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Aims: This study aims to provide representative information on heart failure (HF) patients in China, especially older adults aged ≥75 years. We aim to clarify the age‐related discrepancies in performance measures and the modifying effect of age on the impact of HF patients' characteristics on clinical outcomes. Methods and results: All HF patients admitted into five tertiary and four secondary hospitals of the Capital Medical University were divided into two groups according to age: 1419 (53.3%) were <75 years, and 1244 (46.7%) were ≥75 years. Older HF patients were more likely to be women, with higher left ventricular ejection fraction, with co‐morbidities including chronic obstructive pulmonary disease/asthma, anaemia, chronic kidney disease, stroke/transient ischemic attack (TIA), atrial fibrillation/atrial flutter, hypertension, and coronary artery disease, while obesity, diabetes mellitus, hypercholesterolaemia and valvular heart disease were more prevalent among younger HF patients. Left ventricular ejection fraction assessment was performed in a similar proportion of patients in the younger and older groups (81.7% vs. 80.5%, P = 0.426), while B‐type natriuretic peptide/N terminal pro brain natriuretic peptide was tested in a lower proportion in the younger group (84.8% vs. 89%, P = 0.001). At discharge, HF with reduced ejection fraction patients were less likely to receive beta‐blockers, angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers, or combined beta‐blockers and angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers therapy in the older group (49.74% vs. 63.2%, P = 0.002; 52.9% vs. 64.7%, P = 0.006; and 28.57% vs. 45.5%, P < 0.001, respectively) but were equally likely to receive mineralocorticoid receptor antagonists in the two age groups (80.8% vs. 84.1%, P = 0.322). Older patients with HF had higher risk of in‐hospital and 1 year mortality (2.7% vs. 1.3%, P = 0.011; 21.7% vs. 12.5%; P < 0.001, respectively). Higher body mass index was associated with better outcomes in both age groups. New York Heart Association functional class IV and estimated glomerular filtration rate < 60 mL/min/1.73 m2 were independent predictors of 1 year mortality. The associations between patients' characteristics and risk of mortality were not modified by age. Conclusions: HF patients aged ≥75 years had distinct clinical profiles, received worse in‐hospital therapies and experienced higher in‐hospital and 1 year mortality. [ABSTRACT FROM AUTHOR]

The extreme precipitation (EP) in the early and late rainy seasons in Southern China is investigated from the perspective of moist static energy (MSE). At the synoptic time scale, the EP is accompanied by the charge–discharge paradigm of the vertically integrated MSE (hMSEi); the positive hMSEi anomaly reaches the peak one day before EP and decreases quickly during the event. The charge–discharge paradigm of hMSEi is dominated by the horizontal and vertical advection, respectively. However, synoptic systems responsible for the hMSEi charge in the early and late rainy seasons are different due to the different horizontal distributions of climatological MSE in the lower troposphere caused by the northward migration of solar radiation and the monsoon system. At the interannual time scale, more EP in the early (late) rainy season is associated with the higher seasonal-mean hMSEi that can be caused by the anomalous anticyclone (cyclone) in the western North Pacific induced by the SST anomalies in the tropical Indian Ocean and central North Pacific (the tropical Pacific). The multimodel ensemble mean of CMIP6 models reproduces well the observed hMSEi–EP relationship in both the historical and Shared Socioeconomic Pathway 5–8.5 (SSP5–8.5) runs. Moreover, the mean state of hMSEi increases in the SSP5–8.5 compared to historical runs along with more frequent occurrence of EP events. Hence, hMSEi can serve as a useful metric for studying EP in Southern China at various time scales. [ABSTRACT FROM AUTHOR]

Chinese chives is a popular herb vegetable and medicine in Asian countries. Southwest China is one of the centers of origin, and the mountainous areas in this region are rich in wild germplasm. In this study, we collected four samples of germplasm from different altitudes: a land race of cultivated Chinese chives (Allium tuberosum), wide-leaf chives and extra-wide-leaf chives (Allium hookeri), and ovoid-leaf chives (Allium funckiaefolium). Leaf metabolites were detected and compared between A. tuberosum and A. hookeri. A total of 158 differentially accumulated metabolites (DAM) were identified by Gas Chromatography—Mass Spectrometry (GC-MS) and Liquid Chromatography—Mass Spectrometry (LC-MS), among which there was a wide range of garlic odor compounds, free amino acids, and sugars. A. hookeri contains a higher content of fructose, garlic odor compounds, and amino acids than A. tuberosum, which is supported by the higher expression level of biosynthetic genes revealed by transcriptome analysis. A. hookeri accumulates the same garlic odor compound precursors that A. tuberosum does (mainly methiin and alliin). We isolated full-length gene sequences of phytochelatin synthase (PCS), γ-glutamyltranspeptidases (GGT), flavin-containing monooxygenase (FMO), and alliinase (ALN). These sequences showed closer relations in phylogenetic analysis between A. hookeri and A. tuberosum (with sequence identities ranging from 86% to 90%) than with Allium cepa or Allium sativum (which had a lower sequence identity ranging from 76% to 88%). Among these assayed genes, ALN, the critical gene controlling the conversion of odorless precursors into odor compounds, was undetected in leaves, bulbs, and roots of A. tuberosum, which could account for its weaker garlic smell. Moreover, we identified a distinct FMO1 gene in extra-wide-leaf A. hookeri that is due to a CDS-deletion and frameshift mutation. These results above reveal the molecular and metabolomic basis of impressive strong odor in wild Chinese chives. [ABSTRACT FROM AUTHOR]

Aims: We aimed to investigate the safety of discontinuing oral anticoagulation (OAC) therapy after apparently successful atrial fibrillation (AF) ablation, using data from the Chinese Atrial Fibrillation Registry study.Methods and Results: We identified 4512 consecutive patients who underwent successful AF ablation between August 2011 and December 2017. Of them, 3149 discontinued OAC 3 months post-ablation (Off-OAC group) and 1363 continued OAC beyond this period (On-OAC group). Regular follow-up examinations were undertaken to detect AF recurrence, monitor OAC therapy, and measure clinical outcomes. Primary outcomes included thromboembolic and major bleeding (MB) events experienced beyond 3 months after ablation. Low thromboembolic and MB event rates were noted in the on-treatment analysis. The incidence rates for thromboembolism were 0.54 [95% confidence interval (CI) 0.39-0.76] and 0.86 (95% CI 0.56-1.30) per 100 patient-years, and that for MB events were 0.19 (95% CI 0.11-0.34) and 0.35 (95% CI 0.18-0.67) per 100 patient-years, for the Off-OAC and On-OAC groups over mean follow-up periods of 24.2 ± 14.7 and 23.0 ± 13.6 months, respectively. Similar results were observed in the intention-to-treat analysis. Previous history of ischaemic stroke (IS)/transient ischaemic attack (TIA)/systemic embolism (SE) [hazard ratio (HR) 3.40, 95% CI 1.92-6.02; P < 0.01] and diabetes mellitus (HR 2.06, 95% CI 1.20-3.55, P = 0.01) were independently associated with thromboembolic events, while OAC discontinuation (HR 0.71, 95% CI 0.41-1.23, P = 0.21) remained insignificant in multivariable analysis.Conclusions: This study suggests that it may be safe to discontinue OAC in post-ablation patients under diligent monitoring, in the absence of AF recurrence, history of IS/TIA/SE, and diabetes mellitus. However, further large-scale randomized trials are required to confirm this.Trial Registration: Chinese Clinical Trial Registry ChiCTR-OCH-13003729. URL: http://www.chictr.org.cn/showproj.aspx?proj=5831. [ABSTRACT FROM AUTHOR]

