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ROC curves explicated that both sGA ( I p i = 0.002; AUC: 0.744; 95% CI: 0.634-0.853) and EPI ( I p i = 0.009; AUC:0.703; 95% CI: 0.590-0.815) could predict the early mortality of elderly patients with DLBCL (shown in Figure 1K). To predict the prognosis of elderly DLBCL patients, the Fondazione Italiana Linforni (FIL) developed the simplified geriatric assessment (sGA; shown in Figure 1A) and Elderly Prognostic Index (EPI; shown in Figure 1B). Both sGA and EPI are associated with overall survival (OS) and progression-free survival (PFS) of older patients with DLBCL, while EPI could predict early mortality in these cohorts. [Extracted from the article]

Objective: To evaluate the diagnostic accuracy of the International Ovarian Tumor Analysis (IOTA) Assessment of Different NEoplasias in the adneXa (ADNEX) model in the preoperative diagnosis of adnexal masses using data from a gynecological oncology center in China.Methods: This was a single-center, retrospective diagnostic accuracy study based on ultrasound data collected prospectively, between May and December 2017, from 278 patients with at least one adnexal (ovarian, paraovarian or tubal) mass. Clinical and pathologic information, serum CA 125 level and ultrasonographic findings were collected. All patients underwent surgery and the histopathological diagnosis was used as reference standard. The final diagnosis was classified into five tumor types according to the ADNEX model: benign ovarian tumor, borderline ovarian tumor (BOT), Stage-I ovarian cancer (OC), Stages-II-IV OC and ovarian metastasis. Receiver-operating characteristics (ROC) curve analysis was used to evaluate the diagnostic accuracy of the ADNEX model, with and without inclusion of CA 125 level in the model.Results: Of the 278 women included, 203 (73.0%) had a benign ovarian tumor and 75 (27.0%) had a malignant ovarian tumor, including 18 (6.5%) with BOT, 17 (6.1%) with Stage-I OC, 32 (11.5%) with Stages-II-IV OC and eight (2.9%) with ovarian metastasis. The performance of the IOTA ADNEX model was good for discriminating between benign and malignant tumors, with an area under the ROC curve (AUC) of 0.94 (95% CI, 0.91-0.97) when CA 125 was included in the model and AUC of 0.93 (95% CI, 0.90-0.96) without CA 125. The AUC values of the model including CA 125 ranged between 0.61 and 0.99 for distinguishing between the different types of tumor, and it showed excellent performance in discriminating between a benign ovarian tumor and Stages-II-IV OC, with an AUC of 0.99 (95% CI, 0.97-1.00). The performance of the model was less effective at distinguishing between BOT and Stage-I OC and between Stages-II-IV OC and ovarian metastasis, with AUC values of 0.61 (95% CI, 0.43-0.77) and 0.78 (95% CI, 0.62-0.90), respectively. Although inclusion of CA 125 did not alter the performance of the ADNEX model in discriminating between benign and malignant lesions (AUC of 0.94 and 0.93 with and without CA 125 level, respectively; P = 0.54), the inclusion of CA 125 in the model improved its performance in discriminating between Stage-I OC and Stages-II-IV OC (AUC increased from 0.81 to 0.92; P = 0.04) and between Stages-II-IV OC and metastatic cancer (AUC increased from 0.58 to 0.78; P = 0.01).Conclusions: The IOTA ADNEX model showed good to excellent performance in distinguishing between benign and malignant adnexal masses and between the different types of ovarian tumor in a Chinese setting. Based on our findings, the ADNEX model has high value in clinical practice and can aid in the preoperative diagnosis of patients with an adnexal mass. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

At present, the air environment in China is characterized by complex pollution. In this paper, the pollutant sources, transport paths and aerosol optical properties during the dust pollution was conducted to analyse based on ground-based lidar, space-borne sensor and atmospheric transmission model. Firstly, the NMMB/BSC-Dust model, the VIIRS-Suomi NPP date and HYSPLIT were carried out to analyse the dust transport paths and the dust particle size, and then the concentration of particles was analysed. Finally, the optical properties of aerosol particles in the dust weather were studied. During the formation of this weather, there is high dust in the Gobi and Taklamakan deserts. With the influence of wind direction, the dust moves from north to south, and the dust load significantly increased in southern China. Dust at the low altitude is generally transported from the Taklamakan Desert, while dust at the high altitude is generally transported from the Gobi Desert. The hourly average change of PM10 is from 36 μg/m3 to 818 μg/m3, while the hourly average change of PM2.5 is from 15 μg/m3 to 197 μg/m3. The dust was the main cause of the pollution weather. In this study, the formation process of the dust pollution revealed which can be used to provide guidance for government for the prevention work of dust pollution. [ABSTRACT FROM AUTHOR]

The primary endpoint was 3-year Progression Free Survival (PFS) between two group, the secondary endpoint were Objective Response Rate (ORR), 3-year Overall Survival (OS), or treatment-related adverse events between two groups. The Italian Lymphoma Foundation has showed that comprehensive geriatric assessment (CGA) in elderly DLBCL patients can help to objectively and accurately identify patients who were fit for the full-dose of R-CHOP regimens. 78 patients in the experimental group who will received CGA-driven therapy, 77 patients in the controlled group will received therapy based on clinical judgement. [Extracted from the article]

Dendrobium officinale is a rare and endangered herb with special habitats and endemic to China. Genetic diversity was examined within and among nine natural populations using inter-simple sequence repeat (ISSR) and random amplified polymorphic (RAPD) for conservation. Both molecular markers revealed a high percentage (>89%) of polymorphic bands and ISSR markers detected more diversity than RAPD markers. Analysis of molecular variance (AMOVA) revealed that 78.84% (ISSR) and 78.88% (RAPD) of variability was partitioned among individuals within populations. This genetic structure was probably due to severe genetic drift resulting from habitat fragmentation and human overexploitation since 1950s. Moreover, there is a lack of significant association between genetic and geographic distances ( r = 0.276; p > 0.05) in the populations of D. officinale. From the conservation point of view, populations GL, GS and GSD with higher genetic diversity should be protected firstly to maintain the species potential for evolutionary change and population YG with lower diversity but representing a novel evolutionary unit should also be paid more attention to during D. officinale conservation practice. [ABSTRACT FROM AUTHOR]

The American state of Hawaii presents a tuberculosis (TB) burden more consistent with that of the Philippines and the Pacific Islands than that with the United States (US) or Europe. This study seeks to determine if the genetic families of Mycobacterium tuberculosis (Mtb) that are prevalent in Hawaii display differences in host demographics that may be of use for TB control in Hawaii and the Pacific. This retrospective study was conducted by analyzing data from the Hawaii State Department of Health to investigate the demographics associated with the Beijing (global lineage 2) and Manila (lineage 1) families of Mtb in Hawaii. Deidentified records of all culture-positive TB cases reported by the Hawaii State Department of Health Tuberculosis Control Program from 2004 to 2016 were analyzed to identify lineage-specific demographic differences and trends. Patients' countries of origin, age, sex, and time in the US before TB diagnosis were included in this analysis. Manila family isolates were found to predominantly enter Hawaii through Filipino immigrants, whereas Beijing family isolates originated from a diverse set of countries. Both families exhibited significant differences in age and sex demographics. In addition, Manila family cases presented from patients with significantly longer average time of residence in the US than non-Manila cases, whereas Beijing family cases presented from patients with significantly shorter time of residence in the US than non-Beijing cases. Both the Beijing and Manila families of Mtb demonstrated demographic differences in Hawaii that may prove important for improving TB control and surveillance policy in Hawaii and throughout the Pacific. Areas with heavy Filipino immigration may benefit from directing more resources toward screening and education efforts for middle-aged men and those who have resided in the country longer, whereas other areas of the Pacific should consider a younger and more sex-balanced allocation. Specific to the US and Hawaii, effective screening of youths emigrating from the Compact of Free Association states remains vital. • Hawaii's genetic lineages of Mycobacterium tuberculosis show distinct epidemiology. • Beijing family cases in the Pacific originate from a diverse set of countries. • Manila family TB is most common in older persons who have been in the USA longer. • Beijing family TB has younger, diverse demographic and rapid disease presentation. [ABSTRACT FROM AUTHOR]

