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Numerous factors contribute to the uncertainty inherent in conducting wastewater-based epidemiology (WBE), with shifting populations exerting a significant influence. However, traditional single- and multi-parameter population models suffer from certain limitations. This study employs an evaluation model framework to construct a model (EC model) based on data characteristics. Weight coefficients derived from 16 cities across seven regions of China are aggregated into a national model. In contrast to alternative models, the EC model exhibits a robust correlation (r 2  = 0.98) with census population data, suggesting a potentially more precise depiction of population dynamics. The low variability (RSD = 9.73 %) indicates effective constraint of anomalous parameter fluctuations, yielding minimal Bias (-1.12 %) and SRMSE (14.75 %), thus ensuring reliable population estimation. The model is applied to estimate the consumption of lifestyle-related compounds and the prevalence of hypertension in China. Northern regions demonstrate higher consumption levels, alongside a significant disparity in hypertension prevalence (26.96 %) compared to the south (16.01 %). Hypertension exhibits positive correlations with lifestyle-related compounds such as alcohol and nicotine (r = 0.52, r = 0.55). Sensitivity analysis reveals that the EC model introduces an uncertainty of 24.48 % in population estimates. Through the incorporation of representative datasets and novel algorithms, this model has the potential to enhance the reliability of outcomes in WBE strategy implementation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Recent studies have demonstrated the widespread presence of 1,3-diphenylguanidine (DPG) and its derivatives in environmental matrices. While, the amount of human exposure to these rubber additives remains unclear. In this study, we collected human urine samples from healthy general adults (n = 221) living in Quzhou, China, and analyzed these samples for DPG and its five derivatives. DPG, 1,6-bis(cyano-guanidino)hexane (HCG), 1,3-di-o-tolylguanidine (DTG) and exhibited detection frequencies exceeding 50% in collected human urine. Presence of HCG, 1-(o-tolyl)biguanide (detection frequency 17%), and 1-(4-cyanophenyl)guanidine (6.0%) in human urine was also demonstrated for the first time. The highest mean human urinary concentration was found for DPG (0.89 ng/mL, < LOD-4.7 ng/mL), followed by DTG (0.57 ng/mL, < LOD-3.1 ng/mL) and HCG (0.34 ng/mL, < LOD-1.8 ng/mL). Male participants had consistently higher average human urinary levels of DPG, DTG, and HCG than female subjects, but none of these differences were significant (p > 0.10). DPG and DTQ consistently showed a decline in the human urinary concentrations as age of the participant increased. DPG (mean 170 ng/kg bw/day, median 137 ng/kg bw/day) had the highest human daily exposure amount, followed by DTG (106 ng/kg bw/day, 91 ng/kg bw/day) and HCG (58 ng/kg bw/day, 38 ng/kg bw/day). The study enhances our understanding of human exposure to these rubber additives, which is crucial for assessing their potential health risks., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Silver carp (Hypophthalmichthys molitrix) can filter the carbon in the food taken up by phytoplankton and plays an important role in carbon fixation. In this study, the faeces of silver carp, the dominant fish species in Qiandao Lake, China, were collected and subjected to a closed incubation and transformation experiment for three months. The physical and chemical indices of water and sediment mixture, carbon metabolic enzyme activity, and microbial sequences were analyzed to identify the key microbial strains that affect carbon transformation as well as the main factors influencing carbon transformation. The results showed maximum CO 2 and CH 4 emission fluxes on day 15 of fish faeces and sediment interaction. In the faeces addition group, the contents of soluble organic carbon, soluble inorganic carbon, SO 4 2- , and PO 4 3- were significantly increased, while the dissolved oxygen content was significantly decreased. Furthermore, the pH, total carbon content, volatile suspended solids content, and activities of four carbon-metabolizing enzymes were significantly increased in the faeces addition group. The 16sRNA analysis of methanogenic and methane-oxidizing bacteria showed that Euryarchaea and Pseudomonas accounted for the highest proportion respectively. The most significant differences expression were found for Methylbacterium in the methanogenic bacteria and Methylobacter in the methane oxidizing bacteria. Structural variance model showed that interaction of fish faeces and sediments mainly caused changes in sulfate content, leading to variations in methanogens and methanotrophs and promotion of CH 4 emission. The results of this study can provide a theoretical reference for the mechanism of carbon reduction and emission reduction of lake filter-feeding fish., Competing Interests: Declaration of competing interest We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled, “Effects of filter-feeding fish feces on microbial driving mechanism of lake sediment carbon transformation”., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: To describe the epidemiological distribution of hemorrhoids in a physical examination population in China, which could provide evidence for precision prevention and early intervention of hemorrhoids., Methods: Chinese subjects over 18 years of age who underwent a physical examination in a nationwide chain of physical examination centers in 2018 were studied in a cross-sectional design, which collected information by a questionnaire and physical examination results from each subject. The epidemiological distribution of hemorrhoids was described using Logistic models. The gender-, age-, and region-detection rates of hemorrhoids were standardized to the Sixth National Population Census of the People's Republic of China (2010)., Results: A total of 2 940 295 adult subjects were included in the study, of whom the average age was (41.7±14.0) years, and 52.6% were females. The standardized detection rate of hemorrhoids was higher for females (43.7%) than that for males (17.7%; P < 0.001) in this study. In the females, the age distribution of hemorrhoids was inverted U-shaped, with the highest standardized detection rate of hemorrhoids in the age group of 30-39 years (63.5%). In the males, the standardized detection rate of hemorrhoids increased along with age, with the highest percentage of 17.2% in the age group of 50-59 years, and the standardized detection rate of hemorrhoids in the age group of 60 and above decreased slightly ( P < 0.001 for trend test). The participants with hypertension had a higher standardized detection rate of hemorrhoids than those with normal blood pressure in both males and females ( P < 0.001). The standardized detection rate of hemorrhoids showed a positive correlation with body mass index ( P < 0.001 for trend test in males)., Conclusion: The detection rate of hemorrhoids varied to gender, age, obesity, and hypertension status, which could help to identify the risk factors and the high-risk sub-groups, and hence to strengthen health education and early detection accordingly, which could eventually reduce the incidence of hemorrhoids and improve the quality of life and health in the Chinese population. This study was conducted in a physical examination population, and the conclusions of this study should be extrapolated with caution.

With the development of the pharmaceutical industry, halogenated hydrocarbons, which are the main raw materials and emissions of the pharmaceutical industry, may be defined as atmospheric emerging contaminants due to toxicity and low oxidation of the atmosphere. This study analyzed the volatile organic compounds (VOCs) emissions from four pharmaceutical companies located in the Yangtze River Delta. Samples were taken three times at each of the selected fixed and fugitive sampling sites in each company. Through testing, 141 VOCs were identified. The mean concentration and proportion of halogenated hydrocarbons from the four pharmaceutical companies were the highest of all the industries in the industrial park. They reached 18.9 ppm and 28.8 %, respectively. Fixed emissions of the companies exhibited the mean maximum concentration of dichloromethane and chlorobenzene, which are 11.4 ppm and 250.67 ppb. The mean concentration of fugitive emission of dichloromethane from the four companies in this study is lower than that of pharmaceutical companies in other studies. Newly detected halogenated hydrocarbons, such as 1,1-dichloropropanone and dichloronitromethane, present potential non-cancer and cancer risks to workers. Chlorobenzene was identified as a key potential cancer risk halogenated hydrocarbon the value of which reaches 0.00965. 2,6-dichloropyridine could be a potential emerging contaminant due to its lower MIR value and higher potential cancer risk. The study suggests that relevant pharmaceutical companies focus on the emissions of chlorobenzene and dichloromethane, which may be the atmospheric emerging contaminants for the pharmaceutical industry and focus on improve the treatment of waste gases in workshops and sewage stations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Estuarine and coastal areas are one of the ultimate sinks for terrestrial heavy metals which play a vital role on the aquatic ecosystem. This study examined heavy metals contents and speciations in Yellow River subaqueous delta surface sediment, to characterize their sedimentation and transformation during transport from estuary to the sea. The results showed that higher concentrations were found in the seaward and the shear front affected areas. The surface sediments were generally not contaminated by heavy metals, except for Cd was highly enriched, while the post-standardization spatial distribution reflected the effect of estuarine processes as a "filter" that effectively intercepting heavy metals. The dominated phase was residual fraction for Cr, Cu, Zn, Cd, while reducible fraction for Ni and carbonate fraction for Pb. The transformation of heavy metal species was mainly influenced by the changes in the sediment components such as carbonate minerals, organic matter and FeMn oxides., Competing Interests: Declaration of competing interest We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To understand the health status of solar greenhouse workers, to provide scientific basis for the development of occupational high incidence diseases prevention and control strategies. Methods: In July 2019, a random cluster sampling method was used to select 245 workers engaged in solar greenhouse vegetable cultivation in Daba Village, Jingyuan County, Baiyin City, Gansu Province as the solar greenhouse operation group. Matched by gender, age, marital status, body mass index (BMI), 282 people from adjacent Shaliang Village who did not engage in solar greenhouse operation were selected as the control group. Field investigation and health examination were carried out among the study subjects. The general situation, facial features examination results, ophthalmic examination results, bone and joint examination results and skin examination results were compared between the two groups. And the multiple logistic regression analysis was used to analyze the influencing factors of abnormal bone and joint examination (upper limbs, lower limbs, hands and spine bone joints) in study subjects. Results: There were statistically significant differences in smoking age and alcohol consumption between the two groups ( P <0.001). Compared with the control group, the abnormal detection rates of nose examination, throat examination, slit lamp examination, conjunctival examination, lower limb bone joint examination, hand bone joint examination, spine examination, head and neck skin examination, trunk skin examination, upper limb skin examination, and lower limb skin examination in the solar greenhouse operation group were higher, and the differences were statistically significant (χ(2)=11.53, 7.94, 9.92, 27.93, 79.32, 81.42, 9.43, 6.79, 9.76, 4.34, 8.29, P <0.05). Multivariate logistic regression analysis showed that after adjusting for gender, age, marital status, education level, BMI, compared with the control group, solar greenhouse operation was a risk factor for abnormal bone and joint examination ( OR =1.178, 95% CI : 1.151-2.143, P =0.001) . Conclusion: Solar greenhouse operation has a certain harmful effect on health of workers, and solar greenhouse workers have an increased risk of abnormal diseases of upper limbs, lower limbs, hands and spine bone joints.

