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Abstract Rapid and safe hemostasis is crucial for the survival of bleeding patients in prehospital care. It is urgent to develop high performance hemostatic material to control the massive hemorrhage in the military field and accidental trauma. In this work, an efficient protein hemostat of thrombin was immobilized onto commercial gauze, which was mediated by self-polymerization and anchoring of tannic acid (TA). Through TA treatment, the efficient immobilization of thrombin was achieved, preserving both the biological activity of thrombin and the physical properties of the dressing, including absorbency, breathability, and mechanical performance. Moreover, in the presence of TA coating and thrombin, Gau@TA/Thr could obviously shortened clotting time and enriched blood components such as plasma proteins, platelets, and red blood cells, thereby exhibiting an enhanced in vitro coagulation effect. In SD rat liver volume defect and artery transection hemorrhage models, Gau@TA/Thr still had outstanding hemostatic performance. Besides, the Gau@TA/Thr gauze had inherent antibacterial property and demonstrated excellent biocompatibility. All results suggested that Gau@TA/Thr would be a potential candidate for treating uncontrollable hemorrhage in prehospital care.

The key to restoring arid and semi-arid ecosystems is maintaining soil water and organic carbon contents. Alfalfa (Medicago sativa L.) is a high-yield perennial forage crop and performs ecological functions as a drought-resistance leguminous herb. It has been widely planted for reconstruction of degraded soils in the Loess Plateau in northwestern China, but long-term planting may affect soil carbon–water coupling and lead to crop yield reduction. To maximize the benefits of reconstructed grassland, this study explored the couplings of soil water, organic carbon, and alfalfa productivity along a reconstruction chronosequence in a semi-arid area of the Loess Plateau. Space-for-time substitution approach was used to select different-aged stands of reconstructed grassland (1, 5, 7, 10, 15, 20, 30 years old). Alfalfa above-ground biomass (AGB), soil water storage (SWS), organic carbon storage (SOCS), and carbon–water coupling coordination degree (D) were measured in the 0–100 cm soil profile. Alfalfa AGB reached a peak in the 7th year, and the degradation began in the 10th year. Both SWS and SOCS varied nonlinearly with stand age. The greatest loss of SWS occurred in the 15th year (80–100 cm depth), whereas the largest increase of SOCS occurred in the 30th year (0–20 cm depth). There was a negative feedback relationship between AGB and SWS over the 30-year study period (Pearson r = −0.835, P = 0.098). AGB and SOCS initially showed a trade-off within the first 10 years (Pearson r = −0.7431, P = 0.2569), in contrast to their positive feedback in the 20–30th years (Pearson r = 0.9978, P = 0.0421). A decoupling between SWS and SOCS (D < 0.6) was observed after 12 years of alfalfa planting. For agricultural production, a greater supply of water and organic fertilizer is required from the 7th year of alfalfa planting, and reseeding may be needed around the 10th year to prolong the life of alfalfa community. Alfalfa should be planted for no more than 12 consecutive years in the study area for ecological protection.

ObjectivesPeople living with HIV are aging. This study aimed to assess the factors influencing the requirements for geriatric nursing of older adults living with HIV (OALHIV).MethodsConvenience sampling was used to conduct a survey on the 295 OALHIV aged over 50 in Luzhou, China.ResultsOALHIV had few needs for living care needs. Most people indicate a requirement for reducing medical costs. Regarding psychological comfort needs, disease privacy and confidentiality were the greatest requirement. Multivariable regression analyses found that social support had a positive influence on the requirements for geriatric nursing.ConclusionIt is necessary to provide more social support for OALHIV. Most importantly, China should incorporate OALHIV into national pension security plan, integrate various resources and improve social security for them.

Optimizing the nitrogen (N) fertilization level and cropping system is critically important for achieving good production performance with low environmental pollution. However, there is a knowledge gap on the relationship between crop production sustainability, water and nitrogen consumption, greenhouse gas (GHG) emission under the change in N application rate under cereal and legume mixed systems. A 3-year field experiment with two cropping systems [sole forage sorghum (SS) and forage sorghum/lablab mixed cropping (SL) with four N fertilizer application rates (N0, 0 kg N ha−1; N90, 90 kg N ha−1; N180, 180 kg N ha−1; and N270, 270 kg N ha−1)] was conducted. Results obtained showed that mixed cropping combined with N fertilization enhanced forage biomass and crude protein yield by 34.0 % and 51.1 %, respectively, particularly in mixed cropping combined with the N180 treatment compared with the N0 level in the sole cropping system. Similar improvements were observed for yield stability and sustainability (2.97 % and 0.95, respectively), which reached maximum values at N180 in the mixed cropping system. In addition, mixed cropping increased the water productivity of dry matter yield (WPDM) and water productivity of crude protein yield (WPCPY) by 17.2 % and 27.6 %, respectively, at 180 kg N ha−1 compared with the corresponding treatments of the sole planting system. Furthermore, mixed cropping combined with appropriate N application significantly improved N physiological efficiency (PEN) and reduced GHG intensity (GHGI), where N application of 180 kg ha−1 N increased PEN by 21.3 % and reduced GHGI by 17.6 % compared with the corresponding monoculture in the mixed cropping system. This study demonstrated that reducing N fertilization in cereal–legume cropping systems can promote forage productivity by optimizing water and N management while decreasing environmental pollution. Therefore, forage sorghum mixed with lablab and fertilization at 180 kg N ha–1 is a preferable approach for sustainable agricultural production in the Northwest arid region of China.

