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Abstract Background The continuum management of diabetes remains under-evaluated in China. This study aimed to estimate the proportions of diabetes adults at each stage of the cascade of care framework in Shandong, China. Methods We conducted a secondary analysis using the 2018 China Adult Chronic Disease and Nutrition Surveillance (CACDNS) data in Shandong. This nationwide cross-sectional survey was conducted between September and November 2018, investigating the major chronic diseases among Chinese adults through interviews, physical examinations, and laboratory tests. We employed the cascade model to examine the proportion of diabetes adults, including both type 1 and type 2, from diabetes screening, diagnosis, pharmaceutical and non-pharmaceutical treatments, to single and comprehensive management targets, and quantified the attrition between each stage. Diabetes screening was defined as participants reported to have ever received a blood glucose test. Diabetes diagnosis was defined as: 1) fasting plasma glucose (FPG) ≥ 126 mg/dL, or 2) 2-h oral glucose tolerance test (2 h-OGTT) ≥ 200 mg/dL, or 3) hemoglobin A1c (HbA1c) ≥ 6.5%, or 4) self-reported diabetes. Diabetes management targets included: 1) single glycemic target of personalized HbA1c level, 2) comprehensive ABC targets of personalized HbA1c level, blood pressure (BP)

Abstract Background Short-term exposure to ozone (O3) has been associated with higher stroke mortality, but it is unclear whether this association differs between urban and rural areas. The study aimed to compare the association between short-term exposure to O3 and ischaemic and haemorrhagic stroke mortality across rural and urban areas and further investigate the potential impacts of modifiers, such as greenness, on this association. Methods A multi-county time-series analysis was carried out in 19 counties of Shandong Province from 2013 to 2019. First, we employed generalized additive models (GAMs) to assess the effects of O3 on stroke mortality in each county. We performed random-effects meta-analyses to pool estimates to counties and compare differences in rural and urban areas. Furthermore, a meta-regression model was utilized to assess the moderating effects of county-level features. Results Short-term O3 exposure was found to be associated with increased mortality for both stroke subtypes. For each 10-µg/m3 (lag0-3) rise in O3, ischaemic stroke mortality rose by 1.472% in rural areas and 1.279% in urban areas. For each 0.1-unit increase in the Enhanced Vegetation Index (EVI) per county, the ischaemic stroke mortality caused by a 10-µg/m3 rise in O3 decreased by 0.60% overall and 1.50% in urban areas. Conclusions Our findings add to the evidence that short-term O3 exposure increases ischaemic and haemorrhagic stroke mortality and has adverse effects in urban and rural areas. However, improving greenness levels may contribute to mitigating the detrimental effects of O3 on ischaemic stroke mortality.

ObjectivesLung cancer is one of the most common cancers in Shandong Province, China. Projecting future cancer trend is crucial for planning cancer control. We aimed to examine the trend of lung cancer incidence and mortality from 2012 to 2023, and predict the lung cancer burden to 2030 in Shandong.MethodsData of lung cancer incidence and mortality from 2012 to 2023 were obtained from the Shandong Cancer Registries. The average annual percentage change (AAPC) was used to quantify the trend of the lung cancer age-standardised rate using Joinpoint software. Bayesian age-period-cohort model was used to predict lung cancer incidence and mortality from 2024 to 2030.ResultsThe age-standardised incidence rate (ASIR) remained stable from 2012 to 2023. The ASIR in males decreased with an AAPC of -1.350%, while the ASIR in females increased with an AAPC of 2.429%. The age-standardised mortality rate (ASMR) decreased with an AAPC of -2.911%. This trend was also observed in males (AAPC=-2.513%), females (AAPC=-3.632%), urban areas (AAPC=-3.267%) and rural areas (AAPC=-2.603%). For our predictions, the ASIR will increase to 49.21 per 100,000 until 2030, with an AAPC of 1.873%. This upward trend is expected for females and urban areas, with an AAPC of 4.496% and 4.176%, while it is not observed for males and rural areas. The ASMR is expected to remain stable up to 2030, and this trend will maintain both in males and females. The ASMR will exhibit an upward trend (AAPC=1.100%) in urban areas and a downward trend (AAPC=-0.915%) in rural areas.ConclusionThe ASIR of lung cancer will increase until 2030, while the ASMR of lung cancer is expected to remain stable in Shandong. It is necessary to take further preventive measures such as strengthening tobacco control, enhancing health education and expanding screening efforts.

Summary: Background: To date, comprehensive data on the distribution of chronic kidney disease (CKD), the most prevalent comorbidity in diabetes, among Chinese adults with diabetes is lacking. Additionally, research gaps exist in understanding the association between CKD and cardiovascular health (CVH), an integrated indicator of lifestyle and metabolic control, within a nationwide sample of Chinese adults with diabetes. Methods: A nationally community-based cross-sectional survey was conducted in 2018–2020. 58,560 residents diagnosed with diabetes aged 18–74 years nationwide were invited to participate, and 52,000 participants with complete CKD data were included in this study. CKD was identified by the presence of albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g) and/or decreased estimated glomerular filtration rate (eGFR,

Nitrogen (N) fertilization is critical for spike and floret development, which affects the number of fertile florets per spike (NFFs). However, the physiological regulation of the floret development process by N fertilization is largely unknown. A high temporal-resolution investigation of floret primordia number and morphology, dry matter, and N availability was conducted under three N fertilization levels: 0 (N0), 120 (N1) and 240 (N2) kg ha−1. Interestingly, fertile florets at anthesis stage were determined by those floret primordia with meiotic ability at booting stage: meiotic ability was a threshold that predicted whether a floret primordium became fertile or abortive florets. Because the developmental rate of the 4th floret primordium in the central spikelet was accelerated and then they acquired meiotic ability, the NFFs increased gradually as N application increased, but the increase range decreased under N2. There were no differences in spike N concentration among treatments, but leaf N concentration was increased in the N1 and N2 treatments. Correspondingly, dry matter accumulation and N content of the leaf and spike in the N1 and N2 treatments was increased as compared to N0. Clearly, optimal N fertilization increased leaf N availability and transport of assimilates to spikes, and allowed more floret primordia to acquire meiotic ability and become fertile florets, finally increasing NFFs. There was no difference in leaf N concentration between N1 and N2 treatment, whereas soil N concentration at 0–60 cm soil layers was higher in N2 than in N1 treatment, implying that there was still some N fertilization that remained unused. Therefore, improving the leaf’s ability to further use N fertilizer is vital for greater NFFs.

Hydrogels, known for their outstanding water absorption, flexibility, and biocompatibility, have been widely utilized in various fields. Nevertheless, their application is still limited by their relatively low mechanical performance. This study has successfully developed a dual-network hydrogel with exceptional mechanical properties by embedding amino-functionalized polysiloxane (APSi) networks into a polyvinyl alcohol (PVA) matrix. This hydrogel effectively dissipates energy through dense sacrificial bonds between the networks, allowing for precise control over its tensile strength (ranging from 0.07 to 1.46 MPa) and toughness (from 0.06 to 2.17 MJ/m3) by adjusting the degree of crosslinking in the polysiloxane network. Additionally, the hydrogel exhibits excellent conductivity (10.97 S/cm) and strain sensitivity (GF = 1.43), indicating its potential for use in wearable strain sensors. Moreover, at the end of its life (EOL), the sensor waste can be repurposed as an adsorbent material for metal ions in water treatment, achieving the recycling of hydrogel materials and maximizing resource utilization.

