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Objective: Accurate prediction of survival prognosis is helpful to guide clinical decision-making. The aim of this study was to develop a model using machine learning techniques to predict the occurrence of composite thromboembolic events (CTEs) in elderly patients with atrial fibrillation(AF). These events encompass newly diagnosed cerebral ischemia events, cardiovascular events, pulmonary embolism, and lower extremity arterial embolism., Methods: This retrospective study included 6,079 elderly hospitalized patients (≥ 75 years old) with AF admitted to the People's Liberation Army General Hospital in China from January 2010 to June 2022. Random forest imputation was used for handling missing data. In the descriptive statistics section, patients were divided into two groups based on the occurrence of CTEs, and differences between the two groups were analyzed using chi-square tests for categorical variables and rank-sum tests for continuous variables. In the machine learning section, the patients were randomly divided into a training dataset (n = 4,225) and a validation dataset (n = 1,824) in a 7:3 ratio. Four machine learning models (logistic regression, decision tree, random forest, XGBoost) were trained on the training dataset and validated on the validation dataset., Results: The incidence of composite thromboembolic events was 19.53%. The Least Absolute Shrinkage and Selection Operator (LASSO) method, using 5-fold cross-validation, was applied to the training dataset and identified a total of 18 features that exhibited a significant association with the occurrence of CTEs. The random forest model outperformed other models in terms of area under the curve (ACC: 0.9144, SEN: 0.7725, SPE: 0.9489, AUC: 0.927, 95% CI: 0.9105-0.9443). The random forest model also showed good clinical validity based on the clinical decision curve. The Shapley Additive exPlanations (SHAP) showed that the top five features associated with the model were history of ischemic stroke, high triglyceride (TG), high total cholesterol (TC), high plasma D-dimer, age., Conclusions: This study proposes an accurate model to stratify patients with a high risk of CTEs. The random forest model has good performance. History of ischemic stroke, age, high TG, high TC and high plasma D-Dimer may be correlated with CTEs., (© 2024. The Author(s).)

Invasive pests reduce biodiversity and ecosystem service functions, thereby leading to economic and also agricultural losses. Banana skipper (Erionota torus Evans), red palm weevil (Rhynchophorus ferrugineus), and coconut caterpillar (Opisina arenosella Walker) are invasive insect pests in the palm-growing regions and they have had serious consequences for the planting of bananas (Musa nana), palms (Trachycarpus fortune) and coconut (Cocos nucifera). Based on screened occurrence data, the present research utilized Maximum Entropy model (Maxent) to simulate the distribution dynamics of these three invasive insects in China, under current and future climate (2050s, 2070s, 2090s) in two shared socio-economic pathways (SSPs: 126 and 585) of the newly released coupled model intercomparison project phase6 (CMIP6). The results show that: (1) Under current and future climate conditions, all model groups exhibited an AUC value exceeding 0.92, which shows that the model prediction results are very good;(2) The suitable habitat area of E. torus Evans remains relatively stable with some expansion in the SSP126 of 2090s and some contraction in the SSP585 of 2090s. The suitable habitat area of R. ferrugineus showed an overall contraction, with substantial contraction in the SSP585 of 2090s.The suitable habitat area of O. arenosella has an overall expansion, with the most pronounced expansion in the SSP585 of 2070s; (3) The current centroid of suitable habitats for R. ferrugineus and E. torus Evans is located in Guangxi Province and wholely shift toward the south direction under future climate. The centroid of suitable habitats for O. arenosella is currently located in the northeastern maritime area of Hainan Province and will shift toward the north direction under future climate; (4) Temperature, precipitation and Human disturbance factors (Population density and Human influence index) were crucial variables for describing the distribution of the three species. For E. torus Evans in particular, percentage contributions of Population density was up to 31.4, which is only 0.1 different from ranked first Bio19 (Precipitation of the coldest quarter). The dynamics of habitats of these three species and the correlating driver factors proposed in this work provide essential insights into future spatial management of the three invasive insects in China. Our work is necessary and timely in identifying newly areas at high risk of expansion of the three invasive insects in the future, then suggesting strategic control measures to prevent their spread, and finally providing scientific evidence for the early prevention and rapid response to the three invasive insects., (© 2024. The Author(s).)

