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The Yellow River Basin (YRB) as a source of the oldest world cultures, flows through vast arid and semi‐arid regions of China. Its fragile vegetation is suffering the obvious effect from regional climate change, and easily turns from a critical state into qualitatively different modes of change, which implies significant impacts on humans and ecosystems. Our results show that in the period of 1982–2015, the normalized difference vegetation index (NDVI) appeared significantly discontinuous changes by stagnant warming and strengthening wetting, especially in the central YRB (104.5°–111° E, 35.5°–38° N). The NDVI in this region shifted from slowly increasing (5.42 × 10−4 a−1) to rapidly increasing (5.13 × 10−3 a−1) around 2003, called the turning point (TP). Such shift change is mainly a result of increased moderate rain, with frequency trend changed from 0.083 times·a−1 to 0.324 times·a−1. Meanwhile, these changes on vegetation led to a reversal of the gross primary productivity (GPP) from decreasing to increasing. Such results indicated the vulnerable ecosystem of the central YRB has played a positive contribution to the carbon balance, and more sustainable management of vegetation is required for the ecological development and engaging adaptive strategy. [ABSTRACT FROM AUTHOR]

Ecological security is the state achieved once an ecosystem maintains its stability under external stress. The Yellow River Basin (YRB) is the largest river basin in northwest and north China and an important area for grain and energy production. The assessment and attribution of ecological security in the YRB are important for protecting the natural environment and ensuring sustainable development. Here, the ecological security of the YRB was assessed by the ecological security index (ESI), a comprehensive index based on the oxygen cycle, and its drivers were attributed to climate change, human activities, vegetation, and soil factors. The spatial pattern of ecological security in the YRB showed high heterogeneity. Ecological insecurity occurred mainly in the middle reaches and regions where the major stream of the Yellow River passes through. The ESI decreased at a rate of − 0.82/year since 2000, which indicated the natural environment continued to be improved in the YRB. Climate change dominated the evolution of ecological security in the upper reaches. The level of ecological security has been improved in the middle reaches after a series of ecological restoration projects conducted. With higher intensity of industrial activity, human activities played a more critical role in ecological security in the lower reaches. Our results suggested that government and local people need to adopt different strategies and actions based on the dominant drivers in the upper, middle, and lower reaches to ensure protection of the natural environment and achieve sustainable development targets. [ABSTRACT FROM AUTHOR]

Extreme snow loads can collapse roofs. This load is calculated based on the ground snow load (that is, the snow water equivalent on the ground). However, snow water equivalent (SWE) measurements are unavailable for most sites, while the ground snow depth is frequently measured and recorded. A new simple practical algorithm was proposed in this study to evaluate the SWE by utilizing ground snow depth, precipitation data, wind speed, and air temperature. For the evaluation, the precipitation was classified as snowfall or rainfall according to the air temperature, the snowfall or rainfall was then corrected for measurement error that is mainly caused by wind-induced undercatch, and the effect of snow water loss was considered. The developed algorithm was applied and validated using data from 57 meteorological stations located in the northeastern region of China. The annual maximum SWE obtained based on the proposed algorithm was compared with that obtained from the actual SWE measurements. The return period values of the annual maximum ground snow load were estimated and compared to those obtained according to the procedure suggested by the Chinese structural design code. The comparison indicated that the use of the proposed algorithm leads to a good estimated SWE or ground snow load. Its use allowed the estimation of the ground snow load for sites without SWE measurement and facilitated snow hazard mapping. [ABSTRACT FROM AUTHOR]

Mining under the sea is a challenging task in China. Affected by blasting, tunneling, and other engineering disturbance, surrounding rock is often in a state of cyclic loading and unloading stress. In this study, in order to investigate the effect of cyclic loading and unloading on the deformation and damage characteristics of sandstone underneath the Bohai Sea, the GCTS test machine is used to conduct cyclic loading and unloading tests on sandstone. The results show that under cyclic loading and unloading compression, the stress-strain curves of sandstone form a hysteresis loop. The axial residual deformation first decreases, then increases with the increase of cycle number and unloading stress level. Both the circumferential residual strain and volumetric residual strain decrease with the increase of cycle number and unloading stress level. The axial elastic deformation increases with the increase of the cyclic number and cyclic load. The volume deformation first increases, then decreases, and the circumferential strain gradually decreases. In the process of cyclic loading and unloading, the loading elastic modulus gradually increases. Affected by damage, the unloading stress difference of sandstone initially increases with the increase of cycles. Next, the effects of cycle number and unloading stress level on the damage parameters of sandstone are analyzed. Before brittle failure of the specimen, the absolute damage parameters of axial, circumferential, and volume show an increasing trend, and the increase rates of circumferential damage parameters and volume damage parameters suddenly increase, which is also the precursor of the sandstone specimen's instability failure. [ABSTRACT FROM AUTHOR]

