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ObjectiveTo investigate the characteristics of clinical trials on traditional Chinese medicine (TCM) or natural medicines for treating endometriosis, aiming to inform future clinical practice and the development of new effective drugs.MethodThe global clinical trial registration platform was searched to identify clinical trials investigating the efficacy of TCM/natural medicine in treating endometriosis. Relevant trials were selected based on stringent inclusion and exclusion criteria. Data entry was performed using Microsoft Excel, while data analysis was conducted using SPSS version 23.ResultsThe study encompassed 57 trials, of which ClinicalTrials.gov accounted for 18, ChiCTR for 3, ICRP for 15, and ChiDTR for 21 trials. The number of registrations showed a significant positive correlation with the years. Of the 57 clinical trials, 87.7% were randomized, 63.2% were blinded, 78.9% followed a parallel intervention model, and 56.1% had a sample size below 100. Regarding trial phases, 45.6% of clinical trials did not specify a phase, while Phase 3 and Phase 4 clinical trials accounted for 17.5%. Nine clinical trials involved drugs that are already on the market, including six Chinese patent medicines: Sanjie Zhentong Capsules, Honghua Ruyi Pills, Huayu Sanjie Enema Liquid, Kuntai Capsules, Wenjing Tang, and Xuefu Zhuyu Capsules. Outside China, Iran has the highest number of registrations for natural medicine treatments for endometriosis, with curcumin being the most registered natural medicine.ConclusionThe analysis reveals that clinical trials on TCM and natural remedies for endometriosis often utilize randomization; however, substantial deficiencies remain in blinding and sample size adequacy. These findings suggest that, despite growing interest in TCM and natural remedies, further methodological improvements are necessary to enhance the credibility of future studies. This research highlights the importance of rigorously designed clinical trials in verifying the safety and efficacy of these alternative therapies, which may influence future therapeutic approaches for managing endometriosis.

Abstract Background Deafness autosomal dominant 2A (DFNA2A) is related to non‐syndromic genetic hearing impairment. The KCNQ4 (Potassium Voltage‐Gated Channel Subfamily Q Member 4) can lead to DFNA2A. In this study, we report a case of autosomal dominant non‐syndromic hearing loss with six family members as caused by a novel variant in the KCNQ4 gene. Methods The whole‐exome sequencing (WES) and pure tone audiometry were performed on the proband of the family. Sanger sequencing was conducted on family members to determine if the novel variant in the KCNQ4 gene was present. Evolutionary conservation analysis and computational tertiary structure protein prediction of the wild‐type KCNQ4 protein and its variant were then performed. In addition, voltage‐gated channel activity of the wild‐type KCNQ4 protein and its variant were tested using whole‐cell patch clamp. Results It was observed that the proband had inherited autosomal dominant, non‐syndromic sensorineural hearing loss as a trait. A novel co‐segregating heterozygous missense variant (c.902C>A, p.Ala301Asp) of the KCNQ4 gene was identified in the proband and other five affected family members. This variant was predicted to cause an alanine‐to‐aspartic acid substitution at position 301 in the KCNQ4 protein. The alanine at position 301 is well conserved across different species. Whole‐cell patch clamp showed that there was a significant difference between the WT protein currents and the mutant protein currents in the voltage‐gated channel activity. Conclusion In the present study, performing WES in conjunction with Sanger sequencing enhanced the detection of a novel, potentially causative variant (c301 A>G; p.Ala301Asp) in exon 6 of the KCNQ4 gene. Therefore, our findings contributed to the mutation spectrum of the KCNQ4 gene and may be useful in the diagnosis and gene therapy of deafness autosomal dominant 2A.

Di-(2-ethylhexyl)-phthalate (DEHP), as distinctive endocrine disrupting chemicals, has become a global environmental pollutant harmful to human and animal health. However, the impacts on offspring and mothers with maternal DEHP exposure are largely unknown and the mechanism remains elusive. We established DEHP-exposed maternal mice to investigate the impacts on mother and offspring and illustrate the mechanism from multiple perspectives. Pregnant mice were administered with different doses of DEHP, respectively. Metagenomic sequencing used fecal and transcriptome sequencing using placentas and livers from offspring have been performed, respectively. The results of the histopathology perspective demonstrated that DEHP exposure could disrupt the function of islets impact placentas and fetus development for maternal mice, and cause the disorder of glucose and lipid metabolism for immature offspring mice, resulting in hyperglycemia. The results of the metagenome of gut microbial communities indicated that the dysbiosis of gut microbiota in mother and offspring mice and the dominant phyla transformed through vertical transmission. Transcriptome analysis found DEHP exposure induced mutations of Ahcy and Gstp3, which can damage liver cells and affect the metabolism of the host. DEHP exposure harms pregnant mice and offspring by affecting gene expression and altering metabolism. Our results suggested that exposure of pregnant mice to DEHP during pregnancy and lactation increased the risk of metabolic disorders by altering key genes in liver and gut microbiota, and these results provided new insights into the potential long-term harms of DEHP.

The excavation of pits will induce the vertical displacement of tunnels and lead to engineering problems. The shape as well as size of a pit, and the complex spatial position relationship between the pit and tunnel will induce different deformation responses of tunnel structures; however, the degree to which each factor influences tunnel structure deformation is still unclear. This paper studied the impact of excavation on the deformation of tunnels via a combination of numerical simulation and orthogonal tests. The deformation of tunnels induced by excavation was studied using a numerical method, after which the sensitivity of influencing factors to tunnel deformation was studied by means of range and variance analyses through a four-factor and three-level orthogonal test. The results show that, for a foundation pit with a long side perpendicular to the tunnel longitude, the excavation has the least influence on tunnel deformation. Tunnel deformation increased with an increase in the excavation depth and decreased with an increase in tunnel–pit vertical and horizontal distance. As the plane shape of the foundation pit is 20 m × 45 m, the depth of excavation is 4 m, the pit tunnel vertical distance is 13 m, and the pit tunnel horizontal distance is 28 m, the tunnel has the least deformation. Based on the results of this study, the position relationship between the pit and the tunnel can be optimized in terms of design and construction, and the aim of controlling tunnel deformation can be achieved.

