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The contradiction between the space demand for precast concrete components (PCCs) and the limited area of the construction site is reinforced by the increase in the prefabrication rate of prefabricated buildings, and a large number of PCC hoisting operations may have an adverse impact on the safety and efficiency of the construction site. Therefore, the importance of precast concrete component yard layout planning (PCCYLP) is becoming increasingly prominent. Most existing research on construction site layout planning (CSLP) has focused on all temporary facilities on the construction site and has neglected the particularity of PCC when solving the above problems. Based on this, this paper integrates the PCC hoisting efficiency and safety into the existing CSLP research and optimizes PCCYLP solutions by establishing a PCCYLP model. The model proposes a non-centralized PCC yard division method. Moreover, the surplus rectangle algorithm is used to calculate the yard sizes, which are input into the model in alternative ways. Engineering cases verify the effectiveness of the proposed model, and the non-dominated sorting genetic algorithm is selected for simulation. The results show that the method can enhance the scientific and reasonable layout solution and provide a favorable guarantee for subsequent safe and efficient construction activities.

Abstract Background The association between exposure to PM2.5 chemical constituents and obesity remains to be elucidated, as most studies have used a single measure of obesity. This study aimed to investigate the associations of exposure to PM2.5 chemical constituents with general, abdominal, and visceral obesity, and the mediation effect of physical activity (PA) in the associations. Methods Based on a total of 49,819 adults from the baseline of the Yunnan Behavior and Disease Surveillance cohort (YBDS) in southern China in 2021, we used multiple linear regression, weighted quantile sum regression, and quantile regression to estimate independent and joint effects of PM2.5 chemical constituents on elevated BMI, waist circumference (WC) and visceral adiposity index (VAI) and whether these effects changed in quantiles. Mediation analysis was used to examine whether physical activity acts as a mediator in these pathways. Results Per IQR μg/m3 increase in all PM2.5 chemical constituents was significantly associated with the elevated BMI (β [95% CI]: 0.170 [0.127, 0.214]), WC (0.316 [0.217, 0.415]) and VAI (0.102 [0.075, 0.129]), with the largest weights from OM (53.89, 81.67, and 89.82%, respectively). The effects of PM2.5 chemical constituents on obesity showed an overall upward trend from quantiles 1–4 of BMI, WC, and VAI, especially with a rapid upward trend from the sixth decile of VAI. Reduced PA mediated 3.16, 7.08, and 3.78% of the associations between PM2.5 chemical constituents and elevated BMI, WC, and VAI, respectively. Conclusions Exposure to PM2.5 chemical constituents, especially OM, was significantly associated with increased risks for obesity in adults. The effects of associations increased with obesity severity, with PA playing a mediation role.

Abstract Background Evidence of the optimal blood pressure (BP) target for older adults with disability in long-term care is limited. We aim to analyze the associations of BP with mortality in older adults in long-term care setting with different levels of disability. Methods This prospective cohort study was based on the government-led long-term care programme in Chengdu, China, including 41,004 consecutive disabled adults aged ≥ 60 years. BP was measured during the baseline survey by trained medical personnel using electronic sphygmomanometers. Disability profile was assessed using the Barthel index. The association between blood pressure and mortality was analyzed with doubly robust estimation, which combined exposure model by inverse probability weighting and outcome model fitted with Cox regression. The non-linearity was examined by restricted cubic spline. The primary endpoint was all-cause mortality, and the secondary endpoints were cardiovascular and non-cardiovascular mortality. Results The associations between systolic blood pressure (SBP) and all-cause mortality were close to a U-shaped curve in mild-moderate disability group (Barthel index ≥ 40), and a reversed J-shaped in severe disability group (Barthel index

Accurate identification of the backbone curves of reinforced concrete (RC) columns is key to engineering design and strengthening renovation. In view of the problems of high cost, long time, low accuracy, large dispersion of calculation results and discontinuous stiffness changes of the existing backbone curve identification methods, such as experimental method, finite element simulation method and semi-theoretical and semi-empirical method, it is proposed to transform the backbone curve identification problem into a multi-time series prediction problem. By introducing the attention mechanism and combining it with the bidirectional long short-term memory (BiLSTM), the backbone curve identification model (BC-ABiLSTM) is established considering the relationship between the front and back points of the backbone curves. Compared with the models for backbone curves with BiLSTM (BC-BiLSTM), long short-term memory (BC-LSTM), multilayer perceptron (BC-MLP), and the existing identification methods, the performance of the BC-ABiLSTM model is better, and the mean absolute error (MAE), mean absolute percentage error (MAPE), root mean square error (RMSE), and R2 of the BC-ABiLSTM model on the testing set are 12.492 kN, 10.595 %, 20.838 kN and 0.9924, respectively, which provides a new method for accurate, efficient and cost-effective prediction of RC column backbone curve points under various cyclic loading levels.

Summary: Background: Long-term exposure to PM2.5 is known to increase the risks for diabetes and obesity, but its effects on their coexistence, termed diabesity, remain uncertain. This study aimed to investigate the associations of long-term exposure to PM2.5 and its chemical constituents with the risks for diabesity, diabetes, and obesity. Methods: This cross-sectional study used the baseline data of a multi-center cohort, consisting of three provincially representative cohorts comprising a total of 134,403 participants from the eastern (Fujian Province), central (Hubei Province), and western (Yunnan Province) regions of China. Obesity and diabetes, and diabesity were identified by a body mass index (BMI) ≥28 kg/m2 and fasting plasma glucose (FPG) ≥126 mg/dL. The average concentrations of PM2.5 and five chemical constituents (NO3−, SO42−, NH4+, organic matter, and black carbon) over participants’ residence during the past three years were estimated using machine learning models. Logistic regression models with double robust estimators, Bayesian kernel machine regression, and weighted quantile sum regression were employed to estimate independent and joint effects of PM2.5 chemical constituents on the risks for diabesity, diabetes, and obesity, as well as the differences from the effects on obesity. Stratified analyses were performed to examine effect modification of sociodemographic and lifestyle factors. Findings: There were 129,244 participants with a mean age of 54.1 ± 13.8 years included in the study. Each interquartile range increase in PM2.5 concentration (8.53 μg/m3) was associated with an increased risk for diabesity (OR = 1.23 [1.17, 1.30]), diabetes only (OR = 1.16 [1.13, 1.19]), and obesity only (OR = 1.03 [1.00, 1.05]). Long-term exposure to each PM2.5 chemical constituent was associated with an increased risk for diabesity, where organic matter exposure, with maximum weight (48%), was associated with a higher risk for diabesity (OR = 1.21 [1.16, 1.27]). Among those with obesity, black carbon contributed most (68%) to the joint effect of PM2.5 chemical constituents on diabesity (OR = 1.16 [1.11, 1.22]). Physical activity reduced adverse effects of PM2.5 on diabesity. Also, additive rather than multiplicative effects of obesity on the PM2.5-diabetes association were observed. Interpretation: Long-term exposure to PM2.5 and its chemical constituents was associated with an increased risk for diabesity, stronger than associations for diabetes and obesity alone. The main constituents associated with diabesity and obesity were black carbon and organic matter. Funding: National Natural Science Foundation of China (42271433, 723B2017), National Key R&D Program of China (2023YFC3604702), Fundamental Research Funds for the Central Universities (2042023kfyq04, 2042024kf1024), the Science and Technology Major Project of Tibetan Autonomous Region of China (XZ202201ZD0001G), Science and technology project of Tibet Autonomous Region（XZ202303ZY0007G), Key R&D Project of Sichuan Province (2023YFS0251), Renmin Hospital of Wuhan University (JCRCYG-2022-003), Jiangxi Provincial 03 Special Foundation and 5G Program (20224ABC03A05), Wuhan University Specific Fund for Major School-level Internationalization Initiatives (WHU-GJZDZX-PT07).

