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Changes in land use patterns lead to changes in soil ecosystem functions, and soil microorganisms can sensitively reflect the evolution of soil quality and different ecosystem functions. Here, three typical land use patterns (wetland, arable land, and forest) in the Sanjiang Plain of northeastern China were selected to study the effect of land use changes on the microbial community structure of wetlands. High-throughput sequencing technology based on bacterial 16S rRNA genes was used to study the community structure of soil bacteria in three land use patterns and to explore the relationship between soil bacterial community and environmental factors. Our findings indicated that the dominant bacterial phyla in soils of different land use patterns were Proteobacteria, Acidobacteria, and Actinobacteria. However, the land use patterns significantly changed the composition and abundance of soil bacterial genera. Combined with the soil bacterial alpha diversity index, the soil bacterial α diversity in wetlands was higher than that in forests and farmlands. Soil bacterial beta diversity varied significantly among land use patterns. The redundancy analysis results showed that soil moisture content was the main factor affecting the bacterial community structure of wetland soils, whereas pH, soil organic carbon, and total nitrogen were the main factors affecting the soil bacterial community structure in forests, and total phosphorus and available phosphorus were the main factors affecting the soil bacterial community structure in arable land. [ABSTRACT FROM AUTHOR]

Summary: In a random sample of postmenopausal Chinese women, the prevalence of radiographic vertebral fractures increased from 13% between ages 50 and 59 to over 50% after age 80 years. A model with seven clinical risk factors predicted the probability of vertebral fractures as well with as without BMD and better than a model with only three risk factors. More than half an hour of outdoor activity per day might correlate with lower risk of vertebral fracture in this population. Introduction: We aimed to describe the prevalence and develop a model for prediction of radiographic vertebral fractures in a large random sample of postmenopausal Chinese women. Methods: We enrolled 1760 women from an age-stratified random sample of postmenopausal women in Beijing, China. The presence of vertebral fracture was assessed by semi-quantitative grading of lateral thoracolumbar radiographs, risk factors by interview, bone mineral density (BMD) of the proximal femur and lumbar spine by dual x-ray absorptiometry (DXA), and markers of bone turnover from a fasting blood sample. Associations of these factors were analyzed in logistic models and discrimination by areas of receiver operating characteristics curves (AUC). Results: The prevalence of vertebral fracture, ranged from 13.4% ages 50 to 59 years old to 58.1% at age 80 years or older. Older age, a history of non-vertebral fracture, lower femoral neck BMD T-score, body mass index (BMI), height loss, housework, and less than half an hour of outdoor activity were significantly associated with increased probability of having a vertebral fracture. A model with those seven factors had a similar AUC with or without BMD and performed better than a simple model with three factors. Conclusion: This study is from a true random sample of postmenopausal women in urban China with high response rate. The prevalence of vertebral fractures in postmenopausal women in Beijing increases from 13% under age 60 to over 50% by age 80 years. A model with seven clinical risk factors with or without BMD is better than simple models and may guide the use of spine x-rays to identify women with vertebral fractures. More than half an hour of outdoor activity might correlate with lower risk of vertebral fracture in this population. [ABSTRACT FROM AUTHOR]

It has been generally acknowledged that the diagnosis, treatment and prognosis evaluation of leukemia largely rely on an adequate identification of genetic abnormalities. A systemic analysis of genetic aberrations was performed in a cohort of 1346 patients with newly diagnosed acute lymphoblastic leukemia (ALL) in China. The pediatric patients had higher incidence of hyperdiploidy and t(12;21) (p13;q22)/ETV6-RUNX1 than adults (P<0.0001); in contrast, the occurrence of Ph and Ik6 variant of IKZF1 gene was much more frequent in adult patients (all P<0.0001). In B-ALL, the existence of Ik6 and that of BCR-ABL were statistically correlated (P<0.0001). In comparison with Western cohorts, the incidence of t(9;22) (q34;q11)/BCR-ABL (14.60%) in B-ALL and HOX11 expression in T-ALL (25.24%) seemed to be much higher in our group, while the incidence of t(12;21) (p13;q22)/ETV6-RUNX1 (15.34%) seemed to be lower in Chinese pediatric patients. The occurrence of hyperdiploidy was much lower either in pediatric (10.61% vs 20-38%) or adult patients (2.36% vs 6.77-12%) in our study than in Western reports. In addition, the frequencies of HOX11L2 in adult patients were much higher in our cohort than in Western countries (20.69% vs 4-11%). In general, it seems that Chinese ALL patients bear more adverse prognostic factors than their Western counterparts do. [ABSTRACT FROM AUTHOR]

Objective:To identify the body mass index (BMI; in kg/m2) cutoff that predicts the risk for obesity-related metabolic disorders for the Chinese population.Design:Community-based cross-sectional survey.Setting:Rural regions of Jiangxi and Anhui provinces and an urban community of Jing'an District of Shanghai, China.Subjects:Five hudred and twenty-nine non-pregnant, non-lactating urban and rural adults, aged 20–64 years without diagnosed diabetes.Results:Subjects were divided into two groups: with or without obesity-related metabolic disorders, which was defined as having at least one of the following: hypertension, insulin resistance, high plasma triacylglycerol, low-density lipoprotein-cholesterol or glucose. Gender-specific multiple logistic regression analysis demonstrated a significant dose–response relationship between BMI and obesity-related metabolic disorders, after adjusting for potential confounders. The lowest BMI interval associated with significant risk for both men and women (odds ratios of 2.67 and 3.46, respectively) was that of 22.5–24.4. Receiver-operating characteristic (ROC) curve analysis indicated that a BMI cutoff of 23 had the best combination of sensitivity and specificity and the shortest distance in the ROC curve, with positive and negative predictive values of 0.6–0.7 in both genders.Conclusions:A BMI cutoff of 23 might be appropriate for use in identification of high risk of obesity-related metabolic disorders and serve as a public health action threshold in the Chinese population.Sponsorship:Center of a Livable Future, Johns Hopkins Bloomberg School of Public Health.European Journal of Clinical Nutrition (2006) 60, 931–937. doi:10.1038/sj.ejcn.1602396; published online 8 February 2006 [ABSTRACT FROM AUTHOR]

Background: Early screening for autism spectrum disorder (ASD) is crucial, yet current assessment tools in Chinese primary child care are limited in efficacy., Objective: This study aims to employ machine learning algorithms to identify key indicators from the 20-item Modified Checklist for Autism in Toddlers, revised (M-CHAT-R) combining with ASD-related sociodemographic and environmental factors, to distinguish ASD from typically developing children., Methods: Data from our prior validation study of the Chinese M-CHAT-R (August 2016-March 2017, n = 6,049 toddlers) were reviewed. We extracted the 20-item M-CHAT-R data and integrated 17 sociodemographic and environmental risk factors associated with ASD development to strengthen M-CHAT-R's machine learning screening. Five feature selection methods were used to extract subsets from the original set. Six machine learning algorithms were applied to identify the optimal subset distinguishing clinically diagnosed ASD toddlers from typically developing toddlers., Findings: Nine features were grouped into three subsets: subset 1 contained unanimously recommended items (A1 [Follows point], A3 [Pretend play], A9 [Brings objects to show], A10 [Response to name] and A16 [Gazing following]). Subset 2 added two items (A17 [Gaining parent's attention] and A18 [Understands what is said]), and subset 3 included two more items (A8 [Interest in other children] and child's age). The top-performing algorithm resulted in a seven-item classifier of subset 2 with 92.5 % sensitivity, 90.1 % specificity, and 10.0 % positive predictive value., Conclusions: Machine learning classifiers effectively differentiate ASD toddlers from typically developing toddlers using a reduced M-CHAT-R item set., Clinical Implications: This highlights the clinical significance of machine learning-optimized models for ASD screening in primary health care centers and broader applications., Competing Interests: Declaration of competing interest The authors have indicated they have no potential conflicts of interest to disclose and have no financial relationships relevant to this article to disclose., (Copyright © 2025 The Author(s). Published by Elsevier B.V. All rights reserved.)

Purpose: System delay is associated with mortality in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). However, the influence of patient delay has been relatively overlooked. We aimed to evaluate the influence of patient and system delays on STEMI patients undergoing primary PCI in China., Methods: STEMI patients registered at the Nationwide Chinese Cardiovascular Association Database-Chest Pain Center from January 2017 to September 2021 were screened. The exposures were total ischemic time (TIT), system delay and patient delay. The primary outcome was in-hospital mortality., Results: Among 458,260 patients from 2529 centers, median TIT, system delay and patient delay were 4.1, 1.5 and 2.1 hours, respectively. The adjusted odds ratio of in-hospital mortality increased by 2.2% (odds ratio [OR], 1.022, 95% confidence interval [CI], 1.017-1.027), 2.3% (1.023, 1.006-1.040) and 2.2% (1.022, 1.017-1.027) for every one-hour increase in TIT, system delay and patient delay, respectively., Conclusions: Patient delay demonstrated a comparable impact to system delay on in-hospital mortality among STEMI patients undergoing primary PCI. Widespread primary PCI-capable center, improved awareness about myocardial infarction and regional transfer system are essential to shorten patient delay., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Aim: To examine the association between positive mental well-being and professional identity in nursing students. The mediating effects of resilience and nurse-patient relationship were explored., Background: Professional identity of nursing students can influence their pursuit of a nursing career. Negative mental health problems, such as anxiety, depression, and high stress, are known risk factors for professional identity. Few studies have examined the association of professional identity with positive mental well-being and underlying mechanisms., Methods: This was a cross-sectional study of Chinese nursing students on clinical placement. The Warwick-Edinburgh Mental Well-being Scale, Professional Identity Scale, Connor-Davidson Resilience Scale, Nurse-Patient Relationship Scale, and Patient Health Questionnaire were used, and demographic and study-related characteristics were measured. Multivariable linear regression and mediation analyses analyzed the associations. We followed the STROBE reporting guidelines., Results: Of 208 participants, the total scores of positive mental well-being and professional identity were at a moderate level. Positive mental well-being was associated with professional identity after adjusting for confounders including the main reason for choosing nursing and negative mental health. Resilience was a full mediator of the association between positive mental well-being and professional identity, whereas nurse-patient relationship was a partial mediator., Discussion and Conclusion: Positive mental well-being was associated with professional identity in Chinese nursing students on clinical placement, mediated through resilience and nurse-patient relationship. Positive mental well-being can be a facilitator for the professional identity of nursing students, and resilience and nurse-patient relationship could be potential mechanisms for nurse professional development., Implications for Nursing And/or Health Policy: Nurse researchers, educators, and policymakers are informed to increase the awareness of positive mental well-being and develop interventions targeting resilience and nurse-patient relationship for building a stable and satisfied nursing team., (© 2024 International Council of Nurses.)