Introduction Perinatal anxiety (PNA) is a major public health concern.Methods A hybrid effectiveness-implementation trial was conducted in two antenatal clinics in Hefei, China, to assess the effectiveness and cost-effectiveness of application-based tiered care (Mom’s Good Mood, MGM) in treating PNA and to understand how well it fits into routine practices. Pregnant women who scored at least 5 points on the 7-Item Generalised Anxiety Disorder Scale (GAD-7) scale were successively assigned to the control group or the intervention group, which were given the usual care and MGM on usual care, respectively. At 6 months post partum, anxiety, depression and life satisfaction were assessed. Intention-to-treat analysis and the Reach, Effectiveness, Adoption, Implementation and Maintenance framework were adopted.Results A total of 214 women were assigned to the control group and 341 to the intervention group. The mean changes in GAD-7 scores (Least-squares means, LSM, −1.42, 95% CI −2.18 to −0.66) and the risk of anxiety (adjusted odds ratio, aOR 0.30, 95% CI 0.18 to 0.51) were decreased, and the anxiety remission rate (aOR 2.72, 95% CI 1.69 to 4.40) were improved in the intervention group. Similar findings were observed regarding the change in Edinburgh Postnatal Depression Scale scores (LS −1.92, 95% CI −2.85 to −0.99), depression remission rate (aOR 2.24, 95% CI 1.39 to 3.63) and the risk of depression (aOR 0.57, 95% CI 0.33 to 0.98). MGM only costs ¥1.88 (US$0.27) per pregnant woman to boost the postpartum anxiety remission rate by 1% and was revealed to have a high reach rate of 78.3%, an adoption rate of 51.3%–80.8%.Conclusion MGM is a cost-effective and accessible tool in coping with PNA.Trial registration number ChiCTR2100053419.

PurposePre-myopia, a non-myopic refractive state, is a key concern for myopia prevention because of its association with a significantly higher risk of myopia in children under 3 years of age. Amid the myopia pandemic, its onset at younger ages is increasing, yet research on screening methods for myopia and pre-myopia in preschool children remains limited. This study aimed to establish effective noncycloplegic screening methods for myopia and pre-myopia in preschool children.MethodsThis cross-sectional study included 16 kindergartens in Shanghai, China. Uncorrected distance visual acuity (UDVA) was recorded using a logMAR visual acuity chart. Pre- and post-cycloplegic refractions were obtained using an auto-refractor (TopconKR-800). Noncycloplegic axial length (AL) and corneal curvature radius (CR) were measured using the IOL Master-700. Logistic regression models were developed to establish accurate noncycloplegic screening methods for myopia and pre-myopia.ResultsA total of 1,308 children with a mean age of 4.3 ± 0.9 years were included; among them 640 (48.9%) were girls. The myopia prevalence rate was 2.8% (n = 36), and the prevalence of pre-myopia was 21.9% (n = 286). Pre-myopia screening (cycloplegic spherical equivalent [SE] ≤ −0.5

Background: Shift work is a potential risk factor for women's reproductive health. Evidence suggests that shift work is associated with menstrual disorders, reproductive disturbances, and adverse pregnancy outcomes. However, previous studies did not systematically examine the results of menstrual irregularities, dysmenorrhea, and early menopause at the same time. Objective: To determine the relationship between shift work and women's menstrual characteristics (e.g., irregular menstruation, dysmenorrhea, and early menopause). Methods: Four databases (PubMed, Embase, Cochrane, and Web of Science) were searched up to December 2022. The study characteristics and risk assessment values of the literature were extracted from 21 studies that met the criteria. Odds ratios (ORs), relative risks (RRs), hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated to assess the relationship between shift work exposure and menstruation. The included studies were evaluated for heterogeneity, publication bias, sensitivity analysis, and subgroup analysis. Results: A total of 21 studies with 195,538 female participants, including 16 cross-sectional studies and 5 cohort studies, were included in this meta-analysis. According to the quality evaluation, the included research had high methodological quality. The overall ORs of shift work for the likelihood of irregular menstruation and dysmenorrhea were 1.30 (95% CI, 1.23–1.36) (I2 = 41.9%, P 0.05). Conclusions: This meta-analysis indicated that shift workers have significantly higher odds of menstrual disorders, dysmenorrhea, and early menopause. This study focuses on female reproductive health and has broad implications for adjusting optimal working hours and shift schedules for female workers.

This study investigates the monotonic and cyclic performance of composite bucket foundation breakwater in clay through centrifuge modeling. The application of monotonic loads simulates extreme wave conditions, and cyclic load corresponds to long-term serviceability conditions. In centrifuge tests, three typical soil strengths were tested, and two load eccentricities were simulated to check the influence of wave force height. Multiple measurements were conducted, including rotation angle, horizontal displacement, vertical settlement, and pore pressure variation. When soil strength increases in monotonic centrifuge tests, the ultimate bearing capacity of the bucket foundation experiences significant growth, and the foundation failure pattern varies. In responding to the monotonic test, the foundation’s rotation center constantly moved downward during the loading process, indicating that the deeper soil would be activated to resist the horizontal loading. In contrast, the rotation center movement in the symmetric centrifuge test was opposed to the non-symmetric test because the deeper soil was required to provide resistance to balance the more severe load under the non-symmetric loading condition. It should be noted that non-symmetric loading does not impact the bucket foundation as seriously as symmetric loading. The utilization of deep-soil resistance in non-symmetric tests is beneficial in controlling deformation.

ObjectivesNon-invasive prenatal testing (NIPT) is utilized for screening the likelihood of fetal aneuploidy, presenting the benefits of non-invasiveness, high sensitivity, and specificity. Its application in prenatal screening has become ubiquitous. The inquiry into how pregnant women comprehend and determine NIPT screening strategies is paramount. Regrettably, there has been a dearth of research on this subject in China. Consequently, this study scrutinizes pregnant women’s cognizance and perspectives concerning NIPT, furnishing a foundation for advancing its judicious implementation.MethodsFrom February 2021 to December 2022, a questionnaire survey was conducted among pregnant women receiving prenatal care and screening at the Women’s Hospital, School of Medicine, Zhejiang University, who were randomly selected from a pool of individuals exhibiting a high risk of fetal aneuploidy on serological screening. The survey aimed to gather data on participant characteristics, knowledge, perception, and willingness concerning NIPT. The study employed chi-square and Kruskal Wallis tests to analyze subgroup differences.ResultsA total of 226 valid questionnaires were obtained. 83.2% of women pregnant women identified as high risk by serological screening would opt for NIPT, with 66.4% indicating that they would prefer NIPT for fetal aneuploidy screening in future pregnancies. These findings suggest a notable willingness among pregnant women to undergo NIPT. Additionally, the results suggest that various factors, including place of residence, educational level, family income, causes of abortion, and conception method, influence pregnant women’s knowledge about NIPT Accordingly, the level of NIPT knowledge varies among pregnant women.ConclusionThe survey generally revealed that pregnant women were strongly inclined to select NIPT; however, expectant Chinese mothers possess limited knowledge and perception regarding this screening method for fetal aneuploidy. Therefore, the government must implement effective measures to augment public awareness of fetal aneuploidy screening and encourage the judicious utilization of NIPT.

