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Objective: To evaluate the utility of trio-based prenatal exome sequencing (pES), incorporating splice-site and mitochondrial genome assessment, in the prenatal diagnosis of fetuses with ultrasound anomalies and normal copy-number variant sequencing (CNV-seq) results.Methods: This was a prospective study of 90 ongoing pregnancies with ultrasound anomalies that underwent trio-based pES after receiving normal CNV-seq results, from September 2020 to November 2021, in a single center in China. By using pES with a panel encompassing exome coding and splicing regions as well as mitochondrial genome for fetuses and parents, we identified the underlying genetic causes of fetal anomalies, incidental fetal findings and parental carrier status. Information on pregnancy outcome and the impact of pES findings on parental decision-making was collected.Results: Of the 90 pregnancies included, 28 (31.1%) received a diagnostic result that could explain the fetal ultrasound anomalies. The highest diagnostic yield was noted for brain abnormalities (3/6 (50.0%)), followed by hydrops (4/9 (44.4%)) and skeletal abnormalities (13/34 (38.2%)). Collectively, 34 variants of 20 genes were detected in the 28 diagnosed cases, with 55.9% (19/34) occurring de novo. Variants of uncertain significance (VUS) associated with fetal phenotypes were detected in six (6.7%) fetuses. Interestingly, fetal (n = 4) and parental (n = 3) incidental findings (IFs) were detected in seven (7.8%) cases. These included two fetuses carrying a de-novo likely pathogenic (LP) variant of the CIC and FBXO11 genes, respectively, associated with neurodevelopmental disorders, and one fetus with a LP variant in a mitochondrial gene. The remaining fetus presented with unilateral renal dysplasia and was incidentally found to carry a pathogenic PKD1 gene variant resulting in adult-onset polycystic kidney, which was later confirmed to be inherited from the mother. In addition, parental heterozygous variants associated with autosomal recessive diseases were detected in three families, including one with additional fetal diagnostic findings. Diagnostic results or fetal IFs contributed to parental decision-making about termination of the pregnancy in 26 families (26/72 (36.1%)), while negative pES results or identification of VUS encouraged 40 families (40/72 (55.6%)) to continue their pregnancy, which ended in a live birth in all cases.Conclusion: Trio-based pES can provide additional genetic information for pregnancies with fetal ultrasound anomalies without a CNV-seq diagnosis. The incidental findings and parental carrier status reported by trio-based pES with splice-site and mitochondrial genome analysis extend its clinical application, but careful genetic counseling is warranted. © 2022 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

In the process of disaster emergency response, how to achieve rapid sharing of geographic information data is still a difficult problem to be solved. Combining the demand for emergency geographic information data in response to emergencies and major natural disasters in China, investigating the current situation of existing emergency geographic information data sharing, and based on the actual emergency geographic information service guarantee work, this paper researches and analyzes the sharing demand, designs the emergency geographic information data sharing model, and studies the emergency geographic information data sharing mechanism from the aspects of sharing platform, data sharing requirements, and service sharing requirements. [ABSTRACT FROM AUTHOR]

In the face of the problems that have emerged along with the rapid industrialization and urbanization in China in recent years, the country proposes to compile the national main functional area plan, divides the national land space into four types of main functional areas: optimized development, key development, restricted development and prohibited development, and carries out the compilation of the national main functional area plan at two levels: national and provincial. The spatial evaluation indexes of the country and the results of the main functional area planning are expressed graphically in the form of thematic maps to make them visual, intuitive and easier to understand. In this paper, we study the topic selection of the National Atlas of Main Functional Area Planning, and mainly introduce the research results of the atlas in topic selection research, content structure design and layout design based on the comprehensive analysis of national and provincial information and following the principles of topic selection. [ABSTRACT FROM AUTHOR]

The demand for healthy old-age care is growing rapidly in China. The traditional old-age care model can no longer meet elderly patients' demands for medical care and old-age care. To promote the development of medical care-integrated old-age care, a solution covering multiple aspects is necessary. In the context of the global development of healthy aging, China recently issued many policies to integrate old-age care with medical care, establishing protection for a large number of disabled elderly people. The Integrated Care of Older People (ICOPE) project is an international program developed by the World Health Organization. This paper reviews China's medical and old-age care integration model and the opportunities and challenges in implementing the ICOPE in the context of healthy aging in China. [ABSTRACT FROM AUTHOR]

Objectives: Given the increasing prevalence of osteoporosis and the important role dynamic balanced plays in the assessment of muscle function, we aimed to examine the joint and separate effects of osteoporosis and poor dynamic balance on the incidence of sarcopenia in Chinese elderly individuals. Design: This study was conducted on 658 (44.4% male) Chinese suburban-dwelling participants with a mean age of 68.42 ± 5.43 years who initially had no sarcopenia and were aged >60 years. A quantitative ultrasound scan of each participant's calcaneus with a T score less than −2.5 was used to identify the prevalence of osteoporosis. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia criteria. We assessed dynamic balance using the Timed Up and Go Test (TUGT). Participants who scored in the top 20% on the TUGT were defined as having poor dynamic balance. Results: After a follow-up of three years, the incidence of sarcopenia in the general population was 8.1% (9.6% in males, 6.8% in females). The incidence of sarcopenia was progressively greater in people suffering from both osteoporosis and poor dynamic balance (OR=2.416, 95%CI=1.124–5.195) compared to those who only had osteoporosis (OR=0.797, 95%CI=0.378–1.682) or poor dynamic balance (OR=1.226, 95%CI=0.447–3.363) in models without adjustments. Even after adjusting for potential confounders, the result still held true (OR=2.431, 95%CI=1.053–5.614). Conclusions: In our study, we found individuals who suffered from both osteoporosis and poor dynamic balance simultaneously had a significantly higher incidence of sarcopenia than those who suffered from either one or the other. [ABSTRACT FROM AUTHOR]

Background: Our previous study suggested that mitochondrial haplogroup F (mtDNA F) was a longevity-associated biomarker, but the effect of mitochondrial haplogroup F on longevity individuals with metabolic syndrome (MetS) was not clear. Thus we explored the association between mtDNA F and MetS among longevity and control population in Guangxi Zhuang Autonomous Region, China.Method: A total of 793 individuals consisting of 307 long-lived participants and 486 local healthy controls were involved in this study. Genotypes of mtDNA F were amplified by polymerase chain reaction and Sanger sequenced. MetS was defined according to the revised National Cholesterol Education Program’s Adult Treatment Panel III (NCEP ATPIII ) criteria.Results: The prevalence of MetS in longevity group (28.0%) was higher than that (18.5%) in control group (P=0.002). Through the case-control stratify analysis, the prevalence of MetS in mtDNA F+ longevity individuals (29.8%) was 4.6 fold higher than that (5.3%) in local control group (P<0.001). However, after further longevity-only analysis, no association between MetS and mtDNA F+ in longevity group was observed (P=0.167). Following same analysis of two variables in control group, we found that the prevalence of MetS in mtDNA F- (95.8%) was higher than that in mtDNA F+ (5.3%); conversely, the prevalence of non-metabolic syndrome (NMetS) in mtDNA F+ (94.7%) was markedly higher than that in mtDNA F- (4.2%) (P<0.001).Conclusion: We demonstrated that mtDNA F+, as a molecuar biomarker, might not only confer beneficial effect to resistance against MetS but also function as a positive factor for long-life span among the population in Guangxi Zhuang Autonomous Region, China. [ABSTRACT FROM AUTHOR]

City water utilities are increasingly integrating climate uncertainties into planning process. Considering our current scientific understanding of climate change have been developed into a new level, traditional water utility planning methods, based on an assumption of stationarity, are being fundamentally challenged. It is encouraging that many water utilities, recognizing the limitations of stationarity, are broadening their perspective on climate issues and deliberating new planning methods to deal with conditions of pervasive climatic uncertainty. This paper elaborates steps and processes of a water utility planning approach which is incorporated into water sector (water supply and drainage) of Wuhan. With the Asian Development Bank's financial fund in 2010, the city water utility planners developed a framework and a series of investment decisions through a “bottom-up” method involving Wuhan staff and stakeholders in workshops. An essential lesson draw from this case study is that initiative to increase climate resilience does not need to wait for advancements of future climate conditions study or detailed climate scenarios to be developed or for those scenarios to be incorporated into utility plans. The framework for ranking and identifying impacts and vulnerabilities was derived from widely accepted international methodologies and tailored to suit local conditions. In this way, it takes account of the situation on the ground, including the local perceptions of both conditions and needs, the existing plans, and the need to achieve consensus for investments in climate change adaptation. Finally this paper emphasizes that in order to meet specific needs, decision makers have to select appropriate methodology to suit the circumstances. [ABSTRACT FROM AUTHOR]

