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Objectives We aimed to investigate the value of deep learning (DL) models based on multimodal ultrasonographic (US) images to quantify RA activity. Methods Static greyscale (SGS), dynamic greyscale (DGS), static power Doppler (SPD) and dynamic power Doppler (DPD) US images were collected and evaluated by two expert radiologists according to the EULAR–OMERACT Synovitis Scoring system. Four DL models were developed based on the ResNet-type structure, evaluated on two separate test cohorts, and finally compared with the performance of 12 radiologists with different levels of experience. Results In total, 1244 images were used for the model training, and 152 and 354 for testing (cohort 1 and 2, respectively). The best-performing models for the scores of 0/1/2/3 were the DPD, SGS, DGS and SPD models, respectively (Area Under the receiver operating characteristic Curve [AUC] = 0.87/0.95/0.74/0.95; no significant differences). All the DL models provided results comparable to the experienced radiologists on a per-image basis (intraclass correlation coefficient: 0.239–0.756, P  < 0.05). The SPD model performed better than the SGS one on test cohort 1 (score of 0/2/3: AUC = 0.82/0.67/0.95 vs 0.66/0.66/0.75, respectively) and test cohort 2 (score of 0: AUC = 0.89 vs 0.81). The dynamic DL models performed better than the static ones in most of the scoring processes and were more accurate than the most of senior radiologists, especially the DPD model. Conclusion DL models based on multimodal US images allow a quantitative and objective assessment of RA activity. Dynamic DL models in particular have potential value in assisting radiologists to improve the accuracy of RA US-based grading. [ABSTRACT FROM AUTHOR]

Promoting the accessibility of basic public service facilities is key to safeguarding and improving people's lives. Effective public service provision is especially important for the sustainable development of less developed regions. Lincang in Yunnan Province is a typical underdeveloped region in China. In parallel, multisource remote sensing data with higher spatial resolution provide more precise results for small-scale regional accessibility assessment. Thus, we use an assessment method to measure and evaluate the accessibility of three types of infrastructure in Lincang based on multisource geospatial data. We further analyze the matching between public service facility accessibility and the socioeconomic attributes of inhabitant clusters and different poverty groups. The results show that the accessibility of educational facilities is currently better than that of health facilities in Lincang and that of sanitation facilities is relatively poor. Public service facility accessibility varies significantly among different types of inhabitant clusters, with better accessibility in inhabitant clusters with high levels of population density, aging, and income. Accessibility to healthcare, education, and sanitation is negatively correlated to varying degrees of poverty levels of poor groups, and the mean values of accessibility to various types of public facilities vary significantly across poor groups. Our findings can help inform policy formulation and provide theoretical support for planning and optimizing the layout of public facilities. [ABSTRACT FROM AUTHOR]

Objective: To investigate the long-term changes in nutritional status in children with solid tumors during treatment and the relationship between nutritional status and clinical outcomes. Methods: This study was a retrospective medical records review of data from children who were diagnosed with solid tumors and followed up for more than 3months from January 2016 to December 2021 in China. Patient demographics and clinical information, including nutritional status, parenteral nutrition use, intensive care unit (ICU) transfers, infection during hospitalization, hospitalization frequency, length of stay, hospitalization costs and antibiotic costs, were collected to analyze the nutritional status of children with different types of solid tumors, the dynamic changes in nutritional status during treatment, and the relationship between nutritional status and clinical outcomes. Results: Among the 764 patients (383 males (50.1%); 381 females (49.9%); mean age: 2.58 years), 41.6% of the solid tumors were neuroblastomas, 17.1% were hepatoblastomas, and Wilms tumors as the third most common solid tumors (8.9%). The median follow-up duration was 6months (range: 3–40months). At diagnosis, the proportion of children who were undernourished (underweight and wasting) versus overweight or obese were 26.71% versus 5.21% (25.86% vs. 2.89% in the third month; 29.77% vs. 2.28% in the sixth month; 24.77% vs. 3.27% in the 12th month). The body mass index Z scores decreased from the initial values after the first month (−0.56 (−1.47, 0.23) vs. −0.44 (−1.29, 0.41)) but improved later and decreased again at 6months. The children in the undernutrition group had longer hospital stays (p<0.001), higher hospitalization costs (p<0.001), higher antibiotic costs (p<0.001), a higher risk of neutropenia (OR=4.781 (95% CI: 1.571–14.553), p=0.006), and a higher risk of ICU transfers (OR=1.498 (95% CI: 1.010–2.224), p=0.044). No significant differences in those associations by malnutrition and infection, ICU duration, or length of parenteral nutrition were observed. Conclusion: There is a considerable prevalence of malnutrition in children with solid tumors. Malnutrition is related to adverse clinical outcomes and increases in total hospital expenses and antibiotic costs. [ABSTRACT FROM AUTHOR]

The temporal variations of water quality in rivers reflect the changes in the pollutant load of a basin to a certain extent. The temporal variations of pollution source structures reflect the changes in the contribution rates of different pollution sources. The temporal variations of water quality and pollution source structures were combined in this study to investigate and analyze the water pollution control effects on different pollution sources over 15 years in the upper Tuojiang River Basin (UTRB). The seasonal trend decomposition using loess (STL), principal component analysis (PCA), factor analysis (FA), absolute principal component score (APCS), and multiple linear regression (MLR) were employed in the analysis. According to the results, except for TN, the concentrations of BOD, AN, and TP showed a downward trend. The precipitation had a strong influence on the pollution seasonal patterns. BOD and AN were primarily influenced by urban and rural living sources, while the primary sources for TN and TP were agricultural NPS and phosphate chemical industry sources, respectively. The systematic and comprehensive pollution control strategies in the third stage (2016–2020) have become more effective. In particular, the reduction of TP was successfully achieved by strengthening the pollution abatement on phosphate chemical industry sources. In contrast, the reduction in agricultural NPS emissions was not significant during the study period. [ABSTRACT FROM AUTHOR]