Evidence on the association between long-term ozone exposure and greenness exposure and hemorrhagic stroke (HS) is limited, with mixed results. One potential source of this inconsistency is the difference in exposure time metrics. This study aimed to investigate the association between long-term exposure to ambient ozone, greenness, and mortality from HS using exposure metrics at different times. We also examined whether greenness exposure modified the relationship between ozone exposure and mortality due to HS. The study population consisted of 45771 participants aged ≥40 y residing in 20 counties in Shandong Province who were followed up from 2013 to 2019. Ozone exposure metrics (annual mean and warm season) and the normalized difference a measure of greenness exposure, were calculated. The relationship between environmental exposures (ozone and greenness exposures) and mortality from HS was assessed using time-dependent Cox proportional hazards models, and the modification of greenness exposure was examined using stratified analysis with interaction terms. The person-years at the end of follow-up were 90,663. With full adjustments, the risk of death from hemorrhagic stroke increased by 5% per interquartile range increase in warm season ozone [hazard ratio =1.05; 95 % confidence interval: 1.01–1.08]. No clear association was observed between annual ozone and mortality HS. Both the annual and summer NDVI were found to reduce the risk of HS mortality. The relationships were influenced by age, sex, and residence (urban or rural). Furthermore, greenness exposure was shown to have a modifying effect on the relationship between ozone exposure and the occurrence of HS mortality (P for interaction = 0.001). Long-term exposure to warm season O3 was positively associated with HS mortality, while greenness exposure was inversely associated with HS mortality. Greenness exposure may mitigate the negative effects of warm season ozone exposure on HS mortality.

BackgroundExcessive sodium and low potassium intake are involved in the development of hypertension. Growing evidence showed that the sodium-to-potassium ratio (Na/K) was significantly associated with blood pressure (BP). However, studies on the dose-response relationship of spot urinary Na/K ratio with hypertension and BP in the general population are scarce, especially in the Chinese population.Materials and methodsData from the post-intervention survey of the Shandong Ministry of Health Action on Salt and Hypertension (SMASH) project was analyzed. Associations between Na/K molar ratio and hypertension prevalence and between Na/K molar ratio and BP indices were analyzed using multivariable logistic and linear regression, respectively, followed by subgroup analysis and interaction analysis. The restricted cubic spline model was used to explore the dose–response relationship. Informed by existing literature, we adjusted for potential confounding factors, including temperature and renal function, to assess the association and dose–response relationship.ResultsThere was a non-linear positive association between Na/K and hypertension (OR:1.09, 95%CI: 1.08–1.11) and a linear positive association between Na/K and systolic BP, diastolic BP, and mean arterial pressure (β 0.53, 95%CI: 0.45–0.60; β 0.36, 95%CI: 0.31–0.41; and β 0.42, 95%CI: 0.36–0.47, respectively). The association was stronger in individuals with hypertension, female patients, those in the 50–59-year age group, and those who were obese. Environmental temperatures had little impact on associations.ConclusionOur findings provide further evidence that the spot urinary Na/K ratio is a simple, useful, and convenient indicator for monitoring salt reduction and potassium increase, which could be used in clinical and public health practices.

Abstract Lung cancer is a leading cause of cancer deaths and imposes an enormous economic burden on patients. It is important to develop an accurate risk assessment model to determine the appropriate treatment for patients after an initial lung cancer diagnosis. The Cox proportional hazards model is mainly employed in survival analysis. However, real-world medical data are usually incomplete, posing a great challenge to the application of this model. Commonly used imputation methods cannot achieve sufficient accuracy when data are missing, so we investigated novel methods for the development of clinical prediction models. In this article, we present a novel model for survival prediction in missing scenarios. We collected data from 5,240 patients diagnosed with lung cancer at the Weihai Municipal Hospital, China. Then, we applied a joint model that combined a BN and a Cox model to predict mortality risk in individual patients with lung cancer. The established prognostic model achieved good predictive performance in discrimination and calibration. We showed that combining the BN with the Cox proportional hazards model is highly beneficial and provides a more efficient tool for risk prediction.

ObjectivesThe impact of climate change, especially extreme temperatures, on health outcomes has become a global public health concern. Most previous studies focused on the impact of disease incidence or mortality, whereas much less has been done on road traffic injuries (RTIs). This study aimed to explore the effects of ambient temperature, particularly extreme temperature, on road traffic deaths in Jinan city.MethodsDaily data on road traffic deaths and meteorological factors were collected among all residents in Jinan city during 2011–2020. We used a time-stratified case-crossover design with distributed lag nonlinear model to evaluate the association between daily mean temperature, especially extreme temperature and road traffic deaths, and its variation in different subgroups of transportation mode, adjusting for meteorological confounders.ResultsA total of 9,794 road traffic deaths were collected in our study. The results showed that extreme temperatures were associated with increased risks of deaths from road traffic injuries and four main subtypes of transportation mode, including walking, Bicycle, Motorcycle and Motor vehicle (except motorcycles), with obviously lag effects. Meanwhile, the negative effects of extreme high temperatures were significantly higher than those of extreme low temperatures. Under low-temperature exposure, the highest cumulative lag effect of 1.355 (95% CI, 1.054, 1.742) for pedal cyclists when cumulated over lag 0 to 6 day, and those for pedestrians, motorcycles and motor vehicle occupants all persisted until 14 days, with ORs of 1.227 (95% CI, 1.102, 1.367), 1.453 (95% CI, 1.214, 1.740) and 1.202 (95% CI, 1.005, 1.438), respectively. Under high-temperature exposure, the highest cumulative lag effect of 3.106 (95% CI, 1.646, 5.861) for motorcycle occupants when cumulated over lag 0 to 12 day, and those for pedestrian, pedal cyclists, and motor vehicle accidents all peaked when persisted until 14 days, with OR values of 1.638 (95% CI, 1.281, 2.094), 2.603 (95% CI, 1.695, 3.997) and 1.603 (95% CI, 1.066, 2.411), respectively.ConclusionThis study provides evidence that ambient temperature is significantly associated with the risk of road traffic injuries accompanied by obvious lag effect, and the associations differ by the mode of transportation. Our findings help to promote a more comprehensive understanding of the relationship between temperature and road traffic injuries, which can be used to establish appropriate public health policies and targeted interventions.

Abstract Underwater adhesives with injectable, organic solvent‐free, strong, fast adhesion, and hemostatic properties have become an urgent need in biomedical field. Herein, a novel polyurethane underwater adhesive (PUWA) inspired by mussels is developed utilizing the rapid post‐cure reaction of isocyanate esterification without organic solvents. The PUWA is created through the injectable two component curing process of component A (biocompatible polyurethane prepolymer) and component B (dopamine modified lysine derivatives: chain extender‐LDA and crosslinker‐L3DA). The two‐component adhesive cures quickly and firmly underwater, with an impressive bonding strength of 40 kPa on pork skin and excellent burst pressure of 394 mmHg. Moreover, the PUWA exhibits robust adhesion strength in hostile environments with acid, alkali and saline solutions. Combined with excellent biocompatibility and hemostatic performance, the PUWA demonstrates effectively sealing wounds and promoting healing. With the ability to bond diverse substrates rapidly and strongly, the PUWA holds significant potential for application in both biomedical and industrial fields.

Abstract We aimed to analyse cancer survival and its spatial distribution in Shandong Province. A total of 609,861 cancer cases from 2014 to 2016 were included in the analysis. Survival analysis was performed using strs in Stata. Spatial analysis was performed with GeoDa to determine measures of global and local spatial autocorrelation. Hotspot analysis was used to identify spatial clusters of high values (hotspots) and low values (cold spots) through ArcGIS. The 5-year relative survival rates were 37.85% for all cancers combined, 29.29% for males and 48.88% for females. After age standardisation, the survival rates were 34.47% for all cancers, 28.43% for males and 41.56% for females. Cancers with higher survival rates included thyroid (78.80%), breast (69.52%), uterus (64.51%) and bladder (62.54%) cancers. However, cancers with lower survival rates included pancreatic (11.34%), liver (13.19%), lung (18.39%), bone (19.71%), gallbladder (19.78%), oesophagus (24.52%), and stomach (28.85%) cancers and leukaemia (26.30%). Cancer survival rates in urban areas (37.53%) were higher than those in rural areas (32.83%). From the geographic distribution of cancer survival, we observed that the survival rate displayed a downward trend from east to west and from north to south. The hotspot analysis revealed that some counties of Qingdao, Jinan, Zibo, Dongying and Yantai cities were hotspots, whereas almost all counties of Linyi city and some counties of Weifang, Heze, Rizhao, and Dezhou cities were cold spots. In conclusion, the cancer survival rate in Shandong is still lower than that in China overall. The early diagnosis and treatment of lung and digestive tract cancers need to be further strengthened. Nevertheless, our results reflect a critical first step in obtaining and reporting accurate and reliable estimates of survival in Shandong.