With the continuous decline of global biodiversity, biodiversity conservation has attracted more and more attention from the international society. In order to slow down the trend of biodiversity decline, it is particularly important to identify key areas for biodiversity conservation. However, most of current methods for identifying important areas have different assessment criteria and focus on different biological assemblages (species or communities) and ecosystem types. Key biodiversity areas (KBAs) are sites that contribute significantly to global biodiversity persistence. Unlike traditional research and identification methods, KBAs identification is based on a unified global standard to explore habitats that are critical to endangered plants and animals in terrestrial, freshwater, and marine ecosystems. Based on the theoretical and technical framework of KBAs, we summarized the system of identification criteria and assessment parameters for KBAs. The five high-level criteria are separated into eleven sub-level criteria. Among the eleven evaluation parameters, there is one evaluation parameter for the ecosystem level, eight evaluation parameters for the species level, one evaluation parameter for the gene level, and one comprehensive evaluation parameter. In addition, we analyzed the application of KBAs identification in biodiversity research and conservation combined with relevant domestic and foreign research cases. Furthermore, we discussed the future development direction and application prospect of KBAs identification method in China. This method could provide a new perspective for the formulation of ecological protection policies and the planning of naturally protected areas in China.

Background: Few studies have specifically observed the relationship of sarcopenia, visceral obesity, or their joint effects with lean NAFLD in patients with diabetes. We aimed to investigate the associations of lean NAFLD with sarcopenia, visceral obesity, and sarcopenic visceral obesity (SV) in Chinese patients with type 2 diabetes mellitus (T2DM)., Methods: Altogether, 1,112 T2DM patients with BMI <25 kg/m 2 were enrolled, and 33.18% of them were diagnosed with lean NAFLD by abdominal ultrasonography. Body composition markers were measured by bioelectrical impedance (BIA). Skeletal muscle mass index (SMI) was calculated as appendicular skeletal muscle mass (ASM) divided by weight, and sarcopenia was defined as SMI < 1 standard deviation (SD) below the sex-specific average for a young reference population. Visceral obesity was defined as visceral fat area (VFA) ≥ 100 cm 2 . Participants were categorized into one of the four body composition groups: nonsarcopenia/nonvisceral obesity (NN), nonsarcopenia/visceral obesity (NV), sarcopenia/nonvisceral obesity (SN), and SV., Results: Compared to those in the NN group, patients in the NV and SN groups had a higher risk of lean NAFLD after full adjustments (NV: OR = 1.74; 95% CI: 1.09, 2.78; SN: OR =2.07; 95% CI: 1.23, 3.46). Of note, patients in the SV group had the highest odds of lean NAFLD (OR = 3.29; 95% CI: 2.10, 5.17). There were no significant interaction effects between sarcopenia and metabolic risk factors on prevalent lean NAFLD., Conclusions: The current study demonstrated that SV was more closely associated with higher prevalent lean NAFLD than sarcopenia or visceral obesity alone in Chinese patients with T2DM. Besides, the harmful effect of sarcopenia on lean NAFLD was not influenced by visceral obesity or other metabolic risk factors. We hypothesize that increasing skeletal muscle mass more than just reducing visceral fat might be more optimal for the prevention and management of lean NAFLD, which needs further investigation in future studies., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2022 Xingxing Zhang et al.)