The implementation of emission reductions during the 2014 Asia-Pacific Economic Cooperation (APEC) summit provides a valuable opportunity to study air pollution in Beijing. From 15 October to 30 November 2014, the height of the atmospheric mixing layer and the vertical attenuated backscattering coefficient profiles were observed online using a lidar ceilometer. Compared with fine particulate matter (PM2.5) and aerosol optical depth (AOD) data, the attenuated backscattering coefficients measured by the lidar ceilometer were strongly correlated with the PM2.5 concentration and AOD (correlation coefficients of 0.89 and 0.86, respectively). This result demonstrated the reliability of the vertical distribution of particles measured by the lidar ceilometer. By classifying different degrees of air pollution based on visibility, we found that during the transition period of air pollution, which was affected by transport of southerly flows in the mixing layer, the attenuated backscattering coefficient from 0 to 1500m was enhanced by approximately 1.4Mm-1 sr-1 (140 %). During the polluted period, the attenuated backscattering coefficient from 0 to 300m suddenly increased, and the coefficient near the surface peaked (approximately 14Mm-1 sr-1); however, the attenuated backscattering coefficient from 300 to 900m decreased gradually, and the average value from 0 to 1500mdecreased by 0.5Mm-1 sr-1 (20 %). The height of the mixing layer gradually decreased, and the ratio of CO / SO2 gradually increased, which indicate that the polluted period was dominated by local contribution. Due to the emission reductions during APEC (DAPEC), the concentration of PM2.5 decreased by 59.2 and 58.9% and visibility improved by 70.2 and 56.0% compared to before (BAPEC) and after APEC (AAPEC), respectively. The contribution of regional transport in DAPEC decreased by approximately 36 and 25 %, and the local contribution decreased by approximately 48 and 54% compared to BAPEC and AAPEC, respectively. The most effective method of controlling air pollution in the Beijing area is to reduce regional emissions during the transition period and reduce local emissions during the polluted period. [ABSTRACT FROM AUTHOR]

The article presents a research study concerning the 1/f-noise measurement and its significance in climate and weather observations in Yangtze River, China. Researchers cited the usefulness of such measurement in determining the variations and spectrum of humidity, precipitation, temperature, and wind speed. The river's high volatility and its intra-annual 1/f spectrum is also determined.

This study determined the tuf gene sequence of the phytoplasma specific to paulownia witches’-broom from Nanyang, China (hereby designated PaWB-Ny). The PaWB-Ny tuf gene was 1185 nucleotides in length and confirmed that the phytoplasma belongs to subgroup 16SrI-D of aster yellows. Three characteristic GTP-binding protein motifs were identified based on the peptide deduced from the tuf gene sequence. Results suggested that the elongation factor EF-Tu was localized in the cytoplasm and lacked hydrophobic transmembrane domains. Antibodies against PaWB-Ny EF-Tu were prepared by rabbit immunization with glutathione-S-transferase (GST)-tagged EF-Tu fusion protein expressed in Escherichia coli. EF-Tu exhibited a molecular weight of ∼43 kDa and was detected in PaWB-infected paulownia plants by western blot analysis. Indirect enzyme-linked immunosorbent assays (ELISA) and dot blotting analyses were performed with freezing and thawing treatments during antigen preparation. Dilution of extracts to an appropriate scale significantly reduced non-specific reactions. The resultant PaWB EF-Tu antibody reacted with antigens from plants infected with periwinkle virescence and chinaberry tree witches’-broom phytoplasmas, but not those infected with jujube witches’-broom or bishopwood witches’-broom phytoplasma. The EF-Tu was characteristically localized within the phytoplasmal cytoplasm of infected plant phloem tissues. [ABSTRACT FROM AUTHOR]

A range of Meiyu onset dates (MODs) have been presented but they are highly controversial. The problem is, however, crucial to local activities and meteorological service. The 1957–2001 MODs determined at several typical stations in the mid- and lower reaches of the Yangtze River valley (MLYRV) are employed to construct a regionally averaged index for quantifying the Meiyu onset time in the valley, and the ocean-atmospheric features in the extremely early and late Meiyu onset years are investigated, statistically. Results show that, typically, the Meiyu season starts in June at a regional mean level, and the MOD is of good relationship with the Meiyu duration that dominates the total precipitation during the Meiyu period, i.e., the earlier the Meiyu establishes, the longer it may persist, and thus the more the total rainfall might be. In June, at the lower troposphere the meridional temperature gradient is much larger over the MLYRV with the Meiyu front more northward in early than late onset years. Additionally, the early onset years are often accompanied in the upper troposphere by the extended South Asia High, western Pacific subtropical high more north-westward, East Asian summer monsoon and Walker circulation stronger in comparison to the late onset years. And viewed from sea surface temperature (SST) field for the early onset years, SST is lower in the central and eastern Pacific near the equator, maybe in association with the cool phase of ENSO, and considerably higher in the subtropical western North Pacific than for the late onset years. In addition, there are probably some abnormal precursory signals for the early (late) Meiyu onset years, such as SST being higher (lower) with respect to the mean around the western Pacific warm pool, the Intertropical Convergence Zone more (less) active and the local Hadley circulation stronger (weaker) in previous boreal winter. In northern spring, the convection is probably stronger (weaker) about the Philippines. The North Pacific SST at lower latitudes might be warmer (cooler) from previous April to May, and SST appears higher (lower) over the waters around Australia in proceeding boreal winter and spring. [ABSTRACT FROM AUTHOR]

National price negotiations in China manage to improve affordability of drugs of high value in both money and clinic, and we intend to explore the implication of launch delay on their timely accessibility. Launch delay was defined as the gap days between the approval date of either the U.S. Food and Drug Administration (FDA) or the European Medicines Agency (EMA) and that of the China Center of Drug Evaluation (CDE), and we determined the launch delay of each indication covered by the medical insurance of every specific drug. The Pearson correlation coefficient of the launch delay of the drugs and their each first launch date in EU or the U.S. was -0.5608 (P<0.0001), indicating the drug lag tended to be attenuated over time. [Extracted from the article]

The article discusses the Beet mosaic virus (BtMV) which infects vegetables, particularly lettuce (Lactuca sativa) in China. Accordingly, BtMV is widespread and mainly infects the plants belonging to the Chenopodiaceae, Solanaceae and Fabaceae. In 2004 and 2006, a series of field surveys were conducted to investigate such virus in Shandong Province, China. It mentions that lactuca sativa has shown symptoms of mosaic, puckering and severe stunting with an incidence of 30-40 %. Several tests were conducted and results indicate that the virus is BtMV.

This article is the first report of the occurrence of Monilinia fructicola on stone fruit in China. In 2003 and 2004, peach and nectarine fruit showing typical brown rot symptoms were found in an orchard in a suburb of Beijing, China. The pathogen was identified as Monilinia fructicola based on morphological and molecular approaches. Pathogenicity was tested by inoculating surface sterilized, mature nectarine fruit with a droplet of conidial suspension Brown rot of stone fruit is commonly caused by one of the three Monilinia species. It is still not clear which is the major causal pathogen in stone fruit in China.