Background: The pathogens of suspected spinal tuberculosis (TB) include TB and non-TB bacteria. A rapid and effective diagnostic method that can detect TB and non-TB pathogens simultaneously remains lacking. Here, we used metagenomic next-generation sequencing (mNGS) to detect the pathogens in patients with suspected spinal TB. Methods: The enrolled patients with suspected spinal TB were regrouped three times into patients with spinal infection and controls, patients with spinal TB and controls, and patients with non-TB spinal infection and controls. We tested the three groups separately by using mNGS and conventional detection methods. Results: Ultimately, 100 patients were included in this study. Pathogens were detected in 82 patients. Among the 82 patients, 37 had TB and 45 were infected with other bacteria. In patients with spinal infection, the sensitivity of the mNGS assay was higher than that of culture and pathological examination (p < 0.001, p < 0.001). The specificity of the mNGS assay was not statistically different from that of culture and pathological examination (p = 1.000, p = 1.000). In patients with spinal TB, no statistical difference was found between the sensitivity of the mNGS assay and that of Xpert and T-SPOT.TB (p = 1.000, p = 0.430). The sensitivity of the mNGS assay was higher than that of MGIT 960 culture and pathological examination (p < 0.001, p = 0.006). The specificities of the mNGS assay, Xpert, MGIT 960 culture, and pathological examination were all 100%. The specificity of T-SPOT.TB (78.3%) was lower than that of the mNGS assay (100%; p < 0.001). In patients with non-TB spinal infection, the sensitivity of the mNGS assay was higher than that of bacterial culture and pathological examination (p < 0.001, p < 0.001). The specificity of the mNGS assay was not statistically different from that of bacterial culture and pathological examination (p = 1.000, p = 1.000). Conclusion: Data presented here demonstrated that mNGS can detect TB and non-TB bacteria simultaneously, with high sensitivity, specificity and short detection time. Compared with conventional detection methods, mNGS is a more rapid and effective diagnostic tool for suspected spinal TB. [ABSTRACT FROM AUTHOR]

Assessing the scale effects of land use on water quality is of great significance for effectively controlling nonpoint source (NPS) pollution in river basins. In this study, redundancy analysis (RDA) and stepwise multiple linear regression (SMLR) analysis were applied to assess the effects of land use on water quality across multiscales in the Tuojiang River Basin. All monitoring sections were classified into three groups according to the characteristics of land use and cluster analysis of water quality. Results showed that the improvement in water quality of rivers in the Tuojiang River Basin lies in the emphasis and protection of the small-scale scope. Concomitantly, the linkages between individual water quality parameter and land use were highly dependent on spatial scales and regional basis. For the upstream group A, urban land is the main source of COD and TN pollution, while industrial and rural residential land contributed the most to TP pollution. Water body exhibits favorable effects on ammonia nitrogen due to its absorption and degradation, together with the growth of phytoplankton within it. For group B in the middle-lower reaches, controlling the input of organic fertilizers in paddy field will effectively alleviate COD pollution. Increasing the proportion of grassland near the riparian zone can have a positive effect on TN and TP pollution. It should continue to strengthen the strict supervision of NH3-N concentration in wastewater discharge from industrial enterprises. Our results can provide important information for land use planning and making multiple scale measures for water quality conservation. [ABSTRACT FROM AUTHOR]

Background: The pathogens of suspected spinal tuberculosis (TB) include TB and non-TB bacteria. A rapid and effective diagnostic method that can detect TB and non-TB pathogens simultaneously remains lacking. Here, we used metagenomic next-generation sequencing (mNGS) to detect the pathogens in patients with suspected spinal TB. Methods: The enrolled patients with suspected spinal TB were regrouped three times into patients with spinal infection and controls, patients with spinal TB and controls, and patients with non-TB spinal infection and controls. We tested the three groups separately by using mNGS and conventional detection methods. Results: Ultimately, 100 patients were included in this study. Pathogens were detected in 82 patients. Among the 82 patients, 37 had TB and 45 were infected with other bacteria. In patients with spinal infection, the sensitivity of the mNGS assay was higher than that of culture and pathological examination (p < 0.001, p < 0.001). The specificity of the mNGS assay was not statistically different from that of culture and pathological examination (p = 1.000, p = 1.000). In patients with spinal TB, no statistical difference was found between the sensitivity of the mNGS assay and that of Xpert and T-SPOT.TB (p = 1.000, p = 0.430). The sensitivity of the mNGS assay was higher than that of MGIT 960 culture and pathological examination (p < 0.001, p = 0.006). The specificities of the mNGS assay, Xpert, MGIT 960 culture, and pathological examination were all 100%. The specificity of T-SPOT.TB (78.3%) was lower than that of the mNGS assay (100%; p < 0.001). In patients with non-TB spinal infection, the sensitivity of the mNGS assay was higher than that of bacterial culture and pathological examination (p < 0.001, p < 0.001). The specificity of the mNGS assay was not statistically different from that of bacterial culture and pathological examination (p = 1.000, p = 1.000). Conclusion: Data presented here demonstrated that mNGS can detect TB and non-TB bacteria simultaneously, with high sensitivity, specificity and short detection time. Compared with conventional detection methods, mNGS is a more rapid and effective diagnostic tool for suspected spinal TB. [ABSTRACT FROM AUTHOR]

With the proposal of "mass entrepreneurship, mass innovation" and other ideas, the demand for entrepreneurial talent in China is increasing, but the supply of entrepreneurial talent is far insufficient. Consistent with theory of social cognition and planned behavior, this study outlines a conceptual model including entrepreneurial intention (EI), emotional competency (EC), entrepreneurial self-efficacy (ESE), entrepreneurial attitude (EA), entrepreneurial education (EE), and subjective norms (SN). A structural equation model was applied through a questionnaire survey of 382 vocational college students in Jiangxi province to test the relationship between the constructs in the model. The results show that, firstly, EA, EE, ESE, and EC have positive effects on EI, while the positive effect of SN on EI is not supported. Secondly, a mediating role is played by ESE and EA in the association between EI and EE. Thirdly, ESE and EA play mediating roles in the relationship between EI and EC. Some implications of EI for schools and students were discussed. [ABSTRACT FROM AUTHOR]

