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Objective: Vericiguat is a new medication to demonstrate clinical efficacy in heart failure with reduced ejection fraction (HFrEF) after worsening heart failure (WHF) events, but its cost–utility was unknown. We aimed to assess the cost–utility of combining the application of vericiguat with standard treatment in HFrEF patients who had WHF events. Methods: A multistate Markov model was implemented to mimic the economic results of HFrEF patients who had WHF events in China after receiving vericiguat or placebo. An analysis of cost–utility was conducted; most parameters were set according to the published studies and related databases. All the utilities and costs were decreased at a rate of 5% annually. The incremental cost-effectiveness ratios (ICERs) were the primary outcome measure. We also conducted sensitivity analyses. Results: Over a 20 year lifetime horizon, additional use of vericiguat led to an elevated cost from US$9725.03 to US$20,660.76 at the current vericiguat costs. This was related to increased quality-adjusted life years (QALYs) from 2.50 to 2.66, along with an ICER of US$65,057.24 per QALY, which was over the willingness-to-pay (WTP) threshold of US$36,096.30 per QALY. If the vericiguat costs were discounted at 80%, it contributed to an ICER of US$12,226.77 per QALY. Additional use of vericiguat for patients with plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) of ≤ 5314 pg per ml produced an ICER of US$23,688.46 per QALY. The outcomes of the one-way sensitivity analysis showed the risk of death from cardiovascular disease in both groups was variable with the highest sensitivity. The probabilistic sensitivity analysis showed that 41.6% of the mimicked population receiving vericiguat combined with standard therapy was cost-effective at the WTP threshold of US$36,096.30 per QALY. Conclusions: From the perspective of Chinese public healthcare system, the combined use of vericiguat and standard treatment in patients with HFrEF following WHF events did not generate advantages in cost–utility in China but was a cost-effective therapeutic strategy for those who with plasma NT-proBNP of ≤ 5314 pg per ml. [ABSTRACT FROM AUTHOR]

Many studies have found that feelings and expressions of gratitude bring profound benefits to people and relationships. We complicate this view of gratitude. We examine two variables known to impact people's expectations for relationships: culture (collectivist vs. individualist) and relational distance (close vs. distant), and we find evidence that expressing gratitude conveys that relationship expectations have been exceeded, such that people view it as less desirable to give and receive gratitude for actions that are expected duties of a relationship. In both observational data and real behavior in an experiment, we found that people in a collectivist culture (China) are less likely than those in an individualist culture (America) to express gratitude to close others (Studies 1 and 2). Using hypothetical vignettes, we confirmed this pattern and further found there was no cultural difference for distant others (Study 3). These differences in expressing gratitude reflect differences in underlying feelings of gratitude, as well as differences in expectations of how the target would react to being thanked (Study 4). This cultural difference can be explained by cultural differences in the extent of duties placed on close others (Studies 5 and 6): People in China expect more of their close others. Perhaps as a result, people in China show a weaker preference than Americans for direct expressions of gratitude toward close others, but no difference for distant others (Study 7). Overall, our findings suggest that expressing gratitude may not always be good for close relationships. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the association between self‐efficacy and self‐management by modelling three types of social support as mediators among stroke high‐risk populations. Background: Self‐efficacy and social support (i.e. objective support, subjective support and support utilisation) are important for self‐management among stroke high‐risk populations. Self‐efficacy activates three types of social support, and the effect of social support on self‐management varies by types among chronic patients. Therefore, social support may act as a mediator between self‐efficacy and self‐management, and the mediating role may vary by types of social support. Disentangling the role of these different types of social support can guide tailored interventions. Design: A cross‐sectional study. Methods: This study was conducted among 448 Chinese adults at high risk for stroke. Self‐efficacy, self‐management and social support were assessed using the Self‐Efficacy Scale, the Stroke Self‐management Scale and the Social Support Rating Scale respectively. The PROCESS SPSS Macro version 3.3, model 4 was used to explore the mediating role of different types of social support in the relationship between self‐efficacy and self‐management. This study followed STROBE checklist for cross‐sectional studies (Appendix S1). Results: Self‐efficacy improved three types of social support, and subjective support and support utilisation promoted self‐management, but objective support hindered self‐management. The specific indirect effect of objective support and subjective support was significant but not that of support utilisation. Objective support, subjective support and support utilisation attenuated the total effect of self‐efficacy on self‐management by −23.8%, 23.8% and 7.7% respectively. Conclusions: Mediating effect of social support in the relationship between self‐efficacy and self‐management varies by type, and the positive effect of subjective support is offset by the detrimental effect of objective support. Relevance to clinical practice: Among stroke high‐risk populations, interventions should target objective support and subjective support as well as self‐efficacy to efficiently improve their self‐management. [ABSTRACT FROM AUTHOR]