This study examined parental autonomy support and psychological control and their relations with child biobehavioral functioning. Participants included 238 Chinese parent-child dyads (M age-child  = 8.38 years, 42.0% girls) in two cohorts (2013 and 2021). Parents in the 2021 cohort displayed higher levels of autonomy support and psychological control during the parent-child interaction than in the 2013 cohort. Parental psychological control was positively associated with emotion regulation and negatively associated with externalizing problems in the 2013 cohort, but not in the 2021 cohort. Parental psychological control was also negatively associated with vagal suppression in the 2021 cohort, but not in the 2013 cohort. The result suggests that sociocultural contexts may shape the display of parental behaviors and their significance for child development., (© 2024 The Author(s). Child Development © 2024 Society for Research in Child Development.)

Background: China has a large population of smokers, with half of them dependent on tobacco and in need of cessation assistance, indicating the need for mobile health (mHealth) to provide cessation support., Objective: The study aims to assess the feasibility and preliminary effectiveness of combining chatbot-led support with counselor-led support for smoking cessation among community smokers in China., Methods: This is a 2-arm, parallel, assessor-blinded, pilot randomized controlled trial nested in a smoke-free campus campaign in Zhuhai, China. All participants will receive brief face-to-face cessation advice and group cessation support led by a chatbot embedded in WeChat. In addition, participants in the intervention group will receive personalized WeChat-based counseling from trained counselors. Follow-up will occur at 1, 3, and 6 months after treatment initiation. The primary smoking outcome is bioverified abstinence (exhaled carbon monoxide <4 parts per million or salivary cotinine <30 ng/mL) at 6 months. Secondary outcomes include self-reported 7-day point prevalence of abstinence, smoking reduction rate, and quit attempts. Feasibility outcomes include eligibility rate, consent rate, intervention engagement, and retention rate. An intention-to-treat approach and regression models will be used for primary analyses., Results: Participant recruitment began in March 2023, and the intervention began in April 2023. The data collection was completed in June 2024. The results of the study will be published in peer-reviewed journals and presented at international conferences., Conclusions: This study will provide novel insights into the feasibility and preliminary effectiveness of a chatbot-led intervention for smoking cessation in China. The findings of this study will inform the development and optimization of mHealth interventions for smoking cessation in China and other low- and middle-income countries., Trial Registration: ClinicalTrials.gov NCT05777005; https://clinicaltrials.gov/study/NCT05777005., International Registered Report Identifier (irrid): DERR1-10.2196/58636., (©Xue Weng, Hua Yin, Kefeng Liu, Chuyu Song, Jiali Xie, Ningyuan Guo, Man Ping Wang. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 23.09.2024.)

Background/aims: Necrotizing pancreatitis (NP) presents a more severe clinical trajectory and increased mortality compared to edematous pancreatitis. Prompt identification of NP is vital for patient prognosis. A risk prediction model for NP among Chinese patients has been developed and validated to aid in early detection., Methods: A retrospective analysis was performed on 218 patients with acute pancreatitis (AP) to examine the association of various clinical variables with NP. The least absolute shrinkage and selection operator (LASSO) regression was utilized to refine variables and select predictors. Subsequently, a multivariate logistic regression was employed to construct a predictive nomogram. The model's accuracy was validated using bootstrap resampling (n=500) and its calibration assessed via a calibration curve. The model's clinical utility was evaluated through decision curve analysis., Results: Of the 28 potential predictors analyzed in 218 AP patients, the incidence of NP was 25.2%. LASSO regression identified 14 variables, with procalcitonin, triglyceride, white blood cell count at 48 hours post-admission, calcium at 48 hours post-admission, and hematocrit at 48 hours post-admission emerging as independent risk factors for NP. The resulting nomogram accurately predicted NP risk with an area under the curve of 0.822, sensitivity of 82.8%, and specificity of 76.4%. The bootstrap-validated area under the curve remained at 0.822 (95% confidence interval, 0.737 to 0.892). This model exhibited excellent calibration and demonstrated greater predictive efficacy and clinical utility for NP than APACHE II, Ranson, and BISAP., Conclusions: We have developed a prediction nomogram of NP that is of great value in guiding clinical decision.

Background: Bevacizumab shows superior efficacy in cerebral radiation necrosis (CRN) therapy, but its economic burden remains heavy due to the high drug price. This study aims to evaluate the cost-effectiveness of bevacizumab for CRN treatment from the Chinese payers' perspective., Methods: A decision tree model was developed to compare the costs and health outcomes of bevacizumab and corticosteroids for CRN therapy. Efficacy and safety data were derived from the NCT01621880 trial, which compared the effectiveness and safety of bevacizumab monotherapy with corticosteroids for CRN in nasopharyngeal cancer patients, and demonstrated that bevacizumab invoked a significantly higher response than corticosteroids (65.5% vs. 31.5%, P < 0.001) with no significant differences in adverse events between two groups. The utility value of the "non-recurrence" status was derived from real-world data. Costs and other utility values were collected from an authoritative Chinese network database and published literature. The primary outcomes were total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). The uncertainty of the model was evaluated via one-way and probabilistic sensitivity analyses., Results: Bevacizumab treatment added 0.12 (0.48 vs. 0.36) QALYs compared to corticosteroid therapy, along with incremental costs of $ 2010 ($ 4260 vs. $ 2160). The resultant ICER was $ 16,866/QALY, which was lower than the willingness-to-pay threshold of $ 38,223/QALY in China. The price of bevacizumab, body weight, and the utility value of recurrence status were the key influential parameters for ICER. Probabilistic sensitivity analysis revealed that the probability of bevacizumab being cost-effectiveness was 84.9%., Conclusion: Compared with corticosteroids, bevacizumab is an economical option for CRN treatment in China., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: About 2 billion people have caries in permanent teeth, and 514 million children have caries in primary teeth worldwide. Regional disparities in caries prevalence are evident in various areas of China. A comprehensive understanding of the status of dental caries and its associated risk factors is essential for developing effective dental health policies in economically disadvantaged regions. Thus, this study aims to examine the prevalence of dental caries and its risk factors among students aged 12-15 in Xide County, a remote mountainous area in China., Design: In this cross-sectional study, dental health surveys were conducted using self-administered questionnaires and the Decayed-Missing-Filled Tooth (DMFT) Index. An oral clinical examination was carried out by the criteria and guidelines set forth by WHO., Setting: Xide County, Liangshan prefecture, China in 2022., Participants: 558 students aged 12-15 years completed the survey., Results: The study conducted in Xide County found a dental caries prevalence of 42.5% among 12-15 year-old students, with a mean DMFT of 1.50 (SD=2.25). Multivariable logistic regression analysis identified several significant risk factors for dental caries (p<0.05), including starting brushing after the age of six (OR 0.34, 95% CI 0.17 to 0.65), brushing teeth less than once a day (OR 9.24, 95% CI 5.53 to 15.33) and consuming carbonated drinks more than once a day (OR 0.28, 95% CI 0.14 to 0.53). Additionally, the use of fluoride (OR 0.61, 95% CI 0.43 to 0.85) and awareness of its protective effect on teeth (OR 0.75, 95% CI 0.59 to 0.98) were found to be associated with a lower risk of dental caries (p<0.05)., Conclusion: The prevalence of dental caries among students aged 12-15 in Xide County was identified as a significant public oral health concern. The oral health behaviours of students were found to be influenced by factors at the family and community levels., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The growing generation of construction and demolition waste (CDW) has emerged as a prominent challenge on global environmental agendas. However, the effectiveness of CDW management (CDWM) strategies varies among cities. Existing literature predominantly evaluates the effectiveness of CDWM at the project level, offering a localized perspective that fails to capture a city's comprehensive CDWM profile. This localized focus has certain limitations. To fill this gap in city-scale evaluations, this study introduces a novel model for assessing CDWM effectiveness at the municipal level. An empirical investigation was conducted across 11 cities within the Guangdong-Hong Kong-Macao Greater Bay Area (GBA) to operationalize this model. The model defines five distinct levels of CDWM effectiveness. Findings indicate that Hong Kong consistently achieves the highest level (level I), while the majority of cities fall within levels III and IV. This pattern suggests that CDWM effectiveness in the GBA is moderately developed, with uneven progress in CDW management outcomes and supporting systems. Essentially, there is a lack of synchronous development of CDWM results and guarantee systems. The proposed evaluation model enriches existing CDWM research field and offers a framework that may inform future studies in other countries., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: To investigate the cost-effectiveness of lenvatinib plus pembrolizumab (LP) compared to chemotherapy as a second-line treatment for advanced endometrial cancer (EC) from the United States and Chinese payers' perspective., Methods: In this economic evaluation, a partitioned survival model was constructed from the perspective of the United States and Chinese payers. The survival data were derived from the clinical trial (309-KEYNOTE-775), while costs and utility values were sourced from databases and published literature. Total costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) were estimated. The robustness of the model was evaluated through sensitivity analyses, and price adjustment scenario analyses was also performed., Results: Base-case analysis indicated that LP wouldn't be cost-effective in the United States at the WTP threshold of $200 000, with improved effectiveness of 0.75 QALYs and an additional cost of $398596.81 (ICER $531392.20). While LP was cost-effective in China, with improved effectiveness of 0.75 QALYs and an increased overall cost of $62270.44 (ICER $83016.29). Sensitivity analyses revealed that the above results were stable. The scenario analyses results indicated that LP was cost-effective in the United States when the prices of lenvatinib and pembrolizumab were simultaneously reduced by 61.95% ($26.5361/mg for lenvatinib and $19.1532/mg for pembrolizumab)., Conclusion: LP isn't cost-effective in the patients with advanced previously treated endometrial cancer in the United States, whereas it is cost-effective in China. The evidence-based pricing strategy provided by this study could benefit decision-makers in making optimal decisions and clinicians in general clinical practice. More evidence about budget impact and affordability for patients is needed., (© 2024 Japan Society of Obstetrics and Gynecology.)

