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Composition and stability of soil organic matter (SOM) affect the sustenance and productivity of soil over the long-term. This issue is particularly important for karst regions in China where the water supply and fertilizer use are limiting factors. Here, we used four indicators to evaluate changes in the composition and stability of SOM quantitatively in five main land-use types in karst area, including primary forest [PF], 15-year secondary forest [SF], grazing secondary forest [GF], abandoned farmland [AF] and farmland [FL]. We collected soil samples at a depth of 0–20 cm to conduct the analyses. Four indicators were used: soil physical and chemical properties, active organic carbon (C), humus C composition, and SOM functional groups. Our results showed that the content of SOM, total nitrogen, and easily oxidized organic C at 0–20 cm soil depth differed among the five land-use types ( P < 0.05). For humic acid C concentration, the land-use types were ordered as: SF > PF > GF > FL > AF. Solid-state 13 C NMR spectra showed that the highest ratio of Alkyl C/O-alkyl C was in AF, while the lowest was in SF. Overall, the comprehensive quality of SOM in different land-use types was PF (setting 100%) > SF (83.1%) > GF (58%) > AF (30.9%) > FL (29.9%). For karst areas, we suggest that farmlands in sloping area should be converted back to forests, with only moderate grazing being permitted, whereas farmlands in the plains should implement grain-forage rotation and grain-soybean rotation to meet the needs of the growing population and economic development. In conclusion, our findings provide a scientific basis from which to delineate rational land-use types for different land (geographical and geological) formations. [ABSTRACT FROM AUTHOR]

Improving soil carbon sequestration and reducing greenhouse gas emissions in farmland require understanding how the microbial communities that control the agroecosystem function. Here, we surveyed the soil microbial communities in neighboring pairs of dryland and paddy fields in the black soils of northeastern China. Soil moisture, mean weight diameter of aggregates, fluorescence index and biological index of dissolvable organic matter, total anion concentration, and prokaryotic community α-diversity were higher in paddy soils than in dryland soils, while soil saturated hydraulic conductivity (SHC), dissolvable total nitrogen, and fungal community α-diversity were lower in paddy soils than in dryland soils. Moreover, soil moisture (P < 0.01) and SHC (P < 0.05) had significantly positive correlations with the α-diversity of prokaryotic and fungal communities, respectively. The co-occurrence network complexity of microbial communities was lower in paddy fields than in dryland fields, while the co-occurrence network tightness and cooperation of microbial communities were higher in paddy fields than in dryland fields, which may help paddy microbiome resist environmental disturbances. Taken together, both dryland and paddy fields had their own advantages in evaluating soil biological health from microbial community diversity and network stability. Additionally, the differential groups of CH 4 production, S cycle, and Fe cycle (e.g., Bathyarchaeota, Bacteroidetes, and Geobacter) increased, while those of environmental remediation and biological control (e.g., Blastococcus and Roseiflexus) decreased after the change from dryland to paddy fields. Further combined with metagenomic analysis, the functions of CH 4 production, CO 2 fixation, N fixation, and sulfur reduction were enhanced in paddy soils, while those of CH 4 oxidation, nitrification, and N 2 O production were reduced. In conclusion, the ecological functioning of the differential groups may lead to the increase of CH 4 emission and CO 2 fixation, and the decrease of N 2 O emission in paddy fields of black soil, even in non-flooding period. [Display omitted] • The microbial-mediated potential of soil CO 2 fixation was enhanced in paddy soils. • The microbial-mediated potential of soil N fixation was enhanced in paddy soils. • The microbial-mediated potential of soil nitrification was reduced in paddy soils. • The microbial-mediated potential of soil N 2 O production was reduced in paddy soils. • The microbial-mediated potential of soil CH 4 production was enhanced in paddy soils. [ABSTRACT FROM AUTHOR]