Abstract Background Stressful life events (SLEs) and adverse childhood experiences (ACEs) have been reported to be associated with perinatal depression (PND) or perinatal anxiety (PNA) alone; however, in most cases, majority of PND and PNA coexist and could lead to more serious health consequences. The independent effect of recent SLEs and their joint effects with ACEs on perinatal comorbid anxiety and depression (CAD) remain inadequately explored. Methods Based on a longitudinal study, 1082 participants receiving prenatal care in Ma’anshan, China were included. Women were recruited in the first trimester (T1: ≤14+ 6 weeks) and followed up at 15 ~ 27 weeks (T2), 28 ~ 40 weeks (T3), and postpartum (T4). Depression and anxiety status were assessed at all time points, while recent SLEs and ACEs were measured at T1. Logistic regression was conducted to examine the associations of SLEs with the risks of CAD at different time points, as well as their joint effects with ACEs on CAD. Results Approximately 38.5% of women experienced at least one SLE, which was significantly associated with higher risks of CAD at all time points (p

The International Agency for Research on Cancer (IARC) defines shift work as any arrangement of daily working hours other than the standard daylight hours (typically 7:00/8:00 am–5:00/6:00 pm). To meet the needs of rapid socioeconomic development, shift work is becoming more and more common. The impact of shift work, especially night shift work, on human health cannot be ignored. Female's health is not only important to the well-being of themselves, but also has a far-reaching impact on their children and even their entire family. Increasing epidemiological studies have focused on the effects of night shift work on female's reproductive health. This article reviewed epidemiological evidence of the associations between night shift work and reproductive outcomes, e.g. menstrual cycle, endometriosis, pregnancy rate, adverse pregnancy outcomes, and ovarian cancer. The potential biological mechanisms connecting night shift work to female reproductive health were also introduced, e.g. melatonin regulation, clock gene regulation, and sex hormone regulation. Through this review, we propose to provide a reference for determining occupational risk factors, conducting subsequent relevant studies, and formulating rational health promotion strategies.

Introduction The management of perinatal depression (PND) is challenging in China. The Thinking Healthy Programme (THP), developed under the core theory of cognitive–behavioural therapy, is an evidence-based approach that is recommended as a psychosocial intervention for managing PND in low/middle-income countries. Sparse evidence has been generated, however, to assess the effectiveness of THP and guide its implementation in China.Methods and analysis A hybrid type II effectiveness–implementation study is ongoing in four cities in Anhui Province, China. A comprehensive online platform, Mom’s Good Mood (MGM), has been developed. Perinatal women are screened using the WeChat screening tool (ie, Edinburgh Postnatal Depression Scale embedded as metrics) in clinics. Different intensities of the intervention are delivered through the mobile application for different degrees of depression, according to the stratified care model. The THP WHO treatment manual has been tailored to be the core component of intervention. Guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, process evaluations will be conducted to identify the facilitators and barriers to implementation and to modify the implementation strategy; summative evaluations will be carried out to examine the effectiveness of MGM in the management of PND within the primary healthcare system in China.Ethics and dissemination Ethics approval and consent for this programme were obtained from Institutional Review Boards in China: Anhui Medical University, Hefei, People’s Republic of China (20170358). Results will be submitted to relevant conferences and peer-reviewed journals.Trial registration number ChiCTR1800016844.

Background: The most common disease caused by biallelic AFG3L2 mutations is spastic ataxia type 5 (SPAX5). Identification of complex phenotypes resulting from biallelic AFG3L2 mutations has been increasing in recent years. Methods: A retrospective analysis was performed on a child with microcephaly and recurrent seizures. The child underwent physical and neurological examinations, laboratory tests, electroencephalography (EEG), and brain magnetic resonance imaging (MRI). Trio-whole-exome sequencing (trio-WES) was performed to identify possible causative mutations. Results: We described a child who exhibited early-onset and intractable epilepsy, developmental regression, microcephaly, and premature death. Neuroimaging revealed global cerebral atrophy (GCA) involving the cerebrum, cerebellum, corpus callosum, brainstem, cerebellar vermis, and basal ganglia. On trio-WES, two novel compound heterozygous mutations, c.1834G > T (p.E612*) and c.2176-6T > A in the AFG3L2 gene, were identified in this patient. Conclusions: Our findings have expanded the mutation spectrum of the AFG3L2 gene and identified a severe neurodegenerative phenotype of global cerebral atrophy caused by biallelic AFG3L2 mutations.

Background: Polycyclic aromatic hydrocarbons (PAHs) have been demonstrated to be neurotoxic. Objectives: To summarize the existing epidemiological studies to quantify the effects of PAHs exposure on child neurodevelopment and adult emotional disorders. Data sources and study eligibility criteria: We conducted a systematic literature search for studies of child neurodevelopment and adult emotional disorders published in English up to April 2022 in the databases of PubMed, Web of Science and Embase using combinations of MeSH terms and Entry terms, and the articles were filtered out according to data availability. A variety of common PAHs were included in the meta-analysis: 1-hydroxynaphthalene, 2-hydroxynaphthalene, 2-hydroxyfluorene, 3-hydroxyfluorene, 9-hydroxyfluorene, 1-hydroxyphenanthrene, 2-hydroxyphenanthrene, 3-hydroxyphenanthrene, 4-hydroxyphenanthrene, 9-hydroxyphenanthrene, 1-hydroxypyrene and benzoapyrene (BaP). Study evaluation and synthesis methods: We extracted the content of each article, summarized its design characteristics and performed quality evaluation. We combined the odds ratio (OR) available in various studies to obtain the risk of PAHs exposure and adaptive, language, social, attention, motor skills and child depression/anxiety in children ≤ 15 years old. In addition, we also conducted a meta-analysis on the relationship between PAHs exposure and the risk of depression in adults. Results: We included a total of 16 epidemiological studies (4 cross-sectional studies and 12 cohort studies). The sample size of all included studies ranged from 110 to 9625. Prenatal exposure to PAHs was found to be associated with increased risk of social behavior (OR = 1.60, 95% CI: 1.00–2.54), attention (OR = 2.99, 95% CI: 1.48–6.02), motor skill problems (OR = 1.91, 95% CI: 1.27–2.86) and any adverse neurodevelopmental outcome in children (OR = 2.10, 95% CI: 1.69–2.62). In addition, we found that PAHs exposure could increase the risk of adult depression, with 2-hydroxyfluorene exposure showing the highest combined OR (OR = 1.48, 95% CI: 1.10–2.00). Conclusions: The results suggested that PAHs exposure are associated with increased risk of child neurodevelopment and adult depression. The neurotoxic effects of PAHs exposure in human being should be paid more attention. The results suggested that PAHs exposure are associated with increased risk of child neurodevelopment and adult depression. The neurotoxic effects of PAHs exposure in human being should be paid more attention. Steps should be taken to enhance the biomonitoring of PAHs and to reduce the exposure in general population.

