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B Aims: b To improve the outcome of young DLBCL patients with clinically or biologically high-risk features by a risk-adapted treatment paradigm. FRONT-LINE RISK-ADAPTED THERAPY PRESENTED FAVORABLE OUTCOMES FOR YOUNG PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA: RESULTS FROM A CONSECUTIVE COHORT IN CHINA B Conclusion: b This is the first and largest single-center study in China to report the treatment of young DLBCL patients with risk-adapted therapy, in which IIC was applied to selected patients with clinically or biologically high-risk features and showed favorable results. [Extracted from the article]

The third (Es3) member of the Eocene Shahejie Formation is the main hydrocarbon source rock interval in the Raoyang Sag of the Bohai Bay Basin. The lower Es3 (Es3L) and upper Es3 (Es3U) submembers display clear differences in source rock quality. The formation mechanisms of the source rocks are investigated via geochemical methods using 60 samples from three wells to reconstruct the paleo-environment during deposition. The major element parameters exhibit changes in paleoclimate from humid to arid. Indicators such as Sr/Ba, B/Ga, the gammacerane index and isotopic data suggest fresh–brackish and hydrological open lakes with unstable water column stratification likely occurred during deposition of the Es3L submember and saline and hydrologically closed lakes with stable water column stratification likely during deposition of the Es3U submember. Carbon isotope values of organic matter, trace elements and biomarker parameters suggest that the Es3L submember had moderate productivity, with a significant contribution from terrigenous organic matter whereas the Es3U submember had slightly enhanced productivity, with no or minor contributions from terrigenous organic matter. Furthermore, the pristane/phytane ratio and the enrichment of Mo and U indicate that the euxinic bottom-water conditions (sulfidic) of the lakes during deposition of the Es3U submember were best for preserving organic matter. Comparison of the models of source rock deposition of the Es3L and Es3U submembers indicates that the redox conditions play an important role in the formation of organic-rich source rocks in the Raoyang Sag. [ABSTRACT FROM AUTHOR]

Background The objective of this study was to investigate the contributions of mental health status and attitudes towards suicide on suicidal ideation in a sample of 6568 Chinese children and adolescents in China. Attitudes towards suicide were investigated as a possible moderator and mediator of the influence of mental health status on suicidal ideation. Methods Descriptive statistical analyses, Pearson correlation analyses and hierarchical regression analyses were adopted as methods of data analyses. Results Approximately 35.38% of children and adolescents in our study reported having suicidal ideation. Mental health status and attitudes towards suicide both had an independent effect on the severity of suicidal ideation. Results indicated that mental health status was positively associated with suicidal ideation, while attitudes towards suicide were negatively associated with suicidal ideation. Moderation analysis showed that the impact of mental health status on suicidal ideation was significantly greater among children and adolescents who reported favourable attitudes towards suicide. Attitudes towards suicide partially mediated the link between mental health status and the severity of suicidal ideation. Specifically, students who experienced poorer mental health status might be more likely to report significantly more favourable attitudes towards suicide, which in turn promote greater suicidal ideation. Conclusions These results have implications for the prevention of youth suicide, suggesting that mental health status and attitudes towards suicide could be important targets for prevention and intervention for children and adolescents at risk of suicidal ideation. [ABSTRACT FROM AUTHOR]

Based on institutional and agency theories, this study investigates whether firms use environmental performance as a criterion in incentive schemes for top executives in China, where the weakness of environmental regulations is criticized, and examines the potential moderating effects of board composition on the relationship between environmental performance and top executives’ compensation. Our analysis of 687 publicly traded firms in the manufacturing industry for the period 2008–2010 finds evidence of a positive association between environmental performance and top executives’ compensation. It shows that in firms with Chief Executive Officer–chairperson duality and larger boards, there is a tighter environmental performance–pay relationship, while top executives are found to be rewarded less for environmental performance in firms whose directors hold significant ownership. The presence of independent directors is not found to exert a significant influence on the environmental performance–pay relationship. [ABSTRACT FROM PUBLISHER]

Summary: We established a chronic kidney disease (CKD) mouse model with estrogen deficiency and inserted titanium implants into the femur of such mice to investigate the fixation of the implants. Both the histomorphometry and implant resistance indicated that estrogen deficiency impaired the fixation of titanium implants inserted into such mice. Introduction: CKD has been regarded as a worldwide public health problem. Estrogen is a critical factor for both renal protection and bone remodeling. A previous study demonstrated that CKD impairs the early healing of titanium implants. However, the combined effect of estrogen deficiency and CKD on the fixation of titanium implants is largely unknown. Methods: Forty 9-week-old female C57BL mice were randomly divided into sham, ovariectomy (OVX), CKD, and CKD + OVX groups. Uremia and estrogen deficiency were induced by 5/6 nephrectomy and OVX, respectively. Experimental titanium implants were inserted into the distal end of the femur. Bone-implant contact (BIC) ratio and bone volume (BV/TV) around the implants were histomorphometrically analyzed. The fixation strength of the implant was measured by a biomechanical push-in resistance test. Results: Serum measurement confirmed a significant increase in serum blood urea nitrogen (BUN) in the CKD group, which was further increased by OVX. Estrogen deficiency led to significant decreases in the BIC ratio, BV/TV, and the push-in resistance in CKD animals. There was a significant interaction between the effects of OVX and CKD, with OVX exacerbating the effects of CKD on BIC ratio and push-in resistance. Conclusions: The results indicated that estrogen deficiency exerts a synergistic effect with CKD and further impairs the fixation of titanium implants in CKD mice. [ABSTRACT FROM AUTHOR]

Ankylosing spondylitis (AS) is a chronic inflammatory disease with complex genetic traits. Multiple sequence variations have been associated with AS, but explained only a proportion of heritability. The studies herein aimed to explore potential associations between genomic copy number (CN) variation (CNV) and AS in Han Chinese. Five AS patients were examined with the high-density comparative genomic hybridization microarrays in the first screen test for AS-associated CNVs. A total of 533 AS patients and 792 unrelated controls were examined in confirmation studies with the AccuCopy assays. A significant association was observed between the CNV of HLA-DQA1 and that of AS. Compared with controls, AS patients showed an aberrant CN, and a significantly increased number of patients had more than two copies of HLA-DQA1. Therefore, the CNV of HLA-DQA1 may have an important role in susceptibility to AS in the Han Chinese population. [ABSTRACT FROM AUTHOR]

Abstract: The origin of atmospheric dissolved organic nitrogen (DON) deposition is not very clear at present. Across China, the DON deposition was substantially larger than that of world and Europe, and we found significant positive correlation between contribution of DON and the deposition flux with pristine site data lying in outlier, possibly reflecting the acute air quality problems in China. For a case study in Northeast China, we revealed the deposited DON was mainly derived from intensive agricultural activities rather than the natural sources by analyzing the compiled dataset across China and correlating DON flux with NH4 +–N. Crop pollens and combustion of fossil fuels for heating probably contributed to summer and autumn DON flux respectively. Overall, in Northeast China, DON deposition could exert important roles in agro-ecosystem nutrient management and carbon sequestration of natural ecosystems; nationally, it was suggested to found rational network for monitoring DON deposition. [Copyright &y& Elsevier]3 −–N. Crop pollens and combustion of fossil fuels for heating probably contributed to summer and autumn DON flux respectively. Overall, in Northeast China, DON deposition could exert important roles in agro-ecosystem nutrient management and carbon sequestration of natural ecosystems; nationally, it was suggested to found rational network for monitoring DON deposition. [Copyright &y& Elsevier]

Objective: Dietary copper intake levels of residents living in Beijing were measured with two different methods. Subjects and method: The multistage stratified random process was used. In total, the survey tracked 503 subjects from 189 families distributed in 12 communities of 6 districts in Beijing. 2 investigation methods were used: weighing dietary record and duplicated diet. Results: According to Method 1, median of dietary Cu intake is 1.80 mg/d. The lowest value is 0.68 mg/d, the highest is 5.84 mg/d. 331 subjects (65.8%) had Cu intake lower than 2 mg/d. Cu density in diet is 0,94 mg/1,000 kcal from calculated values both from Methods 1 and 2. In Method 2, the measured value for duplicated samples is lower than the calculated value. The median of dietary Cu intake is 0.90 mg/d, the lowest Cu in- take is 0.26 mg/d, while the highest is 4.15 mg/d. According to the result from measurement, 401(97%) of duplicated diets provided less than 2 mg/d of Cu. Cu density is 0.57 mg/1,000 kcal. Conclusions: Residents in Beijing have no problem of excess Cu intake using either the calculated or measured results from the two methods. [ABSTRACT FROM AUTHOR]

The sequence of novel HLA-Cw*0124 allele differs from Cw*0103 by one nucleotide change at nt 806 from C to A, resulting in an amino acid change at codon 245 from Ala to Glu. [ABSTRACT FROM AUTHOR]

