Search

To evaluate pore networks of the lower Cambrian Niutitang Shale in the Cen-gong Block, multiple techniques, including geochemical analysis, low-pressure gas (CO2 and N2) adsorption, mercury intrusion capillary porosimetry (MICP) and field-emission scanning electron microscope (FE-SEM), were performed to investigate pore structure, including pore-size distribution (PSD), pore volume and surface area of black organic-rich shales from two wells to better understand the mechanism of shale-gas accumulation. Geochemical analysis shows that equivalent vitrinite reflectance ranges from 2.1 to 3.5% and are overmature. Surface areas and pore volumes of micropores calculated from CO2 adsorption, which vary from 8.23 to 37.39 m2/g and from 3.06  10−3 to 10.89  10−3 cm3/g, respectively, can provide large amounts of adsorptive sites for shale-gas accumulation. N2 adsorption shows reversed S-shaped isotherms, which are classified into type H2 and H3 hysteresis loops, indicative of ink-bottle pores and slit-or plate-like pores. N2 adsorption and MICP analysis indicates that the inorganic-associated pores in shales may play a significant role in the storage and production of hydrocarbons. High-resolution FE-SEM analysis suggests that OM pores (OMPs) are common in Niutitang samples with a dominant diameter less 50 nm, but a sample with the highest total organic carbon (TOC) of 10.01 wt% has few OMPs, whereas a sample with the TOC of 7.51 wt% has more OMPs. The percentage of OMP area vs total organic matter area (Øs) ranges from 1.70 to 7.92%. The pore structure characteristics of TX1 well, calculated by multiple techniques, are better than samples from TM1 well. In addition, pore types are dominated by interparticle, intraparticle and organic matter pores, and the minor amounts of OMPs in TM1 well indicates that most of the organic matter may have lost the potential to generate hydrocarbons owing to the release of formation pressure with some graphitisation and high-angle fractures larger in the TX1 well. TOC content, mineral composition and tectonically related thermal maturity may be the main controlling factors of the pore structure and the lower Cambrian Niutitang Shale demonstrates the greatest potential for shale-gas production in South China. [ABSTRACT FROM AUTHOR]

Hydrocarbon generation can yield high fluid pressures in sedimentary basins as the conversion of solid kerogen to hydrocarbons can result in an increase in fluid volume. To quantify the relationship between gas generation and overpressure in source rocks, a set of equations for computing the pressure change due to gas generation has been derived. Those equations can be used to quantitatively estimate overpressure generated by type III kerogen in source rocks by considering gas generation and leakage, gas dissolution in formation water and residual oil, thermal cracking of oil to gas, and hydrocarbon episodic expulsion from source rocks. The equations also take consideration of other factors including source rock porosity, transformation ratio, total organic carbon ( TOC), hydrogen index, and compressibility of kerogen, oil, and water. As both oil and gas are taken into account in the equations, they can also be used to estimate the evolution of overpressure caused by hydrocarbon generation of type I and type II kerogen source rocks. Sensitivity analyses on the type III kerogen source rock indicate that hydrogen index is the most influential parameter for overpressure generation, while TOC and residual gas coefficient (β: ratio of residual gas over the total gas generated) have a moderate effect. Overpressure can be generated even if the gas leakage/loss in the source rock is up to 80% of the total gas generated. This suggests that the internal pressure seal of the source rock is not a critical factor on the pressure change as long as the source rocks are capable of sealing liquid oil. The equations were applied to evaluate the overpressure in the Eocene- Oligocene Enping Formation source rocks due to hydrocarbon generation in the Baiyun Depression, the Pearl River Mouth Basin by considering the source rock properties, hydrocarbon generation history, and hydrocarbon expulsion timing. Two episodes of overpressure development due to gas generation and release were modeled to have occurred in the Enping Formation source rock since 16 Ma. The overpressure release at 10.2-5.3 Ma via hydrocarbon expulsion was apparently related to the Dongsha phase of tectonic deformation, whereas the pressure release at 2-0 Ma was due to pressure generation that was exceeded the fracture-sealing pressure in the source rocks. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the impact of coronavirus disease 2019 (COVID-19) on hospital service utilization and revenue in Chinese tertiary hospitals and develop an optimal pandemic control strategy (OPCS) for the peak period of the Omicron wave., Methods: Retrospective data from three Chinese tertiary hospitals (provincial, city, and county level) were analyzed for three phases: pre-outbreak (Jan-Apr 2019), outbreak (Jan-Apr 2020), and post-outbreak (Jan-Apr 2021). OPCS was developed under the guidance of the China government pandemic control policy during post-break phase of COVID-19. A decision-tree model was constructed to compare OPCS to strict pandemic control strategy during outbreak phase for the hospital service utilization and hospital revenue in a provincial tertiary hospital during the Omicron wave., Results: Outpatient, emergency room (ER) visits, hospitalizations, and intensive care admissions dropped by 33.8-53.4% during the outbreak, with the provincial hospital being the most affected. Hospital revenue also declined, especially for the provincial hospital (40.1%). Post-outbreak, most services recovered, but ER visits remained lower (11.6% decrease for provincial hospital, 46.5% for county hospital). Total income and expenditure decreased, with the provincial hospital experiencing the most significant revenue reduction (45.7%). OPCS showed greater utilization of medical services (31.6 times more outpatient visits; 1.7 times more inpatient days; 3.4% more surgery volume) and higher revenue (¥220.8 million more) compared to the strict pandemic control strategy., Conclusions: COVID-19 measures were associated with less hospital service utilization and revenue in Chinese tertiary hospitals. The developed OPCS in Chinese tertiary hospitals, focusing on isolating infected inpatients but not shutting down the hospital facilities exposed to virus, could be effective in optimizing hospital service utilization and hospital revenue during the Omicron wave., (© 2024. The Author(s).)

Background: Azvudine (FNC) is a novel small molecule antiviral drug for treating COVID-19 that is available only on the Chinese market. Despite being recommended for treating COVID-19 by the Chinese guidelines, its efficacy and safety are still unclear. This study aimed to evaluate the protective effect of FNC on COVID-19 outcomes and its safety., Methods: We followed the PRISMA 2020 guidelines and searched the PubMed, Embase, Web of Science, Scopus, and China National Knowledge Infrastructure (CNKI) databases to evaluate studies on the effectiveness of FNC in treating COVID-19 in China, focusing on mortality and overall outcomes. Additionally, its impact on the length of hospital stay (LOHS), time to first nucleic acid negative conversion (T-FNANC), and adverse events was evaluated. The inclusion criterion was that the studies were published from July 2021 to April 10, 2024. This study uses the ROBINS-I tool to assess bias risk and employs the GRADE approach to evaluate the certainty of the evidence., Results: The meta-analysis included 24 retrospective studies involving a total of 11 830 patients. Low-certainty evidence revealed no significant difference in mortality (OR = 0.91, 95% CI: 0.76-1.08) or LOHS (WMD = -0.24, 95% CI: -0.83 to 0.35) between FNC and Paxlovid in COVID-19 patients. Low-certainty evidence shows that the T-FNANC was longer (WMD = 1.95, 95% CI: 0.36-3.53). Compared with the Paxlovid group, low-certainty evidence shows the FNC group exhibited a worse composite outcome (OR = 0.77, 95% CI: 0.63-0.95) and fewer adverse events (OR = 0.63, 95% CI: 0.46-0.85). Compared with supportive treatment, low certainty shows FNC significantly reduced the mortality rate in COVID-19 patients (OR = 0.61, 95% CI: 0.51-0.74) and decreased the composite outcome (OR = 0.67, 95% CI: 0.50-0.91), and very low certainty evidence shows significantly decreased the T-FNANC (WMD = -4.62, 95% CI: -8.08 to -1.15). However, in very low certainty, there was no significant difference in LOHS (WMD = -0.70, 95% CI: -3.32 to 1.91) or adverse events (OR = 1.97, 95% CI: 0.48-8.17)., Conclusions: FNC appears to be a safe and potentially effective treatment for COVID-19 in China, but further research with larger, high-quality studies is necessary to confirm these findings. Due to the certainty of the evidence and the specific context of the studies conducted in China, caution should be exercised when considering whether the results are applicable worldwide., Trial Registration: PROSPERO number: CRD42024520565., (© 2024 The Author(s). The Clinical Respiratory Journal published by John Wiley & Sons Ltd.)

