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Background: Epilepsy is associated with a significant global burden of disease, affecting over 50 million people worldwide. The specific aim of this study is to compare the burden of epilepsy in the People's Republic of China (PRC) with the global burden, and to analyze the epidemiological trends of epilepsy, the relationship between the burden of epilepsy and social demographic index (SDI), and the relative contributions of epidemiological factors. Methods: This is a retrospective population-based study, data were obtained from the Global Burden of Disease (GBD) study in 2019. We employed Joinpoint software and the age-period-cohort (APC) model to analyze epilepsy's epidemiological trends. Health inequality analysis was conducted to investigate the impact of SDI on epilepsy burden. Decomposition analysis was performed to examine the relative contributions of age, population, and epidemiological changes to epilepsy. Results: Between 1990 and 2019, the incidence rate in the PRC increased by 45%, significantly surpassing the global incidence of epilepsy. However, Disability-Adjusted Life Years (DALY) decreased notably, and the proportion of Years of Life Lost (YLL) decreased from 62.73 to 39.03%. Concerning incidence, the period Rate Ratio (RR) in the PRC initially increased and then decreased, while the cohort RR in the PRC and globally exhibited a consistent upward trend. In terms of mortality, period RR and cohort RR in the PRC displayed a gradual decrease, with mortality starting higher but eventually falling below the global mortality. The net drifts of incidence were greater than 0, whereas the net drifts of mortality were less than 0, both were lower in the PRC than at the global level. Decomposition analysis indicated that the changes of incidence and mortality in the PRC were mainly attributed to epidemiological changes. Additionally, global disparities in epilepsy decreased, with the burden concentrating in low SDI countries. Conclusion: The incidence of epilepsy in the PRC rose during the 30-year study period, while epilepsy mortality decreased. The improved survival rate in the PRC is predominantly attributable to epidemiological changes. The burden of epilepsy in the PRC predominantly affects males, children, and the elderly, Chinese government should focus on specific populations. [ABSTRACT FROM AUTHOR]

This paper uses the multi‐period difference‐in‐differences (DID) method to empirically test the effects of Tech‐Fin on the innovation output of companies based on a quasi‐natural experiment to examine China's Tech‐Fin pilot city reform. We find that Tech‐Fin significantly increased the innovation output of high‐tech companies in the pilot cities and in cities with weak intellectual property protection. In addition, Tech‐Fin had no significant effects on the innovation output of pseudo‐high‐tech companies and technology‐intensive high‐tech companies. We further find that Tech‐Fin motivated high‐tech companies to increase their innovation output through innovation correction and risk‐smoothing effects. [ABSTRACT FROM AUTHOR]

BACKGROUND The optimal apolipoprotein or lipid measures for identifying statin-treated patients with coronary artery disease (CAD) at residual cardiovascular risk remain controversial. This study aimed to compare the predictive powers of apolipoprotein B (apoB), non-high-density lipoprotein cholesterol (non-HDL-C), low-density lipoprotein cholesterol (LDL-C), apoB/apolipoprotein A-1 (apoA-1) and non-HDL-C/HDL-C for myocardial infarction (MI) in CAD patients treated with statins in the setting of secondary prevention. METHODS The study included 9191 statin-treated CAD patients with a five-year median follow-up. All measures were analyzed as continuous variables and concordance/discordance groups by medians. The hazard ratio (HR) with 95% CI was estimated by Cox proportional hazards regression. Patients were classified by the clinical presentation of CAD for further analysis. RESULTS The high-apoB-low-LDL-C and the high-non-HDL-C-low-LDL-C categories yielded HR of 1.40 (95% CI: 1.04-1.88) and 1.51 (95% CI: 1.07-2.13) for MI, respectively, whereas discordant high LDL-C with low apoB or non-HDL-C was not associated with the risk of MI. No association of MI with discordant apoB versus non-HDL-C, apoB/apoA-1 versus apoB, non-HDL-C/HDL-C versus non-HDL-C, or apoB/apoA-1 versus non-HDL-C/HDL-C was observed. Similar patterns were found in patients with acute coronary syndrome. In contrast, no association was observed between any concordance/discordance category and the risk of MI in patients with chronic coronary syndrome. CONCLUSIONS ApoB and non-HDL-C better predict MI in statin-treated CAD patients than LDL-C, especially in patients with acute coronary syndrome. ApoB/apoA-1 and non-HDL-C/HDL-C show no superiority to apoB and non-HDL-C for predicting MI. [ABSTRACT FROM AUTHOR]

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Objective: Bacteremia caused by carbapenem-resistant Pseudomonas aeruginosa (CRPA) has high mortality, threatening the healthcare quality worldwide. Analysis is required to update the epidemiological data of CRPA bloodstream infections (BSI) and evaluate the prevalent strains in China. Moreover, it is necessary to clarify the risk factors associated with the development and mortality of CRPA bacteremia. Methods: This is a 9-year multicenter retrospective study, enrolling 137 patients with CRPA BSI and 137 carbapenem-susceptible P. aeruginosa (CSPA) BSI during January 2012 and December 2020. Antimicrobials susceptibility between the two groups were compared. Risk factors of CRPA BSI were identified by binary logistic regression for development and cox regression for mortality. The Kaplan-Meier method was used to compare time to mortality. CRPA and difficult-to-treat resistant P. aeruginosa (DTRPA) detection rate was analyzed year-by-year in ZYH. Results: A total of 7,384 P. aeruginosa clinical samples were cultured in ZYH during 9 years, and notable increase of CRPA and DTRPA detection rate in P. aeruginosa BSI was identified (from 17 to 60%; from 2.1 to 25%). Multivariate analysis revealed that prior ICU hospitalization, immunosuppressive therapy and exposure to carbapenems were independent risk factors for development of CRPA BSI. The 30-day crude mortality of 137 CRPA BSI was 39%. A total of 46 DTRPA were identified, and the 30-day mortality for patients infected by DTRPA was 50%. The 30-day crude mortality of CRPA BSI was independently associated with multiple organ failure and higher Pitt bacteremia score, whereas receipt appropriate therapy improved prognosis. Conclusion: A significant increase in the detection rate of CRPA and DTRPA in P. aeruginosa BSI was identified. Strict policies for carbapenems usage, cautious decisions regarding the usage of immunosuppressive agent and standard care for patients with prior ICU hospitalization are necessary for CRPA BSI management. [ABSTRACT FROM AUTHOR]

BACKGROUND: To investigate the most appropriate dual antiplatelet therapy (DAPT) duration for patients with acute coronary syndrome (ACS) after drug-eluting stent (DES) implantation in the largest cardiovascular center of China. METHODS: We enrolled 5,187 consecutive patients with ACS who received DES from January to December 2013. Patients were divided into four groups based on DAPT duration: standard DAPT group (11-13 months, n=1,568) and prolonged DAPT groups (13-18 months [n=308], 18-24 months [n=2,125], and >24 months [n=1,186]). Baseline characteristics and 5-year clinical outcomes were recorded. RESULTS: Baseline characteristics were similar across the four groups. Among the four groups, those with prolonged DAPT (18-24 months) had the lowest incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) (14.1% vs. 11.7% vs. 9.6% vs. 24.2%, P<0.001), all-cause death (4.8% vs. 3.9% vs. 2.1% vs. 2.6%, P<0.001), cardiac death (3.1% vs. 2.6% vs. 1.4% vs. 1.9%, P=0.004), and myocardial infarction (MI) (3.8% vs. 4.2% vs. 2.5% vs. 5.8%, P<0.001). The incidence of bleeding was not different among the four groups (9.9% vs. 9.4% vs. 11.0% vs. 9.4%, P=0.449). Cox multivariable analysis showed that prolonged DAPT (18-24 months) was an independent protective factor for MACCEs (hazard ratio [HR] 0.802, 95% confidence interval [CI] 0.729-0.882, P<0.001), all-cause death (HR 0.660, 95% CI 0.547-0.795, P<0.001), cardiac death (HR 0.663, 95% CI 0.526-0.835, P<0.001), MI (HR 0.796, 95% CI 0.662-0.957, P=0.015), and target vessel revascularization (HR 0.867, 95% CI 0.755-0.996, P=0.044). Subgroup analysis for high bleeding risk showed that prolonged DAPT remained an independent protective factor for all-cause death and MACCEs. CONCLUSION: For patients with ACS after DES, appropriately prolonging the DAPT duration may be associated with a reduced risk of adverse ischemic events without increasing the bleeding risk. [ABSTRACT FROM AUTHOR]