Objective: To investigate the relationship between maternal folic acid (FA) supplementation during the pre-conceptional and prenatal periods and the subsequent risk of autism spectrum disorder (ASD) in offspring., Methods: A total of 6,049 toddlers aged 16-30 months were recruited from August 2016 to March 2017 for this cross-sectional study conducted in China. The parents of the enrolled toddlers provided information on maternal supplemental FA, socio-demographic information, and related covariates. Standard diagnostic procedures were implemented to identify toddlers with ASD., Results: Among the 6,049 children included in the study, consisting of 3,364 boys with an average age of 22.7 ± 4.1 months, a total of 71 children (1.2%) were diagnosed with ASD. Mothers who did not consume FA supplements during the prenatal period were found to have a significantly increased risk of having offspring with ASD, in comparison to those who were exposed to FA supplements (odds ratio [ OR ] = 2.47). However, we did not find a similar association during the pre-conceptional period. Compared to mothers who consistently used FA supplements from pre-conception to the prenatal period, those who never used FA supplements were statistically significantly associated with a higher risk of ASD in their offspring ( OR  = 2.88)., Conclusion: This study indicated that providing continuous maternal FA supplementation during the pre-conceptional and prenatal periods may decrease the risk of ASD in offspring. The prenatal period is considered to be the most crucial time for intervention., 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 Jiang, Guo, Kuang, Lin, Xu, Pan, Weng, Jing, Shi, Yi and Wang.)

Aim: To estimate the cost-effectiveness of zolbetuximab plus capecitabine/oxaliplatin (CAPOX) in CLDN18.2-positive, HER2- negative, mG/GEJ adenocarcinoma from the perspective of Chinese payers. Materials & methods: A partitioned survival model was developed to assess the costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICER) of zolbetuximab plus CAPOX versus placebo plus CAPOX. Sensitivity analyses were performed to test the robustness of model. Results: Zolbetuximab plus CAPOX gained an additional cost of $91,551 and an extra health benefit of 0.24 QALY over placebo plus CAPOX, producing an ICER of $388,186/QALY, which exceeded the willingness-to-pay threshold of $38,223/QALY. Sensitivity analysis shows that the model was generally robust. Conclusion: Zolbetuximab plus CAPOX would not be a cost-effective first-line treatment regimen in CLDN18.2-positive, HER2 -negative, mG/GEJ adenocarcinoma in China.

Epstein-Barr virus (EBV)-positive plasma cell neoplasms (PCNs) in immunocompetent patients are a rare entity, the clinicopathological and prognostic features of which have not been well characterized. Fifteen cases of EBV-positive PCN arising in immunocompetent patients from south China were retrospectively analyzed, and an additional 44 cases from the literature were reviewed. The overall EBV-positive rate defined by EBV-encoded small RNAs (EBERs) in-situ hybridization of PCNs was 12.3% (15/122), and it was significantly higher in plasmacytoma (17.1%, 13/76) than in plasma cell myeloma/multiple myeloma (4.3%, 2/46; P=0.031). The age of the patients ranged from 17 to 79 years, with a median age of 56 years. There was a large preponderance of men, with a male-to-female ratio of 4:1. Solitary plasmacytoma of bone (23.8%, 5/21) had comparable EBV-encoded small RNAs-positive rates with extramedullary plasmacytoma arising in the upper respiratory tract (19.5%, 8/41; P=0.949). Anaplastic and classic cytologic appearance was observed in 61.5% (8/13) and 38.5% (5/13) of EBV-positive plasmacytomas, respectively. Cases with an anaplastic cytologic appearance had a significantly higher Ki-67 proliferation index than those with a classic cytologic appearance (median: 55% vs. 10%, P=0.001). In the combined cohorts, anaplastic/plasmablastic cytologic appearance was significantly more common in extramedullary plasmacytoma arising in the upper respiratory tract (72.0%, 18/25) than outside the upper respiratory tract (11.1%, 1/9; P=0.006). Among the 59 cases of EBV-positive PCN, survival data of 34 cases were available for analysis, including 30 cases of plasmacytoma and 4 cases of plasma cell myeloma/multiple myeloma. There was no statistically significant difference in overall survival between patients with EBV-positive plasmacytomas in the combined cohorts and EBV-negative plasmacytomas in the present cohort. The prevalence of EBV in PCN in immunocompetent patients varies according to histologic subtype and tumor location. Compared with EBV-negative cases, EBV-positive plasmacytomas tend to have an anaplastic/plasmablastic cytologic appearance. No significant impact of EBV infection on clinical outcomes is observed in the limited number of reported cases., Competing Interests: Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Synthetic phenolic antioxidants (SPAs) are widely used in diverse industries due to their exceptional antioxidant characteristics. However, human exposure to SPAs may cause health problems. In this study, 226 dust samples were collected from 10 provinces in China, and six SPAs (three parent SPAs and their three transformation products) were analyzed. The concentrations of ∑ 6 SPAs (the sum of six target compounds) ranged from 15.4 to 3210 ng/g (geometric mean (GM): 169 ng/g). The highest concentration of ∑ 6 SPAs was found in Sichuan Province (GM: 349 ng/g), which was approximately 4 times higher than that in Hubei Province (81.6 ng/g) (p < 0.05). The concentrations of butylated hydroxytoluene (BHT), 2,2'-methylene bis (4-methyl-6‑tert-butylphenol) (AO2246), 2,6-di‑tert‑butyl‑1,4-benzoquinone (BHT-Q), 2,6-di‑tert‑butyl‑4-(hydroxymethyl) phenol (BHT-OH), and ∑p-SPAs were substantially higher in dust from urban areas than rural areas (p < 0.05). AO2246 concentration in dust from homes (GM: 0.400 ng/g) was about 4 times higher than that in workplaces (0.116 ng/g) (p < 0.01). Significantly higher ∑p-SPAs concentrations were found in dust from homes (GM: 17.5 ng/g) than workplaces (11.4 ng/g) (p < 0.01). The estimated daily intakes (EDIs) of ∑ 6 SPAs exposed through dust ingestion were 0.582, 0.342, 0.197, 0.076, and 0.080 ng/kg bw/day in different age groups, and exposed through dermal contact was 0.358, 0.252, 0.174, 0.167, and 0.177 ng/kg bw/day. EDIs showed that the exposure risks of SPAs decreased with age. This is the first work to determine SPAs in dust from 10 provinces in China and investigate the spatial distribution of SPAs in those regions., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

The Gutong Patch (GTP) is common in clinical practice for bone diseases. This study compared the efficacy and safety of GTP and nonsteroidal anti-inflammatory drugs (NSAIDs) for KOA patients from 35 medical centers assigned to GTP, selective COX-2 inhibitor (SCI), GTP + SCI, non-selective COX-2 inhibitor (NSCI), and GTP + NSCI groups. The visual analog scale (VAS) pain score, EuroQol-VAS, EuroQol 5D-3 L, time to articular pain relief / disappearance, and joint motion recovery were the efficacy assessments. Safety assessments included contact dermatitis, gastrointestinal disorders, etc. The p-value < 0.05 was considered statistically significant. After statistical analysis, the SCI and GTP + SCI groups showed better improvement of VAS than the GTP group; the time to articular pain relief in the NSCI group was shorter than that in GTP and SCI group; the time to joint motion recovery in the GTP + NSCI group was longer than that in the SCI group. Additionally, the improvement of the quality of life in all groups was significant after treatments. While the incidence of gastrointestinal adverse events in the NSAIDs group was higher than that in the GTP and GTP + NSAIDs groups. GTP and NSAIDs are effective for KOA patients, and GTP is more suitable for KOA patients with cardiovascular and gastrointestinal comorbidities. This study was approved by the Ethics Committee at Peking Union Medical College Hospital (HS-1766) and registered in the Chinese Clinical Trial Registry (ChiCTR2100046391)., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023. Published by Elsevier Ltd.)

