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Objective: To obtain information on the current clinical research training status and evaluate the training needs comprehensively for medical staff in hospitals. Methods: This survey was initiated and conducted by the Health and Family Planning Commission of Shenzhen in conjunction with the Peking University Clinical Research Institute (Shenzhen) from Sep 2016 through Nov 2016. It was planned that no less than 10% of the total staff from each participating hospital were invited to complete the survey. All participants filled out the questionnaire anonymously and voluntarily. Results: A total of 644 subjects from 12 hospitals completed the survey with the response rate of 28.7%. The majority of respondents (80%) have attended training related to clinical research knowledge and skills, however, medical research ethical aspects and statistics knowledge have been provided only for 40% and 27% of respondents, respectively. With regard to preference on training subjects and contents, Protocol design and development (74%) is ranked first, followed by the data analysis and summary (59%) among those researchers from medical professions. Project management and quality control course are mostly demanded for technicians and nurses (53%). Unpredictably, no more than 40% of the respondents consider that it is necessary to receive "Regulation and Research ethics" course even for those Principal investigators. Conclusions: Our survey results indicated that training subjects on protocol design and research ethics are urgently needed and relatively inadequate in China. An appropriate clinical research competency training model should be developed and provided for hospital staffs in China.

The perennial herbaceous night lily, Hemerocallis citrina Baroni, is an important vegetable crop with an increasing production and consumption in China. The long lifecycle and slow growth of the night lily are becoming bottlenecks for the large-scale production of elite lines and various genetic and breeding studies. There is a lack of a protocol for rapid and efficient micropropagation for this crop. Here, we reported the systematic investigation and optimization of in vitro plant regeneration through tissue-culture-based organogenesis in the night lily variety 'Datong Huanghua'. We evaluated various factors affecting the efficiency of callus induction and subculture, shoot regeneration, rooting and plantlet establishment, including explant type and age, inoculation methods, basal culture media and the type and concentration of plant growth regulator (phytohormones) in various growth media. We developed an optimized protocol, as follows. The highest efficiency of callus induction was observed on Murashige and Skoog (MS) medium supplied with 22.7 µM TDZ (thidiazuron) using the young scape (flower stem or stalk) as the explant, which was cut longitudinally in half to produce a segment approximately 0.5 cm in length. Callus subculture and proliferation were more efficient on MS medium containing 9.0 µM 2,4-D (2,4-dichlorophenoxyacetic acid) under light culture conditions. Shoot regeneration showed the highest efficiency on MS medium supplemented with 8.9 µM 6-BA (6-benzylaminopurine) + 5.4 µM NAA (α-naphthaleneacetic acid), while the best rooting medium was MS medium containing 2.7 µM NAA. After transplanting, the transplanted regenerated seedlings showed the highest survival rate (96%) on a substrate mixture with a 2:1:1 ratio of peat/perlite/vermiculite. A protocol and flowchart for the rapid in vitro micropropagation of night lily plants is proposed that will facilitate various genetic, genomic and breeding studies on this crop. [ABSTRACT FROM AUTHOR]

Coal mining and ecological restoration activities significantly affect land surfaces, particularly vegetation. Long-term quantitative analyses of vegetation disturbance and restoration are crucial for effective mining management and ecological environmental supervision. In this study, using the Google Earth Engine and all available Landsat images from 1987 to 2020, we employed the Landsat-based Detection of Trends in Disturbance and Recovery (LandTrendr) algorithm and Support Vector Machine (SVM) to conduct a comprehensive analysis of the year, intensity, duration, and pattern of vegetation disturbance and restoration in the Heidaigou and Haerwusu open-pit coal mines (H-HOCMs) in the Jungar Coalfield of China. Our findings indicate that the overall accuracy for extractions of disturbance and restoration events in the H-HOCMs area is 83% and 84.5%, respectively, with kappa coefficients of 0.82 for both. Mining in Heidaigou has continued since its beginning in the 1990s, advancing toward the south and then eastward directions, and mining in the Haerwusu has advanced from west to east since 2010. The disturbance magnitude of the vegetation greenness in the mining area is relatively low, with a duration of about 4–5 years, and the restoration magnitude and duration vary considerably. The trajectory types show that vegetation restoration (R, 44%) occupies the largest area, followed by disturbance (D, 31%), restoration–disturbance (RD, 16%), disturbance–restoration (DR, 8%), restoration–disturbance–restoration (RDR), and no change (NC). The LandTrendr algorithm effectively detected changes in vegetation disturbance and restoration in H-HOCMs. Vegetation disturbance and restoration occurred in the study area, with a cumulative disturbance-to-restoration ratio of 61.79% since 1988. Significant restoration occurred primarily in the external dumps and continued ecological recovery occurred in the surrounding area. [ABSTRACT FROM AUTHOR]

Ginseng (Panax ginseng C. A. Meyer) is a perennial herb from the genus Panax in the family Araliaceae. It is famous in China and abroad. The biosynthesis of ginsenosides is controlled by structural genes and regulated by transcription factors. GRAS transcription factors are widely found in plants. They can be used as tools to modify plant metabolic pathways by interacting with promoters or regulatory elements of target genes to regulate the expression of target genes, thereby activating the synergistic interaction of multiple genes in metabolic pathways and effectively improving the accumulation of secondary metabolites. However, there are no reports on the involvement of the GRAS gene family in ginsenoside biosynthesis. In this study, the GRAS gene family was located on chromosome 24 pairs in ginseng. Tandem replication and fragment replication also played a key role in the expansion of the GRAS gene family. The PgGRAS68-01 gene closely related to ginsenoside biosynthesis was screened out, and the sequence and expression pattern of the gene were analyzed. The results showed that the expression of PgGRAS68-01 gene was spatio-temporal specific. The full-length sequence of PgGRAS68-01 gene was cloned, and the overexpression vector pBI121-PgGRAS68-01 was constructed. The ginseng seedlings were transformed by Agrobacterium rhifaciens-mediated method. The saponin content in the single root of positive hair root was detected, and the inhibitory role of PgGRAS68-01 in ginsenoside synthesis is reported. [ABSTRACT FROM AUTHOR]

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Background: More than one-fifth of the world's population consumes Chinese cuisines regularly, but no evidence-based healthy diets fitting the Chinese food culture are available for implementation.Methods: A multicenter, patient- and outcome assessor-blind, randomized feeding trial was conducted among 265 participants with 130 to 159 mm Hg baseline systolic blood pressure (SBP) for 4 major Chinese cuisines (Shangdong, Huaiyang, Cantonese, Szechuan). After a 7-day run-in period on a control diet matching the usual local diets, participants were randomized to continue with the control diet or the cuisine-based Chinese heart-healthy diet for another 28 days. The primary outcome was SBP, and secondary outcomes included diastolic blood pressure and food preference score. Linear regression models were used to estimate the intervention effects and adjustments for the center. The incremental cost per 1 mm Hg reduction in SBP was also calculated.Results: A total of 265 participants were randomized (135 on the Chinese heart-healthy diet and 130 on the control diet), with 52% women, mean age of 56.5±9.8 years, and mean SBP and diastolic blood pressure of 139.4±8.3 and 88.1±8.0 mm Hg, respectively, at baseline. The change in SBP and diastolic blood pressure from baseline to the end of the study in the control group was -5.0 (95% CI, -6.5 to -3.5) mm Hg and -2.8 (95% CI, -3.7 to -1.9) mm Hg, respectively. The net difference of change between the 2 groups in SBP and diastolic blood pressure were -10.0 (95% CI, -12.1 to -7.9) mm Hg and -3.8 (95% CI, -5.0 to -2.5) mm Hg, respectively. The effect size did not differ among cuisines (P for interaction=0.173). The mean food preference score was 9.5 (with 10 the best preferred) at baseline, and the net change during intervention was 0.1 (95% CI, -0.1 to 0.2; P=0.558). The incremental cost-effectiveness ratio per 1 mm Hg SBP reduction was CNY 0.4 (USD 0.06) per day. No difference in the number of adverse events was found between the 2 groups (P=0.259), and none of the adverse events was associated with the intervention.Conclusions: The Chinese heart-healthy diet is effective, palatable, and cost-effective in reducing blood pressure in Chinese adults with high blood pressure, with a clinically significant effect applicable across major Chinese cuisine cultures.Registration: URL: https://www.Clinicaltrials: gov; Unique identifier: NCT03882645. [ABSTRACT FROM AUTHOR]