This paper presents an experimental investigation on the effects of initial water content and time during secondary compression on the strength behavior at low effective stresses of dredged clays obtained from two places in China. A suite of vane shear tests was conducted on clay samples consolidated at 16 kPa using the self-developed compression apparatus. Tests results showed that the shear angle corresponding to the peak shear stress almost increases with the decreasing time during secondary compression and the vane shear stress increases with decreasing initial water content at the same shear angle. A significant increase in peak strength with time during secondary compression was observed compared with the insignificant increase in residual strength. The normalized strength increases linearly with log time during secondary compression. The undrained strength of dredged clay specimens with different initial water contents consistently increases with time during secondary compression. The strength and time curve for specimens at lower initial water content lies above that at higher initial water content. A quantitative expression of normalized strength as functions of normalized water content and time during secondary compression was obtained. The proposed equation is verified by comparing the calculated results and measured results for other sources of samples. [ABSTRACT FROM AUTHOR]

OBJECTIVE To determine whether high-risk patients with three-vessel disease (TVD) with and without prior stroke preferentially benefit from three strategies [percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and medical therapy (MT)]. METHODS A total of 8943 patients with TVD were included in the study. Patients enrolled were stratified into two categories according to the presence or absence of prior stroke history. The primary endpoint was all-cause death. Secondary endpoints included stroke and major adverse cardiac and cerebrovascular event (MACCE), a composite of death, myocardial infarction (MI), unplanned revascularization and stroke. RESULTS Prior stroke was present in 888 patients (9.9%). These patients were older and had higher rates of comorbidities. During a median follow-up of 7.5 years, patients with prior stroke were strongly associated with increased risks of all-cause death, cardiac death, stroke and MACCE, even after adjusting for confounding variables and RESULTS been consistent across either treatment subgroup (PCI, CABG and MT) (all adjusted P < 0.01). Notably, there was a significant interaction between prior stroke history and treatment strategies. Revascularization strategy (PCI or CABG) was associated with a lower incidence of all-cause death and MACCE compared with MT alone, and favorable rates of MACCE, MI and unplanned revascularization in the CABG group compared with the PCI group, but with similar rate of all-cause death regardless of prior stroke history. The prevalence of stroke was significantly higher after CABG when compared with PCI or MT in no prior stroke patients [hazard ratio (HR) = 1.429, 95% CI: 1.132-1.805 for CABG vs. MT; HR = 1.703, 95% CI: 1.371-2.116 for CABG vs. PCI]. CONCLUSIONS Patients with TVD and prior stroke have poor clinical outcomes. It is essential to balance benefit and risk when determining the optimal treatment strategy for TVD with and without prior stroke. [ABSTRACT FROM AUTHOR]

Clinical vertebral fractures and femoral neck fractures are severe osteoporotic fractures that increase morbidity and mortality. Anthropometric variables are associated with an increased risk of osteoporotic fractures, but it is not clear whether body surface area (BSA) has an effect on clinically severe osteoporotic fractures. The study included total of 3,694 cases of clinical vertebral fractures and femoral neck fractures (2,670 females and 1,024 males) and 3,694 controls without fractures who were matched with the cases by sex and age. There was a significant positive correlation between BSA and bone mineral density (BMD) in female and male fracture patients (females: r = 0.430-0.471, P < 0.001; males: r = 0.338-0.414, P < 0.001). There was a significant systematic increase in BMD in both genders at various skeletal sites, grouped by BSA quartile. The osteoporosis rates of the lumbar spine (97.9%), femoral neck (92.4%) and total hip (87.1%) in the female Q1 group were significantly higher than those in the Q4 group (P < 0.001), which were 80.0%, 57.9% and 36.9%, respectively, in the Q4 group; the osteoporosis rates of the lumbar spine, femoral neck, and total hip were 53.9%, 59.4%, and 36.3% in the male Q1 group, and 15.2%, 21.9%, and 7.03% in the Q4 group, which were significantly lower than those in the Q1 group (P < 0.001). In age-adjusted Cox regression models, the risk of fracture in the remaining three groups (Q2, Q3, and Q4) for weight, BMI, and BSA for both genders, compared with the highest quartile (Q1 by descending quartile stratification) were significantly higher. In models adjusted for age and BMD, only men in the BSA Q3 (HR = 1.55, 95% CI = 1.09-2.19) and BSA Q4 groups (HR = 1.41, 95% CI = 1.05-1.87) had significantly higher fracture risks. In models adjusted for age, height, weight, BMI, and BSA, low BMD was the greatest fracture risks for both sexes. Our results showed that BSA was closely related to BMD, prevalence of osteoporosis, and fracture risk, and that a decline in BSA may be a new potential risk factor for osteoporotic fractures in Chinese men. [ABSTRACT FROM AUTHOR]

Earlier studies have reaffirmed the pivotal role played by the private sectors in China's development, so the growth of private enterprises deserves more attention. This paper carries out a series of empirical studies based on the motives for holding cash. It is found that private enterprises were forced to maintain a high level of cash holdings to deal with financing constraints, while SOEs accumulate cash proactively for larger financial flexibility. In such context, credit discrimination remains an urgent problem pending Chinese financial system reform solutions. [ABSTRACT FROM AUTHOR]

Based on the daily OISST V2 with 0.25° horizontal resolutions, the present study looks into the variations of sea surface temperature (SST) extremes in the China Seas for different segments of the period 1982-2013. The two segments include the warming acceleration period from 1982 to 1997 and the hiatus period from 1998 to 2013 when the global mean surface temperature (GMST) did not significantly increase as expected, or even decreased in some areas. First, we construct the regional average time series over the entire China Seas (15°-45°N, 105°-130°E) for these SST extremes. During the hiatus period, the regionally averaged 10th, 1th and 0.1th percentile of SSTs in each year decreased significantly by 0.40°C, 0.56°C and 0.58°C per decade, respectively. The regionally averaged 90th, 99th and 99.9th percentile of SSTs in each year decreased slightly or insignificantly. Our work confirm that the regional hiatus was primarily reflected by wintertime cold extremes. Spatially, the trends of cold extremes in different intensity were non-uniformly distributed. Cold extremes in the near-shore areas were much more sensitive to the global warming hiatus. Hot extremes exhibited non-significant trend in the China Seas during the hiatus period. In short, the variations of the SST extremes in the two periods were non-uniform spatially and asymmetric seasonally. It is unexpected that the hot and cold extremes of each year during 1998-2013 were still higher than those extremes during 1982-1997. It is obvious that compared with the warming acceleration period, hot extremes were far more likely to occur in the recent hiatus as a result of a 0.3°C warmer shift in the mean temperature distribution. Moreover, hot extremes in the China Seas will be sustained or amplified with the end of warming hiatus and the continuous anthropogenic warming. Key words: sea surface temperature; linear trend; regional climate change; extreme [ABSTRACT FROM AUTHOR]

The multi-functionality of land as the basis of land use and utilization is under increasing investigation. This study assesses the spatiotemporal dynamic multi-functionality of land use and analyzes the obstacle indicators in Xiangxi using two methods, i.e., the analytic hierarchy process (AHP) and the hierarchical weighting method (HWM). First, we found that the total function level of land use in Xiangxi was constantly optimized. Spatial heterogeneity was clearer. Land use had a trend toward diversification, with a focus on production or living function. The coordination of multifunctional land use has undergone certain changes. It was more apparent in the south than in central and northern regions. Second, we discovered that production function of land use in Xiangxi grew slowly and spatial differentiation was enhanced. The living function fluctuated with the trend of spatial equilibrium. Changes in ecological function and any spatial differentiation were not clear. Third, land use can be divided into living-ecological, production-living, and production obstacle types. Lastly, we state that, to narrow the gap between urban-rural areas and reduce the non-point pollution from agriculture in living-ecological barrier areas, we need to develop production and social public utilities in production-living barrier areas, and develop production and eliminate poverty in production barrier areas. [ABSTRACT FROM AUTHOR]

Purpose The number of cancer cases in China has increased rapidly from 2.1 million in 2000 to 4.3 million in 2015. As a consequence, pain management as an integral part of cancer treatment became an important health care issue. In March 2011, the Good Pain Management (GPM) program was launched to standardize the treatment of cancer pain and improve the quality of life for patients with cancer. With this work, we will describe the GPM program, its implementation experience, and highlight key lessons that can improve pain management for patients with cancer. Methods We describe procedures for the selection, implementation, and assessment procedures for model cancer wards. We analyzed published results in areas of staff training and patient education, pain management in practice, analgesic drugs administration, and patient follow-up and satisfaction. Results Pain management training enabled medical staff to accurately assess the level of pain and to provide effective pain relief through timely dispensation of medication. Patients with good knowledge of treatment of pain were able to overcome their aversion to opioid drugs and cooperate with nursing staff on pain assessment to achieve effective drug dose titration. Consumption of strong opioid drugs increased significantly; however, there was no change for weaker opioids. Higher pain remission rates were achieved for patients with moderate-to-severe pain levels. Proper patient follow-up after discharge enabled improved outcomes to be maintained. Conclusion The GPM program has instituted a consistent and high standard of care for pain management at cancer wards and improved the quality of life for patients with cancer. [ABSTRACT FROM AUTHOR]