Background: Due to the COVID-19 epidemic, Chinese hospitals are forced to impose stringent regulations, which unavoidably affect patients with stroke who need continued rehabilitation and long-term disease treatment. However, there is a lack of qualitative studies in the literature on female relative caregivers of hospitalised patients who had a stroke with dysphagia during the COVID-19 pandemic., Objective: In this study, we aimed to explore the experiences of female Chinese caregivers living in the hospital with patients with post-stroke dysphagia during the pandemic., Design: We conducted a qualitative study using semi-structured interviews., Settings: From May 2022 to July 2022, patients were selected from the Acupuncture and Moxibustion Ward and the Encephalopathy Ward of Shenzhen Chinese Medicine Hospital, which receives patients from across the country., Participants: 10 Chinese women who were caregivers of patients with post-stroke dysphagia were finally interviewed., Methods: Interviews were transcribed verbatim and analysed using Colaizzi's approach., Results: The primary theme was determined to be 'kidnapped' lives. Other sub-themes evolved to depict the lives of female relative caregivers, including inevitable tasks and challenges, precise care, a special dietary pattern, solitary and forgotten, and an elusive future. Due to the trivial nature of caring for patients who had a stroke with dysphagia, the caregivers' lives were tightly organised and entirely dictated by the patient's caring needs. Consequently, the caregivers felt that their lives had been kidnapped., Conclusions: It is imperative that healthcare workers identify and understand the living conditions of female relative caregivers in the hospital, so as to determine their difficulties and needs. Finally, caregivers deserve adequate and effective support, such as technical support, financial support and nutritional guidance., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: It is unclear whether the enhancing contact model (ECM) intervention is effective in reducing family caregiving burden and improving hope and quality of life (QOL) among family caregivers of persons with schizophrenia (FCPWS)., Methods: We conducted a cluster randomized controlled trial in FCPWS in eight rural townships in Xinjin, Chengdu, China. In total, 253 FCPWS were randomly allocated to the ECM, psychoeducational family intervention (PFI), or treatment as usual (TAU) group. FCPWS in three groups were assessed caregiving burden, QOL and state of hope at baseline (T0), post-intervention (T1), 3-month (T2), and 9-month (T3) follow-up, respectively., Results: Compared with participants in the TAU group, participants in the ECM group had statistically significantly lower caregiving burden scores both at T1 and T2 ( p = 0.0059 and 0.0257, respectively). Compared with participants in the TAU group, participants in the PFI group had statistically significantly higher QOL scores in T1 ( p = 0.0406), while participants in the ECM group had statistically significantly higher QOL scores in T3 ( p = 0.0240). Participants in both ECM and PFI groups had statistically significantly higher hope scores than those in the TAU group at T1 ( p = 0.0160 and 0.0486, respectively)., Conclusions: This is the first study to explore the effectiveness of ECM on reducing family caregiving burden and improving hope and QOL in rural China. The results indicate the ECM intervention, a comprehensive and multifaceted intervention, is more effective than the PFI in various aspects of mental wellbeing among FCPWS. Future research needs to confirm ECM's effectiveness in various population.

Background: Before the advent of total hip arthroplasty, Vitallium mold arthroplasty had been widely performed. We present a case with a 42-year follow-up after Vitallium mold arthroplasty. To our knowledge, this case represents the longest known follow-up of Vitallium mold arthroplasty in China., Case Presentation: This was a 59-year-old male. He underwent Vitallium mold arthroplasty of the left hip 42 years ago because of osteonecrosis of the femoral head. He developed left hip pain 3 months ago and underwent total hip revision surgery. There was some clear synovial fluid in the hip joint. The mold was loosened entirely and taken out effortlessly. Gram-positive cocci could be observed occasionally in the synovial fluid smear, while the synovial fluid culture was negative. The inflammatory markers elevated perioperatively, and prophylactic cefuroxime and vancomycin were utilized successively. All elevated inflammatory markers fell since postoperative day 5, and there was no other sign of infection. The pain and function of the hip joint improved significantly after surgery., Conclusions: Although Vitallium mold arthroplasty was inferior to total hip arthroplasty in survival rate and functional outcome, it did provide an excellent long-term function of the hip joint., (© 2023 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

Background: Although stigma and caregiving burden are important in relation to mental health recovery, few studies have been conducted on affiliate stigma and caregiving burden among family caregivers of persons with schizophrenia (FCPWS) in rural China., Aims: This study aimed to examine the severity level of affiliate stigma and caregiving burden, and identify the correlates among FCPWS in rural China., Methods: A mental health survey was conducted ( N  = 253 FCPWS) in Xinjin county, Sichuan province, China. Affiliate Self-Stigma Scale and Zarit Burden Interview Short Form were used. The regression analysis was performed to explore the correlates of stigma and burden., Results: Most FCPWS reported experiencing high and severe level of affiliate stigma (78.66%) and caregiving burden (95.26%). Family caregivers who were middle aged, unemployed, with high caregiving burden and low quality of life (QoL), showed more severe affiliate stigma. Family caregivers who were female, older, with low income, high affiliate stigma and low QoL, experienced greater caregiving burden., Conclusions: The large majority of FCPWS in rural China experienced severe affiliate stigma, caregiving burden and poor QoL. It is crucial to develop culture-specific anti-stigma interventions to reduce caregivers' stigma and caregiving burden, and improve QoL. Specific risk factors of family caregivers' affiliate stigma and caregiving burden should be considered for development of health policy and community-based mental health services.

Combination therapy of zoledronic acid (ZOL) plus aromatase inhibitor (AI) was found to reduce bone metastasis risk and improve overall survival for treatment-naïve postmenopausal women (PMW) with hormone receptor-positive (HR+) early breast cancer (EBC), when compared with AI alone. The objective of this study was to evaluate the cost-effectiveness of adding ZOL to AI in treating PMW with HR+ EBC in China. A 5-state Markov model was constructed to evaluate the cost-effectiveness of adding ZOL to AI for PMW-EBC (HR+) over a lifetime horizon from the perspective of Chinese healthcare provider. Data used were obtained from previous reports and public data. The primary outcomes of this study were direct medical cost, life years (LYs), quality-adjusted LYs (QALYs), and incremental cost-effectiveness ratios (ICERs). One-way and probabilistic sensitivity analyses were performed to examine the robustness of the presented model. Over a lifetime horizon, adding ZOL to AI was projected to yield a gain of 1.286 LYs and 1.099 QALYs compared with AI monotherapy, which yielded ICER $11 140.75 per QALY with an incremental cost of $12 247.36. The one-way sensitivity analysis indicated that the cost of ZOL was the most influential factor in our study. The probability that adding ZOL to AI was cost-effective at a threshold of $30 425 per QALY in China was 91.1%. ZOL is likely to be cost-effective in reducing bone metastasis risk and improving overall survival for PMW-EBC (HR+) in China., (© The Author(s) 2023. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To investigate the rate of periprosthetic joint infection (PJI) revision surgeries and clinical information of hip-/knee- PJI cases nationwide from 2015 to 2017 in China. Methods: An epidemiological investigation. A self-designed questionnaire and convenience sampling were used to survey 41 regional joint replacement centers nationwide from November 2018 to December 2019 in China. The PJI was diagnosed according to the Musculoskeletal Infection Association criteria. Data of PJI patients were obtained by searching the inpatient database of each hospital. Questionnaire entries were extracted from the clinical records by specialist. Then the differences in rate of PJI revision surgery between hip- and knee- PJI revision cases were calculated and compared. Results: Total of 36 hospitals (87.8%) nationwide reported data on 99 791 hip and knee arthroplasties performed from 2015 to 2017, with 946 revisions due to PJI (0.96%). The overall hip-PJI revision rate was 0.99% (481/48 574), and it was 0.97% (135/13 963), 0.97% (153/15 730) and 1.07% (193/17 881) in of 2015, 2016, 2017, respectively. The overall knee-PJI revision rate was 0.91% (465/51 271), and it was 0.90% (131/14 650), 0.88% (155/17 693) and 0.94% (179/18 982) in 2015, 2016, 2017, respectively. Heilongjiang (2.2%, 40/1 805), Fujian (2.2%, 45/2 017), Jiangsu (2.1%, 85/3 899), Gansu (2.1%, 29/1 377), Chongqing (1.8%, 64/3 523) reported relatively high revision rates. Conclusions: The overall PJI revision rate in 34 hospitals nationwide from 2015 to 2017 is 0.96%. The hip-PJI revision rate is slightly higher than that in the knee-PJI. There are differences in revision rates among hospitals in different regions.

Introduction: The natural disasters and climate anomalies caused by increasing global carbon emissions have seriously threatened public health. To solve increasingly serious environmental pollution problems, the Chinese government has committed itself to achieving the goals of peak carbon emissions and carbon neutrality. The low-carbon patent application is an important means to achieve these goals and promote public health., Methods: This study analyzes the basic situation, spatial network, and influencing factors of low-carbon patent applications in China since 2001 at the provincial and urban agglomeration levels using social network analysis based on data from the Incopat global patent database., Results: The following findings are established. (1) From the number of low-carbon patent applications, the total number of low-carbon patent applications in China increased year by year, while the number of applications in the eastern region was larger than those in the central and western regions, but such regional differences had been decreasing. (2) At the interprovincial level, low-carbon patent applications showed a complex and multithreaded network structure. In particular, the eastern coastal provinces occupied the core position in the network. The weighted degree distribution of China's interprovincial low-carbon patent cooperation network is affected by various factors, including economic development, financial support, local scientific research level, and low-carbon awareness. (3) At the urban agglomeration level, the eastern coastal urban agglomerations showed a radial structure with the central city as the core. Urban innovation capability, economic development, low-carbon development awareness, level of technology import from overseas, and informatization level are highly correlated with the weighted degree of low-carbon cooperation networks of urban agglomerations., Discussion: This study provides ideas for the construction and governance of low-carbon technology innovation system and perspectives for theoretical research on public health and high-quality development in China., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Hu, Qiu, Xiang, Wei, Sun, Hu, Weng, Mao and Zeng.)

