Search

Background: Studies have revealed the effects of childhood adversity, anxiety, and negative coping on sleep quality in older adults, but few studies have focused on the association between childhood adversity and sleep quality in rural older adults and the potential mechanisms of this influence. In this study, we aim to evaluate sleep quality in rural older adults, analyze the impact of adverse early experiences on their sleep quality, and explore whether anxiety and negative coping mediate this relationship. Methods: Data were derived from a large cross-sectional study conducted in Deyang City, China, which recruited 6,318 people aged 65 years and older. After excluding non-agricultural household registration and lack of key information, a total of 3,873 rural older adults were included in the analysis. Structural equation modelling (SEM) was used to analyze the relationship between childhood adversity and sleep quality, and the mediating role of anxiety and negative coping. Results: Approximately 48.15% of rural older adults had poor sleep quality, and older adults who were women, less educated, widowed, or living alone or had chronic illnesses had poorer sleep quality. Through structural equation model fitting, the total effect value of childhood adversity on sleep quality was 0.208 (95% CI: 0.146, 0.270), with a direct effect value of 0.066 (95% CI: 0.006, 0.130), accounting for 31.73% of the total effect; the total indirect effect value was 0.142 (95% CI: 0.119, 0.170), accounting for 68.27% of the total effect. The mediating effects of childhood adversity on sleep quality through anxiety and negative coping were significant, with effect values of 0.096 (95% CI: 0.078, 0.119) and 0.024 (95% CI: 0.014, 0.037), respectively. The chain mediating effect of anxiety and negative coping between childhood adversity and sleep quality was also significant, with an effect value of 0.022 (95% CI: 0.017, 0.028). Conclusions: Anxiety and negative coping were important mediating factors for rural older adult's childhood adversity and sleep quality. This suggests that managing anxiety and negative coping in older adults may mitigate the negative effects of childhood adversity on sleep quality. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) and other forms of dementia are the seventh leading cause of death. Studies discern the inclusion of air pollution among modifiable risk factors for dementia, while limited studies are for China. This study aims to examine the short-term association between airborne particulate matter (PM) and the hospitalizations of AD, including the economic costs in China. Methods: A total of 4975 cases of AD patients hospitalized from 2017 to 2019, were collected from nine city and 411 medical institutions in Sichuan Province, China. Data on air pollutants such as PM2.5, PM10, and NO2 were obtained from 183 air quality monitoring stations in Sichuan Province. A time series-generalized additive model was used to estimate the association between short-term exposure to PM (lag1–lag7 and moving average lag01–lag07) and AD hospital admissions (HAs), stratified by gender, age, and season. Results: Positive short-term exposure to airborne PM was found for the HAs of AD. The greatest effect on the number of AD inpatients was on single-day lag1 (PM2.5:1.034 (95% confidence interval (CI) 1.011, 1.058)). The association was also significant in the two-pollutant model. In the study period, 16.48% of AD HAs were attributed to the effect of PM. The total economic costs of AD attributable to PM exposure were US$ 2.56 million, including US$ 2.25 million of direct medical costs and US$ 0.31 million of indirect economic costs. Conclusions: This study suggests that short-term exposure to airborne PM may increase the risk of AD HAs in Sichuan Province and result in associated economic costs. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus (T2DM), a complicated metabolic disease, might be developed or exacerbated by air pollution, resulting in economic and health burden to patients. So far, limited studies have estimated associations between short‐term exposure to air pollution and disease burden of T2DM in China. Hence, we aimed to estimate the associations and burden of ambient air pollutants (NO2, PM10, PM2.5, SO2, and CO) on hospital admissions (HAs) for T2DM using a time‐stratified case‐crossover design. Data on HAs for T2DM during 2017–2019 were collected from hospital electronic health records in nine cities in Sichuan Province using conditional poisson regression. Totally, 92,381 T2DM hospitalizations were recorded. There were significant short‐term effects of NO2, PM10, PM2.5, SO2 and CO on HAs for T2DM. A 10 μg/m3 increment of NO2, PM10, PM2.5, SO2 and CO as linked with a 3.39% (95% CI: 2.26%, 4.54%), 0.33% (95% CI: 0.04%, 0.62%), 0.76% (95% CI: 0.35%, 1.16%), 12.68% (95% CI: 8.14%, 17.42%) and 79.00% (95% CI: 39.81%, 129.18%) increase in HAs for T2DM at lag 6. Stratified analyses modified by age, sex, and season showed old (≥65 years) and female patients linked with higher impacts. Using WHO's air quality guidelines of NO2, PM10, PM2.5, and CO as the reference, the attributable number of T2DM HAs exceeding these pollutants exposures were 786, 323, 793, and 2,127 during 2017–2019. Besides, the total medical costs of 25.83, 10.54, 30.74, and 67.78 million China Yuan were attributed to NO2, PM10, PM2.5, and CO. In conclusion, short‐term exposures to air pollutants were associated with higher risks of HAs for T2DM. Plain Language Summary: Type 2 diabetes mellitus (T2DM) as complicated and severe metabolic disease, would be affected by air pollution, rendering numerous burdens on patients and society. In this study, the associations and burden of air pollutants (NO2, PM10, PM2.5, SO2, and CO) on hospital admissions (HAs) for T2DM were estimated using conditional poisson regression. Data on HAs for T2DM in nine cities in Sichuan Province during 2017–2019 were involved. In summary, there were 92,381 cases of T2DM hospitalizations. Results showed that significant short‐term effects of air pollution on HAs for T2DM. In stratified analyses modified by age, sex, and season, higher impacts were linked with old (≥65 years) and female patients. When adopting WHO's air guidelines of NO2, PM10, PM2.5, and CO, the attributable number and cost of HAs for T2DM exceeding air guidelines were estimated, posing central risks to public health. Continuous and further efforts should be taken to air pollution. Key Point: The short‐term effect of air pollution and disease burden of type 2 diabetes mellitus were estimated in Sichuan, China [ABSTRACT FROM AUTHOR]

Many studies have proven the relationship between air pollutants and respiratory diseases, but few studies have assessed the impacts of air particulate matter exposure on older patients with pneumonia. This study aimed to reveal the impacts of short-term exposure to air particulate matter on the daily number of older adult patients hospitalized due to pneumonia and calculate the economic costs attributable to this exposure. We collected inpatient data from 9 city hospitals in Sichuan Province, China, from January 1, 2018, to December 31, 2019, and calculated odds ratios and 95% confidence intervals using a time-stratified case-crossover study design and an attributable risk model to calculate the economic burden due to particulate matter pollution. It was found that for every 10 μg/m3 increase in PM2.5 and PM10 concentrations, the daily number of older adult pneumonia inpatients increased by 1.5% (95% CI: 1.010–1.021) and 1.0% (95% CI: 1.006–1.014), respectively. Those 65 ~ 79 years old were more susceptible to air particulate pollutants (P < 0.05). During the study period, the total hospitalization costs and out-of-pocket expenses attributable to PM2.5 and PM10 exposure were 44.60 million CNY (6.22%) and 16.03 million CNY (6.21%), respectively, with PM2.5 being the primary influencing factor. This study revealed the relationship between particulate matter pollution and pneumonia among older adults. The role of policies to limit particulate matter concentrations in reducing disease burden among older adults can be further explored. [ABSTRACT FROM AUTHOR]

At 12:52 pm on September 5, 2022, an Ms 6.8 earthquake occurred in Luding County, Sichuan Province, China. Based on high-resolution aerial photographs and satellite imageries obtained after the earthquake, as well as field investigation, a total of 8685 earthquake-triggered landslides (EQTLs) were interpreted. The landslides covered an area of 30.7 km2, with a source area of 9.4 km2. These EQTLs were mainly distributed in areas with a seismic intensity of VIII and IX. Most of the landslides were small and medium in size, and their types included landslide, rockfall, and rock slump. Characteristic landslide distributions were found, EQTLs were distributed along the Xianshuihe fault, landslide area decreased gradually with an increased distance to the fault; EQTLs were distributed along the Daduhe River and roads; besides, landslide distribution was associated with ground deformation caused by the earthquake. EQTLs' characteristics indicated that, a large number of EQTLs were located near the foot of the slope; the full area of EQTLs and their source area followed a power function. This study concluded that Luding EQTLs were greater in number and area but relatively smaller in terms of affected area. Investigations on geo-hazards post-earthquake and risk assessment were proposed in the earthquake-stricken area to support the rehabilitation and reconstruction. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is the most common arrhythmia, resulting in serious cardiovascular diseases. Air pollution may cause heart rate disturbance, but there is no clear or consistent evidence that short-term exposure to air pollution leads to an increased risk of hospitalisation for symptomatic episodes of AF. This study aimed to assess the impact of short-term exposure to air pollution on inpatient numbers. Methods: The inpatient records of AF cases in nine cities of the Sichuan Province, China and air pollution and meteorological data from 183 monitoring stations from 2017 to 2018 were collected. The impact of short-term exposure to air pollution on AF inpatients was evaluated using a time-stratified crossover case study design. The economic burden of AF attributable to air pollution was also estimated. Results: A total of 5,958 patients with AF from 123 medical institutions were included in the analysis. Air pollutants had a significant impact on the number of patients with AF. The number increased by 2.5% (95% confidence interval [CI] = 1.006 to 1.044) and 1.8% (95% CI = 1.003–1.033) for every 10 µg/m3 increase in PM2.5, PM10, concentration, respectively. Moreover, the number increased by 12.7% (95% CI = 1.006 to 1.262) for every 10 µg/m3 increase of SO2 concentration. For every 0.1 μg/m3 increase in CO concentration, the number of inpatients with AF increased by 3.9% (95% CI = 1.010–1.070). People aged 65 years or older and women were more likely to be affected by air pollutants. The AF in 430 and 209 inpatients were attributable to PM2.5 and PM10, respectively. The total hospitalization expenses attributed to excessive exposure to PM2.5 and PM10 were 13.98 million CNY and 6.68 million CNY, respectively. Furthermore, the out-of-pocket expenses were 6.81 million CNY and 3.28 million CNY, respectively. Conclusions: This study showed a strong correlation between air pollution and AF. Hence, there is a need to reduce air pollution to control health risks. [ABSTRACT FROM AUTHOR]