Accompanied with the increasing complicated global value chain (GVC) networks is the carbon emission transfers among countries. Utilizing the complex network analysis alongside quadratic assignment procedure (QAP), this paper detects the community structure and influencing forces of the emission transfers under GVCs. The results imply that the bipolar structure of the network transformed gradually to tripolar owing largely to the surging of carbon emissions from China. Evidence on the existence of environmental Kuznets curve (EKC) in the emission transfers from high-income countries to low-income countries, and a U-shape relationship transfers in the reverse direction, suggesting that growing carbon emissions from both low- and high-income countries transferred to other high-income countries gradually. Gaps in technology, especially in patent applications, between source and destination countries played an important role therein. [ABSTRACT FROM AUTHOR]

Importance: Poor access to existing care for diabetic retinopathy (DR) limits effectiveness of proven treatments. Objectives: We examined whether outreach screening in rural China improves equity of access. Design, setting and participants: We compared prevalence of female sex, age > = 65 years, primary education or below, and requiring referral care for DR between three cohorts with diabetes examined for DR in neighboring areas of Guangdong, China: passive case detection at secondary-level hospitals (n = 193); persons screened during primary-level DR outreach (n = 182); and individuals with newly- or previously-diagnosed diabetes in a population survey (n = 579). The latter reflected the "ideal" reach of a screening program. Results: Compared to the population cohort, passive case detection reached fewer women (50·8% vs. 62·3%, p = 0·006), older adults (37·8% vs. 51·3%, p < 0·001), and less-educated persons (39·9% vs. 89·6%, p < 0·001). Outreach screening, compared to passive case detection, improved representation of the elderly (49·5% vs. 37·8%, p = 0·03) and less-educated (70·3% vs. 39·9%, p<0·001). The proportion of women (59.8% vs 62.3%, P>0.300) and persons aged > = 65 years (49.5% vs 51.3%, p = 0.723) in the outreach screening and population cohorts did not differ significantly. Prevalence of requiring referral care for DR was significantly higher in the outreach screening cohort (28·0%) than the population (14·0%) and passive case detection cohorts (7·3%, p<0·001 for both). Conclusions and relevance: Primary-level outreach screening improves access for the poorly-educated and elderly, and removes gender inequity in access to DR care in this setting, while also identifying more severely-affected patients than case finding in hospital. [ABSTRACT FROM AUTHOR]

Purpose: The application of menopausal hormone therapy (MHT) is generally restricted most likely due to limited prescriptions by doctors. Fear of cancer risk may be a critical factor. We investigated the views of Chinese obstetricians and gynecologists on the relationship between hormone therapy and cancer risk. Methods: A self-administered web-based nationwide cross-sectional questionnaire. Results: In total, 5243 medical workers responded to the questionnaire (response rate 94.5%); 4995 were certified obstetricians and gynecologists. Most were aged 36–55 years (70.9%), had > 10 years of working experience (68.5%), and worked at tertiary (34.8%) and secondary hospitals (49.1%); 70% of the clinicians were aware of the endometrial cancer risk caused by estrogen, and 20% considered progestogen to cause the same risk. Regarding breast cancer, while 67.9 and 74.8% of the clinicians viewed natural and synthetic estrogens as risk factors, respectively, only 41.7% identified the carcinogenic effect of progestins as higher than that of progesterone (26.7%). Approximately 75% of the participants believed synthetic estrogens and progestins constituted a risk for ovarian cancer (higher than the percentages for their natural counterparts); 13.0–21.1% of the respondents were worried about choriocarcinoma due to hormone treatment. Finally, 86.8% of obstetricians and gynecologists claimed to have poor knowledge regarding this field. Conclusion: Misconceptions and a lack of knowledge in this regard may result in the fear of cancer and could be the underlying causes of limited MHT prescriptions. We believe that scientific research, continued education, and the media all have roles to play in changing preconceived ideas regarding MHT prescriptions. [ABSTRACT FROM AUTHOR]

Background: Obesity is associated with the development of polycystic ovary syndrome (PCOS) and contributes substantially to metabolic abnormalities in women with PCOS. The study aimed to describe and compare the practices of physicians in the diagnosis, evaluation, and treatment of obesity in patients with PCOS. Methods: Reproductive endocrinologists (Repro-Endo) and obstetrician-gynecologists (non-reproductive medicine specialty, OB-Gyn) in China participated in a survey, and their responses were analyzed using χ2 tests, Fisher exact tests, and multivariable logistic regression analysis. Results: The study analyzed 1318 survey responses (85.8% OB-Gyn; 97.3% women). Body mass index was the most common diagnostic criterion for obesity; only 1.3% of participants measured waist circumference to identify abdominal obesity. More Repro-Endo participants (25% of all participants) enquired about the psychological problems of patients with obesity than OB-Gyn participants, and 42.5% of participants reported ordering both a lipid profile and oral glucose tolerance test (OGTT) for patients with obesity and PCOS. Multivariable analysis, that included physician's specialty, age, hospital grade, and number of patients with PCOS seen annually, revealed that OB-Gyn participants were less likely to order OGTT (OR, 0.3; 95% CI, 0.2–0.4) and lipid profile (OR, 0.2; 95% CI, 0.1–0.3) than Repro-Endo participants. The most common treatments for patients with PCOS were lifestyle modification (> 95%) and metformin (> 80%). More Repro-Endo participants prescribed metformin at a dose of 1.5 g/day compared with OB-Gyn (47.6% vs. 26.3%), and more OB-Gyn participants reported being unclear about the appropriate dosage of metformin for patients with obesity and PCOS (8.9% vs. 1.6%). Conclusion: Our survey identified knowledge gaps in metabolic screening for patients with obesity and PCOS and a disparity in the evaluation and treatment of obesity in PCOS among different specialties. Similarly, it highlights the need to improve obesity management education for physicians caring for women with PCOS. [ABSTRACT FROM AUTHOR]

Background: The main purpose was to determine basic epidemiological data on CKD among hospitalized pediatric patients in China.Methods: Data from pediatric inpatients with CKD hospitalized from June 1, 2013 to May 31, 2017 were extracted from the electronic records of HQMS database, which includes over 14 million inpatients. Codes from the 10th revision of the International Classification of Diseases (ICD-10) were used to search the database.Results: A total of 524 primary diseases of CKD were included in this study. In all, there were 278 231 pediatric inpatients with CKD, which accounted for 1.95 % of the 14 250 594 pediatric inpatients registered in the HQMS database. The number of pediatric inpatients with CKD was 67 498 in 2013, 76 810 in 2014, 81 665 in 2015 and 82 649 in 2016, which accounted for 1.93 %, 1.93 %, 1.99 and 2.09 %, respectively, of the total population of pediatric inpatients. The etiology of CKD was secondary nephrosis in 37.95 % of cases, which ranked first and followed by CAKUT with a percentage of 24.61 %. Glomerular diseases and cystic kidney disease accounted for 21.18 and 5.07 %, respectively. Among all 278 231 patients, 6 581 (2.37 %) had a primary discharge diagnosis of CKD. The renal pathology findings of CKD showed that IgA accounted for 51.17 %.Conclusions: This study provides a descriptive analysis of the hospitalized population of pediatric CKD patients. Our study provides important, fundamental data for policy making and legislation, registry implementation and the diagnosis, treatment and prevention of CKD in China. [ABSTRACT FROM AUTHOR]

Background: Consumption of nuts improves cardio-metabolic risk factors in clinical trials and relates to lower risk of cardiovascular disease (CVD) in prospective observational studies. However, there has not been an adequately powered randomized controlled trial to test if nuts supplementation actually reduces incident CVD. In order to establish the feasibility of such a trial, the current study aimed to assess the acceptability and adherence to long-term nut supplementation amongst individuals at high CVD risk in China.Methods: This protocol described a 6-month trial performed in Ningxia Province in China among participants with a history of CVD or older age (female ≥65 years, male ≥60 years) with multiple CVD risk factors. Participants were randomized to control (received non-edible gift), low dose walnut (30 g/d), or high dose walnut (60 g/d) groups in a 1:1:1 ratio. Walnuts were provided at no cost to participants and could be consumed according to personal preferences. Follow-up visits were scheduled at 2 weeks, 3 months and 6 months. The primary outcome was fasting plasma alpha linolenic acid (ALA) levels used as an indicator of walnut consumption. Secondary outcomes included self-reported walnut intake from the 24 h dietary recalls. The target sample size of 210 provided 90% statistical power with two-sided alpha of 0.05 to detect a mean difference of 0.12% (as percent of total fatty acid) in plasma ALA between randomized groups.Results: Two hundred and ten participants were recruited and randomized during October 2019. Mean age of participants was 65 years (SD = 7.3), 47% were females, and 94% had a history of CVD at baseline. Across the three study groups, participants had similar baseline demographic and clinical characteristics.Discussion: This trial will quantify acceptability and adherence to long-term walnut supplementation in a Chinese population at high risk of CVD. The findings will support the design of a future large trial to test the effect of walnut supplementation for CVD prevention.Trial Registration: NCT04037943 Protocol version: v3.0 August 14 2019. [ABSTRACT FROM AUTHOR]

