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The continuous development of Educational Data Mining (EDM) and Learning Analytics (LA) technologies has provided more effective technical support for accurate early warning and interventions for student academic performance. However, the existing body of research on EDM and LA needs more empirical studies that provide feedback interventions, and more attention should be paid to primary and secondary school students. This study proposed a data-driven precision teaching intervention mechanism combining EDM and LA technologies. The proposed mechanism aims to assist teachers in predicting students' academic performance and implementing corresponding interventions. This approach enables early warnings and reminders for students in crisis, and offers teaching assistance and support tailored to students at different levels. A quasi-experimental design was employed to examine the impact of the data-driven precision teaching intervention mechanism on secondary school students' learning outcomes. A total of 142 seventh-grade students participated in the intervention experiment, with an experimental group (50) receiving the data-driven precision teaching intervention, control group2 (48) receiving a group intervention stratified by teacher experience, and control group1 (44) receiving a traditional group intervention. Posttest data were collected after three rounds of intervention. Compared to the two control groups, students in the experimental group demonstrated superior academic achievement, intrinsic motivation, self-efficacy, and meta-cognitive awareness. These findings indicate that the data-driven precision teaching intervention approach positively impacted students' academic development, and effectively promoted their personalized learning. The findings provide pedagogical insights into the application of EDM in conjunction with LA prediction and actionable interventions. [ABSTRACT FROM AUTHOR]

Background: As global aging intensifies, the prevalence of ocular fundus diseases continues to rise. In China, the tense doctor-patient ratio poses numerous challenges for the early diagnosis and treatment of ocular fundus diseases. To reduce the high risk of missed or misdiagnosed cases, avoid irreversible visual impairment for patients, and ensure good visual prognosis for patients with ocular fundus diseases, it is particularly important to enhance the growth and diagnostic capabilities of junior doctors. This study aims to leverage the value of electronic medical record data to developing a diagnostic intelligent decision support platform. This platform aims to assist junior doctors in diagnosing ocular fundus diseases quickly and accurately, expedite their professional growth, and prevent delays in patient treatment. An empirical evaluation will assess the platform's effectiveness in enhancing doctors' diagnostic efficiency and accuracy. Methods: In this study, eight Chinese Named Entity Recognition (NER) models were compared, and the SoftLexicon-Glove-Word2vec model, achieving a high F1 score of 93.02%, was selected as the optimal recognition tool. This model was then used to extract key information from electronic medical records (EMRs) and generate feature variables based on diagnostic rule templates. Subsequently, an XGBoost algorithm was employed to construct an intelligent decision support platform for diagnosing ocular fundus diseases. The effectiveness of the platform in improving diagnostic efficiency and accuracy was evaluated through a controlled experiment comparing experienced and junior doctors. Results: The use of the diagnostic intelligent decision support platform resulted in significant improvements in both diagnostic efficiency and accuracy for both experienced and junior doctors (P < 0.05). Notably, the gap in diagnostic speed and precision between junior doctors and experienced doctors narrowed considerably when the platform was used. Although the platform also provided some benefits to experienced doctors, the improvement was less pronounced compared to junior doctors. Conclusion: The diagnostic intelligent decision support platform established in this study, based on the XGBoost algorithm and NER, effectively enhances the diagnostic efficiency and accuracy of junior doctors in ocular fundus diseases. This has significant implications for optimizing clinical diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the infection status of Omicron in the population and the association between COVID-19 vaccination and infection with Omicron. Methods: We conducted a cross-sectional study to openly recruit participants for a survey of SARS-CoV-2 infection by convenience sampling from 1 January to 15 January 2023 after a COVID-19 pandemic swept across China. Additionally, the binary logistic regression model was adopted to evaluate the association between COVID-19 vaccination and the infection outcomes or symptom severity, respectively. Meanwhile, the relations between the vaccination and duration of the symptoms were estimated via ordinal logistic analysis. Results: Of the 2007 participants, the prevalence of infection with Omicron was 82.9%. Compared with unvaccinated individuals, inactivated COVID-19 vaccination could increase the risk of Omicron infection (OR = 1.942, 95% CI: 1.093–3.448), and the receipt of at least one dose of non-inactivated COVID-19 vaccines was a protective factor against infection (OR = 0.428, 95% CI: 0.226–0.812). By contrast, no relations were observed in COVID-19 vaccination with the symptoms of infection and duration of symptoms (p > 0.05). Conclusions: This cross-sectional study concluded that inactivated COVID-19 vaccination might increase the risk of Omicron infection, which should be a concern during COVID-19 vaccination and the treatment of variant infections in the future, and the receipt of at least one dose of non-inactivated COVID-19 vaccine was a protective factor against infection. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity, body pain, sleep disturbance, and depression are major clinical and public health challenges. This paper aimed to examine the associations of multimorbidity with body pain, sleep duration, and depression; and whether the associations varied by socioeconomic status. Methods: Data was derived from four waves of the nationally representative China Health and Retirement Longitudinal Study (CHARLS), including participants aged 45 years and older in 2011. 12 physical non-communicable diseases and 1 mental chronic disease were used to measure multimorbidity. Educational attainment and annual per-capita household consumption expenditure were employed as proxies for socioeconomic status. Results: Of the 16,931 participants aged 45 + years old, the proportion of people with multimorbidity was 37.87% at baseline. The number of multimorbidity increased with older age and higher socioeconomic status. Multimorbidity was associated with more body pain (incidence rate ratio (IRR) = 1.53, 95% CI = 1.45–1.61), and decreased sleep duration (β = -0.26, 95% CI = -0.36–-0.15). Furthermore, multimorbidity was associated with increased depression risks (odds ratio (OR) = 1.54, 95% CI = 1.44–1.64, adjusted for sociodemographic variables), with the mediating effects of the number of body pain and sleep duration. The associations between multimorbidity and depression persisted among different socioeconomic groups. Conclusions: Multimorbidity was associated with increased body pain, decreased sleep duration, and further led to increased depression risks. It is necessary to pay attention to the multimorbidity of middle-aged and older adults, relieve their body pain, guarantee sufficient sleep, so as to reduce depression risks. [ABSTRACT FROM AUTHOR]

Background: Oral health is a major global public health problem, but its risk factors have not been fully identified. The limited evidence suggests that AL may affect oral health conditions, but most of these studies focus only on middle‐aged western populations. Objectives: To examine whether allostatic load is associated with oral health conditions later in life among middle‐aged and older adults in China and there there is a correlation in both middle‐aged and older people. Materials and methods: Data were collected from the China Health and Retirement Longitudinal Study 2011–2018 (N = 10 890) and were analysed using logistic regressions for the overall sample and subsamples by age. Results: Results showed that higher inflammation load significantly increased the odds of edentulism (OR = 1.358, 95% CI = 1.020–1.809, p <.05). Higher metabolic load significantly increased the odds of denture use (OR = 1.375, 95% CI = 1.154–1.640, p < 0.001) and difficulty in chewing solid foods (OR = 1.100, 95% CI = 1.035–1.169, p <.01). These associations were manifested in older adults over 60 years of age, while in the middle‐aged subsample, the associations were not significant. Conclusion: The findings suggested that higher allostatic load was associated with poorer oral health conditions later in life. It is critical to lower allostatic load and improve oral health conditions, especially for older adults over 60 years of age. Prospective studies and intervention trials help to better understand whether allostatic load is causally linked to oral health. [ABSTRACT FROM AUTHOR]

Background: Cholesterol gallstone (CG) disease is a worldwide common disease characterized by cholesterol supersaturation in gallbladder bile. Ganoderma lucidum polysaccharide (GLP) has been shown to possess various beneficial effects against metabolic disorders. However, the role and underlying mechanism of GLP in CG formation are still unknown. This study aimed to determine the role of GLP in ameliorating lithogenic diet (LD)-induced CG formation. Methods: Mice were fed either a normal chow diet, a LD, or LD supplemented with GLP. Real-time quantitative polymerase chain reaction (RT-qPCR) and western blotting were used to detect the expression of genes involved in cholesterol and bile acid (BA) metabolism. The BA concentrations in the ileum were quantified by liquid chromatography-tandem mass spectrometry (LC–MS/MS). The microbiota in cecal contents were characterized using 16S ribosomal RNA (16S rRNA) gene sequencing. Results: GLP effectively alleviated CG formation induced by LD. Specifically, GLP reduced the total cholesterol (TC) levels, increased the total BA levels, and decreased the cholesterol saturation index (CSI) in gallbladder bile. The protective effect of GLP was attributed to the inhibition of farnesoid X receptor (FXR) signaling, increased hepatic BA synthesis and decreased hepatic cholesterol synthesis and secretion. GLP also altered the BA composition in the ileum, reducing FXR-agonistic BAs and increasing FXR-antagonistic BAs, which may contribute to the inhibition of intestinal FXR signaling. Additionally, GLP improved dysbiosis of the intestinal flora and reduced the serum levels of hydrogen sulfide (H2S), a bacterial metabolite that can induce hepatic FXR, thereby inhibiting hepatic FXR signaling. Moreover, the protective effect of GLP against CG formation could be reversed by both the global and gut-restricted FXR agonists. Conclusions: Taken together, GLP ameliorates CG formation by regulating cholesterol and BA metabolism in an FXR-dependent manner. Our study demonstrates that GLP may be a potential strategy for the prevention against CG disease. [ABSTRACT FROM AUTHOR]