In the working environment of rural schools, whether and how does the identity of new comprehensive teachers change before and after service? Research on this problem is beneficial to optimize pre-service training and provide effective support for in-service training. In this study, phenomenological interviews were conducted to understand the formation and change of their identities in the three stages of pre-service, working and current teaching of four new teachers with 3-year teaching experience in the minority areas of western China. The results show that in the working environment of rural schools, three comprehensive teachers in primary schools have gradually changed from being excellent subject teachers to caring teachers. Another determined to become a caring teacher before her career, she retained her own identity in her work and focused more on the healthy growth of her students. The results show that the working environment of rural schools has a significant impact on the identity of first-term teachers of primary schools. Pre-service training should be integrated into local culture to promote the integration of pre-service and in-service and realize its sustainable development. [ABSTRACT FROM AUTHOR]

Background: Rare diseases impose a heavy economic burden on patients' families and society worldwide. This study used the samples from Sichuan Province in China to estimate the curative care expenditure (CCE) of ten rare diseases, for supporting the prioritization of rare disease health policies.Methods: Multi-stage cluster sampling method was adopted to investigate 9714 rare disease patients from 1556 medical institutions in Sichuan Province. Based on the System of Health Accounts 2011, this study estimated the total CCE of 10 rare diseases, financing schemes, and their allocation among different medical institutions and groups of people.Results: In 2018, the total CCE of the ten rare diseases was $19.00 million, the three costliest rare diseases were Hemophilia ($4.38 million), Young-onset Parkinson's disease ($2.96 million), and Systemic Sclerosis ($2.45 million). Household out-of-pocket expenditure (86.00% for outpatients, 41.60% for inpatients) and social health insurance (7.85% for outpatients; 39.58% for inpatients) were the main sources of financing CCE. The out-of-pocket expenditures for patients with Young-onset Parkinson's disease, Congenital Scoliosis, and Autoimmune Encephalitis accounted for more than 60% of the total CCE. More than 80% of the rare disease CCE was incurred in general hospitals. The 40-59 age group accounted for the highest CCE (38.70%) while men spent slightly more (55.37%) than women (44.64%).Conclusions: As rare disease treatment is costly and household out-of-pocket expenditure is high, we suggest taking steps to include rare disease drugs in the National Reimbursement Drug List and scientifically re-design insurance coverage. It is also necessary to explore a multi-tiered healthcare security system to pay for the CCE of rare diseases and reduce the economic burden on patients. [ABSTRACT FROM AUTHOR]

Background: Avian haemosporidia infect both domestic and wild birds, causing anemia, acute tissue degeneration, and depopulation in wild birds. Poultry and wild birds have been reported as common reservoirs of haemosporidia, but limited information is available for red junglefowl (Gallus gallus) in China. The present study investigated the prevalence and molecular characterization of haemosporidia in red junglefowl. Methods: Blood samples were collected from 234 red junglefowl from Jinghong City of Yunnan Province, and genomic DNA was extracted from these samples. The prevalence of haemosporidia was determined by nested PCR targeting the mitochondrial cytochrome b (cytb) gene. Molecular characterization was investigated based on phylogenetic analysis of cytb sequences, and associated risk factors were analyzed using the Chi-square (χ2) test. Results: The overall prevalence of haemosporidia was 74.8% (175/234), and three species were identified, namely Haemoproteus enucleator, Leucocytozoon californicus, and Plasmodium juxtanucleare. The prevalence of haemosporidia in adult fowl (81.1%, 107/132) was significantly higher (χ2 = 6.32, df = 1, P = 0.012) than that in juveniles (66.7%, 68/102). Three novel haemosporidian lineages were revealed. Conclusions: This study examined the prevalence and identified species of avian haemosporidians in red junglefowl, providing new information on the molecular epidemiology and geographical distribution of haemosporidian parasites. Our results indicated high prevalence and diverse species distribution of these haemosporidians in red junglefowl. To the best of our knowledge, this is the first record of haemosporidian infection in red junglefowl in China. [ABSTRACT FROM AUTHOR]

Introduction: To assess the long-term consequences of coronavirus disease (COVID-19) among health care workers (HCWs) in China (hereafter surviving HCWs). Methods: A total of 303 surviving HCWs were included. Lung (pulmonary function test, 6-min walk test [6MWT], chest CT), physical (St. George's Respiratory Questionnaire [SGRQ], Modified Medical Research Council dyspnea scale [mMRC], and Borg scale), and psychiatric functions (Essen Trauma Inventory) were evaluated during the 1-year follow-up. Results: Surviving HCWs had an abnormal diffusion capacity 1 year post-discharge. Participants with a reduced carbon monoxide diffusing capacity (DLCO) comprised 43.48%. The proportion of HCWs with a median 6MWT distance below the lower limit of the normal was 19.4%. An abnormal CT pattern was observed in 37.5% of the HCWs. The SGRQ, mMRC, and Borg scores of surviving HCWs, especially those with critical/severe disease, were significantly higher than those in the normal population. Probable post-traumatic stress disorder (PTSD) was reported in 21.9% of the surviving HCWs. Diffusion capacity impairment was associated with women. Critical/severe illness and nurses were associated with impaired physical function. Conclusions: Most surviving HCWs, especially female HCWs, still had an abnormal diffusion capacity at 1 year. The physical and psychiatric functions of surviving HCWs were significantly worse than those of the healthy population. Long-term follow-up of pulmonary, physical, and psychiatric functions for surviving HCWs is required. [ABSTRACT FROM AUTHOR]

Background: Coronary heart disease (CHD), the leading cause of death globally, might be developed or exacerbated by air pollution, resulting high burden to patients. To date, limited studies have estimated the relations between short-term exposure to air pollution and CHD disease burden in China, with inconsistent results. Hence, we aimed to estimate the short-term impact and burden of ambient PM pollutants on hospitalizations of CHD and specific CHD.Methods: PM10 and PM2.5 were measured at 82 monitoring stations in 9 cities in Sichuan Province, China during 2017-2018. Based on the time-stratified case-crossover design, the effects of short-term exposure to particle matter (PM) pollution on coronary heart disease (CHD) hospital admissions were estimated. Meanwhile, the linked burden of CHD owing to ambient PM pollution were estimated.Results: A total of 104,779 CHD records were derived from 153 hospitals from these 9 cities. There were significant effects of PM pollution on hospital admissions (HAs) for CHD and specific CHD in Sichuan Province. A 10 μg/m3 increase of PM10 and PM2.5 was linked with a 0.46% (95% CI: 0.08, 0.84%), and 0.57% (95% CI: 0.05, 1.09%) increments in HAs for CHD at lag7, respectively. The health effects of air pollutants were comparable modified by age, season and gender, showing old (≥ 65 years) and in cold season being more vulnerable to the effects of ambient air pollution, while gender-specific effects is positive but not conclusive. Involving the WHO's air quality guidelines as the reference, 1784 and 2847 total cases of HAs for CHD could be attributable to PM10 and PM2.5, separately. The total medical cost that could be attributable to exceeding PM10 and PM2.5 were 42.04 and 67.25 million CNY from 2017 to 2018, respectively.Conclusions: This study suggested that the short-term exposure to air pollutants were associated with increased HAs for CHD in Sichuan Province, which could be implications for local environment improvement and policy reference. [ABSTRACT FROM AUTHOR]