In order to improve the decorative properties of Magnesium-Glass-Board (MGB), the surface morphology and decoration performance of MGB, are studied in detail by using profilometer, microscope and SEM, and the influence of its characterization, such as surface roughness, surface porosity and wettability, on decorative properties of MGB is analyzed by comparing with medium density fiberboard (MDF) and medium density particleboard (MDP). The results first showed that the surface of MGB has a porous structure, but MDF and MDP are not, resulting in a poor decorative performance of MGB. Second, it is found that the surface wettability of MGB is better than others. Third, the hot-pressing parameters including pressure, temperature and time have different influence on decorative performance of MGB during hot-pressing experiment. Finally, the surface bonding strength is positively correlated with pressure, but not with temperature and time. In general, a higher surface bonding strength led to a better decorative performance of MGB. The furthermore research can concentrate on the modification method of the MGB's surface according to this paper's conclusion to improve the lamination performance of melamine paper.

Hyaline cartilage plays a critical role in maintaining joint function and pain. However, the lack of blood supply, nerves, and lymphatic vessels greatly limited the self-repair and regeneration of damaged cartilage, giving rise to various tricky issues in medicine. In the past 30 years, numerous treatment techniques and commercial products have been developed and practiced in the clinic for promoting defected cartilage repair and regeneration. Here, the current therapies and their relevant advantages and disadvantages will be summarized, particularly the tissue engineering strategies. Furthermore, the fabrication of tissue-engineered cartilage under research or in the clinic was discussed based on the traid of tissue engineering, that is the materials, seed cells, and bioactive factors. Finally, the commercialized cartilage repair products were listed and the regulatory issues and challenges of tissue-engineered cartilage repair products and clinical application would be reviewed.

Immunohistochemical (IHC) assay is a commonly used auxiliary technique in pathological diagnosis. Compared to the conventional manual scoring methods that are complicated and time-consuming, automated scoring methods have been playing a more and more important role in the development of digital medicine due to their adaptability and consistency. This study proposes an automatic scoring model for tumor IHC images, which mainly consists of a module for extracting the regions of interest (ROI) and a feature fusion scoring network. The former module extracts the effective tissue regions and the nuclear regions as prior knowledge to exclude cytoplasmic staining interference. The feature fusion network includes two branches. The main branch network combines the structure of cross-block stitching feature maps and the frequency channel attention networks (FcaNet) to extract the features of the effective tissue region images. The other branch network extracts the color representation vector of the cell nucleus region images. The fully-connected layers combine the features from both branches to give a comprehensive final score as the result. We performed experiments on IHC images of P53 protein in colorectal cancer. The results show that the proposed P53Net achieves better classification results than the commonly used classification models, with 94.21% accuracy, 89.24% F1-Score, and 0.9136 kappa coefficient.

The spread of fake news across several fields has had serious negative impacts on the public and society. Existing studies have shown that the use of multi-domain labels can improve the accuracy of fake news detection models since news from different domains has different characteristics. However, the previous multi-domain strategy has a problem: if the data lacks domain labels, the domain knowledge learned by the model for each domain cannot be used to determine whether the news is true or fake. Therefore, a novel multi-domain fake news detection model (SLFEND) is proposed to address the above problems by using soft labels. First, using our proposed Leap GRU to skip useless words, the membership function module generates soft labels for each news item. Then, multi-domain features of the messages are extracted using the soft labels to obtain the final overall feature representation. Finally, the overall feature set of the news is fed into the discriminator, and a judgment is made as to whether the news is real or fake. On the Weibo21 and Thu datasets, our proposed SLFEND approach achieves F1 scores of 92.49% and 89.98% respectively, surpassing existing state-of-the-art research. Experiments on the Weibo21 dataset demonstrate the SLFEND model’s practicality and efficacy. Experiments using the Thu dataset indicate that SLFEND can transfer knowledge to the news without multi-domain labels and add suitable multi-domain labels to more scientifically determine whether the news is real or fake.

Background Peritoneal dialysis (PD) is one of the most important kidney replacement therapies for patients with end‐stage kidney disease (ESKD). PD technique failure can lead to an escalated cost and increased infectious and cardiovascular risk, up and including to death. The accumulation of uric acid (UA) was associated with adverse outcomes in ESKD patients. However, the relationship between serum UA and technique failure is little explored. Methods Here, a total of 266 continuous ambulatory peritoneal dialysis (CAPD) patients (age, 41.8 ± 12.6 years; 125 males) were enrolled and followed up for 31.7 months. Serum UA levels were examined at baseline and each visit. Subjects were divided into three groups according to their baseline serum UA concentrations. Multivariable Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of PD technique failure. Results The level of serum UA increased gradually as time prolonged. During the follow-up period, 77 (28.9%) patients occurred PD technique failure, of which 56 (21.1%) transferred to hemodialysis (HD) and 21 (7.9%) died. Compared to the lowest UA tertile, after adjusting for potential confounders, HRs of technique failure in tertile 2 and tertile 3 were 1.82 (95% CI: 0.95–3.49) and 2.03 (95% CI: 1.05–3.92), respectively, and p for trend was 0.043. Adjusted HRs of all-cause technique failure, transferring to HD and mortality with each 1 mg/dL increase in serum UA were 1.20 (95% CI: 1.03–1.40, p = 0.019), 1.22 (95% CI: 1.01–1.48, p = 0.039), and 1.25 (95% CI: 0.94–1.67, p = 0.128), respectively. Conclusion Higher serum UA level predicted higher risk of technique failure in CAPD patients.

Abstract Background The relative contributions of genetic and environmental factors versus unavoidable stochastic risk factors to the variation in cancer risk among tissues have become a widely-discussed topic. Some claim that the stochastic effects of DNA replication are mainly responsible, others believe that cancer risk is heavily affected by environmental and hereditary factors. Some of these studies made evidence from the correlation analysis between the lifetime number of stem cell divisions within each tissue and tissue-specific lifetime cancer risk. However, they did not consider the measurement error in the estimated number of stem cell divisions, which is caused by the exposure to different levels of genetic and environmental factors. This will obscure the authentic contribution of environmental or inherited factors. Methods In this study, we proposed two distinct modeling strategies, which integrate the measurement error model with the prevailing model of carcinogenesis to quantitatively evaluate the contribution of hereditary and environmental factors to cancer development. Then, we applied the proposed strategies to cancer data from 423 registries in 68 different countries (global-wide), 125 registries across China (national-wide of China), and 139 counties in Shandong province (Shandong provincial, China), respectively. Results The results suggest that the contribution of genetic and environmental factors is at least 92% to the variation in cancer risk among 17 tissues. Moreover, mutations occurring in progenitor cells and differentiated cells are less likely to be accumulated enough for cancer to occur, and the carcinogenesis is more likely to originate from stem cells. Except for medulloblastoma, the contribution of genetic and environmental factors to the risk of other 16 organ-specific cancers are all more than 60%. Conclusions This work provides additional evidence that genetic and environmental factors play leading roles in cancer development. Therefore, the identification of modifiable environmental and hereditary risk factors for each cancer is highly recommended, and primary prevention in early life-course should be the major focus of cancer prevention.