Background: Part of tuberculosis (TB) patients were missed if symptomatic screening was based on the main TB likely symptoms. This study conducted to compare the yield and relative costs of different TB screening algorithms in active case-finding in the whole population in China.Methods: The study population was screened based on the TB likely symptoms through a face-to-face interview in selected 27 communities from 10 counties of 10 provinces in China. If the individuals had any of the enhanced TB likely symptoms, both chest X-ray and sputum tests were carried out for them furtherly. We used the McNemar test to analyze the difference in TB detection among four algorithms in active case-finding. Of four algorithms, two were from WHO recommendations including 1a/1c, one from China National Tuberculosis Program, and one from this study with the enhanced TB likely symptoms. Furthermore, a two-way ANOVA analysis was performed to analyze the cost difference in the performance of active case-finding adjusted by different demographic and health characteristics among different algorithms.Results: Algorithm with the enhanced TB likely symptoms defined in this study could increase the yield of TB detection in active case-finding, compared with algorithms recommended by WHO (p < 0.01, Kappa 95% CI: 0. 93-0.99) and China NTP (p = 0.03, Kappa 95% CI: 0.96-1.00). There was a significant difference in the total costs among different three algorithms WHO 1c/2/3 (F = 59.13, p < 0.01). No significant difference in the average costs for one active TB case screened and diagnosed through the process among Algorithms 1c/2/3 was evident (F = 2.78, p = 0.07). The average costs for one bacteriological positive case through algorithm WHO 1a was about two times as much as the costs for one active TB case through algorithms WHO 1c/2/3.Conclusions: Active case-finding based on the enhanced symptom screening is meaningful for TB case-finding and it could identify more active TB cases in time. The findings indicated that this enhanced screening approach cost more compared to algorithms recommend by WHO and China NTP, but the increased yield resulted in comparative costs per patient. And it cost much more that only smear/bacteriological-positive TB cases are screened in active case-finding. [ABSTRACT FROM AUTHOR]

Background: In 2013, a tuberculosis (TB) outbreak occurred in a middle school in Henan province of China. An outbreak survey was carried out in the school. Objectives: This study was undertaken to investigate the detection rate of TB cases and those with strong Mantoux positive (SMP), defined as tuberculin skin test (TST) indurations of 15mm or larger and/or blisters, necrosis or lymphangitis, and to identify their risk factors. Methods: The TST, chest x-ray/radiography, and TB-suspicious symptoms interview were used to screen for TB cases. Their diagnosis was made by sputum smear microscopy, liquid culture, computed tomography (CT), and diagnostic therapy if necessary. We retrospectively analyzed the outbreak survey data of 4082 students and 278 staff in the school. Logistic regression models were used to identify the risk factors associated with SMP and TB disease. Results: Approximately 3.55% of students and 16.55% of staff were SMP. SMP rate in students was significantly lower than that in staff (p<0.001). 55 TB cases in students and none in staff were identified in the school from February to November, 2013, with a detection rate of 1.35% for students. SMP and TB case detection rates were 20.29% and 41.77%, respectively, in the index class, both significantly higher than that in the other classes (3.26% and 0.55%, respectively; both p<0.001). In the index class, TB case detection rate over the study period in students with SMP was not significantly higher than that with TST indurations of <15mm (38.18% vs 21.43%, p = 0.24), but it was significantly higher in the other classes (7.81% vs 0.18%, p<0.001). Risk factors independently associated with SMP and TB cases shared the following with the index case: same dormitory-floor (adjusted odds ratio (AOR) 5.36, 95% CI 3.02–9.48, p<0.001 for SMP; AOR 2.67; 95% CI 1.03–6.96, p = 0.044 for TB cases), same classroom (AOR 4.01; 95% CI 1.95–8.26, p<0.001 for SMP; AOR 165.08; 95% CI 66.88–407.47, p<0.001 for TB cases), same teaching-floor in different classroom (AOR 5.41; 95% CI 3.02–9.71, p<0.001 for SMP; AOR 11.24; 95% CI 3.71–34.03, p<0.001 for TB cases) and same teaching-building on different floor (AOR 1.81; 95% CI 1.16–2.85, p = 0.009 for SMP; AOR 3.30; 95% CI 1.16–9.42, p = 0.025 for TB cases). The closer the contact was with the index case, the larger the AORs for SMP and TB cases were. Conclusion: Same dormitory-floor, same classroom, same teaching-floor and same teaching-building with the index case were all risk factors for both TB infection and disease for students in the outbreak, and the closer the contact was with the index case, the higher the risk was observed. Attention should also be paid to students with TST indurations <15mm, as well as to those with that ≥15mm for the index class in dealing with the outbreak. [ABSTRACT FROM AUTHOR]

