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Exposure to mercury has been associated with adverse effects on pregnancy outcomes. However, there is limited literature on mercury exposure and pregnancy outcomes in Chinese pregnant women. Our study was to investigate the possible association between maternal mercury exposure and spontaneous preterm birth and birth weight. This study was a nested case-control study. The association between blood mercury concentration and both spontaneous preterm birth and birth weight was analyzed using conditional logistic regression and linear regression adjusted for the potential confounding factors, respectively. The dose-response relationship between mercury concentration and birth outcomes was estimated using restricted cubic spline regression. The mean concentration of mercury was 2.8 ± 2.2 µg/L. A positive relationship was observed between maternal blood mercury concentration and SPB when analyzed as a continuous variable. However, it was not found to be statistically significant (adjusted OR = 1.10, 95% CI = 0.95-1.26, P = 0.202). Moderate mercury exposure was associated with a higher risk of SPB (Q3 vs. Q1: crude OR = 2.50, 95% CI = 1.16-5.41, P = 0.02; adjusted OR = 3.49, 95% CI = 1.33-9.11, P = 0.011). After considering the combined effects of chemicals other than mercury exposure (including lead, selenium, and cadmium), the results remained consistent. There was no statistically significant association between blood mercury levels and birth weight (adjusted coefficient = 18.64, P-value = 0.075). There were no statistically significant dose-response associations between mercury concentration and birth outcomes (SPB: P = 0.076; birth weight: P = 0.885). Public health policies should focus on reducing environmental releases of mercury, improving food safety standards, and providing education to pregnant women about the risks of mercury exposure and preventive measures., (© 2024. The Author(s).)

Background: Saccharomyces cerevisiae has been considered a harmless yeast, but in recent years, increasing evidence has shown that it can cause disease in humans, especially invasive infections in infants/children and vulvovaginal infections in women. This study aimed to investigate the clinical information and antifungal susceptibility of clinical cases with S. cerevisiae and establish a foundation for the prevention and treatment of fungal infections., Methods: This study was conducted from May 2018 to May 2023 at a national regional medical center in Southwest China for women and children. The demographic and clinical characteristics of patients isolated with S. cerevisiae were collected and analyzed. All the isolates were cultured on Sabouraud medium plates and identified by MALDI-TOF MS. The antifungal susceptibility of S. cerevisiae to 10 agents (amphotericin B, fluconazole, itraconazole, voriconazole, micafungin, caspofungin, terbinafine and 5-flucytosine) was determined via the microdilution broth method to determine the minimum inhibitory concentrations (MICs)., Results: A total of 75 cases of S. cerevisiae isolated from patients with vulvovaginal candidiasis (VVC, 44 cases), pneumonia (13 cases), or diarrhea (18 cases) were included after data review. The MICs of voriconazole and flucytosine for S. cerevisiae isolated from different body sites differed, with higher resistance in intestinal isolates. In this study, S. cerevisiae caused VVC, but there was no clear evidence that it was involved in pneumonia or diarrhea. Compared with those of Candida albicans, the primary pathogen of VVC, the MICs of fluconazole (11.96 ± 5.78 µg/mL vs. 67.64 ± 16.62 µg/mL, p = 0.002), itraconazole (0.77 ± 0.19 µg/mL vs. 2.31 ± 0.53 µg/mL, p = 0.008), voriconazole (0.22 ± 0.09 µg/mL vs. 5.02 ± 1.09 µg/mL, p < 0.001), and terbinafine (10.41 ± 0.84 µg/mL vs. 14.93 ± 4.77 µg/mL, p < 0.001) for S. cerevisiae (isolated from the genital tract) were significantly lower, while those of micafungin (0.14 ± 0.01 µg/mL vs. 0.06 ± 0.01 µg/mL, p < 0.001) and caspofungin (0.27 ± 0.04 µg/mL vs. 0.06 ± 0.01 µg/mL, p < 0.001) were significantly greater., Conclusion: Azoles remain the recommended regimen for S. cerevisiae-related VVC, and the use of amphotericin B vaginal effervescent tablets could be considered for the treatment of azole-resistant isolates. The antifungal susceptibility of S. cerevisiae varies according to the isolated source, and the pathogenicity trend of S. cerevisiae should be studied., (© 2024. The Author(s).)

Purpose: To explore the impact of mobile social media on the psychological well-being of Chinese international students and analyze the mechanisms of influence to enhance their overall psychological health and social interactions in a foreign environment., Methods: Convenience sampling was employed, using questionnaires on Mobile Social Media, Psychological Resilience, Body Image, Health Goal Setting, Physical Activity Level, and Mental Health Status as measurement tools. Data were gathered from 378 Chinese international students across 33 universities in South Korea, including Kangwon National University, Myongji University, Kunsan National University, Seoul National University, and Chonbuk National University. Confirmatory factor analysis, correlation analysis, common method bias testing, and chain mediation effect analysis were conducted using SPSS and AMOS 23.0., Results: Mobile social media has significant indirect effects on the mental health of international students through various factors: psychological resilience and physical activity level (effect 'adg' = 0.080, 95% CI [0.029, 0.144]), body image and physical activity level (effect 'beg' = 0.122, 95% CI [0.044, 0.247]), and health goal setting and physical activity level (effect 'cfg' = 0.255, 95% CI [0.123, 0.428])., Conclusion: The study shows that mobile social media benefits the mental health of Chinese international students by enhancing psychological resilience, physical activity, body image perception, and health goal setting. Collaboration between educational institutions and social media platforms is recommended to promote physical activity among international students. This collaboration can involve sharing encouraging messages, joining health communities, setting goals, and providing accessible exercise resources. Utilizing mobile apps or social media for tracking progress and goal-setting can also improve self-management skills., (© 2024. The Author(s).)

Introduction: Digital therapeutics have been approved as a treatment aid for various medical conditions and are increasingly prevalent. Despite numerous studies on the potential of digital therapeutic interventions in preventing gestational diabetes mellitus (GDM), there is a critical need for more high-quality, large-scale studies to validate their effectiveness. This need arises from the inconsistencies in results and variations in the quality of previous research., Methods and Analysis: We propose a non-randomised controlled trial involving 800 high-risk pregnant women in 6 maternity and child health hospitals in Fujian, China. This study aims to investigate the role and effectiveness of digital therapeutics-based lifestyle intervention in managing the health of pregnant women at high risk for GDM. The study will compare the differences in GDM prevalence, pregnancy weight management and other pregnancy-related health outcomes between pregnant women who received digital therapeutics-based lifestyle intervention and those in the control group. The intervention includes dietary guidance, a personalised physical activity programme and lifestyle improvement strategies delivered through a smartphone app. Primary outcomes include the incidence of GDM at 24-28 weeks gestation and gestational weight gain (GWG). Secondary outcomes comprise improvements in individual lifestyle and risk factors, nutritional issues, implementation outcomes and other pregnancy-related outcomes., Ethics and Dissemination Section: The trial was approved by the Ethics Committee of Fujian Maternity and Child Health Hospital (approval number: 2023KY046), Jianyang Maternity and Child Health Hospital (approval number: A202401), Fuqing Maternity and Child Health Hospital (approval number: FY2024003), Changting Maternity and Child Health Hospital (approval number: 202401), Datian Maternity and Child Health Hospital (approval number: dtfy202401) and Quanzhou Maternity and Child Health Hospital (approval number: 2024(50)). We will disseminate our findings by publishing articles in leading peer-reviewed journals., Trial Registration Number: ChiCTR2300071496., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Huyou (Citrus changshanensis) is a significant citrus species that originated in Zhejiang Province, China, where it is also primarily cultivated. It is valued for its distinctive flavor and notable health benefits, owing to its high content of bioactive compounds like naringin and limonin. However, the absence of a high quality reference genome has limited the exploration of these health-promoting compounds in Huyou and hindered research into the mechanisms behind its medicinal properties. In this study, we present a phased chromosome-level genome assembly of Huyou. By combining PacBio and Hi-C sequencing, we generated a primary genome assembly and two haplotypes, comprising nine pseudo-chromosomes, with sizes of 339.91 Mb, 323.51 Mb, and 311.89 Mb, respectively. By integrating transcriptome data and annotations of homologous species, we identified a total of 29,775 protein-coding genes in the genome of Huyou. Additionally, we detected lots of structural variants between the two haplotypes. This represents the first reference genome of Huyou, providing a valuable resource for future studies on its agricultural characteristics and medicinal applications., (© 2024. The Author(s).)