The water resources carrying capacity (WRCC) strongly determines the agricultural development in arid areas. Evaluation of WRCC is important in balancing the availability of water resources with society's economic and environmental demands. Given the demand for sustainable utilization of agricultural water resources, we combine the water stress index and comprehensive index of WRCC and use multi-source data to evaluate agricultural WRCC and its influencing factors at the township scale. It makes up for the deficiencies of current research, such as the existence of single-index evaluation systems, limited calibration data, and a lack of a sub-watershed (i.e., township) scale. By applying multi-source data, this study expands the spatial scale of WRCC assessment and establishes a multidimensional evaluation framework for the water resources in dryland agriculture. The results indicate water stress index ranges from 0.52 to 1.67, and the comprehensive index of WRCC ranges from 0.25 to 0.70, which are significantly different in different types of irrigation areas and townships. Water quantity and water management are key factors influencing WRCC, the water ecosystem is an area requiring improvement, and the water environment is not a current constraint. Different irrigation areas and different types of townships should implement targeted measures to improve WRCC. [ABSTRACT FROM AUTHOR]

This paper presents an experimental study to assess the behaviour of coal samples under tensile loadings to better understand the failure mechanisms and the interactions with the coal characteristics. A set of Brazilian splitting tests were carried out using disk specimens obtained from Tashan Coal Mine in China. The digital speckle correlation method and acoustic emission (AE) were used to capture the deformation localisation and AE characteristics of each specimen during the loading process. The precursor characteristics of AE and the failure mechanism are discussed. It was found that the entire loading process mainly consists of compaction, elastic and post-peak dropping stage without an obvious yielding stage. Two kinds of deformation localisation were observed: central symmetry and axis symmetry. The corresponding AE evolution patterns have different phases, including gradual rise, step rise, transient rise and steady rise. During the subcritical failure stage, AE counts demonstrate a "rapidly increasing + flatten" intermittent feature. The results provide a reference for a better understanding of the damage process of the brittle coal material and its application in ground control design. [ABSTRACT FROM AUTHOR]

Introduction: Over the past two decades, China has experienced rapid economic development, which has not only led to a rapid increase in the use of raw materials but has also created environmental problems. This research analyzes the environmental impacts of resource extraction in China at the provincial level, and fully considers the environmental impact of various resources extraction. In addition, it is the first time to quantitatively study the spatial pattern and evolution characteristics of the environmental impacts of China's resource extraction from multiple perspectives by means of spatial visualization. Outcomes: The results showed that the center of gravity of abiotic depletion potential (ADP) moved northwest, respiratory inorganics (RI) moved southwest and global warming potential (GWP) moved west. The results of the standard deviation ellipse showed that RI and GWP varied over time and space, while ADP showed a discrete trend. In addition, the distribution of the four in the northeast-southwest direction became more prominent. Conclusion: To mitigate the environmental impacts of resource extraction, we recommend that regional governments implement measures to control environmental impacts in the provinces within the distributed ellipse and design targeted policies based on actual conditions. [ABSTRACT FROM AUTHOR]

Over the past three decades, China has experienced rapid economic growth along with a rapid increase in urbanization and living standards, leading to a boom in infrastructure demand. A large part of China's newly constructed infrastructure is through urban construction; thus, cities have become a major source of material consumption and carbon emissions. Understanding the relationship between material consumption, carbon emissions, and the economic growth of cities is key to ensuring that the construction of infrastructure satisfies the needs for both economic development and dematerialization. In this study, we first accounted for material consumption and the carbon emissions of infrastructure construction of 34 cities in Northeast China and characterized spatial and temporal changes from 2010–2017. The material use and carbon emissions of infrastructure construction declined by 34.6% and 30.2% during this period. Specifically, material consumption decreased from 305.2 million tonnes to 199.6 million tonnes, and carbon emissions decreased from 77.7 million tonnes to 54.3 million tonnes. Furthermore, we used a decoupling indicator to evaluate the decoupling of material consumption or carbon emissions from GDP in these cities. We found that most cities have achieved the absolute decoupling of material consumption and carbon emissions from GDP over the study period. Finally, we proposed several policy recommendations for promoting the sustainable development of the infrastructure of cities. To ensure that cities realize low-carbon urbanization, policymakers need to promote modular buildings and low-emission construction materials. This paper also serves as a practical reference for the improvement of relevant materials and carbon emissions management strategies for other developing regions. [ABSTRACT FROM AUTHOR]

Frequent occurrence of landslides has seriously threatened the infrastructural projects in the Loess Plateau, China. At the beginning, with development of the landslide, several fissures were generated along the internal weak surface. Then, under the constant influence of rainfall and irrigation, the fissures were expanded and connected, which formed a consecutive sliding surface, consequently leading to the occurrence of the landslide. Therefore, the key to treat the landslide is to prevent the expansion and connection of fissures in the potential slip zone inside the slope. In this paper, an old landslide, which occurred at an early stage of the construction of the Lvliang Airport, was selected as a case study. A new type of grouting material was used to fill the fissures and reinforce the loess in the slip zone, so as to study the effect of material content on the slope stability. With current methods, loess specimens were taken from the slip zone inside the Lvliang Airport slope. Based on the GDS triaxial test system, a series of laboratory tests were performed on the undisturbed loess and the remolded which contained the stabilizer, including triaxial shear tests at constant matric suctions and wetting tests at constant deviator stresses. Moreover, the dichotomy in mathematics was chosen to find the threshold of the material content. The test results showed that the cohesion and the internal friction angle of the loess obviously increased after grouting. The failure behaviour of the loess along the wetting path was dependent on the material ratio and the stress level. Meanwhile, the critical state line of the slope, grouted with materials of different ratios, was compared by fitting the regression equation. It was found that the threshold value of the stabilizer content was between 15% and 20%, which was the most suitable ratio for improving slope stability with relatively lower cost. [ABSTRACT FROM AUTHOR]