The typical resolution for long-term wind speed records that are publicly available in China is daily, this is too coarse for a sound analytical simulation of snowdrift on building roofs. Take Harbin, China as an example, an algorithm was proposed in this study to address this issue, where the commonly-used 2-parameter Weibull distribution was applied to fit the distribution of 10-min mean wind speed. A parameter estimation method, which combines the method of moment and cumulative probability, was proposed to estimate the parameters of Weibull distribution using very limited information on wind speed. The fitted probability model was validated using high-resolution wind speed data by comparing the snowdrift estimated by the modeled wind speed and that estimated by the actual wind speed. Finally, an analytical simulation of snowdrift on a flat roof was carried out to illustrate the application of the proposed model, and the probabilistic characteristic of the derived ground-to-roof conversion factors for snow loads were analyzed. It is indicated that the proposed model is easy to implement and provides a good estimation of the snowdrift on building roofs, and the derived conversion factors could be satisfactorily modeled using a Generalized Extreme Value (GEV) distribution or a normal distribution. • An algorithm was proposed to incorporate very limited wind information into the analytical simulation of roof snow load. • The proposed algorithm is the first of its kind. • An analytical simulation of snowdrifts on a flat roof was carried out using the proposed algorithm. • Probabilistic characteristics of the derived ground-to-roof conversion factors were analyzed. [ABSTRACT FROM AUTHOR]

Abstract A high-fill slope located in Zhenxiong County, Yunnan Province, China, was designed for building placement on its top platform. A reinforcement system consisting of a geogrid, front stability piles (FSPs), retaining sheets, prestressed anchors, and rear deeply buried piles (DBPs) has been used to stabilize the slope. Two typical slope sections were selected to study the high-fill slope stability and retaining mechanism of the reinforcement system. Field measurements of the horizontal displacement and strain in the piles, as well as the anchor working load, were collected and analyzed. In addition, a series of two-dimensional finite element method (FEM) analyses combined with a strength reduction technique was conducted to analyze two selected cross sections. The results show that the retaining structure behavior is closely related to the fill construction process of a high-fill slope. The deflection of the stabilizing pile increases almost linearly with the filling height in the initial stage of fill construction. The variation in the working load of the prestressed anchor shows an offset between prestress loss and increasing fill pressure. The FEM results can provide insight into the pile-soil interaction mechanism and its contribution to fill slope stabilization. The FSPs shift the sliding surface from through the slope toe to through the top of the FSPs. The anchors can reduce the bending moment by supplying additional bearing points. The DBPs can share a portion of the sliding thrust and effectively enhance the safety factor. This paper provides a reference for reinforcement system design for similar engineering projects considering high-fill slopes. Highlights • A case of reinforcement and monitoring for a high-fill slope is presented. • The reinforcement system includes two rows of piles, retaining sheets and anchors. • The behavior of the reinforcement system is investigated through field measurements. • The reinforcement mechanism is analyzed by FEM combined with monitoring. • This study provides a reference for the design of similar high-fill slopes. [ABSTRACT FROM AUTHOR]

• Systemic inflammation is distinct between pulmonary and extrapulmonary tuberculosis. • Concentrations of biomarkers correlate with mycobacterial loads in sputum. • Levels of biomarkers and their relationships can identify severe tuberculosis. • Molecular degree of perturbation persists after antitubercular treatment. The identification of meaningful biomarkers of tuberculosis (TB) has potential to improve diagnosis, disease staging and prediction of treatment outcomes. It has been shown that active pulmonary TB (PTB) is associated with qualitative and quantitative changes in systemic immune profile, suggesting a chronic inflammatory imbalance. Here we characterized the profile of PTB and extrapulmonary TB (EPTB) in a prospective cohort study. We measured a panel of 27 inflammatory cytokines, soluble receptors, and lipid mediators in peripheral blood from patients with PTB or EPTB from a prospective clinical study in China. Multidimensional analyses were performed to describe associations between plasma levels of biomarkers and different TB disease presentation profiles. Mycobacterium tuberculosis infection induced changes in both the expression and correlation profiles of plasma mediators of inflammation in patients with PTB compared to those with EPTB. Increases in mycobacterial loads in sputum smears were associated with rises in concentrations of several molecules involved in TB pathogenesis, such as IL-1β, IFN-α, IL-10 and PGF2α. Moreover, PTB patients presenting with severe disease exhibited a distinct inflammatory profile hallmarked by heightened levels of TNF-α, IL-1β, IL17, IL-18 and IL-27. Interestingly, while antitubercular treatment (ATT) resulted in early changes of plasma concentrations of markers in PTB, changes were delayed in EPTB patients. Exploratory analyses of the molecular degree of perturbation (MDP) of the inflammatory mediators before and during ATT suggested the occurrence of infection and/or treatment-induced long lasting "inflammatory imprinting" of biomarker profiles in TB. At 24 weeks post ATT commencement, markers underlying the observed increases in MDP scores were IL-27 in PTB and IL-1β in EPTB patients. Our findings describe systemic and durable changes in the concentrations of inflammatory cytokines and lipid mediators in both PTB and EPTB and emphasize the role of M. tuberculosis bacterial burden and site of disease in modulating patient immune biomarkers. [ABSTRACT FROM AUTHOR]