BackgroundImproving the quality of life (QoL) of older adults is becoming an important global issue. However, very few studies have been focused on the relationship between socioeconomic status (SES) and QoL in older adults with hypertension. The purpose of this study is to investigate (a) the status of QoL and (b) the mediating effect of social capital in the relationship between SES and QoL, among rural older adults with hypertension in China.MethodsUsing multistage stratified random sampling, a face-to-face questionnaire survey was conducted among rural older adults with hypertension in Shandong province of China from June to July 2021. Three typical measures representing SES were used, namely, annual household income, educational level, and employment status. Individual social capital and QoL were assessed by the Resource Generator-China Scale (RG—China) and a 34-item simplified Patient Report Outcome (PRO)-specific scale for older adults with hypertension, respectively. A total of 950 rural older adults with hypertension were included in the analysis. The mediation model based on bootstrap analyses was employed to explore the relationship between SES and QoL and the mediating role of social capital in the SES-QoL nexus.ResultsThe sampled rural older adults with hypertension had an upper-middle level of QoL, and the average score was 132.57 ± 19.40. SES was positively correlated with both QoL and individual social capital; individual social capital was significantly positively correlated with QoL. Controlling for sociodemographic variables, SES was still significantly associated with individual social capital (β = 0.140, P < 0.001), and the higher the individual social capital, the better QoL (β = 0.153, P < 0.001). Individual social capital played a partially mediating role in the association between SES and QoL (indirect effect = 0.021, 95% CI: 0.010–0.038), which accounted for 9.38% of the total effect.ConclusionThis study provides evidence that the effect of SES on QoL was partially mediated by individual social capital among rural older adults with hypertension in China. The government should pay more attention to the rural older hypertensive population with lower SES and strive to reduce the negative impact of poor SES on their QoL, based on effective strategies including improving their individual social capital.

Background: The effects of fine particulate matter (PM2.5) on acute myocardial infarction (AMI) have been widely recognized. However, no studies have comprehensively evaluated future PM2.5-attributed AMI burdens under different climate mitigation and population change scenarios. We aimed to quantify the PM2.5-AMI association and estimate the future change in PM2.5-attributed AMI incident cases under six integrated scenarios in 2030 and 2060 in Shandong Province, China. Methods: Daily AMI incident cases and air pollutant data were collected from 136 districts/counties in Shandong Province from 2017 − 2019. A two-stage analysis with a distributed lag nonlinear model was conducted to quantify the baseline PM2.5-AMI association. The future change in PM2.5-attributed AMI incident cases was estimated by combining the fitted PM2.5-AMI association with the projected daily PM2.5 concentrations under six integrated scenarios. We further analyzed the factors driving changes in PM2.5-related AMI incidence using a decomposition method. Results: Each 10 μg/m3 increase in PM2.5 exposure at lag05 was related to an excess risk of 1.3 % (95 % confidence intervals: 0.9 %, 1.7 %) for AMI incidence from 2017 − 2019 in Shandong Province. The estimated total PM2.5-attributed AMI incident cases would increase by 10.9−125.9 % and 6.4–244.6 % under Scenarios 1 − 3 in 2030 and 2060, whereas they would decrease by 0.9–5.2 % and 33.0–46.2 % under Scenarios 5 – 6 in 2030 and 2060, respectively. Furthermore, the percentage increases in PM2.5-attributed female cases (2030: −0.3 % to 135.1 %; 2060: −33.2 % to 321.5 %) and aging cases (2030: 15.2–171.8 %; 2060: −21.5 % to 394.2 %) would wholly exceed those in male cases (2030: −1.8 % to 133.2 %; 2060: −41.1 % to 264.3 %) and non-aging cases (2030: −41.0 % to 45.7 %; 2060: −89.5 % to −17.0 %) under six scenarios in 2030 and 2060. Population aging is the main driver of increased PM2.5-related AMI incidence under Scenarios 1 − 3 in 2030 and 2060, while improved air quality can offset these negative effects of population aging under the implementation of the carbon neutrality and 1.5 °C targets. Conclusion: The combination of ambitious climate policies (i.e., 1.5 °C warming limits and carbon neutrality targets) with stringent clean air policies is necessary to reduce the health impacts of air pollution in Shandong Province, China, regardless of population aging.

Abstract Background The incidence of perioperative stroke following spinal surgery, including ischemic and hemorrhagic stroke, has not been fully investigated in the Chinese population. Whether specific spinal or emergency/elective procedures are associated with perioperative stroke remains controversial. This study aimed to investigate the incidence of perioperative stroke, health economic burden, clinical outcomes, and associated risk factors. Method A retrospective cohort study using an electronic hospital information system database was conducted from Jan 1, 2015, to Jan 1, 2021, in a tertiary hospital in China. Patients aged ≥18 years who had undergone spinal surgery were included in the study. We recorded patient demographics, comorbidities, and health economics data. Clinical outcomes included perioperative stroke during hospitalization and associated risk factors. The patients’ operative data, anesthetic data, and clinical manifestations were recorded. Result A total of 17,408 patients who had undergone spinal surgery were included in this study. Twelve patients had perioperative stroke, including seven ischemic stroke (58.3%) and five hemorrhagic stroke (41.7%). The incidence of perioperative stroke was 0.07% (12/17,408). In total, 12 stroke patients underwent spinal fusion. Patients with perioperative stroke were associated with longer hospital stay (38.33 days vs. 9.78 days, p

Abstract The interactive corrosion between stainless steel 316 (SS) and International Simple Glass (ISG) has been studied for 12 months. The samples were placed in intimate contact to create crevice corrosion conditions on SS in a 0.6 M NaCl solution with and without 142 ppm dissolved silica species enriched in 29Si. Corrosion on SS was observed with large pits located close to the crevice mouth at the end of 1 year in 0.6 M NaCl solution. The SS corrosion was also associated with the dissolution of nearby glass in a highly localized manner. When the leaching solution was saturated with silica species, the corrosion rate of SS was suppressed. However, the presence of SS enhances ISG dissolution in both conditions. The implications of the observed phenomena on the long-term storage of nuclear waste are discussed.

We report the discovery of the energy-dependent morphology of the GeV gamma-ray emission from HESS J1857+026 with more than 13 yr of Fermi Large Area Telescope data. The GeV gamma-ray emission from this region is composed of two extended components. The hard component with an index of 1.74 ± 0.07 in the energy range of 0.5–500 GeV is spatially coincident with HESS J1857+026, and its 68% containment radius varies from ∼0.°44 below 40 GeV to ∼0.°30 above 140 GeV. The hard GeV gamma-ray spectrum and the energy-dependent morphology of HESS J1857+026 make it favor a pulsar wind nebula origin, which is associated with the energetic pulsar PSR J1856+0245. The soft component with an index of 2.70 ± 0.16 and another extended gamma-ray source detected in this region, 4FGL J1857.9+0313e, with an index of 2.55 ± 0.07, are spatially coincident with two molecular clumps in the northeast and southwest of HESS J1857+026, which favors the hadronic process, and the protons could be accelerated by the hypothetical supernova remnant associated with PSR J1856+0245.

HESS J1813-178 is one of the brightest and most compact TeV γ -ray sources, and whether its γ -ray emission is associated with supernova remnant (SNR), pulsar wind nebula (PWN), or young stellar cluster (YSC) is still under debate. By analyzing the GeV γ -ray data in the field of HESS J1813-178 using 14 yr of PASS 8 data recorded by the Fermi Large Area Telescope (Fermi-LAT), we report the discovery of three different sources with different spectra in this region. The hard source with a PL spectral index of 2.11 ± 0.08 has a small size extension, which is spatially and spectrally coincident with the TeV γ -ray emission from HESS J1813-178. CO observations display the dense molecular clouds surrounding HESS J1813-178 in the velocity range of 45–60 km s ^−1 . The possible origins of the γ -ray emission from HESS J1813-178 are discussed, including SNR G12.820.02, the PWN driven by the energetic X-ray pulsar PSR J1813-1749 and YSC Cl 1813-178. However, none of them can be ruled out clearly. Note that the maximum energy of protons in the hadronic model should exceed a few hundred TeV, which makes HESS J1813-178 a promising PeVatron. A detailed LHAASO data analysis about the morphology and spectrum would be helpful to investigate the origin of the γ -ray emission in this region and test its PeVatron nature.