[Display omitted] An individual's level of lower limb motor function is associated with his or her disability level after stroke, and motor improvement may lead to a better prognosis and quality of life. Data from animal models show that Qizhitongluo (QZTL) capsule facilitates recovery after focal brain injury. We aimed to validate the efficacy and safety of the QZTL capsule for promoting lower limb motor recovery in poststroke patients. In this randomized, multicenter, double-blind, placebo- and active-controlled trial from 13 sites in China, participants with ischemic stroke and Fugl-Meyer motor scale (FMMS) scores of <95 were eligible for inclusion. Patients were randomly assigned in a 2:1:1 ratio to the QZTL group, Naoxintong (NXT) group or placebo group for 12 weeks at 15–28 days after the onset of stroke. The primary outcome was the change in the Lower Limb FMMS (FMMS-LL) score from baseline over the 12-week intervention period. 622 participants were randomly assigned to the QZTL group (309), NXT group (159), or placebo group (154). The FMMS-LL score increased by 4.81 points (95 % CI, 4.27–5.35) in the QZTL group, by 3.77 points (95 % CI, 3.03–4.51) in the NXT group and by 3.00 points (95 % CI, 3.03–4.51) in the placebo group at week 12. The QZTL group showed significantly larger improvements compared with the placebo group at each interview from weeks 4–12 (difference, 0.89 [0.30,1.49] at week 4, P = 0.0032; difference, 1.83[1.01,2.66] at 90 days poststroke, P < 0.0001; difference, 1.81[0.88,2.74] at week 12, P = 0.0001). The QZTL capsule is an effective treatment for lower limb motor impairment. The finding indicates that the QZTL capsule may be used as a potential new strategy for stroke rehabilitation. [ABSTRACT FROM AUTHOR]

Macrosomia poses significant health risks to mother and fetuses, yet the protective sensitive window for the effects of green space resources on the risk of macrosomia remains unexplored. This study identified sensitive windows of green space exposure and examined the interactions with air pollutants. In a study of 221,380 full-term newborns delivered at the Hospital, from 2017 to 2021, Normalized Difference Vegetation Index (NDVI) and atmospheric pollutant concentrations were matched to participants based on their residences in the Ningxia region. A Cox proportional hazards model was utilized to estimate the association between green space exposure and macrosomia and analyze the differences between the macrosomia (<4500 g) and macrosomia (≥4500 g) groups. Green space exposure for each month of pregnancy was employed to identify possible sensitive windows. Possible interactions between green spaces and air pollutants were tested on additive and multiplicative scales. Across 250, 500, 1000, and 2000-m buffers, increased NDVI exposure and range throughout the pregnancy were linked to a lower macrosomia risk, with the strongest association in the macrosomia (≥4500 g) group. The key window for the protective effect of green spaces was in late pregnancy, with the most pronounced protective effect noted in the 9th month of pregnancy. We also found a consistent combined effect between low green space and the air pollutants (NO 2 and SO 2 ). The research highlights the beneficial impact of increased green space during late pregnancy and the combined effect of low green space and elevated air pollutant levels on macrosomia risk, which can support government initiatives in urban green space development and public 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 © 2025 Elsevier Ltd. All rights reserved.)

Objective: This study aims to investigate the changes in admission appropriateness after patients were admitted and provide a reference for physicians to make admission decisions and for the supervision of medical service behavior by the medical insurance regulatory department., Methods: Medical records of 4,343 inpatients were obtained based on the largest and most capable public comprehensive hospital in four counties in central and western China for this retrospective study. The binary logistic regression model was employed to examine the determinants of changes in admission appropriateness., Results: Nearly two-in-thirds (65.39%) of the 3,401 inappropriate admissions changed to appropriate at discharge. Age, type of medical insurance, medical service type, severity of the patient upon admission, and disease category were found to be associated with the changes in the appropriateness of admission. Older patients (OR = 3.658, 95% CI [2.462-5.435]; P < 0.001) were more likely to go from "inappropriate" to "appropriate" than younger counterparts. Compared with circulatory diseases, the case evaluated as "appropriate" at discharge was more frequent in the urinary diseases (OR = 1.709, 95% CI [1.019-2.865]; P = 0.042) and genital diseases (OR = 2.998, 95% CI [1.737-5.174]; P < 0.001), whereas the opposite finding was observed for patients with respiratory diseases (OR = 0.347, 95% CI [0.268-0.451]; P < 0.001) and skeletal and muscular diseases (OR = 0.556, 95% CI [0.355-0.873]; P = 0.011)., Conclusions: Many disease characteristics gradually emerged after the patient was admitted, thus the appropriateness of admission changed. Physicians and regulators need to take a dynamic view of disease progression and inappropriate admission. Aside from referring to the appropriateness evaluation protocol (AEP), they both should pay attention to individual and disease characteristics to make a comprehensive judgment, and strict control and attention should be paid to the admission of respiratory, skeletal, and muscular diseases., 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 Chang, Gao, Su, Li and Chen.)