Background: Postprandial distress syndrome (PDS) is referred to as meal-related functional dyspepsia (FD) and causes a reduced quality of life (QoL) for patients. Several randomized controlled trials (RCTs) have suggested that acupuncture is an effective treatment for FD, but few studies were particularly for PDS. This pilot study was designed to determine the feasibility and efficacy of acupuncture in patients with PDS characterized by postprandial fullness and early satiation according to the Rome III criteria.Methods: This is a multi-center, two-arm, blinded (participants), pilot RCT. Forty-two participants who meet the inclusion criteria will be randomly assigned to the verum acupuncture group or minimal acupuncture group in a 1:1 ratio. Both treatments consist of 12 sessions of 20 min duration over four weeks (three sessions per week). The primary outcome measurement is the proportion of persons who improve as assessed using the global outcome by the overall treatment effect (OTE) at end-of-treatment (EOT) (four weeks after randomization). Global assessment at weeks 8 and 16 after randomization is one of the secondary outcomes. The other secondary outcomes including symptoms, disease-specific QoL, and depression and anxiety will be assessed at weeks 4, 8, and 16 after randomization.Discussion: This pilot study will help determine the feasibility and efficacy of acupuncture in patients with PDS.Trial Registration: ISRCTN Registry, ISRCTN18135146 . Registered on 7 July 2016. [ABSTRACT FROM AUTHOR]

Severe root rot was observed in fields of cabbages (Brassica oleracea L.) in 2015 in China. Cardinal symptoms of this disease included root rot and wilting leaves. A fungus was isolated from diseased tissues consistently. Based on the morphological features and molecular analysis of the ITS-5.8S rDNA and D1/D2 domain of the 28S rRNA gene, it was identified as Plectosphaerella cucumerina. This is the first report of P. cucumerina causing cabbage root rot in China and the world. [ABSTRACT FROM AUTHOR]

In recent years, the concentration of ozone (O 3) in typical urban agglomerations in China has generally increased. This study carried out a three-year observation in the active photochemical reaction period (August–November) in Shenzhen, a megacity in the Pearl River Delta (PRD). Principal coordinate analysis (PCoA) was first applied to identify the major factors influencing daily maximum 8-h average O 3 (MDA8-O 3) concentration. Then, the MDA8-O 3 concentration fitting equation was established by a stepwise multiple linear regression (MLR). In result, sensitivity test based on the fitting equation showed that temperature (+35.8%), photolysis rate of j [NO 2 ] (+11.1%), relative humidity (−10.4%) and photolysis rate of j [O1D] (−9.5%) had more effect on the concentration of MDA8-O 3 with per factor perturbation (25% change), while increments of △CO (6.9%) and NO 2 (2.7%) had less effect. The insignificant effect produced by NO 2 is consistent with Shenzhen being in a transition area for O 3 -VOCs-NO x sensitivity. Moreover, it is found in this study that PM 2.5 likely promotes O 3 formation by scattering light to influence j [NO 2 ] and j [O1D] differently, which provides a new explanation for the coupled formation of PM 2.5 and O 3 in the PRD region. [Display omitted] • Continuous photolysis rate observations were carried out in a megacity in the PRD. • Temperature and photolysis rate of NO 2 were most critical in daytime O 3 formation. • The role of NO 2 suggested a transition regime for the O 3 –VOCs-NO x sensitivity. • PM 2.5 likely promoted O 3 formation by scattering light with wavelength dependence. [ABSTRACT FROM AUTHOR]

Background Atrial fibrillation (AF) is associated with increased incidence of cardiovascular disease, and hence, statin therapy is indicated in majority of AF patients. Methods and results We analyzed data from the Chinese Atrial Fibrillation Registry (CAFR) involving 11,496 AF patients from 2011 to 2014. Practice patterns of statin therapy and factors associated with statin underuse were analyzed. Based on the 2013 ACC/AHA cholesterol management guidelines, statins should be recommended for 67.4% (7720/11,461) of AF participants in CAFR, but only 43.4% (3352/7720) with appropriate indications were taking statins. Statin underuse in AF patients was independently associated with male sex, tertiary hospital treatment, outpatient attendance, and absence of ‘high risk’ cardiovascular risk factors (overweight, diabetes, coronary heart disease, stroke/transient ischemic attack/peripheral embolism and hypertension). Conclusions A high proportion of Chinese AF patients had indications for statin therapy. Evidence-based statin prescribing was suboptimal in this population. Greater efforts should be made to improve a holistic approach to cardiovascular risk management in the Chinese AF population. [ABSTRACT FROM AUTHOR]

Ambient ozone air pollution is one of the most important environmental challenges in China today, and it is particularly significant to identify pollution sources and formulate control strategies. In present study, we proposed a novel method of positive matrix factorization-SHapley Additive explanation (PMF-SHAP) for evaluating the impact of emission sources on ozone formation, which can quantify the main emission sources of ozone pollution. In this method, we first used the PMF model to identify the source of volatile organic compounds (VOCs), and then quantified various emission sources using a combination of machine learning (ML) models and the SHAP algorithm. The R2 of the optimal ML model in this method was as high as 0.96, indicating that the prediction performance was excellent. Furthermore, we explored the impact of different emission sources on ozone formation, and found that ozone formation in Shenzhen was more affected by VOCs, of which vehicle emission sources may have the greatest impact. Our results suggest that the appropriate combination of traditional models with ML models can well address environmental pollution problems. Moreover, the conclusions obtained based on the PMF-SHAP method were different from the traditional ozone formation potential (OFP) results, providing valuable clues for related mechanism studies. [Display omitted] • A novel method is used to quantify various emission sources on O 3 formation. • The results of PMF-SHAP provide valuable clues for related mechanism studies. • Vehicle emission sources in Shenzhen may have the greatest impact on O 3 formation. [ABSTRACT FROM AUTHOR]

ntroduction: The aim of the study was to analyze clinicopathologic characteristics and survival and to identify prognostic factors for Chinese patients with HER2-positive metastatic breast cancer. Material and methods: A total of 243 patients with HER2-positive metastatic breast cancer, treated during the period 2002 to 2009, were followed up from initial disease diagnosis to death or date of last follow-up (December 2011). Cumulative survival curves were created using Kaplan-Meier analysis with the log-rank test. Prognostic factors were analyzed by univariate and multivariate Cox proportional hazards regression analysis. Results: During follow-up, 205 patients died, with a median OS of 27 months (95% CI: 23.5, 30.5 months), and the 1-, 3-, and 5-year survival rates were 84.4%, 38.6%, and 18.1%, respectively. The median OS of HR+ patients was significantly higher than that of HR- patients (p < 0.001). Surgery (hazard ratio = 0.60, p = 0.002), endocrine therapy (hazard ratio = 0.53, p < 0.01), and anti-HER2 therapy (hazard ratio = 0.63, p = 0.003) were favorable independent prognostic factors for patients with HER2-positive metastatic breast cancer. Conclusions: These results indicated that surgical intervention, endocrine therapy, and anti-HER2 therapy were good for these HER2 positive patients with metastatic breast cancer, but ECOG performance status < 1 and metastasis to brain were unfavorable independent prognostic factors. HR status was not an independent prognostic factor. [ABSTRACT FROM AUTHOR]