Topical timolol and lasers are widely used for the treatment of infantile hemangioma (IH), and they can replace propranolol as the first‐line treatment of IH. We aimed to investigate the efficacy and safety of topical timolol alone or lasers plus topical timolol versus lasers alone for the treatment of IH using a meta‐analysis. We searched the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases. A more conservative random effect model meta‐analysis technique was used to analyze the efficacy and adverse reactions of timolol and lasers. Ten RCTs with a total of 979 patients with IH were included in this meta‐analysis. Treatment with topical timolol alone was as effective as lasers in treating IH (risk ratio [RR] = 0.99, p = 0.94), with similar adverse events. The difference was not statistically significant (RR = 1.67, p = 0.14). Combined treatment with topical timolol and lasers showed a favorable response rate compared with treatment with either lasers (RR = 1.23, p = 0.01) or topical timolol (RR = 1.35, p = 0.001) alone. Furthermore, compared to topical timolol alone, the combined treatment indicated similar risks of adverse events (RR = 0.70, p = 0.38) but fewer risks of adverse events (RR = 0.39, p = 0.004) compared to lasers alone. This meta‐analysis provided evidences that a combined treatment with topical timolol and lasers might be more effective than a single treatment strategy in infants with IH, and with no significant increase in adverse reactions. The combination of topical timolol and laser therapy might be the preferred choice for the treatment of IHs. [ABSTRACT FROM AUTHOR]

Cognitive frailty, a potentially reversible condition describing the concurrence of physical frailty and mild cognitive impairment (MCI), has been recently proposed to incorporate subjective cognitive decline (SCD), a reversible pre-MCI state with more readily available cognitive reserve, as well as pre-physical frailty. Reversible cognitive frailty has been associated with dementia and mortality. We aimed to examine the association of reversible cognitive frailty with other adverse outcomes including disability, poor quality of life (QOL), depression, and hospitalization. This was a cohort study with 1-year follow-up among 735 Chinese community-dwelling older adults with intact cognition. Reversible cognitive frailty was operationalized with the presence of pre-physical or physical frailty identified by the Frailty Phenotype and SCD identified by the simplified SCD questionnaire including four self-report cognitive domains of memory, naming, orientation, and mathematical reasoning. Adverse outcomes included incident Activities of Daily Living (ADL)-Instrumental ADL (IADL) disability, poor physical, mental and overall QOL, depression, and hospitalization over 1-year follow-up. The prevalence of reversible cognitive frailty was 27.8%. Participants with reversible cognitive frailty had higher risk of the incidence of ADL-IADL disability, poor physical QOL, poor mental QOL, poor overall QOL, and depression (Odds Ratios: 1.67–4.38, P < 0.05), but not higher risk of hospitalization over 1-year follow-up. Reversible cognitive frailty was not uncommon and associated with incident disability, poor QOL, and depression among community-dwelling older adults. Early identification of reversible cognitive frailty can facilitate targeted interventions and may promote independence in older adults. Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2021.2011835 [ABSTRACT FROM AUTHOR]

Aim: This study is aimed to evaluate the effectiveness of a theory‐driven exercise intervention for Chinese community‐dwelling (pre)frail older adults, and to clarify the underlying mechanisms of the exercise intervention in this population. Design: A stepped‐wedge cluster‐randomized trial. Methods: A stepped‐wedge cluster‐randomized trial will be conducted among (pre)frail older adults at six communities in a county of central China. A 12‐week multicomponent exercise intervention based on the integration of the Health Belief Model (HBM) and the Theory of Planned Behaviour (TPB) will be implemented to all participants during the study period. The primary outcomes are frailty, muscle mass, muscle strength and physical performance. Secondary outcomes include beliefs in exercise, exercise behaviours and other physical, mental and social functioning. Assessments will be conducted at baseline and at week 12, 24 and 36. A multilevel regression model will be used to evaluate the effectiveness of exercise interventions. A multilevel mediation model will be used to clarify the underlying mechanisms of this exercise intervention. Discussion: This study is expected to provide an effective and practical mode for exercise interventions among Chinese community‐dwelling (pre)frail older adults, and contribute to the existing evidence in this field. Trial registration: Chinese Clinical Trial Registry ChiCTR2100041981. [ABSTRACT FROM AUTHOR]