HLA-C*04:03:02 differs from the closest allele C*04:03:01 at 218T>C in exon 2 and is synonymous. [ABSTRACT FROM AUTHOR]

A novel HLA-C allele, Cw*0824, which was identified from an individual of the Han Chinese, differs from Cw*080101 at codon 222 (GAG > AAG ) in exon 4, which results in an amino acid change Glu222Lys. In recent years, many human leukocyte antigen (HLA)-C alleles have been identified. Up to date, 23 different Cw*08 alleles have been identified according to the IMGT/HLA Database release 2.25.2 May 2009 (1) . Here, we describe the identification of the novel allele HLA-Cw*0824 that was found during routine high resolution sequence-based typing (SBT) of a Chinese stem cell voluntary donor. The HLA alleles of the donor were typed as A*11, 24; B*15, 46; and DRB1*09, 12. [ABSTRACT FROM AUTHOR]

The genomic sequence of HLA-Cw*1222 allele is identical to Cw*120202 except for a single-nucleotide substitution at codon 87 (CAG→CGG) resulting in an amino acid change from Gln to Arg. [ABSTRACT FROM AUTHOR]

We report the identification of a novel human leukocyte antigen (HLA)-B*56 allele, B*5618 and an extension of B*2736 that were found during routine high-resolution sequence-based typing in Chinese Han individual. The B*5618 allele has 4nt changes from B*5610 in exon 3, The B*2736 allele has 10nt changes from B*270401 in exons 3–4. [ABSTRACT FROM AUTHOR]

We report the identification of the novel allele HLA-A*3018 that was found during routine high resolution sequence-based typing of a Chinese bone marrow donor. The A*3018 allele has three nucleotides that differ from A*300101 at codon 17 (AGT→CGC) and codon 18 (GGA→GGG) in exon 2. [ABSTRACT FROM AUTHOR]

Abstract: Little information about the nitrogen (N) deposition in the lower Liaohe River Plain (LRP) of Northeast China was available. A continuous 5-year observation (from 2004 to 2008) was conducted to determine the nitrogen deposition in precipitation collected by a standard rain gage, and then we assessed its ecological consequences. The mean inorganic nitrogen concentrations were 1.82mgNL−1 for NH4 +–N and 0.89mgNL−1 for NO3 −–N. On an annual basis, the averaged amounts of N deposition were 14.5kgNha−1 year−1, which were much lower than that of hotspots in China. However, the amount of deposited N should still be taken account into the N fertilizer management of the agroecosystems. Compared with the critical loads (CL) of N deposition, the deposited N would likely threaten the natural ecosystems in LRP. The N concentrations in rainwater and the amount of N deposition showed a clear seasonal pattern, and precipitation played an important role in regulating the N concentration. Furthermore, the seasonal fluctuation of NH4 +/NO3 − ratio reflected that the deposited N originated from both fertilizer application and fossil fuel combustion, and environmental factor (soil temperature, lightning and sunshine) might also contribute to the seasonal cycles of NH4 +/NO3 − ratio. The high annual NH4 +/NO3 − ratio (2.05) compared with the more developed region suggested that N deposition in this region was mostly affected by agricultural activities rather than industrial activities. [Copyright &y& Elsevier]

Objective: To investigate the incidence of shoulder work-related musculoskeletal disorders (WMSDs) among occupational population in China, and to explore their intrinsic association with personal and work-related factors. Methods: In April 2024, 73497 valid questionnaires of the Chinese version of the Musculoskeletal Disorders Electronic Questionnaire were retrospectively analyzed from June 2018 to December 2023 in 22 provinces and 29 key industries in China, and the general information, occurrence of WMSDs and related risk factors of key occupational populations in different regions in China were collected. By using Chi-square test and confirmatory factor analysis, the relationship between shoulder fatigue and pain in key occupational groups and individual factors, work type, work posture and work organization was discussed, and the internal relationship was analyzed based on structural equation model. Results: Higher incidence of shoulder fatigue and pain were associated with female, lack of physical exercise, uncomfortable working posture and neck leaning forward ( P <0.05). Structural equation model analysis showed that work type, work posture and work organization were strongly correlated ( r =0.58, 0.55). Work organization and work type were strongly correlated with shoulder fatigue ( r =0.65) and moderately correlated with shoulder fatigue ( r =0.21). Shoulder fatigue was moderately associated with shoulder pain ( r =0.40). Individual factors, work type, work posture and shoulder fatigue could directly affect shoulder pain ( OR =0.07, -0.09, 0.17 and 0.40), and work type and work posture could also indirectly affect shoulder pain through shoulder fatigue ( OR =0.08, 0.03). Work organization only indirectly affected shoulder pain through shoulder fatigue ( OR =0.26) . Conclusion: The main influencing factor of shoulder pain is shoulder fatigue, followed by work posture and individual factors. Structural equation model can better reflect the complex relationship between work type, work posture and work organization and shoulder WMSDs. Improving work posture and work organization may be an effective way to control the influence of shoulder fatigue on shoulder pain.

Objective: To investigate the prevalence of blindness and visual impairment in adults and the related causes in China. Methods: A population-based cross-sectional survey was conducted during 2021 and 2022 among 13 provinces, municipalities, and autonomous regions, including Beijing, Hebei, Jiangsu, Shanghai, Guangdong, Henan, Shanxi, Ningxia Hui Autonomous Region, Chongqing, Yunnan, Sichuan, Heilongjiang, and Liaoning. Respondents were adults aged 18 years and above, and were classified into groups of young adults (18 to 39 years), middle-age adults (40 to 59 years), and the elderly (≥60 years). The examinations included visual acuity measurement, non-contact tonometry, slit-lamp examination, fundus photography, automatic refraction (non-mydriasis), and demographics (questionnaire). The diagnosis and distribution of eye diseases were analyzed. The Cochran-Armitage test was used for statistical processing. Results: A total of 93 123 adults with a mean age of 48.8 years (range, 18 to 101 years) completed the survey, and the response rate was 76.2% (93 123/122 191). There were 37 725 males (40.5%) and 55 398 females (59.5%), while 32 357 (34.75%) were aged 18 to 39, 29 127 (31.28%) were aged 40 to 59, and 31 639 (33.97%) were aged≥60. According to the best-corrected visual acuity (BCVA) in the better eye of 93 123 adults, the blindness, moderate to severe visual impairment (low vision), and mild visual impairment were found in 280, 2 270, and 4 679 patients, respectively. Based on BCVA of the worse eye, the top three causes of blindness and low vision were cataract (1 271/2 982, 42.62%), uncorrected refractive error (433/2 982, 14.52%), and pathological myopia (90/2 982, 3.02%), without considering trauma or other undefined fundus diseases. Conclusions: From 2021 to 2022, the prevalence rates of blindness and low vision in Chinese adults were 0.30% and 2.44%, respectively. Cataract was the primary eye disease leading to blindness and low vision, and pathological myopia became the major cause of irreversible blindness in the population.

The Yangtze River constitutes a crucial aquatic system in China, and lakes downstream play a significant role in the stability of ecosystem functions. However, human activities have caused the lakes to suffer from eutrophication. Moreover, it is important to investigate the aquatic ecosystems of Qingting Lake, Fengming Lake, and Yin Lake in Wuhu City, Anhui Province, China, for tracing and controlling eutrophication. We focused on the differences in aquatic communities and their relationships with environmental variables. A total of 61 species of zooplankton, 69 species of phytoplankton, and 15 species of benthos were detected in the three lakes. Dragonfly Lake had the highest number of zooplankton and phytoplankton species； the number of phytoplankton species was 17.65% and 22.06%, significantly higher than those of Fengming Lake and Silver Lake, respectively （ P &lt;0.05）. Inconsistently, the benthic biomass was 97.46% and 97.64% significantly higher in Silver Lake [（149.39±10.97） g·m -2 ] compared with those in Dragonfly Lake and Fengming Lake （ P &lt;0.01）. The zooplankton with high dominance included Pseudoanabaena sp., Merismopedia sp., Polyarthra vulgaris , Moina micrura , and Strobilidium sp., and those in benthos were Limnodrilus sp. and Tanypus sp. Water nitrogen and phosphorus, sediment nitrogen and phosphorus, water depth, salinity, pH, oxidation-reduction potential, and dissolved oxygen were the important environmental factors leading to differences in dominant species of zooplankton, phytoplankton, and benthos among the lakes, with a total influence of 70.70%, 76.69%, and 70.32%, respectively （redundancy analysis）. Finally, the results indicated that Dragonfly Lake and Fengming Lake were both characterized as eutrophic, but Silver Lake was mesotrophic when we calculated water parameters, integrated trophic state index, and biological index together.

