with disabilities in China. This study drew from a population-based cross-sectional survey in Shenzhen, China. Proportional quota sampling was conducted to get data from 2500 family caregivers of children with disabilities in rehabilitation service centers (response rate = 94.9%, n = 2373), accounting for 25% of the total population of children with disabilities receiving service in Shenzhen. Latent profile analysis was conducted to categorize three perceived discrimination groups among caregivers (i.e., severe perceived discrimination group, moderate perceived discrimination group, and low perceived discrimination group). The multinomial logistic regression models were conducted to test the association between these social determinants and perceived discrimination. Most caregivers (82.9%) reported moderate or severe levels of perceived discrimination. Caregivers of children with moderate and severe impairments and children with mental and multiple disabilities were more vulnerable to perceiving severe social discrimination. Socio-familial characteristics, particularly the intersectionality between gender and employment, influence caregivers' perceived discrimination. Caregivers of children with disabilities experience pervasive social discrimination in contemporary urban China. Our study demonstrates that the social construction of disablism and the affiliate discrimination against family caregivers of children with disabilities is complex and multidimensional and depends upon the children's disability and the caregivers' socio-demographic characteristics. • 80% disabled children's parents report moderate/severe perceived discrimination. • Mental and more severe disability are related to greater perceived discrimination. • Being female and unemployed are associated with greater perceived discrimination. [ABSTRACT FROM AUTHOR]

Cities consume most of the global energy and account for approximately 75% of global CO 2 emissions. Moreover, resource-based cities tend to consume higher amounts of fossil fuel and produce higher carbon emissions than other cities, whereas there are still insufficiencies about energy carbon reduction in resource-based cities in developed urban agglomerations. Therefore, it is necessary to explore the energy planning of such cities to achieve carbon peaking and carbon neutrality, and this is crucial for achieving carbon neutrality in urban agglomerations. This study aims to apply a scenario-based analysis approach to a resource-based heavy industrial city in China, Tangshan, based on the Long-range Energy Alternative Planning model, to explore Tangshan's future energy consumption, generation, and associated carbon emissions from 2010 to 2050. The impacts of different energy policies are analyzed for the Tangshan energy system by considering four scenarios. Under each scenario, energy consumption increased steadily by 2050, but the growth rate is different. The business as usual scenario is the fastest, and the low-carbon scenario is the slowest. In the comprehensive and integrated low-carbon transition scenarios, CO 2 is expected to peak at 298.34 million tons (Mt) in 2028. The main industrial sectors of Tangshan with high output value, high energy consumption, and high carbon emissions include smelting and pressing of ferrous metals, petroleum processing and coking, raw chemical materials and chemical products, etc. Combining Tangshan's coal resource endowment, the development of renewable energy, and introducing advanced technology can effectively reduce carbon emissions and increase the diversity of energy supply. We analyzed the cost-benefit of the energy system and found that the implementation of carbon capture and storage technology could effectively reduce carbon emissions by 219.62 Mt and increased costs by 563.12 billion yuan. The research could provide a scientific basis for the medium and long-term energy sustainable transformation of resource-based cities, especially for resource-based cities in urban agglomerations. [ABSTRACT FROM AUTHOR]

Anthropogenic and natural shrub encroachment have similar ecological consequences on native grassland ecosystems. In fact, there is an accelerating trend toward anthropogenic shrub encroachment, as opposed to the century-long process of natural shrub encroachment. However, the soil quality during the transition of anthropogenic shrub encroachment into grasslands remains insufficiently understood. Here, we used a soil quality assessment method that utilized three datasets and two scoring methods to evaluate changes in soil quality during the anthropogenic transition from temperate desert grassland to shrubland. Our findings demonstrated that the soil quality index decreased with increasing shrub cover, from 0.49 in the desert grassland to 0.31 in the shrubland. Our final results revealed a gradual and significant decline of 36.73 % in soil quality during the transition from desert grassland to shrubland. Reduced soil moisture levels, nutrient availability, and microbial activity characterized this decline. Nearly four decades of anthropogenic shrub encroachment have exacerbated soil drought conditions while leading to a decrease in perennial herbaceous plants and an increase in bare ground cover; these factors can explain the observed decline in soil quality. These findings emphasize the importance of considering soil moisture availability and potential thresholds when implementing revegetation strategies in arid and semiarid regions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Lay Abstract: Timely detection is an issue of paramount importance in the care of children with autism spectrum disorder. Whether the delayed autism spectrum disorder diagnosis can be explained by children's clinical presentations and socio-familial status in China is a question to be addressed. We investigated 1235 autism spectrum disorder children from 132 rehabilitation organisations in Shenzhen, China. These children were found to have a mean age of diagnosis of 31.4 ± 12.7 months and a median age of diagnosis of 30.0 months. The majority of these children were able to receive their diagnosis during toddlerhood. However, about one in six were not diagnosed until they entered preschool or later, thus missing the golden window of opportunity for early intervention. The age of diagnosis was likely to be late if the children were older, were less severe and presented with no intellectual impairment. The odds of having a delayed autism spectrum disorder diagnosis were more than 9 times higher among migrant autism spectrum disorder children than among those with local household registrations, thus underscoring the importance of identifying culturally sensitive socio-economic determinants in autism spectrum disorder detection, as these factors are likely to affect the quality of life of many autism spectrum disorder children and their families., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

