Search

Abstract Objectives This study aims to investigate the links between the clinical, demographic, and psychosocial factors and cancer-related worry in patients with early-stage lung cancer after surgery. Methods The study utilized a descriptive cross-sectional design. Questionnaires, including assessments of cancer-related worry, symptom burden, illness perception, psychological resilience, coping modes, social support and participant characteristics, were distributed to 302 individuals in early-stage lung cancer patients after surgery. The data collection period spanned from January and October 2023. Analytical procedures encompassed descriptive statistics, independent Wilcoxon Rank Sum test, Kruskal-Wallis- H- test, Spearman correlation analysis, and hierarchical multiple regression. Results After surgery, 89.07% had cancer-related worries, with a median (interquartile range, IQR) CRW score of 380.00 (130.00, 720.00). The most frequently cited concern was the cancer itself (80.46%), while sexual issues were the least worrisome (44.37%). Regression analyses controlling for demographic variables showed that higher levels of cancer-related worry (CRW) were associated with increased symptom burden, illness perceptions, and acceptance-rejection coping modes, whereas they had lower levels of psychological resilience, social support and confrontation coping modes, and were more willing to obtain information about the disease from the Internet or applications. Among these factors, the greatest explanatory power in the regression was observed for symptom burden, illness perceptions, social support, and sources of illness information (from the Internet or applications), which collectively explained 52.00% of the variance. Conclusions Healthcare providers should be aware that worry is a common issue for early stage lung cancer survivors with a favorable prognosis. During post-operative recovery, physicians should identify patient concerns and address unmet needs to improve patients’ emotional state and quality of life through psychological support and disease education.

Hot deformation is a commonly employed processing technique to enhance the ductility and workability of Mg alloy. However, the hot deformation of Mg alloy is highly sensitive to factors such as temperature, strain rate, and strain, leading to complex flow behavior and an exceptionally narrow processing window for Mg alloy. To overcome the shortcomings of the conventional Arrhenius-type (AT) model, this study developed machine learning-based Arrhenius-type (ML-AT) models by combining the genetic algorithm (GA), particle swarm optimization (PSO), and artificial neural network (ANN). Results indicated that when describing the flow behavior of the AQ80 alloy, the PSO-ANN-AT model demonstrates the most prominent prediction accuracy and generalization ability among all ML-AT and AT models. Moreover, an activation energy-processing (AEP) map was established using the reconstructed flow stress and activation energy fields based on the PSO-ANN-AT model. Experimental validations revealed that this AEP map exhibits superior predictive capability for microstructure evolution compared to the one established by the traditional interpolation methods, ultimately contributing to the precise determination of the optimum processing window. These findings provide fresh insights into the accurate constitutive description and workability characterization of Mg alloy during hot deformation.

To explore the thermoformability of Mn–Cr–Ni–Co steel for ball mill liner, isothermal compression tests were performed on Mn–Cr–Ni–Co steel using a Gleeble-3800 thermal compressive testing machine. Flow stress curves at 900 °C–1200 °C and 0.01s−1∼10s−1 were obtained. Results show Mn–Cr–Ni–Co steel has obvious positive strain rate sensitivity, with peak stress decreasing with increasing temperature. A constitutive equation for Mn–Cr–Ni–Co steel was established using the Arrhenius model based on strain compensation, and fitted values were compared to experimental values. A hot working map for Mn–Cr–Ni–Co steel was established and analyzed. Hot working process parameters are: deformation temperature of 980∼1200 °C, strain rate of 0.04–1.78s−1, providing a basis for selecting the hot forging process of the ball mill liner. Forging and forming experiments of the ball mill liner were carried out using the optimal parameters of Mn–Cr–Ni–Co steel from the hot working map. The ball mill liner has good forming quality with a relatively uniform martensitic structure inside. Tensile and impact tests were performed on the ball mill liner. Compared to the mechanical properties of traditional cast Mn13 ball mill liners, results show the tensile strength increased by 159.75%, elongation by 18.8%, and impact capacity by about 16.7%.

Dynamic recrystallization (DRX) and deformation twinning play a pivotal role in stress partitioning during hot deformation of magnesium alloy. However, the influence of twinning on stress is diverse, and the interaction between DRX and twinning is intricate. Existing constitutive models cannot simultaneously describe the relationship between DRX and twinning, as well as their effects on stress. In this study, the hot compression tests were conducted to study the flow behavior and microstructure evolution of AZ31. The obtained flow curves and microstructure revealed that AZ31 alloy undergoes simultaneously DRX softening and twinning hardening during hot deformation. Furthermore, texture evolution was significantly influenced by both DRX and twinning behaviors. As a result of DRX behavior, there was a decrease in twin volume fraction in the later stages of deformation. Consequently, a twin volume fraction model that incorporates the inhibitory effect of DRX was proposed. According to the experimental results of high temperatures and low strain rates, a constitutive model incorporating work hardening, dynamic recovery (DRV), and DRX was established. Additionally, the influence of twinning on flow stress was incorporated into the model, resulting in a constitutive model that considers both DRX and twinning simultaneously. Finally, the proposed model's reliability was validated through the wedging spinning process, successfully predicting both macroscopic deformation and microstructure evolution of the spinning parts.

Abstract Background A major shift in the “dynamic zero-COVID” policy was announced by China’s National Health Commission on December 7, 2022, and the subsequent immediate large-scale outbreak of SARS-CoV-2 infections in the entire country has caused worldwide concern. This observational cross-sectional study aimed to describe the epidemiological characteristics of this outbreak in Sichuan, China. Methods All data were self-reported online by volunteers. We described the epidemic by characterizing the infection, symptoms, clinical duration, severity, spatiotemporal clustering, and dynamic features of the disease. Prevalence ratio (PR), Odds ratios (ORs) and adjusted ORs were calculated to analyze the associations between risk factors and infection and the associations of risk factors with clinical severity using log-binomial and multivariable logistic regression models; 95% confidence intervals (CIs) and Wald test results were reported. The prevalence rates and clinical severity among different subgroups were compared using the Chi-square and trend Chi-square tests. Results Between January 6 and 12, 2023, 138,073 volunteers were enrolled in this survey, and 102,645 were infected with COVID-19, holding a prevalence rate of 74.34%; the proportion of asymptomatic infections was 1.58%. Log-binomial regression revealed that the risk of infection increased among those living in urban areas. Multivariable logistic regression analysis showed that female sex, chronic diseases, older age and the fewer doses of vaccine received were associated with an increased risk of severe clinical outcomes after infection. We estimated the mean reproduction number during this pandemic was 1.83. The highest time-dependent reproduction number was 4.15; this number decreased below 1 after 11 days from December 7, 2022. Temporal trends revealed a single peak curve with a plateau pattern of incidence during the outbreak, whereas spatiotemporal clustering analysis showed that the onset in 21 cities in the Sichuan province had four-wave peaks. Conclusions The peak of the first wave of Omicron infection in Sichuan Province had passed and could be considered a snapshot of China under the new control strategy. There were significant increases in the risk of severe clinical outcomes after infection among females, with chronic diseases, and the elderly. The vaccines have been effective in reducing poor clinical outcomes.