We obtained the first full-length genome sequence of canine bocavirus 2 (CBoV2) from the faeces of a healthy dog in Guangzhou city, Guangdong province, mainland China. The genome of GZHD15 consisted of 5059 nucleotides. Sequence analysis suggested that GZHD15 was close to a previously circulated Hong Kong isolate. [ABSTRACT FROM AUTHOR]

Previously, we identified three porcine circovirus type 2 (PCV2) strains in buffalo meat samples from southern China. In this study, we confirmed the reappearance of those buffalo-origin-like PCV2 strains in swine herds in this region, which supported the possible cross-species infection of PCV2 between buffalos and pigs under field conditions. [ABSTRACT FROM AUTHOR]

Background DNA repair genes can be used as prognostic biomarkers in many types of cancer. We aimed to identify prognostic DNA repair genes in patients with gastric cancer (GC) by systematically bioinformatic approaches using web-based database. Methods Global gene expression profiles from altogether 1,325 GC patients' samples from six independent datasets were included in the study. Clustering analysis was performed to screen potentially abnormal DNA repair genes related to the prognosis of GC, followed by unsupervised clustering analysis to identify molecular subtypes of GC. Characteristics and prognosis differences were analyzed among these molecular subtypes, and modular key genes in molecular subtypes were identified based on changes in expression correlation. Multivariate Cox proportional hazard analysis was used to find the independent prognostic gene. Kaplan-Meier method and log-rank test was used to estimate correlations of key DNA repair genes with GC patients'overall survival. Results There were 57 key genes significantly associated to GC patients' prognosis, and patients were stratified into three molecular clusters based on their expression profiles, in which patients in Cluster 3 showed the best survival (P < 0.05). After a three-phase training, test and validation process, the expression profile of 13 independent key DNA repair genes were identified can classify the prognostic risk of patients. Compared with patients with low-risk score, patients with high risk score in the training set had shorter overall survival (P < 0.0001). Furthermore, we verified equivalent findings by these key DNA repair genes in the test set (P < 0.0001) and the independent validation set (P = 0.0024). Conclusions Our results suggest a great potential for the use of DNA repair gene profiling as a powerful marker in prognostication and inform treatment decisions for GC patients. Legal entity responsible for the study The authors. Funding This study was supported by the National Natural Science Foundation of China (81602081, 81602078). Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Objectives To explore the characteristics of Helicobacter pylori resistance in China and the association between antibiotic resistance and several clinical factors. Methods H. pylori strains were collected from patients in 13 provinces or cities in China between 2010 and 2016. Demographic data including type of disease, geographic area, age, gender and isolation year were collected to analyse their association with antibiotic resistance. Antibiotic resistance was detected using the Etest test and the Kirby-Bauer disc diffusion method. Results H. pylori were successfully cultured from 1117 patients. The prevalence of metronidazole, clarithromycin (CLA), azithromycin, levofloxacin (LEV), moxifloxacin, amoxicillin (AMO), tetracycline and rifampicin resistance was 78.2, 22.1, 23.3, 19.2, 17.2, 3.4, 1.9 and 1.5%, respectively. No resistance to furazolidone was observed. The resistance rates to LEV and moxifloxacin were higher in strains isolated from patients with gastritis compared to those with duodenal ulcer and among women. Compared to patients ≥40 years old, younger patients exhibited lower resistance rates to CLA, azithromycin, LEV and moxifloxacin. The resistance rates to CLA and AMO were higher in strains isolated more recently, and we also found that the prevalence of resistance to metronidazole, CLA, azithromycin and AMO were significantly different among different regions of China. Conclusions The resistance rates to metronidazole, CLA and LEV were high in China. Patient age, gender, disease and location were associated with the resistance of H. pylori to some antibiotics. Furazolidone, AMO and tetracycline are better choices for H. pylori treatment in China. [ABSTRACT FROM AUTHOR]

Objective: Cryopyrin-associated periodic syndrome (CAPS) is characterized by excessive IL-1β release resulting in systemic and organ inflammation. As an anti-IL-1 agent, canakinumab has been approved with all CAPS phenotypes in USA and European countries. However, the use of canakinumab in CAPS in Chinese patients was rarely reported. In this study, we aimed to assess the effectiveness and safety of canakinumab in Chinese patients with CAPS., Methods: Patients with CAPS treated with canakinumab were included. Clinical data were collected retrospectively from medical records. Treatment response was evaluated by CAPS disease activity score, C-reactive protein (CRP), and/or serum amyloid A (SAA) levels. Data was analyzed at canakinumab initiation, at months 1, 3, 6, 9, and 12, or the last follow-up., Results: A total of 10 CAPS patients were included. 40% of patients were males, the median age at disease onset was 2.5 (2.5, 6) days and the median duration of follow-up while on canakinumab was 22.5 (8.5, 27.5) months. 80% (8/10) of CAPS patients presented with moderate-severe disease activity before the canakinumab treatment. 30% (3/10) of patients required canakinumab dose increase to control disease activity. After treatments, 60% (6/10) of CAPS patients achieved complete remission without relapse and the rest showed minimal disease activity. Clinical symptoms such as fever and rash were improved significantly in most patients (80%). Although abnormal imaging in brain MRI remained in over half of those patients, neurological manifestations were all relieved. 60% (6/10) of patients received prednisone before starting canakinumab therapy and five of them discontinued prednisone later. The most common adverse event was infection (40%). No serious adverse events occurred during the treatment of canakinumab., Conclusions: Canakinumab may be effective and tolerable for Chinese CAPS patients, helping to reduce the dosage of corticosteroids. However, additional trials on large samples are required to further evaluate its efficacy and safety in China., (© 2024. The Author(s).)

Background: Zoonotic infections, characterized with huge pathogen diversity, wide affecting area and great society harm, have become a major global public health problem. Early and accurate prediction of their outbreaks is crucial for disease control. The aim of this study was to develop zoonotic diseases risk predictive models based on time-series incidence data and three zoonotic diseases in mainland China were employed as cases., Methods: The incidence data for schistosomiasis, echinococcosis, and leptospirosis were downloaded from the Scientific Data Centre of the National Ministry of Health of China, and were processed by interpolation, dynamic curve reconstruction and time series decomposition. Data were decomposed into three distinct components: the trend component, the seasonal component, and the residual component. The trend component was used as input to construct the Long Short-Term Memory (LSTM) prediction model, while the seasonal component was used in the comparison of the periods and amplitudes. Finaly, the accuracy of the hybrid LSTM prediction model was comprehensive evaluated., Results: This study employed trend series of incidence numbers and incidence rates of three zoonotic diseases for modeling. The prediction results of the model showed that the predicted incidence number and incidence rate were very close to the real incidence data. Model evaluation revealed that the prediction error of the hybrid LSTM model was smaller than that of the single LSTM. Thus, these results demonstrate that using trending sequences as input sequences for the model leads to better-fitting predictive models., Conclusions: Our study successfully developed LSTM hybrid models for disease outbreak risk prediction using three zoonotic diseases as case studies. We demonstrate that the LSTM, when combined with time series decomposition, delivers more accurate results compared to conventional LSTM models using the raw data series. Disease outbreak trends can be predicted more accurately using hybrid models., (© 2024. The Author(s).)

