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After we developed a saturated iron core type 35 kV/90 MVA superconductive fault current limiter and installed the device in a transmission network at Puji substation of China Southern Power Grid for live-grid operation in 2007, we continued our efforts in advancing this technology. A 220 kV/300 MVA device has been designed, manufactured and factory tested. This device differs from the 35 kV device in its form of electrical insulation even though the two devices have the same working principle and similar core structure. Improvements in the dc magnetization circuit and the cryogenic system were also achieved. This 220 kV/300 MVA superconductive fault current limiter has been installed and has passed all field tests at Shigezhuang substation in Tianjin, China. Trial operation is underway. This paper introduces the major design parameters, key functional specifications and some testing results of the device. [ABSTRACT FROM AUTHOR]

Introduction: Patients with Primary Sjögren's syndrome (pSS) are at a higher risk of thyroid disorders than the general population. This retrospective analysis of 202 patients with pSS was conducted to uncover risk factors associated with thyroid involvement and to create a predictive model for this condition., Methods: We analyzed 202 patients with pSS from Guang'anmen Hospital, China Academy of Chinese Medical Sciences, with 105 cases of thyroid involvement and 97 without. The Least Absolute Shrinkage and Selection Operator method was used to identify key variables for our risk model. These variables were then subjected to multivariate logistic regression to develop the model. The accuracy of the model was assessed through the C-index, receiver operating characteristic curves, calibration plots, and decision curve analysis, with internal validation via bootstrapping., Results: High-sensitivity C-reactive protein (HCRP), pulmonary disease, pharyngeal dryness, forgetfulness, night sweats, hyperuricemia, nasal dryness, anxiety, Ro52, and aspartate aminotransferase (AST) were incorporated into the nomogram. The model showed robust discrimination and calibration abilities. Decision curve analysis indicated the clinical utility of our nomogram in intervening on the probability thresholds of thyroid disease., Conclusion: By integrating HCRP, pulmonary disease, pharyngeal dryness, forgetfulness, night sweats, hyperuricemia, nasal dryness, anxiety, Ro52, and AST, our thyroid risk nomogram can predict the risk of thyroid involvement in patients with pSS, aiding in more informed treatment strategies., Competing Interests: The authors declare 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 Yang, Du, Ren, Mei, Jiang, Liu, Zhang and Cui.)

The main stream of the Tarim River is a crucial part of China's ecological security strategy within the "two screens and three belts" framework, serving the "northern sand control belt" and the ecological civilization corridor. Evaluating and understanding desertification dynamics and driving factors is essential for achieving the United Nations Sustainable Development Goals and promoting ecological civilization. This study, based on the United Nations Convention to Combat Desertification, quantified the desertification process of the Tarim River's main stream from 1990 to 2020 using Landsat series satellite imagery from Google Earth Engine. Additionally, we employed panel data models to analyze the driving roles of climate change, socio-economic factors, and policies in desertification.Results indicate that between 1990 and 2020, desertification in the main stream of the Tarim River initially intensified, with 15% of the area experiencing desertification between 1990 and 2000. However, this trend was subsequently reversed, with only 0.6% of the area undergoing desertification over the 30-year period. Extensive economic development (-37.2%) and population growth (-48.7%) were the predominant factors exacerbating desertification in the initial period (1990-2000), whereas positive policies (55.3%) were the key to reversing desertification in the main stream of the Tarim River over the past 30 years.We also explored whether policies necessarily play a positive role in combating and preventing desertification. Based on this, we suggest actively engaging in interdisciplinary research and linking research outcomes with practical situations to formulate scientifically sound policies and measures for desertification prevention and control., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Suspended atmospheric microplastics (SAMPs) display varying occurrence characteristics on different underlying surfaces in urban areas. This study investigated the occurrence characteristics, source apportionment, and transportation patterns of SAMPs in two typical underlying surfaces: the downtown area (Site T) and the industrial area (Site C) of a coastal city in China. In the spring of 2023, a total of 32 types comprising 1325 SAMPs were detected. The average MP abundances were found to be 3.74 ± 2.86 n/m 3 in Site T and 2.67 ± 1.68 n/m 3 in Site C. In Site T, SAMPs attributed to living source constituted 78.05%, while industry was the main source in Site C with a proportion reaching 42.89%, consistent with the functional zoning of the underlying surface. Furthermore, HYSPLIT analysis revealed that there was no significant difference between these two sites in long-distance horizontal transport affected by external airflow regardless of altitude; conversely, PCA indicated a notable correlation between vertical velocity and both abundance and species diversity. According to the hourly average wind speeds, the maximum transmission distance was computed as 350 km for updraft and the minimum transmission distances was as low as 32 m for downdraft. Subsequently, the coincidence between the source proportion of SAMPs on random day and meteorological parameters confirmed the synergistic impact on SAMPs transport influenced by functional zoning, geographic environment, and vertical velocity., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Brown rice over-milling causes high economic and nutrient loss. The rice degree of milling (DOM) detection and prediction remain a challenge for moderate processing. In this study, a self-established grain image acquisition platform was built. Degree of bran layer remaining (DOR) datasets is established with image capturing and processing (grain color, texture, and shape features extraction). The mapping relationship between DOR and the DOM is in-depth analyzed. Rice grain DOR typical machine learning and deep learning prediction models are established. The results indicate that the optimized Catboost model can be established with cross-validation and grid search method, with the best accuracy improving from 84.28% to 91.24%, achieving precision 91.31%, recall 90.89%, and F1-score 91.07%. Shapley additive explanations analysis indicates that color, texture, and shape feature affect Catboost prediction accuracy, the feature importance: color > texture > shape. The YCbCr-Cb_ske and GLCM-Contrast features make the most significant contribution to rice milling quality prediction. The feature importance provides theoretical and practical guidance for grain DOM prediction model. PRACTICAL APPLICATION: Rice milling degree prediction and detection are valuable for rice milling process in practical application. In this paper, image processing and machine learning methods provide an automated, nondestructive, and cost-effective way to predict the quality of rice. The study may serve as a valuable reference for improving rice milling methods, retaining rice nutrition, and reducing broken rice yield., (© 2024 Institute of Food Technologists.)