This study aimed to explore the impact of social participation (SP) on physical functioning and depression among empty-nest elderly taking part in the fourth wave of the China Health and Retirement Longitudinal Survey (CHARLS, 2018). The instrumental variable (IV) method and propensity score matching (PSM) method were used to analyse the impact of SP. The two-stage regression results of the IV method showed that SP has a significant negative impact on the physical functioning scores of empty-nest elderly (β = -3.539, p < 0.001) and non-empty-nest elderly (β = -4.703, p < 0.001), and SP has a significant negative impact on the depression scores of empty-nest elderly (β = -2.404, p < 0.001) and non-empty-nest elderly (β = -1.957, p < 0.001). The results of the PSM method were basically consistent with the IV method. Compared with non-empty-nest elderly, SP had more positive effects on the depression of empty-nest elderly (Wald χ 2 = 6.62, p = 0.010). Providing a friendly and supportive environment for the SP of empty-nest elderly was an important measure to promote healthy ageing. Targeted SP may be one of the greatest opportunities to improve the mental health of empty-nest elderly.

Target: To compare the ultrasound characteristics between functional, mature arteriovenous fistulas and functional, non-mature arteriovenous fistulas and to identify the predictors of arteriovenous fistula maturation in the forearm., Methods: Patients with newly set-up functional arteriovenous fistulas were enrolled in this prospective cohort study. Ultrasound examinations were conducted pre-operatively and post-operatively. The inner vessel diameter, blood flow volume, and resistance index were measured and compared between the maturation group (Group M) and non-maturation group (Group N). Baseline parameters were calculated to determine the predictors of non-maturation of arteriovenous fistulas., Results: All 52 patients with functional arteriovenous fistulas, who were categorized into Group M (25 patients, 48.08%) and Group N (27 patients, 51.92%), finished 24 weeks of follow-up after arteriovenous fistula surgery. The arteriovenous fistulas displayed a significant and rapid increase in the vessel diameter (mean increase of 1.34 times in the arteries and 1.92 times in the veins) and blood flow volume (mean increase of 9.29 times of the arteries and 43.66 times of the veins) and a decrease in the resistance index (mean decrease in 48.00% in the arteries) 8 weeks after surgery. Group N had a lesser increase in the vessel diameters (1.78 times vs 2.06 times, t  = -3.136, p  = 0.003) and blood flow volume (33.98 times vs 54.11 times, t  = -2.383, p  = 0.021) of the cephalic vein draining segments (a6) than Group M. The baseline diameter of a6 was the only independent predictor (regression coefficient = 26.229, p  = 0.008) of maturation of the functional arteriovenous fistulas after correcting for sex, age, diabetes kidney disease, weight, and height., Conclusion: The baseline diameter of the cephalic vein was the only predictor of arteriovenous fistula maturation based on the pre-operative ultrasound measurements in Chinese hemodialysis patients.

Background: A healthcare system refers to a typical network production system. Network data envelopment analysis (DEA) show an advantage than traditional DEA in measure the efficiency of healthcare systems. This paper utilized network data envelopment analysis to evaluate the overall and two substage efficiencies of China's healthcare system in each of its province after the implementation of the healthcare reform. Tobit regression was performed to analyze the factors that affect the overall efficiency of healthcare systems in the provinces of China., Methods: Network DEA were obtained on MaxDEA 7.0 software, and the results of Tobit regression analysis were obtained on StataSE 15 software. The data for this study were acquired from the China health statistics yearbook (2009-2018) and official websites of databases of Chinese national bureau., Results: Tobit regression reveals that regions and government health expenditure effect the efficiency of the healthcare system in a positive way: the number of high education enrollment per 100,000 inhabitants, the number of public hospital, and social health expenditure effect the efficiency of healthcare system were negative., Conclusion: Some provincial overall efficiency has fluctuating increased, while other provincial has fluctuating decreased, and the average overall efficiency scores were fluctuations increase.

Rural China is piloting an integrated payment system, which prepays a budget to a medical alliance rather than a single hospital. This study aims to evaluate the effect of this reform on the direct economic burden and readmission rates of cerebral infarction inpatients. The settlement records of 78,494 cerebral infarction inpatients were obtained from the New Rural Cooperative Medical Scheme (NRCMS) database in Dingyuan and Funan Counties in the Anhui Province. The direct economic burden was estimated by total costs, out-of-pocket expenditures, the out-of-pocket ratio, and the compensation ratio of the NRCMS. Generalized additive models and multivariable linear/logistic regression were applied to measure the changes of the dependent variables along with the year. Within the county, the total costs positively correlated to the year ( β = 313.10 in 2015; 163.06 in 2016). The out-of-pocket expenditures, out-of-pocket ratios, and the length-of-stay positively correlated to the year in 2015 ( β = 105.10, 0.01, and 0.18 respectively), and negatively correlated to the year in 2016 ( β = -58.40, -0.03, and -0.30, respectively). The odds ratios of the readmission rates were less than one within the county (0.70 in 2015; 0.53 in 2016). The integrated payment system in the Anhui Province has considerably reduced the direct economic burden for the rural cerebral infarction inpatients, and the readmission rate has decreased within the county. Inpatients' health outcomes should be given further attention, and the long-term effect of this reform model awaits further evaluation.

