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

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

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

Deep-buried tunnel at high-ground temperature is prone to the sudden surge of water when crossing the water-rich formation, resulting in casualties and economic losses. Slurry injection is a common and effective method of governance for addressing this issue. However, there has been little research into pulping at high-ground temperature, with most of the existing research focusing on room temperature conditions. We studied two kinds of slurry commonly used in grouting, cement slurry and cement-sodium silicate slurry. Indoor testing was used in this paper to clarify the effect of temperature on slurry viscosity, and numerical simulation was used to study slurry diffusion in flat cracks at different temperatures. The results showed that in a hydrostatic environment, the spread rate of slurry was independent of temperature and type of slurry. For the same kind of slurry, the higher the temperature, the greater the maximum slurry pressure. The higher the temperature in a flow environment, the faster the slurry diffusion. As the temperature rised, the grouting pressure required for crack sealing decreased at first then rises. In a flow environment, the sealing effect of cement-sodium silicate slurry was superior to that of cement slurry.

There is currently no way for subway air-conditioning systems to adjust to changes in passenger capacity in terms of air-supply volume and air-supply temperature. In this paper, a study of the setting of the air-supply volume and controlling the temperature in subway trains was conducted. Based on the fact that the air-supply volume in a subway train needs to meet the requirements of cooling load and humidity load, as well as fresh-air volume, the minimum critical air-supply volume curve was determined on the basis of theoretical calculations under different passenger capacities. Under different passenger capacity and air-supply-volume conditions, the PMV (predicted mean vote) distribution of the subway train was simulated and calculated, and the results indicated that increasing the air-supply volume would not be sufficient to achieve PMV = 0. Therefore, in accordance with the theoretical formulation of the PMV, multiple linear regression was used to fit the temperature-control curve for various passenger capacities. A simulation calculation of the subway train was used to assess the uniformity of the flow field and the temperature field within the subway train in accordance with EN14750. It is evident from the results that under the control curve of the air-supply volume and temperature under different passenger capacities, the uniformity of the flow field and the temperature field can meet the standard requirements. By using the air-supply volume and temperature-control curve proposed in this paper, it is possible to adjust the air-supply volume in real-time, control the temperature of the air-conditioning system of the subway train, improve the passenger comfort of the train, and reduce the energy consumption of the air-conditioning system.

In order to explore the possibility that adding an appropriate amount of alkaline activator into fly ash cement may improve the early activity of fly ash and ensure the strength performance of concrete, this study analyzed the influence of 0–30% fly ash substitute on the early and late (3–28 days) compressive strength of concrete by using three methods, namely, the concrete laboratory test, orthogonal test, and neural network, under the condition of 0.5 water binder. We obtained the following results: (1) The strength of the concrete mixed with fly ash at the same alkali and the same age decreases with the increase of fly ash content and decreases with the decrease of age; the strength is the highest when the alkali content is 6% or 5%. (2) The higher the content of fly ash, the lower the strength of the mixture, and the greater the decrease of the early strength of the mixture, while the optimum dosage of NaOH is the same. (3) Orthogonal experimental design can be effectively used to analyze the primary and secondary degree of each factor and the best combination of them (cement, fly ash, NaOH, standard, water, etc.). (4) High correlations between the compressive strength and the component composition of concrete can be obtained using the prediction abilities of the neural networks. The above test results show that on the basis of the concrete compressive strength test, the comprehensive application of the orthogonal test and the neural network method can be used to analyze the relationship between strength and the variables and to test the influence of the variables and their interaction on concrete strength, and the results are accurate and reliable.

Objective: To explore the relationships among the epithelial to mesenchymal transition (EMT)-related factors (SNAIL, TWIST, and E-Cadherin) and clinicopathological parameters and gastric mesangial tumor deposits (TDs) in advanced gastric cancer (AGC) patients and their value in gastric cancer prognosis judgment. Materials and Methods: The data of 190 patients who underwent radical resection of ACG were analyzed retrospectively, including 75 cases of TDs (+) and 115 cases of TDs (-). The expression of EMT-related transforming factors Snail, Twist, and E-cadherin in the primary tumor, paracancerous normal tissues, and TDs was detected by immunohistochemistry. Results: SNAIL and TWIST were overexpressed in primary tumors and TDs, whereas E-Cadherin was down-expressed in primary tumors. SNAIL was correlated significantly with tumor differentiation, lymph node metastases, and TDs (P < 0.05); TWIST was correlated strongly with tumor location, lymph node metastases, and TDs (P < 0.05); E-Cadherin was correlated closely with tumor differentiation and lymph node metastases (P < 0.05). Kaplan-Meier curves showed that SNAIL expression was correlated with DFS (P < 0.05), and TWIST expression was correlated with OS (P < 0.05). Tumor differentiation, lymph node metastasis, and TWIST expression were prognostic-independent risk factors of AGC patients (P < 0.05). Conclusion: The occurrence and development of gastric cancer and the formation of TDs may be related to EMT, analyzing the expression of EMT-related transforming proteins may be helpful to judge the prognosis of gastric cancer.