Neonicotinoid insecticides (NNIs) have attracted global concern due to its extensive use in agricultural activities and their potential risks to the animal and human health, however, there is limited knowledge on the regional traits and ecological risks of NNIs in the aquatic environments. We herein investigated the occurrence of NNIs within the midsection of Yangtze River in China, offering the inaugural comprehensive report on NNIs within this region. In this study, eleven NNIs were analyzed in 108 river water and sediment samples from three seasons (normal, dry and wet season). We detected a minimum of seven NNIs in the water and four NNIs in the sediment, with total concentrations ranging from 12.33 to 100.5 ng/L in water and 0.08-5.68 ng/g in sediment. The levels of NNIs in both river water and sediment were primarily influenced by the extent of agricultural activities. The estimated annual load of NNIs within the midsection of Yangtze River totaled 40.27 tons, April was a critical contamination period. Relative potency factor (RPF) analysis of the human exposure risk revealed that infants faced the greatest exposure risk, with an estimated daily intake of 11.27 ng kg -1 ∙bw∙d -1 . We established the acute and chronic thresholds for aquatic organisms by employing the Species Sensitive Distribution (SSD) method (acute: 384.1 ng/L; chronic: 168.9 ng/L). Based on the findings from this study, 33% of the river water samples exceeded the chronic ecological risks thresholds, indicating the urgent need for intervention programs to guarantee the safety of the river for aquatic life in the Yangtze River Basin., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This study investigated the concentrations of heavy metals in the water sources of the upstream region of the Huangpu River, the Yangtze River Estuary, and various areas in Shanghai, as well as the heavy metal concentrations in the blood of Shanghai residents. It aimed to analyze the heavy metal elements absorbed by the human body and the resulting pathological effects. The results revealed that surface water primarily contains five heavy metals: copper (Cu), lead (Pb), zinc (Zn), arsenic (As), and mercury (Hg), while water sediments primarily contain seven heavy metals: Cu, cadmium (Cd), Pb, chromium (Cr), Zn, As, and Hg. The main heavy metals present in the human body are Pb, Hg, As, and Cd. By reviewing previous articles, it was found that heavy metal concentrations in human blood are higher than those in surface water, suggesting uncertainties in the heavy metal content of surface water and its tendency to settle at the bottom. Furthermore, a comparison of heavy metal content in sediments revealed that Hg is the most readily absorbed heavy metal by the human body and is also a toxic environmental pollutant. Within the cell, Hg is highly toxic to mitochondria and may cause oxidative stress and neurodegenerative disease. This study concludes that water sediments serve as the major source of pollution in the human body and pose significant health risks, thereby necessitating the implementation of effective preventive measures., (© 2024 Wiley Periodicals LLC.)

Objective: This study was designed to comprehensively evaluate the changes in facial skin biophysical parameters with age, as well the influence of gender differences in populations of Shaanxi Province, China., Methods: Fourteen skin parameters, including stratum corneum hydration (SCH), transdermal water loss (TEWL), erythema, melanin, R0, R2, R5, R7, F4, gloss, skin surface pH, skin erythema index (a*), wrinkle length, and sebum, were measured by noninvasive instruments in 481 volunteers from Shaanxi Province. Spearman correlation analysis was performed to analyze the relationship between skin parameters and age. Additionally, skin parameters were analyzed for different age groups and different genders., Results: The results of the study showed a linear decrease in skin surface pH and sebum content with age, and the skin elasticity parameters R0, R2, R5, and R7 decreased significantly at the age of 54-65 years. Wrinkle length showed a linear and increase with age. R5 showed a weak negative correlation with age, R2, R7, and sebum content showed a moderate negative correlation, while wrinkle length showed a strong positive correlation. Considering the effect of gender on skin parameters, the results showed that SCH and gloss were lower in men than in women, while TEWL, erythema, melanin, wrinkle length, and sebum were higher than in women. However, there was no difference in skin elasticity between them., Conclusion: The facial skin parameters, especially for the wrinkle length, exhibited the strong correlation relationship with ages in Shaanxi Province. Meanwhile, most skin parameters show significant differences with gender, which can provide a reference for future research and development in the field of cosmetics., (© 2023 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

To explore contaminant concerns as a result of anthropogenic disturbance of the river system, this study provided the first extensive investigation of the contamination profiles, possible driving factors, and ecological risks of 40 target compounds including pharmaceuticals and personal care products (PPCPs), neonicotinoid pesticides (NNIs), polybrominated diphenyl ethers (PBDEs), and polychlorinated biphenyls (PCBs) in sediments of the whole Yangtze River (the world's third longest river). Among these target compounds, PPCPs were the dominant contaminants with a total concentration (∑ 15 PPCPs) of 2.13-14.99 ng/g, followed by ∑ 7 PCBs (11 NNIs (7 PBDEs (

HLA-DPB1*1550:01 differs from HLA-DPB1*02:02:01:01 by one nucleotide in exon 2., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Liverworts provide valuable ecological services to improve the sustainability of agriculture, encompassing soil health maintenance and natural pest management. Some liverworts have potential applications in medicine and as food additives. Twenty-two novel diterpenoids (anajoerins A-V), of which anajoerins B-G are rearranged labdanes featuring an unprecedented 6/5 fused ring system, were isolated from the Chinese liverwort Anastrophyllum joergensenii Schiffn. The absolute configurations of all compounds were identified based on high-resolution electrospray ionization mass spectroscopy data, NMR spectra, and ECD calculations. Plausible biogenetic pathways for unprecedented rearranged labdanes were proposed. Seven diterpenoids exhibited anti-inflammatory activity by reducing nitric oxide production in LPS-stimulated RAW264.7 murine macrophages in a dose-dependent manner with IC 50 s between 9.71 and 56.56 μM. All tested compounds showed no cytotoxicity at the tested concentrations. Western blot analyses of NF-κB p65 downregulation showed that anajoerin L could inhibit the NF-κB signaling pathway. Furthermore, anajoerin L also suppressed the secretion of the ConA-induced proinflammatory cytokines IFN-γ, TNF-α, and IL-6.

Atmospheric dryness events are bound to have a broad and profound impact on the functions and structures of grassland ecosystems. Current research has confirmed that atmospheric dryness is a key moisture constraint that inhibits grassland productivity, yet the risk threshold for atmospheric dryness to initiate ecosystem productivity loss has not been explored. Based on this, we used four terrestrial ecosystem models to simulate gross primary productivity (GPP) data, analyzed the role of vapor pressure deficit (VPD) in regulating interannual variability in Chinese grasslands by focusing on the dependence structure of VPD and GPP, and then constructed a bivariate linkage function to calculate the conditional probability of ecosystem GPP loss under atmospheric dryness, and further analyzed the risk threshold of ecosystem GPP loss triggered by atmospheric dryness. The main results are as follows: we found that (1) the observed and modeled VPD of Chinese grasslands increases rapidly in both historical and future periods. VPD has a strongly negative regulation on ecosystem GPP, and atmospheric dryness is an important moisture constraint that causes deficit and even death to ecosystem GPP. (2) The probability of the enhanced atmospheric dryness that induced GPP decline in Chinese grasslands in the future period increases significantly. (3) When the VPD is higher than 40.07 and 27.65 percentile of the past and future time series, respectively, the risk threshold of slight ecosystem GPP loss can be easily initiated by atmospheric dryness. (4) When the VPD is higher than 82.57 and 65.09 percentile, respectively, the threshold of moderate ecosystem GPP loss can be exceeded by the benchmark probability. (5) The risk threshold of severe ecosystem GPP loss is not initiated by atmospheric dryness in the historical period, and the threshold of severe ecosystem GPP loss can be initiated when the future VPD is higher than 91.92 percentile. In total, a slight atmospheric dryness event is required to initiate a slight ecosystem GPP loss threshold, and a stronger atmospheric dryness event is required to initiate a severe ecosystem GPP loss. Our study enhances the understandings of past and future atmospheric dryness on grassland ecosystems, and strongly suggests that more attention be invested in improving next-generation models of vegetation dynamics processes with respect to the response of mechanisms of ecosystem to atmospheric dryness., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Under the global warming, it is particularly important to explore the response of extreme climate to global climate change over the arid regions. Based on daily temperature (maximum, minimum, and average) and precipitation data from meteorological stations in Xinjiang, China, we analyzed the spatiotemporal characteristics of extreme temperature and extreme precipitation events via combining thin plate smoothing spline function interpolation, Sen's slope, and Mann-Kendall test. Our results showed that during 1960-2019, the extreme low temperature index of frost days (FD), icing days (ID), cold days (TX10p), cold nights (TN10p), and cold speel duration index (CSDI) all showed the downward trend to varying degrees, and the extreme high temperature index of summer days (SD25), warm days (TX90p), warm night (TN90p), and warm speel duration index (WSDI) all showed an upward trend to varying degrees, and the extreme low temperature index of high altitude mountains decreases more than that of the basin and plains. In addition, all the extreme temperature indices are closely related to the annual average temperature in Xinjiang (R > 0.6). Among the extreme precipitation indices, except for the consecutive dry days (CDD), the other extreme precipitation indices showed increasing trends to different degrees, but the changes in extreme precipitation in Xinjiang were mainly manifested by the increase of heavy precipitation in a short period (the increase of heavy precipitation and extreme heavy precipitation was the largest, 44.8 mm/10a and 17.6 mm/10a, respectively) and spatially concentrated in the Ili River and Altai Mountains in northern Xinjiang. Meanwhile, annual precipitation was positively correlated with the extreme precipitation index (R > 0.4), except for the CDD. This study provides theoretical support for the prevention and control of natural disasters in the dry zone., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Diabetes affects 1 in 10 adults in China. Diabetic retinopathy (DR) is a diabetes-related complication that, if untreated, impairs vision and causes blindness. Evidence on DR diagnosis and risk factors is limited. This study aimed to add evidence from socioeconomic factors., Design: A cross-sectional survey of people with diabetes conducted in 2019 was analysed by using logistic regression to evaluate the association of socioeconomic factors with the glycated haemoglobin (HbA1c) level and DR., Setting: Five counties/districts of western China (Sichuan) were included., Participants: Registered participants with diabetes aged from 18 to 75 years were selected, and at last 2179 participants were included in the analysis., Results: In this cohort, 37.13% (adjusted value 36.52%), 19.78% (adjusted value 19.59%) and 17.37% of participants had HbA1c<7.0%, DR (24.96% of those in the high-HbA1c group) and non-proliferative DR, respectively. Participants with higher social health insurance coverage (urban employee insurance (UEI)), higher income and urban residents tended to have glycaemic control (HbA1c) compared with their counterparts (OR: 1.48, 1.08 and 1.39, respectively). Participants with UEI or higher income had a lower risk of DR (OR: 0.71 and 0.88, respectively); higher education was associated with a 53%-69% decreased risk of DR., Conclusion: This study shows disparities in the effect of socioeconomic factors on glycaemic (HbA1c) management and DR diagnosis among people with diabetes in Sichuan. Lower socioeconomic (especially non-UEI) status conferred a higher risk of high HbA1c and DR. The insights from this study indicate the need for national programmes to implement community-level measures to facilitate access to better HbA1c management and early detection of DR in patients with lower socioeconomic status and diabetes., Trial Registration Number: Chinese Clinical Trial Registry (ChiCTR1800014432)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Migrants are the key population for tuberculosis (TB) transmission in China. However, it remains unknown how many migrants have received TB education and through what means., Objectives: To identify the rate and methods of TB education among migrants in China by using nationally representative data., Method: This study used secondary data analysis. The data were derived from the China Migrants Dynamic Survey 2014-2017. A total sample of 745,926 migrants was included in the following analysis. Information on TB education was collected through a self-report questionnaire. We used hierarchical logistic regression models to explore the relationship between the independent variables and the receipt of TB education., Results: Only 30.4% ( n = 226,458) received TB education. Among all age-groups, participants between 65 and 69 years old had the highest TB education rate (33.4%). Bulletin boards (86.5%-91%), media (73% to 86.7%), and books/magazines (59.2%-67.4%) were the most common ways for migrants to receive TB education., Conclusions: Our study showed the rates of TB education in each region of China and indicated the significant disparity among the seven regions. Traditional media, off-line medical consultation, community advocacy, and bulletin boards should be the primary methods of delivering TB education. TB education campaigns targeting migrants with a low socioeconomic status should be actively promoted.

