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BackgroundSince December 2019, an outbreak of the coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly in Wuhan and worldwide. However, previous studies on pregnant patients were limited. ObjectiveThe aim of this study is to evaluate the clinical characteristics and outcomes of pregnant and nonpregnant women with COVID-19. MethodsThis study retrospectively collected epidemiological, clinical, laboratory, imaging, management, and outcome data of 43 childbearing-age women patients (including 17 pregnant and 26 nonpregnant patients) who presented with laboratory-confirmed COVID-19 in Tongji Hospital, Wuhan, China from January 19 to March 2, 2020. Clinical outcomes were followed up to March 28, 2020. ResultsOf the 43 childbearing-age women in this study, none developed a severe adverse illness or died. The median ages of pregnant and nonpregnant women were 33.0 and 33.5 years, respectively. Pregnant women had a markedly higher proportion of history exposure to hospitals within 2 weeks before onset compared to nonpregnant women (9/17, 53% vs 5/26, 19%, P=.02) and a lower proportion of other family members affected (4/17, 24% vs 19/26, 73%, P=.004). Fever (8/17, 47% vs 18/26, 69%) and cough (9/17, 53% vs 12/26, 46%) were common onsets of symptoms for the two groups. Abdominal pain (n=4, 24%), vaginal bleeding (n=1, 6%), reduced fetal movement (n=1, 6%), and increased fetal movement (n=2, 13%) were observed at onset in the 17 pregnant patients. Higher neutrophil and lower lymphocyte percent were observed in the pregnant group compared to the nonpregnant group (79% vs 56%, P

Abstract Background Knee osteoarthritis (KOA) has become a public health issue. Several systematic reviews (SRs) and meta-analyses (MAs) indicate that traditional Chinese exercise (TCE) may be an effective treatment for reducing pain and stiffness and improving physical function in people with knee osteoarthritis (KOA). Objectives To evaluate the literature quality and evidence for the systematic reviews of TCE for KOA and provide evidence to support the clinical application of TCE for KOA. Methods Eight databases were searched from their inception to January 3, 2023, to retrieve relevant literature, including China National Knowledge Infrastructure (CNKI), Wanfang, Chinese Scientific Journal Database (VIP), China Biology Medical literature database (CBM), PubMed, Embase, Web of Science and Cochrane Library, without restrictions on publication date or language. AMSTAR-2 and PRISMA 2020 assessed the methodological and reporting quality of included SRs/MAs. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was utilized to evaluate the quality of evidence. Results A total of 18 SRs/MAs were included. The methodological quality was “very low” based on AMSTAR-2. The overall reporting quality was deficient based on PRISMA 2020. The quality of Chinese and English literature differed, with English literature being superior in methodological and reporting quality. Among 93 pieces of evidence obtained, 46 (49.46%) were of very low quality, 34 (36.56%) were of low quality, 13 (13.98%) were of moderate quality, and none were of high quality. TCE was supported by 76 pieces of evidence (81.72%). Conclusion TCE appears beneficial and safe for managing KOA. However, due to the relatively low methodological and evidentiary quality of included SRs/MAs, clinicians should interpret these findings cautiously.

AIM: To figure out whether various atropine dosages may slow the progression of myopia in Chinese kids and teenagers and to determine the optimal atropine concentration for effectively slowing the progression of myopia. METHODS: A systematic search was conducted across the Cochrane Library, PubMed, Web of Science, EMBASE, CNKI, CBM, VIP, and Wanfang database, encompassing literature on slowing progression of myopia with varying atropine concentrations from database inception to January 17, 2024. Data extraction and quality assessment were performed, and a network Meta-analysis was executed using Stata version 14.0 Software. Results were visually represented through graphs. RESULTS: Fourteen papers comprising 2475 cases were included; five different concentrations of atropine solution were used. The network Meta-analysis, along with the surface under the cumulative ranking curve (SUCRA), showed that 1% atropine (100%)>0.05% atropine (74.9%) >0.025% atropine (51.6%)>0.02% atropine (47.9%)>0.01% atropine (25.6%)>control in refraction change and 1% atropine (98.7%)>0.05% atropine (70.4%)>0.02% atropine (61.4%)>0.025% atropine (42%)>0.01% atropine (27.4%)>control in axial length (AL) change. CONCLUSION: In Chinese children and teenagers, the five various concentrations of atropine can reduce the progression of myopia. Although the network Meta-analysis showed that 1% atropine is the best one for controlling refraction and AL change, there is a high incidence of adverse effects with the use of 1% atropine. Therefore, we suggest that 0.05% atropine is optimal for Chinese children to slow myopia progression.