A simulation study on occupant evacuation in high-speed railway stations (HSRSs) was presented in China. Pathfinder was employed as the simulation platform and a typical HSRS in a medium-sized city in China was selected for model development. The model was carefully calibrated and validated, by comparing ssmulation results with field data. Evacuation efficiency could be improved with the increased door width while such effect decreased when the door width reached a marginal value. And the marginal value varies under different occupant densities. An exponential function between evacuation time and occupant density was fUted, indicating that occupant density signficantly afected evacuation efficiency. A set of different evacuation strategies were compared, in terms of their evacuation performances. It was found that a balanced door usage would result in more etficient evacuations in HSRSs. Thus, occupant flows were suggested to be managed considering door capacity. To avoid potential safety issues caused by such strategy (e.g., more occupants could be evacuated from a smaller area designed with higher door capacity), occupant needed to enhance their awareness of following evacuation guidance instead of panic escape in emergencies. Moreover, such safety issues could also be avoided during the design phase that the evacuation capacity was designed to be proportional to the room capaciiy for each floor. The results of this study provide valuable information for HSRS design and flow management in China. [ABSTRACT FROM AUTHOR]

The objective of this paper is to analyze land use characteristics of rural settlements in urban fringe so as to provide references for optimizing the regional distribution of rural settlements, consolidating rural settlements, and coordinating urban-rural integrated development. The methods of spatial statistical analysis, buffer analysis, Ripley's K function, kernel density analysis based on GIS (Geographic Information System) were used to analyze the characteristics of scale, spatial differentiation and spatial patterns of the rural settlements in Liangjiang New Area in Chongqing Municipality of China. The fractal dimension formula was also developed to reflect fractal feature of the rural settlements. The results show that, the scale of rural settlements in Liangjang New Area takes on distinct characteristics of spatial differentiation along with changes in elevation, gradient, location, geo-hazards distribution, and the like. The fractal characteristic of rural settlements has obvious regional variations subject to the 6 factors of location in the Liangjiang New Area. Overall, the worse the terrain conditions are, the larger the fractal dimension values become. The better the location conditions, the larger the fractal dimension values are. The spatial pattern in the township scale presents three kinds of distribution as being aggregated, uniform and random. In contract, the spatial pattern in the plaque scale displays a banding distribution from a general view with several aggregation zones centering on each town center. From the results, we can see that the characteristics of rural settlements in urban fringe are more complicated. For such kind of rural settlements in special regions, in the rural land consolidation more attention should be paid to improve the rural living environments and public services, as well as to promote the harmonious relationship between the urban and rural areas. [ABSTRACT FROM AUTHOR]

Background: Pneumocystis jiroveci pneumonia (PJP) in non-HIV patients is still a challenge for intensivists. The aim of our study was to evaluate mortality predictors of PJP patients requiring Intensive care unit (ICU) admission. Methods: Retrospectively review medical records of patients with diagnosis of PJP admitted to four ICUs of two academic medical centers from October 2012 to October 2015. Results: Eighty-two patients were enrolled in the study. Overall hospital mortality was 75.6 %. Compared with survivors, the non-survivors had older age (55 ± 16 vs. 45 ± 17, p = 0.014), higher APACHE II score (20 ± 5 vs. 17 ± 5, p = 0.01), lower white blood cell count (7.68 ± 3.44 vs. 10.48 ± 4.62, p = 0.005), less fever (80.6%vs. 100 %, p = 0.033), more hypotension (58.1 % vs. 20 %, p = 0.003), more pneumomediastinum (29 % vs. 5 %, p = 0.027). Logistic regression analysis demonstrated that age [odds ratio (OR)1.051; 95 % CI 1.007-1.097; p = 0.022], white blood cell count [OR 0.802; 95 % CI 0.670-0.960; p = 0.016], and pneumomediastinum [OR 16.514; 95 % CI 1.330-205.027; p = 0. 029] were independently associated with hospital mortality. Conclusions: Mortality rate for non-HIV PJP patients requiring ICU admission was still high. Poor prognostic factors included age, white blood cell count and pneumomediastinum. [ABSTRACT FROM AUTHOR]

INTRODUCTION: In mainland China, there are no special care centers (long-term acute care, weaning, chronic care facilities) for patients requiring prolonged mechanical ventilation (PMV). Our goal was to characterize the prevalence and outcome of patients undergoing PMV in Chinese intensive care units (ICUs). METHODS: A prospective 1-d prevalence study was performed at 55 ICUs, with 28-d follow-up. RESULTS: On the observation day, 622 adult patients occupied ICU beds. Enrollment criteria were met by 302 subjects receiving invasive mechanical ventilation, of which 109 (36.1%) had received ventilation for more than 21 d (median 51, 21-3,419), which was defined as PMV. During the following 28 d, another 45 subjects were classified as receiving PMV, but only 5% (3/58) of the subjects who were newly admitted to the ICU on the study day received PMV. Thirty-six (22.9%) of the 157 subjects receiving PMV were weaned, and 81 (51.6%) continued ventilation in the ICU. In the logistic regression analysis, age >74 y (odds ratio = 2.78, 95% CI 1.05-7.40, P = .041) and chronic congestive heart failure (odds ratio =12.23, 95% CI 1.48-101.05, P = .020) were associated with failure to wean in 28 d, while acute respiratory distress syndrome (ARDS) as the reason for mechanical ventilation (odds ratio = 0.14, 95% CI 0.04-0.52, P = .003) was associated with successful weaning. CONCLUSION: The number of subjects receiving PMV was surprisingly high in this cross-section of Chinese ICUs. In the following 28 ICU days, only a small proportion of these subjects were weaned. Age and chronic heart dysfunction were high risk factors for weaning failure. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to elucidate recurrent pregnancy loss (RPL)-associated psychosocial effects and sexual functions of Chinese men whose partners experience a history of RPL. Methods: Questionnaire data from a total of 236 men whose partners experience RPL(RPL group) and another 236 non-RPL male volunteers(control group) were analyzed. The self-administered questionnaires included anxiety and depression measures (SAS & SDS), the Index of Sexual Satisfaction (ISS) and the International Index of Erectile Function (IIEF-5) for evaluating psychological burden, sexual satisfaction and erectile function, respectively. Results: The mean age of the RPL group and control group was 29.8 ± 8.6 and 28.2 ± 7.3, respectively. The incidence of erectile dysfunction was significantly higher in the RPL group than in the control group (19.07 % vs. 7.63 %, < 0.001). P Anxiety and depression were also more prevalent in RPL group than in the control group (anxiety: 36.90 % vs. 19.08 %, P < 0.001; depression: 26.30 % vs. 7.63 %, < 0.001). Furthermore, after adjusting for age in the RPL group, negative P relationships were observed between the IIEF-5 score and anxiety and depression ( < 0.001), and a positive correlation P was found between the ISS and anxiety and depression ( < 0.001). In addition, history of RPL, anxiety and depressive P symptoms were significantly associated with a higher risk of ED. Conclusions: Psychological functioning, sexual satisfaction and erectile function are impaired in infertile men with RPL partners. These men should be targeted for psychological consultation. [ABSTRACT FROM AUTHOR]

Symphoricarpos sinensis is an important ornamental plant in China. Due to the lack of efficient molecular markers, although recent studies supported that Symphoricarpos was phylogenetically closely related to Lonicera, Triosteum, Heptacodium, and Leycesteria, relationships among these taxa remained uncertain. To examine the phylogenetic position of Symphoricarpos within Caprifoliaceae, we characterized the complete chloroplast (cp) genome of S. sinensis. The results showed that S. sinensis shared a typical quadripartite structure as with most angiosperms. It was 155,738 bp in length, including two inverted repeat (IR) regions (24,010 bp), a small single-copy (SSC) region (18,942 bp) and a large single-copy (LSC) region (88,776 bp). Phylogenetic analysis demonstrated that Caprifoliaceae and Adoxaceae formed two distinct monophyletic clades, and S. sinensis was closely related to lonicera and Triosteum, albeit with low support. The whole cp genome of S. sinensis will be useful resources for future studies on phylogeny and conservation in Symphoricarpos. [ABSTRACT FROM AUTHOR]

