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Warm-sector heavy rainfall (WR), shear-line heavy rainfall (SR), and frontal heavy rainfall (FR) are three types of rainfall that frequently occur during the pre-summer rainy season in south China. In this research, we investigated the differences in microphysical characteristics of heavy rainfall events during the period of 10-15 May 2022 based on the combined observations from 11 S-band polarimetric radars in south China. The conclusions are as follows: (1) WR has the highest radar echo top height, the strongest radar echo at all altitudes, the highest lightning density, and the most active ice-phase process, which suggests that the convection is the most vigorous in the WR, moderate in the FR, and the weakest in the SR. (2) Three types of rainfall are all marine-type precipitation, the massweighted mean diameter (Dm, mm) and the intercept parameter (Nw, mm-1m-3) of the raindrops in the WR are the largest. (3) The WR possesses the highest proportion of graupel compared with the FR and SR, and stronger updrafts and more abundant water vapor supply may lead to larger raindrops during the melting and collision-coalescence processes. (4) Over all the heights, liquid and ice water content in the WR are higher than those in the SR and FR, the ratio of ice to liquid water content in the WR is as high as 27% when ZH exceeds 50 dBZ, definitely higher than that in the SR and FR, indicating that the active ice-phase process existing in the WR is conducive to the formation of heavy rainfall. [ABSTRACT FROM AUTHOR]

Polarimetric radar data are an important tool for quantitative precipitation estimation (QPE), which is essential for monitoring and forecasting precipitation. Previous studies have shown that the drop size distribution (DSD) and polarimetric radar parameters of typhoon-induced precipitation differ significantly from those of other types of rainfall. South China is a region that frequently experiences typhoons and heavy rainfall, which can cause serious disasters. Therefore, it is critical to develop a QPE algorithm that is suitable for typhoon precipitation over South China. In this study, we constructed four simple QPE estimators, R(ZH), R(ZH, ZDR), R(KDP) and R(KDP, ZDR) based on two-dimensional video disdrometer (2DVD) DSD observations of typhoon-induced precipitation over South China in 2017–2018. We analyzed the DSD characteristics and the estimation accuracy of these four QPE estimators in the reflectivity–differential reflectivity (ZH–ZDR) space, as well as the S-band polarimetric radar (S-POL) data of seven typhoon-induced precipitation events that affected South China in 2017–2019. We used these data to quantitatively determine the optimal ranges of the estimators and establish a typhoon precipitation QPE algorithm for typhoon-induced precipitation over South China (2DVD-Typhoon). The evaluation results showed that: (1) compared to R(ZH) and R(KDP), R(ZH, ZDR) and R(KDP, ZDR) had lower performance in estimating typhoon-induced rainfall after incorporating the polarimetric parameter ZDR, as strong crosswind of the typhoon caused some bias in the raindrop-induced ZDR; (2) the 2DVD-Typhoon algorithm utilizes the respective advantages of the individual estimators to generate the best QPE results; (3) the QPE performance of 2DVD-Typhoon and the Colorado State University–Hydrometeor Identification Rainfall Optimization (CSU-HIDRO) is used as a comparison for hourly rainfall, cumulative rainfall and different rainfall intensity. The comparison shows that 2DVD-Typhoon gives a better normalized error (NE), root mean square error (RMSE) and correlation coefficient (CC), indicating its strength in rainfall estimation for typhoons over South China. The above results provide theoretical support for improving typhoon-induced rainfall monitoring and numerical weather forecasting models in South China. [ABSTRACT FROM AUTHOR]

Based on ERA5 reanalysis data and multi-source observations, including polarimetric radar and automatic weather stations, this study analyzes the formation mechanism and microphysical characteristics of a warm-sector heavy rainfall event caused by a convective system with multiple-rain-bands organizational mode over the western coast of south China. In the early stage, under the influence of coastal convergence and topography, convection was triggered in the coastal mountainous areas and moved north-eastwards. Nocturnal cooling induced the north winds in the inland mountainous area. A mesoscale convergence line was formed in the middle of Yangjiang city between the inland north and coastal south winds, which facilitated the developing and merging of convective storms into a linear convective band along the convergence line. This relatively long convective band presented a quasi-stationary state in the south of Mt. Ehuangzhang and Mt. Tianlu, which results in the first precipitation peak. At this stage, the convection developed to a higher level, with relatively larger raindrops, producing larger amounts of rainfall, which was probably related to the active merging of convection. In the later phase, as the environmental winds shifted, convective bands tended to move southeastwards, accompanied with the cold pools. At the same time, the multiple short convective bands were formed, which were almost parallel to the shear line, and a multiple-rain-bands organizational mode occurred. The mesoscale convergence line maintained due to the outflows of cold pools caused by precipitation in the preceding period, and then gradually moved southwards. Under the influence of the mesoscale convergence and topography, convection was continuously triggered at the southern end of the short convective bands. This back-building characteristic favored the development of the convective system. The multiple rain bands passed through the same place in a "rainband-training" form, resulting in the second peak of precipitation. The collision process was active in the low levels during this event. [ABSTRACT FROM AUTHOR]