Background: Wheezing is a common clinical manifestation in children with pneumonia. However, the risk factors associated with the development of wheezing pneumonia and its clinical features are not fully characterized, especially in children with severe pneumonia., Methods: We retrospectively recruited 1434 pediatric patients diagnosed with severe pneumonia between April 2012 and September 2019 in Fujian Maternity and Child Health Hospital. The medical records regarding demographic information, clinical manifestations, radiographic/laboratory findings, and complications were collected. Based on the presence or absence of wheezing symptoms and signs, subjects were divided into wheezing cohort (N.=684) and non-wheezing cohort (N.=750), and their clinical data were compared. Multivariate cox regression analysis was performed to identify independent risk factors of wheezing., Results: Demographic features including gender, weigh, onset season, birth weight, full-term birth or not, history of pneumonia were significantly associated with the occurrence of wheezing in severe CAP (P<0.05). Specifically, male gender, onset seasons in autumn/winter, and absence of a history of pneumonia were identified as independent risk factors of wheezing in multivariate analysis (P<0.05). As for clinical features, wheezing cohort differed from the non-wheezing one in terms of clinical manifestation (higher incidence of cough and breathless, but lower incidence of fever), laboratory finding (higher levels of red blood cells, hemoglobin, and albumin and lower levels of total or indirect bilirubin and creatine), pathogen detection (higher incidence of respiratory syncytial viral infection), and clinical complications (lesser risk of sepsis and hydrothorax) (P<0.05)., Conclusions: Severe CAP with wheezing is a special clinical entity of severe pneumonia in children, which has specific risk factors and differ from non-wheezing pneumonia in terms of clinical features and etiologic pathogens.

The prospective cohort study was to explore the association between serum uric acid (SUA) and arterial stiffness in a Chinese hypertensive population. A total of 7444 participants with hypertension who completed two or more measurements of brachial-ankle pulse wave velocity (baPWV) and baseline SUA detection were followed-up in the Kailuan Study from 2010 to 2020. A restricted cubic spline curve was used to verify whether there was a linear association between baseline SUA and arterial stiffness. A Cox proportional hazard regression model was used to explore the association of between baseline SUA and the incidence of arterial stiffness. Our results showed that the restricted cubic spline curve revealed a linear relationship between baseline SUA and arterial stiffness in total participants (p < 0.001). After follow-up 4.6 ± 2.8 years, Kaplan-Meier survival curves indicated that the risk of arterial stiffness was increased in the high level of baseline SUA (Log-rank p = 0.0002). After adjusting for potential confounding factors, the HR (95% CI) for risk of stiffness was 1.33 (1.17-1.52, p < 0.001) in the highest SUA group. Hierarchical analysis showed that the HRs (95% CI) for risk of arterial stiffness were 1.45 (1.25-1.69), 1.38 (1.19-1.60), 1.41 (1.21-1.64), and 1.35 (1.15-1.58) in the highest SUA group of males, <65 years old, not taking antihypertensive drugs, and failure to achieve the control targets of blood pressure respectively (p < 0.001). These results reveal that high SUA is a risk factor for arterial stiffness in the Chinese hypertensive population., (© 2024. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)

Backgrounds: Improving quality of life (QOL) is one of the main aims of lung transplantation (LTx). There is a need to identify those who have poor quality of life early. However, research addressing inter individual quality of life variability among them is lacking. This study aims to identify group patterns in quality of life among lung transplant recipients and examine the predictors associated with quality of life subgroups., Methods: In total, 173 lung transplant recipients were recruited from one hospital in Guangdong Province between September 2022 and August 2023. They were assessed using the Lung Transplant Quality of Life scale (LT-QOL), Mindful Attention Awareness Scale (MAAS), Life Orientation Test-Revised scale (LOT-R), and Positive and Negative Affect Scale (PANAS). Latent profile analysis was used to identify QOL subtypes, and logistic regression analysis was used to examine the associations between latent profiles and sociodemographic and psychosocial characteristics., Results: Two distinct QOL profiles were identified: "low HRQOL" profile [ N  = 53 (30.94%)] and "high HRQOL" profile [ N  = 120 (69.06%)]. Single lung transplant recipients, and patients who reported post-transplant infection, high levels of negative emotion or low levels of mindfulness and optimism were significantly correlated with the low QOL subgroup., Conclusion: Using the domains of the LT-QOL scale, two profiles were identified among the lung transplant recipients. Our findings highlighted that targeted intervention should be developed based on the characteristics of each latent class, and timely attention must be paid to patients who have undergone single lung transplantation, have had a hospital readmission due to infection, exhibit low levels of optimism, low levels of mindfulness or high negative emotions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Song, Luo, Liu, Zhou, Huang, Ju, Chen, Wong, Chen, Tan, Miao, Ma and Chen.)

Hydro-Fluctuation Belt (HFB), a periodically exposed bank area formed by changes in water level fluctuations, is critical for damaging the reservoir wetland landscape and ecological balance. Thus, it is important to explore the mechanism of hydrological conditions on the plant-soil system of the HFB for protection of the reservoir wetland and landscape restoration. Here, we investigated the response of plant community characteristics and soil environment of the HFB of Tonghui River National Wetland Park (China), is a typical reservoir wetland, to the duration of inundation, as well as the correlation between the distribution of dominant plants and soil pH, nutrient contents, and enzyme activity by linear regression and canonical correlation analyses. The results show that as the duration of inundation decreases, the vegetation within the HFB is successional from annual or biennial herbs to perennial herbs and shrubs, with dominant plant species prominent and uneven distribution of species. Soil nutrient contents and enzyme activities of HFB decreased with increasing inundation duration. Dominant species of HFB plant community are related to soil environment, with water content, pH, urease, and available potassium being principle soil environmental factors affecting their distribution. When HFB was inundated for 0-30 days, soil pH was strongly acidic, with available potassium content above 150 mg kg -1 and higher urease activity, distributed with Arundo donax L., Polygonum perfoliatum L., Alternanthera philoxeroides (Mart.) Griseb., and Daucus carota L. communities. When inundated for 30-80 days, soil pH was acidic, with lower available potassium content (50-150 mg kg -1 ) and urease activity, distributed with Beckmannia syzigachne (Steud.) Fern.+ Polygonum lapathifolium L., Polygonum lapathifolium L., Medicago lupulina L. + Dysphania ambrosioides L. and Leptochloa panicea (Retz.) Ohwi communities. Using the constructed HFB plant-soil correlation model, changes in the wetland soil environment can be quickly judged by the succession of plant dominant species, which provides a simpler method for the monitoring of the soil environment in the reservoir wetland, and is of great significance for the scientific management and reasonable protection of the reservoir-type wetland ecosystem., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Yumin Liu reports financial support was provided by Qijiang District of Chongqing Tonghui River National Wetland Park ecological., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aim: Global competence has become an important competence for medical graduates in the globalized world. However, research on it is scarce. This study was built upon the scholarship published in the field to measure medical graduates' global competence., Materials and Methods: A questionnaire was administered to China's medical graduates sampled from four institutions of medical education. Descriptive statistics were made to analyze the level of medical graduates GC. Influencing factors were investigated using multiple linear regression. Multiple levels of regression analysis were used to identify the influence of different independent variables on the dependent variable., Results: The sample had a relatively good level of global competence in general, but lacked skills in cross-cultural communication and international academic communication. "Internationalization Concept and System" and "International Development of Teachers" in the school dimension and "Taking International Courses", "International Publication" and "Participation in International Conference" in the dimension of individual international involvement had a significant positive impact on the cultivation of global competence., Conclusions: The universities should aim for the construction of an effective institutional mechanism for internationalization to help improve students' global competence.

Background: While China's primary health care (PHC) system covers all citizens, the use of medical services supplied by primary health institutions (PHIs) is not at ideal levels. This study explored the impact of socioeconomic status (SES) on residents' first choice of medical services provided by PHIs., Methods: This community-based, cross-sectional study was conducted in Jiangsu Province, China, from October 2021 to March 2022. A custom-designed questionnaire was used to evaluate 4,257 adults, of whom 1,417 chose to visit a doctor when they were sick. Logistic regression was used to test the relationships among SES, other variables and the choice of medical services, and interaction effects were explored., Results: A total of 1,417 subjects were included in this study (48.7% female; mean age 44.41 ± 17.1 years). The results showed that older age ( p < 0.01), rural residence ( p < 0.01), a preference for part-time medical experts in PHIs ( p < 0.01), and lack of coverage by basic medical insurance ( p < 0.05) were associated with the first choice to use PHIs. In the multiple logistic regression model, SES was not associated with the first choice of medical services supplied by PHIs ( p > 0.05), but it interacted with three variables from the Commission on Social Determinants of Health Framework (material circumstances, behaviors and biological factors, and psychosocial factors)., Conclusion: Vulnerable individuals who are the target visitors to PHIs are older, live in rural areas, and suffer from chronic diseases. SES, as a single factor, did not impact whether medical services at PHIs were preferred, but it mediated relationships with other factors., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Miao, Fang, Sun, Yin, Li, Shen, Chen and Huang.)