Background: Aminolevulinic acid photodynamic therapy (ALA-PDT) is an effective treatment for multiple actinic keratosis (AK). However, PDT-induced pain often discontinues the therapy to reduce its efficacy, limiting its application. If modified painless PDT schedule with shorter photosensitizer dressing and higher dose illumination could achieve good efficacy in AK, it is still unknown., Objectives: To explore the efficacy and pain tolerance of the modified painless PDT (M-PDT) in facial multiple AK., Methods: A split-face controlled clinical study including 14 patients with facial multiple AK was conducted. The patients received conventional PDT (C-PDT) on the left and M-PDT in the contralateral area. The left area (C-PDT) was illuminated by a red light-emitting diode light (144 J/cm 2 ) after applying the 10% ALA cream for 3 h; the other had illumination for a total light dose of 288 J/cm 2 after applying the 10% ALA cream for 0.5 h. The primary endpoint was the lesion clearance rate at 1-month postthree sessions of PDT. Secondary endpoints included pain scores, the incidence of adverse events during treatment, and cosmetic outcomes., Results: At 1 month following three treatments, the total lesion clearance rate was comparable between M-PDT and C-PDT (91.6% vs. 89.0%). While the lesion clearance rate of M-PDT was higher than that of C-PDT in the Grade III lesions (86.5% vs. 72.0%, respectively) (p < 0.05). M-PDT achieved a 100% lesion clearance rate for Grade I lesions earlier than C-PDT, with M-PDT treated twice and C-PDT treated thrice. Moreover, the pain score during illumination was significantly lower for M-PDT than for C-PDT (p < 0.01). Regarding photoaging, the Global Subjective Skin Aging Assessment score showed that the total and atrophy scores of C-PDT and M-PDT were significantly improved, and M-PDT also reduced discoloration. There was no significant difference in adverse reactions between C-PDT and M-PDT., Conclusions: M-PDT is comparable to C-PDT's efficacy for treating facial multiple AK, resulting in much lower pain scores., (© 2023 Wiley Periodicals LLC.)

Background: Recurrence continues to place significant burden on patients and tuberculosis programmes worldwide, and previous studies have rarely provided analysis in negative recurrence cases. We characterized the epidemiological features of recurrent pulmonary tuberculosis (PTB) patients, estimated its probability associated with different bacteriology results and risk factors., Methods: Using 2005-2018 provincial surveillance data from Henan, China, where the permanent population approximately were 100 million, we described the epidemiological and bacteriological features of recurrent PTB. The Kaplan-Meier method and Cox proportional hazard models, respectively, were used to estimate probability of recurrent PTB and risk factors., Results: A total of 7143 (1.5%) PTB patients had recurrence, and of 21.1% were bacteriological positive on both laboratory tests (positive-positive), and of 34.9% were negative-negative. Compared with bacteriological negative recurrent PTB at first episodes, the bacteriological positive cases were more male (81.70% vs 72.79%; P < 0.001), higher mortality risk (1.78% vs 0.92%; P = 0.003), lower proportion of cured or completed treatment (82.81% vs 84.97%; P = 0.022), and longer time from onset to end-of-treatment. The probability of recurrence was higher in bacteriological positive cases than those in bacteriological negative cases (0.5% vs 0.4% at 20 months; P < 0.05)., Conclusions: Based on patient's epidemiological characteristics and bacteriological type, it was necessary to actively enact measures to control their recurrent., (© 2022. The Author(s).)

Background: 5-Aminolaevulinic acid photodynamic therapy (ALA-PDT) is an effective therapy for cutaneous diseases, such as precancers, superficial non melanoma skin cancers and certain inflammatory or viral conditions. However, the absence of a complete picture of adverse reactions limits the promotion of ALA-PDT., Objective: To systemically investigate the detailed evidence of adverse reactions relating to ALA-PDT for skin diseases., Methods: A retrospective study performed at the Shanghai Skin Disease Hospital., Results: In the retrospective study, 439 patients were included. Incidences of adverse reactions, including in-treatment pain (98.8%), erythema (92.4%), edema (35.0%), exudation (23.0%), hyperpigmentation (27.3%) were clarified. Edema was more common in female patients (P<0.05). Patients with HPV-related skin diseases were more likely to suffer erythema, edema or exudation (P<0.05). Hyperpigmentation was more likely to occur in skin appendage disorders (P<0.05). Fever (2.4%) and hypopigmentation (1.9%) are two neglected adverse reactions analyzed in detail. Fever is more prevalent in female patients. Hypopigmentation occurred predominantly in elderly with skin cancer or precancerosis lesions., Conclusion: The results outline detailed information about the adverse reactions, including systemic reactions following ALA-PDT, assisting dermatologists in predicting and managing adverse reactions for greater efficacy and higher patient satisfaction., (Copyright © 2022. Published by Elsevier B.V.)