States encourage listed companies to use stock repurchase to elevate the market value of listed firms. After China's promulgation of the new Company Law in 2018, the number of listed companies that issued stock repurchase notices has increased, and the frequency is also increasing. But whether market value management is the real incentive for the action remains debatable. To reduce the risk of pledges, controlling shareholders may use stock repurchases to maintain the security of control rights, and stock repurchase notice may become a tool for controlling shareholders to manage pledge risks. From the perspective of pledge risk management, this paper selects the listed companies from 2012 to 2019 and finds that the share pledge of the controlling shareholder affects the stock repurchase behavior of listed companies by affecting the current pledge risk and the quality of information disclosure plays the interactive role between the two., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Cao et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Cryptococcosis is progressively acknowledged among people, irrespective of the human with or without immunodeficiency virus (HIV). This change in epidemiology has been recorded in recent years, prompting closer examination and a broader understanding of the disease manifestations and risk factors., Methods: The data of cryptococcal infections in China during 11 years were retrospectively analyzed. According to the position of infection, the patients were categorized into the pulmonary infection group and extrapulmonary infection group. The composition of the two groups was compared, and the potential risk factors of disseminated infection were analyzed. Logistic regression was used to analyze the prognostic risk factors of the disease., Results: A total of 165 patients were enrolled. 113 (68.5%) were male, and the age was 47.49 (18-82) years. 101 cases (61.2%) had a normal immune function and 64 cases (38.8%) had impaired immune function. 45 patients had extrapulmonary infection, involving the central nervous system, bone and joint, skin and bloodstream, and 120 patients had simple pulmonary infection. The mortality of the extrapulmonary infection group (48.9%) was significantly higher than that of the pulmonary infection group (0.8%). According to univariate logistic regression analysis, immune status (hazard ratio [HR], 4.476; 95% confidence interval [CI], 1.725-11.618; P = 0.002), infection position ([HR], 113.826; [CI], 14.607-886.967; P < 0.001), white blood cell count, ([HR],1.209;[CI], 1.054-1.386; P = 0.007), hemoglobin ([HR], 0.970; [CI], 0.955-0.986; P < 0.001), platelet count ([HR], 0.993; [CI], 0.987-0.999; P = 0.026), neutrophil percentage ([HR], 1.115; [CI], 1.065-1.168; P < 0.001), lymphocyte percentage ([HR], 0.875; [CI], 0.827-0.927; P < 0.001), neutrophil-to-lymphocyte Ratio (NLR) ([HR], 1.144; [CI], 1.072-1.221; P < 0.001), monocyte percentage ([HR], 0.752; [CI], 0.618-0.915; P = 0.004) were related to the prognosis. Multivariate logistic regression analysis showed that the infection position was remained related to the prognosis with statistical significance ([HR], 0.018; [CI], 0.001-0.384; P = 0.001)., Conclusion: Extrapulmonary infection of Cryptococcosis is an important risk factor for prognosis. High levels of neutrophils and NLR, and low levels of lymphocytes and monocytes may lead to disseminated infection of Cryptococcosis. Further studies are needed to reduce the occurrence rate of extrapulmonary infection and mortality., (© 2024. The Author(s).)

As the six central provinces account for 23% of total national carbon emissions (CE), research into the decoupling status of their economic growth (EG) and carbon emissions is critical to achieving the Dual Carbon Goals and the Rise of Central China Plan. This research initially examines the decoupling status between CE and EG using the Tapio decoupling model, based on energy consumption (EC) dataset from six central provinces in China between 2000 and 2019. The decoupling index (DI) is then divided into five decoupling drivers using the LMDI method. Finally, an enhanced STIRPAT model is used to examine the decoupling status of CE and EG in the six central provinces from 2020 to 2040. The research findings are: (1) The six central provinces exhibited a stable decoupling status between 2000 and 2019. The DI of the six central provinces ranged from -1.2 to 3.4. (2) The decoupling performance is influenced mainly by the inhibitory effect of economic development (GI) and the promoting effect of energy intensity (EI). The GI consistently maintains an impact value of around 0.9. EI performance varies widely across provinces. (3) From 2020 to 2040, Anhui, Hubei, Henan, and Hunan show significantly strong decoupling indices distributed between -2.21 and -0.07 in all three scenarios. It is important to note that Shanxi and Jiangxi provinces will experience a Reverse Decoupling phenomenon. These findings are helpful in developing regionally coordinated development policies and strategies for reducing CE., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: Temporomandibular disorders (TMDs) have a relatively high prevalence among university students. This study aimed to identify independent risk factors for TMD in university students and develop an effective risk prediction model., Methods: This study included 1,122 university students from four universities in Changchun City, Jilin Province, as subjects. Predictive factors were screened by using the least absolute shrinkage and selection operator (LASSO) regression and the machine learning Boruta algorithm in the training cohort. A multifactorial logistic regression analysis was used to construct a TMD risk prediction model. Internal validation of the model was conducted via bootstrap resampling, and an external validation cohort comprised 205 university students undergoing oral examinations at the Stomatological Hospital of Jilin University., Results: The prevalence of TMD among university students was 44.30%. Ten predictive factors were included in the model, comprising gender, facial cold stimulation, unilateral chewing, biting hard or resilient foods, clenching teeth, grinding teeth, excessive mouth opening, malocclusion, stress, and anxiety. The model demonstrated good predictive ability with area under the receiver operating characteristic curve (AUC) values of 0.853, 0.838, and 0.821 in the training cohort, internal validation cohort, and external validation cohort, respectively. The calibration curves demonstrated that the predicted results were consistent with the actual results, and the decision curve analysis (DCA) indicated the model's high clinical utility., Conclusions: An online nomogram of TMD in university students with good predictive performance was constructed, which can effectively predict the risk of TMD in university students. The model provides a useful tool for the early identification and treatment of TMDs in university students, helping clinicians to predict the probability of TMDs in each patient, thus providing more personalized and accurate treatment decisions for patients., (© 2024. The Author(s).)

Lung cancer has emerged as a major global public health concern. With growing public interest in lung cancer, online searches for related information have surged. However, a comprehensive evaluation of the credibility, quality, and value of lung cancer-related videos on digital media platforms remains unexamined. This study aimed to assess the informational quality and content of lung cancer-related videos on Douyin and Bilibili. A total of 200 lung cancer-related videos that met the criteria were selected from Douyin and Bilibili for evaluation and analysis. The first step involved recording and analyzing the basic information provided in the videos. Subsequently, the source and type of content for each video were identified. All videos' educational content and quality were then evaluated using JAMA, GQS, and Modified DISCERN. Douyin videos were found to be more popular in terms of likes, comments, favorites, and shares, whereas Bilibili videos were longer in duration (P < .001). The majority of video content on both platforms comprised lung cancer introductions (31/100, 31%), with medical professionals being the primary source of uploaded videos (Douyin, n = 55, 55%; Bilibili, n = 43, 43%). General users on Douyin scored the lowest on the JAMA scale, whereas for-profit businesses scored the highest (2.50 points). The results indicated that the videos' informational quality was insufficient. Videos from science communications and health professionals were deemed more reliable regarding completeness and content quality compared to videos from other sources. The public should exercise caution and consider the scientific validity when seeking healthcare information on short video platforms., (© 2024. The Author(s).)

Purpose: One of the most frequent side effects of radical prostatectomy (RP) is urinary incontinence. The primary cause of urine incontinence is usually thought to be impaired urethral sphincter function; nevertheless, the pathophysiology and recovery process of urine incontinence remains unclear. This study aimed to identify potential risk variables, build a risk prediction tool that considers preoperative urodynamic findings, and direct doctors to take necessary action to reduce the likelihood of developing early urinary incontinence., Methods: We retrospectively screened patients who underwent radical prostatectomy between January 1, 2020 and December 31, 2023 at the First People 's Hospital of Nantong, China. According to nomogram results, patients who developed incontinence within three months were classified as having early incontinence. The training group's general characteristics were first screened using univariate logistic analysis, and the LASSO method was applied for the best prediction. Multivariate logistic regression analysis was carried out to determine independent risk factors for early postoperative urine incontinence in the training group and to create nomograms that predict the likelihood of developing early urinary incontinence. The model was internally validated by computing the performance of the validation cohort. The nomogram discrimination, correction, and clinical usefulness were assessed using the c-index, receiver operating characteristic curve, correction plot, and clinical decision curve., Results: The study involved 142 patients in all. Multivariate logistic regression analysis following RP found seven independent risk variables for early urinary incontinence. A nomogram was constructed based on these independent risk factors. The training and validation groups' c-indices showed that the model had high accuracy and stability. The calibration curve demonstrates that the corrective effect of the training and verification groups is perfect, and the area under the receiver operating characteristic curve indicates great identification capacity. Using a nomogram, the clinical net benefit was maximised within a probability threshold of 0.01-1, according to decision curve analysis (DCA)., Conclusion: The nomogram model created in this study can offer a clear, personalised analysis of the risk of early urine incontinence following RP. It is highly discriminatory and accurate, and it can help create efficient preventative measures and identify high-risk populations., (© 2024. The Author(s).)