Peroxyacetyl nitrate (PAN) is a typical secondary product of photochemical smog and is widely considered an indicator when evaluating the severity of photochemical pollution, but there have been few quantitative studies on the thermal decomposition of ambient PAN in southern China. In this study, online sampling of PAN and ozone (O 3) was conducted from August to November 2020, which is the most severe photochemical pollution period of the year, in Shenzhen, a megacity in southern China. During the sampling period, two photochemical pollution periods occurred in August (EP1) and October (EP2). The mean O 3 concentrations during EP1 and EP2 were very close, 36.3 and 36.9 ppb, respectively, while PAN concentrations were very different (0.66 and 1.06 ppb, respectively). The diurnal variation showed that the PAN formation rate in the initial stage of photochemical reactions (9:00–11:00) during EP1 was significantly faster than that during EP2, while there was significant consumption at noon and almost complete decomposition at night in EP1. Calculating the thermal decomposition of PAN (TPAN), we found that the average concentration of TPAN in EP1 was 8.47 ppb, approximately 9 times that in EP2 (0.94 ppb), which significantly reduced the concentration of PAN in EP1. This indicates that when using PAN as an indicator of photochemical reaction activity, the consumption of PAN due to thermal decomposition must be considered. In addition, we found that regional transport may significantly contribute to the formation of PAN by increasing the concentration of precursor VOCs, although the lifetime of PAN was only a few hours due to a large amount of thermal decomposition. • Two photochemical pollution episodes represented by high O 3 and PAN were captured. • Thermal decomposition significantly consumes the atmospheric PAN formed in summer. • Ambient PAN observed may not accurately reflect the photochemical pollution levels. • Regional transport of the precursors will promote the in-situ formation of PAN. [ABSTRACT FROM AUTHOR]

Acupuncture is a therapeutic technique and part of traditional Chinese medicine (TCM). Acupuncture has clinical efficacy on various autonomic nerve-related disorders, such as cardiovascular diseases, epilepsy, anxiety and nervousness, circadian rhythm disorders, polycystic ovary syndrome (PCOS) and subfertility. An increasing number of studies have demonstrated that acupuncture can control autonomic nerve system (ANS) functions including blood pressure, pupil size, skin conductance, skin temperature, muscle sympathetic nerve activities, heart rate and/or pulse rate, and heart rate variability. Emerging evidence indicates that acupuncture treatment not only activates distinct brain regions in different kinds of diseases caused by imbalance between the sympathetic and parasympathetic activities, but also modulates adaptive neurotransmitter in related brain regions to alleviate autonomic response. This review focused on the central mechanism of acupuncture in modulating various autonomic responses, which might provide neurobiological foundations for acupuncture effects. [ABSTRACT FROM AUTHOR]

Background. Recent reports suggest that a proportion of tinnitus patients suffer from mental illness. Autonomic nervous system plays a useful role in tinnitus therapy since electrical vagal nerve stimulation (VNS) has been frequently used to alleviate tinnitus-induced depression in clinic. heart rate variability (HRV), which is reflective of autonomic nervous system function, has been proved to be modulated by acupuncture. In the present study,we aim to compare the effect of deqi sensation on heart rate variability in adult tinnitus patients. Methods. Thirty participants are randomly assigned to verum acupuncture (creating deqi) or shallow acupuncture (not creating deqi) at Baihui (Du-20), Shenting (Du-24), Tinghui (GB-2), Waiguan (SJ-5), and Zulinqi (GB-41) for 3 weeks. The primary outcome measure is heart rate variability, which is measured at the first acupuncture, as well as the last acupuncture. Discussion. Completion of this trial will help to identify the role of deqi sensation in acupuncture effect for tinnitus and reveal an autonomic modulation mechanism for acupuncture effect. Trial Registration. [ABSTRACT FROM AUTHOR]

Abstract: A two-line hybrid rice combination, Liangyoupeijiu, was used to estimate several factors of plant type, and environmental models for these factors at the heading stage were established using the data of eight ecological experimental sites in 2006 and 2007. According to climatic data from 1951 to 2005, the differences in those factors and their effects on plant canopy were analyzed for four rice cropping areas in China, including South China, the middle-lower reaches of the Yangtze River, Sichuan Basin, and river valley in Yunnan, China. The thickness of leaf layer (the distance from pulvinus of the third leaf from the top to the tip of flag leaf) and distribution of leaf area could be used as candidate indices for the plant type of a rice canopy. [ABSTRACT FROM AUTHOR]

This pilot project in Zhejiang Province, China, aimed at improving the nutrition and health status of students, school personnel and parents, and developing a model project for nutrition interventions for the development of health-promoting schools (HPS) in China. Three primary and three secondary schools participated. Interventions included establishing school-based working groups, nutrition training for school staff, distribution of materials on nutrition, nutrition education for students, student competitions, school-wide health promotion efforts and outreach to families and communities. Results of a pre- and post-intervention survey one and a half years apart showed improvements in nutrition knowledge, attitudes and behavior among all target groups. Primary school students at the pilot schools made the greatest knowledge gains in the areas of Chinese dietary guidelines (increased from 49.2 to 78.0%, p < 0.01) and adequate dietary principles (increased from 42.9 to 68.0%, p < 0.01). Scores of secondary school students who reported liking school lunches rose at pilot schools from 17.9 to 45.2% (p < 0.01). School staff at control schools who reported taking breakfast declined from 81.4 to 66.6% (p < 0.01), while staff who reported taking lunch at school increased in pilot schools from 87.5% at baseline to 93.9% (p < 0.01). The largest increases in nutrition knowledge among all target groups occurred among parents and guardians. At the pilot schools parents increased their knowledge in the areas of nutritional deficiencies (from 35.0 to 66.2%, p < 0.01) and nutrient-rich foods (from 38.8 to 66.8%, p < 0.01). Talks with target groups confirmed changes in attitudes and behavior, and school visits revealed improvements to school facilities and school health services, establishing of school policies and a positive school climate. This study suggests that nutrition can effectively serve as an entry point to establish HPS in China and that the HPS concept is feasible to improve the dietary knowledge, attitudes and behavior of students, parents and school personnel. [ABSTRACT FROM AUTHOR]