China's economic liberalization in 1978 created new gendered and sexual subjectivities. This essay examines a new internet meme gaymi ("gay confidante") and its discursive construction of gay men as genteel embodiments of a women-friendly "emergent masculinity" (Inhorn and Wentzell, 2011). We argue that firstly, the gaymi discourse actually centers on the women who desire gay male companionship, because it ironically articulates the desires of these women and not those of the men. Secondly, strong links possibly exist between the rise of the gaymi and the popularity of the Korean Wave in China. Hence, the gaymi gestures at intra-Asian cultural globalization. [ABSTRACT FROM AUTHOR]

The article reports on the introduction of inactivated poliovirus vaccine (IPV) and its impact on the risk for vaccine-associated paralytic poliomyelitis (VAPP) in Beijing, China, from 2014 to 2016. The government introduced IPV into the city's Expanded Program on Immunization (EPI) in December 2014. Acute flaccid paralysis surveillance was used to identify VAPP cases in the city during the period.

Three previously unreported anthraquinones, fistulaquinones A–C (1–3), together with three known ones (4–6) were isolated from the twigs ofCassia fistula. Their structures were determined by means of extensive NMR and MS spectroscopic analyses. All the isolated compounds were tested for their anti-tobacco mosaic virus (anti-TMV) activity, and compound3showed significant activity with inhibition rate of 34.5% at 20 μM concentration, even more potent than positive control. Additionally, compounds1–6exhibited moderate cytotoxicity with IC50values ranging from 2.8 to 9.4 μM for some tested human tumor cell lines. [ABSTRACT FROM PUBLISHER]

• Poverty poses a central barrier in the implementation of the SDGs. • Poverty inhibits synergies and magnifies trade-offs among SDGs. • Poverty turns synergies into trade-offs for certain SDGs. • Inhibitory effect of poverty is heterogeneous among different SDGs and groups. The synergies and trade-offs between the Sustainable Development Goals (SDGs) influence their ultimate achievement. Poverty eradication is the first goal of the SDGs, and the impact of poverty is clearly all-encompassing. However, it remains unclear how poverty affects the changing synergies and trade-offs between the SDGs. Here, taking a typical underdeveloped region in China as the research area, this study evaluated the synergies and trade-offs between SDGs by calculating the SDG Index and the Multidimensional Poverty Index. We further explored the heterogeneous effects of poverty on different impoverished groups and the mechanism of the synergies and trade-offs between SDGs. The results showed that SDGs were mainly synergistic, and a few indicators (SDG 12 Responsible Consumption and Production, SDG 13 Climate Action, SDG 15 Life on Land) had trade-offs with other indicators. Poverty hindered the achievement of most SDGs, and inhibition was heterogeneous among different SDGs and impoverished groups. Poverty inhibited synergies and magnified trade-offs among SDGs; it also turned synergies into trade-offs for certain SDGs (SDGs 1 and 7, SDGs 2 and 8, and SDGs 3 and 8). This study can provide a reference for other less developed regions to make reasonable and integrated arrangements for their sustainable development. [ABSTRACT FROM AUTHOR]

Liparis nervosa, a terrestrial orchid was widely used as a traditional medicinal plant in China. In this study, we assembled the complete chloroplast genome of L. nervosa using Illumina sequencing data. The whole genome is 158,716 bp, contains a large single-copy region (LSC 86,010 bp), a small single-copy region (SSC 18,276 bp), and a pair of inverted repeats (IR 27,215 bp). The complete genome has 132 genes, including 77 protein-coding genes, 38 tRNA genes, and 8 rRNA genes. In addition, a maximum-likelihood phylogenetic analysis demonstrated that L. nervosa was most closely related to Oberonia japonica. This work provides a theoretical basis for the development of conservation strategies of L. nervosa. [ABSTRACT FROM AUTHOR]

As the largest user of primary materials globally China has made a commitment to rebuild its economy to a circular model and to enhance the efficiency of material use, which is spelled out in the Circular Economy Promotion Law. Measuring progress of the new policy requires datasets, metrics and indicators that monitor the performance of the economy regarding the scale of primary materials use, waste flows, and recycling and circularity. We employ material flow analysis, including measures for inputs and outputs, to assess progress of the circular economy in China over time. We find that circularity increased from 2.7% to 5.8% between 1995 and 2015, from an input socioeconomic cycling rate perspective. End of life waste recycling improved from 7.2% to 17% over the same time frame and occurred against the backdrop of a strong physical growth dynamic during this whole period. We present a set of policy indicators and situate them in the context of the Chinese indicator sets for a Green Development Indicator System, the Ecological Civilization Construction Assessment Target System and the Sustainable Development Goals. Moving from an economy based on infrastructure and capital investment production for the world market, to a consumption-based economy, may increase the potential for circular economy in China in the future. The policy indicators can also be used to set targets and create ambition for a swift transition to closed loop urban and industrial systems in China. [ABSTRACT FROM AUTHOR]

• Spatial-temporal variations of FC concentration in the Tuojiang River were observed. • Health risks of FC for drinking water were evaluated by QMRA and DALY. • Potential health risks were increasing in the basin especially in upstream areas. • Variation of health risks presumably was associated with regional development. Fecal coliform (FC) indicators are commonly used to evaluate microbial or fecal contamination in surface water. As an important tributary of the Yangtze River in China, the Tuojiang River not only receives polluted water but is also a source of drinking water. Previous studies have reported the presence of conventional chemical pollutants, but the contamination and human health risk of FC in this watershed have usually been ignored. In this study, monthly FC concentration data from 2008 to 2018 were utilized to analyze the spatiotemporal distribution and to assess human health risk for daily drinking water by quantitative microbial risk assessment (QMRA) and disability adjusted life year (DALY) models. The results showed that there were significant monthly variations in the concentrations of FC, and the concentrations in May to August were significantly higher than those in other months. The annual concentration in the whole watershed increased slowly from 2008 to 2018. The annual probability of falling ill (P ill_year) caused by FC upstream, midstream and downstream was 4.30 ± 3.92 × 10−5, 1.38 ± 0.49 × 10−5 and 3.38 ± 2.72 × 10−5, respectively. It was found that 5.82% of the DALY values were greater than the limit of 10−6 per person per year (pppy) and could be defined as high health risk points. A total of 37.3% of samples could be deemed potential risk points whose DALY values were between 10−7 and 10−6 pppy. There were significant spatial differences in FC concentrations and health risk among upstream, midstream, and downstream regions. With the rising health-risk value, the high-risk region has transferred from downstream to upstream since 2015. Furthermore, we found that domestic wastewater and livestock sewerage were deemed to be primary sources of FC in the Tuojiang watershed. Moreover, the increasing health risk faced by the local people in the watershed should receive more attention from the public and government. The results of this study could provide insight into the management of FC pollution and health risks, such as sewage treatment, livestock manure management, and personal dietetic hygiene. [ABSTRACT FROM AUTHOR]