Taking care of people with dementia is stressful for informal caregivers. Respite care can provide a break for them. But it is often underused, and its acceptability can be low in China. One reason is that it fails to meet their needs. This study aimed to explore the preference of caregivers of people with dementia for respite care services. A discrete choice experiment was used. Attributes and levels of respite care were informed by a literature review and expert consultations. A fractional factorial design was used to reduce the number of choice sets. A questionnaire survey was conducted in Tianjin, China. A mixed logit model was used to compute coefficients for attributes and levels. Respite care packages differed in five attributes, which were content, provider, duration, frequency, and cost. 322 caregivers completed valid discrete choice experiment questionnaires. All five attributes were statistically significant. Two most preferred attributes were "providers" (coefficient 1.297, p < 0.001) and "frequency" (coefficient 1.169, p < 0.001). Caregivers prefer highly qualified service providers and frequent respite care. The desirable respite care for caregivers would be assistance with personal care for people with dementia which was provided by an experienced worker with attitudes of understanding and respect towards people with dementia more than 3 times per week regularly and more than 4 h every time with a lower cost. This study offered new information on Chinese dementia caregivers' preferences for respite care. Policymakers should pay attention to the frequency and quality of providers when designing respite care to improve service uptake and ultimately lighten the burden on caregivers of people with dementia. [ABSTRACT FROM AUTHOR]

The continuation of the COVID-19 pandemic has caused a decline in people's subjective well-being and emotional states. Digital travel based on 360° videos provides an alternate way for people to improve their mental health at home during this specific period. Yet, how to construct effective digital travel content that improves emotions remains an issue. This investigation assessed the impact of people's perceived presence and sense of place (SOP) on emotional improvement during a 360° digital travel experience. A total of 156 undergraduate students volunteered to participate, and anxiety, emotion levels, and life satisfaction were measured before and after the digital travel experience; presence and SOP ratings were also collected after the experience. A Latent Change Score model was then developed, and the results indicated that the greater presence and SOP individuals experienced during their digital travel, the better their digital travel experience and emotional improvement. Furthermore, the current data highlight that SOP has a greater impact on emotional improvement than presence. This result provides a novel understanding that how SOP is generated may be more critical to digital travel than presence. This new understanding should help improve relevant applications in the field of digital travel, such as the possibility of providing meaningful narrative context in a virtual environment to induce SOP more effectively, and improve the digital travel experience. Overall, the findings of this study expand our understanding of the digital travel experience and lay the groundwork for future research on SOP and digital travel. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare the prevalence of sarcopenia according to the old and new Asian Working Group on Sarcopenia (AWGS) operational criteria and explore the effects of sarcopenia on adverse outcomes in older adults with type 2 diabetes (T2D). Methods: A total of 386 patients with T2D aged ≥ 60 years were recruited in retrospective cohort study. Sarcopenia was assessed with different versions of the AWGS consensus, including the AWGS2014, AWGS2019H (muscle mass adjusted for height), and AWGS2019B (muscle mass adjusted for body mass index). The median follow-up period was 47 months. The composite primary endpoint was the first occurrence of cardiovascular disease (CVD), fragility fracture, and all-cause mortality and the secondary outcomes included the three separate components of the primary outcome. Results: In this study, the prevalence of sarcopenia under different criteria was significantly different, with AWGS2019H having the highest prevalence of 31.3%. The agreement among sarcopenia criteria was unsatisfactory. By Cox regression analysis, all three AWGS definitions of sarcopenia were associated with the composite outcome of all-cause mortality, fracture and CVD (hazard ratio [HR], 2.69 vs. HR, 2.63; vs. HR, 2.23; model 3). Further exploratory analysis, sarcopenia defined by the AWGS2019H criteria was an independent risk factor for death, incident CVD, and fractures. While AWGS2014 criteria was an increased risk factor of death and CVD. The AWGS2019B criteria were only associated with incident fractures. Conclusion: All three AWGS definitions of sarcopenia were associated the composite primary endpoint. Additionally, the AWGS2019H criteria may be a better independent risk factor for negative health outcomes. [ABSTRACT FROM AUTHOR]

Research on government service quality can help ensure the success of digital government services and has been the focus of numerous studies that proposed different frameworks and approaches. Most of the existing studies are based on traditional researcher-led methods, which struggle to capture the needs of citizens. In this paper, a citizen-feedback-based analysis framework was proposed to explore citizen demands and analyze the service quality of digital government. Citizen feedback data are a direct expression of citizens' demands, so the citizen-feedback-based framework can help to obtain more targeted management insights and improve citizen satisfaction. Efficient machine learning methods used in the framework make data collection and processing more efficient, especially for large-scale internet data. With the crawled user feedback data from the Q&A e-government portal of Luzhou, Sichuan Province, China, we conducted experiments on the proposed framework to verify its feasibility. From citizens' online feedback on Q&A services, we extracted five service quality factors: efficiency, quality, attitude, compliance, and execution of response. The analysis of five service quality factors provides some management insights, which can provide a guide for improvements in Q&A services. [ABSTRACT FROM AUTHOR]

Cropland elevation uplift (CLEU) has recently become a new challenge for agricultural modernization, food security, and sustainable cropland use in China. Uncovering the rules of CLEU is of great theoretical and practical significance for China's sustainable agricultural development and rural revitalization strategy. However, existing studies lack in-depth disclosure of multi-scale CLEU evolution rules, making it difficult to support the formulation of specific cropland protection policies. We analyzed the spatio-temporal evolution and multi-scale CLEU in China from 1980 to 2020 using the Lorenz curve, gravity center model, hotspot analysis, and cropland elevation spectrum. The results indicated that the center of gravity of cropland moved to the northeast from 1980 to 2000 and then shifted to the northwest. The spatial distribution of cropland became increasingly imbalanced from 1980 to 2000. The change hotspots clustered in the northwest and the northeast, whereas cold-spots were mainly in southeastern China. The average elevation of cropland increased by 17.38 m, and the elevation uplift rule in different regions differed evidently across scales. From 1980 to 2000, all provinces except Xinjiang, Inner Mongolia, Gansu, and Yunnan exhibited CLEU, with Qinghai, Tibet, Beijing, and Guangdong showing the most noticeable uplifting. The CLEU can alleviate the shortage of cropland to some extent. However, without a planning constraint, the CLEU will lead to the increase of ecological risk and food security risk. [ABSTRACT FROM AUTHOR]

Predation is one of the most important extrinsic factors acting upon animal populations and is a strong selective force in the evolution of form and function. Understanding the impact of predation on bird population dynamics is crucial for understanding the predation pressure of bird populations and implementing conservation strategies, especially for threatened or endemic bird species. In this paper, we sorted the predation events in the wild Crested Ibis population in Yangxian County, Shaanxi Province, from 1981 to 2021 and in the reintroduced Crested Ibis population in Ningshan from 2008 to 2021. With the use of age‐classified Leslie matrix models to simulate Crested Ibis populations under different predation pressures, the random population growth rate was estimated, and the impact of predation on population dynamics was evaluated. The results showed that snakes and raptors were the main predators of Crested Ibis in the wild and reintroduced populations, and the number of dead individuals was unevenly distributed within the three age classes in both the wild population (df = 2, χ2 = 13.236, p < 0.05) and reintroduced population (df = 2, χ2 = 49.273, p < 0.01). Predation caused a reduction in the potential annual population growth rate of 2.37% (confidence interval [CI]: 2.29–2.45) in the wild population and 2.88% (CI: 2.82–2.94) in the reintroduced population. The overall average growth rates of the wild and reintroduced populations derived from population model simulations were 12.84 and 18.13%, respectively, which suggested that the wild and reintroduced populations was increasing under the current predation pressure and that the impact of predation on the population was acceptable and sustainable. [ABSTRACT FROM AUTHOR]