Aiming at the needs of mechanism analysis of rainstorms and development of numerical prediction models in south China, the Guangzhou Institute of Tropical and Marine Meteorology of China Meteorological Administration and the Chinese Academy of Meteorological Sciences jointly set up the Longmen Cloud Physics Field Experiment Base, China Meteorological Administration. This paper introduces the instruments and field experiments of this base, provides an overview of the recent advances in retrieval algorithms of microphysical parameters, improved understanding of microphysical characteristics, as well as the formation mechanisms and numerical prediction of heavy rainfalls in south China based on the field experiments dataset. [ABSTRACT FROM AUTHOR]

On 1 June 2021, a heavy rainstorm hit the coast of South China (148.6 mm in 1 h, 361 mm over 12 h). The storm process was successively affected by two convective systems (CSs). The initial convection of the two CSs occurred at a similar location; however, they subsequently showed different evolution characteristics. Based on multi-source data, including dual-polarimetric radars, wind profiling radars, sounding, and automatic weather stations, we explored the differences in the key characteristics of these two CSs. It was found that the convection was initially triggered at a similar location for both CSs, closely related to the mesoscale boundary and the hilly terrain. After formation, CS1 moved eastward to the regions with lower surface temperature and weaker lower-level convergence but similar humidity, which means the environmental conditions for sustaining the CS became less favorable. As a result, CS1 dissipated rapidly and only lasted for about 90 min, resulting in 5% of the total precipitation of the overall storm. In contrast, during the lifespan of CS2, the southerly wind over the South China Sea became stronger. This caused an intense lower-level convergence zone along the coastal region of Guangdong Province, which provided favorable dynamic conditions for maintaining CS2. Favored by the strong coastal convergence and abundant moisture, new convective cells (CCs) were generated continuously and merged with CS2, acting as another favorable condition for its sustainment. Overall, CS2 lasted for 8 h, and its precipitation accounted for 95% of the total rainfall. In CS1, CCs showed a notable evaporation process below 4 km, manifested by the large raindrops. However, in CS2, the CCs had a higher concentration of small raindrops and higher ice and liquid water content. Since CS2 was close to the coastal region, the warm local environment promoted convection, leading to intense precipitation. In addition, the riming and melting processes were active, leading to a high precipitation efficiency and strong local precipitation during a short period of time. [ABSTRACT FROM AUTHOR]

On 22 June 2017, an extreme warm-sector rainfall event hit the western coastal area of South China, with maximum hourly and 12-h rainfall accumulations of 189.4 and 464.8 mm, respectively, which broke local historical records. Multisource observations were used to reveal multiscale processes contributing to the extreme rainfall. The results showed that a marine boundary layer jet (BLJ) coupled with a synoptic low-level jet (LLJ) inland played an important role in the formation of an extremely humid environment with a very low lifting condensation level of near-surface air. Under the favorable pre-convective conditions, convection was initialized at a mesoscale convergence line, aided by topographic lifting in the evening. During the nocturnal hours, the rainstorm developed and was maintained by a quasi-stationary mesoscale outflow boundary, which continuously lifted warm, moist air transported by the enhanced BLJ. When producing the extreme rainfall rates, the storm possessed relatively weak convection, with the 40 dBZ echo top hardly reaching 6 km. The extreme rainfall was produced mainly by the warm rain microphysical processes, mainly because the humid environment and the deep warm cloud layer facilitated the clouds' condensational growth and collision–coalescence, and also reduced rain evaporation. As the storm evolved, the raindrop concentration increased rapidly from its initial stage and remained high until its weakening stage, but the mean raindrop size changed little. The extreme rain was characterized by the highest concentration of raindrops during the storm's lifetime with a mean size of raindrops slightly larger than the maritime regime. [ABSTRACT FROM AUTHOR]

During the passage of Typhoon Nida, the raindrop size distribution parameters, the raindrop spectra, the shape and slope (μ–Λ) relationship, the radar reflectivity factor, and rain rate (Z–R) relationship were investigated based on a two-dimensional (2D) video disdrometer in Guangdong, China, from August 1 to 2, 2016. Due to the underlying surface difference between the ocean and land, this process was divided into two distinct periods (before landfall and after landfall). The characteristics of raindrop size distribution between the period before landfall and the period after landfall were quite distinct. The period after landfall exhibited higher concentrations of each size bin (particularly small drops) and wider raindrop spectral width than the period before landfall. Compared with the period before landfall, the period after landfall had a higher average mass-weighted mean diameter Dm that was smaller than those of other TCs from the same ocean (the Pacific). The μ–Λ relationship and Z–R relationship in this study were also compared with other TCs from the same ocean (the Pacific). This investigation of the microphysical characteristics of Typhoon Nida before landfall and after landfall may improve radar quantitative precipitation estimation (QPE) products and microphysical schemes by providing useful information. [ABSTRACT FROM AUTHOR]