Volatile organic compounds (VOCs) are important precursors of photochemical pollution. However, a substantial fraction of VOCs, namely, oxygenated VOCs (OVOCs), have not been sufficiently characterized to evaluate their sources in air pollution in China. In this study, a total of 119 VOCs, including 60 OVOCs in particular, were monitored to provide a more comprehensive picture based on different online measurement techniques, proton-transfer-reaction time-of-flight mass spectrometry (PTR-ToF-MS) and online gas chromatography/mass spectrometry (GC/MS), at a receptor site in southeastern China during a photochemically active period. Positive matrix factorization (PMF) and photochemical age-based parameterization were combined to identify and quantify different sources of major VOCs during daytime hours, with the advantage of including VOC decay processes. The results revealed the unexpected role of biomass burning (21%) in terms of ozone (O 3) formation potential (OFP) when including the contributions of OVOCs and large contributions (30–32%) of biomass burning to aldehydes, as more OVOCs were measured in this study. We argue that biomass burning could significantly enhance the continental atmospheric oxidizing capacity, in addition to the well-recognized contributions of primary pollutants, which should be seriously considered in photochemical models and air pollution control strategies. [Display omitted] • 119 VOCs, including 60 OVOCs, were online monitored with different techniques. • PMF and photochemical age methods were combined to estimate VOC sources. • Biomass burning showed large contribution to atmospheric oxidizing capacity. [ABSTRACT FROM AUTHOR]

Oxygenated volatile organic compounds (OVOCs) are important precursors and intermediate products of atmospheric photochemical reactions, which can promote the formation of secondary pollutants such as ozone (O 3) and secondary organic aerosol (SOA). However, there have been few studies on the sources of and long-term variation in ambient OVOCs. This study combined sensitive, near real-time measurements of VOCs by proton transfer reaction-mass spectrometry (PTR-MS) with an improved photochemical age parameterization method to quantify daytime sources of OVOCs in an urban atmosphere in China from 2014 to 2019, permitting the observation of the impacts of emission control strategies that were implemented during this period. Temporal variation in six key OVOCs (methanol, acetaldehyde, acetone, methyl ethyl ketone (MEK), formic acid, and acetic acid) were observed. The sum of concentrations of OVOCs was averagely 13% higher during the dry season (November to April), when winds transported polluted air masses to Shenzhen from the continent, than during the wet season, and peak diurnal levels occurred during the daytime year-round due to photochemical production and higher daytime anthropogenic emissions. The average dry season concentration of OVOCs declined from a peak of 30.3 ppb in 2015 to 18.7 ppb in 2019. The results of source apportionment showed that primary anthropogenic sources contributed the most to methanol, MEK, and acetic acid (32–51%); the dominant sources of acetaldehyde and formic acid were both primary and secondary anthropogenic sources; and biomass burning contributed a small fraction (5–11%) to the six OVOCs. From 2014 to 2019, contributions from primary anthropogenic sources of OVOCs decreased significantly by 50–60% due to intensive pollution control measures in Shenzhen, whereas pollution control measures had no observable impact on secondary OVOCs, indicating their formation was not limited by availability of their primary VOC precursors. Image 1 • Long-term changes in oxygenated VOCs were monitored by PTR-MS over 6 years. • Primary emission of OVOCs dropped by 50% during 2014–2019 due to pollution control. • Secondary formation of OVOCs is not limited by abundance of primary VOC precursors. [ABSTRACT FROM AUTHOR]

Polygonatum sibiricum is a traditional Chinese medicinal herb and can also be used as tea and ornamental plant. During 2016 to 2018, a disease with symptoms similar to gray mold was extensively observed on leaves of P. sibiricum in the Sichuan Province of China. The pathogen was isolated from the diseased plants and identified as Botrytis cinerea based on the morphological features and Internal transcribed spacer (ITS), DNA dependent RNA polymerase subunit II gene (RPB2), heat-shock protein 60 gene (HSP60) and ATP-dependent RNA helicase DBP7 gene (MS547) all of which showed 99.89%–99.91% identities to the reported B. cinerea strains. Pathogenicity was confirmed through inoculation experiments fulfilling Koch's postulates. To our knowledge, this is the first report of B. cinerea causing gray mold disease on P. sibiricum in China. • This research first reported the occurrence of a gray mold of Polygonatum sibiricum in China. • The pathogen fungus was isolated and identified as B. cinerea. • Pathogenicity tests confirmed Botrytis cinerea was virulent to P. sibiricum. [ABSTRACT FROM AUTHOR]

Oxygenated volatile organic compounds (OVOCs) are critical precursors of atmospheric ozone (O 3) and secondary organic aerosols (SOA). Although China is experiencing increasing O 3 pollution from north to south, understanding the major sources of OVOCs in this region is still limited due to their active photochemical behaviors. In this study, five critical OVOCs at a northern urban site (Beijing) and a southern urban site (Shenzhen) were monitored in summer using proton transfer reaction-mass spectrometry (PTR-MS). The mean total concentration of VOCs measured in Beijing (39.4 ppb) was much higher than that measured in Shenzhen (16.7 ppb), with methanol and formaldehyde being the most abundant in concentration at both sites. The source apportionment of daytime OVOCs was conducted effectively using a photochemical age-based parameterization method. Biogenic and anthropogenic secondary sources were the main sources of formaldehyde, acetaldehyde, and acetone at both sites, with a total contribution of 46–82%; acetone also had a large regional-scale background contribution (36–38%); methanol and methyl ethyl ketone (MEK) were mainly derived from anthropogenic primary sources (35–55%) at both sites. In addition, the regional background levels of OVOCs measured in North China were shown to be much higher than those measured in South China. The calculation of the total O 3 formation potential (OFP) of OVOCs highlights the comparable contributions from anthropogenic and biogenic sources in both Beijing and Shenzhen, indicating the important role of biogenic OVOC sources even in polluted environments. Since biogenic sources are already important but uncontrollable, anthropogenic emissions in China need to be restricted even more critically in the future. Image 1 • Oxygenated VOCs in urban air are much higher in northern than in southern China. • Biogenic and anthropogenic secondary sources are the main sources of aldehydes. • Biogenic sources largely influence ozone formation through oxygenated VOCs. Oxygenated volatile organic compounds have comparable contributions from biogenic and anthropogenic sources in terms of O 3 formation potential. [ABSTRACT FROM AUTHOR]