Chromium (Cr), one of the prime hazardous trace elements in coals, may engender adverse effects on eco-environment and threaten human health during utilization of coal. Based on the samples obtained in our laboratory and published literature, the abundance and modes of occurrence of Cr in Chinese coals, and the environmental impacts associated with coal-fired power plants (CFPPs) were elucidated in this study. With a total of 1397 sets of data, the mean concentration of Cr in Chinese coals was calculated as 21.33 μg/g by the "reserve-concentration" weighted calculation method. Spatially, the average Cr contents increased gradually from North China to South China. Temporally, coals from T 3 , E-N and P 2 were relatively enriched in Cr compared to the other geological time. The Cr concentration in coal varied with different coal ranks. The geological factors accounted for Cr enrichment in coals could be divided into the primary, secondary and epigenetic processes. Higher percentages of organically Cr occurred in low-rank coals, while inorganically associated Cr was mainly found in clay minerals. After coal combustion, most of Cr was enriched in solid wastes (e.g., fly ash and bottom ash). The leaching of Cr from solid wastes in the rainy season (especially acid rain) needs to be a concern for CFPPs. It was estimated that the atmospheric emission of Cr from CFPPs increased annually from 2015 to 2019 and reached approximately 159 tons in 2019., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

The soil contamination caused by the discharge of cadmium (Cd) from coal mining activities has aroused continuous attention due to the detrimental effects on the human health. This study aimed to investigate the characteristics on distribution of Cd in soils and its accumulation in wheat grains under wheat-cultivation system, and further assess the human health risks to adults and children. 58 soils and wheat samples in pairs from Linhuan coal mining area, Anhui Province were collected and analyzed. Results showed that the concentrations of Cd in 17.24% of soil samples exceeded the limit value established by the Ministry of Ecology and Environment. The ordinary kriging interpolation displayed that the spatial variability of Cd concentrations in soils was mainly influenced by coal mining activities. The transfer capacity of Cd from soils to wheat roots was greater than that from the wheat roots to grains. Multiple linear regression model clarified that soil pH and exchangeable Cd fraction in soils were the critical factors affecting the Cd accumulation in wheat grains. The carcinogenic risk of Cd levels in our studied wheat grains was a concern but still within the acceptable range, while their non-carcinogenic hazard was negligible for adults and children. The calculation results were in accord with the uncertainty analysis conclusion based on Monte Carlo simulation. The study was expected to promote the source management and control strategy of reducing tailing discharge, and providing scientific references for current soil remediation and land degradation prevention., 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.)

Water infiltration in the soil is a crucial hydrological function in the land water cycle, especially in the semiarid region where water is relatively scarce. The semiarid grassland in Northern China represents the regional vegetation in the vast area of Eurasian continent and is sensitive to land use change. However, no clear patterns exist regarding the comprehensive examination of water infiltration in relation to clipping across six plant community sites. This study aimed to test the effect of clipping and plant community sites, which were dominated by Agropyron cristatum, Stipa krylovii, Leymus chinensis, Potentilla tanacetifolia, Artemisia frigida, or Lespedeza davurica, on the water infiltration rate in the semiarid grassland. Clipping significantly decreased the water initial, steady, and average infiltration rates by 39.13, 4.36, and 12.46 mm h -1 , respectively, across the six plant community sites. Clipping-induced changes in the average infiltration rate positively correlated with the changes in the plant cover (r = 0.60, P < 0.01), litter mass (r = 0.53, P < 0.01), forb functional group ratio (r = 0.46, P = 0.03), and total porosity (r = 0.49, P = 0.02), and negatively with water-holding capacity (r = -0.45, P = 0.03). Further, the water infiltration rate significantly differed among the six plant community sites. The L.davurica site had the highest water initial infiltration rate with a value of 137.63 ± 17.76 mm h -1 , while the L. chinensis site had the lowest rate with a value of 74.08 ± 5.26 mm h -1 . Principal component analysis showed that the total porosity, litter mass, plant cover, and forb functional group ratio were the main factors affecting water infiltration rates in the control grassland. Overall, our findings suggested that local governments and herders should implement unclipping as a potential sustainable management for improving hydrological function in the semiarid grassland., 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 © 2022 Elsevier B.V. All rights reserved.)

The production connection is a crucial component of the Inter City Association. An urban network based on the enterprise perspective better reflects the structural characteristics of regional cities. Based on data gathered from the headquarters and branches of the listed manufacturing enterprises in 2020, this paper analyzes the county-level administrative units in the Beijing-Tianjin-Hebei region of China. Using the subordinate connection model and the social network analysis method, this paper examines the spatial structural characteristics and factors of urban networks in the Beijing-Tianjin-Hebei region. The results suggest that resource allocation in the Beijing-Tianjin-Hebei region is unbalanced, with a significant difference in urban radiation and agglomeration capacity. As the administrative centers, Beijing, Tianjin, and Shijiazhuang show a strong ability to allocate resources within the network. The overall network density in the region was shown to be relatively low, with the main links being of low or medium level. The urban network is defined by the network connection led by Beijing and Tianjin with Beijing-Tianjin-Tangshan and Beijing-Baoding-Shijiazhuang as the main axis. These cities exhibit a "dense southeast and sparse northwest" pattern. From a hierarchical perspective, high-level network connections are based mainly on spatial proximity. Analyzing the agglomerative subgroups, the study found that the inner and outer connections of the core subgroups were relatively high. Semi-marginal subgroups generally accepted the radiation of core subgroups, while marginal subgroups had little connection with other subgroups in the region. The results of the QAP analysis show that the administrative relationship, spatial distance, city size difference, economic development level difference, industrial structure difference, and labor cost difference have a significant influence on the urban network of the Beijing-Tianjin-Hebei region., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Changes in the amount and timing of precipitation may affect plant species coexistence. However, little is known about how these changes in precipitation structure plant communities. Here, we conducted a 6-year field precipitation manipulation experiment in the semi-arid steppe of Inner Mongolia, China, to assess the importance of species extinction and colonization in community assembly by incorporating information on phylogenetic and functional relatedness. Our results demonstrated that the decline in plant species richness under decreasing precipitation in the late and entire growing season could be attributed to a decrease in species colonization and an increase in species loss, respectively. The increase in species richness under increasing precipitation in the late growing season was mainly caused by increases in colonizing species. The loss of species that were more closely related to other residents under decreasing precipitation in the late growing season did not alter patterns of phylogenetic overdispersion, and the colonization of species that were more distantly related to residents under increasing precipitation in the late growing season shifted functional relatedness from clustering to randomness. Increasing precipitation may weaken the strength of environmental filtering induced by water stress in this semi-arid steppe and thus increase the probability of successful colonization of functionally dissimilar species relative to residents. Our study suggests that incorporating information on the functional and phylogenetic relatedness of locally lost resident species and the colonization of new species into analyses of community assembly processes can provide new insights into the general responses of plant communities to global change., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Elucidating the characteristics and influencing mechanisms of PM 2.5 concentrations is the premise and key to the precise prevention and control of air pollution. However, the temporal and spatial heterogeneity of PM 2.5 concentrations and its driving mechanism are complex and need to be further analyzed. We analyzed the temporal and spatial variations of PM 2.5 concentrations in the "2 + 26" cities from 2015 to 2021, and quantified the influence of meteorological factors and anthropogenic emissions and their interactions on PM 2.5 concentrations based on geographic detector model. We find the inter-annual and inter-season PM 2.5 concentrations show downward trend from 2015 to 2021, and the inter-month PM 2.5 concentrations present a U-shaped distribution. The PM 2.5 concentrations in the "2 + 26" cities manifest a spatial distribution pattern of high in the south and low in the north, and high in the middle and low in the surroundings. Meteorological conditions have stronger effects on PM 2.5 concentrations than anthropogenic emissions, and planetary boundary layer height and temperature are the two main driving factors at the annual scale. On the seasonal scale, sunshine duration is the dominant factor of PM 2.5 concentrations in summer and autumn, and planetary boundary layer height is the dominant factor of PM 2.5 concentrations in winter. The effect of anthropogenic emissions on PM 2.5 concentration is higher in winter and spring than in summer and autumn, and ammonia and ozone have stronger effects on PM 2.5 concentrations than other anthropogenic emissions. Interactions between the factors significantly enhance the PM 2.5 concentrations. The interactions between planetary boundary layer height and other impacting factors play dominant roles on PM 2.5 concentrations at annual scale and in winter. Our results not only provide crucial information for further developing air quality policies of the "2 + 26" cities, but also bear out several important implications for clean air policies in China and other regions of the world., 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 © 2022 Elsevier Ltd. All rights reserved.)