The aim of this study is to examine the association between insufficient sleep and astigmatism, as well as its related refractive components, in preschool children. Preschool children aged 3 to 6 from two kindergartens in Shanghai participated in this study. Non-cycloplegic refraction was assessed using an auto-refractor (Topcon KR-800, Tokyo, Japan), and biometric parameters were measured with the IOL Master 700 (Carl Zeiss, Jena, Germany). Sleep duration and lifestyle information were collected via questionnaires. Total Astigmatism (TA), Anterior Corneal Astigmatism (ACA), Internal Astigmatism (IA), and Compensation Factor (CF) were calculated from vector components J 0 and J 45 . A total of 451 preschool children (55% males, mean age 5.20 ± 0.84 years) were included, with 5.8% experiencing astigmatism. Insufficient sleep was associated with higher astigmatism prevalence (OR = 2.932, 95% CI: 1.121 to 7.669) and increased cylinder power (β = 0.155, 95% CI: 0.024 to 0.286). Total sleep duration showed an inverse association with cylinder power (β = -0.049, 95% CI: -0.092 to -0.007). Insufficient sleep correlated significantly with J 0t (β = 0.123, 95% CI: 0.032-0.215) and J 0i (β = 0.170, 95% CI: 0.072-0.269), and CF 0 (Adjusted OR = 1.731, 95% CI: 1.005 - 2.981). Sleep duration was also significantly associated with J 0t , J 0i and CF 0 . Insufficient sleep is significantly associated with astigmatism in preschool children, primarily through internal astigmatism. These findings emphasize the need for vision screening in children with insufficient sleep to identify and address refractive issues early. What is Known: • Refractive errors, including astigmatism, are common in preschool children and influenced by both environmental and genetic factors. • Insufficient sleep is significantly associated with refractive errors, particularly myopia, and is known to affect visual health and ocular conditions. What is New: • Insufficient sleep is significantly associated with astigmatism in preschool children. • This association may primarily stem from internal compensation mechanisms., Competing Interests: Declarations. Ethics approval: This study involves human participants, was approved by Ethics Committee for Medical Research at the School of Public Health, Fudan University (IRB#2023–11-1088). All participants provided written informed consent prior to participation in the study. Patient consent for publication: Consent obtained from parent(s)/guardian(s). Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The assessment of human papillomavirus (HPV) genotype distribution could inform targeted cervical cancer prevention strategies. The epidemiology of HPV genotypes in terms of age and cervical lesions in Fujian Province, China has not been well described. This 9-year retrospective study aimed to delineate the prevalence pattern and trend of HPV genotypes among a large-scale community-based population. Deidentified data were retrieved from the national cervical cancer screening program in China. We included eligible women aged 35-65 years who underwent cervical cancer screening between 2014 and 2022 in Fujian Province. The HPV prevalence within distinct subpopulations was calculated, and trends in HPV prevalence over the years and across age groups were examined using the Cochran-Armitage trend test. A total of 551 604 women (median age 49 years [42, 54]; 0.10% with cervical cancer) were included in this study. The overall HPV prevalence was 11.72% (95% CI: 11.63%-11.80%), with HR-HPV (high-risk HPV) and HPV 16/18 prevalence at 10.02% (9.94%-10.10%) and 1.74% (1.71%-1.78%), respectively. HPV-52, 58, 16, 39, 51, and 68 were the most predominant genotypes in the general population. Nearly all genotypes, except for HPV-39 and 66, showed a decreasing trend in prevalence over the years, while a relatively high prevalence of HR-HPV was observed across all age groups. As lesion severity increased, HR-HPV and 9v-HPV prevalence also increased. Our study underscores the importance of ongoing surveillance of HPV prevalence in China. While the overall decline in HPV infections over the years is encouraging, the relatively high prevalence of HR-HPV warrants continued attention. Strengthening public health strategies-including prioritizing and promoting the current 9-valent vaccination, extending HPV testing and cervical cancer screening to older women where feasible, and developing future vaccines targeting more HR-HPV genotypes-will be crucial in eliminating cervical cancer and HPV-related disease in China and beyond., (© 2025 Wiley Periodicals LLC.)

Background China implemented extensive non-pharmaceutical interventions (NPIs) to contain COVID-19. Methods National and provincial data on monthly reported HIV and AIDS cases from January 2017 to December 2020 were collected from the National Health Commission of the People's Republic of China. We used interrupted time series analysis to assess whether COVID-19-related NPIs had an impact on reported HIV and AIDS cases in 31 provinces in China, and estimated underreported numbers of HIV and AIDS cases in the first month of the COVID-19 pandemic. Results A total of 393,357 HIV cases and 254,735 AIDS cases were recorded in China from January 2017 to December 2020. Nationally, the number of reported HIV cases decreased by 25.1% in the first month of the NPIs period (January 2020) compared with the counterfactual (incidence rate ratio (IRR) 0.749; 95% confidence interval (CI) 0.664-0.845), whereas the number of reported AIDS cases decreased by 36.5% (IRR 0.635, 95% CI 0.543-0.741). An estimated 2208 HIV cases (95% CI 1209-3335) and 1525 AIDS cases (95% CI 927-2233) were underdiagnosed and underreported in the first month of the NPIs in China. The highest numbers of underdiagnosed and underreported HIV cases in the first month of NPIs were estimated in Sichuan (IRR 577, 95% CI 239-978), Guangdong (IRR 185, 95% CI 170-200) and Henan (IRR 170, 95% CI 77-286). Conclusions There was substantial underdiagnosis and underreporting of HIV and AIDS cases during the first month of the COVID-19 pandemic in China and certain provinces. Health departments should consider the specific barriers encountered during the pandemic, such as disrupted healthcare access and resource limitations, and implement targeted strategies to strengthen HIV surveillance and report systems.

Background: The decision-making process between autologous hematopoietic stem cell transplant (autoHSCT) and less-intensive treatments necessitates shared decision-making between older patients with hematological malignancies and healthcare providers. However, there is limited knowledge from both perspectives. This qualitative study aimed to comprehensively understand the experiences of shared decision-making regarding autoHSCT among older patients with hematological malignancies and physicians., Methods: Older patients and physicians were recruited from the hematology department at one of the affiliated general hospitals of Wuhan University. They participated in semi-structured, in-depth face-to-face individual interviews from August 2022 to March 2023. The interviews explored their experiences with shared decision-making about autoHSCT. Interviews were transcribed verbatim and analyzed using Colaizzi's phenomenological method., Results: Thirteen older patients and eight physicians were recruited. Two themes were identified: (1) Factors influencing AutoHSCT recommendations and decision-making: Seven factors were categorized into three groups: physician-driven factors (pretransplant assessments, experience-based judgment, and communication approaches), patient-driven factors (perceived benefits and risks, financial challenges, and family involvement), and mutual trust between patients and physicians, which is a bidirectional factor relying on both physicians' trust and the active participation of patients in the decision-making process. (2) Treatment planning and outcome expectations: Regardless of treatment choices, patients focused on engaging in self-management and prioritizing quality of life, and maintaining hope for positive outcomes., Conclusions: The shared decision-making process for autoHSCT between older patients with hematological malignancies and physicians is shaped by physician-driven factors, patient-driven factors, and mutual trust. These findings provide a foundation for developing patient-centered care strategies, including decision aids and enhanced communication training for physicians, aimed at improving outcomes for older patients facing complex treatment choices. Future research should explore how these factors interact over time, through longitudinal studies, to assess their long-term impact on patient outcomes and quality of life., (© 2024 The American Geriatrics Society.)

Introduction: Previous studies, using clinical trial data, demonstrated that once-weekly (OW) semaglutide is dominant versus other glucagon-like peptide 1 receptor agonists (GLP-1 RAs) in China. This study aims to evaluate the long-term clinical and economic effects of switching to OW semaglutide from other GLP-1 RAs among patients with type 2 diabetes mellitus (T2DM) in China., Methods: The Institute of Health Economics Diabetes Cohort Model (IHE-DCM) was used to project life expectancy, quality-adjusted life years (QALYs), and total direct medical cost over 40 years from a Chinese healthcare system perspective. Baseline characteristics, clinical effectiveness, and the treatment dose of OW semaglutide were derived from previously real-world studies. Patients were assumed to switch to semaglutide or continue previous GLP-1 RAs for 3 years and change to intensive therapy. Drug prices were based on the median bidding price in January 2024 in China. Costs of other GLP-1 RAs were calculated on the basis of their market share in China. All costs were accounted as 2023 Chinese yuan (CNY). A discount of 5% was applied. One-way sensitivity analyses and probabilistic sensitivity analyses were used to test the robustness of the base-case result., Results: The results show that switching to OW semaglutide from other GLP-1 RAs among patients with T2DM in China can improve life expectancy by 0.02 years and afford an additional 0.12 QALYs per patient. Meanwhile, switching to OW semaglutide is associated with decreased total lifetime direct medical costs of 4204 CNY per patient, mainly resulting from savings in microvascular costs (2214 CNY) and macrovascular costs (1228 CNY). Sensitivity analyses show the robustness of modeling projection findings., Conclusion: Based on real-world data from China, this modeling projection study demonstrates that switching to OW semaglutide from other GLP-1 RAs can have better clinical and economic effects for patients with T2DM in China, indicating it as a dominant treatment choice., Competing Interests: Declarations. Conflict of Interest: Hao Zhang is an employee of Novo Nordisk. Ying Hu, Xianwen Chen, Huimin Zou, Hao Zhang, Qi Ni, Yijun Li, Carolina Oi Lam Ung, and Yiming Mu declare that they have no competing interests. Ethics Approval: This article is based on previously conducted clinical trials and does not contain any studies with human participants or animals performed by any authors., (© 2024. The Author(s), under exclusive licence to Springer Healthcare Ltd., part of Springer Nature.)