A begomovirus isolated from whiteflies (Bemisia tabaci) and tomato, sweet potato in China was found to be representative of a distinct begomovirus species, for which the name tomato yellow leaf curl Chuxiong virus (TYLCCxV) is proposed. The results of genomic identification and sequence comparison showed that TYLCCxV shares the highest complete nucleotide sequence identity (88.3%) with croton yellow vein mosaic virus (CroYVMV), and may have originated from the recombination between synedrella leaf curl virus (SyLCV) and squash leaf curl Yunnan virus (SLCuYV). Agrobacterium-mediated inoculation showed that TYLCCxV is highly infectious for a range of plant species, producing upward leaf curling, leaf crumpling, chlorosis, distortion, and stunt symptoms in Solanum lycopersicum plants. The results of Southern blot indicated that TYLCCxV is capable of efficiently replicating two heterologous betasatellites. The inoculation of PVX::C4 on Nicotiana benthamiana induced upward leaf curling and stem elongation symptoms, suggesting that TYLCCxV C4 functions as a symptom determinant. TYLCCxV V2 is an important virulence factor that induces downward leaf curling symptoms, elicits systemic necrosis, and suppresses local and systemic GFP silencing in co-agroinfiltrated N. benthamiana and transgenic 16c plants. Considering the multifunctional virulence proteins V2 and C4, the possibility of TYLCCxV causing devastating epidemics on tomato in China is discussed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

It can provide a basis for decision making for the conservation and sustainable use of forest ecosystems in mountains to understand the stoichiometric properties and nutrient allocation strategies of major tree species. However, the plant nutrient allocation strategies under different environmental gradients in forest systems of arid and semi-arid mountains are not fully understand. Therefore, three typical regions in the Qilian Mountains on the eastern edge of the Qinghai-Tibet Plateau were selected based on precipitation and temperature gradients, and the stoichiometric characteristics and nutrient allocation strategies of Qinghai spruce (Picea crassifolia) of the dominant tree species under different environmental gradients were investigated. The results showed that (1) the stoichiometric characteristics of plant tissues were different in the three regions. (2) The importance of each tissue in the plant nutrient allocation varied in different regions, showing that the plant roots are more important in the warm-wet region, while the plant leaves, branches and trunks are more important in the transition and hot-dry regions. (3) The influencing factors affecting plant nutrient allocation strategies were inconsistent across regions, which showed that plant nutrient allocation strategies in the warm-wet and transition region were mainly influenced by soil factors, while they were more influenced by climatic factors in the hot-dry region. The patterns of plant nutrient allocation strategies and drivers under different environmental gradients could help us better understand the ecological adaptation mechanism and physiological adjustment mechanism of forest ecosystem in mountains., (© 2024. The Author(s) under exclusive licence to International Society of Biometeorology.)

This study aims to analyze the epidemiological and pathogenic characteristics of an outbreak primarily caused by respiratory syncytial virus (RSV), human rhinovirus (HRV), and human metapneumovirus (HMPV) in a kindergarten and primary school. The outbreak was investigated by field epidemiological investigation, and the common respiratory pathogens were screened by RT-PCR detection technology. The attack rate of this outbreak was 63.95% (110/172). Main symptoms included cough (85.45%), sore throat (60.91%), and sneezing (60.00%). Multifactorial logistic regression analysis revealed that continuous handwashing and mouth and nose covering when sneezing were protective factors. All 15 collected throat swab specimens tested positive for viruses, with HMPV as the predominant pathogen (80.00%), followed by HRV (53.33%), and two cases of positive respiratory syncytial virus (13.33%). Among them, six samples showed coinfections of HMPV and HRV, and one had coinfections of HMPV and RSV, resulting in a coinfection rate of 46.67%. Genetic sequencing indicated that the HMPV genotype in this outbreak was A2c, and the HRV genotype was type A, resulting in a coinfection outbreak of HMPV, HRV, and RSV in schools and kindergartens, suggesting that multi-pathogen surveillance of respiratory tract infections should be strengthened.

Teachers played an important role on the transmission of influenza in schools and communities. The study aims to investigate the influenza vaccination coverage and the factors determining flu vaccination acceptance among teachers in Hangzhou, China. A total of 1039 junior high school teachers in Hangzhou were recruited. The self-made questionnaire was used to investigate the influenza vaccine coverage among teachers and the influencing factors of influenza vaccination acceptance. Univariate analysis using the chi-square test and multivariable analysis using binary logistic regression were conducted to determine the relative predictors. The Influenza vaccine coverage among teachers was 5.9% (62/1039). 52.9% of teachers had the intention to receive influenza vaccine, 25.3% (247/977)/21.8% (213/977) of participants was hesitant/did not have the intention to get influenza vaccine. The top three sources for teachers to gain knowledge about influenza were website (72%), TV/radio (66.1%) and social media (58%). Whether get influenza vaccination before, knowledge about influenza and influenza vaccine, the beliefs for the likelihood of catching flu, the severity of getting flu, the effectiveness of influenza vaccine, the possibility of side effects after vaccination, and the troublesome of vaccination, doctors' recommendation, as well as the situation of vaccination among other teachers were the associated factors of influenza vaccination acceptance. The influenza vaccination coverage was low but the intentions were relatively high among junior high school teachers. Future research should focus on the relationship between vaccination acceptance and behavior to increase influenza vaccination rates.

Objective: Using Meta-analysis to evaluate the vaccine effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13) against invasive Streptococcus pneumoniae disease (IPD) caused by serotype 19A in children <5 years old. Methods: "Streptococcus pneumoniae infection""invasive pneumococcal disease""13-valent pneumococcal polysaccharide conjugate vaccine""PCV13""effectiveness""infant""child" and related terms were searched from China National Knowledge Infrastructure (CNKI), WANFANG DATA, PubMed, SCOPUS and Web of science with no limited on language, region and research institution. The retrieval time was limited from January 2010 to February 2023 and cohort study, case-control study and randomized controlled trial were included. Data were extracted from eligible studies by two independent reviewers, and after study quality assessment by NOS scale, Meta-analysis was completed using Stata 16.0 software. Results: A total of 2 340 related literatures were searched, and 10 literatures were finally included, including 5 case-control studies and 5 indirect cohort studies, which showed good literature quality. The vaccine effectiveness against serotype 19A IPD of PCV13 in children was 83.91% (95% CI : 78.92%-88.89%), and the subgroup analysis ( P =0.240) showed there was no significant difference among the case-control study (VE=87.34%, 95% CI :79.74%-94.94%) and the indirect cohort study (VE=81.30%, 95% CI :74.69%-87.92%). The funnel plot and Egger test suggested that the possibility of publication bias was small. Conclusion: The present evidence indicates that PCV13 has a good vaccine effectiveness against serotype 19A IPD in children, and it is recommended to further increase the vaccination rate of PCV13 to reduce the disease burden of IPD in children <5 years old.

Objectives: To investigate the prevalence of sleep disturbance, sleep patterns, sleep-related factors, and medical demands among university and college students in Chongqing, China., Methods: Demographic data and responses to the sleep problem questionnaire (SPQ) were collected from 1973 students from 11 universities and 10 colleges between November 2022 and January 2023., Results: The prevalence of sleep disturbance in university and college students was different in different periods (58.17% during campus lockdown and 40.30% after the lifting of lockdown). The combined prevalence was 49.72%. The prevalence of the 6 types of sleep disturbance showed the same trend. The average sleep latency was 32.79 minutes and the average sleep duration was 7.53 hours. Male, university students, upper-class students, history of depression, academic stress, major life events, bad bedroom environment, and campus lockdown were factors related to sleep disturbance among respondents. Most of the respondents (52.09%) had no medical care requests, and the major reasons were a lack of access to medical care (75.15%), economic pressure (68.49%), concerns regarding curative effects (58.51%), and academic pressure (56.56%)., Conclusion: The prevalence of sleep disturbance for university and college students was obviously improved after the lifting of campus lockdown, and the major factors related to sleep disturbance were study, life, mental health, and sleep environment. The students examined herein reported relatively low medical care requests when they experience sleep disturbance., (Copyright: © Saudi Medical Journal.)