Objective: To compare cesarean delivery (CD) rates in referral and non-referral hospitals in Maternal Safety Collaboration in Jiangsu province, China., Methods: Sixteen participants (4 referral hospitals, 12 non-referral hospitals) from Drum Tower Hospital Collaboration for Maternal Safety reported CD rates in 2019 using ten-group classification system and maternal/neonatal morbidity and mortality., Results: A total of 22,676 CDs were performed among 52,499 deliveries and the average CD rate was 43.2% (range 34.8-69.6%). CD rate in non-referral hospitals (44.7%) was significantly higher than it was in referral hospitals (40.4%, p  < .001). Term singleton cephalic nulliparous women with spontaneous labor (Group 1) or induced labor (Group 2a) had higher CD rates if they were cared in non-referral hospitals compared with those in referral hospitals (Group 1: 11.8% vs. 4.4%, p  < .001; Group 2a: 29.1% vs. 21.3%, p  < .001). In non-referral hospitals, CD rate in Group 5 and the proportion of Group 5 to the overall population were also significantly higher than those in referral hospitals (98.5% vs. 92.5%, p  < .001; and 21.0% vs. 14.5%, p  < .001)., Conclusion: To decrease the CD rate, we need to take efforts in decreasing unnecessary operations for term singleton cephalic nulliparous women and increasing the rate of trial of labor after CD.

Background: The determination of HER2 expression status contributes significantly to HER2-targeted therapy in breast carcinoma. However, an economical, efficient, and non-invasive assessment of HER2 is lacking. We aimed to develop a clinicoradiomic nomogram based on radiomics scores extracted from multiparametric MRI (mpMRI, including ADC-map, T2W1, DCE-T1WI) and clinical risk factors to assess HER2 status., Methods: We retrospectively collected 214 patients with pathologically confirmed invasive ductal carcinoma between January 2018 to March 2021 from Fudan University Shanghai Cancer Center, and randomly divided this cohort into training set (n = 128, 42 HER2-positive and 86 HER2-negative cases) and validation set (n = 86, 28 HER2-positive and 58 HER2-negative cases) at a ratio of 6:4. The original and transformed pretherapy mpMRI images were treated by semi-automated segmentation and manual modification on the DeepWise scientific research platform v1.6 ( http://keyan.deepwise.com/ ), then radiomics feature extraction was implemented with PyRadiomics library. Recursive feature elimination (RFE) based on logistic regression (LR) and LASSO regression were adpoted to identify optimal features before modeling. LR, Linear Discriminant Analysis (LDA), support vector machine (SVM), random forest (RF), naive Bayesian (NB) and XGBoost (XGB) algorithms were used to construct the radiomics signatures. Independent clinical predictors were identified through univariate logistic analysis (age, tumor location, ki-67 index, histological grade, and lymph node metastasis). Then, the radiomics signature with the best diagnostic performance (Rad score) was further combined with significant clinical risk factors to develop a clinicoradiomic model (nomogram) using multivariate logistic regression. The discriminative power of the constructed models were evaluated by AUC, DeLong test, calibration curve, and decision curve analysis (DCA)., Results: 70 (32.71%) of the enrolled 214 cases were HER2-positive, while 144 (67.29%) were HER2-negative. Eleven best radiomics features were retained to develop 6 radiomcis classifiers in which RF classifier showed the highest AUC of 0.887 (95%CI: 0.827-0.947) in the training set and acheived the AUC of 0.840 (95%CI: 0.758-0.922) in the validation set. A nomogram that incorporated the Rad score with two selected clinical factors (Ki-67 index and histological grade) was constructed and yielded better discrimination compared with Rad score (p = 0.374, Delong test), with an AUC of 0.945 (95%CI: 0.904-0.987) in the training set and 0.868 (95%CI: 0.789-0.948; p = 0.123) in the validation set. Moreover, calibration with the p-value of 0.732 using Hosmer-Lemeshow test demonstrated good agreement, and the DCA verified the benefits of the nomogram., Conclusion: Post largescale validation, the clinicoradiomic nomogram may have the potential to be used as a non-invasive tool for determination of HER2 expression status in clinical HER2-targeted therapy prediction., (© 2022. The Author(s).)

Background: SARS-CoV-2, a new coronavirus first reported by China on December 31st, 2019, has led to a global health crisis that continues to challenge governments and public health organizations. Understanding COVID-19 knowledge, attitudes, and practices (KAP) is key for informing messaging strategies to contain the pandemic. Cross-national studies (e.g.: comparing China to the U.S.) are needed to better understand how trans-cultural differences may drive differences in pandemic response and behaviors. The goal of the study is to compare knowledge and perceptions of COVID-19 between adults in China and the U.S. These data will provide insight into challenges these nations may face in coordinating pandemic response., Methods: This is a convergent mixed methods study comparing responses from China and the U.S. to a multinational COVID-19 KAP online survey. The survey included five quantitative constructs and five open-ended questions. Chinese respondents (n = 56) were matched for gender, age, education, perceived social standing, and time of survey completion with a U.S. cohort (n = 57) drawn from 10,620 U.S., Respondents: Quantitative responses were compared using T-test & Fisher-Exact tests. Inductive thematic analysis was applied to open-ended questions., Results: Both U.S. and Chinese samples had relatively high intention to follow preventive behaviors overall. Differences in intended compliance with a specific recommendation appear to be driven by the different cultural norms in U.S. and China. Both groups expressed trepidation about the speed of COVID-19 vaccine development, driven by concern for safety among Chinese respondents, and concern for efficacy among U.S., Respondents: The Chinese cohort expressed worries about other countries' passive handling of the pandemic while the U.S. cohort focused on domestic responses from individuals and government. U.S. participants appeared more knowledgeable on some aspects of COVID-19. Different perspectives regarding COVID-19 origins were identified among the two groups. Participants from both samples reported high trust in health professionals and international health organizations., Conclusions: Mixed methods data from this cross-national analysis suggests sociocultural differences likely influence perceptions and knowledge of COVID-19 and its related public health policies. Discovering and addressing these culturally-based differences and perceptions are essential to coordinate a global pandemic response., (© 2022. The Author(s).)

Backgrounds: Mismatch between knee surface and prosthesis components is related to postoperative complications. Morphological differences between ethnicity and gender may affect prosthesis coverage. The purpose of this study is to describe morphological characters of resected knee surface (distal femur, proximal tibia) in the Chinese population, analyze the influence of gender and other demographical factors, and validate the effect of ethnic difference by calculating the coverage of Western-designed knee prostheses on Chinese knee surface., Methods: Intraoperative anthropometries were performed during total knee arthroplasty performed by one single team. After screening out severe deformities and bone defects, data were separated via prosthesis system. Multiple linear regression and partial correlation analysis of morphological parameters on age, gender, height, weight were used to find out independent factors influencing morphology. Based on the 5 mm-tolerance in the prosthesis, simulation on scatter plots was brought out to calculate the prosthesis coverage to the resected bone surface., Results: A total of 865 cases of total knee arthroplasty were involved in this study. Though gender differences were found in all knee morphological parameters regardless of the type of prosthesis, significant association was only found between gender and mediolateral width of femoral surface after adjusting demographical factors (p < 0.001). The two included prosthesis systems, Genesis-II and Scorpio NRG covered most cases in at least one dimension. Males had lower complete coverage and higher no coverage rate on femurs. Asymmetry prostheses had higher lateral coverage on tibiae., Conclusions: Based on our analysis, the only confirmed demographical factor in knee morphology is gender on femoral mediolateral length. Wider femoral prostheses for males may improve results of gender-specific prostheses. The overall fitness between Western-designed prostheses and Chinese knee surface is appliable, but the ratio of complete coverage is low. Further modification of prostheses systems can aim at the number of sizes and geometrical shapes., (© 2022. The Author(s).)

Background: The association between low birth weight (LBW) and dental caries is currently unclear. The aim of this study was to investigate the association of LBW with dental caries in permanent teeth in children of Ningbo city., Methods: A total of 1975 children aged 11-to-13 years in Ningbo, China were enrolled in this cross-sectional study. LBW was defined as a birthweight< 2500 g. Ten dentists assessed the status of dental caries in permanent teeth in line with the World Health Organization (WHO) criteria and guidelines. Decayed, missing or filled teeth were considered to have dental caries. Parental questionnaires were used to collect child information. Non-conditional logistic regression analysis was used to estimate odds ratios (ORs) and the corresponding 95% confidence intervals (CIs)., Results: Dental caries in permanent teeth was found in 610 children (30.9%), with a mean DMFS of 2.09 (SD = 1.2). The adjusted ORs for dental caries in permanent teeth was 1.46 (95% CI 1.00, 2.13) for LBW., Conclusions: LBW was not associated with dental caries in permanent teeth in the study population., (© 2021. The Author(s).)