With the 15 yr of Pass 8 data recorded by the Fermi Large Area Telescope, we report the detection of an extended gigaelectronvolt emission component with a 68% containment radius of 0.°85, which is spatially associated with the newly identified supernova remnant (SNR) G321.3–3.9. The γ -ray spectrum is best described by a log-parabola model in the energy range of 100 MeV–1 TeV, which shows a significant spectral curvature at ∼1 GeV. Either a leptonic or a hadronic model could explain the multiwavelength data of G321.3–3.9, while the leptonic model predicts a too-low strength of magnetic field. Also considering the flat radio spectrum of G321.3–3.9 and the γ -ray upper limit in the low energy band, the hadronic model is favored. The spatial coincidence between the γ -ray morphology and the diffuse thermal X-ray emission of G321.3–3.9 and the curved gigaelectronvolt γ -ray spectrum make G321.3–3.9 similar to the typical middle-aged SNRs interacting with molecular clouds (MCs). Such characteristics provide further evidence of the potential hadronic origin for its γ -ray emission. However, there is no MC detected around G321.3–3.9, which challenges the hadronic model.

Background: The occurrence of compound hot extreme (CHE) events in China is increasingly frequent. This study aimed to investigate the association between CHEs and all-cause mortality in Shandong Province and to estimate the attributable excess deaths. Methods: We collected daily data on weather, air pollution, and all-cause mortality at the subdistrict level in Shandong Province from 2013 to 2018. A CHE was defined as both daily maximum and minimum temperatures being higher than their historical 90th percentiles during 2013–2018 hot seasons. A case time-series analysis with a distributed lagged non-linear model was applied to analyze the subdistrict-specific association between different hot extremes and mortality risk, which were then pooled at the province level using meta-analysis. Results: Hot nights (RR = 1.44, 95%CI: 1.35–1.53) and CHEs (RR = 1.77, 95%CI: 1.64–1.90) were significantly associated with an increased mortality risk. CHEs had a greater effect for females (RR = 1.99, 95%CI: 1.81–2.19) and the elderly (>74 years) (RR = 2.14, 95%CI: 1.93–2.38) than their counterparts, respectively. Cardiovascular and respiratory deaths were more susceptible to CHEs than other deaths. Each year, 4888 (95%CI: 4133–5811) excess deaths in Shandong Province were attributable to CHEs, accounting for 2.60% (95%CI: 2.20–3.10%) of all-cause deaths and equating to 50 (95%CI: 42–58) deaths per 1,000,000 residents. The CHE-related mortality burden varied across subdistricts, with the highest occurring in the southeastern area and the lowest occurring in the northeastern and southwestern regions. Conclusion: CHEs and hot nights were substantially associated with excess deaths in Shandong Province, especially for females, the elderly, and residents living in the southeastern area. Our findings may facilitate the development of a heat alert warning system and preventive measures for vulnerable populations.

With the interdisciplinary convergence of biology, medicine and materials science, both research and clinical translation of biomaterials are progressing at a rapid pace. However, there is still a huge gap between applied basic research on biomaterials and their translational products - medical devices, where two significantly different perspectives and mindsets often work independently and non-synergistically, which in turn significantly increases financial costs and research effort. Although this gap is well-known and often criticized in the biopharmaceutical industry, it is gradually widening. In this article, we critically examine the developmental pipeline of biodegradable biomaterials and biomaterial-based medical device products. Then based on clinical needs, market analysis, and relevant regulations, some ideas are proposed to integrate the two different mindsets to guide applied basic research and translation of biomaterial-based products, from the material and technical perspectives. Cartilage repair substitutes are discussed here as an example. Hopefully, this will lay a strong foundation for biomaterial research and clinical translation, while reducing the amount of extra research effort and funding required due to the dissonance between innovative basic research and commercialization pipeline.

BackgroundThe migrant elderly following children (MEFC) are a vulnerable group that emerged during fast urbanization in China. The MEFC faced physical and psychological discomfort upon their arrival in the inflow city, particularly those who came from rural areas.ObjectiveThis study aimed to explore the relationship between oral health status, loneliness, and sleep quality among the MEFC in China and to clarify the disparities in the above mentioned relationship by migration type.MethodsIn 2021, a cross-sectional survey was conducted in Weifang, Shandong Province, using multistage cluster random sampling to collect data from the MEFC aged 60 years and over. In total, 613 respondents [525 rural-to-urban (RTU) and 88 urban-to-urban (UTU)] were included in the final database. The chi-square test, t-test, and structural equation modeling (SEM) were used to investigate the relationship between oral health status, loneliness, and sleep quality among the RTU and UTU MEFC.ResultsTotal scores [mean ± standard deviation (SD)] for oral health status, loneliness, and sleep quality were 54.95 ± 6.47, 8.58 ± 3.03, and 4.47 ± 3.60, respectively. SEM revealed that, among the RTU and UTU MEFC, oral health status was positively and significantly related to sleep quality; however, the correlation was slightly stronger in the UTU MEFC. In both groups, there was a significant negative correlation between oral health status and loneliness, which was stronger in the UTU MEFC. In the RTU MEFC, a significant negative correlation between loneliness and sleep quality was observed, and in the UTU MEFC, no significant association between loneliness and sleep quality was observed.ConclusionThe sleep quality among the MEFC in this study was higher compared to previous studies. Oral health status was negatively correlated with loneliness and positively associated with sleep quality, whereas loneliness was negatively correlated with sleep quality. These three associations differed significantly between the UTU and RTU MEFC. The government, society, and families should take measures to improve oral health and reduce loneliness among the MEFC to improve their sleep quality.

Abstract Smart coatings that provide corrosion protection on demand have received a lot of recent attention. In the present study, nanofibers containing a corrosion inhibitor were prepared by a coaxial electrospinning technique, which addresses the limitations of inhibitor-loaded microcapsules or nanocontainers. The as-prepared nanofibers have a core-shell structure with Ce(NO3)3 and the chitosan/polyacrylic acid polyelectrolyte coacervate as the core and shell materials, respectively. UV-vis spectroscopic analysis confirms that the nanofibers are pH-sensitive and able to release the enclosed Ce(NO3)3 at both low and high pH conditions, which are spontaneously generated during corrosion at local anodes and cathodes, respectively. A coating system consisting of such nanofibers within a polyvinyl butyral coating matrix exhibits improved corrosion protection of an AA2024-T3 substrate. Moreover, the embedded Ce(NO3)3-loaded nanofibers can persistently release Ce(NO3)3 to impede corrosion of AA2024-T3 when the artificially damaged coating sample is exposed to NaCl solution.

IntroductionNumerous studies have reported the modification of particulate matters (PMs) on the association between cold temperature and health. However, it remains uncertain whether the modification effect may vary by size of PMs, especially in Shandong Province, China where the disease burdens associated with cold temperature and PMs are both substantial. This study aimed to examine various interactive effects of cold exposure and ambient PMs with diameters ≤1/2.5 μm (PM1 and PM2.5) on premature deaths in Shandong Province, China.MethodsIn the 2013-2018 cold seasons, data on daily mortality, PM1 and PM2.5, and weather conditions were collected from the 1822 sub-districts of Shandong Province. A time-stratified case-crossover study design was performed to quantify the cumulative association between ambient cold and mortality over lag 0-12 days, with a linear interactive term between temperature and PM1 and PM2.5 additionally added into the model.ResultsThe mortality risk increased with temperature decline, with the cumulative OR of extreme cold (−16.9°C, the 1st percentile of temperature range) being 1.83 (95% CI: 1.66, 2.02), compared with the minimum mortality temperature. The cold-related mortality risk was 2.20 (95%CI: 1.83, 2.64) and 2.24 (95%CI: 1.78, 2.81) on high PM1 and PM2.5 days, which dropped to 1.60 (95%CI: 1.39, 1.84) and 1.60 (95%CI: 1.37, 1.88) on low PM1 and PM2.5 days. PM1 showed greater modification effect for per unit concentration increase than PM2.5. For example, for each 10?g/m3 increase in PM1 and PM2.5, the mortality risk associated with extreme cold temperature increased by 7.6% (95% CI: 1.3%, 14.2%) and 2.6% (95% CI: −0.7%, 5.9%), respectively.DiscussionThe increment of smaller PMs' modification effect varied by population subgroups, which was particularly strong in the elderly aged over 75 years and individuals with middle school education and below. Specific health promotion strategies should be developed towards the greater modification effect of smaller PMs on cold effect.