BACKGROUND: Respiratory therapist (RT) is a nascent career in China, so little information is available about intensive care unit (ICU) respiratory care resources and practices, requirements for RTs, and barriers to recruit RTs. METHODS: Using survey methodology, we designed and mailed a questionnaire to ICU supervisors and staffs at all 106 ICUs within 46 tertiary and university-affiliated hospitals in Beijing. RESULTS: We obtained responses from 72 of 106 ICUs. There were 644 ICU beds, 18 RTs, 464 physicians, and 1,362 nurses in these 72 ICUs. The ratios of invasive and noninvasive ventilators to beds were 0.7/1 and 0.31/1. Nineteen ICUs were not equipped with noninvasive ventilators; 18 had started using noninvasive ventilation only within the last 5 years; 9 had only nasal cannulas for conventional oxygen therapy. Of 194 responders, 57.8% implemented spontaneous breathing trial before extubation; 23.7% never monitored airway temperature while using heated humidifier; 56.7% changed circuits once a week; and 20.6% every 1-3 days. The survey indicated that 91.2% had heard of the profession of RT before, mostly by attending academic conferences; 86.1% believed respiratory care should be provided by RTs. Due to the paucity of trained RTs, only 9.7% (7/72) ICUs had actually recruited RTs. The specific tasks supposed to be assigned to RTs were mechanical ventilation, chest physiotherapy, and airway care. CONCLUSIONS: ICU respiratory care equipment and the knowledge to use them are insufficient. Important differences exist in respiratory care practice, which is mostly provided by nurses and physicians. RTs have been gradually recognized and accepted by ICU staff, while professional training and education are needed. [ABSTRACT FROM AUTHOR]

The detection of Coronal Mass Ejections (CMEs) is an important prerequisite for establishing a CME event database and realizing the prediction of CME interplanetary propagation. The Lyman-alpha Solar Telescope (LST) aboard the ASO-S (Advanced Space-based Solar Observatory) satellite will be equipped with a white-light coronagraph. The images with CME detected will be contributed to various space weather prediction centers in China for CME early warning. The Visual Geometry Group (VGG) 16 convolutional neural network method is applied by us to automatically and effectively classify coronagraph images. Firstly, based on the image of the white light coronagraph of Large Angle and Spectrometric Coronagraph Experiment (LASCO) C2, we labeled the images according to whether a CME is observed. Then, the data set was used for training the VGG model. We find that the accuracy of the model in the test set classification reaches 92.5%. Next, according to the obtained classification results and combined with the space-time continuity rules, we corrected the mislabeling of images, and derived our final CME image sequences. Compared with the manual CME catalog of Coordinated Data Analysis Workshops (CDAW), the classified CME image sequences can include CME data more completely, and have higher detection sensitivity for weak CME structures. [ABSTRACT FROM AUTHOR]

Background: As the Diagnostic and Statistical Manual of Mental Disorders fifth version (DSM-5) was published, the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (K-SADS-PL) was modified to adapt the new version (K-SADS-PL DSM-5). We translated it to Chinese (K-SADS-PL-C DSM-5) and described its reliability and validity.Methods: A total of 154 groups of 6 to 18-year-old children and their guardians were included. Trained interviewers interviewed subjects using the K-SADS-PL-C DSM-5. Interrater reliability was assessed by audio recording. Parent-reported scales, like child behavior checklist (CBCL), the Chinese version of Swan-son Nolan and Pelham, version IV scale-parent form (SNAP-IV), social responsiveness scale (SRS-1), and children-reported scales like depression self-rating scale for children (DSRSC) and the screen for child anxiety related emotional disorders (SCARED) were used to examine the validity of depressive disorder, ADHD, ASD, and ODD.Results: The K-SADS-PL-C DSM-5 had fair to excellent interrater (0.537-1.000) and test-retest (0.468-0.885) reliability of affective disorder and neurodevelopment disorder. The convergent validity of affective disorder and neurodevelopment disorder was good, and their divergent validity was acceptable.Limitations: i) Clinical questionnaires were insensitive in classifying disorders and had limitations in derived diagnoses. ii) Samples only came from clinical environment, iii) covered limited disease species, and iv) were small.Conclusion: The K-SADS-PL-C DSM-5 can support reliable and valid diagnoses for children with affect, neurodevelopmental, and behavioral disorders in China. [ABSTRACT FROM AUTHOR]

[Display omitted] • Stable isotope and element fingerprints can track the geographical origin of tobacco. • Both OPLS-DA and RF models displayed satisfactory overall performance. • The fusion of stable isotopes and elements has higher discrimination accuracy. • This study builds the traceability fingerprints dataset of tobacco from different areas. Tobacco is an important economic crop widely grown around the world. Its quality and features are closely interrelated to its geographical origin. With a view to identify the geographical origin of tobacco leaves, stable isotope ratios (δ13C, δ15N and δ2H) and 33 element contents in 260 tobacco samples collected from six provinces in China were determined by stable isotope ratio mass spectrometry (IRMS) and inductively coupled plasma mass spectrometry (ICP-MS), respectively, and analyzed with the aid of chemometric methods such as Orthogonal Partial Least-Squares Discriminant Analysis (OPLS-DA) and Random Forest (RF). Experimental results revealed that δ2H, Zn and Tl were significantly different in samples from different regions, which indicated their potential to be used in geographical origin classification of tobacco samples. Both OPLS-DA and RF models displayed satisfactory overall performance for the discrimination of geographical origins of tobacco samples from six cultivation areas. Particularly, the RF model built on the fused data of IRMS and ICP-MS had an exquisite sensitivity of 98.5% in comparison with the RF models on either the data set produced by IRMS or ICP-MS alone, whose sensitivity values were 92.3% and 95.4%, respectively. It was found that the top ten influential indicators for identifying the geographic origin of tobacco were δ2H, Cr, δ15N, 87/86Sr, Li, Ba, Sb, Pb, Tl, and Zn. This work may open up an avenue for geographical origin classification of tobacco. [ABSTRACT FROM AUTHOR]

Objective: This study aims to identify morphological changes in the lung parenchyma of acute respiratory distress syndrome (ARDS) survivors after extracorporeal membrane oxygenation (ECMO) by high-resolution computed tomography (HRCT) follow-up. Factors influencing these changes are also examined. Methods: Information and lung HRCT scans were collected and studied 1, 3, 6, and 12 months after the withdrawal of severe ARDS survivors rescued by ECMO in the Respiratory Care Unit of Beijing Chaoyang Hospital from November 2009 to August 2012. The observation endpoint was set as the time when the lung lesions were basically absorbed or 12 months after withdrawal. Results: Among nine survivors, one survivor was lost to follow-up. The lesions of two patients, which were attributed to bacterial pneumonia and pneumocystis pneumonia, were basically absorbed 1 month after surgery. Six patients completed the 12 month follow-up. Although initial morphological changes varied, different degrees of absorption improvement were observed in later stages of treatment. Lung HRCT analysis on the sixth month indicated that the degree of involvement of the ventral region was greater than that of the dorsal area. No significant difference was observed in patients in terms of ECMO support time, pre-ECMO Murray score, and APACHE II score, among others. Conclusion: Lung HRCT of severe ARDS survivors after ECMO treatment showed various degrees of morphological changes in the lung parenchyma. The severity of these changes may be associated with the disease duration. [ABSTRACT FROM AUTHOR]

In China, the epidemiological and socioeconomic status of the migrant population suggests that the vulnerable population should be prioritized for tuberculosis (TB) control. A face-to-face interview using a structured questionnaire was performed on a total of 314 smear-positive pulmonary TB patients among the migrant population of 12 randomly selected counties in Shandong Province, China. From the results, the cases of patient delay of diagnosis accounted for 40.8%, and the completion rate of Direct Observation Therapy, Short-course (DOTS) was as low as 67.2%. There were 47.1% missed cases in the first diagnosis. Factors affecting detection and treatment were present in their socioeconomic status, working style, and the accessibility to related TB care. The findings indicated that migrant TB patients suffer delayed diagnosis, a low case detection rate and a low completion DOTS rate. Improvement of migrants' working conditions and accessibility to specialized TB care is essential and is expected to lead to better case detection and treatment completion. [ABSTRACT FROM AUTHOR]

Many large-scale southwestern mountain rivers have intensive hydropower development in China, and it is difficult for the mainstream habitats to meet the needs of fish; thus, the replacement of tributary habitats has become an effective measure for river ecological protection. Appropriate ecological flow is an important tool used to repair fish habitats and plays an important role in the ecological protection of tributaries, but this practice has caused conflicts with the economic interests of hydropower owners, which has made the implementation of restoration work more difficult; therefore, it is imperative to ease the contradiction between the two. Based on field investigation and monitoring, this paper designs remedial measures for the horizontal and vertical sections of the river section, namely, dredging the river horizontally and constructing a water-retaining weir and underwater dam vertically. A two-dimensional hydrodynamic model was used to numerically simulate the hydrodynamic conditions before and after different ecological restoration measures, and the corresponding weighted usable area (WUA) was calculated to evaluate the different restoration effects on habitats. The results show that the suitable ecological flow rate of the study section is 16.80 m3/s (35% average annual flow), and the WUA increased by 317.37% compared with the initial state of 2.39 m3/s (5% average annual flow); when discharge flow is 4.80 m3/s (10% average annual flow), the improvement measures of habitat quality include the combination of river dredging and the construction of water-retaining weir, construction of water-retaining weir, construction of underwater dam, and river dredging. The initial state increased by 129.96%, 177.19%, 226.51% and 329.21%, respectively. The partial excavation and dredging have a complementary effect with the construction of the water trap, and the increase in the WUA caused by the combination of the two exceeds the increase caused by the appropriate ecological flow. In summary, targeted restoration measures can achieve the goal of maintaining a high level of habitat quality at lower flow levels. [ABSTRACT FROM AUTHOR]