China's public hospital price change reform was progressively piloted at urban-level tertiary hospitals in 2015, aiming to adjust the healthcare expenditure structure, reorient public hospitals towards social objectives and control inflated healthcare expenditure. This study investigates the impacts of price changes on inpatient expenditure, service quantity, quality and efficiency and whether the impacts varied in different specialities, treatments and hospitals. A difference-in-differences analysis was conducted using data from 25 million patients from 124 nationally representative tertiary hospitals between 2013 and 2018. The study analyses changes in total expenditure, drug, medical services and diagnostic test/medical consumables expenditure per admission, the use of antibiotics, performed surgery, readmission within 30 days and length of stay (LOS). These factors are examined before and after adjusting the price changes for demographic, socioeconomic and clinical covariates. The price changes decreased drug expenditure per admission (-13.5%, P < 0.001, USD 96.6) and increased medical services expenditure per admission (30.9%, P < 0.001, USD 153.3). They also reduced the LOS (-1.2%, P = 0.019, 0.1 days) while not significantly affecting total expenditure per admission, diagnostic test/medical consumables per admission and the use of antibiotics, surgery performed and readmission rates. In heterogeneity analysis, price changes reform increased efficiency in major diagnostic categories (MDCs) with high drug share and improved quality in nonoperating room surgical groups and hospitals with high drug share; however, it increased total expenditure in MDCs with low drug share or surgical groups. China's public hospital price change reform generally adjusted the inpatient expenditure structure and reduced the LOS in tertiary public hospitals. Sufficient compensation from medical services and government subsidies that minimize the income effects may be the key to the success of price change reform. [ABSTRACT FROM AUTHOR]

Children's unexpected cardiac arrest warrants cardiopulmonary resuscitation (CPR) by kindergarten teachers. Yet, recent research revealed trained personnel reporting poor transfer of acquired skills during real‐world emergencies with conventional CPR training. Immersive virtual reality (IVR) training induces a greater sense of presence and agency than conventional CPR training and may be more effective in terms of increasing trainees' intention and initiative to perform CPR in real‐world emergencies. A quasi‐experiment was conducted to assess the effectiveness of the IVR‐based CPR training method in terms of enhancing the intention to perform CPR. The trial enrolled 50 participants, 25 of whom examined a child patient in an IVR virtual scenario, using an AED, and performed two rounds of two‐minute chest compressions. The remaining 25 participants were trained using a video with consistent content on a monitor. A generalised estimating equation analysis demonstrated that the IVR training method significantly increased prospective kindergarten teachers' self‐efficacy for performing CPR, positive attitudes towards CPR, and CPR knowledge. This advantage was also maintained after the five‐week follow‐up. Thus, CPR teaching via IVR looks to be an excellent way to enhance the intention to perform CPR and may be of great value in improving existing CPR training systems. Practitioner notesWhat is already known about this topic Many trainees who have received traditional cardiopulmonary resuscitation (CPR) training hesitate to perform the skills learned in a real‐world emergency.The critical determinant of whether an individual performs a behaviour is the individual's 'intention' to perform that behaviour.Individual's self‐efficacy to perform CPR, attitudes towards CPR, and perceived social norms are three determinants that influence intention to perform CPR.Immersive media such as virtual reality may elicit more attitudinal changes and a greater sense of learner self‐efficacy than current mainstream media.What this paper adds The study's results indicated that compared to conventional technology‐supported video training, immersive virtual reality (IVR) training significantly increased participants' self‐efficacy about performing CPR, positive attitudes towards CPR and CPR knowledge.CPR training through IVR may enhance trainees' intention to perform CPR in real‐world emergencies.Implications for practice and/or policy The effectiveness of combining IVR technology into existing CPR training methods such as mixed reality training, which blends virtual environments with realistic mannequins, should be further examined in the future.IVR may be a more effective medium for enhancing the intention to perform behaviour than conventional technology. Future research could further experiment with the use of IVR as a behavioural intervention technique in education [ABSTRACT FROM AUTHOR]

China's diets are undergoing a profound transformation, and carbon storage loss generated by dietary structure change is increasingly serious, accompanied by concerns about sustainable diets and food supply–demand conflicts. This paper designed a dual 'material–environmental' framework based on the dietary structure classification, around which we conducted the heterogeneity analysis of food supply–demand patterns and land carbon loss, and then tracked hotspot diets of trade-generated carbon loss through the multi-regional input–output (MRIO) model. The research found that 31 provinces could be classified into five clusters with obvious spatial agglomeration patterns, most of which still had a high proportion of staches, but also showed an evolutionary trend towards diversified compositions. Driven by dietary structure, the national food supply–demand match under the material accessibility dimension showed barely balanced overall, while in terms of environmental effects, ecosystems lost significant amounts of carbon stocks, with losses of 331 and 950 Tg 1 1 Tg refers to teragram, a weight unit, 1 Tg = 106 t = 1012 g of vegetation carbon and soil organic carbon, respectively, which together accounted for 14 percent of the total carbon stocks in the vegetation and topsoil carbon pools. The clusters to which Henan, Jiangsu, Zhejiang and Guangdong belong were tracked as hot dietary clusters exhibiting hotspots in inter-regional trade, contributing to carbon loss in external provinces through trade linkages. Heilongjiang and Inner Mongolia were at a low level of supply–demand balance but played the role of a carbon storage loser, while Guangdong, Zhejiang, and Jiangsu not only possessed higher balance levels but also pulled more external carbon loss. China's food system should optimise internal cropping structures and monitor external land use conversion. It is equally important to track food consumption side rights and responsibilities. • The "Material-Environmental" framework to diagnose dietary sustainability was designed. • Provinces could be classified into five clusters with obvious spatial agglomeration patterns. • Land use changes driven by dietary transition have resulted in significant carbon losses of 1281 Tg. • Specific clusters were hotspot clusters that pulled carbon loss from external regions during inter-regional trade. • Diet sustainability enhancement based on land use environmental effects deserves attention. [ABSTRACT FROM AUTHOR]

China implemented the Targeted Poverty Alleviation (TPA) policy in 2015 to fight against poverty. In order to assess the health performance of the TPA policy, this study aims to evaluate the impact of the TPA policy on healthcare utilization among older adults who normally have higher vulnerability to poverty and diseases. Drawing on data from four waves of the China Health and Retirement Longitudinal Study (CHARLS), we investigated the impact of the TPA policy on older individuals' outpatient and inpatient utilization using the difference-in-differences (DID) approach. In total, 5285 older respondents were incorporated into a final sample. The results indicated that the implementation of the TPA policy had a significantly positive impact on increasing inpatient care utilization for poor older adults. However, its impact on outpatient service utilization was not significant. To ensure that the increased level of inpatient care utilization was not caused by deteriorating health status, we further analyzed the impact of the TPA policy on poor older adults' health outcomes. Results indicated that the TPA policy improved self-rated health and reduced the number of ADL limitations among older adults in registered poor households. The positive impact of the TPA policy on inpatient care utilization was found to be most beneficial for older adults in poor households who were female, coupled, and aged 70 years and above. The TPA policy in China improved healthcare access for economically disadvantaged older adults and contributed to the enhancement of their health outcomes. This evidence may have broad implications for other low- and middle-income countries aiming to reduce poverty and achieve health equity. • This study assessed the TPA policy's impact on healthcare utilization, focusing on older adults for the first time. • The TPA policy increased inpatient care utilization for older adults in poor households. • The TPA policy improved health outcomes for poor older adults. • Policy effect on inpatient care utilization is stronger for femle, coupled, or senior older adults. [ABSTRACT FROM AUTHOR]

Background: In China, nitrogen (N)-deficiency often occurs in Citrus orchards, which is one of the main causes of yield loss and fruit quality decline. Little information is known about the adaptive responses of Citrus carbon (C) and N metabolisms to N-deficiency. Seedlings of 'Xuegan' (Citrus sinensis (L.) Osbeck) were supplied with nutrient solution at an N concentration of 0 (N-deficiency), 5, 10, 15 or 20 mM for 10 weeks. Thereafter, we examined the effects of N supply on the levels of C and N in roots, stems and leaves, and the levels of organic acids, nonstructural carbohydrates, NH4+-N, NO3−-N, total soluble proteins, free amino acids (FAAs) and derivatives (FAADs), and the activities of key enzymes related to N assimilation and organic acid metabolism in roots and leaves. Results: N-deficiency elevated sucrose export from leaves to roots, C and N distributions in roots and C/N ratio in roots, stems and leaves, thus enhancing root dry weight/shoot dry weight ratio and N use efficiency. N-deficient leaves displayed decreased accumulation of starch and total nonstructural carbohydrates (TNC) and increased sucrose/starch ratio as well as a partitioning trend of assimilated C toward to sucrose, but N-deficient roots displayed elevated accumulation of starch and TNC and reduced sucrose/starch ratio as well as a partitioning trend of assimilated C toward to starch. N-deficiency reduced the concentrations of most FAADs and the ratios of total FAADs (TFAADs)/N in leaves and roots. N-deficiency reduced the demand for C skeleton precursors for amino acid biosynthesis, thus lowering TFAADs/C ratio in leaves and roots. N-deficiency increased (decreased) the relative amounts of C-rich (N-rich) FAADs, thus increasing the molar ratio of C/N in TFAADs in leaves and roots. Conclusions: Our findings corroborated our hypothesis that C and N metabolisms displayed adaptive responses to N-deficiency in C. sinensis seedlings, and that some differences existed between roots and leaves in N-deficiency-induced alterations of and C and N metabolisms. [ABSTRACT FROM AUTHOR]