Regeneration plays an essential role in the restructuring of plant communities, with seedlings and sprouts representing two different regeneration strategies. As an important timber species, Cunninghamia lanceolata is widely distributed throughout southern and eastern China. However, the morphology and growth of its sprouts and seedlings under natural environments have not been examined in detail. Our study quantified the morphology and growth of Cunninghamia lanceolata during its early regeneration phase. We selected a secondary mixed coniferous forest in the Huangshan region of China as the research location, and examined sapling height, basal stem diameter, lateral branch length, as well as the relationships between main stem and lateral branch elongation, and between sapling basal stem diameter and height. The results showed that high light intensity promoted the extension growth of main stems and the elongation of lateral branches of seedlings. Meanwhile, sprouts generally had shorter height growth than seedlings with the same basal stem diameter, and the growth allocation of seedlings was generally more dependent on light intensity. Our findings suggest that the morphology and growth of C. lanceolata might vary depending on the interaction of regeneration mode (plants originating from sprouts or seedlings) and light intensity. [ABSTRACT FROM AUTHOR]

We aimed to explore whether there were cold and heat temperature adverse effects on years of life lost (YLL) for non-accidental mortality in Yuxi, a southwest plateau region of China. From data for 89,467 non-accidental deaths over an 8-year study period, we used a general linear regression model combined with a distributed lag non-linear model to assess the burden of disease non-accidental mortality due to ambient temperature with the YLL indicator. We estimated the mean YLL change per 1 °C decrease from the 25th to 1st percentile mean temperature as the cold effect and per 1 °C increase from the 75th to 99th percentile as the heat effect. The 95% empirical confidence intervals (eCIs) were calculated by using a bootstrap simulation method. The exposure–response curve between average temperature and YLL was U-shaped. The cold effect peaked at the first day after exposure and disappeared at 2 weeks, and the heat effect only lasted for the first 3 days. A per 1 °C decrease from the 25th to 1st mean temperature percentile was associated with an increase of 15.6 (95% eCI: 2.4, 22.9) in YLL for non-accidental diseases, and the cumulative effects due to cold were stronger in contrast to that attributed by heat. Cold temperature had a significant impact on YLL among the subgroups, with higher YLL in cardiovascular disease, stroke, males, Han nationality, married, and those engaged in agriculture than their corresponding categories. An increasing death burden of non-accidental in Yuxi of China due to cold temperature was demonstrated, and the association was also modified by specific disease causes and individual features. [ABSTRACT FROM AUTHOR]

In contrast to the surge of attention to China's business registration reform per se , the environmental externalities of the reform have been somewhat neglected by mainstream academics. Adopting the difference-in-differences method alongside propensity-score matching, and utilizing the panel data of 283 cities in China from 2000 to 2013, this paper investigates the impacts of the deregulation reform on PM2.5 concentrations. The results indicate that the business registration reform has contributed to PM2.5 air pollution, with above-average impacts in central areas, but insignificant effects in western China. Furthermore, the treatment effects are stronger in cities with larger entry of small and medium enterprises and greater pressure to achieve targets for local GDP growth. Aiming to draw public attention to the problems arising from the reform, our study advocates necessary environmental regulations on business registration, which lends support to the theoretical view of "public interest" rather than "public choice". • Deregulation reform of business registration increases PM2.5 concentrations in China. • Treatment effects of deregulation reform on PM2.5 air pollution vary widely among regions. • More SME entries and higher targets for GDP growth are associated with stronger effects of deregulation reform on PM2.5. • PM2.5 air pollution should be considered during the deregulation reform in China and other developing economies. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Valid and reliable instruments for measuring are needed. To add knowledge to the subject of tools of evidence‐based practice (EBP) evaluation in mainland China, the present study aims to translate the Quick‐EBP‐VIK into Chinese, which is an instrument for the assessment of nurses' value, knowledge, and implementation of EBP, and to evaluate the metric characteristics of the Chinese version. Methods: In this methodological study, a total sample of 402 nurses from mainland China was applied. Construct validity was evaluated by using factor analysis and further supported through known‐group validity. A panel of experts examined the content validity. Internal consistency was determined using composite reliability and Cronbach alpha. The intraclass correlation coefficient (ICC) was calculated to assess test‐retest reliability. Results: The exploratory factor analysis revealed a three‐factor structure model same to the original instrument. The confirmatory factor analysis showed a good fit model with a comparative fit index of 0.957 and a root mean square error of approximation of 0.065. Significant differences were found in the item means of the tool between nurses who received EBP training and those who had not, which supported the known‐group validity. The Cronbach alpha and composite reliability for the three subscales were all higher than 0.70. The ICC ranged from 0.569 to 0.928 for the three subscales and from 0.494 to 0.903 for the items included in the instrument. Conclusion: The Chinese version of the Quick‐EBP‐VIK has evidence of acceptable reliability and validity and can be used to measure value, knowledge, and implementation of EBP for Chinese nurses. [ABSTRACT FROM AUTHOR]

Increasing and persistent regional income inequality contrasts strikingly with the world economy's outstanding performance, especially in China. Constructing direct import penetration and indirect intermediate import exposure indexes within a global value chain framework and evaluating regional disparities with nighttime light data, this analysis uncovers the effect of both direct and indirect import penetration on the regional income gap in China, and delves into potential mechanisms from economic development, industrial structure, and factor mobility. Our findings suggest that the positive effect of indirect import exposure of intermediate inputs lies in minimizing regional income disparities, while the effect of direct import exposure remains obscure. In addition, growing disparities in trade openness and fixed capital investment exacerbate regional inequality, in contrast to the positive role that government intervention plays in narrowing the income gap. These results are expected to hold for other countries at similar stages of development. [ABSTRACT FROM AUTHOR]

Temperature has long been accepted as the major controlling factor in determining vegetation phenology in the middle and higher latitudes. The influence of water availability is often overlooked even in arid and semi-arid environments. We compared vegetation phenology metrics derived from both in situ temperature and satellite-based normalized difference vegetation index (NDVI) observations from 1982 to 2006 by an example of the arid region of northwestern China. From the satellite-based results, it was found the start of the growing season (SOS) advanced by 0.37 days year and the end of the growing season (EOS) delayed by 0.61 days year in Southern Xinjiang over 25 years. In the Tianshan Mountains, the SOS advanced by 0.35 days year and the EOS delayed by 0.31 days year. There were almost no changes in Northern Xinjiang. Compared with satellite-based results, those estimates based on temperature contain less details of spatial variability of vegetation phenology. Interestingly, they show different and at times reversed spatial patterns from the satellite results arising from water limitation. Phenology metrics derived from temperature and NDVI conclude that water limitation of onset of the growing season is more severe than the cessation. Phenology spatial patterns of four oases in Southern Xingjiang show that, on average, there is a delay of the SOS of 1.6 days/10 km of distance from the mountain outlet stations. Our results underline the importance of water availability in determining the vegetation phenology in arid regions and can lead to important consequences in interpreting the possible change of vegetation phenology with climate. [ABSTRACT FROM AUTHOR]

[Display omitted] • Dew/hoar frost can be distinguished by leaf wetness sensor and air temperature. • The differences in dew duration on and below canopy depended on plant species. • Sky view factor and shading effects were main factors leading to the differences. • Dew can be an important water supply during sharp declines of soil water. Dew and hoar frost are important sources of water available in dryland ecosystems in arid and semi-arid areas, however, little is known about the quantitative characteristics of dew/hoar frost on the canopies and underlying surfaces of typical shrubs in Northwest China. Few studies have examined the ecological relevance of dew/hoar frost to drought. We conducted an observational experiment regarding the frequency, duration, and amount of dew/hoar frost on both canopies and underlying surfaces of the Artemisia ordosica (AO) and Salix psammophila (SP)—two common species in northern China—using leaf wetness sensor (LWS) in a desert shrubland in Northwest China from May to December 2015. Potential dew/hoar frost was estimated using the Penman–Monteith (P–M) equation, while measuring meteorological parameters. Results showed that dew/hoar frost exhibited a significant diurnal variation that occurred mainly between 20:00 and 09:00 the following day, while peaking at about 04:00–06:00 (i.e., before dawn). The monthly mean duration of dew/hoar frost was longer in November and December, and shorter in May and June. Eighty percent of daily dew values were within 0–0.4 mm d−1. For SP, the durations of dew and hoar frost were both longer on the canopy than on the underlying surface. For AO, however, the duration of dew was longer and that of hoar frost was shorter on the canopy than on the underlying surface. The P–M equation may underestimate dew/hoar frost during cold times with higher wind speed. Dew may be an important water supply, especially during two periods of sharp declines of soil water during the long (the period > one month) and short term (the period < one month) droughts (equal to 63.77 and 96.18% of rainfall, respectively). Our findings suggest that AO is more conducive to the formation of dew/hoar frost than SP, and dew/hoar frost can serve as a sustainable significant water resource during periods of drought, especially in desert areas. [ABSTRACT FROM AUTHOR]