ObjectiveThe World Health Organization advocated for enhanced integration of traditional medicine and complementary medicine into national healthcare systems across all countries. This study aims to explore the progress and challenges in integrated traditional Chinese and western medicine (ITCWM) in China over 20 years using nationwide data.MethodsThis cross-sectional study examined various facets of ITCWM in China in terms of policies, resources, services, and funding. National policy documents from 2009 onwards were retrieved from official websites of the Chinese government. Data on ITCWM resources, services and subsidies from 2002 to 2021 were extracted from the China Statistical Yearbooks of Chinese Medicine and China Health Statistical Yearbooks. Research fund projects with the ITCWM discipline were collected from the database of National Natural Science Foundation of China. A mixed method of both quantitative and qualitative approaches was employed to present a comprehensive overview of the collected data.ResultsThis study presented five key findings. First, despite the issuance of 17 national policies by the Chinese government since 2009 to promote the development of traditional Chinese medicine (TCM), only three of them were specifically tailored for ITCWM. Second, although the average annual growth rates of ITCWM institutions, beds, and practitioners reached 0.35%, 10.56%, and 10.88% from 2002 to 2021, with more equitable allocation of ITCWM resources, the overall proportion of ITCWM remained below 5% in 2021. Third, progress has been made in ITCWM practices, yet service efficiency requires further enhancement. In 2021, ITCWM hospitals accounted for 2% of outpatient and emergency visits and 1.57% of hospital admissions among all hospitals, and 9.82% of delivered services were preventive healthcare services. Fourth, ITCWM served a crucial role in primary healthcare services, but its service capabilities need improvement. From 2007 to 2021, the average growth rates of ITCWM clinics, outpatient departments, and practitioners in outpatient departments were 13.30%, 2.57%, and 12.14%, respectively, while the proportion within TCM hospitals dropped. Lastly, despite the Chinese government’s emphasis on financial investment and related project funding for ITCWM, it remained lower than that allocated to TCM and western medicine.ConclusionITCWM played a pivotal role in China’s healthcare system to advance individuals’ health and well-being across the lifespan. In the future, China will provide further support to enhance ITCWM health resources and improve service capability, and the strategic integration of ITCWM into the broader healthcare system will play a crucial role in achieving universal health coverage and the Sustainable Development Goals.

Summary: Background: In non-high-risk individuals, risk-category-based atherosclerotic cardiovascular disease (ASCVD) screening strategies may be more cost-effective than one-size-fits-all approaches. However, current decisions are constrained by a lack of research evidence. We aimed to explore appropriate risk-category-based screening interval strategies for non-high-risk individuals in ASCVD primary prevention in the Chinese population. Methods: We used data from 28,624 participants in the China Kadoorie Biobank (CKB) who had completed at least two field surveys. The risk assessment tools were the 10-year ASCVD risk prediction models developed based on the CKB cohort. We constructed multistate Markov models to model disease progression and estimate transition probabilities between different risk categories. The total person-years spent unidentified in the high-risk state over a 10-year period were calculated for each screening interval protocol. We also estimated the number of ASCVD events prevented, quality-adjusted life years (QALYs) gained, and costs saved when compared to the 3-yearly screening protocol. Findings: When compared to the uniform 3-yearly protocol, most risk-category-based screening interval protocols would identify more high-risk individuals timely, thus preventing more ASCVD events and gaining QALYs. A few of them would reduce total health-care costs. The protocol, which used 6-year, 3-year, and 2-year screening intervals for low-risk, intermediate-low-risk, and intermediate-high risk individuals, was optimal, and would reduce the person-years spent unidentified in the high-risk category by 17.9% (95% CI: 13.1%–21.9%), thus preventing an estimated 113 thousand (95% CI: 83–138) hard ASCVD events for Chinese adults aged 30–79 over a 10-year period. When using a lower cost of statin therapy, more screening protocols would gain QALYs while saving costs. Interpretation: For the primary prevention of ASCVD, risk-category-based screening protocols outperformed the one-size-fits-all approach in the Chinese population. Funding: This work was supported by National Natural Science Foundation of China (82192904, 82388102, 82192900) and grants (2023YFC2509400) from the National Key R&D Program of China. The CKB baseline survey and the first re-survey were supported by a grant from the Kadoorie Charitable Foundation in Hong Kong. The long-term follow-up is supported by grants from the UK Wellcome Trust (212946/Z/18/Z, 202922/Z/16/Z, 104085/Z/14/Z, 088158/Z/09/Z), grants (2016YFC0900500) from the National Key R&D Program of China, National Natural Science Foundation of China (81390540, 91846303, 81941018), and Chinese Ministry of Science and Technology (2011BAI09B01).

The growth and biological decline of alfalfa may be linked to the rhizosphere microbiome. However, plant–microbe interactions in the rhizosphere of alfalfa and associated microbial community variations with stand age remain elusive. This study explored the successional pattern of rhizosphere microbial communities across different aged alfalfa stands and its relationship with alfalfa decline. Rhizosphere soils were collected from 2- and 6-year-old alfalfa stands. Control soils were collected from interspaces between alfalfa plants in the same stands. Soil bacterial and fungal communities were characterized by 16S and ITS rRNA gene sequencing, respectively. Specific microbial taxa colonized the rhizosphere soils, but not the control soils. The rhizosphere-specific taxa mainly included potentially beneficial genera (e.g., Dechloromonas, Verrucomicrobium) in the young stand and harmful genera (e.g., Peziza, Campylocarpon) in the old stand. Alfalfa roots regulated soil microbial communities by selective promotion or inhibition of distinct taxa. The majority of time-enriched taxa were reported as harmful fungi, whose relative abundances were negatively correlated with plant traits. Time-depleted taxa were mostly known as beneficial bacteria, which had relative abundances positively correlated with plant traits. The relative abundances of functional bacterial genes associated with vancomycin biosynthesis, zeatin biosynthesis, and amino acid metabolism trended lower in rhizosphere soils from the old stand. An upward trend was observed for fungal pathogens and wood saprotrophs with increasing stand age. The results suggest that root activity drives the negative succession of rhizosphere microbial communities during alfalfa decline in old stands.