Gaining a comprehensive understanding of the effect of land use/land cover (LULC) and soil depth on soil carbon storage, through the manipulation of external carbon input and turnover processes, is crucial for accurate predictions of regional soil carbon storage. Numerous research investigations have been conducted to examine the impact of LULC on the storage and cycling of carbon in the surface soils of coastal wetlands. Nevertheless, there remains a dearth of understanding concerning the implications of this phenomenon on subterranean soils, a crucial factor in discerning the capacity for carbon sequestration in coastal wetlands and implementing measures for their preservation. The study focused on the Yellow River Delta (YRD) in China, which serves as a representative model system. It aimed to assess the impact of LULC as well as soil depth on carbon storage. This was achieved by a combination of remote sensing interpretation and field samplings. The findings of the study indicate that there was an increase in soil organic carbon storage with both the area covered and the depth of the soil across the four different land use types, namely forest, grass, tidal flat, and cultivated land. Cultivated land was identified as the predominant LULC type, encompassing 41.73% of the entire YRD. Furthermore, it accounted for a substantial carbon storage of 76.08%. In comparison to soil layers at depths of 0-20 cm and 20-40 cm, 40-60 cm was discovered to have the maximum carbon storage, accounting for 42.29% of total carbon storage. Furthermore, one of the main factors influencing carbon storage is salinity, which shows a negative association with carbon storage. Moreover, the aforementioned findings underscore the significance of the conjoined physical and chemical properties induced by LULC in influencing the dynamics of soil carbon. This suggests that the inclusion of deep soil carbon in the estimation and restoration of soil carbon storage is necessary. This inclusion will support the realization of the United Nations' "Toward Zero Carbon" effort and facilitate the implementation of China's national carbon neutrality objectives., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Streptococcus pneumoniae infection is a major public health concern with high morbidity and mortality rates. This study aimed to evaluate the serotype distribution, antimicrobial resistance changes, clonal composition, and virulence factors of S. pneumoniae isolates causing pneumococcal disease in northeast China from 2000 to 2021. A total of 1,454 S. pneumoniae isolates were included, with 568 invasive strains and 886 non-invasive strains. The patients from whom the S. pneumoniae were isolated ranged in age from 26 days to 95 years, with those ≤ 5 years old comprising the largest group (67.19%). 19 F, 19 A, 23 F, 14, and 6B were the most common serotypes, of which 19 A and 19 F were the main serotypes of invasive and non-invasive S. pneumoniae, respectively. CC271 was the most common multilocus sequence type. Serotype 14 had the lowest expression of cbpA, rrgA, and psrP genes, but expression levels of 19 A and 19 F genes were similar. All isolates were sensitive to ertapenem, moxifloxacin, linezolid, and vancomycin but highly resistant to macrolides, tetracyclines, and cotrimoxazole. Simultaneous resistance to erythromycin, clindamycin, tetracyclines, and trimethoprim/sulfamethoxazole was common pattern among multidrug-resistant isolates. Non-invasive S. pneumoniae had higher resistance to β-lactam antibiotics than invasive strains. 19 A and 19 F were the main strains of penicillin-resistant S. pneumoniae. The resistance rate of β-lactam antibiotics decreased from 2017 to 2021 compared to previous periods. Including PCV13 in the national immunization program can reduce the morbidity and mortality rates of pneumococcal disease effectively., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Tidal channel networks, which characterize all river deltas, control the exchange of water and nutrients (hydrological connectivity) between the ocean and the delta area. Therefore, a tidal channel network in optimal conditions ensures the maintenance of the diversity and stability of the deltaic ecosystem. However, the developmental status of channel networks in the Yellow River Delta, China, has not been clearly determined. Here, we selected a typical tidal channel network in this delta that showed different spatial patterns (e.g., connectivity attributes) in the past three decades and explored its evolution using entropy as an index of connectivity. Seven scenarios were set up to determine the optimal status of the tidal channel network by optimizing its structure. The optimization effect was evaluated by comparing the connectivity attributes of the channel network before and after optimization. The results showed that the network experienced two obviously different developmental phases: an evolution before 2005 and a regression after 2005. Mann-Kendall analysis indicated that the channel network achieved dynamic stability before 2014 and became unstable thereafter. The simulations conducted to optimize the system showed that adding outlets changed the current patterns of the network' structural and functional connectivity. As the optimization proceeded, structural connectivity increased while functional connectivity decreased, and the tidal channel network tended to be dynamically stable. Our study elucidated the quantitative relationship between outlet number and stability within tidal channel networks, providing reference information that could be incorporated into future projects for the restoration and management of river deltas., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.□The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:, (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The effects of volatile organic compounds on urban air quality and the ozone have been widely acknowledged, and the contributions of relevant biogenic sources are currently receiving rising attentions. However, inventories of biogenic volatile organic compounds (BVOCs) are in fact limited for the environmental management of megacities. In this study, we provided an estimation of BVOC emissions and their spatial characteristics in a typical urbanized area, Shenzhen megacity, China, based on an in-depth vegetation investigation and using remote sensing data. The total BVOC emission in Shenzhen in 2019 was estimated to be 3.84 × 10 9  g C, of which isoprene contributed to about 24.4%, monoterpenes about 44.4%, sesquiterpenes about 1.9%, and other VOCs (OVOCs) about 29.3%. Metropolitan BVOC emissions exhibited a seasonal pattern with a peak in July and a decline in January. They were mainly derived from the less built-up areas (88.9% of BVOC emissions). Estimated BVOCs comprised around 5.2% of the total municipal VOC emissions in 2019. This percentage may increase as more green spaces emerge and anthropogenic emissions decrease in built-up areas. Furthermore, synergistic effects existed between BVOC emissions and relevant vegetation-based ecosystem services (e.g., air purification, carbon fixation). Greening during urban sprawl should be based on a trade-off between BVOC emissions and ecosystem benefits of urban green spaces. The results suggested that urban greening in Shenzhen, and like other cities as well, need to account for BVOC contributions to ozone. Meanwhile, greening cites should adopt proactive environmental management by using plant species with low BVOC emissions to maintain urban ecosystem services while avoid further degradation to ozone pollution., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Hyperlipidemia is a major risk factor for many diseases. Previous studies have shown that diet is closely associated with hyperlipidemia. However, the relationship between cooking methods and hyperlipidemia remains unclear. The objective of this study was to identify the major cooking patterns existing in the Eastern Chinese population and evaluate their association with the prevalence of hyperlipidemia., Methods: We interviewed 4,710 residents in Eastern China regarding the consumption frequency of each cooking method when they prepare food at home or when eating out and regarding the prevalence of hyperlipidemia. Factor analysis, Chi-square tests, analysis of variance, and binary logistic regression analysis were used to identify the cooking patterns and analyze the characteristics of participants' categories of cooking patterns and the relationship between different cooking patterns and prevalence of hyperlipidemia., Results: Three major cooking patterns were identified: Traditional Chinese, Bland (little or no oil is used to process the food), and High-temperature cooking patterns. After controlling for potential confounders, participants in the highest quartile of the Bland cooking pattern had lower odds of hyperlipidemia than those in the lowest quartile. Nevertheless, no significant associations were observed between the Traditional Chinese and High-temperature cooking patterns and the prevalence of hyperlipidemia., Conclusions: This study confirms the association between cooking patterns and the prevalence of hyperlipidemia and indicates that the Bland cooking pattern is associated with a reduced prevalence of hyperlipidemia., (© 2024. The Author(s).)

Background: Endoscopic surgery is widely performed with an increasing use of powered vascular staplers (PVS). However, few studies have examined PVS use in China, most of which have focused on clinical effects; fewer studies have examined the economic benefits of PVS. This study evaluated the clinical and economic benefits of the PVS compared to standard-of-care (SOC) staplers in lobectomy using results from a single-arm, multicenter clinical trial conducted in China and actual clinical use in a hospital collected in a real healthcare setting., Methods: Patients with lung cancer undergoing thoracoscopic lobectomy were included in the study. The clinical and economic benefits of powered vascular stapler have been evaluated from a hospital's perspective based on parameters such as bleeding occurrence, hospitalization time, secondary thoracotomy, and hospitalization costs. To compare the bleeding associated with use of PVS and SOC stapler in clinical use, PVS single-arm multi-center clinical trial data is used for the intervention group, and sampling data from hospitals is used for the control group. To ensure the outcome indicators between the two groups are comparable, we set the same inclusion criteria for the two groups of data and then used propensity score matching (PSM) to match two groups of patients according to the baseline characteristics., Results: The results show that bleeding incidence in patients with SOC stapler group is 17.33% from hospital sampling data. In contrast, in the PVS group, it is 4.00%, and these rates are statistically different ( p  = 0.0167). Considering converted to open thoracic surgery, the rate of the SOC stapler group is 5.78% and that of the PVS group is 4.00%. These rates are not statistically different ( p  = 0.6166). Regarding hospitalization days, the length of the SOC stapler group is 18.97 days, while that in the PVS group is 12.38 days, and these data are statistically different ( p  = 0.0002). As patients in the PVS group have reduced bleeding, they will require less resource use from blood transfusion, drug services, and surgical services. If PVS is used for transection of vessel, it can reduce the bleeding incidence by 13.33% and save 75.47 CNY in blood transfusion costs, 571.36 CNY in drug costs, and 183.38 CNY in surgical service costs per patient. From these three aspects, the hospital saves per patient 830.21 CNY., Conclusions: Compared with the SOC stapler group, the PVS group has a lower bleeding incidence and shorter hospital days for lobectomy. In terms of blood transfusion costs, drug costs, and surgical service costs, the hospital saves per patient 830.21 CNY.

Understanding the mechanisms by which the geomorphic structures affect habitat invasibility by mediating various abiotic and biotic factors is essential for predicting whether these geomorphic structures may provide spatial windows of opportunity to facilitate range-expansion of invasive species in salt marshes. Many studies have linked geomorphic landscape features such as tidal channels to invasion by exotic plants, but the role of tidal channel meanders (i.e., convex and concave sides) in regulating the Spartina alterniflora invasion remains unclear. Here, we examined the combined effects of tidal channel meander-mediated hydrodynamic variables, soil abiotic stresses, and propagule pressure on the colonization of Spartina in the Yellow River Delta, China, by conducting field observations and experiments. The results showed that lower hydrodynamic disturbance, bed shear stress, and higher propagule pressure triggered by eddies due to the convex structure of channel meanders facilitated Spartina seedling establishment and growth, whereas the concave side considerably inhibited the Spartina invasion. Lower soil abiotic stresses also significantly promoted the invasibility of the channel meanders by Spartina. Based on these findings, we propose a conceptual framework to illustrate the effects of the meandering geomorphology of tidal channels on the mechanisms that might allow the landward spread of Spartina and related processes. Our results demonstrate that the meandering geomorphic structures of tidal channels could act as stepping-stones to significantly facilitate the landward invasion of Spartina along tidal channels. This implies that geomorphic characteristics of tidal channels should be integrated into invasive species control and salt marsh management strategies., (© 2023 The Ecological Society of America.)

Cooking methods can change the composition of foods and have important effects on human health. The Chinese people have developed many distinct and unique cooking methods. However, the daily cooking patterns of Chinese people and the characteristics and evolution of trends in cooking patterns commonly used by Chinese consumers remain unclear. The objective of this study was to identify the major cooking patterns and discuss their effects on human health, as well as to identify the cooking pattern consumer clusters and the evolution of trends in Chinese consumer cooking patterns. From March to June 2021, this study interviewed 4,710 residents in Eastern China regarding the consumption frequency of each cooking method when food is prepared at home or when eating out. Exploratory factor analysis, K-Means cluster analysis, Chi-square test, pairwise comparisons of multiple sample rates, and multivariate linear regression were used to identify the cooking patterns and cooking pattern consumer clusters, to assess differences in consumption preferences between consumer clusters, and to examine the relationship between demographic characteristic variables and different cooking patterns. Results revealed three major cooking patterns, namely traditional Chinese (cooking methods with native Chinese characteristics), bland, and high-temperature cooking patterns, as well as seven cooking pattern consumer clusters and their demographic characteristics in the Eastern Chinese population. With increases in age, education level, and income, consumers tended to choose the healthy "Bland" cooking pattern. Further, there was a higher proportion of people aged 36-65 years in the C3 cluster, which is characterized by the "Bland" cooking pattern. However, participants who were male and younger made fewer healthy choices in their cooking patterns. Specifically, a higher proportion of participants aged 21-35 years were found in the C5 cluster, which is characterized by the unhealthy "High-temperature" cooking pattern. Therefore, culinary health education should focus on individuals who are male and young. Specifically, the shift in cooking patterns among people aged 21-35 years should receive special attention., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Liang 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.)