Since the COVID-19 outbreak was detected and reported at the end of 2019, the pandemic continues worldwide, with public health authorities and the general public in each country struggling to balance safety and normal travel activities. However, the complex public health environment and the complexity of human behaviors, as well as the constant mutation of the COVID-19 virus, requires the development of theoretical and simulation tools to accurately model all segments of society. In this paper, an agent-based model is proposed, the model constructs the real geographical environment of Shanghai Huangpu District based on the building statistics data of Shanghai Huangpu District, and the real population data of Shanghai Huangpu District based on the data of China's seventh Population census in 2020. After incorporating the detailed elements of COVID-19 transmission and the real data of WHO, the model forms various impact parameters. Finally, the model was validated according to the COVID-19 data reported by the official, and the model is applied to a hypothetical scenario. Shanghai is one of the places hardest hit by the current outbreak, Huangpu District is the "heart, window and name card" of Shanghai, and its importance to Shanghai is self-evident. so we used one-to-one population modeling to simulate the spread of COVID-19 in Huangpu District of Shanghai, In addition to the conventional functions of crowd movement, detection and treatment, the model also takes into account the burden of nucleic acid detection on the model caused by diseases similar to COVID-19, such as seasonal cold. The model validation results show that we have constructed a COVID-19 epidemic agent risk assessment system suitable for the individual epidemiological characteristics of COVID-19 in China, which can adjust and reflect on the existing COVID-19 epidemic intervention strategies and individual health behaviors. To provide scientific theoretical basis and information decision-making tools for effective prevention and control of COVID-19 and public health intervention in China.

Background: Male fertility has shown a continuously declining tendency for decades. Over exposure to metal/metalloid elements has been proposed as associated with reproductive impairment. However, the hazard profile remained unclear in general public experiencing low-level and combined metal exposure., Methods: Based on the MARHCS cohort in Chongqing, China, 796 college students were recruited from June 2013 and 666 subjects were followed up next year. At each phase, semen and blood samples were collected for an assessment of semen quality and six sex hormones levels. Eighteen urinary metal/metalloid elements were quantified by ICP-MS as internal exposure biomarkers. Cluster analysis was conducted to characterize reproductive outcomes in the subgroups for different overall estimated exposure levels. Effects of each metal/metalloid element were analyzed using multiple statistical strategies: single-element mixed model, multiple-elements model and self before-after comparison design., Results: The urine concentration for 18 metal/metalloid elements was at a typically lower level (far away from the exposure limits) and positively associated with each other. After adjustment of the potential confounders, a decrease of 11.53% (95% CI: -18.61, -3.84%) and 10.84% (95% CI: -17.93, -3.14%) in spermatid morphology was observed in the highest quantile groups of vanadium (V) and nickel (Ni), respectively. Urinary silver (Ag) was dose-dependent associated with an increase in total sperm number (6.91%, 95% CI: 1.14, 13.00%), sperm concentration (16.38%, 95% CI: 5.15, 28.81%) and semen volume (23.73%, 95% CI: 10.46, 38.60%). Further, hormone testosterone presented a significant decrease in subgroup with higher overall estimated exposure and a stable negative association with lithium (Li). The above relationships remained significant across different statistical strategies (all p values <0.05)., Conclusion: Our study provided new evidences that exposure to metal/metalloid elements potentially exert bidirectional influences on semen quality at a relatively low level. And serum testosterone appears as a vulnerable index for metal exposure., 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.)

Accurate segmentation of ground glass nodule (GGN) is important in clinical. But it is a tough work to segment the GGN, as the GGN in the computed tomography images show blur boundary, irregular shape, and uneven intensity. This paper aims to segment GGN by proposing a fully convolutional residual network, i.e. , residual network based on atrous spatial pyramid pooling structure and attention mechanism (ResAANet). The network uses atrous spatial pyramid pooling (ASPP) structure to expand the feature map receptive field and extract more sufficient features, and utilizes attention mechanism, residual connection, long skip connection to fully retain sensitive features, which is extracted by the convolutional layer. First, we employ 565 GGN provided by Shanghai Chest Hospital to train and validate ResAANet, so as to obtain a stable model. Then, two groups of data selected from clinical examinations (84 GGN) and lung image database consortium (LIDC) dataset (145 GGN) were employed to validate and evaluate the performance of the proposed method. Finally, we apply the best threshold method to remove false positive regions and obtain optimized results. The average dice similarity coefficient (DSC) of the proposed algorithm on the clinical dataset and LIDC dataset reached 83.46%, 83.26% respectively, the average Jaccard index (IoU) reached 72.39%, 71.56% respectively, and the speed of segmentation reached 0.1 seconds per image. Comparing with other reported methods, our new method could segment GGN accurately, quickly and robustly. It could provide doctors with important information such as nodule size or density, which assist doctors in subsequent diagnosis and treatment.

This study aims to explore and visualize relationships among multiple psychological symptoms among people living with HIV (PLWH) with different HIV-positive durations and to compare centrality indices and densities of psychological symptom networks. We used subsets of data collected from five designated HIV/AIDS hospitals in China. Networks were constructed among 16 psychological symptoms. Centrality properties, including strength and closeness, were adopted to describe relationships among symptoms. The results showed that PLWH with longer HIV-positive durations had denser emotional networks, which indicated that they had more emotional neuroticism than their newly diagnosed counterparts. Sadness, self-abasement, and self-loathing were the most central psychological symptoms across different HIV-positive durations. Our study suggests the need to provide psychosocial support services targeting PLWH according to changing symptom severity and neuroticism trajectories. Interventions should focus on increasing empathy for PLWH and enhancing the ability to consider the situation from different perspectives to avoid the development of neuroticism in long-term survivors.