IntroductionTo explore changes in performance, weaknesses, and utilization of the long-term care (LTC) system for older people with disabilities and dementia (OPWDD) in Zhejiang Province, China, thereby providing a reference for decision-making amid a progressively aging population.MethodsA performance evaluation model of the LTC system for OPWDD was constructed using three dimensions: input, process, and outcome. Performance indicators and trends were calculated based on data collected from statistical yearbooks, documents, and work reports of the Bureau of Statistics and other government departments in Zhejiang Province, China, published in 2015–2021.ResultsSignificant improvements were observed in most LTC performance indicators for OPWDD, such as input, process, and outcome, with notable enhancements in fairness, accessibility, and affordability of LTC services. By 2021, there were 6.20 nursing and rehabilitation beds in medical institutions and 3.77 general practitioners per 1,000 people aged 65 and above, up 144.14% and 13.73%, respectively, from 2015. The rate of health management for older people was 70.91%, representing a 10.33% increase from 2015. The actual reimbursement ratio of hospitalization expenses covered by basic medical insurance for older people rose 7.05%, from 72.76% in 2015 to 77.89% in 2021. Social security satisfaction rose 12.4%, from 71.3% in 2015 to 83.7% in 2021. Certain indicators, however, showed no significant improvement and tended to decline, such as the number of beds at older care institutions and caregivers per 1,000 people aged 65 and over.DiscussionIt is imperative to further balance the allocation of care resources, using a people-centered and integrated LTC system. The proportion of rehabilitation and nursing beds for older people should be consistently increased to effectively alleviate the shortage of care beds. Furthermore, a talent incentive policy should be improved to train caregivers and provide whole-person and whole-life course care based on OPWDD needs.

Objective Inconsistent results were reported on the association of physical activity with ovarian cancer. However, given the limitations of confounders and inverse causation, the validity of the association remained unclear. Therefore, we conducted a two-sample Mendelian randomization analysis, which can effectively avoid the aforementioned interference, to evaluate whether physical activity had a protective effect on ovarian cancer. Methods The exposure of interest was physical activity (both self-reported moderate-to-vigorous physical activity and accelerometer-measured physical activity). Summary statistics for physical activity traits were recruited from the UK Biobank ( n = 91,084–377,234), whereas ovarian cancer summary genetic data were obtained from a genome-wide association study involving 25,509 cases and 40,941 healthy individuals. The inverse variance weighted approach was used as the primary Mendelian randomization method. Sensitivity analyses using Mendelian randomization-Egger regression, weighted median, and Mendelian randomization pleiotropy residual sum and outlier were also performed. Results The Mendelian randomization analyses indicated that there was no effect of moderate-to-vigorous physical activity (odds ratio, 1.11; 95% confidence interval: 0.66–1.85; P = 0.702), accelerometer-measured “average acceleration” (0.99 [0.91–1.08]; P = 0.848), and “overall activity” physical activity (0.97 [ 0.48–1.95]; P = 0.927) on the risk of overall ovarian cancer. However, “overall accelerations” physical activity (0.18 [0.05–0.64]; P = 0.008) were suggestively related to a lower risk of endometrioid ovarian cancer. Conclusions The Mendelian randomization analyses suggested that physical activity may not help to decrease the risk of overall ovarian cancer.

Current microbial reduction technologies have been proven to be suitable for decontaminating industrial wastewaters containing high concentrations of selenium (Se) oxyanions, however, their application is strictly limited by the elemental Se (Se0) accumulation in the system effluents. In this work, a continuous-flow anaerobic membrane bioreactor (AnMBR) was employed for the first time to treat synthetic wastewater containing 0.2 mM soluble selenite (SeO32−). The SeO32− removal efficiency by the AnMBR was approachable to 100% in most of the time, regardless of the fluctuation in influent salinity and sulfate (SO42−) stress. Se0 particles were always undetectable in the system effluents, owing to their interception by the surface micropores and adhering cake layer of membranes. High salt stress led to the aggravated membrane fouling and diminished content ratio of protein to polysaccharide in the cake layer-contained microbial products. The results of physicochemical characterization suggested that the sludge-attached Se0 particles presented either sphere- or rod-like morphology, hexagonal crystalline structure and were entrapped by the organic capping layer. According to the microbial community analysis, increasing influent salinity led to the diminished population of non-halotolerant Se-reducer (Acinetobacter) and increased abundance of halotolerant sulfate reducing bacteria (Desulfomicrobium). In the absence of Acinetobacter, the efficient SeO32− abatement performance of the system could still be maintained, as a result of the abiotic reaction between SeO32− and S2- generated by Desulfomicrobium, which then gave rise to the production of Se0 and S0.

Abstract Background The association between gestational diabetes mellitus (GDM) and perinatal depression (PND) remains controversial. Our study aimed to comprehensively assess this association in a longitudinal cohort study with repeated measurements of depression. Methods Our cohort study was nested in a pilot study of an implementation study aiming to screen and manage perinatal depression within the primary health system in China. Women were recruited in the first trimester from May–September 2019 and followed four times up to 1 year postpartum. Data on sociodemographic characteristics and depression were collected using self-developed questionnaires incorporating the Edinburgh Postnatal Depression Scale (EPDS). Oral glucose tolerance test at 24 ~ 28 weeks and fasting plasma glucose (FPG) data were extracted from medical records. Depression throughout the whole period was divided into different trajectories. Associations of GDM with PND at different time periods and PND of different trajectories were determined by logistic regression. The path of association between blood glucose and depression over time was estimated with an autoregressive cross-lagged model. Results In total, 1043 women were included in this analysis and 313 (30.0%) were diagnosed with GDM. The prevalence of depression in the first, second, and third trimesters and postpartum period were 17.2, 6.9, 6.8 and 9.0%, respectively. GDM was neither significantly associated with PND at any time point nor with any specific trajectory of depression. Except for autoregressive paths, no cross-lagged path of FPG and scores of EPDS was significant. Conclusions Our study indicates no association between GDM/blood glucose and PND.