To determine the prevalence of bladder and bowel dysfunction (BBD) and its relationship with delayed elimination communication (EC) in children. A cross-sectional study was carried out in kindergartens and primary schools in mainland China. A total of 10,166 children ranging from 4 to 10 years old were included. A total of 10,166 valid questionnaires were collected, and 409 children were diagnosed with BBD. The overall prevalence was 4.02% (409/10,166) and decreased with age, from 6.19% at age 4 to 1.96% at age 10. With the prolonged use of disposable diapers (DDs), the commencement of usage of EC in a child was significantly put off or delayed by parents, and the prevalence of BBD amongst these children increased (P < 0.001). The prevalence of BBD among children who stopped using DDs within the first 12 months and after more than 24 months was 2.79% and 4.38% respectively. Additionally, the prevalence among children who started EC within 12 months after birth and those who never engaged in EC was 1.36% and 15.71% respectively. Early introduction of EC and weaning of DD usage has a positive correlation with lower prevalence of BBD in children in China.

Organic trace minerals (OTMs) have the potential to replace inorganic trace minerals (ITMs), but the degree to which the dietary levels can be reduced is not well defined. This study aimed to investigate the effect of replacing of ITMs with lower levels of OTMs on growth performance, blood parameters, antioxidant status, and immune indexes in weaned piglets. The experiment was conducted in a subtropical city in Guangdong Province in South China (subtropical climate) from July to September 2018. A total of 600 pigs with an average initial BW of 8.90 kg were allotted by gender and weight to 5 treatments with 6 replicate pens per treatment. Experimental treatments: (A) Control group (a basal diet with iron, copper, manganese, and zinc from sulfates and sodium selenite providing commercially utilized levels in China of 150, 25, 40, 150, and 0.5 mg/kg, respectively). (B) 1/2 ITM group (inorganic trace minerals providing 1/2 control group levels). (C) 1/2 OTM group (1/2 control group trace mineral levels with manganese, iron, zinc, and selenium from Sel-Plex® and Cu from Bioplex®). (D) 1/3 ITM group (1/3 control group trace mineral levels from inorganic forms). (E) 1/3 OTM group (1/3 control group trace mineral levels from organic forms). The results suggest no significant effects of trace mineral sources or levels, on average daily gain (ADG) and average daily feed intake (ADFI) among different treatments during the entire experiment. The level of zinc in serum was significantly decreased in the 1/3 ITM group. The 1/3 OTM group had a significantly higher (P < 0.05) immunoglobulin G (IgG) level in serum. Fecal mineral excretion decreased significantly (P < 0.05) when decreased dietary levels of trace minerals were included at 1/2 and 1/3 levels regardless of sources. Fecal concentrations of zinc excretion were lower (P < 0.05) with 1/2 OTM supplementation than 1/2 ITMs. The present study shows that replacing high doses of ITMs with low concentrations (1/3) of OTMs does not adversely affect the growth performance of piglets. At low levels, total replacement of ITMs with OTMs improved IgG and reduced fecal excretion of copper, zinc, iron, and manganese, thereby mitigating environmental pollution.

This study aims to describe the spatial and temporal characteristics of human infections with H7N9 virus in China using data from 19 February 2013 to 30 September 2017 extracted from Centre for Health Protection of the Department of Health (CHP) and electronic databases managed by China's Center for Disease Control (CDC) and provincial CDCs synthetically using the Geographic Information System (GIS) software ArcMap™ 10.2 and SaTScan. Based on the multiple analyses of the A(H7N9) epidemics, there was a strong seasonal pattern in A(H7N9) virus infection, with high activity in the first quarter of the year, especially in January, February, and April, and a gradual dying out in the third quarter. Spatial distribution analysis indicated that Eastern China contained the most severely affected areas, such as Zhejiang Province, and the distribution shifted from coastline areas to more inland areas over time. In addition, the cases exhibited local spatial aggregation, with high-risk areas most found in the southeast coastal regions of China. Shanghai, Jiangsu, Zhejiang, and Guangdong were the high-risk epidemic areas, which should arouse the attention of local governments. A strong cluster from 9 April 2017 to 24 June 2017 was also identified in Northern China, and there were many secondary clusters in Eastern and Southern China, especially in Zhejiang, Fujian, Jiangsu, and Guangdong Provinces. Our results suggested that the spatial-temporal clustering of H7N9 in China is fundamentally different, and is expected to contribute to accumulating knowledge on the changing temporal patterns and spatial dissemination during the fifth epidemic and provide data to enable adequate preparation against the next epidemic.