The aim of this study was to evaluate the seroprevalence of rubella antibodies and factors associated with antibody seropositivity after vaccination among healthy children aged 14 and below. A multi-stage stratified random sampling method was employed to recruit participants for the rubella serological test. An enzyme-linked immunosorbent assay method was used to detect human IgG antibodies with avidity for rubella virus in the sera of participants. Univariate and multivariate analyses were used to analyze associations between variables. A total of 778 subjects were included in the subsequent analysis. The overall positive rate of rubella antibody was 83.0% (95%CI: 80.2-85.5%), and the overall geometric mean concentration (GMC) was 58.05 IU/ml. In multivariate analysis, gender, residence, birth year group, and time since the last rubella-containing vaccines (RCV) vaccination were significantly associated with the seroprevalence of rubella antibodies. Our study showed a decreasing trend in rubella antibody positivity and GMC in the population aged five to 14 years. Therefore, we recommend a catch-up dose of RCV for adolescents and young people aged over 14 years not yet vaccinated.

Importance: Adenomyosis is a common chronic gynecological disorder, and its treatment is an unmet need. New therapies need to be developed. Mifepristone is being tested for adenomyosis treatment., Objective: To determine whether mifepristone is effective and safe for adenomyosis treatment., Design, Setting, and Participants: This multicenter, placebo-controlled, double-blind randomized clinical trial was conducted in 10 hospitals in China. In total, 134 patients with adenomyosis pain symptoms were enrolled. Trial enrollment began in May 2018 and was completed in April 2019, and analyses were conducted from October 2019 to February 2020., Interventions: Participants were randomized 1:1 to receive mifepristone 10 mg or placebo orally once a day for 12 weeks., Main Outcomes and Measures: The primary end point was the change in adenomyosis-associated dysmenorrhea intensity, evaluated by the visual analog scale (VAS) after 12 weeks of treatment. Secondary end points included the change in menstrual blood loss, increased level of hemoglobin in patients with anemia, CA125 level, platelet count, and uterine volume after 12 weeks of treatment. Safety was assessed according to adverse events, vital signs, gynecological examinations, and laboratory evaluations., Results: In total, 134 patients with adenomyosis and dysmenorrhea were randomly assigned, and 126 patients were included in the efficacy analysis, including 61 patients (mean [SD] age, 40.2 [4.6] years) randomized to receive mifepristone and 65 patients (mean [SD] age, 41.7 [5.0] years) randomized to received the placebo. The characteristics of the included patients at baseline were similar between groups. The mean (SD) change in VAS score was -6.63 (1.92) in the mifepristone group and -0.95 (1.75) in the placebo group (P < .001). The total remission rates for dysmenorrhea in the mifepristone group were significantly better than those in the placebo group (effective remission: 56 patients [91.8%] vs 15 patients [23.1%]; complete remission: 54 patients [88.5%] vs 4 patients [6.2%]). All the secondary end points showed significant improvements after mifepristone treatment for menstrual blood loss, hemoglobin (mean [SD] change from baseline: 2.13 [1.38] g/dL vs 0.48 [0.97] g/dL; P < .001), CA125 (mean [SD] change from baseline: -62.23 [76.99] U/mL vs 26.89 [118.70] U/mL; P < .001), platelet count (mean [SD] change from baseline: -28.87 [54.30]×103/µL vs 2.06 [41.78]×103/µL; P < .001), and uterine volume (mean [SD] change from baseline: -29.32 [39.34] cm3 vs 18.39 [66.46] cm3; P < .001). Safety analysis revealed no significant difference between groups, and no serious adverse events were reported., Conclusions and Relevance: This randomized clinical trial showed that mifepristone could be a new option for treating patients with adenomyosis, based on its efficacy and acceptable tolerability., Trial Registration: ClinicalTrials.gov Identifier: NCT03520439.

Background: Understanding the stoichiometric characteristics and nutrient allocation strategies of dominant tree species in montane forest systems can provide a basis for decision-making in relation to montane system management. Therefore, according to precipitation and temperature gradients, we selected three typical areas in the Qilian Mountains on the eastern margin of the Qinghai-Tibet Plateau to analyse the spatial relations of plant-soil stoichiometric characteristics and nutrient allocation strategies of plant tissues for Qinghai spruce (Picea crassifolia) along different environmental gradients., Results: 1) The plant and soil stoichiometric characteristics had similar spatial patterns. The C content of plants and soils tended to decrease with increasing latitude, and the N and P contents and the N:P ratio tended to increase with increasing latitude. 2) The stoichiometric characteristics of the plant tissues also interacted with each other and showed synergistic trade-offs. Nutrient allocation in the eastern section of the Qilian Mountains was similar to that in the western section, while more N and P in the plant stems were allocated to maintain plant growth in the relatively arid western Sect. 3) The nutrient allocation strategies in the plant tissues were mainly regulated by soil and climate., Conclusions: Information on plant-soil stoichiometric characteristics along different gradients can help us better understand the nutrient patterns and dynamics of forest ecosystems under arid and semiarid conditions at a wide geographic scale from the perspective of plant nutrient partitioning., (© 2023. The Author(s).)

To investigate the clinical characteristics of skin disorders among hospitalized patients before and during the coronavirus disease 2019 (COVID-19) pandemic, a retrospective study was conducted based on hospitalized patients with skin diseases from Xiangya Hospital of Central South University, the largest hospital in the south-central region of China, between January 1, 2018, and December 31, 2021. A total of 3039 hospitalized patients were enrolled in the study, including 1681 patients in the prepandemic group and 1358 patients in the pandemic group. The total number of hospitalized patients in the pandemic group decreased by 19.2%, with an increased proportion of patients over 60 years of age (39.8% vs. 35.8%). Moreover, compared with the prepandemic group, there were decreases in the occurrence of most skin diseases in the pandemic group, but the proportions of keratinolytic carcinoma (6.6% vs. 5.2%), dermatitis (24.0% vs. 18.9%), and psoriasis (18.0% vs. 14.8%) were higher in the pandemic group. In addition, longer hospital stays (β = 0.07, SE = 0.02, P = 1.35 × 10 -3 ) and higher hospital costs (β = 0.06, SE = 0.03, p = 0.031) were found in the pandemic group through general linear models, even after the corresponding adjustment. In summary, the COVID-19 pandemic has had a lasting impact on patients with skin diseases, with fewer hospitalized patients, increased proportions of older patients, longer hospital stays, and increased hospital costs. These findings will facilitate better preparation for the most effective response to future pandemics., (© 2023 Wiley Periodicals LLC.)

Introduction: While China continues to optimize the tiered medical care system, the status quo of patients preferring higher-tier hospitals has not improved. Herein, we aimed to analyze the factors influencing patients' healthcare choices in China and to provide an evidentiary basis for optimizing the tiered healthcare system., Patient Concerns: Most patients are concerned that primary care services will not provide appropriate treatment or health advice. Also, patients consider medical technology, cost, experience, quality of service and convenience before seeking care., Outcomes: A total of 18 cross-sectional studies involving 10,348 samples were included. After combining the effect size, the factors affecting the choice of Chinese patients for medical treatment were medical technology and quality (49%), the convenience of medical treatment (37%), medical expenses (23%), hospital service quality (20%) medical insurance policy (16%), and acquaintance relationship (11%)., Conclusion: The selection of medical treatment for Chinese residents is primarily influenced by medical technology and convenience. The medical insurance policy does not provide sufficient guidance. Furthermore, the tiered medical care system should be optimized to improve the usability of primary care services., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: The wound, ostomy and continence nursing practice has its own scope and standards, and each standard requires relevant competency. However, the core competencies of wound, ostomy and continence nurses that contribute to the career success are poorly known. To identify associations between career success and core competencies of wound, ostomy and continence nurses in China., Design: A cross-sectional survey with a convenience sample., Setting: Participants were recruited from 108 hospitals in 28 provinces., Participants: A total of 123 wound, ostomy and continence nurses were surveyed., Measures: Career success, core competencies and demographic characteristics of wound, ostomy and continence nurses, were measured in this study., Methods: A survey was distributed to 123 wound, ostomy and continence nurses were recruited from 108 hospitals in 28 provinces. Multivariate logistic regression was undertaken to explore associations between career success outcomes and core competency scores of wound ostomy and continence nurses and their demographic characteristics., Results: The career success and core competency of wound, ostomy and continence nurses were both above average. Nurses who had higher total scores of core competency were more likely to have higher career success, including total score (OR=4.90), career satisfaction (OR=5.58) and perceived internal (OR=4.55)/external (OR=3.42) organisation competitiveness. Higher competency in interpersonal communication (OR=7.70) and more time for wound care per month (OR=8.80) predicted higher career satisfaction. Additionally, nurses with higher professional development were more likely to score higher in perceived internal organisation competitiveness of career success (OR=4.36) and the overall career success (OR=5.96)., Conclusions: The career success and core competency of the wound, ostomy and continence nurses in China were at an above average level. The associations between career success and core competency of the wound, ostomy and continence nurses were positive, suggesting that competency enhancement could improve nurses' career success., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Peritoneal dialysis (PD) is an effective and successful renal replacement therapy. The baseline peritoneal solute transfer rate (PSTR) is related to local membrane inflammation and may be partially genetically determined. Herein, we focused on vascular endothelial growth factor (VEGF) and its receptor, kinase insert domain containing receptor (KDR)., Methods: This study recruited 200 PD patients from Renji Hospital in Shanghai, China. We analysed the association between the polymorphisms of VEGF and KDR and the 4-hour dialysate-to-plasma ratio for creatinine (4 h D/P Cr), which was measured between one and three months after initiating PD., Results: The CC genotype in VEGF rs3025039 and the AA genotype in KDR rs2071559 were both positively associated with a fast baseline PSTR (VEGF rs3025039 CC vs. TT + TC: 0.65 ± 0.12 vs. 0.61 ± 0.11; P = 0.029; KDR rs2071559 AA vs. GA + GG: 0.65 ± 0.12 vs. 0.62 ± 0.12; P = 0.039)., Conclusion: Baseline PSTR was partly determined by VEGF and KDR gene polymorphisms., (© 2022. The Author(s).)