In a large-scale region, governance for connectivity in an ecological system often conflicts with management boundaries, causing inefficiencies. Collaboration among management organizations in different areas can help overcome this problem. However, few studies quantified the collaborations' practical relationship with connectivity, considering that some potentially connected paths are easy to neglect by managers. In this paper, collaborations among government agencies in project application process were analyzed, and a multilevel social-ecological network analysis (SENA) approach was developed to identify the collaboration's effect on genetically connected coastal areas. The network framework and methods were shown in a case of coastal saltmarsh conservation and development in the Yellow River Delta, China. Collaboration patterns in conservation and development networks were analyzed and compared among local, subregional, and regional government agencies working in genetically connected coastal areas. Project information flow, reflecting communication frequency and decision-making chances among government agencies was quantified and correlated with ecological connectivity to inform governance effects. Results showed areas with the potential to realize social-ecological alignment, where collaborative networks were measured by network density (percentage of connected network edges). The current reveals that development has more significant potential than conservation at most levels to overcome the misalignment of the social-ecological system, also known as scale mismatch. Empirical evidence also showed a correlation between communication capacity in development networks and improved ecological conditions. The multilevel SENA advanced in this paper can be used for natural resource management when connectivity plays a major role., Competing Interests: Declaration of competing interest The authors declare there are no conflicts of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objectives: The effect of insulin use on gout risk remains unknown. This study aimed to investigate the association between insulin use and gout risk among patients with type 2 diabetes mellitus (T2DM)., Methods: Based on the Shanghai Link Healthcare Database, patients with newly diagnosed T2DM, with or without insulin exposure, were identified from January 1, 2014 to December 31, 2020, and followed until December 31, 2021. Apart from the original cohort, we also established a 1:2 propensity score-matched cohort. A time-dependent Cox proportional hazards model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for gout incidence associated with insulin exposure., Results: A total of 414,258 patients with T2DM, including 142,505 insulin users and 271,753 insulin non-users, were enrolled in this study. After a median follow-up of 4.08 years (interquartile range, 2.46-5.90 years), the incidence of gout was significantly higher in insulin users than in insulin non-users (319.35 versus 302.20 cases per 100,000 person-years; HR 1.09, 95% CI 1.03-1.16). The results were robust in propensity score-matched cohort, sensitivity analyses, and stratified analysis of aspirin. In other stratified analyses, the association between insulin use and increased gout risk was found only in patients who were female, or aged 40-69 years, or without hypertension, dyslipidemia, ischemic heart disease, chronic lung disease, kidney disease, or not using diuretic., Conclusions: Insulin use is associated with a significantly increased risk of gout among patients with T2DM. Key Points • The first real-world study to investigate the effect of insulin use on gout risk. • Insulin use is associated with a significantly increased risk of gout among patients with type 2 diabetes mellitus., (© 2023. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Understanding the spatiotemporal landscape dynamics and spread pathways of invasive plants, as well as their interactions with geomorphic landscape features, are of great importance for predicting and managing their future range-expansion in non-native habitats. Although previous studies have linked geomorphic landscape features such as tidal channels to plant invasions, the potential mechanisms and critical characteristics of tidal channels that affect the landward invasion by Spartina alterniflora, an aggressive plant in global coastal wetlands, remain unclear. Here, using high-resolution remote-sensing images of the Yellow River Delta from 2013 to 2020, we first quantified the evolution of tidal channel networks by analyzing the spatiotemporal dynamics of their structural and functional characteristics. The invasion patterns and pathways of S. alterniflora were then identified. Based on the above-mentioned quantification and identification, we finally quantified the influences of tidal channel characteristics on S. alterniflora invasion. The results showed that tidal channel networks presented increasing growth and development over time, and their spatial structure evolved from simple to complex. The external isolated expansion of S. alterniflora played a dominant role during the initial invasion stage, and then they connected the discrete patches into the meadow through marginal expansion. Afterwards, tidal channel-driven expansion gradually increased and became the primary way during the late invasion stage, accounting for about 47.3%. Notably, tidal channel networks with higher drainage efficiency (shorter OPL, higher D and E) attained larger invasion areas. The longer the tidal channels and the more sinuous the channel structure, the greater the invasion potential by S. alterniflora. These findings highlight the importance of structural and functional properties of tidal channel networks in driving plant invasion landward, which should be incorporated into future control and management of invasive plants in coastal wetlands., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Global warming is expected to increase the atmospheric evaporative demand and make more surface water for evapotranspiration, aggerating water sources' social and ecological shortage. Pan evaporation, as a routine observation worldwide, is an excellent metric to indicate the response of terrestrial evaporation to global warming. However, several non-climatic effects, such as instrument upgrades, have destroyed the homogenization of pan evaporation and limited its applications. In China, 2400s meteorological stations have observed daily pan evaporation since 1951. The observed records became discontinuous and inconsistent due to the instrument upgrade from micro-pan D20 to large-pan E601. Here, combining the Penpan model (PM) and random forest model (RFM), we developed a hybrid model to assimilate different types of pan evaporation into a consistent dataset. Based on the cross-validation test, on a daily scale, the hybrid model has a lower bias (RMSE=0.41 mm day -1 ) and better stability (NSE=0.94) than the two sub-models and the conversion coefficient method. Finally, we produced a homogenized daily dataset of E601 across China from 1961 to 2018. Based on this dataset, we analyzed the long-term trend of pan evaporation. Pan evaporation showed a -1.23±0.57 mm a -2 downward trend from 1961-1993, primarily caused by decreased pan evaporation in warm seasons over North China. After 1993, the pan evaporation in South China increased significantly, resulting in a 1.83±0.87 mm a -2 upward trend across China. With better homogeneity and higher temporal resolution, the new dataset is expected to promote drought monitoring, hydrological modeling, and water resources management. Free access to the dataset can be found at https://figshare.com/s/0cdbd6b1dbf1e22d757e., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