Background: For patients receiving one lung ventilation in thoracic surgery, numerous studies have proved the superiority of lung protective ventilation of low tidal volume combined with recruitment maneuvers (RM) and individualized PEEP. However, RM may lead to overinflation which aggravates lung injury and intrapulmonary shunt. According to CT results, atelectasis usually forms in gravity dependent lung regions, regardless of body position. So, during anesthesia induction in supine position, atelectasis usually forms in the dorsal parts of lungs, however, when patients are turned into lateral decubitus position, collapsed lung tissue in the dorsal parts would reexpand, while atelectasis would slowly reappear in the lower flank of the lung. We hypothesize that applying sufficient PEEP without RM before the formation of atelectasis in the lower flank of the lung may beas effective to prevent atelectasis and thus improve oxygenation as applying PEEP with RM., Methods: A total of 84 patients scheduled for elective pulmonary lobe resection necessitating one lung ventilation will be recruited and randomized totwo parallel groups. For all patients, one lung ventilation is initiated the right after patients are turned into lateral decubitus position. For patients in the study group, individualized PEEP titration is started the moment one lung ventilation is started, while patients in the control group will receive a recruitment maneuver followed by individualized PEEP titration after initiation of one lung ventilation. The primary endpoint will be oxygenation index measured at T4. Secondary endpoints will include intrapulmonary shunt, respiratory mechanics, PPCs, and hemodynamic indicators., Discussion: Numerous previous studies compared the effects of individualized PEEP applied alone with that applied in combination with RM on oxygenation index, PPCs, intrapulmonary shunt and respiratory mechanics after atelectasis was formed in patients receiving one lung ventilation during thoracoscopic surgery. In this study, we will apply individualized PEEP before the formation of atelectasis while not performing RM in patients allocated to the study group, and then we're going to observe its effects on the aspects mentioned above. The results of this trial will provide a ventilation strategy that may be conductive to improving intraoperative oxygenation and avoiding the detrimental effects of RM for patients receiving one lung ventilation., Trial Registration: www.Chictr.org.cn ChiCTR2400080682. Registered on February 5, 2024., (© 2024. The Author(s).)

Purpose: Hirschsprung's disease (HSCR) is the leading cause of neonatal functional intestinal obstruction, which has been identified in many familial cases. HSCR, a multifactorial disorder of enteric nervous system (ENS) development, is associated with at least 24 genes and seven chromosomal loci, with RET and EDNRB as its major genes. We present a genetic investigation of familial HSCR to clarify the genotype-phenotype relationship., Methods: We performed whole exome sequencing (WES) on Illumina HiSeq X Ten platform to investigate genetic backgrounds of core family members, and identified the possibly harmful mutation genes. Mutation carriers and pedigree relatives were validated by Sanger sequencing for evaluating the gene penetrance., Results: Four familial cases showed potential disease-relative variants in EDNRB and RET gene, accounting for all detection rate of 57.1%. Three familial cases exhibited strong pathogenic variants as frameshift or missense mutations in EDNRB gene. A novel c.367delinsTT mutation of EDNRB was identified in one family member. The other two EDNRB mutations, c.553G>A in family 2 and c.877delinsTT in family 5, have been reported in previous literatures. The penetrance of EDNRB variants was 33-50% according mutation carries. In family 6, the RET c.1858T>C (C620R) point mutation has previously been reported to cause HSCR, with 28.5% penetrance., Conclusion: We identified a novel EDNRB (deleted C and inserted TT) mutation in this study using WES. Heterozygote variations in EDNRB gene were significantly enriched in three families and RET mutations were identified in one family. EDNRB variants showed an overall higher incidence and penetrance than RET in southern Chinese families cases., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Food and nutrition literacy (FNL) plays an important role in young adults' dietary habits and nutrition. This study aimed to investigate FNL status and its associated factors among young adults aged 15-44 years in Shenzhen., Methods: A cross-sectional survey of 5,390 participants was conducted in June 2021. FNL was measured using the Food and Nutrition Literacy Questionnaire for Chinese Adults (FNLQ). A generalized linear model was employed to analyze the factors associated with FNL., Results: The median FNL score (total score = 100) was 68.00, which was below the adequate level of 80. FNL was divided into the two different domains of knowledge and skills, with significantly different scoring rate of 85.30 and 67.77%, respectively. The overall proportion of respondents with adequate FNL was 19.52%. The FNL score was significantly higher among the participants who were female ( β  = 2.665; 95% confidence interval [CI]: 2.031-3.299) and with higher education levels ( β ranging from 5.632 [CI: 3.845-7.419] to 10.756 [CI: 8.973-12.538]), healthcare-related work experience ( β  = 4.197; CI: 3.557-4.837) and a higher economic status ( β ranging from 0.753 [CI: 0.079-1.426] to 6.217 [CI: 5.208-7.227]). Those who were divorced or with an unknown marital status ( β  = -8.438; CI: -9.701, -7.175), abnormal body mass index (thin [ β  = -2.115; CI: -3.063, -1.166], overweight [ β  = -1.427; CI: -2.254, -0.600]), and suffering from chronic diseases (single disease [ β  = -3.483; CI: -4.485, -2.480], multimorbidity [ β  = -5.119; CI: -5.912, -4.327]) had significantly lower FNL scores., Conclusion: Generally, the level of FNL among young adults in Shenzhen, China, was relatively low. Thus, nutrition education programs targeted at promoting improved FNL status call for additional emphasis, especially in subgroups with lower scores., 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 Zhixue, Ying, Zheng, Yan, Yanfang, Dewang, Weijun, Rencheng, Qing and Meihong.)

Mushroom poisoning is a public health concern worldwide that not only harms the physical and mental health of those who are poisoned but also increases the medical and financial burden on families and society. The present study aimed to describe and analyze the current situations and factors influencing mushroom poisoning outbreaks in Guizhou province, Southwest China, between January 2012 and June 2022, and to predict the future trends of its occurrence. Our study provides a basis for the rational formulation of prevention and control and medical resource allocation policies for mushroom poisoning. The epidemiological characteristics and factors influencing mushroom poisoning incidence were analyzed using descriptive epidemiological methods and the chi-squared test, respectively. Then, future occurrence trends were predicted using the SARIMA and Prophet models. In total, 1577 mushroom poisoning incidents were recorded in Guizhou Province, with 7347 exposures, 5497 cases, 3654 hospitalizations, and 93 fatalities. The mortality rate was 4.45% in 1 ~ 6 years higher than other age groups. There were notable geographic and seasonal characteristics, with the number of occurrences much higher in rural areas (1198) than in cities (379), and poisoning cases were more common during the rainy season (June to September). The mortality rate of household poisoning cases was 1.86%, with the most deaths occurring in households. Statistically significant differences were observed in the incidence across various cities, periods, and poisoning locations (P < 0.05). Both models had advantages and disadvantages for prediction. Nevertheless, the SARIMA model had better overall prediction results than the Prophet model (R > 0.9, the residual plot of the prediction results was randomly distributed, and RMSE SARIMA  < RMSE Prophet ). However, the prediction result plot of the Prophet model was more explanatory than the SARIMA model and could visualize overall and seasonal trends. Both models predicted that the prevalence of mushroom poisoning would continue to increase in the future; however, the number of fatalities is generally declining. Seasonal patterns indicated that a high number of deaths from gooseberry mushroom poisoning occurred in October. The epidemiological trends of mushroom poisoning remain severe, and health education on related knowledge must be strengthened in rural areas, with June to October as the key prevention and control phase. Further, medical treatment of mushroom poisoning cases with clinical symptoms should pay attention to inquiries to check whether the mushroom is similar in appearance to the Amanita, particularly in October., (© 2023. The Author(s).)