The objective of this research was to acquire a raindrop size distribution (DSDs) retrieved from C-band polarimetric radar observations scheme for the first time in south China. An observation period of the precipitation process was selected, and the shape-slope (μ-Λ) relationship of this region was statistically analyzed using the raindrop sample observations from the two-dimensional video disdrometer (2DVD) at Xinfeng Station, Guangdong Province. Simulated data of the C-band polarimetric radar reflectivity ZHH and differential reflectivity ZDR were obtained through scattering simulation. The simulation data were combined with DSD fitting to determine the ZDR-Λ and log10(ZHH/N0)-Λ relationships. Using Xinfeng C-band polarimetric radar observations ZDR and ZHH, the raindrop Gamma size distribution parameters μ, Λ, and N0 were retrieved. A scheme for using C-band polarimetric radar to retrieve the DSDs was developed. This research revealed that during precipitation process, the DSDs obtained using the C-band polarimetric radar retrieval scheme are similar to the 2DVD observations, the precipitation characteristics of rainfall intensity (R), mass-weighted mean diameter (Dm) and intercept parameter (Nw) with time obtained by radar retrieval are basically consistent with the observational results of the 2DVD. This scheme establishes the relationship between the observations of the C-band polarimetric radar and the physical quantities of the numerical model. This method not only can test the prediction of the model data assimilation system on the convective scale and determine error sources, but also can improve the microphysical precipitation processes analysis and radar quantitative precipitation estimation. The present research will facilitate radar data assimilation in the future. [ABSTRACT FROM AUTHOR]

Rice planthoppers and associated virus diseases have become the most important pests threatening food security in China and other Asian countries, incurring costs of hundreds of millions of US dollars annually in rice losses, and in expensive, environmentally harmful, and often futile control efforts. The most economically damaging species, the brown planthopper, Nilaparvata lugens (Hemiptera: Delphacidae), cannot overwinter in temperate East Asia, and infestations there are initiated by several waves of windborne spring or summer migrants originating from tropical areas in Indochina. The interaction of these waves of migrants and synoptic weather patterns, driven by the semi-permanent western Pacific subtropical high-pressure (WPSH) system, is of critical importance in forecasting the timing and intensity of immigration events and determining the seriousness of subsequent planthopper build-up in the rice crop. We analysed a 26-year data set from a standardised light trap network in Southern China, showing that planthopper aerial transport and concentration processes are associated with the characteristics (strength and position) of the WPSH in the year concerned. Then, using N. lugens abundance in source areas and indices of WPSH intensity or related sea surface temperature anomalies, we developed a model to predict planthopper numbers immigrating into the key rice-growing area of the Lower Yangtze Valley. We also demonstrate that these WPSH-related climatic indices combined with early-season planthopper catches can be used to forecast, several months in advance, the severity of that season's N. lugens infestations (the correlation between model predictions and outcomes was 0.59), thus allowing time for effective control measures to be implemented. [ABSTRACT FROM AUTHOR]

To explore the epidemic history of HIV-1 CRF01_AE in China, 408 fragments of gag gene sequences of CRF01_AE sampled in 2002-2010 were determined from different geographical regions and risk populations in China. Phylogenetic analysis indicates that the CRF01_AE sequences can be grouped into four clusters, suggesting that at least four genetically independent CRF01_AE descendants are circulating in China, of which two were closely related to the isolates from Thailand and Vietnam. Cluster 1 has the most extensive distribution in China. In North China, cluster 1 and cluster 4 were mainly transmitted through homosexuality.The real substance of the recent HIV-1 epidemic in men who have sex with men(MSM) of North China is a rapid spread of CRF01_AE, or rather two distinctive natives CRF01_AE. The time of the most recent common ancestor (tMRCA) of four CRF01_AE clusters ranged from the years 1990.9 to 2003.8 in different regions of China. This is the first phylogenetic and temporal dynamics study of HIV-1 CRF01_AE in China. [ABSTRACT FROM AUTHOR]

Objectives: Tracheobronchial foreign body aspiration is a life-threatening accident in infants, and is still a formidable clinical emergency to both otorhinolaryngologists and anesthesiologists. In this study, we attempted to assess the safety and ease of tracheobronchial foreign body removal in infants via suspension laryngoscopy and Hopkins telescopy under general anesthesia with endotracheal intubation. Methods: The retrospective clinical study from 2006 to 2010 included 50 infants with foreign body aspiration, of whom 35 underwent suspension laryngoscopy and Hopkins telescopy and the other 15 underwent rigid bronchoscopy. All of the procedures were under general anesthesia with endotracheal intubation. Results: All of the patients underwent temporary extubation. The foreign body was successfully removed in 46 cases and was not found in the other 4 cases. The mean operation time in the rigid bronchoscopy group was 13.20 ± 9.01 minutes, and that in the Hopkins telescopy group was 5.79 ± 3.54 minutes. The oxygen saturation level was below 90% in 17 cases, of which 7 were in the rigid bronchoscopy group and 10 were in the Hopkins telescopy group. The vital signs, including the partial pressure of carbon dioxide in expiratory gas and the heart rate, were stable in all cases. Conclusions: Foreign body removal in infants via suspension laryngoscopy and Hopkins telescopy under general anesthesia with endotracheal intubation should be promoted, since it is relatively safe and easy for both anesthesiologists and otorhinolaryngologists to perform and has a remarkable success rate. [ABSTRACT FROM AUTHOR]