Background: While evidence suggests that PM2.5 is associated with overall prevalence of Metabolic (dysfunction)-Associated Fatty Liver Disease (MAFLD), effects of comprehensive air pollutant mixture on MAFLD and its subtypes remain unclear. Objective: To investigate individual and joint effects of long-term exposure to comprehensive air pollutant mixture on MAFLD and its subtypes. Methods: Data of 27,699 participants of the Chinese Cohort of Working Adults were analyzed. MAFLD and subtypes, including overweight/obesity, lean, and diabetes MAFLD, were diagnosed according to clinical guidelines. Concentrations of NO3–, SO42−, NH4+, organic matter (OM), black carbon (BC), PM2.5, SO2, NO2, O3 and CO were estimated as a weighted average over participants’ residential and work addresses for the three years preceding outcome assessment. Logistic regression and weighted quantile sum regression were used to estimate individual and joint effects of air pollutant mixture on presence of MAFLD. Results: Overall prevalence of MAFLD was 26.6 % with overweight/obesity, lean, and diabetes MAFLD accounting for 92.0 %, 6.4 %, and 1.6 %, respectively. Exposure to SO42−, NO3–, NH4+, BC, PM2.5, NO2, O3and CO was significantly associated with overall MAFLD, overweight/obesity MAFLD, or lean MAFLD in single pollutant models. Joint effects of air pollutant mixture were observed for overall MAFLD (OR = 1.10 [95 % CI: 1.03, 1.17]), overweight/obesity (1.09 [1.02, 1.15]), and lean MAFLD (1.63 [1.28, 2.07]). Contributions of individual air pollutants to joint effects were dominated by CO in overall and overweight/obesity MAFLD (Weights were 42.31 % and 45.87 %, respectively), while SO42− (36.34 %), SO2 (21.00 %) and BC (12.38 %) were more important in lean MAFLD. Being male, aged above 45 years and smoking increased joint effects of air pollutant mixture on overall MAFLD. Conclusions: Air pollutant mixture was associated with MAFLD, particularly the lean MAFLD subtype. CO played a pivotal role in both overall and overweight/obesity MAFLD, whereas SO42− were associated with lean MAFLD.

Abstract Background Healthy lifestyles are crucial for preventing chronic diseases. Nonetheless, approximately 90% of Chinese community residents regularly engage in at least one unhealthy lifestyle. Mobile smart devices-based health interventions (mHealth) that incorporate theoretical frameworks regarding behavioral change in interaction with the environment may provide an appealing and cost-effective approach for promoting sustainable adaptations of healthier lifestyles. We designed a randomized controlled trial (RCT) to evaluate the effectiveness of a socioecological model-guided, smart device-based, and self-management-oriented lifestyles (3SLIFE) intervention, to promote healthy lifestyles among Chinese community residents. Methods This two-arm, parallel, cluster-RCT with a 6-month intervention and 6-month follow-up period foresees to randomize a total of 20 communities/villages from 4 townships in a 1:1 ratio to either intervention or control. Within these communities, a total of at least 256 community residents will be enrolled. The experimental group will receive a multi-level intervention based on the socioecological model supplemented with a multi-dimensional empowerment approach. The control group will receive information only. The primary outcome is the reduction of modifiable unhealthy lifestyles at six months, including smoking, excess alcohol consumption, physical inactivity, unbalanced diet, and overweight/obesity. A reduction by one unhealthy behavior measured with the Healthy Lifestyle Index Score (HLIS) will be considered favorable. Secondary outcomes include reduction of specific unhealthy lifestyles at 3 months, 9 months, and 12 months, and mental health outcomes such as depression measured with PHQ-9, social outcomes such as social support measured with the modified Multidimensional Scale of Perceived Social Support, clinical outcomes such as obesity, and biomedical outcomes such as the development of gut microbiota. Data will be analyzed with mixed effects generalized linear models with family and link function determined by outcome distribution and accounting for clustering of participants in communities. Discussion This study will provide evidence concerning the effect of a mHealth intervention that incorporates a behavioral change theoretical framework on cultivating and maintaining healthy lifestyles in community residents. The study will provide insights into research on and application of similar mHealth intervention strategies to promote healthy lifestyles in community populations and settings. Trial registration number ChiCTR2300070575. Date of registration: April 17, 2023. https://www.chictr.org.cn/index.aspx .

Abstract Metabolic syndrome (MetS) is characterized by metabolic dysfunctions and could predict future risk for cardiovascular diseases (CVDs). However, the traditionally defined dichotomous MetS neither reflected MetS severity nor considered demographic variations. Here we develop a continuous, age-sex-ethnicity-specific MetS score based on continuous measures of the five metabolic dysfunctions (waist circumference [WC], triglycerides [TG], high-density lipoprotein cholesterol [HDL-C], mean arterial pressure [MAP], and fasting blood glucose [FBG]). We find that the weights of metabolic dysfunctions in the score vary across age-sex-ethnicity-specific subgroups, with higher weights for TG, HDL-C, and WC. Each unit increase in the score is associated with increased risks for hyperlipidemia, diabetes, and hypertension, and elevated levels of HbA1c, cholesterol, body mass index, and serum uric acid. The score shows high sensitivity and accuracy for detecting CVD-related risk factors and is validated in different geographical regions. Our study would advance early identification of CVD risks and, more broadly, preventive medicine and sustainable development goals.

Lycium barbarum L. ( L. barbarum ), an important medicinal and food crop from the Solanaceae family, is known for excellent tolerance to saline–alkaline and drought stresses. Therefore, it has significant research and application value. The nuclear and chloroplast genomes of L. barbarum have been previously reported; however, its mitochondrial genome is still unexplored. In this study, mitochondrial DNA sequencing and assembly in L. barbarum were studied via second- and third-generation sequencing technologies using the anthers collected from the main cultivars “Ningqi No.1” (fertile line) and its male-sterile natural mutant “Ningqi No.5” from Ningxia, China. The results revealed that “Ningqi No.1” and “Ningqi No.5” have the same mitochondrial circular genome structure with a total length of 413,881 bp. In total, 61 genes were annotated, including 35 protein-coding genes, four rRNA genes, 22 tRNA genes, and 2,242 open reading frames with unknown functions. The repeat sequences in mtDNA were analyzed, in which short repeats (30–59 bp) exhibited the highest number. Overall, 23 protein-coding genes in “Ningqi No.1” and “Ningqi No.5” exhibited RNA-editing phenomenon, with different RNA-editing site number and distribution position. Phylogenetic analysis demonstrated that L. barbarum has the closest relationship with Hyoscyamus niger . These results provided a basis for a comprehensive understanding of the mitochondrial genome of L. barbarum and the relevant data for omics studies on L. barbarum .

