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Background: Pathologic complete response (pCR) following preoperative systemic therapy is associated with improved outcomes after subsequent liver transplant/resection in hepatocellular carcinoma (HCC). However, the relationship between radiographic and histopathological response remains unclear. Methods: We retrospectively examined patients with initially unresectable HCC who received tyrosine kinase inhibitor (TKI) plus anti–programmed death 1 (PD-1) therapy before undergoing liver resection between March 2019 and September 2021 across 7 hospitals in China. Radiographic response was evaluated using mRECIST. A pCR was defined as no viable tumor cells in resected samples. Results: We included 35 eligible patients, of whom 15 (42.9%) achieved pCR after systemic therapy. After a median follow-up of 13.2 months, tumors recurred in 8 non-pCR and 1 pCR patient. Before resection, there were 6 complete responses, 24 partial responses, 4 stable disease cases, and 1 progressive disease case, per mRECIST. Predicting pCR by radiographic response yielded an area under the receiver operating characteristic curve (AUC) of 0.727 (95% CI: 0.558–0.902), with an optimal cutoff value of 80% reduction in the enhanced area in MRI (called major radiographic response), which had a 66.7% sensitivity, 85.0% specificity, and a 77.1% diagnostic accuracy. When radiographic response was combined with α-fetoprotein response, the AUC was 0.926 (95% CI: 0.785–0.999); the optimal cutoff value was 0.446, which had a 91.7% sensitivity, 84.6%, specificity, and an 88.0% diagnostic accuracy. Conclusions: In patients with unresectable HCC receiving combined TKI/anti–PD 1 therapy, major radiographic response alone or combined with α-fetoprotein response may predict pCR. [ABSTRACT FROM AUTHOR]

Commercial diesel consists of hundreds of hydrocarbons such as alkanes, cycloalkanes, and aromatics. The components of the fuel's composition are what determine its physical and ignition properties, and their variations affect engine performance. In this study, n-heptane, n-dodecane, tetralin, and decalin were chosen as typical additives to blend with commercial diesel according to the China VI standard (Heavy Duty Diesel Vehicle Pollutant Emission Limits and Measurement Methods) in 20% and 50% volume fractions, respectively. The physical properties of the fuel blends, such as viscosity, density, cetane number (CN), and distillation range, were measured first. Then, the commercial diesel's lower heat value was measured, and blended fuels were calculated accordingly. The CN of the blended fuel is tested by an Ignition Quality Tester (IQT), which is known as the derived cetane number (DCN). The results show that adding n-dodecane increases the value of DCN, while tetralin reduces the DCN, and n-heptane and decalin have negative effects. This study uses a type of WP12 diesel engine made by Weichai that meets China's emission regulation 6. During the tests, the fuel injection strategy was kept as a pure diesel operation without any modifications. Compared with pure diesel operation, the bench test results show the following characteristics: the maximum torque output increased with increased decalin, followed by tetralin and n-dodecane, while n-heptane has a side effect compared to pure diesel operation. The addition of n-dodecane and n-heptane can reduce fuel consumption, while tetralin will increase it, and decalin has no obvious effect on fuel consumption. It was found that n-heptane increases HC and NOx emissions significantly. Furthermore, n-dodecane slightly increases CO, HC and NOx emissions. Decalin increases CO and HC emissions when mixed in a large proportion. In addition, tetralin causes a substantial increase in HC, CO and NOx emissions at medium and high loads. [ABSTRACT FROM AUTHOR]

Background and Aim: Nasopharyngeal carcinoma (NPC) is one of the most common cancers in Southern China, Southeast Asia. Radiotherapy is the main treatment for NPC. Still, about 20% of patients with NPC have a recurrence. No effective serum biomarkers are available for recurrent nasopharyngeal carcinoma (rNPC) to date. This study aimed to explore whether amyloid beta (A4) precursor protein (APP) might serve as a valuable diagnostic and prognostic biomarker for patients with rNPC. Methods: In a previous study, a tandem mass tag–based proteomic test was performed, which screened 59 differentially expressed proteins (DEPs) between nonrecurrent nasopharyngeal carcinoma (nrNPC) and rNPC. In this study, a protein–protein interaction was conducted to screen the key proteins among the 59 DEPs. APP was validated and evaluated by enzyme-linked immunosorbent assay in 70 serum samples [recurrence (n = 35) and no-recurrence (n = 35)]. Also, the receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of APP. Results: The area under the ROC curve was 0.666 (95% CI: 0.514–0.818, P = 0.044). The best cutoff point of the relative expression levels for APP was 1.23 (concentration = 16.95 ng/mL), at which the sensitivity was 55.2% and the specificity was 90.9%. Conclusion: The findings indicated that APP might be a valuable diagnostic and prognostic biomarker for patients with rNPC. [ABSTRACT FROM AUTHOR]

Abstract: This study aims to estimate the three greenhouse gas (GHG) emissions (i.e. CO2, CH4, N2O) from a vertical subsurface flow constructed wetland (VSSF CW, 1000m2) and a cluster of conventional wastewater treatment plants (WWTPs) in the city of Changzhou, China. The two estimated emissions are set up for comparison. The results show that the WWTP system emits 7.3kg CO2-eq to remove 1kg BOD in the studied life cycle, while the VSSF system only emits 3.18kg CO2-eq, which is only half of the amount given off by the WWTP system. Especially at the treatment stage, the WWTP system''s GHG emissions are almost 7 times higher than the VSSF system''s. N2O emissions in both systems are only a minor fraction of the total emissions. Therefore, this study has concluded that the VSSF system is an effective option for GHG emissions mitigation in the wastewater sector. The study further suggests that developing countries like China should extensively build up VSSF systems for decentralized wastewater treatment, which could also potentially reduce GHG emissions by 8–17 million ton CO2-eq per year compared with the centralized scenario. [Copyright &y& Elsevier]