Objective: To investigate the population dynamics and Echinococcus infections in small rodents around human settlement in Yushu City, Qinghai Province., Methods: Rodents were captured using the mouse trap method in pastures from Batang Township and Longbao Township of Yushu City, Qinghai Province on May, August and October, 2018. The body weight and snout-vent length of all captured rodents were measured, and the species was identified according to the rodent morphology. Genomic DNA was extracted from rodent liver specimens and lesion specimens, and the mitochondrial cox1 gene of Echinococcus was amplified using PCR assay for identification of parasite species. In addition, the tissue specimens positive for PCR assay were sampled for pathological examinations. The prevalence of Echinococcus infections was estimated in rodents, and a phylogenetic tree was created based on Echinococcus cox1 gene sequences., Results: A total of 285 small rodents were captured, including 143 Ochotona curzoniae (50.2%), 141 Lasiopodomys fuscus (49.5%), and 1 Neodon irene (0.3%), and there was a remarkable variation in habitat selection among these three rodent species. The number of L. fuscus correlated positively with vegetation coverage ( r = 0.350, P = 0.264), with the greatest number seen in August, and the number of O. curzoniae negatively with vegetation coverage ( r = -0.371, P = 0.235), with the highest number seen in August and the lowest number in May. The female/male ratios of O. curzoniae and voles were 1:0.96 and 0.82:1, respectively. The body weight ( r = 0.519, P < 0.01) and snout-vent length ( r = 0.578, P < 0.01) of O. curzoniae showed a tendency towards a rise with month, while the body weight ( r = -0.401, P < 0.01) and snout-vent length ( r = -0.570, P < 0.01) of voles presented a tendency towards a reduction with month. No Echinococcus infection was detected in voles, while 2.1% prevalence of E. shiquicus infection was seen in O. curzoniae . Phylogenetic analysis revealed consistent sequences of cox1 gene from E. shiquicus in Yushu City of Qinghai Province and Shiqu County, Ganzi Tibetan Autonomous Prefecture of Sichuan Province., Conclusions: The small rodents around the human settlement in Yushu City of Qinghai Province mainly include O. curzoniae and L. fuscus , with the greatest numbers seen in May and August, respectively. Following the concerted efforts for echinococcosis control, the prevalence of Echinococcus infections is low in small rodents around the human settlement in Yushu City; however, there is still a risk of echinococcosis transmission.

Background: We conducted a cost-effectiveness analysis incorporating recent phase III clinical trial (MONALEESA-7) data to evaluate the cost-effectiveness of ribociclib (RIB) as a first-line treatment for premenopausal women with hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer (ABC) from the United States healthcare payer perspective. In addition, because RIB has not been marketed in China, we identified the range of drug costs for which RIB could be considered cost effective from a Chinese healthcare system perspective., Patients and Methods: A Markov model was developed to evaluate the cost-effectiveness of adding RIB to endocrine therapy over a lifetime. The clinical outcomes and utility data were obtained from published literature. Costs data were obtained from United States and Chinese official websites, and we determined the potential price for RIB in China based on its price in the United States. The main outcomes of this study were the incremental cost-effectiveness ratio (ICER) and quality-adjusted life-years (QALYs)., Results: The model projected that mean outcome was better with RIB and endocrine combined (3.83366 QALYs) than with endocrine therapy alone (2.71203 QALYs). In the United States, RIB and endocrine therapy cost an additional $604,960.06, resulting in an ICER of $539,357.95/QALY compared with endocrine monotherapy. Subgroup analyses indicated that, in China, the projected mean outcomes were better for RIB and endocrine therapy (6.37 QALYs) than for endocrine monotherapy (2.71 QALYs). The corresponding incremental costs were $224,731.88943. Thus, the ICER comparing RIB and endocrine therapy with endocrine therapy alone represented a $61,454.96/QALY gain., Conclusion: Additional use of RIB is estimated to not be cost effective as a first-line treatment for premenopausal women with HR-positive, HER2-negative ABC in the United States. A value-based price for the cost of RIB is less than $31.74/200 mg for China., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: Mindfulness training (MT) has shown preliminary efficacy as a behavioral treatment for smoking cessation. We examined the effect of a brief-MT intervention on smoking cessation for Chinese women in workplaces in Hong Kong, China., Methods: In this pilot randomized controlled trial, 213 daily smokers were recruited from workplaces and computer-randomized into the intervention (n = 114) or control (n = 99) groups. Participants in both groups received a self-help booklet. Participants in the intervention group additionally attended 2 sessions of a brief-MT workshop. The primary outcome was self-reported 7-day point-prevalence abstinence (PPA) at 6 months. Secondary outcomes were biochemically validated abstinence (exhaled CO < 4 ppm and salivary cotinine < 10 ng/mL) and smoking reduction at 6 months. Analyses were done by intention to treat. We conducted a post-trial qualitative evaluation on participants in the intervention group (n = 14). Data were analyzed thematically., Results: At 6-month follow-up, self-reported 7-day PPA were similar between the intervention and control groups (18.4% vs. 21.2%; P = 0.61). Very few participated in biochemical validation (n = 17), and validated abstinence and smoking reduction rates showed no significant difference (5.3% vs. 11.1%, P = 0.12 and 20.2% vs. 20.2%, P = 1.00, respectively). A posteriori analysis showed that brief-MT participants who were psychologically engaged with the intervention had greater 6-month PPA. Qualitative evaluation showed brief-MT reduced stress but its effectiveness was restrained by the insufficient home practice., Conclusions: This pilot trial on a brief-MT intervention for smoking cessation on Chinese women in workplaces showed feasibility, but improving compliance is needed to maximize the efficacy in future fully powered trials., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Polyunsaturated fatty acids (PUFAs) are essential for mammalian testis development and sperm function. However, PUFAs that are contained in linseed oil are easily oxidized in the diet and biohydrogenated in the rumen. In this study, we investigated the effect of linseed as a source of PUFAs on the antioxidant capacity and testis development in Hu lamb. Seventy-five 3-month-old lambs were randomly assigned to three groups. Within each treatment group, 25 lambs were allocated to five pens (five lambs per pen). The lambs in the control group were fed a control diet without linseed for 42 days from D22 to D63. Group I (BS28) was fed a control diet from D22 to D35 and 8% linseed diet from D36 to D63. Group II (BS42) was fed an 8% linseed diet for 42 days from D22 to D63. After 63-day feeding trial, all lambs except the heaviest and lightest in each pen were humanely slaughtered and investigated. Results revealed that feeding linseed did not affect the body weight, scrotal circumference, and testis weight, whereas feeding linseed for 42 days increased the epididymis weight (37.85 ± 1.61 g vs. 32.09 ± 1.06 g, P < 0.05) compared with the control group. Feeding lambs with linseed for 42 days also significantly upregulated the expression of antioxidative (glutathione peroxidase 4 and copper-zinc superoxide dismutase), steroidogenesis (3β-hydroxysteroid dehydrogenase and steroid acute regulatory protein), and PUFA metabolism-related genes (fatty acid desaturase 2 and elongation of very long-chain fatty acid protein 2) and proliferating cell nuclear antigen mRNA (P < 0.05). It also increased the relative expression of mitochondrial DNA (P < 0.05), total antioxidant capacity (0.230 ± 0.019 mmol/mgprot vs. 0.175 ± 0.011 mmol/mgprot, P < 0.05), and superoxide dismutase (1661.467 ± 147.117 U/mgprot vs. 1158.891 ± 98.850 U/mgprot, P < 0.05) in testicular tissue but decreased the cholesterol concentration (0.331 ± 0.073 mmol/mgprot vs. 0.671 ± 0.092 mmol/mgprot, P < 0.05) compared with the control group. Therefore, feeding lambs with linseed for 42 days stimulated seminiferous tubule development and increased the number of Sertoli cells (20.71 ± 0.89 vs. 17.6 ± 0.73, P < 0.05), epididymal cauda lumina diameter (638.26 ± 22.32 μm vs. 444.41 ± 34.80 μm, P < 0.05), and the number of sperm in the epididymal cauda (68.91 ± 7.06 × 10 8 /g vs. 36.61 ± 7.50 × 10 8 /g). All these results suggested that feeding linseed in the early reproductive development stage of lambs upregulated the expression of antioxidative, steroidogenesis, and PUFA metabolism-related genes; increased the antioxidant capacity in lamb's testis; and contributed to testis development and spermatogenesis., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Leprosy is an infectious disease caused by Mycobacterium leprae (M. leprae), with about 210,000 new cases per year worldwide. Although numerous risk loci have been uncovered by genome-wide association studies, the effects of common genetic variants are relatively modest. To identify possible new genetic locus involved in susceptibility to leprosy, whole exome sequencing was performed for 28 subjects including 14 patients and 12 unaffected members from 8 leprosy-affected families as well as another case and an unrelated control, and then the follow-up SNP genotyping of the candidate variants was studied in case-control sample sets. A rare missense variant in mitochondrial ribosomal protein S5 (MRPS5), rs200730619 (c. 95108402T>C [p. Tyr137Cys]) was identified and validated in 369 cases and 270 controls of Chinese descent (Padjusted = 0.006, odds ratio [OR] = 2.74) as a contributing factor to leprosy risk. Moreover, the mRNA level of MRPS5 was downregulated in M. leprae sonicate-stimulated peripheral blood mononuclear cells. Our results indicated that MRPS5 may be involved in leprosy pathogenesis. Further studies are needed to determine if defective MRPS5 could lead to impairment of energy metabolism of host immune cells, which could further cause defect in clearing M. leprae and increase susceptibility to infection., Competing Interests: The authors have declared that no competing interests exist.

Tiller angle largely determines plant architecture, which in turn substantially influences crop production by affecting planting density. A recent study revealed that HEAT STRESS TRANSCRIPTION FACTOR2D ( HSFA2D ) acts upstream of LAZY1 ( LA1 ) to regulate tiller angle establishment in rice ( Oryza sativa ). However, the mechanisms underlying transcriptional regulation of HSFA2D remain unknown. In this study, two class II homeodomain-Leu zipper genes, OsHOX1 and OsHOX28 , were identified as positive regulators of tiller angle by affecting shoot gravitropism. OsHOX1 and OsHOX28 showed strong transcriptional suppressive activity in rice protoplasts and formed intricate self- and mutual-transcriptional negative feedback loops. Moreover, OsHOX1 and OsHOX28 bound to the pseudopalindromic sequence CAAT(C/G)ATTG within the promoter of HSFA2D , thus suppressing its expression. In contrast to HSFA2D and LA1 , OsHOX1 and OsHOX28 attenuated lateral auxin transport, thus repressing the expression of WUSCHEL-RELATED HOMEOBOX 6 ( WOX6 ) and WOX11 in the lower side of the shoot base of plants subjected to gravistimulation. Genetic analysis further confirmed that OsHOX1 and OsHOX28 act upstream of HSFA2D Additionally, both OsHOX1 and OsHOX28 inhibit the expression of multiple OsYUCCA genes and decrease auxin biosynthesis. Taken together, these results demonstrated that OsHOX1 and OsHOX28 regulate the local distribution of auxin, and thus tiller angle establishment, through suppression of the HSFA2D - LA1 pathway and reduction of endogenous auxin content. Our finding increases the knowledge concerning fine tuning of tiller angles to optimize plant architecture in rice., (© 2020 American Society of Plant Biologists. All Rights Reserved.)