Objective: This study aims to examine the thyroid hormone profile and its association with severe coronavirus disease 2019 (COVID-19) in patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)., Methods: This retrospective cohort study enrolled patients admitted to a tertiary hospital due to SARS-CoV-2 infection between February 18 and May 18, 2022. Clinical data were collected retrospectively from the electronic medical record system. Based on the thyroid function, patients were divided into five groups: normal, non-thyroid illness syndrome (NTIS), hypothyroidism, thyrotoxicosis, and unclassified. The association between thyroid function and severe COVID-19 was detected using multivariable logistic regression and restricted cubic splines analysis., Results: This study included 3,161 patients, with 7.7% of them developing severe COVID-19. 44.9% of the patients had normal thyroid function, 36.5% had NTIS, 6.7% had hypothyroidism, and 1.0% had thyrotoxicosis on admission. After adjusting for age, sex, and relevant clinical characteristics, NTIS and hypothyroidism were associated with increased risks of severe COVID-19 (odds ratio [OR] 2.38, 95% confidence interval [CI] 1.59-3.56 and OR 2.29, 95% CI 1.23-4.26, respectively), compared to normal thyroid function group. Among patients with NTIS or hypothyroidism, higher levels of total triiodothyronine (TT3) are associated with lower risks of severe COVID-19 (OR 0.73, 95% CI 0.64-0.82, for every 0.1nmol/L increase in TT3 level)., Conclusion: Thyroid hormone profiles of NTIS or hypothyroidism are associated with increased risks of severe COVID-19. The decreased level of TT3 correlated with the increased risk of severe COVID-19 in patients with NTIS or hypothyroidism., 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 © 2024 Yang, Qian, Wu, Xu, Qu, Zhou, Liu, Zhu, Wang and Zhao.)

Objective: To evaluate the economic value of mepolizumab as an add-on therapy to the standard of care (SoC) for patients with severe eosinophilic asthma in China., Methods: A Markov model with three health conditions was constructed to calculate the incremental cost per quality-adjusted life year (QALY) in mepolizumab with SoC and SoC only groups from the perspective of the Chinese healthcare system throughout an entire lifespan. The model was populated with local costs, while efficacy parameters were obtained from the global Phase III MENSA trial and mortality was derived from two surveys. One-way and probabilistic sensitivity analyses were conducted. Additional scenario analysis was used to estimate the cost-effectiveness impact of changes in the price of mepolizumab., Results: Over the lifetime treatment horizon, the incremental cost-effectiveness ratio (ICER) of mepolizumab plus SoC compared to SoC alone was $170 648.73 per QALY. Sensitivity analyses focused on these results. Scenario analysis showed that mepolizumab would require a price reduction of at least 82% to reach the current willingness-to-pay (WTP=$38 223.34/QALY) threshold., Conclusion: Mepolizumab is not a cost-effective healthcare resource in China at its current pricing.

We evaluated the vaccine effectiveness (VE) of two doses of recombinant zoster vaccine (RZV) against herpes zoster (HZ) and postherpetic neuralgia (PHN) in Chinese adults at Kaiser Permanente Southern California (KPSC). Chinese KPSC members were identified based on self-reported ethnicity or self-reported preferred spoken/written language. Those aged ≥50 years who received two doses of RZV 4 weeks to ≤ 6 months apart were matched 1:4 to RZV unvaccinated Chinese members and followed through June 2022; second doses were accrued 6/1/2018-12/31/2020. We estimated incidence and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) comparing outcomes (HZ and PHN). Adjusted VE (%) was calculated as (1-aHR)×100. 3978 RZV vaccinated Chinese members were matched to 15,912 RZV unvaccinated Chinese members. The incidence per 1000 person-years (95% CI) of HZ in the vaccinated group was 1.5 (0.9-2.5) and 10.9 (9.8-12.1) in the unvaccinated group; aHR (95% CI) was 0.12 (0.07-0.21). Adjusted VE (95% CI) was 87.6% (78.9-92.7) against HZ. We identified 0 PHN cases in the vaccinated group and 19 in the unvaccinated group. Among Chinese adults aged ≥50 years, two doses of RZV provided substantial protection against HZ and PHN supporting the real-world effectiveness of the vaccine in this population.

Epithelial ovarian cancer (EOC) is a deadly disease with limited diagnostic biomarkers and therapeutic targets. Here we conduct a comprehensive proteomic profiling of ovarian tissue and plasma samples from 813 patients with different histotypes and therapeutic regimens, covering the expression of 10,715 proteins. We identify eight proteins associated with tumor malignancy in the tissue specimens, which are further validated as potential circulating biomarkers in plasma. Targeted proteomics assays are developed for 12 tissue proteins and 7 blood proteins, and machine learning models are constructed to predict one-year recurrence, which are validated in an independent cohort. These findings contribute to the understanding of EOC pathogenesis and provide potential biomarkers for early detection and monitoring of the disease. Additionally, by integrating mutation analysis with proteomic data, we identify multiple proteins related to DNA damage in recurrent resistant tumors, shedding light on the molecular mechanisms underlying treatment resistance. This study provides a multi-histotype proteomic landscape of EOC, advancing our knowledge for improved diagnosis and treatment strategies., (© 2024. The Author(s).)

The consistent input of antibiotics into aquatic environments may pose risks to various creatures and ecosystems. However, risk assessment of pharmaceuticals and personal care products (PPCPs) in aquatic environments is frequently limited by the lack of toxicity data. To investigate the risk of commonly used antibiotics to various aquatic creatures, we focused on the distribution patterns and temporal dynamics of antibiotics in the coastal estuary area of China and performed a comprehensive ecological risk assessment for four antibiotics: erythromycin (ERY), tetracycline (TCN), norfloxacin (NOR) and sulfamethoxazole (SMX). An interspecies correlation estimation (ICE)-species sensitivity distribution (SSD) combined model was applied to predict the toxicity data of untested aquatic species, and an accurate ecological risk assessment procedure was developed to evaluate the risk level of PPCPs. The results of risk quotient assessments and probabilistic risk assessments (PRAs) suggested that four objective antibiotics in the Chinese coastal estuary area were at a low risk level. These antibiotics posed a high risk in antibiotic-related global hot spots, with probabilistic risk values for ERY, NOR, SMX, and TCN of 81.33 %, 27.08 %, 21.13 %, and 15.44 %, respectively. We applied an extrapolation method to overcome the lack of toxicity data in ecological risk assessment, enhanced the ecological reality of water quality criteria derivation and reduced the uncertainty of risk assessment for antibiotics., 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.)