Climate change and climate extremes and their impacts on agriculture, water resources, and ecosystems have become important issues globally. Agricultural sustainability and food security are facing unprecedented challenges due to the increasing occurrence of extreme climatic events, including, notably, extreme droughts in recent years in China. In this study, a threshold determination model of extreme agro-climatic droughts (EADs) was built based on the cumulative probability distribution functions (CDF) of an agricultural drought index—the consecutive days without available precipitation (CDWAP). The CDWAP was established by combining meteorological data with the characteristics of cropping patterns and the water requirement in different growing periods of crops. The CDF of CDWAP was obtained based on the relationship of CDWAP and its occurrence frequency. Based on the model, the spatial pattern of the thresholds of EADs and the threshold exceedance time series of EADs in 500 meteorological stations were obtained, and then changes in the frequencies and intensities of EADs in China and their impacts on grain yields in rain-fed regions during the past 50 years were analyzed. The results follow: (1) The threshold value of EADs in China gradually increased from southeast to northwest. The stations of the highest value were located in the Northwest China, with the CDWAP more than 60 days, while the lowest value was in the middle reaches of the Yangzi River, with the CDWAP less than 16 days. (2) The frequencies and intensities of the EADs increased mostly in the east areas of the Hu Huanyong line, which was also the main agricultural production region in China. The North China (NC) and Southwest China (SW) regions showed the highest increasing rates of the EADs; their frequencies and intensities were 11.3% and 2.2%, respectively, for the NC region, and 9.3% and 2.7%, respectively, for the SW region. (3) Case studies in the NC, SW, and SE regions indicated that there was a negative correlation between grain yields and EAD frequency and intensity; i.e., the low grain yields often occurred in the year with relatively higher frequency or/and stronger intensity of EADs. The correlation coefficients of grain yield and EAD were generally greater than that of merely extreme climatic droughts; therefore, the study of EAD is necessary when researching the impacts of extreme drought events on grain yield. [ABSTRACT FROM AUTHOR]

Background: With increasing cases of iatrogenic premature ovarian insufficiency (POI), more clinicians are required to counsel patients regarding the gonadotoxic effects of iatrogenic treatments. This survey aimed to explore obstetricians and gynaecologists' knowledge regarding iatrogenic POI. A national online questionnaire survey was conducted across China. Respondents were asked to select the iatrogenic condition(s) that can cause POI based on their experience and knowledge. Results: Of the 5523 returned questionnaires, 4995 were analysed. Among tumour therapies causing POI, most respondents agreed that radiotherapy (73.5% of respondents) and chemotherapy (64.1%) are risk factors for POI. While only 6.5 and 7.8% of the gynaecological oncologists believed that tumour immunotherapy and tumour-targeting therapy, respectively, may cause ovarian impairment, 31.8 and 22.2% of the non-gynaecologic oncologists believed that these therapies could affect ovarian health. Most respondents believed that ovarian cystectomy (54.4%) was a risk factor for POI. In contrast, only a few respondents believed that hysterectomy with bilateral salpingectomy (39.6%) and uterine artery embolisation (33.5%) could cause ovarian impairment. Only 30.5% of respondents believed that immunosuppressants (ISs) increased the risk of POI. Views differed with experience and hospital setting. Conclusions: The knowledge of gonadal toxicity due to traditional tumour treatments is generally high among Chinese obstetricians and gynaecologists. A misunderstanding may exist in primary care hospitals and general gynaecologists regarding a link between novel tumour treatments and POI, owing to the lack of convincing evidence. Knowledge of POI caused by hysterectomy and ISs should be improved. [ABSTRACT FROM AUTHOR]

Increases in climate extremes and their impacts have attracted global attention recently. In this study, the change-point years of precipitation extremes (PEs) and drought extremes (DEs) were investigated by Moving t-Test at 500 stations across the six regions in China. The detailed temporal change processes of them were demonstrated by the cumulative deviation method based on the data from nine typical stations. The results showed that: 1) DEs were more significantly and widely increased than PEs, the stations with increasing trends of PEs and DEs accounted for greater than 52.6% and 61.6% of the total, respectively; 2) increasing trends of DEs were mainly distributed in the east of Hu Huanyong Line. In this area, the increasing change-point years of DEs often occurred in the early 1980s in the south of the Yangzi River, while occurred in the 1990s in the north of the Yangzi River; 3) increasing trends of PEs were mainly distributed in Qing-Tibet Platen, Northwest China, and the southeastern area of Hu Huanyong Line. In these areas, the increasing change-point years of PEs often occurred around 1990 in the southeast of Hu Huanyong Line, while often occurred in the early 1980s in Qing-Tibet Platen. The results indicated that the area in the southeast of Hu Huanyong Line was under the threats of both PEs and DEs, this may produce severe impacts on agriculture, environment, water resources management, human society, etc. [ABSTRACT FROM AUTHOR]

Background: There are many public health issues to resolve regarding rare diseases, including a lack of data from large-scale studies. The objective of this study was to explore fundamental data for a list of rare diseases in China, based on a hospitalization summary reports (HSRs) database. The Target Rare Diseases List (TRDL) 2017 was generated using an expert consensus method in which experts listed diseases according to research priorities. Using codes of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and key search terms of rare diseases in English and Chinese, data were obtained from HSRs of 96 hospitals, covering a population of over 15 million in China from 2014 to 2015. We extracted and analyzed information on demographics, hospitalizations, and readmissions.Results: A total 281 rare diseases were included in the TRDL 2017. Altogether, 106,746 hospitalizations for a rare disease were captured from 1 January 2014 to 31 December 2015, accounting for 0.69% of inpatients during the same period. The top 10 rare diseases with most cases on the TRDL 2017 were thalassemia, idiopathic pulmonary arterial hypertension, pulmonary Langerhans cell histiocytosis, moyamoya disease, motor neuron disease, idiopathic pulmonary fibrosis, systemic sclerosis, hepatolenticular degeneration, coarctation of the aorta, and transposition of the great arteries. Among the 24 cities in the database, the five cities with the most types of the rare disease were Beijing, Changsha, Guangzhou, Shanghai, and Chengdu, with 191, 162, 143, 141, and 133 types, respectively. The five cities with most cases of the 281 rare diseases were Beijing, Guangzhou, Shanghai, Nanning, and Chengdu. The age distribution of rare diseases was 52% for the age group 25-64 years, and 27% of cases in the age group of 0-14 years were among children. The 10 highest readmission rates ranged from 35 to 65%.Conclusions: This study provided the TRDL 2017 and descriptive analysis of 281 rare diseases in a hospitalized population. Our study reveals important fundamental information that will be useful in national policy making and legislation; registry implementation; and diagnosis, treatment, and prevention of rare diseases in China. [ABSTRACT FROM AUTHOR]

Changes in climate extremes have become a hot issue in the research field of climate change recently. Many studies have reported that climate extremes have occurred more frequently and with increasing intensity in recent decades. In this study, thresholds of precipitation and drought extremes were determined by the cumulative distribution function, and their spatiotemporal changes over the past half-century in China were analyzed by relative change rate. The results show that: (1) precipitation extremes increased in all regions except North China, while increasing trends of drought extremes were detected in all regions except Northwest China and the Qing–Tibet Plateau; (2) the maximum change rates in frequency of precipitation extremes were found in Northwest China and the Qing–Tibet Plateau, with values of 16.13% and 8.12%, and the maximum change rates in frequency of drought extremes were in Southwest and Southeast China, whose increases in intensity of drought extremes were also the maximum; (3) variation in precipitation extremes showed a relatively mixed pattern with higher heterogeneity compared to that of drought extremes; and (4) changes in precipitation and drought extremes relate to mid-intensity, lower-intensity, and annual precipitation. [ABSTRACT FROM AUTHOR]