Objective: The purpose of this paper is to investigate the characteristics and determinants of inappropriate admission to hospital of elderly people in rural China., Design: A cross-sectional study of a comparison between the elderly and non-elderly groups of people., Setting: The survey was conducted on the largest county-level general hospitals in four counties in central and western China., Participants: A total of 652 rural patients admitted in hospitals were surveyed, who were divided into two groups according to age: elderly group (n=230, age ≥60 years) and non-elderly group (n=422, age <60 years)., Primary Measures: The Chinese version of the appropriateness evaluation protocol was used to evaluate the inappropriate admission rates. The interactive regression models based on the relationship of age (elderly and non-elderly) with other factors and binary logistic regression models were used in the analysis of the specific factors and determinants of the inappropriate admission of elderly people., Result: The inappropriate admission rate for the rural elderly was 30%, which was lower than that of the non-elderly people (40.8%). Compared with the non-elderly group, women in the elderly group (OR=0.33, 95% CI 0.15 to 0.73) had a lower incidence of inappropriate admission, and elderly people with chronic diseases (OR=3.33, 95% CI 1.23 to 9.04) were more prone to being inappropriately admitted than non-elderly people with chronic diseases. The binary logistic regression analysis shows that county, age (OR=0.94. 95% CI 0.90 to 0.99), gender (OR=0.49, 95% CI 0.25 to 2.98), department and response to doctor's admission request were the determinants of the inappropriate admission of elderly patients., Conclusion: The inappropriate admission rate of elderly people in rural China was high. We found that gender and chronic disease are the specific factors that were specific to non-elderly people. County, age, gender, department and response to a doctor's admission request had substantial influence on the inappropriate admission of the elderly in rural China., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This study aimed to evaluate the effects of the differences between two typical payment methods for the new rural cooperative medical scheme (NRCMS) in China on the utilisation of inpatient services. Interrupted time-series analysis (ITSA) and propensity score matching (PSM) were used to measure the difference between two typical payment methods for the NRCMS with regard to the utilisation of inpatient services. After the reform was formally implemented, the level and slope difference after reform compared with pre-intervention (distribution of inpatients in county hospitals (DIC), distribution of inpatients in township hospitals (DIT) and the actual compensation ratio of inpatients (ARCI)) were not statistically significant. Kernel matching obtained better results in reducing the mean and median of the absolute standardised bias of covariates of appropriateness of admission (AA), appropriateness of disease (AD). The difference in AA and AD of the matched inpatients between two groups was -0.03 ( p -value = 0.042, 95% CI: -0.08 to 0.02) and 0.21 ( p -value < 0.001, 95% CI: -0.17 to 0.25), respectively. The differences in the utilisation of inpatient services may arise owing to the system designs of different payment methods for NRCMS in China. The causes of these differences can be used to guide inpatients to better use medical services, through the transformation and integration of payment systems.

This study aimed to assess the effect of the county-level medical centre policy on the health outcomes of trauma patients transported by emergency medical service (EMS) system in rural China. The methodology involved the use of electronic health records (EHRs, after 2016) of patients with trauma conditions such as head injury ( n = 1931), chest (back) injury ( n = 466), abdominal (waist) injury ( n = 536), and limb injury ( n = 857) who were transported by EMS to the county-level trauma centres of Huining County and Huan County in Gansu, China. Each patient was matched with a counterpart to a county-level trauma centre hospital by propensity score matching. Cox proportional hazard models were used to estimate the hazard ratios (HRs) of such patients in different hospitals. The HRs of all patients with the abovementioned traumatic conditions transported by EMS to county-level trauma centre hospitals were consistently higher than those transported by EMS to traditional hospitals after adjusting for numerous potential confounders. Higher HRs were associated with all patients with trauma (HR = 1.249, p < 0.001), head injury (HR = 1.416, p < 0.001), chest (back) injury (HR = 1.112, p = 0.560), abdominal (waist) injury (HR = 1.273, p = 0.016), and limb injury (HR = 1.078, p = 0.561) transported by EMS to the county-level trauma centre hospitals. Our study suggests that the construction of county-level medical centre provides an effective strategy to improve the health outcomes of EMS-transported trauma patients in Gansu, China. Policy makers can learn from the experience and improve the health outcomes of such patients through a personalised trauma treatment system and by categorizing the regional trauma centre.