Background: This study extends from the 2015 Shandong Province Epidemiological Survey of Mental Disorders in adults aged 18 and above. Over five years, it investigates pain characteristics and influencing factors in individuals with depressive disorders in Shandong Province., Methods: The study encompasses 871 individuals who met DSM-IV criteria for depressive disorders in 2015. Using 1:1:1 matching by gender, age, and residence, 825 non-afflicted individuals were selected as high-risk controls, and 825 screening-negative individuals became low-risk controls. A follow-up study in 2020 involved 1848 participants. Survey tools included a general information questionnaire, General Health Questionnaire-12 (GHQ-12), SCID-I/P, Global Pain Scale (GPS), Quality of Life Questionnaire (QLQ), PSQI, MoCA, and clinical data questionnaire., Results: GPS scores in the current depressive group were higher than in non-current depressive group (Z = 14.36, P < 0.01). GPS scores in study group exceeded those in high-risk and low-risk control groups (H = 93.71, P < 0.01). GPS scores in non-remission group were higher than in the remission group (Z = 8.90, P < 0.01). Regression analysis revealed positive correlations between GPS scores and physical illnesses, current depression, incumbency, GHQ-12 total score, and PSQI total score. Negative correlations were observed with QLQ total score and MoCA total score., Limitations: The study could not assess pain during the 2015 survey, limiting controlled pain analysis before and after five years., Conclusion: Depression sufferers may experience prolonged heightened pain, potentially relieved when depression subsides. Individual pain is influenced by depression, physical illnesses, sleep quality, quality of life, cognitive function, gender, residence, and occupation., Competing Interests: Declaration of competing interest All authors declared no conflict of interest involved in this manuscript submission., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Wh-words have been analysed as existential quantifiers (Chierchia in Logic in grammar: polarity, free choice, and intervention. Oxford University Press, Oxford, 2013; Fox, in Sauerland U, Stateva P (eds) Presupposition and implicature in compositional semantics (Palgrave studies in pragmatics, language and cognition). Palgrave MacMillan, Houndmills, pp 71-120, 2007; Liao in Alternative and exhaustification: non-interrogative uses of Chinese wh-words. Harvard University, 2010) or universal quantifiers (Nishigauchi, in: Theoretical and applied linguistics at Kobe Shoin 2, Kobe Shoin Institute for Linguistic Sciences, 1999). These two accounts have distinct predictions on how children initially interpret wh-words. The universal account predicts that children should initially interpret wh-words as universal quantifiers, whereas the existential account anticipates that children should start out with the existential interpretation. To adjudicate between the two accounts, the present study was designed to explore pre-schoolers' semantic knowledge of wh-quantification. Specifically, it investigated the interpretation of the wh-word shenme 'what' with 4-and 5-year-old Mandarin-speaking children and a control group of adults. Using a Truth Value Judgment Task (Crain and Thornton in Investigations in universal grammar: a guide to experiments on the acquisition of syntax and semantics. MIT Press, Cambridge, 1998), Experiment 1 evaluated whether children interpret the wh-word shenme 'what' as closer in meaning to the polarity sensitive item renhe 'any' or the universal quantifier suoyou 'all' in the antecedent of ruguo 'if' conditionals. Using a Question-Answer Task, Experiments 2 & 3 respectively investigated whether children interpret shenme 'what' as closer in meaning to renhe 'any' or suoyou 'all' in two types of questions: yes-no questions with the particle ma and A-not-A questions. It was found that both children and adults interpret shenme 'what' as closer in meaning to renhe 'any' than suoyou 'all'. The findings suggest that Mandarin-speaking pre-schoolers already have adult-like semantic knowledge of wh-quantification: wh-words are existential quantifiers rather than universal quantifiers. Due to the paucity of primary linguistic input, children's early mastery of the non-interrogative wh-words appear to support the biolinguistic approach to language acquisition (Chomsky in Aspects of the theory of syntax. MIT Press, Cambridge, 1965; Pinker in Language learnability and language development. Harvard University Press, Cambridge, 1984; Crain et al. in Language acquisition from a biolinguistic perspective. Neurosci Biobehav Rev, 2016. https://doi.org/10.1016/j.neubiorev.2016.09.004 )., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Studies on various thrombopoietic agents for cancer treatment-induced thrombocytopenia (CTIT) in China are lacking. This study aimed to provide detailed clinical profiles to understand the outcomes and safety of different CTIT treatment regimens., Methods: In this retrospective, cross-sectional study, 1664 questionnaires were collected from 33 hospitals between March 1 and July 1, 2021. Patients aged >18 years were enrolled who were diagnosed with CTIT and treated with recombinant interleukin 11 (rhIL-11), recombinant thrombopoietin (rhTPO), or a thrombopoietin receptor agonist (TPO-RA). The outcomes, compliance, and safety of different treatments were analyzed., Results: Among the 1437 analyzable cases, most patients were treated with either rhTPO alone (49.3%) or rhIL-11 alone (27.0%). The most common combination regimen used was rhTPO and rhIL-11 (10.9%). Platelet transfusions were received by 117 cases (8.1%). In multivariate analysis, rhTPO was associated with a significantly lower proportion of platelet recovery, platelet transfusion, and hospitalization due to chemotherapy-induced thrombocytopenia (CIT) than rhIL-11 alone. No significant difference was observed in the time taken to achieve a platelet count of >100 × 10 9 /L and chemotherapy dose reduction due to CIT among the different thrombopoietic agents. The outcomes of thrombocytopenia in 170 patients who received targeted therapy and/or immunotherapy are also summarized. The results show that the proportion of platelet recovery was similar among the different thrombopoietic agents. No new safety signals related to thrombopoietic agents were observed in this study. A higher proportion of physicians preferred to continue treatment with TPO-RA alone than with rhTPO and rhIL-11., Conclusions: This survey provides an overview of CTIT and the application of various thrombopoietic agents throughout China. Comparison of monotherapy with rhIL-11, rhTPO, and TPO-RA requires further randomized clinical trials. The appropriate application for thrombopoietic agents should depend on the pretreatment of platelets, treatment variables, and risk of bleeding., Plain Language Summary: To provide an overview of the outcome of cancer treatment-induced thrombocytopenia in China, our cross-sectional study analyzed 1437 cases treated with different thrombopoietic agents. Most of the patients were treated with recombinant interleukin 11 (rhIL-11) and recombinant thrombopoietin (rhTPO). rhTPO was associated with a significantly lower proportion of platelet recovery and platelet transfusion compared with rhIL-11., (© 2024 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Occupational therapy is a profession with origins rooted in Western values. As culture plays an important role in shaping theory and practice, the curriculum design of academic programs that train future rehabilitation professionals should reflect the local context. As part of an international partnership, a dual-degree graduate program in occupational therapy was established between a Chinese and an American university. A team composed of members from both institutions collaborated on culturally adapting an entry-level master's program in occupational therapy for China, based on a U.S. program, which welcomed its first cohort in September 2019. This article details the timeline and process of program design and adaptation from conception, through implementation to evaluation and revision, with the aim of offering a framework for curriculum adaptation of other academic programs in the U.S. and internationally. The adapted curriculum includes the program mission, vision, and philosophy; the curriculum model with program outcomes and threads; the program scope and sequence; materials and resources; and course-specific objectives, learning activities, and assessments. The authors also share lessons learned through this experience of international collaboration as well as next steps for program evaluation and sustainability. The detailed overview of this international collaboration offers suggestions for individuals and institutions seeking to develop global partnerships and adapt curricula across cultural contexts., Competing Interests: There is no conflict of interest regarding the publication of this paper., (Copyright © 2024 Julie McLaughlin Gray et al.)

Transradial approach is the classical access for coronary angiography and percutaneous coronary intervention (PCI). With the increase in the number of interventional procedures, some disadvantages of the transradial approach have also been found, it is easy to lead to various complications, such as radial artery occlusion, radial nerve injury, and puncture difficulties after radial artery spasm. Therefore, some experts put forward the approach of distal radial artery approach for interventional therapy, which has the advantages of convenient positioning, easy postoperative hemostasis, less damage to the proximal radial artery and improving patients' comfort. However, there is no special distal radial artery hemostat in clinic, which limits the development of this approach to a certain extent. Therefore, based on the principles of anatomy and physics, cardiovascular physician at Jiading District District Central Hospital in Shanghai designed and invented a distal radial artery hemostatic device, which is convenient for clinical hemostasis of distal radial artery puncture, and obtained the National Utility Model Patent (patent number: ZL 2021 2 2097829.6). The hemostatic device consists of a glove body with a silicone gasket protruding towards the skin on the inner surface and a binding component. The patient's hand is inserted into the glove body, and after being fixed by the restraint component, the silicone gasket can effectively compress the location of the radial artery puncture point, and play a good hemostatic effect with less pressure, avoid the common complications of proximal radial artery hemostatic, and reduce the discomfort of the patient. Has good application value.

With the rapid development of information technology, internet enterprises have sprung up, bringing about huge power consumption due to constantly expanding enterprise scale, which in turn leads to significant carbon emissions. Additionally, the large influence of internet enterprises on the public and other businesses makes it particularly necessary to pay attention to their carbon emission reduction efforts. To explore the evolution path and patterns of carbon emission reduction among internet enterprises under the carbon neutrality goal, this paper constructs an evolutionary game model for internet enterprises to enter the carbon emissions trading market based on Externality and Sustainable Development Theories, while considering constraints from the carbon market, financial institutions and the public. The model utilizes Python 3.8.2 software for numerical simulations, aiming to push internet enterprises towards low-carbon development. The research findings indicate that: (1) Carbon emission reduction behavior of internet enterprises exhibits significant externality, and when constraints are weak or incentives are not evident, the motivation for enterprises to reduce carbon emissions is insufficient. (2) The carbon market can effectively promote carbon emission reduction among internet enterprises, and the strategy of entering the carbon market becomes the preferred option for these enterprises gradually. (3) Multiple constraints, including emission reduction costs, penalty for non-compliance, government subsidies, financing costs, opportunity losses, and reputation losses, can force internet enterprises towards low-carbon development., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Zhou, Qian. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Estuarine sedimentation is an important historical record of potentially toxic metal (PTM) emissions from human activities that can be used to improve environmental management. However, the contribution of different human activities to PTM deposition has not been accurately estimated, and their coupled relationship with riverine organic matter is typically not considered. In this study, we reconstruct the century-scale PTM depositional history of sediment cores from the Yangtze Grand Delta. Eight potential metal sources (PMSs) were identified using positive matrix factorization, and the results of lagged correlation determined the PMSs associated with the riverine discharge of the Yangtze River. Riverine PTMs were predominantly composed of Cr (79.0%), Ni (77.3%), and Pb (64.1%) but were deprived in Cu (34.9%). Glomalin-related soil protein (GRSP), which is a typical terrestrial refractory carbon, has a strong affinity for Cu, and contributed to 2.82-22.6% Cu deposition. The change in the PMS is mainly related to power generation, whereas the GRSP-bound PTM is mainly related to road construction and transportation. We advocate for responsible management of human activities in river catchments, particularly on coal-based power generation and road transportation, to maintain ecological security and promote the overall achievement of the Sustainable Development Goals., 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 © 2023 Elsevier B.V. All rights reserved.)