Background: This study aimed to establish a consensus on the delineation of target volumes for neoadjuvant radiation therapy (nRT) in esophageal squamous cell carcinoma (ESCC) within China., Methods: From February 2020 to June 2021, nine ESCC patients who received nRT were retrospectively selected from Sun Yat-sen University Cancer Center and Shandong Cancer Hospital. A panel from eight cancer radiotherapy centers performed two rounds of nRT target volume delineation for these patients: the first round for cases 1-6 and the second for cases 7-9. Online meetings were held after each delineation round to discuss findings. The consistency of delineations across centers was compared using mean undirected Hausdorff distances (Hmean), dice similarity coefficients (DSC), and total volumes, analyzed with the Mann-Whitney U test., Results: The second round of delineations showed improved consistency across centers (total clinical target volume (CTVtotal): mean DSC = 0.76-0.81; mean Hmean = 2.11-3.14 cm) compared to the first round (CTVtotal: mean DSC = 0.63-0.64; mean Hmean = 5.66-7.34 cm; DSC and Hmean: P < 0.050 between rounds), leading to the formation of a consensus and an atlas for ESCC nRT target volume delineation. A proposal was reached through evaluating target volume delineations, analyzing questionnaire survey outcomes, and reviewing pertinent literature., Conclusions: We have developed guidelines and an atlas for target volume delineation in nRT therapy for ESCC in China. These resources are designed to facilitate more consistent delineation of target volumes in both clinical practice and clinical trials., (© 2024. The Author(s).)

Objective: A prospective, multicenter, randomized study evaluated the efficacy of major depressive disorder (MDD) patients after 2-3 months of acute treatment based on the dual factors of education and age., Methods: This study classified the included patients into four groups using two classification parameters: age (≤45 years, vs. >45 years) and education years (≤12 vs. >12). We analyzed age, gender, marital status, personal income, depression onset history, medication use, and follow-up across various groups. We evaluated residual somatic symptoms and social functioning in depression patients was conducted using the 16-item Quick Inventory of Depressive Symptomatology Self-report (QIDS-SR16), the Patient Health Questionnaire-15 (PHQ15), and the Sheehan Disability Scale (SDS)., Results: In China, 16 hospitals, 553 depression patients, and 428 fulfilled the inclusion criteria. Baseline patient data revealed significant differences among the different age groups in gender, marital status, income, first onset age, physical illness, combination of antipsychotics, and benzodiazepines use (all p < .05). Statistically significant differences were observed in overall comparisons among the four groups, encompassing the QIDS-SR16 score, PHQ15 score, and various SDS parameters (all p < .05). However, no statistically significant differences (all p > .05) were found in residual somatic symptoms and social functioning parameters between different education levels (≤12 years vs. >12 years) at baseline, 3 months, and 6 months, based on total scores on the scale. Repeated measures mixed model indicates that the QIDS-SR16 assessment indicates statistical differences among various marital statuses, income levels, medical histories, and antipsychotic medication use (p < .05). Furthermore, PHQ-15 and SDS assessments reveal statistical differences between single and married/cohabiting statuses, physical comorbidities, 3 and 6 months follow-ups compared to baseline (p < .05)., Conclusion: This study indicates that compared to depressive patients >45 years old, those ≤45 years old often exhibit more residual depression, somatic symptoms, and severe social functional impairment; patients' education levels less influence this trend., (© 2024 The Author(s). Brain and Behavior published by Wiley Periodicals LLC.)

Enzootic bovine leukosis, a neoplastic disease caused by the bovine leukemia virus (BLV), was the primary cancer affecting cattle in China before 1985. Although its prevalence decreased significantly between 1986 and 2000, enzootic bovine leukosis has been re-emerging since 2000. This re-emergence has been largely overlooked, possibly due to the latent nature of BLV infection or the perceived lack of sufficient evidence. This study investigated the molecular epidemiology of BLV infections in dairy cattle in Henan province, Central China. Blood samples from 668 dairy cattle across nine farms were tested using nested polymerase chain reaction assays targeting the partial envelope ( env ) gene (gp51 fragment). Twenty-three samples tested positive (animal-level prevalence of 3.4%; 95% confidence interval: 2.2, 5.1). The full-length env gene sequences from these positive samples were obtained and phylogenetically analyzed, along with previously reported sequences from the GenBank database. The sequences from positive samples were clustered into four genotypes (1, 4, 6, and 7). The geographical annotation of the maximum clade credibility trees suggested that the two genotype 1 strains in Henan might have originated from Japan, while the genotype 7 strain is likely to have originated from Moldova. Subsequent Bayesian stochastic search variable selection analysis further indicated a strong geographical association between the Henan strains and Japan, as well as Moldova. The estimated substitution rate for the env gene ranged from 4.39 × 10 -4 to 2.38 × 10 -3 substitutions per site per year. Additionally, codons 291, 326, 385, and 480 were identified as positively selected sites, potentially associated with membrane fusion, epitope peptide vaccine design, and transmembrane signal transduction. These findings contribute to the broader understanding of BLV epidemiology in Chinese dairy cattle and highlight the need for measures to mitigate further BLV transmission within and between cattle herds in China.

Background: Medical security work for the 2022 Beijing Winter Olympic and Paralympics faced enormous challenges under COVID-19. This study aimed to investigate the mental status of those medical team members to provide a reference for scientifically implementing medical security services for large-scale events., Methods: In this prospective cohort study, the Patient Health Questionnaire-9, Self-rating Anxiety Scale, General Self-Efficacy Scale, and Psychological Questionnaire for Emergent Events of Public Health (PQEEPH) were administered to 145 members of the medical team. A generalized mixed linear model was used to analyze the impact of work duration, position, on/off rotation, and gender on psychological status., Results: Work duration significantly impacted depression, anxiety, self-efficacy, and all dimensions of PQEEPH. Women scored higher than men in the PQEEPH dimensions of depression, neurasthenia, fear, and total score. Working status affected the dimensions of depression, neurasthenia, and total score. Deterioration in emotional state became apparent in the fourth week and recovered 1 week after the task concluded, while self-efficacy decreased from beginning to end., Conclusion: All the medical team members experienced emotional deterioration and decreased self-efficacy in medical security tasks. To maintain a medical team's psychological wellbeing during large-scale activities, rotation times should be set reasonably, and adequate mental health services should be provided., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhu, Zhu, Qi, Li, Tan and Yang.)

Background: With the fast pace of modern life, people have less time for meals, but few studies have examined the association between the habit of fast eating and metabolic diseases., Objective: Combining the results of the current study and the prior ones, we aimed to investigate the possible relationship between fast eating and the risk of metabolic dysfunction-associated steatotic liver disease (MASLD)., Methods: This is a sub-analysis of a multicenter cross-sectional study of 1965 participants investigated the association between fast eating and MASLD in Chinese. Fast eating was defined as meal time less than five minutes and participants were divided into three categories based on their self-reported frequency of fast eating: ≤1 time/month, ≤1 time/week and ≥2 times/week. We further conducted a literature search for available studies published before November, 2023 as well as a meta-analysis to investigate the association between fast eating and MASLD., Results: The proportion of MASLD was 59.3%, 50.5%, and 46.2% in participants with fast eating ≥2 times/week, ≤1 time/week and ≤1 time/month, respectively (P for trend <0.001). The frequency of fast eating was independently associated with risk of MASLD after multiple adjustment for sex, age, demographics, smoking and drinking status, BMI and clinical metabolic parameters (OR, 1.29; 95%CI, 1.09-1.53). Participants who ate fast frequently (≥2 times/week) had 81% higher risk of MASLD (P = 0.011). A meta-analysis of five eligible studies confirmed that frequent fast eating was associated with increased risk of MASLD (pooled OR, 1.22; 95%CI, 1.07-1.39)., Conclusions: Frequent fast eating was associated with an increased risk of MASLD., (© 2024. The Author(s).)