Camellia oil (CA), mainly produced in southern China, has always been called Oriental olive oil (OL) due to its similar physicochemical properties to OL. The high nutritional value and high selling price of CA make mixing it with other low-quality oils prevalent, in order to make huge profits. In this paper, the transverse relaxation time (T2) distribution of different brands of CA and OL, and the variation in transverse relaxation parameters when adulterated with corn oil (CO), were assessed via low field nuclear magnetic resonance (LF-NMR) imagery. The nutritional compositions of CA and OL and their quality indices were obtained via high field NMR (HF-NMR) spectroscopy. The results show that the fatty acid evaluation indices values, including for squalene, oleic acid, linolenic acid and iodine, were higher in CA than in OL, indicating the nutritional value of CA. The adulterated CA with a content of CO more than 20% can be correctly identified by principal component analysis or partial least squares discriminant analysis, and the blended oils could be successfully classified by orthogonal partial least squares discriminant analysis, with an accuracy of 100% when the adulteration ratio was above 30%. These results indicate the practicability of LF-NMR in the rapid screening of food authenticity. [ABSTRACT FROM AUTHOR]

Geochemical and Sr-Nd-Pb isotopic data are presented for volcanic rocks from Zougouyouchaco (30.5 Ma) and Dogai Coring (39.7 Ma) of the southern and middle Qiangtang block in northern Tibet. The volcanic rocks are high-K calc-alkaline trachyandesites and dacites, with SiO2 contents ranging from 58.5 to 67.1 wt % The rocks are enriched in light REE (LREE) and contain high Sr (649 to 986 ppm) and relatively low Yb (0.8 to 1.2 ppm) and Y (9.5 to 16.6 ppm) contents, resulting in high La/Yb (29-58) and Sr/Y (43-92) ratios, as well as relatively high MgO contents and Mg no., similar to the compositions of adakites formed by slab melting in subduction zones. However, the adakitic rocks in the Qiangtang block are characterized by relatively low ϵNd(t) values (-3.8 to -5.0) and highly radiogenic Sr ((87Sr/86Sr)i = 0.706-0.708), which are inconsistent with an origin by slab melting. The geochemistry and tectonics indicate that the adakitic volcanic rocks were most likely derived from partial melting of delaminated lower continental crust. As the pristine adakitic melts rose, they interacted with the surrounding mantle peridotite, elevating their MgO values and Mg numbers. [ABSTRACT FROM AUTHOR]

The oriented lamellar K-rich exsolutions within clinopyroxene host were recognized in garnet peridotite massif at Zhimafang in the Sulu ultrahigh pressure metamorphic terrane, eastern China. EMP and TEM analyses revealed that the composition and the index of electron diffraction for this exsolution are corresponding with phlogopite, and the shape is the lamellae with 1 µm in width and 5 to 30 µm in length. Moreover, the topotaxy is that the (001) of K-rich exsolution parallels to (100) of the clinopyroxene host. The electron diffraction analyzing shows the exsolution is of a 1M polymorphism. The high-resolution lattice fringe image displays the stack features along [001], which only a layer mineral shows. We conclude that the clinopyroxene with 1M and K-rich exsolution was probably derived from mantle depths over 240 km, thus resulting from decompressional exsolution in the initial stage of slab exhumation. [ABSTRACT FROM AUTHOR]

The article assesses the usefulness of patch testing with the European standard series to the diagnosis of contact dermatitis in Shanghai, China. All 88 patients with suspected contact dermatitis were included. More than 2 weeks after skin lesions had disappeared, all patients were patch tested by three experienced dermatologists, with the European standard series and other supplementary substances suspected from their history. 41 of the 88 patients were positive on patch testing. 30 to the standard series and 21 to other substances. The most common allergens were nickel sulphate, potassium dichromate and fragrance mix. Results show that the European standard series is applicable to patch testing in Shanghai.

• A computer-aided expert system was developed to distinguish edible oils. • The contents of fatty acids and quality parameters of edible oils were assessed. • All the unqualified edible oils were screened out and identified. • The identification accuracy for pure and mixed edible oils are over 90%. • The quality information of the edible oils was provided. The advantages of nuclear magnetic resonance (NMR) such as nondestructive and simultaneous detection, high reproducibility and rapidity make it easily develop the objective and credible methods for food analysis and identification. In this study, we developed a computer-aided, MATLAB-scripted expert system which enables NMR data to distinguish different edible oils and evaluate the quality of edible oils. The NMR spectral data of seven species of most popular vegetable edible oils in China were used to establish the assessment criterions including the content percentage of fatty acids and the quality parameters of edible oils. In our case, the identification accuracy of vegetable origin for the pure edible oils is 95.83% and that for the mixed edible oils is 89.58%, and all the recycled waste cooking oils and fried oils were correctly screened out and identified by the expert system. Further, the quality information of the edible oils was also provided. Our results show that the current expert system is a fast, easy-operated and convenient tool for the adulteration identification and quality control of edible oils. [ABSTRACT FROM AUTHOR]