Geriatric assessment can aid in optimizing treatment strategies and supportive interventions for older patients with diffuse large B-cell lymphoma (DLBCL). Fondazione Italiana Linformi has recently introduced novel geriatric assessment tools, simplified Geriatric Assessment (sGA) and Elderly Prognostic Index (EPI), aimed at tailoring the treatment and predicting the outcomes for older patients with DLBCL. The objectives of this study are the validation and possible modification of the sGA and EPI in China. In the study, both sGA and EPI demonstrated the predictive capabilities for overall survival (OS) and early mortality (both p < 0.05) in older individuals with DLBCL. Albumin, serving as an independent predictive biomarker for OS (p = 0.006), was utilized to adjust the measurements, resulting in the establishment of sGA-A and EPI-A. The sGA-A effectively addressed the shortcomings of the sGA and EPI in predicting PFS and surpassed them in predicting OS and early mortality. Nevertheless, there is insufficient evidence to support the use of sGA and EPI as treatment guidance tools. In conclusion, the modified sGA-A model proved to be a successful instrument for geriatric assessment of older patients with DLBCL., (© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Objective: We conducted a randomized, double-blind, placebo-controlled phase 2 trial to evaluate the efficacy and safety of mazdutide, a once-weekly glucagon-like peptide 1 and glucagon receptor dual agonist, in Chinese patients with type 2 diabetes., Research Design and Methods: Adults with type 2 diabetes inadequately controlled with diet and exercise alone or with stable metformin (glycated hemoglobin A1c [HbA1c] 7.0-10.5% [53-91 mmol/mol]) were randomly assigned to receive 3 mg mazdutide (n = 51), 4.5 mg mazdutide (n = 49), 6 mg mazdutide (n = 49), 1.5 mg open-label dulaglutide (n = 50), or placebo (n = 51) subcutaneously for 20 weeks. The primary outcome was change in HbA1c from baseline to week 20., Results: Mean changes in HbA1c from baseline to week 20 ranged from -1.41% to -1.67% with mazdutide (-1.35% with dulaglutide and 0.03% with placebo; all P < 0.0001 vs. placebo). Mean percent changes in body weight from baseline to week 20 were dose dependent and up to -7.1% with mazdutide (-2.7% with dulaglutide and -1.4% with placebo). At week 20, participants receiving mazdutide were more likely to achieve HbA1c targets of <7.0% (53 mmol/mol) and ≤6.5% (48 mmol/mol) and body weight loss from baseline of ≥5% and ≥10% compared with placebo-treated participants. The most common adverse events with mazdutide included diarrhea (36%), decreased appetite (29%), nausea (23%), vomiting (14%), and hypoglycemia (10% [8% with placebo])., Conclusions: In Chinese patients with type 2 diabetes, mazdutide dosed up to 6 mg was generally safe and demonstrated clinically meaningful HbA1c and body weight reductions., (© 2023 by the American Diabetes Association.)

The question of whether community nucleic acid testing contributes to an increase in infections within residential compounds has not been definitively answered. Shanghai, one of the largest cities in China, conducted city-wide community testing during its lockdown from late March to May 2022. This situation provided a unique opportunity to examine the effect of community testing on infection rates, as the lockdown largely eliminated confounding factors such as citizen mobility. In our study, based on a survey of 208 residential compounds in Shanghai and the daily infection data during the lockdown period, we found a significant correlation between community testing and infection risk in these compounds. However, after addressing potential issues of reverse causality and sampling bias, we found no significant causal link between community testing and infection risk. Furthermore, we discovered that increased awareness of mask-wearing correlated with a decrease in infections within the residential compounds during community testing. This suggests that the perceived correlation between community testing and infection risk may be confounded by residents' adherence to mask-wearing practices. Our findings emphasize the need for public health decision-makers to reinforce the importance of mask-wearing during community testing, as a means to prevent infections among citizens., (© 2023. The Author(s).)

Background: The pancreatic index (PI) is a useful preoperative imaging predictor for pancreatic ductal adenocarcinoma (PDAC). In this retrospective study, we determined the predictive effect of PI to distinguish patients of pancreatic body/tail cancer (PBTC) with vascular involvement who can benefit from upfront surgery., Method: All patients who received distal pancreatectomy for PDAC from 2016 to 2020 at the Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine were considered for the study. A total of 429 patients with PBTC were assessed in relation to the value of PI. Fifty-five patients were eventually included and divided into low PI group and 29 patients in the normal PI group., Results: The median overall survival (mOS) was significantly shorter in the low PI group (13.1 vs. 30.0 months, p = 0.002) in this study, and PI ≥ 0.78 (OR = 0.552, 95% CI: 0.301-0.904, p = 0.020) was an independent influencing factor confirmed by multivariate analysis. Subgroup analysis showed that PI was an independent prognostic factor for LA-PBTC (OR = 0.272, 95% CI: 0.077-0.969, p = 0.045). As for BR PBTC, PI (OR = 0.519, 95% CI: 0.285-0.947, p = 0.033) combined with carbohydrate antigen 125 (CA125) (OR = 2.806, 95% CI: 1.206-6.526, p = 0.017) and chemotherapy (OR = 0.327, 95% CI: 0.140-0.763, p = 0.010) were independent factors., Conclusion: This study suggests that the PI can be used as a predictive factor to optimize the surgical indication for PBTC with vascular involvement. Preoperative patients with normal PI and CA125 can achieve a long-term prognosis comparable to that of resectable PBTC patients., (© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

The imbalance between supply and demand of elderly care resources in the Yangtze River Delta is increasing. By the older adult agglomeration, spatial cluster analysis, hotspot analysis, and coupling coordination model, this study explores the spatial coupling relationship between older adults and elderly care resources in the Yangtze River Delta in 2020 from the perspective of a supply-and-demand balance. The results demonstrate that: (1) population aging is mainly in the moderate aging stage, followed by the primary aging stage; (2) there are significant spatial differences in elderly care resources on the urban scale in the Yangtze River Delta; and (3) elderly care resources and the older adults in the Yangtze River Delta are mostly highly coupled. However, Nantong, with the highest degree of aging, has a serious mismatch in life service resources and ecological environment resources. The social security resources and medical resources of provincial capital cities with low aging are mismatched. Medical and health resources in underdeveloped areas are seriously mismatched. The social security resources are barely matched in Shanghai. A path for optimizing the spatial allocation of elderly care resources is proposed. This research offers a decision-making reference for coordinating elderly care resources distribution., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Wu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Selenium (Se), as an essential microelement, can be supplied through Se-biofortified food from Se-rich soils and associated farming practices for human health, while it can also cause eco-risks if overapplied. In this study, a multi-scale spatiotemporal meta-analysis was conducted to guide sustainable Se-rich farming in China by combining a long-term survey with a reviewed database. The weighted mean concentration, spatial distribution of soil Se, nationwide topsoil Se variation from cropping impacts and its bioavailability-based ecological risks were assessed and quantified. The results showed that the weighted mean content (0.3 mg kg -1 ) of China was slightly higher than that of previous nationwide topsoil Se surveys, as more Se-rich areas were found in recent high-density sampling surveys. Cropping has overall reduced Se content by 9.5% from farmland across China and deprived more with the increase in farming rotation driven by geo-climatic conditions. Long-term cropping removed Se from Se-rich areas but accumulated it in Se-deficient areas. Additionally, the bioavailable Se content of topsoil in China ranged from 0 to 332 μg kg -1 , and the bioavailability-based eco-risks indicated that high eco-risks only existed in overfertilized and extremely high-Se soils, such as in Enshi, Ziyang and some coalfield areas. This work provides evidence for the development of sustainable Se-rich farming with proper utilization of soil Se resources, simultaneously protecting the soil eco-environment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Bacterial sulfate reduction plays a crucial role in the mobilization of toxic substances in aquifers. However, the role of bacterial sulfate reduction on iodine mobilization in geogenic high-iodine groundwater systems has been unexplored. In this study, the enrichment of groundwater δ 34 S SO4 (15.56 to 69.31‰) and its significantly positive correlation with iodide and total iodine concentrations in deep groundwater samples of the North China Plain suggested that bacterial sulfate reduction participates in the mobilization of groundwater iodine. Similar significantly positive correlations were further observed between the concentrations of iodide and total iodine and the relative abundance of the dsrB gene by qPCR, as well as the composition and abundance of sulfate-reducing bacteria (SRB) predicted from 16S rRNA gene high-throughput sequencing data. Subsequent batch culture experiments by the SRB Desulfovibrio sp. B304 demonstrated that SRB could facilitate iodine mobilization through the enzyme-driven biotic and sulfide-driven abiotic reduction of iodate to iodide. In addition, the dehalogenation of organoiodine compounds by SRB and the reductive dissolution of iodine-bearing iron minerals by biogenic sulfide could liberate bound or adsorbed iodine into groundwater. The role of bacterial sulfate reduction in iodine mobilization revealed in this study provides new insights into our understanding of iodide enrichment in iodine-rich aquifers worldwide.