Background: Some prevalent but rarely studied causes of hospital admissions, such as sepsis is still unknown whether affected by air pollution.Methods: We used time-series regression within generalized additive models to estimate the effect of air pollutant level on the sepsis-related hospital admissions, for the years 2017-18, using data from six cities in Sichuan, China. Potential effect modifications by age and sex were also explored. The effects of air pollutant on hospital stays for sepsis were also quantified.Results: Positive associations between short-term exposure to NO2 and O3 and risk of sepsis-related hospital admissions and stays were found. Each 10 μg/m3 increase in short-term NO2 at lag 03 and O3 at lag 4 was associated with an increase of 2.76% (95% CI: 0.67, 4.84%) and 0.64% (95% CI: 0.14, 1.14%) hospital admissions, respectively. An increase of 0.72% (95% CI: 0.05, 1.40%) hospital stay was associated with 10 μg/m3 increase in O3 concentration at lag 4. Besides, the adverse effect of exposure to NO2 was more significant in males and population aged less than 14 years; while more significant in females and population aged 14 ~ 65 and over 65 years for exposure to O3. These associations remained stable after the adjustment of other air pollutants.8.Conclusion: Exposure to ambient NO2 and O3 may cause substantial sepsis hospitalizations, and hospital stays in Sichuan, China. These associations were different in subgroup by age and sex. [ABSTRACT FROM AUTHOR]

Background: Smoking exerts substantial medical burdens on society. Precise estimation of the smoking-attributable medical expenditures (SAME) helps to inform tobacco control policy makers. Based on the epidemiological approach, prior studies in China only focused on a few smoking-related diseases to estimate SAME. In contrast, this study used the econometric approach, which is capable of capturing all of the potential costs.Methods: Three waves of panel data from the 2011-2015 national China Health and Retirement Longitudinal Study (CHARLS) were used. A total of 34,503 observations aged 45 and above were identified. Estimates from econometric models were combined to predict the smoking-attributable fraction (SAF) and medical expenditures attributable to smoking by sex, registered residency and healthcare service categories. All monetary amounts were adjusted to 2015 dollars.Results: In 2015, the overall smoking-attributable fraction (SAF) of China was 10.97%, ranging from 5.77% for self-medication to 16.87% for inpatient visits. The smoking-attributable medical expenditure (SAME) was about $45.28 billion, accounting for 7.24% of the total health expenditure. The SAME was $226.77 per smoker aged 45 and above. The regression results suggest that being a former smoker has the greatest impact, which decreases over time after quitting however, on the value of medical expenditures.Conclusions: Smoking-attributable medical expenditures was substantial and placed a heavy burden on Chinese society. Comprehensive tobacco control policies and regulations are still needed to promote progress toward curbing the tobacco related losses. [ABSTRACT FROM AUTHOR]

Summary: Background: In China, the prevalence of superficial fungal infections of the foot is high and recurrence is common. However, a prospective, large‐scale and multicentre study on the aetiology of superficial fungal infections of the foot is still lacking. Objectives: To study the epidemiology of aetiological agents of superficial fungal infections of the foot in urban outpatients in mainland China, as well as to understand the aetiology features of the pathogenic agent. Methods: The study was designed as a multicentre, prospective epidemiological survey. A total of 1704 subjects were enrolled from seven geographical areas in mainland China. For each subject, one mycological sample and one bacterial sample were collected. KOH wet mount examination and culture were performed at local laboratories. The bacterial results were only reported in those with positive mycology. Further morphological identification and, if necessary, molecular biological identification were conducted in a central laboratory. Results: Of 1704 enrolled subjects, 1327 (77.9%) subjects had positive fungal culture results. The incidence of dermatophytes, yeasts and moulds was 90.1%, 8.1% and 1.1%, respectively. The most frequently isolated aetiological agent (fungus) was Trichophyton rubrum. Moccasin form was the most commonly reported clinical diagnosis of superficial fungal infections. The most frequently isolated bacterial genus in patients was Staphylococcus. Conclusion: This study prospectively investigated the clinical and mycological features of human dermatophytosis in mainland China. T rubrum was the most frequently isolated fungus, and moccasin form was the most commonly reported clinical diagnosis of superficial fungal infections. [ABSTRACT FROM AUTHOR]

Introduction: Smoking is hazardous to health and places a heavy economic burden on individuals and their families. Clearly, smoking in China is prevalent since China is the largest consumer of tobacco in the world. Chinese smoking and nonsmoking households were compared in terms of the incidence and intensity of Catastrophic Health Expenditures (CHEs). The factors associated with catastrophic health expenditures were analyzed. Methods: Data for this study were collected from two waves of panel data in 2011 and 2013 from the national China Health and Retirement Longitudinal Study (CHARLS). A total of 8073 households with at least one member aged above 45 were identified each year. Catastrophic health expenditure was measured by the ratio of a household's out-of-pocket healthcare payments (OOP) to the household's Capacity to Pay (CTP). A panel logit random-effects model was used to examine correlates with catastrophic health expenditure. Results: The incidence of catastrophic health expenditures for Chinese households with members aged 45 and above in 2011 and 2013 were 12.99% and 15.56%, respectively. The mean gaps (MGs) were 3.16% and 4.88%, respectively, and the mean positive gaps (MPGs) were 24.36% and 31.40%, respectively. The incidences of catastrophic health expenditures were 17.41% and 20.03% in former smoking households, 12.10% and 15.09% in current smoking households, and 12.72% and 13.64% in nonsmoking households. In the panel logit regression model analysis, former smoking households (OR = 1.444, P<0.001) were more prone to catastrophic health expenditures than nonsmoking households. Risk factors for catastrophic health expenditures included members with chronic diseases (OR = 4.359, P<0.001), hospitalized patients (OR = 8.60, P<0.001), elderly people aged above 65 (OR = 1.577, P<0.001), or persons with disabilities (OR = 1.275, P<0.001). Protective factors for catastrophic health expenditures included being in an urban household, having a larger family size, and having a higher household income. Conclusions: The incidence of catastrophic health expenditures in Chinese households is relatively high. Smoking is one of the primary risk factors for catastrophic health expenditures. Stronger interventions against smoking should be made in time to reduce the occurrence of health issues caused by smoking and the financial losses for individuals, families and society. [ABSTRACT FROM AUTHOR]

Introduction: Nonsmoking pregnant women in China have significant exposure to secondhand smoke (SHS). Few interventions have focused on pregnant women reducing their SHS exposure.Methods: This clustered randomized controlled trial, conducted at eight hospitals in Sichuan, China, compared a prenatal health education intervention with usual clinical care as a control. The primary outcome was self-reported "no SHS exposure" before and 3 months after birth. The intervention consisted of three large group educational sessions, standardized clinician advice, brief monthly follow-up calls, and educational materials and resources. A random sample of participants was biochemically validated before birth with hair nicotine, a long-term biomarker of smoke exposure.Results: Overall, 1181 participants were randomized to intervention (n = 526) and control (n = 655) groups. More participants in the intervention group than the control group reported no SHS exposure 3 months after birth (Total: 77.9% vs. 52.6%, P < .001; Home: 81.2% vs. 53.3%, P < .001). The intervention group also had greater changes in improved smoke-free homes and SHS knowledge and attitudes. Controlling for covariates, the intervention group was less likely to report SHS exposure than the control group (Total: OR = 0.47, 95% CI = 0.31 to 0.71; Home: OR = 0.33, 95% CI = 0.21 to 0.53), and this effect was sustained 3 months after birth. The adjusted log concentration of hair nicotine for the intervention group decreased by 0.28 log µg/g more than the control group.Conclusions: Our smoke-free health education intervention for nonsmoking pregnant women significantly reduced SHS exposure before and after birth. This intervention model can become part of a standard protocol for the care of pregnant women in hospital settings. [ABSTRACT FROM AUTHOR]

Objective To estimate the health-related economic costs attributable to smoking in China for persons aged 35 and older in 2003 and in 2008 and to compare these costs with the respective results from 2000. Methods A prevalence-based, disease-specific approach was used to estimate smoking-attributable direct and indirect economic costs. The primary data source was the 2003 and 2008 China National Health Services Survey, which contains individual participant's smoking status, healthcare use and expenditures. Results The total economic cost of smoking in China amounted to $17.1 billion in 2003 and $28.9 billion in 2008 (both measured in 2008 constant US$). Direct smoking-attributable healthcare costs in 2003 and 2008 were $4.2 billion and $6.2 billion, respectively. Indirect economic costs in 2003 and 2008 were $12.9 billion and $22.7 billion, respectively. Compared to 2000, the direct costs of smoking rose by 72% in 2003 and 154% in 2008, while the indirect costs of smoking rose by 170% in 2003 and 376% in 2008. Conclusions The economic burden of cigarette smoking has increased substantially in China during the past decade and is expected to continue to increase as the national economy and the price of healthcare services grow. Stronger intervention measures against smoking should be taken without delay to reduce the health and financial losses caused by smoking. [ABSTRACT FROM AUTHOR]