Summary: Background: Hospitals in China are classified into tiers (1, 2 or 3), with the largest (tier 3) having more equipment and specialist staff. Differential health insurance cost-sharing by hospital tier (lower deductibles and higher reimbursement rates in lower tiers) was introduced to reduce overcrowding in higher tier hospitals, promote use of lower tier hospitals, and limit escalating healthcare costs. However, little is known about the effects of differential cost-sharing in health insurance schemes on choice of hospital tiers. Methods: In a 9-year follow-up of a prospective study of 0.5 M adults from 10 areas in China, we examined the associations between differential health insurance cost-sharing and choice of hospital tiers for patients with a first hospitalisation for stroke or ischaemic heart disease (IHD) in 2009–2017. Analyses were performed separately in urban areas (stroke: n = 20,302; IHD: n = 19,283) and rural areas (stroke: n = 21,130; IHD: n = 17,890), using conditional logit models and adjusting for individual socioeconomic and health characteristics. Findings: About 64–68% of stroke and IHD cases in urban areas and 27–29% in rural areas chose tier 3 hospitals. In urban areas, higher reimbursement rates in each tier and lower tier 3 deductibles were associated with a greater likelihood of choosing their respective hospital tiers. In rural areas, the effects of cost-sharing were modest, suggesting a greater contribution of other factors. Higher socioeconomic status and greater disease severity were associated with a greater likelihood of seeking care in higher tier hospitals in urban and rural areas. Interpretation: Patient choice of hospital tiers for treatment of stroke and IHD in China was influenced by differential cost-sharing in urban areas, but not in rural areas. Further strategies are required to incentivise appropriate health seeking behaviour and promote more efficient hospital use. Funding: Wellcome Trust, Medical Research Council, British Heart Foundation, Cancer Research UK, Kadoorie Charitable Foundation, China Ministry of Science and Technology, and National Natural Science Foundation of China.

Summary: Background: Previous observational studies established a positive relationship between snoring and stroke. We aimed to investigate the causal effect of snoring on stroke. Methods: Based on 82,339 unrelated individuals with qualified genotyping data of Asian descent from the China Kadoorie Biobank (CKB), we conducted a Mendelian randomization (MR) analysis of snoring and stroke. Genetic variants identified in the genome-wide association analysis (GWAS) of snoring in CKB and UK Biobank (UKB) were selected for constructing genetic risk scores (GRS). A two-stage method was applied to estimate the associations of the genetically predicted snoring with stroke and its subtypes. Besides, MR analysis among the non-obese group (body mass index, BMI

Cereal and legume mixed cropping has been widely adopted to increase forage production in the sustainable development of agriculture and livestock. Among the different mixed cropping combinations, forage sorghum and lablab bean mixed cropping can be adapted globally. However, knowledge regarding the relation between forage production, interspecific competition, and resource utilization efficiency in the forage sorghum and lablab bean mixed cropping system remains unclear. A 3-year field experiment was conducted in 2020, 2021, and 2022 to investigate the effects of different cropping systems (16.5 kg·ha−1 lablab bean mixed cropping with forage sorghum [SD1], 33.0 kg·ha−1 lablab bean mixed cropping with forage sorghum [SD2], 49.5 kg·ha−1 lablab bean mixed cropping with forage sorghum [SD3], 66.0 kg·ha−1 lablab bean mixed cropping with forage sorghum [SD4], sole forage sorghum [SS], and sole lablab bean [DD]) on forage production, forage quality, competition parameters, water use efficiency (WUE), and radiation use efficiency (RUE). The results obtained revealed that mixed cropping practices enhanced forage yield by mitigating soil water depletion and optimizing canopy structures. Specifically, SD3 treatment was an efficient farming practice that increased system dry matter yield by 32.6–67.5%, crude protein yield by 12.5–15.1%, WUE by 9.2–67.4%, and RUE by 39.6–38.2% compared with other treatments. In addition, SD4 treatment increased crude protein content by 11.1% compared with forage sorghum monocropping; however, there were no significant differences in crude protein between SD3 and SD4 mixed cropping systems. The land equivalent ratio values were greater than one when forage sorghum was mixed with lablab bean, especially for the SD3 system (averaged 1.43). In addition, forage sorghum was more dominant and had higher aggressiveness (0.65) and competitive ratios (3.44) than lablab bean. This indicates that mixing cereals with legumes enhances RUE by interspecific competition. Consequently, the SD3-mixed cropping system is recommended for supporting the sustainable development of agriculture and livestock production in the arid region of China when considering forage production and nutritional quality.

The distribution of energetic ion flux in the ring current region, such as a meteorological cumulonimbus cloud, stores up the particle energy for a geomagnetic substorm. It is helpful to study the geomagnetic substorm mechanism by using a lunar base ENA imaging simulation of the dynamic evolution of the ring current, and establishing the corresponding relationship between key node events of the substorm. Based on the previous observation experience and our simulation results of the dynamic evolution of the ring current, we propose a macroscopic model of substorms related to the dynamic evolution of ring currents and present the possibility of confirming the causal sequence of some of those critical node events of substorms with the lunar base ENA imaging measurement. IBEX, operating in the ecliptic plane, may even give examples of the telemetry of ring current ion fluxes through ENA measurements during substorms/quiets.

High-quality demand-side management requires an abundance of load profiles to support decision-making processes. However, customer energy consumption data often contains sensitive personal information, and service providers face significant challenges in accessing a substantial amount of energy consumption data. To generate a large volume of customer data without compromising privacy, this study introduces a data-driven approach integrating Information Maximizing Generative Adversarial Networks (InfoGAN) with Multivariate Kernel Density Estimation (MKDE) for the generation of load profiles. InfoGAN is firstly trained based on existing customer load profiles, with the Q network disentangling the load into feature variables and the generator producing realistic profiles. Subsequently, MKDE is utilized to assess the distribution of these features, enabling the generation of new profiles by sampling new feature variables. The proposed method circumvents the need for intricate sampling or modeling processes and generates realistic data that represents the inherent uncertainties and fluctuations characterizing customers’ electricity consumption. The generated data could be used as the substitution for real electricity consumption data, thereby facilitating further applications without compromising privacy concerns.

Quantitative identification of mixed-valence metal ions is essential for gaining deeper insights into critical chemical and biological processes in environmental science, chemical engineering, and biological systems. However, a simple approach of quantitative identification mixed-valence metal ions in solution has remained a challenge. In this study, we have experimentally observed a significant linear correlation (R2 = 0.99) between the concentration of high-valence metal ions (using iron ions as an example) and the fluorescence intensity of graphene quantum dots (GQDs). Utilizing the distinct fluorescence responses of GQDs to high-valence and low-valence metal ions, reliable quantitative detection of mixed-valence metal ions has been successfully achieved. Remarkably, we introduced real-time monitoring of mixed-valence metal ions, revealing a shift from a molar ratio of approximately 4.0 to 2.0. Density functional theory calculations have revealed significant differences in charge transfer between high-valence and low-valence states of metal ions adsorbed onto GQDs. Furthermore, the versatility of this method can extend to various types of GQDs and metal ions, highlighting its universal applicability. This work presents a simple, convenient, and cost-effective approach for quantitatively identifying mixed-valence metal ions in solution, offering a new avenue and opportunity for applications in biochemistry, environmental science, catalysis and materials science.