Background: While previous cross-sectional studies have suggested a link between psychotic-like experiences (PLEs) and internet addiction (IA), longitudinal evidence remains scarce. This study aimed to explore the prospective relationship between IA and PLEs among college students., Method: A total of 636 college students (80 % female) were assessed in November 2022 and again one year later. IA was measured using the Internet Addiction Diagnosis Questionnaire (IADQ), and PLEs were assessed with the 16-item Prodromal Questionnaire (PQ-16). Demographic, psychological, and environmental factors were collected and controlled. Multiple logistic regression and cross-lagged panel analyses examined the longitudinal associations between IA and PLEs., Results: At baseline, the prevalence of IA and PLEs was 11.3 % and 16.8 %, respectively. Higher baseline IADQ scores (Adjusted odds ratio = 1.035; 95 % confidence interval = 1.002-1.069; p = 0.036) were independently associated with an increased risk of PLEs at follow-up, while baseline PQ-16 scores were not linked to later IA. Cross-lagged panel analysis revealed that IA at baseline predicted later PLEs (β = 0.082, p = 0.043), whereas baseline PLEs did not predict IA (β = 0.049, p = 0.255). Specifically, IA predicted unusual thoughts (β = 0.122, p = 0.003) and negative PLEs (β = 0.111, p = 0.008), but not perceptual abnormalities (β = 0.040, p = 0.301)., Conclusion: IA may be an independent risk factor for PLEs in college students, particularly for unusual thoughts and negative PLEs, but not for perceptual abnormalities. Targeted interventions addressing IA may help reduce PLEs., Competing Interests: Declaration of competing interest On behalf of all authors, the corresponding author states that there is no conflict of interest, and manuscript is approved by all authors for submission and publication. This study did not receive any funding., (Copyright © 2024. Published by Elsevier Inc.)

Background: There is evidence that fine particulate matter (PM 2.5 ) exposure is associated with premature rupture of membranes (PROM); however, studies of its effect on term PROM (TPROM) are limited, and the results are inconsistent., Objective: This study aimed to investigate the association between exposure to PM 2.5 and its components and the risk of TPROM., Methods: From 2018 to 2022, we collected delivery data from pregnant women in Guangzhou. Using 1:1 case matching, we included 1,216 TPROM cases and 1,216 controls. PM 2.5 and its component concentrations were obtained from Tracking Air Pollution in China. The time-varying mean concentration method was used to estimate exposure to PM 2.5 and its components during different trimesters. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) to evaluate the associations of exposure to PM 2.5 and its components with the risk of TPROM., Results: The incidence of TPROM in this study was 19.66%. After adjusting for potential confounders, statistically significant associations were found between TPROM and exposure to PM 2.5 , nitrate ( NO 3 - ), ammonium ( NH 4 + ), and black carbon (BC) during the second trimester and between TPROM and exposure to PM 2.5 , sulphate ( SO 4 2 - ), and BC during the third trimester. Specifically, the interquartile range (IQR) 3 (IQR3) and IQR4 of SO 4 2 - exposure during the third trimester increased the risk of TPROM by 18% (95% CIs [1.01-1.39]) and 18% (95% CIs [1.01-1.39]), respectively. A nonlinear relationship was observed between exposure to PM 2.5 , SO 4 2 - , NH 4 + , and OM during the second trimester and the risk of TPROM. No significant interactions were found between PM 2.5 and its components with TPROM across various subgroups., Conclusion: Our findings indicate significant associations between the risk of TPROM and exposure to PM 2.5 and several of its components during pregnancy. Contribute to the literature on the associations of PM 2.5 and its components with TPROM., Competing Interests: The authors declare there are no competing interests., (©2025 Qin et al.)

Background: Nonadherence to medication is a prevalent issue among patients with type 2 diabetes mellitus (T2DM). The family doctor system promotes continuous, integrated, and personalized primary care, which may improve medication adherence. However, more evidence is needed regarding causal association between family doctor system and medication adherence. This study is to assess the impact of the family doctor system on medication adherence among T2DM patients., Methods: This cohort study utilized data between 2014 and 2019 from three separate administrative databases of an eastern city in China. Adult patients with T2DM who continuously registered with family doctors from 2015 to 2019 (n = 18,841) were assigned to the intervention group, while those who never registered during this period (n = 1,429) were classified as the control group. A difference-in-differences design was employed to compare medication adherence between registered and unregistered T2DM patients after the first stage of family doctor system in 2015 and the second stage in 2018. Propensity score matching was applied to ensure the robustness. The mean proportion of days covered (PDC), and proportion of patients with good adherence (PDC ≥ 80%) were the outcomes of interest. All recommended T2DM medications were included to calculate PDC., Results: Compared to the unregistered group, PDC across all institutions for registered patients increased by 5.0% (p < 0.001) after the first stage of family doctor system, and by 5.9% (p < 0.001) after the second stage. The proportion of patients with good adherence increased by 9.5% (p < 0.001) and by 11.8% (p < 0.001) after two stages, respectively. The adherence improvement was more pronounced in community health centers. However, the overall good adherence rate among registered patients in 2019 remained relatively low, reaching only 59.77%., Conclusions: The family doctor system significantly improved medication adherence among T2DM patients by providing patient-centered, continuous, and integrated primary services, especially in community health centers. Nevertheless, further efforts should be made to enhance medication adherence., Competing Interests: Declarations. Ethics approval and consent to participate: As the administrative data used in this study were obtained from anonymized databases and did not influence patient health or outcomes, the requirement for informed consent was waived. The study was reviewed and approved by The Ethics Review Committee of the School of Public Health, Fudan University approved our study (IRB#2023-TYSQ-02-261). Consent for publication: Not applicable. Conflict of interest: The authors declare no conflicts of interest., (© 2025. The Author(s).)

Objectives: Noise risk control or management based on noise level has been documented, but noise risk management based on a combination of noise level and noise's temporal structure is rarely reported. This study aimed to develop a framework for industrial noise risk management based on noise kurtosis (reflecting noise's temporal structure) and its adjustment for the noise level., Design: A total of 2805 Chinese manufacturing workers were investigated using a cross-sectional survey. The noise exposure data of each subject included L EX,8h , cumulative noise exposure (CNE), kurtosis, and kurtosis-adjusted L EX,8h (L EX,8h -K). Noise-induced permanent threshold shifts were estimated at 3, 4, and 6 kHz frequencies (NIPTS 346 ) and 1, 2, 3, and 4 kHz frequencies (NIPTS 1234 ). The prevalence of high-frequency noise-induced hearing loss prevalence (HFNIHL%) and noise-induced hearing impairment (NIHI%) were determined. Risk 346 or Risk 1234 was predicted using the ISO 1999 or NIOSH 1998 model. A noise risk management framework based on kurtosis and its adjustment was developed., Results: Kurtosis could identify the noise type; Kurtosis combining noise levels could identify the homogeneous noise exposure group (HNEG) among workers. Noise kurtosis was a risk factor of HFNIHL or NIHI with an adjusted odds ratio of 1.57 or 1.52 ( p < 0.01). At a similar CNE level, the NIPTS 346 , HFNIHL%, NIPTS 1234 , or NIHI% increased with increasing kurtosis. A nonlinear regression equation (expressed by logistic function) could rebuild a reliable dose-effect relationship between L EX,8h -K and NIPTS 346 at the 70 to 95 dB(A) noise level range. After the kurtosis adjustment, the median L EX,8h was increased by 5.45 dB(A); the predicted Risk 346 and Risk 1234 were increased by 11.2 and 9.5%, respectively; NIPTS 346 -K of complex noise at exposure level <80, 80 to 85, and 85 to 90 dB(A), determined from the nonlinear regression equation, was almost the same as the Gaussian noise. Risk management measures could be recommended based on the exposure risk rating or the kurtosis-adjusted action levels (e.g., the lower and upper action levels were 80 and 85 dB(A), respectively)., Conclusions: The kurtosis and its adjustment for noise levels can be used to develop an occupational health risk management framework for industrial noise. More human studies are needed to verify the risk management framework., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 The Authors. Ear & Hearing is published on behalf of the American Auditory Society, by Wolters Kluwer Health, Inc.)