Background: Acne vulgaris is a chronic inflammatory skin disease around pilosebaceous unit. 5-Aminolaevulinic acid photodynamic therapy (ALA-PDT) is an effective therapy for severe acne vulgaris. However, the lack of detailed information of adverse reactions limits the promotion of ALA-PDT in clinic., Objective: To systemically investigate the adverse reactions relating to ALA-PDT for acne vulgaris., Methods: A prospective study was performed at the Shanghai Skin Disease Hospital., Results: In the prospective study, 35 patients with acne vulgaris completed the trial. The adverse reactions were first divided into acute-phase adverse reactions, including erythema (94.3%), post-treatment pain (91.4%), burning skin (91.4%), dry skin (91.4%), itching (85.7%), pustule (82.9%), edema (20%) and blister (11.4%), or recovery-phase adverse reactions, which included crust (65.6%), exudation (48.6%) and hyperpigmentation (42.7%). Younger patients were more likely to have pustules (P<0.05). Male patients were represented itching more often than female patients (P<0.05). The efficacy of ALA-PDT for severe acne was positively related to the severity of acute-phase adverse reactions. The duration of pain was shortest. Crusting and hyperpigmentation lasted considerably longer., Conclusion: In the present study, we recorded the relative incidence of various adverse reactions following ALA-PDT for acne vulgaris. The severity of adverse reactions tended to decrease with increased patient age, except for itching and hyperpigmentation. Light-to-moderate adverse reactions might be the inflammatory reactions of ALA-PDT, predicting a good efficacy. A form for evaluation of adverse reactions based on the present study could assist dermatologists in predicting and managing adverse reactions for greater efficacy and higher patient satisfaction., (Copyright © 2022. Published by Elsevier B.V.)

On June 17, 2018, a case of pulmonary tuberculosis (TB) was reported among students at a senior high school in Luoning, China. The outbreak encompassed a total of 23 cases along with TB screening in the whole school by means of PPD and chest X-ray. By the end of September 2018, the entire 9 cases cultured positive had epidemiological association. All of the 9 Mycobacterium tuberculosis (Mtb) isolates available were sensitive to all drugs tested and had similar spoligotyping and 15 loci mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) profile. Whole-genome sequencing (WGS) of the Mtb isolates revealed 20 variable nucleotide positions within 8 cases, indicating a clonal outbreak. The index case, which was first identified and diagnosed, is separated from the cluster by a minimum number of 95 distinct SNPs. Minimum distance spanning tree (MST) indicted that the 8 cases were indeed part of a single transmission chain. It was concluded that this is an epidemic situation of TB outbreak exposed by the aggrieved index case at school, which was caused by the veiled infectious case wherein a student was suffering from TB and attending school simultaneously., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Li, Liu, Liang, Liu, Zhao, Shi, Zhao, Ou and Zhang.)

Background: Squamous cell carcinoma (SCC) of the lip removed by surgery may cause lip dysfunction and scar. ALA-PDT (5-Aminolevulinic acid photodynamic therapy) is a minimally invasive treatment for superficial SCC in situ. However, few studies reported the use of topical ALA-PDT to manage lip SCC., Methods: Between 2015 and 2017, 6 patients with Tis to T2 lip squamous cell carcinoma without evidence of lymph node spread, were treated with topical ALA-PDT at Shanghai Skin Disease Hospital. Clinical responses and side effect were evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST) at 1 month, 6 months, 12 months and 24 months after ALA-PDT., Results: All of the 6 patients achieved complete response (CR) by 2-7 sessions of ALA-PDT. There was no relapse during 24 months follow up for 4 patients. Two out of 6 patients relapsed at 10 months and 20 months post PDT but achieved CR again by 1-3 more sessions of PDT. There was no functional or aesthetic problem., Conclusion: Topical 5-Aminolevulinic acid photodynamic could be considered a potential alternative therapeutic option for early-stage lip squamous cell carcinoma without lymph node spread., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: In 2005, China established an internet-based Tuberculosis Information Management System (TBIMS) to monitor changes in tuberculosis (TB). Many scholars have conducted epidemiological research using TBIMS; however, few studies assessing control strategies have been performed based on this platform data. Henan province is a high TB incidence area in China where, in addition to following the nationwide TB strategies, a series of local intervention combinations have been implemented., Objective: Our study aims to evaluate the impact of nationwide TB intervention combinations on epidemiological changes and determine whether Henan province can achieve the World Health Organization's (WHO) goal of reducing TB incidence by 50% and TB mortality by 75% by the year 2025., Methods: We used descriptive statistical methods to show the spatial and temporal distribution of pulmonary tuberculosis (PTB) reported to the TBIMS database from 2005 to 2018, and logistic regression analysis was performed to identify the risk factors of bacteriological-positive TB. The dynamic compartmental model and Bayesian melding approach was adopted to estimate the burden of TB under the impact of different TB control policies., Results: In total, 976,526 PTB cases were notified to the TBIMS in Henan in a period of 14 years. Although the overall incidence of PTB declined from 91.4/10 5 to 58.5/10 5 , and the overall incidence of bacteriological-positive PTB declined from 44.5/10 5 to 14.7/10 5 , the WHO's 2025 goal could not be met. The distribution of high incidence and poverty-stricken counties were basically overlapped. Men, farmers and herdsmen (in rural areas), and subjects aged ≥60 years were more likely to develop bacteriological-positive PTB. The increasing treatment success for drug-susceptible tuberculosis and multidrug-resistant tuberculosis has not provided the desired reduction in incidence and mortality., Conclusions: To achieve the targeted goal, while improving the cure rate of TB, new active (rather than passive) detection and intervention strategies should be formulated based on epidemiological characteristics in Henan province., (©Hui Jiang, Guolong Zhang, Jinfeng Yin, Dongyang Zhao, Fangchao Liu, Yuxia Yao, Chao Cai, Jiying Xu, Xinwei Li, Wangli Xu, Weimin Li. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 22.01.2021.)