Raindrop size distribution (DSD) is a basic feature of precipitation microphysics, and it plays a vital role in improving radar quantitative precipitation estimation and forecast accuracy. In South China, due to the influence of atmospheric circulation and weather systems, precipitation is frequent, and the types of precipitation and their temporal and spatial distributions are complex. It has become essential to study the types of precipitation in this area and their seasonal variation characteristics. Therefore, in this study, the DSDs in the dry and wet seasons of southern China are analyzed using measurements from seven ground-based two-dimensional video disdrometers (2DVDs) over the course of four years (2016–2019). The dynamic and microphysical characteristics of precipitation in the dry and wet seasons are established for South China, combined with the Moderate Resolution Imaging Spectroradiometer (MODIS) and the European Centre for Medium-Range Weather Forecasts (ECMWF) Fifth-generation Reanalysis (ERA5) data. Compared to the dry season results, the concentration of small raindrops (diameters <1 mm) in wet season is similar, while the concentration of midsized raindrops (diameters between 1 and 3 mm) and large raindrops (diameters >3 mm) in the wet season are significantly greater. Furthermore, taking the contributions to precipitation into account, the rainfall in the dry season is dominated by stratiform rain, which accounts for 59.3% of the total rainfall. Considering precipitation in the wet season, convective rain accounts for 77.9% of total the rainfall. The obtained relations of the shape parameter (μ) versus the slope parameter (Λ) (μ-Λ) and the radar reflectivity factor (Z) versus the rainfall rate (R) (Z-R) have obvious differences for different type rainfall in the two seasons. In the wet season, the water vapor is sufficient and the upward convection activity is intense in South China, causing the frequent occurrence of raindrop collisions and coalescence. This is also the reason that the D m and R values in the wet season are greater than those in the dry season, while the wet season log 10 N w is relatively small. This not only deepens the understanding of the seasonal DSD variation in South China, but also provides theoretical support for improving numerical weather prediction models. • The differences in the DSD characteristics between dry and wet seasons in South China are analyzed using 2DVD and remote sensing data. • The study provides the Z-R and μ-Λ relations of different types of precipitation in South China. • Dynamical and thermodynamical interactions are found to impact the RSD differences between dry and wet seasons′ rainfall. [ABSTRACT FROM AUTHOR]

Abstract: Compared to the Feed-in tariff in China, the Renewable Portfolio Standard (RPS) could not only help to change the driving force of renewable energy industry development, but also provide the renewable energy industry with incentives to achieve the governments' planned goal. This paper first compares the features of RPS of the major industrialized countries. Second the barriers of implementing the Renewable Portfolio Standard in China are analyzed from five aspects. Finally, based on the above analysis, this paper puts forward relative institutional arrangements for the implementation of Renewable Portfolio Standard in China making recommendations for the development of renewable energy industry. [Copyright &y& Elsevier]

Sweet oranges with distinguished origin label have been becoming a fraud target by confusing or hiding origins. In this study, high-resolution nuclear magnetic resonance (NMR) spectroscopy in combination with chemometrics was used to discriminate the geographical origins of China's sweet oranges from four main producing regions (Hunan, Hubei, Sichuan and Guangxi). Sixty-two components, including various saccharides, amino acids, organic acids, alcohols, ketone, flavanones and other compounds, were identified and quantified via their 1H NMR spectra, and the producing region-specific geographical indication components of China's sweet orange were further screened out. The sweet oranges in Hubei show favorable antioxidant properties due to their rich phenolic compounds, and those in Sichuan show rich and fresh flavors due to their wealthy amino acids. Our results are readily available for nutritional recommendation in human consumption, and helpful to distinguish the geographical origin of sweet oranges based on their nutritional characteristics especially geographical indication markers. • A rapid and inexpensive NMR method was used to analyze sweet orange. • 62 nutritional components in China's sweet oranges were identified and quantified. • The geographical indication markers of each geographical origin were screened out. • The results are available for nutritional recommendation in human consumption. [ABSTRACT FROM AUTHOR]

Background: The impact of labor epidural analgesia (LEA) on breastfeeding remains controversial. The aim of this study was to assess the relationship between LEA use and exclusive breastfeeding (EBF) up to 6 months., Methods: This was a cross-sectional survey on healthy mothers who had vaginal delivery with infants aged 7-12 months from seven maternal health WeChat groups in Jiaxing, China. Data including EBF status up to 6 months, maternal sociodemographic characteristics, LEA use in labor, breastfeeding supports during hospitalization and reasons for stopping EBF were collected using online self-administered questionnaires in October 2021. A multivariable logistic regression model was used to determine the potential association of LEA use with EBF up to 6 months by the adjusted odds ratio (AOR) and 95% confidence interval (CI)., Results: Of a total of 537 surveyed mothers, 408 (76.0%) delivered with LEA and 398 (74.1%) exclusively breastfed their infants until 6 months. All mothers delivered in the hospitals with active breastfeeding policies. There was no statistical difference in the rate of EBF up to 6 months between mothers with and without LEA (73.8% versus 75.2%, P = 0.748). Multivariable logistic regression analysis indicated that only increased maternal age (AOR = 0.906, 95% CI 0.854-0.961, P = 0.001) and perceived insufficient breast milk (AOR = 0.129, 95% CI 0.082-0.204, P <  0.001) were associated with lower odds of EBF up to 6 months. The top three reasons for non-EBF were no or insufficient breast milk (41.7%), inability to breastfeed infants after return to work (27.3%), and maternal related factors (24.4%)., Conclusions: LEA does not affect EBF up to 6 months. Other factors such as health education and breastfeeding-friendly hospital strategies may be much more important to breastfeeding outcomes compared to LEA use., (© 2022. The Author(s).)