As a critical component of a train, the railway wagon bogie adapter has higher quality requirements. During the forging process, external loads can induce voids, cracks, and other defects in the forging, thereby reducing its service life. Hence, studying the damage behavior of the forging material, specifically AISI 1035 steel, becomes crucial. This study involved obtaining stress–strain curves for AISI 1035 steel through uniaxial tensile tests at temperatures of 900 °C, 1000 °C, and 1100 °C, with strain rates of 0.1 s−1, 1 s−1, and 10 s−1. Subsequently, SEM was used to observe samples at various deformation stages. The damage parameters, q1, q2 and q3 in the GTN model “a computational model used to analyze and simulate material damage which can effectively capture the damage behavior of materials under different loading conditions” were then calibrated using the Ramberg–Osgood model and stress–strain curve fitting. Image Pro Plus software v11.1 quantified the sample porosity as f0, fn, fc and fF. A finite element model was established to simulate the tensile behavior of the AISI 1035 steel samples. By comparing the damage parameters of f0, fn, fc and fF obtained by the finite element method and experimental method, the validity of the damage parameters obtained by the finite element inverse method could be verified.

The raw data from ground-based telescopic optical observations serve as a key foundation for the analysis and identification of optical scattering properties of space objects, providing an essential guarantee for object identification and state prediction efforts. In this paper, a spatial object optical characterization model based on Augmented Implicit Neural Representations (AINRs) is proposed. This model utilizes a neural implicit function to delineate the relationship between the geometric observation model and the apparent magnitude arising from sunlight reflected off the object’s surface. Combining the dual advantages of data-driven and physical-driven, a novel pre-training procedure method based on transfer learning is designed. Taking omnidirectional angle simulation data as the basic training dataset and further introducing it with real observational data from ground stations, the Multi-Layer Perceptron (MLP) parameters of the model undergo constant refinement. Pre-fitting experiments on the newly developed S−net, R−net, and F−net models are conducted with a quantitative analysis of errors and a comparative assessment of evaluation indexes. The experiment demonstrates that the proposed F−net model consistently maintains a prediction error for satellite surface magnitude values within 0.2 mV, outperforming the other two models. Additionally, preliminary accomplishment of component-level recognition has been achieved, offering a potent analytical tool for on-orbit services.

Metallic plastic deformation involves complex microstructural changes and defect evolution, posing challenges in predicting and controlling the quality and performance of formed parts. Therefore, a pressing demand exists for a proficient online defect‐sensing system to monitor defects evolution continuously within components during plastic deformation in real time. This article proposes an intelligent online sensing approach for detecting defects in metallic plastic forming based on acoustic emission (AE) and machine learning. A comparative analysis is conducted on AE amplitude signals, stress–strain curves, and defect evolution during the tensile process of TA15 titanium alloy specimens under different stress states. It is found that the defect formation process can be divided into four stages based on the AE amplitude signals. A convolutional neural network model for intelligent defect sensing is established. It leverages transfer learning and is grounded in the relationship between AE signals and the evolution of internal defects. The prediction accuracy using different pretrained models is investigated and compared. It is discerned that utilizing GoogleNet as the pretrained model offers the swiftest training pace with a prediction accuracy of 97.57%. This approach enables intelligent online sensing of internal defect evolution in metal plastic deformation processes.

Abstract Classic biphasic pulmonary blastoma (CBPB), a distinct type of lung cancer, is a dual‐phasic tumor characterized by the co‐existence of low‐grade fetal adenocarcinoma and primitive mesenchymal stroma. Accounting for less than 0.1% of surgically removed lung cancers, CBPB commonly presents in individuals during their fourth to fifth decades of life, with smoking as a significant risk factor. The optimal management strategy entails surgical resection, supplemented by chemotherapy to improve prognosis. The frontline chemotherapeutic agents typically include platinum agents and etoposide, with preoperative neoadjuvant chemotherapy potentially enabling operability for initially inoperable cases. In recent years, targeted therapies, such as antiangiogenic agents, have emerged as promising new treatment strategies for CBPB. For patients exhibiting brain metastases or deemed inoperable, radiation therapy proves to be a crucial therapeutic component. CBPB prognosis is adversely affected by factors such as early metastasis, tumor size exceeding 5 cm, and tumor recurrence. In this regard, serological markers have been identified as valuable prognostic indicators. To exemplify, we recount the case of a 44‐year‐old female patient with CBPB, wherein serum lactate dehydrogenase levels showed significant diagnostic value. This report further incorporates a comprehensive review of CBPB literature from the past 22 years.

Intrahepatic cholestasis of pregnancy (ICP) is a liver disease that sometimes develops during pregnancy and is characterized by increased serum bile acid levels. Here the authors report that the gut microbiome species B. fragilis is enriched in patients with ICP and promotes ICP development in mice via inhibition of signalling though the bile acid receptor FXR.

Asymmetric electrochemical synthesis via ion-pairing catalysis is challenging due to interference of the electrolyte with the ion-pairing catalyst. Here, the authors describe a biphasic system to enable the asymmetric ion-pairing catalysis under electrochemical conditions.

Aiming at the contradiction between large stroke and high precision characteristics of precision positioning table, a coaxial integrated macro-micro composite actuators (MMCA) with large stroke and high precision characteristics is proposed by combining voice coil motor (VCM), and giant magnetostrictive actuator(GMA). In order to increase macro-motion stability and reduce fretting error, its structural parameters are optimized by finite element analysis, and the optimal combination mode is designed by using orthogonal experimental scheme. Finally, a model machine is developed and an experimental platform is built for performance testing. The results show that: macro external yoke(α), macro inner yoke(β), and Wall thickness of magnetic isolator(γ) it has different effects on macro-motion stability and fretting error of MMCA, When α=12mm, β=5mm, γ=12mm, the output performance of the MMCA is the best. The maximum macro-motion force of the model machine can reach 294.45N, and the maximum micro error is only 4nm. This shows that the proposed design scheme of coaxial integrated MMCA is reasonable and feasible, which lays a theoretical and technical foundation for further optimization and development of precision positioning worktable with, large stroke and high-precision characteristics.