ObjectiveThe efficacy of concurrent chemoradiotherapy (CRT) after induction chemotherapy (IC) in the treatment of esophageal squamous cell carcinoma (ESCC) remains unclear. The purpose of this study was to explore the efficacy of IC in patients with ESCC.Methods124 patients with ESCC receiving CRT were included. Patients were divided into IC+CRT group and CRT group. Short-term and long-term efficacy as well as survival time of the two groups were compared, influencing factors of IC efficacy were investigated, and overall survival (OS) and progression-free survival (PFS) between the two groups were compared in different subgroups.ResultsThere was no significant difference in the objective response rate (ORR) between the two groups. After IC, the ORR was higher in patients with single-drug concurrent chemotherapy weekly and patients with effective IC. In the long-term efficacy, advanced clinical stage patients had a shorter PFS compared to early-stage patients, and chemoradiotherapy mode ameliorates patients’ PFS. OS and PFS of IC+CRT group were longer than that of CRT group in both tumor diameter

Objective This study examines the impact of a salt reduction campaign on knowledge, attitudes, intentions, behaviours and barriers to behaviour change relating to salt consumption in two provinces of China.Methods In 2019, the ‘Love with Less Salt’ campaign ran on China Central Television and on local television channels in Shandong and Anhui provinces. Data for this study come from two representative household surveys conducted among a sample of adults aged 25–65 years in Shandong and Anhui provinces: precampaign (n=2000) and postcampaign (n=2015). Logistic regression was performed to estimate the effects of the campaign on knowledge, attitudes, intentions, behaviours and barriers to behaviour change.Results Overall, 13% of postcampaign respondents recalled seeing the campaign, and reactions towards the campaign were positive. Postcampaign respondents were more likely to plan to reduce their purchase of foods high in salt than precampaign respondents (OR=1.45, p=

Pea sprouts have rich nutrition and are considered good for heart health. In this study, the kaspa peas and black-eyed peas were chosen to clarify the effect of different LED spectral combinations on the growth, yield, and nutritional quality of pea sprouts under long photoperiod (22 h light/2 h dark). The results showed that the two pea varieties responded differently to light spectral combinations. Black-eyed pea sprouts had higher plant height, fresh weight per plant, dry weight per plant, soluble sugar content, and lower malondialdehyde (MDA) content than kaspa peas under the same light treatment. Compared with white light, red-to-blue ratio of 2:1 significantly increased peroxidase (POD) and superoxide dismutase (SOD) activity, soluble sugar and soluble protein content of kaspa pea sprouts, and decreased MDA content of black-eyed pea sprouts. Blue light was negatively correlated with the plant height of pea sprouts and positively correlated with SOD activity, vitamin C, soluble sugar, and soluble protein content. Antioxidant capacity, yield, and nutritional quality of black-eyed pea sprouts were higher than those of kaspa pea sprouts under the same light treatment. Blue light improved the nutritional quality of pea sprouts. Compared with other light treatments, the red-to-blue ratio of 2:1 was more conducive to improving the antioxidant capacity and nutritional quality of pea sprouts under long photoperiod.

Wheat seedlings are becoming popular for its high nutritional value. Effects of White (W), White + Red (WR), and White + Blue (WB) light-emitting diodes (LEDs) treatments on growth, nutritional characteristics and antioxidant properties of wheat seedlings were studied in a plant factory. The results showed that height, leaf area, shoot fresh, and shoot dry weight per wheat seedling were the highest under WR at 13 and 22 days after planting. Soluble sugar content in leaves and stems were 22.3 and 65% respectively higher under WB than those under W. Soluble protein content in leaves and stems were 36.8 and 15.2% respectively lower under WR than those under W. Contents of total flavonoids, glutathione (GSH) and ascorbic acid (ASA) in leaves were the highest under WB, whereas malondialdehyde (MDA) content in leaves was the lowest under WB. The activities of antioxidant enzymes [superoxide dismutase (SOD), peroxidase (POD), and ascorbate peroxidase (APX)] in leaves and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging ability were also the highest under WB. In conclusion, WR promoted the growth of wheat seedlings, and WB promoted antioxidant level and nutritional accumulation. This study provides guidance for wheat seedlings to carry out preferential production (biomass or quality).

Background: Primary health care system is a critical component of diabetes care and management. This article aimed to analyze the availability of glucose-lowering drugs in primary health institutions (PHIs) in China, and to explore the relationship between availability of glucose-lowering drugs and medication adherence among type 2 diabetes mellitus (T2DM) patients. Methods: This cross-sectional study conducted in Shandong Province, eastern China (hereafter referred to as Shandong), between August and December 2017. In total, 2 520 community-managed T2DM patients were selected from 68 PHIs in Shandong, including 62 village-level and 6 township-level PHIs. The self-developed questionnaire was used to survey the availability of glucose-lowering drugs in PHIs. Patients’ medication adherence was assessed by four self-reported questions, and was classified as either adherent or non-adherent. Descriptive statistics was used to analyze the availability of glucose-lowering drugs in PHIs and the medication adherence among the T2DM patients. Multilevel logistic regression models were used to explore the relationship between the availability of glucose-lowering drugs in PHIs and patients’ medication adherence. Results: A total of 1 866 T2DM patients prescribed with at least one glucose-lowering drug were included in analysis. Among them, 58.5% patients followed their antidiabetic treatment well. In village-level PHIs, the patient's adherence rate was lower than in township-level PHIs (55.9% vs. 61.1%, P < 0.05). Among the 68 PHIs, average (2.53±0.97) glucose-lowering products (generic names) were available, which in village-level PHIs were less than in township-level PHIs (2.47 vs. 3.17, P < 0.05). And the number of available glucose-lowering products in PHIs was associated with the adherence of T2DM patients. Conclusion: Poor availability of glucose-lowering products was found in PHIs in Shandong. The availability of glucose-lowering products in PHIs was positively associated with patients’ medication adherence, and could be enhanced to improve the control of diabetes in primary care settings.