Background: Secondhand smoke (SHS) exposure harms pregnant women and the fetus. China has the world's largest number of smokers and a high male smoking prevalence rate.Objective: To compare exposure to SHS among rural and urban Chinese non-smoking pregnant women with smoking husbands, and analyze factors associated with the level of SHS exposure and hair nicotine concentration.Setting: Sichuan province, China.Population: In all 1,181 non-smoking pregnant women with smoking husbands recruited from eight district/county Women and Children's hospitals.Methods: The women completed a questionnaire in April and May 2008. Based on systematic sampling, 186 pregnant women were selected for sampling the nicotine concentration in their hair. Ordinal logistic regression analysis was conducted to examine correlates with self-reported SHS exposure (total and at home); linear regression was conducted for the sub-sample of hair nicotine concentrations.Main Outcome Measures: Secondhand smoking exposure rates, hair nicotine levels.Results: About 75.1% of the non-smoking pregnant women with smoking husbands reported regular SHS exposure. The major source of exposure was through their husband. In the multivariate analysis, the risk of greater SHS exposure (total and at home) and hair nicotine concentration was increased for women who were rural, had a husband with greater cigarette consumption, less knowledge about SHS, less negative attitudes about SHS, and no smoke-free home rules.Conclusions: The high prevalence rate of SHS exposure suggests that it is important for non-smoking pregnant women, especially rural women, to establish smoke-free home rules and increase knowledge and negative attitudes towards SHS. [ABSTRACT FROM AUTHOR]

The aim of this study was systematic investigation of the differentially expressed genes during carcinogenesis in hepatocellular carcinoma (HCC) using cDNA microarray technology. The differentially expressed genes between 22 fresh HCC tissues and para-cancerous liver tissues (PCLT) were displayed using cDNA microarray technology. The result was verified by the reverse transcriptase polymerase chain reaction. Among the 8,464 human genes, 507 (5.99%) genes were expressed differentially at the mRNA levels between HCC and PCLT. Two hundred (2.36%) genes were down-regulated, whereas 307 (3.63%) genes were up-regulated. The mRNA expression levels of RhoC and protocadherin LKC detected by reverse transcription polymerase chain reaction (RT-PCR) were consistent with the microarray experiment. This study describes a gene expression profiling of HCC, which provides an extensive list of potential molecular markers for early diagnosis and molecular targets for the development of drugs to treat patients with primary HCC. [ABSTRACT FROM AUTHOR]

Describes the social conditions of Beijing, China under the leadership of Jiang Zemin. Impact of communist revolution on Chinese literature; Efforts of literary merchants to appear in the press for publication's approval; Struggle of industrial workers under the rule of Jiang Zemin.

Background: Although numerous studies have been carried out in recent decades, soil respiration remains one of the less understood elements in global carbon budget research. Tropical forests store a considerable amount of carbon, and a well-established knowledge of the patterns, components, and controls of soil respiration in these forests will be crucial in global change research. Methods: Soil respiration was separated into two components using the trenching method. Each component was measured at multiple temporal scales and in different microhabitats. A commercial soil efflux system (Li8100/8150) was used to accomplish soil respiration monitoring. Four commonly used models were compared that described the temperature dependence of soil heterotrophic respiration using nonlinear statistics. Results and Conclusions: Trenching has a limited effect on soil temperature but considerably affects soil water content due to the exclusion of water loss via tree transpiration. Soil respiration decreased gradually from 8 to 4 μmol·m−2·s−1 6 days after trenching. Soil autotrophic (Ra) and heterotrophic respiration (Rh) have contrasting diel patterns and different responses to temperature. Rh was negatively correlated with temperature but positively correlated with relative humidity. Both Ra and Rh varied dramatically among microhabitats. The Q10 value of Rh derived using the Q10 model was 2.54. The Kirschbaum–O'Connell model, which implied a strong decrease of Q10 with temperature, worked best in describing temperature dependence of Rh. Heterotrophic respiration accounted for nearly half of the total soil efflux. We found an unexpected diurnal pattern in soil heterotrophic respiration which might be related to diurnal moisture dynamics. Temperature, but not soil moisture, was the major controller of seasonal variation of soil respiration in both autotrophic and heterotrophic components. From a statistical perspective, the best model to describe the temperature sensitivity of soil respiration was the Kirschbaum–O'Connell model. Soil respiration varied strongly among the microhabitats and played a crucial role in stand-level ecosystem carbon balance assessment. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance Piper wallichii (Miq.) Hand.-Mazz. is a medicinal plant used widely for the treatment of rheumatoid arthritis, inflammatory diseases, cerebral infarction and angina in China. Previous study showed that lignans and neolignans from Piper spp. had potential inhibitory activities on platelet aggregation. In the present study, we investigated the chemical constituents of Piper wallichii and their antithrombotic activities, to support its traditional uses. Materials and methods The methanolic extract of the air-dried stems of Piper wallichii was separated and purified using various chromatographic methods, including semi-preparative HPLC. The chemical structures of the isolates were determined by detailed spectroscopic analysis, and acidic hydrolysis in case of the new glycoside 2 . Determination of absolute configurations of the new compound 1 was facilitated by calculated electronic circular dichroism using time-dependent density-functional theory. All compounds were tested for their inhibitory effects on platelet aggregation induced by platelet activating factor (PAF) in rabbits׳ blood model, from which the active ones were further evaluated the in vivo antithrombotic activity in zebrafish model. Results A new neolignan, piperwalliol A ( 1 ), and four new aromatic glycosides, piperwalliosides A–D ( 2 – 5 ) were isolated from the stems of Piper wallichii , along with 25 known compounds, including 13 lignans, six aromatic glycosides, two phenylpropyl aldehydes, and four biphenyls. Five known compounds ( 6 – 10 ) showed in vitro antiplatelet aggregation activities. Among them, (–)-syringaresinol ( 6) was the most active compound with an IC 50 value of 0.52 mM. It is noted that in zebrafish model, the known lignan 6 showed good in vivo antithrombotic effect with a value of 37% at a concentration of 30 μM, compared with the positive control aspirin with the inhibitory value of 74% at a concentration of 125 μM. Conclusion This study demonstrated that lignans, phenylpropanoid and biphenyl found in Piper wallichii may be responsible for antithrombotic effect of the titled plant. [ABSTRACT FROM AUTHOR]

Background: Depression has become the most common mental disease globally and is a strong predictor for suicide. Studies have indicated that exposure to high levels of air pollution increased the risk of depression, but evidence in human populations is still limited. At present, a few studies estimated the impact of multi-pollutants on hospitalization for depression in multi-city in areas with severe air pollution. We aimed to examine the association between short-term exposure to common ambient air pollutants and hospital admissions (HAs) for depression based on statistics of inpatients with depression in multi-city.Methods: The 10,459 records of HAs for depression from medical institutions in nine cities/prefectures, Sichuan Province, China, between January 1, 2017 and December 31, 2018 were collected. Air pollutant data including PM2.5, PM10, SO2 and NO2 from provincial ecological environment monitoring stations were obtained. Based on a time-stratified case-crossover design, we estimated the impact on relative risk (RR) of short-term exposure to air pollutants on hospitalization for depression, with stratification by sex, age, and economic level. The cost of illness method was used to further assess hospitalization costs.Results: The short-term exposure to air pollutants was positively associated with hospitalization for depression. The increase of air particulate matter (PM) had the strongest effect on lag 0 day (PM2.5:1.037 (95% CI:1.022,1.052), PM10:1.024 (95% CI:1.013,1.036)). The effects of SO2 reached the peak on lag 2 day (1.317 (95% CI:1.151,1.507)). Women and older people were more likely to be affected by air pollutants and prone to depression (P = 0.013, P = 0.006). During the study period, the economic cost of hospitalization for depression caused by PM pollution was US$ 8.36 million.Limitations: The air pollutant concentration level of the monitoring stations in the study area was regarded as personal pollutant exposure, which may not accurately reflect the patient's exposure level, resulting in a certain measurement error.Conclusions: Short-term changes to ambient air pollution exposure may increase the risk of hospital admissions for depression and cause economic costs due to hospitalization. [ABSTRACT FROM AUTHOR]