Ecosystem services (ES), which serve as the link between human activities and natural ecosystems, are crucial for maintaining ecological balance and supporting economic development. The Ecosystem Services Value (ESV) is an indicator used to quantifying ecosystem services. Accurately estimating the dynamics of ESV and the threshold effects of influencing factors is of great importance for the sustainable development of the region. This study constructs an ESV valuation model based on the equivalent factor method, incorporating construction land, and corrects the initial valuation results in three dimensions. By constructing a random forest model and integrating partial dependence analysis, Elevation, Evapotranspiration, Normalized Difference Vegetation Index, and the proportion of built-up land area were identified as significant factors in determining ecologically vulnerable areas within the study region. The results show that: (1) The total ESV in Henan along the Yellow River in 2000, 2005, 2010, 2015, and 2020 was 204.612 billion yuan, 249.775 billion yuan, 239.100 billion yuan, 234.868 billion yuan and 202.767 billion yuan, respectively. The overall trend of change is first growth and then decline, with spatial features remaining relatively stable, and ESV polarization becoming more pronounced. (2) The spatial clustering characteristics of ESV in Henan along the Yellow River are remarkable, and the cold and hot spot areas show a bidirectional expansion trend. The cold spot areas expand substantially around the construction land, whilethe hot spot areas show a small expansion around the western mountain areas and the vegetation areas along the Yellow River, but the overall growth is slower. (3) The main factors affecting ESV include three natural factors and one anthropogenic factor, namely evapotranspiration (ET), the proportion of built-up land area (POB), normalized vegetation index (NDVI) and elevation (ELEV). ESV is at a high level when ELEV>718 m, ET0.7, and POB

Abstract BackgroundSevere fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that was first identified in mainland China in 2009 and has been reported in Zhejiang Province, China, since 2011. However, few studies have focused on the association between ticks, host animals, and SFTS. ObjectiveIn this study, we analyzed the influence of meteorological and environmental factors as well as the influence of ticks and host animals on SFTS. This can serve as a foundational basis for the development of strategic policies aimed at the prevention and control of SFTS. MethodsData on SFTS incidence, tick density, cattle density, and meteorological and environmental factors were collected and analyzed using a maximum entropy–based model. ResultsAs of December 2019, 463 laboratory-confirmed SFTS cases were reported in Zhejiang Province. We found that the density of ticks, precipitation in the wettest month, average temperature, elevation, and the normalized difference vegetation index were significantly associated with SFTS spatial distribution. The niche model fitted accurately with good performance in predicting the potential risk areas of SFTS (the average test area under the receiver operating characteristic curve for the replicate runs was 0.803 and the SD was 0.013). The risk of SFTS occurrence increased with an increase in tick density, and the response curve indicated that the risk was greater than 0.5 when tick density exceeded 1.4. The risk of SFTS occurrence decreased with increased precipitation in the wettest month, and the risk was less than 0.5 when precipitation exceeded 224.4 mm. The relationship between elevation and SFTS occurrence showed a reverse V shape, and the risk peaked at approximately 400 m. ConclusionsTick density, precipitation, and elevation were dominant influencing factors for SFTS, and comprehensive intervention measures should be adjusted according to these factors to reduce SFTS incidence in Zhejiang Province.