Objective: To explore the association between adiposity and plasma folate deficiency odds among women of reproductive age in China., Methods: A cross-sectional survey on nutritional status among women of reproductive aged 18-30 years in 2005-2006 in China was conducted. General adiposity was defined as body mass index (BMI) ≥24 kg/m 2 , and central adiposity was defined as waist circumference >80 cm. A plasma folate concentration <10.5 nmol/L (measured through microbiological assay) was defined as plasma folate deficiency. Odds ratios (ORs) and 95% confidence intervals (CIs) for plasma folate deficiency were calculated using a logistic regression model, with adjustment for potential confounders., Results: A total of 3,076 women of reproductive age were included in the final analysis. Compared to women with normal BMI and WC, women with both general and central adiposity had the highest odds for plasma folate deficiency (OR = 3.107, 95% CI: 1.819-5.307). Women with exclusively central adiposity had excess odds for plasma folate deficiency (WC > 80 cm, BMI <24 kg/m 2 ; OR = 2.448, 95% CI: 1.144-5.241), which was higher than women with exclusively general adiposity (BMI ≥ 24 kg/m 2 , WC ≤ 80 cm; OR = 1.709, 95% CI: 1.259-2.319). The combined use of BMI and WC can detect more women (11.7%) at higher plasma folate deficiency odds than either used alone., Conclusions: Women with central adiposity in normal weight have higher odds for plasma folate deficiency than those with general obesity only. Early screening for central adiposity among women of reproductive age would be meaningful to prevent folate deficiency and improve life-cycle health., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zhang, Du, Che, Xia, Zhang and Liu.)

Background: With increased consumer demand in Europe for natural and efficacious health products, the use of herbal products in the market is rising. Products of Chinese herbal medicine (CHM) could greatly expand European consumer options; however, only seven herbal medicinal products (HMPs) based on CHM formulae have been registered in the European Union (EU) since 2012., Purpose: This study reviews the ten-year registration status of HMPs based on CHM formulae in Europe and identifies major challenges and possible solutions for pharmaceutical companies seeking market access for new HMPs., Methods: An overview of relevant EU regulations identifies pathways to market access in EU countries for CHM products. A discussion of successful attempts to register HMPs based on CHM formulae since 2012 highlights specific challenges that applicants can expect to face., Results: CHM products can enter the EU market as HMPs through the full or well-established use marketing authorization, or through the simplified registration procedure. Alternatively, some CHM products have entered the market as dietary supplements, nutritional foods, and agricultural products; however, under these categories, claims for medicinal use cannot be advertised. Since the registration of the first CHM product, Diao Xin Xue Kang (with the single component of Dioscorea nipponica rhizome), in 2012, only six other HMPs based on CHM formulae have been successfully registered. Among these, four are mono-component products. The remaining two products contain combinations of several herbal ingredients. It is more difficult to register combination products than mono-component products, due to their more complex composition and differences in registration requirements (esp. concerning establishing indications) in China and Europe., Conclusions: To promote the successful registration of CHM products in Europe, pharmaceutical companies are advised to: demonstrate full control of, and the ability to test, their supply chain and manufacturing procedures following the guidance of European competent authorities; carefully adhere to all steps of the registration process and advices from European competent authorities; take the medication habits and pharmaceutical needs of European market into consideration; and establish collaboration with European local organizations, as appropriate., (Copyright © 2022. Published by Elsevier GmbH.)

Macrozoobenthos and submerged macrophytes interact closely. However, studies in China have focused on the middle and lower reaches of the Yangtze River, where shallow lakes are concentrated, rather than on temperate lakes. To clarify the responses of taxonomic and functional groups of macrozoobenthos in temperate lakes to changes in submerged macrophyte biomass (B Mac ) on a large scale, 19 temperate lakes within Baiyangdian Lake were investigated in this study. The B Mac differed greatly across the 19 lakes, and Potamogeton crispus was the dominant species. According to the B Mac , the 19 lakes were divided into 4 groups. One-way analysis of variance and Pearson correlation analysis showed that the water environmental parameters were different among the 4 groups, and the B Mac was significant correlated with all the physical and chemical parameters of water bodies (except for water depth). Forty-one taxa of macrozoobenthos were identified in the 19 lakes, with oligochaetes, Hirudinea, gastropods, crustaceans, chironomid larvae, and aquatic insects (excluding chironomid larvae) represented by 9, 1, 4, 2, 19, and 6 species, respectively. Chironomid larvae and oligochaetes dominated by density, and gastropods and chironomid larvae dominated by biomass. Canonical correspondence analysis showed that the B Mac was the most important factor affecting the macrozoobenthos community structure in group 1 to group 4. Macrozoobenthos with low pollution tolerance values were mainly found in areas with high B Mac , while species with high pollution tolerance values were mainly distributed in areas with low B Mac and high nutrient contents. Different taxonomic and functional groups of macrozoobenthos responded differently to changes in B Mac . As B Mac increased, density and biomass of oligochaetes and chironomid larvae tended to decrease, while those of gastropods and aquatic insects tended to first decrease and then increase. Collectors had more species than any other functional group in group 1 to group 4. As B Mac increased, density and biomass of collectors gradually decreased, while density of predators, shredders, and scrapers tended to first decrease and then increase., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

To address the increasing labor cost of resin tapping, more efficient methods for resin tapping need to be developed. This study aimed to evaluate the features of resinosis as affected by stimulant pastes in Pinus elliottii × P. caribaea, which is also one of the predominant resin-producing species hybrids in South China. The resin yields and resin compositions were assessed in 33 P. elliottii × P. caribaea F 1 families, with the application of four kinds of chemical stimulants, potassium (K 2 SO 4 ) paste, naphthalene acetic acid (NAA) paste, benzoic acid (BA) paste and 2-chloroethylphosphonic acid (CEPA) paste. Our results showed that all four pastes significantly increased the resin yield by at least 20% at each tapping, and 3- to fivefold increases were detected at the beginning of each year. The correlations between resin yield and growth at each tapping ranged from uncorrelated to moderately positively correlated, indicating that resin yield was mostly but not always determined by tree size. The concentration of each resin component did not change with the stimulant applications. In P. elliottii × P. caribaea, selecting a larger tree diameter at breast height and employing the chemical stimulants at the first several tapping rounds are efficient tapping procedures. Moreover, the K 2 SO 4 -based stimulant can be recommended considering its promoting effects on resin yield and the low cost of the chemicals required to produce it., (© 2022. The Author(s).)

Mobile monitoring with direct-inlet MS (DI-MS), one of the most direct and effective ways to track emission sources, can effectively serve air quality management in chemical industrial parks (CIPs). Mobile monitoring using a high mass-resolution proton-transfer-reaction time-of-flight MS (HMR-PTR-TOFMS) and single-photon ionization time-of-flight MS (SPI-TOFMS) was conducted in a large fine and petroleum CIP in eastern China for three days. The high mixing ratios of aliphatic hydrocarbons (AHs), aromatics, oxygenated VOCs (OVOCs), and nitrogenous VOCs (NVOCs) were found in the northeast, middle, north, and northeast of the fine chemical industrial zone (FCIZ), respectively. OVOCs were the most abundant VOC group in this area. Abnormal emissions of aromatics were universal throughout the CIP. We discovered 38 characteristic VOCs by the HMR-PTR-TOFMS, mainly including C6-C10 aromatics, C2-C6 carbonyls, C2-C3 organic acids, and some NVOCs. The time series and spatial distribution of the TVOCs obtained by the two DI-MSs are generally consistent. A comparison of the speciated VOCs at the TVOC peak points illustrates that the characteristic VOCs obtained by different instruments differed significantly: PTR-TOFMS showed an advantage in measuring aromatics and OVOCs; SPI-TOFMS showed an advantage in measuring aromatics and some Ahs; offline GC-MS showed an advantage in measuring AHs, aromatics, some OVOCs, and halohydrocarbons. Similarities were compared between five positive matrix factorization (PMF) model-based fingerprints of VOCs in a previous study and observed profiles of VOCs from mobile monitoring. The emission sources of the five fingerprints were identified and validated: two were widely distributed, one was a chemical reagent production factory, one was an acrylic fiber production plant, and one was a pesticide factory. This study demonstrated methods for analyzing mobile monitoring data, characterizing the VOCs in the fine and petroleum CIP, correlating the results of stationary observation and mobile monitoring, and integrating the source tracing system with DI-MSs., 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.)