This paper studies the problem of shield tunnels laterally passing through piles based on in situ tests and numerical methods. The effects of vertical load, pile–tunnel distance, and tunnel-cover depth on the horizontal displacement and the bending moment of adjacent piles were investigated. The results show that the shield tunnel induced adjacent pile displacement toward the tunnel side near the tunnel axis, and the soil below and above the tunnel axis constrained the pile, displacing toward the tunnel side. The maximum values of the horizontal displacement and bending moment were at the tunnel axis. The vertical load on the cap had little influence on the horizontal response of the pile. The main influence area induced by shield construction was located within 1.5 times the tunnel diameter. The maximum horizontal displacement and maximum bending moment were reduced by 36–45% and 45–78% on the far pile due to the shading effect induced by the near pile. The tunnel-cover depth had a significant influence on the distribution patterns of the horizontal displacement and the bending moment. The positions of the maximum horizontal displacement and the maximum bending moment moved downward with increases in tunnel-cover depth. The maximum horizontal displacement and bending moment increased with increases in tunnel-cover depth.

Background: Tobacco smoking and alcohol consumption have been associated with frailty in observational studies. We sought to examine whether these associations reflect causality using the two-sample Mendelian randomization (MR) design.Methods: We used summary genome-wide association statistics for smoking initiation (N = 2,669,029), alcohol consumption (N = 2,428,851), and the frailty index (FI, N = 175,226) in participants of European ancestry. Both univariable and multivariable MR were performed to comprehensively evaluate the independent effects of smoking and alcohol consumption on the FI, accompanied by multiple sensitivity analyses. Results were verified using lifetime smoking and alcohol use disorder. Reverse direction MR was undertaken to assess the potential for reverse causation.Results: Genetic predisposition to smoking initiation was significantly associated with increased FI (univariable MR: β = 0.345; 95% confidence interval [CI] = 0.316 to 0.374; p = 1.36E-113; multivariable MR: β = 0.219; 95% CI = 0.197 to 0.241; p = 2.44E-83). Genetically predicted alcohol consumption showed a suggestive association with the FI (univariable MR: β = −0.090; 95% CI = −0.151 to −0.029; p = 0.003; multivariable MR β = −0.153; 95% CI = −0.212 to −0.094; p = 2.03E-07), with inconsistent results in sensitivity analyses. In complementary analysis, genetic predicted lifetime smoking, but not alcohol use disorder was associated with the FI. There is no convincing evidence for reverse causation.Conclusion: The present MR study supported smoking as a causal risk factor of frailty. Further research is warranted to investigate whether alcohol consumption has a causal role in frailty.

Objective: Given the association between physical activity and the reduced risk of gallstone disease as suggested in observational studies, a Mendelian randomization study was conducted to evaluate the causal nature of this association in genetic epidemiology.Study: Including self-reported and accelerometer-based physical activity traits, the independent genetic variants associated with physical activity were selected from the corresponding genome-wide association studies as instrumental variables. The summary-level data for gallstone disease were sourced from the UK Biobank (7,682 cases and 455,251 non-cases) and FinnGen consortium (23,089 cases and 231,644 non-cases). Then, two-sample Mendelian randomization analysis was conducted. Inverse-variance weight (IVW), weighted median, and Mendelian randomization–Egger regression were determined through Mendelian randomization analyses. To ensure the robustness of the results, sensitivity analyses were also carried out in the study.Results: The negative causality between the genetically predicted accelerometer-based “average acceleration” physical activity and the risk of gallstone disease was suggested in the UK Biobank study (p = 0.023, OR = 0.93, 95% CI: 0.87–0.99), and accelerometer-based “overall activity” physical activity and the risk of gallstone disease in the UK Biobank study (p = 0.017, OR = 0.38, 95% CI: 0.17–0.84). With accelerometer-based “average acceleration” physical activity negatively correlated with gallstone disease in the FinnGen consortium data (p = 0.001, OR = 0.94, 95% CI: 0.90–0.97). As for self-reported moderate-to-vigorous physical activity, however, there was no causality observed in both pieces of data.Conclusion: Our studies provide the evidence suggesting a casual association between physical activities and gallstone disease through analysis of genetic data. As indicated by the research results, there is a possibility that a higher level of physical activities could mitigate the risk of gallstone disease.

As one kind of endocrine disrupting chemical, di-(2-ethylhexyl) phthalate (DEHP) has been reported to cause liver dysfunction in epidemiological and experimental studies. Abnormal liver function in pregnancy is associated with adverse maternal and perinatal outcomes. Few studies have investigated the potential effect of gestational DEHP exposure on the liver in pregnant mice, and the underlying mechanisms remain unclear. In the present study, pregnant ICR mice were exposed to doses (0, 500, 1,000 mg/kg/day) of DEHP in the presence or absence of 5 mg/kg/day ferrostatin-1 (Fer-1, ferroptosis inhibitor) by oral gavage from gestation day 4 to day 18. HepG2 cells were exposed to different doses of monoethylhexyl phthalate (MEHP, a major metabolite of DEHP) in vitro. Hepatic function and pathologic changes were observed. Oxidative stress, iron metabolism, and ferroptosis-related indicators and genes were evaluated both in vivo and in vitro. The results showed that gestational DEHP exposure induced disordered liver function and hepatocyte morphology changes in pregnant mice, along with increased malondialdehyde (MDA) and Fe2+ content and decreased glutathione (GSH) levels. The expression levels of the selected ferroptosis-related genes Slc7a11, Gpx4, and Nfr2 were significantly decreased, and Ptgs2 and Lpcat3 were significantly increased. Notably, Fer-1 attenuated DEHP-induced liver injury and ferroptosis. Furthermore, MEHP exhibited a synergistic effect with RSL3 (a GPX4 inhibitor) in promoting ferroptosis in vitro. Taken together, the results demonstrated that DEHP induced liver injury and ferroptosis in pregnant mice, probably by inhibiting the GPX4 pathway through lipid peroxidation and iron accumulation.

Endocrine and metabolic diseases show increasing incidence and high treatment costs worldwide. Due to the complexity of their etiology and mechanism, therapeutic strategies are still lacking. Osteoprotegerin (OPG), a member of the tumor necrosis factor receptor superfamily, appears to be a potential candidate for the treatment of these diseases. Studies based on clinical analysis and rodent animal models reveal the roles of OPG in various endocrine and metabolic processes or disorders, such as bone remodeling, vascular calcification, and β-cell proliferation, through the receptor activator of nuclear factor kappa-B ligand (RANKL) and the receptor activator of NF-κB (RANK). Thus, in this review, we mainly focus on relevant diseases, including osteoporosis, cardiovascular disease (CVD), diabetes, and gestational diabetes mellitus (GDM), to summarize the effects of the RANKL/RANK/OPG system in endocrine and metabolic tissues and diseases, thereby providing a comprehensive insight into OPG as a potential drug for endocrine and metabolic diseases.