Measurement(s) pitting potential • repassivation potential • Crevice corrosion potential • pitting temperature • Crevice corrosion temperature • corrosion current density • passive current density • corrosion rate • corrosion potential Technology Type(s) digital curation Factor Type(s) alloy composition • temperature • pH • chloride ion concentration • alloy microstructure • alloy heat treatment Machine-accessible metadata file describing the reported data: https://doi.org/10.6084/m9.figshare.13611623

BackgroundThe aim of this study was to build and validate a radiomics nomogram by integrating the radiomics features extracted from the CT images and known clinical variables (TNM staging, etc.) to individually predict the overall survival (OS) of patients with non-small cell lung cancer (NSCLC).MethodsA total of 1,480 patients with clinical data and pretreatment CT images during January 2013 and May 2018 were enrolled in this study. We randomly assigned the patients into training (N = 1036) and validation cohorts (N = 444). We extracted 1,288 quantitative features from the CT images of each patient. The Least Absolute Shrinkage and Selection Operator (LASSO) Cox regression model was applied in feature selection and radiomics signature building. The radiomics nomogram used for the prognosis prediction was built by combining the radiomics signature and clinical variables that were derived from clinical data. Calibration ability and discrimination ability were analyzed in both training and validation cohorts.ResultsEleven radiomics features were selected by LASSO Cox regression derived from CT images, and the radiomics signature was built in the training cohort. The radiomics signature was significantly associated with NSCLC patients’ OS (HR = 3.913, p < 0.01). The radiomics nomogram combining the radiomics signature with six clinical variables (age, sex, chronic obstructive pulmonary disease, T stage, N stage, and M stage) had a better prognostic performance than the clinical nomogram both in the training cohort (C-index, 0.861, 95% CI: 0.843–0.879 vs. C-index, 0.851, 95% CI: 0.832–0.870; p < 0.001) and in the validation cohort (C-index, 0.868, 95% CI: 0.841–0.896 vs. C-index, 0.854, 95% CI: 0.824–0.884; p = 0.002). The calibration curves demonstrated optimal alignment between the prediction and actual observation.ConclusionThe established radiomics nomogram could act as a noninvasive prediction tool for individualized survival prognosis estimation in patients with NSCLC. The radiomics signature derived from CT images may help clinicians in decision-making and hold promise to be adopted in the patient care setting as well as the clinical trial setting.

Abstract The excessive dependence on fossil fuels contributes to the majority of CO2 emissions, influencing on the climate change. One promising alternative to fossil fuels is green hydrogen, which can be produced through water electrolysis from renewable electricity. However, the variety and complexity of hydrogen evolution electrocatalysts currently studied increases the difficulty in the integration of catalytic theory, catalyst design and preparation, and characterization methods. Herein, this review first highlights design principles for hydrogen evolution reaction (HER) electrocatalysts, presenting the thermodynamics, kinetics, and related electronic and structural descriptors for HER. Second, the reasonable design, preparation, mechanistic understanding, and performance enhancement of electrocatalysts are deeply discussed based on intrinsic and extrinsic effects. Third, recent advancements in the electrocatalytic water splitting technology are further discussed briefly. Finally, the challenges and perspectives of the development of highly efficient hydrogen evolution electrocatalysts for water splitting are proposed.

BackgroundLocal governments in China took restrictive measures after the outbreak of COVID-19 to control its spread, which unintentionally resulted in reduced anthropogenic emission sources of air pollutants. In this study, we intended to examine the effects of the COVID-19 lockdown policy on the concentration levels of particulate matter with aerodynamic diameters of ≤1 μm (PM1), ≤2.5 μm (PM2.5), and ≤10 μm (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO) and the potential subsequent reductions in the incidence of ischemic and hemorrhagic stroke in Shandong Province, China.MethodsA difference-in-difference model combining the daily incidence data for ischemic and hemorrhagic stroke and air pollutant data in 126 counties was used to estimate the effect of the COVID-19 lockdown on the air pollutant levels and ischemic and hemorrhagic stroke incident counts. The avoided ischemic stroke cases related to the changes in air pollutant exposure levels were further estimated using concentration-response functions from previous studies.ResultsThe PM1, PM2.5, PM10, NO2, and CO levels significantly decreased by −30.2, −20.9, −13.5, −46.3, and −13.1%, respectively. The O3 level increased by 11.5% during the lockdown compared with that in the counterfactual lockdown phase of the past 2 years. There was a significant reduction in population-weighted ischemic stroke cases (−15,315, 95% confidence interval [CI]: −27,689, −2,942), representing a reduction of 27.6% (95% CI: −49.9%, −5.3%). The change in the number of hemorrhagic stroke cases was not statistically significant. The total avoided PM1-, PM2.5-, PM10-, NO2-, and CO–related ischemic stroke cases were 739 (95% CI: 641, 833), 509 (95% CI: 440, 575), 355 (95% CI: 304, 405), 1,132 (95% CI: 1,024, 1,240), and 289 (95% CI: 236, 340), respectively.ConclusionThe COVID-19 lockdown indirectly reduced the concentration levels of PM1, PM2.5, PM10, NO2, and CO and subsequently reduced the associated ischemic stroke incidence. The health benefits due to the lockdown are temporary, and long-term measures should be implemented to increase air quality and related health benefits in the post-COVID-19 period.

Abstract Borosilicate glasses are widely used to confine high-level radioactive wastes. The lifetime of these materials could reach hundreds of thousands of years if leaching of the glass into groundwater enables the formation of a passivating gel layer. Even in this regime, the glass will never stop corroding as thermodynamic equilibrium between glass and solution cannot be achieved. Therefore, accurate predictions of glass durability including passivation, require a deep understanding of the mechanisms controlling the so-called residual rate. However, despite tremendous efforts, these mechanisms remain poorly understood. Here, focusing on the behavior of the soluble elements of the International Simple Glass (B, Na, and Ca), we show that the residual rate is controlled by the behavior of B, a glass former supposed to dissolve instantaneously when in contact with water and thus widely considered as an ideal tracer. We then demonstrate that B release is controlled by multiple processes highly dependent on the pH. At the beginning of the passivating layer formation, the hydrolysis of B-O-Si linkages is rate-limiting and has an activation energy of ∼60 kJ mol−1, a value slightly lower than that for breaking Si-O-Si linkages. Once the fraction of closed pores resulting from gel restructuring is high enough, then diffusion of both reactants (water molecules) and some products (mainly Baq, Caaq) through the growing gel layer becomes rate-limiting. Consequently, B and Ca accumulate in an inner layer referred to as the active zone, with potential feedback on the B-O-Si hydrolysis. A new paradigm, including B as a key element of the system, is proposed to develop a comprehensive model for the corrosion of borosilicate glass.

Abstract Background Community-based diabetes management is known to be an important strategy for global diabetes control. In China, community-based diabetes management care, including regular blood glucose tests and guidance on medicine use, dietary control, and physical exercise provided by primary health institutions (PHIs), as one of the key contents of the national essential public health services (EPHS), was implemented since 2009 when the new round of health system reform was initiated. This study aimed to investigate the utilization of community-based diabetes management care services, and explore the factors influencing utilization from both patients’ and providers’ points of view. Methods In total, 2520 type-2 diabetes mellitus (DM) patients registered for EPHS were selected from 63 PHIs in eight counties of Shandong province, China, using multi-stage stratified sampling. Of those, 2166 patients (response rate: 85.4%) completed face-to-face structured questionnaires on their utilization of community-based diabetes management care services. Further, 63 PHIs were surveyed on diabetes care delivery, and 444 primary healthcare providers were purposively sampled from those PHIs to measure their knowledge of diabetes management care delivery, using a self-developed questionnaire. Descriptive statistics were used to analyze the delivery and utilization of diabetes management care services. Multilevel logistic regression models were used to analyze the factors associated with patients’ utilization of diabetes management services. Results All 63 PHIs reported that all the required four diabetes management services were provided through EPHS. However, only 49.6% of the patients reported they fully used these services, with no statistically significant difference between urban and rural patients. Patients who had higher knowledge of diabetes and better self-efficacy in controlling the condition, were more likely to fully utilize diabetes management care. A larger number of PHI health staff per 1000 population was associated with better utilization of care. Conclusion Although community-based diabetes management services are well available to Chinese DM patients under the framework of EPHS, the actual utilization of diabetes management services among the patients was poor. The size of the PHI workforce, patients’ knowledge and self-efficacy in controlling diabetes, were important predictors of utilization, and could be enhanced to improve control of diabetes.