In this work, the effect of prior cold deformation on the bainite transformation kinetics of austempered GCr15 bearing steel was investigated by means of dilatometry. It is found that prior cold deformation retards bainite transformation by increasing the incubation and growth time and decreasing the transformation rate, indicating that the effect of carbon content in parent austenite on bainite transformation kinetics is larger than the refinement of prior austenite grain size. Meanwhile, it also found from microstructures analysis that the prior cold deformation is beneficial to refine prior austenite grain size, facilitate dissolution of spherical carbides and improve its aspect ratio. After the heat treatment of austenitizing at 850 °C for 30 min and following austempering at 240 °C for 30 min, a marginal improvement of tensile strength and significant improvement of impact toughness were achieved in specimen with 30% prior cold deformation, which is increased by 6.2% and 29.3%, as compared to that of the specimen without prior cold deformation. In addition, the effect of prior cold deformation on microstructural evolution is also discussed.

Desorption of ions from sorbents generally involves high acid or base concentrations and long desorption times, especially for multivalent ions. Here the authors report a rapid and efficient desorption of Co2+, Mn2+, and Sr2+ adsorbed on magnetite-graphene oxide that occurs by adding low amounts of Al3+, which is shown to interact with graphene more strongly than divalent ions.

ObjectivesThe incidence of non-tuberculous mycobacterial pulmonary disease (NTM-PD) has increased steadily globally, but the current culture-based diagnosis of NTM-PD is difficult and time-consuming, leading to a high possibility of misdiagnosis. Therefore, new methods should be introduced to improve the processes for clinical diagnosis of this disease.MethodsOur retrospective observational study enrolled 12 NTM-PD patients who were identified by way of metagenomic next-generation sequencing (mNGS), as well as the characteristic radiological presentation of slowly progressed, usually concomitant bronchiectasis, small cavitary opacity, and multiple nodules that respond poorly to empirical antibiotic therapy. These patients received the recommended drug regimen based on the identified non-tuberculous mycobacteria (NTM) species. Clinical data, including symptoms, laboratory tests, dynamic computed tomography imaging, treatment, and outcome, were recorded and analyzed.ResultsThe results of mNGS were all positive, with the standard specifically mapped read numbers (SDSMRN) of NTM ranging from 1 to 766; this was confirmed in six patients via quantitative polymerase chain reaction (qPCR) analysis. The duration fromsample collection tomNGS results was 1–4 days. Among our 12 patients (except for one lost to follow-up) the CT imaging for 11 patients showed significant absorption of lesions.ConclusionsOur results draw attention to NTM infection as a possible cause of community-acquired pneumonia, especially in patients with suggestive radiological presentation and poor responses to empirical antibiotic therapy. Our study also indicated that mNGS represented a potentially effective tool for the rapid identification of NTM in the respiratory sample. Improved clinician awareness combined with the utilization of mNGS could guide earlier diagnosis and targeted treatment, and finally improved the prognoses of patients with NTM-PD.

The experimental and computational studies for MILD combustion of diesel were conducted in this paper. The experiment was carried out in a constant pressure bomb and the computation was completed with the SAGE combustion model. The initial condition in the experiment covers two temperatures (723 K and 773 K), two pressures (18 bar and 25 bar), with a constant fuel flow of 2 kg/h, an oxygen flow of 1 kg/h, and a wide range of carbon dioxide flow containing 35–160 kg/h. Normal combustion has bright yellow flame and MILD combustion has blue flame according to observation in the experiment. The effects of ejection ratio, initial temperature and pressure are investigated to illustrate the mechanism of MILD combustion. The results show an increase in ejection ratio and an increase in initial temperature are propitious to achieve MILD combustion, while increased pressure needs more strict requirements to realize MILD combustion. Generally, experiment results and computations have similar trends for the effects of initial conditions on MILD combustion.

In this work, effect of martensite pre-quenching on the subsequent bainite transformation kinetics of GCr15 bearing steel has been investigated by means of dilatometry. The results show that the pre-quenched martensite is significantly accelerate nucleation of subsequent bainite transformation in comparison with direct bainite austempering. Meanwhile, specimen of martensite pre-quenching at 200 °C has the shortest incubation period of bainite transformation at 240 °C. Moreover, the transformation rate of bainite transformation after martensite pre-quenching is faster than direct bainite austempering in the initial growth stage, and decrease with the decreasing of martensite pre-quenching temperature. Compared with the conventional quenched and tempered (QT) specimen, the tensile strength is slightly decrease from 2170 MPa to 2143 MPa, but the impact toughness is obviously increase from 43 J to 71 J in specimen heat-treated by martensite pre-quenching at 200 °C and subsequent bainite transformation at 240 °C. In addition, the mechanical stability of retained austenite in all martensite pre-quenching specimens are higher than that of QT specimen.

Skene’s gland is homologous to the male prostate and can secrete prostate fluid. However, Skene’s gland carcinoma is extremely rare, with only 20 cases reported in the literature thus far. We report the first case of adenosquamous carcinoma of Skene’s gland. The patient was a 54-year-old woman who was admitted to our hospital due to vaginal bleeding and a vaginal mass, accompanied by multiple lymph nodes and vulvar metastases. She had a history of dysuria and episodic hematuria for 2 years. Contrast-enhanced pelvic MRI showed a mass in the right labia majora and swelling of the right inguinal lymph nodes. In addition, a mass in the anterior vaginal wall surrounded the urethra and grew in a semi-encircled manner. After receiving neoadjuvant chemotherapy, MRI revealed that the mass surrounding the urethra had shrunk, and the nodular shadow of the right labia majora was larger than before. The patient underwent elective surgery. Surgical pathology showed adenosquamous carcinoma, and immunohistochemistry suggested intestinal differentiation. Forty-six days after surgery, the patient subsequently died of tumor consumption and organ insufficiency due to cerebral infarction, recurrence, and multiple metastases. This paper describes the clinical, radiological, and histopathologic features as well as the prognosis of the rare disease adenosquamous carcinoma of Skene’s gland. In addition, we briefly review the published literature.