Background: We aimed to systematically identify novel susceptible factors related to the occurrence and development of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)-like symptoms that were not limited to lifestyles or dietary habits in Chinese population., Methods: We recruited participants from three centers (Shanghai [northeast], Hefei [east], and Lanzhou [northwest]) from August 2020 to June 2021. Demographics, lifestyles, dietary habits, past medical history, and national institutes of health-chronic prostatitis symptom index (NIH-CPSI) were collected from the individuals via optimized questionnaires. Logistic regression analysis and multivariate adjustment models were used to calculate the odds ratio (OR) and 95% confidence interval (95% CI) to assess the association between these variables and CP/CPPS-like symptoms., Results: A total of 1851 participants were enrolled in this study (764 cases and 1087 controls). Age distributions differed between groups (median, range: 32, 18-74 vs. 29, 18-70, p < 0.001). After adjustment, physicochemical occupational hazards were identified significantly related to CP/CPPS-like symptom occurrence and development (OR occurrence : 1.389, 95% CI: 1.031-1.870, p < 0.001; OR development : 2.222, 95% CI: 1.464-3.372, p < 0.001); besides, greater than or equal to four ejaculations per week significantly increased the likelihood of CP/CPPS-like symptoms compared with one ejaculation per week (OR occurrence : 3.051, 95% CI: 1.598-5.827, p = 0.001). For these patients, who were easily felt gastrointestinal discomfort caused by spicy food intake, they had a higher incidence to affect with CP/CPPS-like symptoms (OR occurrence : 2.258, 95% CI: 1.858-2.745, p < 0.001). In addition, history of drug allergy and genitourinary infections were identified as independent susceptible factors for the occurrence of CP/CPPS-like symptoms (OR occurrence : 1.689, 95% CI: 1.007-2.834, p = 0.047; OR occurrence : 3.442, 95% CI: 2.202-5.382, p < 0.001, respectively), while the history of rheumatic immune diseases was found tightly associated with the development of CP/CPPS-like symptoms (OR development : 2.002, 95% CI: 1.008-4.058, p = 0.048)., Conclusion: Infection/inflammatory/immune-related disorders, novel dietary habits, and lifestyles associated with the susceptibility of CP/CPPS-like symptoms' occurrence and development are identified. Altering these irregular conditions serves as potential strategies for the treatment of patients with CP/CPPS-like symptoms., (© 2022 Wiley Periodicals LLC.)

Objective: To investigate the distribution of HIV-1 genetic subtypes and pretreatment drug resistance (PDR) among men who have sex with men (MSM) from 19 cities of 6 provinces in China. Methods: From April to November 2019, 574 plasma samples of ART-naive HIV-1 infected MSM were collected from 19 cities in Hebei, Shandong, Jiangsu, Zhejiang, Fujian, and Guangdong provinces, total ribonucleic acid (RNA) was extracted and amplified the HIV-1 pol gene region by nested polymerase chain reaction (PCR) after reverse transcription. Then sequences were used to construct a phylogenetic tree to determine genetic subtypes and submitted to the Stanford drug resistance database for drug resistance analysis. Results: A total of 479 samples were successfully amplified by PCR. The HIV-1 genetic subtypes included CRF01&#95;AE, CRF07&#95;BC, B, CRF55&#95;01B, CRF59&#95;01B, CRF65&#95;cpx, CRF103&#95;01B, CRF67&#95;01B, CRF68&#95;01B and unrecognized subtype, which accounted for 43.4%, 36.3%, 6.3%, 5.9%, 0.8%, 0.8%, 0.4%, 0.4%, 0.2% and 5.5%, respectively. The distribution of genetic subtypes among provinces is statistically different ( χ 2 =44.141, P <0.001). The overall PDR rate was 4.6% (22/479), the drug resistance rate of non-nucleoside reverse transcriptase inhibitors, nucleoside reverse transcriptase inhibitors, and protease inhibitors were 3.5% (17/479), 0.8% (4/479) and 0.2% (1/479), respectively. The PDR rate of recent infections was significantly higher than that of long-term infections ( χ 2 The HIV-1 genetic subtypes among MSM infected with HIV-1 from 19 cities of 6 provinces in China are diverse, and the distribution of subtypes is different among provinces. The overall PDR rate is low, while the PDR rate of recent infections was significantly higher than that of long-term infections, suggesting the surveillance of PDR in recent infections should be strengthened.P =0.031). Conclusions: The HIV-1 genetic subtypes among MSM infected with HIV-1 from 19 cities of 6 provinces in China are diverse, and the distribution of subtypes is different among provinces. The overall PDR rate is low, while the PDR rate of recent infections was significantly higher than that of long-term infections, suggesting the surveillance of PDR in recent infections should be strengthened.

Objectives: This study explored the prevalence of and individual influencing factors for metabolic syndrome (MS) as well as associated socioeconomic factors and regional aggregation., Design: Four cross-sectional surveys were analysed for trends in MS and associations with socioeconomic and individual factors through multilevel logistic regression analyses. The risk associated with nutrient intake was also assessed through a dietary survey in 2015., Setting: From 2010 to 2018, 8-15 counties/districts of West China were included., Participants: A total of 28 274 adults were included in the prevalence analysis. A total of 23 708 adults were used to analyse the related factors., Results: The overall prevalence of MS ranged from 21.4% to 27.8% over the 8 years, remaining basically stable within the 95% CI. Our study found that the urbanisation rate and hospital beds per 1000 people were positively associated with MS, and the number of doctors in healthcare institutions per 1000 persons was negatively associated with MS. The ORs for females, people with college education and higher and unmarried or single people were 1.49, 0.67 and 0.51, respectively (p<0.05). The ORs of people who smoked at least 20 cigarettes/day, ate more than 100 g of red meat/day, consumed fruit or vegetable juice and drank carbonated soft drinks less than weekly were 1.10, 1.16, 1.19-1.27 and 0.81-0.84, respectively. The ORs rose with increasing sedentary time and decreased with higher physical activity., Conclusion: The high burden of MS, unreasonable proportions of energy and micronutrient intake and low percentage of high levels of physical activity were the major challenges to public health in western China. Improving the human resources component of medical services, such as the number of doctors, increasing the availability of public sports facilities and E-health tools and improving individual dietary quality and education might help prevent MS., 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: Wilson's disease (WD) is an autosomal recessive disorder of copper metabolism caused by ATP7B (encoding a copper-transporting P-type ATPase) variants that shows various characteristics according to race and geographical region. This study was aimed to provide a comprehensive analysis of ATP7B variants in China and to investigate a plausible role of common variants in WD manifestations., Methods: A total of 1366 patients (1302 index patients and 64 siblings) clinically diagnosed with WD (Leipzig score ≥ 4) were recruited. They underwent ATP7B gene sequencing and information of age and symptoms at onset was collected. The genotype-phenotype correlation was assessed in the index patients who were examined with two pathogenic variants and onset with hepatic (n = 276) or neurologic (n = 665) symptoms., Results: We identified 294 potentially pathogenic ATP7B variants (112 truncating, 174 missense, 8 in-frame) in the 1302 index patients, including 116 novel variants. The most frequent variant was c.2333G>T (R778L, allele frequency: 28.96%), followed by c.2975C>T (P992L, 13.82%), c.2621C>T (A874V, 5.99%), c.2755C>G (R919G, 2.46%), and c.3646G>A (V1216M, 1.92%). In 1167 patients, both pathogentic variants were identified, of which 532 different variant combinations were found. By binary logistic regression analysis, the factor associated with neurological presentation was high age-at-onset, but not sex, protein-truncating variant (PTV), or the common missense variants (R778L, P992L, and A874V). In the neurological group, low age-at-onset was a factor associated with dystonia, gait abnormality, and salivation; high age-at-onset was a factor associated with tremor; and the sex, low age-at-onset and A874V were independent factors associated with dysarthria. In addition, PTV, R778L, and P992L were predominant in early-onset patients, whereas A874V was predominant in late-onset patients, and patients with R778L/A874V genotype displayed a higher age-at-onset than patients with R778L/R778L or R778L/P992L genotype., Conclusions: Our work expanded the ATP7B variant spectrum and highlighted the differences among patients with WD in age-at-onset and ATP7B variants, which may provide some valuable insights into the diagnosis, counseling, and treatment of patients with WD., (© 2022. The Author(s).)

Objective: Although it is reported that patients with coronavirus disease 2019 (COVID-19) disease who have comorbidities are at higher risk to suffer adverse clinical outcomes, there are inadequate evidence to clarify the association between COVID-19 and asthma. On this ground, this study aims to systematically analyze the clinical characteristics of COVID-19 patients with asthma., Methods: In this single-center, retrospective and observational cohort study, 21 COVID-19 patients with asthma and 100 non-asthma COVID-19 patients were statistically matched by propensity score based on age, sex and comorbidities. Meanwhile, a collection and comparison concerning demographic indicators, clinical and laboratory examinations, treatments and outcomes were conducted between two groups to specify their differences., Results: Statistically, the COVID-19 patients with asthma had a higher proportion of ICU admission (14.3% [3/21] vs. 2.1% [2/96] p  = 0.040) than those who do not have. On top this, a higher level of inflammatory responses, such as interleukin 6, interleukin 8, procalcitonin, leukocytes, neutrophils and CD4 + T cells was presented in asthma patients. Moreover, the increase of organ damage indices like D-dimer, lactate dehydrogenase and high-sensitivity cardiac troponin I, were more pronounced in COVID-19 patients with asthma., Conclusions: Exacerbated inflammatory responses and multiple organ damages were triggered in COVID-19 patients with asthma, which highlights more intensive surveillance and supportive treatment.