Chromium (Cr) in solid wastes from ultra-low emission (ULE) coal-fired power plants (CFPPs) could engender adverse effects on environment and human health. Hence, solid waste samples containing bottom ash, fly ash, gypsum and sludge were collected from a typical ULE CFPP in China to study the distribution, speciation, bioaccessibility and human health risk of Cr. The results showed that Cr was depleted in gypsum, whereas significantly enriched in bottom ash, fly ash and sludge comparing with feed coal. The ratios of Cr(VI) to total Cr in solid wastes were relatively low, but the increase of flow fractions in Cr chemical binding forms implied the deterioration of environmental stability. Based on the in vitro simulated digestion methods of solubility bioavailability research consortium (SBRC) and physiologically based extraction test (PBET), the bioaccessibility of Cr in the gastric and intestinal phases reached the highest values in either gypsum or sludge. After incorporating bioaccessibility in human health risk assessment, the carcinogenic risk (CR) within acceptable limits of Cr in solid wastes to adults and children was concluded, with the non-carcinogenic hazard quotient (HQ) was all within the safety threshold. The Monte Carlo model was applied to evaluate the uncertainty analysis of human health risk assessment at 5% and 95% confidence interval, and the fitting results were consistent with the calculation results of the carcinogenic and non-carcinogenic risk for adults and children. This study is expected to provide insights for the integration of bioaccessibility into the health risk assessment of Cr in solid wastes from ULE CFPPs, thus is conducive to the disposal of solid wastes and human health protection., 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 © 2022 Elsevier Ltd. All rights reserved.)

Nature reserves (NRs) are designated as a result of the ecosystem, species, economy, population, and land use coordination. However, the extent to which these factors influence the geographical pattern of NRs is unclear. Here, 11 indices (seven natural and four anthropogenic) were examined to identify these relationships in over 2600 terrestrial NRs in mainland China at the provincial level. Correlation analysis between natural and anthropogenic factors and NRs showed that desert and grassland had a positive correlation with NR coverage and area, and a negative correlation with NR density. This result was reversed in the correlation analysis between forest wetland coverage, endangered species, wildlife and NR coverage, area, and density. Similar results were found in the correlation analysis of all anthropogenic factors (population density, agricultural land, roads, and per capita GDP) with the coverage, area, and density of NRs. Canonical correspondence analysis (CCA) showed that three significant natural indicators (desert ecosystems, grasslands ecosystems, and forested and wetlands ecosystems) could explain 64.2 % of the pattern of NRs. The largest contributor was desert coverage, explaining 48.3 % (P = 0.002) of all indicators, followed by grassland coverage, explaining 8.6 % (P = 0.012), and forest and wetland coverage, explaining 7.3 % (P = 0.008). Human activities were significantly positively correlated with forest and wetland coverage, flora, and fauna, and negatively correlated with desert and grassland coverage. Compared with sand and grassland in the western region, the forest wetlands and wildlife in the eastern and central provinces were under greater pressure from anthropogenic activities. Therefore, natural factors determine the general layout of NRs, while the influence of anthropogenic activities makes the distribution of NRs patchy. When establishing national parks, governments must design strategies to coordinate areas with high biodiversity and high levels of human activity., 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 © 2022 Elsevier B.V. All rights reserved.)

Metropolitan areas are the main spatial units sustaining development. Investigating internal factor changes in metropolitan areas are of great significance for improving the quality of development in these areas. As an emerging national central city of China, Zhengzhou has experienced rapid urban expansion and urbanization. In this study, principal component analysis and the model and Geodetector model were used to comprehensively analyze the influencing factors of land use change in Zhengzhou from 1980 to 2015. Based on the CA-Markov model, we improved the accuracy of multi-criteria evaluation of suitability factors and simulated land use change in 2015. The results show that land use conversions in the study area between 1980 and 2015 were frequent, with the areas of farmland, woodland, grassland, water, and unused land decreasing by 5.00%, 17.12%, 21.59%, 18.31%, and 94.48%, respectively, while construction land increased by 53.61%. The key influences on land use change are the urbanization and growth of residential or non-agricultural populations. In 2035, the area of farmland in the study area will decrease by 11.09% compared with that in 2015 and construction land will increase by 38.94%, while the area of other land use types will not significantly change. Zhengzhou, as the center city, forms a diamond-shaped core development area of Zhengzhou-Kaifeng-Xinxiang-Jiaozuo, while Xuchang is considered an independent sub-center uniting the surrounding cities for expansion. With its radiation power of unipolar core development for many years and the developmental momentum of Zhengzhou-Kaifeng integration, Zhengzhou city jointly drives the economic development of the surrounding cities. The protection of farmland and control of the expansion of construction land are the major challenges for the Zhengzhou metropolitan area to achieve sustainable development.

Background: The relationship between childbirth delivery methods and the risk of wheezing in children remains controversial. Few studies have explored it under different maternal conditions., Objective: To explore the influence of childbirth delivery method on the onset of wheezing in children of different parity., Methods: A total of 21716 patients were included in this retrospective observational study. Multivariable logistic regression was used to analyze the relationship between childbirth delivery method and wheezing in children under 18 years of age in Fujian Province., Results: Wheezing differed statistically based on the child's sex, age, season of onset, parity, jaundice history, and feeding patterns ( P  < 0.05). After adjusting for confounding factors, in cases of parity greater than two, the risk of wheezing in cesarean section deliveries was higher than that in vaginal deliveries (OR: 1.107; 95% CI 1.010-1.214). In girls with parity greater than two (OR: 1.179; 95% CI 1.003-1.387) and normal-weight infants with parity greater than two (OR: 1.106; 95% CI 1.003-1.220), the risk of wheezing in cesarean section deliveries was higher. The interaction term between the mode of childbirth and parity was significant in girls ( P  = 0.014)., Conclusion: The method of childbirth delivery and parity are related to the risk of wheezing and may be relevant to gender and birth weight. Parity and gender have synergistic effects on wheezing.

Background and Aims: Previous studies investigating plant-plant interactions have focused on plant growth, context dependence and shifts in interactive outcomes. However, changes in functional traits in the context of interactions have been inadequately explored; few studies have focused on the effects of interactions on the plasticity of functional strategies., Methods: We conducted a 4-year removal experiment for the xeric shrub Artemisia ordosica and perennial graminoids (PGs) in the Mu Us Desert, northern China. Soil nutrient content, biomass and 12 functional traits related to plant morphology and nutrient status were measured for the shrub species and a dominant PG species (i.e. Leymus secalinus) in the presence and absence of shrubs and PGs., Key Results: Shrubs affected the functional traits of L. secalinus, reducing leaf dry matter content and increasing plant height, which probably promoted the functional strategy of L. secalinus towards a more resource-acquisitive and competitive strategy. In contrast, when the shrubs were affected by PGs, they shifted towards a resource-conservative and stress-tolerative strategy, by increasing leaf dry matter content and decreasing specific leaf area. Moreover, the shrub species relied more on internal nutrient recycling (higher nitrogen resorption efficiency) rather than on external nitrogen uptake under nitrogen competition; instead, L. secalinus tended to exhibit higher external nitrogen uptake from soil during nitrogen shortages., Conclusions: This study indicated that the functional strategies and nutrient cycling of the shrub species and the dominant PG were altered by each other. The shifts in functional traits may help plants to coexist in the community for a relatively long time. Our findings highlighted that interspecific interactions alter plant functional strategies and provided new insights into community assembly and succession mechanisms in a revegetated shrubland for ecological restoration of drylands., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Annals of Botany Company. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Due to its low vapor pressure, chromium (Cr) mostly emitted as fly ash particles (especially PM 2.5 ) into environment in coal-fired power plants (CFPPs). The ultra-low emission (ULE) control technologies used in current CFPPs may be beneficial to reducing both the regular pollutants and hazardous trace elements (e.g., Cr), but the insight into the removal efficiency of Cr by different upgrading air pollution cleaning devices (APCDs) and the environmental stability of the Cr-bearing wastes produced from those APCDs in the ULE CFPPs has rarely reported. This study investigated and compared the distribution and emission characteristics of Cr in a Chinese CFPP before and after ULE, and the leaching behavior of Cr after ULE retrofitting in combustion byproducts was also revealed. The results showed that Cr was primarily captured in bottom and fly ashes (80.85%), followed by gypsum (0.02%) and sludge from wet electrostatic precipitator (WESP) (4.52 × 10 -4 %), with only 3.02 × 10 -8 % emitted into the atmosphere. Additional WESP had a large removal efficiency of Cr with the value of 92.04%, and the overall Cr removal efficiency of selective catalytic reduction (SCR) equipment, electrostatic precipitator (ESP), wet flue gas desulphurization (WFGD) system, and WESP equipped after ULE retrofitting was 99.99%. Notably, although the mass percentage of Cr in WESP sludge was negligible, the concentration of Cr in WESP sludge was 324.04 mg/kg. The leaching concentrations of Cr in combustion byproducts were in the descending order: fly ash > WESP sludge > bottom ash > gypsum. The atmospheric emission factor of Cr in the studied power plant was 1.08 mg/t coal, which was significantly lower than those of the CFPPs before ULE retrofitting. Therefore, the ULE retrofitting for CFPP was beneficial to reduce Cr emissions. More attention should be paid to the subsequent processing problem of solid combustion byproducts, especially the WESP sludge., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: The effects of meteorological factors and air pollutants on respiratory diseases (RDs) were various in different populations according to the demographic characteristics, and children were considered a vulnerable population. Previous studies were mainly based in cities with serious air pollution. This study aimed to qualify the lag effects of meteorological factors and air pollution on respiratory diseases among children under 18 years old in Fuzhou., Methods: Meteorological data, air pollutants concentrations and hospital admission data of Fujian Maternity and Child Health Hospital between 2015 and 2019 were collected. A Distributed Lag Nonlinear Model (DLNM) was used to evaluate the nonlinear and lagged effect of meteorological factors and air pollutants on daily RDs number. A subgroup analysis was also conducted to evaluate the effect on different sex groups and age groups., Results: A total number of 796 125 RDs visits was included during the study period. For meteorological factors, lower mean temperature and relative humidity were significantly associated with daily RDs number (peak relative risk (RR) = 1.032 (95% confidence interval (CI) = 1.011-1.053) and 1.021 (95% CI = 1.013-1.029)), while lower wind speed showed a significant association at low range (peak RR = 0.995 (95% CI = 0.992-0.999)). Temperature warming was a significant protective factor for RDs (peak RR = 0.989 (95% CI = 0.986-0.993)). For air pollutants, SO 2 , NO 2 , PM 10 and PM 2.5 were all significantly associated with RDs (peak RR = 1.028 (95% CI = 1.022-1.035), 1.024 (95% CI = 1.013-1.034), 1.036 (95% CI = 1.025-1.047), 1.028 (95% CI = 1.019-1.037)), and the relationship had no threshold. The estimated RR and peak lag day did not change extremely between subgroups., Conclusions: The findings provide statistical evidence for the prevention of child RDs. In addition, our findings suggested that even at low concentrations, air pollutants still have negative effects on the respiratory system., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2022 by the Journal of Global Health. All rights reserved.)