Visceral leishmaniasis (VL) remains a serious public health problem in China. To explore the temporal, spatial, and spatiotemporal characteristics of visceral leishmaniasis (VL), the spatial and spatiotemporal clustering distribution and their relationships with the surrounding geographic environmental factors were analyzed. In this study, the average nearest-neighbor distance (ANN), Ripley's K-function and Moran's I statistics were used to evaluate spatial autocorrelation in the VL distribution of the existing case patterns. Getis⁻Ord Gi* was used to identify the hot-spot and cold-spot areas based on Geographic Information System (GIS), and spatiotemporal retrospective permutation scan statistics was used to detect the spatiotemporal clusters. The results indicated that VL continues to be a serious public health problem in Kashi Prefecture, China, particularly in the north-central region of Jiashi County, which is a relatively high-risk area in which hot spots are distributed. Autumn and winter months were the outbreak season for VL cases. The detection of spatial and spatiotemporal patterns can provide epidemiologists and local governments with significant information for prevention measures and control strategies.

Water use efficiency (WUE) and nitrogen fertilizer use efficiency (NUE) of winter wheat are urgently needed to further improve in the North China Plain (NCP). In this study, a 3-year field experiment was conducted during the 2014-2017 growing seasons to clarify the effect of traditional flood irrigation (TI), surface drip irrigation (DI), and micro-sprinkling irrigation (MSI) on grain yield, WUE, and NUE of winter wheat. Across the 3 years, grain yield of DI and MSI improved by 9.79% and 14.1%, WUE of DI and MSI increased by 12.3% and 17.7%, and NUE of DI and MSI increased by 9.77% and 14.0%, respectively compared with those of TI. Wheat subjected to the micro-irrigation treatments (DI and MSI) had higher chlorophyll content in flag leaves 10 days post-anthesis; this postponed senescence of the flag leaves, which increased dry matter accumulation post-anthesis, and increased 1000-grain weight and grain yield. The micro-irrigation treatments reduced pre-anthesis water consumption but increased post-anthesis water consumption and ensured the water supply in the top soil layer at the critical stage, thus increasing WUE. Root length density (RLD) of TI in the 0-80-cm soil layer was significantly higher than that of micro-irrigation, whereas micro-irrigation had higher RLD than TI below the 80-cm soil layer, which promoted the absorption and utilization of water and nitrogen in deep soil. The micro-irrigation treatments increased total nitrogen accumulation of the plants, reduced soil nitrate nitrogen (NO 3 - -N) content at maturity, ensured the nitrogen supply in the top soil layer, thus increasing NUE. Overall, micro-irrigation with water and fertilizer as an integrated pattern significantly improved grain yield, WUE, and NUE of winter wheat in the NCP by co-locating the root, water, and N-fertilizer distribution and reducing NO 3 - -N accumulation in deep soil. The best treatment was micro-sprinkling irrigation., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: To explore the association between Particulate Matter (PM)2.5 (particles with an aerodynamic diameter less than 2.5 µm) and lung cancer mortality rates and to estimate the potential risk of lung cancer mortality related to exposure to high PM2.5 concentrations., Design: Geographically weighted regression was performed to evaluate the relation between PM2.5 concentrations and lung cancer mortality for males, females and for both sexes combined, in 2008, based on newly available long-term data. Lung cancer fatalities from long-term exposure to PM2.5 were calculated according to studies by Pope III et al and the WHO air quality guidelines (AQGs)., Setting: 31 provinces in China., Results: PM2.5 was associated with the lung cancer mortality of males, females and both sexes combined, in China, although there were exceptions in several regions, for males and females. The number of lung cancer fatalities calculated by the WHO AQGs ranged from 531,036 to 532,004, whereas the number calculated by the American Cancer Society (ACS) reached 614,860 after long-term (approximately 3-4 years) exposure to PM2.5 concentrations since 2008., Conclusions: There is a positive correlation between PM2.5 and lung cancer mortality rate, and the relationship between them varies across the entire country of China. The number of lung cancer fatalities estimated by ACS was closer to the actual data than those of the WHO AQGs. Therefore, the ACS estimate of increased risk of lung cancer mortality from long-term exposure to PM2.5 might be more applicable for evaluating lung cancer fatalities in China than the WHO estimate., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objective: To investigate the efficacy of surgery in the treatment of metastatic renal cell carcinoma (mRCC) and to identify prognostic factors., Methods: A single center retrospective study of 96 patients with mRCC from December 2004 to August 2013., Results: The median follow-up time was 45 months. Thirty-one (32.3%) of the patients received complete resection of metastatic sites, 11 (11.5%) of the patients underwent incomplete resection of metastatic sites, and 54 (56.3%) of the patients received no surgery. In the univariate Kaplan-Meier analysis, the median overall survival times of the three groups were 52 months, 16 months, and 22 months, respectively (p < 0.001). The difference in the overall survival time was statistically significant between complete resection and no surgery groups (HR = 0.43, p = 0.009), while there was no significant difference between the incomplete metastasectomy and no surgery groups (HR = 1.80, p = 0.102). According to the multivariate Cox regression analysis, complete metastasectomy (HR = 0.49, p = 0.033), T stage > 3 (HR = 1.88, p = 0.015), disease free interval <12 months (HR = 2.34, p = 0.003), and multiorgan involvement (HR = 2.00, p = 0.011) were significant prognostic factors., Conclusion: In the era of targeted therapy, complete metastasectomy can improve overall survival. Complete metastasectomy, T stage > 3, disease free interval <12 months, and multiorgan involvement are independent prognostic factors.