Blue carbon ecosystems (BCEs), located at the land-sea interface, provide critical ecological services including the buffering of anthropogenic pollutants. Understanding the interactions between trace element (TE) loads in BCEs and socioeconomic development is imperative to informing management plans to address pollution issues. However, the identification of anthropogenic TE pollution in BCEs remains uncertain due to the complex geochemical and depositional processes and asynchronous socioeconomic development along continental coastlines. Here, priority-controlled TE (As, Cd, Cr, Cu, Hg, Ni, Pb, and Zn) concentrations in the mangrove, saltmarsh and seagrass soils and plant tissues along the coastline of China were investigated while taking bare flat and upland soils as corresponding references. We demonstrate that blue carbon (BC) soils accumulated markedly higher concentrations of anthropogenic TEs than the reference soils, mainly due to the effective trapping of fine-grained particles and higher binding capacities. We identify the time course of TE changes over the last 100 years which shows increasing anthropogenic TE accumulation resulting from military activities (1930-1950) and the growth of industrial and agricultural activities (1950-1980), then reaching a maximum after national economic reform (1980-2000). Since the 2000s, decreases in TE discharges driven by socioeconomic reform and strengthened environmental regulations have led to a widespread reversal of anthropogenic TE concentrations in BC soils. Based on the current TE flux we estimate that BCEs can filter over 27.3-100 % of the TEs emitted in industrial wastewaters from Chinese coastal provinces annually. However, the uptake of these TEs by plants can be substantially reduced through various mechanisms offered by edaphic properties such as organic carbon, clay, and sulfur contents. Therefore, enhancing TE filtering while preventing TEs from entering food webs through the conservation and restoration of BCEs will greatly aid in achieving the sustainable development goal of the coastal zone under intensified anthropogenic activities., 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 © 2023. Published by Elsevier Ltd.)

Background: This multi-center study aimed to identify factors affecting fever and delayed defervescence in bacterial meningitis (BM) patients under 3 years of age because of the variability of fever in this patient population., Methods: Only BM patients under 3 years treated at 49 centers in China from November 2018 to end-April 2021 were included in the study. Univariate and multivariate logistic regression analyses were performed to determine factors associated with afebrile presentation and fever of delayed defervescence., Results: A total of 863 BM patients under 3 years were included in the study. Coagulase negative staphylococcus was associated with afebrile presentation (OR = 1.176), while septicaemia and ear-nose-throat infections were associated with fever (P < 0.05). The patients with fever were assigned into early and delayed defervescence groups based on defervescence time (less than and more than or equal to one week). Furthermore, Streptococcus agalactiae meningitis (OR = 1.124), concomitant gastrointestinal infection (OR = 1.276), encephalomalacia (or = 1.339), and subdural effusion (OR = 1.454) were independently associated with delayed defervescence (all P < 0.05)., Conclusions: The findings can aid in the efficient utilization of fever in auxiliary diagnosis and evaluating the condition of the disease., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: High body mass index was considered as a risk factor for minimally invasive surgery. The short-term outcomes of robot-assisted pancreaticoduodenectomy (RPD) remain controversial. This study aims to investigate the feasibility and advantage of RPD in patients with high body mass index compared to open pancreaticoduodenectomy (OPD)., Methods: Clinical data of 304 patients who underwent pancreaticoduodenectomy from January 2016 to December 2019 in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine was collected. Patients with BMI >25 kg/m 2 were included and divided into RPD and OPD group. After PSM at a 1:1 ratio, 75 patients of OPD and 75 patients of RPD were recorded and analyzed., Results: The RPD group showed advantages in the estimated blood loss (EBL) (323.3 mL vs. 480.7 mL, p = 0.010), the postoperative abdominal infection rate (24% vs. 44%, p = 0.010), the incidence of Clavien-Dindo III-V complications (14.7% vs. 28.0%, p = 0.042) over OPD group., Conclusion: RPD shows advantages in less EBL, lower incidence rate of Clavien-Dindo III-V complications over OPD in overweight and obese patients. RPD was confirmed as a safe and feasible surgical approach for overweight or obsess patients., (© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Institutions are the fundamental determinants of carbon emission performance. However, the environmental impact of intellectual property institution, especially its impact on carbon emissions, has been paid little attention. Therefore, the main purpose of this study is to assess the effect of intellectual property institution on carbon emission reduction, revealing a new solution to control carbon emissions. To achieve the goal, this study regards the National Intellectual Property Demonstration City (NIPDC) policy in China as a quasi-natural experiment of intellectual property institution construction and exploits the difference in difference approach to objectively evaluate the impact of intellectual property institution on carbon emission reduction based on the panel data of China's cities. The study draws the following important conclusions. First, compared with non-pilot cities, the NIPDC policy has reduced urban carbon emissions by 8.64% in pilot cities. In particular, the "carbon emission reduction dividend" of the NIPDC policy is in the long term but not in the short term. Second, the influence mechanism analysis shows that the NIPDC policy can promote carbon emission reduction by stimulating technology innovation, especially breakthrough innovation. Third, the space overflow analysis reveals that the NIPDC policy can mitigate carbon emissions in adjacent areas, resulting in obvious spatial radiation effect. Fourth, the heterogeneity analysis confirms that the carbon emission reduction effect of the NIPDC policy is more obvious in low administrative hierarchic cities, small and medium-sized cities, and western cities. As a result, Chinese policymakers should orderly promote the construction of NIPDCs, strengthen technology innovation, give full play to the spatial radiation role of NIPDCs, and optimize the role of government, so as to better release the carbon emission abatement effect of intellectual property institution., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The inland and estuary wetlands that characterized by different natural environment perform distinctly in soil carbon (C) sink. It was deemed that estuary wetland has a higher organic C accumulation rate than inland wetland, due to its higher primary production and tidal organics input, thus having higher organic C sink capacity. While from CO 2 budge in view, whether does the large organic input from tide restrict CO 2 sequestration capacity of estuary wetland has not been discussed comparing with inland wetland. In this study, inland and estuary wetlands were selected to study the potential of CO 2 sequestration capacity. It was found that inland wetland had most of soil organic carbon (SOC) derived from plant C, which brought remarkable organic C content and nourished higher microbial biomass, dehydrogenase, and β&#95;glucosidase than estuary wetland. The estuary wetland instead accumulated less SOC, a considerable proportion of which came from tidal waters, therefore supporting lower microbial biomass and enzyme activities than that in inland wetland. However, estuary wetland was evaluated having higher capability in SOC mineralization than inland wetland in consideration of soil respiration (SR) and SR quotient. It was concluded that tidal organic C accelerated the SOC mineralization in estuarine wetland, thus weakening the CO 2 sequestration. These results implied the importance of pollution control for reservation CO 2 sink function in estuarine wetland., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This retrospective analysis of fatal intoxication case autopsies was performed at Tongji Center for Medicolegal Expertise in Hubei (TCMEH) from 2009 to 2021 to obtain up-to-date information on intoxication cases. The objective was to describe important data about evolving patterns in intoxication occurrences, enhance public safety policies, and assist forensic examiners and police in more efficient handling of such cases. Analyses based on sex, age, topical exposure routes, toxic agents, and mode of death were performed using 217 records of intoxication cases collected from TCMEH as a sample, and the results were compared with reports previously published (from 1999 to 2008) from this institution. Deaths from intoxications occurred at a higher rate in males than in females and were most common among individuals aged 30-39 years. The most frequent method of exposure was oral ingestion. The causative agents of deadly intoxications have changed when compared to the data from the previous 10 years. For instance, deaths from amphetamine overdoses are becoming more prevalent gradually, whereas deaths due to carbon monoxide and rodenticide intoxication have declined dramatically. In 72 cases, pesticides continued to be the most frequent intoxication cause. A total of 60.4% of the deaths were accidental exposure. Men died from accidents at a higher rate than women, although women were more likely to commit suicide. Particular focus is needed on the use of succinylcholine, cyanide, and paraquat in homicides., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Lihua, Yuning, Henghui, Xiang, Min, Zehao, Lianjie and Qian.)