Abstract Background Global warming leading to heat stress (HS) is becoming a major challenge for broiler production. This study aimed to explore the protective effects of seaweed (Enteromorpha prolifera) polysaccharides (EPS) on the intestinal barrier function, microbial ecology, and performance of broilers under HS. A total of 144 yellow-feathered broilers (male, 56 days old) with 682.59 ± 7.38 g were randomly assigned to 3 groups: 1) TN (thermal neutral zone, 23.6 ± 1.8 °C), 2) HS (heat stress, 33.2 ± 1.5 °C for 10 h/d), and 3) HSE (HS + 0.1% EPS). Each group contained 6 replicates with 8 broilers per replicate. The study was conducted for 4 weeks; feed intake and body weights were measured at the end of weeks 2 and 4. At the end of the feeding trial, small intestine samples were collected for histomorphology, antioxidant, secretory immunoglobulin A (sIgA) content, apoptosis, gene and protein expression analysis; cecal contents were also collected for microbiota analysis based on 16S rDNA sequencing. Results Dietary EPS promoted the average daily gain (ADG) of broilers during 3–4 weeks of HS (P

In this paper, two classes of near-Hamiltonian systems with a nilpotent center are considered: the coexistence of algebraic limit cycles and small limit cycles. For the first class of systems, there exist 2n+1 limit cycles, which include an algebraic limit cycle and 2n small limit cycles. For the second class of systems, there exist n2+3n+22 limit cycles, including an algebraic limit cycle and n2+3n2 small limit cycles.

The evolution of the population ecosystem is closely related to resources and the environment. Assuming that the environmental capacity of a predator population is positively correlated with the number of prey, and that the prey population has a sheltered effect, we investigated a predator–prey model with a juvenile–adult two-stage structure. The dynamical behaviour of the model was examined from two distinct environmental perspectives, deterministic and stochastic, respectively. For the deterministic model, the conditions for the existence of equilibrium points were obtained by comprehensive use of analytical and geometric methods, and the local and global asymptotic stability of each equilibrium point was discussed. For the stochastic system, the effect of noise intensity on the long-term dynamic behavior of the population was investigated. By constructing appropriate Lyapunov functions, the criteria that determined the extinction of the system and the ergodic stationary distribution were given. Finally, through concrete examples and numerical simulations, the understanding of the dynamic properties of the model was deepened. The results show that an improvement in the predator living environment would lead to the decrease in the prey population, while more prey shelters could lead to the decline or even extinction of predator populations.

SmB_{6} is a mixed-valence compound with flat f-electron bands that have a propensity to magnetism. Here, using a realistic Γ_{8} quartet model, we investigate the dynamical spin susceptibility and describe the in-gap collective mode observed in neutron scattering experiments. We show that as the Sm valence increases with pressure, the magnetic correlations enhance and SmB_{6} undergoes a first-order phase transition into a metallic antiferromagnetic state, whose symmetry depends on the model parameters. The magnetic orderings give rise to distinct band topologies: while the A-type order leads to an overlap between valence and conduction bands in the form of Dirac nodal lines, the G-type order has a negative indirect gap with weak Z_{2} indices. We also consider the spin polarized phase under a strong magnetic field, and find that it exhibits Weyl points as well as nodal lines close to the Fermi level. The magnetic phases show markedly different surface states and tunable bulk transport properties, with important implications for experiments. Our theory predicts that a magnetic order can be stabilized also by lifting the Γ_{8} cubic symmetry, thus explaining the surface magnetism reported in SmB_{6}.

AbstractIntroduction Coronavirus disease 2019 (COVID-19), originated in late December 2019, in Wuhan, China. The World Health Organization declared a pandemic on 11 March 2020, with the rapidly rising number of cases and fatalities over hours and days all around the world.Aim To assess the number and the trend of the poisoning consultations to the Poison Unit in the Mansoura Emergency Hospital during the era of the COVID-19 pandemic in 2020.Methods We collected data from the database of the Poison Unit and the Statistics Department of the Mansoura Emergency Hospital of the cases and the calls coming to the Poison Unit in the period from January 2018 through December 2020. We compared 2020 exposures to 2018–2019 exposures by using simple logistic models to provide effect size with odds ratios.Results The Mansoura Emergency Hospital Poison Unit treated 1752 cases in 2020, compared to 2210 cases in 2018 and 2539 cases in 2019. The Poison Unit treated 26% fewer patients in 2020 than either 2018 or 2019), while calls increased nearly 50% in 2020 than in 2018 and 2019. Calls came more frequently from the general public than health professionals and more frequently in afternoon and evening than in the morning. There was a significant increase in the cases of pharmaceuticals ingestion, food poisoning, corrosives and households exposures in 2020 compared to 2018 and 2019 (p-value 0.004, 0.024, and 0.0002, respectively; odds ratio 1.224, 1.691, and 1.692, respectively).Conclusion The COVID-19 pandemic changed the pattern of poisoning exposure and use of the Poison Control Center services.

There has been significant interest in using spin-waves or magnons for information processing, due to their low energy dissipation and short wavelength at terahertz frequencies, however, manipulating magnons can be challenging. Here, Kim et al show that magnons in Sr2IrO4 are extremely strain sensitive, with small applied strains leading to large variation in the magnon energy.

Despite ongoing control efforts, the mosquito population and diseases vectored by them continue to thrive worldwide, causing major health concerns. There has been growing interest in the use of botanicals as alternatives to insecticides due to their widespread insecticidal properties, biodegradability, and adaptability to ecological conditions. In this study, we investigated the larvicidal activity and cytotoxicity effects of solvent extracts from three aromatic plants—Curcuma longa (turmeric), Ocimum americanum (hoary basil), and Petroselinum crispum (parsley)—against Aedes albopictus. Subsequently, we examined the phytochemical composition of the extracts through gas chromatography–mass spectrometry (GC–MS) analysis. Results revealed that the hexane extracts of O. americanum and P. crispum exhibited the greatest larvicidal activity with the lowest median lethal concentration (LC50) values (O. americanum.