Objective: To study the effect of gas explosion on brain nerve behavior of rats in real roadway environment., Methods: Before the gas explosion, the real gas explosion roadway environment was simulated by using the roadway and explosion test system of gas explosion test in a large coal mine in Chongqing Research Institute of China Coal Science & Technology Group, and cage fixation and explosion parameter setting were carried out. That was to use the equivalent of 9. 0% gas containing mixed air and to install special cage in roadway gas detonation distance at point 40 m, 160 m and 240 m. The SPF grade healthy adult SD male rats anesthetized with chloral hydrate were placed among them, and the rats were placed in a position that could force the head. At the same time, the trunk part below the occipital foramen and the mouth and face above the line of inner canthus were fully protected, and the gas explosion experiment was carried out. A total of 40 rats were randomly divided into four groups according to their body weight: control group, burn-blast combined injuries group(40 m), proximal group(160 m) and distance group(240 m). Ten rats in each group were placed in cages at different distance points under anesthesia except the normal control group. The general physiological behavior of the rats was observed 2 h and 7 d after the explosion, and the neurobehavioral indexes of the rats were monitored by open field behavior experiment. Gross observation and pathological examination of brain tissue were performed 7 days later., Results: The spirits of the rats in the 2 h exposure group after explosion were poor, and improved slightly after 7 d. The degree of surface burn was the most serious in group 40 m. The number of urination decreased while the number of feces increased(P&gt;0. 05). At the end of the experiment, it was found that cerebral edema and hyperemia were obvious in rats. Compared with the normal control group, the brain weight of rats in each exposure group increased, and the difference was statistically significant(P&lt;0. 05). Pathological observation showed that the brain tissues of rats in each exposed group showed irregular and disordered arrangement of nerve cells, interstitial edema, dense and deep staining of loose nuclear chromatin, formation of dense mass and other characteristics of apoptotic cells, as well as increased glia and aggregation of inflammatory cells. At 2 d and 7 h after the explosion, compared with the control group, the resting time of the neurobehavioral indicators of rats at different distance points was significantly prolonged(P&lt;0. 01), while the number of standing times, movement time and movement distance were significantly reduced, and the difference was statistically significant(P&lt;0. 01)., Conclusion: The gas explosion in real roadway environment can cause certain damage to the brain tissue of rats, and has obvious influence on its neural behavior.

Objectives: Few studies have investigated the association between losing a child and parental health and wellbeing, especially among older Chinese bereaved parents. This study examined depressive symptoms, life satisfaction, and self-rated health of older Chinese bereaved parents to estimate the health and well-being of this group., Methods: This research used data from the 2015 China Health and Retirement Longitudinal Study (CHARLS). A total number of 11,507 participants age 45 and older were enrolled in the analysis, including 1,758 bereaved adults who had experienced a child's death and 9,749 non-bereaved counterparts. Multivariate linear and logistic regression models were used to examine the effect of bereavement and its interaction effect by sex and age., Results: Multivariate analyses revealed that the death of a child is associated with an increasing likelihood of experiencing depressive symptoms (adjusted OR = 1.425, p < 0.001), and a reduced probability of a high level of life satisfaction (adjusted OR = 0.725, p < 0.05), whereas experiencing a child's death is not significantly associated with self-reported health status. The effects of bereavement on health and well-being were found to have a much greater impact among participants who were males (compared to females) and who aged<60 years (compared to those ≥60 years)., Discussion: Future longitudinal prospective research is expected to examine the causal relationship and explore the attributes of child death and its effects on parental health. Interventions to improve the health and well-being of the older bereaved population are warranted, particularly for those who are male and under 60 years of age., Competing Interests: Declaration of competing interest No conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: The novel coronavirus pneumonia COVID-19 caused by SARS-CoV-2 infection could lead to a series of clinical symptoms and severe illnesses, including acute respiratory distress syndrome (ARDS) and fatal organ failure. We report the fundamental pathological investigation in the lungs and other organs of fatal cases for the mechanistic understanding of severe COVID-19 and the development of specific therapy in these cases., Methods: The autopsy and pathological investigations of specimens were performed on bodies of two deceased cases with COVID-19. Gross anatomy and histological investigation by Hematoxylin and eosin (HE) stained were reviewed on each patient. Alcian blue/periodic acid-Schiff (AB-PAS) staining and Masson staining were performed for the examinations of mucus, fibrin and collagen fiber in lung tissues. Immunohistochemical staining was performed on the slides of lung tissues from two patients. Real-time PCR was performed to detect the infection of SARS-CoV-2. Flow cytometry analyses were performed to detect the direct binding of S protein and the expression of ACE2 on the cell surface of macrophages., Findings: The main pathological features in lungs included extensive impairment of type I alveolar epithelial cells and atypical hyperplasia of type II alveolar cells, with formation of hyaline membrane, focal hemorrhage, exudation and pulmonary edema, and pulmonary consolidation. The mucous plug with fibrinous exudate in the alveoli and the dysfunction of alveolar macrophages were characteristic abnormalities. The type II alveolar epithelial cells and macrophages in alveoli and pulmonary hilum lymphoid tissue were infected by SARS-CoV-2. S protein of SARS-CoV-2 directly bound to the macrophage via the S-protein-ACE2 interaction., Interpretation: Infection of alveolar macrophage by SARS-CoV-2 might be drivers of the "cytokine storm", which might result in damages in pulmonary tissues, heart and lung, and lead to the failure of multiple organs ., Funding: Shanghai Guangci Translational Medical Research Development Foundation, Shanghai, China., Competing Interests: Declaration of Competing Interest The authors declare no competing interests., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: PTEN is a tumour suppressor gene that has been proven to be related to breast cancer incidence and tumour progression. The aim of this study was to investigate the frequency of PTEN mutations in breast carcinomas in China and the relationships of PTEN mutations with clinicopathological parameters and clinical outcomes., Material and Methods: Trimmomatic, Burrows-Wheeler Aligner (BWA), ANNOVAR, SAMtools, and Sanger sequencing were used to analyse PTEN mutations and identify variants in Chinese breast cancer. The frequency of PTEN mutations and the relationships of PTEN mutations with clinicopathological parameters and clinical outcomes were evaluated in breast carcinomas in China., Results: The rate of PTEN germline mutation was 0.23% (n = 9) among 3955 unselected primary breast cancer patients. Of these 9 patients, 2 carried pathogenic mutations, and both were identified as having infiltrative carcinoma. One patient had a family history. The other 7 patients carried only PTEN germline variants that were not identified as pathogenic mutations., Conclusions: We studied the frequency of PTEN germline mutations in a sequential cohort of Chinese breast carcinoma patients. Based on these data, we hypothesize that the germline mutation of the PTEN gene is not closely related to the occurrence of breast cancer in the Chinese population. In the clinic, the PTEN germline mutation cannot be used as the basis for the detection of breast cancer., 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 © 2020. Published by Elsevier B.V.)

Objective: The authors conducted a cost-effectiveness analysis incorporating recent phase III clinical trial (IMpassion130) data to evaluate the cost-effectiveness of atezolizumab in combination with nab-paclitaxel (AnP) against nab-paclitaxel alone as the first-line treatment for advanced triple-negative breast cancer in developed and developing countries., Materials and Methods: A decision-analytic Markov model was developed using IMpassion130 data to evaluate the cost-effectiveness of AnP over a lifetime from the US health care payer and Chinese health care system perspective. Model inputs were derived from IMpassion130 and published literature. The primary outcomes of the model were quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). Uncertainty was addressed using univariate and probabilistic sensitivity analyses., Results: For the intention-to-treat (ITT) population, the projected mean outcome was better with AnP (1.41 QALYs) than with nab-paclitaxel alone (0.99 QALYs). Similar results were obtained for the programmed death ligand 1 (PD-L1)-positive population, with the obtained mean outcomes of 1.66 and 0.88 QALYs, respectively. For the Unites States, the ICER values comparing AnP with nab-paclitaxel were US$331,996.89 and US$229,359.88 per QALY gained for the ITT and PD-L1-positive populations, respectively. For China, the ICER values were US$106,339.26 and US$72,971.88 per QALY gained for the ITT and PD-L1-positive populations, respectively. The univariate sensitivity analysis indicated that the price of atezolizumab was the most influential factor in our study. AnP had 0% cost-effectiveness at the willingness-to-pay thresholds of US$150,000/QALY in the United States and US$29,383/QALY in China., Conclusion: AnP is not a cost-effective choice as the first-line treatment for advanced triple-negative breast cancer in the United States and China.