ABSTRACTThe intestine is prone to radiation damage in patients undergoing radiotherapy for pelvic tumors. However, there are currently no effective drugs available for the prevention or treatment of radiation-induced enteropathy (RIE). In this study, we aimed at investigating the impact of indole-3-carboxaldehyde (I3A) derived from the intestinal microbiota on RIE. Intestinal organoids were isolated and cultivated for screening radioprotective tryptophan metabolites. A RIE model was established using 13 Gy whole-abdominal irradiation in male C57BL/6J mice. After oral administration of I3A, its radioprotective ability was assessed through the observation of survival rates, clinical scores, and pathological analysis. Intestinal stem cell survival and changes in the intestinal barrier were observed through immunofluorescence and immunohistochemistry. Subsequently, the radioprotective mechanisms of I3A was investigated through 16S rRNA and transcriptome sequencing, respectively. Finally, human colon cancer cells and organoids were cultured to assess the influence of I3A on tumor radiotherapy. I3A exhibited the most potent radioprotective effect on intestinal organoids. Oral administration of I3A treatment significantly increased the survival rate in irradiated mice, improved clinical and histological scores, mitigated mucosal damage, enhanced the proliferation and differentiation of Lgr5+ intestinal stem cells, and maintained intestinal barrier integrity. Furthermore, I3A enhanced the abundance of probiotics, and activated the AhR/IL-10/Wnt signaling pathway to promote intestinal epithelial proliferation. As a crucial tryptophan metabolite, I3A promotes intestinal epithelial cell proliferation through the AhR/IL-10/Wnt signaling pathway and upregulates the abundance of probiotics to treat RIE. Microbiota-derived I3A demonstrates potential clinical application value for the treatment of RIE.

Small water bodies, such as ponds, are widely distributed in agricultural watersheds. They not only serve agricultural irrigation and drainage but also play a crucial role in reducing nitrogen and phosphorus in agricultural non-point source pollution and improving river water quality. However, the linkage between river water quality and the spatial distribution pattern of small water bodies is still unclear. In this study, an agricultural watershed, consisting of nine sub-watersheds and over 1800 ponds was selected, to evaluate the impact of small water body distribution on river water quality. Despite ponds account for less than 0.6 % of the sub-watershed area, they largely determine water quality variations. Specifically, sub-watersheds with lower connectivity among ponds and shorter distances between ponds and farmland exhibited better water quality. These two indicators alone explain more than 87 % variations of nutrient concentrations among the sub-watersheds. This indicates that dispersed ponds that are located close to farmlands serve as important sinks for pollutants in agricultural watersheds. In this study, we emphasize the importance of location of small water bodies in maintaining river water quality, which can provide crucial information for future agricultural watershed land use planning and the development of optimized strategies for water quality improvement.

Background: Chikungunya is emerging and reemerging word-widely in the past decades. It is non-endemic in Zhejiang Province, Southeast China. Aedes albopictus, one of major vectors of chikungunya, is widely-distribution in Zhejiang, and autochthonous transmission is possible after introducing chikungunya virus. Methods: Retrospectively collected the epidemiological, clinical and genetic data of chikungunya and conducted the descriptive analysis and gene sequence analysis. Results: From 2008 to 2022, 29 chikungunya cases, including 26 overseas imported and 3 local cases, were reported and no cases died of chikungunya. More than half of the imported cases (53.85%) were from Southeast Asia. Seasonal peak of the imported cases was noted between August and September, and 42.31% cases onset in those 2 months. Eight prefecture-level cities and 16 counties reported cases during the study period, with Jinghua (27.59%) and Hangzhou (24.14%) reporting the largest number of cases. The 3 local cases were all reported in Qujiang, Quzhou in 2017. For imported cases, the male-female gender ratio was 2.71:1, 20–30 years old cases (46.15%) and commercial service (42.31%) accounted for the highest proportion. Clinically, fever (100%), fatigue (94.44%), arthralgia (79.17%), headache (71.43%) and erythra (65.22%) were the most common reported symptoms. Eight whole-genome sequences were obtained and belonged to East/Central/South African (ECSA) or Asian genotype. Conclusions: With the change of immigration policy, the surveillance of chikungunya should be strengthened and the ability of the case discovery and diagnosis should be improved in Zhejiang in the post-COVID-19 era.

Objective: To estimate the potential causal impact of Enterovirus A71 (EV71) vaccination program on the reduction of EV71-infected hand, foot, and mouth disease (HFMD) in Zhejiang Province. Methods: We utilized the longitudinal surveillance dataset of HFMD and EV71 vaccination in Zhejiang Province during 2010–2019. We estimated vaccine efficacy using a Bayesian structured time series (BSTS) model, and employed a negative control outcome (NCO) model to detect unmeasured confounding and reveal potential causal association. Results: We estimated that 20,132 EV71 cases (95% CI: 16,733, 23,532) were prevented by vaccination program during 2017–2019, corresponding to a reduction of 29% (95% CI: 24%, 34%). The effectiveness of vaccination increased annually, with reductions of 11% (95% CI: 6%, 16%) in 2017 and 66% (95% CI: 61%, 71%) in 2019. Children under 5 years old obtained greater benefits compared to those over 5 years. Cities with higher vaccination coverage experienced a sharper EV71 reduction compared to those with lower coverage. The NCO model detected no confounding factors in the association between vaccination and EV71 cases reduction. Conclusions: This study suggested a potential causal effect of the EV71 vaccination, highlighting the importance of achieving higher vaccine coverage to control the HFMD.