• SSRMs boosted running properties of bioelectrogenesis and acidogenesis effectively. • SSRMs improved the protein and carbohydrate metabolisms-related genes' expression. • SSRMs elevated electron transfer efficiency by up-regulating cytochrome c oxidase. • SSRMs raised microbial diversity to realize superior bioelectrogenesis/acidogenesis. Anaerobic biological treatment was regarded as one of promising options for realizing concurrent WAS reduction, stabilization and bioenergy/bioresource recycle. But the relatively low treatment efficiency limited its spreading application toward larger scale considerably in China. Aimed at such barrier, this study offered a novel enhancing strategy for achieving high-efficiency of bioenergy/bioresource recycle from WAS anaerobic treatment via improving bioelectrogenesis/acidogenesis using sludge source-redox mediators (SSRMs). SSRMs not only facilitated bioeletrogenesis with an increasing efficiency of 36% for voltage output and 39% for bioelectricity bioconversion, but also enhanced acidogenesis of WAS with a mean elevating efficiency of 37.5% of volatile fatty acids (VFAs) production within 5 d Mechanistic investigations indicated that SSRMs had a potential influence on improving the protein and carbohydrate metabolisms-related genes' expression for enhancing bioelectrogenesis and acidogenesis. Moreover, SSRMs exerted roles of electrochemical "catalysts" or as terminal electron acceptors with affecting functional proteins of complexes of Ⅰ and Ⅳ in electron transfer chains for improving electron transfer efficiency. Meanwhile, the core members' abundance, microbial diversity and community distributive evenness were prompted concurrently for carrying out superior bioelectrogenesis and acidogenesis. A schematic illustration was established for demonstrating the mechanism of SSRMs for enhancing bioelectrogenesis and acidogenesis via changing microbial metabolism functions, enhancing electron transfer efficiency, and regulating functional genes' expression of functional proteins (up-regulating cytochrome c oxidase and down-regulating-NADH dehydrogenase). This study provided an effective enhancing strategy for facilitating WAS bioconversion to bioenergy/bioresource with well-process sustainability. [Display omitted] [ABSTRACT FROM AUTHOR]

• We examined biophysical controls on dew formation at multi-temporal scales. • Dew was controlled by stomatal conductance and relative humidity seasonally. • The timing, duration and degree of drought significant influenced dew amount. • Dew can reduce nocturnal evapotranspiration during wheat growing period. Dew, as an important contribution of non-rainfall water (NRW), is found to be an important hydrological component for ecosystem water stress alleviation and further ecosystem functions maintenance during rainless seasons. The North China Plain (NCP) is facing severe water shortage mainly due to intensive agricultural irrigation. However, few studies have examined the variations and controlling mechanism of dew in the typical croplands predisposed to drought. Here, seasonal variation in dew was examined during growing period in a wheat and maize rotation cropland in the NCP over 3 years (2008–2010), based on the eddy-covariance measurements of latent heat flux (LE) during nighttime, and the ecosystem drought was defined to occur when the relative extractable water content (REW) in the soil dropped below 0.4. Results showed that annual (from April to September) mean dew amount for this cropland was 7.61 ± 0.02 mm, accounting for 2.5 % of precipitation (PPT), and the annual mean dew amount during drought period was 3.11 mm, accounting for 3.4 % of PPT. Seasonal variation in dew was mainly regulated by relative humidity (RH) and surface stomatal conductance (g s), furthermore, dew was influenced by g s and vapor pressure deficit (VPD) during the wheat growing period, and by g s during maize growing period. 51.1 %–72.0 % of drought events occurred during wheat growing season. Compared to maize growing season with higher nocturnal evapotranspiration (ET N), the higher frequency of dew occurrence during wheat growing season had reduced the ET N amount. Drought timing, duration, and degree together influenced dew amount. Long-term drought (e.g. >1-month drought) would induce an increase of dew amount after drought period. Our findings clarified the temporal dynamics in dew across different crop growing periods (such as wheat and maize); and contribute to the sustainable utilization of non-rainfall water (especially dew) in cropland in the context of extreme climate (such as droughts) in the future. [ABSTRACT FROM AUTHOR]

Bacterial leaf streak caused by Xanthomonas oryzae pv. oryzicola (Xoc) is a devastating disease of rice worldwide, including China. The second messenger c -di-GMP plays an important role in the transduction of intercellular signals. However, little is known about the function of EAL domain protein in c -di-GMP that regulates the virulence in Xoc. In this study, the function of EAL domain protein encoded by pde (FE36_09715) gene in the regulation of c -di-GMP was investigated. Results of this study, showed that the deletion of pde gene led to a significant reduction in the virulence of Xoc and was positively related to the reduction of exopolysaccharides production, biofilm formation, and flagellar motility. However, these significantly impaired properties from the ∆ pde mutant strain were partially recovered in the complementary strain. In addition, the deletion of pde gene in Xoc strain YM15 had no visible effect on the colony morphology, amylase, and protease activities of Xoc. It is concluded that, as a regulator for the c -di-GMP level, the pde gene plays an important role in partial biological processes in Xoc and is essential for its virulence. • Bacterial leaf streak caused by Xanthomonas oryzae pv. oryzicola is a devastating disease of rice. • pde gene plays an important role in the virulence of Xanthomonas oryzae pv. oryzicola. • pde gene is positively related to reductions of exopolysaccharides production, biofilm formation, and flagellar motility. • Deletion of pde gene had no visible effect on colony morphology, amylase, and protease activities. [ABSTRACT FROM AUTHOR]

The soil fungus Fusarium spp, is the main cause of apple replant disease in China. The M9T337 apple rootstock was used to investigate the molecular responses to Fusarium solani infection using transcriptome analysis. We identified 667 differentially expressed genes in F. solani -infected rootstocks, of which 543 were up-regulated and 124 were down-regulated. These differentially expressed genes included receptor kinases, transcription factors, and genes involved in the production and transport of metabolites. In particular, secondary metabolites can enhance plant resistance to pathogens while P450s and UDP-glycosyltransferase play a unique roles in the defense response. • The molecular responses of apple root to Fusarium solani infection was reached using RNA-seq. • DEGs function was analyzed in different process of defense responses, such as receptor kinases, transcription factors, and genes involved in the production and transportation of metabolites. • The secondary metabolites, can enhance plant resistance to pathogen, are important in defence response. • P450s and UDP-glycosyltransferase plays an unique role in defence response. [ABSTRACT FROM AUTHOR]

Bacterial leaf streak of rice (BLS), caused by Xanthomonas oryzae pv. oryzicola (Xoc), is an increasingly serious disease in southwestern China. This study aimed to evaluate the response of the native rice variety Hongyou-4 (HY4) to two different transcription activator-like effectors (TALEs) genotypes of Xoc. HY4 was significantly susceptible to Xoc strain 13T19 and resistant to Xoc strain YM15. Transcriptomic analysis of HY4 leaves inoculated with the two Xoc TALEs genotypes revealed 1339 and 1219 differentially expressed genes (DEGs) in rice inoculated with Xoc strain 13T19 (HY.Q) and Xoc strain YM15 (HY.R), respectively, compared to the control. Quantitative real-time PCR (qRT-PCR) for expression of 10 randomly selected genes was used to verify the RNA-Seq data. Gene ontology (GO) analysis of the transcriptomic data showed DEGs of defense-related genes were predominantly assigned to 11 GO terms, with nine terms showing differential expression in HY4 after inoculation with the two Xoc genotypes. KEGG pathway clustering analysis revealed DEGs involved in plant-pathogen interactions and secondary metabolite pathways of phenylpropanoid biosynthesis were down-regulated in HY.Q compared to HY.R. Four transcription factors including bZIP, GLK, MADS, and MYB families, three resistance genes, and the TalAM2 effector target gene OsSWEET13, were differentially expressed in HY4 inoculated with the two Xoc TALEs genotypes. These data clarify the mechanism of interactions between rice and different TALE genotypes of Xoc , and can help reveal disease-related metabolic pathways, molecular regulatory networks, and candidate genes involved in rice responses to TALEs of Xoc. • Transcriptome profiles of a rice HY4 responding to two Xoc strains 13T19 and YM15 was described. • A local rice variety Hongyou-4, which is of good yield and quality was used. • TAL gene numbers in these two strains are different, implying TAL genes virulence in rice. • We identified 4 transcription factors (TFs), 3 resistance gene and the TalAM2 effector target gene OsSWEET13. • The mechanism of interactions between rice and different TALEs genotypes Xoc was revealed. [ABSTRACT FROM AUTHOR]