Background: The global epidemic of novel coronavirus pneumonia (COVID-19) has resulted in substantial healthcare resource consumption. Since patients' hospital length of stay (LoS) is at stake in the process, an investigation of COVID-19 patients' LoS and its risk factors becomes urgent for a better understanding of regional capabilities to cope with COVID-19 outbreaks., Methods: First, we obtained retrospective data of confirmed COVID-19 patients in Sichuan province via National Notifiable Diseases Reporting System (NNDRS) and field surveys, including their demographic, epidemiological, clinical characteristics and LoS. Then we estimated the relationship between LoS and the possibly determinant factors, including demographic characteristics of confirmed patients, individual treatment behavior, local medical resources and hospital grade. The Kaplan-Meier method and the Cox Proportional Hazards Model were applied for single factor and multi-factor survival analysis., Results: From January 16, 2020 to March 4, 2020, 538 human cases of COVID-19 infection were laboratory-confirmed, and were hospitalized for treatment, including 271 (50%) patients aged ≥ 45, 285 (53%) males, and 450 patients (84%) with mild symptoms. The median LoS was 19 (interquartile range (IQR): 14-23, range: 3-41) days. Univariate analysis showed that age and clinical grade were strongly related to LoS (P<0.01). Adjusted multivariate analysis showed that the longer LoS was associated with those aged ≥ 45 (Hazard ratio (HR): 0.74, 95% confidence interval (CI): 0.60-0.91), admission to provincial hospital (HR: 0.73, 95% CI: 0.54-0.99), and severe illness (HR: 0.66, 95% CI: 0.48-0.90). By contrast, the shorter LoS was linked with residential areas with more than 5.5 healthcare workers per 1,000 population (HR: 1.32, 95% CI: 1.05-1.65). Neither gender factor nor time interval from illness onset to diagnosis showed significant impact on LoS., Conclusions: Understanding COVID-19 patients' hospital LoS and its risk factors is critical for governments' efficient allocation of resources in respective regions. In areas with older and more vulnerable population and in want of primary medical resources, early reserving and strengthening of the construction of multi-level medical institutions are strongly suggested to cope with COVID-19 outbreaks., Competing Interests: The authors have declared that no competing interests exist.

Background: Policymakers must promote the development of public health education and human resources. As a feature of the political environment, public opinion is essential for policy-making, but virtually the attitudes of Chinese citizens toward human resources development in public health is unknown. Methods: This study conducted a crosssectional survey from February 4, 2021 to February 26, 2021 in China. We adopted a convenient sampling strategy to recruit participators. Participants filled out the questions, which assess the attitudes of the expanding public health professionals. A logistic regression analysis was given to identify the predictors associated with the attitudes of the subjects. Results: There were 2,361 residents who have finished our questionnaire. Chinese residents who lived in urban (OR = 1.293, 95% CI = 1.051-1.591), "themselves or relatives and friends have participated in relevant epidemic prevention work" (OR = 1.553, 95% CI = 1.160-2.079), "themselves or family members engaged in medical-related work" (OR = 1.468, 95% CI = 1.048-2.056), and those who "were aware of public health before the outbreak of COVID-19" (OR = 1.428, 95% CI = 1.125-1.812) were more likely to support the promotion of public health education and training. Conclusions: The present study found that 74.50% of Chinese citizens supported the promotion of public health education and training in China, in which economic status, personal perception, and comprehension are the crucial factors that influence public opinion. COVID-19 has aroused the attention of Chinese residents to public health education, with only 22.11% of residents being aware of public health before the outbreak of COVID-19. The COVID-19 pandemic has profound implications for human society. Literally, this impact will feed back into future public health policies based on public opinion. This innovative perspective will also help us better understand the potential social impact of COVID-19 on human resources and development for health in the modern world., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Shen, Li, Dong, Cao, Feng, Lei, Wang, Han, Lv and Gan.)

In response to the increasing care demand of older adults and their families, the construction of the long-term care (LTC) security system has been widely recognized by the government, society and families. This article discusses the socio-demographic background, current situation, achievements and issues of this system. The LTC security system in China has achieved considerable progress in enriched service provision and expanded social insurance system pilot programs. However, the issues of unbalanced service provision and the explorative design of the insurance system still need to be resolved. Our recommendations for the development of the LTC security system include comprehensively reviewing the integrated care service system in terms of placing "old adults at the center," addressing the long-standing divisions between urban and rural areas in service provision and insurance design, advancing research and discussion concerning pilot experiences and improving the unified evaluation and financial planning systems.

High serum thyroid-stimulating hormone (TSH) levels are linked to many metabolic disorders, but the effects of TSH levels on the oral microbiota are still largely unknown. This study aimed to explore the association between the salivary microbiome in adults and serum TSH levels. Saliva and fasting blood samples were obtained from a health census conducted in Southeast China. All participants were divided according to serum TSH levels. The microbial genetic profiles and changes were acquired by 16S rDNA sequencing and bioinformatics analysis. Relevant anthropometric and biochemical measurements such as insulin resistance, blood lipids, and body composition were evaluated with laboratory tests and physical examinations. The salivary microbiome in individuals with higher TSH level showed significantly higher taxa diversity. Principal coordinates analysis and partial least squares discriminant analysis showed distinct clustering in the Abnormal and Normal Groups (Adonis, P =0.0320). Granulicatella was identified as a discriminative genus for comparison of the two groups. Fasting serum insulin, Homeostatic Model Assessment for Insulin Resistance, and hemoglobin A1 were elevated in the Abnormal Group ( P <0.05), showing the presence of insulin resistance in individuals with abnormal higher serum TSH levels. Distance-based redundancy analysis revealed the association of this distinctive difference with salivary microbiome. In conclusion, shifts in microbial profile were observed in the saliva of individuals with different serum TSH levels, and insulin resistance may play an important role in the biochemical and microbial alteration., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Dong, Zhao, Yuan, Zhu, Wang, Xia, Lu and Huang.)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has caused a worldwide pandemic and poses a serious public health risk. It has been proven that lung ultrasound can be extremely valuable in the diagnosis and treatment of the disease, which could also minimize the number of exposed healthcare workers and equipment. Because healthcare workers in ultrasound departments are in close contact with patients who might be infected or virus carriers, it is extremely important that they be provided sufficient protection. Extremely aggressive protection should be avoided because it might lead to a lack of protection equipment for the hospital. Guidance on proper protection management should be provided in detail, for example, how to choose personal protective equipment, how to disinfect the environment. To address these problems, on behalf of the Chinese Ultrasound Doctors Association, Chinese PLA Professional Committee of Ultrasound in Medicine, Beijing Institute of Ultrasound in Medicine and Chinese Research Hospital Association Ultrasound Professional Committee, the authors have summarized the recommendations for effective protection according to existing hygienic standards, their experience and available literature. After the recommendations were completed, two online conferences were held on January 31, 2020 and February 7, 2020, at which the recommendations were discussed in detail. A modified version of the work was circulated and finally approved by all authors, and is the present Chinese Expert Consensus on Protection for Ultrasound Healthcare Workers against COVID-19., (Copyright © 2020 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Background: The associations between maternal exposure to fine particles with aerodynamic diameter ≤ 2.5 μm (PM 2.5 ) and gestational age as well as premature rupture of membranes (PROM) remain unclear. Few studies have focused on preconception exposure and components of fine particles in China., Methods: A total of 1715 pregnant women were enrolled at hospitals affiliated with Nanjing Medical University from 2014 to 2015. Personal exposure to PM 2.5 was estimated from preconception to the first trimester. Gestational age and PROM were investigated to explore their associations with PM 2.5 and its components., Results: From 12 weeks before conception to the end of the first trimester, the gestational age was reduced by 0.89 days (95% CI: -1.37, -0.40) per 10 μg/m 3 increment in PM 2.5 exposure. After the exposure period was separated into two groups, PM 2.5 exposure reduced the gestational age by 0.35 days (95% CI: -0.59, -0.11) in the 12 weeks before pregnancy. With maternal exposure to PM 2.5 early in the first trimester, gestational age was reduced by 0.62 days (95% CI: -1.09, -0.14). After mediation analysis, we found that PROM mediated the association between PM 2.5 and gestational age from preconception to the first trimester. Components analysis indicated that exposure to black carbon, organic matter, and nitrate increased the risk of PROM and decreased gestational age., Conclusion: Exposure to PM 2.5 as well as some components of PM 2.5 before and during early pregnancy was associated with PROM and gestational age. PROM might be a potential mediator in associations between PM 2.5 as well as various components and gestational age., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The COVID-19 spread worldwide quickly. Exploring the epidemiological characteristics could provide a basis for responding to imported cases abroad and to formulate prevention and control strategies in areas where COVID-19 is still spreading rapidly., Methods: The number of confirmed cases, daily growth, incidence and length of time from the first reported case to the end of the local cases (i.e., non-overseas imported cases) were compared by spatial (geographical) and temporal classification and visualization of the development and changes of the epidemic situation by layers through maps., Results: In the first wave, a total of 539 cases were reported in Sichuan, with an incidence rate of 0.6462/100,000. The closer to Hubei the population centres were, the more pronounced the epidemic was. The peak in Sichuan Province occurred in the second week. Eight weeks after the Wuhan lockdown, the health crisis had eased. The longest epidemic length at the city level in China (except Wuhan, Taiwan, and Hong Kong) was 53 days, with a median of 23 days. Spatial autocorrelation analysis of China showed positive spatial correlation (Moran's Index > 0, p < 0.05). Most countries outside China began to experience a rapid rise in infection rates 4 weeks after their first case. Some European countries experienced that rise earlier than the USA. The pandemic in Germany, Spain, Italy, and China took 28, 29, 34, and 18 days, respectively, to reach the peak of daily infections, after their daily increase of up to 20 cases. During this time, countries in the African region and Southeast Asian region were at an early stage of infections, those in the Eastern Mediterranean region and region of the Americas were in a rapid growth phase., Conclusions: After the closure of the outbreak city, appropriate isolation and control measures in the next 8 weeks were key to control the outbreak, which reduced the peak value and length of the outbreak. Some countries with improved epidemic situations need to develop a continuous "local strategy at entry checkpoints" to to fend off imported COVID-19.