As a high-quality legume forage, alfalfa is restricted by various abiotic stresses during its growth and development. Melatonin is a multifunctional signaling molecule that involves in plant defense against multiple stresses. However, little is known about its downstream signaling pathway and regulatory mechanisms in salt stress of alfalfa. In this study, we investigated the protective effects and key regulatory pathways of melatonin on alfalfa under salt tolerance. The results showed that melatonin promoted the growth of alfalfa seedlings under salt stress, as demonstrated by higher plant height, leaf area, and fresh weight. Melatonin treatment resulted in an increase in the photosynthetic capacity and starch content of alfalfa. Moreover, melatonin decreased cell membrane damage and reactive oxygen species (ROS) accumulation by enhancing antioxidant defense activity under salt stress conditions. Transcriptome sequencing (RNA-seq) analysis revealed that melatonin mainly induced the transcription of genes involved in Ca2+ signaling (cyclic nucleotide gated channel, CNGCs; cam modulin/calmodulin-like protein, CAM/CMLs and calcium-dependent protein kinase, CDPKs), starch and sucrose metabolism (α-amylase, AMYs; β-amylase, BAMs; starch synthase, SSs and sucrose synthase, SUSs), plant hormone signal transduction (auxin/indole acetic acid protein, AUX/IAAs; ABA receptor, PYL4; protein phosphatase 2C, PP2Cs; scarecrow-like protein, SCLs and ethylene-responsive transcription factor 1B, ERF1B), and key transcription factors (C3Hs, MYBs, ERFs, and WRKYs). Specifically, we focused on starch and sucrose metabolism and plant hormone signal transduction pathways. The interactions between melatonin and other phytohormones occurred via regulation of the expression of genes involved in hormone signaling pathways. In addition, melatonin increased the contents of endogenous melatonin, auxin, gibberellic acid (GA3), salicylic acid, brassinosteroids, and ethylene, while decreasing the abscisic acid content under salt stress. In summary, this study established a regulatory network for melatonin-induced key signaling pathways and functional genes under salt stress and provided a theoretical basis for salt tolerance breeding in alfalfa.

Tumor metastasis and invasion are the main impediments to lung adenocarcinoma successful treatment. Previous studies demonstrate that chemotherapeutic agents can elevate the malignancy of cancer cells other than their therapeutic effects. In this study, the effects of transient low-dose cisplatin treatment on the malignant development of lung adenocarcinoma cells (A549) were detected, and the underlying epigenetic mechanisms were investigated. The findings showed that A549 cells exhibited epithelial-mesenchymal transition (EMT)-like phenotype along with malignant progression under the transient low-dose cisplatin treatment. Meanwhile, low-dose cisplatin was found to induce contactin-1 (CNTN-1) upregulation in A549 cells. Subsequently, we found that further overexpressing CNTN-1 in A549 cells obviously activated the EMT process in vitro and in vivo, and caused malignant development of A549 cells in vitro. Taken together, we conclude that low-dose cisplatin can activate the EMT process and resulting malignant progression through upregulating CNTN-1 in A549 cells. The findings provided new evidence that a low concentration of chemotherapeutic agents could facilitate the malignancy of carcinoma cells via activating the EMT process other than their therapeutic effects.

Abstract Background This article reports a patient who survived severe pneumonia, pyopneumothorax with acute respiratory distress syndrome (ARDS), and septic shock, which is very difficult to treat. Case presentation Antibiotics, continuous renal replacement therapy (CRRT), bronchial lavage and other treatments were used to treat a patient with pneumonia, pyopneumothorax, severe ARDS and septic shock. After comprehensive treatment, the patient was successfully treated and survived for a long time. Conclusions There is a low successful clinical treatment rate for patients with pneumonia, pyopneumothorax with severe ARDS and septic shock. The successful treatment of this patient benefited from early and effective empirical therapy, targeted drug selection in the later stage, adequate closed thoracic drainage, repeated bronchial lavage, early CRRT, an appropriate respiratory support mode and parameter setting, immunotherapy and nutritional support therapy. This paper proposes a reference diagnosis and treatment solution for similar cases.

Mixing cereal with legume crops is an efficient approach for improving forage production and ensuring the sustainable development of agriculture and livestock. However, the knowledge of the relationship between forage production and interspecific competition in the forage oat (Avena sativa L.) and common vetch (Vicia sativa L.) mixed cropping system remains unclear. A 2-year field experiment was conducted in 2020 and 2021 to investigate the effects of different mixed cropping systems (peer mixing (PM), alternate-row mixing (AM), cross mixing (CM), bar mixing (BM), sole forage oat (SO), and sole common vetch (SV)) on the dry matter production, forage quality, land equivalent ratio (LER), and competition parameters. The results showed that the system forage yield increased by 13.4–202.8% when forage oat was mixed with common vetch (p < 0.05). However, no significant difference was obtained between the AM and PM mixed cropping systems. Additionally, the forage oat–common vetch mixed cropping improved crude protein yield by 52.5–150.1% compared with monocultures (p < 0.05). The LER values were greater than the one when forage oat was mixed with common vetch, especially for the AM system (averaged 1.38). In addition, forage oat was the dominant crop and had higher aggressiveness and competitive ratios compared to common vetch, but without a significant difference in the aggressiveness and competitive ratio in mixed cropping systems. It indicated that mixing of cereal with legume crops was helpful in enhancing resource use efficiency without obvious interspecific competition. Consequently, the AM mixed cropping system is recommended for supporting the sustainable development of agriculture and livestock production in the arid region of China when considering both forage production and nutritional quality.