The growing number of Mpox cases in China has posed a challenge to public health. The prevalence of men who have sex with men behaviors among students has been consistently increasing each year in China, accompanied by a high frequency of unprotected anal sex. As crowded places, schools are highly likely to cause an Mpox outbreak among students through long-term close contact. Understanding university students' perceptions about Mpox and willingness to vaccinate play a vital role in implementing preventive measures in schools. This study aimed to assess knowledge, concerns, and vaccine acceptance toward Mpox among university students in North and Northeast China. A cross-sectional study was conducted among 3831 university students from seven universities in North and Northeast China between September 10 and September 25, 2023. This study found a relative insufficiency in Mpox knowledge among university students (71.60%), with less than half expressing concern about the Mpox outbreak (39.57%), and the majority exhibiting a positive attitude to vaccination (76.30%). Multivariate regression analysis revealed that a good knowledge level was associated with age, study discipline, education level, and a high level of concern about Mpox. Male, elderly, or highly educated participants had a low level of concern about Mpox. Participants with a high level of knowledge toward Mpox were more likely to have the vaccination willingness. This study might help governments and schools to understand students' Mpox perceptions and vaccination intentions, enabling them to implement effective measures in addressing the issue of inadequate understanding regarding Mpox among university students.

COVID-19 vaccine hesitancy remains prevalent globally. However, national data on this issue in the general population after the termination of the zero-COVID policy in China are limited. In March 2023, we conducted a nationwide cross-sectional survey among Chinese adults using a self-administered questionnaire. Descriptive statistics and multivariate logistic regressions were employed. Among 4,966 participants, 43.8% reported COVID-19 vaccine hesitancy following the end of the zero-COVID policy in China. Higher rates of vaccine hesitancy were associated with being married (married: OR 1.36, 95%CI 1.17-1.57; other marital status: OR 1.86, 95%CI 1.36-2.55), working in healthcare (OR 1.64, 95%CI 1.38-1.96), having both minors and older adults in the household (OR 1.45, 95%CI 1.20-1.75), having no minors and older adults in the household (OR 1.44, 95%CI 1.17-1.77), having chronic diseases (OR 1.42, 95%CI 1.23-1.64), experiencing adverse events post-vaccination (OR 1.39, 95%CI 1.19-1.61), and uncertainty about previous COVID-19 infection (OR 1.45, 95%CI 1.13-1.86). Conversely, participants who had received the influenza vaccine in the past three years (OR 0.62, 95%CI 0.54-0.72), had previously taken the COVID-19 vaccine (OR 0.44, 95%CI 0.32-0.59), and had higher confidence in vaccines (OR 0.63, 95%CI 0.60-0.67) were less likely to exhibit hesitancy. Our findings indicate a significant level of vaccine hesitancy, underscoring the urgent need for tailored public health strategies to address vaccine hesitancy and improve uptake post-zero-COVID policy in China. A comprehensive understanding of public concerns and related factors is essential for developing effective vaccine communication strategies.

Objective: To establish a structural equation model of lower back pain and its risk factors in occupational population in China based on a large-sample occupational epidemiological survey and structural equation analysis, so as to lay the foundation for the prevention of this disease. Methods: A total of 73497 occupational epidemiological cases were selected from June 2018 to December 2023 using the Chinese version of the Musculoskeletal Disorders Electronic Questionnaire. The results were analyzed using ergonomic hazard factors and their risk source classification criteria. Confirmatory factor analysis was then applied to extract individual factors, work organization, working postures, work types, muscle fatigue, and lower back pain. These factors were subsequently classified into six categories and structural equation model was established. Results: The main structural reliability and validity indexes of the structural equation model of lower back pain and its adverse ergonomic factors after adjustment were basically up to standard[goodness of fit index (GFI) was 0.956, the adjusted goodness of fit index (AGFI) was 0.944, the root mean square error of approximation (RMSEA) was 0.043, the normed fit index (NFI) was 0.922, the comparative fit index (CFI) was 0.923, and the Tucker-Lewis index (TLI) was 0.908], and the model fit was good. There were correlations among four exogenous latent variables: individual factors, work organization, working postures and work types. Among them, individual factors had a weak negative correlation with the three exogenous potential variables of work organization, working postures and work types ( r =-0.30, -0.11, -0.18), and work organization had a moderate positive correlation with working postures and work types ( r =0.49, 0.55). There was a strong positive correlation between work types and working postures ( r =0.72). The direct path coefficients of individual factors, working postures and muscle fatigue were 0.07, 0.11 and 0.40, respectively. The direct path coefficients of work types were -0.07. There was an indirect path mediated by muscle fatigue between work types, working postures and work organization and lower back pain, and the indirect path coefficients were: work types-muscle fatigue-lower back pain (0.15), working postures-muscle fatigue-lower back pain (-0.04) and work organization-muscle fatigue-lower back pain (0.27) . Conclusion: When carrying out the prevention and control of lower back pain, the pathogenesis of lower back pain induced by workers' muscle fatigue caused by work organization, working postures, and work types factors should be comprehensively considered, so as to provide a theoretical reference for improving the prevention and control level of lower back pain.

Objective: To analyze the distribution characteristics of work-related musculoskeletal disorders (WMSDs) among the occupational population in China's key industries during the period from 2018 to 2023, and to provide data support for the formulation of targeted prevention strategies. Methods: Between January 1, 2018, and December 31, 2023, a cross-sectional epidemiological survey and a retrospective investigation were conducted in seven geographical regions of North China, East China, Central China, South China, Southwest China, Northwest China, and Northeast China, using a combination of epidemiological cross-sectional and retrospective surveys. The industries were stratified according to the degree of closeness to WMSDs, the size of the occupational population, and the importance of the national economy, and then cluster sampling was conducted according to the size of the enterprises (large, medium, and small) within each stratum. Representative enterprises were selected, and workers who had been employed for more than one year and met the inclusion criteria were selected as the study subjects. The survey subjects completed the Chinese version of the Musculoskeletal Disorders Survey Questionnaire online by scanning a QR code. A total of 88, 609 valid questionnaires were collected. Continuous data were described by means and standard deviations, and the standardized incidence rates of WMSDs were evaluated using chi-square tests to compare the standardized incidence rates of different body parts. Results: The standardized prevalence rate of WMSDs among the frontline working population in China was 36.7%, with the top three being the neck (21.37%), shoulders (18.23%), and lower back (14.92%). There was a statistically significant difference in the standardized prevalence rate of WMSDs between different body parts (χ(2)=47577.82, P <0.05). The lowest standardized prevalence rate of WMSDs was found in the southeast coastal region of China (32.54%), while the highest was in the northwest (49.70%) and northeast regions (46.16%). The standardized prevalence rate of WMSDs decreased from 42.88% in 2018 to 29.94% in 2023. The micro-enterprise observation group had a higher concentration of WMSDs in the neck (20.66%), lower back (17.95%), and shoulders (17.79%), while the large enterprise observation group had a higher concentration in the neck (20.54%), shoulders (17.52%), and lower back (14.65%). Among the industries surveyed, the highest standardized prevalence rate of WMSDs was found in the healthcare industry (53.18%), followed by the toy manufacturing industry (50.54%), the automotive manufacturing industry (43.39%), general aviation services (42.71%), and the ship and related equipment manufacturing industry (40.56%). The standardized prevalence rate of WMSDs among women was significantly higher than that of men ( OR value=1.44, P <0.05). In addition, the standardized prevalence rate of WMSDs with multiple affected body parts (four or more body parts affected simultaneously) was higher, and the risk of WMSDs increased with subjective fatigue, showing a significant "S-shaped" trend (the OR value was 2.19, 3.16, 4.71, 5.49, and 3.97 when the RPE was 13, 15, 17, 19, and 20, respectively. χ(2)(trend)=17.23, P <0.001) . Conclusion: The distribution characteristics of WMSDs in key industries in China show obvious differences in different parts, regions, time, enterprise scale, industry and population attributes. Agriculture, pharmaceutical manufacturing, packaging and decoration and other printing industries have a high proportion of WMSDs in multiple parts at the same time and in a single site. It is necessary to study and implement precise preventive measures according to specific regions, industries and enterprise scales, as well as the characteristics of multi-site WMSDs, so as to effectively protect the health and well-being of the working population.