Ensuring safety in autonomous driving is crucial for effective motion planning and navigation. However, most end-to-end planning methodologies lack sufficient safety measures. This study tackles this issue by formulating the control optimization problem in autonomous driving as Constrained Markov Decision Processes (CMDPs). We introduce an innovative, model-based approach for policy optimization, employing a conditional Value-at-Risk (VaR)-based soft actor-critic (SAC) to handle constraints in complex, high-dimensional state spaces. Our method features a worst-case actor to ensure strict compliance with safety requirements, even in unpredictable scenarios. The policy optimization leverages the augmented Lagrangian method and leverages latent diffusion models to forecast and simulate future trajectories. This dual strategy ensures safe navigation through environments and enhances policy performance by incorporating distribution modeling to address environmental uncertainties. Empirical evaluations conducted in both simulated and real environments demonstrate that our approach surpasses existing methods in terms of safety, efficiency, and decision-making capabilities.

Background: The level of the regulator of G-protein signaling 4-1 (RGS4-1) isoform, the longest RGS4 isoform, is significantly reduced in the dorsolateral prefrontal cortex (DLPFC) of people with schizophrenia. However, the mechanism behind this has not been clarified. The 3′untranslated regions (3′UTRs) are known to regulate the levels of their mRNA splice variants. Methods: We constructed recombinant pmir-GLO vectors with a truncated 3′ regulatory region of the RGS4 gene (3R1, 3R2, 3R3, 3R4, 3R5, and 3R6). The dual-luciferase reporter assay was conducted to find functional regions in HEK-293, SK-N-SH, and U87cells and then predicted miRNA binding to these regions. We performed a dual-luciferase reporter assay and a Western blot analysis after transiently transfecting the predicted miRNAs. Results: The dual-luciferase reporter assay found that regions +401–+789, +789–+1152, and +1562–+1990 (with the last base of the termination codon being +1) might be functional regions. Hsa-miR-874-3p, associated with many psychiatric disorders, might target the +789–+1152 region in the 3′UTR of the RGS4 gene. In the dual-luciferase reporter assay, the hsa-miR-874-3p mimic, co-transfected with 3R1, down-regulated the relative fluorescence intensities. However, this was reversed when the hsa-miR-874-3p mimic was co-transfected with m3R1 (deletion of +853–+859). The hsa-miR-874-3p mimic significantly decreased the endogenous expression of the RGS4-1 isoform in HEK-293 cells. Conclusions: Hsa-miR-874-3p inhibits the expression of the RGS4-1 isoform by targeting +853–+859.

An oscillating flow past a structure represents a complex, high-dimensional, and nonlinear flow phenomenon, which can lead to the failure of structures due to material fatigue or constraint relaxation. In order to better understand flow-induced vibration (FIV) and coupled flow fields, a numerical simulation of a two-degrees-of-freedom FIV in a cylinder was conducted. Based on the Lagrangian-based dynamic mode decomposition (L-DMD) method, the vorticity field and motion characteristics of a cylinder were decomposed, reconstructed, and predicted. A comparison was made to the traditional Eulerian-based dynamic mode decomposition (E-DMD) method. The research results show that the first-order mode in the stable phase represents the mean flow field, showcasing the slander tail vortex structure during the vortex-shedding period and the average displacement in the in-line direction. The second mode predominantly captures the crossflow displacement, with a frequency of approximately 0.43 Hz, closely matching the corresponding frequency observed in the CFD results. The higher dominant modes mainly capture outward-spreading, smaller-scale vortex structures with detail displacement characteristics. The motion of the cylinder in the in-line direction was accompanied by symmetric vortex structures, while the motion of the cylinder in the crossflow direction was associated with anti-symmetric vortex structures. Additionally, crossflow displacement will cause a symmetrical vortex structure that spreads laterally along the axis behind the cylinder. Finally, when compared with E-DMD, the L-DMD method demonstrates a notable advantage in analyzing the nonlinear characteristics of FIV.