Tumor necrosis factor (TNF) is one of the most important cytokines involved in various biological processes in vertebrates and invertebrates. In the present study, a new member of the TNF superfamily (named EsTNFSF) was identified from the Chinese mitten crab (Eriocheir sinensis). The full-length cDNA of EsTNFSF is 2462 bp and encodes a polypeptide with 499 amino acids. The deduced EsTNFSF protein contained a transmembrane region and a conserved extracellular C-terminal TNF domain. Phylogenetic analysis indicated that EsTNFSF was closely related to other TNFSFs from crustaceans. Quantitative real-time PCR analysis showed that EsTNFSF was expressed in all the tissues examined, and the highest expression was found in the hepatopancreas. The mRNA levels of EsTNFSF in hemocytes underwent a time-dependent and variable degree of enhancement after stimulation with lipopolysaccharide, peptidoglycan, Staphylococcus aureus, and Vibrio parahaemolyticus. Functionally, EsTNFSF knockdown by siRNA suppressed the transcriptional levels of c-Jun N-terminal kinase and two antimicrobial peptides, anti-lipopolysaccharide factor and crustin. Furthermore, purified recombinant EsTNFSF protein accelerated the bacterial clearance in vivo and inhibited the growth of V. parahaemolyticus and S. aureus in vitro. The results revealed that EsTNFSF, as an inducible immune response gene, plays a crucial role in the antibacterial immune defense of E. sinensis., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: Although duration of reproductive years and time since menopause were previously implicated in the metabolic syndrome, the evidence is more limited. Few of the previous studies were able to take into account related reproductive variables simultaneously. The aim of the present study was to explore the influence of these two reproductive factors on the prevalence of metabolic syndrome in postmenopausal parous women from Southeast China., Methods: In all, 1,536 postmenopausal parous women were recruited. Self-reported information about reproductive status, including age at menarche, age at menopause, number of children, prepregnancy body weight, and oral contraceptive use, was collected, and duration of reproductive years and time since menopause were calculated. Clinical parameters related with metabolic syndrome were also measured., Results: Longer duration of reproductive years was significantly related with increased presence of the metabolic syndrome (odds ratio [OR] 1.570, 95% confidence interval [CI] 1.091, 2.259 for tertile 2 group; OR 1.850, 95% CI 1.163, 2.944 for tertile 3 group; P for trend = 0.010). Women with more than 20 years since menopause were more likely to experience metabolic syndrome (OR 2.422, 95% CI 1.109, 5.286, P = 0.026) and elevated blood pressure (OR 3.239, 95% CI 1.406, 7.458, P = 0.006) when compared with those with less than 10 years since menopause., Conclusions: Longer duration of reproductive years and time since menopause were associated with higher prevalence of metabolic syndrome in postmenopausal parous women from Southeast China.

Background: The skeletal muscle mass-to-visceral fat area ratio (SVR) has been linked to arterial stiffness in non-diabetic adults. We examined the association between the SVR and arterial stiffness in patients with type 2 diabetes mellitus (T2DM)., Methods: Patients with type 2 diabetes mellitus (252 men and 171 women) aged 40-75 years were enrolled and divided into three groups according to SVR tertiles. Arterial stiffness was measured as brachial-ankle pulse wave velocity (baPWV), with baPWV> 1800 mm/s defined as high. Spearman's partial correlation was used to adjust confounding factors. The odds ratio for high baPWV was determined by multiple logistic regression analyses, and receiver-operating characteristic analysis was conducted., Results: SVR was associated with baPWV in Chinese patients with T2DM (Spearman's partial correlation = - 0.129, P < 0.01). SVR was found to be significantly associated with baPWV on multiple logistic regression analysis. Patients in the lower SVR tertiles had a higher OR than did those in the higher SVR tertiles, after adjusting for multiple covariates (Q1: OR = 4.33 in men and 4.66 in women; Q3: OR = 1). The area under the curve for SVR was significantly greater than that for appendicular skeletal muscle (ASM), ASM/height 2 , and visceral fat area (VAF) for identifying high baPWV (0.747 in men and 0.710 in women). The optimal cutoffs values of SVR for detecting high baPWV were 191.7 g/cm 2 for men and 157.3 g/cm 2 for women., Conclusions: SVR has an independent, negative association with arterial stiffness, and is a better risk-assessment tool than ASM, ASM/height 2 , and VFA in clinical practice to identify patients with type 2 diabetes at high cardiovascular risk.

Background: Study suggested that elevated homocysteine showed a multiplicative effect on cardiovascular diseases in hypertensive subjects. It was reported that elevated homocysteine level was independently associated with increased arterial stiffness in prehypertensives. It remains unclear whether prehypertensives combined with elevated homocysteine have adverse cardiovascular risk factors. We aimed to compare cardiometabolic risk profile between prehypertensives with hyperhomocysteinaemia and those without either condition., Methods: Plasma total homocysteine and risk profile were determined among 874 Chinese non-hypertension individuals in Tianjin. They were subdivided into four groups: prehypertension with hyperhomocysteinaemia (≥10 μmol/L), prehypertension with normal homocysteine (<10 μmol/L), normotension with hyperhomocysteinaemia, normotension with normol homocysteine, respectively., Results: In 874 participants, 22.5% of them were male, mean age was 56.8 years. In multiple comparisons, after adjustment for age, gender, smoking, alcohol, exercise, education prehypertensives had higher body mass index (BMI) and high sensitive C reactive protein (hs-CRP) than normotensives (p < 0.05, respectively); Only prehypertensive subjects with hyperhomocysteinaemia had higher triglyceride and serum uric acid compared to normotensive subjects, and lower HDL cholesterol than normotensives with normal homocysteine (p < 0.05, respectively). However, the significance of higher hs-CRP, uric acid and lower HDL cholesterol were abolished when further adjustment was made for BMI., Conclusion: The combination of prehypertension and hyperhomocusteinaemia increases the likelihood of having adverse cardiometabolic risk profile. Strict lipid management and weigh control may be needed in prehypertensives with elevated homocysteine.