Therapeutics based on messenger RNA (mRNA) have become a promising class of methods for various diseases’ treatments in recent years. The safe and effective delivery of mRNA into target cells is the premise of the clinical translation of mRNA. Due to the protonation of ionizable lipids in acidic conditions, the ionizable lipid nanoparticles (iLNPs) have lower toxicity and higher endosomal escape efficiency than permanent cationic lipid nanoparticles (cLNPs). They not only exhibit excellent delivery ability in commercial COVID‐19 mRNA vaccines but also are highly potential carriers for delivering mRNA drugs. This review summarizes the composition, preparation, stability of mRNA iLNPs, and the recent progress in the mRNA delivery by iLNPs. According to the structure characteristics of ionizable heads, the ionizable lipids are classified into tertiary amine, quaternary amine, imidazole core, piperidine core, piperazine core, and diketopiperazine core‐based head lipids. Their design, optimization, and applications on mRNA delivery are discussed. The current status of representative clinical trials based on mRNA iLNPs delivery is also analyzed. The challenges and prospects of mRNA iLNPs delivery in clinical applications are proposed at the end.

IntroductionPatient activation is determined by an individual’s knowledge, skills and confidence in managing his/her health. It is vital for people living with HIV (PLWH) to enhance their self-management skills and health outcomes, especially those from low- and middle-income regions, since they are at higher risk of worse health outcomes. However, literature from those regions is limited, especially in China.ObjectivesThis study aimed to explore the status and factors associated with patient activation among Yi minority PLWH in Liangshan, China and to determine whether patient activation is associated with HIV clinic outcomes.MethodsThis cross-sectional study included 403 Yi minority people living with HIV in Liangshan between September and October 2021. All participants completed an anonymous survey measuring sociodemographic characteristics, HIV-related information, patient activation and illness perception. Multivariate linear regression and multivariate binary logistic regression were used to explore factors associated with patient activation and the association between patient activation and HIV outcomes, respectively.ResultsThe Patient Activation Measure (PAM) score was low (mean = 29.8, standard deviation = 4.1). Participants with negative illness perception, low income, and self-rated antiretroviral therapy (ART) effect based on self-perception were most likely to have a lower PAM score (β = −0.3, −0.2, −0.1, respectively; all p

Strategy selection is critical for constellation deployment missions, both in terms of energy consumption and time cost. The different effects of impulse thrust and continuous thrust on orbit elements lead to a different choice of strategy. With impulse thrust, constellation types are differentiated according to high and medium-low inclinations. Constellations with high inclination are deployed using a strategy that controls the inclination. Constellations with medium-low inclination are deployed using a strategy that controls the semi-long axis. With continuous thrust, constellations are classified according to high, medium, and low inclination. High inclination constellations are deployed with a strategy of controlling inclination. Medium inclination constellations are deployed with a strategy that controls the semi-long axis. Low inclination constellations are deployed with a strategy of directly applying continuous thrust.

Continuous thrust spacecraft in circular orbits have had a great influence on the identification and cataloging of space targets. Gaussian-type orbital element variational equations are simplified and approximated. Ground-based radar observation datasets are transformed into orbit elements datasets. The initial thrust and orbit elements are obtained by optimally solving the spatial parameter error sum of squares minimization problem with the Levenberg–Marquardt method. The simulation analysis is carried out under the high-precision orbit model, and the solution error of tangential acceleration is around 5 × 10−7 m/s2, and that of normal acceleration is around 3 × 10−6 m/s2; the accuracy of the semi-major axis is 350 m, and the accuracy of inclination is 0.095°. The method is applicable to the preliminary identification of thrust and orbit elements for circular orbit continuous thrust spacecraft and can provide reliable initial values for the subsequent precision orbit determination of such spacecraft.

The use of nanocrystal technology to manufacture drug delivery systems intended to enhance therapeutic efficacy has attracted the attention of the pharmaceutical industry. However, the clinical application of nanocrystal drugs for injection is restricted by Ostwald ripening and the large-scale use of stabilizers such as polysorbate and lecithin, which have potential toxicity risks including hemolysis and allergies. Here, we designed an amorphous nanocrystal drug complex (IHNC), which is stabilizer-free and composed of indocyanine green (ICG) framework loading with a chemotherapeutic agent of 10-hydroxycamptothecin (HCPT). Considering the possibility of industrial manufacturing, IHNC was simply prepared with the assistance of ferric ion (III) via supramolecular assembly strategy. The theoretical result of Materials Studio simulation indicated that the prepared ICG-Fe(III) framework showed a stable spherical structure with the appropriate cavity for encapsulating the two drugs of HCPT and ICG with equal mass ratio. The IHNC was stable at physiological pH, with excellent PTT/PDT efficacy, and in vivo probing characteristics. The nanoscale size and reductive stimuli-responsiveness can be conducive to drug accumulation into the tumor site and rapid unloading of cargo. Moreover, such combination therapy showed synergistic photo/chemotherapy effect against 4T1 breast cancer and its tumor inhibition rate even up to 79.4%. These findings demonstrated that the nanocrystal drug delivery strategy could avoid the use of stabilizers and provide a new strategy for drug delivery for combination therapy.

As industrial modernization surges forward, the heat treatment industry strives for lower pollution, reduced oxidation and defects, minimized waste, and automatization. This paper reviews the mechanisms, processes, equipment, and simulations of the vacuum gas quenching technology, presenting a comprehensive account of the structure and working principle of a typical vacuum gas quenching furnace. Firstly, the mechanism of the heat transfer process, flow process, and flow–heat transfer–phase transition coupling were summarized. Then, the influences of process parameters on the mechanical properties and distortion of vacuum gas quenched workpieces, as well as the process optimization methods, were discussed. Finally, the advantages of vacuum gas quenching in energy saving, low pollution, and high efficiency were introduced, with the future development directions figured out.

BackgroundRectal cancer patients who received neoadjuvant chemoradiotherapy (CRT) may have a lower cancer stage and a better prognosis. Some patients may be able to avoid invasive surgery. It is critical to accurately assess lymph node metastases (LNM) after neoadjuvant chemoradiotherapy. The goal of this study is to identify clinical variables associated with LNM and to develop a nomogram for LNM prediction in rectal cancer patients following nCRT.MethodsFrom 2010 to 2015, patients were drawn from the Surveillance, Epidemiology, and End Results (SEER) database. To identify clinical factors associated with LNM, the least absolute shrinkage and selection operator (LASSO) aggression and multivariate logistic regression analyses were used. To predict the likelihood of LNM, a nomogram based on multivariate logistic regression was created using decision curve analyses.ReslutThe total number of patients included in this study was 6,388. The proportion of patients with pCR was 17.50% (n=1118), and the proportion of patients with primary tumor pCR was 20.84% (n = 1,331). The primary tumor was pCR in 16.00% (n=213) of the patients. Age, clinical T stage, clinical N stage, and histology were found to be significant independent clinical predictors of LNM using LASSO and multivariate logistic regression analysis. The nomogram was developed based on four clinical factors. The 5-year overall survival rate was 78.9 percent for those with ypN- and 66.3 percent for those with ypN+, respectively (P