The invasion of Spartina alterniflora has caused severe damage to the coastal wetland ecosystem of the Yellow River Delta, China. Flooding and salinity are key factors influencing the growth and reproduction of S. alterniflora. However, the differences in response of S. alterniflora seedlings and clonal ramets to these factors remain unclear, and it is not known how these differences affect invasion patterns. In this paper, clonal ramets and seedlings were studied separately. Through literature data integration analysis, field investigation, greenhouse experiments, and situational simulation, we demonstrated significant differences in the responses of clonal ramets and seedlings to flooding and salinity changes. Clonal ramets have no theoretical inundation duration threshold with a salinity threshold of 57 ppt (part per thousand); Seedlings have an inundation duration threshold of about 11 h/day and a salinity threshold of 43 ppt. The sensitivity of belowground indicators of two propagules-types to flooding and salinity changes was stronger than that of aboveground indicators, and it is significant for clones (P < 0.05). Clonal ramets have a larger potentially invadable area than seedlings in the Yellow River Delta. However, the actual invasion area of S. alterniflora is often limited by the responses of seedlings to flooding and salinity. In a future sea-level rise scenario, the difference in responses to flooding and salinity will cause S. alterniflora to further compress native species habitats. Our research findings can improve the efficiency and accuracy of S. alterniflora control. Management of hydrological connectivity and strict restrictions on nitrogen input to wetlands, for example, are potential new initiatives to control S. alterniflora invasion., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Soil heavy metal(loid)s contamination caused by rapid urbanization and industrialization seriously affects human health and hinders the global sustainable development goals (SDGs). Currently, there is a lack of comprehensive human health risk assessment (HHRA) studies for multiple land use types at the regional scale. We propose a practical risk assessment framework that integrates empirical Bayesian kriging (EBK), pollution level analyses, and modified HHRA modeling. The concentrations of copper industry-related metals (Cu, Ni, Cd, As, and Hg) in 332 topsoil samples from the south bank of the Yangtze River in Tongling were investigated. Obvious enrichment of Cu, Cd, As, and Hg was detected, and the average concentration of Cu was 5.24 times higher than the background values. The distribution of heavy metal(loid) pollution was typically high in the south and east, and low in the north and west. The mean errors of interpolation for Cu, Ni, and Hg were 0.84, 1.29, and 0, respectively, and the root mean square errors of interpolation for Cd and As were 1.29 and 0.86, respectively. Non-carcinogenic risks of soil heavy metal(loid)s were assessed as acceptable throughout the studied area. The hazard index decreased in the order As (0.448) > Ni (0.0729) > Cd (0.0136) > Hg (9.04 ×10 -4 ) > Cu (6.41 ×10 -4 ). Nevertheless, the carcinogenic risks of Ni, Cd, and As in 70-80% of the administrative units (AUs) were between 10 -6 to 10 -4 , considered an unacceptable level. Exposure through the oral ingestion route accounted for 88.0-99.2% of the total three exposure routes. It is worth noting that four AUs were considered to be the priority control units, and Ni and As were identified as the priority control soil heavy metal(loid)s. This case demonstrates the feasibility and scientific validity of the new EBK-HHRA framework, which confirms that EBK can effectively predict the spatial distribution patterns of soil heavy metal(loid)s and that modified HHRA models are conducive to risk integration at the regional scale. The EBK-HHRA approach is generic and provides substantial support for risk source identification and risk management of soil heavy metal(loid)s contamination at the regional scale., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Invasive Spartina spp. mostly colonizes a bare tidal flat and then establishes a new vegetated habitat, where it promotes the productivity of local ecosystems. However, it was unclear whether the invasive habitat could well exhibit ecosystem functioning, e.g. how its high productivity propagates throughout the food web and whether it thereby develops a high food web stability relative to native vegetated habitats. By developing quantitative food webs for a long-established invasive Spartina alterniflora habitat and adjacent native salt marsh (Suaeda salsa) and seagrass (Zostera japonica) habitats in China's Yellow River Delta, we investigated the distributions of energy fluxes, assessed the stability of food webs, and investigated the net trophic effects between trophic groups by combining all direct and indirect trophic interactions. Results showed that the total energy flux in the invasive S. alterniflora habitat was comparable to that in the Z. japonica habitat, whereas 4.5 times higher than that in the S. salsa habitat. While, the invasive habitat had the lowest trophic transfer efficiencies. Food web stability in the invasive habitat was about 3 and 40 times lower than that in the S. salsa and Z. japonica habitats, respectively. Additionally, there were strong net effects caused by intermediate invertebrate species in the invasive habitat rather than by fish species in both native habitats. This study revealed the contradiction between the promotion of energy fluxes and the decrease of food web stability resulting from the invasion of S. alterniflora, which provides new insights into the community-based management of plant invasions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Inadequate hand-washing among chefs is a major contributor to outbreaks of foodborne illnesses originating in restaurants. Previous studies have found that mental health influences hygiene behaviors among food handlers, who have a high rate of job burnout. However, it is still unclear whether job burnout leads to restaurant kitchen chefs' poor hand washing behaviors (HWBs). In this study, we interviewed 453 restaurant kitchen chefs in Jiangsu Province, China regarding job burnout and HWBs during the summer (July-August) of 2020. The aims were to investigate job burnout (an individual internal motivation factor), identify determinants of job burnout, and examine the association between job burnout and HWBs. Variance analysis, post hoc multiple comparisons, linear regression models, and structural equation modeling were used to analyze the response data. This study revealed that chef age and the scale of the restaurant were significantly and negatively associated with reduced professional efficacy. Combined cuisine and pastry chefs had a more positive perception of their own professional efficacy than the other kitchen chefs, whereas the incidence of exhaustion was significantly higher in pastry chefs than in cuisine chefs and kitchen hands. Reduced professional efficacy was significantly and negatively associated with HWBs for all chefs. To improve the level of hand hygiene among chefs, measures should be taken to enhance chefs' professional efficacy. Furthermore, close attention should be paid to chefs in small-scale restaurants, younger chefs, cuisine chefs, pastry chefs, and kitchen hands.

Neutralizing antibody (NtAb) levels are key indicators in the development and evaluation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccines. Establishing a unified and reliable WHO International Standard (IS) for NtAb is crucial for the calibration and harmonization of NtAb detection assays. National and other WHO secondary standards are key links in the transfer of IS to working standards but are often overlooked. The Chinese National Standard (NS) and WHO IS were developed by China and WHO in September and December 2020, respectively, the application of which prompted and coordinated sero-detection of vaccine and therapy globally. Currently, a second-generation Chinese NS is urgently required owing to the depletion of stocks and need for calibration to the WHO IS. The Chinese National Institutes for Food and Drug Control (NIFDC) developed two candidate NSs (samples 33 and 66-99) traced to the IS according to the WHO manual for the establishment of national secondary standards through a collaborative study of nine experienced labs. Either NS candidate can reduce the systematic error among different laboratories and the difference between the live virus neutralization (Neut) and pseudovirus neutralization (PsN) methods, ensuring the accuracy and comparability of NtAb test results among multiple labs and methods, especially for samples 66-99. At present, samples 66-99 have been approved as the second-generation NS, which is the first NS calibrated tracing to the IS with 580 (460-740) International Units (IU)/mL and 580 (520-640) IU/mL by Neut and PsN, respectively. The use of standards improves the reliability and comparability of NtAb detection, ensuring the continuity of the use of the IS unitage, which effectively promotes the development and application of SARS-CoV-2 vaccines in China., 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 © 2023 Guan, Mao, Tan, Liu, Zhang, Li, Liu, Wang, Cheng, Cui, He, Wang, Gao, Wang, Bian, Wu, Hou, Liang and Xu.)

Background: All-cause mortality risk prediction models for patients with type 2 diabetes mellitus (T2DM) in mainland China have not been established. This study aimed to fill this gap., Methods: Based on the Shanghai Link Healthcare Database, patients diagnosed with T2DM and aged 40-99 years were identified between January 1, 2013 and December 31, 2016 and followed until December 31, 2021. All the patients were randomly allocated into training and validation sets at a 2:1 ratio. Cox proportional hazards models were used to develop the all-cause mortality risk prediction model. The model performance was evaluated by discrimination (Harrell C-index) and calibration (calibration plots)., Results: A total of 399 784 patients with T2DM were eventually enrolled, with 68 318 deaths over a median follow-up of 6.93 years. The final prediction model included age, sex, heart failure, cerebrovascular disease, moderate or severe kidney disease, moderate or severe liver disease, cancer, insulin use, glycosylated hemoglobin, and high-density lipoprotein cholesterol. The model showed good discrimination and calibration in the validation sets: the mean C-index value was 0.8113 (range 0.8110-0.8115) and the predicted risks closely matched the observed risks in the calibration plots., Conclusions: This study constructed the first 5-year all-cause mortality risk prediction model for patients with T2DM in south China, with good predictive performance., (© 2022 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai JiaoTong University School of Medicine and John Wiley & Sons Australia, Ltd.)

Due to the resistance of Streptococcus pneumoniae to β-lactams, macrolides, and tetracyclines, treatment alternatives have become increasingly limited worldwide. We aim to describe the characterization of erythromycin-resistant S. pneumoniae (ERSP) strains in northeastern China over a period of 20 years. A total of 1,240 ERSP strains were collected and classified into five groups based on the ages of the patients. Etest strips and Kirby-Bauer disk diffusion were performed for drug susceptibility testing. The capsule swelling test was used for capsule typing. The phenotype of drug resistance was detected by the erythromycin and clindamycin double-disk method. The ermB , ermTR , mefA , and tetM genes were detected by PCR. Among the 1,240 ERSP strains, 510 were invasive isolates, and 730 were noninvasive isolates. The results of drug susceptibility testing showed that the rates of resistance to penicillin, amoxicillin, cefotaxime, ceftriaxone, meropenem, tetracycline, trimethoprim-sulfamethoxazole, and chloramphenicol varied among the different age groups. 19F, 19A, 23F, 14, and 6B were the serotypes that were commonly found among ERSP strains. Among all strains, 99.03% (1,228/1,240) exhibited an MLSB (macrolide-lincosamide-streptogramin B) resistance phenotype, of which 1,221 strains displayed a constitutive MLSB (cMLSB) phenotype and 7 strains showed an inducible MLSB (iMLSB) phenotype. All of these strains carried the ermB gene. In contrast, only 0.97% of strains of M phenotypes were found to carry the mefA gene. Both the ermB and mefA genes were detected in 704 strains that exhibited multidrug resistance, whereas the ermTR gene was not detected. Furthermore, 1,185 tetracycline-resistant strains were found to carry the tetM gene. Macrolide antimicrobial drugs should be used cautiously for the empirical treatment of S. pneumoniae infections. IMPORTANCE This study presents a retrospective analysis using 1,240 clinical erythromycin-resistant Streptococcus pneumoniae (ERSP) isolates collected in northeastern China between January 2000 and December 2019. The serotype distribution, corresponding vaccine coverage, as well as resistance phenotypes, genes, and mechanisms to macrolide and tetracycline of these isolates were systematically described, analyzed, and discussed. We hope that this study will inform clinicians in their respective regions when selecting antimicrobial agents. We also hope that this study is useful for researchers in related fields. Finally, we emphasize in this study that vaccination is the best preventive measure for S. pneumoniae infection considering its resistance to commonly used antibiotics. The determination of the S. pneumoniae serotype distribution also provides valuable empirical evidence for local health authorities when introducing appropriate vaccines in a specific area.