The virtual rehabilitation system combining virtual rehabilitation environment and upper limb rehabilitation technology is interactive and interesting, which can improve the enthusiasm and initiative of patients for rehabilitation training, improve the efficiency of rehabilitation training and improve the effect of rehabilitation treatment. This paper firstly conducts in-depth research and analysis on the research progress of the upper limb rehabilitation robot system, and deeply studies the principle and rehabilitation principle of the stroke caused by hemiplegic dyskinesia, and summarizes the goals and methods of the upper limb rehabilitation system design. Secondly, the hand motion tracking is realized by Kinect's bone tracking, and the optimal tracking distance is determined experimentally, which verifies the stability and robustness of the tracking. Static gesture recognition adopts two gesture recognition schemes based on Kinect depth image and color space model respectively. Finally, using the rehabilitation robot and Kinect sensor as the hardware platform, the virtual rehabilitation training system experimental platform is constructed, and the horizontal rehabilitation exercise and the three-dimensional space rehabilitation exercise are respectively studied experimentally, and the exercise data obtained by using healthy subjects as the experimental object is analyzed. Based on this, the validity and feasibility of the Kinect-based upper limb exercise rehabilitation interactive system were verified.

Summary: Background: Stroke is a leading cause of death and disability worldwide. Despite considerable improvements in diagnosis and treatment, little is known about the short-term and long-term prognosis after a first stroke in low-income and middle-income countries, including China. We aimed to assess the short-term and long-term risk of recurrent stroke and mortality after a first stroke for each of the major pathological stroke types. Methods: This population-based cohort study included adults aged 35–74 years without disability who were recruited to the China Kadoorie Biobank (CKB). A baseline survey was conducted in ten geographical areas (five urban, five rural) in China, and participants had clinical measurements recorded. Participants were followed up by monitoring death registries and by electronic linkage to health registries and health insurance claims databases, with follow-up until Jan 1, 2017. Participants were excluded from analyses if they had a previous history of stroke, transient ischaemic attack, or ischaemic heart disease at baseline. All incidences of fatal and non-fatal stroke during the study period were recorded by type (ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and unspecified type). Primary outcome measures were 28-day mortality, recurrent stroke, major vascular events (recurrent stroke, myocardial infarction, or vascular death), vascular mortality, and all-cause mortality. Findings: Of 512 715 individuals in the CKB, 489 586 participants without previous ischaemic heart disease and stroke at recruitment were included, of whom 45 732 (42 073 [92%] confirmed by brain imaging) had a stroke during the study period. The mean age was 59·3 years (SD 9·8) for participants who had a stroke (54% women) and 50·8 years (10·3) for participants with no stroke (60% women). 36 588 (80%) of the incident cases of stroke were ischaemic stroke, 7440 (16%) were intracerebral haemorrhage, 702 (2%) were subarachnoid haemorrhage, and 1002 (2%) were an unspecified stroke type. 28-day mortality was 3% (95% CI 3–4) for ischaemic stroke, 47% (46–48)for intracerebral haemorrhage, 19% (17–22; 52% for rural areas and 32% for urban areas) subarachnoid haemorrhage, and 24% (22–27) for unspecified stroke. Among participants who survived stroke at 28 days, 41% (41–42) had recurrent stroke at 5 years (ischaemic stroke 41% [41–42], intracerebral haemorrhage 44% [42–46], subarachnoid haemorrhage 22% [18–27], unspecified stroke type 40% [35–44]) and mortality at 5 years was 17% ([17–18] ischaemic stroke 16% [15–16], intracerebral haemorrhage 28% [26–29], subarachnoid haemorrhage 16% [12–20], unspecified stroke type 15% [12–19]). After a first ischaemic stroke, 91% of recurrent strokes were also ischaemic stroke; after an intracerebral haemorrhage, 56% of recurrent strokes were intracerebral haemorrhage, and 41% of recurrent strokes were ischaemic stroke. Interpretation: After a first stroke, the risk of recurrence or death within 5 years was high among this population of Chinese adults. Urgent improvements to secondary prevention of stroke in China are needed to reduce these risks. Funding: Wellcome Trust, Medical Research Council, British Heart Foundation, Cancer Research UK, Kadoorie Charitable Foundation, Chinese Ministry of Science and Technology, National Natural Science Foundation of China. Copyright: © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Summary: Background: Cooking practice has transitioned from use of solid fuels to use of clean fuels, with addition of better ventilation facilities. However, the change in mortality risk associated with such a transition remains unclear. Methods: The China Kadoorie Biobank (CKB) Study enrolled participants (aged 30–79 years) from ten areas across China; we chose to study participants from five urban areas where transition from use of solid fuels to clean fuels for cooking was prevalent. Participants who reported regular cooking (weekly or more frequently) at baseline were categorised as persistent clean fuel users, previous solid fuel users, or persistent solid fuel users, according to self-reported fuel use histories. All-cause and cardiopulmonary mortality were identified through linkage to China's Disease Surveillance Point system and local mortality records. Findings: Between June 24, 2004, and July 15, 2008, 226 186 participants living in five urban areas of China were enrolled in the CKB Study. Among 171 677 participants who reported cooking regularly (weekly or more frequently), 75 785 (44%) were persistent clean fuel users, 80 511 (47%) were previous solid fuel users, and 15 381 (9%) were persistent solid fuel users. During a mean of 9·8 (SD 1·7) years of follow-up, 10 831 deaths were documented, including 3819 cardiovascular deaths and 761 respiratory deaths. Compared with persistent clean fuel users, persistent solid fuel users had significantly higher risks of all-cause mortality (hazard ratio [HR] 1·19, 95% CI 1·10–1·28), cardiovascular mortality (1·24, 1·10–1·39), and respiratory mortality (1·43, 1·10–1·85). The excess risk of all-cause and cardiopulmonary mortality fell by more than 60% in 5 years after cessation of solid fuel use and continued to decrease afterwards. Use of ventilation was associated with lower all-cause mortality risk, even among persistent clean fuel users (HR 0·78, 0·69–0·89). Interpretation: Solid fuel use for cooking is associated with a higher risk of mortality, and cessation of solid fuel use cuts excess mortality risks swiftly and substantially within 5 years. Ventilation use also lowers the risk of mortality, even among people who persistently use clean fuels. It is of prime importance for both policy makers and the public to accelerate the transition from solid fuels to clean fuels and promote efficient ventilation to minimise further adverse health effects. Funding: National Natural Science Foundation of China, Wellcome Trust, and Kadoorie Charitable Foundation.