Anti-PD-1 therapy and chemotherapy is a recommended first-line treatment for recurrent or metastatic nasopharyngeal carcinoma, but the role of PD-1 blockade remains unknown in patients with locoregionally advanced nasopharyngeal carcinoma. We assessed the addition of sintilimab, a PD-1 inhibitor, to standard chemoradiotherapy in this patient population. This multicentre, open-label, parallel-group, randomised, controlled, phase 3 trial was conducted at nine hospitals in China. Adults aged 18–65 years with newly diagnosed high-risk non-metastatic stage III–IVa locoregionally advanced nasopharyngeal carcinoma (excluding T3–4N0 and T3N1) were eligible. Patients were randomly assigned (1:1) using blocks of four to receive gemcitabine and cisplatin induction chemotherapy followed by concurrent cisplatin radiotherapy (standard therapy group) or standard therapy with 200 mg sintilimab intravenously once every 3 weeks for 12 cycles (comprising three induction, three concurrent, and six adjuvant cycles to radiotherapy; sintilimab group). The primary endpoint was event-free survival from randomisation to disease recurrence (locoregional or distant) or death from any cause in the intention-to-treat population. Secondary endpoints included adverse events. This trial is registered with ClinicalTrials.gov (NCT03700476) and is now completed; follow-up is ongoing. Between Dec 21, 2018, and March 31, 2020, 425 patients were enrolled and randomly assigned to the sintilimab (n=210) or standard therapy groups (n=215). At median follow-up of 41·9 months (IQR 38·0–44·8; 389 alive at primary data cutoff [Feb 28, 2023] and 366 [94%] had at least 36 months of follow-up), event-free survival was higher in the sintilimab group compared with the standard therapy group (36-month rates 86% [95% CI 81–90] vs 76% [70–81]; stratified hazard ratio 0·59 [0·38–0·92]; p=0·019). Grade 3–4 adverse events occurred in 155 (74%) in the sintilimab group versus 140 (65%) in the standard therapy group, with the most common being stomatitis (68 [33%] vs 64 [30%]), leukopenia (54 [26%] vs 48 [22%]), and neutropenia (50 [24%] vs 46 [21%]). Two (1%) patients died in the sintilimab group (both considered to be immune-related) and one (<1%) in the standard therapy group. Grade 3–4 immune-related adverse events occurred in 20 (10%) patients in the sintilimab group. Addition of sintilimab to chemoradiotherapy improved event-free survival, albeit with higher but manageable adverse events. Longer follow-up is necessary to determine whether this regimen can be considered as the standard of care for patients with high-risk locoregionally advanced nasopharyngeal carcinoma. National Natural Science Foundation of China, Key-Area Research and Development Program of Guangdong Province, Natural Science Foundation of Guangdong Province, Overseas Expertise Introduction Project for Discipline Innovation, Guangzhou Municipal Health Commission, and Cancer Innovative Research Program of Sun Yat-sen University Cancer Center. For the Chinese translation of the abstract see Supplementary Materials section. [ABSTRACT FROM AUTHOR]

Background: Patients with locoregionally advanced nasopharyngeal carcinoma have a high risk of disease relapse, despite a high proportion of patients attaining complete clinical remission after receiving standard-of-care treatment (ie, definitive concurrent chemoradiotherapy with or without induction chemotherapy). Additional adjuvant therapies are needed to further reduce the risk of recurrence and death. However, the benefit of adjuvant chemotherapy for nasopharyngeal carcinoma remains controversial, highlighting the need for more effective adjuvant treatment options.Methods: This multicentre, open-label, parallel-group, randomised, controlled, phase 3 trial was done at 14 hospitals in China. Patients (aged 18-65 years) with histologically confirmed, high-risk locoregionally advanced nasopharyngeal carcinoma (stage III-IVA, excluding T3-4N0 and T3N1 disease), no locoregional disease or distant metastasis after definitive chemoradiotherapy, an Eastern Cooperative Oncology Group performance status of 0 or 1, sufficient haematological, renal, and hepatic function, and who had received their final radiotherapy dose 12-16 weeks before randomisation, were randomly assigned (1:1) to receive either oral metronomic capecitabine (650 mg/m2 body surface area twice daily for 1 year; metronomic capecitabine group) or observation (standard therapy group). Randomisation was done with a computer-generated sequence (block size of four), stratified by trial centre and receipt of induction chemotherapy (yes or no). The primary endpoint was failure-free survival, defined as the time from randomisation to disease recurrence (distant metastasis or locoregional recurrence) or death due to any cause, in the intention-to-treat population. Safety was assessed in all patients who received at least one dose of capecitabine or who had commenced observation. This trial is registered with ClinicalTrials.gov, NCT02958111.Findings: Between Jan 25, 2017, and Oct 25, 2018, 675 patients were screened, of whom 406 were enrolled and randomly assigned to the metronomic capecitabine group (n=204) or to the standard therapy group (n=202). After a median follow-up of 38 months (IQR 33-42), there were 29 (14%) events of recurrence or death in the metronomic capecitabine group and 53 (26%) events of recurrence or death in the standard therapy group. Failure-free survival at 3 years was significantly higher in the metronomic capecitabine group (85·3% [95% CI 80·4-90·6]) than in the standard therapy group (75·7% [69·9-81·9]), with a stratified hazard ratio of 0·50 (95% CI 0·32-0·79; p=0·0023). Grade 3 adverse events were reported in 35 (17%) of 201 patients in the metronomic capecitabine group and in 11 (6%) of 200 patients in the standard therapy group; hand-foot syndrome was the most common adverse event related to capecitabine (18 [9%] patients had grade 3 hand-foot syndrome). One (<1%) patient in the metronomic capecitabine group had grade 4 neutropenia. No treatment-related deaths were reported in either group.Interpretation: The addition of metronomic adjuvant capecitabine to chemoradiotherapy significantly improved failure-free survival in patients with high-risk locoregionally advanced nasopharyngeal carcinoma, with a manageable safety profile. These results support a potential role for metronomic chemotherapy as an adjuvant therapy in the treatment of nasopharyngeal carcinoma.Funding: The National Natural Science Foundation of China, the Key-Area Research and Development Program of Guangdong Province, the Natural Science Foundation of Guangdong Province, the Innovation Team Development Plan of the Ministry of Education, and the Overseas Expertise Introduction Project for Discipline Innovation.Translation: For the Chinese translation of the abstract see Supplementary Materials section. [ABSTRACT FROM AUTHOR]