Background: China has a high burden of hepatocellular carcinoma, and hepatitis B virus (HBV) infection is the main causative factor. Patients with hepatocellular carcinoma have a poor prognosis and a substantial unmet clinical need. The phase 2-3 ORIENT-32 study aimed to assess sintilimab (a PD-1 inhibitor) plus IBI305, a bevacizumab biosimilar, versus sorafenib as a first-line treatment for unresectable HBV-associated hepatocellular carcinoma., Methods: This randomised, open-label, phase 2-3 study was done at 50 clinical sites in China. Patients aged 18 years or older with histologically or cytologically diagnosed or clinically confirmed unresectable or metastatic hepatocellular carcinoma, no previous systemic treatment, and a baseline Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 were eligible for inclusion. In the phase 2 part of the study, patients received intravenous sintilimab (200 mg every 3 weeks) plus intravenous IBI305 (15 mg/kg every 3 weeks). In the phase 3 part, patients were randomly assigned (2:1) to receive either sintilimab plus IBI305 (sintilimab-bevacizumab biosimilar group) or sorafenib (400 mg orally twice daily; sorafenib group), until disease progression or unacceptable toxicity. Randomisation was done using permuted block randomisation, with a block size of six, via an interactive web response system, and stratified by macrovascular invasion or extrahepatic metastasis, baseline α-fetoprotein, and ECOG performance status. The primary endpoint of the phase 2 part of the study was safety, assessed in all patients who received at least one dose of study drug. The co-primary endpoints of the phase 3 part of the study were overall survival and independent radiological review committee (IRRC)-assessed progression-free survival according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 in the intention-to-treat population. The study is registered with ClinicalTrials.gov, NCT03794440. The study is closed to new participants and follow-up is ongoing for long-term outcomes., Findings: Between Feb 11, 2019 and Jan 15, 2020, we enrolled 595 patients: 24 were enrolled directly into the phase 2 safety run-in and 571 were randomly assigned to sintilimab-bevacizumab biosimilar (n=380) or sorafenib (n=191). In the phase 2 part of the trial, 24 patients received at least one dose of the study drug, with an objective response rate of 25·0% (95% CI 9·8-46·7). Based on the preliminary safety and activity data of the phase 2 part, in which grade 3 or worse treatment-related adverse events occurred in seven (29%) of 24 patients, the randomised phase 3 part was started. At data cutoff (Aug 15, 2020), the median follow-up was 10·0 months (IQR 8·5-11·7) in the sintilimab-bevacizumab biosimilar group and 10·0 months (8·4-11·7) in the sorafenib group. Patients in the sintilimab-bevacizumab biosimilar group had a significantly longer IRRC-assessed median progression-free survival (4·6 months [95% CI 4·1-5·7]) than did patients in the sorafenib group (2·8 months [2·7-3·2]; stratified hazard ratio [HR] 0·56, 95% CI 0·46-0·70; p<0·0001). In the first interim analysis of overall survival, sintilimab-bevacizumab biosimilar showed a significantly longer overall survival than did sorafenib (median not reached [95% CI not reached-not reached] vs 10·4 months [8·5-not reached]; HR 0·57, 95% CI 0·43-0·75; p<0·0001). The most common grade 3-4 treatment-emergent adverse events were hypertension (55 [14%] of 380 patients in the sintilimab-bevacizumab biosimilar group vs 11 [6%] of 185 patients in the sorafenib group) and palmar-plantar erythrodysaesthesia syndrome (none vs 22 [12%]). 123 (32%) patients in the sintilimab-bevacizumab biosimilar group and 36 (19%) patients in the sorafenib group had serious adverse events. Treatment-related adverse events that led to death occurred in six (2%) patients in the sintilimab-bevacizumab biosimilar group (one patient with abnormal liver function, one patient with both hepatic failure and gastrointestinal haemorrhage, one patient with interstitial lung disease, one patient with both hepatic faliure and hyperkalemia, one patient with upper gastrointestinal haemorrhage, and one patient with intestinal volvulus) and two (1%) patients in the sorafenib group (one patient with gastrointestinal haemorrhage and one patient with death of unknown cause)., Interpretation: Sintilimab plus IBI305 showed a significant overall survival and progression-free survival benefit versus sorafenib in the first-line setting for Chinese patients with unresectable, HBV-associated hepatocellular carcinoma, with an acceptable safety profile. This combination regimen could provide a novel treatment option for such patients., Funding: Innovent Biologics., Translation: For the Chinese translation of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests ZR has received honoraria as an advisor from Innovent Biologics, AstraZeneca, F Hoffmann-La Roche, and Merck Sharp & Dohme. YY, MC, YW. and HZ are employees of Innovent Biologics. All other authors declare no competing interests., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

This study analyzed performance of public hospitals and regional differences in performance following reform of medical service prices in Guangdong province, China. From three cities in four regions, we randomly selected a total of 12 traditional Chinese medicine hospitals and 12 general tertiary hospitals. Six questionnaires were completed by the hospitals, using 2014-2018 internal data. Principal components analysis was used to compare performances of the hospitals and regions following price reform. The extent to which medical service prices were adjusted varied considerable for different procedures in the same region and for the same category of procedures among regions. After reform, compensation for medical services in public hospitals reached the target of 80%, except in the Western region. However, annual growth of costs to patients was generally above 4%; the burden on patients was not alleviated by fee control. Reforms were more effective for comprehensive than Chinese traditional medicine hospitals. Performance scores of general hospitals in the Pearl River Delta, Eastern, Western, and Northern regions were 1.24, 1.16, -0.22, and -1.01, respectively. This is consistent with ranking by level of economic development of each region. The government should implement a regional medical service pricing mechanism. Additionally, comprehensive and traditional Chinese medicine hospitals should each have appropriate pricing policies. Future policies should focus on controlling costs incurred by patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Weng, Xia, Lin and Wang.)