Introduction: The development of urban resilience, which is fundamentally a balance between the supply capacity of primary care resources and the demand from urban residents, includes an appropriate architecture of primary care facilities. Resilient city construction in highland areas is hampered by the physical environment and transportation constraints and frequently encounters issues like poor accessibility and unequal distribution of primary care facilities., Methods: To optimize the supply and demand of primary care resources in highland cities and effectively improve the resilience of urban public health, this paper assesses the distribution of primary care facilities within the built-up area of Lhasa (China) through a spatial network analysis method based on GIS, combined with population distribution data, and employs a location-allocation model to optimize the distribution., Results: Firstly, the overall supply of primary care exceeds the overall demand, but the facilities' service area can only accommodate 59% of the residences. Secondly, there is a clear spatial variation in the accessibility of primary care facilities, and the time cost of healthcare is too high in some residences. Thirdly, the supply-demand relationship of primary care facilities is unbalanced, with both over-saturated and over-deficient areas., Discussion: After distribution optimization, the coverage and accessibility of primary care facilities have increased significantly, and the spatial imbalance of supply and demand has been alleviated. This paper proposes a research method to evaluate and optimize the spatial distribution of primary care facilities from multiple perspectives based on the resilience theory. The results of the study and visualization analysis methods can be used as an invaluable reference for planning the distribution of urban healthcare facilities and urban resilience construction in highland areas and other underdeveloped areas., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Yu, Zhou, Qian, Yang, Dong and Zhang.)

The trade-off between the potentially detrimental effects of fine particulate matter (PM 2.5 ) and the benefits of physical activity (PA) is unclear. We aimed to explore the independent and interaction effects between long-term PM 2.5 exposure and PA on blood pressure (BP) and hypertension. A total of 8704 adults (≥45 years) without hypertension at baseline in a nationwide cohort of the China Health and Retirement Longitudinal Study (CHARLS) were followed from 2011 to 2015. The participants were selected using a four-stage, stratified, and cluster sampling procedure. The annual PM 2.5 concentrations at the residential address were estimated from a two-stage machine learning model with a 10 km × 10 km resolution. A standard questionnaire collected information on PA and potential confounders, and metabolic equivalents (MET·h/wk), which combined frequency, intensity, and duration information, were used to assess PA levels. We adopted mixed-effects regression models to explore the independent and interaction effects between long-term PM 2.5 exposure and PA on BP and risk of hypertension. Systolic blood pressure (SBP) decreased by -0.84 mmHg (95% CI: -1.34, -0.34) per an IQR (interquartile range, 175.5 MET·h/wk) increase in PA, and diastolic blood pressure (DBP) decreased by -0.42 mmHg (95% CI: -0.76, -0.07). Each IQR (36.1 μg/m 3 ) increment in PM 2.5 was associated with 0.48 mmHg (95% CI: -0.24, 1.20) in SBP and -0.02 mmHg (95% CI: -0.44, 0.39) in DBP. PM 2.5 showed an elevated effect with risks of hypertension (odds ratio, OR = 1.01; 95% CI: 1.00, 1.03), while PA showed the inverse result (OR = 0.98; 95% CI: 0.97, 0.99). Interaction analyses indicated PA maintained the beneficial effects on BP, but the negative association was attenuated, accompanied by the increase of PM 2.5 . PA decreased the BP and hypertension risks, while PM 2.5 showed the opposite results. PM 2.5 attenuated the beneficial effects of PA on BP and modified the association between PA and the risk of hypertension., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Estuarine wetlands with high organic carbon (OC) accumulation rates due to their high plant biomass and interception of tide-derived OC are generally considered as large CO 2 sinks. However, our previous study found that tidal OC input seems to stimulate soil CO 2 emissions, potentially weakening CO 2 sequestration in estuarine wetlands. To further verify this phenomenon, we first established a structural equation model, which confirmed a positive correlation between tidal OC input and soil organic carbon (SOC) and soil respiration. We then performed trace analysis to determine the stability of SOC derived from different sources and its effect on soil CO 2 emissions by analyzing the input and retention of OC derived from tides and plants in the Yangtze Estuary wetlands. From upstream to downstream, as tidal OC input decreased, the relative retention ratio of the tidal OC in wetland soil increased from 1.259 to 2.148, whereas the relative retention ratio of plant OC in the soil decreased from 61.5% to 14.8%. Our findings indicated that the degradability of tidal OC was higher upstream than that downstream, but both inhibited plant OC degradation, thus providing an important reason for the higher CO 2 emissions upstream of wetlands (with higher tidal OC input). In addition, the primarily contributor to CO 2 (δ 13 ) emissions' transforming from plant SOC (81.35%) to tidal SOC (91.18%) was an increase in organic matter input from the tide in a microcosm system. Consequently, a higher CO 2 output than CO 2 input (plant OC) due to the ready degradation of tidal OC consequently weakens the CO 2 sequestration capacity of the estuarine wetlands. This phenomenon is cause for concern regarding the CO 2 sink function of estuarine wetlands intercepting large amounts of organic matter., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Lei Wang reports financial support was provided by National Natural Science Foundation of China., (Copyright © 2023. Published by Elsevier Ltd.)

Objective: This study aimed to investigate the knowledge status of Alzheimer's disease (AD) among community health service center (CHSC) staff in Jiaxing, China, and to compare the effects of online with offline training., Methods: A total of 763 people from 12 community health service centers were investigated using a self-created general situation questionnaire and the Alzheimer's Disease Knowledge Scale (ADKS). Among the participants, 261 people who were willing to receive training were randomly divided into two groups according to the institution in which they worked to receive online or offline training, respectively., Results: The average ADKS score was 19.77, and the awareness rate was 65.92%; the results for every field were as follows: treatment and management (81.32%); life impact (77.76%); disease course (75.23%); assessment and diagnosis (68.94%); risk factors (65.05%); symptoms (57.90%); caregiving (44.06%). Education and profession had impacts on the total ADKS scores ( P < 0.05). A total of 261 people participated in the training, and there were significant differences in ADKS scores before and after training ( P < 0.05). Before the training, there was no significant difference in ADKS score between the two groups; after the training, either ( P > 0.05). There were significant differences in the ADKS scores after training in both groups ( P < 0.05)., Conclusion: Community health service center staff in Jiaxing had limited knowledge of AD, particularly in the "symptom" and "caregiving" dimensions. One instance of training on AD-related knowledge to some degree helped to improve this but still fell short of meeting the national requirements. No significant differences were found between offline and online training effects., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ma, Zhu, Tang, Diao, Qian, Feng and Zhang.)