Abstract Background The endoglycosidase heparanase which degrades heparan sulfate proteoglycans, exerts a pro-inflammatory mediator in various inflammatory disorders. However, the function and underlying mechanism of heparanase in acute pancreatitis remain poorly understood. Here, we investigated the interplay between heparanase and the gut microbiota in the development of acute pancreatitis. Methods Acute pancreatitis was induced in wild-type and heparanase-transgenic mice by administration of caerulein. The differences in gut microbiota were analyzed by 16S ribosomal RNA sequencing. Antibiotic cocktail experiment, fecal microbiota transplantation, and cohousing experiments were used to assess the role of gut microbiota. Results As compared with wild-type mice, acute pancreatitis was exacerbated in heparanase-transgenic mice. Moreover, the gut microbiota differed between heparanase-transgenic and wild-type mice. Heparanase exacerbated acute pancreatitis in a gut microbiota-dependent manner. Specially, the commensal Parabacteroides contributed most to distinguish the differences between wild-type and heparanase-transgenic mice. Administration of Parabacteroides alleviated acute pancreatitis in wild-type and heparanase-transgenic mice. In addition, Parabacteroides produced acetate to alleviate heparanase-exacerbated acute pancreatitis through reducing neutrophil infiltration. Conclusions The gut–pancreas axis played an important role in the development of acute pancreatitis and the acetate produced by Parabacteroides may be beneficial for acute pancreatitis treatment. Video abstract

The high-temperature deformation process and dynamic recrystallization (DRX) process of 21-4N were investigated under the conditions of the deformation temperature range of 1273~1453K, the strain rate range of 0.01~10s–1 and the deformation degree of 60% (the total deformation is 0.916) by using Gleeble-1500D thermal simulated test machine. The curves of stress-strain (σ – ε) were obtained, and the curves of work hardening rate (θ) and strain (ε) were obtained by taking derivative of σ – ε. The DRX critical strains under different conditions were determined by the curves of work hardening rate (θ – ε), and the DRX critical strain model was established. The peak strains of 21-4N were obtained by the curves of σ – ε, the relationship between peak stress (σp) and critical strain (εc) was determined, and the peak strain model was established. The DRX volume fraction models of 21-4N were established by using Avrami equation. The DRX grain size of 21-4N was calculated by Image Pro Plus 6.0, and its DRX grain size models were established.

The Gleeble-1500D thermal simulator was used for the isothermal compression test of 21-4N heat-resistant steel under the T range of 1273–1453 K and ε˙ of 0.01–10s−1. Using the obtained stress - strain data, various parameters of the Fields–Backofen (F-B), the modified F–B (m–F–B) equations and the modified Zerilli–Armstrong (m–Z–A) equations were calculated respectively. The constitutive equations of 21-4N heat-resistant steel based on the F–B, the m–F–B and the m–Z–A were established. Second, the predictive ability of the three constitutive equations were evaluated using the correlation coefficient (R), average absolute relative error (AARE) and the relative error (r). Third, the established model was imported into Deform-3D to simulate the valve forging process of 21-4N heat-resistant steel, and the distribution rules of the effective stress, effective strain, temperature and damage condition of the forging were analyzed. Finally, a hot forging experiment was performed on a 160t hot die forging press. Results show that the flow stress of 21-4N heat resistant steel is affected by temperature, strain rate and strain. The m–F–B and m–Z–A models can describe the rheological behavior of 21-4N heat-resistant steel, while the original F–B model has a high predictive ability, but only under low temperature, low strain rate and small deformation. The simulation process can be completed successfully, indicating that the established models can be used for the simulation study of the thermal deformation of 21-4N heat-resistant steel and all models are correct. The results can provide some important basic data for the simulation of 21-4N heat resistant steel in the plastic deformation process.

Objective: Many cancer cells cannot survive without exogenous glutamine (Gln); however, cancer cells expressing glutamine synthetase (GS) do not have this restriction. Previous metabolomics studies have indicated that glutamine metabolism is altered during pituitary tumorigenesis. However, the main role of Gln in pituitary adenoma (PA) pathophysiology remains unknown. The aim of this study was to evaluate the expression of GS and the main role of Gln in human PAs. Methods: We used cell proliferation assay and flow cytometry to assess t he effect of Gln depletion on three different pituitary cell lines and human prim ary PA cells. We then investigated the expression level of Gln synthetase (GS) in 24 human PA samples. At last, we used LC-MS/MS to identify the differences in metabolite s of PA cells after the blockage of both endogenous and exogenous Gln. Results: PA cell lines showed different sensitivities to Gln starvation, and the sensitivity is correlated with GS expression level. GS expressed in 21 out of the 24 human PA samples. Furthermore, a positive p53 and ki-67 index was correlated with a higher GS expression level (P < 0.05). Removal of both endogenous and exogenous Gln from GS- expressing PA cells resulted in blockage of nucleotide metabolism and cell cycle arrest. Conclusions: Our data indicate that GS is needed for PA cells to undergo proliferation during Gln deprivation, and most human PA cells express GS and might have a negative response to exogenous Gln depletion. Moreover, Gln is mainly responsible for nucleotide metabolism in the proliferation of GS-expressing pituitary tumor cells.

The solution of the short-arc angles-only orbit determination problem has large uncertainty because the topocentric range is not observable. For a certain angular observation tracklet with measurement noise, there exist numerous potential orbits, all of which are compatible with the observations. However, the solution of a deterministic initial orbit determination algorithm is usually far different from the true orbit, especially for the semimajor axis and the eccentricity. A new sampling method is proposed to describe the probability distribution of the orbit determination solutions. Firstly, a series of orbits are sampled in the semimajor axis - eccentricity plane. A chi-square test method is proposed to select candidate orbits from the sample orbits. The weights of the candidate orbits are calculated to measure their probability being the true orbit. Finally, the kernel density estimation algorithm is used to estimate the probability density function of the true orbits. With some a priori assumptions, the candidate orbits can be further screened, and their weight can be modified. The a priori knowledge can significantly improve the accuracy of the orbit determination solution.

Abstract Benefiting from the merits of low cost, ultrahigh‐energy densities, and environmentally friendliness, metal–sulfur batteries (M–S batteries) have drawn massive attention recently. However, their practical utilization is impeded by the shuttle effect and slow redox process of polysulfide. To solve these problems, enormous creative approaches have been employed to engineer new electrocatalytic materials to relieve the shuttle effect and promote the catalytic kinetics of polysulfides. In this review, recent advances on designing principles and active centers for polysulfide catalytic materials are systematically summarized. At first, the currently reported chemistries and mechanisms for the catalytic conversion of polysulfides are presented in detail. Subsequently, the rational design of polysulfide catalytic materials from catalytic polymers and frameworks to active sites loaded carbons for polysulfide catalysis to accelerate the reaction kinetics is comprehensively discussed. Current breakthroughs are highlighted and directions to guide future primary challenges, perspectives, and innovations are identified. Computational methods serve an ever‐increasing part in pushing forward the active center design. In summary, a cutting‐edge understanding to engineer different polysulfide catalysts is provided, and both experimental and theoretical guidance for optimizing future M–S batteries and many related battery systems are offered.