Clarifying the sources and historical variation of metal(loid)s in agricultural river sediments is vital for watershed contamination control and environmental improvements. In this study, a systematical geochemical investigation of Pb isotopic characteristics and the spatial-temporal distribution of metal(loid)s abundances was conducted to delineate the origins of metal(loid)s (Cd, Zn, Cu, Pb, Cr, and As) in sediments from an agricultural river, Sichuan Province, Southwest China. The results showed significant enrichment of Cd and Zn in the whole watershed, with substantial anthropogenic contributions of 86.1% and 63.1% for the surface sediments, and 79.1% and 67.9% for the core sediments, respectively. As was mainly derived from natural sources. Cu, Cr, and Pb were originated from the mixing sources of natural and anthropogenic processes. The anthropogenic origin of Cd, Zn, and Cu in the watershed was closely correlated with agricultural activities. The profile of EF-Cd and EF-Zn displayed an increasing trend from the 1960s-1990s, and then kept a high value, which was consistent with the development of national agricultural activities. Pb isotopic signatures suggested multiple sources of the anthropogenic Pb contamination, including industrial/sewage discharge, coal combustion, and vehicle exhaust. The average anthropogenic 206 Pb/ 207 Pb ratio (1.1585) approximated that of local aerosols (1.1660), suggesting aerosol deposition was a crucial pathway of anthropogenic Pb input to sediment. Furthermore, the anthropogenic Pb percentages (mean of 52.3 ± 10.3%) from the EF approach were in line with that from the Pb isotopic method (mean of 45.5 ± 13.3%) for sediments under intense anthropogenic impacts., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Environmental pressures have rapidly increased in various regions worldwide due to globalization. Thus, sustainable consumption and production are crucial for sustainable resource development. The material footprint (MF) of 180 countries was calculated from 1995 to 2015, and spatial autocorrelation analysis was conducted to investigate the spatiotemporal trend of the global MF. The results show that the global MF presented an upward trend from 1995 to 2015, increasing by 83%, and we find that the global per capita MF exhibits clustering, with an increasing trend during the study period. The findings indicate that resource consumption is similar in neighboring areas, especially in countries with a high MF surrounded by countries with a high MF (high-high clustering) and countries with low-low clustering. In addition, the number of countries with high clustering increased during the study period. We should take advantage of clustering, improve resource utilization, increase the technical carrying capacity, and develop energy-saving technologies. In African regions with low-low clustering, the economy of the surrounding areas should be stimulated to strengthen economic and technological clustering. In addition, advanced technology should be incorporated to improve the efficiency of using natural resources. This study can provide a reference for the spatial distribution of sustainable resource development., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