Background: Although a varicella vaccine has been available in China since 1998 in the private sector, varicella outbreaks and breakthrough varicella (BV) still occur. In 2018, four varicella outbreaks with high BV rate sequentially occurred in four schools in Lu'an, sparking local public health authority's concerns on the varicella vaccine. Therefore, we conducted this investigation to evaluate varicella vaccine effectiveness (VE), characterize BV, and detect potential risk factors associated with BV., Methods: This was a three-stage study. First, a retrospective cohort study was done in each school to estimate the VEs of varicella vaccine  during outbreaks. Second, a descriptive epidemiological method was used to describe the characteristics of the four outbreaks and to compare the clinical characteristics between the BV cases and unvaccinated varicella cases. To identify the risk factors associated with BV, we conducted an unmatched case-control study in the third stage of the study., Results: A total of 199 cases were identified among four outbreaks, and the overall attack rate was 14%. Of 1203 students with available vaccination information, 822 (68%) were vaccinated at least once. The overall VEs among four outbreaks ranged from 19% to 69%, whereas the VE against moderate or severe varicella ranged from 74% to 90%. Compared with unvaccinated varicella cases, the moderate or severe varicella ( p < .001) and fever ( p = .029) in the BV group were less common. Besides, BV cases had a shorter duration of disease ( p = .007). Children vaccinated more than six years before the outbreak had a higher risk of developing BV compared with those vaccinated within the past six years (OR = 2.4, 95% CI: 1.2-4.8). The risk of developing BV differed by the exposure intensity. Compared with the presence of three or fewer varicella cases in the same class, the OR was 7.8 (95% CI: 3.6-16.9) for four to nine cases in the same class and 25.2 (95% CI: 13.5 -47.2) for that of 10 or more cases., Conclusions: The overall VE was insufficient to protect varicella infection, and the VE for moderate or severe varicella was only moderate. The manifestations of BV cases were generally milder than those seen in natural varicella infection. The time since vaccination and the intensity of exposure are risk factors for developing BV during an outbreak.

The aim of this study was to evaluate the safety and clinical effectiveness of endovascular stent repair of celiac arterial aneurysm (CAA).From January 2015 to December 2018, 11 patients (7 males, 4 females with a mean age of 52.2 ± 7.9 years) underwent endovascular stent repair of CAA in our center. A covered stent was used to occlude the CAA neck. Follow-up was performed 2 weeks and 1, 3, 6, and 12 months following surgery and yearly thereafter. Rates of technical success, treatment-related complications, and long-term outcome were analyzed.Each patient was placed with 1 stent for repair of CAA. Stent was placed in the celiac and common hepatic arteries for 10 patients and was placed in the celiac artery for 1 patient. The duration of the procedure ranged from 50 to 75 minutes (mean 63.2 ± 7.2 minutes). The rate of technical success of the endovascular stent repair was 100%. No patient experienced CAA rupture or instant endoleak during or after stent insertion. Abdominal pain was relieved progressively after stent insertion. All patients were followed-up for 6 to 48 months (mean 22.4 ± 10.8 months). All patients were alive during the follow-up. No endoleaks were experienced during follow-up with 100% stent patency rate. No patient suffered splenic, hepatic, or bowel infarction during follow-up.Endovascular stent repair is a safe, simple, and effective treatment for patients with CAA.

Rationale: Epidemiological studies suggest that elevated homocysteine is linked to stroke and heart disease. However, the results of lowering homocysteine levels in reducing the risk of stroke recurrence are controversial., Aims: The study aims to evaluate whether homocysteine-lowering therapy with folic acid and vitamins B6 and B12 reduces recurrent stroke events and other combined incidence of recurrent vascular events and vascular death in ischemic stroke patients of low folate regions., Design: This is a multicenter, randomized, double-blinded, placebo-controlled trial. Patients (n = 8000, α = 0.05, β = 0.10) within one-month of ischemic stroke (large-artery atherosclerosis or small-vessel occlusion) or hypertensive intracerebral haemorrhage with plasma homocysteine level ≥ 15 μmol/l will be enrolled. Eligible patients will be randomized by a web-based, random allocation system to receive multivitamins (folic acid 0.8 mg, vitamin B6 10 mg, and vitamin B12 500 μg) or matching placebo daily with a median follow-up of three-years., Study Outcomes: Patients will be evaluated at six monthly intervals. The primary outcome event is the composite event 'stroke, myocardial infarction, or death from any vascular cause', whichever occurs first. Secondary outcome measures include nonvascular death, transient ischemic attack, depression, dementia, unstable angina, revascularization procedures of the coronary, and cerebral and peripheral circulations., Discussion: This is the first multicenter randomized trial of secondary prevention for ischemic stroke in a Chinese population with a higher homocysteine level but without folate food fortification., (© 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.)