Cardiac magnetic resonance (CMR), a non-radiation based type of examination, can achieve the simultaneous comprehensive multi-parameter, multi-plane, and multi-sequence evaluation of the anatomical structure of the heart; and at the same time, determine systolic and diastolic function, and blood perfusion and tissue characteristics. Traditional late gadolinium enhancement imaging based on CMR reflects focal replacement fibrosis, in contrast to normal myocardial signal intensity, but cannot effectively identify diffuse myocardial fibrosis. T1 mapping and its derived extracellular volume fraction can be used to quantitatively analyze the extracellular space in myocardial tissue and evaluate diffuse myocardial interstitial fibrosis that is invisible to the naked eye. Diffusion tensor imaging reveals the direction of cardiomyocyte aggregates by quantifying the anisotropy of water molecule diffusion, and can be applied to evaluate the integrity of myocardial tissue and arrangement structure of myocardial microstructural characteristics. On the basis of the micro-motion of myocardial tissue, feature tracking analysis decomposes myocardial deformation into three dimensions of micro-mechanical changes, and can identify early systolic and diastolic dysfunction before heart enlargement or ejection fraction reduction. This Commentary discusses current research advances in these new techniques, as well as their clinical application prospects and limitations for non-ischemic cardiomyopathies.

Abstract Background Healthcare workers suffered with high prevalence of occupational burnout, which might be related with their job satisfaction and well-being. This study aimed to provide evidence of complex interrelations among occupational burnout, flourishing, and job satisfaction, and identify key variables from the perspective of network structure among healthcare workers. Methods A cross-sectional study was conducted between July and October 2021, and 907 (the response rate was 98.4%) HIV/AIDS healthcare workers completed their sociodemographic characteristics, occupational burnout, flourishing and job satisfaction. Network analysis was conducted to investigate the interrelations of occupational burnout, flourishing, and job satisfaction communities, and identify central variables and bridges connecting different communities with different bridge strength thresholds in the network structure. The Network Comparison Test (NCT) was conducted to examine the gender differences in networks. Results In the network, feeling exhausted at work (strength: 1.42) and feeling frustrated at work (1.27) in occupational burnout community, and interested in daily activities (1.32) in flourishing community were central variables. Bridges in the network were job reward satisfaction (bridge strength: 0.31), satisfaction with job itself (0.25), and job environment satisfaction (0.19) in job satisfaction community, as well as interested in daily activities (0.29) and feeling respectable (0.18) in flourishing community, with bridges selected with top 20% bridge strengths. Feeling frustrated at work (0.14) in occupational burnout community and leading a purposeful and meaningful life (0.11) in flourishing community became bridges when using thresholds of top 25% and 30% bridge strengths, respectively. We also observed higher network densities in females (network density: 0.37) than that in males (0.34), and gender differences in the distribution of partial correlation coefficients (M = 0.27, P = 0.017). Conclusions In the network structure of occupational burnout-flourishing-job satisfaction, feeling frustrated at work in occupational burnout community and interested in daily activities in flourishing community were both central variables and bridges, which may be targeted variables to intervene to alleviate the overall level of symptoms in the network and therefore prevent poor health outcomes in healthcare workers.

Background Strain analysis is a sensitive method for the assessment of ventricular structural or functional alterations. The authors aimed to determine whether right ventricular (RV) strain parameters can discriminate patients with revised Task Force Criteria–diagnosed arrhythmogenic RV cardiomyopathy (ARVC) incremental to the existing cardiovascular magnetic resonance (CMR) criteria, thus improving the diagnostic yield of CMR in ARVC. Methods and Results A total of 74 patients with revised Task Force Criteria–diagnosed ARVC (37 borderline and 37 definite) and 37 controls were retrospectively enrolled for analysis. Using CMR feature tracking, RV global longitudinal (GLS), circumferential, and radial strain of all participants were evaluated. Compared with controls, the study patients demonstrated significantly impaired global biventricular strain in all 3 directions (all P50% presenting with impaired RV GLS. When both conventional criteria and RV GLS were considered together, this new diagnostic method demonstrated an overall diagnostic accuracy of 90%. The likelihood ratio test showed a significant incremental diagnostic value of RV GLS (P=0.02) over the existing CMR major criteria. Conclusions The current study showed an improved diagnostic accuracy when both RV GLS and the existing CMR criteria were considered together, especially for patients with borderline diagnosis, suggesting the incremental value of strain analysis to the initial assessment of ARVC.

Abstract Background Inequality in health is a prevalent and growing concern among countries where people with disabilities are disproportionately affected. Unmet healthcare needs explain a large part of the observed inequalities between and within countries; however, there are other causes, many non-modifiable, that also play a role. Aim This article explores the difference in health across income levels in populations with spinal cord injury (SCI). SCI is of special interest in the study of health systems, as it is an irreversible, long-term health condition that combines a high level of impairment with subsequent comorbidities. Methods We estimated the importance of modifiable and non-modifiable factors that explain health inequalities through a direct regression approach. We used two health outcomes: years living with the injury and a comorbidity index. Data come from the International Spinal Cord Injury Survey (InSCI), which has individual data on people with SCI in 22 countries around the world. Due to the heterogeneity of the data, the results were estimated country by country. Results On average, the results exhibit a prevalence of pro-rich inequalities, i.e., better health outcomes are more likely observed among high-income groups. For the years living with the injury, the inequality is mostly explained by non-modifiable factors, like the age at the time of the injury. In contrast, for the comorbidity index, inequality is mostly explained by unmet healthcare needs and the cause of the injury, which are modifiable factors. Conclusions A significant portion of health inequalities is explained by modifiable factors like unmet healthcare needs or the type of accident. This result is prevalent in low, middle, and high-income countries, with pervasive effects for vulnerable populations like people with SCI, who, at the same time are highly dependent on the health system. To reduce inequity, it is important not only to address problems from public health but from inequalities of opportunities, risks, and income in the population. Highlights • Better health status is evident among high-income groups, which is reflected in pro-rich inequalities. • Age at the time of the injury is the most important factor to explain inequalities in years living with the injury. • Unmet health care needs are the most important factor to explain inequalities in comorbidities. • The inequality in health varies by country dependent upon socioeconomic factors.

Abstract Objective Metabolic-associated fatty liver disease (MAFLD) is of concern in employed adults, while the crucial indicators in predicting MAFLD are understudied in this population. We aimed to investigate and compare the prediction performance of a set of indicators for MAFLD in employed adults. Methods A cross-sectional study recruiting 7968 employed adults was conducted in southwest China. MAFLD was assessed by abdominal ultrasonography and physical examination. Comprehensive indicators of demographics, anthropometric, lifestyle, psychological, and biochemical indicators were collected by questionnaire or physical examination. All indicators were evaluated for importance in predicting MAFLD by random forest. A prognostic model based on multivariate regression model was constructed to obtain a prognostic index. All indicators and prognostic index were compared to evaluate their prediction performance in predicting MAFLD by the receiver operating characteristic (ROC) curve, calibration plot, and Decision curve analysis (DCA). Results Triglyceride Glucose-Body Mass Index (TyG-BMI), BMI, TyG, triglyceride (TG)/high-density lipoprotein-cholesterol (HDL-C), and TG ranked the top five important indicators, and TyG-BMI performed the most accurate prediction of MAFLD according to the ROC curve, calibration plot and DCA. The area under the ROC curves (AUCs) of the five indicators were all over 0.7, with TyG-BMI (cut-off value: 218.284, sensitivity: 81.7%, specificity: 78.3%) suggesting the most sensitive and specific indicator. All five indicators showed higher prediction performance and net benefit than the prognostic model. Conclusion This epidemiological study firstly compared a set of indicators to evaluate their prediction performance in predicting MAFLD risk among employed adults. Intervention targeting powerful predictors can be helpful to reduce the MAFLD risk among employed adults.