City planners are increasingly drawn to ways of transforming urban spatial structure as an important strategy for reducing pollutant emissions. As its main contribution, this paper uses firm-level emissions data to quantify impact mechanisms related to factor flow, firm size, and division of labour. We examine the effects of spatial polycentricity on firm-level industrial emissions, using a pooled cross-sectional model, based on emissions data from individual firms in China. We show that, all else being equal, polycentric spatial structures help to reduce the emissions of industrial firms. This finding is not affected by index measures, changes in industrial structure, or city-sample selection. A mechanism analysis shows that polycentric structures not only enhance the emission-reduction effects of factor flow and firm size, but also reduce firm-level emissions by strengthening the urban division of labour. Our findings support the emission-reduction performance of polycentric spatial structures, promoting the integration of city planning and industrial policies that jointly contribute to reducing firm-level emissions and preventing and controlling air pollution.

The COVID-19 epidemic has emerged as one of the biggest challenges, and the world is focused on preventing and controlling COVID-19. Although there is still insufficient understanding of how environmental conditions may impact the COVID-19 pandemic, airborne transmission is regarded as an important environmental factor that influences the spread of COVID-19. The natural ventilation potential (NVP) is critical for airborne infection control in the micro-built environment, where infectious and susceptible people share air spaces. Taking Wuhan as the research area, we evaluated the NVP in residential areas to combat COVID-19 during the outbreak. We determined four fundamental residential area layouts (point layout, parallel layout, center-around layout, and mixed layout) based on the semantic similarity model for point of interest (POI) picking. Our analyses indicated that the center-around and point layout had a higher NVP, while the mixed and parallel layouts had a lower NVP in winter and spring. Further analysis showed that the proportion of the worst NVP has been rising, while the proportion of the poor NVP remains very high in Wuhan. This study suggested the need to efficiently improve the residential area layout in Wuhan for better urban ventilation to combat COVID-19 without losing other benefits.

Actinomycete strain YIM PH20352, isolated from the rhizosphere soil sample of Panax notoginseng collected in WenShang, Yunnan Province, China, exhibited antifungal activity against some phytopathogenic fungi. The structures of bioactive molecules, isolated from the ethyl acetate extract of the fermentation broth of the strain, were identified as rabelomycin (1) and dehydrorabelomycin (2) based on extensive spectroscopic analyses. Compound 1 exhibited antifungal activity against four tested root-rot pathogens of the Panax notoginseng including Plectosphaerella cucumerina, Alternaria panax, Fusarium oxysporum, and Fusarium solani with the MIC values at 32, 64, 128, and 128 μg/mL, respectively. Compound 2 exhibited antifungal activity against F. oxysporum, P. cucumerina, F. solani, and A. panax with the MIC values at 64, 64, 128, and 128 μg/mL, respectively. Based on the phylogenetic analyses, the closest phylogenetic relative of strain YIM PH20352 is Streptomyces cellulosae NBRC 13027  T (AB184265) (99.88%), so strain YIM PH20352 was identified as Streptomyces cellulosae. To the best of our knowledge, this is the first report of rabelomycin and rabelomycin-type antibiotics from Streptomyces cellulosae and their antifungal activity against root-rot pathogens of the Panax notoginseng., (© 2022. Institute of Microbiology, Academy of Sciences of the Czech Republic, v.v.i.)

Objective: This study aimed to investigate the organization, workload, and psychological impact of COVID-19 on healthcare workers from the domestic Medical Aid Teams (MATs) sent to Wuhan in China., Methods: Leaders and members of MATs involved in the care for COVID-19 patients were invited to participate in a study by completing 2 separate self-report questionnaires from April 1 to 24, 2020., Results: A total of 9 MAT leaders were involved and 464 valid questionnaires were collected from 140 doctors and 324 nurses. Mean age of the doctors and nurses were 39.34 ± 6.70 (26∼58 years old) and 31.88 ± 5.29 (21∼52 years old), with 72 (15.5%) being males. Nurses were identified as an independent risk factor (HR 1.898; P = 0.001) for a day working time in the multivariate analysis. The proportions of psychological consulting received among nurses were higher than those among doctors (49.7 vs 30.0%, P < 0.001). More than 50% of the anesthetists and emergency doctors who have received psychological consulting thought that it was effective according to self-evaluation., Conclusions: This study focused on healthcare workers' situation during the early period of the pandemic. Nurses worked longer than doctors. The effectiveness of psychological consulting depends on the physicians' specialties and the working conditions of the nurses and psychological consulting targeting different specialties need to be improved.

The purpose of this study was to assess the psychological experience of COVID-19 basic vaccination, the willingness to receive booster vaccines, and to determine their relationships among Chinese people. Between 6 August 2021 and 9 August 2021, a research firm performed a national cross-sectional online survey among Chinese individuals (aged over 18), using the snowball sampling approach, with 26,755 participants. Factor analysis and binary logistic regression were used to evaluate the existing associations. The overall COVID-19 vaccination psychological experience score of the participants was 25.83 (25.78~25.89; scores ranged from 7-35). A total of 93.83% (95%CI = 93.54~94.12) of respondents indicated a willingness to receive booster vaccines. After classifying psychological experiences associated with COVID-19 vaccination into positive and negative experiences and adjusting for confounding factors, for the former, the willingness to receive booster vaccines for participants with the highest scores of 13-15 was 3.933 times higher (OR = 3.933, 95%CI = 3.176~4.871) than participants who obtained scores of 3-9, and for the latter, the willingness to receive booster vaccines for participants with the highest scores of 19-20 was 8.871 times higher (OR = 8.871, 95%CI = 6.240~12.612) than participants who obtained scores of 4-13. Our study suggests that a good psychological experience with vaccination is positively associated with an increased willingness to receive booster vaccines.

Reconstruction of natural streamflow is fundamental to the sustainable management of water resources. In China, previous reconstructions from sparse and poor-quality gauge measurements have led to large biases in simulation of the interannual and seasonal variability of natural flows. Here we use a well-trained and tested land surface model coupled to a routing model with flow direction correction to reconstruct the first high-quality gauge-based natural streamflow dataset for China, covering all its 330 catchments during the period from 1961 to 2018. A stronger positive linear relationship holds between upstream routing cells and drainage areas, after flow direction correction to 330 catchments. We also introduce a parameter-uncertainty analysis framework including sensitivity analysis, optimization, and regionalization, which further minimizes biases between modeled and inferred natural streamflow from natural or near-natural gauges. The resulting behavior of the natural hydrological system is represented properly by the model which achieves high skill metric values of the monthly streamflow, with about 83% of the 330 catchments having Nash-Sutcliffe efficiency coefficient (NSE) > 0.7, and about 56% of the 330 catchments having Kling-Gupta efficiency coefficient (KGE) > 0.7. The proposed construction scheme has important implications for similar simulation studies in other regions, and the developed low bias long-term national datasets by statistical postprocessing should be useful in supporting river management activities in China., Competing Interests: Conflict of interest The authors declare that they have no conflict of interest., (Copyright © 2021 Science China Press. Published by Elsevier B.V. All rights reserved.)