Abstract Objective To understand the related risk factors of occurrence and recurrence of hypertension and provide scientific basis for relevant departments to better guide prevention and control work. Methods From September 2017 to September 2018, a prospective follow‐up study was performed on patients with hypertension who visited the Second People's Hospital of Wuhu City, Anhui Province. Multivariate Cox regression was used to analyze influencing factors of stroke occurrence and recurrence in follow‐up of hypertensive patients. Results A total of 769 hypertensive patients were enrolled in this study. The average age of hypertensive patients was 65.66 ± 11.70 years old and the BMI index was 24.99 ± 4.17. In this study, 769 patients with hypertension were followed up for 1 year, and the incidence of stroke was 14.69%. This study found that higher levels of blood glucose (RR = 2.027, 95% CI: 1.195–3.438), HCY (RR = 5.928,95% CI: 1.438–24.440), aggravated extent of carotid artery stenosis (RR = 2.620, 95% CI: 1.532–4.481), and drinking (RR = 3.867, 95% CI: 2.038–7.339) were risk factors, and maintaining exercise (RR = 0.325, 95% CI: 0.117–0.907) was a protective factor for stroke occurrence; however, aggravated extent of carotid artery stenosis (RR = 3.158, 95% CI: 1.797–5.550) and smoking (RR = 2.271, 95% CI: 1.142–4.517) were risk factors for stroke recurrence for hypertensive patients. Conclusions For people with high blood pressure, it is necessary to exercise properly, control body weight, avoid obesity, quit smoking, reduce alcohol consumption, and reasonably control blood pressure, blood sugar, and blood lipid.

One of the approaches to improve operation indices, such as power loss and reliability, is to smoothen voltage profiles. Energy management of generation units and network reconfiguration are two methods to achieve this. Hence, the latter is presented in this paper in a distribution with distributed generation units. To this end, an objective function is formulated aiming to minimize power loss and enhance the operating situation of the network. This problem is subject to various constraints and limits such as AC power flow equations, operation limits, planning model, and operation model of distributed generations. It is an integer nonlinear optimization problem and is solved using the crow search algorithm and the optimal solution is obtained. Two major innovations of the study include modeling generation units’ operation and network configuration mathematical expression of operation indicators. The method is applied to a test system and results demonstrate the high performance of this approach in improving the operation of the network. Finding the solution in less time with a satisfying standard deviation are two advantages of the proposed algorithm. Adopting this method, the network operator can reduce power loss through proper management of distributed generation power and optimal scheduling of switches. Moreover, the obtained voltage profile is more desirable in comparison to that of power flow studies.

BackgroundObservational studies indicate that osteoarthritis (OA) and coronary artery disease (CAD), as well as myocardial infarction (MI), are often diagnosed as comorbid diseases. We performed a bidirectional Mendelian randomization (MR) study to demonstrate whether there is a causal relationship between OA, CAD, and MI.MethodsWe extracted single nucleotide polymorphisms (SNPs) related to OA in the Genetics of Osteoarthritis (GO) Consortium as instrumental variables to assess whether OA is associated with CAD and MI in the CARDIoGRAMplusC4D 1,000 Genomes genome-wide association study (GWAS). In the reverse MR, we used CAD-associated and MI-associated SNPs to the GWAS of OA to analyze their causality. These GWASs included 766,690 individuals of OA, 184,305 individuals of CAD, and 166,065 individuals of MI. MR was conducted using several methods, including the inverse variance weighted (IVW) method, the weighted median method, the MR-Egger method, and the MR-Pleiotropy RESidual Sum and Outlier (MR-PRESSO) method.ResultsThe forward causal effect of OA on CAD and MI was not observed. In reverse analysis, no causal effect was discovered for CAD on the risk of OA. Notably, we observed a causal association between MI and total OA [IVW odds ratio (OR) = 0.95, 95% CI = 0.93, 0.98, P = 4E−04] and spine OA (IVW OR = 0.92, 95% CI = 0.88, 0.97, P = 0.001) but a null association between MI and knee OA, hip OA, hand OA, and thumb OA.ConclusionThis MR study identifies a potentially protective effect of genetically predicted MI on total and spine OA risks.

The ubiquitous presence of tetrabromobisphenol A (TBBPA) in aquatic environments has caused severe environmental and public health concerns; it is therefore of great significance to develop effective techniques to remove this compound from contaminated waters. Herein, a TBBPA imprinted membrane was successfully fabricated via incorporating imprinted silica nanoparticles (SiO2 NPs). The TBBPA imprinted layer was synthesized on the 3-(methacryloyloxy) propyltrimethoxysilane (KH-570) modified SiO2 NPs via surface imprinting. Eluted TBBPA molecularly imprinted nanoparticles (E-TBBPA-MINs) were incorporated onto a polyvinylidene difluoride (PVDF) microfiltration membrane via vacuum-assisted filtration. The obtained E-TBBPA-MINs embedded membrane (E-TBBPA-MIM) showed appreciable permeation selectivity toward the structurally analogous to TBBPA (i.e., 6.74, 5.24 and 6.31 of the permselectivity factors for p-tert-butylphenol (BP), bisphenol A (BPA) and 4,4′-dihydroxybiphenyl (DDBP), respectively), far superior to the non-imprinted membrane (i.e., 1.47, 1.17 and 1.56 for BP, BPA and DDBP, respectively). The permselectivity mechanism of E-TBBPA-MIM could be attributed to the specific chemical adsorption and spatial complementation of TBBPA molecules by the imprinted cavities. The resulting E-TBBPA-MIM exhibited good stability after five adsorption/desorption cycles. The findings of this study validated the feasibility of developing nanoparticles embedded molecularly imprinted membrane for efficient separation and removal of TBBPA from water.

Abstract Background Many studies focused on health inequality between migrant older adults and local older adults, while few study concerned the health inequalities between urban-to-urban and rural-to-urban migrant older adults. This study aimed to compare physical health and mental health between these two groups in Hangzhou, Zhejiang Province, China, and to explore the relationship between cognitive social capital, social integration and health among migrant older adults. Methods A two-stage stratified sampling method was employed to recruit participants from May to August 2013 in Hangzhou. Measurement data were compared with student’s t-tests and multivariate analysis of variance (MANOVA). Multiple linear regression was adopted in this study. Results A total of 1000 of participants who met the inclusion criteria were analyzed, consisting of 527 (52.7%) urban-to-urban and 473 (47.3%) rural-to-urban migrant older adults. There were no statistically significant difference in physical health and mental health between urban-to-urban and rural-to-urban groups on the whole. However, urban-to-urban migrant older adults had a higher reciprocity and social integration than did in rural-to-urban group (13.36 vs. 12.50, p