A quality of life questionnaire specific to sarcopenia (SarQoL®) was successfully developed. There is a huge demand for translation and validation in Chinese. The aim of this study was to translate the SarQoL® into Chinese and investigate its psychometric properties. The translation and cross-cultural adaptation process recommended by the developers of the initial questionnaire was followed. A total of 159 participants were investigated. The translation process consists of five steps: (1) two bilinguals independently translate initial English to Chinese; (2) synthesize the two translations into one; (3) backward translations; (4) expert committee review and (5) test of the pre-final version. The validation consists of three parts: (1) validity (discriminative power, construct validity); (2) reliability (internal consistency, test-retest reliability) and (3) floor and ceiling effects. There was no difficulty in translation process. Regarding the validity, good discriminant validity {quality of life for sarcopenic subjects [35.56 (29.73-42.70)] vs. non-sarcopenic ones [73.22 (60.09-82.90)], p < 0.001} and consistent construct validity [high correlations (spearman's r) of SarQoL® with generic Short Form-36 version 2 questionnaire (0.250 to 0.824) and EuroQoL-5-Dimension questionnaire (- 0.114 to - 0.823)] were found in SarQoL®. Regarding reliability, high internal consistency (Cronbach's alpha coefficient was 0.867) and excellent test-retest reliability (intraclass coefficient correlation was 0.997, 95% CI 0.994-0.998) were found. No ceiling/floor effect was reflected. A valid SarQoL® questionnaire is now available for Chinese population. It can provide a better understanding of the sarcopenia disease burden and serve as a therapeutic outcome indicator in research., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Corticosteroid therapy is used commonly in patients with COVID-19, although its impact on outcomes and which patients could benefit from corticosteroid therapy are uncertain., Research Question: Are clinical phenotypes of COVID-19 associated with differential response to corticosteroid therapy?, Study Design and Methods: Critically ill patients with COVID-19 from Tongji Hospital treated between January and February 2020 were included, and the main exposure of interest was the administration of IV corticosteroids. The primary outcome was 28-day mortality. Marginal structural modeling was used to account for baseline and time-dependent confounders. An unsupervised machine learning approach was carried out to identify phenotypes of COVID-19., Results: A total of 428 patients were included; 280 of 428 patients (65.4%) received corticosteroid therapy. The 28-day mortality was significantly higher in patients who received corticosteroid therapy than in those who did not (53.9% vs 19.6%; P < .0001). After marginal structural modeling, corticosteroid therapy was not associated significantly with 28-day mortality (hazard ratio [HR], 0.80; 95% CI, 0.54-1.18; P = .26). Our analysis identified two phenotypes of COVID-19, and compared with the hypoinflammatory phenotype, the hyperinflammatory phenotype was characterized by elevated levels of proinflammatory cytokines, higher Sequential Organ Failure Assessment scores, and higher rates of complications. Corticosteroid therapy was associated with a reduced 28-day mortality (HR, 0.45; 95% CI, 0.25-0.80; P = .0062) in patients with the hyperinflammatory phenotype., Interpretation: For critically ill patients with COVID-19, corticosteroid therapy was not associated with 28-day mortality, but the use of corticosteroids showed significant survival benefits in patients with the hyperinflammatory phenotype., (Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Objectives: To derive normative carotid artery stiffness data in rural adult Chinese population-based study of ultrasound measurements of carotid elasticity by using quality arterial stiffness (QAS), and to assess the changes of relevant parameters in Chinese adults 40 years of age and older., Design: A China stroke cohort study (total number: 1586) in the northern countryside were carried out between June 2013 and April 2016, designed to investigate the risk factors of cardiovascular and age-related diseases., Setting: The present study was a cross-sectional analysis of an ongoing community-based Shunyi cohort study in China., Participants: A total of 583 participants (227 men and 356 women; aged 40-80 years) with ultrasound carotid QAS examination were retrieved from the study to analyse., Primary and Secondary Outcome Measures: Arterial stiffness parameters included diastolic diameter (Dd), pulse wave velocity (PWV), stiffness indices α and β were calculated by QAS. Other clinical indicators included physical measurements, medical histories and blood biochemical test., Results: In the entire study sample, mean Dd was 7.93±0.88 mm, mean PWV was 9.4±2.4 m/s, mean α was 7.65±5.13 and mean β was 15.53±10.29. PWV was significant higher in participants with hypertension (9.9 m/s vs 9.2 m/s in those without, p=0.002), and with diabetes (10.3 m/s vs 9.2 m/s in those without, p=0.003). PWV were significantly higher in participants with HbA1c at 5.8%-6.4% versus <5.8%, but no difference was found between subjects with glycohaemoglobin (HbA1c) at 5.8%-6.4% versus >6.4% (p=0.005, p=0.955, respectively). Age increase by every 10 years was associated with Dd increased by 0.27 mm, PWV increased by 1.2 m/s, α increased by 1.34 and β increased by 2.71. Systolic blood pressure (SBP) increase by every 10 mm Hg was associated with Dd increased by 0.15 mm, PWV increased by 0.35 m/s, α increased by 0.13 and β increased by 0.15., Conclusion: Among the participants older than 40 years, stiffness of the carotid artery had differences between hypertension and non-hypertension adults, as well as between diabetes and non-diabetes adults. Stiffness of the carotid artery also have differences between adults with HbA1c at 5.8%-6.4% versus <5.8%. Stiffness of the carotid artery increases with increasing age and increasing SBP at a range from 40 and up., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Giardia duodenalis and Enterocytozoon bieneusi are widespread pathogens that can infect humans and various animal species. Thus far, there are only a few reports of G. duodenalis and E. bieneusi infections in ruminant wildlife. Thus, the objective of this study was to examine the prevalence of G. duodenalis and E. bieneusi in forest musk deer in Sichuan, China, as well as identifying their genotypes., Results: In total, we collected 223 faecal samples from musk deer at the Sichuan Institute of Musk Deer Breeding in Dujiangyan (n = 80) and the Maerkang Breeding Institute (n = 143). Five (2.24%) faecal samples were positive for G. duodenalis; three belonged to assemblage E, and two belonged to assemblage A based on the sequence analysis of the β-giardin (bg) gene. One sample each was found to be positive based on the glutamate dehydrogenase (gdh) and triosephosphate isomerase (tpi) gene, respectively. Thirty-eight (17.04%) faecal samples were found to be E. bieneusi-positive based on the internal transcribed spacer (ITS) sequence, and only SC03 genotype was identified, which belonged to the zoonotic group 1 according to the phylogenic analysis. The infection rates were significantly different among the different geographical areas and age groups but had no apparent association with gender or clinical symptoms., Conclusions: To our knowledge, this was the first molecular characterisation of G. duodenalis and E. bieneusi in musk deer. Identification of the zoonotic genotypes indicated a potential public health threat, and our study suggested that the forest musk deer is an important carrier of these parasites.

Background: International literature has illustrated that the health impacts of heat waves vary according to differences in the spatial variability of high temperatures and the social and economic characteristics of populations and communities. However, to date there have been few studies that quantitatively assess the health vulnerability to heat waves in China., Objectives: To assess the spatial distribution of health vulnerability to heat waves in Guangdong Province, China., Methods: A vulnerability framework including dimensions of exposure, sensitivity, and adaptive capacity was employed. The last two dimensions were called social vulnerability. An indicator pool was proposed with reference to relevant literatures, local context provided by relevant local stakeholder experts, and data availability. An analytic hierarchy process (AHP) and a principal component analysis were used to determine the weight of indicators. A multiplicative vulnerability index (VI) was constructed for each district/county of Guangdong province, China., Results: A total of 13 items (two for exposure, six for sensitivity, and five for adaptive capacity) were proposed to assess vulnerability. The results of an AHP revealed that the average VI in Guangdong Province was 0.26 with the highest in the Lianzhou and Liannan counties of Qingyuan (VI=0.50) and the lowest in the Yantian district of Shenzhen (VI=0.08). Vulnerability was gradiently distributed with higher levels in northern inland regions and lower levels in southern coastal regions. In the principal component analysis, three components were isolated from the 11 social vulnerability indicators. The estimated vulnerability had a similar distribution pattern with that estimated by AHP (Intraclass correlation coefficient (ICC)=0.98, p<0.01)., Conclusions: Health vulnerability to heat waves in Guangdong Province had a distinct spatial distribution, with higher levels in northern inland regions than that in the southern coastal regions.