Abstract: This study develops a theoretical framework of green consumer behavior to determine the effects of personal influence, knowledge of green consumption, attitudes toward green consumption, internal and external moderators and examines whether these effects differ significantly among purchasing, using and recycling behaviors. Correlation analysis and multiple regression are applied to assess data collected by a questionnaire survey. The results indicate that attitudes are the most significant predictor of purchasing behavior. Using behavior is mainly determined by income, perceived consumer effectiveness and age, while recycling behavior is strongly influenced by using behavior. These findings have policy implications and improve understanding of green consumer behavior in China. [Copyright &y& Elsevier]

China has been undergoing rapid economic growth since its reform and opening-up at the expense of resource depletion and environmental pollution. We estimated the monetary costs of resource depletion and environmental pollution in China over the past 14 recent years by establishing integrated mathematical models with System for Integrated Environmental and Economic Accounting (SEEA) framework. Results showed four points. Firstly, the total temporal costs of natural resource depletion and environmental pollution witnessed an inverted 'U' shape pattern with the turning point in 2012. The relationship between cost of mineral resource depletion, as well as water pollution cost, and per capita GDP were found to follow the Inverted-U shape environmental Kuznets curve (EKC). Secondly, the average annual share of natural resources of the total costs was more than 80%, indicating that the rapid economic growth of China is highly dependent on resource depletion. Thirdly, Although China still has the highest worldwide in its total energy consumption and CO 2 emission, China's struggles with adjustment of industrial & energy consumption structure, and pollution controls have resulted in a general temporal decline of the share of resource and environmental costs to China's GDP. The green GDP of China is growing at an average rate of 14.76%. Finally, although in the process of manufactured goods for the whole world, China has reduced environmental pollution and left it at home as much as possible. Driving forces behind the progress in green GDP of China were analyzed by using Differences-in-Differences method and Spearman rank correlation analysis. [Display omitted] • An integrated model was proposed to calculate China's costs of resources and environment. • Total costs of resource depletion and environment witnessed an inverted 'U' shape. • Driving forces behind decreasing trend of green GDP in China were analyzed. [ABSTRACT FROM AUTHOR]

Background: For decades, stratification criteria for first-line clinical studies have been highly uniform. However, there is no principle or consensus for restratification after systemic treatment progression based on immune checkpoint inhibitors (ICIs). The aim of this study was to assess the patterns of disease progression in patients with advanced hepatocellular carcinoma (HCC) who are not eligible for surgical intervention, following the use of immune checkpoint inhibitors., Methods: This is a retrospective study that involved patients with inoperable China liver stage (CNLC) IIIa and/or IIIb. The patients were treated at eight centers across China between January 2017 and October 2022. All patients received at least two cycles of first-line treatment containing immune checkpoint inhibitors. The patterns of disease progression were assessed using RECIST criteria 1.1. Different progression modes have been identified based on the characteristics of imaging progress. The study's main outcome measures were post-progression survival (PPS) and overall survival (OS). Survival curves were plotted using the Kaplan-Meier method to compare the difference among the four groups. Subgroup analysis was conducted to compare the efficacy of different immunotherapy combinations. Variations in the efficacy of immunotherapy have also been noted across patient groups exhibiting alpha-fetoprotein (AFP) levels equal to or exceeding 400ng/mL, in contrast to those with AFP levels below 400ng/mL., Results: The study has identified four distinct patterns of progress, namely p-IIb, p-IIIa, p-IIIb, and p-IIIc. Diverse patterns of progress demonstrate notable variations in both PPS and OS. The group p-IIb had the longest PPS of 12.7m (95% 9.3-16.1) and OS 19.6m (95% 15.6-23.5), the remaining groups exhibited p-IIIb at PPS 10.5 months (95%CI: 7.9-13.1) and OS 19.2 months (95%CI 15.1-23.3). Similarly, p-IIIc at PPS 5.7 months (95%CI: 4.2-7.2) and OS 11.0 months (95%CI 9.0-12.9), while p-IIIa at PPS 3.4 months (95%CI: 2.7-4.1) and OS 8.2 months (95%CI 6.8-9.5) were also seen. Additional stratified analysis was conducted and showed there were no differences of immunotherapy alone or in combination in OS (HR= 0.92, 95%CI: 0.59-1.43, P=0.68) and PPS (HR= 0.88, 95%CI: 0.57-1.36, P=0.54); there was no significant difference in PPS (HR=0.79, 95% CI: 0.55-1.12, P=0.15) and OS (HR=0.86, 95% CI: 0.61-1.24, P=0.39) for patients with AFP levels at or over 400ng/mL. However, it was observed that patients with AFP levels above 400ng/mL experienced a shorter median progression of PPS (8.0 months vs. 5.0 months) after undergoing immunotherapy., Conclusion: In this investigation of advanced hepatocellular carcinoma among Chinese patients treated with immune checkpoint inhibitors, we identified four distinct progression patterns (p-IIb, p-IIIa, p-IIIb and p-IIIc) that showed significant differences in PPS and OS. These findings demonstrate the heterogeneity of disease progression and prognosis after immunotherapy failure. Further validation in large cohorts is necessary to develop prognostic models that integrate distinct progression patterns to guide subsequent treatment decisions. Additionally, post-immunotherapy progression in patients with AFP levels ≥400ng/mL indicates a shortened median PPS. These findings provide valuable insights for future personalized treatment decisions., 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 Yang, Pan, Ye, Zhu, Xue, Li, Yuan, Zhang, Xu, Chen, Wang, Sun, Liu and China Liver Cancer Study Group Young Investigators (CLEAP).)