Reactivation of fetal hemoglobin (HbF, α2γ2) alleviates clinical symptoms in patients with β-thalassemia and sickle cell disease, although the regulatory mechanisms of γ-globin expression have not yet been fully elucidated. Recent studies found that interfering with the expression of the membrane protein ANTXR1 gene upregulated γ-globin levels. However, the exact mechanism by which ANTXR1 regulates γ-globin levels remains unclear. Our study showed that overexpression and knockdown of ANTXR1 in K562, cord blood CD34+, and HUDEP-2 cells decreased and increased γ-globin expression, respectively. ANTXR1 regulates the reactivation of fetal hemoglobin (HbF, α2γ2) in K562, cord blood CD34+, and adult peripheral blood CD34+ cells through interaction with LRP6 to promote the nuclear entry of β-catenin and activate the Wnt/β-catenin signaling pathway. The overexpression or knockdown of ANTXR1 on γ-globin and Wnt/β-catenin signaling in K562 cells was reversed by the inhibitor XAV939 and the activator LiCl, respectively, where XAV939 inhibits the transcription of β-catenin in the Wnt pathway, but LiCl inhibits GSK3-β. We also showed that the binding ability of the rank4 site in the transcriptional regulatory region of the SOX6 gene to c-Jun was significantly increased after overexpression of ANTXR1 in K562 cells. SOX6 protein expression was increased significantly after overexpression of the c-Jun gene, indicating that the transcription factor c-Jun initiated the transcription of SOX6, thereby silencing γ-globin. Our findings may provide a new intervention target for the treatment of β-hemoglobinopathies.

Herein, the influence of various contents of polyethylene glycol (PEG) on the dispersion of TiO2 nanoparticles and the comprehensive properties of PVDF/TiO2 composite membranes via the steric hindrance interaction was systematically explored. Hydrophilic PEG was employed as a dispersing surfactant of TiO2 nanoparticles in the pre-dispersion process and as a pore-forming additive in the following membrane preparation process. The slight overlap shown in the TEM image and low TSI value (2), a higher interaction energy barrier (0.65 KT) and low flux declination during the filtration process. The high critical flux and low fouling rate both in winter and summer as well as the long-term running operation in A/O-MBR firmly supported the elevated antifouling performance, which implies a promising application in the municipal sewage treatment field.

The H2-based membrane biofilm reactor (H2-MBfR) has been acknowledged as a cost-effective microbial reduction technology for oxyanion removal from drinking water sources, but it remains unknown how the evolution of biofilm characteristics responds to the changing critical operating parameters of the H2-MBfR for simultaneous bromate (BrO3−) and nitrate (NO3−) elimination. Therefore, an expanded multispecies model, applicable to mechanistically interpret the bromate-reducing bacteria (BRB)- and denitrifying bacteria (DNB)-dominated metabolic processes in the biofilm of the H2-MBfR, was developed in this study. The model outputs indicate that (1) increased BrO3− loading facilitated the metabolism of BRB by increasing BRB fraction and BrO3− gradients in the biofilm, but had a marginal influence on NO3− reduction; (2) H2 pressure of 0.04 MPa enabled the minimal loss of H2 and the extension of the active region of BRB and DNB in the biofilm; (3) once the influent NO3− concentration was beyond 10 mg N/L, the fraction and activity of BRB significantly declined; (4) BRB was more tolerant than DNB for the acidic aquatic environment incurred by the CO2 pressure over 0.02 MPa. The results corroborate that the degree of microbial competition for substrates and space in the biofilm was dependent on system operating parameters.

CircRNAs have been reported to play essential roles in regulating immunity and inflammation, which may be an important regulatory factor in the development of vitiligo. However, the expression profile of circRNAs and their potential biological functions in vitiligo have not been reported so far. In our study we found there are 64 dysregulated circRNAs and 14 dysregulated miRNAs in the patients with vitiligo. Through the correlation analysis, we obtained 12 dysregulated circRNAs and 5 dysregulated miRNAs, forming 48 relationships in the circRNA-miRNA-mRNA regulatory network. Gene Ontology analysis indicated dysregulated circRNAs in vitiligo is closely related to the disorder of the metabolic pathway. The KEGG pathway of dysregulation of circRNAs mainly enriched in the biological processes such as ubiquitin mediated proteolysis, endocytosis and RNA degradation, and in Jak-STAT signaling pathway. Therefore, we found the circRNA-miRNA-mRNA regulatory network are involved in the regulation of numerous melanocyte functions, and these dysregulated circRNAs may closely related to the melanocyte metabolism. Our study provides a theoretical basis for studying the vitiligo pathogenesis from the perspective of circRNA-miRNA-mRNA network.

Creep generally showed a great impact on the temperature stress of concrete structure. At present, little research has been done on the creep law of cemented sand and gravel (CSG), and the calculation of creep temperature stress mainly adopts a set of relevant parameters. In this context, experimental compressive creep tests were carried out on the specimens of large-sized cylinders with different cementing agent contents; the creep temperature stress of CSG was also calculated. The results showed that the creep of CSG increased with the increase of cementing agent content, but the specific creep was not obvious. In addition, the creep model of CSG with high accuracy was also obtained, which could provide a basis for the numerical simulation of CSG dam. Furthermore, the results of numerical simulation showed that creep has a great influence on the stress of CSG dam, and the thermal stress energy was less than 37%. At the same time, it was necessary to determine whether temperature control should be considered according to different cementing agent content and external climate conditions, which cannot be generalized.

An adiabatic temperature rise test of cemented sand and gravel (CSG) is conducted, a model for temperature rising of CSG is proposed, and its application to temperature stress prediction of CSG dam is presented. Adiabatic temperature rise tests are first conducted to investigate the temperature rise properties of CSG material with different cementing agent contents. The results demonstrate that the hydration reaction time is longer for CSG material with higher cementing agent content, and a linear relationship is presented between cementing agent contents and final value of adiabatic temperature rise. Then, a calculation model considering different cementing agent contents is developed based on the regression analysis of the test data. The proposed model is implanted into the ANSYS software platform for predictions of temperature distributions and stress fields of a typical CSG dam. The results show that the distributions of temperature and temperature stress are similar to those of roller compacted concrete (RCC) dam. Due to the high temperature stress at the long intermittent surface and downstream surface of the dam, the thermal insulation measures on the surface of the dam should be considered in the CSG dam with high cementing agent contents and in the severe cold environment. Therefore, it cannot be generally considered that the temperature control of the CSG dam does not need to be considered, and it should be determined according to the specific working conditions.