Background: The pastoral area of the eastern Tibetan Plateau is highly endemic for human echinococcosis. Domestic dogs are the main definitive host for the transmission of both Echinococcus granulosus (sensu lato) and E. multilocularis to humans. To control the infection risks, a national-level canine echinococcosis prevention and control programme has been implemented since 2015 in Shiqu County, Ganze Tibetan Autonomous Prefecture, Sichuan, China. The objective of this study was to evaluate its effect on Echinococcus spp. prevalence in dogs., Methods: We surveyed 69 households with 84 owned dogs, for dog fecal samples and dog keeping information in the villages of Rizha and Eduoma. A total of 105 dog fecal samples (75 from owned dogs and 30 unknown dog fecal samples) were collected between 2015-2017 to determine Echinococcus spp. prevalence using copro-PCR. Eight variables based on household surveys were included into a logistic regression model for significant risk factors to canine echinococcosis prevalence in dogs., Results: Between 2015-2017, the overall Echinococcus spp. copro-DNA prevalence decreased significantly in dogs from 51.2% (2015) to 20.0% (2017) in Rizha, and insignificantly from 11.5% (2016) to 4.3% (2017) in Eduoma. Echinococcus multilocularis was the most prevalent species continually copro-DNA detected during the entire study period, while E. granulosus was rare and not detected in 2017. Echinococcus shiquicus copro-DNA prevalence (a probable non-zoonotic wildlife species) was as high in dogs as that of E. multilocularis, although only detected in 2015 in Rizha. Unleashed dog feces were mainly collected in Rizha in 2015. Although 93.2% of owned dogs were leashed, and the monthly praziquantel dosing rate reached 97%, E. multilocularis infection could still be detected in 11.1% of owned dogs in 2017. Monthly deworming, leashing dogs 24 h per day, and the avoidance of dogs feeding on livestock viscera were significant measures to prevent canine echinococcosis infection in owned dogs., Conclusions: Carrying out a canine echinococcosis prevention and control programme can significantly decrease Echinococcus spp. prevalence. The potential contact between leashed dogs and wild small mammals is still a risk for re-infection of owned dogs with E. multilocularis. This study shows that the long-term application of regular dog treatment with praziquantel in the vast and remote echinococcosis endemic areas of the eastern Tibetan Plateau can reduce transmission in dogs but remains a challenging intervention.

Background: There has been a great deal of evidence indicating that cytokines participate in meningeal inflammation. Different cytokine profiles may be presented in central nervous system (CNS) infection due to different pathogens. We have attempted to investigate cytokine profiles in cerebrospinal fluid (CSF) of patients with CNS infection., Methods: Forty-three patients with CNS infection including tuberculous meningitis, purulent meningitis and cryptococcal meningitis were enrolled and 11 patients with normal CSF were enrolled as control group. The concentrations of Th1-, Th2- and Th17-type cytokines in CSF were detected using multiplex cytokine assay. Furthermore, the correlation between CSF cytokines and CSF parameters in CNS infection was analyzed., Results: The CSF levels of IL-1β, IL-4, IL-6, IL-10, IL-17, IL-23, IL-33, IFN-γ, TNF-α and sCD40L among the patients with CNS infection were all higher than control group (all P < 0.05). A remarkable elevation of CSF IL-6 in the patients with CNS infection was observed with the least overlap of the CSF concentrations compared to controls. Moreover, CSF IL-6 levels were strongly negatively correlated with CSF glucose and the CSF/blood glucose ratio (r = -0.4375, P = 0.0042; r = -0.4991, P = 0.0009)., Conclusions: The excessive activation of immune response characterized by elevated levels of CSF Th1-, Th2- and Th17-type cytokines has been observed during CNS infection. Furthermore, we observed negative correlations between CSF IL-6 levels and CSF glucose and CSF/blood glucose ratio in CNS infection. And we suggested that combined CSF IL-6 levels with CSF glucose may serve as a novel biomarker pool for the differential of CNS infection., (Copyright © 2018. Published by Elsevier B.V.)

Introduction: Prolonged-release oxycodone/naloxone (OXN PR), combining an opioid analgesic with selective blockade of enteric µ-opioid receptors, provided effective analgesia and improved bowel function in patients with moderate-to-severe pain and opioid-induced constipation in clinical trials predominantly conducted in Western countries. This double-blind randomized controlled trial investigated OXN PR (N = 116) versus prolonged-release oxycodone (OXY PR, N = 115) for 8 weeks at doses up to 50 mg/day in patients with moderate-to-severe, chronic, non-malignant musculoskeletal pain and opioid-induced constipation recruited in China., Methods: A total of 234 patients at least 18 years of age with non-malignant musculoskeletal pain for more than 4 weeks that was moderate-to-severe in intensity and required round-the-clock opioid therapy were randomized (1:1) to OXN PR or OXY PR. The primary endpoint was bowel function using the Bowel Function Index (BFI). Secondary endpoints included safety, Brief Pain Inventory-Short Form (BPI-SF), use of analgesic and laxative rescue medication, and health-related quality of life (EQ-5D)., Results: While BFI scores were comparable at baseline, at week 8 improvements were greater with OXN PR vs OXY PR (least squares mean [LSM] difference (95% CI) - 9.1 (- 14.0, - 4.2); P < 0.001. From weeks 2 to 8, mean BFI scores were in the range of normal bowel function (≤ 28.8) with OXN PR but were in the range of constipation (> 28.8) at all timepoints with OXY PR. Analgesia with OXN PR was similar and non-inferior to OXY PR on the basis of modified BPI-SF average 24-h pain scores at week 8: LSM difference (95% CI) - 0.3 (- 0.5, - 0.1); P < 0.001. The most frequent treatment-related AEs were nausea (OXN PR 5% vs OXY PR 6%) and dizziness (4% vs 4%)., Conclusion: OXN PR provided clinically meaningful improvements in bowel function and effective analgesia in Chinese patients with moderate-to-severe musculoskeletal pain and pre-existing opioid-induced constipation., Trial Registration: ClinicalTrials.gov, identifier NCT01918098.

Background: In this study, we evaluated the diagnostic potential and clinical impact of an automated multiplex PCR platform (the FilmArray Respiratory Panel; FA-RP), specially designed for pathogen detection in respiratory tract infections in adults with unexplained pneumonia (UP)., Methods: A total of 112 UP patients in Shanghai, China, were enrolled prospectively and assessed using the FA-RP from October 2016 to March 2018. We examined the test results and their influence on clinical decisions. Furthermore, as a control group, we retrospectively obtained the clinical data of 70 UP patients between October 2014 and March 2016 (before the FA-RP was available). The two patient groups were compared with respect to factors, including general antimicrobial use and defined daily dose (DDD) numbers., Results: Between October 2016 and March 2018, the positive rate obtained using FA-RP for UP was 76.8%. The primary pathogens in adults with UP were Influenza A/B (47.3%, 53/112). Compared with the patients before FA-RP was available, patients who underwent FA-RP testing had higher rates of antiviral drug use and antibiotic de-escalation during clinical treatment. FA-RP significantly decreased the total DDDs of antibiotic or antifungal drugs DDDs by 7 days after admission (10.6 ± 2.5 vs 14.1 ± 8.8, P < .01)., Conclusions: The FA-RP is a rapid and sensitive nucleic acid amplification test method for UP diagnosis in adults. The application of FA-RP may lead to a more accurately targeted antimicrobial treatment and reduced use of antibiotic/antifungal drugs., (© 2019 The Authors. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.)

Background: Acinetobacter baumannii is a gram-negative aerobic bacillus that is commonly causes of hospital-acquired infections. Community-acquired pneumonia caused by Acinetobacter baumannii (CAP-Ab) is rare but fatal if diagnosis and treatment are delayed. Conventional culture of clinical specimens is the main method for clinical diagnosis of A. baumannii infections which may suffer from limited positive rate and is time consuming. Timely and precise diagnosis of CAP-Ab remains challenging., Case Presentation: A 66-year-old man with 24 h history of acute fever and dyspnea was admitted to our hospital. He was diagnosed as severe community acquired pneumonia (CAP), septic shock, respiratory failure and acute kidney injury. Next-generation sequencing (NGS) was performed on the patient's sputum and blood, which identified numerous A. baumannii nucleotide sequences in the sample of sputum and led to the rapid diagnosis and treatment of community acquired pneumonia caused by A. baumannii. This result was confirmed by subsequent sputum culture., Conclusions: This case described that the successful application of the next generation sequencing assisting the speedy diagnosis of A. baumannii infection provides a new idea for the timely diagnosis of CAP-Ab and highlights that NGS is a promising tool in rapid etiological diagnosis of acute and severe infectious diseases.

Background: A CYP2D6 gene polymorphism is related to the effect of tamoxifen treatment in patient with estrogen-receptor positive (ER) positive breast cancer and CYP2D6*10 T/T can lead to a poor prognosis in Asian patients. Although one-off pharmacogenetic testing may optimize adjuvant endocrine therapy, testing prior to tamoxifen initiation incurs additional costs., Aim: We conducted a study to assess the cost-effectiveness of CYP2D6*10 pharmacogenetic testing to guide the adjuvant endocrine therapy compared with tamoxifen without CYP2D6*10 testing in China., Methods: A semi-Markov model was developed to evaluate costs and health outcomes represented as quality adjusted life year (QALY) gained. Input data were obtained from the public literature. The results were expressed as incremental cost per QALY gained. A one-way deterministic sensitivity analysis explored the impact of uncertainty in the model parameters on results, and probabilistic uncertainty was assessed through a Monte Carlo probabilistic sensitivity analysis., Results: In the base-case analysis, in the CYP2D6*10 testing and alternative adjuvant endocrine therapy group, the incremental total cost was US$17,966.95 and the incremental QALY was 3.582. Thus, the incremental cost-effectiveness ratio was US$5015.693 per QALY gained. Compared with a willingness-to-pay threshold of US$26,508/QALY in China, the CYP2D6*10 testing is the dominant strategy in postmenopausal women with ER-positive breast cancer in China, and the increased cost of genetic testing was completely worthwhile. The sensitivity analyses showed that the model we built was quite stable., Conclusion: From the perspective of the Chinese healthcare system, CYP2D6*10 pharmacogenetic testing was cost effective for postmenopausal women with ER-positive early breast cancer.