Abstract Background Formative assessment (FA) is becoming increasingly common in higher education, although the teaching practice of student-centred FA in medical curricula is still very limited. In addition, there is a lack of theoretical and pedagogical practice studies observing FA from medical students’ perspectives. The aim of this study is to explore and understand ways to improve student-centred FA, and to provide a practical framework for the future construction of an FA index system in medical curricula. Methods This study used questionnaire data from undergraduate students in clinical medicine, preventive medicine, radiology, and nursing at a comprehensive university in China. The feelings of medical students upon receiving student-centred FA, assessment of faculty feedback, and satisfaction were analysed descriptively. Results Of the 924 medical students surveyed, 37.1% had a general understanding of FA, 94.2% believed that the subject of teaching assessment was the teacher, 59% believed that teacher feedback on learning tasks was effective, and 36.3% received teacher feedback on learning tasks within one week. In addition, student satisfaction results show that students’ satisfaction with teacher feedback was 1.71 ± 0.747 points, and their satisfaction with learning tasks was 1.83 ± 0.826 points. Conclusion Students as participants and collaborators in FA provide valid feedback for improving student-centred FA in terms of student cognition, empowered participation, and humanism. In addition, we suggest that medical educators avoid taking student satisfaction as a single indicator for measuring student-centred FA and to try to build an assessment index system of FA, to highlight the advantages of FA in medical curricula.

Air pollution has been standing as one of the most pressing global challenges. The changing patterns of air pollutants at different spatial and temporal scales have been substantially studied all over the world, which, however, were intricately disturbed by COVID-19 and subsequent containment measures. Understanding fine-scale changing patterns of air pollutants at different stages over the epidemic’s course is necessary for better identifying region-specific drivers of air pollution and preparing for environmental decision making during future epidemics. Taking China as an example, this study developed a multi-output LightGBM approach to estimate monthly concentrations of the six major air pollutants (i.e., PM2.5, PM10, NO2, SO2, O3, and CO) in China and revealed distinct spatiotemporal patterns for each pollutant over the epidemic’s course. The 5-year period of 2019–2023 was selected to observe changes in the concentrations of air pollutants from the pre-COVID-19 era to the lifting of all containment measures. The performance of our model, assessed by cross-validation R2, demonstrated high accuracy with values of 0.92 for PM2.5, 0.95 for PM10, 0.95 for O3, 0.90 for NO2, 0.79 for SO2, and 0.82 for CO. Notably, there was an improvement in the concentrations of particulate matter, particularly for PM2.5, although PM10 exhibited a rebound in northern regions. The concentrations of SO2 and CO consistently declined across the country over the epidemic’s course (p < 0.001 and p < 0.05, respectively), while O3 concentrations in southern regions experienced a notable increase. Concentrations of air pollutants in the Beijing–Tianjin–Hebei region were effectively controlled and mitigated. The findings of this study provide critical insights into changing trends of air quality during public health emergencies, help guide the development of targeted interventions, and inform policy making aimed at reducing disease burdens associated with air pollution.

Abstract Background Assessing the structure and function of left atrium (LA) is crucial in hypertrophic obstructive cardiomyopathy (HOCM) because LA remodeling correlates with atrial fibrillation. However, few studies have investigated the potential effect of myomectomy on LA phasic remodeling in HOCM after myectomy using cardiovascular magnetic resonance (CMR) feature tracking (FT). This study aims to evaluate the LA structural and functional remodeling with HOCM after myectomy by CMR-FT and to further investigate the determinants of LA reverse remodeling. Methods In this single-center study, we retrospectively studied 88 patients with HOCM who received CMR before and after myectomy between January 2011 and June 2021. Preoperative and postoperative LA parameters derived from CMR-FT were compared, including LA reservoir function (total ejection fraction [EF], total strain [εs], peak positive strain rate [SRs]), conduit function (passive EF, passive strain [εe], peak early negative strain rate [SRe]) and booster function (booster EF, active strain [εa], late peak negative strain rate [SRa]). Eighty-six healthy participants were collected for comparison. Univariate and multivariate linear regression identified variables associated with the rate of change of εa. Results Compared with preoperative parameters, LA reservoir function (total EF, εs, SRs), booster function (booster EF, εa, SRa), and SRe were significantly improved after myectomy (all P

Abstract The fermented milk mainly consists of Lactobacillus bulgaricus and Streptococcus thermophilus. This research was aimed to investigate the cofermentation characteristics of different L. bulgaricus and S. thermophilus strains. Three strains of L. bulgaricus and S. thermophilus ST‐2 were mixed and prepared into the starter (A, B, and C) and applied to milk fermentation for screening of optimal combination, and the commercial starter (D) was used as the reference. The microrheological properties during fermentation were analyzed by using multifrequency diffusion spectroscopy. Meanwhile, the fermented milk's stability, texture, and sensory characteristics were also observed during storage. Microrheology analysis revealed that the time to reach the fermentation endpoint of starters A, B, and C was almost the same during fermentation. Groups A, B, and C showed more elastic solid‐state properties and groups A and C had higher elastic factors, indicating that the gel structure of the sample was relatively strong. During storage, the pH value of fermented milk in each group D, A, C, and B was in sequence from high to low, and the titratable acidity was also in sequence from high to low in B, C, A, and D groups, respectively. The viscosity of group A was significantly higher than that of groups B and C (p 0.05). The sensory score of fermented milk in group A was higher, and the overall texture was good. Results concluded that group A starter culture produced fermented milk with a firm gel structure and excellent texture and flavor. This study will provide data support and methodology for developing and screening compound starters applied for milk fermentation in the future.

Abstract Background China has the world’s highest rail transportation network density, and the prevalence of obesity among railway workers in China is more than twice that of adults in the world. Carotid artery plaque (CAP) is a simple and noninvasive predictor of early atherosclerosis, while the association between different obese phenotypes and CAP risk among Chinese male railway drivers is unclear. Methods This cross-sectional study was performed among 8,645 Chinese male railway drivers. Obese phenotypes were assessed based on the obesity status (the body mass index ≥ 28 kg/m2 as obesity vs.

Social capital refers to the effective functioning of social groups through networks of relationships. The lockdown measures due to coronavirus disease 2019 (COVID-19) may change the social capital among youths. This study aimed to evaluate changes in social capital before and during COVID-19 lockdown among Chinese youths. It was based on the online COVID-19 Impact on Lifestyle Change Survey (COINLICS) conducted among 10 540 youths at three educational levels, including high/vocational school, undergraduate, and graduate, before and during COVID-19 lockdown. Measures of perceptions of social capital were adapted from a validated Chinese version of Health-related Social Capital Measurement based on youths’ characteristics of living and studying environment. Social capital was measured at four dimensions, including individual social capital (ISC), family social capital (FSC), community social capital (CSC), and society social capital (SSC). Overall, compared to before lockdown, ISC and CSC scores decreased, while FSC and SSC scores increased during lockdown. When stratified by educational levels, the trends for each dimension of social capital were consistent with the overall population. There were 43.9%, 5.7%, 32.1%, and 3.7% of the participants showing decreased scores during lockdown for ISC, FSC, CSC, and SSC, respectively, while 7.2%, 24.0%, 15.3%, and 10.7% of participants showed increased scores for ISC, FSC, CSC, and SSC, respectively. Our timely, largescale study showed decreased social capital in individual and community dimensions and increased social capital in family and society dimensions during lockdown.