Introduction: Based on the data from the China Health and Retirement longitudinal study (CHARLS), we aimed to investigate the bidirectional relationship between depressive symptoms and functional disability., Methods: Data were collected across 3 waves from 2013 to 2018. The activities of daily living (ADLs) and the instrumental activities of daily living (IADLs) scales were used to measure functional disability and the CESD-10 was used to measure depressive symptoms. Cross-lagged models were performed to examine cross effect between depressive symptoms and functional disability across three waves., Results: Data on 10,092(mean [SD] age, 61.98[8.44] years; 3764 females [37.30%]) and 10,180 participants (mean [SD] age, 62.01[8.46] years; 3788 females [37.21%]) in IADL sample and ADL sample were included in the analyses. For IADL disability, the cross-lagged model shows a bidirectional association across three waves; the multivariable GEE model revealed that changes in CESD-10 score across waves were associated with worse IADL disability (β ranges: 0.08-0.10) and vice versa, worsen of IADL disability ascending developing of CESD-10 score (β ranges: 0.09-0.10). For ADL disability, the cross-lagged model shows a bidirectional association across three waves; the multivariable GEE model revealed that changes of CESD-10 score across waves were associated with worse IADL disability (β ranges: 0.08-0.10) and vice versa, worsen of IADL disability ascending developing of CESD-10 score (β ranges: 0.09-0.10)., Discussion: Study findings underscore a significant bidirectional between depressive symptoms and functional disability in older adults. Thus, simultaneous intervention should be taken to manage the mutual development of functional disability and depression., (© 2024. The Author(s).)

Background: China's transition into an aging society is accelerated by the simultaneous decline in fertility rates and the prolonged life expectancy of older adults. The impact of widowhood, a significant stressor in old age, has emerged as a crucial factor affecting the quality of life among the elderly., Methods: This study is based on data from the 2018 China Health and Aging Tracking Survey. Multiple linear regression models were employed to investigate the influence of widowhood on the quality of life of older adults in China. Additionally, Bootstrap mediation effects were utilized to assess the mediating role of intergenerational support, considering both financial and emotional support from children., Results: The findings indicate a substantial reduction in the quality of life index among older adults following widowhood. Moreover, the impact is more pronounced among older men compared to older women. Rural older adults experience a significant decline in quality of life post-widowhood, while the effect on urban counterparts is not statistically significant., Conclusions: Intergenerational financial support was identified as a partial mediator between widowhood and the quality of life among older adults. This underscores the importance of familial financial assistance in mitigating the adverse effects of widowhood on the well-being of the elderly. These results offer valuable insights into the nuanced impact of widowhood on the quality of life among older adults in China, emphasizing the need for targeted interventions, especially in rural areas., Clinical Trial: Not applicable., (© 2024. The Author(s).)

Episyrphus balteatus can provide dual ecosystem services including pest control and pollination, which the larvae are excellent predators of aphid pest whereas adults are efficient pollinator. In this study, we assembled a high-quality genome of E. balteatus from northern China geographical population at the chromosome level by using Illumina, PacBio long reads, and Hi-C technologies. The 467.42 Mb genome was obtained from 723 contigs, with a contig N50 of 9.16 Mb and Scaffold N50 of 118.85 Mb, and 90.25% (431.75 Mb) of the assembly was anchored to 4 pseudo-autosomes and one pseudo-heterosome. In total, 14,848 protein-coding genes were annotated, and 95.14% of genes were fully represented in NR, GO, KEGG databases. Besides, we also obtained the mitochondrial genome of E. balteatus of 16, 837 bp in length with 37 typical mitochondrial genes. Overall, this high-quality genome is valuable for evolutionary and genetic studies of E. balteatus and other Syrphidae hoverfly species., (© 2024. The Author(s).)

Background: The purpose of this study was to investigate the relationships between generalized, abdominal, and visceral fat obesity and the prevalence of gout in patients with type 2 diabetes mellitus (T2DM)., Methods: Data were obtained from the electronic medical databases of the National Metabolic Management Center (MMC) of Yuhuan Second People's Hospital and Taizhou Central Hospital (Taizhou University Hospital) between September 2017 and June 2023. Four obesity indicators were analyzed: waist circumference (WC), waist-to-hip ratio (WHR), body mass index (BMI), and visceral fat area (VFA). The relationships between these parameters and gout prevalence were analyzed using multivariate logistic regression and restricted cubic spline (RCS) analyses. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficacy of the four parameters for gout., Results: This cross-sectional study enrolled 10,535 participants (600 cases and 9,935 controls). Obesity was more common in patients with gout, and the obesity indicators were markedly higher in this group. After adjustment for confounders, obesity, as defined by BMI, WC, WHR, and VFA, was found to be associated with greater gout prevalence, with odds ratios (OR) of 1.775, 1.691, 1.858, and 1.578, respectively (P < 0.001). The gout odds ratios increased markedly in relation to the obesity indicator quartiles (P-value for trend < 0.001), and the obesity indicators were positively correlated with gout prevalence, as shown using RCS. The area under the ROC curve values for BMI, WC, WHR, and VFA were 0.629, 0.651, 0.634, and 0.633, respectively., Conclusion: Obesity-whether general, abdominal, or visceral fat obesity-was positively linked with elevated gout risk. But uncovering the causality behind the relationship requires further prospective study. Obesity indicators (BMI, WC, WHR, and VFA) may have potential value for diagnosing gout in clinical practice., (© 2024. The Author(s).)

Pseudorabies have caused enormous economic losses in China's pig industry and have recurred on many large pig farms since late 2011. The disease is caused by highly pathogenic, antigenic variant pseudorabies virus (vPRV) strains. Our laboratory isolated a pseudorabies virus in 2015 and named it XJ5. The pathogenic ability of this mutant strain was much stronger than that of the original isolate. After we sequenced its whole genome (GenBank accession number: OP512542), we found that its overall structure was not greatly changed compared with that of the previous strain Ea (KX423960.1). The whole genome alignment showed that XJ5 had a strong genetic relationship with the strains isolated in China after 2012 reported in GenBank. Based on the isolation time of XJ5 and the mutation and recombination analysis of programs, we found that the whole genome homology of XJ5 and other strains with Chinese isolates was greater than 95%, while the homology with strains outside Asia was less than 94%, which indicated that there may be some recombination and mutation patterns. We found that virulent PRV isolates emerged successively in China in 2011 and formed two different evolutionary clades from foreign isolates. At the same time, this may be due to improper immunization and the presence of wild strains in the field, and recent reports have confirmed that Bartha vaccine strains recombine with wild strains to obtain new pathogenic strains. We performed genetic evolution analysis of XJ5 isolated and sequenced in our laboratory to trace its possible mutations and recombination. We found that XJ5 may be the result of natural mutation of a virus in a branch of mutant strains widely existing in China., (© 2024. The Author(s).)

Soil organic carbon (SOC) is a crucial component of the global carbon cycle, playing a significant role in ecosystem health and carbon balance. In this study, we focused on assessing the surface SOC content in Shandong Province based on land use types, and explored its spatial distribution pattern and influencing factors. Machine learning methods including random forest (RF), extreme gradient boosting (XGBoost), and support vector machine (SVM) were employed to estimate the surface SOC content in Shandong Province using diverse data sources like sample data, remote sensing data, socio-economic data, soil texture data, topographic data, and meteorological data. The results revealed that the SOC content in Shandong Province was 8.78 g/kg, exhibiting significant variation across different regions. Comparing the model error and correlation coefficient, the XGBoost model showed the highest prediction accuracy, with a coefficient of determination (R²) of 0.7548, root mean square error (RMSE) of 7.6792, and relative percentage difference (RPD) of 1.1311. Elevation and Clay exhibited the highest explanatory power in clarifying the surface SOC content in Shandong Province, contributing 21.74% and 13.47%, respectively. The spatial distribution analysis revealed that SOC content was higher in forest-covered mountainous regions compared to cropland-covered plains and coastal areas. In conclusion, these findings offer valuable scientific insights for land use planning and SOC conservation., Competing Interests: The authors declare that they have no competing interests., (© 2024 Chen et al.)