Conservation and restoration have long been regarded as two separate management avenues to maintain or enhance ecosystem functioning. Despite the commonalities in goals, restoration is generally considered a lower priority than conservation due to its generally greater cost, uncertainties in multiple trajectories and deals with already degraded habitats. However, when resources and opportunities for meeting conservation needs are limited, restoration could be an imperative avenue to provide additional benefits from conservation. The priority of conservation and restoration should be integrated based on an identical framework cost effectively to obtain the maximum ecological benefits with minimal costs. We propose a methodological framework to integrate conservation and restoration based on theories of Systematic Conservation Planning, which could identify best integrated conservation and restoration pattern in a cost-effective way on the basis of the provisions of multiple ecosystem services (i.e., carbon storage, water yield, soil retention and habitat quality). The trade-offs among four ecosystem services are assessed with an each of 10% increment in the target levels of ecosystem services. We demonstrated our approach at a regional scale, in the Dongting Lake Area, China. Our results showed that conservation is prioritized in a higher proportion of the study area when the targets are low. When the target level became higher, restoration gained more importance with growing area. This highlights that restoration pattern is indispensable when target setting become high and the integrated conservation and restoration planning is more cost efficient than that of conservation alone. Improving the carbon storage and soil retention would also contribute greatly to an increase in other ecosystems, but increasing the water yield and habitat quality would not guarantee an improvement for others. Integrated conservation and restoration planning will facilitate refine target achievement of conservation and restoration recommendations, by the trade-offs between conservation and restoration, and among different ecosystem services, our prioritization framework provides a useful insight in implementing the integrated planning, which can improve the efficiency in increasing ecosystem services compared to use either conservation or restoration ways., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Knowledge of adequate diets can improve an individual's health status. Although previous studies have identified the main resources from which Chinese people acquire dietary knowledge, it is still unclear whether information sources regarding diets (ISRDs) can increase individuals' knowledge of adequate diets (KAD) and which ISRDs are most effective in conveying KAD to the Chinese population. In this study, we interviewed 4,710 residents in Eastern China regarding their ISRDs and KAD. Descriptive statistics, ANOVA, and multivariate linear regression were used to analyze the effectiveness of different ISRDs in transmitting KAD to Chinese individuals and to determine the relationship between ISRDs and KAD. Results showed that the KAD scores of the respondents were low overall in Eastern China. Providing dietary information through expert lectures, books, newspapers, magazines, and social media could significantly improve the average KAD score of Chinese individuals. Respondents with a greater number of ISRDs were more likely to have higher KAD scores. These findings suggest that the number of ISRDs should be increased. In particular, emphasis should be placed on the role of expert lectures, books, newspapers, magazines, and social media., 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 © 2022 Cui, Wang, Wang, Peng, Ma, Chen, Xu, Ke and Tian.)

Introduction: The artery of Percheron (AOP) is a rare anatomical variant in which bilateral paramedian thalami are supplied by a single vascular branch arising from the P1 segment of the posterior cerebral artery. We present a case of AOP occlusion presenting as loss of consciousness and summarize the literature in Chinese to find the clinical characteristics., Case Report: An 83-year-old woman was found unconscious for 1 day at home and was sent to the hospital the next day. Cerebral magnetic resonance imaging on day 1 of the patient showed a recent bilateral paramedian thalamic infarction. Simultaneously, magnetic resonance angiography found evident artery stenosis of the right P1 segment of the posterior cerebral artery, suggesting that the patient was diagnosed with AOP occlusion. Since the patient has missed the best time for thrombolytic therapy, anticoagulant therapy was given immediately; as the patient was then found to have pulmonary infections, antibiotic therapy was also initiated. The neurological status of this patient improved very slow. In about 2 weeks, the patient becomes more conscious but still could not speak or move., Conclusion: Our report suggests that unusual mood disorder and language disorder of aged patients might indicate the AOP occlusion, and cerebral imaging of magnetic resonance imaging (better with magnetic resonance angiography) should be performed to establish the diagnosis of AOP occlusion. The fast and accurate diagnosis of stroke because of AOP occlusion could best benefit the patients., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

Chinese consumers often prefer to buy live chickens for cooking at home rather than chilled or frozen chicken meat because of the superior flavor. Even though the purchase of live chickens for consumption was restricted by the Chinese government after the avian influenza (AI) virus outbreak in 2013, people continue to buy live chickens. Thus, it is important to understand why people make this decision. The goal of this study was to investigate the relationships among chicken meat taste preferences, perceived risk of human infection with AI virus, and chicken meat consumption behaviors in China. To address this, a survey of 1108 individuals was carried out in Jiangsu Province. This province was selected because its per capita consumption of poultry products is higher than the national average, and it is at the highest risk for avian influenza A H7N9 and H5N1 virus epidemics out of all provinces in China. Descriptive statistics, multivariate linear regression, and hierarchical regression modeling were used to analyze the data. The results showed that Chinese consumers still buy live chickens at a high rate due to taste preferences, and have a very low perceived risk of infection with AI virus. Multivariate linear and hierarchical regression analyses showed that total monthly household income was significantly and positively associated with the perceived importance of chicken taste; the number of people in the household and the perceived importance of chicken taste were significantly and positively associated with the purchase of live chickens for consumption; age was significantly and negatively associated with the purchase of chilled and frozen chicken for consumption; and education and expertize in livestock-related fields were significantly and positively associated with the purchase of live chickens for consumption. Expertize in livestock-related fields was significantly and positively associated with perceived risk of human infection with AI virus, and perceived risk was significantly and positively associated with the purchase of chilled chicken for consumption. However, the perceived risk of human infection with AI virus had no effect on the relationship between the perceived importance of chicken taste and the purchase of live chickens for consumption. The findings from this study suggest that, over time and with increasing public education, the purchase of live poultry for consumption will gradually decline in China. However, to accelerate this process, measures should be taken to reduce consumer perception of taste differences between chilled chicken meat and meat from freshly killed chickens. In addition, educating consumers about livestock to enhance their risk perception could also be another effective means of promoting the purchase of chilled and frozen chicken meat., (Copyright © 2022 Elsevier B.V. All rights reserved.)

High levels of ambient fine particulate matter (PM 2.5 ) might increase the risk of death due to cardiovascular diseases (CVDs). As a critical risk factor for CVDs, dyslipidemia can cause CVDs or exacerbate pre-existing ones. This study aimed to investigate whether a short-time exposure to PM 2.5 leads to dyslipidemia (HyperTC, HyperLDL-C, HyperTG and HypoHDL-C) in adults. The serum lipid data were provided by the Sichuan Provincial People's Hospital Medical Examination Center. We included 309,654 subjects aged 18-79 between May 10, 2015, and May 10, 2017. An advanced distributed lag nonlinear model (DLNM) was applied to investigate the acute and lag effects of ambient PM 2.5 on the risk of dyslipidemia. This study was also stratified by sex, age, BMI and season to examine potential effect modification. We observed that the associations between an interquartile increase in PM 2.5 (43 μg/m 3 ) and dyslipidemia were [relative risk (RR); 95% confidence interval (CI)]: 1.042 (1.013, 1.071) for HyperLDL-C and 1.027 (1.006, 1.049) for HyperTC at lag0 day. The lag effects were found at lag6 day for HyperLDL-C, in lag4-6 days for HyperTC and lag4-7 days for HyperTG. Short-term exposure to ambient PM 2.5 was related to dyslipidemia and the effect modification was observed in the subgroup analysis. The female and normal-weight populations were more susceptible to the risks of PM 2.5 on HyperLDL-C and HyperTC., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Estimating the biomass of Phragmites australis (Cav.) Trin. ex Steud., i.e., a common wetland macrophyte, and the associated carbon sequestration capacity has attracted increasing attention. Hanshiqiao Wetland Nature Reserve (HWNR) is a large P. australis wetland in Beijing, China, and provides an ideal case study site for such purpose in an urban setting. In this study, an existing P. australis growth dynamics model was adapted to estimate the plant biomass, which was in turn converted to the associated carbon sequestration capacity in the HWNR throughout a typical year. To account for local differences, the modeling parameters were calibrated against the above-ground biomass (AGB) of P. australis retrieved from hyperspectral images of the study site. We also analyzed the sensitivity of the modeling parameters and the influence of environmental factors, particularly the nutrient availability, on the growth dynamics and carbon sequestration capacity of P. australis . Our results show that the maximum AGB and below-ground biomass (BGB) of P. australis in the HWNR are 2.93 × 10 3 and 2.49 × 10 3 g m -2 , respectively, which are higher than the reported level from nearby sites with similar latitudes, presumably due to the relatively high nutrient availability and more suitable inundation conditions in the HWNR. The annual carbon sequestration capacity of P. australis in the HWNR was estimated to be 2040.73 gC m -2 yr -1 , which was also found to be highly dependent on nutrient availability, with a 50% increase (decrease) in the constant of the nutrient availability K NP , resulting in a 12% increase (23% decrease) in the annual carbon sequestration capacity. This implies that a comprehensive management of urban wetlands that often encounter eutrophication problems to synergize the effects of nutrient control and carbon sequestration is worth considering in future practices.

Studies have revealed key genomic aberrations in pediatric acute myeloid leukemia (AML) based on Western populations. It is unknown to what extent the current genomic findings represent populations with different ethnic backgrounds. Here we present the genomic landscape of driver alterations of Chinese pediatric AML and discover previously undescribed genomic aberrations, including the XPO1-TNRC18 fusion. Comprehensively comparing between the Chinese and Western AML cohorts reveal a substantially distinct genomic alteration profile. For example, Chinese AML patients more commonly exhibit mutations in KIT and CSF3R, and less frequently mutated of genes in the RAS signaling pathway. These differences in mutation frequencies lead to the detection of previously uncharacterized co-occurring mutation pairs. Importantly, the distinct driver profile is clinical relevant. We propose a refined prognosis risk classification model which better reflected the adverse event risk for Chinese AML patients. These results emphasize the importance of genetic background in precision medicine., (© 2022. The Author(s).)