Wastewater treatment plants (WWTPs) are usually considered gateways for microplastics (MPs) to enter the environment because large amounts of sewage are produced and MPs are incompletely removed during treatment processes. However, the contribution of effluent MPs to aquatic environmental pollution and that of sludge application to MPs in agricultural soil are still unknown. This study examines the presence of MPs in sewage and sludge in Shenzhen WWTPs and estimates the annual mass loading of MPs from WWTPs to surface water and farmland soil in China. According to our results, for Shenzhen, the annual contribution of MPs from WWTPs (which was obtained by multiplying the annual treated sewage volume by the estimated MP density in the treated sewage) to surface water could be 70.6−302 tons. With a normalized extrapolation model of population density, the contribution of national urban WWTPs to MPs in surface water was estimated to be 734 −3.10 × 103 tons/year, of which 220−950 tons/year entered the marine environment. Furthermore, the riverine flux of MPs from WWTPs to the ocean amounts to at least 7.0%–30% based on the maximum value of WWTP contribution to MPs in surface water. For sludge, the potential contribution of MPs to agricultural soil from Shenzhen WWTPs is (1.00−2.80) × 103 tons/year. With the above calculation procedure, it was estimated that the contribution of MPs to farmland from sludge application in China is (1.30−3.90) × 104 tons/year. The source appointment results for MPs in China's agricultural soil suggested that the contributions of the main four sources, namely, atmospheric deposition, agricultural mulch film, sludge application, and organic fertilizers, are 52%, 30%, 11%, and 7.0%, respectively. [Display omitted] • WWTPs' contribution to MPs in surface water is 734–3.1 × 103 tons/year in China. • Sludge for farmland use input (1.3–3.9) × 104 tons/year MPs to agricultural soil in China. • Mass of MPs entering the ocean from China's WWTPs reached 220–950 tons/year. • Atmospheric deposition contribution to farmland soil MPs is approximately 52%. [ABSTRACT FROM AUTHOR]

Volatile organic compounds (VOCs) are the main precursors of ozone (O 3) and secondary organic aerosol (SOA) formation in the atmosphere. The traditional positive matrix factorization (PMF) source apportionment method is mainly based on the time series of VOCs at a single site, and its results cannot indicate the difference spatially. In this study, a refined spatial distribution study was carried out in Shenzhen in the Pearl River Delta (PRD) region, China, with 110 sampling sites covering the city. Ninety-two VOC compounds were quantitatively analyzed and the spatial distribution characteristics of various VOCs were obtained. Based on the PMF source apportionment of multisite samples, five types of sources and their spatial distributions of vehicle exhaust, gasoline leakage, industrial processes, airport-related sources and regional transport were identified. The airport source was resolved for the first time in the VOC source apportionment and was further verified by the measured source spectra in the airport. It is found that the airport-related sources accounted for 19% of the ambient VOC concentrations in Shenzhen and had strong Cl radical reaction activity, indicating that the airport-related sources may have a greater impact on O 3 and SOA formation in coastal cities than previously expected. [Display omitted] • VOC samples were collected simultaneously at 110 sites in Shenzhen. • Five VOC sources and their spatial distributions were identified by PMF. • Airport-related sources were found to account for 19% of VOC concentrations. • Airport-related sources may have great impact on O 3 and SOA formation in PRD. [ABSTRACT FROM AUTHOR]

Formaldehyde (HCHO) plays an important role in atmospheric photochemistry and air quality. In this study, to investigate the sources and characteristics of formaldehyde pollution in different regions of southern China, formaldehyde online monitoring system and proton transfer reaction mass spectrometer were used to simultaneously monitor the level of HCHO and other non-methane hydrocarbons in the environment at urban site (HSTY) and rural site (NA) in the Pearl River Delta (PRD) of China. The results showed that formaldehyde concentrations were higher in autumn, with (4.46 ± 3.15 ppbv) and (2.13 ± 1.46 ppbv) for urban and rural sites, respectively, compared to (1.51 ± 0.80 ppbv) and (1.84 ± 0.93 ppbv) for winter. Continental air masses bring many secondary and biological species, with isoprene playing an important role in secondary HCHO generation. Using a photochemical age-based method to allocate HCHO, the highest proportion of secondary anthropogenic occurs at urban site (39.4%–42.5%), whereas biogenic contribute the most at rural site (39.1%–43.7%). Fewer human activities result in a lower proportion of primary anthropogenic at rural site (10.8%) compared to urban site (12.2%). These findings demonstrate the interplay between anthropogenic and biogenic sources, which would help understand the formation of photochemical pollution in the PRD. [Display omitted] • HCHO with a high time resolution was measured online at both urban and rural sites in the Pearl River Delta (PRD) of China. • Urban site exhibited greater seasonal difference in ambient formaldehyde compared to rural site. • The dominant source of daytime HCHO was found to be the secondary anthropogenic source at an urban site. • Biogenic sources contributed most to HCHO at a rural site. [ABSTRACT FROM AUTHOR]