Aim: To examine the association of life‐course socioeconomic status (SES) and mobility with allostatic load (AL) in a large cohort of Chinese middle‐aged and older adults. Methods: Drawing on data from 17 552 middle‐aged and older adults from three waves of a longitudinal study conducted in China in 2011–2015, generalized estimating equation (GEE) models were used for the overall sample and subsample to examine the association between life‐course SES and AL. Results: On the whole, those who were literate had lower AL (β = −0.034, 95% CI = −0.065, −0.004), while those with a non‐agricultural occupation (β = 0.093, 95% CI = 0.065, 0.120) and better financial status in childhood (β = 0.037, 95% CI = 0.012, 0.063) or adulthood (β = 0.033, 95% CI = 0.009, 0.058) had higher AL. In terms of SES mobility, a stable high education was associated with lower AL (β = −0.041, 95% CI = −0.078, −0.004). Upward (β = 0.090, 95% CI = 0.061, 0.120) or stable high (β = 0.075, 95% CI = 0.025, 0.125) occupation was related to higher AL. Downward (β = 0.034, 95% CI = 0.003, 0.064) or stable high (β = 0.072, 95% CI = 0.037, 0.107) financial status was associated with higher AL. Education manifested no associations with AL for the rural and men samples. Financial status showed no relationship with AL for the urban sample. Conclusions: Our findings demonstrate the importance of applying life‐course models for gaining an understanding of SES and AL. Efforts to lower AL among Chinese middle‐aged and older adults should consider childhood and current SES status, as well as different subgroups. Geriatr Gerontol Int 2022; 22: 425–432. [ABSTRACT FROM AUTHOR]

The Landsat time-series dataset is one of the most widely used datasets for land surface research due to its long time-series and Land Surface Reflectance (LSR) product. Though the United States Geological Survey (USGS) provides Landsat LSR products for later Landsat 4–5 Thematic Mapper (TM), Landsat 7 Enhanced Thematic Mapper Plus (ETM+), and Landsat 8 Operational Land Imager (OLI), no early Landsat 1–5 Multispectral Scanner System (MSS) LSR product is generated currently, limiting the research traced back to the 1970s. Atmospheric correction is one of the necessary preprocesses for generating LSR products. However, it is challenging for MSS images, not only because the image quality is lower and bands are different compared with the current sensors, but also because of the multiple effects of other preprocesses, such as radiometric calibration. Based on the Second Simulation of a Satellite Signal in the Solar Spectrum Vector (6SV) model, we propose a novel framework for generating Landsat 1–5 MSS LSR data of China. Ground-based visibility records are introduced to replace the images-based aerosol optical depth (AOD) to effectively generate MSS LSR data of the 1970s. We evaluate the generated MSS LSR data by the cross-validation of the simultaneous observation of MSS and TM sensors in Landsat 4 and Landsat 5 using Landsat Ecosystem Disturbance Adaptive Processing System (LEDAPS) surface reflectance product as the truth value. The evaluation result shows that the generated MSS LSR data is comparable with the later Landsat TM LSR product, with slightly larger uncertainties. In addition, it shows that the non-atmospheric factors (e.g., the difference of relative spectral responses of TM and MSS, the georegistration errors, the radiometric calibration uncertainty, and image noises) bring larger uncertainties than the atmospheric factors (e.g., the AOD retrieval method by visibility) to the cross-validation results. We apply the MSS LSR data generated by the proposed framework on time series analysis in the regions of interest (ROIs) of the spectral-stable land cover in China for all the MSS sensors. The application demonstrates the potential and promise of the MSS LSR data generated by the proposed framework. [ABSTRACT FROM AUTHOR]

With the process of population aging and urbanization, a vast amount of studies have confirmed the increasing urban-rural cognition gaps, while less is known about the extent to which cognition gaps can be explained by urban-rural difference and urbanization status. This study aimed to examine the role of urbanization in bridging the cognition gaps for Chinese middle-aged and older adults. Based on the national representative China Health and Retirement Longitudinal Study (CHARLS) 2015, the Blinder–Oaxaca decomposition method was employed. The method uses stratified linear regression to disaggregate cognition gaps into explained and unexplained differences, as well as the absolute and relative attribution of explanatory factors. There were significant cognitive differences between urban and rural samples. Migrating to the urban predicts better cognition among the rural-born. A larger environment-related explained gap existed for those fully urbanized and those migrating earlier, indicating that migration can operate through a beneficial and cumulative change in the environment and bridge the urban-rural cognition gap. Public health actions targeting cognitive disparities can benefit from focusing on the unequal distribution in urban-rural social and economic recourses. Areas of priority include promoting their socioeconomic status, physical functioning, social support, and lifestyles. [ABSTRACT FROM AUTHOR]

Lower education is related to higher biological risks for physiological health, but it remains unclear whether the risks can be reduced through policies aimed at increasing years of education. We utilized China's compulsory education reforms as a unique natural experiment, which stipulates that primary and lower secondary education is mandatory and free for all school-age children. Using a regression discontinuity design (RDD), we assessed the effect of the reform eligibility on biomarkers. The reforms resulted in an increase in years of education for those from communities with the middle 1/3 per capita income (PCI) (β = 2.44, 95% CI = 0.23-4.64). Reform eligibility had no impact on allostatic risks for the total sample (β = 0.065, 95% CI = -0.70 to 0.83) and for those from communities with the lowest (β = 0.35, 95% CI = -0.77 to 1.47) or highest third of PCI (β = 0.68, 95% CI = -0.64 to 2.00), while it reduced the metabolic risk (β = -0.14, 95% CI = -0.26 to -0.015) and total allostatic load (β = -1.58, 95% CI = -3.00 to -0.16) among those from communities with the middle third PCI. The results were confirmed by sensitivity analyses of different placebo cut-off points and bandwidths. The reforms led to better physiological health to some extent, but the effect only manifested in people from communities with a moderate community PCI, and had little impact on affluent or disadvantaged groups. Our findings stressed that the institutional context and respondents' socioeconomic environment must be taken into account when assessing the health impact of China's compulsory education reforms. [ABSTRACT FROM AUTHOR]

Lung cancer is the leading cause of cancer-related deaths worldwide and in China. Screening for lung cancer by low dose computed tomography (LDCT) can reduce mortality but has resulted in a dramatic rise in the incidence of indeterminate pulmonary nodules, which presents a major diagnostic challenge for clinicians regarding their underlying pathology and can lead to overdiagnosis. To address the significant gap in evaluating pulmonary nodules, we conducted a prospective study to develop a prediction model for individuals at intermediate to high risk of developing lung cancer. Univariate and multivariate logistic analyses were applied to the training cohort (n = 560) to develop an early lung cancer prediction model. The results indicated that a model integrating clinical characteristics (age and smoking history), radiological characteristics of pulmonary nodules (nodule diameter, nodule count, upper lobe location, malignant sign at the nodule edge, subsolid status), artificial intelligence analysis of LDCT data, and liquid biopsy achieved the best diagnostic performance in the training cohort (sensitivity 89.53%, specificity 81.31%, area under the curve [AUC] = 0.880). In the independent validation cohort (n = 168), this model had an AUC of 0.895, which was greater than that of the Mayo Clinic Model (AUC = 0.772) and Veterans' Affairs Model (AUC = 0.740). These results were significantly better for predicting the presence of cancer than radiological features and artificial intelligence risk scores alone. Applying this classifier prospectively may lead to improved early lung cancer diagnosis and early treatment for patients with malignant nodules while sparing patients with benign entities from unnecessary and potentially harmful surgery. Clinical Trial Registration Number: ChiCTR1900026233, URL: http://www.chictr.org.cn/showproj.aspx?proj=43370. [ABSTRACT FROM AUTHOR]