Extreme heat events have become more frequent and severe under climate change and seriously threaten rice growth. Most existing crop models tend to underestimate the impacts of heat stress on rice yields. Heat stress modules in crop models have not been extensively explored, particularly on a large scale. This study modeled rice growth under heat stress at the flowering and filling stages through two heat stress models which coupled into the CERES-Rice model. We evaluated the advanced model with provincial statistics and Gridded Observed Rice Yield. Our improved CERES-Rice model produced more accurate estimates on rice yield than the original model evidenced by an increased correlation coefficient (R) of 12.72% and d-index of 0.02%. The RMSE and MAE decreased by 5.94% and 6.01%, respectively. Most pseudo positive correlations between rice yield and the number of heat days were corrected to the negative ones by the improved model. The future projections from the improved model signifies multi-model ensemble yield projection without CO 2 effect (MME-I-NOCO 2 ) has an apparent fall from 2020 to 2099 under RCP4.5, RCP6.0 and RCP8.5 with the decreasing percentages of 6%, 14%, and 37%, respectively, whereas the decreasing trend (12%) only occurs under RCP8.5 with CO 2 effect (MME-I-CO 2 ). The apparently decreasing trends of yield projection from MME-I-NOCO 2 will occur in most rice-planted regions of China with the decreasing rate < 50 kg/ha/a especially in the central-south and southern cropping regions, and this decreasing trend will be slowed down for MME-I-CO 2 . Relative to rice yield of historical period, rice yield variations of MME-I-NOCO 2 for different growing seasons show a downward trend with the decrease of approximately 54%, 60%, and 43%, respectively. Our study highlights the importance of modeling crop yields under heat stress to food security, agricultural adaptation and mitigation to climate change., 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.)

Alphasatellites, which encode only a replication-associated protein (alpha-Rep), are frequently found to be non-essential satellite components associated with begomovirus/betasatellite complexes, and their presence can modulate disease symptoms and/or viral DNA accumulation during infection. Our previous study has shown that there are three types of alphasatellites associated with begomovirus/betasatellite complexes in Yunnan province in China and they encode three corresponding types of alpha-Rep proteins. However, the biological functions of alpha-Reps remain poorly understood. In this study, we investigated the biological functions of alpha-Reps in post-transcriptional gene silencing (PTGS) and transcriptional gene silencing (TGS) using 16c and 16-TGS transgenic Nicotiana benthamiana plants. Results showed that all the three types of alpha-Rep proteins were capable of suppressing the PTGS and reversing the TGS. Among them, the alpha-Rep of Y10DNA1 has the strongest PTGS and TGS suppressor activities. We also found that the alpha-Rep proteins were able to increase the accumulation of their helper virus during coinfection. These results suggest that the alpha-Reps may have a role in overcoming host defense, which provides a possible explanation for the selective advantage provided by the association of alphasatellites with begomovirus/betasatellite complexes.

The synthetic resin industry plays an important role in Volatile organic compounds (VOCs) emissions from industrial sources. However, owing to various products and their different emission characteristics, it is extremely difficult to study the source profiles of synthetic resins. In this study, the product-based pollution characteristics of VOCs from eight synthetic resin enterprises were investigated in Shanghai, China. Up to 133 VOCs were identified, including 106 based on the Photochemical Assessment Monitoring Stations (PAMS) and the Toxic Organics (TO-15) methods, and the remaining 27 were identified based on the new mass spectrometry analysis method. Aromatics (39.7%) and oxygenated VOCs (29.9%) accounted for a relatively high proportion in the synthetic resin industry. The product-based source profiles of each process unit are compiled. Generally, 1,4-dioxane, methyl isobutyl ketone, toluene, benzene, styrene, propane, and dichloromethane are the most abundant species in synthetic resin. Furthermore, the product-based ozone formation potentials (OFPs) and sources reactivity (SR) were calculated, the synthetic resin industry SR range from 0.3 g g -1 to 4.6 g g -1 . Results suggest that toluene, benzene, styrene, propylene, ethylene, and oxygenated VOCs (including 1,4-dioxane, methyl isobutyl ketone, and aldehyde) should be preferentially controlled to reduce the OFPs. A three-level classification was established to evaluate the degree of photochemical pollution in different industries. Emission factors were calculated and ranked for eight synthetic resins. A VOC emission inventory of Chinese synthetic resin from 2005 to 2018 was compiled. It is estimated that the Chinese synthetic resin emitted 23.96 Gg of VOCs in 2018. In this study, a product-based VOC source profile and emission inventory of the synthetic resin industry were established for the first time. Finally, combined with product types, processes, and processing equipment, feasible recommendations for reducing VOC emissions in the synthetic resin industry are proposed., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: The objective of this study is to examine the association between livelihood capital and catastrophic health expenditure (CHE)., Design: Between July and August 2019, a cross-sectional study was conducted in critically ill patients., Setting: Shandong, China., Participants: 1041 households with critically ill patients from 77 villages., Primary and Secondary Outcome Measures: We defined expenditure as being catastrophic if a household's out-of-pocket payments were greater than or equal to 40% of their capacity to pay. Using the sustainable livelihoods framework, this study explored the associations between CHE and the various forms of livelihood capital-inclusive of human capital, natural capital, physical capital, financial capital and social capital. χ 2 tests, t-tests, Wilcoxon tests and binary logistic regression analysis were performed to examine these associations., Results: The incidence of CHE among households with critically ill patients was 76.37% in this study. Better livelihood capital was significantly associated with lower incidence of CHE. After controlling for confounding factors, households with healthier patients (OR 0.47, 95% CI 0.23 to 0.96), more real estate ownership (OR 0.35, 95% CI 0.19 to 0.67) and better economic status (OR 0.33, 95% CI 0.18 to 0.62) were associated with a reduction in the occurrence of CHE., Conclusions: Livelihood capital was significantly associated with CHE in rural families with critically ill patients. This association suggests that, in addition to providing health insurance to the critically ill, more attention should be paid to their ability to create and preserve livelihood capital., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Species loss has attracted much attention among scientists for more than half a century. However, we have little information on the trends in phylogenetic and functional changes behind the species loss although this information is always asynchronous and important for conservation and management. We measured community trends in Anatidae (ducks and geese) for the last 50 yr to quantify trends in phylogenetic and functional diversity patterns coinciding with taxonomic historical dynamics. We used one-way ANOVAs to test if there was a significant historical trend in communities of Anatidae. We characterized taxonomic, phylogenetic, and functional diversity of communities. For taxonomic diversity, we used species richness (SR). For phylogenetic diversity, we calculated the standardized effect size of mean pairwise distances (ses.MPD) and the standard effect size of mean nearest taxon distances (ses.MNTD) in communities. For functional diversity, we calculated functional richness (FRic), functional evenness (FEve), functional divergence (FDiv), and the community-level weighted means (CWM) of trait values for diet, foraging stratum, and body mass, separately. From the 1950s to 2010s, species richness declined without significant trends. The ses.MNTD of Anatidae communities showed no clear trends. However, ses.MPD of Anatidae communities declined dramatically during this period. For functional diversity, functional evenness of diet, foraging stratum, body mass, and functional dispersion of diet, foraging stratum did not increase or decline significantly. However, functional evenness of all traits, functional richness, and functional dispersion of body mass showed declined trends. The basic phylogenetic diversity and species body mass of Anatidae communities declined significantly because of a declining trend in the relative independent branch of geese. This makes it more challenging for implement community recovery in the future. More attention in conservation biology should consider taxonomic diversity and asynchrony in phylogenetic and functional diversity., (© 2021 The Authors. Ecological Applications published by Wiley Periodicals LLC on behalf of Ecological Society of America.)

Background: In nature, green apple are associated with the accumulation of chlorophyll, while red apple varieties are associated with anthocyanins accumulation. Notably, in this study, the green skin color apple variety 'white winter pearmain' treated with ultraviolet-B (UV-B) exhibited red skins and marked anthocyanin accumulation, while visible light could not. But there are few reports on the biosynthesis difference of anthocyanins in green apple by visible light and UV-B-treatment. Here, we explored the difference of metabolites and genes expression level in green apple by transcriptomic and metabolic., Results: The metabolic analysis revealed that there were 152 and 178 significantly changed metabolites in the visible light and UV-B-treated green apple, respectively, compared to the control, and flavone, flavonol, and anthocyanin were the most significantly increased; and transcriptomic analysis showed that 37,110 and 37,709 differentially expressed genes, including 382 and 475 transcription factors (TFs) were detected in light and UV-B-treatment fruit, respectively. Quantitative reverse transcription PCR (qRT-PCR) results confirmed changes in the expression levels of genes encoding metabolites involved in the flavonoid synthesis pathways. The flavonoid metabolic flux in the UV-B treatment increased the accumulation of cyanidin 3-glucoside and cyanidin 3, 5-diglucoside compared to under the light-treatment. Furthermore, we performed qRT-PCR analysis of anthocyanin biosynthesis genes and predicted the gene of MD00G1134400 (a UDP glucose-flavonoid 3-0-glucosyltransferase) may be a candidate gene for anthocyanins accumulation and highly expressed in UV-B-treatment fruit. Expression profiles of several transcription factors of the families MYB, bHLH, NAC were highly correlated with the content of the anthocyanin., Conclusions: The composition and contents of anthocyanins in green apple in UV-B-treatment very greatly. A series of metabolites and candidate genes were revealed through combined analysis of metabolome and transcriptome. These results provide an important data for dissecting candidate genes and molecular basis governing green apple color formation in response to visible light and UV-B light., (© 2021. The Author(s).)