Background: In recent years, there has been an increase in the incidence of health problems among college students in China, the lack of adequate physical exercise is the major reason. This study aimed to investigate methods to promote exercise behavior and cardiovascular fitness among college students based on the motivation theory., Methods: Cardiovascular fitness levels of 641 college students (20.72 ± 1.41 years old) were measured. Exercise motivation was assessed using the physical exercise motivation scale and physical exercise rating scale. Correlation analysis, regression analysis, and structural equation models were used to assess exercise motivation, exercise behavior, and cardiovascular fitness. Energy relationships were determined to develop a path model that promotes exercise behavior and aerobic fitness among college students., Results: The exercise motivation of college students was directly related to cardiovascular fitness (effect value: 0.577) or indirectly related through the mediating effect of exercise behavior (effect value: 0.215). The influence of health motivation on exercise behavior (β = 0.132, p = 0.001) and cardiovascular fitness (β = 0.251, p < 0.001) was greater than that of other factors of motivation., Conclusions: The physical exercise behavior of college students partially mediates the relationship between exercise motivation and cardiovascular fitness. Therefore, the educational concept of "Health First" should be promoted in college sports. Internal motivation of exercise can be transformed into external motivation to improve students' exercise behavior and cardiovascular fitness through enhancing their cardiopulmonary capacity., (© 2022. The Author(s).)

Objective. Cultures have essential influences on emotions. However, most studies on cultural influences on emotions are in the areas of psychology and neuroscience, while the existing affective models are mostly built with data from the same culture. In this paper, we identify the similarities and differences among Chinese, German, and French individuals in emotion recognition with electroencephalogram (EEG) and eye movements from an affective computing perspective. Approach. Three experimental settings were designed: intraculture subject dependent, intraculture subject independent, and cross-culture subject independent. EEG and eye movements are acquired simultaneously from Chinese, German, and French subjects while watching positive, neutral, and negative movie clips. The affective models for Chinese, German, and French subjects are constructed by using machine learning algorithms. A systematic analysis is performed from four aspects: affective model performance, neural patterns, complementary information from different modalities, and cross-cultural emotion recognition. Main results. From emotion recognition accuracies, we find that EEG and eye movements can adapt to Chinese, German, and French cultural diversities and that a cultural in-group advantage phenomenon does exist in emotion recognition with EEG. From the topomaps of EEG, we find that the γ and β bands exhibit decreasing activities for Chinese, while for German and French, θ and α bands exhibit increasing activities. From confusion matrices and attentional weights, we find that EEG and eye movements have complementary characteristics. From a cross-cultural emotion recognition perspective, we observe that German and French people share more similarities in topographical patterns and attentional weight distributions than Chinese people while the data from Chinese are a good fit for test data but not suitable for training data for the other two cultures. Significance. Our experimental results provide concrete evidence of the in-group advantage phenomenon, cultural influences on emotion recognition, and different neural patterns among Chinese, German, and French individuals., (© 2022 IOP Publishing Ltd.)

Environmental molecular markers can be used to understand the sources, transport, and fate of pollutants. Furthermore, they can also be applied to assess the influences of anthropogenic activities and elucidate urbanization from different perspectives. In this study, the potential of linear alkylbenzenes (LABs) and polycyclic aromatic hydrocarbons (PAHs) as chemical indicators of urbanization was examined first. Overall, the concentrations of LABs and PAHs ranged from 5.49-148 ng/g (mean: 15.6, median: 9.33) and 3.61-4878 ng/g (mean: 181, median: 71.3), respectively. Owing to the different sources and input methods of these two substances in soil, the area-weighted median values for LABs were more suitable to assess the magnitude of contamination on the administrative scale. For PAHs, the average values were more practical. LAB (consumption-induced pollutants) and PAH (production-induced pollutants) concentrations exhibited good correlations with some indices for residential daily life and industrialization, which indicated that soil can be utilized to reveal multidimensional urbanization-environment relationships. Two different patterns, the inverted U-shaped pattern and the upward pattern, were employed to simulate the environment-urbanization relationships in Shenzhen, China, which indicated that raising the standard of living or industrialization had created different soil pollution. The environmental quality demand was more difficult to meet by changing the energy structure than by improving infrastructure., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Globally, postpartum hemorrhage (PPH) is the leading cause of maternal death. Women with immune thrombocytopenia (ITP) are at increased risk of developing PPH. Early identification of PPH helps to prevent adverse outcomes, but is underused because clinicians do not have a tool to predict PPH for women with ITP. We therefore conducted a nationwide multicenter retrospective study to develop and validate a prediction model of PPH in patients with ITP. We included 432 pregnant women (677 pregnancies) with primary ITP from 18 academic tertiary centers in China from January 2008 to August 2018. A total of 157 (23.2%) pregnancies experienced PPH. The derivation cohort included 450 pregnancies. For the validation cohort, we included 117 pregnancies in the temporal validation cohort and 110 pregnancies in the geographical validation cohort. We assessed 25 clinical parameters as candidate predictors and used multivariable logistic regression to develop our prediction model. The final model included seven variables and was named MONITOR (maternal complication, WHO bleeding score, antepartum platelet transfusion, placental abnormalities, platelet count, previous uterine surgery, and primiparity). We established an easy-to-use risk heatmap and risk score of PPH based on the seven risk factors. We externally validated this model using both a temporal validation cohort and a geographical validation cohort. The MONITOR model had an AUC of 0.868 (95% CI 0.828-0.909) in internal validation, 0.869 (95% CI 0.802-0.937) in the temporal validation, and 0.811 (95% CI 0.713-0.908) in the geographical validation. Calibration plots demonstrated good agreement between MONITOR-predicted probability and actual observation in both internal validation and external validation. Therefore, we developed and validated a very accurate prediction model for PPH. We hope that the model will contribute to more precise clinical care, decreased adverse outcomes, and better health care resource allocation., (© 2021 Wiley Periodicals LLC.)

Purpose: As yet, no checkpoint inhibitor has been approved to treat nasopharyngeal carcinoma (NPC). This study was aimed to evaluate the antitumor activity, safety, and biomarkers of toripalimab, a new programmed death-1 (PD-1) inhibitor for recurrent or metastatic NPC (RM-NPC) refractory to standard chemotherapy., Patients and Methods: In this single-arm, multicenter phase II study, patients with RM-NPC received 3 mg/kg toripalimab once every 2 weeks via intravenous infusion until confirmed disease progression or unacceptable toxicity. The primary end point was objective response rate (ORR). The secondary end points included safety, duration of response (DOR), progression-free survival (PFS), and overall survival (OS)., Results: Among all 190 patients, the ORR was 20.5% with median DOR 12.8 months, median PFS 1.9 months, and median OS 17.4 months. Among 92 patients who failed at least two lines of systemic chemotherapy, the ORR was 23.9%. The ORRs were 27.1% and 19.4% in PD-L1+ and PD-L1- patients, respectively ( P = .31). Patients with ≥ 50% decrease of plasma Epstein-Barr virus (EBV) DNA copy number on day 28 had significantly better ORR than those with < 50% decrease, 48.3% versus 5.7% ( P = .0001). Tumor mutational burden had a median value of 0.95 muts/mega-base in the cohort and had no predictive value for response. Whole-exome sequencing results from 174 patients revealed that the patients with genomic amplification in 11q13 region or ETV6 genomic alterations had poor responses to toripalimab., Conclusion: The POLARIS-02 study demonstrated a manageable safety profile and durable clinical response of toripalimab in patients with chemorefractory metastatic NPC. An early decrease in plasma EBV DNA copy number correlated with favorable response.

Objective: To explore the clinical manifestations, pathological features and treatment of small cell neuroendocrine carcinoma of the prostate (SCPCa)., Methods: We reported 1 case of SCPCa treated in Jinan People's Hospital and analyzed the clinical data on another 57 cases reported in China., Results: Of the total number of cases, 52 (91.2%) had urinary tract symptoms, including 40 cases of urinary tract obstruction symptoms and 53 (91.2%) had abnormal prostatic nodules on digital rectal examination, 17 (29.8%) with PSA > 4 μg/L. The clinical data on 43 (75.4%) of the cases were valuable for the assessment of clinical stages, including 30 cases with confirmed metastases and another 20 with lymph node and distant metastases. Thirty-seven of the cases (64.9%) were reported with immunohistochemical results, 30 (52.6%) with follow-up data (followed up for 1－24 months, with median survival time of 8 months, and a 1-year survival rate of 16.7%), and another 26 with therapeutic information, 14 treated by chemotherapy, with a median survival time of 11 months and a 1-year survival rate of 28.6%, significantly higher than in the non-chemotherapy groups (P<0.01)., Conclusions: Small cell carcinoma of the prostate is highly malignant with poor prognosis. Its clinical symptoms mainly include urinary tract obstruction, its definite diagnosis chiefly depends on histopathology and immunohistochemistry, and its treatment recommended is chemotherapy-based comprehensive protocol.