Introduction: Recent studies have shown that inflammatory patterns of nasal polyps from patients with chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) in East Asia have changed over time. However, to date there is a marked lack of similar data for CRSwNP in Northern China. This study thus aimed to assess the changes in the clinical and histological characteristics of CRSwNP patients from Northern China over the past 2–3 decades. Methods: This was a retrospective study, which examined data from 2 groups of 150 CRSwNP patients each, who had undergone endoscopic sinus surgery in Beijing Tongren Hospital from 1993 to 1995 (group A) and from 2015 to 2019 (group B). All relevant data for demographic, clinical, and histological parameters were collected for each patient from the 2 groups and compared for overall changes between the 2 groups. Results: The comorbidity of CRSwNP and asthma increased over time and the cellular phenotype of CRSwNPchanged significantly; in particular, the proportion of eosinophil-dominant CRSwNP increased, lymphocyte-dominant and plasma-dominant CRSwNP decreased significantly, and the proportions of neutrophil-dominant and mixed CRSwNP were not altered. The rate of polyp recurrence increased in CRSwNP but did not in eosinophilic CRSwNP. Smoking and age did not significantly impact the inflammatory patterns of CRSwNP. Conclusions: The inflammatory patterns of CRSwNP patients have changed and comorbidity of asthma significantly increased in CRSwNP patients in Northern China over the past 2–3 decades. [ABSTRACT FROM AUTHOR]

Due to the cold winters in northeast China, the energy consumption of the rural residential buildings is much higher in this region than in other regions. In this study, the energy sustainability of bio-based wall construction is examined through applications in rural residential buildings. Comparisons of the energy sustainability of the bio-based wall constructions and the conventional wall constructions are evaluated using IESVE-2019 computational simulation. The results show notable reductions in heating energy requirements and coal use, which is the major heating source for rural residential buildings in China. The results show that reductions of 45.82–204.07 kWh/m2/year in heating energy requirements and more than 40% in coal use are possible through application of bio-based wall constructions. The application of bio-based wall construction will result in lower seasonal air pollution and coal use through straw burning in northeast China. [ABSTRACT FROM AUTHOR]

Based on the Boussinosq Approximation formulas in the symmetric, cylindric coordinates, the nonlinear effects of the internal inertial gravity waves on the meso-micro scale convective activities of Southwest China Vortex system are analyzed by the multi-scale and perturbation approximation methods. The results obtain two main conclusions: (1) When the atmospheric stratification is stable, the inertial gravity waves for Southwest China Vortex may also develop into finite-amplitude wave packet with a solitonic characteristics of large amplitude and short duration, forming a long-narrow wave band which activates and organizes severe convective activities like high wind and thunderstorm of Southwest China Vortex. When the atmospheric stratification is unstable, the inertial gravity waves exhibits attenuating oscillation characteristics and develops into finite-amplitude wave packet with large amplitude and fast speed, forming queue-type wave band that activates and organizes extreme weather like persistent heavy rainfall of Southwest China Vortex. (2) Under different atmospheric stratifications, the effects of thermal forcing on the inertial gravity waves for Southwest China Vortex are different. In the stable atmospheric stratification, the thermal forcing mainly intensifies the inertial gravity waves and has no significant effect on its duration. And in the unstable atmospheric stratification, the thermal forcing not only strengthens its growth but also obviously extends its duration. The research has revealed the some nonlinear characteristics of the internal inertial gravity waves for Southwest China Vortex, and improved the theoretical understanding about the critical role of the internal inertial gravity waves dynamic processes and its influence mechanism on the meso-micro scale severe convection weather for Southwest China Vortex. • The evolution of the gravity wave in the SWCV of different layers is illustrated. • How the thermal forces impact convective motion varies on the SWCV are illustrated. • A multi-scale coupling mechanism for convection in the SWCV is proposed. [ABSTRACT FROM AUTHOR]