Background: : Coronavirus disease 2019 (COVID-19) is an emerging and rapidly evolving disease, with no recommended effective anti-coronavirus treatments. Traditional Chinese Medicine (TCM) has been widely used to treat COVID-19 in China, and the most used one is Lianhuaqingwen (LH). This study aimed to assess the efficacy and safety of LH combined with usual treatment vs usual treatment alone in treating mild or moderate COVID-19 by a meta-analysis of randomized controlled trials (RCTs)., Methods and Analysis: : We systematically searched the Medline (OVID), Embase, the Cochrane Library, and 4 Chinese databases from inception to July 2020 to include the RCTs that evaluated the efficacy and safety of LH in combination with usual treatment vs usual treatment for mild or moderate COVID-19. A meta-analysis was performed to calculate the risk ratio (RR) and 95% confidence interval (CI) for binary outcomes and mean difference (MD) for continuous outcomes., Results: : A total of 5 RCTs with 824 individuals with mild or moderate COVID 19 were included. Compared with the usual treatment alone, LH in combination with usual treatment significantly improved the overall clinical efficacy (RR = 2.39, 95% CI 1.61-3.55), increased the rate of recovery of chest computed tomographic manifestations (RR = 1.80, 95% CI 1.08-3.01), reduced the rate of conversion to severe cases (RR = 0.47, 95% CI 0.29-0.74), shorten the duration of fever (MD = -1.00, 95% CI -1.17 to -0.84). Moreover, LH in combination with usual treatment did not increase the occurrence of the adverse event compared to usual treatment alone., Conclusion: : Our meta-analysis of RCTs indicated that LH in combination with usual treatment may improve the clinical efficacy in patients with mild or moderate COVID-19 without increasing adverse events. However, given the limitations and poor quality of included trials in this study, further large-sample RCTs or high-quality real-world studies are needed to confirm our conclusions., Competing Interests: The authors have no funding and conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Despite China's Expanded Program on Immunization (EPI) provides 2 doses of group A and group C meningococcal polysaccharide vaccine (MPV-AC) for children at 3 years and 6 years old, more self-paying group ACYW135 meningococcal polysaccharide vaccines (MPV-ACYW135) have been used as an alternative to MPV-AC to prevent Neisseria meningitidis serogroup C,Y,W135. We provide recommendations for Chinese booster immunization of meningococcal meningitis vaccine by analyzing the service status of MPV-AC and MPV-ACYW135., Methods: Reported data of routine immunization coverage from all districts of Hangzhou registered in the China Information Management System For Immunization Programming (CIMSFIP) between 2014 to 2019 were described and evaluated. Descriptive epidemiological methods were used to characterize the data. Adverse event following immunization (AEFI) were collected from Chinese national adverse event following immunization information system (CNAEFIIS) to compare the safety of MPV-AC and MPV-ACYW135., Results: 1376919 doses of booster immunization of meningococcal meningitis vaccine (MenV) in CIMSFIP were conducted in China Hangzhou from 2014 to 2019, with reported immunization coverage rates above 95%. The proportion of children using MPV-ACYW135 increased from 12.63% in 2014 to 29.45% in 2019. The incidence of AEFI of MPV-AC and MPV-ACYW135 were 49.75 per 100,000 and 45.44 per 100,000, respectively, without statistical difference., Conclusion: Children in Hangzhou had high booster immunization of MenV coverage. The use amount and use rate of MPV-ACYW135 increased year by year, indicating more and more parents had chosen MPV-ACYW135 as an alternative to MPV-AC at their own expense for children. The use proportions of MPV-ACYW135 were different in urban, suburban and rural areas. Both MPV-AC and MPV-ACYW135 were safe for children., Competing Interests: The authors have declared that no competing interests exist.

Background: Although China's Expanded Program on Immunization (EPI) provides two doses of group A meningococcal polysaccharide vaccine (MPV-A) for children younger than 2 y, more self-paying group A and group C meningococcal polysaccharide conjugate vaccine (MCV-AC) has been used as an alternative to MPV-A, to prevent Neisseria meningitidis serogroup C (Men-C) earlier. We evaluated the pattern of MPV-A and MCV-AC utilization to provide evidence for China to upgrade the national meningococcal meningitis vaccination strategy., Methods: Children born between 2008 and 2017 registered in Hangzhou's Immunization Information System (HZIIS) were included. Descriptive epidemiological methods were used to characterize the data. Adverse event following immunization (AEFI) was collected from Chinese national adverse event following immunization information system (CNAEFIIS) to compare the safety of MPV-A and MCV-AC., Results: Data of 1149,027 children from HZIIS were analyzed. The average immunization rate of meningococcal meningitis vaccine (MenV) was 97.50%. Percentages of children using MPV-A-only, MCV-AC-only, and MPV-A/MCV-AC sequential schedules were 68.20%, 29.73%, and 2.07%, respectively. The vaccination rate of MCV-AC-only increased by age and it was higher in resident children than migration children. The incidence rate of AEFI of MPV-A and MCV-AC was 53.36 per 100,000 and 62.13 per 100,000, respectively., Conclusion: Children in Hangzhou had high MenV coverage. MCV-AC-only schedule use increased by year and was higher in urban areas among locally born children. Both MPV-A and MCV-AC were safe for children, while MCV-AC could protect against Men-C more effectively. This supports the rationale to introduce MCV-AC into China's EPI system for free instead of MPV-A.

The current study explored compliance with hand hygiene and related influencing factors among nursing assistants (NAs) in nursing homes. A descriptive observational research design was used. Seven nursing homes in Chongqing, China, including hospital-affiliated, public, and private, were selected. A hand hygiene observation tool was used to assess NAs' ( N = 237) hand hygiene practice ( N = 2,370 opportunities). NAs' overall compliance rate was 3.6%: 6.8%, 3.1%, and 1.9% at hospital-affiliated, public, and private nursing homes, respectively. Compliance rate between two opportunities, after contact with residents and after contact with residents' surroundings, differed significantly ( p = 0.002 and 0.038, respectively). The highest and lowest compliance rates occurred after bodily fluid exposure (8.3%; odds ratio [OR] = 0.37, 95% confidence interval [CI] [0.218, 0.627], p < 0.001) and before resident contact (1.2%; OR = 3.142, 95% CI [1.265, 7.805], p = 0.014), respectively. Working experience and educational background were the two major influencing factors for hand hygiene. It is urgent to improve NAs' hand hygiene accordingly. [ Journal of Gerontological Nursing, 47 (4), 45-52.].

Background: Osteoarthritis (OA) is thought to be the most prevalent chronic joint disease, especially in Tibet of China. Here, we aimed to explore the integrative lncRNA and mRNA landscape between the OA patients of Tibet and Han., Methods: The lncRNA and mRNA expression microarray profiling was performed by SurePrint G3 Human Gene Expression 8x60K v2 Microarray in articular cartilage samples from OA patients of Han nationality and Tibetans, followed by GO, KEGG, and trans-regulation and cis-regulation analysis of lncRNA and mRNA., Results: We found a total of 117 lncRNAs and 297 mRNAs differently expressed in the cartilage tissues of Tibetans (n = 5) comparing with those of Chinese Han (n = 3), in which 49 lncRNAs and 158 mRNAs were upregulated, and 68 lncRNAs and 139 mRNAs were downregulated. GO and KEGG analysis showed that several unreported biological processes and signaling pathways were particularly identified. LncRNA-mRNA co-expression analysis revealed a remarkable lncRNA-mRNA relationship, in which OTOA may play a critical role in the different mechanisms of the OA progression between Tibetans and Chinese Han., Conclusion: This study identified different lncRNA/mRNA expression profiling between OA patients of Tibetans and Han, which were involved in many characteristic biological processes and signaling pathways.

To investigate composition characteristics and assess occupational health risks and odor pollution of volatile organic compounds (VOCs) from industrial activities in the Yangtze River Delta (YRD) region, China, one-year field measurements of VOCs were conducted simultaneously at an iron and steel industrial park (ISP), one chemical industrial park (CMP) and one petrochemical industrial park (PCP) from September, 2018 to August, 2019. The concentrations of VOCs were 80.2 ± 67.9 ppbv, 28.1 ± 27.2 ppbv and 144 ± 378 ppbv for ISP, CMP and PCP, respectively. Aromatics, alkanes and alkenes were the major components of VOCs at ISP, CMP and PCP, respectively. Moreover, the toluene to benzene ratios were 0.330 ± 0.302, 4.31 ± 6.48 and 1.84 ± 3.34, which generally showed the characteristics of combustion source for ISP, industrial activities for CMP and petrochemical industry for PCP, respectively. The hazard index values were 0.752 ± 0.438, 0.108 ± 0.248 and 0.090 ± 0.260 at ISP, CMP and PCP, which were generally lower than threshold limit value, suggesting a low noncarcinogenic risk for workers. Meanwhile, the 95th percentile LCR values of VOCs were 8.76 × 10 -5 , 1.15 × 10 -5 and 1.00 × 10 -5 at ISP, CMP and PCP, respectively, which were also under acceptable risk level, indicating a low carcinogenic risk. Benzene and 1,3-butadiene were main harmful substances for both noncarcinogenic and carcinogenic risks of VOCs. The odor levels of VOCs were 2.12 ± 4.21, 12.5 ± 28.7 and 1.01 ± 7.84 at ISP, CMP and PCP, respectively. Aromatics for ISP and sulfide compounds for CMP and PCP were primary pollutants for odor pollution. This work could improve the understanding of risk levels and odor characteristics of VOCs and benefit policy development on alleviating odor complaints and health risks for workers in YRD region, China., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Background : 23-valent pneumococcal polysaccharide vaccine (PPSV23) has been used to prevent pneumococcal disease, and PPSV23 became available in 2003 in Hangzhou, China as a private-sector, vaccinee-chosen vaccine. No national guidelines for PPSV23 have been developed. We analyzed PPSV23 coverage and utilization in Hangzhou to determine patterns of PPSV23 use and the occurrence of adverse events following immunization (AEFI) in Hangzhou. Materials and Methods : Individuals over 2 years of age in Hangzhou were included. Vaccination data during 2006-2017 was retrieved from Hangzhou's Immunization Information System (HZIIS). We used descriptive epidemiological methods to determine PPSV23 usage patterns and AEFI occurrence. Results : In 2017, there were 9,027,973 persons above 2 years of age with the coverage of PPSV23 of 2.98%. The coverage of PPSV23 among elders ranged from 0.17% to 0.69%, and the overall coverage was higher in urban areas (3.70%) than in rural (3.34%) and suburban areas (2.16%). 93.45% of 268957 recipients were vaccinated with PPSV23 at 2-4 years of age. 394 AEFI of PPSV23 cases were reported to the Chinese national adverse event following immunization information system (CNAEFIS) during 2008-2017, with the reporting rate of 140.39 per 100,000 doses. Conclusion : Persons in Hangzhou had overall low PPSV23 vaccination coverage especially for adults. Most of PPSV23 were used in children, while the proportion of the old population over 60 years slightly increased over year. PPSV23 was safe with a low reported AEFI rate, which was a little higher for children than for the elderly (over 60 years).