Amidst the global antimicrobial resistance (AMR) crisis, antibiotic resistance has permeated even the most remote environments. To understand the dissemination and evolution of AMR in minimally impacted ecosystems, the resistome and mobilome of wetlands across the Qinghai-Tibetan Plateau and its marginal regions were scrutinized using metagenomic sequencing techniques. The composition of wetland microbiomes exhibits significant variability, with dominant phyla including Proteobacteria, Actinobacteria, Bacteroidetes, and Verrucomicrobia. Notably, a substantial abundance of Antibiotic Resistance Genes (ARGs) and Mobile Genetic Elements (MGEs) was detected, encompassing 17 ARG types, 132 ARG subtypes, and 5 types of MGEs (Insertion Sequences, Insertions Sequences, Genomic Islands, Transposons, and Integrative Conjugative Elements). No significant variance was observed in the prevalence of resistome and mobilome across different wetland types (i.e., the Yellow River, other rivers, lakes, and marshes) (R=-0.5882, P=0.607). The co-occurrence of 74 ARG subtypes and 22 MGEs was identified, underscoring the pivotal role of MGEs in shaping ARG pools within the Qinghai-Tibetan Plateau wetlands. Metagenomic binning and analysis of assembled genomes (MAGs) revealed that 93 out of 206 MAGs harbored ARGs (45.15 %). Predominantly, Burkholderiales, Pseudomonadales, and Enterobacterales were identified as the primary hosts of these ARGs, many of which represent novel species. Notably, a substantial proportion of ARG-carrying MAGs also contained MGEs, reaffirming the significance of MGEs in AMR dissemination. Furthermore, utilizing the arg&#95;ranker framework for risk assessment unveiled severe contamination of high-risk ARGs across most plateau wetlands. Moreover, some prevalent human pathogens were identified as potential hosts for these high-risk ARGs, posing substantial transmission risks. This study aims to investigate the prevalence of resistome and mobilome in wetlands, along with evaluating the risk posed by high-risk ARGs. Such insights are crucial for informing environmental protection strategies and facilitating the management of water resources on the Qinghai-Tibetan Plateau., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

The evidence regarding the effects of blood pressure changes on older individuals remains inconclusive, and the impact of frailty throughout the life course is not known. We investigated the associations of different change patterns of blood pressure during 3-year intervals with frailty and mortality. Participants included 7335 persons from 2008 to 2014 of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Change in blood pressure was calculated as the difference between follow-up and baseline. Frailty was evaluated using a 40-item frailty index. Mortality status was ascertained up to December 31, 2014. The mean age of participants was 82.6 ± 10.7 years. The optimal blood pressure level (SBP, 130-150 mmHg; DBP, 70-90 mmHg) was associated with the lowest risk of frailty while decreasing follow-up SBP and DBP were significantly correlated with frailty. Lower baseline blood pressure levels (SBP < 130 mmHg; DBP < 70 mmHg) were associated with decreased mortality risk when participants increased their blood pressure to optimal levels during follow-up SBP and DBP (0.78, 0.63-0.98), compared to maintaining a steady low SBP (< 130 mmHg) and DBP (< 70 mmHg). For those with DBP around 70-90 mmHg, decreasing follow-up DBP (< 70 mmHg) was associated with higher mortality (1.23, 1.07-1.42) compared to maintaining stable follow-up DBP (70-90 mmHg). These results remain significant after adjusting for frailty. Optimal blood pressure levels were associated with the lowest risk of frailty. The association between lower blood pressure and increased mortality risk persisted even after accounting for frailty. We used a nationally representative longitudinal cohort study by using 2008-2014 of the Chinese Longitudinal Healthy Longevity in China. Change in blood pressure was calculated as the difference between follow-up and baseline. We investigated the associations of different change patterns of blood pressure during 3-year intervals with frailty and mortality., (© 2024. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)

Sichuan cuisine was previously fitted into the Chinese Heart-Healthy Diet (CHH) trial to verify the antihypertensive effect. Whether the modified Sichuan diet lessens cardiovascular disease (CVD) is not fully explored. We aimed to estimate the effects of the Sichuan version of CHH diet (CHH diet-SC) on the 10-year risk of CVD and vascular age. A single-blinded randomised controlled feeding trial was conducted. General CVD prediction model was used in manners of intention-to-treat and per-protocol set. After a 7-d run-in period, fifty-three participants with pre- and grade I hypertension from local communities were randomised and provided with either CHH diet-SC ( n 27) or a control diet ( n 26) for 4 weeks. Mean absolute and relative estimated CVD risks were reduced by 4·5 % and 27·9 % in the CHH diet-SC group, and the between-group relative risk reduction was 19·5 % ( P < 0·001) using linear mixed-effects models. The sensitivity analysis with datasets and models showed consistent results, and pre-specified factors were not associated with the intervention effects. The vascular age of CHH-SC group was theoretically 4·4 years younger than that of the control group after intervention. Compared with a typical diet, adopting the CHH diet-SC over 1 month significantly reduced 10-year CVD risks and vascular ages among local adults with mild hypertension.

Background: Healthy diet is essential for cardiovascular disease risk management, but its effects among Chinese patients, whose diets differ from Western diets, remain largely unknown., Methods: In this multicenter, patient- and outcome assessor-blind, randomized controlled feeding trial, 265 Chinese adults with baseline systolic blood pressure 130 to 159 mmHg were randomly assigned into Chinese heart-healthy (CHH) diet or usual diet for a 28-d intervention after a 7-d run-in period on usual diet. Blood lipids and glucose were measured from overnight fasting blood samples before and after the intervention. Ten-year cardiovascular disease risk was estimated using models previously developed and validated in Chinese. The changes in secondary outcomes of serum total cholesterol (TC), blood glucose, and 10-y cardiovascular disease risk over the intervention period were compared between intervention groups, adjusting for center, among participants with baseline and follow-up blood samples available. Sensitivity analyses were done with further adjustment for baseline values and covariables; missing data imputed; and among per-protocol population., Results: Among 256 eligible participants (130 on CHH diet, 126 on control diet), 42% had hypercholesterolemia and 15% had diabetes at baseline. In the control group, TC and 10-y cardiovascular disease risk decreased after the intervention by 0.16 mmol/L and 0.91%, respectively, but blood glucose increased by 0.25 mmol/L. Compared with usual diet, the CHH diet lowered TC (-0.14 mmol/L, P = 0.017) and 10-y cardiovascular disease risk (-1.24%, P = 0.001) further. No effect on blood glucose was found. All sensitivity analyses confirmed the results on TC and 10-y cardiovascular disease risk, and analysis with multiple variables adjusted showed a borderline significant effect on blood glucose (-0.17 mmol/L, P = 0.051). The differences in intake of nutrients and food groups between intervention groups explained the results., Conclusions: The CHH diet reduced TC and 10-y cardiovascular disease risk and was likely to reduce blood glucose among Chinese adults with mild hypertension. Further studies with longer terms are warranted. This trial was registered at clinicaltrials.gov as NCT03882645., (Copyright © 2023 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Objective: To determine willingness to pay for a diabetic retinopathy screening, and its determinants, among people with diabetes mellitus in Qujiang District of Shaoguan City, rural Guangdong, southern China., Design: This cross-sectional study was conducted through a large-scale screening programme in 2019. We randomly selected 575 (21.5%) among 2677 people over 18 years old with known diabetes who attended the screening. Participants elected to pay nothing or RMB10-RMB120 (US$1.6-US$18.8), in RMB10 intervals, displayed on printed cards. One trained interviewer collected all the data., Setting: Ten primary health centres in Qujiang District of Shaoguan City, Guangdong., Participants: 545 from the 575 randomly selected people (94.8%) agreed to participate in the study., Outcome Measures: Proportion of participants willing to pay anything for screening, mean amount they were willing to pay and determinants of these figures., Results: Among 545 participants (mean age 64.6 years (SD±10.4), 40.7% men), 327 (60.0%) were willing to pay something for screening, of whom 273 (83.5%) would pay RMB10-RMB30 (US$1.6-US$4.7). People living in rural areas and those from lower-income families were more likely to be willing to pay anything, while men, urban residents and those covered by employer-linked insurance were willing to pay larger sums (p<0.05 for all)., Conclusion: Nearly two-thirds of participants were willing to pay for screening in this screening programme organised at the primary care level in rural China. This finding offers the potential that such activities can be sustained and scaled up through user fees., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The traditional approach to evaluating dietary quality is based on the achievement of the recommended intakes for each food group, which may overlook the achievement of correct relative proportions between food groups. We propose a "Dietary Non-Adherence Score (DNAS)" to assess the degree of similarity between subjects' diets and those recommended in the Chinese Dietary Guidelines (CDG). Furthermore, it is important to incorporate the time-dependent nature of dietary quality into mortality prediction. This study investigated the association between long-term changes in adherence to the CDG and all-cause mortality. This study included 4533 participants aged 30-60 from the China Health and Nutrition Survey study with a median follow-up of 6.9 years. Intakes from 10 food groups were collected in 5 survey rounds from 2004 to 2015. We calculated the Euclidean distance between the intake of each food and the CDG-recommended intake, and then summed all the food groups as DNAS. Mortality was assessed in 2015. Latent class trajectory modeling was used to identify three classes of participants with distinct longitudinal trajectories of DNAS during the follow-up period. The Cox proportional hazard model was used to assess the risk of all-cause mortality in the three classes of people. Risk factors for death and confounders for diets were sequentially adjusted in the models. There were 187 deaths overall. Participants in the first class identified had consistently low and decreasing DNAS levels (coefficient = -0.020) over their lifetime, compared with a hazard ratio (HR) of 4.4 (95% confidence interval [CI]: 1.5, 12.7) for participants with consistently high and increasing DNAS levels (coefficient = 0.008). Those with moderate DNAS had an HR of 3.0 (95% CI: 1.1, 8.4). In summary, we find that people with consistently high adherence to CDG-recommended dietary patterns had a significantly lower mortality risk. DNAS is a promising method to assess diet quality.