[Display omitted] • NDCI and physical model were combined to assess the blooms in TGR. • Algal blooms were more severe in dry years and slow-flow zones. • Water level of TGR was always the key influencing factor for algae blooms. • Three algae bloom patterns were found in the TGR. • Different strategies were given to manage algae based on local influencing factor. The construction of reservoirs often caused algae blooms but there is controversy over pattern and attribution of blooms in reservoir-impacted tributaries due to lacking of detailed records. Herein, the remote sensing data with resolution of 10-meter pixels and physics-based model were combined to explore spatiotemporal distribution of algae blooms in key tributaries of Three Gorges Reservoir, China. Self-organizing maps were used for identifying the drivers of blooms. The results revealed that algae blooms were more serious during dry years and there was little difference between dry or wet years for multi-stage gate river with coverage remaining at 42.90%. The open waters with slow currents were identified as high-risk zones. Hotspots of algae blooms changed during the year, which were close to estuary in spring, upstream in autumn, and dispersed in backwater region in summer. Water level was major measure for managing algae blooms, while meteorological conditions were identified as the key factor (40.25%) for river with multi-stage dams and characteristics of shallow lakes. For the nutrients-rich river, blooms were driven by both water level (13.98%) and climate factors (23.34%). The blooms of natural backwater river were stimulated by combination of water level, climate and waterhed nutrients. These results highlighted necessity of region water quality management in reservoir-impacted regions. [ABSTRACT FROM AUTHOR]

Background: Functional ability is the important prerequisite to live independently and achieve aging in place, which depends on the complex interaction of intrinsic and extrinsic factors. Identifying the trends and influencing factors of functional ability would contribute to the accurate assessment and intervention of geriatric health. This study aimed to disentangle the moderating effect of 3 types of social support, namely objective support, subjective support, and support utilization, on the relationship between frailty and functional ability trajectories., Methods: This was a secondary analysis using data from a prospective 3-wave study with a sample of 777 Chinese community-dwelling older adults. Social support was assessed using the Social Support Rating scale. Frailty was assessed using the FRAIL scale. Functional ability was measured by the Lawton Instrumental Activities of Daily Living scale. Latent growth curve models were implemented to test their relationships., Results: Objective support but not subjective support or support utilization moderated on the relationship between frailty and functional ability slope. Functional ability decline over time was buffered by objective support among robust individuals but exacerbated among (pre)frail individuals., Conclusions: The moderating effect of social support on the relationship between frailty and functional ability trajectory varies by support types, which reminded that social support may be a promising intervention target to maintain functional independence for frail individuals, opening up a new perspective on social support in the field of disability prevention. Effective interventions should particularly address objective support in conjunction with empowering the frail older population to optimize the trajectory of functional ability., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: We examined joint trajectories of physical frailty and social frailty as well as their associations with adverse outcomes., Methods: We conducted a prospective cohort study by using five waves of national data from China Health and Retirement Longitudinal Study (CHARLS 2011-2020), involving 4531 participants aged ≥60 years. We identified 4-year trajectories at three examinations from 2011 to 2015 using parallel process latent class growth analysis. Adverse outcomes were obtained from 2015 to 2020 across two subsequent waves. We calculated hazard ratios (HR) using Cox proportional hazard models. We also conducted analyses by gender., Results: Three joint trajectories were identified, including persistent absence of physical and social frailty (58.5 %), no physical frailty but social frailty (28.1 %), and persistent combination of physical and social frailty (13.4 %). Compared with persistent absence of physical and social frailty, no physical frailty but social frailty and persistent combination of physical and social frailty were associated with higher risk of instrumental activities of daily living (IADL) disability (HR = 1.182-2.020, 95 % CI: 1.014-2.416) and all-cause mortality (HR = 1.440-2.486, 95 % CI: 1.211-3.009). The persistent combination of physical and social frailty was also associated with ADL disability (HR = 2.412, 95 % CI: 1.999-2.911) and falls (HR = 1.410, 95 % CI: 1.196-1.662). Gender differences were observed in relationships between joint trajectories and adverse outcomes., Conclusion: Community-dwelling older adults exhibit distinct joint trajectories and those with persistent combination of physical and social frailty experience greatest risk of incident adverse outcomes. Clinical and public health measures targeting physical or social frailty should account for both and be gender-specific., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