Achieving net-zero greenhouse gas emissions in the construction sector is essential to sustainable development policy. Previous studies have ignored the impact of the digital economy on carbon emissions in the construction industry. Using relevant city-level data from China from 2011 to 2021 and employing ArcGIS and Stata software, this study examines the current status of carbon emissions from the construction industry and investigates the impact of the digital economy on these emissions. The findings reveal that (1) from 2011 to 2021, carbon emissions of the construction industry have a pattern of decreasing-increasing-decreasing-increasing across the country. There is an increasing concentration of areas with high and relatively high carbon discharges in Heilongjiang, Jilin, Ningxia, Inner Mongolia, Shanxi, Guangxi, and Guizhou. (2) The standard deviation ellipse indicates the core area of carbon emissions in China's construction industry is moving northeast and becoming more decentralized. (3) Through a series of robustness tests, the digital economy has been proven to effectively reduce carbon emissions from the construction sector in municipal areas. (4) In severely cold regions, mild regions, and high-population-density cities, the digital economy reduces building sector's carbon output. However, it stimulates carbon emissions in the hot summer and cold winter regions. (5) Mechanism tests show that the digital economy reduces China's urban construction carbon emissions by fostering technological progress and green innovation. Urban resilience further strengthens the contribution of the digital economy to reducing carbon discharges in the urban construction sector of China. This article presents empirical evidence demonstrating how the digital economy empowers the construction industry to curtail emissions., Competing Interests: Declaration of Competing interest there is no conflict of interest between the authors., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Continuous emergence of new variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), enhanced transmissibility, significant immune escape, and waning immunity call for booster vaccination. We evaluated the safety, immunogenicity, and efficacy of heterologous booster with a SARS-CoV-2 mRNA vaccine SYS6006 versus an active control vaccine in a randomized, open-label, active-controlled phase 3 trial in healthy adults aged 18 years or more who had received two or three doses of SARS-CoV-2 inactivated vaccine in China. The trial started in December 2022 and lasted for 6 months. The participants were randomized (overall ratio: 3:1) to receive one dose of SYS6006 ( N  = 2999) or an ancestral receptor binding region-based, alum-adjuvanted recombinant protein SARS-CoV-2 vaccine ( N  = 1000), including 520 participants in an immunogenicity subgroup. SYS6006 boosting showed good safety profiles with most AEs being grade 1 or 2, and induced robust wild-type and Omicron BA.5 neutralizing antibody response on Days 14 and 28, demonstrating immunogenicity superiority versus the control vaccine and meeting the primary objective. The relative vaccine efficacy against COVID-19 of any severity was 51.6% (95% CI, 35.5-63.7) for any variant, 66.8% (48.6-78.5) for BA.5, and 37.7% (2.4-60.3) for XBB, from Day 7 through Month 6. In the vaccinated and infected hybrid immune participants, the relative vaccine efficacy was 68.4% (31.1-85.5) against COVID-19 of any severity caused by a second infection. All COVID-19 cases were mild. SYS6006 heterologous boosting demonstrated good safety, superior immunogenicity and high efficacy against BA.5-associated COVID-19, and protected against XBB-associated COVID-19, particularly in the hybrid immune population. Trial registration: Chinese Clinical Trial Registry: ChiCTR2200066941.

Objectives: This cross-sectional correlational study aimed to understand nurses' perceived overqualification and work engagement, explore their effects on job satisfaction and provide a theoretical basis for hospital management policies in a public comprehensive tertiary hospital in China., Design: Cross-sectional correlational study., Setting: The study was conducted in a public comprehensive tertiary hospital in China. The specific location is not disclosed., Participants: 584 nurses participated in the study, with a completion rate of 97.3%. The average age of participants was 34.8±6.7 years, with 96.4% being women. 67.8% held a bachelor's degree or higher, and 71.6% had over 5 years of work experience., Primary and Secondary Outcome Measures: The Scale of Perceived Overqualification was used to assess nurses' perceptions of their qualifications, demonstrating a high level of reliability with a Cronbach's alpha coefficient of 0.832. Utrecht Work Engagement Scale was used to assess nurses' work engagement, showing internal consistency coefficients (Cronbach's alpha) of 0.683 for the vigour dimension, 0.693 for the dedication dimension and 0.834 for the absorption dimension. Minnesota Satisfaction Questionnaire was used to evaluate nurses' job satisfaction, with internal consistency coefficients (Cronbach's alpha) of 0.765 for the intrinsic satisfaction scale and 0.734 for the extrinsic satisfaction scale. The primary outcome measures included perceived overqualification, work engagement and job satisfaction., Results: The average scores for perceived overqualification, work engagement and job satisfaction were 26.38±3.44, 65.36±14.92 and 74.29±15.04, respectively. Perceived overqualification showed negative correlations with work engagement (r=-0.562, p<0.05) and job satisfaction (r=-0.674, p<0.05). However, work engagement was positively correlated with job satisfaction (r=0.519, p<0.05). Path analysis indicated that perceived overqualification had both a direct (β=-0.06, p<0.001) and an indirect effect (β=-0.35, p=0.015) on job satisfaction, with work engagement partially mediating this relationship., Conclusion: The perception of overqualification among nurses shows a significant correlation with both their work engagement and job satisfaction. This finding suggests that hospital administrators should pay attention to nurses' perceptions of their qualifications and take measures to enhance their job satisfaction. Furthermore, work engagement acts as a mediator between the perception of overqualification and job satisfaction, emphasising the importance of increasing work engagement. Overall, hospitals can improve nurses' work engagement and job satisfaction by providing career development opportunities, establishing feedback mechanisms and fostering work-life balance. Comprehensive management measures focusing on nurses' career development opportunities and levels of work engagement are necessary. Future research could expand the sample size, employ more diverse research designs and integrate qualitative research methods to further explore the factors influencing nurses' job satisfaction and happiness., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: In the treatment of advanced pancreatic cancer, chemotherapy plays a pivotal role. Despite its effectiveness, this regimen is often marred by side effects such as anemia, neuropathy, fatigue, nausea, and malnutrition, which significantly affect patients' tolerance to the treatment. Some studies have shown that vitamin C could potentially augment chemotherapy's tolerability, notably by boosting iron absorption, ameliorating anemia, and relieving pain and numbness in hands and feet. Nevertheless, the integration of vitamin C with chemotherapy to mitigate toxic side effects and enhance the quality of life for advanced pancreatic cancer patients has not been examined in any randomized controlled trials to date., Methods: A prospective, single-center, open-label, randomized controlled trial will be conducted at Fudan University Shanghai Cancer Center from September 2023 to September 2026. A total of at least 100 patients with advanced pancreatic adenocarcinoma exhibiting distant metastases will be recruited and randomly assigned to the chemotherapy group or the chemotherapy plus vitamin C group. The primary endpoint is the rate of anemia. Secondary endpoints include the rate of grade 3 neuropathy, change of numeric rating scale, quality of life, and overall survival., Discussion: This study aims to assess the impact of low-dose vitamin C on enhancing the quality of life for patients with metastatic pancreatic cancer undergoing gemcitabine and nab-paclitaxel chemotherapy., Trial Registration: The trial was registered with the ClinicalTrials.gov (NCT06018883) on August 31, 2023., (© 2024. The Author(s).)

Background: The prevalence of high-risk pregnancy increased after the implementation of two-child policy in China, but the impact of this policy change on the burden and profile of multiple high-risk factors in pregnancy (MHFP) has been insufficiently explored. We hypothesised that the profile of MHFP might have changed after the two-child policy was implemented and aimed to estimate the prevalence, intercorrelation, and outcomes of MHFP before and after its introduction., Methods: We obtained data on the population of pregnant women before (2015) and after (2020/2021) the implementation of universal two-child policy in Huai'an. We then included 33 risk factors in our analysis based on the Five-Colour Management framework and defined MHFP as an individual having two or more of these factors. We also estimated the changes of the prevalence of each single factor and their coexistence. Lastly, we performed a network analysis to assess the intercorrelations across these factors and used logistic regression models to evaluate MHFP-related pregnancy outcomes., Results: We observed an increase in the prevalence of MHFP after the implementation of the universal two-child policy (25.8% in 2015 vs 38.4% in 2020/2021, P < 0.01). Chronic conditions (e.g. gestational diabetes mellitus, abnormal body mass index) had the largest increase among the included factors, while cardiovascular disease and hypertensive disorders were central factors of the network structures. The correlations of advanced maternal age with abnormal pregnancy histories and scarred uteri increased significantly from 2015 to 2020/2021. MHFP was associated with multiple pregnancy outcomes, including preterm birth (adjusted odds ratio (aOR) = 2.57; 95% confidence interval (CI) = 2.39-2.75), low birthweight (aOR = 2.77; 95% CI = 2.54-3.02), low Apgar score (aOR = 1.41; 95% CI = 1.19-1.67), perinatal death (aOR = 1.75; 95% CI = 1.44-2.12), and neonatal death (aOR = 1.76; 95% CI = 1.42-2.18). Moreover, an increasing number and certain combinations of MHFP were associated with higher odds of pregnancy outcomes. For example, the aOR of preterm birth increased from 1.67 (95% CI = 1.52-1.87) for one risk factor to 8.03 (95% CI = 6.99-9.22) for ≥4 risk factors., Conclusions: Chinese women experienced a higher burden of multiple high-risk factors after the introduction of the two-child policy, particularly those with advanced maternal age, obesity, and chronic conditions. Strategies targeting chronic conditions for women with MHFP should be prioritised and a shift to a multiple-factor-oriented framework is needed in the expanding Chinese maternal health care system., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