Background : The varicella vaccine (VarV) is not included in the national childhood immunization schedules in China, although 2-dose VarV (VarV2) were recommended for children at 1 and 4 years of age in Hangzhou since 2014. However, the reported incremental vaccine effectiveness (VE) of VarV2 varies widely among studies. We described the epidemiological characteristics of varicella in Hangzhou, assessed the VE of VarV, so as to provide scientific evidence on optimization and adjustment of immunization strategies for varicella prevention in China. Methods : All varicella cases diagnosed in a hospital in Hangzhou are reported to China Information System for Disease Control and Prevention (CISDCP). The demographic information of reported varicella cases onset from January 1 to December 31, 2019 was extracted from CISDCP on Jan 31, 2020. The demographic information was obtained from the information system of the National Center for Disease Prevention and Control. We conducted a 1:1 matched case-control study to assess the effectiveness of VarV. Participant data were collected with standardized questionnaires. VarV vaccination status was checked by using Hangzhou Immunization Information System (HZIIS). Results : A total of 11,813 varicella cases were reported in Hangzhou, China, 2019, without any death. Annual estimated incidence of varicella was 120 cases per 100,000 populations in 2019. The overall estimated incidence rate of varicella was high, especially for persons aged 10-19 years old and in suburb areas. The seasonal pattern was apparent, mostly due to the cases among students and children in kindergarten. In total, 218 varicella cases and 218 matched controls were included for evaluating the VE of VarV. VarV vaccination produced a high level of protection against varicella, while VE of VarV2 was even better. VE of VarV1 was 91.0% (95%CI: 81.6%-95.8%), and VE was 98.0% (95.5%-99.2%) for VarV2. Conclusion : Continuous monitoring and management of varicella cases is necessary, especially in those endemic areas, high-risk populations, and peak periods; a 2-dose VarV strategy is highly recommended, and relevant health institutions should consider the inclusion of VarV in the national immunization program to better control varicella epidemic and reduce the burden of varicella.

The laws of regional differentiation of county development and influencing factors on the quality of rural life (QRL), affect not only the vital interests of rural residents but also the scientific implementation of rural revitalization strategy. In this paper, taking 87 counties (cities, districts) of Gansu Province as the region of study, we constructed five-dimensional model of QRL index. Then, Pearson correlation, spatial coupling, geographical detector and tradeoff analysis methods were used to analyze the QRL's spatial differentiation and quantitively identify its natural controlling factors. Further, we discussed the mechanism of spatial differentiation of QRL in Gansu Province and provided recommendations for improving QRL. The results show that: (1) QRL in Gansu Province is characterized by spatial heterogeneity and agglomeration, and decreases from west to east. There are five hot spots and four cold spots of QRL. (2) Altitude, slope, precipitation, and distance to the provincial capital (DTTPC) are the natural controlling factors of spatial differentiation of QRL in Gansu Province. Their influences are quantified to be 0.19, 0.37, 0.37 and 0.20, respectively. (3) The tradeoff between QRL and precipitation is the strongest, with root mean square deviation (RMSD) of 0.293. The tradeoff between QRL and altitude/slope/DTTCC are of medium level and decrease successively, with values of 0.238, 0.255 and 0.2 respectively. (4) According to the different influences of natural controlling factors on QRL, Gansu Province was classified into three regional types: natural environment restricted type, resource abundance restricted type and economic location restricted type. Thus, we can improve the QRL on the basis of identifying driving mechanisms in different regions, make policies according to local conditions, and further promote the rural development., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Ovarian hyperstimulation syndrome (OHSS), a life-threatening complication occurring in stimulated ovarian cycles, arises from treatment with gonadotropin for inducing follicular maturation., Objectives: The aim of this study was to compare the risk factors between patients with severe OHSS and those without OHSS after in vitro fertilization by intracytoplasmatic sperm injection/embryo transfer (IVF-ICSI/ET). Identifying the associated risk factors may provide guidance for clinicians on how to prevent OHSS., Material and Methods: The retrospective study involved patients who had completed IVF-ICSI/ET cycles. The difference in markers for predicting the occurrence of OHSS between groups was compared. The potential protective and risk factors, as well as the predictive markers, were identified., Results: Patients with OHSS were younger (p = 0.015), had higher basal antral follicle counts (AFC) (p < 0.001) and lower total dosages of gonadotropin (Gn) (p = 0.011). On the day of human chorionic gonadotropin (hCG) administration, significantly higher total numbers of follicles (p < 0.001), serum estradiol (E2) (p < 0.001) and progestrone (Pg) (p = 0.001) levels, numbers of oocytes (p < 0.001) and metaphase II (MII) oocytes (p < 0.001) were also observed in the OHSS group when compared to the non-OHSS group. A univariate regression analysis revealed that age (OR = 0.898, 95% CI = 0.822-0.981) and total dosage of Gn (OR = 0.999, 95% CI = 0.999-1.000) were protective factors, whereas AFC (OR = 1.090, 95% CI = 1.051-1.131) and, on the day of hCG injection, the number of follicles (OR = 1.185, 95% CI = 1.027-1.230), serum E2 (OR = 1.000, 95% CI = 1.000-1.000) and Pg (OR = 2.773, 95% CI = 0.510-3.370) levels, the number of oocytes (OR = 1.254, 95% CI = 0.894-1.472) and MII oocytes (OR = 1.238, 95% CI = 0.747-1.217) were risk factors for OHSS. However, a multivariate regression analysis showed that the total number of follicles (OR = 1.124, 95% CI = 1.027-1.230) was the only predictive factor for the occurrence of OHSS., Conclusions: The study demonstrated that the follicle count measured on the day of hCG administration was the only predictive factor for the occurrence of OHSS. This provides basic guidance to clinicians on the prevention of the complication when using assisted reproductive technologies (ART).

Pancreatic cancer (PC), one of the most lethal malignancies, accounts for 8%-10% of digestive system cancers, and the incidence is increasing. Surgery, chemotherapy, and radiotherapy have been the main treatment methods but are not very effective. However, only 20% of patients have the opportunity to undergo surgical operation. Approximately 30-40% of patients present with locally advanced, unresectable pancreatic cancer because of invasion of mesenteric vessels or adjacent organs. The first patient with unresectable pancreatic cancer was treated with Intraoperative radiotherapy (IORT) in 1959 [1]. Since then, new surgical and radiotherapeutic techniques have been developed, clinical trials have provided new evidence, and intriguing long-term effects have emerged from global metadatabases. IORT has the advantages of more accurate target, better local control rate, less complications, longer survival time and better life quality. During the past decade, IORT has been applied in some hospitals in the world, but there is little agreement on technical details and standards. A guidelines of IORT in pancreatic cancer is therefore necessary and timely. To develop standardized criteria for the application of IORT in pancreatic cancer, the experts from China to discuss treatment methods and arrive at a consensus on the indications, contraindications, and preferred techniques of IORT in pancreatic cancer. This detailed and agreed technical description of IORT may have implications on training, assessment, quality control, and future research., (Copyright © 2019 The Author(s). Published by Elsevier B.V. All rights reserved.)

Chewing lice (Insecta: Phthiraptera) are abundant ectoparasites of birds and mammals. They are adapted to life in the plumage or pelage of their hosts and virtually never leave the host during their life cycle. Most species are highly host specific. This study was carried out to determine species richness, abundance, and prevalence of chewing lice of wild forest birds in the southern region of China. Between July 2012 and June 2016, 2,210 birds (belonging to 8 orders, 45 families, and 215 species) were captured by mist nets and examined for chewing lice. In total, 622 birds of 117 species were parasitized by lice belonging to 89 species in 25 genera from 2 suborders (Amblycera and Ischnocera). Of these, 28 louse species represent new host-louse records for China and 10 worldwide. Chewing louse prevalence varied significantly among host species. There was no evidence of a correlation between climate zones and louse prevalence, but host guild affected prevalence significantly, with insectivorous birds having the lowest prevalence. Louse prevalence was positively correlated with host body mass and bill length, but mean intensity was only correlated with host body mass. These findings contribute further knowledge of avian chewing lice.