The conventional community sports facility allocation methods have high minimum costs, and a new community sports facility allocation performance optimization method is designed based on a linear programming model in order to reduce the performance capital investment. The standardized community sports facility allocation performance objective function is established, and a pairwise model is built to divide the feasible and optimal solutions, and the feasible solutions and their constraints are found out. Establish a community sports facility configuration performance optimization model, delineate the boundaries of the optimal solution by bifurcation, and set the feasible domain of the performance optimization model. The performance optimization algorithm is designed to improve the speed of community sports facility allocation performance optimization. In the experiment, the method is compared with data-driven method, digital management method, and evolutionary game algorithm, which requires less capital investment in spring, autumn, and winter than digital management method and evolutionary game algorithm, and the minimum capital investment in summer is less than the other three methods. From the above experimental data, it is clear that the performance optimization method has the smallest minimum capital investment and achieves the purpose of reducing the input cost.

The COVID-19 epidemic has spread worldwide, infected more than 0.6 billion people, and led to about 6 million deaths. Conducting large-scale COVID-19 nucleic acid testing is an effective measure to cut off the transmission chain of the COVID-19 epidemic, but it calls for deploying numerous nucleic acid testing sites effectively. In this study, we aim to optimize the large-scale nucleic acid testing with a dynamic testing site deployment strategy, and we propose a multiperiod location-allocation model, which explicitly considers the spatial–temporal distribution of the testing population and the time-varied availability of various testing resources. Several comparison models, which implement static site deployment strategies, are also developed to show the benefits of our proposed model. The effectiveness and benefits of our model are verified with a real-world case study on the Chenghua district of Chengdu, China, which indicates that the optimal total cost of the dynamic site deployment strategy can be 15% less than that of a real plan implemented in practice and about 2% less than those of the other comparison strategies. Moreover, we conduct sensitivity analysis to obtain managerial insights and suggestions for better testing site deployment in field practices. This study highlights the importance of dynamically deploying testing sites based on the target population’s spatial–temporal distribution, which can help reduce the testing cost and increase the robustness of producing feasible plans with limited medical resources.

The accurate calibration of material parameters in crystal plasticity models is essential for applying crystal plasticity (CP) simulations. Identifying these parameters usually requires unfeasible single-crystal experiments or expensive time costs due to the use of traditional genetic algorithm (GA) optimization. This study proposed an efficient and interpretable method for calibrating the constitutive parameters with macroscopic mechanical tests. This approach utilized the Bayesian neural network (BNN)-based surrogate-assisted GA (SGA) optimization method to identify a group of constitutive parameters that can reproduce the experimental stress–strain curve and crystallographic orientation by crystal plasticity simulation. The proposed approach was performed on the calibration of typical high-entropy alloy material parameters in two different CP models. The use of the surrogate model reduces the call count of simulation in the parameter searching process and speeds up the calibration significantly. With the help of infill sampling, the accuracy of this optimization method is consistent with the CP simulation and not limited by the accuracy of the surrogate model. Another merit of this method is that the pattern that the BNN surrogate found in the model parameters can be interpreted with its integrated gradients, which helps us to understand the relationship between constitutive parameters and the output mechanical response. The interpretation of BNN can guide further experiment design to decouple particular parameters and add constraints provided by the attached experiment or prior knowledge.

TC4 titanium alloy has excellent comprehensive properties. Due to its light weight, high specific strength, and good corrosion resistance, it is widely used in aerospace, military defense, and other fields. Given that titanium alloy components are often fractured by impact loads during service, studying the fracture behavior and damage mechanism of TC4 titanium alloy is of great significance. In this study, the Johnson–Cook failure model parameters of TC4 titanium alloy were obtained via tensile tests at room temperature. The mechanical behavior of TC4 titanium alloy during the tensile process was determined by simulating the sheet tensile process with the finite element software ABAQUS. The macroscopic and microscopic morphologies of tensile fracture were analyzed to study the deformation mechanism of the TC4 titanium alloy sheet. The results provide a theoretical basis for predicting the fracture behavior of TC4 titanium alloy under tensile stress.

The plastic forming process involves many influencing factors and has some inevitable disturbance factors, rendering the multi-objective collaborative optimization difficult. With the rapid development of big data and artificial intelligence (AI) technology, intelligent process optimization has become one of the critical technologies for plastic forming. This paper elaborated on the research progress on the intelligent optimization of plastic forming and the data-driven process planning and decision-making system in plastic forming process optimization. The development trend in intelligent optimization of the plastic forming process was researched. This review showed that the intelligent optimization algorithm has great potential in controlling forming quality, microstructure, and performance in plastic forming. It is a general trend to develop an intelligent optimization model of the plastic forming process with high integration, versatility, and high performance. Future research will take the data-driven expert system and digital twin system as the carrier, integrate the optimization algorithm and model, and realize the multi-scale, high-precision, high-efficiency, and real-time optimization of the plastic forming process.

Hydrogen fuel cells have been used worldwide due to their high energy density and zero emissions. The metallic bipolar plate is the crucial component and has a significant effect on a cell’s efficiency. However, the springback behavior of the metallic bipolar plate will greatly influence its forming accuracy in the micro-scale sheet metal forming process. Therefore, accurate calculation of the springback angle of the micro-scale metallic bipolar plate is urgent but difficult given the state of existing elastoplastic theory. In this paper, a constitutive model that simultaneously considers grain size effect and strain gradient is proposed to analyze micro-scale bending behavior and calculate springback angles. The specialized micro-scale four-point bending tool was designed to better calculate the springback angle and simplify the calculation step. A pure micro-bending experiment on a 316LN stainless steel sheet with a thickness of 0.1 mm was conducted to verify the constitutive model’s accuracy.

Low-carbon steel pipelines are frequently used as transport pipelines for various media. As the pipeline transport industry continues to develop in extreme directions, such as high efficiency, long life, and large pipe diameters, the issue of pipeline reliability is becoming increasingly prominent. This study selected Q235 steel, a typical material for low-carbon steel pipelines, as the research object. In accordance with the pipeline service environment and the accelerated corrosion environment test spectrum, cyclic salt spray accelerated corrosion tests that simulated the effects of the marine atmosphere were designed and implemented. Corrosion properties, such as corrosion weight loss, morphology, and product composition of samples with different cycles, were characterized through appearance inspection, scanning electron microscopy analysis, and energy spectrum analysis. The corrosion behavior and mechanism of Q235 low-carbon steel in the enhanced corrosion environment were studied, and the corrosion weight loss kinetics of Q235 steel was verified to conform to the power function law. During the corrosion process, the passivation film on the surface of the low-carbon steel and the dense and stable α-FeOOH layer formed after the passivation film was peeled off played a role in corrosion resistance. The passivation effect, service life, and service limit of Q235 steel were studied and determined, and an evaluation model for quick evaluation of the corrosion life of Q235 low-carbon steel was established. This work provides technical support to improve the life and reliability of low-carbon steel pipelines. It also offers a theoretical basis for further research on the similitude and relevance of cyclic salt spray accelerated corrosion testing.