As one of the most concerned issues in modern society, air quality has received extensive attentions from the public and the government, which promotes the continuous development and progress of air quality forecasting technology. In this study, an automated air quality forecasting system based on machine learning has been developed and applied for daily forecasts of six common pollutants (PM 2.5 , PM 10, SO 2 , NO 2 , O 3 , and CO) and pollution levels, which can automatically find the best "Model + Hyperparameters" without human intervention. Five machine learning models and an ensemble model (Stacked Generalization) were integrated into the system, supported by a knowledge base containing the meteorological observed data, pollutant concentrations, pollutant emissions, and model reanalysis data. Then five-year data (2015-2019) of Beijing, Shanghai, Guangzhou, Chengdu, Xi'an, Wuhan, and Changchun in China, were used as an application case to study the effectiveness of the automated forecasting system. Based on the analysis of seven evaluation criteria and pollution level forecasts, combined with the forecasting results for the next 3-days, it is found that the automated system can achieve satisfactory forecasting performance, better than most of numerical model results. This implied that the developed system unveils a good application prospect in the field of environmental meteorology., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Early diagnosis and proper management of a large number of chronic obstructive pulmonary disease (COPD) patients are great challenges for the Chinese health care system. Although tiered medical services have been promoted by the Chinese government since 2015, they have not been ideally implemented for COPD diagnosis and management., Patients and Methods: We designed a cross-sectional study. Eligible COPD patients (n = 648) and physicians (n = 161) were consecutively recruited from 8 hospitals in different tiers in China. COPD characteristics and treatments were compared among hospitals in different tiers. Multivariate logistic regression was performed to identify risk factors associated with airflow limitation, symptoms and acute exacerbation., Results: The PFT rate at first diagnosis was 99%, 69.4% and 29.9% in teaching, second-tier and community hospitals (P < 0.001). Only approximately 10.9%, 1.7% and 9.6% and 21.8%, 6.9% and 32% of COPD patients received influenza or pneumococcal vaccines (P < 0.001). The proportion of patients who did not use inhaled drugs or had irregular inhalation was 2%, 24.6% and 78.8% (P < 0.001). Education level (RR-1 = -41.26%, P = 0.007), FEV1%pred (RR-1 = -2.76%, P < 0.001), and influenza vaccination in the last year (RR-1 = -64.53%, P = 0.006) were all negatively correlated with COPD acute exacerbation (AE). COPD duration (RR-1 = 131.73%, P = 0.009), AE (RR-1 = 151.39%, P < 0.001), and COPD Assessment Test (CAT) scores (RR-1 = 3.82%, P = 0.019) were all positively correlated with COPD airflow limitation severity., Conclusion: Differences exist in the diagnosis, treatment and management of COPD among different tiers of hospitals in China. Teaching hospitals can manage COPD patients relatively well. There are still some gaps compared with developed countries., Competing Interests: The authors report no conflicts of interest in this work., (© 2022 Mao et al.)

Background: The Chinese government has promoted the 'tiered medical services' policy in which diseases are classified by severity, mode of onset and difficulty of treatment since 2015 to optimize medical resources. We evaluated the diagnosis and treatment of acute exacerbation (AE) of chronic obstructive pulmonary disease (AECOPD) under the tiered system., Methods: We conducted a cross-sectional study. COPD characteristics and treatments were compared among hospitals in different tiers. Associations were examined by univariate and multivariable logistic regression analysis. In addition, multivariate logistic regression was performed to identify the possible influencing factors of antibiotics, glucocorticoids and anticoagulant usages., Results: Eligible COPD patients ( n  = 432) were consecutively recruited from eight hospitals in different tiers in China. Patients in the countryside preferred the community hospitals, whereas patients in cities preferred second-tier and teaching hospitals when they suffer from AECOPD. It indicates most COPD patients are likely to treat their disease locally. The severity of COPD AE increased with tiers of hospitals ( p  < 0.001). However, our results clearly show that most community hospitals can only deal with mild exacerbation of COPD. Approximately 90% of AE patients received antibiotics. We speculated that antibiotics abuse might exist in the three tiers of hospitals. Multivariate analysis demonstrated that long-term antibiotics usage (⩾14 days) was associated with moderate exacerbation [odds ratio (OR): 5.295, 95% confidence intervals (CI) 2.248-12.473, p  < 0.001], radiographic progression (OR: 2.176, 95% CI: 1.047-4.522, p  = 0.037), positive sputum etiology (OR: 3.073, 95% CI: 1.477-6.394, p  = 0.003) and increased white blood cells (OR: 2.470, 95% CI: 1.190-5.126, p  = 0.015). The proportion of glucocorticoids increased with the hospital hierarchy (18.6% versus 45.6% versus 69.2%, p  < 0.001). The proportions of severe cases in the second-tier hospitals were 26.9%; however, non-invasive positive pressure ventilation (NPPV) rate was only 14.7%. Anticoagulant is not commonly used in AECOPD, and the community hospitals had the lowest proportion of anticoagulation regimen (1.7% versus 14.3% versus 20.5%, p  = 0.002)., Conclusions: The 'tiered medical services' policy in AECOPD management has been unsatisfactory in the past years. Irrational treatment strategies in different hospitals were still found when comparing with international guideline. Further reform of the policy is still needed to optimize the management of AECOPD in China.

Human brucellosis is caused by Brucella species and remains a major burden in both human and domesticated animal populations, especially in Inner Mongolia, China. The aims of this study were to analyze the spatiotemporal trends in human brucellosis in Inner Mongolia during 2010 to 2015, to explore the factors affecting the incidence of brucellosis. The results showed that the annual incidence was 29.68-77.67 per 100,000, and peaked from March to June. The majority of human brucellosis was male farmers and herdsmen, aged 40-59 years. The high-risk areas were mainly Xilin Gol League and Hulunbeier City. The incidence of human brucellosis in Inner Mongolia decreased during 2010 to 2015, although the middle and eastern regions were still high-risk areas. The regions with larger number of sheep and cattle, lower GDP per capita, less number of hospital beds, higher wind speed, lower mean temperature more likely to become high-risk areas of human brucellosis., (© 2021. The Author(s).)

Background: To explore the association of cigarette smoking with retinal thickness and vascular structure in an elderly Chinese population., Methods: This cross-sectional study enrolled employees and retirees aged over 50 years at Tianjin University of Sport from October 2020 to December 2020. Information on smoking status and lifestyle was obtained using a detailed questionnaire. All participants underwent full ophthalmic examination. OCTA image was acquired. Vascular and the thickness parameters in central fovea and peripapillary parameters were automatically calculated. Multiple linear regression analyses were utilized to assess the association of smoking with retinal thickness and vascular structure after controlling potential confounders., Results: Compared with non-smoking adults, current smokers (β=-36.78; P = 0.01) and ever smokers (β=-35.45; P = 0.00) tended to have thinner macular fovea. Cigarettes daily, pack-years of smoking and CSI were negatively related to macular thickness (cigarettes daily: β=-1.43; pack-years: β=-14.73; CSI: β=-14.70), while they were positively associated with the circumference (cigarettes daily: β=0.03; pack-years: β=0.30; CSI: β=0.31) and the area of FAZ (cigarettes daily: β=0.01; pack-years: β=0.07)., Conclusions: Cigarette smoking seems associated with decreased macular fovea thickness and elevated circumference and area of the FAZ compared to non-smokers. Our data add to evidence of smoking on retinal thickness and the microvascular system in the macular area., (Copyright © 2021 Elsevier B.V. All rights reserved.)