Abstract An ocean downscaling model product, forced under the Representative Concentration Pathway 8.5 future climate change scenario, has been used to understand the ocean heat balance of the Indian Ocean in a warming climate. Toward the end of the 21th century, the model simulates a significant reduction of Indonesian throughflow (ITF) transport, which reduces the Pacific to Indian Ocean heat transport by 0.20 PW, whereas across 32°S in the Southern Indian Ocean (SIO), the southward heat transport is reduced by 0.28 PW, mainly contributed from the weakening western boundary current, the Agulhas Current (0.21 PW). The projected weakening of the Agulhas Current is to compensate for the reduction of the ITF transport, with additional contribution from the spin‐down of the SIO subtropical gyre. Thus, being amplified by the ocean circulation changes in the SIO, the projected Indian Ocean warming trend will be faster than the direct air‐sea heat flux input.

Immunogenicity of hepatitis B vaccine between 20 μg with 3-dose schedule and 60 μg with 2-dose regimens was compared 2 years after primary immunization. A total of 353 healthy adults aged 18–25 years were enrolled in the study and randomly assigned (1: 1: 1) into 3 vaccine groups: A (20 μg, 0–1–6 month), B (60 μg, 0–1 month) and C (60 μg, 0–2 month). Serum samples were collected at 1 month after a series vaccination and 12 months, 24 months after the first-dose. The GMC level of anti-HBs antibody was measured using Chemiluminescent Microparticle ImmunoAssay (CMIA). There were 59, 45 and 55 vaccinees available to follow-up with 2 year later in vaccine groups A, B and C, respectively. No significant differences existed in sex ratio, age and body mass index (BMI) among vaccinees at month 24 and the corresponding participants at baseline in each group (P > 0.05). The seroprotection rates in group A, B and C were 98.31%, 88.37% and 85.19%, respectively (P = 0.014), reflecting the fact that the rate of group A was significantly higher than that in group C (P = 0.026). Also, the GMC level of anti-HBs antibody in group A was significantly higher than those of other two groups (427.46 mIU/ml vs. 89.74 mIU/ml, 89.80 mIU/ml, respectively; all P < 0.01). This data suggested that the standard 20 μg (0–1–6 month) regimen of hepatitis B vaccine should be recommended as a priority on the premise of complete compliance in adults.

Abstract Background Existing evidence remains inconclusive as to the association between chronic hepatitis B virus (HBV) infection and the risk of chronic kidney disease (CKD). We prospectively examined the association between chronic HBV infection and CKD risk, and the joint associations of HBV infection with established risk factors of several lifestyle factors and prevalent diseases on CKD risk. Methods Participants from the China Kadoorie Biobank were enrolled during 2004–2008 and followed up until 31 December 2015. After excluding participants with previously diagnosed CKD, cancer, heart disease, and stroke at baseline, the present study included 469,459 participants. Hepatitis B surface antigen (HBsAg) was qualitatively tested at baseline. Incident CKD cases were identified mainly through the health insurance system and disease and death registries. Results During a median follow-up of 9.1 years (4.2 million person-years), we documented 4555 incident cases of CKD. Cox regression yielded multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Compared with HBsAg-negative participants, the multivariable-adjusted HR (95% CI) for CKD was 1.37 (1.18, 1.60) for HBsAg-positive participants. The association was stronger in men (HR = 1.77; 95% CI: 1.43, 2.20) than in women (HR = 1.10; 95% CI: 0.88, 1.36). HBsAg-positive participants, with or without hepatitis or cirrhosis, whether or not under treatment, all showed increased risk of developing CKD. We observed positive additive interactions of HBsAg positivity with smoking, physical inactivity, or diabetes on CKD risk. Compared with HBsAg-negative participants who were nonsmokers, more physically active, or did not have diabetes at baseline, the greatest CKD risk for HBsAg-positive participants was for those who were smokers (HR = 1.85; 95% CI: 1.44, 2.38), physically inactive (HR = 1.91; 95% CI: 1.52, 2.40), or diabetic (HR = 6.11; 95% CI: 4.47, 8.36). Conclusions In countries with a high endemicity of HBV infection, kidney damage associated with chronic HBV infection should be a non-negligible concern. Our findings also highlight the importance of health advice on quitting smoking, increasing physical activity, improving glucose control, and early screening for CKD in people with chronic HBV infection.

With the increased resolution capability of modern sensors, an object should be considered as extended if the target extent is larger than the sensor resolution. Multiple maneuvering extended object tracking (MMEOT) uses not only measurements of the target centroid but also high-resolution sensor measurements which may resolve individual features or measurement sources. MMEOT aims to jointly estimate object number, centroid states, and extension states. However, unknown and time-varying maneuvers of multiple objects produce difficulties in terms of accurate estimation. For multiple maneuvering star-convex extended objects using random hypersurface models (RHMs) in particular, their complex maneuvering behaviors are difficult to be described accurately and handled effectively. To deal with these problems, this paper proposes an interacting multiple model Gaussian mixture probability hypothesis density (IMM-GMPHD) filter for multiple maneuvering extended object tracking. In this filter, linear maneuver models derived from RHMs are utilized to describe different turn maneuvers of star-convex extended objects accurately. Based on these, an IMM-GMPHD filtering recursive form is given by deriving new update and merging formulas of model probabilities for extended objects. Gaussian mixture components of different posterior intensities are also pruned and merged accurately. More importantly, the geometrical significance of object extension states is fully considered and exploited in this filter. This contributes to the accurate estimation of object extensions. Simulation results demonstrate the effectiveness of the proposed tracking approach—it can obtain the joint estimation of object number, kinematic states, and object extensions in complex maneuvering scenarios.