Objective: To explore the occupational contact characteristics of work-related musculoskeletal disorders (WMSDs) among key occupational groups in China, assess the impact of occupational factors on the occurrence of WMSDs, and propose corresponding preventive strategies. Methods: Between January 1, 2018, and December 31, 2023, a cross-sectional epidemiological survey method was employed to retrospectively investigate the occurrence of WMSDs and related occupational factors. Valid questionnaire data from 88609 on-the-job workers in 441 enterprises across 29 industries or job types in seven regions of China were collected, and the relationship between WMSDs and various occupational factors was discussed using multifactorial logistic regression analysis. Odds ratios ( OR ) and their 95% confidence intervals ( CI ) were calculated to assess the impact of different factors on the risk of WMSDs occurrence, with all statistical tests performed as two-tailed tests, using P <0.05 as the criterion for statistical significance. Results: Among the surveyed subjects, 59989 were male, accounting for 67.7% (59989/88609) ; 28620 women, accounting for 32.3% (28620/88609). The standardized incidence rate of work related musculoskeletal disorders (WMSDs) in 9 parts of the body was statistically significant ( P <0.05) among different working age groups without considering specific parts. The average length of service for onset of WMSDs (regardless of location) is (4.52±2.67) years, and there is a statistically significant difference in the length of service for onset of WMSDs in different locations ( P <0.05). As the frequency of heavy object handling increases, the standardization rate and OR value of WMSDs in various parts show a significant increase trend. The incidence of WMSDs is significantly correlated with maintaining poor work posture for a long time, frequent repetitive operations, and heavy object handling ( OR =1.52, 1.45, 1.63, P <0.01) . Conclusion: This study reveals that the risk of WMSDs in China's occupational population shows a non-linear change with increasing length of service, especially with a significant increase in 10 to 25 years of service. Poor work posture, frequent repetitive operations, and heavy object handling are significantly correlated with WMSDs, providing a scientific basis for developing more accurate and effective prevention strategies for WMSDs.

Background: Suicidal ideation among college students and adolescents represents a significant public health issue worldwide. Research has indicated that emotional difficulties may mediate the relationship between bullying victimization and suicidal ideation. However, insights from Thomas Joiner's interpersonal theory and Klonsky's The Three-Step Theory suggest that suicidal ideation arises not merely from emotional distress but from the interplay of hopelessness along with these emotional challenges. Therefore, this study aims to investigate whether variouse affective problems mediated the relationship between bullying victimization and suicidal ideation among college students., Methods: In this study, we utilized a convenience sampling method to collect data from 2717 college students (mean age = 19.81 years, 22.49% male) in South China. We examined the relationships between variables using Spearman's correlation analysis. To analyze potential mediation effects, we employed PROCESS model 4 within SPSS., Results: Our findings revealed that different forms of bullying victimization can predict experiences of depression, anxiety, and social anxiety. However, these emotional responses did not significantly influenced suicidal ideation among college students. Additionally, while different forms of bullying victimization did not directly correlate with feelings of hopelessness, hopelessness was closely associated with the prevalence of suicidal ideation. Furthermore, our results highlighted a significant mediating role of psychiatric prodromal experiences in the relationship between different forms of bullying victimization and suicidal ideation., Conclusions: The results suggested that affective problems may not serve as a significant mediating factor in the relationship between bullying victimization and suicidal ideation. We proposed an integrated emotion-response model that enhances understanding of suicidal ideation among college and offers a framework for more effective prevention strategies., Competing Interests: Declarations. Ethics approval and consent to participate: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee of the School of Psychology, South China Normal University, with ethical approval number: SCNU-PSY-2022-217. Informed consent was obtained from all individual participants included in the study. Consent for publication: All authors have contributed to and have approved the final manuscript. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Retinol binding protein 4 (RBP4), as a novel adipokine, has been proven to be highly related to insulin resistance, obesity, diabetes, hypertension, hyperuricemia and other metabolic diseases, which are all risk factors for chronic kidney disease (CKD). However, there is a lack of sufficient studies to explore the relationship between RBP4 and CKD, and no reports have described the predictive value of RBP4 for CKD. This study was designed to clarify the relationship between RBP4 and CKD and its potential predictive value., Methods: Our team has conducted a large-scale cross-sectional survey that contained 2117 individuals on the southern coast of China. Correlation test, logistic regression analysis were used to evaluate the association between RBP4 and CKD. Receiver operating characteristic (ROC) were used to evaluate the optimal cut-off and predictive value of RBP4 for predicting CKD., Results: By using the quartile grouping method, the population was divided into four groups according to the RBP4 level. As the RBP4 level increased, the prevalence of CKD also gradually increased among different groups. RBP4 was also correlated with various metabolic risk factors, such as blood glucose, blood lipids, blood pressure, waist circumference, uric acid, and with kidney function indicators such as creatinine, urine protein. Logistic regression analysis found that after adjusting for confounders, RBP4 remained significantly associated with CKD, independent of metabolic risk factors. ROC analysis showed that RBP4 as a single index, AUC (0.666) was superior to Scr, FBG, Log HOMA-IR, WC, TG, VLDL-C, UA, HDL-C, LDL-C, and that combining RBP4 indicator and other common risk factors of CKD can improve the accuracy for predicting CKD., Conclusion: This study found that the RBP4 was strongly correlated with CKD, RBP4 may become a valuable marker and have strong power for predicting CKD., 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 Chen, Liu, Wu, Long, Feng, Lu, Chen, Hong, Zhou, Wang, Luo, Zou and Liu.)

Evidence for the prognostic impact of chest pain in acute pulmonary embolism (APE) is limited. This study aimed to assess the prognostic value of chest pain in a Chinese cohort of patients with APE. Consecutive hospitalized patients diagnosed with APE between January 2016 and December 2019 were retrospectively enrolled and followed prospectively for 2 years at West China Hospital of Sichuan University. The primary outcome was in-hospital all- cause mortality, while the secondary outcomes included 3-month, 6-month, and 2-year all-cause mortality, APE recurrence, mechanical ventilation, and length of hospital stay (LOS). A total of 737 APE patients met the study criteria, with 254 patients (34.5%) presented with chest pain at admission. Patients with chest pain had significantly lower in-hospital (3.1% vs. 11.2%), 3-month (3.7% vs. 7.5%), 6-month (5.3% vs. 10.0%), and 2-year (9.8% vs. 15.4%) all-cause mortality compared to patients without chest pain (all P < 0.05). A lower rate of mechanical ventilation was observed in APE patients with chest pain, and no significant differences were identified in terms of APE recurrence and LOS between APE patients with and without chest pain. Chest pain was an independent predictor of in-hospital mortality in three separate multivariable models (range of odds ratios 0.390-0.423, all P < 0.05). APE patients with chest pain had a lower short-term and long-term all-cause mortality compared to those without chest pain. Chest pain may be considered a strong, favorable prognostic marker in acute pulmonary embolism., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: This study was approved by the institutional review board of the West China Hospital of Sichuan University in accordance with the Declaration of Helsinki. The informed consent was waived by the Ethics Review Committee of West China Hospital of Sichuan University., (© 2024. The Author(s).)

This study evaluates the impact of an expanded HIV testing initiative, launched in June 2018 in Luzhou, Sichuan, China, on antiretroviral therapy (ART) initiation rates among people living with HIV (PLWH). Using an uncontrolled interrupted time-series design, we analyzed data from 11,040 PLWH between June 2016 and December 2022, extracted from 108 health facilities via the Center for Disease Control and Prevention's ART database. The primary outcome measures were ART initiation rates within 7 and 30 days of HIV diagnosis. Results showed a significant improvement in the 30-day ART initiation rate following expanded testing, increasing from 46.1% to 90.9% by the study's end. The 7-day initiation rate also improved but remained below 30%. The study found that expanded testing enhanced the role of primary health care institutions in ART initiation. However, the COVID-19 pandemic, beginning January 2020, negatively impacted ART initiation rates, with a slight effect on 30-day rates but a persistent negative impact on 7-day rates. Despite these challenges and an increased HIV burden, Luzhou's ART initiation rates surpassed the national average. This study emphasizes the effectiveness of expanded HIV testing in ensuring timely ART access, crucial for HIV epidemic control, and improved patient outcomes. It also reveals challenges in maintaining HIV services during public health crises, offering insights into health care system resilience. Future research should focus on evaluating long-term treatment outcomes and strategies to support ending the AIDS epidemic.