Summary: Chiral cyclic sulfamidates are useful building blocks to construct compounds, such as chiral amines, with important applications. Often these compounds can only be generated through expensive precious metal catalysts. Here, Ni(OAc)2/(S, S)-Ph-BPE-catalyzed highly efficient asymmetric hydrogenation of cyclic sulfamidate imines was successfully developed, affording various chiral cyclic sulfamidates with high yields and excellent enantioselectivities (up to 99% yield, >99% enantiomeric excess [ee]). This Ni-catalyzed asymmetric hydrogenation on a gram scale has been achieved with only 0.1 mol% catalyst loading in 99% yield with 93% ee. Other types of N-sulfonyl ketimines were also hydrogenated well to obtain the corresponding products with >99% conversion, 96%–97% yields, and 97%–>99% ee. In addition, this asymmetric methodology could produce other enantioenriched organic molecules, such as chiral β-fluoroamine, amino ether, and phenylglycinol. Moreover, a reasonable catalytic cycle was provided according to the deuterium-labeling studies, which could reveal a possible mechanism for this Ni-catalyzed asymmetric hydrogenation. : Chemistry; Catalysis; Organic Chemistry; Stereochemistry Subject Areas: Chemistry, Catalysis, Organic Chemistry, Stereochemistry

EZH2-mediated methylatation of histone 3 is essential for immune regulation. Here, the authors show that EZH2 inhibitors attenuate experimental colitis in mice by promoting the development of myeloid-derived suppressor cells, and delay the onset of colitis-associated cancer.

There is an inherent need to track and catalog space debris (objects) in geosynchronous earth orbits (GEO) based on space-based surveillance networks and a large amount of observation data. However, for objects in GEO, angle-only measurements containing noises have been regarded as difficult for short-arc orbit determination (OD) when pursuing high accuracy. In this paper, from a data-driven perspective, we propose a novel method for space-based OD based on distribution regression (DR), which is called the weighting distribution-regression OD (WDR-OD) method. The OD is treated as a regression process, which is learned from abundant observation data and the corresponding orbits of known objects. First, we propose the structure of space-based OD samples, wherein the feature variables with a weighting matrix are introduced to enhance prediction accuracy. Second, a two-stage sampled learning theory is employed to learn the mapping from measurements to objects' orbit through kernel mean embedding. The proposed method is experimentally compared with the improved Laplace method and shows greater robustness in measurements with white Gaussian noise (WGN) and colored noise. The positional RMSE reaches 0.8793 km with WGN and 1.6972 km with colored noise, which are significantly smaller than the corresponding Laplace method's 5.0804 km and 14.8132 km. Furthermore, we propose a RIP-based ROMP algorithm to provide the theoretical bound of sparsity and then to pursue a sparse solution. Although the positional RMSE increases to 1.6554 km in the sparse method, it shrinks the 90% to 93% nonzero elements of the coefficients matrix to zero, which is helpful in reducing the computing load, and it meaningfully extends the application domain of the WDR-OD method.

Sodium-cooled reactors (SFR) have always been recognized as one of the most promising candidates for the fourth-generation nuclear systems as announced by the Generation-IV International Forum. In the design of SFR, helical wire-wrapped rod is applied to stabilize the structure of the rod bundle and enhance coolant mixing. Although there has been considerable research on SFR in computational fluid dynamics (CFD), the phenomenon of heat transfer has rarely been paid attention to. This article discovered that there exists reversed heat flux from coolant to wrapped wire, which is contrary to our usual understanding. This phenomenon has not been reported in previous CFD calculations. Hence, a solid heat conduction model is proposed to prove this phenomenon and analyze the heat transfer process. The simulation results show that the wrapping wire embedding depth, the shape of the calculation domain and the physical properties of all components have great influence on the magnitude of the reversed heat flux. The present findings will have strong influence on the temperature field and maximum value of the fuel rod as well as profound reference value for future flow calculation, especially in grid generation and treatment of the junction between the winding wire and fuel rod.

Background: Propofol injection pain, despite various interventions, still occurs during the anesthesia induction and causes intense discomfort and anxiety in patients. This study aimed to explore the effect of intravenous dexmedetomidine on propofol injection pain prior to anesthesia induction with propofol at 4°C.Methods: A total of 251 patients (American Society of Anesthesiologists I–II) who underwent oral and maxillofacial surgery were randomly assigned to a combination group (n = 63), lidocaine group (n = 62), dexmedetomidine group (n = 63), and placebo-control group (n = 63); they received 0.5 ug/kg dexmedetomidine prior to anesthesia induction with propofol at 4°C, 40 mg lidocaine, 0.5 ug/kg dexmedetomidine prior to anesthesia induction, and normal saline, respectively. Incidence of pain, pain intensity, and reaction to the pain stimulus were evaluated by using verbal categorial scoring (VCS), a numerical rating scale (NRS), and the Surgical Pleth Index (SPI), respectively. In addition, hemodynamic parameters such as heart rate (HR) and mean arterial pressure (MAP) were also measured. The VCS and NRS were evaluated at 5 s after propofol injection. In addition, SPI, HR, and MAP were evaluated at three time points (before anesthesia induction and 5 and 30 s after propofol injection).Results: The incidence of pain in the combination group (51%) was significantly lower than that in the lidocaine group (71%), dexmedetomidine group (67%), or placebo-control group (94%) (p < 0.001). VCS and NRS scores in the combination group were also lower compared with the other three groups (p < 0.001), with no statistically significant differences between the lidocaine group and dexmedetomidine group (p > 0.05). The SPI of the combination group decreased significantly in comparison with the other three groups at 5 s after propofol injection (F = 96.23, p < 0.001) and 30 s after propofol injection (F = 4.46, p = 0.005). Further comparisons between HR and MAP revealed no significant differences across the groups (p > 0.05).Conclusion: Because of the sedative nature of dexmedetomidine and analgesic effect of low temperature, this study showed that intravenous dexmedetomidine prior to anesthesia induction with propofol at 4°C is highly effective in attenuating the incidence and severity of pain during injection compared with lidocaine (40 mg), dexmedetomidine 0.5 ug/kg) and placebo. This approach was not associated with any anesthesia complications.Clinical Trial Registration:ClinicalTrials.gov, identifier: ChiCTR-2000034663

Timely access to emergency care can substantially improve overall population’s health outcomes. However, currently existed evidence focusing on access to emergency care in China remains insufficient. A better understanding of emergency care from the perspective of spatial accessibility is therefore essential to assist in future healthcare planning. This study provided a brief introduction to the emergency medical service system of China, and assessed the spatial accessibility of emergency care as well as its associated social-economic characteristics based on Sichuan province. Based on populational and hospital administrative data in 2018, we employed the nearest-neighbor method to measure the spatial accessibility while identifying its associated social-economic factors via conventional Ordinary Least Square (OLS) model. The shortest travel time analysis reported a relatively high level of overall spatial accessibility to emergency care in Sichuan. However, substantial geographical disparity in accessibility could nevertheless be observed throughout the province, with the eastern area presenting much higher accessibility than the western area. Regression results suggested that county-level discrepancies in accessibility could be significantly attributed to the variance in local economic development, urbanization level and administrative area. These findings indicated that long-term efforts need to be made by central government on optimizing the allocation of healthcare resources, as well as on fortifying financial support and providing preferential policies for economically disadvantaged regions.