We examined the effects of thinning and reshaping on the canopy micro-domain environment, leaves micro-structure, physiological characteristics and photosynthetic capacity of 16 year-old Fuji apple dense orchards by measuring canopy relative light intensity, temperature, relative humidity, leaf chlorophyll content, micro-structure, and photosynthetic fluorescence. After thinning and reshaping, relative light intensity and temperature of tree canopy were significantly improved, and the distribution was balanced. Effective light intensity (&gt;30%) was 57% higher than that of control (thinning and reshaping, CK), and temperature increased by 1.1 ℃. Due to the improvement of relative light intensity and temperature in the canopy, leaf chlorophyll, leaf thickness, and palisade tissue thickness of thinning trees were increased by 8.7%, 5.4%, and 9.2%, respectively. Net photosynthetic rate, transpiration rate and stomatal conductance of the leaves were also significantly increased, being 12.6%, 17.1% and 7.3% higher than CK, respectively. Leaf photosynthesis capacity of both treatments was limited by non-stomatal factors. After thinning and reshaping, F m (maximum fluorescence) and q N (non-photochemical quenching coefficient) of PSⅡ in leaves were increased by 1.5% and 2.1%. Leaves did not suffer strong light photoinhibition, with ABS/RC (unit reaction center absorbs light energy), ETo/RC (energy used for electron transfer captured by unit reaction center) and TRo/RC (energy captured by the unit reaction center to reduce Q A ) of leaves being significantly improved. The physiological characteristics of leaves were closely related to light and temperature environment. After thinning, light and temperature of the orchard canopy were improved, which promoted leaves growth and development, improved foliar micro-structure and photosynthetic efficiency. Thinning and reshaping were suitable strategies for the adjustment and optimization of Fuji orchard density in Loess Plateau of eastern Gansu.

Benzene is a globally occurring environmental and occupational pollutant that causes leukemia. To better understand telomere length (TL) as a function of benzene toxicity, we recruited 294 shoe-making workers and 102 controls from Wenzhou, China in 2011. Biomarkers of TL, cytokinesis-block micronucleus (MN) frequency, and white blood cells (WBC) were measured. In total, 18 polymorphic sites in environmental response genes, including metabolic and DNA repair genes, were analyzed. Results indicate that benzene exposure led to a longer TL at a threshold of 32 mg/m 3 -year of cumulative exposure dose (CED). Furthermore, the TL was longer in members of the damaged group, when evaluated for MN frequency (P < 0.001) and reduced WBC (P < 0.001), than in those of the normal group. Workers carrying genotype TT (β = 0.32, P = 0.042) in rs3212986 of ERCC1 and genotype TC (β = 0.24, P = 0.082) in rs1051740 of mEH exon3 were associated with a longer TL as compared to the wild-type group. TA (β = -0.53, P < 0.001) in rs6413432 of CYP2E1 was associated with a shorter TL. Benzene exposure interacted with the TA type in rs6413432 (β = 0.003, 95% CI: 0, 0.006, P = 0.042) and the CC type in rs1051740 (β = 0.007, 95% CI: 0.001, 0.013, P = 0.015) after adjusting for confounding factors. Our results indicate that benzene induces an increase in TL at a threshold of CED ≥32mg/m 3 -year. Rs1051740, rs3212986, and rs6413432 were found to be involved in benzene-induced telomere growth; in particular, rs1051740 and rs6413432 interacted with the benzene exposure, resulting in an extended TL., Competing Interests: Declaration of competing interest There are no conflicts of interest. Telomere length was transformed by natural logarithm (ln). Compared with wild-type for each genotype case; the data derived from Mlti-linear models after adjusting age, gender, smoking and drinking. b the data derived from signal factor models, and ‘c’ the data were adjusted age, gender, smoking and drinking., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Air pollution is a serious environmental problem in China. This study was designed to investigate whether exposure to particulate matter with an aerodynamic diameter ≤ 2.5 μm (PM 2.5 ) before pregnancy is associated with gestational diabetes mellitus (GDM) and fasting glucose in China., Methods: We recruited subjects and collected clinical data from the Nanjing Maternity and Child Health Care Hospital from July 2016 to October 2017. A series of validated land-use regression (LUR) models were built to assess individual exposure to PM 2.5 in a 1 × 1 km area at both work and home addresses following a time-weighted pattern. Multiple linear regression and logistic regression analyses were performed to examine the association between PM 2.5 exposure and GDM and fasting glucose., Results: In total, 11,639 of 16,995 women were included in the final analysis. Among the 11,639 women, 2776 (23.85%) had GDM. Individual exposure to PM 2.5 within three months before pregnancy ranged from 21.58 to 85.92 μg/m 3 . Positive associations were observed among the interquartile ranges (IQRs) of exposure to PM 2.5 within three months before pregnancy and GDM (OR = 2.61, 95% CI: 1.40-4.93, p < .01) as well as fasting glucose levels (β = 0.57, 95% CI: 0.45-0.68, p < .01). The diabetogenic effects of PM 2.5 gradually increased from the first month before pregnancy, peaked in the second month and then gradually decreased until the third month when the week-specific exposure were analyzed to identify the sensitive time window., Conclusion: Our study confirmed that higher exposure to PM 2.5 within three months before pregnancy is significantly associated with increased risk of GDM and elevated fasting glucose levels, reflecting the importance of preconceptional environmental exposure in the development of maternal GDM., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020. Published by Elsevier B.V.)

BACKGROUND Ethnic background may affect the prevalence of nasal bone absence and the length of the nasal bone. This study aimed to elucidate the significance of absent or hypoplastic fetal nasal bone in the Chinese Han population and to formulate an optimal management plan for patients age 35 or older in cases of isolated abnormal fetal nasal bone. MATERIAL AND METHODS We prospectively assigned pregnant women whose fetuses had nasal bone absence or hypoplasia to separate groups according to their choice for noninvasive prenatal screening (NIPS) between January 1, 2013, and December 31, 2018. Demographic data, ultrasound findings, results of conventional maternal serum screening and NIPS, fetal karyotype, pregnancy outcomes, and expenses associated with prenatal testing were recorded. The incidence and odds ratio of nasal bone abnormality and the sensitivity and specificity of different prenatal genetic screening tests were calculated. RESULTS A total of 1946 cases with fetal nasal bone absence or hypoplasia were included. Cases of isolated nasal bone abnormality (1736 cases) were divided into the NIPS group (Gr 1, n=429) and the non-NIPS group (Gr 2, n=1307). Sixty-four cases involved chromosomal abnormality. The sensitivity, specificity, and positive and negative predictive values of NIPS in Gr 1 were 100%, 100%, 100%, and 100%, respectively. The odds ratio of fetal chromosomal abnormalities for isolated fetal nasal bone abnormalities when maternal age was ≥35 was 4.615 (95% CI: 1.592-13.381). The cost-effectiveness ratio of contingent screening (NIPS first) was significantly lower than amniocentesis directly. CONCLUSIONS The nasal bone provides an important marker for chromosome abnormalities in some populations, but to a lesser extent in the Chinese Han population. NIPS is an excellent first option for follow-up among pregnant women age ≥35 in cases of absent or hypoplastic fetal nasal bone in the first trimester ultrasound scan.

Background Women with congenital heart disease are considered at high risk for adverse events. Therefore, we aim to establish 2 prediction models for mothers and their offspring, which can predict the risk of adverse events occurred in pregnant women with congenital heart disease. Methods and Results A total of 318 pregnant women with congenital heart disease were included; 213 women were divided into the development cohort, and 105 women were divided into the validation cohort. Least absolute shrinkage and selection operator was used for predictor selection. After validation, multivariate logistic regression analysis was used to develop the model. Machine learning algorithms (support vector machine, random forest, AdaBoost, decision tree, k-nearest neighbor, naïve Bayes, and multilayer perceptron) were used to further verify the predictive ability of the model. Forty-one (12.9%) women experienced adverse maternal events, and 93 (29.2%) neonates experienced adverse neonatal events. Seven high-risk factors were discovered in the maternal model, including New York Heart Association class, Eisenmenger syndrome, pulmonary hypertension, left ventricular ejection fraction, sinus tachycardia, arterial blood oxygen saturation, and pregnancy duration. The machine learning-based algorithms showed that the maternal model had an accuracy of 0.76 to 0.86 (area under the receiver operating characteristic curve=0.74-0.87) in the development cohort, and 0.72 to 0.86 (area under the receiver operating characteristic curve=0.68-0.80) in the validation cohort. Three high-risk factors were discovered in the neonatal model, including Eisenmenger syndrome, preeclampsia, and arterial blood oxygen saturation. The machine learning-based algorithms showed that the neonatal model had an accuracy of 0.75 to 0.80 (area under the receiver operating characteristic curve=0.71-0.77) in the development cohort, and 0.72 to 0.79 (area under the receiver operating characteristic curve=0.69-0.76) in the validation cohort. Conclusions Two prenatal risk assessment models for both adverse maternal and neonatal events were established, which might assist clinicians in tailoring precise management and therapy in pregnant women with congenital heart disease.