The complex air pollution driven by both Ozone (O 3 ) and fine particulate matter (PM 2.5 ) significantly influences the air quality in the Sichuan Basin (SCB). Understanding the O 3 formation during autumn and winter is necessary to understand the atmospheric oxidative capacity. Therefore, continuous in-site field observations were carried out during the late summer, early autumn and winter of 2020 in a rural area of Chongqing. The total volatile organic compounds (VOCs) concentration reported by a Proton-Transfer-Reaction Time-of-Flight Mass Spectrometry (PTR-ToF-MS) were 13.66 ± 9.75 ppb, 5.50 ± 2.64 ppb, and 9.41 ± 5.11 ppb in late summer, early autumn and winter, respectively. The anthropogenic VOCs (AVOCs) and biogenic VOCs (BVOCs) were 8.48 ± 7.92 ppb and 5.18 ± 2.99 ppb in late summer, 3.31 ± 1.89 ppb and 2.19 ± 0.93 ppb in autumn, and 6.22 ± 3.99 ppb and 3.20 ± 1.27 ppb in winter. A zero-dimensional atmospheric box model was employed to investigate the sensitivity of O 3 -precursors by relative incremental reactivity (RIR). The RIR values of AVOCs, BVOCs, carbon monoxide (CO), and nitrogen oxides (NO x ) were 0.31, 0.71, 0.09, and -0.36 for late summer, 0.24, 0.59, 0.22, and -0.38 for early autumn, and 0.30, 0.64, 0.33 and -0.70 for winter, and the results showed that the O 3 formation of sampling area was in the VOC-limited region, and O 3 was most sensitive to BVOCs (with highest RIR values, > 0.6). This study can be helpful in understanding O 3 formation and interpreting the secondary formation of aerosols in the winter., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Owing to its biotoxicity and inductive effect on photochemical pollution, atmospheric peroxyacetyl nitrate (PAN), which is a typical product of atmospheric photochemical reactions, has attracted much research attention. However, to the best of our knowledge, few comprehensive studies have been conducted on the seasonal variation and key influencing factors of PAN concentrations in southern China. In this study, PAN, ozone (O 3 ), precursor volatile organic compound (VOC), and other pollutant concentrations were measured online for 1 year (from October 2021 to September 2022) in Shenzhen, a megacity in the Greater Bay Area of China. The average concentrations of PAN and peroxypropionyl nitrate (PPN) were 0.54 and 0.08 parts per billion (ppb), and the maximum hourly concentrations reached 10.32 and 1.01 ppb, respectively. The results of the generalized additive model (GAM) showed that the atmospheric oxidation capacity and precursor concentration were the most important factors affecting the PAN concentration. According to the steady-state model, the average cumulative contribution to the peroxyacetyl (PA) radical formation rate by six major carbonyl compounds was calculated at 4.2 × 10 6 molecules cm -3  s -1 , and acetaldehyde (63.0 %) and acetone (13.9 %) contributed the most. Furthermore, the photochemical-age-based parameterization method was used to analyze the source contributions of carbonyl compounds and PA radicals. The results showed that although the primary anthropogenic (40.2 %), biogenic (27.8 %), and secondary anthropogenic (16.4 %) sources were the most important contributors of PA radicals, the biogenic and secondary anthropogenic source contributions both increased considerably in summer, and the cumulative proportion of both sources reached ~70 % in July. In addition, a comparison of PAN pollution processes in different seasons revealed that in summer and winter, the PAN concentration was predominantly limited by precursors and meteorological parameters, such as light intensity, respectively., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Birth asphyxia causes hypoxia or inadequate perfusion to the organs of newborns, leading to metabolism dysfunctions including blood glucose disorders., Methods: Neonates with and without birth asphyxia were retrospectively recruited from 53 hospitals in Hubei Province from January 1 to December 31, 2018. In summary, 875, 1139, and 180 cases in the control group, the mild asphyxia group, and the severe asphyxia group were recruited, respectively. Neonatal blood glucose values at postnatal 1, 2, 6, and 12 h (time error within 0.5 h was allowed) were gathered from the medical records., Results: The incidence rates of hyperglycemia in the control group, the mild asphyxia group and the severe asphyxia group were 2.97%, 7.90%, and 23.33%, respectively (p < 0.001). Additionally, the incidence rates of hypoglycemia in the three groups above were 3.66%, 4.13%, and 7.78%, respectively (p = 0.042). The blood glucose values of neonates with hypoglycemia in the asphyxia group were lower than in the control group (p = 0.003). Furthermore, the blood glucose values of neonates with hyperglycemia were highest in the severe asphyxia group (p < 0.001). There were 778 and 117 cases with blood glucose records at four predefined time points in the mild and severe asphyxia group, respectively. The incidence of blood glucose disorders in the mild asphyxia group significantly decreased from postnatal 6 h (p＜0.05). However, we found no obvious changes of the incidence of glucose disorders within postnatal 12 h in the severe asphyxia group (p = 0.589)., Conclusion: Birth asphyxia is likely to cause neonatal blood glucose disorders, both hypoglycemia and hyperglycemia, during the early postnatal life. The neonates with severe asphyxia have higher incidence, worse severity and longer duration of blood glucose disorders than neonates with mild asphyxia., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2023 Taiwan Pediatric Association. Published by Elsevier B.V. All rights reserved.)

Objective: To analyze 43 leukemia genes in children with acute lymphoblastic leukemia (ALL) in Yunnan province, and provide the basis for the diagnosis and treatment of children with ALL in this area., Methods: The clinical data of 428 children with newly diagnosed ALL in Yunnan area from January 2015 to December 2020 were retrospectively analyzed. Multiple nested PCR technology was used to detect 43 common leukemia genes., Results: Among the 428 children with ALL, 159 were positive for leukemia genes, with a positive rate of 37.15% (159/428), and a total of 15 leukemia genes were detected. Among the 159 leukemia gene-positive children, ETV6-RUNX1 + accounted for 25.79% (41/159), followed by E2A-PBX1 + and BCR-ABL + , accounting for 24.53% (39/159) and 23.27% (37/159) respectively. MLL + accounted for 6.29% (10/159), WT1 + accounted for 4.40% (7/159), IKZF1 gene deletion and CRLF2 + accounted for 3.77% (6/159) respectively. The positive rate of MLL (46.15%) was the highest in ＜1-year old group, the positive rate of ETV6-RUNX1 (10.56%) was the highest in 1-10-year old group, and BCR-ABL + rate (23.65%) was the highest in >10-year old group. The distribution of leukemia genes in different age groups was statistically significant ( P <0.05)., Conclusion: The most common fusion gene of children with ALL in Yunnan is ETV6-RUNX1 , followed by E2A-PBX1 and BCR-ABL .

Background: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging disease. The consequences of SARS-CoV-2 exposure in infants remain unknown. Therefore, this study aims to investigate whether neonates born to mothers with COVID-19 have adverse brain development., Methods: This multicenter observational study was conducted at two designated maternal and children's hospitals in Hubei Province, mainland China from February 1, 2020 to May 15, 2020. Neonates born to mothers with COVID-19 were enrolled. Brain magnetic resonance imaging (MRI) findings, and volumes of grey and white matters, and physical growth parameters were observed at 44 weeks corrected gestational age., Results: Of 72 neonates born to mothers with COVID-19, 8 (11%) were diagnosed with COVID-19, 8 (11%) were critically ill, and no deaths were reported. Among the eight neonates that underwent brain MRI at corrected gestational age of 44 weeks, five neonates were diagnosed with COVID-19. Among these five neonates, three presented abnormal MRI findings including abnormal signal in white matter and delayed myelination in newborn 2, delayed myelination and brain dysplasia in newborn 3, and abnormal signal in the bilateral periventricular in newborn 5. The other three neonates without COVID-19 presented no significantly changes of brain MRI findings and the volumes of grey matter and white matter compared to those of healthy newborns at the equivalent age (P > 0.05). Physical growth parameters for weight, length, and head circumference at gestational age of 44 weeks were all above the 3rd percentile for all neonates., Conclusions: Some of the neonates born to mothers with COVID-19 had abnormal brain MRI findings but these neonates did not appear to have poor physical growth. These findings may provide the information on the follow-up schedule on the neonates exposed to SARS-CoV-2, but further study is required to evaluate the association between the abnormal MRI findings and the exposure to SARS-CoV-2.

Background: Accurate prediction of ischemic stroke is required for deciding anticoagulation use in patients with atrial fibrillation (AF). Even though only 6% to 8% of AF patients die from stroke, about 90% are indicated for anticoagulants according to the current AF management guidelines. Therefore, we aimed to develop an accurate and easy-to-use new risk model for 1-year thromboembolic events (TEs) in Chinese AF patients., Methods: From the prospective China Atrial Fibrillation Registry cohort study, we identified 6601 AF patients who were not treated with anticoagulation or ablation at baseline. We selected the most important variables by the extreme gradient boosting (XGBoost) algorithm and developed a simplified risk model for predicting 1-year TEs. The novel risk score was internally validated using bootstrapping with 1000 replicates and compared with the CHA2DS2-VA score (excluding female sex from the CHA2DS2-VASc score)., Results: Up to the follow-up of 1 year, 163 TEs (ischemic stroke or systemic embolism) occurred. Using the XGBoost algorithm, we selected the three most important variables (congestive heart failure or left ventricular dysfunction, age, and prior stroke, abbreviated as CAS model) to predict 1-year TE risk. We trained a multivariate Cox regression model and assigned point scores proportional to model coefficients. The CAS scheme classified 30.8% (2033/6601) of the patients as low risk for TE (CAS score = 0), with a corresponding 1-year TE risk of 0.81% (95% confidence interval [CI]: 0.41%-1.19%). In our cohort, the C-statistic of CAS model was 0.69 (95% CI: 0.65-0.73), higher than that of CHA2DS2-VA score (0.66, 95% CI: 0.62-0.70, Z = 2.01, P = 0.045). The overall net reclassification improvement from CHA2DS2-VA categories (low = 0/high ≥1) to CAS categories (low = 0/high ≥1) was 12.2% (95% CI: 8.7%-15.7%)., Conclusion: In Chinese AF patients, a novel and simple CAS risk model better predicted 1-year TEs than the widely-used CHA2DS2-VA risk score and identified a large proportion of patients with low risk of TEs, which could potentially improve anticoagulation decision-making., Trial Registration: www.chictr.org.cn (Unique identifier No. ChiCTR-OCH-13003729)., (Copyright © 2021 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.)