Epidemiological studies around the world have reported that fine particulate matter (PM2.5) is closely associated with human health. The distribution of PM2.5 concentrations is influenced by multiple geographic and socioeconomic factors. Using a remote-sensing-derived PM2.5 dataset, this paper explores the relationship between PM2.5 concentrations and meteorological parameters and their spatial variance in China for the period 2001-2010. The spatial variations of the relationships between the annual average PM2.5, the annual average precipitation (AAP), and the annual average temperature (AAT) were evaluated using the Geographically Weighted Regression (GWR) model. The results indicated that PM2.5 had a strong and stable correlation with meteorological parameters. In particular, PM2.5 had a negative correlation with precipitation and a positive correlation with temperature. In addition, the relationship between the variables changed over space, and the strong negative correlation between PM2.5 and the AAP mainly appeared in the warm temperate semihumid region and northern subtropical humid region in 2001 and 2010, with some localized differences. The strong positive correlation between the PM2.5 and the AAT mainly occurred in the mid-temperate semiarid region, the humid, semihumid, and semiarid warm temperate regions, and the northern subtropical humid region in 2001 and 2010.

Currently, pediatric emergency medicine (PEM) as practiced in many developed countries is different from ours in China. Chinese pediatric emergency medicine is just children's internal medicine and does not include general surgery, ear-nose-throat, etc. If children have an emergency condition that require specialized treatments they need to go to different departments. However in Canada, the pediatric emergency physicians will first treat the patients whatever the condition, then, if it is a complicated sub specialty problem, they will consult the specialist or let the patient see the specialist later. In addition, resuscitation is done in the pediatric intensive care unit (PICU) in China, but it is done in the emergency room in Canada. This article compares the differences in the pediatric emergency systems in Canada and China and also introduces the international standard system of pediatric triage.

Vascular endothelial cells produce nitric oxide (NO), which contributes to the regulation of blood pressure and regional blood flow. Polymorphisms of the endothelial nitric oxide synthase (eNOS) gene are associated with coronary artery disease; however, associations between polymorphism (G894T) of the eNOS gene and essential hypertension remain unclear. This study was designed to investigate the association between a eNOS-G894T polymorphism and essential hypertension (EH). A total of 190 Chinese EH patients (EH group) and 94 healthy participants (control group) were included in the study. eNOS-G894T was determined using multi-polymerase chain reaction and polymorphisms in eNOS-G894T were genotyped using gene chip technology. Patients carrying eNOS GT + TT genotypes had a higher risk of EH than those carrying the GG genotype (OR = 2.82, 95% CI: 1.05-7.60, P = 0.033). The EH group showed a significantly higher frequency of the T-allele compared with controls (OR = 3.48, 95% CI: 1.34-9.07; P = 0.007). eNOS-894T was found to be significantly associated with EH in the dominant genetic model. Thus, the study demonstrated a significant and independent association between a eNOS-G894T polymorphism and EH in the Chinese patients. The study also showed that eNOS-G894T polymorphism is a risk factor for EH in Chinese patients.