Background: To primarily investigate the effect of using a clinical decision support system (CDSS) in community health centers in Shanghai, China, on the proportion of patients prescribed guideline-directed antithrombotic therapy. This study also gauged the general practitioner (GP)'s acceptance of the CDSS who worked in the atrial fibrillation (AF) special consulting room of the CDSS group., Methods: This was a prospective cohort study that included a semistructured interview and a feasibility study for a cluster-randomized controlled trial. Eligible patients who sought medical care in the AF special consulting rooms in two community health centers in Shanghai, China, between April 1, 2020, and October 1, 2020, were enrolled, and their medical records from the enrollment date, up to October 1, 2021, were extracted. Based on whether the GPs in the AF special consulting rooms of the two sites used the CDSS or not, we classified the two sites as a software group and a control group. The CDSS could automatically assess the risks of stroke and bleeding and provide suggestions on treatment, follow-up, adjustment of anticoagulants or dosage, and other items. The primary outcome was the proportion of patients prescribed guideline-directed antithrombotic therapy. We also conducted a semistructured interview with the GP in the AF special consulting rooms of the software group regarding the acceptance of the CDSS and suggestions on the optimization of the CDSS and the study protocol of the cluster-randomized controlled trial in the future., Results: Eighty-four patients completed the follow-up. The mean age of these subjects was 75.71 years, the median time of clinical visits was six times per person, and the follow-up duration was 15 months. The basic demographics were similar between the two groups, except for age ( t  = 2.109, p  = 0.038) and the HAS-BLED score ( χ 2  = 4.363, p  = 0.037). The primary outcome in the software group was 8.071 times higher than that in the control group (adjusted odds ratio (OR) = 8.071, 95% confidence interval (2.570-25.344), p  < 0.001). The frequency of consultation between groups was not significantly different ( p  = 0.981). It seemed that the incidence of adverse clinical events in the software group was lower than that in the control group. The main reason for dropouts in both groups was "following up in other hospitals." The GP in the AF special consulting rooms of the software group accepted the CDSS well., Conclusions: The findings indicated that it was feasible to further promote the CDSS in the study among community health centers in China. The use of the CDSS might improve the proportion of patients prescribed guideline-directed antithrombotic therapy. The GP in the AF special consulting room of the software group showed a positive attitude toward the CDSS., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Xueying Ru et al.)

Using nationally representative data from China, this paper investigated the impact of internal migration on sexual attitudes and whether this relationship is moderated by Internet use. We provide evidence that internal migration had a significantly positive impact on attitudes toward the acceptance of premarital sex, extramarital sex, and homosexuality. We also found that the positive nexus between internal migration and sexual attitudes was moderated by Internet use. The results further indicated that internal migration influenced sexual attitudes through extrication from traditional gender role values, the deterioration of subjective well-being, and the improvement of economic status., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: Postoperative pancreatic fistula (POPF) is the main complication of distal pancreatectomy (DP) and affects the prognosis of patients. The impact of several clinical factors mentioned in recent studies on POPF remains controversial. This study aimed to investigate the impact of a remnant pancreas and other perioperative factors on POPFs occurring after robot-assisted distal pancreatectomy (RDP) for nonmalignant pancreatic neoplasms., Methods: A total of 197 patients who received robot-assisted distal pancreatectomy (RDP) for nonmalignant pancreatic neoplasms at the Pancreatic Disease Center, Ruijin Hospital Shanghai Jiaotong University School of Medicine from January 2018 to December 2020 were included in this retrospective study. According to the intraoperative transection plan, patients were divided into an RDP body group and an RDP tail group. Clinical and pathological features and perioperative factors affecting POPF were analyzed and compared between the two groups., Results: The results showed that a transection plan involving the tail of the pancreas (OR = 2.133, 95% CI 1.109-4.103, p = 0.023) and spleen preservation (OR = 2.588, 95% CI 1.435-4.665, p = 0.001) independently increased the incidence of POPF in patients with nonmalignant pancreatic neoplasms treated by RDP. A transection plan involving the tail of the pancreas was also an independent risk factor (OR = 3.464, 95% CI 1.270-9.450, p = 0.015) for grade B/C POPF. Length of remnant pancreas > 6.23 cm was an independent risk factor for POPF (OR = 3.116, 95% CI 1.364-7.121, p = 0.007). Length of remnant pancreas > 9.82 cm was an independent risk factor for grade B/C POPF (OR = 3.340, 95% CI 1.386-8.051, p = 0.007)., Conclusion: This retrospective study suggests that a transection plan involving the tail of the pancreas is an independent risk factor for POPF in patients with nonmalignant neoplasms treated by RDP. We also propose that the postoperative length of the remnant pancreas evaluated by computed tomography scans can be used to identify patients with a high risk of POPF in order to optimize the individualized strategy., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

With the full implementation of poverty alleviation resettlement (PAR), the restoration and improvement of the comprehensive living standards of relocated households have received increasing attention from policy researchers. The measurement of resilience and its determinants provides new ideas for PAR at the community level. This article proposes a method for examining community resilience in the context of PAR through a survey of 459 relocated households in western China and uses regression analysis to identify the determinants of community resilience. The results showed that the four dimensions of community resilience, in descending order, included: environmental resilience, economic resilience, management resilience, and social resilience. Income level and livelihood diversification were positively correlated with the community resilience index. Relocation time, relocation type, and resettlement mode were all essential determinants of the community resilience of relocated households. Finally, some suggestions were put forward, such as the need to build an interpersonal relationship network, guide pure farmers and non-farmers to transform into diversified livelihood households, and formulate a unified community action plan and interest protection mechanism so as to provide a reference for decision-making among managers to make decisions.

A Gram-negative, aerobic, motile with paired polar flagella and rod-shaped bacterium strain (56D2 T ) was isolated from tobacco planting soil in Yunnan, PR China. Major fatty acids were C 16  :  1 ω 7 c (summed feature 3), C 16  :  0 and C 18  :  1   ω 7 c (summed feature 8). The polar lipid profile of strain 56D2 T consisted of diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylglycerol, one unidentified aminophospholipid and one unidentified glycolipid. Moreover, strain 56D2 T contained ubiquinone Q-8 as the sole respiratory quinone. 16S rRNA gene sequence analysis showed that strain 56D2 T was closely related to members of the genus Ralstonia and the two type strains with the highest sequence identities were R. mannitolilytica LMG 6866 T (98.36 %) and R. pickettii K-288 T (98.22 %). The 16S rRNA gene sequence identities between strain 56D2 T and other members of the genus Ralstonia were below 98.00 %. Genome sequencing revealed a genome size of 5.87 Mb and a G+C content of 63.7 mol%. The average nucleotide identity values between strain 56D2 T and R. pickettii K-288 T , R. mannitolilytica LMG 6866 T and R. insidiosa CCUG 46789 T were less than 95 %, and the in silico DNA-DNA hybridization values (yielded by formula 2) were less than 70 %. Based on these data, we conclude that strain 56D2 T represents a novel species of the genus Ralstonia , for which the name Ralstonia wenshanensis sp. nov. is proposed. The type strain of Ralstonia wenshanensis sp. nov. is 56D2 T (=CCTCC AB 2021466 T =GDMCC 1.2886 T =JCM 35178 T ).

Tailings resulting from mining and smelting activities may cause soil heavy-metal pollution and harm human health. To evaluate the environmental impact of heavy metals from tailings on farmland soils in the surrounding area, heavy metals (As, Cd, Cr, Cu, Ni, Pb, and Zn) in tailings and farmland soils in the vicinity of a typical copper tailings pond were analyzed. Contamination status, potential sources, and health risks for farmland soils were investigated. The results showed that the tailings contained a high concentration of Cu (1136.23 mg/kg). The concentrations of Cd and Cu in the farmland soils exceeded the soil quality standard. The geoaccumulation index ( I geo ) indicated that the soils were moderately polluted by Cu and Cd, and slightly polluted by Ni, Cr, and Zn. The absolute principal component scores-multiple linear regression (APCS-MLR) model was applied for source apportionment. The results showed that tailings release is the main source of soil heavy-metals contamination, accounting for 35.81%, followed by agricultural activities (19.41%) and traffic emission (16.31%). The health risk assessment suggested that the children in the study region were exposed to non-carcinogenic risks caused by As, while the non-carcinogenic risk to adults and the carcinogenic risk to both adults and children were at acceptable levels. It is necessary to take effective measures to control heavy-metal contamination from tailings releases to protect humans, especially children, from adverse health risks.