Objective: A continuous survey on influenza was conducted in Hulunbuir, China from January 2010 to May 2019 to reveal epidemiological, microbiological and air pollutants associated with laboratory-confirmed influenza cases., Methods: Influenza-like illness and severe acute respiratory infection subjects were enrolled from a sentinel hospital in Hulunbuir during the study period for epidemiological and virological investigation. The association between air pollutants and influenza-positivity rate was assessed by a generalised additive model., Results: Of 4667 specimens, 550 (11.8%) were tested positive for influenza. The influenza-positivity was highest in the age groups of 5-14 years, 50-69 years and ⩾70 years. We found that the effect of particulate matter ⩽2.5 μm (PM2.5) concentrations on the influenza-positivity rate was statistically significant, particularly on day lag-4 and lag-5. Genetic characterisations showed that (H1N1) pdm09 strains belonged to subclade 6B.1 and that influenza B isolates belonged to subclade 1A-3Del, with significant substitutions in the haemagglutinin and neuraminidase proteins compared with those in the WHO-recommended vaccine strains., Conclusions: Elderly individuals and school-age children were at high risk for influenza infection. PM2.5 concentrations showed significant effects on influenza-positivity rate in Hulunbuir, which could be considered in local influenza prevention strategies.

Background: A novel enveloped RNA beta coronavirus, Corona Virus Disease 2019 (COVID-19) caused severe and even fetal pneumonia in China and other countries from December 2019. Early detection of severe patients with COVID-19 is of great significance to shorten the disease course and reduce mortality. Methods: We assembled a retrospective cohort of 80 patients (including 56 mild and 24 severe) with COVID-19 infection treated at Beijing You'an Hospital. We used univariable and multivariable logistic regression analyses to select the risk factors of severe and even fetal pneumonia and build scoring system for prediction, which was validated later on in a group of 22 COVID-19 patients. Results: Age, white blood cell count, neutrophil, glomerular filtration rate, and myoglobin were selected by multivariate analysis as candidates of scoring system for prediction of disease severity in COVID-19. The scoring system was applied to calculate the predictive value and found that the percentage of ICU admission (20%, 6/30) and ventilation (16.7%, 5/30) in patients with high risk was much higher than those (2%, 1/50; 2%, 1/50) in patients with low risk ( p = 0.009; p = 0.026). The AUC of scoring system was 0.906, sensitivity of prediction is 70.8%, and the specificity is 89.3%. According to scoring system, the probability of patients in high risk group developing severe disease was 20.24 times than that in low risk group. Conclusions: The possibility of severity in COVID-19 infection predicted by scoring system could help patients to receiving different therapy strategies at a very early stage. Topic: COVID-19, severe and fetal pneumonia, logistic regression, scoring system, prediction., (Copyright © 2020 Zhang, Qin, Li, Wang, Zhao, Xu, Liang, Dai, Feng, Sun, Li, Hu, Xiang, Dong, Jin and Zhang.)

The aim of this study was to investigate service needs and health care utilization among people with type 2 diabetes, further to identify the relationship between service needs and health care utilization.We used a self-reported questionnaire to collect data regarding demographic and diabetes characteristics, service needs toward self-management and follow-up care, and 4 health care utilizations during past year. Multiple linear regression and binary logistic regression were used to test the impacts of demographic and diabetes characteristics on service needs and health care utilizations, respectively. Spearman rank correlations were used to explore correlation between service needs and health care utilization.We recruited 1796 participants with type 2 diabetes from 20 community health centers across 12 cities of Sichuan Province in China. Needs of self-management and follow-up had significant positive correlations with health care utilization. Participants rated that nutrition was the most needed aspects of self-management (78.5%), and out-patient visit was the most popular type of follow-up (66.8%). Educational level and treatment modality were predictors of self-management needs. Low educational level (elementary school or blow, β = 0.11, P = .008; middle school, β = 0.10, P = .015) and insulin treatment (β = 0.08, P = .007) were positive factors of self-management needs. Younger age (age < 45 years old, β = 0.07, P = .046), being employed (β = 0.14, P < .001), and underdeveloped region (β = 0.16, P < .001) were positive factors of follow-up care needs. Elementary educational level (OR: 0.53; CI: 0.30-0.96) and underdevelopment region (OR: 0.01; CI: 0.01-0.07) were protective factors of general practitioner visit, in contrast, those factors were risk factors of specialist visit (elementary educational level, OR: 1.69; CI: 1.13-2.5; underdevelopment region, OR: 2.93; CI: 2.06-4.16) and emergency room visit (elementary educational level, OR: 2.97; CI: 1.09, 8.08; underdevelopment region, OR: 6.83; CI: 2.37-14.65).The significant positive relationship between service needs and health care utilization demonstrated the role of service needs in influencing health care utilization. When self-management education is provided, age, educational level, employment status, treatment modality, and region should be considered to offer more appropriate education and to improve health care utilization.

Objectives: This study aims to investigate which neighborhood-based social capital components are associated with a higher level of cognitive function in LMICs., Methods: This international population-based study used cross-sectional survey data from the World Health Organization's Study on global AGEing and adult health (SAGE), a study of adults aged 50 years or older in China, Ghana, India, the Russian Federation, and South Africa from 2007 through 2010 (N = 29 528). Associations between neighborhood-based social capital indicators (trust in neighbors, perceived neighborhood safety, and community participation) and cognitive function were examined using ordinary least squares regressions and random-effects meta-analyses., Results: Results of the meta-analyses of within-country effects indicated that trust in neighbors were positively associated with cognitive function across India, Russia, and Ghana, but negatively associated in South Africa (β = -0.041, SE = .013, P < .01) and no effect in China (P > .05). The significant effect of perceived neighborhood safety was only found in South Africa (β = 0.051, SE = .007, P < .001) and China (β = 0.030, SE = .005, P < .001). Community participation approached a null effect in South Africa (P > .05)., Discussion: Different indicators of neighborhood-based social capital, which are well-established protective resources for cognitive function, may have varied relationships with cognitive function cross-nationally. This finding provides a better understanding of the mechanisms by which neighborhood social capital may contribute to better cognitive function in LMICs than high-income countries, potentially due to differences in neighborhood environments, health systems, and availability of public resources., (© 2019 John Wiley & Sons, Ltd.)

Background: The quality of the dying experience among older adults should improve with a better understanding of the dying experience and its association with the place of death in Mainland China. Objective: This study investigated the relationship between the dying experience and place of death among older Chinese adults in the context of an urban-rural bifurcated system. Design: We used the end-of-life module data from the China Longitudinal Aging Social Survey conducted in 2014 and 2016 with an eligible sample of 352 decedents ages 60 and older. Facial expression and sadness at the end of life were indicators of the dying experience in the present study. We performed multiple regression models to examine the association between the place of death and dying experience after adjusting for an ecological array of factors at the individual, family, and community levels. Results: The urban-rural differences in the association between facial expression at death and place of death were identified (interaction term: β  = 0.16, p  = 0.004). Among the decedents with a rural residence status, dying in a hospital was associated with a more peaceful facial expression at death than dying at home ( p  < 0.001). Among the decedents with an urban residence status, the place of death was not significantly related to the dying experience. Conclusion: Although home is perceived as a common place for death, the findings revealed that dying at home was less positive for rural older adults compared with dying in hospital. Bridging the gaps between urban and rural areas is necessary for the reform and construction of health care and long-term care systems in China.

Objective: A lack of education among migrants remains an important but overlooked issue that indirectly contributes to HIV transmission. It is necessary to know who has received HIV education and who has a lower probability of being educated among migrants across different regions and age groups in China., Methods: We used pooled data from the 2014 and 2015 Migrants Population Dynamic Monitoring Survey. The study population included 406,937 Chinese migrants. Participants were asked whether they had received any HIV education after migrating to the destination city. Regions were categorized into east-coast, central, northwest, southwest, west-Tibet, west-Uyghur, and northeast regions. Hierarchical logistic regression modeling was conducted to investigate the relationships between the independent variables and HIV education., Results: Of 406,937 participants, half (50.6%) had reported receiving HIV education. Individuals in the west-Uyghur region had the highest proportion of receiving HIV education (73.0%), followed by the southwest region (67.9%) and the west-Tibet region (54.8%). Methods of receiving HIV education varied among different age groups. Individuals who were in a region with a higher prevalence of HIV, a lower density of medical professionals, and a higher density of migrants were more likely to receive HIV education., Conclusions: The study showed significant regional disparities among migrants in China. More HIV resources need to be allocated to regions with large-scale floating populations, such as the east-coast region. Providing multiple options, including both new and traditional media, for both young and elderly migrants is essential. HIV education should be tailored to the age of migrants with low educational and income levels.