Background: 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) is a reliable treatment for actinic keratosis (AK), though the concentration of 20 % is applied in most ALA-PDT for the treatment of AK, it was found that 10 % ALA could achieve similar outcome during clinical practice. However, there are limited number of reports comparing the efficacy and the safety of ALA-PDT with different ALA doses when treating AK., Objectives: This study was designed to compare the efficacy, the adverse effects and the costs of 10 % and 20 % ALA-PDT for AK treatment., Methods: We reviewed the records of patients who had received ALA-PDT in our department between January 1, 2012, and April 30, 2017, the efficacy, the adverse effects were recorded, and the costs were analyzed. Follow-up data were collected until April 30, 2018., Results: A total of 59 AK patients' records were analyzed for the efficacy, the adverse events, the recurrence and the costs. All the AK lesions were tapped with plum-blossom needle as a pre-treatment before receiving ALA-PDT. There was no statistical difference between 10 % ALA-PDT and 20 % ALA-PDT in terms of efficacy and adverse events. In the 10 % ALA group, there was one recurrence out of 34 patients and in the 20 % group there were none. The average treatment cost of each lesion was significantly lower in 10 % ALA group than in 20 % ALA group., Conclusions: 10 % ALA-PDT has similar efficacy and adverse effects as 20 % ALA-PDT with lower costs. Taken together, this supports the use of 10 % ALA-PDT in clinical practice., (Copyright © 2019. Published by Elsevier B.V.)

Background: Photodynamic therapy (PDT) is an effective and safe treatment modality for acne vulgaris, and a variety of light sources have been investigated. Sunlight has been used as a PDT light source in a limited number of acne studies . However, to date, a comparative study of conventional PDT (C-PDT) and daylight PDT (DL-PDT) on acne is still lacking., Objectives: This study aims to assess the efficacy and safety of DL-PDT vs. C-PDT in the treatment of acne vulgaris., Methods: Eighty patients with facial moderate-to-severe acne vulgaris were randomly assigned to either DL-PDT group or C-PDT group. All patients got two to three treatment sessions at two-week intervals. The lesions were photographed with VISIA digital imaging system at baseline and weeks 2, 4, and 6. Follow-up monthly for 3 months. The endpoints include efficacy (lesion response), safety (VAS pain score) and patient satisfaction., Results: A total of 77 patients completed the study. There was no statistical difference in objective response rate between DL-PDT group and C-PDT group at weeks 2, 4, and 6, respectively (40.0 %, 90.0 %, and 94.7 % vs. 45.0 %, 85.0 %, and 92.3 %, p > 0.05). The IGA score of DL-PDT group has no difference from C-PDT at baseline and at weeks 6, respectively (3.3 ± 0.4, 1.5 ± 0.7 vs. 3.4 ± 0.5, 1.6 ± 0.7, p > 0.05). The VAS pain score of DL-PDT group was lower than that of C-PDT group (1.8 ± 0.2, vs. 5.8 ± 0.3, p < 0.05). Adverse reactions such as mild burning sensation, erythema, dryness, crusting, scales and hyperpigmentation were all tolerated. Patient satisfaction was similar between the two groups (p > 0.05)., Conclusions: DL-PDT is an effective and well-tolerated regimen for moderate-to-severe acne vulgaris compared with C-PDT., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Tuberculosis (TB) is a chronic inflammatory disease caused by Mycobacterium tuberculosis infection which causes tremendous morbidity and mortality worldwide. Clinical presentation of TB patients is very diverse and disease heterogeneity is associated with changes in biomarker signatures. Here, we compared at the molecular level the extent of individual inflammatory perturbation of plasma protein and lipid mediators associated with TB in patients in China versus India. We performed a cross-sectional study analyzing the overall degree of inflammatory perturbation in treatment-naïve pulmonary TB patients and uninfected individuals from India (TB: n = 97, healthy: n = 20) and China (TB: n = 100, healthy: n = 11). We employed the molecular degree of perturbation (MDP) adapted to plasma biomarkers to examine the overall changes in inflammation between these countries. M. tuberculosis infection caused a significant degree of molecular perturbation in patients from both countries, with higher perturbation detected in India. Interestingly, there were differences in biomarker perturbation patterns and the overall degree of inflammation. Patients with severe TB exhibited increased MDP values and Indian patients with this condition exhibited even higher degree of perturbation compared to Chinese patients. Network analyses identified IFN-α, IFN-β, IL-1RI and TNF-α as combined biomarkers that account for the overall molecular perturbation in the entire study population. Our results delineate the magnitude of the systemic inflammatory perturbation in pulmonary TB and reveal qualitative changes in inflammatory profiles between two countries with high disease prevalence.