Urban transformation is an inevitable trend for mining cities to achieve sustainable development. Analyzing the spatiotemporal evolution laws and driving mechanisms of mining cities is necessary for providing a scientific basis for their transformation. In this study, Jixi was taken as an example, which is a typical mining city in China. Based on geographic information system, various mathematical statistical analysis methods were used to quantitatively analyze the evolution pattern of mining cities. In addition, the driving mechanisms of land expansion in mining cities were examined further. The results showed that (1) the urban land in the mining city is mainly distributed in low-lying areas, and land expansion mainly occurred in flat areas. (2) Based on the distribution of mineral resources, the land use pattern of mining cities was scattered; with steady economic development, the urban spatial pattern tends to be compact. (3) The spatial pattern of mining cities is affected by natural, economic, and policy factors. The results reveal the spatiotemporal evolution law and driving mechanism of the patterns in mining cities, thereby providing a scientific basis for the sustainable development planning and land management of mining cities. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies have found that severe acute respiratory syndrome (SARS) was associated with the physical and psychological stress of those infected. However, research is sparse regarding the long‐term health consequence of community SARS exposure for older adults. Methods: Using data from the 2011 and 2015 China Health and Retirement Longitudinal Study (CHARLS), we estimated multilevel regression models of allostatic load (AL) in the years after the SARS epidemic among 7735 respondents. Interaction terms between SARS epidemic exposure and social participation or community environment were included to examine potential effects. Results: We found that community SARS exposure was associated with greater AL for those who had no social participation. Among those who were in worse community environment, community SARS exposure was strongly related to elevated load in the cardiovascular system. However, for those had social participation and lived in better community environment, community SARS exposure manifested no association with AL years later. Active social participation and better community environment could offset the negative association between SARS exposure and AL. Conclusions: Taken together, these findings helped determine the positive direction of future social efforts and policy decisions to guide the global recovery from the devastating COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

To determine the association between self-reported hearing status and risk of hospitalisation among Chinese middle-aged and older adults. Prospective cohort study. Discrete-time hazards models and negative binomial models were fitted to examine the relationship. About 11,902 participants aged 45 years or older with no hospitalisation at baseline. 49.28–62.70% of the participants reported their hearing as fair or poor. For older adults aged 60 and above, compared to people with excellent and very good hearing, those with good, fair or poor hearing reported shorter time to first hospitalisation [hazard ratio (HR) = 1.38, 1.38, 1.63, respectively]. They also manifested greater number of hospitalisations [incident rate ratio (IRR) = 1.21, 1.25, 1.54, respectively], and longer duration of hospitalisation (IRR = 1.36, 1.26, 1.53, respectively). However, there was no significant association between hearing status and hospitalisation for middle-aged adults for none of the hearing categories. Although no significant relationship between hearing and hospitalisation was found for middle-aged adults, older adults with poorer hearing experienced greater risk of hospitalisation. Given that hearing impairment is highly prevalent among older adults, future analyses are needed to investigate whether hearing rehabilitative therapies could help mitigate hospitalisations in hearing-impaired older adults. [ABSTRACT FROM AUTHOR]

In recent years, the technology-driven industrial upgrading in China has resulted in human labor being replaced with robots. This article explores the impact of "intelligent manufacturing" on workers from the following two perspectives: labor relations and the labor process. The authors argue that workers on the shopfloor are experiencing some forms of labor degradation due to robotization, i.e., more flexible labor relations, deskilling, and strengthened technical control. Such a corporation-led and machine-centered industrial upgrading is driven by state policy, capital, and the labor market. [ABSTRACT FROM AUTHOR]

Purpose: Available biomarkers lack sensitivity for an early lung cancer. Circulating genetically abnormal cells (CACs) occur early in tumorigenesis. To determine the diagnostic value of CACs in blood detected by 4-color fluorescence in situ hybridization (FISH) for lung cancer. Methods: This was a prospective study of patients with pulmonary nodules ≤ 30 mm detected between 10/2019 and 01/2020 at four tertiary hospitals in China. All patients underwent a pathological examination of lung nodules found by imaging and were grouped as malignant and benign. CACs were detected by 4-color FISH. Patients were divided into the training and validation cohorts. Receiver operating characteristics analysis was used to analyze the diagnosis value of CACs. Results: A total of 205 participants were enrolled. Using a cut-off value of ≥ 3, blood CACs achieved areas under the curve (AUCs) of 0.887, 0.823, and 0.823 for lung cancer in the training and validation cohorts, and all patients, respectively. CACs had high diagnostic values across all tumor sizes and imaging lesion types. CACs were decreased after surgery (median, 4 vs. 1, P < 0.001) in the validation set. The CAC status between blood and tissues was highly consistent (kappa = 0.909, P < 0.001). The AUC of CAC (0.823) was higher than that of CEA (0.478), SCC (0.516), NSE (0.506), ProGRP (0.519), and CYFRA21-1 (0.535) (all P < 0.001). Conclusion: CACs might have a high value for the early diagnosis of lung cancer. These findings might need to be validated in future studies. Evidence suggested homology in genetic aberrations between the CACs and the tumor cells. [ABSTRACT FROM AUTHOR]

Post‐release dispersal of reintroduced animals refers to the process of successful colonization and failed settlement. To ensure the establishment and persistence of a reintroduced population, the impacts of different factors on the post‐release dispersal of captive‐bred animals must be assessed. In this article, we focused on two reintroduced Crested Ibis (Nipponia nippon) populations in Shaanxi Province, China. We applied multiple approaches to evaluate the effects of age, body weight, sex, timing of release, size of acclimatization cages for rewilding, and duration of acclimatization on the survival rate of released populations. The results showed that the survival capacity of released individuals was negatively correlated with their age in Ningshan County (Spearman, r = −0.344, p = 0.03, n = 41). The released ibises in Ningshan and Qianyang County had an average dispersal direction of 210.53° ± 40.54° (Rayleigh's z test: z = 7.881 > z0.05, p < 0.01, n = 13) and 27.05° ± 2.85° (Rayleigh's z test: z = 5.985 > z0.05, p < 0.01, n = 6), respectively, suggesting that the dispersal tended to clump in one direction in both sites. The MaxEnt modeling results indicated that the most significant environmental factor responsible for breeding site selection in Ningshan County was paddy field. In Qianyang County, precipitation affects nest site selection through influencing food availability. In conclusion, the evaluation framework used in this study can serve as an example for developing conservation priorities on the landscape scale for more animal reintroductions. [ABSTRACT FROM AUTHOR]

Background: Hearing loss is quite prevalent and can be related to people's quality of life. To our knowledge, there are limited studies assessing the efficacy of hearing interventions on quality of life in adults. Therefore, we aim to conduct a randomized controlled trial (RCT) to determine the impact and cost-effectiveness of community-based hearing rehabilitation on quality of life among Chinese adults with hearing loss.Methods/design: In this two-arm feasibility study, participants aged 16 and above with some degree of hearing loss (n = 464) will be recruited from Linyi City, Shandong Province. They are randomly assigned to the treatment group or the control group. Those in the treatment group are prescribed with hearing aids, while those in the control group receive no intervention. Reinstruction in use of devices is provided for the treatment group during booster visits held 12 months post-randomization or unscheduled interim visits when necessary. Data are collected at baseline and the follow-up 20 months later. The primary outcome is changes in quality of life over a 20-month study period. Secondary outcomes include sub-dimensions in quality of life, physical functioning, chronic diseases, cognitive function, depression, social support, hospitalizations, falls, and healthcare costs. Finally, we will evaluate whether hearing aids intervention is cost-effective to apply in a large scale.Discussion: The trial is designed to evaluate the impact and cost-effectiveness of a community-based rehabilitation intervention on quality of life among Chinese adults with hearing loss. We hope that it would help improve the well-being for Chinese adults and provide references in policy and practice for China and other countries.Trial Registration: Chinese Clinical Trial Registry ChiCTR1900024739 . Registered on 26 July 2019. [ABSTRACT FROM AUTHOR]

Background: Lung cancer screening using low-dose computed tomography (LDCT) often leads to unnecessary biopsy because of the low specificity among patients with pulmonary nodules ≤10 mm. Circulating genetically abnormal cells (CACs) can be used to discriminate lung cancer from benign lung disease. To examine the diagnostic value of CACs in detecting lung cancer for patients with malignant pulmonary nodules ≤10 mm. Methods: In this prospective study, patients with pulmonary nodules ≤10 mm who were detected at four hospitals in China from January 2019 to January 2020 were included. CACs were detected using fluorescence in-situ hybridization. All patients were confirmed as lung cancer or benign disease by further histopathological examination. Multivariable logistic regression models were established to detect the presence of lung cancer using CACs and other associated characteristics. Receiver operating characteristic analysis was used to evaluate the performance of CACs for lung cancer diagnosis. Results: Overall, 125 patients were included and analyzed. When the cutoff value of CACs was >2, the sensitivity and specificity for lung cancer were 70.5 and 86.4%. Male (OR = 0.330, P = 0.005), maximum solid nodule (OR = 2.362, P = 0.089), maximum nodule located in upper lobe (OR = 3.867, P = 0.001), and CACs >2 (OR = 18.525, P < 0.001) met the P < 0.10 criterion for inclusion in the multivariable models. The multivariable logistic regression model that included the dichotomized CACs (>2 vs. ≤2) and other clinical factors (AUC = 0.907, 95% CI = 0.842–0.951) was superior to the models that only considered dichotomized CACs or other clinical factors and similar to the model with numerical CACs and other clinical factors (AUC = 0.913, 95% CI = 0.850–0.956). Conclusion: CACs presented a significant diagnostic value in detecting lung cancer for patients with pulmonary nodules ≤10 mm. [ABSTRACT FROM AUTHOR]