Hydroformylation of 1,2-disubstituted alkenes usually occurs at the α position of the directing heteroatom. Here, the authors report the asymmetric rhodium-catalyzed hydroformylation of 1,2-disubstituted alkenylsilanes with excellent regioselectivity at the β position (relative to the silicon heteroatom) and enantioselectivity.

The stress strain curve of 7075 aluminum alloy in the temperature range of 310 °C to 410 °C was obtained by Gleeble-3800. By Nakazima test, the isothermal thermoforming limit diagrams of 7075 aluminum alloy at different deformation temperatures and stamping speeds were acquired. Moreover, the parameters of automotive S-rail hot stamping process were optimized by GA-BP neural network. The results show that the forming limit curve of 7075 aluminum alloy increases as the deformation temperature and stamping speed increase. The predicted optimal parameters for hot stamping of automotive S-rails by GA-BP neural network are: stamping speed is 50 mm/s, friction coefficient between die and blank is 0.1, and blank holder force is 5 kN. The maximum thinning rate at this process parameter is 9.37%, which provided a reference for 7075 aluminum alloy automotive S-rail hot stamping.

A new type insulated gate bipolar transistor (IGBT) with electron injection (EI-IGBT) is proposed in which an N+-buried layer is implemented in P-base region. The mechanism of the EI-IGBT is that electrons are injected in both OFF- and ON-state, thus accelerated electron-hole recombination is achieved, resulting in a fast turn-off process. Meanwhile, a low forward voltage drop is obtained due to an enhanced conductivity modulation. The simulation results show that, compared with the conventional IGBT, the proposed EI-IGBT delivers a comparable breakdown voltage while featuring an 80% shorter turn-off time (or a 72% lower turn-off loss) or a 23% lower forward voltage drop, resulting in a reduction of total energy loss.

Objective Secondary hyperparathyroidism (sHPT) is one of the most serious complications in patients on long-term hemodialysis. These patients may suffer from metabolic bone diseases, severe atherosclerosis, and undesirable cardiovascular events. Endoscopic parathyroidectomy with autotransplantation is a treatment option for those who do not respond to clinical management. This study aimed to investigate practical use of a self-made device in parathyroid autotransplantation for patients with sHPT, and to compare this device with ordinary surgical scissors. Methods A total of 15 patients with sHPT were treated with endoscopic parathyroidectomy and autotransplantation. Pieces of parathyroid tissue were squeezed in our self-made device and injected into the brachioradialis muscle. Sixteen patients with sHPT who were treated with traditional parathyroid transplantation served as controls. Serum levels of parathyroid hormone, alkaline phosphatase, calcium, phosphorus and intact parathyroid hormone were measured before and after surgery. Results Preoperative symptoms were alleviated, and serum parathyroid hormone and alkaline phosphatase levels, hyperphosphatemia, and hypercalcemia were improved or normalized in all of the patients in both groups. Pathological examinations showed that parathyroid cells remained active. Conclusion Application of our squeezing device is an economic, effective, and safe method in endoscopic parathyroidectomy and autotransplantation for patients with sHPT.

Lung cancer is one of the serious malignant tumors with high morbidity and mortality due to the poor diagnosis and early metastasis. The developing nanotechnology provides novel concepts and research strategies for the lung cancer diagnosis by employing nanomaterials as diagnostic reagents to enhance diagnostic efficiency. This commentary introduces recent progress using nanoparticles for lung cancer diagnosis from two aspects of in vivo and in vitro detection. The challenges and future research perspectives are proposed at the end of the paper.

Based on an 33Cr23Ni8Mn3N thermal simulation experiment, the application of an artificial neural network (ANN) in thermomechanical processing was studied. Based on the experimental data, a microstructure evolution model and constitutive equation of 33Cr23Ni8Mn3N heat-resistant steel were established. Stress, dynamic recrystallization (DRX) fraction, and DRX grain size were predicted. These models were evaluated by a variety of statistical indicators to determine that these models would work well if applied in predicting microstructure evolution and that they have high precision. Then, based on the weight of the ANN model, the sensitivity of the input parameters was analyzed to achieve an optimized ANN model. Based on the most widely used sensitivity analysis (SA) method (the Garson method), the input parameters were analyzed. The results show that the most important factor for the microstructure of 33Cr23Ni8Mn3N is the strain rate ( ε ˙ ). For the control of the microstructure, the control of the ε ˙ is preferred. ANN was applied to the development of processing map. The feasibility of the ANN processing map on austenitic heat-resistant steel was verified by experiments. The results show that the ANN processing map is basically consistent with processing map based on experimental data. The trained ANN model was implanted into finite element simulation software and tested. The test results show that the ANN model can accurately expand the data volume to achieve high precision simulation results.

Magnetic biochar derived from agricultural biomass has been recognized as a cost-effective biochar sorbent for phosphate removal. This study evaluated the use of novel Fe/Mg-biochar nanocomposites (WBC1x), prepared by impregnating ground walnut shell in a solution with a different molar ratio of Fe2+ to Mg2+, then pyrolyzing slowly, at a temperature of 600 °C, to remove phosphate. The results showed that MgO and Fe3O4 were loaded onto the biochar successfully through the impregnation-pyrolysis method and the composites were able to be separated easily by magnetic field. Meanwhile, a higher surface area and point of zero charge on WBC1x were observed compared to the non-magnetic biochar (WBC). Moreover, the isothermal adsorption and kinetics data further suggested the that phosphate adsorption onto WBC1x resulted from chemisorption. Additionally, the maximum phosphate adsorption capacity of WBC1x was 6.9 mg.g−1, obtained though the Langmuir−Freundlich model, which was threefold higher than WBC, where MgO addition could enhance the adsorption capacity of WBC1x markedly by improving the surface charge.