• Antivirus activities, adverse reactions, advance on COVID-19 treatment, and general usage of potential chemical drugs against SARS-CoV-2 are summarized. • Various TCMs with practical effects, including Chinese herbal compound prescriptions, injection preparations, and active ingredients of TCMs, on the treatment of COVID-19 are reviewed. • Biological products, such as interferon-α, vaccines, stem cells, and convalescent plasma, are concluded to treat COVID-19. The fight against the novel coronavirus pneumonia (namely COVID-19) that seriously harms human health is a common task for all mankind. Currently, development of drugs against the novel coronavirus (namely SARS-CoV-2) is quite urgent. Chinese medical workers and scientific researchers have found some drugs to play potential therapeutic effects on COVID-19 at the cellular level or in preliminary clinical trials. However, more fundamental studies and large sample clinical trials need to be done to ensure the efficacy and safety of these drugs. The adoption of these drugs without further testing must be careful. The relevant articles, news, and government reports published on the official and Preprint websites, PubMed and China National Knowledge Infrastructure (CNKI) databases from December 2019 to April 2020 were searched and manually filtered. The general pharmacological characteristics, indications, adverse reactions, general usage, and especially current status of the treatment of COVID-19 of those potentially effective drugs, including chemical drugs, traditional Chinese medicines (TCMs), and biological products in China were summarized in this review to guide reasonable medication and the development of specific drugs for the treatment of COVID-19. [ABSTRACT FROM AUTHOR]

Short-term exposure to air pollution is associated with hospitalization for ischemic stroke (IS); however, evidence of the impact of the exposure on IS in highly polluted developing regions is limited. This study aimed to assess the relationships between air pollutants and IS hospitalization, as well as economic burden attributable to the hospitalization in Sichuan, China. Records from 160,555 IS hospitalizations were collected from medical institutions in nine cities in Sichuan from 2017 to 2019, along with simultaneous meteorological and air pollution data. Generalized additive model (GAM) was used to analyze the relationship between air pollutants and IS hospitalizations. The economic burden due to air pollutants exposure were further assessed using a cost-of-illness (COI) method. All p values were corrected for multiple comparisons. The single pollutant model showed that the effects of each interquartile range (IQR) increase in PM 2.5 , PM 10 , O 3 , and CO, on IS hospitalization peaked on lag 07, with relative risk values of 1.057(95% CI: 1.030–1.085), 1.060(95% CI:1.032–1.090), 1.110(95% CI:1.043–1.181), and 1.096 (95% CI:1.060–1.132), respectively. Stratified analysis shows that older people are more susceptible to the impact of air pollutants, and compared to the warm season, IS hospitalization in the cold season is more susceptible to exposure to O 3 and CO. It has been determined that during the study period, the number of IS hospitalizations attributable to PM 2.5 pollution was 5,157 and to PM 10 pollution was 3,650, with an economic cost of CNY 67, 966, 100 and 48, 107, 900, respectively. In this study, we found that short-term exposure to PM 2.5 , PM 10 , O 3 , and CO can lead to increased hospitalizations for stroke and a quantifiably greater economic burden. • Short-term exposure to PM 2.5 , PM 10 , O 3 , and CO can lead to increased hospitalizations for stroke. • Older people are more susceptible to air pollutants. • The IS hospitalization was more susceptible to O 3 and CO exposure during the cold season. • The burden of hospitalization for ischaemic stroke due to exposure to air pollutants is enormous. [ABSTRACT FROM AUTHOR]

Abstract: Infection with certain types of human papillomaviruses (HPVs) is a risk factor for the development of cervical cancer. HPV type 58 (HPV 58) is prevalent among Chinese women. The intratype sequence variants differ in oncogenic potential and their prevalences vary across geographic regions. The objective of this study was to analyze the variations of HPV 58 E6, E7, L1 genes and long control region (LCR) in a large samples collected from northeastern Chinese women with cervical lesions. A total of 2938 cervical samples were collected and tested for HPV type using a chip hybridization assay. The E6, E7, L1 genes and LCR of HPV 58 strains were amplified and the amplicons were subjected to direct nucleotide sequencing for variation identification. A total of 235 specimens were HPV 58 positive. High proportions of HPV 58 E6 (83.8%), E7 (76.7%), L1 (90.8%) genes and LCR (91.4%) variants were identified in strains from Chinese women. The most frequently observed variations were C307T (52.4%) in E6, T744G (74.9%) in E7, A6014C (56.9%) in L1 genes and C7266T, A7714G (55.2%) in LCR. For the E6 gene, nine nucleotide variations were identified. Among them, the A140G (T11A), A184C (E25D), G266C (V53L) and A313G were novel variations. Sequencing of the E7 gene revealed four typical nucleotide changes: G761A (G63D), G694A (G41R), T803C (V77A) and T744G. In the L1 gene, 39 nucleotide variations and 13 amino acid substitutions were identified. Among these mutations, 21 variations are reported here for the first time. Lineage A of HPV 58 was found in 142 of 174 strains (81.6%). The most prevalent HPV 58 variants in Chinese northeastern women belongs to lineage A. Novel variations in E6 and L1 genes were also reported. These findings provide new data regarding E6 and L1 gene variations of HPV 58 from women in northeast China. [Copyright &y& Elsevier]

Polygonatum cyrtonema is a known tonic herb in Chinese Materia Medica, extensively consumed in China, but the structure and activity of its polysaccharide components remain to be clarified. Herein, two new polysaccharides (a fructan and a galactan) were purified from the dried and the processed P. cyrtonema rhizome, respectively. Structural analysis suggested that the fructan consisted of a (2 → 6) linked β- d -Fru f residues backbone with an internal α- d -Glc p residue and two (2 → 1) linked β- d -Fru f residues branches, and that the galactan was a (1 → 4)-β- d -galactan branched with a single β- d -galactose at C-6 at about every nine residues in its main chain. The bioactive assay showed that the fructan and the galactan remarkably promoted growth of Bifidobacterium and Lactobacillus strains, indicating that they possess prebiotic activity. These findings may help expand the application of the polysaccharides from the tonic herb P. cyrtonema as functional ingredients in food products. [Display omitted] • Two purified polysaccharides were first obtained from the tonic herb Polygonatum cyrtonemal • The fructan consisted of a (2→6) linked β-D-Fru f backbone with an internal α-D-Glc p and two (2→1) linked β-D-Fru f branches • The galactan was a (1→4)-β-D-galactan branched with a single β-D-galactose at C-6 at every nine residues in main chain • The fructan and galactan had prebiotic effect on Bifidobacterium and Lactobacillus strains [ABSTRACT FROM AUTHOR]

• Nematodes were confirmed in three instars of intermediate host Haematobia irritans. • Parasite growth rate increased as intermediate host developed through instar stages. • P. skrjabini infection of Haematobia irritans begins in the larval stage. Parabronemosis is a disease that severely threatens camel health, causing huge economic losses to industries involved in camel husbandry. Previous studies have reported that horn flies (Haematobia irritans) act as intermediate hosts of Parabronema skrjabini ; however, the infection and developmental processes of P. skrjabini in horn flies remain unclear. In the present study, the infection rates of P. skrjabini were determined in morphologically and molecularly identified horn flies collected from Bactrian camels (Camelus bactrianus) producing regions in Inner Mongolia, China that have high P. skrjabini infection rates. The horn flies were dissected to obtain the nematode larvae at various instar stages. The P. skrjabini found in the different instar stages of horn fly instars were counted and identified to assess the infection and developmental status. Nematode larvae at different developmental stages were obtained from the horn fly instars for further molecular analysis. Sequencing results confirmed that the nematode larvae were P. skrjabini. Furthermore, we found that the mean growth rate of the nematode larva increased as the horn fly instars develops. The results suggested that P. skrjabini infected the horn flies at the larval instar stage, and that the nematode larvae developed simultaneously with the horn fly instars stages. Our findings provide useful information into the elucidation of P. skrjabini infection and life history by studying horn fly development. [ABSTRACT FROM AUTHOR]

• A unique glycosaminoglycan (SGAG) was purified from the cultured snail. • SGAG is a structural regular GAG without anticoagulant activity. • SGAG accelerated the healing of full-thickness wounds in diabetic mice. • SGAG alleviated the inflammation and dermal edema in early stage and promoted angiogenesis. Diabetic foot ulcer (DFU) is a common high-risk complication in patients with diabetes mellitus, but current drugs and therapies in management of this disease cannot meet the urgent clinical needs. In this study, a snail glycosaminoglycan (SGAG) from the cultured China white jade snail was purified and structurally clarified. This snail glycosaminoglycan is a regular sulfated polysaccharide, composed of iduronic acid (IdoA) and N-acetyl-glucosamine (GlcNAc) with the repeating sequence of →4)-α-GlcNAc (1→4)-α-IdoA2S (1→. The biological assays showed that SGAG had no anticoagulant activity for lacking specific heparin pentasaccharide sequence. The pharmacological experiments suggested that SGAG markedly accelerated the healing of full-thickness wounds in diabetic mice skin. Histologic and immunohistochemical analysis revealed that SGAG treatment alleviated the inflammation and dermal edema, and promoted angiogenesis. This is the first report applying the snail glycosaminoglycan to favor diabetic wound healing. [ABSTRACT FROM AUTHOR]