Vehicle exhaust emissions are posing an increasingly adverse impact on urban air quality. The emission characteristics analysis and health effect assessment of specific air pollution sources can provide scientific evidence for environmental air quality management. The characteristics and health effects of PM 2.5 emissions from vehicles and economic losses caused by them in the Beijing-Tianjin-Hebei Region were analyzed from 2010 to 2020. From 2010 to 2020, PM 2.5 emissions from vehicles in the Beijing-Tianjin-Hebei Region showed an annual increase at first, followed by a slow decrease. According to the emission sharing ratios of different vehicle types, heavy-duty trucks and buses were the main contributors to PM 2.5 , with a total contribution rate of over 65.27%. The emission characteristics of vehicle pollutants varied in different cities. The contribution rate of pollutants in Beijing decreased significantly, and the emission reduction in other cities was also dramatic. The evaluation results of the impact of PM 2.5 emissions from vehicles on human health showed that the number of health endpoints in the Beijing-Tianjin-Hebei Region was on the rise. In 2020, PM 2.5 pollution caused approximately 34337 premature deaths (95% CI:9025-57209), 45500 hospitalizations (95% CI:10800-80200), 282300 outpatients (95% CI:140500-416300), and 439000 people to fall ill (95% CI:160300-679200). Beijing had the largest number of patients that presented different health endpoints. The total health and economic losses caused by PM 2.5 emissions from vehicles in 2010, 2015, and 2020 were 27.742 billion yuan (95% CI:8.616-44.643 billion yuan), 90.608 billion yuan (95% CI:28.476-144.050 billion yuan), and 129.965 billion yuan (95% CI:40.829-205.245 billion yuan), respectively. In addition, due to the differences in vehicle ownership, PM 2.5 concentrations, population, and economic losses per case of health outcome, the health effects and economic losses varied in different cities within the region. Among these cities, Beijing, Tianjin, Baoding, and Tangshan were at higher health risks and suffered more economic losses. The results of this study will help reduce the adverse effects on health and economic losses caused by pollution discharge and provide scientific evidence for environmental protection authorities to implement targeted pollution prevention and control.

Objectives: To study the features of unintentional injury in children under the impact of coronavirus disease 2019 (COVID-19)., Methods: A retrospective analysis was performed on the medical data of 2 526 children with unintentional injury in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2019 to June 2022. The study period was divided into 5 stages: before the epidemic (July to December, 2019), the Wuhan epidemic period (January to April, 2020), the epidemic remission period in China (May 2020 to February 2022), the Shanghai epidemic period (March to May, 2022), and the epidemic remission period in Shanghai (June 2022). The incidences of unintentional injury in children at different time stages and different ages were compared. A questionnaire survey was conducted on 107 children of the 2 526 children to explore the features of unintentional injury., Results: There were significant differences in gender composition, age, age distribution and proportion of many types of unintentional injuries among the five time stages ( P <0.05). There was a reduction in the number of children who attended the emergency department due to unintentional injury during the Wuhan epidemic and the Shanghai epidemic. The proportion of children with trauma-related unintentional injuries in each stage reached more than 50%, and the proportion of children with trauma-related unintentional injuries reached 63.9% and 82.0%, respectively during the Wuhan epidemic and the Shanghai epidemic. Most children suffering from unintentional injury were mainly school-aged and preschool children (1 823 children, 72.17%). Compared with the same period of Shanghai epidemic in 2021, the age of children with unintentional injury was younger (median 7 years vs 11 years), and the proportion of children with trauma-related unintentional injuries increased (97% vs 69%) during the Shanghai epidemic ( P <0.05)., Conclusions: Under the COVID-19 epidemic, there is a reduction in the number of children with unintentional injury, while there is an increase in the proportion of children with trauma-related unintentional injuries. Unintentional injury is more common among school-aged and preschool children.

Nasopharyngeal carcinoma (NPC) is a malignant epithelial tumor originating in the nasopharynx and has a high incidence in Southeast Asia and North Africa. To develop these comprehensive guidelines for the diagnosis and management of NPC, the Chinese Society of Clinical Oncology (CSCO) arranged a multi-disciplinary team comprising of experts from all sub-specialties of NPC to write, discuss, and revise the guidelines. Based on the findings of evidence-based medicine in China and abroad, domestic experts have iteratively developed these guidelines to provide proper management of NPC. Overall, the guidelines describe the screening, clinical and pathological diagnosis, staging and risk assessment, therapies, and follow-up of NPC, which aim to improve the management of NPC., (© 2021 The Authors. Cancer Communications published by John Wiley & Sons Australia, Ltd. on behalf of Sun Yat-sen University Cancer Center.)