The issue of how to achieve removal of recently accumulated sediment is one of the largest unresolved puzzles in China's lower Yellow River. In this work, the feasibility and sustainability of achieving full-stream erosion in the lower Yellow River based on a water-sediment regulation scheme (WSRS) have been comprehensively investigated. The results indicate that the erosion-deposition state of the lower Yellow River is controlled by the incoming flow discharge level and the corresponding sediment concentration. The year 1987 is identified as an abrupt change point for streamflow in Xiaolangdi station. The relationships between channel erosion or deposition and the sediment concentration of the incoming discharge are constructed for the periods 1960-1987 and 1988-2017. Based on a constrained optimization approach, a sediment concentration lower than 19.96 kg/m 3 in the discharge from Xiaolangdi Reservoir is determined to be the critical controlling condition for achieving full-stream erosion in the lower Yellow River under the average discharge level observed during 1960-1987; however, it is challenging to achieve full-stream erosion under the average discharge level of 1988-2017. Although this erosion status could potentially be achieved through continued implementation of the WSRS, its sustainability is restricted by the declining storage capacity of Xiaolangdi Reservoir, decreasing water discharge levels and riverbed coarsening in the Yellow River. It is necessary to design cross-basin collaboration measures for the upper, middle and lower Yellow River to achieve sustainable sediment reduction and healthy development of the Yellow River basin as a whole., 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.)

In this study, tropospheric formaldehyde (HCHO) vertical column densities (VCDs) were measured using multi-axis differential optical absorption spectroscopy (MAX-DOAS) from January to November 2019 in Shenyang, Northeast China. The maximum HCHO VCD value appeared in the summer (1.74 × 10 16 molec/cm 2 ), due to increased photo-oxidation of volatile organic compounds (VOCs). HCHO concentrations increased from 08:00 and peaked near 13:00, which was mainly attributed to the increased release of isoprene from plants and enhanced photolysis at noon. The HCHO VCDs observed by MAX-DOAS and OMI have a good correlation coefficient (R) of 0.78, and the contributions from primary and secondary HCHO sources were distinguished by the multi-linear regression model. The anthropogenic emissions showed unobvious seasonal variations, and the primary HCHO was relatively stable in Shenyang. Secondary HCHO contributed 82.62%, 83.90%, 78.90%, and 41.53% to the total measured ambient HCHO during the winter, spring, summer, and autumn, respectively. We also found a good correlation (R = 0.78) between enhanced vegetation index (EVI) and HCHO VCDs, indicating that the oxidation of biogenic volatile organic compounds (BVOCs) was the main source of HCHO. The ratio of secondary HCHO to nitrogen dioxide (NO 2 ) was used as the tracer to analyze O 3 -NO x -VOC sensitivities. We found that the VOC-limited, VOC-NO x -limited, and NO x -limited regimes made up 93.67%, 6.23%, 0.11% of the overall measurements, respectively. In addition, summertime ozone (O 3 ) sensitivity changed from VOC-limited in the morning to VOC-NO x -limited in the afternoon. Therefore, this study offers information on HCHO sources and corresponding O 3 production sensitivities to support strategic management decisions., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Lumpectomy is important for preventing malignant changes in benign tumors and diagnosing malignant tumors. Intercostal nerve blocks (ICNBs) are useful for breast lumpectomy as either the primary anesthetic or as an adjuvant anesthetic procedure. To our knowledge, no studies have evaluated the association between Horner syndrome and ICNB., Objectives: This study aimed to explore the characteristics of and related risk factors for Horner syndrome after ICNB., Study Design: A prospective, nested case-control study., Setting: Fudan University Shanghai Cancer Centre from April 2020 through July 2020., Methods: Patients scheduled for breast lumpectomy under ICNB from April 2020 through July 2020 in our hospital were recruited. The ICNB was introduced at the intersection of the midaxillary line and the inferior border of the ribs, according to the location of the mass. Horner syndrome indicators were assessed one, 5, 10, 15, 30, 45, and 60 minutes and 3, 6, 12 and 24 hours after ICNB. Personal data (age, body mass index [BMI], ASA classes), data on anesthetic (the puncture points, dose of local anesthetics, duration of ICNB, Horner syndrome indicators, other complications) and data on postoperative recovery (postoperative activity time, postoperative feeding time) were recorded. Univariate and multivariate logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals., Results: Ipsilateral Horner syndrome was found in 35 of 998 (3.5%) patients. Ipsilateral miosis, the first symptom to appear and last to disappear, occurred within 4 minutes and lasted 45 minutes to 240 minutes after ICNB. Seven patients showed obvious ipsilateral facial flushing. Logistic multivariate regression analysis showed that independent risk factors for Horner syndrome after ICNB were age <= 45 years, body mass index <= 18.5 kg/m2, and the need for a second ICNB., Limitations: Firstly, the patients in this study are all adult women, and the applicability of other populations is uncertain. Secondly, the flow trajectory of local anesthetics was not confirmed by imaging tracers., Conclusions: ICNB via an anterolateral approach promoted enhanced recovery after breast lumpectomy. The incidence of Horner syndrome following ICNB for breast lumpectomy was 3.5%. Horner syndrome occurred on the ipsilateral side of the ICNB and was reversible. Younger age, lower BMI, and the need for a second ICNB were risk factors for Horner syndrome after ICNB., Key Words: Horner's syndrome, intercostal nerve block, breast lumpectomy, enhanced recovery.

PM 2.5 pollution has gradually attracted people's attention due to its important negative impact on public health in recent years. The influence of anthropogenic emission factors on PM 2.5 concentrations is more complicated, but their relative individual impact on different emission sectors remains unclear. With the aid of the geographic detector model (GeoDetector), this study evaluated the impacts of anthropogenic emissions from different sectors on the PM 2.5 concentrations of major cities in China. The results indicated that the influence of anthropogenic emissions factors with different emission sectors on PM 2.5 concentrations exhibited significant changes at different spatial and temporal scales. Residential emissions were the dominant driver at the national annual scale, and the NO X of residential emissions explained 20% ( q = 0.2) of the PM 2.5 concentrations. In addition, residential emissions played the leading role at the regional annual scale and during most of the seasons in northern China, and ammonia emissions from residents were the dominant factor. Traffic emissions play a leading role in the four seasons for MUYR and EC in southern China, MYR and NC in northern China, and on a national scale. Compared with primary particulate matter, secondary anthropogenic precursors have a more important effect on PM 2.5 concentrations at the national or regional annual scale. The results can help to strengthen our understanding of PM 2.5 pollution, improve PM 2.5 forecasting models, and formulate more precise government control policy.

Honeybees are crucial pollinators with significant ecologic value. The decline of wild honeybee populations has been recognized and documented during recent decades. However, the health status of wild non-cave Apis spp., including giant and dwarf honeybees, remains generally unknown. We investigated eight common viruses and five bacterial or fungal pathogens in four wild non-cave honeybee species at 11 locations in Southwest China. As a result, Melissococcus plutonius, the pathogenic agent of European foulbrood, was detected in all the species, and the sequences were identical to the pathogen in managed cave honeybees. Only one virus, black queen cell virus (BQCV), was positive in one dwarf species, Apis florea, in our study. The positive BQCV infected three A. florea colonies in Guangxi Province, with distinct sequences from this virus reported in cave honeybees or in the same host in the nearby Yunnan Province. Although our results indicated a low pathogenic level of common diseases in the wild non-cave Apis spp. in Southwest China, the conservation of these wild pollinators is of importance in light of the noticeable decline in populations and the irreplaceable position of pollination., (© Wildlife Disease Association 2021.)

Objective: This meta-analysis evaluated the effect of probiotics and synbiotics on insulin resistance in patients with polycystic ovary syndrome (PCOS)., Methods: A systematic search was performed to identify all relevant publications listed on the electronic databases (PubMed®, Web of Science, Embase® and China National Knowledge Infrastructure) between inception and 30 October 2020. All statistical analyses were performed on randomized controlled trials (RCTs) using RevMan version 5.3 software provided by the Cochrane Collaboration., Results: A total of 486 patients from seven RCTs were included in the meta-analysis. Probiotic and synbiotic supplementation appeared to improve levels of homeostatic model assessment of insulin resistance (mean difference = -0.37; 95% confidence interval -0.69, -0.05) and serum insulin (standardized mean difference = -0.66; 95% confidence interval -1.19, -0.12). The results failed to show any influence of probiotic and synbiotic supplementation on body mass index, waist circumference, hip circumference and fasting blood sugar., Conclusions: Probiotics and synbiotics appear to have a partially beneficial effect on indices of insulin resistance in patients with PCOS.