Objectives: To determine the integrative value of clinical, hematological, and computed tomography (CT) radiomic features in survival prediction for locally advanced non-small cell lung cancer (LA-NSCLC) patients., Methods: Radiomic features and clinical and hematological features of 118 LA-NSCLC cases were firstly extracted and analyzed in this study. Then, stable and prognostic radiomic features were automatically selected using the consensus clustering method with either Cox proportional hazard (CPH) model or random survival forest (RSF) analysis. Predictive radiomic, clinical, and hematological parameters were subsequently fitted into a final prognostic model using both the CPH model and the RSF model. A multimodality nomogram was then established from the fitting model and was cross-validated. Finally, calibration curves were generated with the predicted versus actual survival status., Results: Radiomic features selected by clustering combined with CPH were found to be more predictive, with a C-index of 0.699 in comparison to 0.648 by clustering combined with RSF. Based on multivariate CPH model, our integrative nomogram achieved a C-index of 0.792 and retained 0.743 in the cross-validation analysis, outperforming radiomic, clinical, or hematological model alone. The calibration curve showed agreement between predicted and actual values for the 1-year and 2-year survival prediction. Interestingly, the selected important radiomic features were significantly correlated with levels of platelet, platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR) (p values all < 0.05)., Conclusions: The integrative nomogram incorporated CT radiomic, clinical, and hematological features improved survival prediction in LA-NSCLC patients, which would offer a feasible and practical reference for individualized management of these patients., Key Points: • An integrative nomogram incorporated CT radiomic, clinical, and hematological features was constructed and cross-validated to predict prognosis of LA-NSCLC patients. • The integrative nomogram outperformed radiomic, clinical, or hematological model alone. • This nomogram has value to permit non-invasive, comprehensive, and dynamical evaluation of the phenotypes of LA-NSCLC and can provide a feasible and practical reference for individualized management of LA-NSCLC patients.

T cell epitopes restricted by several protective HLA alleles, such as B*57, B*5801, B*27, B*51 and B*13, have been very well defined over the past two decades. We investigated 32 well-known T cell epitopes restricted by protective HLA molecules among 54 Chinese men who have sex with men (MSM) at the early stage of HIV-1 infection. Subjects in our cohort carrying protective HLA types did not exhibit slow CD4 T cell count decline (P = 0.489) or low viral load set points (P = 0.500). Variations occurred in 96.88% (31/32) of the known wild-type epitopes (rate 1.85-100%), and the variation rates of the strains of two CRF01&#95;AE lineages were significantly higher than those of non-CRF01&#95;AE strains (76.82% vs. 48.96%, P = 0.004; 71.27% vs. 8.96%, P = 0.025). Subjects infected with CRF01&#95;AE exhibited relatively rapid disease progression (P = 0.035). Therefore, the lack of wild-type protective T cell epitopes restricted by classic protective HLA alleles in CRF01&#95;AE HIV-1 strains may be one of the reasons why rapid disease progression is observed in Chinese MSM with HIV-1 infection.

Chronic diseases have become serious threats to public health in China; the risk is particularly high for internal migrants. Chronic disease education is a key to the prevention and control of chronic diseases for such population. The national population-based Migrants Population Dynamic Monitoring Survey (MPSMA) was used to examine the current status and delivery methods of chronic disease education among internal migrants, from both provincial level and individual's level. The study population included 402 587 internal migrants. Multilevel logistic regression was used to investigate factors that were related to chronic diseases education. In total, only 33.9% of the participants received chronic disease education. In the final model, parameter estimates on key variables from both individual and provincial level were significant ( P < .001). Participants from provinces with higher level of health care resources and lower density of internal migrants were more likely to receive chronic disease education. The percentage and methods of receiving education varied across different age groups. This study suggests that future chronic disease education in China need to be more focused on areas with high density of internal migrants and younger internal migrants with low level of education and income. Attention should be paid to use tailored education methods to different populations.

Objective: This study aims to investigate the distribution of HLA-A genes and identify alleles related to cervical cancer., Materials and Methods: A total of 252 cervical cancer patients (56 Han ethnic and 196 Uyghur ethnic) and 213 controls (103 Han ethnic and 110 Uyghur ethnic) were recruited in this study. HLA-A alleles were examined by polymerase chain reaction with sequence-specific primers. The frequencies of different HLA-A alleles were compared between the two ethnic groups as well as patients and controls. The correlation of HLA-A frequencies with various clinical characteristics and short-term treatment efficacy was analyzed., Results: (1) Significantly higher frequencies of HLA-A*03:01 and HLA-A*03:02 and lower frequencies of HLA-A*11:01, HLA-A*24:02, and HLA-A*30:01 were observed in the Uyghur control groups than in Han control groups (P ≤ 0.05). (2) The frequency of HLA-A*01:01 in patients was significantly higher than controls. In contrast, the frequencies of HLA-A*30:01 and HLA-A*33:03 were lower in patients (P ≤ 0.05). (3) The frequency of HLA-A*30:01 in Han patients was lower than Han control group (P ≤ 0.05). However, there was no statistically significant in the frequency of HLA-A between Uyghur patients and controls (P > 0.05). (4) There was no significant association between HLA-A alleles and HPV16 or squamous cell carcinoma antigen levels (P > 0.05). (5) The frequency of HLA-A*30:01 allele in complete response + partial response group was higher than stable disease + progressive disease group (P ≤ 0.05)., Conclusions: People from two ethnic groups displayed different HLA-A gene distribution. HLA-A*30:01 and HLA-A*33:03 alleles are the protective factors to cervical cancer patients from Xinjiang while HLA-A*01:01 serves as the susceptible gene., Competing Interests: There are no conflicts of interest

In order to examine the effects of thinning and reshaping on canopy structure, leaf physio-logical property at late growth stage, characteristic of nutrient accumulation and distribution in leaf, and the spatial and temporal distribution of soil moisture, 18 year-old 'Fuji' apple trees in dense apple orchards were used to measure the canopy size, types and numbers of branches, leaf area index before and after the thinning and reshaping practices. The results showed that before pruning, the photosynthesis was limited by non-stomatal factors, with a reduction in F v /F m , F v /F o PIabs by 1.2%, 11.5%, 13.9%, respectively. However, the thinning and reshaping practices reduced leaf area index and canopy coverage, increased light interception up to 79% and improved tree construction. The total number of shoots decreased to 1100400 per hectare, while the individual shoot numbers were increased by 5.0% and the ratio of spur increased up to 73%. Due to the improvement of canopy lighting distribution, the average leaf area, specific leaf quality, hundred leaf mass and chlorophyll content were increased. With the increases of photosynthesis, the accumulation of photosynthate such as starch was increased by 143.5%. There was a close correlation between leaf development and light interception. Our results indicated that tree structure and canopy light interception could be improved by thinning and reshaping the dense trees, which resulted in higher leaf growth, development and photosynthetic capability but less water loss. Thinning and reshaping should be recommended to the renewal of the dense apple orchards in Loess Plateau of eastern Gansu.

Objective: To construct a monitoring and risk assessment system of schistosomiasis epidemic focus in marshland, so as to grasp the risk of schistosomiasis transmission, and to provide the technical support for targeted prevention and control measures., Methods: The crowd and the risk source of schistosomiasis in Hankou marshland in Wuhan City were monitored to grasp the risk factors of schistosomiasis. The risk level was evaluated by the three-dimensional risk matrix and three-dimensional visualization method., Results: The total numbers of people on holidays and working days were 59 582 and 36 382 persontimes a day respectively in Hankou marshland. Fishing and swimming were the most common ways to contact the river water. The most majority of the people exposed to river water were male (73.9%), retirees (36.1%), local residents (69.7%) and people whose income was 1000 - 3000 yuan per month (52.1%), and the awareness of protection of them was low. In spring, the average density of living Oncomelania hupensis snails was 0.993/0.1 m 2 , the rat density was 7.72%, and the density of wild feces was 0.78/hm 2 . In autumn, the average density of living snails was 0.596 /0.1 m 2 , the rat density was 5.22%, and the density of wild feces was 0.32/hm 2 . The average density of living snails, the rat density and the density of wild feces were reduced by 39.9%, 32.4% and 59.0% respectively in autumn compared with those in spring. The risk assessment results of three-dimensional matrix showed that part 1 and part 2 were medium risk, part 3 was high risk and part 4 was maximum risk. The risk assessment results of the visualization method showed that the risk level increased from part 1 to part 4, which were basically consistent with the results of the risk matrix., Conclusions: There is a relatively large risk of schistosome infection in Hankou marshland in 2013. The surveillance and risk assessment system of epidemic focus is feasible and scientific.