Background Sarcomere gene mutation and myocardial fibrosis are both associated with poorer clinical outcomes in patients with hypertrophic cardiomyopathy (HCM). The aim of this study was to determine the relationship between sarcomere gene mutation and myocardial fibrosis measured by both histopathology and cardiac magnetic resonance (CMR). Methods and Results Two hundred twenty‐seven patients with HCM who underwent surgical treatment, genetic testing, and CMR were enrolled. We retrospectively analyzed basic characteristics, sarcomere gene mutation, and myocardial fibrosis measured by CMR and histopathology. In our study, the mean age was 43 years, and 152 patients (67.0%) were men. A total of 107 patients (47.1%) carried a positive sarcomere gene mutation. The myocardial fibrosis ratio was significantly higher in the late gadolinium enhancement (LGE)+ group (LGE+ 14.3±7.5% versus LGE− 9.0±4.3%; P=0.001). Patients with HCM with SARC+ showed a high probability of fibrosis both in histopathology (myocardial fibrosis ratio 15.3±8.0% versus 12.4±6.5%; P=0.003) and CMR examination (LGE+ 98.1% versus 84.2%; P

With limited time to achieve the 2030 Agenda for Sustainable Development, the world needs effective, scalable approaches to measure and monitor global progress toward the 17 Sustainable Development Goals (SDGs). Given that many SDGs are closely related to the environment in which people live, satellite data are commonly used for SDG assessment, but they are only based on a top-down view and have inherent technical issues (e.g., insufficient spatial resolution and cloud coverage). In recent years, street view imagery (SVI), as an emerging source of remote sensing data, has been an indispensable supplement to monitor SDGs, by recording the environment from an eye-level view. However, the systematic and comprehensive understanding of SVI applications to promote SDGs is insufficient. We reviewed SVI-related studies of SDGs and found that SVI is mainly used for good health and well-being (SDG 3), sustainable cities and communities (SDG 11), zero hunger (SDG 2), and climate action (SDG 13). The SVI-based greenery view index was the most common element feature related to SDGs. The SVI-derived human perception features were also often used to assess SDG 3 and SDG 11. Future studies may further investigate the potential mechanisms between SVI-based features and SDGs. This review provides a comprehensive summary and guidance for governments and scholars worldwide to assess SDGs based on SVI in the future.

The control and prevention of public health emergencies can face severe challenges, especially financial and material challenges during the coronavirus disease 2019 (COVID-19). Enabling and ensuring smooth financial and material flows across levels, within the country, and across countries are essentially important to preparedness for global health emergencies, which cannot easily be achieved without being facilitated by preferential tax policies. China’s preferential tax policy practice developed at early stages of the COVID-19 pandemic could be useful experiences which can be adapted to unique contexts of other countries, so different stakeholders including citizens could be effectively motivated and involved in the fight against the COVID-19 pandemic. However, we should see that these policies are temporary and issued as an afterthought. There is still much to learn about how epidemic responders and policy-makers can make the most of each other’s expertise to fit into the wider information architecture of epidemic response.

Abstract Background Drought is an important abiotic stress that constrains the growth of many species. Despite extensive study in model organisms, the underlying mechanisms of drought tolerance in Nostoc flagelliforme remain elusive. Results We characterized the drought adaptation of N. flagelliforme by a combination of proteomics and qRT-PCR. A total of 351 differentially expressed proteins involved in drought stress adaptation were identified. It was found that the expression of several nutrient influx transporters was increased, including molybdate ABC transporter substrate binding protein (modA), sulfate ABC transporter substrate-binding protein (sbp) and nitrate ABC transporter (ntrB), while that of efflux transporters for toxic substances was also increased, including arsenic transporting ATPase (ArsA), potassium transporter (TrkA) and iron ABC transporter substrate-binding protein (VacB). Additionally, photosynthetic components were reduced while sugars built up during drought stress. Non-enzymatic antioxidants, orange carotenoid protein (OCP) homologs, cytochrome P450 (CYP450), proline (Pro) and ascorbic acid (AsA) were all altered during drought stress and may play important roles in scavenging reactive oxygen species (ROS). Conclusion In this study, N. flagelliforme may regulates its adaptation to drought stress through the changes of protein expression in photosynthesis, energy metabolism, transport, protein synthesis and degradation and antioxidation. Highlights • A total of 351 DEPs involved in adaptation to drought stress were identified. • Changes in the expression of six OCP homologs were found in response to drought stress. • Differential expression of transporters played an important role in drought stress adaptation. • Most PSII proteins were downregulated, while PSI proteins were unchanged in response to drought stress. • Sugar metabolism was upregulated in response to drought stress.

Abstract Background Few studies have explored the health and development of AIDS orphans using the positive youth development (PYD) framework. Grounded in this framework, the main objective of this study is to examine how internal assets (i.e., resilience) and external assets (i.e., school connectedness, peer support) affect subjective well-being among Yi AIDS orphans in the Liangshan Yi Autonomous Prefecture, Sichuan province, China. Methods A cross-sectional survey was conducted by interviewing 571 AIDS orphans and 979 non-orphans of Yi ethnic minority from 5th-10th grades. Structural equation models (SEM) were utilized to identify and estimate the direct and indirect effects of internal and external assets on subjective well-being. Results The average score of subjective well-being was significantly lower for AIDS orphans than for in non-orphans (P

Lactiplantibacillus plantarum (L. plantarum) ST was isolated from De’ang pickled tea in Yunnan Province, China. The genomes of strain ST were fully sequenced and analyzed using the PacBio RS II sequencing system. Our previous study has shown that L. plantarum ST is a potential probiotic strain. It had strong tolerance in the simulated artificial gastrointestinal tract, and in the antagonism tests, this strain showed strong antibacterial activity. Therefore, as a probiotic, it may be used in animal breeding. L. plantarum ST genome was composed of 1 circular chromosome and 7 plasmids. The length of the whole genome was 3320817 bp, and the annular chromosome size was 3058984 bp, guanine + cytosine (G ± C) content (%) was 44.76%, which contained 2945 protein-coding sequences (CDS). This study will contribute to a further comprehensive understanding of L. Plantarum ST at the genomic level and provide a theoretical basis for its future application in animal breeding.

Introduction: Limited studies have focused on how the COVID-19 outbreak and thereby lockdown had affected the youth’s food ordering patterns, which was associated with their dietary behaviors and could have longer term impacts on their later-life health status if the trend persists. This study aimed to evaluate changes in food ordering patterns among youths in China after the COVID-19 outbreak. Methods: The data were obtained from a national retrospective survey (COINLICS) conducted in early May 2020 via social media platforms in China among more than 10,000 youth participants at 3 educational levels. Participants reported their basic sociodemographic characteristics, weight status, and lifestyles including food ordering patterns. We described and compared their weight status and food ordering patterns before COVID-19 (January) and under lockdown (February). Results: We observed significant changes in youths’ weight status and food ordering patterns under lockdown. A significant increase was observed in the prevalence of overweight/obesity (13.5%–17.0%) and obesity (8.7–10.8%), which varied by sex and educational level. Overall, the average weekly frequency of food ordering among the Chinese students had declined, with the largest decrease seen among graduate students, followed by undergraduate and high/vocational school students. Regardless of types of food, the percentage of participating youths who started ordering under lockdown was all lower than that of youths who stopped ordering. Among those who had still ordered foods under lockdown, a larger percentage of female than male high/vocational school students ordered barbecue/grill and cakes/pastries; no significant differences were found across the educational levels. Conclusion: The participating youths’ food ordering patterns had significantly changed during the COVID-19 lockdown, with heterogeneities observed to different extents between sexes and across educational levels. Our findings would inform policy makers and health professionals of these changes in time, for better policy making and public health practice.