Background: Risk factors that predispose the development of severe community-acquired pneumonia (CAP) among pediatric CAP patients of different age ranges are yet to be identified., Methods: We retrospectively analyzed pediatric in-patients (< 6 years old) diagnosed with CAP in our hospital. We subdivided patients into four age groups (< 6 months, 6 months-1 year, 1-2 years, and 2-6 years). Their medical records, including demographic information, clinical features, laboratory findings, and chest radiographic reports, were reviewed and collected for further analysis. Univariate logistic regression analysis and stepwise regression analysis were applied to identify risk factors associated with severe CAP and ICU admission for overall patients and age-stratified subgroups., Results: A total of 20,174 cases were initially included. Among them, 3309 (16.40%) cases were identified as severe CAP, and 2824 (14.00%) cases required ICU admission. Potential risk factors for severe CAP and ICU admission identified by univariate analysis included younger age, rural residency, premature birth, low birth weight (LBW), formula feeding, congenital heart disease (CHD), history of pneumonia or neonatal jaundice, patients with other health issues, certain symptoms (manifesting wheezing, dyspnea, cyanosis, but have no cough or fever), abnormal laboratory findings (abnormal levels of white blood cells, albumin, and C-reactive protein and RSV infection), and chest X-ray (odds ratio [OR] > 1 for all). CHD, low albumin, proteinuria, abnormal chest x-ray were independent risks factors across different age groups, whereas birth or feeding history, history of pneumonia, cyanosis or dyspnea on admission, and RSV infection were independent risk factors for only younger kids (< 1 year), and wheezing was an independent risk factor only for older children (2-5 years old)., Conclusions: Risk factors predicting disease severity among children hospitalized with CAP vary with age. Risk factor stratification of pediatric CAP based on age-specific risk factors can better guide clinical practice., Trial Registration: This study has been registered in China, with the registration number being ChiCTR2000033019 .

Objectives: High retention rates among direct care workers (DCWs) affect the quality of aged care. However, limited research has explored factors associated with retention in China's aged care industry. This study compared turnover intention among DCWs in Chinese hospitals and long-term care facilities (LTCFs)., Design: A cross-sectional survey with the stratified-random sampling method., Setting and Participants: A total of 370 DCWs from 7 hospitals and 311 DCWs from 7 LTCFs located in Fujian Province, China, were surveyed., Measures: Turnover intention, contractual status, income, sociodemographic characteristics, and other work-related factors were self-reported by surveyed DCWs., Results: Approximately 80% of DCWs in hospitals had employment contracts, whereas only 9% of DCWs were contractual in LTCFs. DCWs from hospitals reported lower turnover intention (20.5% vs. 37.0%) than did DCWs from LTCFs. Contracted DCWs from hospitals had the lowest turnover intention (14.8%). Contracted and noncontracted DCWs in LTCFs were more likely to report turnover intention than hospital contracted DCWs (odds ratio [OR] 3.68, P = .008 and OR = 3.17, P < .001, respectively)., Conclusions and Implications: Contractual status and facility type were jointly associated with turnover intention of DCWs in China. DCWs in LTCFs were likely to report much higher turnover intention than contracted DCWs in hospitals. The expanded use of employment contracts may lower turnover intention in long-term care DCWs by improving their job stability and security. The labor market of DCWs needs to be regulated by the Chinese Labor Law., (Copyright © 2020 AMDA — The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Intracranial aneurysm is a common life-threatening disease. Computed tomography angiography is recommended as the standard diagnosis tool; yet, interpretation can be time-consuming and challenging. We present a specific deep-learning-based model trained on 1,177 digital subtraction angiography verified bone-removal computed tomography angiography cases. The model has good tolerance to image quality and is tested with different manufacturers. Simulated real-world studies are conducted in consecutive internal and external cohorts, in which it achieves an improved patient-level sensitivity and lesion-level sensitivity compared to that of radiologists and expert neurosurgeons. A specific cohort of suspected acute ischemic stroke is employed and it is found that 99.0% predicted-negative cases can be trusted with high confidence, leading to a potential reduction in human workload. A prospective study is warranted to determine whether the algorithm could improve patients' care in comparison to clinicians' assessment.

Vegetation growth is importantly affected by seasonal weather patterns. The time lag between changes in these patterns and the vegetative response is an important factor in vegetation-climate interactions and can vary considerably with the spatial heterogeneity of an ecosystem. In this study of the Loess Plateau, China, highly accurate time lags were determined at the daily scale using linear regression based on a multiyear normalized difference vegetation index (NDVI) dataset (1982-2015) and the corresponding reconstructed monthly climate series. We found that lag length varied among catchments, vegetation zones, and land-cover types. The mean time lag between precipitation and the NDVI response varied from 7.9 days to 17.7 days across the catchments; for temperature and NDVI, the lag in response ranged from 6.2 days to 25.3 days. Across the six vegetation zones that range from the southeast to the northwest of the Loess Plateau, both the precipitation-NDVI and temperature-NDVI lag lengths were largest in the central zones and lower in the zones closer to the edges of the plateau. Among the different land-cover types, grassland had the largest lags between precipitation or temperature change and the NDVI response, followed by shrubland, arable land, and then forests. The possible impact of vegetative time lags on sediment yield was also investigated for the first time, and this information has great relevance for soil conservation on the Loess Plateau and sediment reduction in the lower Yellow River., 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.)

Objective: To connect with the measurement data of asbestos dust fiber concentration in foreign countries, improve the accuracy of asbestos fiber detection in China, and understand the dust exposure in the working environment of asbestos and man-made mineral fiber production and processing sites in Zhejiang Province. The fiber count concentrations of working environment in glass fiber, ceramic fiber and asbestos processing plants were measured and compared. Methods: The dust concentration in the working environment of two glass fiber factories, one ceramic fiber factory and eight asbestos products processing factories was measured. The total dust mass concentration was measured according to GBZ/T 192.1-2007, and the fiber count concentration was measured by phase contrast microscope. Kruskal Wallis was used to test and compare the dust concentration in the working environment of each post. The correlation between asbestos mass concentration and fiber count concentration was analyzed by Spearman correlation. Results: Under the phase contrast microscope, there were many short and fine asbestos fibers in the field of vision, and there were many impurities around. The average dust concentration of asbestos processing plant was 3.2 f/ml, and the dust concentration of cotton ginning was the highest (6.68 f/ml) . There was a significantly positive correlation between asbestos fiber count concentration and mass concentration ( r =0.535, P =0.033) . The average fiber count concentration of glass fiber factory was 0.001 f/ml, and the highest was 0.005 f/ml. The average fiber count concentration of ceramic fiber factory was 0.001 f/ml, and the highest was 0.006 f/ml. Conclusion: The fiber count concentration in the working environment of asbestos factory in Zhejiang Province is obviously over the standard, which is one of the important reasons for the high incidence of mesothelioma in this area. Short and small asbestos fibers are easy to be ignored when counting. It is necessary to improve the actual operation process of fiber counting to form a laboratory standard in China.

Ground-level ozone pollution has negative impacts on human health and vegetation and has increased rapidly across China. Various factors are implicated in the formation of ozone (e.g., meteorological factors, anthropogenic emissions), but their relative individual impact and the impact of interactions between these factors remains unclear. This study quantified the influence of specific meteorological conditions and anthropogenic precursor emissions and their interactions on ozone concentrations in Chinese cities using the geographic detector model (GeoDetector). Results revealed that the impacts of meteorological and anthropogenic factors and their interactions on ozone concentrations varied significantly at different spatial and temporal scales. Temperature was the dominant driver at the annual time scale, explaining 40% (q = 0.4) of the ground-level ozone concentration. Anthropogenic precursors and meteorological conditions had comparable effects on ozone concentrations in summer and winter in northern China. Interactions between all the factors can enhance effects. The interaction between meteorological factors and anthropogenic precursors had the strongest impact in summer. The results can be used to enhance our understanding of ozone pollution, to improve ozone prediction models, and to formulate pollution control measures., 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 Elsevier Ltd. All rights reserved.)

Aim: Maintenance hemodialysis (MHD) frequency is associated with survival and complication rates. Achieving the optimal balance between healthcare, quality of life (QOL), and medical costs is challenging. We compared complications, inflammatory status, nutritional status, and QOL between patients with different MHD frequencies., Material and Methods: This was a multicenter randomized trial of patients treated between May 2011 and August 2017 at 3 tertiary hospitals in Wenzhou. Patients were grouped according to their treatment schedule over 1 year: twice-weekly or 3-times-weekly. Complications, biochemistry parameters, and QOL (KDQOL-SFTM 1.3 scale) were assessed., Results: One hundred forty patients were included aged 29 to 68 years (mean age, 50.9 ± 4.3 years). There were no significant differences in infection, heart failure, or cerebral hemorrhage complications between the 2 groups (P = .664). Pre-dialysis hemoglobin, high-sensitivity C-reactive protein, serum albumin, total cholesterol, triglyceride, calcium, phosphate, parathyroid hormone, and ejection fraction were similar in both groups (P > .05). After 1 year of MHD, both groups exhibited significant improvements in these parameters (all P < .05) with no significant differences between groups. Serum creatinine, blood urea nitrogen (BUN), and weekly standard hemodialysis treatment adequacy did not improve after treatment (all P > .05), although a difference in BUN was observed between the 2 groups (P < .001). QOL was superior in the twice-weekly group than in the 3-times-weekly group (all P < .05), except for social support, which was slightly better in the 3-times-weekly group than in the twice-weekly group., Conclusions: Twice- and 3-times-weekly MHD resulted in comparable inflammatory and nutritional clinical outcomes and adverse events. QOL was better for the twice-weekly schedule. Even for patients with economic constraints, twice- or 3-times-weekly MHD should be selected with caution after consideration of BUN levels at baseline.