Background: Conventional photodynamic therapy (C-PDT) is an effective treatment for actinic keratoses (AKs) in Asia, with some unmet needs. Severe PDT-associated pain results in low treatment willingness. Daylight photodynamic therapy (DL-PDT) is a more simple and tolerable treatment that has the same efficacy as C-PDT in Europe. However, few studies have been conducted with Asian patients., Objective: To evaluate the efficacy and safety of DL-PDT vs. C-PDT for treating AK patients in China., Methods: This randomized and prospective study was conducted in Shanghai, China. Sixty patients with AKs (grades I-III) were randomized into two groups (DL-PDT and C-PDT). PDT was performed once every two weeks for a total of three times. Patients were evaluated before each treatment (baseline and two weeks after the first and second treatment) and at one month after the third treatment. Endpoints included efficacy (lesion response) and safety (pain scale and adverse events)., Results: A total of 55 patients completed the study. At the first month after 3 sessions of PDT, the overall lesion clearance rate of DL-PDT (95.5%) was similar to that of C-PDT (96.8%). However, in some particular parts (eyebrow and sideburns), C-PDT resulted in higher rates of cured lesions than DL-PDT. Additionally, patients undergoing DL-PDT had nearly no pain, showing significantly lower pain scores than those undergoing C-PDT (1.7 ± 0.9 for DL-PDT vs. 5.2 ± 1.7 for C-PDT). Moreover, fewer subjects undergoing DL-PDT had related adverse events than those undergoing C-PDT (36.7% vs. 63.3%)., Conclusion: DL-PDT was effective, better tolerated and nearly painless compared with C-PDT in AK patients in China., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Nagashima-type palmoplantar keratosis (NPPK) is an autosomal recessive form of palmoplantar keratoderma (PPK), which is caused by mutations in the SERPINB7 gene. NPPK has only been reported in Japanese and Chinese populations. The present study was conducted on 12 unrelated Chinese patients who were clinically predicted to suffer from NPPK. Mutation screening was performed by direct sequencing of the entire coding regions of SERPINB7, SLURP1, AQP5, CSTA, KRT1 and KRT9 genes. Direct sequencing of SERPINB7 revealed five homozygous founder mutations (c.796C>T) and four compound heterozygous mutations in nine patients, including one novel mutation (c.122&#95;127delTGGTCC). Nine out of the 12 patients were diagnosed with NPPK due to SERPINB7 pathogenic mutations, and the results expanded the known mutation spectrum of NPPK. Taking the other seven reported Chinese patients, who had been definitively diagnosed with NPPK by genetic testing, into account, the present study further demonstrated that NPPK is a common entity in Mainland China, and c.796C>T is the most prevalent mutation and exerts a founder effect. Furthermore, the NPPK cases described in the current study presented a consistently mild phenotype, as compared with the degrees of phenotypic variability associated with other types of relatively severe PPK, including Mal de Meleda and Olmsted syndrome.

Neurofibromatosis type 1 (NF1) is a hereditary disorder caused by mutations in the NF1 gene. Detecting mutation in NF1 is hindered by the gene's large size, the lack of mutation hotspots, and the presence of pseudogenes.Our goal was to establish a sensitive, feasible, and comparatively economical protocol to detect NF1 mutations using blood samples.We developed a method to screen patients for mutations. Thirty-two NF1 patients from 32 unrelated families and 120 unrelated population-match controls were investigated in this study. Specific primers were designed for NF1 to avoid pseudogenes. NF1 mutations were detected by sequencing at the deoxyribonucleic acid (DNA) and complementary DNA (cDNA) levels, and multiplex ligation-dependent probe amplification (MLPA) and familial segregation analyses were used.Forty-four specific primers designed according to the NF1 structure were successfully used for polymerase chain reaction (PCR) and DNA sequencing, which was more feasible and useful than cDNA sequencing. Thirty distinct NF1 mutations were identified in 32 patients. Thirteen mutations were novel and most were frameshift mutations (33.3%). Mutations were detected at a rate of 93.8%.Our study suggests that this sensitive, feasible, and comparatively economical protocol is effective for the detection of NF1 mutations., Competing Interests: The authors have no conflicts of interest to disclose.