IntroductionWith the rapid aging population, the mental health of older adults is paid more and more attention. Anxiety is a common mental health illness in older adults. Therefore, the study aimed to explore the current situation of anxiety and its factors among the elderly in China.MethodsBased on the data from 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), a total of 10,982 respondents aged 60 and above were selected. Generalized Anxiety Disorder (GAD-7) scale was used to assess the anxiety. Univariate and multivariate analysis were used to analyze the influencing factors of anxiety. Random forest was established to rank the importance of each influencing factors.ResultsThe results showed that the prevalence of anxiety among the elderly was 11.24%. Anxiety was mainly associated with 14 factors from five aspects: sociodemographic characteristics, health status, psychological state, social trust and social participation, among which loneliness related to psychological status was the most important factor.DiscussionThe revelation of this study is that the present situation of anxiety among the elderly cannot be ignored, and it is necessary to take measures to prevent and control it from many aspects.

Objectives: This study examined whether social capital (SC) mediated the association between internalized homophobia (IH) and condomless sex among men who have sex with men (MSM), with the interaction of SC and IH considered.Methods: A cross-sectional study was conducted between November 2018 and April 2019 in Sichuan Province, China. A total of 540 participants were recruited to investigate their IH, SC, and condomless sex. A four-way decomposition of causal mediation analysis was used to test SC’s roles in the association between IH and condomless sex.Results: Condomless sex was prevalent (46.7%) among the participants, which was significantly associated with IH [odds ratio (OR) = 1.70] and SC (OR = 0.55). A direct effect [excess risk ratio (RR = 0.32)] and an indirect effect (excess RR = 0.16) of SC were found to be significant in the association between IH and condomless sex. Heterogeneities in effects were observed when taking the SC’s domains (e.g., individual and family-based SC) as mediators. SC’s effects were significant only in the homosexual subgroup.Conclusion: IH-based intervention with consideration of SC can be tailored to MSM to decrease condomless sex and curb the spread of HIV, especially for the homosexual subgroup.

Abstract Background The number of older people living with HIV (PLWH) is increasing. Although there are many studies affecting medication adherence, research on the impact of social capital and mental health on medication adherence in this particular population is limited. Method Data were collected from an ongoing observational prospective cohort study, starting from November 2018, among older PLWH in Sichuan province, China. Five hundred twenty-one participants were interviewed. Social capital consists of the individual and family (IF) scale, and the community and society (CS) scale. The presence of probable depression and probable anxiety were assessed using the CES-D-10 and GAD-7 scales. Adherence was defined as taking ≥80% of prescribed HIV medication in 4 days prior to the interview. Two sets of Firth’ penalized regression analyses were used to estimate the association between social capital, mental health, and medication adherence. Results The prevalence of non-adherence was 18.2% (95/521) among older PLWH in this study. After adjusting for significant factors, the CS social capital (OR: 0.92, 95%CI:0.85–0.99, p

BackgroundGreenness exposure is beneficial to human health, but its potential mechanisms through which the risk for metabolic syndrome (MetS) could be reduced have been poorly studied. We aimed to estimate the greenness-MetS association in southeast China and investigate the independent and joint mediation effects of physical activity (PA), body mass index (BMI), and air pollutants on the association.MethodsA cross-sectional study was conducted among the 38,288 adults based on the Fujian Behavior and Disease Surveillance (FBDS), established in 2018. MetS was defined as the presence of three or more of the five components: abdominal obesity, elevated triglyceride, reduced high-density lipoprotein cholesterol (HDL-C), high blood pressure, and elevated fasting glucose. The residential greenness exposure was measured as the 3-year mean values of the normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI) within the 250, 500, and 1,000 meters (m) buffer zones around the residential address of each participant. Logistic regression models were used to estimate the greenness-MetS association. The causal mediation analysis was used to estimate the independent and joint mediation effects of PA, BMI, particulate matter with an aerodynamic diameter of 2.5 μm (PM2.5), particulate matter with an aerodynamic diameter ≤ 10 μm (PM10), nitrogen dioxide (NO2), and sulfur dioxide (SO2).ResultsEach interquartile range (IQR) increase in greenness was associated with a decrease of 13% (OR = 0.87 [95%CI: 0.83, 0.92] for NDVI500m and OR = 0.87 [95%CI: 0.82, 0.91] for EVI500m) in MetS risk after adjusting for covariates. This association was stronger in those aged < 60 years (e.g., OR = 0.86 [95%CI: 0.81, 0.92] for NDVI500m), males (e.g., OR = 0.73 [95%CI: 0.67, 0.80] for NDVI500m), having an educational level of primary school or above (OR = 0.81 [95%CI: 0.74, 0.89] for NDVI500m), married/cohabitation (OR = 0.86 [95%CI: 0.81, 0.91] for NDVI500m), businessman (OR = 0.82 [95%CI: 0.68, 0.99] for NDVI500m), other laborers (OR = 0.77 [95%CI: 0.68, 0.88] for NDVI500m), and non-smokers (OR = 0.77 [95%CI: 0.70, 0.85] for NDVI500m). The joint effect of all six mediators mediated about 48.1% and 44.6% of the total effect of NDVI500m and EVI500m on the MetS risk, respectively. Among them, BMI showed the strongest independent mediation effect (25.0% for NDVI500m), followed by NO2 and PM10.ConclusionExposure to residential greenness was associated with a decreased risk for MetS. PA, BMI, and the four air pollutants jointly interpreted nearly half of the mediation effects on the greenness-MetS association.

The adsorption equilibrium of methyl blue (MB) at different temperatures was optimized using activated graphene (AG) as an adsorbent. The experimental data were compared using five linear and nonlinear adsorption isotherms, namely, Langmuir, Freundlich, Redlich–Peterson (R-P), Sips, and Toth, to estimate the best fit of the equilibrium data. Five distinct error functions were utilized to conduct nonlinear regression for the adsorption equilibrium: SSE, ARE, HYBRID, MPSD, and EABS. These functions offered a wide range of residuals for comparison. For a more accurate prediction of the isotherm model, two statistical techniques—SNE and CND—were applied. By using these techniques in conjunction, a more objective analysis of the error and deviation between the observed and predicted data was achieved, ultimately leading to improved accuracy in the error analysis. The sorption results demonstrated the highest MB removal of 691.89 mg g−1, which amounted to 98.32% within 120 min. The error analysis findings indicated that the SSE and HYBRID functions produced the smallest error residuals. Based on the “goodness of fit” criterion, the models in this study were ranked as R-P > Toth > Langmuir > Sips > Freundlich. Among these models, the R-P isotherm demonstrated the best fit for the data, exhibiting the lowest variance in residuals. Its CND value ranged between 0.0025 and 0.0048, which further supports its superior fit compared to the other models. The combination of multiple error functions and statistical methods allowed for a comprehensive and objective assessment of the nonlinear regression models. The results highlight the importance of using various techniques to improve the accuracy of error analysis and identify the best-fitting isotherms for adsorption.