Background: Much of the epidemiology of atrial fibrillation (AF) is based on data from Western populations. Despite the huge population of Asia, data on the clinical epidemiology of AF in Asian countries are limited. The current study aimed to investigate the prevalence and incidence of newly diagnosed (ie, incident) AF, as well as lifetime risk, in China and to determine the clinical risk factors contributing to its development., Methods: Using a medical insurance database involving > 10 million individuals for the years 2001 to 2012 in the southwest of China, trends in incident AF were calculated using Kaplan-Meier analysis and Cox regression. The usefulness of the CHADS2 (congestive heart failure, hypertension, age, diabetes, stroke [doubled]) and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 [doubled], diabetes, stroke [doubled], vascular disease, age 65-74, and sex category [female]) scores was tested in predicting the occurrence of incident AF., Results: A total of 471,446 individuals (aged ≥ 20 years) were studied, with 1,924,975 person-years of experience. We identified 921 patients with incident AF (62% male; mean age, 62 years). The prevalence of incident AF in subjects aged ≥ 20 years was 0.2 per 100 people, with an incidence of AF of 0.05 per 100 person-years overall. Over an 11-year period, the prevalence of AF increased 20-fold, whereas AF-related stroke increased 13-fold. The lifetime risk of AF was approximately one in five among Chinese adults, and it increased with advancing age. The CHA2DS2-VASc score was superior to the CHADS2 score in predicting the risk of incident AF in our Chinese population (DeLong test, Z = 6.621, P < .001)., Conclusions: The AF burden, as well as the risk of AF-related stroke, has increased significantly over the past 11 years in the southwest of China. The public health burden of AF and its complications are greatest in the very elderly, with major implications for health-care systems given the global burden of this common arrhythmia.

The transtheoretical model proposes that behavior change is experienced as a series of stages. Interventions tailored to these stages are most likely to be effective in progressing people through the model's hypothesized behavior change continuum. In this study, a stage-tailored, 12-week, exercise behavior intervention based on the transtheoretical model was conducted among a sample of 150 Chinese youth with hearing loss. Participants were randomized into an intervention or control group with all the core transtheoretical model constructs assessed pre- and post-intervention. Participants in the intervention group showed greater advances in their stage of exercise behavior change, decisional balance, and processes of change use compared to those in the control group. The intervention, however, was insufficient for increasing participants' self-efficacy for exercise behavior. The findings partially support the utility of the theory-based intervention for improving the exercise behavior of Chinese youth with hearing loss, while simultaneously helping to identify areas in need of improvement for future applications.

The present paper is to study the effects of electroacupuncture (EA) on acute ischemic stroke patient and acute cerebral ischemic rat. In clinic, 42 acute ischemic stroke patients were randomly divided into 2 therapeutic groups: drug group and EA+ drug group. Neurological deficits of patients were evaluated before and after the treatment by Chinese Stroke Scale. The results showed that the acute ischemic stroke patients treated by drug or EA+ drug were all partially recovered, but the clinical functional recovery in EA+ drug group was significantly better than in the drug group (P < 0.01). In laboratory, the model of reversible middle cerebral artery occlusion (MCAO) was used in rats. The somatosensory evoked potential (SEP) was recorded before and after MCAO. EA was applied one hour after cerebral ischemia and once a day after reperfusion for 7 days in EA+ MCAO group. It was shown that the amplitude of P1-N1 wave of SEP before MCAO was 100%. After MCAO 30 min the P1-N1 wave of SEP on the ipsilateral side of MCAO was decreased to 2.2 +/- 3% (MCAO group), 1.9 +/- 2% (MCAO+ EA group); and then recovered to 25.5 +/- 14.1% (MCAO group), 58.6 +/- 27.2% (MCAO+ EA group) after 7 days of reperfusion following MCAO 2 hours. The above results indicated that EA could promote the recovery of neurological function in acute ischemic stroke patients and SEP on MCAO rats.