Background: The hospitalization rate of ambulatory care sensitive conditions (ACSCs) has been recognized as an essential indicator reflective of the overall performance of healthcare system. At present, ACSCs has been widely used in practice and research to evaluate health service quality and efficiency worldwide. The definition of ACSCs varies across countries due to different challenges posed on healthcare systems. However, China does not have its own list of ACSCs. The study aims to develop a list to meet health system monitoring, reporting and evaluation needs in China., Methods: To develop the list, we will combine the best methodological evidence available with real-world evidence, adopt a systematic and rigorous process and absorb multidisciplinary expertise. Specific steps include: (1) establishment of working groups; (2) generations of the initial list (review of already published lists, semi-structured interviews, calculations of hospitalization rate); (3) optimization of the list (evidence evaluation, Delphi consensus survey); and (4) approval of a final version of China's ACSCs list. Within each step of the process, we will calculate frequencies and proportions, use descriptive analysis to summarize and draw conclusions, discuss the results, draft a report, and refine the list., Discussion: Once completed, China's list of ACSCs can be used to comprehensively evaluate the current situation and performance of health services, identify flaws and deficiencies embedded in the healthcare system to provide evidence-based implications to inform decision-makings towards the optimization of China's healthcare system. The experiences might be broadly applicable and serve the purpose of being a prime example for nations with similar conditions., (© 2024. The Author(s).)

Background: This study aimed to explore the relationship between air pollution and hospital admissions for asthma in older adults, and to further assess the health and economic burden of asthma admissions attributable to air pollution., Methods: We collected information on asthma cases in people over 65 years of age from nine cities in Sichuan province, as well as air pollution and meteorological data. The relationship between short-term air pollutant exposure and daily asthma hospitalizations was analyzed using the generalized additive model (GAM), and stratified by gender, age, and season. In addition, we assessed the economic burden of hospitalization for air pollution-related asthma in older adults using the cost of disease approach., Results: The single pollutant model showed that every 1 mg/m 3 increase in CO was linked with an increase in daily hospitalizations for older adults with asthma, with relative risk values of 1.327 (95% CI: 1.116-1.577) at lag7. Each 10 μg/m 3 increase in NO 2 , O 3 , PM 10 , PM 2.5 and SO 2 , on asthma hospitalization, with relative risk values of 1.044 (95% CI: 1.011-1.078), 1.018 (95% CI: 1.002-1.034), 1.013 (95% CI: 1.004-1.022), 1.015 (95% CI: 1.003-1.028) and 1.13 (95% CI: 1.041-1.227), respectively. Stratified analysis shows that stronger associations between air pollution and asthma HAs among older adult in females, those aged 65-69 years, and in the warm season, although all of the differences between subgroups did not reach statistical significance. During the study period, the number of asthma hospitalizations attributable to PM 2.5 , PM 10 , and NO 2 pollution was 764, 581 and 95, respectively, which resulted in a total economic cost of 6.222 million CNY, 4.73 million CNY and 0.776 million CNY, respectively., Conclusion: This study suggests that short-term exposure to air pollutants is positively associated with an increase in numbers of asthma of people over 65 years of age in Sichuan province, and short-term exposure to excessive PM and NO 2 brings health and economic burden to individuals and society., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhang, Yang, Jiang, Gao, Yang, Feng and Yang.)

Background: In response to an aging population, the Chinese government implemented the three-child policy in 2021 based on the comprehensive two-child policy. With the implementation of the new birth policy, people's maternal and child health (MCH) needs will also increase. The allocation and fairness of MCH human resources directly affect people's access to MCH services. The purpose of this study is to analyze the allocation of health human resources in Chinese maternal and child health care institutions, evaluate the fairness of the allocation, to provide a reference for the rational allocation of MCH human resources., Methods: The data of health technicians, licensed (assistant) physicians, and registered nurses in maternal and child health care institutions nationwide from 2016 to 2020 were included. The health resource density index (HRDI) is used to evaluate the allocation level of MCH human resources. The Gini coefficient (G) and Theil index (T) are used to evaluate the fairness of the allocation of MCH human resources from the perspectives of population and geographic area., Results: From 2016 to 2020, the average annual growth rate of the number of health technicians, licensed (assistant) physicians, and registered nurses in Chinese maternal and child health care institutions was 7.53, 6.88, and 9.12%, respectively. The Gini coefficient (G) of the three types of MCH human resources allocated by population were all below 0.23, and the Gini coefficient (G) allocated by geographical area were all above 0.65. The Theil index (T) of the three types of MCH human resources allocated by population was all lower than 0.06, and the Theil index (T) allocated by geographical area was all higher than 0.53. In addition, the three types of MCH human resources allocated by population and geographic area contributed more than 84% of the Theil index within the group (T intra ) to the Theil index (T)., Conclusions: China's MCH human resources were fair in terms of population allocation, but unfair in terms of geographical area allocation. In the future, more attention should be paid to the geographical accessibility of MCH human resources, and the allocation of resources should comprehensively consider the two factors of serving the population and geographical area., (© 2023. The Author(s).)

Background: There are few studies on the effects of air pollutants on acute lower respiratory tract infections (ALRI) in children. Here, we investigated the relationship of fine particulate matter (PM 2.5 ), inhalable particulate matter (PM 10 ), sulfur dioxide (SO 2 ), and nitrogen dioxide (NO 2 ) with the daily number of hospitalizations for ALRI in children in Sichuan Province, China, and to estimate the economic burden of disease due to exposure to air pollutants., Methods: We collected records of 192,079 cases of childhood ALRI hospitalization between January 1, 2017 and December 31, 2018 from nine municipal/prefecture medical institutions as well as the simultaneous meteorological and air pollution data from 183 monitoring sites in Sichuan Province. A time series-generalized additive model was used to analyze exposure responses and lagged effects while assessing the economic burden caused by air pollutant exposure after controlling for long-term trends, seasonality, day of the week, and meteorological factors., Results: Our single-pollutant model shows that for each 10 μg/m 3 increase in air pollutant concentration (1 μg/m 3 for SO 2 ), the effect estimates of PM 2.5 , PM 10 , SO 2 , and NO 2 for pneumonia reached their maximum at lag4, lag010, lag010, and lag07, respectively, with relative risk (RR) values of 1.0064 (95% CI, 1.0004-1.0124), 1.0168(95% CI 1.0089-1.0248), 1.0278 (95% CI 1.0157-1.0400), and 1.0378 (95% CI, 1.0072-1.0692). By contrast, the effect estimates of PM 2.5 , PM 10 , SO 2 , and NO 2 for bronchitis all reached their maximum at lag010, with RRs of 1.0133 (95% CI 1.0025-1.0242), 1.0161(95% CI 1.0085-1.0238), 1.0135 (95% CI 1.0025-1.0247), and 1.1133(95% CI 1.0739-1.1541). In addition, children aged 5-14 years were more vulnerable to air pollutants than those aged 0-4 years (p < 0.05). According to the World Health Organization's air quality guidelines, the number of ALRI hospitalizations attributed to PM 2.5 , PM 10 , and NO 2 pollution during the study period was 7551, 10,151, and 7575, respectively, while the incurring economic burden was CNY 2847.06, 3827.27, and 2855.91 million., Conclusion: This study shows that in Sichuan Province, elevated daily average concentrations of four air pollutants lead to increases in numbers of childhood ALRI hospitalizations and cause a serious economic burden., (© 2023. The Author(s).)

Background: Few studies have investigated the effects of air pollutants on children with acute bronchitis. This study aimed to explore the acute effects of four air pollutants [fine particulate matter (PM 2.5 ), inhalable particulate matter (PM 10 ), sulfur dioxide (SO 2 ), and nitrogen dioxide (NO 2 )] on the daily number of children admitted to the hospital for acute bronchitis in Sichuan Province, China., Methods: The 49,975 records of hospitalized children with acute bronchitis from medical institutions in nine cities/prefectures, Sichuan Province, China, as well as the simultaneous meteorological data and air pollution data from 183 monitoring sites, were collected from 1 January 2017 to 31 December 2018. A generalized additive model was adopted to analyze the exposure-response and lag effects of hospitalizations of children with acute bronchitis to air pollutants. Stratified analyses were conducted based on sex, age, and season., Results: The single-pollutant model showed that a 10 µg/m 3 increase at lag07 of PM 2.5 , PM 10 , SO 2 , and NO 2 corresponded to an increase of 1.23% [95% confidence interval (CI) 0.21-2.26%], 1.33% (95% CI 0.62-2.05%), 23.52% (95% CI 11.52-36.81%), and 12.47% (95% CI 8.46-16.64%) in daily hospitalizations for children with acute bronchitis, respectively. Children aged 0-2 were more prone to PM 2.5 (P < 0.05). Interestingly, the effects were stronger in the warm season than in transition seasons and the cool season for PM 2.5 and PM 10 (P < 0.05)., Conclusion: The higher daily average concentrations of four pollutants in Sichuan Province can result in an increased number of children hospitalized for acute bronchitis., (© 2022. Children's Hospital, Zhejiang University School of Medicine.)