It is widely recognized that green infrastructures in urban ecosystems provides important ecosystem services, including air purification. The potential absorption of nitrogen oxides (NO x ) by urban trees has not been fully quantified, although it is important for air pollution mitigation and the well-being of urban residents. In this study, four common tree species (Sophora japonica L., Fraxinus chinensis Roxb., Populus tomentosa Carrière, Sabina chinensis (L.)) in Beijing, China, were studied. The dual stable isotopes ( 15 N and 18 O) and a Bayesian isotope mixing model were applied to estimate the sources contributions of potential nitrogen sources to the roadside trees based on leaf and soil sampling in urban regions. The following order of sources contributions was determined: soil > dry deposition > traffic-related NO x . The capacity of urban trees for NO x removal in the city was estimated using a remote sensing and GIS approach, and the removal capacity was found to range from 0.79 to 1.11 g m -2 a -1 across administrative regions, indicating that 1304 tons of NO x could be potentially removed by urban trees in 2019. Our finding qualified the potential NO x removal by urban trees in terms of atmospheric pollution mitigation, highlighting the role of green infrastructure in air purification, which should be taken into account by stakeholders to manage green infrastructure as the basis of a nature-based approach., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: The new Family-Community-Hospital (FCH) three-level comprehensive management aimed to improve the efficiency and scale of peritoneal dialysis (PD) to meet the increased population of end-stage renal disease (ESRD). Our study focused on the clinical outcomes, quality of life, and costs evaluation of this model in a multi-center and prospective cohort study. Methods: A total of 190 ESRD patients who commenced PD at Shanghai Songjiang District were enrolled. According to different PD management models, patients were divided into the Family-Community-Hospital three-level management model ( n  = 90) and the conventional all-course central hospital management model ( n  = 100). The primary outcome was clinical outcomes of PD. The secondary outcomes were health-related quality of life (HRQOL) and medical costs evaluation. Results: Compared to conventional management, community-based FCH management achieved a similar dialysis therapeutic effect, including dropout rate ( p  = 0.366), peritonitis rate ( p  = 0.965), patient survival ( p  = 0.441), and technique survival ( p  = 0.589). Follow-up data showed that similar levels of the renal and peritoneal functions, serum albumin, cholesterol and triglyceride, PTH, serum calcium, and phosphorus between the two groups (all p  > 0.05). HRQOL survey showed that the FCH management model helped to improve the psychological status of PD patients, including social functioning ( p  = 0.006), role-emotional ( p  = 0.032), and mental health ( p  = 0.036). FCH management also reduced the hospitalization ( p  = 0.009) and outpatient visits ( p  = 0.001) and saved annual hospitalization costs ( p  = 0.005), outpatient costs ( p  = 0.026), and transport costs ( p  = 0.006). Conclusions: Compared with conventional management, community-based FCH management achieved similar outcomes, improved psychological health, reduced medical budgets, and thus had a good social prospect.

Background: Growing evidence indicates that arsenic (As) exposure can increase the risk of gestational diabetes mellitus (GDM). However, little is known about As species and GDM and the combined effect of As and one-carbon metabolism (OCM) on GDM., Objectives: We aimed to examine the associations between As species and GDM and evaluate the potential interactions of folate, vitamin B 12 , and homocysteine (Hcy) with As species on GDM prevalence., Method: We measured levels of arsenite (As 3+ ), arsenate (As 5+ ), dimethylarsinic acid (DMA), and arsenobetaine (AsB) species in urine and folate, vitamin B 12 , and Hcy in serum from 396 pregnant women in Tianjin, China. The diagnosis of GDM was based on an oral glucose tolerance test. Associations of As species in urine with GDM were evaluated using generalized linear models (GLMs) and Bayesian kernel machine regression (BKMR). Additive interactions of As and OCM with GDM were estimated by determining the relative excess risk due to interaction (RERI)., Results: Of the 396 pregnant women, 89 were diagnosed with GDM. Continuous increases in urinary inorganic As were associated with GDM in the GLMs, with adjusted odds ratios of 2.12 (95% CI: 0.96, 4.71) for As 3+ , and 0.27 (95% CI: 0.07, 0.98) for As 5+ . The BKMR in estimating the exposure-response functions showed that As 3+ and AsB were positively associated with GDM. However, As 5+ showed a negative relationship with GDM. Although the additive interactions between As exposure and OCM indicators were not significant, we found that pregnant women with higher urinary As 3+ and total As accompanied by lower serum vitamin B 12 were more likely to have higher odds of GDM (3.12, 95% CI: 1.32, 7.38 and 3.10, 95% CI: 1.30, 7.38, respectively)., Conclusions: Our data suggest a positive relation between As 3+ and GDM but a negative relation between As 5+ and GDM. Potential additive interaction of As and OCM with GDM requires further investigation., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To explore the attitudes and views of patients with inflammatory bowel disease (IBD) on COVID-19 vaccination. Methods: An online interview questionnaire concerning the acceptance or hesitancy toward vaccination for COVID-19 was designed and 543 patients with IBD in China were invited to complete the structured self-administered anonymous questionnaire. Results: Of all the participants, 50.7% were indecisive about the vaccination and only 16.0% opted for it. Vaccination hesitancy was significantly associated with women and those without medical or biomedical backgrounds. The acceptance of COVID-19 vaccination was higher in participants with no history of immune-modifying therapies, especially in those without immunosuppressants. Participants who considered vaccination critically important to self-health or the health of others were more likely to choose immediately or later vaccination. Safety and potential adverse reactions, personal hypoimmunity, efficacy, and reliability of COVID-19 vaccines were the top three concerns of the participants that were independent of their willingness for vaccination. Conclusions: This study discloses the presence of hesitancy for COVID-19 vaccination in patients with IBD. Further studies are warranted to evaluate the efficacy and safety of COVID-19 vaccines in IBD individuals, with a specific focus on the impact of immune-modifying therapies. Health education and recommendation from authoritative sources may facilitate COVID-19 vaccination efforts., 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 © 2021 Wu, Lin, Buch, Ding, Zhang, Cui and Ji.)

Background: The COVID-19 pandemic has alarming implications for individual and population level mental health. Although the future of COVID-19 is unknown at present, more countries or regions start to ease restrictions. The findings from this study have provided the empirical evidence of prevalence and patterns of mental disorders in Chinese general population before and after easing most COVID-19 restrictions, and information of the factors associated with these patterns., Methods: A cross-sectional population-based online survey was carried out from February to March 2020 in the general population across all provinces in China. The 12-item General Health Questionnaire (GHQ-12) was incorporated in the survey. Latent class analyses were performed to investigate the patterns of mental disorders and multinomial logistic regressions were used to examine how individual and regional risk factors can predict mental disorder patterns., Results: Four distinctive patterns of mental health were revealed in the general population. After the ease of most COVID-19 restrictions, the prevalence of high risk of mental disorders decreased from 25.8% to 20.9% and prevalence of being high risk of unhappiness and loss of confidence decreased from 10.1% to 8.1%. However, the prevalence of stressed, social dysfunction and unhappy were consistently high before and after easing restrictions. Several regional factors, such as case mortality rate and healthcare resources, were associated with mental health status. Of note, healthcare workers were less likely to have mental disorders, compared to other professionals and students., Conclusions: The dynamic management of mental health and psychosocial well-being is as important as that of physical health both before and after the ease of COVID-19 restrictions. Our findings may help in mental health interventions in other countries and regions while easing COVID-19 restrictions., Competing Interests: No authors, including Wenjuan Li from Yunque Medical Technology Shanghai Co. Ltd who just moved to a new position at AstraZeneca China Co. Ltd, have competing interests. The funders, Li Ka Shing Foundation and Canadian Institute of Health Research, have not provided any salaries for any author, and have no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The commercial affiliation (AstraZeneca China Co. Ltd) does not alter our adherence to PLOS ONE policies on sharing data and materials.

Objectives: No tailored model incorporating physical frailty for 2-year mortality in cirrhosis is available for practitioners in general practice. Thus we aimed to develop a model based on laboratory results and physical frailty allowing clinicians for stratifying cirrhotics by using individual estimate., Methods: One hundred and thirteen cases were assigned to the primary cohort, and all other 76 patients were regarded as the validation cohort. Multivariate Cox regression was performed, and a nomogram including five-meter gait speed (5MGS) were generated. The performance of the proposed model was assessed by C-index, calibration curve, and decision curve analysis (DCA)., Results: On multivariate analysis, the Model for End-Stage Liver Disease-Sodium, albumin and 5MGS were independent predictors for 2-year mortality in cirrhosis. A nomogram incorporating all these parameters achieved a C-index of 0.804 (95%CI, 0.731-0.877). The calibration curve implied optimal correspondence between the predicted survival and actual outcomes. Our model is useful in the clinical settings based on DCA. Similar results were observed in the validation cohort with a C-index of 0.796 (95%CI, 0.689-0.899). Moreover, 5MGS, as a surrogate of physical performance, significantly correlated with multiple domains of general frailty according to Frailty Index (our published data), including instrumental activities of daily living, self-reported health, social activity and falls., Conclusion: In conclusion, the nomogram incorporating 5MGS may represent an individualized tool for predicting mortality in cirrhosis for primary care physicians.