Camrelizumab is a programmed death receptor-1 inhibitor originally developed in China for the treatment of refractory lymphoma. It has also been effective in non-small-cell lung cancer patients. However, the rechallenge of camrelizumab was not reported previously. We report the rechallenge of camrelizumab therapy in two patients previously treated with microwave ablation (MWA) and camrelizumab. Although objective responses were achieved, camrelizumab therapy was discontinued because of the development of immune-related pneumonia (IRP). Treatment with camrelizumab was reinitiated after the patients recovered from IRP. The reoccurrence of more severe IRP necessitated additional corticosteroid therapy. The rechallenge of camrelizumab in patients treated with MWA plus camrelizumab regimen and who developed IRP should be cautious. [ABSTRACT FROM AUTHOR]

Background: Hearing impairment is a common chronic condition which can be closely related to people's health. However, current studies on this topic are quite limited in developing countries, and few with standardized audiometric measurement and multiple health outcomes. Therefore, we aimed to explore the association between hearing impairment and its severity with physical and mental health among Chinese middle-aged and older adults.Methods: We obtained data from two sources: (1) China Health and Retirement Longitudinal Study (CHARLS) 2011, 2013, and 2015, in which hearing impairment was measured by asking whether participants aged 45 years old had hearing problems; and (2) Hearing Survey 2019, the baseline survey of a randomized controlled trial conducted in Shandong Province of China, including 376 middle-aged and older participants. The severity of hearing impairment was identified by pure tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz.Results: In CHARLS, 1248 (8.36%) participants suffered from hearing impairment at baseline, and hearing-impaired individuals were more likely to have chronic diseases, impaired activities of daily living (ADLs), impaired instrumental activities of daily living (IADLs) and depressive symptoms. For the 376 hearing-impaired participants in Hearing Survey 2019, 30.32, 38.30 and 31.38% of them had moderate, severe and profound hearing impairment, respectively. As the severity of hearing impairment increased, individuals were likely to have impaired ADLs, impaired IADLs and depressive symptoms.Conclusions: Hearing impairment and its severity were closely related to multiple physical and mental health outcomes among Chinese middle-aged and older adults. Actions should be taken to prevent and treat hearing impairment, so as to improve people's health and well-being. [ABSTRACT FROM AUTHOR]

The applications, evaluations and funding of projects at mechanical design and manufacturing discipline(division II of engineering science) of the NSFC in 2019, as well as the research progresses and fruits of the executing and finished projects were reviewed. Specific measures of mechanical design and manufacturing discipline were stated, such as the new age reform of scientific fund, academic exchange and cooperation, talent cultivation, and academic team construction and so on. Finally, the researches of the medium and long-term development planning and the 14th five-year development strategic plan was briefly introduced. [ABSTRACT FROM AUTHOR]

In the face of ongoing habitat fragmentation, many primate species have experienced reduced gene flow resulting in a reduction of genetic diversity, population bottlenecks, and inbreeding depression, including golden snub-nosed monkeys Rhinopithecus roxellana. Golden snub-nosed monkeys live in a multilevel society composed of several 1 male harem units that aggregate to form a cohesive breeding band, which is followed by one or more bachelor groups composed of juvenile, subadult, and adult male members. In this research, we examine the continuous landscape resistance surface, the genetic diversity and patterns of gene flow among 4 isolated breeding bands and 1 all-male band in the Qinling Mountains, China. Landscape surface modeling suggested that human activities and ecological factors severely limit the movement of individuals among breeding bands. Although these conditions are expected to result in reduced gene flow, reduced genetic diversity, and an increased opportunity for a genetic bottleneck, based on population genetic analyses of 13 microsatellite loci from 188 individuals inhabiting 4 isolated breeding bands and 1 all-male band, we found high levels of genetic diversity but low levels of genetic divergence, as well as high rates of gene flow between males residing in the all-male band and each of the 4 breeding bands. Our results indicate that the movement of bachelor males across the landscape, along with their association with several different breeding bands, appears to provide a mechanism for promoting gene flows and maintaining genetic diversity that may counteract the otherwise isolating effects of habitat fragmentation. [ABSTRACT FROM AUTHOR]

Purpose: Hearing loss has not received sufficient attention, especially in low- and middle-income countries where more than 80% of the people with hearing loss reside. Little is known about the preference for hearing aids among people with hearing loss in developing countries. The aim of this study is to elicit the preferences for hearing aid attributes among rural Chinese adults with moderate or greater hearing loss and examine how preferences vary across different individual socioeconomic characteristics. Patients and Methods: We interviewed 125 adults in two rural counties in Shandong province in China. A discrete choice experiment (DCE) with eight attributes, comprising out-of-pocket (OOP) costs, hearing aid style, effective in quiet settings and noisy settings, feedback (whistling), connectivity, water/sweat resistance and battery life, were employed to examine participants' preference for hearing aids. Mixed logit models were used for the statistical analyses. Results: While OOP costs, effectiveness in quiet settings, water/sweat resistance and battery life were significantly associated with choosing a hearing aid, rural Chinese adults with moderate or greater hearing loss valued effectiveness in noisy settings above other attributes of hearing aids, followed closely by lack of feedback. The preference of the attributes of OOP costs, in the canal hearing aids, effectiveness in noisy settings, connectivity and battery life varied across individual socioeconomic characteristics including sex, marriage, employment, income and education level. Conclusion: Our study supported the view that the development of noise suppression and feedback cancellation systems remained the main challenge for the hearing aid industry. Since OOP costs were also associated with choosing a hearing aid, the policy advice is to improve reimbursements from insurance schemes and/or reduce the costs of hearing aids. [ABSTRACT FROM AUTHOR]

Background: Previous studies have documented the therapeutic value of computed tomography (CT)‐guided percutaneous microwave ablation (MWA) for early‐stage non‐small cell lung cancer (NSCLC). However, few studies have focused on patients aged 80 years and older. This retrospective study aimed to evaluate the safety and clinical outcomes of CT‐guided percutaneous MWA in patients aged 80 years and older with early‐stage peripheral NSCLC. Methods: A retrospective analysis of 63 patients aged 80 years and older with cT1a‐2bN0M0 peripheral NSCLC who underwent CT‐guided percutaneous MWA was performed between January 2008 and January 2018 at 11 hospitals in Shandong Province, China. Results: The median follow‐up time was 21.0 months. The overall median survival time was 50 months. The cancer‐specific median survival time was not reached in five years. The one‐, two‐, three‐, four‐, and five‐year overall survival rates were 97.1%, 92.6%, 63.4%, 54.4%, and 32.6%, respectively. The one‐, two‐, and three‐year cancer‐specific survival (CSS) rates were 97.9%, 97.9%, and 69.4%, respectively. The four‐ and five‐year CSS rates were not achieved. A total of 14 patients (22.2%) had local progression. The one‐, two‐, three‐, four‐, and five‐year local control rates were 88.8%, 78.8%, 70.3%, 63.9%, and 63.9%, respectively. The mortality rate was 0% within 30 days after the procedure. Major complications included pneumothorax requiring drainage (21.1%), pulmonary infection (4.2%), and pleural effusions requiring drainage (2.8%). Conclusions: CT‐guided percutaneous MWA is a safe and effective modality for treating patients aged 80 years and older with early‐stage peripheral NSCLC. [ABSTRACT FROM AUTHOR]

Invasive species are a major and growing threat to China's native freshwater biodiversity. They have caused species extinctions, biodiversity loss, and environmental changes. Mrigal carp (Cirrhinus mrigala), one of the most widespread and invasive of freshwater fish species, now occurs in major rivers throughout southern China. We report the current (to 2017) distribution of mrigal carp throughout southern China, and experiments with temperature, water quality and food availability, that assess possible impacts of this species on populations of native mud carp (C. molitorella)". In the wild, the mud carp to mrigal carp weight ratio was 1:1.65. Mrigal carp were a dominant species in some rivers of southern China, such as Liuxi River, Zengjiang River and the Zhaoqing section of Xijiang River. Manipulative experiments reveal mrigal carp to be more tolerant of colder temperature, more eutrophic conditions, and lower dissolved oxygen levels than mud carp. In food-limited experiments, mrigal carp displayed no direct aggression towards mud carp, but they did snatch food from them, and excluded them from eating. Mud carp growth was curtailed in the presence of mrigal carp in food-limited treatments, with a growth rate 2.71%, only 17.02% of that in treatments where carp were fed to satiation. In satiation treatments, mrigal carp also grew up to 2.21 times faster than mud carp. Our results indicate that mrigal carp will outcompete mud carp for resources and habitat, and that both its distribution and population will increase in the future. [ABSTRACT FROM AUTHOR]