Background and aim: To perform a longitudinal analysis of serial CT findings over time in patients with COVID-19 pneumonia. Methods: From February 5 to March 8, 2020, 73 patients (male to female, ratio of 43:30; mean age, 51 years) with COVID-19 pneumonia were retrospectively enrolled and followed up until discharge from three institutions in China. The patients were divided into the severe and non-severe groups according to treatment option. The patterns and distribution of lung abnormalities, total CT scores, single ground-glass opacity (GGO) CT scores, single consolidation CT scores, single reticular CT scores and the amounts of zones involved were reviewed by 2 radiologists. These features were analyzed for temporal changes. Results: In non-severe group, total CT scores (median, 9.5) and the amounts of zones involved were slowly increased and peaked in disease week 2. In the severe group, the increase was faster, with scores also peaking at 2 weeks (median, 20). In both groups, the later parameters began to decrease in week 4 (median values of 9 and 19 in the non-severe and severe groups, respectively). In the severe group, the dominant residual lung lesions were reticular (median single reticular CT score, 10) and consolidation (median single consolidation CT score, 7). In the non-severe group, the dominant residual lung lesions were GGO (median single GGO CT score, 7) and reticular (median single reticular CT score, 4). In both non-severe and severe groups, the GGO pattern was dominant in week 1, with a higher proportion in the severe group compared with the non-severe group (72% vs. 65%). The consolidation pattern peaked in week 2, with 9 (32%) and 19 (73%) in the non-severe and severe groups, respectively; the reticular pattern became dominant from week 4 (both group >40%). Conclusion: The extent of CT abnormalities in the severe and non-severe groups peaked in disease week 2. The temporal changes of CT manifestations followed a specific pattern, which might indicate disease progression and recovery., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Objectives: This study attempts to analyse the impact of smoking on the income level of Chinese urban residents to provide a reference for creating informed regulations on cigarette smoking., Design: A population-based cohort study., Method: Two waves of panel data in 2014 and 2016 from the China Family Panel Study were used. A total of 8025 urban adults were identified. The Hausman-Taylor model was used to analyse the theoretical relationship between smoking and income., Results: The percentage of current smokers decreased from 27.39% (2014) to 26.24% (2016), while the percentage of former smokers rose from 9.78% to 11.78%. The results from the Hausman-Taylor model showed that current smokers and former smokers are associated with statistically significant decrease in the income of urban residents of 37.70% and 44.00%, respectively, compared with that of non-smokers. After eliminating the impact of smoking on income, the poverty rate among urban residents decreased from 15.33% to 13.63%., Conclusions: Smoking can significantly reduce the income of Chinese urban residents, resulting in immense negative impacts on Chinese society. Therefore, the government should raise the tax rate on tobacco, include smoking cessation treatment in medical insurance coverage, promote publicity campaigns on the awareness of tobacco hazards and encourage smokers to quit smoking early., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To present the temporal changes of CT manifestations in COVID-19 patients from a single fangcang shelter hospital and to facilitate the understanding of the disease course. Materials and Methods: This retrospective study included 98 patients (males: females, 43:55, mean year, 49±12 years) with confirmed COVID-19 at Jianghan fangcang shelter hospital admitted between Feb 05, 2020, and Feb 09, 2020, who had initial chest CTs at our hospital. Radiographic features and CT scores were analyzed. Results: A total of 267 CT scans of 98 patients were evaluated. Our study showed a high median total CT score of 7 within the first week from symptom onset, peaked in the 2 nd week at 10, followed by persistently high levels of CT score with 9.5, 7 and 7 for the week 3, 4, and >4, respectively, and a prolonged median disease course (30 days, the median interval between the onset of initial symptoms and discharge). Ground-glass opacity (GGO) (58%, 41/71) was the earliest and most frequent finding in week 1. Consolidation (26%, 14/53) and mixed pattern (40%, 21/53) were predominant patterns in 2 nd week. GGO and reticular were the main patterns of later phase CT scans in patients with relatively advanced diseases who had longer illness duration (≥4 weeks). Among the 94 CT abnormalities obtained within 3 days from the twice RT-PCR test turned negative, the mixed pattern was mainly presented in patients with disease duration of 2-3 weeks, for GGO and reticular were common during the whole course. Conclusion: Discharged patients from fangcang shelter hospital demonstrated a high extent of lung abnormalities on CT within the first week from symptom onset, peaked at 2 nd week, followed by persistence of high levels and a prolonged median disease course. GGO was the predominant pattern in week 1, consolidation and mixed pattern in 2 nd week, whereas GGO and reticular patterns in later stages (≥4 weeks)., Competing Interests: Competing Interests: The authors have declared that no competing interest exists. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (© The author(s).)

Rationale : Up to date, the exploration of clinical features in severe COVID-19 patients were mostly from the same center in Wuhan, China. The clinical data in other centers is limited. This study aims to explore the feasible parameters which could be used in clinical practice to predict the prognosis in hospitalized patients with severe coronavirus disease-19 (COVID-19). Methods: In this case-control study, patients with severe COVID-19 in this newly established isolation center on admission between 27 January 2020 to 19 March 2020 were divided to discharge group and death event group. Clinical information was collected and analyzed for the following objectives: 1. Comparisons of basic characteristics between two groups; 2. Risk factors for death on admission using logistic regression; 3. Dynamic changes of radiographic and laboratory parameters between two groups in the course. Results : 124 patients with severe COVID-19 on admission were included and divided into discharge group (n=35) and death event group (n=89). Sex, SpO2, breath rate, diastolic pressure, neutrophil, lymphocyte, C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), and D-dimer were significantly correlated with death events identified using bivariate logistic regression. Further multivariate logistic regression demonstrated a significant model fitting with C-index of 0.845 (p<0.001), in which SpO2≤89%, lymphocyte≤0.64×10 9 /L, CRP>77.35mg/L, PCT>0.20μg/L, and LDH>481U/L were the independent risk factors with the ORs of 2.959, 4.015, 2.852, 3.554, and 3.185, respectively (p<0.04). In the course, persistently lower lymphocyte with higher levels of CRP, PCT, IL-6, neutrophil, LDH, D-dimer, cardiac troponin I (cTnI), brain natriuretic peptide (BNP), and increased CD4+/CD8+ T-lymphocyte ratio and were observed in death events group, while these parameters stayed stable or improved in discharge group. Conclusions : On admission, the levels of SpO2, lymphocyte, CRP, PCT, and LDH could predict the prognosis of severe COVID-19 patients. Systematic inflammation with induced cardiac dysfunction was likely a primary reason for death events in severe COVID-19 except for acute respiratory distress syndrome., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Rationale : To retrospectively analyze serial chest CT and clinical features in patients with coronavirus disease 2019 (COVID-19) for the assessment of temporal changes and to investigate how the changes differ in survivors and nonsurvivors. Methods : The consecutive records of 93 patients with confirmed COVID-19 who were admitted to Wuhan Union Hospital from January 10, 2020, to February 22, 2020, were retrospectively reviewed. A series of chest CT findings and clinical data were collected and analyzed. The serial chest CT scans were scored on a semiquantitative basis according to the extent of pulmonary abnormalities. Chest CT scores in different periods (0 - 5 days, 6 - 10 days, 11 - 15 days, 16 - 20 days, and > 20 days) since symptom onset were compared between survivors and nonsurvivors, and the temporal trend of the radiographic-clinical features was analyzed. Results : The final cohort consisted of 93 patients: 68 survivors and 25 nonsurvivors. Nonsurvivors were significantly older than survivors. For both survivors and nonsurvivors, the chest CT scores were not different in the first period (0 - 5 days) but diverged afterwards. The mortality rate of COVID-19 monotonously increased with chest CT scores, which positively correlated with the neutrophil-to-lymphocyte ratio, neutrophil percentage, D-dimer level, lactate dehydrogenase level and erythrocyte sedimentation rate, while negatively correlated with the lymphocyte percentage and lymphocyte count. Conclusions : Chest CT scores correlate well with risk factors for mortality over periods, thus they may be used as a prognostic indicator in COVID-19. While higher chest CT scores are associated with a higher mortality rate, CT images taken at least 6 days since symptom onset may contain more prognostic information than images taken at an earlier period., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Background: Whether mesohepatectomy should be performed for large hepatocellular carcinoma (HCC) located in the central part of the liver is controversial, and the safety and long-term survival after this operation remain to be investigated., Methods: Between January 2002 and December 2012, 696 patients with HCC located in the central part of the liver who received liver resection in our hospital were included in this study. These patients were divided into three groups: 158 patients with large HCC (tumor size >5.0 cm) and 192 patients with small HCC (tumor size ≤ 5.0 cm) who received mesohepatectomy were classified as the mesohepatectomy for large HCC (MHG-L) group and the mesohepatectomy for small HCC (MHG-S) groups, respectively, and 346 patients with large HCC who received hemihepatectomy or less were classified as the non-mesohepatectomy for large HCC (NMHG-L) group. The operative indications, techniques, and outcomes of the three groups were analyzed retrospectively., Results: There were no substantial differences among the three groups in in-hospital mortality or postoperative complication rates. The overall survival and disease-free survival were not different between the MHG-L group and the NMHG-L group or between the MHG-L group and the MHG-S group. Univariable and multivariable analyses of the MHG-L mesohepatectomy group indicated that cirrhosis, tumor number, and vascular invasion were independent risk factors of poor long-term survival of mesohepatectomy. In the MHG-L and NMHG-L groups, solitary large hepatocellular carcinoma had better long-term survival than nodular large hepatocellular carcinoma., Conclusion: Mesohepatectomy is safe and efficacious for BCLC B/C patients who have centrally located large HCC, especially for solitary tumors, with good survival outcomes., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Neurology is complex, abstract, and difficult for students to learn. However, a good learning method for neurology clerkship training is required to help students quickly develop strong clinical thinking as well as problem-solving skills. Both the traditional lecture-based learning (LBL) and the relatively new team-based learning (TBL) methods have inherent strengths and weaknesses when applied to neurology clerkship education. However, the strengths of each method may complement the weaknesses of the other. Combining TBL with LBL may produce better learning outcomes than TBL or LBL alone. We propose a hybrid method (TBL + LBL) and designed an experiment to compare the learning outcomes with those of pure LBL and pure TBL., Methods: One hundred twenty-seven fourth-year medical students attended a two-week neurology clerkship program organized by the Department of Neurology, Sun Yat-Sen Memorial Hospital. All of the students were from Grade 2007, Department of Clinical Medicine, Zhongshan School of Medicine, Sun Yat-Sen University. These students were assigned to one of three groups randomly: Group A (TBL + LBL, with 41 students), Group B (LBL, with 43 students), and Group C (TBL, with 43 students). The learning outcomes were evaluated by a questionnaire and two tests covering basic knowledge of neurology and clinical practice., Results: The practice test scores of Group A were similar to those of Group B, but significantly higher than those of Group C. The theoretical test scores and the total scores of Group A were significantly higher than those of Groups B and C. In addition, 100% of the students in Group A were satisfied with the combination of TBL + LBL., Conclusions: Our results support our proposal that the combination of TBL + LBL is acceptable to students and produces better learning outcomes than either method alone in neurology clerkships. In addition, the proposed hybrid method may also be suited for other medical clerkships that require students to absorb a large amount of abstract and complex course materials in a short period, such as pediatrics and internal medicine clerkships.