Significant intraoperative bleeding and injuries to vital structures in the liver remnant can occur during liver parenchymal transection using the conventional clamp-crushing technique. We performed liver resection on 242 patients using a mosquito clamp-crushing technique combined with a self-assembled saline-linked diathermy for liver parenchymal transection. The mean blood loss was 215 mL (range 20-1100). There was no damage to the vital structures in the liver remnant. The mean liver transection time was 53 minutes (range 15-125). Our technique has the advantages of reducing blood loss, exposing vessles clearly and being simple, cheap and efficacious.

Background: There are a variety of treatment options for Bell's palsy. Evidence from randomized controlled trials indicates corticosteroids can be used as a proven therapy for Bell's palsy. Acupuncture is one of the most commonly used methods to treat Bell's palsy in China. Recent studies suggest that staging treatment is more suitable for Bell's palsy, according to different path-stages of this disease. The aim of this study is to compare the effects of prednisolone and staging acupuncture in the recovery of the affected facial nerve, and to verify whether prednisolone in combination with staging acupuncture is more effective than prednisolone alone for Bell's palsy in a large number of patients., Methods/design: In this article, we report the design and protocol of a large sample multi-center randomized controlled trial to treat Bell's palsy with prednisolone and/or acupuncture. In total, 1200 patients aged 18 to 75 years within 72 h of onset of acute, unilateral, peripheral facial palsy will be assessed. There are six treatment groups, with four treated according to different path-stages and two not. These patients are randomly assigned to be in one of the following six treatment groups, i.e. 1) placebo prednisolone group, 2) prednisolone group, 3) placebo prednisolone plus acute stage acupuncture group, 4) prednisolone plus acute stage acupuncture group, 5) placebo prednisolone plus resting stage acupuncture group, 6) prednisolone plus resting stage acupuncture group. The primary outcome is the time to complete recovery of facial function, assessed by Sunnybrook system and House-Brackmann scale. The secondary outcomes include the incidence of ipsilateral pain in the early stage of palsy (and the duration of this pain), the proportion of patients with severe pain, the occurrence of synkinesis, facial spasm or contracture, and the severity of residual facial symptoms during the study period., Discussion: The result of this trial will assess the efficacy of using prednisolone and staging acupuncture to treat Bell's palsy, and to determine a best combination therapy with prednisolone and acupuncture for treating Bell's palsy., Trial Registration: ClinicalTrials.gov: NCT01201642.

Aim: To determine the clinical, radiographic and laboratory characteristics, diagnostic methods, and therapeutic variables in immunocompetent patients with tuberculosis (TB) of the pancreas and peripancreatic lymph nodes., Methods: The records of 16 patients (6 male, 10 female; mean age 37 years, range 18-56 years) with tuberculosis of the pancreas and peripancreatic lymph nodes from 1983 to 2001 in the Southwest Hospital were analyzed retrospectively. In addition, 58 similar cases published in Chinese literature were reviewed and summarized. We reviewed the clinical, radiographic and laboratory findings, diagnostic methods, therapeutic approaches, and outcome in the patients. Criteria for the diagnosis of pancreatic tuberculosis were the presence of granuloma in histological sections or the presence of Mycobacterium tuberculosis DNA by polymerase chain reaction (PCR)., Results: Predominant symptoms consisted of abdominal nodule and pain (75 %), anorexia/weight loss (69 %), malaise/weakness (64 %), fever and night sweats (50 %), back pain (38 %) and jaundice (31 %). Swelling of the head of the pancreas with heterogeneous attenuation echo was detected with ultrasound in 75 % (12/16). CT scan showed pancreatic mass with heterogeneous hypodensity focus in all patients, with calcification in 56 % (9/16) patients, and peripancreatic nodules in 38 % (6/16) patients. Anemia and lymphocytopenia were seen in 50 % (8/16) patients, and pancytopenia occurred in 13 % (2/16) patients. Hypertransaminasemia, elevated alkaline phosphatase (AP) and GGT were seen in 56 % (9/16) patients. The erythrocyte sedimentation rate (ESR) was elevated in 69 % (11/16) cases. Granulomas were found in 75 % (12/16) cases, and in 38 % (6/16) cases caseous necrosis tissue was found. Laparotomy was performed in 75 % (12/16) cases, and ultrasound-guided fine needle aspiration (FNA) was done in 63 % (10 of 16). The most commonly used combinations of medications were isoniazid/rifampin/streptomycin (63 %, n=10) and isoniazid/rifampin pyrazinamide/streptomycin or ethambutol (38 %, n=6). The duration of treatment lasted for half or one year and treatment was successful in all cases. The characteristics of 58 cases from Chinese literature were also summarized., Conclusion: Tuberculosis of the pancreas and peripancreatic lymph nodes should be considered as a diagnostic possibility in patients presenting with a pancreatic mass, and diagnosis without laparotomy is possible if only doctors are aware of its clinical features and investigate it with appropriate modalities. Pancreatic tuberculosis can be effectively cured by antituberculous drugs.