A chemical investigation of the Chinese liverwort Chandonanthus birmensis Steph identified five undescribed cembrane-type diterpenoids, together with six known cembrane diterpenes, one fusicoccane-type diterpenoid, and a dolabellane-type diterpenoid. Their structures were established by comprehensive analysis of HRESIMS, NMR spectroscopic data, electronic circular dichroism (ECD) calculations and single-crystal X-ray diffraction analysis. Cytotoxicity tests of the isolated diterpenoids against five cancer cell lines (A2780, A549, H460, H460RT, and HeLa) revealed that several compounds showed moderate inhibitory effects with IC 50 values ranging from 11.1 to 36.2 μM., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The investigation of Ecological Agriculture (EA) patterns can reveal the differences, aggregation, and diversity of agricultural development, providing specific paths in agricultural development and environmental protection to achieve the Sustainable Development Goals. Although field surveys, literature analysis, and the method using administrative statistics can be employed to investigate EA records and determine EA distributions comprehensively, they still rely on manual operations that are generally unable to support the rapid and large-scale identification of EA patterns required by current agricultural sustainable researches. To address this issue, this paper proposes a novel and rapid approach for Ecological Agriculture Pattern Investigation Based on Web-text (WEAPI), with the ability to automatically acquire EA pattern records, including pattern type, occurrence time, precise location, and other relevant information. The proposed method is employed in a national-scale case study to investigate trends in Chinese Ecological Agriculture (CEA). Results of the study reveal WEAPI's ability to detect new trends in CEA via the latest news and the corresponding distributions. The WEAPI method can also exhibit the unknown patterns of the current Chinese agricultural development. Further validation experiments demonstrate that the proposed method achieves over 95 % precision in the pattern parse processes and an 87 % coverage rate at the town level of the official CEA pattern list. Moreover, WEAPI can provide dynamic changing analyses on the annual evolution of the EA patterns in each type. Despite limitations under sparse records in partial classes, the results reveal WEAPI as a promising and powerful tool for agricultural research and agricultural development planning., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2022. Published by Elsevier B.V.)

Objective: To evaluate the diagnostic efficacy of Qisexingtai hand diagnostic method in the diagnosis of coronary artery disease (CAD)., Methods: This was an investigator-initiated, prospective, multi-center, cross-sectional study. All the participants from three hospitals in China had been diagnosed by both Qisexingtai hand diagnostic method and coronary angiography. We compared the two diagnostic methods to calculate the sensitivity, the specificity, the omission diagnostic rate, the mistaken diagnostic rate and accuracy in order to evaluate the diagnostic efficacy of Qisexingtai hand diagnostic method for CAD., Results: A total of 326 subjects were enrolled, diagnosed by both Qisexingtai hand diagnostic method and coronary angiography. As a result, there were 166 positive cases according to Qisexingtai hand diagnostic method, and 131 positive cases according to coronary angiography. Compared with the results of coronary angiography, the sensitivity of Qisexingtai hand dia-gnostic method was 80.2%, the specificity was 68.7%, the omission diagnostic rate was 19.8%, the mistaken diagnostic rate was 31.3%, and the accuracy was 73.3%. Area under the receiver operating characteristic curve was estimated as 0.735 for all, and 0.718, 0.735, 0.783 for the three sub-centers., Conclusion: Qisexingtai hand diagnostic method with high accuracy and sensitivity has certain application value in the diagnosis of CAD.

Background: Scrub typhus has become a serious public health concern in the Asia-Pacific region including China. There were new natural foci continuously recognized and dramatically increased reported cases in mainland China. However, the epidemiological characteristics and spatiotemporal patterns of scrub typhus in Fujian province have yet to be investigated., Objective: This study proposes to explore demographic characteristics and spatiotemporal dynamics of scrub typhus cases in Fujian province, and to detect high-risk regions between January 2012 and December 2020 at county/district scale and thereby help in devising public health strategies to improve scrub typhus prevention and control measures., Method: Monthly cases of scrub typhus reported at the county level in Fujian province during 2012-2020 were collected from the National Notifiable Disease Surveillance System. Time-series analyses, spatial autocorrelation analyses and space-time scan statistics were applied to identify and visualize the spatiotemporal patterns of scrub typhus cases in Fujian province. The demographic differences of scrub typhus cases from high-risk and low-risk counties in Fujian province were also compared., Results: A total of 11,859 scrub typhus cases reported in 87 counties from Fujian province were analyzed and the incidence showed an increasing trend from 2012 (2.31 per 100,000) to 2020 (3.20 per 100,000) with a peak in 2018 (4.59 per 100,000). There existed two seasonal peaks in June-July and September-October every year in Fujian province. A significant positive spatial autocorrelation of scrub typhus incidence in Fujian province was observed with Moran's I values ranging from 0.258 to 0.471 (P<0.001). Several distinct spatiotemporal clusters mainly concentrated in north and southern parts of Fujian province. Compared to low-risk regions, a greater proportion of cases were female, farmer, and older residents in high-risk counties., Conclusions: These results demonstrate a clear spatiotemporal heterogeneity of scrub typhus cases in Fujian province, and provide the evidence in directing future researches on risk factors and effectively assist local health authorities in the refinement of public health interventions against scrub typhus transmission in the high risk regions., Competing Interests: The authors have declared that no competing interests exist.

Background: Despite cumulative evidence reports the interaction effects of physical activity (PA) and air pollution on lung function, the findings have been inconsistent. We aimed to identify the threshold values that reverse the beneficial effects of PA on lung function., Methods: This multistage probability sampling study examined 13,032 individuals aged ≥45 years across China from 2011 to 2015. City-level particulate matter 2.5 μm or less in diameter (PM 2.5 ) were estimated based on a two-stage machine learning model, with a spatial resolution of 0.1° × 0.1°. We assessed PA and a range of covariates using standardized self-reported questionnaires. The peak expiratory flow (PEF) was measured using a peak flow meter. We used mixed-effects linear regression models to examine the associations between PA and PM 2.5 , and their interactions with PEF., Results: Participants were 60.4 ± 9.4 years old [mean ± standard deviation (SD)]. The mean ± SD of PM 2.5 and PEF was 54.4 ± 23.0 μg/m 3 and 273 ± 116 L/min, respectively. Each 10 μg/m 3 increase in PM 2.5 was associated with a 1.27 L/min decrease in PEF. The PEF increased by 2.48 (95% confidence interval, CI: 0.40, 4.55) L/min, 0.74 (95% CI: -1.17, 2.66) L/min, and 1.99 (95% CI: 0.001, 3.99) L/min following a 10 h/week increment of walking, moderate intensity PA, and vigorous intensity PA, respectively. Detrimental associations between PM 2.5 and PEF outweighed PA benefits for approximate PM 2.5 concentrations >81 μg/m 3 (95% CI: 58.9, 111) and >77 μg/m 3 (95% CI: 39.7, 102) for walking and vigorous intensity PA, respectively., Conclusions: We identified the threshold of ambient PM 2.5 above which the beneficial association of PA with lung function may be reversed to an adverse one. Although the threshold may vary across populations and places, the findings suggested that reducing air pollution could enhance the benefits of PA on lung function., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Few studies have simultaneously explored which size of particles has the greatest impact on the risk for pediatric asthma, bronchitis and upper respiratory tract infections (URTIs)., Objectives: To investigate the short-term association between size-segregated particle number concentrations (PNCs) and outpatient-department visits (ODVs) for major pediatric respiratory diseases., Methods: Daily counts of pediatric ODVs for asthma, bronchitis and URTIs were obtained from 66 hospitals in Shanghai, China, from 2016 to 2018. Pollutant effects were estimated using Poisson generalized additive models combined with polynomial distributed lag models. We also fitted co-pollutant cumulative effects models included six criteria air pollutants and conducted stratifying analyses by gender, age, season and geographic distances., Results: We identified a total of 430,103 patients with asthma, 1,547,013 patients with bronchitis, and 2,155,738 patients with URTIs from the hospitals. Effect estimates increased with decreasing particle size. Ultrafine particle (UFP) and PNCs of 0.10-0.40 µm particles (PNC 0.10-0.40 ) were associated with increased ODVs for asthma, bronchitis and URTIs at cumulative lags up to 3d. Associations tended to appear stable after adjusting for criteria air pollutants. At the cumulative lag 0-2d, each interquartile range increase in UFP was associated with increased ODVs due to asthma (relative risk 1.21, 95% CI: 1.07, 1.38), bronchitis (1.20, 95% CI: 1.07, 1.34) and URTI (1.17, 95% CI: 1.06, 1.30), whereas the associations for PNC 0.10-0.40 remained significant but attenuated in magnitude., Conclusions: UFP may be a leading contributor to the adverse respiratory effects of particulate air pollution and the effects increased with decreasing particle size., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)