The association between vitamin A and single cardiometabolic diseases has been extensively studied, but the relationship between dietary vitamin A intake and the risk of cardiometabolic multimorbidity (CMM) has not been studied. Therefore, the present study was conducted to explore the association with CMM risk by analyzing different sources of vitamin A. This study utilized 13,603 subjects aged ≥ 18 years from 1997 to 2015 from the China Health and Nutrition Survey (CHNS). Dietary intake was calculated from 3 consecutive 24-h dietary recalls combined with a house hold food inventory. CMM is defined as the development of at least two cardiometabolic diseases. After a median follow-up of 9.0 years, there were 1050 new cases of CMM. The risk of CMM was significantly lower in those with higher vitamin A intake (Q1 vs Q5 HR 0.66, 95% CI 0.54-0.81). β-carotene (Q1 vs Q5 HR 0.82, 95% CI 0.66-1.02) and retinol (Q1 vs Q5 HR 0.59, 95% CI 0.48-0.73) intake had a similarly negative correlation. Using restricted cubic spline found an L-shaped relationship between retinol intake and CMM (p non-linear < 0.001). Negative associations were also found in specific CMD groups (hypertension, cardiovascular disease, stroke and diabetes). Dietary intake of vitamin A was negatively associated with CMM risk, and this protective effect was more pronounced in patients with cardiovascular disease. There was an L-shaped association between retinol intake and CMM risk., (© 2024. The Author(s).)

Objective: The International Federation of Gynecology and Obstetrics (FIGO) 2023 staging system for endometrial cancer (EC) was released with incorporating histology, lympho-vascular space invasion, and molecular classification together. Our objective is to further explore the clinical utility and prognostic significance of the 2023 FIGO staging system in China., Methods: A retrospective analysis was conducted for patients who received standard surgeries and underwent genetic testing using multigene next-generation sequencing (NGS) panels between December 2018 and December 2023 at Fudan University Shanghai Cancer Center, Shanghai, China. The genomic and clinical data of all patients were analyzed, and stages were determined by both the 2009 and 2023 FIGO staging systems. Kaplan-Meier estimators and Cox proportional hazards models were used for survival analysis., Results: A total of 547 patients were enrolled in the study. After the restaged by the FIGO 2023 staging system, stage shifts occurred in 147/547 (26.9%) patients. In patients with early stages in FIGO 2009 (stage I-II), 63 cases were rearranged to IAmPOLEmut and 53 cases to IICmp53abn due to the molecular classification of POLEmut and p53abn. Altogether 345 cases were in stage I, 107 cases in stage II, 69 cases in stage III, and 26 cases in stage IV according to the FIGO 2023 staging criteria. For stage I diseases, the 3-year PFS rate was 92.7% and 95.3% in 2009 and 2023 FIGO staging systems, respectively. The 3-year PFS of stage II in 2023 FIGO was lower than that of FIGO 2009 (3-year PFS: 85.0% versus 90.9%), especially in substage IIC and IICmp53abn. Three cases (12%) of stage IIIA in FIGO 2009 were shifted to stage IA3 FIGO 2023, with 3-year PFS rates of 90.9% versus 100%, respectively. In NGS analysis, the most prevalent gene alterations were observed in PTEN and PIK3CA., Conclusion: The FIGO 2023 staging system was proved to be a good predictor of survival for EC patients with enhanced precision compared to FIGO 2009. Predominant stage shifts were observed in early-stage diseases. Distinct gene alterations of different subtypes may help to explore more accurate target therapies., (© 2024. The Author(s).)

Background: Colorectal cancer (CRC) ranks as the second most prevalent type of cancer in China. The financial implications of treatment are a significant factor to be taken into account for patients diagnosed with middle and advanced stages of colorectal cancer (III-IV CRC). The research aims to explore current financial toxicity (FT) conditions and analyze factors that may influence it in patients with middle and advanced CRC., Method: This is a cross-sectional survey. The participants of the study were individuals diagnosed with middle and advanced colorectal cancer who were admitted to the hospital between January and June 2023. The cross-sectional survey utilized a variety of instruments, including a general information questionnaire, a cancer patient report outcome economic toxicity scale, a medical coping style questionnaire, an Anderson symptom assessment scale, a disease shame scale, and a social support scale. Multiple linear regression analysis was employed to examine the factors influencing FT., Result: A cohort of 264 patients diagnosed with stage III-IV CRC were included in the study. The majority of patients with intermediate and advanced CRC (87.1%, n = 230) reported experiencing substantial financial strain. Multivariate analysis revealed that factors influencing FT included low family monthly income, out-of-pocket expenses, unemployment, undergoing surgical treatment, the level of stigma, and the severity of symptoms ( P < 0.001)., Conclusion: Patients with stage III-IV cancer (CRC) demonstrate increased levels of financial toxicity (FT), a common occurrence in individuals with moderate to severe CRC. In patients with stage III-IV CRC, the presence of FT is correlated with various factors including family monthly income, medical payment methods, work status, surgical treatment, stigma levels, and symptom severity. These characteristics may serve as influencing factors for subsequent treatment decisions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 He, Chen, Zhang, Li, Zhu, Zhao and Chen.)

Acute leukemia is the most common hematopoietic stem cell malignant tumor in children, which ranks in the top one of the incidence of tumor in children, it is a major disease that affects the growth and survival of children. With the continuous improvement of medical diagnosis and treatment and the extensive development of immunotherapy, the survival rate and quality of life of children with acute leukemia have been significantly improved. In recent years, three cooperative groups of childhood leukemia have been established in China, and a series of high-level research results have been published. In the future, efforts should be made to promote the process of standardization and homogenization in the diagnosis and treatment of children's acute leukemia, explore the monitoring targets of sensitive residual diseases, and find the best treatment for refractory/recurrent cases. Speeding up the clinical research of new drugs will be an urgent problem and development direction in the field of acute leukemia diagnosis and treatment in children.

Background: The link between nonalcoholic fatty liver disease and type 2 diabetes has not been fully established. We investigated the temporal relationship between nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2D), quantitatively assessed the impact, and evaluated the related mediation effect., Methods: This study involved participants from the China Multi-Ethnic Cohort Study and the UK Biobank. We performed cross-lagged path analysis to compare the relative magnitude of the effects between NAFLD and T2D using two-period biochemical data. Hepatic steatosis and fasting blood glucose elevation (FBG) represented NAFLD and T2D respectively. We fitted two separate Cox proportional-hazards models to evaluate the influence of hepatic steatosis on T2D. Furthermore, we applied the difference method to assess mediation effects., Results: In cross-lagged path analyses, the path coefficients from baseline hepatic steatosis to first repeat FBG (β CMEC  = 0.068, β UK-Biobank  = 0.033) were significantly greater than the path coefficients from baseline FBG to first repeat hepatic steatosis (β CMEC  = 0.027, β UK-Biobank = -0.01). Individuals with hepatic steatosis have a risk of T2D that is roughly three times higher than those without the condition (HR = 3.478 [3.314, 3.650]). Hepatic steatosis mediated approximately 69.514% of the total effect between obesity and follow-up T2D., Conclusions: Our findings contribute to determining the sequential relationship between NAFLD and T2D in the causal pathway, highlighting that the dominant pathway in the relationship between these two early stages of diseases was the one from hepatic steatosis to fasting blood glucose elevation. Individuals having NAFLD face a significantly increased risk of T2D and require long-term monitoring of their glucose status as well., (© 2024. The Author(s).)