Quality Problem or Issue: Chinese medical institutions need clinical guidelines to improve healthcare quality. Unfamiliarity with clinical methodology and procedures leads to poor quality.Initial Assessment: This study examined 327 clinical guidelines made in China during the period of 2006-10 and found these clinical guidelines have many problems in terms of guideline making procedures-compliant process, conflicts of interest disclosure.Choice Of Solution: Chinese Medical Association organized a working group in 2014 to make a national [Guideline for Clinical Guidelines Constitution/Amendment] and invited multidiscipline experts to prove its possibility.Implementation: Experts investigated and reviewed numerous domestic and foreign published literature within the past 2 years, concluded that a clinical guideline should have following seven components: I. Objective; II. General Principle; III. Procedure and Methodology; IV. Confirmation, Publication and Dissemination; V. Update and Amendment; VI. Implementation and Outcome Validation; VII. Reference.Evaluation: The [Guideline for Clinical Guidelines Constitution/Amendment] will improve the quality of Chinese clinical guidelines and regulate applications, as well as outcome evaluations of clinical guidelines in China.Lessons Learned: Standardized methodology and procedures are important for constituting high-quality clinical guidelines. [ABSTRACT FROM AUTHOR]

Background: Despite the progression of dialysis techniques,  the mortality of hemodialysis (HD) patients is still high in China. Here, a retrospective study was performed to investigate the neglected risk factors of all-cause mortality during maintenance HD (MHD). Methods: We investigated 117 MHD patients who died between 2011 and 2016 in the Second Xiangya Hospital of Central South University HD center. In order to analyze the risk factors of 48 months all-cause death, the methods of Kaplan-Meier and Cox regression were used. Results: Multivariate analyses of adjusted age and gender showed that MHD patients with estimated glomerular filtration rate <7 or >10 mL/min/1.73 m2 and anemia (hemoglobin <100 g/L) at the initiation of dialysis are independently associated with the higher death risk. Using central venous catheter vascular access, cerebrovascular comorbidities, diabetes, low-flux dialyzer, and dialysis frequency ≤2 times weekly were also the independent risk factors of death within 48 months. Conclusions: This study indicated that the status of HD initiation is a risk factor of long-term survival in MHD patients, which were usually ignored for lacking of nephrology care prior and could potentially be identified and modified to improve the survival prognosis. Video Journal Club "Cappuccino with Claudio Ronco" at  https://www.karger.com/Journal/ArticleNews/223997?sponsor=52 [ABSTRACT FROM AUTHOR]

Surgery remains the first choice of cure for early stage lung cancer. However, many patients are diagnosed at advanced stage, and thus miss the opportunity to undergo surgery. As such patients derive limited benefits from chemotherapy or radiotherapy, alternatives focusing on local control have emerged, including iodine‐125 seed implantation. The Interstitial Brachytherapy Society, Committee of Minimally Invasive Therapy in Oncology, Chinese Anti‐Cancer Association organized a group of multidisciplinary experts to develop guidelines for this treatment modality. These guidelines aim to standardize iodine‐125 seed implantation procedures, inclusion criteria, and outcome assessment to prevent and manage procedure‐related complications. [ABSTRACT FROM AUTHOR]

[Display omitted] • Affected by natural and economic factors, there are differences in the value of ecosystem services and expanded built-up land in China between North and South. • The multi-regional input–output (MRIO) model is used to quantify virtual land transfer among regions. • Part of expanded built-up land serves external regions, with build-up land and ecological costs shifting from south to north. • Economically developed regions dominate regional trade, and regional inequities exist in a few regions. During rapid economic development and urbanisation, land expansion in built-up areas is China's dominant land-use change type, resulting in the loss of ecosystem service value (ESV). Economic development is China's main driving force for built-up land expansion. Under the trend of the spatial separation of production and consumption, expanded built-up land embodied in trade flows between regions as a scarce land resource. Through trade, a region can indirectly use built-up land from outside areas, which may affect land use within the user and provider regions. Regional ESV loss may be affected by outer regions, although previous studies have seldom considered it. Accordingly, this study quantified ESV for the whole of China in high resolution and determined ESV loss caused by expanded built-up land for each province and ESV loss flows embodied in interregional interactions. The results found that China's total ESV of terrestrial ecosystems was 37.44 trillion yuan in 2015, and the expanded built-up land resulted in a loss of 13.7 billion yuan in ESV. Due to the north–south differences in natural and economic levels in China, there was significant spatial heterogeneity in ESV and ESV loss caused by built-up land expansion, with the high-value areas mainly in the southern coastal areas. With regional interaction, the leading regional flow direction of built-up land and ESV loss was from north to south, mainly from economically developing regions to economically developed regions. However, there was a discrepancy between the actual users of the built-up land and the ESV loss-bearers. Evident regional inequalities existed in several provinces with regional interactions. Overall, this study provides a reference for developing China's interregional economic and ecological harmony strategies in the context of sustainable development. [ABSTRACT FROM AUTHOR]

Lung cancer ranks first in incidence and mortality in China. Surgery is the primary method to cure cancer, but only 20–30% of patients are eligible for curative resection. In recent years, in addition to surgery, other local therapies have been developed for patients with numerous localized primary and metastatic pulmonary tumors, including stereotactic body radiation therapy and thermal ablative therapies through percutaneously inserted applicators. Percutaneous thermal ablation of pulmonary tumors is minimally invasive, conformal, repeatable, feasible, cheap, has a shorter recovery time, and offers reduced morbidity and mortality. Radiofrequency ablation (RFA), the most commonly used thermal ablation technique, has a reported 80–90% rate of complete ablation, with the best results obtained in tumors < 3 cm in diameter. Because the clinical efficacy of RFA of pulmonary tumors has not yet been determined, this clinical guideline describes the techniques used in the treatment of localized primary and metastatic pulmonary tumors in nonsurgical candidates, including mechanism of action, devices, indications, techniques, potential complications, clinical outcomes, post‐ablation surveillance, and use in combination with other therapies. In the future, the role of RFA in the treatment of localized pulmonary tumors should ultimately be determined by evidence from prospective randomized controlled trials comparing sublobar resection or stereotactic body radiation therapy. [ABSTRACT FROM AUTHOR]

The Chinese government adopted six ecological restoration programs to improve its natural environments. Although these programs have proven successful in improving local environments, some studies have questioned their performance when regions suffer from drought. Whether we should consider the effects of drought on vegetation change in assessments of the benefits of ecological restoration programs is unclear. Therefore, taking the Grain for Green Program (GGP) region as a study area, we estimated vegetation growth in the region from 2000-2010 to clarify the trends in vegetation and their driving forces. Results showed that: 1) vegetation growth increased in the GGP region during 2000-2010, with 59.4% of the area showing an increase in the Normalized Difference Vegetation Index (NDVI). This confirmed the benefits of the ecological restoration program. 2) Drought can affect the vegetation change trend, but human activity plays a significant role in altering vegetation growth, and the slight downward trend in the NDVI was not consistent with the severity of the drought. Positive human activity led to increased NDVI in 89.13% of areas. Of these, 22.52% suffered drought, but positive human activity offset the damage in part. 3) Results of this research suggest that appropriate human activity can maximize the benefits of ecological restoration programs and minimize the effects of extreme weather. We therefore recommend incorporating eco-risk assessment and scientific management mechanisms in the design and management of ecosystem restoration programs. [ABSTRACT FROM AUTHOR]

The rural landscape is undergoing rapid changes. In China, the expansion of rural settlements is widespread, causing problems to the environment. Previous studies have focused on the effects of built-up land expansion on ecosystem carbon, and this paper further explores the effects of rural settlement changes on ecosystem carbon and investigates the spatial heterogeneity of the relationship. The result shows: rural settlement expansion has led to a significant loss in carbon sinks and vegetation carbon stock, respectively. The main pathway of ecosystem carbon loss is the occupation of cropland. A total of 31% of the regions have a negative coupling relationship between the area of per capita rural settlement and the growth of carbon sinks. The regions where both rural settlements and carbon sink function have declined are mainly concentrated in the northwest, and ecological and rural development in these regions requires additional attention. 63% of the regions show great resilience in terms of carbon sink function in the face of rural settlement expansion. • Terrestrial carbon variations are analyzed from the aspect of the seldom-mentioned rural settlement. • The corrected population data were included in the coupling analysis. • Rural settlement is still expanding in China together with fast urbanization. • Most regions show a negative correlation between carbon sink and rural settlement expansion. [ABSTRACT FROM AUTHOR]