Aim: To evaluate the efficacy and safety of paclitaxel-nedaplatin combination as a front-line regimen in Chinese patients with metastatic esophageal squamous cell carcinoma (ESCC)., Methods: A two-center, open-label, single-arm phase II study was designed. Thirty-nine patients were enrolled and included in the intention-to-treat analysis of efficacy and adverse events. Patients received 175 mg/m² of paclitaxel over a 3 h infusion on 1 d, followed by nedaplatin 80 mg/m² in a 1 h infusion on 2 d every 3 wk until the documented disease progression, unacceptable toxicity or patient's refusal., Results: Of the 36 patients assessable for efficacy, there were 2 patients (5.1%) with complete response and 16 patients (41.0%) with partial response, giving an overall response rate of 46.1%. The median progression-free survival and median overall survival for all patients were 7.1 mo (95%CI: 4.6-9.7) and 12.4 mo (95%CI: 9.5-15.3), respectively. Toxicities were moderate and manageable. Grade 3/4 toxicities included neutropenia (15.4%), nausea (10.3%), anemia (7.7%), thrombocytopenia (5.1%), vomiting (5.1%) and neutropenia fever (2.6%)., Conclusion: The combination of paclitaxel and nedaplatin is active and well tolerated as a first-line therapy for patients with metastatic ESCC.

Objective: To evaluate the vulnerability to floods in Guangdong province at district level., Methods: Data were collected from the sixth census, the 2010 Statistical Yearbook of Guangdong, the 2010 Health Statistics Yearbook of Guangdong and China Disease Prevention and Control information systems, etc. The weight of each indicator was determined based on subjective method and objective method respectively; and finally the results of the two methods were compared., Results: 13 indicators were selected for the assessment of vulnerability to floods, including 6 sensitivity indicators, 5 adaptability indicators and 2 exposure indicators. Indicators with large weight (subjective weight/objective weight) were the proportion of population older than 65 years old (0.31/0.30), the proportion of population older than 65 years old (0.16/0.23), infant mortality rate (0.18/0.20), the total Gross Domestic Product (GDP) per capita (0.33/0.21), the proportion of illiterate in the population older than 15 years old (0.19/0.28), history frequency of floods (0.75/0.75). The mean vulnerability index (VI) calculated by subjective method was 0.35 with the standard deviation of 0.10; the mean vulnerability index calculated by objective method was 0.31 with the standard deviation of 0.08. The two weighting methods showed consistent results of vulnerability index (ICC = 0.975, P < 0.01). VI of most districts dropped in the interval of 0.30 - 0.39. Districts with subjective VI > 0.50 or objective VI > 0.40 should pay more attention to floods, including parts of the coastal areas, Beijiang River Basin, the eastern tributary area of Dongjiang River and the northern part of Pearl River Delta. Dapu district of Meizhou (0.55/0.45), Dianbai district and Maogang district of Maoming (0.54/0.48) were most vulnerable. Districts of Heyuan, Dongguan, Zhaoqing and Huizhou were less vulnerable, Yuancheng district of Heyuan showed least vulnerable to floods (0.15/0.12) followed by Dongguan (0.18/0.16), Duanzhou district (0.18/0.16) and Guangning (0.17/0.15) district of Zhaoqing. The score of indicators differed among different level of vulnerability (P < 0.05)., Conclusion: Different regions of Guangdong province showed different vulnerability to floods, vulnerable areas should be priority in the prevention and control of floods.

Objective: The vaccines currently developed against infectious diseases fail to induce effective antiviral immune responses to control an abrupt outbreak of viral diseases epidemic in a short space of time. Hence there is an urgent need to develop emergency vaccines capable of producing prophylactic effects against infectious diseases. RNA interference (RNAi) is a mechanism that inhibits gene expression by causing the degradation of specific RNA molecules or hindering the transcription of specific genes. The rapidity and uniqueness of RNAi responses can make up for the current inadequacy of antiviral preventive regimes. Here we evaluate the antiviral potential of short hairpin RNA (shRNA) targeting C (core) gene of hepatitis B virus (HBV). It plays essential roles in HBcAg encoding and viral attachment to susceptible cells during its life cycle. The present study was intended to investigate the inhibitory effect of C-specific shRNAs on HBV replication and expression in BHK-21 cells., Methods: The reporter gene expression vector of pC-EGFP-N1 was constructed by cloning the DNA (PCR product) of HBV C into the EcoRI-HindIII sites of pEGFP-N1 to fuse C to enhanced green fluorescent protein (EGFP) for providing a reporting system for monitoring siRNA function. Plasmid pC was constructed by cloning the DNA of HBV C into the EcoRI-HindIII sites of pCDNA3.1B(-) directly under the control of cytomegalovirus promoter. Two plasmids (S1 & S2) were constructed to express shRNAs targeting C of HBV with the length of 24 nucleotide (nt) homologous in sequence to the HBV C gene. Plasmids were designed and synthesized according to the HBV genome (HBV genotype B, ayw1 subtype) of chronic hepatic B patients from 56 ethnic minorities in China. After cloning and sequencing, the investigators registered them with the GenBank accession numbers of AY517488 (CYN/2002) and AY517489 (CYN/2000), etc. Simultaneously, one of nonspecific shRNA-S3 with a length of 24 nt was also designed randomly for negative control. After cloning into vector pU6 for constructing shRNA-expressing plasmids, they were then cotransfected into BHK-21 cells along with reporter gene expression vector of pC-EGFP-N1. First, upon a determination of the number of cells exhibiting EGFP expression in BHK-21 cells as detected by an Olympus BH-2 fluorescence microscope and FACS-440 flow cytometry (Becton-Dickinson, USA) at different times after cotransfection, the investigators evaluated the gene inhibitory efficiency of both plasmids by an EGFP reporter system in BHK-21 cells. Subsequently, the antiviral efficacy of both plasmids in BHK-21 cells was further investigated by real-time quantitative polymerase chain reaction., Results: In comparison with single plasmid transfection pC-EGFP-N1 or pEGFP-N1, fluorescence microscope and flow cytometry detection at 24 h post-cotransfection revealed that the expression of reporter gene EGFP in cotransfection group involving S1 or S2 and S1 + S2 cotransfection group was reduced significantly by about 90% in EGFP signal versus the control. And the EGFP expression in control plasmid cotransfected S3 or pU6 was not significantly reduced in BHK-21 cells (P < 0.01). It was found that the expression of mRNAs of HBV C and EGFP gene as detected by real-time quantitative PCR was the same as that detected by fluorescence microscope and flow cytometry (P < 0.01), thereby further corroborating the antiviral efficacy of RNAi. The antiviral efficacy extended to almost 48 hours. The results indicted that a DNA vector-based RNAi technology could effectively and specifically inhibit the replication and expression of HBV in BHK-21 cells., Conclusion: For the first time it has been found that RNAi induced by shRNA targeting C gene exerts an effective and unique inhibition of HBV replication and expression in BHK-21 cells. Thus RNAi may provide an effective emergency vaccine against major infectious diseases such as HBV infection.