The research on spatial pattern and optimization of regional ecological carrying capacity is especially necessary to promote the overall development of economic transformation, upgrading and ecological protection and restoration. This study chose the natural, social and economic complex ecosystem of Jiangsu coastal area as subject. The concept model of pressure-state-potential (PSP) of ecological carrying capacity was established. A total of 15 indices were used to represent the interaction of three level states. With the support of GIS and other space technologies, the magnitude, spatial variation of regional ecological carrying capacity were examined through comprehensive evaluation of multiple indices and analysis of single index. Results showed that the spatial pattern of the suitability of single factor ecological carrying capacity in Jiangsu coastal area showed a variety of trends. There were significant differences in the area, proportion and layout of the same index across different cities and counties. The spatial differentiation of pressure and state superposition index showed that low pressure suitable bearing, low pressure generally suitable bearing, low pressure unsuitable bearing, high pressure suitable bearing, high pressure generally suitable bearing, bearing high pressure unsuitable bearing area was 3971.42, 6885.21, 3705.23, 4597.03, 6853.26, and 6403.97 km 2 , accounting for 12.3%, 21.2%, 11.4%, 14.2%, 21.1% and 19.8% of the total area, respectively. The results of spatial differentiation of superposition index of state and potential showed that the area integral of low potential suitable bearing, low potential general sui-table bearing, low potential unsuitable bearing, high potential suitable bearing, high potential general sui-table bearing and high potential unsuitable bearing was 3030.79, 6545.30, 5874.31, 3253.31, 7614.38, and 6097.83 km 2 , accounting for 9.4%, 20.2%, 18.1%, 10.0%, 23.5% and 18.8% of the total area, respectively. Most areas showed distribution characteristics of low pressure bearing area corresponding to high potential bearing area and high pressure bearing area corresponding to low potential bearing area in spatial pattern. There was an interaction of mutual influence, mutual promotion and collaborative promotion between pressure and state superposition index and state and potential superposition index.

Background: The incidence of combined hepatocellular carcinoma-intrahepatic cholangiocarcinoma (cHCC-ICC) is relatively low, and the knowledge about the prognosis of cHCC-ICC remains obscure. In the study, we aimed to screen existing primary liver cancer staging systems and shed light on the prognosis and risk factors for cHCC-ICC., Methods: We retrospectively reviewed 206 cHCC-ICC patients who received curative surgical resection from April 1999 to March 2017. The correlation of survival measures with the histological types or with tumor staging systems was determined and predictive values of tumor staging systems with cHCC-ICC prognosis were compared., Results: The histological type was not associated with overall survival (OS) (P = 0.338) or disease-free survival (DFS) (P = 0.843) of patients after curative surgical resection. BCLC, TNM for HCC, and TNM for ICC stages correlated with both OS and DFS in cHCC-ICC (all P < 0.05). The predictive values of TNM for HCC and TNM for ICC stages were similar in terms of predicting postoperative OS (P = 0.798) and DFS (P = 0.191) in cHCC-ICC. TNM for HCC was superior to BCLC for predicting postoperative OS (P = 0.022) in cHCC-ICC., Conclusion: The TNM for HCC staging system should be prioritized for clinical applications in predicting cHCC-ICC prognosis., (Copyright © 2020. Published by Elsevier B.V.)

China has put forward CO 2 emissions reduction target (committing to achieve CO 2 emissions peak or plateau by 2030) to prevent global climate change. With Jiangsu Province as a case, we explored whether China could achieve the 2030 CO 2 emissions reduction target. We predicted the peak volume and time of CO 2 emission in three scenarios, i.e., quick scenario, medium scenario, slow scenario, respectively, based on the long-range energy alternatives planning system (LEAP) model and the logarithmic mean Divisia index decomposition approach. The results showed that, during the period 2000 to 2015, the economic scale effect was the most important driver, whose contribution to the increase of total CO 2 emissions was as high as 147.4%. The technology progress effect was the main mitigation factor for CO 2 emissions, which caused CO 2 emissions to decrease by 60.4%. In addition, the contributions of energy structure effect, industrial structure effect, per capita income effect and population scale effect to CO 2 emissions were -5.3%, 9.7%, 11.0%, and 0.6% respectively. In quick and medium scenarios, the peak CO 2 emissions of Jiangsu Province would be 701 million tons in 2025, and 795 million tons in 2029, respectively. In slow scenario, however, Jiangsu Province could not achieve the 2030 CO 2 emissions reduction target. To achieve the 2030 target, Jiangsu Province needs to adopt some strategies, including actively developing the tertiary industry to balance the economic structure, continuously promoting energy saving and emissions reduction technologies to reduce energy consuming intensity, and vigorously deploying clean energy to optimize the energy consuming structure.

Objective: The Prostate Cancer Prevention Trial risk calculator (PCPT-RC) is an online tool for assessing the risk of prostate cancer (PCa) based on age, race, serum PSA, biopsy history, family history, and other factors. This study aimed to investigate the value, sensitivity and specificity of the PCPT-RC 2.0 in assessing the risk of PCa in the Chinese high-risk population., Methods: This study included 622 patients with the high risk of PCa characterized by high serum PSA (PSA >3 μg/L) or abnormality in digital rectal examination or imaging of the prostate. According to the results of prostate biopsy, we divided the patients into a PCa and a non-PCa group and used the PCPT-RC 2.0 for evaluation of all the cases followed by statistical analysis., Results: PCa was detected in 264 (42.4%) of the 622 patients, including 126 cases of high-grade malignancy. Compared with the non-PCa group, the PCa patients showed a significantly older age (［68.40 ± 7.30］ vs ［72.80 ± 7.20］ yr, P <0.001), higher serum PSA level (［11.20 ± 7.76］ vs ［15.06 ± 10.65］, P <0.001), and higher PCPT risk score (［37.0 ± 10.8］% vs ［44.4 ± 12.6］%, P <0.001). The PCPT risk score exhibited a greater area under the ROC curve than the level of serum PSA in evaluating the risk of PCa (0.67 vs 0.61, P <0.05), but no statistically significant difference between the two in predicting the risk of high-grade malignancy (0.67 vs 0.66, P >0.05)., Conclusions: The PCPT risk score is valuable in predicting the risk of PCa in China, which may play a better role than the serum PSA level in screening PCa and avoid unnecessary prostate biopsy, though its advantage is not so obvious in identifying high-grade malignancy. A prediction tool needs to be established for evaluating the risk of PCa in the Chinese population.