Terrestrial ecosystem carbon sink examination in China still faces great uncertainties. Determinant analysis has focused on climate change but ignored the influence of fast urban expansion. Using remote sensing images, climate variable data, and high-resolution land use data, this research improved net ecosystem productivity (NEP) simulation model based on a large number of field observations, and investigated spatial-temporal changes of NEP. This research calculated the NEP loss caused by built-up land expansion and used geographically weighted regression (GWR) model to explore the spatial heterogeneity of the relationship between NEP growth and built-up land expansion. The results showed that China contributed a carbon sink of 0.33 Pg C per year from 2000 to 2020. Southern China had a greater capacity to sequester carbon than northern China. The carbon sink capacity of most Chinese regions increased. Built-up land expansion caused 4.95 Tg C of carbon sink loss per year, which was mainly concentrated in eastern China. In GWR model, 50.8% of regions showed negative correlations between NEP growth and built-up land expansion. These two variables were mostly positively correlated in the northwest and negatively correlated in the southeast. Consequently, this study suggests that maintaining the capacity of carbon sinks in southern provinces is important for China to meet its carbon neutrality goal. • Newer observation point data and non-linear fitting method are used to improve the method of NEP estimate. • GWR model is used to study the spatial heterogeneity of built-up land expansion's impact on NEP density. • Identifying the spatiotemporal evolution of NEP in China. • Expansion of built-up land causes large carbon sink loss. [ABSTRACT FROM AUTHOR]

An examination of regional carbon neutrality gaps is needed for China to reach its 2060 carbon neutrality goal. China's carbon sink remains uncertain, and regional interactions require the scientific check of carbon emission reduction responsibility. This study provides a design for a new research framework to check the carbon neutrality gap in each province of China by considering regional inequities and diagnosing land-use problems to recommend some optimizations. The results show that Yunnan, Sichuan, and Hainan are the only regions with more carbon sinks than emissions. North and northwest China have more regions with large gaps between their current state and carbon neutrality. Hebei, Shandong, and Jiangsu have the largest gaps, while small gaps occur more in the southwest. Except for Jiangsu, the developed regions send considerable amount of carbon emissions to the undeveloped regions. There is obvious regional inequity, and 17 provinces should take their extra carbon emissions back that are sent to other regions. Shanghai, Tianjin, and Beijing have much larger carbon neutrality gaps per unit area compared with other provinces. Both land-use structure and land-use efficiency can determine the regional carbon neutrality gaps. The regions with higher percentages of built-up and industrial land are mostly located in the east and along the coastline, while the regions with higher percentages of vegetated land are concentrated in the south. The undeveloped regions are characterized by the low efficiency of industrial land, while the developed regions are marked by the low efficiency of cropland. In general, the developed regions have more advantages. Low-carbon land-use strategies should be developed according to regional physical conditions and from the perspective of regional coordination and fair development. • China,s carbon neutrality gaps were examined at grid scale without considering regional interactions. • Both carbon emissions and vegetation carbon loss embodied in inter-provincial trade were figured out by MRIO. • Provincial carbon neutrality gaps were rechecked based on the carbon embodied in trade. • Land use problems were diagnosed and policy implications were proposed. [ABSTRACT FROM AUTHOR]

Changes in vegetation phenology are key indicators of the response of ecosystems to climate change. Therefore, knowledge of growing seasons is essential to predict ecosystem changes, especially for regions with a fragile ecosystem such as the Loess Plateau. In this study, based on the normalized difference vegetation index (NDVI) data, we estimated and analyzed the vegetation phenology in the Loess Plateau from 2000 to 2010 for the beginning, length, and end of the growing season, measuring changes in trends and their relationship to climatic factors. The results show that for 54.84% of the vegetation, the trend was an advancement of the beginning of the growing season (BGS), while for 67.64% the trend was a delay in the end of the growing season (EGS). The length of the growing season (LGS) was extended for 66.28% of the vegetation in the plateau. While the temperature is important for the vegetation to begin the growing season in this region, warmer climate may lead to drought and can become a limiting factor for vegetation growth. We found that increased precipitation benefits the advancement of the BGS in this area. Areas with a delayed EGS indicated that the appropriate temperature and rainfall in autumn or winter enhanced photosynthesis and extended the growth process. A positive correlation with precipitation was found for 76.53% of the areas with an extended LGS, indicating that precipitation is one of the key factors in changes in the vegetation phenology in this water-limited region. Precipitation plays an important role in determining the phenological activities of the vegetation in arid and semiarid areas, such as the Loess Plateau. The extended growing season will significantly influence both the vegetation productivity and the carbon fixation capacity in this region. [ABSTRACT FROM AUTHOR]

The morphology, chemistry and phylogenetic relationships of Chinese populations of Bulbothrix are described. Nine species, including two new species B. mammillaria Y. Y. Zhang & Li S. Wang sp. nov. and B. lacinia Y. Y. Zhang & Li S. Wang sp. nov., and two newly recorded for the flora, B. scortella and B. meizospora, are reported. Bulbothrix mammillaria can be recognized by the sparse cilia that are reduced to a bulbate structure and the broad lobes (3–11 mm). Bulbothrix lacinia differs from other species of the genus by dark brown, spherical to short-cylindrical isidia and common lacinulae on the upper surface. Phylogenetic relationships of currently known ITS sequences from Bulbothrix were inferred to assess the affinities of the new species. A key to all known species from China is presented. [ABSTRACT FROM PUBLISHER]

In recent years, with the constant change in the global climate, the effect of climate factors on net primary productivity (NPP) has become a hot research topic. However, two opposing views have been presented in this research area: global NPP increases with global warming, and global NPP decreases with global warming. The main reasons for these two opposite results are the tremendous differences among seasonal and annual climate variables, and the growth of plants in accordance with these climate variables. Therefore, it will fail to fully clarify the relation between vegetation growth and climate changes by research that relies solely on annual data. With seasonal climate variables, we may clarify the relation between vegetation growth and climate changes more accurately. Our research examined the arid and semiarid areas in China (ASAC), which account for one quarter of the total area of China. The ecological environment of these areas is fragile and easily affected by human activities. We analyzed the influence of climate changes, especially the changes in seasonal climate variables, on NPP, with Climatic Research Unit (CRU) climatic data and Moderate Resolution Imaging Spectroradiometer (MODIS) satellite remote data, for the years 2000-2010. The results indicate that: for annual climatic data, the percentage of the ASAC in which NPP is positively correlated with temperature is 66.11%, and 91.47% of the ASAC demonstrates a positive correlation between NPP and precipitation. Precipitation is more positively correlated with NPP than temperature in the ASAC. For seasonal climatic data, the correlation between NPP and spring temperature shows significant regional differences. Positive correlation areas are concentrated in the eastern portion of the ASAC, while the western section of the ASAC generally shows a negative correlation. However, in summer, most areas in the ASAC show a negative correlation between NPP and temperature. In autumn, precipitation is less important in the west, as opposed to the east, in which it is critically important. Temperatures in winter are a limiting factor for NPP throughout the region. The findings of this research not only underline the importance of seasonal climate variables for vegetation growth, but also suggest that the effects of seasonal climate variables on NPP should be explored further in related research in the future. [ABSTRACT FROM AUTHOR]

Background: Although human leukocyte antigens (HLA) have been shown in association with the outcomes of hepatitis C virus (HCV) infection among different ethnic groups, such studies remain absent in China, where the HCV prevalence is higher than the global average. Methods: In this study, 426 HCV-infected and 709 uninfected blood donors were analyzed, among whom the HLA alleles were sequenced using a high-resolution genotyping method. Results: At the 2-digit level, none of the alleles showed a statistical difference between the HCV-infected and uninfected groups. However, at the 4-digit level, the HLA-B alleles B*15:01 and B*15:02 showed an opposite association with HCV infection, i.e. B*15:01 was significantly higher in the HCV-infected group (odds ratio, OR = 1.561, p = 0.010), while B*15:02 was significantly higher in the uninfected group (OR = 0.778, p = 0.016). We also identified a higher frequency of B*13:02 in the HCV-infected group (OR = 1.515, p = 0.009) and a higher frequency of B*07:05 in the uninfected group (OR = 0.299, p = 0.001). Conclusions: The frequencies of four HLA alleles, B*07:05, B*13:02, B*15:01, and B*15:02, were found to be significantly different between the HCV-infected and uninfected blood donors in China, revealing an inverse relation of B*15:01 and B*15:02 with HCV infection. This finding suggests that the ethnic genetic variations of HLA may greatly affect the host immune responses against HCV. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]