Long-term immunoreactivity to mycobacterial antigens in Bovis Calmette-Guérin (BCG)-vaccinated population is not well investigated. Herein, 361 volunteer healthy donors (HDs) with neonatal BCG vaccination from Shanghai region (China) were enrolled. They were subdivided into ESAT-6/CFP10 - (E6C10 - ) and ESAT-6/CFP10 + (E6C10 + ) groups based on gamma-interferon release assays (IGRAs). Three mycobacterial antigens, including Rv0934, Rv3006, and Rv3841, were subjected to the determination of immunoreactivity by ELISPOT assay. The immunoreactivities to three mycobacterial antigens were firstly compared among TB patients (N=39), E6C10 + HDs (N=78, 21.61% of HDs) and E6C10 - HDs (N=283, 78.39% of HDs). It was revealed that Rv3006 was dominant upon M.tb infection, while Rv3841 was likely to be more responsive upon latent TB infection. In E6C10 - population, the immunoreactivity to Rv3841 maintained along with aging, whereas those to Rv3006 and Rv0934 attenuated in E6C10 - HDs older than 45 years old. Our study implies the shift of dominant antigens at different infection statuses, providing the clues for the selection of mycobacterial antigens in vaccine development and precision revaccination in the future., 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 © 2021 Yang, Zhang, Xiao, Liang, Ji, Wang, Wang and Chen.)

Background: Molecular subtyping of triple-negative breast cancers (TNBCs) via gene expression profiling is essential for understanding the molecular essence of this heterogeneous disease and for guiding individualized treatment. We aim to devise a clinically practical method based on immunohistochemistry (IHC) for the molecular subtyping of TNBCs., Materials and Methods: By analyzing the RNA sequencing data on TNBCs from Fudan University Shanghai Cancer Center (FUSCC) (n = 360) and The Cancer Genome Atlas data set (n = 158), we determined markers that can identify specific molecular subtypes. We performed immunohistochemical staining on tumor sections of 210 TNBCs from FUSCC, established an IHC-based classifier, and applied it to another two cohorts (n = 183 and 214)., Results: We selected androgen receptor (AR), CD8, FOXC1, and DCLK1 as immunohistochemical markers and classified TNBCs into five subtypes based on the staining results: (a) IHC-based luminal androgen receptor (IHC-LAR; AR-positive [+]), (b) IHC-based immunomodulatory (IHC-IM; AR-negative [-], CD8+), (c) IHC-based basal-like immune-suppressed (IHC-BLIS; AR-, CD8-, FOXC1+), (d) IHC-based mesenchymal (IHC-MES; AR-, CD8-, FOXC1-, DCLK1+), and (e) IHC-based unclassifiable (AR-, CD8-, FOXC1-, DCLK1-). The κ statistic indicated substantial agreement between the IHC-based classification and mRNA-based classification. Multivariate survival analysis suggested that our IHC-based classification was an independent prognostic factor for relapse-free survival. Transcriptomic data and pathological observations implied potential treatment strategies for different subtypes. The IHC-LAR subtype showed relative activation of HER2 pathway. The IHC-IM subtype tended to exhibit an immune-inflamed phenotype characterized by the infiltration of CD8+ T cells into tumor parenchyma. The IHC-BLIS subtype showed high expression of a VEGF signature. The IHC-MES subtype displayed activation of JAK/STAT3 signaling pathway., Conclusion: We developed an IHC-based approach to classify TNBCs into molecular subtypes. This IHC-based classification can provide additional information for prognostic evaluation. It allows for subgrouping of TNBC patients in clinical trials and evaluating the efficacy of targeted therapies within certain subtypes., Implications for Practice: An immunohistochemistry (IHC)-based classification approach was developed for triple-negative breast cancer (TNBC), which exhibited substantial agreement with the mRNA expression-based classification. This IHC-based classification (a) allows for subgrouping of TNBC patients in large clinical trials and evaluating the efficacy of targeted therapies within certain subtypes, (b) will contribute to the practical application of subtype-specific treatment for patients with TNBC, and (c) can provide additional information beyond traditional prognostic factors in relapse prediction., (© AlphaMed Press 2020.)

This study evaluates the eco-efficiency of agriculture in Pupiao Town, in the Yunnan province of China, through micro-level research. The term "eco-efficiency" refers to the efficiency with which ecological resources are used to meet human needs. Interviews and field research were conducted to collect the data of the 23 villages from 2016 to 2018. The Data Envelopment Analysis model (DEA) was used for data analysis. The results were as follows: (1) The eco-efficiency scores of Pupiao Town had considerable spatial heterogeneity, exhibiting a general trend of higher in the middle and lower in the east and west, which suggested eco-efficiency may be correlated with topography and transportation. (2) The value of eco-efficiency for the entire town had considerable areas for improvement and showed a slow-growth trend. (3) Fertilizers, pesticides, agricultural diesel, agricultural carbon emission, and non-point source pollution had a significant impact on eco-efficiency, followed by agricultural labor and arable land. (4) Agricultural chemicals were primary determinants affecting eco-efficiency. Most of the factors had a stronger effect on the eastern and western regions. The study suggests that transportation should be improved to promote the conveyance of market information and the application of more efficient and productive farm methods. The most important way is to improve effective utilization and to reduce the amount of agricultural chemicals. In addition, it is necessary to offer technical training and help to support farmers in upgrading their farm operations.

Objective: Recently, immune checkpoints blockers showed higher anti-tumor activity for advanced gastric cancer (GC). The purpose of the study is to find out predictive biomarkers related to anti-cytotoxic lymphocyte antigen 4 (CTLA4) therapy. Materials and methods: Datasets of gene expression omnibus (GEO), the cancer genome atlas (TCGA), and gene set enrichment analysis (GESA) were extracted. Differential expression of CTLA4 between cancer tissues and normal mucosa, enrichment of WT (wild type) vs. CTLA4&#95;KO (knockout) upregulated gene set and clinical significance were analyzed. The expression of CTLA4, CD3, and granzyme A (GZMA) were validated on 30 cases of Chinese GC. Microsatellite instability (MSI) marker MLH1 and Epstein-Barr virus (EBV) marker EBER were examined on 30 cases of Chinese GC by immunohistochemistry and in situ hybridization. Results: CTLA4 was upregulated in GC tissue relative to normal mucosa in datasets of GSE27342 (fold change = 1.586, p  < .001) and GSE63089 (fold change = 1.365, p  < .001). Increased CTLA4 expression was positively related to CTLA4 activation. EBV-associated GC (EBVaGC) and microsatellite instability GC (MSIGC) disclosed higher CTLA4 levels than other GCs. Genomic stability GC (GSGC) also showed higher enrichment score of CTLA4 activation. CTLA4 activation resulted in shorter overall survival in GC. The expression level of CTLA4 was well correlated to expression levels of GZMA ( R  = 0.701, p  < .001) and CD3 ( R  = 0.750, p  < .001). Conclusions: Based on bioinformatics analysis, GSGC should be worth noticed as a potential GC subtypes responsive to anti-CTLA4 treatment.

Due to rapid increases in socioeconomic development and the human population over the past few decades, the shallow lakes in China have suffered from eutrophication and poor water quality. The conditions in Lake Dianchi Caohai, which is in the northern part of Lake Dianchi, are considered the most serious. The ecological restoration of Lake Dianchi Caohai began in the late 1980s. Lake managers and the public have been puzzled by the lack of a significant response of the water quality to the flow pattern despite the tremendous investment in water quality improvements. Therefore, lake managers desperately need to understand the responses of pollutant behaviors to proposed management measures. In this paper, a depth-averaged two-dimensional hydrodynamic and water quality model based on hydrological data, measured lake bed elevation, and water quality data is developed to simulate the flow field and water quality of Lake Dianchi Caohai. This model was validated using water quality data from the Caohaizhongxin site in 2016, and a close agreement was found between the model results and observations. Wind-driven circulation in Lake Dianchi Caohai was observed in the model results, which revealed that the lake flow pattern was dominated by wind-driven circulation, while the inflow/outflow played only a subsidiary role during this period. The formation of the wind-driven current in Lake Dianchi Caohai could be roughly divided into three stages. The hydrodynamic processes connected with the distribution of chlorophyll a are evaluated and discussed to adequately understand the hydraulic mechanisms driving the accumulation of cyanobacteria. Moreover, we designed three scenarios after comparing all possible operation scenarios to analyze the contributions of each different operation scenario to the water quality improvements. The optimal ecological operation scenario which has the best impacts on the water quality, especially the reduction in Chla and NH₃-N concentration, is proposed based on our comprehensive analysis. The water quality improvement and management suggestions proposed in this paper are based on lake flow patterns and make up for previous studies that did not consider the effects of hydraulic characteristics on water quality improvement in Lake Dianchi Caohai.