To determine the incidence of anogenital warts (AGWs) in the Chinese general population, we compared the data from a prospective study and from the National Notifiable Disease Report System (NNDRS). A cohort study including 2378 women and 2309 men aged 18–55 years old enrolled from Liuzhou, China, was conducted with three scheduled visits at 6-month intervals from May 2014 to March 2016. And, a questionnaire survey was performed to collect the diagnosis history of AGWs at the enrollment visit. The data on reported AGW cases of Liuzhou in the NNDRS from 2006 to 2015 were also analyzed. Overall, the incidence rates of AGWs in the prospective study, in the self-reported diagnosis during past 12 months and in the NNDRS were 1.26 per 1000 person-years (95% confidence interval (CI): 0.16–2.37), 2.35 (95% CI: 1.17–4.20) and 0.183 (95% CI: 0.178–0.187), respectively. Human papillomavirus 6 or 11 were found in all the AGW biopsy samples (10/10). The onset time of AGWs in women was earlier, and the cumulative risk increased more quickly at a young age along with each subsequent younger birth cohort (P

To improve dynamic characteristics of the motor operating mechanism for high-voltage circuit breaker, the motor drive operating mechanism by a three-phase permanent-magnet synchronous motor is studied in this article. After analysing the movement characteristics of the moving contact during the switching process, the movement process is divided into three stages: the starting stage, the constant speed stage, and the buffering stage. Considering the problems of the motor such as large start delay, instability, and strong buffeting in later stage with traditional fixed given displacement strategy, a new control strategy of given segmented displacement is proposed and studied on the simulation platform. The experiment results show that the design of the segmented control is reasonable and effective, not only can improve the dynamic characteristics of the motor, but also can implement the project more easily. So, it provides a theoretical basis for exploring the efficient dynamic control method of the new motor operating mechanism.

Asthma is characterized by airway inflammation and mucus hypersecretion. Curcumin possessed a potent anti-inflammatory property involved in the PPARγ-dependent NF-κB signaling pathway. Then, the aim of the current study was to explore the value of curcumin in asthmatic airway inflammation and mucus secretion and its underlying mechanism. In vivo, mice were sensitized and challenged by ovalbumin (OVA) to induce chronic asthma. Airway inflammation and mucus secretion were analyzed. In vitro, BEAS-2B cells were obtained. MCP-1, MUC5AC, and PPARγ expression and the phosphorylation of NF-κB p65 and NF-κB p65 DNA-binding activity were measured in both the lungs and BEAS-2B cells. shRNA-PPARγ was used to knock down PPARγ expression. We found that OVA-induced airway inflammation and mucus hypersecretion in mice, OVA and IL-4-induced upregulation of MCP-1 and MUC5AC, suppression of PPARγ, and activation and translocation of NF-κB p65 were notably improved by curcumin both in vivo and in vitro. Our data also showed that these effects of curcumin were significantly abrogated by shRNA-PPARγ. Taken together, our results indicate that curcumin attenuated OVA-induced airway inflammation and mucus hypersecretion in mice and suppressed OVA- and IL-4-induced upregulation of MCP-1 and MUC5AC both in vivo and in vitro, most likely through a PPARγ-dependent NF-κB signaling pathway.

To investigate the ignition characteristics of an axial-flow injection burner for a Stirling engine, a combustion chamber was designed. Diesel was used as fuel and oxygen as oxidant. The experiments of ignition characteristics were carried out with an electric plug igniter. The ignition characteristics under different combustion chamber pressure, pre-oxygen supply time, oxygen supply flow and ignition position were studied. The experimental results show that, with the increase of the pressure, the ignition time of the burner increases gradually, and the ignition success rate decreases gradually. The oxygen flow rate is related to ignition time in a certain range, while the pre-oxygen supply time has little effect. With the ignition position moving downward, the ignition time decreases gradually.

Oncogenic human papillomavirus (HPV) infection is a cause of many anogenital cancers in women and men; however, there is little research on HPV prevalence and risk factors that includes both women and men from the same population. A total of 4687 participants, including 2378 women and 2309 men aged 18–55 years old from the same community, were enrolled in the study in Liuzhou, China. Exfoliated cells were collected from the participants from different anatomic sites and were tested for 13 oncogenic and 3 non-oncogenic HPV types. The prevalence of any oncogenic HPV type was higher in women than in men (18.7% vs 9.4%, P

The Wang-Sheeley-Arge (WSA)−ENLIL+Cone model is used extensively in space weather operations world-wide to model coronal mass ejection (CME) propagation. As such, it is important to assess its performance. We present validation results of the WSA−ENLIL+Cone model installed at the Community Coordinated Modeling Center (CCMC) and executed in real-time by the CCMC space weather team. CCMC uses the WSA−ENLIL+Cone model to predict CME arrivals at NASA missions throughout the inner heliosphere. In this work we compare model predicted CME arrival-times to in situ interplanetary coronal mass ejection leading edge measurements at Solar TErrestrial RElations Observatory-Ahead (STEREO-A), Solar TErrestrial RElations Observatory-Behind (STEREO-B), and Earth (Wind and ACE) for simulations completed between March 2010 and December 2016 (over 1,800 CMEs). We report hit, miss, false alarm, and correct rejection statistics for all three locations. For all predicted CME arrivals, the hit rate is 0.5, and the false alarm rate is 0.1. For the 273 events where the CME was predicted to arrive at Earth, STEREO-A, or STEREO-B, and was actually observed (hit event), the mean absolute arrival-time prediction error was 10.4 ± 0.9 h, with a tendency to early prediction error of −4.0 h. We show the dependence of the arrival-time error on CME input parameters. We also explore the impact of the multi-spacecraft observations used to initialize the model CME inputs by comparing model verification results before and after the STEREO-B communication loss (since September 2014) and STEREO-A sidelobe operations (August 2014–December 2015). There is an increase of 1.7 h in the CME arrival time error during single, or limited two-viewpoint periods, compared to the three-spacecraft viewpoint period. This trend would apply to a future space weather mission at L5 or L4 as another coronagraph viewpoint to reduce CME arrival time errors compared to a single L1 viewpoint.

Using an observation data set of temperature and the Simple Ocean Data Assimilation (SODA), the decadal variability of upper ocean heat content (0–400 m; hereafter, OHC) in the South China Sea (SCS) was investigated for the period from 1958 to 2007. Decadal variability was identified as the dominant mode of upper OHC besides the seasonal cycle. According to decreasing or increasing OHC, four periods were chosen to discuss detailed processes behind OHC variability in the SCS; the four periods are 1958–1968, 1969–1981, 1982–1992, and 1993–2003. Results show that advection was the major factor for decreasing (increasing) OHC during 1958–1968 (1968–1981). During 1982–1992 and 1993–2003, the net surface heat flux was the main contributor to the variability of OHC besides the advection. The OHC, advection and net surface heat flux had significant positive trends during 1992–2003. The spatial characteristics of OHC variability and heat budget in the Luzon Strait, west of Luzon Island, and in the Xisha warm eddy region are also discussed.