Abstract Background Some previous studies have assessed catastrophic health expenditure (CHE) in households with hypertensive patients, but few have examined the difference of CHE in hypertensive patients with and without complications. The purpose of this study is to compare the incidence and determinants of CHE between hypertensive patients with and without complications. Methods Data of this study were from a cross-sectional study in Shandong Province in China in 2016. Of the recruited 3457 hypertensive patients registered in the NCDs management system in the sampling villages, 3113 completed the survey, with a response rate of 90.05%.CHE was defined as out-of-pocket payments for hypertensive care that equaled or exceeded 40% of the household capacity to pay (non-food expenditure). Hypertension complications (e.g., stroke, coronary heart disease, hypertensive kidney disease, etc.) were collected in this study, which was categorized into 0 (no), 1(single), and 2 and more according to the types of hypertensive complications. We employed Chi-square test to explore associated factors and logistic regression model to identify the determinants of CHE. Results The incidence of CHE and impoverishment is 13.6 and 10.8% among hypertensive patients. The incidence of CHE with one complication is 25.3% (Ρ = 0.000, OR = 2.29) and 47.3% (P = 0.000, OR = 3.60) in patients with two or more complications, which are both statistically higher than that in patients without complication (6.1%). Across all types of patients, income levels are inversely related to the incidence of CHE. Patients who use outpatient or inpatient service are more likely to experience CHE (Ρ = 0.000). Factors including living arrangements, family size, educational attainment are found to be significantly associated with CHE in some subgroups (Ρ

Fresh fruit and vegetables are invaluable for human health; however, their quality often deteriorates before reaching consumers due to ongoing biochemical processes and compositional changes. We currently lack any objective indices which indicate the freshness of fruit or vegetables resulting in limited capacity to improve product quality eventually leading to food loss and waste. In this conducted study, we hypothesized that certain proteins and compounds, such as glucosinolates, could be used as one potential indicator to monitor the freshness of broccoli following harvest. To support our study, glucosinolate contents in broccoli based on HPLC measurement and transcript expression of glucosinolate biosynthetic genes in response to postharvest stresses were evaluated. We found that the glucosinolate biosynthetic pathway coincided with the progression of senescence in postharvest broccoli during storage. Additionally, we applied machine learning-based hyperspectral image (HSI) analysis, unmixing, and subpixel target detection approaches to evaluate glucosinolate level to detect postharvest senescence in broccoli. This study provides an accessible approach to precisely estimate freshness in broccoli through machine learning-based hyperspectral image analysis. Such a tool would further allow significant advancement in postharvest logistics and bolster the availability of high-quality, nutritious fresh produce.

HESS J1356-645 is considered to be a pulsar wind nebula (PWN) associated with the pulsar PSR J1357-6429. We reanalyze the GeV gamma-ray emission in the direction of HESS J1356-645 with more than 13 yr of Fermi-Large Area Telescope data. The extended gamma-ray emission above 5 GeV is found to be spatially coincident with HESS J1356-645. The spectrum in the energy range of 1 GeV–1 TeV can be described by a power law with an index of Γ = 1.51 ± 0.10. The broadband spectrum of HESS J1356-645 can be reproduced by a leptonic model with a broken power-law electronic spectrum. In addition, we found evidence that the morphology of the GeV emission from HESS J1356-645 varies with energy; a behavior that is similar to that of the PWN Vela-X. More broadband observations will be helpful to study the energy-dependent characteristics of HESS J1356-645.

CTB 109 is a middle-aged shell-type supernova remnant (SNR) with bright thermal X-ray emission. We reanalyze the GeV γ -ray emission from CTB 109 using 13 yr of Pass 8 data recorded by the Fermi Large Area Telescope. The γ -ray emission of CTB 109 shows a center bright morphology, which is well consistent with its thermal X-ray emission rather than the shell-type structure in the radio band. The spectral analysis shows an evident spectral curvature at ∼several GeV for the GeV γ -ray spectrum, which can naturally explain the lack of TeV γ -ray emission from CTB 109. Although either a leptonic or a hadronic model could fit the multiwavelength observations of CTB 109, the hadronic model is favored considering its γ -ray morphology and the spectral curvature of the GeV spectrum. The unusual γ -ray spectrum of CTB 109 with other SNRs and the luminosity-diameter squared relation make CTB 109 distinguished both from the young-aged SNRs with hard GeV γ -ray spectra and several old-aged SNRs interacting with molecular clouds.

We report the extended GeV γ -ray emission around the high Galactic latitude supernova remnant DA 530 with the PASS 8 data recorded by the Fermi Large Area Telescope. The γ -ray spectrum in the energy range of 100 MeV–1 TeV follows a power-law model with an index of 2.23. The γ -ray emission, which is much more extended than the radio shell of DA 530, and the spatial coincidence with the molecular cloud suggest that the γ -ray emission could be originated from the hadronic process, where the high-energy protons accelerated in and escaped from the shock of DA 530. With a steady-state injection model of protons, the γ -ray spectrum can be well fitted with the typical Galactic value for the diffusion coefficient and the low-energy content of the total escaped protons.

Background: Lung cancer has emerged as one of the most common cancers in recent years. The mitochondrial electron transport chain (ETC) is closely connected with metabolic pathways and inflammatory response. However, the influence of ETC-associated genes on the tumor immune response and the pathogenesis of lung cancer is not clear and needs further exploration.Methods: The RNA-sequencing transcriptome and clinical characteristic data of LUAD were downloaded from the Cancer Genome Atlas (TCGA) database. The LASSO algorithm was used to build the risk signature, and the prediction model was evaluated by the survival analysis and receiver operating characteristic curve. We explored the function of FDX1 through flow cytometry, molecular biological methods, and liquid chromatography–tandem mass spectrometry/mass spectrometry (LC–MS/MS).Results: 12 genes (FDX1, FDX2, LOXL2, ASPH, GLRX2, ALDH2, CYCS, AKR1A1, MAOB, RDH16, CYBB, and CYB5A) were selected to build the risk signature, and the risk score was calculated with the coefficients from the LASSO algorithm. The 1-year, 3-year, and 5-year area under the curve (AUC) of ROC curves of the dataset were 0.7, 0.674, and 0.692, respectively. Univariate Cox analysis and multivariate Cox regression analysis indicated that the risk signature is an independent risk factor for LUAD patients. Among these genes, we focused on the FDX1 gene, and we found that knockdown of FDX1 neither inhibited tumor cell growth nor did it induce apoptosis or abnormal cell cycle distribution. But FDX1 could promote the ATP production. Furthermore, our study showed that FDX1 was closely related to the glucose metabolism, fatty acid oxidation, and amino acid metabolism.Conclusion: Collectively, this study provides new clues about carcinogenesis induced by ETC-associated genes in LUAD and paves the way for finding potential targets of LUAD.

Abstract Background Although massive studies have explored the risk factors of suicidal ideation (SI), the prevalence of SI and its associated factors in the hypertensive individuals are largely unknown. This study aims to investigate the factors associated with SI in the hypertensive individuals. Methods Three thousand nine hundred eleven hypertensive individuals in Shandong, China were included in the analysis. SI was assessed by using a question from the NCS (National Comorbidity Survey). We used binary logistic regression analysis to explore the factors associated with SI, and path analysis to test the direct and indirect relationships between associated factors and SI among hypertensive patients. Results The prevalence of SI in the hypertensive individual was19.6%. Psychological distress had the greatest direct (β = 0.640, p-value

Abstract This paper analyzes current cloud computing, cloud rendering industry, and related businesses. In this field, cloud system performance lacks unified evaluation criterion. A novel analysis method and a related measure of cloud rendering system performance are presented in this paper. The main paper investigates the number of system concurrent users and average response delay about user access, average frame speed, system operation speed, and average response about user browsing system. This paper makes a theoretical analysis of a core business process about cloud rendering system, multi-task rendering processes especially. This paper analyzes the efficiency, average frame rate, rendering performance bottleneck of the cloud rendering system, and put forward a unique parameter adjustment strategy to improve system performance, by optimizing related server and rendering machine configuration. This paper puts forward a method to reduce the bottleneck of the system and prevent system performance deterioration in the new scheme. This paper puts forward a set of system optimization strategies to improve system performance. This is a new cloud rendering system performance optimization configuration scheme and optimization strategy.