Patients suffering from epilepsy need long-term medication. However, after the epilepsy is completely under control, the recurrence rate is high once the drug dose is reduced gradually. The present study investigated the possible correlation between the changes shown by ambulatory electroencephalography (EEG) and epilepsy recurrence after medication withdrawal, and assessed the value of ambulatory EEG findings in predicting the recurrence of epilepsy after medication withdrawal, in 265 patients from Southern China followed up for 5 years. Anticonvulsants were withdrawn until onset had been controlled thoroughly for over 3 years and ambulatory EEG detected no abnormalities. Ambulatory EEG was performed at least once per year, and findings at the first visit, during treatment, and before and after medication withdrawal were compared and analyzed. There were 47 patients with recurrent epilepsy in this study. Patients with normal ambulatory EEG findings at the first visit and during treatment had lower recurrence rate (about 8.1%) compared to patients with epileptic waves (25.0%), and patients with focal epileptic waves in the temporal, occipital, frontal, and parietal lobes, or in multiple areas was even higher. Patients with epileptic waves also showed higher clinical recurrence rate during the follow-up period. Abnormal ambulatory EEG findings are an important indicator of epileptic recurrence, and is of great value in predicting the recurrence of epilepsy after medication withdrawal.

Background: Secondhand smoke (SHS) exposure harms pregnant women and the fetus. China has the world's largest number of smokers and a high male smoking prevalence rate., Objective: To compare exposure to SHS among rural and urban Chinese non-smoking pregnant women with smoking husbands, and analyze factors associated with the level of SHS exposure and hair nicotine concentration., Setting: Sichuan province, China., Population: In all 1,181 non-smoking pregnant women with smoking husbands recruited from eight district/county Women and Children's hospitals., Methods: The women completed a questionnaire in April and May 2008. Based on systematic sampling, 186 pregnant women were selected for sampling the nicotine concentration in their hair. Ordinal logistic regression analysis was conducted to examine correlates with self-reported SHS exposure (total and at home); linear regression was conducted for the sub-sample of hair nicotine concentrations., Main Outcome Measures: Secondhand smoking exposure rates, hair nicotine levels., Results: About 75.1% of the non-smoking pregnant women with smoking husbands reported regular SHS exposure. The major source of exposure was through their husband. In the multivariate analysis, the risk of greater SHS exposure (total and at home) and hair nicotine concentration was increased for women who were rural, had a husband with greater cigarette consumption, less knowledge about SHS, less negative attitudes about SHS, and no smoke-free home rules., Conclusions: The high prevalence rate of SHS exposure suggests that it is important for non-smoking pregnant women, especially rural women, to establish smoke-free home rules and increase knowledge and negative attitudes towards SHS.

The aim of this study was systematic investigation of the differentially expressed genes during carcinogenesis in hepatocellular carcinoma (HCC) using cDNA microarray technology. The differentially expressed genes between 22 fresh HCC tissues and para-cancerous liver tissues (PCLT) were displayed using cDNA microarray technology. The result was verified by the reverse transcriptase polymerase chain reaction. Among the 8,464 human genes, 507 (5.99%) genes were expressed differentially at the mRNA levels between HCC and PCLT. Two hundred (2.36%) genes were down-regulated, whereas 307 (3.63%) genes were up-regulated. The mRNA expression levels of RhoC and protocadherin LKC detected by reverse transcription polymerase chain reaction (RT-PCR) were consistent with the microarray experiment. This study describes a gene expression profiling of HCC, which provides an extensive list of potential molecular markers for early diagnosis and molecular targets for the development of drugs to treat patients with primary HCC., (© Springer Science+Business Media, LLC 2008)

Stream macro-invertebrate assemblages were collected from 64 stream sites in Xitiaoxi Stream, Anji County, Zhejiang Province, China. Thirty-six candidate metrics were evaluated stepwise by distributing range analysis, discriminatory power analysis, and Pearson's correlation analysis. The B-IBI was composed of seven metrics: total taxa, EPT taxa, Coleoptera %, three dominant taxa, Hydropsychidae (Trichoptera) %, filterers %, and Biotic Index (BI). The ratio scoring method was used to transform the value of each metric into a uniform score. A variability coefficient method and an entropy method were used to calculate the weight value of each metric of the B-IBI. The measurement accuracy of the health criteria for the B-IBI derived from all sample data was better than that from only reference data. The entropy method had a higher accuracy (92.9%) than the sum total score method (85.7%) and the variability coefficient method (78.5%) in discriminating stressed and reference sites. The B-IBI health criteria for Xitiaoxi Stream were: B-IBI > 0.69 = healthy, 0.52 - 0.68 = sub-healthy, 0.35-0.51 = good-fair, 0.18-0.34 = fair, B-IBI < 0.17 = poor. The Pearson's correlation analysis between B-IBI and chemical-physical variables showed that the B-IBI strongly corresponded with the habitat quality index (r = 0.62, p < 0.01), water temperature (r = -0.64, p < 0.01), and altitude (r = 0.64, p < 0.01). Our results suggest that the B-IBI is a good indicator in stream health assessment and should be used in water resource management in China.

Objective: To analyze the risk factors for metastasis and recurrence of hepatocellular carcinoma (HCC) postoperatively., Methods: Data of 270 cases of postoperative HCC were analyzed by SPSS software retrospectively., Results: Out of the 270 cases, 162 got follow-up study and 136 showed metastasis and recurrence. Lots of risk factors induced the recurrence of HCC, such as AFP, tumor form, venous blood invasion, HBV infection, resection dimension and perioperative transfusion. There were different risk factors at different stages., Conclusion: The early recurrence of HCC may be mediated by macro- or micro-vessel blood invasion and metastasis, the late recurrence by multicentric carcinogenesis or introhepatic cacinoma de novo.