Aims: This study sought to compare healthcare quality and 30 day, 90 day, and 1 year mortality rates among patients admitted to secondary and tertiary hospitals for heart failure (HF) in Beijing., Methods and Results: This study retrospectively enrolled patients hospitalized with a primary discharge diagnosis of HF during January 2014 to December 2015, from five tertiary and four secondary hospitals, in Beijing, China. Mortality data were extracted from Beijing Death Surveillance Database. HF healthcare quality indices were used to evaluate in-hospital care. Associations between hospital level and mortality rates were assessed using generalized linear mixed models, adjusting for patients' baseline characteristics and intra-hospital correlation. Data from 1413 patients (median [interquartile range] age = 74 [65-80] years, 52.7% female) from secondary hospitals and 1250 patients (median [interquartile range] age = 72 [61-79] years, 43.3% female) from tertiary hospitals were collected. Rates of left ventricular ejection fraction assessment (73.2% vs. 90.1%) and combined use of β-blockers and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (30.1% vs. 49.3%) were lower in secondary hospitals than those in tertiary hospitals, respectively. Patients admitted to secondary hospitals had a higher 90 day mortality [10.8% vs. 5.0%; adjusted odds ratio (OR): 2.06; 95% confidence interval (CI): 1.10-3.84, P = 0.024 and a higher 1 year mortality rate [21.0% vs. 12.1%; adjusted OR: 1.64; 95% CI: 1.02-2.62, P = 0.039], but 30 day mortality rates were not significantly different (5.5% vs. 3.0%; adjusted OR: 1.49; 95% CI: 0.63-3.52, P = 0.368)., Conclusions: Worse quality of care for patients with HF in secondary hospitals was associated with higher 90 day and 1 year mortality rates. Improving care quality in secondary hospitals is crucial to improve prognosis of patients they served., (© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Aims: We aimed to investigate the safety of discontinuing oral anticoagulation (OAC) therapy after apparently successful atrial fibrillation (AF) ablation, using data from the Chinese Atrial Fibrillation Registry study., Methods and Results: We identified 4512 consecutive patients who underwent successful AF ablation between August 2011 and December 2017. Of them, 3149 discontinued OAC 3 months post-ablation (Off-OAC group) and 1363 continued OAC beyond this period (On-OAC group). Regular follow-up examinations were undertaken to detect AF recurrence, monitor OAC therapy, and measure clinical outcomes. Primary outcomes included thromboembolic and major bleeding (MB) events experienced beyond 3 months after ablation. Low thromboembolic and MB event rates were noted in the on-treatment analysis. The incidence rates for thromboembolism were 0.54 [95% confidence interval (CI) 0.39-0.76] and 0.86 (95% CI 0.56-1.30) per 100 patient-years, and that for MB events were 0.19 (95% CI 0.11-0.34) and 0.35 (95% CI 0.18-0.67) per 100 patient-years, for the Off-OAC and On-OAC groups over mean follow-up periods of 24.2 ± 14.7 and 23.0 ± 13.6 months, respectively. Similar results were observed in the intention-to-treat analysis. Previous history of ischaemic stroke (IS)/transient ischaemic attack (TIA)/systemic embolism (SE) [hazard ratio (HR) 3.40, 95% CI 1.92-6.02; P < 0.01] and diabetes mellitus (HR 2.06, 95% CI 1.20-3.55, P = 0.01) were independently associated with thromboembolic events, while OAC discontinuation (HR 0.71, 95% CI 0.41-1.23, P = 0.21) remained insignificant in multivariable analysis., Conclusions: This study suggests that it may be safe to discontinue OAC in post-ablation patients under diligent monitoring, in the absence of AF recurrence, history of IS/TIA/SE, and diabetes mellitus. However, further large-scale randomized trials are required to confirm this., Trial Registration: Chinese Clinical Trial Registry ChiCTR-OCH-13003729. URL: http://www.chictr.org.cn/showproj.aspx?proj=5831., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)

BACKGROUND Several factors determine the efficacy of warfarin anticoagulation in patients with non-valvular atrial fibrillation (NVAF). This study aimed to use data from the Chinese Atrial Fibrillation Registry study to assess the control of anticoagulation therapy in Chinese patients with NVAF treated with warfarin. MATERIAL AND METHODS From the Chinese Atrial Fibrillation Registry study the anticoagulant use and dosing, the time in therapeutic range (TTR) of the international normalized ratio (INR), and standard deviation of the observed INR values (SDINR), and their influencing factors were evaluated. RESULTS The median INR and SDINR were 2.04 (IQR 1.71-2.41) and 0.50 (IQR, 0.35-0.69), respectively. The median TTR was 51.7% (IQR, 30.6-70.1%) and only 25.1% had a TTR ≥70%. Age was ≥70 years (OR, 0.72; 95% CI, 0.55-0.94; P=0.015), bleeding history (OR 0.48; 95% CI, 0.23-0.89; P=0.029), the use of a single drug (OR, 0.62; 95% CI, 0.42-0.92; P=0.016), more than drug (OR, 0.60; 95% CI, 0.41-0.88; P=0.009), and lack of assessment of bleeding risk (OR, 0.72; 95% CI, 0.54-0.97; P=0.033) were associated with TTR <70% (INR 2.0-3.0). Coronary heart disease (CHD) and peripheral artery disease (PAD) (OR, 0.69; 95% CI, 0.52-0.90; P=0.007) and diabetes mellitus (OR, 0.79; 95% CI, 0.62-0.99; P=0.044) were associated with increased variability in INR (SDINR ≥0.5). CONCLUSIONS In Chinese patients with NVAF, warfarin anticoagulation was associated with lower TTR and less stable anticoagulation than in current guidelines, and risk factors for reduced safety and efficacy were identified.