Objective: The aim of this study was to compare the 2008 Chinese and the 7th edition of the American Joint Committee on Cancer (AJCC) staging systems for nasopharyngeal carcinoma and to provide proposals for updating T and N staging systems of the present staging system., Methods: Between January 2007 and December 2012, a cohort of 752 patients with biopsy-proven, newly diagnosed, non-metastatic nasopharyngeal carcinoma who were treated with intensity-modulated radiotherapy were retrospectively analysed. Prognoses were compared by T stage, N stage, and clinical stage according to the two staging systems for overall survival (OS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS)., Results: In terms of both the T and N staging systems, the two current staging systems were comparable in predicting OS. The T classification of the 2008 Chinese staging system was better in predicting LRFS, while the N classification of the 7th edition AJCC staging system was superior in predicting DMFS. In the modern era of intensity-modulated radiotherapy, the staging system should be updated by down-staging the current stage T2 to T1, and it might be rational to merge subcategories N1 and N2., Conclusions: The two current staging systems each had advantages in predicting prognosis. It seems reasonable to downstage T2 to T1 and to merge N1 and N2., Competing Interests: The authors have declared that no competing interests exist.

The prostate stem cell antigen (PSCA) gene, which encodes a prostate-specific antigen (PSA), was identified as a gene involved in cell adhesion and proliferation. The associations between the PSCA rs2294008 and rs2976392 single nucleotide polymorphisms (SNPs) and gastric cancer (GCa) susceptibility were still controversial. To derive a more precise estimation of the associations, we conducted a case-control study of 1,124 cases and 1,192 controls in an eastern Chinese population. We found that the rs2294008T variant genotypes were associated with an increased GCa risk in this study population (CT vs CC, OR=1.59, 95% CI=1.33-1.89 and CT+TT vs CC, OR=1.38, 95% CI=1.17-1.62). For SNP rs2976392, the variant A genotypes were also associated with an increased GCa risk (AG vs GG, OR=1.61, 95% CI=1.35-1.91 and AG+AA vs GG, OR=1.47, 95% CI=1.25-1.74). The results were further validated by a meta-analysis. In conclusion, the results indicated that the PSCA rs2294008 T and rs2976392 A alleles were low-penetrate risk factors for GCa in this study population. However, large and well-designed studies are warranted to validate our findings.

Objective: The aim of this study was to prospectively evaluate the cognitive function, depression, anxiety, and sleep quality in patients with nasopharyngeal cancer (NPC) before and after intensity-modulated radiotherapy (IMRT)., Methods: Eligible patients with newly diagnosed NPC treated with primary IMRT were recruited. A series of neuropsychological tests were performed within 1 week before and after IMRT. Cognitive function was measured with the Das-Naglieri cognitive assessment system. The Self-rating Anxiety Scale and Self-rating Depression Scale were used to assess mood states. Sleep quality was evaluated by means of the Pittsburgh Sleep Quality Index., Results: A total of 51 patients were enrolled. The overall prevalence of depression, anxiety, and poor sleep quality showed a significant increase after RT, compared with their pre-RT levels (39.2% vs. 3.9%, p = 0.000; 19.6% vs. 3.9%, p = 0.039; 64.7% vs. 37.3%, p = 0.003, respectively). Multiple linear regression analysis revealed that pre-RT depression and younger age and pre-RT anxiety and younger age were significant predictors of post-RT depression and anxiety, respectively (p < 0.05). Poor sleep quality before treatment was also associated with poor sleep after RT (p = 0.032). However, the cognitive function evaluated by the cognitive assessment system from pre-RT was similar to the post-RT results., Conclusions: Exposure to ionizing radiation for the treatment of NPC decreased mood and sleep quality following IMRT, especially for patients with depression, anxiety, younger age, or poor sleep before treatment. No acute cognitive deficits were found resulting from IMRT, but the long-term effects of RT might still warrant concern., (Copyright © 2014 John Wiley & Sons, Ltd.)

This paper first applied material flow analysis (MFA) to construct three levels of regional eco-efficiency indicators, i.e., regional direct eco-efficiency (RDE), regional total eco-efficiency (RTE), and holistic eco-efficiency (HE), and adopted the newly developed data envelopment analysis (DEA) to evaluate the eco-efficiency of Tongling City during the period of 1990-2008. We also applied Malmquist productivity index (MPI) to explore the eco-efficiency change between two following years and its driving factors. The main results were summarized as 1) though the RDE of Tongling City in 1990-2008 kept an increasing trend, its mean eco-efficiency was not high (close to 0.8 in 80% of the years), being lower than that of the RTE and HE, and 2) the RDE change was closely relevant to the improvement in resource management and the technical input in environmental protection in recent years. In order to further improve the RDE of the City, it would be necessary to raise its eco-efficiency via expanding raw material input, reducing domestic extraction, promoting resources productivity, and taking more measures on environmental protection facilities construction.

Objective: Primary mitral valve (MV) tumor is a rare lesion, and to date, there have been few larger surgical series of MV tumors. We retrospectively analyzed 11 cases of primary MV tumors regarding clinical and pathological features, surgical procedure and long-term outcomes., Methods: From November 1983 to December 2008, we operated on 11 patients (age 36.3 ± 17.7 years, weight 55.4 ± 11.2 kg) with primary MV tumors. Symptoms were cardiac in 8 cases (72.7%) and neurologic in 3 (26.3%). Surgical procedures included en bloc excision and MV repair in 8 cases and tumor resection and MV replacement in 3. No radiotherapy or chemotherapy was given to patients with malignant tumors., Results: Pathological diagnosis was papillary fibroelastoma in 3 cases, myxoma in 3, lymphangioma in 1, lipoma in 1, hemangioma in 1 and sarcoma in 2. No early deaths or complications occurred. Late death occurred in 2 patients with sarcoma 1 year postoperatively. At the latest follow-up, with a maximum of 25 years (mean 10.6 ± 8.8), the 9 survivors were in New York Heart Association functional class I with normal MV function and no echocardiographic evidence of local recurrence., Conclusions: The majority of primary MV tumors are benign. They can cause cardiac or neurologic symptoms and should be excised as soon as a diagnosis is made. For benign tumors, valve-sparing resection and valve repair are often possible with excellent long-term outcomes. The prognosis of malignant MV tumors is poor., (Copyright © 2011 S. Karger AG, Basel.)