Farmers are the major participants in rural development process and their willingness to settle in urban areas directly affects the implementation of rural revitalization strategy. Based on Ostrom's institutional analysis and development (IAD) framework, we analyzed farmers' willingness to settle in urban areas and its influencing factors by binary Logistic regression and cluster analysis of survey data of 190 rural households in Sihe village of Gansu Province of China. The results show that: (1) In Sihe village, farmers' willingness to settle in urban areas was low in general and influenced by their neighbors' decisions or behaviors. Households willing and unwilling to migrate to urban areas both presented significant spatial agglomeration. (2) The factors influencing farmers' willingness to settle in urban areas were analyzed from six aspects: individual characteristics, family characteristics, residence characteristics, cognitive characteristics, institutions, and constraints. The main influencing factors were found to be age, occupation, number of non-agricultural workers in the family, household cultivated land area, annual household income, house building materials, degree of satisfaction with social pension, homestead and contracted land subsidies, income constraints, and other constraints. (3) Individual heterogeneity and difference in economic basis determined the difference in farmers' willingness to settle in urban areas. Institutions and constraints played different roles in the migration willingness of different groups of farmers (Note: More details on the sample as well as further interpretation and discussion of the surveys are available in the associated research article ("Village-Scale Livelihood Change and the Response of Rural Settlement Land Use: Sihe Village of Tongwei County in Mid-Gansu Loess Hilly Region as an Example" (Ma, L.B.; Liu, S.C.; Niu, Y.W.; Chen, M.M., 2018)).

Objective: To delineate seroepidemiology of pertussis in Hangzhou, to evaluate the protection levels of pertussis among healthy populations, for improving prevention strategy of pertussis. Methods: During 2009-2017, a multistage stratified random sampling method was employed to select participants included via physical examination for subjects in several Community Health Centers in Hangzhou. Enzyme-Linked Immunosorbent Assay (ELISA) was used to detect Immunoglobulin G (IgG) antibodies against pertussis in serum samples. Results were compared among 11 age groups. Univariate and multivariate analysis were used to analyze the associations among the rates of pertussis IgG seropositivity and the geometric mean concentration (GMC) levels of pertussis IgG and the related factors. Results: A total of 3360 subjects with available information were included, with 1745 male and 1615 female. Of these, 59.6% subjects had a clear immunization history of diphtheria-tetanus-pertussis vaccine (DTP). The vaccination rates of DTP had a declined trend with older age. The rate of pertussis IgG seropositivity was 69.9% (95% confidence interval: 68.3-71.5) and the GMC for pertussis IgG was 48.46 U/ml. Significantly higher seropositivity and GMC for pertussis IgG were found in subjects that had inoculation vaccine history or unknown history when compared those without inoculation of vaccine, lower in age groups <10, 20-29, and 30-39 y when compared to the other age groups evaluated. Conclusions: There are different distribution profiles both of the seropositivity and GMC for pertussis IgG for different age groups and immunization history of vaccine groups. In order to prevent pertussis occurrence, it is important to employ a booster dose of pertussis vaccine in adolescents and adults.

Establishing protected areas is the primary goal and tool for preventing irreversible biodiversity loss. However, the effectiveness of protected areas that target specific species has been questioned for some time because targeting key species for conservation may impair the integral regional pool of species diversity and phylogenetic and functional diversity are seldom considered. We assessed the efficacy of protected areas in China for the conservation of phylogenetic diversity based on the ranges and phylogenies of 2279 terrestrial vertebrates. Phylogenetic and taxonomic diversity were strongly and positively correlated, and only 12.1-43.8% of priority conservation areas are currently protected. However, the patterns and coverage of phylogenetic diversity were affected when weighted by species richness. These results indicated that in China, protected areas targeting high species richness protected phylogenetic diversity well overall but failed to do so in some regions with more unique or threatened communities (e.g., coastal areas of eastern China, where severely threatened avian communities were less protected). Our results suggest that the current distribution of protected areas could be improved, although most protected areas protect both taxonomic and phylogenetic diversity., (© 2017 Society for Conservation Biology.)

Objective To delineate seroepidemiology of VZV in children aged 1-14 years in Hangzhou, to evaluate immunological response of VarV via 2 dose regimen immunization of VarV, for improving immunization strategy of VarV. Methods From 2014-2016, a multi-stage stratified random sampling method was employed to select participants included via physical examination for children in the Community Health Centre in Hangzhou. Results were compared among 11 various age groups: 1-,2-,3-,4-,5-,6-,7-,8-,9-,10-,11-14 years. Demographic data and vaccination history of all subjects derived from Zhejiang Information System for Immunization Program. Then, the second dose of the VarV was conducted on children aged 4-6 years who had immunization history of one dose of VarV. ELISA was used to detect VZV IgG in serum samples. Results 895 subjects with available information were included. The rate of VZV IgG seropositivity was 65.59% and the geometric mean concentration (GMC) for VZV IgG was 5.14 ± 1.89 mIU/ml. The GMC in urban subjects were higher than rural ones. Both the rate of VZV IgG seropositivity and the GMC in children aged 4-6 years groups were statistically lower than participants younger than 4 years and aged 7-14 years (1-,2-,3-,7-,8-,9-,10-,11-14 years). 627 subjects had immunization history of VarV. Both the rate of VZV IgG seropositivity and the GMC in subjects had immunization history of VarV was higher than who had no immunization history.90 subjects were included after the 2nd dose immunization of VarV. Both the rate of VZV IgG seropositivity and the GMC were significantly increased after the immunization of the 2nd dose of VarV. Conclusions The GMC for VZV IgG in children aged 4-6 years were lower than participants groups (1-,2-,3-,7-,8-,9-,10-,11-14 years).2 doses regimen immunization of VarV are effective for increasing both the rate of VZV IgG seropositivity and the GMC in these subjects.

To assess prognostic benefits of intraoperative electron beam radiation therapy (IOERT) in patients with nonmetastatic locally advanced pancreatic cancer (LAPC) and evaluate optimal adjuvant treatment after IOERT.A retrospective cohort study using prospectively collected data was conducted at the Cancer Hospital of the Chinese Academy of Medical Sciences, China National Cancer Center.Two hundred forty-seven consecutive patients with nonmetastatic LAPC who underwent IOERT between January 2008 and May 2015 were identified and included in the study. Overall survival (OS) was calculated from the day of IOERT. Prognostic factors were examined using Cox proportional hazards models. The 1-, 2-, and 3-year actuarial survival rates were 40%, 14%, and 7.2%, respectively, with a median OS of 9.0 months. On multivariate analysis, an IOERT applicator diameter < 6 cm (hazards ratio [HR], 0.67; 95% confidence interval [CI], 0.47-0.97), no intraoperative interstitial sustained-release 5-fluorouracil chemotherapy (HR, 0.46; 95% CI, 0.32-0.66), and receipt of postoperative chemoradiotherapy followed by chemotherapy (HR, 0.11; 95% CI, 0.04-0.25) were significantly associated with improved OS. Pain relief after IOERT was achieved in 111 of the 117 patients, with complete remission in 74 and partial remission in 37. Postoperative complications rate and mortality were 14.0% and 0.4%, respectively. Nonmetastatic LAPC patients with smaller size tumors could achieve positive long-term survival outcomes with a treatment strategy incorporating IOERT and postoperative adjuvant treatment.Chemoradiotherapy followed by chemotherapy might be a recommended adjuvant treatment strategy for well-selected cases. Intraoperative interstitial sustained-release 5-fluorouracil chemotherapy should not be recommended for patients with nonmetastatic LAPC., Competing Interests: The authors have no conflicts of interest to disclose.

From 2020, influenza viruses circulation was largely affected by the global coronavirus disease (COVID-19) pandemic, notably leading to the extinction of the B/Yamagata lineage and raising questions about the relevance of the quadrivalent influenza vaccine, which includes this lineage. Evaluating vaccine effectiveness (VE) against influenza infections is important to inform future vaccine programs. A test-negative case-control study was conducted in five tertiary hospitals in Hangzhou, the capital city of Zhejiang province, China, enrolling medically-attended patients aged >6 months who presented with influenza-like illness (ILI) from October 1, 2023, to March 31, 2024. The VE was estimated using multivariate logistic regression models adjusted for sex, age, influenza detection methods, and influenza testing timing. Of the 157,291 medically-attended ILI participants enrolled 56,704 (36%) tested positive for influenza. Adjusted overall VE against any medically-attended influenza infection was 48% (95% Confidence interval [CI]: 46%-51%). The overall VE of the trivalent inactivated influenza vaccine (IIV3) was 59% (95% CI: 50%-66%), followed by the trivalent live attenuated vaccine (LAIV3) (VE = 53%, 95% CI: 42%-62%) and quadrivalent inactivated influenza vaccine (IIV4) (VE = 47%, 95% CI: 45%-50%). IIV3 provided even better protection against medically-attended influenza B infection than IIV4 (VE = 87%, 95% CI: 81%-92% for IIV3 versus VE = 53%, 95% CI: 50%-57% for IIV4). In the 2023/24 season in Hangzhou, China, the influenza vaccine offered moderate protection during a major epidemic. The results supported the World Health Organization recommendation to exclude the B/Yamagata lineage antigen in quadrivalent influenza vaccines in 2023.