Background: To compare the impact of tunneled cuffed catheters (TCCs) and arteriovenous fistulas (AVFs) on outcomes in elderly hemodialysis (HD) patients., Methods: A retrospective matched cohort study was performed. Propensity score matching (PSM) was applied to balance the baseline conditions, and we compared all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCEs), hospitalization, and infection rates between AVF and TCC patients ≥70 years old. Cox survival analysis was used to analyze the risk factors for death., Results: There were 2119 patients from our center in the Chinese National Renal Data System (CNRDS) between 1 January 2010 and 10 October 2023. Among these patients, 77 TCC patients were matched with 77 AVF patients. There was no significant difference in all-cause mortality between the TCC and AVF groups (30.1/100 vs. 33.3/100 patient-years, p  = 0.124). Among the propensity score-matched cohorts, no significant differences in Kaplan-Meier curves were observed between the two groups (log-rank p  = 0.242). The TCC group had higher rates of MACCEs, hospitalization, and infection than the AVF group (33.7/100 vs. 29.5/100 patient-years, 101.2/100 vs. 79.5/100 patient-years, and 30.1/100 vs. 14.1/100 patient-years, respectively). Multivariate analysis showed that high Charlson comorbidity index (CCI) score was a risk factor for death., Conclusions: There was no significant difference in all-cause mortality between elderly HD patients receiving TCCs and AVFs. Compared with those with a TCC, elderly HD patients with an AVF have a lower risk of MACCEs, hospitalization, and infection.

Background: With application of artificial intelligence (AI) in the disease screening, process reengineering occurred simultaneously. Whether process reengineering deserves special emphasis in AI implementation in the community-based blinding fundus diseases screening is not clear., Method: Cost-effectiveness and cost-utility analyses were performed employing decision-analytic Markov models. A hypothetical cohort of community residents was followed in the model over a period of 30 1-year Markov cycles, starting from the age of 60. The simulated cohort was based on work data of the Shanghai Digital Eye Disease Screening program (SDEDS). Three scenarios were compared: centralized screening with manual grading-based telemedicine systems (Scenario 1), centralized screening with an AI-assisted screening system (Scenario 2), and process reengineered screening with an AI-assisted screening system (Scenario 3). The main outcomes were incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR)., Results: Compared with Scenario 1, Scenario 2 results in incremental 187.03 years of blindness avoided and incremental 106.78 QALYs at an additional cost of $ 490010.62 per 10,000 people screened, with an ICER of $2619.98 per year of blindness avoided and an ICUR of $4589.13 per QALY. Compared with Scenario 1, Scenario 3 results in incremental 187.03 years of blindness avoided and incremental 106.78 QALYs at an additional cost of $242313.23 per 10,000 people screened, with an ICER of $1295.60 per year of blindness avoided and an ICUR of $2269.35 per QALY. Although Scenario 2 and 3 could be considered cost-effective, the screening cost of Scenario 3 was 27.6 % and the total cost was 1.1 % lower, with the same expected effectiveness and utility. The probabilistic sensitivity analyses show that Scenario 3 dominated 69.1 % and 70.3 % of simulations under one and three times the local GDP per capita thresholds., Conclusions: AI can improve the cost-effectiveness and cost-utility of screenings, especially when process reengineering is performed. Therefore, process reengineering is strongly recommended when AI is implemented., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To study the incidence of congenital posterior arch defects of the atlas and in combination with other congenital variations in the Chinese population., Methods: We retrospectively reviewed 1405 images of cervical 3-dimensional computed tomography (3D CT) and 1284 images of head and cervical 3-dimensional computed tomography angiography (3D CTA), including images of 1539 male and 1150 female individuals. These images of cervical 3D CT and head and cervical 3D CTA were obtained in the Department of Radiology of 2 hospitals, Second and Third People's Hospital of Jingzhou, China, from January 2020 to October 2023. Congenital posterior arch defects of the atlas were classified according to the criteria of Currarino and colleagues. Congenital posterior arch defects of the atlas combined with other congenital variations including occipitalization of the atlas, the ponticulus posticus variation of the vertebral artery groove of the atlas, cervical fusion, and the transversal foramen of the atlas variant were also observed., Results: A total of 2689 patients were included in this study. The overall prevalence of congenital posterior arch defects of the atlas was 0.74% (20 of 2689). There was no statistically significant difference in incidence between male (0.78%, 12 of 1539) and female patients (0.70%, 8 of 1150) (P > 0.05). Among all posterior defects, type A and B defects were found in 0.6% (16 of 2689) and 0.15% (4 of 2689) cases, respectively. There were no type C, D, and E defects and no anterior arch defects. However, in 20 cases of congenital posterior arch defects of atlas, 40% (8 of 20) combined with other congenital variations including occipitalization of atlas in 4 type A cases, bilateral complete ponticulus posticus variation of atlas vertebral groove in 1 type A case, C2-C3 fusion in 1 type A case, coexistence of unilateral complete ponticulus posticus variation of the vertebral artery groove of the atlas and unilateral unclosed transverse foramen in 1 type B case, and coexistence of unilateral unclosed transverse foramen in 1 type A case., Conclusions: The incidence of congenital posterior arch defects of the atlas was low in a Chinese population. There was no difference between male and female individuals. Types A and B were the 2 major defects in this Chinese population, and the prevalence of type A and B combined with other congenital cervical variations were higher than those of types C, D, and E., (Copyright © 2024. Published by Elsevier Inc.)

Objective: This study aimed to explore the mediating roles of mindfulness and illness perception in the effects of a social media-based Mindfulness psyCho-behAvioRal intErvention (MCARE) on depressive and anxiety symptoms among patients with ACS., Methods: This study conducted a secondary longitudinal mediation analysis using data from a randomized controlled trial of the MCARE grogram in patients with ACS. Participants were recruited at two tertiary hospitals in Jinan, China. The MCARE program consisted of six weekly sessions addressing mindfulness training and disease management to facilitate understanding and management of emotions and illness. The analytical sample included participants who completed measures of the primary outcomes, i.e., depression (PHQ-9) and anxiety (GAD-7) and potential mediators, i.e., mindfulness (CAMS-R) and illness perception (Brief-IPQ) at baseline (T0), immediate post-intervention (T1), and 12-week after the commencement of the intervention (T2)., Results: This study included 146 participants (mean age 58.9 years (SD = 8.9), 69.2 % male), including both intervention and control groups. The mediation analysis revealed a significant mediating effect of T1 mindfulness in the relationship between the group and T2 depression symptoms (indirect effect: -0.109, 95 % CI: -0.191, -0.041; P = 0.004), accounting for 26 % of the effect. For T2 anxiety symptoms, T1 illness perception exhibited a significant mediating effect (indirect effect: -0.055, 95 % CI: -0.110, -0.005; P = 0.035), accounting for 22 % of the effect., Conclusions: This study found that mindfulness and illness perception played a mediating role in the effects of the MCARE program on depressive and anxiety symptoms among patients with ACS., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

Non-suicidal self-injury (NSSI) is an emerging concern in the field of public health. The objective of this study is to develop a conditional process model to investigate the relationship between social anxiety and NSSI, and the role of impulsiveness and self-esteem in this relationship. A convenience sample of 2717 university students (M age  = 19.81, 22.49% male) from Southern China was recruited. The age range of the participants is between 18 and 25 years. The data were analysed using Spearman correlation analysis, mediation analysis and moderation analysis. The study revealed a positive correlation between social anxiety and NSSI, with impulsiveness serving as a mediating factor in this association. The relationship between social anxiety and NSSI, impulsiveness and social anxiety, impulsiveness and NSSI were all found to be moderated by self-esteem. The prevalence of NSSI among college students exhibited a strong association with social anxiety and impulsiveness. The present investigation additionally demonstrated that there was no significant association between social anxiety, impulsivity and NSSI when high self-esteem was included. This finding implies that self-esteem plays a crucial role in safeguarding against NSSI., (© 2024 International Union of Psychological Science.)

Objectives: Growing evidence has suggested that, in addition to noise exposure level, noise temporal structure (i.e., kurtosis) plays an important role in the development of noise-induced hearing loss, while most of the relevant research has been on the results of pure-tone audiometry. This study focuses on the combined effect of noise exposure level and noise kurtosis on distortion product otoacoustic emissions (DPOAEs) in young workers with normal hearing., Design: A cross-sectional study among young workers in manufacturing industries was conducted in Zhejiang Province, China. Individual noise exposure measurements were performed on participants to obtain an A-weighted noise exposure level normalized to 8 hr ( LAeq, 8hr ), cumulative noise exposure (CNE), kurtosis, and kurtosis-adjusted CNE (CNE-K). The DPOAE test was performed on the participants and DPOAE levels were obtained. The relationships between noise exposure level, kurtosis, and DPOAE levels were explored by univariate analyses. Furthermore, multivariate regression models were conducted to estimate the combined effects of exposure level and kurtosis after adjusting for age, gender, and use of hearing protection devices., Results: The overall DPOAE curves across frequency bands presented a fluctuating downward trend with increasing frequency. Both exposure level and kurtosis were found to be associated with decreases in DPOAE levels. The multivariate regression model including CNE-K as a joint indicator of complex noise showed an increased R2 compared with the model including CNE. After adjustment for age, gender, and the use of hearing protection devices, significant effects of CNE-K on DPOAE levels were observed at 3, 4, and 5 kHz frequencies, with maximum effect presented at 4 kHz., Conclusions: DPOAE is a sensitive test that can detect cochlear damage in limited areas that cannot be detected by conventional audiometry. The present study provided a more comprehensive understanding of the impact of complex noise on the DPOAE levels. It also suggested that CNE-K was an effective metric in assessing DPOAE levels associated with complex noise., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 The Authors. Ear & Hearing is published on behalf of the American Auditory Society, by Wolters Kluwer Health, Inc.)