Background: Several ECG criteria have been widely used for diagnosis of left ventricular hypertrophy (LVH) in clinical practice. However, their performance in a general Chinese population is limited., Methods and Results: A multi-stage, stratified cluster sampling across China was performed and 7415 representative Chinese adults aged 18-85 years were analyzed. ECG was collected by using GE MAC 5500 machine. The association between five ECG-LVH criteria (i.e., Peguero-Lo Presti, Cornell, Cornell product, Sokolow-Lyon and Sokolow-Lyon product) and echocardiographic LVH (Echo-LVH) was assessed by Pearson's correlation, diagnostic statistics like predictive values, and receiver operating characteristics (ROC) curve. We found that the prevalence of the Echo-LVH was 11% while ECG-LVH ranged from 3% to 27%. All ECG-LVH criteria had high negative predictive value (NPV) (89%) and specificity (73-96%) but low positive predictive value (PPV) (12-24%) and sensitivity (4-29%). The newly Peguero-Lo Presti criteria had higher sensitivity (29%) but lower specificity (73%) and accuracy (68%) compared with other criteria. Cornell product had the best diagnostic performance (AUC: 0.59), as well as the highest specificity (96%) and accuracy (86%) but lowest sensitivity (4%). Among single-lead components of ECG criteria, R aVL voltage and QRS duration performed relatively better than others. Hypertensive and older individuals had higher sensitivity but lower specificity and accuracy than their counterparts., Conclusion: ECG-LVH criteria had high NPV to detect Echo-LVH. Though with higher sensitivity, Peguero-Lo Presti criteria did not have better diagnostic performance to detect Echo-LVH. R aVL and QRS duration had stronger association with Echo-LVH among all single-lead components., (© 2021 The Authors. Annals of Noninvasive Electrocardiology published by Wiley Periodicals LLC.)

The genus Dracaena is the main source of dragon's blood, which is a plant resin and has been used as traditional medicine since ancient times in different civilizations. However, the chromosome numbers and karyotypes present in this genus remain poorly understood. In this study, fluorescence in situ hybridization (FISH) using oligonucleotide probes for ribosomal DNAs (5S and 45S rDNA) and telomeric repeats (TTTAGGG)3 was applied to analyze 4 related species: Dracaena terniflora Roxb., Dracaena cambodiana Pierre ex Gagnep., Aizong (Dracaena sp.), and Dracaena cochinchinensis (Lour.) S.C. Chen. In all 4 species, both 5S and 45S rDNA showed hybridization signals in the paracentromeric region of a pair of chromosomes; the sizes of the 45S rDNA signals were larger than those of the 5S rDNA. Importantly, the telomeric repeat signals were located in the telomeric regions of almost all chromosomes. The results indicated that the chromosome number of all 4 Dracaena species is 2n = 40, and the lengths of the mitotic metaphase chromosomes range from 0.99 to 2.98 μm. Our results provide useful cytogenetic information, which will be beneficial to future studies in genome structure of the genus Dracaena., (© 2021 S. Karger AG, Basel.)

Objectives: To investigate the clinical validity of using a handheld fundus camera to detect diabetic retinopathy (DR) in China., Design and Settings: Prospective comparison study of the handheld fundus camera with a standard validated instrument in detection of DR in hospital and a community screening clinic in Guangdong Province, China., Participants: Participants aged 18 years and over with diabetes who were able to provide informed consent and agreed to attend the dilated eye examination with handheld tests and a standard desktop camera., Primary and Secondary Outcome Measures: Primary outcome was the proportion of those with referable DR (R2 and above) identified by the handheld fundus camera (the index test) compared with the standard camera. Secondary outcome was the comparison of proportion of gradable images obtained from each test., Results: In this study, we examined 304 people (608 eyes) with each of the two cameras under mydriasis. The handheld camera detected 119 eyes (19.5%) with some level of DR, 81 (13.3%) of them were referable, while the standard camera detected 132 eyes (21.7%) with some level of DR and 83 (13.7%) were referable. It seems that the standard camera found more eyes with referable DR, although McNemar's test detected no significant difference between the two cameras.Of the 608 eyes with images obtained by desktop camera, 598 (98.4%) images were of sufficient quality for grading, 12 (1.9%) images were not gradable. By the handheld camera, 590 (97.0%) were gradable and 20 (3.2%) images were not gradable.The two cameras reached high agreement on diagnosis of retinopathy and maculopathy at all the levels of retinopathy., Conclusion: Although it could not take the place of standard desktop camera on clinic fundus examination, the handheld fundus camera showed promising role on preliminary DR screening at primary level in China. To ensure quality images, mydriasis is required., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Unhealthy diet has been identified as the number one attributor of total mortality in China, accounting for more than 20% of total deaths. Although the Dietary Approach to Stop Hypertension (DASH) and Mediterranean diets have been proven beneficial in managing cardiovascular risk factors in Western countries, whether healthy diets with similar cardiovascular benefits can be developed that are consistent with Chinese food culture remains unknown., Methods/design: The Diet, ExerCIse and CarDiovascular hEalth (DECIDE)-Diet trial is a multicentre, single-blind, randomised controlled feeding trial to evaluate the effect of the Chinese Healthy Heart (CHH) diet, in comparison with the Chinese usual diet, in lowering cardiovascular risk factors among community residents with the increased cardiovascular risk. A total of 360 adults aged between 25 and 75 years old and with systolic blood pressure between 130 and 159 mm Hg will be recruited from four centres located in four areas representing four major Chinese cuisines: Beijing, Shanghai, Guangzhou and Chengdu. After 1 week of run-in period with local usual diet, the compliant participants will be randomised to the intervention group with the CHH diet or the control group with the usual local diet, on a 1:1 ratio, for 4 weeks. Body weight of study participants will be maintained during the entire study period. The primary outcome is the change in SBP from the baseline to the end of the study. DECIDE-Diet trial will be the first randomised controlled feeding trial to evaluate the effect of a CHH diet in lowering cardiovascular risk factors. This trial will provide compelling evidence on the CHH diet in effect of improving cardiovascular health among Chinese food consumers all around the world., Ethics and Dissemination: This trial adheres to the Declaration of Helsinki and guidelines of Good Clinical Practice. Signed informed consent will be obtained from all participants. The trial has been approved by the Peking University Institutional Review Board (approval number: IRB00001052-18094). The results will be disseminated through academic conferences and publications in international peer-reviewed journals., Trail Registration Number: ClinicalTrials.gov Registry (NCT03882645); Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Basic helix-loop-helix (bHLH) gene family is a gene family of transcription factors that plays essential roles in plant growth and development, secondary metabolism and response to biotic and abiotic stresses. Therefore, a comprehensive knowledge of the bHLH gene family is paramount to understand the molecular mechanisms underlying these processes and develop advanced technologies to manipulate the processes efficiently. Ginseng, Panax ginseng C.A. Meyer, is a well-known medicinal herb; however, little is known  about the bHLH genes (PgbHLH) in the species. Here, we identified 137 PgbHLH genes from Jilin ginseng cultivar, Damaya, widely cultivated in Jilin, China, of which 50 are newly identified by pan-genome analysis. These 137 PgbHLH genes were phylogenetically classified into 26 subfamilies, suggesting their sequence diversification. They are alternatively spliced into 366 transcripts in a 4-year-old plant and involved in 11 functional subcategories of the gene ontology, indicating their functional differentiation in ginseng. The expressions of the PgbHLH genes dramatically vary spatio-temporally and across 42 genotypes, but they are still somehow functionally correlated. Moreover, the PgbHLH gene family, at least some of its genes, is shown to have roles in plant response to the abiotic stress of saline. These results provide a new insight into the evolution and functional differentiation of the bHLH gene family in plants, new bHLH genes to the PgbHLH gene family, and saline stress-responsive genes for genetic improvement in ginseng and other plant species.