Background: Dyschromatosis symmetrica hereditaria (DSH) is a rare autosomal dominant cutaneous disorder caused by the mutations of adenosine deaminase acting on RNA1 (ADAR1) gene. We present a clinical and genetic study of seven unrelated families and two sporadic cases with DSH for mutations in the full coding sequence of ADAR1 gene., Methods: ADAR1 gene was sequenced in seven unrelated families and two sporadic cases with DSH and 120 controls. Functional significance of the observed ADAR1 mutations was analyzed using PolyPhen 2, SIFT and DDIG-in., Results: We describe six novel mutations of the ADAR1 gene in Chinese patients with DSH including a nonstop mutation p.Stop1227R, which was firstly reported in ADAR1 gene. In silico analysis proves that all the mutations reported here are pathogenic., Conclusion: This study is useful for functional studies of the protein and to define a diagnostic strategy for mutation screening of the ADAR1 gene. A three-generation family exhibiting phenotypic variability with a single germline ADAR1 mutation suggests that chilblain might aggravate the clinical phenotypes of DSH.

Objective: To detect FLG gene mutations in 10 families affected with ichthyosis vulgaris and to explore mutational hot spot of the FLG gene in Chinese Han population., Methods: PCR and direct sequencing were carried out to identify potential mutations of the FLG gene in above families. One hundred healthy individuals were analyzed as normal controls., Results: Three mutations (3321delA, 5757delCCAG and S2706X) were identified in 7 families. A homozygous mutation 3321delA was also detected in two unrelated patients. No mutations were found in the remaining three families. Neither of the null mutations (5757delCCAG and S2706X) was found in the 100 controls. However, for 3321delA, a heterozygous mutation was also found in two of the controls., Conclusion: Three FLG mutations have been identified in the selected families with ichthyosis vulgaris, and the 3321delA mutation was most prevalent (46.9%). Mutations 5757delCCAG and S2706X were first found in patients with ichthyosis vulgaris. Other candidate genes may underlie the disease in those without a FLG mutation.

Encephalomyocarditis virus (EMCV) can infect many host species and cause acute myocarditis and sudden death in preweaned piglets. In this study, an EMCV strain (NJ08) was isolated from newborn pigs with clinical signs on a pig farm in mideastern China. It was identified by indirect immunofluorescence assay and reverse-transcription polymerase chain reaction. Experiments showed that the isolate could cause severe clinical symptoms and pathological changes in mice but no obvious clinical and pathological changes in commercial piglets. Complete genomic sequencing showed that the NJ08 strain was 78.3% to 100% identical with other isolates in regions coding for various proteins. Phylogenetic analysis showed that the NJ08 isolate belonged to subgroup Ia. This study confirmed that an EMCV isolate from pigs could be fatal to mice and provided new epidemiologic data on EMCV in China.

Seventy-four Mycobacterium tuberculosis clinical isolates from China were subjected to drug susceptibility testing using ethambutol, isoniazid, rifampin, and ofloxacin. The results revealed that the presence of embB mutations did not correlate with ethambutol resistance but was associated with multiple-drug resistance, especially resistance to both ethambutol and rifampin.

Background: There is little reliable data on the global drug resistance to tuberculosis (TB) as most of the existing data is based upon biased samples, is not standardized or was obtained using poor techniques. For this reason, the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD) developed a global project on anti-TB drug resistance surveillance (DRS) in 1994. China joined this project in 1995 and the province of Henan was selected as the first site for collection of representative samples to survey the prevalence of drug-resistant TB., Methodology: Standard drug susceptibility testing by the proportion method against streptomycin (S), isoniazid (H), rifampicin (R), and ethambutol (E) was performed with Mycobacterium tuberculosis isolated from 916 new cases and 456 previously treated cases. Treatment outcome of these patients has been evaluated according to the regimens and drug susceptibility patterns., Results: Drug resistance among new cases to any drug was found to be 43.0% and any resistance: S, 32.5%; H, 31.0%; R, 20.7%; and E, 10.3%. Drug resistance among previously treated cases to any drug was 68.2% and any resistance: S, 52.2%; H, 49.3%; R, 48.3%; and E, 20.4%. The cure rate for new cases was 43.3% and 29.4% for previously treated cases. The poor cure rate resulted mainly from a high defaulter rate., Conclusion: Drug-resistant TB was found to be highly prevalent in Henan and the cure rate remained poor. The results strongly indicated that Henan should take immediate action to improve the cure rate of patients through expansion of the introduction of the directly observed treatment short-course strategy.