Aims/Background Pregnancy can affect various bodily functions, including metabolism, cardiovascular function, and eyesight. Pathological ocular changes observed during pregnancy are linked to the development of pregnancy-specific conditions, such as preeclampsia/eclampsia and gestational diabetes. This study aims to analyze clinical data disease history and maternal characteristics collected during pregnancy, to determine ocular parameters and develop a risk prediction model for adverse ocular outcomes. Methods We retrospectively analyzed the medical records of 760 pregnant women (1520 eyes) from September 2020 to September 2022 at The Third Affiliated Hospital of Guangzhou Medical University. We identified maternal variables that could influence adverse ocular outcomes, including maternal age, pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), eclampsia, pre-eclampsia, uterine disease, fetal abnormalities, in vitro fertilization with embryo transfer, hypoproteinemia, and major comorbidities during pregnancy. Univariate and multivariate logistic regression analyses were conducted to evaluate the effects of these independent predictors on adverse ocular outcomes. Additionally, receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off probability with for optimal sensitivity and specificity. Results Eclampsia, pre-eclampsia, GDM, a history of chronic hypertension, and hypoproteinemia were identified as independent predictors of adverse ocular outcomes during pregnancy ( p < 0.05). Maternal age, PIH, intrauterine growth retardation (IUGR), obesity, and pregnancy with immunoglobulin A nephropathy were predictors of moderate and severe retinal arteriole sclerosis during pregnancy ( p < 0.05). Additionally, hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome were predictors of retinal hemorrhage and exudate during pregnancy ( p < 0.05). The area under the ROC curve for adverse ocular outcomes were 0.75 and 0.74, respectively. Conclusion Our predictive model effectively forecasts adverse ocular outcomes during pregnancy, incorporating risk factors such as maternal age, eclampsia and pre-eclampsia, GDM, obesity, a history of chronic hypertension, hypoproteinemia, IUGR, pregnancy with immunoglobulin A nephropathy, and HELLP syndrome.

Background: To explore the relationship of insulin resistance (IR) with chronic kidney disease (CKD) in individuals without diabetes., Methods: We performed a cross-sectional survey among 2142 community-based participants without diabetes from southern China from June to October 2012 and excluded the incomplete data. We divided all the participants into four groups according to the quartiles of homeostasis model assessment of IR (HOMA-IR). Logistic regression models were used to explore the associations of IR with CKD in these subjects., Results: In the unadjusted model, compared with the quartile one group, IR was significantly associated with CKD (odds ratio [OR] = 2.24, P < 0.001; OR = 4.46, P < 0.001) in the quartile three and four groups, and the association was still significant (OR = 2.08, P = 0.005; OR = 3.89, P < 0.001 ) after adjusting for potential confounders (including age, current smoker, current alcohol use, physical inactivity, education level, systolic blood pressure, diastolic blood pressure, serum triglyceride, and body mass index). The area under the receiver operating characteristic curve (95% confidence interval) of HOMA-IR for diagnosing CKD was 0.67 (0.64, 0.71). The cut-off value was 2.5, the sensitivity was 75.2%, and the specificity was 56.4%., Conclusions: IR is associated with Chronic Kidney Disease (CKD) in participants without diabetes. It has been proposed that CKD patients may benefit from reducing their insulin resistance., Competing Interests: Declarations. Ethics approval and consent to participate: The experimental scheme was approved by the ethics committee of the Third Affiliated Hospital of Southern Medical University (201,708,011). Written informed consent was obtained from all participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Both long and short sleep durations may lead to cognitive decline in the elderly individuals, though the underlying mechanisms remain unclear., Aims: To explore the mediating mechanism of activities of daily living and depression on different sleep durations and cognitive function in older Chinese older adults., Methods: This retrospective study used data from 5,899 older adults who completed the 2018 China Health and Retirement Longitudinal Surveys. We used the PROCESS macro in SPSS to determine the chain mediating effect of ADL and depression on the relationship between different sleep durations and cognitive functions., Results: (1) There were significant correlations among sleep duration, ability to perform ADL, depression, and cognitive function. (2) For sleep durations ≤ 7 h/night or > 7 h/night, ADL and depression play a chain mediating role in the relationship between sleep duration and cognitive function., Conclusions: Shorter or longer sleep durations were associated with cognitive decline by weakening ADL and worsening depression, which suggests that medical personnel should take action to correct abnormal sleep duration in older adults. Timely treatment of ADL impairment and depression may help prevent cognitive decline., Competing Interests: Declarations Ethics approval and consent to participate Ethical approval for the collection of data from the CHARLS was obtained from the Institutional Review Board of Peking University (IRB00001052-11015). Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

The association between plasma low-density lipoprotein cholesterol (LDL-C) and atrial fibrillation (AF) recurrence after catheter ablation remains unclear. We aimed to assess the relationship between preprocedural LDL-C and the AF recurrence in patients undergoing catheter ablation. The cohort study consecutively included AF patients who underwent de novo catheter ablation between April 2021 and January 2023 in the Second Affiliated Hospital of Nanchang University in Jiangxi Province, China. Patients were divided into quartiles based on their baseline fasting LDL-C level (Q1-Q4). Multivariable Cox proportional hazards models were used to evaluate the relationship between LDL-C and AF recurrence. Our analysis included the use of a generalized additive model and smooth curve fitting (penalized spline method), and two-piecewise Cox proportional hazards models, to address the nonlinearity between preprocedural LDL-C and AF recurrence. A total of 482 AF patients with de novo catheter ablation were enrolled, with a median follow-up period of 15.00 months, AF recurrence occurred in 96 (19.92%) patients. The relationship between preprocedural LDL-C and AF recurrence after ablation presented as an L-shape, and the inflection point for the curve was found at the LDL-C level of 3.20 mmol/L (Log likelihood ratio P = 0.031). The hazard ratios (HR) [(95% confidence intervals (CI)] for AF recurrence were 0.50 (0.33-0.74) and 2.11 (0.76-5.89) to the left and right of the inflection point, respectively. Lower LDL-C level is associated with increased AF recurrence risk after catheter ablation were consistent across all subgroups., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: College students in Western China face unique economic, cultural, and educational environments, yet limited studies have specifically investigated the factors or interventions concerning emotional distress within this population., Aim: This study aimed to explore whether school belongingness mediates the relationship between expectations regarding school and emotional distress among college students in Western China, and whether physical exercise moderates this mediation., Methods: Employing a cross-sectional design, 1,063 college students in Xinjiang, China were recruited for this study. A self-administered electronic questionnaire assessed expectations regarding school, school belongingness, physical exercise, anxiety, and depression. Structural equation modeling was utilized to analyze mediating and moderating effects., Results: Expectations regarding school was negatively associated with emotional distress. School exclusion and school acceptance fully mediated the effect of expectations regarding school on emotional distress. Physical exercise moderated the mediating effect of school exclusion, but not that of school acceptance., Conclusion: Expectations regarding school and school belongingness, particularly the exclusion component, emerge as pivotal factors influencing emotional distress among college students in Western China. Furthermore, physical exercise presents itself as a promising targeted intervention for alleviating emotional distress within this demographic., 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 Su, Huang, Zou, Zhang and Feng.)

Depression and anxiety significantly impact college students, leading to various negative outcomes. While numerous studies have investigated the relationship between these two conditions, their temporal sequence remains unresolved. Many previous studies have concentrated on broad latent variables, often neglecting the nuanced symptomatology perspective, which may offer deeper insight into the clinical characteristics of these disorders. In this study, we collected questionnaire data from a college in South China using a cluster random sampling method. Data collection occurred over two time points, with the first round completed in November 2022 and May 2023, with a six-month interval. A total of 689 participants successfully completed the questionnaires during both rounds. Employing cross-lagged network analysis from a symptom-focused perspective, this research examines the interactions and predictive relationships between symptoms of depression and anxiety. The findings identified key symptoms-specifically "Irritability", "Guilty" and "Sad mood"- as critical bridging nodes of connection within the depression and anxiety symptom network. Our analysis revealed both bidirectional predictive relationships between certain symptoms nodes of depression and anxiety, as well as unidirectional ones. By highlighting these core nodes and their directional relationships, this study offers valuable insights that can inform targeted intervention and treatment strategies for enhancing mental health among college students., Competing Interests: Declaration of competing interest On behalf of all authors, the corresponding author states that there is no conflict of interest, and manuscript is approved by all authors for submission and publication., (Copyright © 2024 Elsevier Ltd. All rights reserved.)