Volatile organic compound (VOC) emissions from furnishings have created a major indoor air pollution problem in China. The aim of this study was to investigate the VOC emission of larch particleboard under different processing conditions. VOCs collection chamber, parts per billion VOC monitor, and gas chromatography-mass spectrometer were used to analyze the VOC components and quantities. The results were shown as follows: (1) concentration and emission rate of VOCs were significantly affected by hot-pressing temperature and time. With the increase of hot-pressing temperature and time, both the earlier emission concentration and the amount of total volatile organic compounds increased. (2) The composition of VOCs was also influenced by temperature and time, especially the variety of terpene, benzene, and derivative. The existence and quantities of esters were still the main components of VOCs emissions.

Wujingang region was taken as the study area to explore the relationship between landscape pattern and river water quality. Remote sensing image was interpreted and buffer zones were constructed, and then landscape patterns characterized by land-use patterns and five selected landscape metrics including Number of patches (NP), Area-weighted mean patch fractal dimension (FRAC &#95;AM), Shannon's diversity index (SHDI), Shannon' s evenness index (SHEI), Contagion index (CONTAG) in each buffer zone were obtained. By employing the correlation analysis between the landscape pattern and river water quality, the results indicated that the river water quality was influenced by landscape pattern. The percentage of built-up area was positively related with water quality indicators, demonstrating that the percentage of built-up area was one of the key factors affecting the river water quality, while the percentage of cultivated land showed a negative relationship. Furthermore, the relationships between the selected five landscape metrics and water quality were also revealed. SHDI and SHEI were significantly positively related with water quality indicators, while CONTAG showed the opposite relationship.

Background: Hypogammaglobulinemia is common in infant humoral immunodeficiencies and has complicated causes and outcomes. We aimed to determine the clinical manifestations, immunological changes and outcomes of Shanghai infants with hypogammaglobulinemia., Methods: Patients under 2 years old, having one or more warning signs of primary immunodeficiency disorders, serum immunoglobulin levels below the lower limit of reference range per age, and with normal numbers for lymphocyte subsets, were analyzed and followed up for 2 to 3 years., Results: A total of 91 children (male-to-female ratio: 2.25: 1) participated in the study. Initial clinical presentation was recurrent upper respiratory tract infection (46%), invasive infection (3%), atopic disease (32%). IgA reduction (77%) was prevalent; 34% patients had more than one isotype reduced. During follow-up, 51 of 62 patients (82.25%) had immunoglobulins normalized at the age between 12 - 48 months; these were diagnosed as transient hypogammaglobulinemia of infancy (THI). Long-term follow-up may reveal a diagnosis for the remaining 11 infants with persistent lower immunoglobulin levels, who did not have antibody titers measured. Earlier onset was correlated with higher rates of normalization. More patients were diagnosed with isolated hypogammaglobulinemia in 2006 compared with the previous 4 years (2002 - 2005)., Conclusions: The awareness of immunodeficiency among pediatricians has been greatly improved. Recurrent otitis media was not a major infection in our patients. THI is a relatively common condition associated with infant hypogammaglobulinemia. In the absence of specific antibody titers, the diagnosis of THI can be confirmed retrospectively with Ig levels normalized in follow-up visits. Therefore, long-term follow-up and frequent re-evaluation of these patients are necessary to distinguish them from true primary immunodeficiency.

Study Design: Validation study to define validity and reliability of an adapted and translated questionnaire., Objective: This study attempted to validate the traditional Chinese (Hong Kong) version of the modified Scoliosis Research Society (SRS) Outcomes Instrument, SRS-22, into simplified Chinese for use in mainland China., Summary of Background Data: Although a traditional Chinese (Hong Kong) adaptation of the SRS-22 has been previously validated, no culturally adapted, validated SRS-22 exists for use in mainland China., Methods: Adhering to International Quality of Life Assessment Project guidelines, the adapted traditional Chinese SRS-22 was translated into simplified Chinese while referencing the original English questionnaire. To examine the psychometric properties and clinical application of the adapted simplified Chinese SRS-22, a survey was conducted in a group of randomly selected 87 patients previously surgically treated at an outpatient clinic. Reliability assessment of the simplified Chinese version of the SRS-22 was determined by calculating Cronbach's alpha and intraclass coefficient (ICC) values. Concurrent validity was evaluated by comparing SRS-22 domains with relevant domains of the simplified Short-Form-36 questionnaire; correlation was made using Pearson correlation coefficients., Results: Cronbach's alpha, applied to each of the 22 questions of the adapted SRS-22, revealed very satisfactory internal consistency (Cronbach's alpha = 0.80-0.89) for function/activity and pain, and good consistency (Cronbach's alpha = 0.50-0.79) for the remaining domains. The test/retest reproducibility was found to be good (ICC > or =0.40-0.75) in the function/activity domain, and excellent (ICC > or =0.75) in the remaining domains. In terms of concurrent validity, 3 domains had excellent correlation, while 10 had good correlation, and 21 had moderate correlation., Discussion: The authors report the validation of a simplified Chinese SRS-22 for use in mainland China, which is culturally relevant, reliable, repeatable, psychometrically sound, and suitable for immediate clinical use.