How leaf traits vary with environmental and climatic variables in cold and arid environments is an essential issue in environmental ecology. Here, we analyzed the variations in leaf nitrogen (N) and phosphorus (P) stoichiometry and leaf dry matter content (LDMC) in Qilian juniper (Juniperus przewalskii Kom.) growing in 14 environmentally different plots on the northeastern Tibetan Plateau. The results showed that the N and P concentrations, N:P ratio and LDMC of Qilian juniper were 10.89 mg.g -1 , 1.04 mg.g -1 , 10.80 and 483.06 mg.g -1 , respectively. The spatial coefficients of the variations in leaf N and P stoichiometry were significantly higher than the seasonal ones, and the correlations of leaf N and P concentrations with spatial variables were stronger than their correlations with the season. During the growing season, only the leaf N concentration and N:P ratio significantly increased. Soil nutrients were highly positively significantly correlated with leaf P concentrations but negatively correlated with the N:P ratio and LDMC. However, leaf N concentrations showed no significant correlations with soil nutrients. We suggest that the effects of temperature on the N concentration and LDMC were stronger than the effects of drought, while those on the P concentration and N:P ratio were weaker. Drought reduced leaf N and P concentrations and increased the N:P ratio and LDMC. In the arid region, with an increasing mean annual temperature (MAT), leaf N concentration significantly decreased, and LDMC significantly increased. In the semi-arid region, as MAT increased, leaf N and P concentrations significantly increased and LDMC and the N:P ratio significantly decreased. These opposite results supported the growth rate hypothesis that plant N and P concentrations increase while the N:P ratio and LDMC decrease as the growth rate increases., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objectives: To better understand the strengths and weaknesses, and to propose policy recommendations, regarding conducting high-quality clinical research in Shenzhen, China., Design: A qualitative study conducted from August to November 2016 using a semistructured interview format involving both focus group interviews and individual interviews., Setting: Shenzhen, China., Participants: Stratified purposive and convenience sampling were used. Thirty individuals experienced in conducting and managing clinical research were selected from key stakeholder groups, comprising 11 from local hospitals, 14 from pharmaceutical/medical device companies and 5 from government agencies., Methods: A semistructured interview guide was developed by the study group and used by experienced interviewers in focus group discussions and individual interviews. The interviewees were encouraged to share their opinions freely and discuss their own topics of interest during the interviews. Thematic analysis was used for analysis and all data were coded and extracted using NVivo V.11.0 software., Results: Favourable driving factors for clinical research in Shenzhen identified by all stakeholders included the recent trend of increased governmental funding for clinical research, supportive governmental policies, wide recognition of the value of clinical research and high demands from local industry. The major challenges include a lack of technical infrastructure, weak human research subject protection and a lack of capable research resources., Conclusions: Despite the established strengths, Shenzhen still needs to develop suitable technical platforms, human resources training programmes and strong human research subject protection programmes pertaining to clinical research. This would facilitate the establishment of a functional system that can be expected to lead to increased medical research innovation in Shenzhen., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To examine the total non-accidental mortality burden attributable to ambient temperatures and assess the effect modification of the burden by specific causes of death and individual characteristics in a high plateau area in southwest China., Methods: Using daily mortality and meteorological data from 2009 to 2016, we applied a quasi-Poisson model combined with a distributed lag non-linear model to estimate the temperature-mortality association with the assessment of attributable fraction and number. We calculated attributable fractions and deaths with 95% empirical CIs (eCIs), that were due to cold and heat, defined as temperatures below and above the median temperature, and for mild and extreme temperatures, defined by cut-offs at the 2.5th and 97.5th temperature percentiles., Results: We analysed 89 467 non-accidental deaths; 4131 were attributable to overall temperatures, with an attributable fraction of 4.75% (95% eCI 2.33% to 6.79%). Most of the mortality burden was caused by cold (4.08%; 0.86% to 7.12%), whereas the burden due to heat was low and non-significant (0.67%; -2.44% to 3.64%). Extreme cold (1.17%; 0.58% to 1.69%) was responsible for 24.6% (ie, 1.17% divided by 4.75%) of the total death burden. In the stratification analyses, attributable risk due to cold was higher for cardiovascular than respiratory disease (6.18% vs 3.50%). We found a trend of risk of increased death due to ambient temperatures with increasing age, with attributable fractions of 1.83%, 2.27% and 6.87% for age ≤64, 65-74 and ≥75 years old, respectively. The cold-related burden was slightly greater for females, farmers, ethnic minorities and non-married individuals than their corresponding categories., Conclusions: Most of the burden of death was attributable to cold, and specific causes and individual characteristics might modify the mortality burden attributable to ambient temperatures. The results may help make preventive measures to confront climate change for susceptible population in this region., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

BACKGROUND This study was designed to explore the effect of menopausal hormone therapy (MHT) on bone mineral density (BMD) in Chinese women. MATERIAL AND METHODS This was a prospective, open-label, randomized-controlled clinical trial. We randomly assigned 123 postmenopausal women to 3 groups: group A received 0.625 mg conjugated equine estrogen (CEE) plus 100 mg micronized progesterone (MP), group B received 0.3 mg CEE daily plus 100 mg MP, and group C received 0.625 mg CEE daily plus 10 mg dydrogesterone (DHG). All subjects received a 2-year intervention and drugs were given in a continuous sequential pattern. RESULTS Ninety-six patients were followed up. At 1 year, groups A and B gained 2.31% and 1.95% BMD, respectively (P<0.01); at 2 years, groups B and C gained 2.37% and 4.15% BMD (P<0.01) respectively. At 2 years, group A gained 3.28% BMD in the femoral neck and 3.77% BMD in Ward's triangle (P<0.05). At 1 year, group B lost 2.14% BMD in the trochanter and 1.20% BMD in the total hip (P<0.05); at 2 years, group B lost 1.51% BMD in the total hip (P<0.01). ALP, Ca, P, and Ca/Cr levels were all decreased in the 3 groups (P<0.05). The changes in Cr level at 1 and 2 years were not significant when compared with baseline in all groups (P>0.05). CONCLUSIONS Both lower-dose and standard-dose CEE increased lumbar BMD, sustain femoral neck BMD, and Ward's triangle BMD, while there was a reduced bone turnover rate. Standard-dose CEE combined with MP can increase BMD at these 2 sites. CEE combined with MP is recommended because it has better clinical benefits.

Problem: Clinical and translational research is increasing in China, attracting faculty-to-faculty collaborations between U.S. and Chinese researchers. However, examples of successful institution-to-institution collaborations to facilitate this research are limited. The authors describe a partnership between Peking University Health Science Center (PUHSC) and the University of Michigan Medical School (UMMS) designed to enable faculty-initiated joint translational and clinical research projects., Approach: In 2009, UMMS leadership identified PUHSC as the most appropriate institutional partner, and the Joint Institute for Translational and Clinical Research was established in 2010. Each contributed $7 million for joint research projects in areas of mutual interest. A shared governance structure, four thematic programs (pulmonary, cardiovascular, liver, and renal diseases), three joint research-enabling cores, and processes for awarding funding have been established along with methods for collaborating and mechanisms to share data and biomaterials., Outcomes: As of November 2015, 52 joint faculty proposals have been submitted, and 25 have been funded. These projects have involved more than 100,000 patients in the United States and China and have generated 13 peer-reviewed publications. Pilot data have been leveraged to secure $3.3 million of U.S. extramural funding. Faculty and trainee exchanges take place regularly (including an annual symposium), and mechanisms exist to link faculty seeking collaborations. Critical determinants of success include having co-ownership at all levels with coinvestment of resources., Next Steps: Each institution is committed to continuing its support with a repeat $7 million investment. Next steps include initiating studies in new clinical areas and pursuing large clinical intervention trials.