This study aimed to examine joint trajectories of loneliness, social isolation and sarcopenia and their associations with adverse outcomes. A total of 4701 participants aged ≥60 years who had a baseline and at least one follow-up assessment of loneliness, social isolation and sarcopenia across 2011, 2013 and 2015 waves in China Health and Retirement Longitudinal Study. Adverse outcomes were obtained in 2018 wave. Joint trajectories were fit using the parallel process latent class growth analysis, and their associations with adverse outcomes were evaluated using modified Poisson regression. Joint trajectory patterns for social relationship and sarcopenia did not vary by the assessment for sarcopenia, but did vary by the assessment for social relationship. Older adults exhibit distinct joint trajectories and those with persistent combination of loneliness or social isolation and sarcopenia experience greatest risk of adverse outcomes. These findings implicate integration of health care and social care for community-dwelling older adults., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The current study validated and compared three short Geriatric Depression Scales (GDS), including the GDS-5, D'Ath GDS-4, and van Marwijk GDS-4, among 917 Chinese community-dwelling older adults. The GDS-5, D'Ath GDS-4, and van Marwijk GDS-4 presented satisfactory accuracy against the GDS-15 (area under the curve [AUC] = 0.872 to 0.952), and the GDS-5 and D'Ath GDS-4 had better accuracy than the van Marwijk GDS-4. Satisfactory accuracy (AUC = 0.842 to 0.979) for the three scales was also observed across subgroups by age, sex, education, cognitive function, and multimorbidity. The GDS-5 but not D'Ath GDS-4 and van Marwijk GDS-4 retained a 2-point optimal cutoff for depressive symptoms across subgroups. The GDS-5 (average inter-item correlation coefficient [AIIC] = 0.233) and the D'Ath GDS-4 (AIIC = 0.171) but not van Marwijk GDS-4 (AIIC = 0.128) had acceptable internal consistency. Three scales had stable test-retest reliability within a 1- to 2-week interval (intraclass correlation coefficient = 0.670 to 0.885). The GDS-5 is an accurate and reliable depression screening tool with an invariable optimal cutoff among Chinese community-dwelling older adults. The variable optimal cutoffs for the D'Ath GDS-4 and van Marwijk GDS-4 across subgroups may limit their applicability in this population. [ Research in Gerontological Nursing, 15 (6), 283-291.].

Background: This study aimed to comprehensively investigate the effect of spread through air spaces (STAS) on clinicopathologic features, molecular characteristics, immunohistochemical expression, and prognosis in lung adenocarcinomas (ADC) and squamous cell carcinomas (SQCC) based on the 8th edition AJCC/UICC staging system., Methods: In total, 303 ADC and 121 SQCC cases were assessed retrospectively. Immunohistochemical staining was performed for E-cadherin, vimentin, Ki67, survivin, Bcl-2, and Bim. Correlations between STAS and other parameters were analyzed statistically., Results: STAS was observed in 183 (60.4%) ADC and 39 (32.2%) SQCC cases. In ADC, the presence of STAS was associated with wild-type EGFR, ALK and ROS1 rearrangements, low E-cadherin expression, and high vimentin and Ki67 expression. In SQCC, STAS was associated with low E-cadherin expression and high vimentin and survivin expression. Based on univariate analysis, STAS was associated with significantly shorter disease-free survival (DFS) and overall survival (OS) in ADC. In SQCC, STAS tended to be associated with shorter OS. By multivariate analysis, STAS was an independent poor prognostic factor in ADC for DFS but not OS. Stratified analysis showed that STAS was correlated with shorter DFS for stage I, II, IA, IB, and IIA ADC based on univariate analysis and was an independent risk factor for DFS in stage I ADC cases based on multivariate analysis., Conclusions: Our findings revealed that STAS is an independent negative prognostic factor for stage I ADC using the new 8th edition AJCC/UICC staging system. Stage I patients with STAS should be followed up more closely and might need different treatment strategies.