Based on the study of the relationships between economic growth and industrial pollutant discharge of Suzhou City in 1991-2005, the environmental Kuznets curve (EKC) of the City was estimated by several kinds of function, with the cause analyzed. The results showed that the EKC of Suzhou was not a typical one. The industrial pollution of the City increased dramatically by scale effect of economic growth and the clear environmental benefit of industrial structure adjustment was not received obviously, while generalized discharge reduction technologies showed great results. In general terms, the pollution increase was comparatively slower than the GDP growth. As a whole, the environmental policy of Suzhou was in effect. However, the relationships between economic growth and industrial pollutant discharge had not been a benign development yet. In order to achieve win-win situation of economic growth and pollution reduction, Suzhou needed to optimize its industry structure, push the energy conservation and discharge reduction policy deeply, increase environmental investment, and enforce the strictest environmental and industrial policy. In doing these, Suzhou could turn the traditional omega-shaped EKC into delta-shaped EKC.

Objective: To study the spatial distribution characteristics of liver cancer in Guangxi so as to provide evidence for the development of control and prevention on liver cancer., Methods: The average eight year morbidity was computed, using the rates of liver cancer in 2000-2007. The spatial statistics module of GIS was used to conduct spatial autocorrelation analysis, and the disease mapping was drawn, using the Map Info 8.0 software., Results: The average morbidity rate was clustered in Guangxi in the past eight years, with Moran's I index as 0.34 and P value below 0.01. G index appeared to be 0.77 and the P value was below 0.01. Moran's I correlogram lifted up in four spaces, specifically, the cluster took place in both macro-scale (one to three spatial intervals, 45 to 135 km real scale) and micro-scale (16 to 18 spatial intervals, 720 to 800 km real scale). When the spatial interval became 14 and real scale was 60 km, the spatial distribution of liver cancer showed the most intensive autocorrelation. Most of the regions with high morbidity would be clustered in the southwest and southern parts, along the coastal areas of Guangxi while the regions with low morbidity clustered in the northern part of Guangxi., Conclusion: Liver cancer was found un-randomly distributed and geographically clustered in Guangxi in 2000-2007.

By the methods of grey prediction and curve regression, the estimation and forecast models of water pollution load in coastal zone of Xiamen City, Southeast China were established, and validated with the statistic data of the pollution load in past decade. The estimation revealed that the industrial wastewater discharge per ten thousand RMB production value decreased yearly, while the total discharge of main pollutants increased gradually. In the total discharge of point source wastewater, about 76% of nitrogen and phosphorus came from domestic wastewater. In non-point source pollution loads, nitrogen and phosphorus of agricultural source occupied a larger proportion, while those of urban source were the least. In 2005, the nitrogen pollution load from different sources was in the order of domestic wastewater (DW) > agricultural non-point source (ANPS) > industrial wastewater (IW) > tourism wastewater (TW) > urban non-point source (UNPS), while phosphorus pollution load was ANPS > DW > IW > TW > UNPS.

Thirty microsatellite markers were used to analyze the genetic diversity of five Silver carp populations in the middle and lower reaches of the Yangtze River. A total of 144 different alleles were found and the number of alleles in each locus ranged from 1 to 10. Twenty-five loci (83.33%) were polymorphic. In the five populations, the average number of alleles was 4.0 to 4.1, the number of mean valid alleles was 2.4445 to 2.6332, the value of average observed and expected heterozygosity ranged from 0.3233 to 0.3511 and 0.4421 to 0.4704, and the mean PIC was 0.4068 to 0.4286. Fst value indicated that the populations were moderately differentiated. Chi-square test was used to analyze the genotypes based on Hardy-Weinberg equilibrium, the P value denoted that the five populations deviated equilibrium partially. The genetic similarity coefficient of the five populations was 0.8466 to 0.9146, and the genetic distance of the populations was 0.0893 to 0.1665. A UPGMA dendrogram was constructed based on Nei's standard genetic distance for the five Silver carp populations.

Objective: The purpose of this study was to explore the association of gender and age on in-hospital mortality after coronary artery bypass graft (CABG) among the Chinese population., Methods: A total of 2682 patients (male: 2316, female: 366) who underwent CABG surgery were retrospectively investigated between January 1st, 1997 and December 31st, 2001 for perioperative risk factors and in-hospital mortality rate after CABG., Results: Preoperative comorbidity rate and postoperative complication rate were higher in women than that in men, although left ventricular ejection fraction was higher and the number of diseased vessels fewer in women than in men. The in-hospital mortality rate was three times higher in women than that in men (3.01% vs. 1.12%, P = 0.001), especially in the younger age group (2.6% vs. 0.5%, P = 0.001, risk-adjusted odds ratio 4.844, 95% CI: 1.549 - 15.142). In older patients, there was no notable difference in in-hospital mortality between the genders (3.7% for women vs. 2.4% for men, P = 0.383)., Conclusions: Chinese woman, especially in younger age, had a higher in-hospital mortality rate post CABG than that in men, suggesting that younger female gender is an independent risk factor for in-hospital mortality after CABG. Future studies are warranted to clarify the underlying mechanisms.

Minimally invasive cardiac surgery has captured the interest and attention of cardiac surgeons throughout the world. We reviewed our experience of minimal access cardiac operations performed through a lower median ministernotomy. Between January 1997 and August 2003, 100 congenital, 178 valvular, 168 coronary, 12 aneurysmal, and 2 other operations were performed via a 6 to 9 cm lower ministernotomy in 460 consecutive patients. No special instruments were required. Four patients died, and 2 re-operations were necessary. Complications occurred in 28 patients (6.1%). The mean cardiopulmonary bypass time was 88.50 +/- 65.16 min, crossclamp time was 55.81 +/- 31.89 min, time to extubation was 14.71 +/- 29.33 h, and total chest drainage was 7.28 +/- 5.07 mL.kg(-1). Blood transfusions of 951.42 +/- 642.34 mL were needed in 282 patients. Postoperative hospital stay was 11.6 +/- 6.0 days. Our experience shows that many types of cardiac operations can be performed through a lower ministernotomy. This technique results in less trauma, quick recovery, and reduces the risk of infection and blood loss. It is a safe and easy procedure that can bring about favorable early outcomes in a wide range of cardiac operations.