Summary: Background: China has high stroke rates despite the population being relatively lean. Uncertainty persists about the relevance of adiposity to risk of stroke types. We aimed to assess the associations of adiposity with incidence of stroke types and effect mediation by blood pressure in Chinese men and women. Methods: The China Kadoorie Biobank enrolled 512 891 adults aged 30–79 years from ten areas (five urban and five rural) during 2004–08. During a median 9 years (IQR 8–10) of follow-up, 32 448 strokes (about 90% confirmed by neuroimaging) were recorded among 489 301 participants without previous cardiovascular disease. Cox regression analysis was used to produce adjusted hazard ratios (HRs) for ischaemic stroke (n=25 210) and intracerebral haemorrhage (n=5380) associated with adiposity. Findings: Mean baseline body-mass index (BMI) was 23·6 kg/m2 (SD 3·2), and 331 723 (67·8%) participants had a BMI of less than 25 kg/m2. Throughout the range examined (mean 17·1 kg/m2 [SD 0·9] to 31·7 kg/m2 [2·0]), each 5 kg/m2 higher BMI was associated with 8·3 mm Hg (SE 0·04) higher systolic blood pressure. BMI was positively associated with ischaemic stroke, with an HR of 1·30 (95% CI 1·28–1·33 per 5 kg/m2 higher BMI), which was generally consistent with that predicted by equivalent differences in systolic blood pressure (1·25 [1·24–1·26]). The HR for intracerebral haemorrhage (1·11 [1·07–1·16] per 5 kg/m2 higher BMI) was less extreme, and much weaker than that predicted by the corresponding difference in systolic blood pressure (1·48 [1·46–1·50]). Other adiposity measures showed similar associations with stroke types. After adjustment for usual systolic blood pressure, the positive associations with ischaemic stroke were attenuated (1·05 [1·03–1·07] per 5 kg/m2 higher BMI); for intracerebral haemorrhage, they were reversed (0·73 [0·70–0·77]). High adiposity (BMI >23 kg/m2) accounted for 14·7% of total stroke (16·5% of ischaemic stroke and 6·7% of intracerebral haemorrhage). Interpretation: In Chinese adults, adiposity was strongly positively associated with ischaemic stroke, chiefly through its effect on blood pressure. For intracerebral haemorrhage, leanness, either per se or through some other factor (or factors), might increase risk, offsetting the protective effects of lower blood pressure. Funding: UK Wellcome Trust, UK Medical Research Council, British Heart Foundation, Cancer Research UK, Kadoorie Charitable Foundation, Chinese Ministry of Science and Technology, Chinese National Natural Science Foundation.

Summary: Background: The age-specific association between blood pressure and vascular disease has been studied mostly in high-income countries, and before the widespread use of brain imaging for diagnosis of the main stroke types (ischaemic stroke and intracerebral haemorrhage). We aimed to investigate this relationship among adults in China. Methods: 512 891 adults (59% women) aged 30–79 years were recruited into a prospective study from ten areas of China between June 25, 2004, and July 15, 2008. Participants attended assessment centres where they were interviewed about demographic and lifestyle characteristics, and their blood pressure, height, and weight were measured. Incident disease was identified through linkage to local mortality records, chronic disease registries, and claims to the national health insurance system. We used Cox regression analysis to produce adjusted hazard ratios (HRs) relating systolic blood pressure to disease incidence. HRs were corrected for regression dilution to estimate associations with long-term average (usual) systolic blood pressure. Findings: During a median follow-up of 9 years (IQR 8–10), there were 88 105 incident vascular and non-vascular chronic disease events (about 90% of strokes events were diagnosed using brain imaging). At ages 40–79 years (mean age at event 64 years [SD 9]), usual systolic blood pressure was continuously and positively associated with incident major vascular disease throughout the range 120–180 mm Hg: each 10 mm Hg higher usual systolic blood pressure was associated with an approximately 30% higher risk of ischaemic heart disease (HR 1·31 [95% CI 1·28–1·34]) and ischaemic stroke (1·30 [1·29–1·31]), but the association with intracerebral haemorrhage was about twice as steep (1·68 [1·65–1·71]). HRs for vascular disease were twice as steep at ages 40–49 years than at ages 70–79 years. Usual systolic blood pressure was also positively associated with incident chronic kidney disease (1·40 [1·35–1·44]) and diabetes (1·14 [1·12–1·15]). About half of all vascular deaths in China were attributable to elevated blood pressure (ie, systolic blood pressure >120 mm Hg), accounting for approximately 1 million deaths (

Summary: Background: In developed countries, smoking is associated with increased risk of diabetes. Little is known about the association in China, where cigarette consumption has increased (first in urban, then in rural areas) relatively recently. Moreover, uncertainty remains about the effect of smoking cessation on diabetes in China and elsewhere. We aimed to assess the associations of smoking and smoking cessation with risk of incident diabetes among Chinese adults. Methods: The prospective China Kadoorie Biobank enrolled 512 891 adults (59% women) aged 30–79 years during 2004–08 from ten diverse areas (five urban and five rural) across China. Participants were interviewed at study assessment clinics, underwent physical measurements, and had a non-fasting blood sample taken. Participants were separated into four categories according to smoking history: never-smokers, ever-regular smokers, ex-smokers, and occasional smokers. Incident diabetes cases were identified through linkage with diabetes surveillance systems, the national health insurance system, and death registries. All analyses were done separately in men and women and Cox regression was used to yield adjusted hazards ratios (HRs) for diabetes associated with smoking. Findings: 68% (n=134 975) of men ever smoked regularly compared with 3% (n=7811) of women. During 9 years' follow-up, 13 652 new-onset diabetes cases were recorded among 482 589 participants without previous diabetes. Among urban men, smokers had an adjusted HR of 1·18 (95% CI 1·12–1·25) for diabetes. HRs increased with younger age at first smoking regularly (1·12, 1·20, and 1·27 at ≥25 years, 20–24 years, and

Limited evidence exists for the association between diet pattern and obesity phenotypes among Chinese adults. In the present study, we analyzed the cross-sectional data from 474,192 adults aged 30–79 years from the China Kadoorie Biobank baseline survey. Food consumption was collected by an interviewer-administered questionnaire. Three dietary patterns were extracted by factor analysis combined with cluster analysis. After being adjusted for potential confounders, individuals following a traditional southern dietary pattern had the lowest body mass index (BMI) and waist circumference (WC); the Western/new affluence dietary pattern had the highest BMI; and the traditional northern dietary pattern had the highest WC. Compared to the traditional southern dietary pattern in multivariable adjusted logistic models, individuals following a Western/new affluence dietary pattern had a significantly increased risk of general obesity (prevalence ratio (PR): 1.06, 95% confidence interval (CI): 1.03–1.08) and central obesity (PR: 1.07, 95% CI: 1.06–1.08). The corresponding risks for the traditional northern dietary pattern were 1.05 (1.02–1.09) and 1.17 (1.25–1.18), respectively. In addition, the associations were modified by lifestyle behaviors, and the combined effects with alcohol drinking, tobacco smoking, and physical activity were analyzed. Further prospective studies are needed to elucidate the diet-obesity relationships.