The mechanisms of biogeomorphic feedbacks and its influencing factors have been extensively studied for pioneer species colonization in tidal environment. However, biogeomorphic impacts of alien species over the entire invasion process coupled with hydro-geomorphologic processes and ecoengineering traits still lack sufficient understanding to forecast salt marsh succession. In this study, we developed a bio-hydrogeomorphic model to account for the tidal platform evolution and vegetation distribution under Spartina alterniflora invasion in the Yellow River Delta, China. Our field observation and modelling results revealed that salt marsh transformed from a stabilized to a self-organized system due to the significant geomorphic-biological feedback under Spartina alterniflora invasion. Tidal channels took shape differently along the elevation gradient of the intertidal platform. Patch-scale feedbacks promoted the channel initiation in the low-elevated zone during early colonization phase. While landscape-scale feedbacks dominated channel incision in the middle to high platform during the mature phase. Specifically, the channel initiation in the middle-elevated ecotone could be attributed to the change from homogenous sheet flow to concentrated channel flow along the marsh edge, which was determined by tidal prism and discrepancy in organism traits. Hence, our study showed that scale-dependent feedback and gaps in ecoengineering capacity of organism determined the morphological variation in the invasive ecosystem. This would provide the insights into biogeomorphic impacts of invasive species and scientific conservation for native ecosystems., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Goals: Chemotherapy, the most conventional modality for cancer therapy, usually brings serious side effects because of the low cancer-therapeutic specificity and bioavailability. It is of great significance for cancer treatment to develop new effective strategies to regulate biochemical reactions in organelles, enhance the specificity of chemotherapeutic drugs and reduce their side effects. Methods: We report herein a zeolitic imidazole framework-90 (ZIF-90) based nanoplatform, which was used to initiate a series of mitochondrial cascade reactions using ATP as a molecular switch for cancer therapy. The thioketal linked camptothecin (camptothecin prodrug, TK-CPT) and 2-Methoxyestradiol (2-ME) were encapsulated into the pores of ZIF-90 nanoparticles using a simple one-pot method, and the nanoplatform was finally coated with a layer of homologous cell membrane. Results: Mitochondrial ATP can efficiently degrade ZIF-90 and then release the loaded 2-ME and CPT prodrugs. 2-ME can inhibit the activity of superoxide dismutase (SOD), which induces the up-regulation of reactive oxygen species (ROS) in situ . The thioketal linkers in CPT prodrug can respond to ROS, thereby achieving subsequent release of parent CPT drug. This cascade of reactions can lead to prolonged high oxidative stress and cause continuous cancer cell apoptosis, due to the increased ROS level and the liberation of CPT. Conclusion: We constructed an ATP-triggered strategy using nanoscale ZIF-90 to initiate mitochondrial cascade reactions for cancer therapy. The ZIF-90 based nanoplatform exhibited low cytotoxicity, good mitochondria-targeting ability, and excellent therapeutic effect. In vivo experiments demonstrated that the growth of tumor can be efficiently inhibited in a mouse model. This ATP-triggered strategy to induce mitochondrial biochemical reactions offers more possibilities for developing organelle-targeted therapeutic platforms., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Background: A new device has been added to the Chinese MicroHand surgical robot family, developed based on the successful application of control algorithms. As a benefit of using these specialized control algorithms, the motion mapping relation can be accommodated into the system without the help of a built-in image system, resulting in a novel Chinese domestic surgical robot with two arms called MicroHand SII, which is different from the former MicroHand S and da Vinci systems. In this study, we investigate the performance of a novel MicroHand SII robotic platform in patients with obesity., Methods: From March 2018 to April 2019, a total of 7 patients whose BMI ranged from 29.9 to 49.8 kg/m 2 were operated on with the robot-assisted technique using the MicroHand SII surgical system. Data regarding demography, surgical procedure and the 3-month outcome postoperation were collected., Results: There were 2 female and 5 male patients with a median age (range) of 35 (20-51) years. The median operative time was 160 (149-195) minutes. None were converted to open surgery. All anthropometry indices improved significantly (p < 0.05) at 3 months postoperatively. There were no cases of surgical site infection, gastrointestinal/abdominal bleeding, or conversion to an open operation., Conclusions: The initial experience showed that the Chinese domestic robot surgical system MicroHand SII could be feasibly and safely applied in sleeve gastrectomy in patients with obesity. Because of the unique design of this system such as a two-hand robot, an array of master-slave motion strategies, and a roll joint at the end of the instruments that allows 7 degrees of freedom, this robotic platform has presented its own obvious advantages.

'Invasibility', or the extent to which a habitat is prone to being invaded by plants, is a measure of the resistance of that ecosystem to biological invasion: a limited extent represents abiotic conditions unsuitable for invasion by invasive species; however, human activity can change that and make a habitat prone to rapid invasion. Field surveys and greenhouse experiments were carried out to explore, using spatial analysis, how a strong invader, namely Spartina alterniflora, is assisted by such activities as constructing levees and digging trenches, ditches, and pits in a tidal salt marsh. These activities changed the lateral hydrological connectivity of a salt marsh. The invasibility was then estimated based on the probability of seed dispersal and retention using the classical probabilistic method, and the rate of seedling emergence using threshold analysis. Changes in lateral hydrological connectivity led to more seeds of the invading species being retained, especially in high marshes, and promoted the emergence of its seedlings by making the soil more moist and less saline. The results suggest that changes in the lateral hydrological connectivity in a salt marsh can make it more prone to being invaded. The results have important implications for the control of invasive plants by limiting human activity and thereby regulating lateral hydrological connectivity in coastal ecosystems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020. Published by Elsevier B.V.)

Algae-dominance in seagrass beds has been well recognized, however, the competitive relationship between seagrass and macroalgae along land-sea gradients and their ecological effects has received little attention. In this study, a field survey was conducted at the Yellow River Estuary to investigate the effects of macroalgal proliferation on seagrass and macrobenthic invertebrate communities. Our results suggested that strong competitive interaction existed between the two primary producers, and the positive or negative effects of macroalgae on seagrass growth varied along land-sea gradient. Furthermore, the dominant controlling factors on the biomass, density and diversity of macrobenthic invertebrate communities were found to vary accordingly, i.e., from features of the primary producers in the nearshore where macroalgae suppressed seagrass growth to hydrodynamic disturbance in the offshore where macroalgae facilitated seagrass growth. Our study emphasizes the importance to integrate interspecific competition into ecosystem-based management of seagrass ecosystem, and provides references for additional ecological indicators., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Inadequate hand washing among chefs is a major contributor to outbreaks of foodborne illnesses originating in restaurants. Although many studies have evaluated hand hygiene knowledge (HHK) and self-reported hand washing behaviors (HWBs) in restaurant workers in different countries, little is known about HHK and HWBs in restaurant kitchen chefs, particularly in China. In this study, we interviewed 453 restaurant kitchen chefs in Jiangsu Province in China regarding their HHK and HWBs and used Chi-square tests (Fisher exact tests), pairwise comparisons, and linear regression models to analyze the responses and identify determinants of HHK and HWBs. Results reveal that less frequent hand washing after leaving work temporarily and after touching used cutlery were the main issues among restaurant kitchen chefs in Jiangsu Province. Kitchen hands had lower levels of HHK and engaged less frequently in good HWBs than the other type of chefs. Furthermore, working in a large restaurant and having worked in the restaurant industry for a longer amount of time were correlated with better HHK and HWBs. These findings suggest that close attention should be paid to the HWBs of chefs during food preparation, that kitchen hands are the key group of restaurant kitchen workers who need training in HHK, and that regulatory activities should focus on small-scale restaurants.

Biogeomorphological processes and structures (BPS) can affect plant growth and community structure and promote landscape complexity in ecosystems. However, there is a lack of understanding of how BPS facilitates seedling establishment and distribution of annual plants and promotes the success of coastal restoration. We studied the relationships between seedling establishment of a native annual plant species (Suaeda salsa) and BPS resulting from crabs and plants in a middle elevation salt marsh with moderate tides (where inhabited generally high density of plants and crabs) in the Yellow River Delta of China. While there were many crabs but fewer plants in lower elevation areas with more frequent and stronger tides; and in higher elevation areas with weaker tides there were both fewer crabs and plants. Investigations and field manipulation experiments of microtopography, crabs and plants were conducted to determine if and how these BPS influenced seedling establishment and distribution under tidal influence in the middle elevation salt marshes. Results demonstrated that biogeomorphological structures, mainly concave hollows generated by crab burrowing and concave hollows around plant roots and stems under tidal influence, were associated with the trapping of seeds and influenced the establishment and distribution of seedlings. Additionally, upon senescence, maternal plants with unreleased seeds lodged on the ground and influenced seed retention and seedling establishment. The artificial concave hollows that were created experimentally also trapped many seeds and facilitated seedling establishment. Experimental plantings and creation of artificial hollow microtopography attracted crabs that created burrows, resulting in a positive feedback on seedling establishment. We used information obtained from the experimental component of the study to conduct a hollow microtopography manipulation to successfully restore degraded salt marshes. Understanding the associations between seedling establishment and biogeomorphological processes provides important insights for the utilization of natural or human ecosystem engineering to restore coastal vegetation ecosystems., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest regarding publication of this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction: The HbA1c has been considered as the 'gold standard' in diabetes diagnosis and management, however, age, gender and body mass index (BMI) might have certain effects on HbA1c. We are aiming to further investigate the correlation between age and HbA1c, and whether it was affected by gender and BMI., Methods: A cross-sectional survey including 135,893 nondiabetic individuals who took the physical examination between 2013 and 2017 was conducted. The subjects were grouped by gender, age and BMI, and the interactive and independent effects of the 3 factors on the HbA1c were detected. The median and 95% confidence interval (CI) of HbA1c levels were calculated., Results: The HbA1c levels gradually increased along with age, both in female and male, and there is a positive association between BMI and the HbA1c. The difference on HbA1c in gender was associated with both age and BMI, the age-related increase in HbAlc was accentuated in the subgroup with higher BMI, and there was a marked accentuation of the positive association between BMI and HbA1c as age increased. In almost all the young and middle-aged (aged 20-59) subgroups, the 97.5 th percentiles of HbA1c levels were lower than 6.5%, suggesting that the single HbA1c cutoff value is probably not applicable to the young and middle-aged population., Conclusions: We recommend that the effects of age, gender and BMI should be taken into consideration when using HbA1c for the diagnosis and management of diabetes, especially in the young and middle-aged population., Competing Interests: The authors declare no conflict of interest., (Thieme. All rights reserved.)