Some scholars have already proved the important role of agglomeration in studying how environmental regulation (ER) affects the location of polluting firms. However, further research is needed on both the mechanism and the empirical evidence. This paper reports the construction of a location database of new chemical plants in China's Yangtze River Economic Belt (YREB), where a fixed-effects panel threshold regression model was used to explore the agglomeration threshold of effective ER. We found a single agglomeration threshold for the whole YREB region that represented the turning point of ER from excluding to attracting new chemical enterprises. Additionally, there were two agglomeration thresholds in the lower reaches. If agglomeration reached the lower threshold, the effect of ER changed from repulsion to nonsignificant attraction. Once above the upper threshold, the attraction effect became large and significant. The results for this region were consistent with the Porter hypothesis. Furthermore, there was a single agglomeration threshold in the middle reaches. When agglomeration level exceeded the threshold, the repellant effect of ER was no longer significant. In the upper reaches, we found no valid threshold and ER always exhibited a small and nonsignificant exclusion effect. The pollution haven hypothesis was more explanatory in the middle and upper reaches. In the end, some suggestions are provided to support the government to formulate differentiated environmental policies.

Background: To evaluate the feasibility and effect of implementing enhanced recovery after surgery (ERAS) in patients undergoing radical cystectomy (RC) and urinary diversion., Materials and Methods: Since October 2016, a 15-point ERAS protocol has been implemented for patients undergoing elective RC and urinary diversion at Fudan University Shanghai Cancer Center (FUSCC). We retrospectively assessed patients who underwent RC performed between January 2014 and June 2018. The effects of implanting ERAS for RC were validated., Results: A total of 443 patients were included. The ERAS and non-ERAS groups included 185 and 258 patients, respectively. There was no significant difference in the patients' demographic characteristics, operative variables, perioperative systemic inflammation-based scores or mortality rates. Compared with the non-ERAS group, our study showed decreases in intraoperative blood loss volumes and transfusion rates in the ERAS group. Patients in the ERAS group also had earlier times to tolerate a clean liquid diet intake, first ambulation and first flatus. The incidences of postoperative pneumonia, urine leakage, intestinal obstruction and deep venous thrombosis were also significantly lower in the ERAS group. The time to pelvic drainage tube removal and the length of stay (LOS) were significantly shorter in the ERAS group than in the non-ERAS group, and the ERAS group also had a significantly lower incidence of 30-day readmission., Conclusions: The results of this study suggest that ERAS protocols can accelerate the rehabilitation of patients undergoing RC, reduce the incidence of postoperative complications, shorten the LOS, and are safe and feasible in the field of RC. This study provides experience from FUSCC to further optimize ERAS protocols for patients with bladder cancer., (Copyright © 2019. Published by Elsevier Ltd.)

Concentrations, health risks, and sources of 9 metal(loid)s (As, Cd, Co, Cr, Cu, Hg, Ni, Pb, and Zn) and 16 PAHs in dusts collected from the 29 driving school campuses in the urban area of Kaifeng, Henan Province, China, were evaluated. The health risks due to exposure to these pollutants in dusts were assessed under three different scenarios (working for 10 years, 20 years, and 30 years in driving schools), using the health risk assessment model developed by US EPA. The results indicated that the mean concentrations for As, Cd, Cr, Cu, Hg, Pb, and Zn were higher than the local dust background except Co and Ni. The total PAH concentrations ranged from 198.21 to 3 400.89 μg kg -1 , with a mean value of 908.72 μg kg -1 . The dominant components were the two and three member-ring PAHs, accounting for 55.79% of the ∑PAHs, while PAHs with four to six member-rings accounted for 44.21% of total PAHs. The non-cancer risks of metal(loid)s in most samples were within the safe range except for two samples, with Pb as the major non-carcinogenic risk factor. The cancer risks of As, Cd, Cr, and Ni were also within the currently acceptable range except for one sample under two scenarios (working for 20a and 30a in a driving school). The cancer risks of PAHs in most samples were within the safe range except for one sample under scenario 3. The source identification results demonstrated that Pb, Zn, Cu, and Cd in the driving school dusts are mainly affected by the emission of driving-school vehicles. For PAHs, the typical driving school vehicle emissions were predominated by Phe and Ant, followed by Flu, Pyr, BkF, and Nap. The concentrations and health risks of the metal(loid)s and PAHs in the dusts were not significantly related to the driving school operation time or vehicle density, but closely related to the surrounding environments and the historical land uses of driving schools.

The aim of this study was to conduct a more comprehensive analysis of the association between psoriasis and abnormal lipid metabolism.The case-control study included 222 psoriatic patients and 445 non-psoriatic control patients matched for age and gender. Clinical parameters included age, gender, and body mass index (BMI). Serum lipid levels were recorded and included cholesterol (CHO), triglycerides (TG), low-density lipoprotein (LDL), high density lipoprotein (HDL), phospholipids (PLIP), free fatty acids (FFA), lipoprotein (a) [Lp(a)], and apolipoproteins (apoA1, apoB, and apoE). Statistical analysis was carried out through the IBM Statistical Package for the Social Studies version 23.0.Compared with controls, levels of BMI and the prevalence of obesity were significantly higher in psoriatic patients. The results revealed that when compared to controls, significant elevation of serum TG (P <.001) and Lp(a) (P = .022) was observed. Levels of HDL (P <.001) and apoA1 (P <.001) were significantly lower in psoriatic patients. There was no significant difference in CHO (P = .367), LDL (P = .400), apoB (P = .294), apoE (P = .05), PLIP (P = .931) and FFA (P = .554) between patients and controls. The levels of CHO, TG, PLIP, FFA, and apoE were positively correlated with BMI level.Dyslipidemia was more common in psoriatic patients, compared with non-psoriatic controls.

Better understanding of esophageal precancerous lesions (EPL) can inform prevention strategies for esophageal squamous cell carcinoma (ESCC). Here, a cross-sectional epidemiologic study based on the Early Diagnosis and Early Treatment Project of Esophageal Cancer database from 2011 to 2017 was performed to fully investigate and characterize the epidemiology of EPL in rural Huai'an District. Data of 11,518 participants ages 35-75 years were collected through face-to-face interviews by questionnaire. Participants underwent a routine endoscopy examination, tissues were biopsied, and diagnosed according to the histologic criteria of dysplasia. Unconditional univariate and multivariate logistic regression analyses were performed to obtain crude and adjusted odds ratios and corresponding 95% confidence intervals, respectively. A total of 667 subjects were diagnosed with EPL. Factors associated with an increased risk of EPL included: drinking shallow well water and surface water, irregular diet, excessive smoking, exposure to secondhand smoke, consumption of corn, corn flour, pickled food, fried food, and hot food, and having a history of digestive system diseases. In addition, liquor use, but not other alcohol types, contributed to risk of EPL. Consumption of deep well water and vegetables, fruits, and animal livers were associated with lower EPL risk. This study suggested a completely distinct pattern that alcohol use plays only a minor role in EPL and excessive tobacco use shows a significant association in rural Huai'an District, while eating habits and environmental exposure may be the dominant factors. This work may be promising to provide scientific evidence to support primary prevention of ESCC in this region., (©2019 American Association for Cancer Research.)

Actinomycete strain YIM PH20520, isolated from the rhizosphere soil sample of Panax notoginseng collected in Wenshang, Yunnan Province, China, exhibited antifungal activity against root-rot pathogens of the Panax notoginseng. The structures of bioactive molecules, isolated from the ethyl acetate extract of the fermentation broth of the strain, were identified as echinosporin (1) and 7-deoxyechinosporin (2) based on extensive spectroscopic analyses. 1 exhibited antifungal activity against four tested root-rot pathogens of Panax notoginseng include Fusarium oxysporum, Fusarium solani, Alternaria panax, and Phoma herbarum with the MIC value at 64, 64, 32, and 64 μg/mL, respectively. 2 exhibited antifungal activities against F. oxysporum, F. solani, A. panax, and P. herbarum with the MIC value at 128, 128, 64, and 128 μg/mL, respectively. Based on the phylogenetic analyses, the closest phylogenetic relative of strain YIM PH20520 is Amycolatopsis speibonae JS72 T (97.69%), so strain YIM PH20520 was identified as Amycolatopsis strain. To the best of our knowledge, this is the first report of echinosporin antibiotics isolated from Amycolatopsis strain besides Streptomyces strain and their antifungal activity against four tested root-rot pathogens of the Panax notoginseng. The results provide a reliable evidence for the following related biosynthetic investigations on Amycolatopsis strain YIM PH20520 due to echinosporins antibiotics' unique tricyclic acetal-lactone structures.