Objective: To investigate the incidence of neonatal asphyxia and possible contributing factors for the development of severe asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture, China., Methods: A total of 16 hospitals in Hubei Enshi Tujia and Miao Autonomous Prefecture were selected as research centers. A retrospective analysis was performed for the clinical data of 22 294 live births in these 16 hospitals from January to December, 2016 to investigate the incidence rate of neonatal asphyxia and possible contributing factors for the development of severe asphyxia., Results: Of the 22 294 neonates born alive, 733 (3.29%) were diagnosed with neonatal asphyxia, among whom 627 had mild asphyxia and 106 had severe asphyxia. The neonates with low maternal education level, maternal anemia during pregnancy, chorioamnionitis, abnormal amniotic fluid, abnormal umbilical cord, placenta previa, placental abruption, Tujia Minority, preterm birth, and low birth weight had a higher incidence of severe asphyxia (P<0.05)., Conclusions: The incidence rate of neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture is higher. Low maternal education level, maternal anemia during pregnancy, chorioamnionitis, abnormal amniotic fluid, abnormal umbilical cord, placenta previa, placental abruption, Tujia Minority, preterm birth, and low birth weight may be related to the development of severe neonatal asphyxia.

Background Previous studies have provided conflicting results as to whether women are at higher risk than men for thromboembolism in the setting of atrial fibrillation ( AF ). We investigated whether women with AF were at higher risk of ischemic stroke in the China-AF (China Atrial Fibrillation Registry) Study. Methods and Results A total of 19 515 patients were prospectively enrolled between August 2011 and December 2016 in the China- AF Study. After exclusion of patients receiving anticoagulation or ablation therapy, 6239 patients (2574 women) with results from at least 6 months of follow-up were used for the analysis. Cox proportional hazards models were performed to evaluate whether female sex was an independent risk factor for thromboembolism after multivariate adjustment. The primary outcome was the time to the first occurrence of ischemic stroke or systemic embolism. After a mean follow-up of 2.81±1.46 years, 152 female patients reached the primary outcome, as compared with 172 male patients. Crude incidence rates of thromboembolism between women and men were of borderline statistical significance (2.08 versus 1.68 per 100 patient-years, P=0.058). After multivariable analysis, female sex was not independently associated with an increased thromboembolism risk (hazard ratio 1.09, 95% confidence interval 0.86-1.39). There was no significant difference in thromboembolism risk by sex stratified by age and presence or absence of risk factors ( P for interaction all >0.1). Conclusions Although crude incidence rates of thromboembolism were higher in Chinese female patients with AF compared with male patients, female sex did not emerge as an independent risk factor for thromboembolism on multivariate analysis. Clinical Trial Registration URL : http://www.chictr.org.cn/ . Unique identifier: Chi CTR - OCH -13003729.

Background:  Anti-coagulant therapy satisfaction for patients with atrial fibrillation is a critical issue, which impacts on their treatment adherence and clinical outcomes. The disadvantages of long-term warfarin treatment are well-described, and novel oral anti-coagulants have become an alternative option., Materials and Methods:  We compared patient-reported treatment satisfaction with dabigatran versus warfarin in non-valvular atrial fibrillation (NVAF) patients in China. Treatment satisfaction was assessed using the Anti-Clot Treatment Scale (ACTS) questionnaire, which included a 12-item ACTS Burdens scale and a 3-item ACTS Benefits scale., Results:  Among 834 patients, 246 patients (29.5%) were taking dabigatran and the others were on warfarin. Propensity score matching was employed to identify 182 patient pairs with balanced baseline characteristics. The global ACTS Burdens score and the global ACTS Benefits score were comparable between the dabigatran and warfarin groups (44.86 ± 3.95 vs. 44.28 ± 3.51, p  = 0.423; 11.49 ± 2.92 vs. 11.42 ± 3.03, p  = 0.194, respectively). The monthly cost of dabigatran was significantly higher compared with that of warfarin due to a lack of insurance coverage (USD 176.78 ± 9.15 vs. USD 2.49 ± 0.76, p  = 0.000). The discontinuation rate of dabigatran was significantly higher than warfarin at the 6-month follow-up (33.5% vs. 19.2%, p  = 0.003). Adjusted logistic regression showed that dabigatran was associated with a significant greater odds of non-persistence (odds ratio: 2.13, 95% confidence interval: 1.27-3.59, p  = 0.004)., Conclusion:  Dabigatran therapy in patients with NVAF in China associated with no improvement in satisfaction and a higher discontinuation rate compared with warfarin therapy largely due to increased economic burden., Competing Interests: Dr. Chang-Sheng Ma received honoraria from Bristol-Myers Squibb (BMS), Pfizer, Johnson & Johnson, Boehringer-Ingelheim (BI) and Bayer for giving lectures. Dr. Jian-Zeng Dong also received honoraria from Johnson & Johnson for giving lectures. The other authors report no conflicts of interest., (Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To analyze the injuries after the earthquake with otorhinolaryngology symptoms and the characteristics of with injuries and to provide some information when dealing with similar disasters in the future., Methods: The basic information of earthquake-related injuries with otorhinolaryngology symptoms was collected in 11 large and medium-sized hospitals (including foreign medical teams) in Mianyang City and the surrounding four hard-hit counties. Their characteristics were analyzed together., Results: There were 289 patients that have otorhinolaryngology symptoms in the 11 included hospitals, among them there were 217 cases have definite records that could be analyzed. The data showed that damage to ear and head and neck injuries as the main symptoms was large proportion of injuries suffer multiple fractures and soft tissue injuries such as skin abrasions . Nose injury and facial fractures were also common. Orbital fracture and eye damage could be combined occurred. Brain injury and skull fractures often occurred while trachea and throat injury was rare happened., Conclusions: Different disaster cause different damage. After the establishment of disaster-related injuries in professional spectrum more active and effective could be behaved in life rescue and the arrangement of personnel and material when dealing with similar situations.

Background: Scarlet fever is caused by group A beta-hemolytic streptococci (GAS). The clinical syndrome has receded in recent years, but occasionally explosive outbreaks do occur likely due to the emergence of GAS with virulence factors peculiar to this syndrome., Methods: Following the notification of an unexpectedly large number of scarlet fever cases amongst adults associated with a school in Ningbo, China, in June 2006, the epidemiological and clinical features of the outbreak were investigated. Logistic regression was conducted to investigate the risk factors of the outbreak and its transmission route., Results: Forty five individuals suffered scarlet fever with an attack rate of 4.98% (45/904). There was a single peak in the epidemic curve, with the majority of the cases occurring during the first two days of the outbreak. The median age of cases was 35.5 years (range 17-65). Most patients had fever (43/45), sore throat (40/45), scarlatinoid rash (39/45) and strawberry-like tongue (30/45). In laboratory detection, 45 cases' throat swabs samples were collected and GAS were isolated from 8 throat swabs samples. All of the cases, except for 2, had eaten the Plain Boiled Chicken (PBC) for lunch on June 6th, and teaching staff and students who had not eaten the PBC were not affected by the epidemic. Logistic regression analysis indicated that PBC was a key risk factor (OR=21.0, P<0.05). The chef of the school refectory was responsible for washing, braising, cutting, and distributing the PBC, and was identified as the likely source., Conclusions: We describe an outbreak of scarlet fever caused by GAS-contaminated food.