Objective: To investigate the expression in Escherichia coli (E. coli) of hepatitis B virus (HBV) genes from minority nationality patients in Yunnan province with chronic hepatitis B (CHB) and their antigenicity., Methods: Peripheral blood samples were collected from 25 minority nationality patients with CHB in Yunnan province. Twenty-five CHB patients of Han nationality in Yunnan were used as controls. The full length HBV preS2/S and C genes were amplified by PCR, cloned, sequenced, and inserted into the prokaryotic expression vector p lambda PR. The recombinant plasmids p lambda PR-S2S and p lambda PR-C were transfected into E. coli of the line TOP10. The expression of the non-fusion proteins encoded by the HBV preS2S and C genes was determined by sodium dodecyl sulphate polyacrlamide gel electrophoresis (SDS-PAGE) and Western blotting. The antigenicity of the non-fusion proteins was examined by ELISA. Fifty samples of serum of patients with hepatitis A, 50 samples of serum of patients with hepatitis C, and 50 samples of serum of healthy blood donors were used as controls in the study of the antigenicity of non-fusion proteins., Results: SDS-PAGE showed that the recombinant plasmids p lambda PR-S2S and p lambda PR-C were both stably and highly expressed in the E. coli for all 50 CHB patients. The molecular weights of the expressed non-fusion proteins, with a concentration of 16% and a purity of 50%, were between 31,000 and 21,000. Western blotting and ELISA showed that the purified recombinant non-fusion proteins reacted strongly with the antibodies HBpreS2S/SAb and HBcAb and the serum of CHB patients, but there was no cross-activity between the non-fusion proteins and all the serum samples of controls with HA and HC, and normal controls., Conclusion: The HBV preS2S and C genes from the minority nationality patients with CHB can be stably and highly expression in E. coli. The non-fusion proteins encoded by the HBV preS2S and C genes have high antigenicity. These findings have potential values in development of HB vaccines.

Objective: To determine whether there is evolutionary difference in hepatitis B virus (HBV) genotypes among the patients with chronic hepatitis B (CHB) of different nationalities and its clinical significance., Methods: Peripheral blood samples were collected from 50 CHB patients, 25 of diverse nationalities and 25 of Han nationality from the ethnic minority regions in Yunnan Province, China, The HBV preS2/S (pre S2/S) and C genes were amplified by PCR. The PCR products were inserted into the vector pBluescriptIISK (pBS). The cloned preS2/S and C genes were sequenced., Results: The sequences of HBV preS2/S and C genes from the 50 patients were 846 (with 49.1% of GC) and 552 (with 46.1% of GC) nucleotides (nt) in length, and encoded 281 and 183 amino acids (aa) respectively. These findings were registered in GenBank Accession Numbers: AY517619, AY517620, AY517488, AY517489, AY517598, AY517599. Compared with the HBV and subtype sequences in the GenBank database, the HBV preS2/S and C genes among all the subjects were homologous to ayw1 in sequence by 97.5% - 98.6% and 94.5% - 97.8% respectively. The "a" determinant region of S genes in all cases were found to be Arginine (AGA) and Lysine (AAA) at corresponding aa 122nd and 160th respectively. HBV genotype B was identified in all patients with CHB (ayw1 subtype). Genotypes A, C, D, E, F, G, and H were not detected in any of them. The quasi-species nature of the HBV in the sera was observed in 2 of the 50 samples examined (4%). There was not a significant difference in the prevalence of HBV genotype B between the 25 diverse nationality patients and the 25 control Han nationality patients (P > 0.05). In the 50 CHB patients, the preS2/S genes were identified to have aa substitutions at the positions R124K (1.1%), L172P (1.3%), M306T (1.5%), and I361M (1.6%), with a frequency of more than 1%. In all subjects, the frequency of aa G145R (0.4%) substitutions was less than 1%. In all subjects, nt variations of C genes caused aa substitutions among aa 27 - 63, 80 - 110, and 135 - 153 involved in T and B cell epitopes. In 45 CHB patients, C genes was identified to have aa substitutions at the positions V 27, N38, V63, Q135, and A147, due to nt variations of 1979A to G, 2012T to A, 2088G to T, 2304C to A, and 2339A to G transitions respectively. The frequency of aa substitutions of C genes was more than 1%. Whereas as for the other 5 severe CHB patients, the C gene variations of A to G, and A to C transitions at nt positions 2159 and 2189 led to aa substitutions of S to G and I to L at positions G87 and L97. No insertion or deletion was found in preS2/S and C regions. HBV genotype B was not relevant to different nationalities (all P > 0.05)., Conclusion: It is the first time that the genotype of the HBV epidemic strains in the ethnic minority areas of Yunnan Province has been identified as genotype B subtype ayw1. The HBV genotype B is not related with nationality. A novel genotyping method by using PCR, gene cloning, followed by DNA sequencing that can identify all major genotypes has been developed. HBV genotype B is the geographic original strain in this area and is correlated with the severity of liver diseases and curative effect. HBV viral is the only significant variable associated with the CHB patients' prognosis.