Abstract Background While much literature reported the access of Chinese older migrants to health services, little was known about the differences among sub-groups of older adults, including urban-to-urban and rural-to-urban migrants, and urban and rural permanent residents. This study aimed to examine the access of these four groups to health services in Zhejiang Province, China and provide an evidence for the development of health services policies. Methods A cross-sectional survey was conducted in community-dwelling older adults (aged 60 years or above) in 2013. Participants were recruited by random sampling. Demographic information and access to health services for the elderly populations were obtained via interviews using a self-designed structured questionnaire. Pearson’s chi-square tests and Cochran-Mantel-Haenszel (CMH) tests were performed to examine the differences in access to health services among the four groups. Binary logistic regression was conducted to explore the associations of participants’ visits to doctors with their group status after controlling confounding factors. Results The two-week hospital visiting rates were significantly lower in migrants (55.56% in rural-to-urban and 62.50% in urban-to-urban) than that in urban and rural permanent residents (67.40 and 82.25%, respectively; p

Abstract Background Tens of millions of rural “left-behind children (LBC)” in China grow up experiencing prolonged separation from their migrant worker parents. This study aimed to explore how children are affected by parental migration, from the perspectives of children, parents, and grandparents, focusing on the experiences of prolonged parent-child separation and relationship dynamics in the extended family. Methods Qualitative in-depth interviews were conducted in a migrant-sending rural area of eastern China. Participants included 25 children (aged 7 to 14), 17 parents, and 13 grandparents, from 30 families, as well as 24 key informants from the communities. Data analysis followed a grounded theory approach. Results The results showed that despite the original purpose of benefiting children, parental migration resulted in challenges in child psychosocial well-being, due to the emotional impacts from prolonged parent-child separation. Parental absence also led to inadequate care and support for left-behind children. The negative effects of parental migration may be exacerbated by other vulnerabilities such as parents’ divorce, poverty and grandparent caregivers’ frailty. Concerns about child well-being made some migrants decide to return home permanently, because of the altered trade-offs of migration. Conclusion Prolonged separation following migration often disrupts parent-child relationships and results in psychosocial difficulties in LBC, especially among those who live with multiple adversities in the family. Community-based interventions may help migrant parents and co-resident caregivers to better engage children and promote their resilience.

Summary: Background: Identification of windows of heightened vulnerability to environmental factors has substantial public health implications. Prenatal exposure to vanadium has been linked to adverse birth outcomes; however, critical windows for such exposure during fetal growth remain unknown. We aimed to assess trimester-specific associations of vanadium exposure with ultrasound measures of fetal growth and birth size in a Chinese longitudinal cohort. Methods: The present study was embedded in our ongoing prospective prenatal cohort study at the Wuhan Women and Children Medical Care Center (Wuhan, Hubei, China). Pregnant women were eligible for inclusion if they provided signed informed consent and were less than 16 weeks pregnant with a single gestation, and agreed to take in-person interviews, undergo ultrasound examinations, and provide blood and urine samples. We collected urine samples and measured urinary vanadium concentrations using inductively coupled plasma mass spectrometry. We calculated SD scores for ultrasound-measured biparietal diameter, head circumference, occipitofrontal diameter, abdominal circumference, femur length, and estimated fetal weight at 16, 24, and 31 weeks of gestation. We applied linear regressions with generalised estimating equations to estimate associations of urinary vanadium concentrations in each trimester with ultrasound-measured fetal growth parameters or neonatal size at birth. Findings: As of Oct 12, 2016, we recruited 3075 women who were non-smokers and non-drinkers during pregnancy, provided up to three urine samples during the first, second, and third trimesters, and gave birth to live singletons without birth defects. We excluded women who did not provide information on ultrasound measurements (n=20) or who only had one ultrasound measurement of fetal crown–rump length at the first trimester (n=14). We excluded another 16 women because they had missing values for confounding variables, leaving 3025 women retained in the study. Every doubling of urinary vanadium concentration in the first trimester was associated with a significant increase in femur length (adjusted percentage change 6·4%, 95% CI 0·7 to 12·1) at 16 weeks of gestation and reductions in biparietal diameter (−4·2%, −8·2 to −0·1), head circumference (−6·0%, −10·1 to −1·9), occipitofrontal diameter (−5·7%, −9·9 to −1·5), and abdominal circumference (−5·3%, −9·4 to −1·2) at 31 weeks of gestation. Every doubling of urinary vanadium concentration in the second trimester was significantly associated with reductions in SD scores for head circumference (−7·2%, −14·1 to −0·3) and abdominal circumference (−6·9%, −13·8 to −0·1) at 31 weeks of gestation. The highest quartile of urinary vanadium concentration (>1·18 μg/L) in the first trimester, when compared with the lowest quartile (≤0·60 μg/L), was associated with a mean decrease in birthweight of 12·6 g (95% CI 2·5–22·8; ptrend=0·0055) and a mean decrease in ponderal index of 0·07 kg/m3 (0·01–0·12; ptrend=0·0053). Moreover, newborns with restricted birth size had higher vanadium exposure in the first and third trimesters. Interpretation: Vanadium might be toxic to humans and impair fetal growth. The first, early second, and late third trimesters could be critical windows for heightened vulnerability to vanadium for fetal growth. Our findings require further investigation in other populations. Funding: National Key R&D Plan of China, National Natural Science Foundation of China, and Fundamental Research Funds for the Central Universities, Huazhong University of Science and Technology.

Background: Vanadium, an important pollutant produced from anthropogenic activities, has been suggested to be embryotoxic and fetotoxic in animal studies. However, little is known about its effects on humans. We aimed to assess the association of prenatal exposure to vanadium with the risk of adverse birth outcomes in babies born to women in China. Methods: For this population-based cohort study, the Healthy Baby Cohort, women were recruited from three cities in Hubei Province, China. Women included in this analysis were recruited from Wuhan Women and Children Medical Care Center, Wuhan. We measured urinary concentrations of vanadium and other metals simultaneously using inductively coupled plasma mass spectrometry. We used multivariable logistic regressions, with adjustment for potential confounders, to estimate the associations of natural logarithm transformed creatinine-corrected urinary vanadium (Ln-vanadium) concentrations as continuous variables and categorised into quartiles (Q; Q1: ≤0·84 μg/g creatinine, Q2: 0·84–1·40 μg/g creatinine, Q3: 1·40–2·96 μg/g creatinine, Q4: >2·96 μg/g creatinine, with the lowest quartile set as reference) with preterm delivery, early-term delivery, low birthweight, and being small for gestational age. We applied restricted cubic spline models to evaluate the dose-response relationships. Findings: Data from 7297 women recruited between Sept 22, 2012, and Oct 22, 2014, were included in this study. Urinary Ln-vanadium concentrations showed non-linear dose-response relationships with risk of preterm delivery (S-shaped, p