Introduction: In mainland China, there are no special care centers (long-term acute care, weaning, chronic care facilities) for patients requiring prolonged mechanical ventilation (PMV). Our goal was to characterize the prevalence and outcome of patients undergoing PMV in Chinese intensive care units (ICUs)., Methods: A prospective 1-d prevalence study was performed at 55 ICUs, with 28-d follow-up., Results: On the observation day, 622 adult patients occupied ICU beds. Enrollment criteria were met by 302 subjects receiving invasive mechanical ventilation, of which 109 (36.1%) had received ventilation for more than 21 d (median 51, 21-3,419), which was defined as PMV. During the following 28 d, another 45 subjects were classified as receiving PMV, but only 5% (3/58) of the subjects who were newly admitted to the ICU on the study day received PMV. Thirty-six (22.9%) of the 157 subjects receiving PMV were weaned, and 81 (51.6%) continued ventilation in the ICU. In the logistic regression analysis, age >74 y (odds ratio = 2.78, 95% CI 1.05-7.40, P = .041) and chronic congestive heart failure (odds ratio =12.23, 95% CI 1.48-101.05, P = .020) were associated with failure to wean in 28 d, while acute respiratory distress syndrome (ARDS) as the reason for mechanical ventilation (odds ratio = 0.14, 95% CI 0.04-0.52, P = .003) was associated with successful weaning., Conclusion: The number of subjects receiving PMV was surprisingly high in this cross-section of Chinese ICUs. In the following 28 ICU days, only a small proportion of these subjects were weaned. Age and chronic heart dysfunction were high risk factors for weaning failure., (Copyright © 2016 by Daedalus Enterprises.)

Aim: To investigate the influence of nodal status on response and clarify the optimal treatment for operable esophageal squamous cell carcinoma (OSCC)., Methods: We retrospectively analyzed 1490 OSCC patients who underwent transthoracic esophagectomy and lymphadenectomy between December 1996 and December 2009 at the Sun Yat-sen University Cancer Center. The surgical approach and the number of resected lymph nodes (LNs) were considered in the assessment of surgery. Patients were classified according to their nodal statuses (N0 vs N1 vs N2-3). Overall survival was defined as the time from the date of death or final follow-up. Survival analysis was performed using the Kaplan-Meier method and differences between curves were assessed by the log-rank test. Univariate and multivariate Cox regression analyses were used to identify factors associated with prognosis. Statistical significance was assumed at a P < 0.05., Results: With a median time from surgery to the last censoring date for the entire cohort of 72.2 mo, a total of 631 patients were still alive at the last follow-up and the median survival time was 35.5 mo. The surgical approach (left transthoracic vs Ivor-Lewis/tri-incisional) was verified as independent prognostic significance in patients with N0 or N1 status, but not in those with N2-3 status. Similar results were also observed with the number of resected LNs (≤ 14 vs ≥ 15). Compared with surgery alone, combined therapy achieved better outcomes in patients with N1 or N2-3 status, but not in those with N0 status. For those with N2-3 status, neither the surgical approach nor the number of resected LNs reached significance by univariate analysis, with unadjusted HRs of 0.826 (95%CI: 0.644-1.058) and 0.849 (95%CI: 0.668-1.078), respectively, and aggressiveness of surgery did not influence the outcome; the longest survival was observed in those patients who received the combined therapy., Conclusion: Combined therapy has a positive role in OSCC with LN metastasis, and aggressive surgical resection does not improve survival in patients with N2-3 status.

Purpose: This study set out to examine the relationship between step frequency and velocity to develop a step frequency-based equation to predict Chinese youth's energy expenditure (EE) during walking and running., Method: A total of 173 boys and girls aged 11 to 18 years old participated in this study. The participants walked and ran on a treadmill at speeds of 3 km/hr, 4 km/hr, 5 km/hr, 6 km/hr, 7 km/hr, and 8 km/hr. EE was measured using indirect calorimetry of open circuit spirometry (Cosmed K4b2 metabolic analyzer). Using multiple regression analysis, the relationship between step frequency and velocity was first examined, and the prediction equation of EE based on step frequency, age, and gender was derived., Results: The hypothesized relationship between step frequency and velocity was confirmed and an accurate (R2 = .78) EE prediction equation was derived: NetEE = - 13.7744 + 1.8004 (step frequency) - 5.5715 (age) - 11.5244 (gender)., Conclusion: A step frequency-, age-, and gender-based equation was derived to predict the EE of youth during walking and running. The equation can be used to develop a simple device to estimate EE during walking and running in this population.

Background: The importance of basic surgical skills is entirely agreed among surgical educators. However, restricted by ethical issues, finance etc, the basic surgical skills training is increasingly challenged. Increasing cost gives an impetus to the development of cost-effective training models to meet the trainees' acquisition of basic surgical skills. In this situation, a cost-effective training framework was formed in our department and introduced here., Methods: Each five students were assigned to a 'training unit'. The training was implemented weekly for 18 weeks. The framework consisted of an early, a transitional, an integrative stage and a surgical skills competition. Corresponding training modules were selected and assembled scientifically at each stage. The modules comprised campus intranet databases, sponge benchtop, nonliving animal tissue, local dissection specimens and simulating reality operations. The training outcomes used direct observation of procedural skills as an assessment tool. The training data of 50 trainees who were randomly selected in each year from 2006 to 2011 year, were retrospectively analysed., Results: An excellent and good rate of the surgical skills is from 82 to 88%, but there is no significant difference among 6 years (P > 0.05). The skills scores of the contestants are markedly higher than those of non-contestants (P < 0.05). The average training cost per trainee is about $21.85-34.08., Conclusion: The present training framework is reliable, feasible, repeatable and cost-effective. The skills competition can promote to improve the surgical skills level of trainees., (© 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.)

This study examined the polyphenols of tea leaves as chemotaxonomic markers to investigate the phenetic relationship between 89 wild (the small-leaved C.sinensis var. sinensis and large-leaved C. sinensis var. assamica), hybrid, and cultivated tea trees from China and Japan. (-)-Epigallocatechin 3-O-gallate, EGCG (1); (-)-epigallocatechin, EGC (2); (-)-epicatechin 3-O-gallate, ECG (3); (-)-epicatechin, EC (4); (+)-catechin, CA (5); strictinin, STR (6); and gallic acid, GA (7) were used as polyphenolic markers. Of the 13 polyphenol patterns observed, Principal Component Analysis (PCA) indicated that the structure-types of the flavonoid B-rings, such as the pyrogallol-(EGCG (1) and EGC (2)) and catechol-(ECG (3) and EC (4)) types, greatly influenced the classification. Ward's minimum-variance cluster analysis was used to produce a dendrogram that consisted of three sub-clusters. One sub-cluster (A) was composed of old tea trees 'Gushu' cha (C. sinensis var. assamica) and cv 'Taidi' cha, suggesting that relatively primitive tea trees contain greater amounts of compounds 3 and 4 and lower amounts of compounds 1 and 2. The other two sub-clusters B and C, made up of Chinese hybrids (sub-cluster B) and Japanese and Taiwanese tea trees (sub-cluster C), had lower contents of 3 and 4 than sub-cluster A. Therefore, PCA and cluster analysis indicated that the greater the amounts of 1 and 2 (and the lower of 3 and 4), the more recent the origin of the tea line. Based on morphological characteristics, geographical information, and the historical information on tea trees, these results show good agreement with the current theory of tea tree origins, and this suggests that the Xishuangbanna district and Puer City are among the original sites of the tea tree species., (Copyright 2010 Elsevier Ltd. All rights reserved.)

E-cadherin, a calcium-dependent cell-cell adhesion molecule, functions as maintenance of epithelial integrity. nm23, encoded by non-metastatic 23 gene, plays a key role in differentiation of many kinds of epithelium. Loss or dysfunction of E-cadherin and nm23 was frequently identified in many types of human cancers and is considered to correlate with invasive/metastatic phenotype. We previously reported that defective expression of E-cadherin might play a role in the development of the malignant phenotype in non-small cell lung cancer (NSCLC) [Q.Y. Fei, H.T. Zhang, X.F. Chen, et al., Defected expression of Ecadherin in non-small cell lung cancer, Lung Cancer 37 (2002) 147-152]. In an attempt to evaluate the significance of E-cadherin and nm23 in human non-small cell lung cancer, we performed mRNA expression and genetic structure analyses of the E-cadherin and nm23 genes in 54 NSCLCs and 46 normal lung tissues. The mRNA expression was determined by semi-quantitative RT-PCR, and genetic structure was examined through PCR-SSCP followed by sequencing. Although no mutation of the E-cadherin and nm23 genes was detected, the results obtained in the present study showed that reduction of E-cadherin and nm23 mRNA expression remarkably correlated with low histological differentiation, increasing stage as well as lymph node metastases (P<0.05). These data provide us with support for the idea that dysfunction of E-cadherin and nm23 has a role in progression of NSCLC and that the examination of E-cadherin and nm23 expression can provide experimental evidence for clinical treatment.