Abstract Background Aging population and other factors have led to a rapid rise in cancer incidence in China. However, under the influence of traditional perception of diseases, deaths and economic factors, many patients who are unresponsive to radical treatment are still adherent to excessive and unnecessary treatment, which may lead to poor quality of life (QoL) and increase unnecessary medical burden. Aim Compare the difference of the quality of life and cost-utility value between patients who received palliative care (PC) and patients who were adherent to conventional anticancer treatment (CAT) and provides empirical evidence of clinical and economic value for hospital-based PC. Methods Chinese Quality of Life Questionnaire (CQLQ) Scale was used to collect advanced cancer patients’ QoL on admission and discharge days. Paired and independent samples’ statistical analysis were used to compare inter- and intra- QoL between PC and CAT group. Delphi and Analytic Hierarchy Process were used to weight QoL scores and converted the QoL to quality-adjusted life years (QALYs). Propensity Score Matching (PSM) for 1:1 was used to compare average hospitalization expenses between two groups. The expense per QALYs was used for Cost-Utility analysis between the two treatments. Results A total of 248 hospitalized patients diagnosed with metastatic disease at stage IV were recruited from West China Fourth Hospital between January 2018 and August 2018, including 128 patients receiving PC and 120 patients receiving CAT. Although both treatments had positive effects on improving QoL for patients, the QoL in the PC group were significantly higher than that in the CAT group (55.90 ± 18.80 vs 24.00 ± 8.60, t = 7.51, p

Abstract Aims This study aims to demonstrate the characteristics of late gadolinium enhancement (LGE) assessed by cardiovascular magnetic resonance (CMR) imaging in patients with giant cell myocarditis (GCM). Methods and results Six patients histologically diagnosed with GCM were retrospectively recruited in this study. All of them underwent CMR during hospitalization. The distribution and extent of LGE were assessed on both ventricles, and the AHA‐17 segment model was used for left ventricular (LV) analysis. Nine case reports with CMR in GCM were reviewed and summarized to investigate the features of LGE further. LGE was detected on both ventricular walls in all subjects. For a detailed analysis of LGE in the LV, the extent ranged from 21.6% to 56%. Among 70 segments (68.6%) involved by LGE, the subendocardial LGE was the most common pattern (46/102, including 24 segments located in the right‐sided septum), followed by the subepicardial pattern (23/102). The right‐sided septum, the subepicardial anterior wall, and the subendocardial right ventricular (RV) wall were observed in all subjects. To summarize the results of the present study with these case reports, the three most common patterns of LGE are the right‐sided septum (73%), the subepicardial anterior wall (60%), and the subendocardial RV wall (53%). Conclusions Extensive LGE seems to be common in GCM, affecting both LV and RV walls. Apart from subepicardial LGE, subendocardial LGE, which was used to be implicated in ischaemic disease, was frequently presented in GCM. The right‐sided subendocardial septum, the subepicardial anterior wall, and the subendocardial RV wall might be the vulnerable areas of LGE in GCM.

COVID-19 has caused almost 770,000 deaths in the United States by November 2021. The nighttime light (NTL), representing the intensity of human activities, may reflect the degree of human contacts and therefore the intensity of COVID-19 transmission. This study intended to assess the associations between NTL differences and COVID-19 incidence and mortality among U.S. counties. The COVID-19 data of U.S. counties as of 31 December 2020 were collected. The average NTL values for each county in 2019 and 2020 were derived from satellite data. A negative binomial mixed model was adopted to assess the relationships between NTL intensity and COVID-19 incidence and mortality. Compared to the counties with the lowest NTL level (0.14–0.37 nW/cm2/sr), those with the highest NTL level (1.78–59.61 nW/cm2/sr) were related with 15% higher mortality rates (mortality rate ratio:1.15, 95 %CI: 1.02–1.30, p-value: 0.02) and 23% higher incidence rates (incidence rate ratio:1.23, 95 %CI: 1.13–1.34, p-value

Although two years have passed since the coronavirus disease 2019 (COVID-19) outbreak, various variants are still rampant across the globe. The Omicron variant, in particular, is rapidly gained dominance through its ability to spread. In this study, we elucidated the spatial distribution pattern of Omicron from a global perspective. We used the cumulative number of notified COVID-19 cases per country spanning four weeks up to February 10, 2022, and the proportion of the Omicron variant genomic sequences from the Global Initiative on Sharing Avian Influenza Data (GISAID). The global spatial distribution of Omicron was investigated by analyzing Global & Local Moran’s I and Getis- Ord General G. The spatial weight matrix was defined by combining K-Nearest neighbour and flight connectivity between countries. The results showed that the epidemic is relatively severe in Europe, countries with a high number of Omicron cases and incidence tended to be clustered spatially. In contrast, there are relatively fewer Omicron cases in Asia and Africa, with few hotspots identified. Furthermore, some noted spatial outliers, such as a lowvalue area surrounded by high-value areas, deserve special attention. This study has improved our awareness of the global distribution of Omicron. The findings can provide helpful information for deploying targeted epidemic preparedness for the subsequent COVID-19 variant and future epidemics.

BackgroundEvidence on the efficacy of antiretroviral therapy (ART) regimen switches on the mortality of patients with HIV drug resistance (HIVDR) is limited. ObjectiveWe aim to provide policy guidance for ART regimen selection and evaluate the effectiveness of ART regime switches for people living with HIV and HIV-1 drug resistance. MethodsThis retrospective observational cohort study included 179 people living with HIV and HIV-1 drug resistance from 2011 to 2020. The time that participants switched treatment regimens either to protease inhibitor (PI)–based ART regimens (PIs) or nonnucleoside reverse transcriptase inhibitor (NNRTI)–based ART regimens (NNRTIs) was taken as an observation starting point and followed up every 12 months. The parametric g-formula was used to estimate the 5-year risk of mortality under the situations of (1) natural course, (2) immediate switch to NNRTIs, (3) immediate switch to PIs, and (4) if CD4(+) T cells

Abstract Objective Sleep plays an important role in the health and well-being of middle aged and elderly people, and social capital may be one of the important factors for sleep disorders. This study aimed to understand the relationship between social capital and sleep disorders in a unique region of China –Tibet that generally has the disadvantaged economic status compared to other parts of China. Methods The study was based on Tibetan data from The China Multi-Ethnic Cohort (CMEC) and was conducted from May 2018 to September 2019. A total of 3194 Tibetans aged > 50 were selected from the community population by multi-stage stratified cluster sampling. Social capital was measured using two validated health-related social capital scales, family/community and society.. Sleep disorders were measured as the presence of disorders of initiating and maintaining sleep, early morning awakening, or daytime dysfunction. Logistic regression models were applied to examine the association between social capital and sleep disorders. Results 39.9% (1271/3194) of the participants had sleep disorders. In addition, after controlling for all potential variables, family social capital was significantly negatively associated with sleep disorders (OR = 0.95, P

Abstract Smoking has a substantial impact on deaths from non-communicable chronic diseases (NCDs). Quantitatively measuring the impact of tobacco control on population health is of great theoretical and practical importance, for governments to make health policy decisions. Focusing on premature deaths, we predicted the deaths by 2030 from major NCDs caused by smoking among people aged 30–69 years in Sichuan Province, Southwest China. We extracted data for 1990–2015 from the Global Burden of Disease Study 2015 and calculated the population attributable fraction, to estimate the proportion of deaths caused by smoking. Four different tobacco control standards were used to estimate 2030 projections for the prevalence of smoking and premature mortality. If smoking prevalence were reduced by 30% from 2015 levels, premature mortality could be expected to decline by 24.4% in 2030, achieving 81.3% of the World Health Organization target for reducing premature mortality by 30%. Compared with the continuation of historical trends, the strongest tobacco control policy scenario would reduce premature mortality by 6.6%, prevent 23,600 deaths, reduce mortality by 7.8%, and increase life expectancy at birth by 0.3 years. Smoking bans represent an important action toward achieving national health goals.

The characteristics and shortcomings of the current multi-port direct current (DC) to DC (DC/DC) energy router were analyzed.A multi-port DC/DC energy router for the energy Internet was optimized and designed.Through the analysis of the operating voltage requirements under different working conditions,the full-bridge proportional design of the sub-module was proposed.On this basis,an alternating current (AC) to DC (AC/DC) decoupling control strategy to realize riding through the DC fault without de-blocking any devices was proposed.The multi-port DC/DC energy router was used to realize the interconnection of multiple DC power grids with different voltage levels.It not only retained the advantages of low cost and low loss of the traditional DC autotransformer,but also effectively improved the shortcomings that the DC autotransformer cannot ride through the DC fault.Finally,the simulation test was carried out in the MATLAB/Simulink environment to verify the stability of the technology in the normal operation,the feasibility of suppressing the DC fault and the effectiveness of the control strategy.

Abstract Background The drug resistance and the virologic failure of antiretroviral therapy (ART) are quite severe in Liangshan. A better understanding of the virologic failure of ART and the HIV-1 transmission network dynamics is essential for the surveillance and prevention of HIV. Here, we analyzed the HIV-1 CRF07_BC strain genetic transmission networks and their associated factors among people living with HIV-1 (PLWH) who had virologic failure of ART by using close genetic links. Methods The drug-resistant mutations were determined using the Stanford University HIV Drug Resistance Database. HIV-1 pol genes sequences were used for phylogenetic and genotypic drug resistance analysis. The genetic transmission networks were performed by comparing sequences, constructing the phylogenetic tree, calculating the pairwise distance, and visualizing the network. Results A total of 1050 PLWH with CRF07_BC pol sequences were finally identified and included in the genetic transmission network analysis from 2016 to 2017. Of the 1050 CRF07_BC pol sequences, 346 (32.95%) fell into clusters at a genetic distance of 0.006, resulting in 137 clusters ranging in size from 2 to 40 individuals. Subjects who were widowed or divorced were less likely to form a genetic transmission network (adjusted OR: 0.50), while subjects who had shared a needle ≥ five times were more likely to form a network (adjusted OR: 1.88). Conclusions The genetic transmission networks revealed the complex transmission pattern, highlighting the urgent need for transmission monitoring of virologic failure of ART and selection of more effective therapeutic regimens to promote viral suppression.

Abstract Background Liangshan Yi Autonomous Prefecture is one of the areas that most severely affected by human immunodeficiency virus (HIV) in China, and virological failure on antiretroviral therapy (ART) is serious in this area. Analyses of prevalence and determinants of ART failure, the genetic diversity and drug resistance among people living with HIV (PLWH) helps improve HIV treatment efficiency and prevent HIV transmission. Methods A total of 5157 PLWH were recruited from 2016 to 2017. The venous blood samples were subjected to RT-PCR, followed by sequencing of the HIV-1 pol gene, targeting the protease and reverse transcriptase fragments. HIV-1 diversity was analyzed using the DNAStar software and drug resistance mutations were analyzed using the Stanford University HIV Drug Resistance Database. Results A total of 2156 (41.81%) PLWH showed virological failure on ART. Males (ORm = 1.25), heterosexual behaviors and drug injection (ORm = 1.44) and mother to child transmission routes (ORm = 1.58), the clinical stage of AIDS (ORm = 1.35), having used illicit drugs and shared the needles (1–4 times: ORm = 1.34; more than 5 times: ORm = 1.52), having ever replaced ART regimen (ORm = 1.48) increased the risk of virological failure among PLWH, while higher education lever (ORm = 0.77) and ≥ 12 months on ART (12 ~ 36 months: ORm = 0.72; ≥36 months: ORm = 0.66) was associated with lower likelihood of virological failure. The data revealed that CRF07_BC (1508, 95.62%) were the most common strains, and the drug-resistant rate was 32.10% among PLWH with virological failure in this area. The high frequencies of drug resistance were found in EFV and NVP of NNRTIs, ABC, FTC and 3TC of NRTIs, and TPV/r in PIs. The most common mutations in NNRTIs, NRTIs and PIs were K103N/KN (64.69%), M184V/MV/I (36.29%) and Q58E/QE (4.93%), respectively. Conclusion We concluded that surveillance of virological failure, HIV-1 subtypes, and drug resistance to understand HIV-1 epidemiology and guide modification of ART guidelines, and target prevention and control strategies should be formatted to reduce the virological failure and drug resistance to promote viral suppression and prevent HIV-1 transmission.

Abstract Background Mental health problems are common among older people living with HIV and associated with poorer health outcomes. Social capital is an important determinant of mental health problems but under-studied in this population. This study investigated the association between social capital and mental health problems among older people living with HIV in China. Methods The study was based on the baseline data of a cohort study investigating mental health among older people living with HIV in Sichuan, China during November 2018 to February 2019. Participants were people living with HIV aged ≥50 years living in Sichuan province. Stratified multi-stage cluster sampling was used to recruit participants from 30 communities/towns; 529 out of 556 participants being approached completed the face-to-face interview. Social capital was measured by two validated health-related social capital scales: the Individual and Family scale and the Community and Society scale. Presence of probable depression (CES-D-10 score ≥ 10) and probable anxiety (GAD-7 score ≥ 5) were used as dependent variables. Two-level logistic regression models were applied to examine the association between social capital and probable depression/anxiety. Results The prevalence of probable depression and probable anxiety was 25.9% (137/529) and 36.3% (192/529), respectively. After adjusting for significant covariates, the individual/family level of social capital was inversely associated with both probable depression (odds ratios (OR): 0.89, 95% CI: 0.84–0.93, p 0.05). Conclusions Interventions building up social capital should be considered to improve mental health of older people living with HIV. Some useful strategies include cognitive processing therapy, improving community networking and engagement, and promoting social bonding with neighborhood.

Abstract Background Hypertension is highly prevalent and is the primary risk factor for cardiovascular disease (CVD) and chronic kidney disease (CKD). While declining in some developed countries, it is increasing rapidly in some developing countries. Sichuan province is the largest and underdeveloped region in southwest China, with 486 thousand square kilometers, more than 80 million residents, unbalanced economic development, and high prevalence, low awareness, low treatment and low control rate of hypertension. We forecasted the death burden due to high systolic blood pressure (SBP) in Sichuan from 1990 to 2030, to raise the awareness of public and government of the importance and benefits of hypertension control. Methods We conducted secondary analysis based on data of Global Burden of Disease (GBD) 1990–2015, and predicted the population SBP level, population attributable fraction, and death burden for people aged 30–69 under different scenarios in 2030. Results Comparing with natural trend, if the prevalence of high SBP can be reduced relatively by 25% by 2030, the deaths of non-communicable chronic diseases (NCDs), CVD and CKD would be reduced by 27.1 thousand, 26.2 thousand and 0.8 thousand for people aged 30–69; the mortality would be reduced by 10.8, 32.8 and 16.0%; and the premature mortality would be reduced by 9.9, 32.0 and 16.0%, respectively. Conclusions Controlling or decreasing the prevalence of high SBP can significantly reduce the deaths, death rate and premature mortality of NCDs, CVD and CKD for the 30–69 years old population in Sichuan. There would be huge benefits for the governments to take cost-effective measures to control or reduce the prevalence of hypertension.