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Purpose: Currently, there are no reliable preoperative methods for predicting component separation (CS) during incisional hernia repair. By quantitatively measuring preoperative computed tomography (CT) imaging, we aimed to assess the value of hernia defect size, abdominal wall muscle quality, and hernia volume in predicting CS. Methods: The data of 102 patients who underwent open Rives-Stoppa retro-muscular mesh repair for midline incisional hernia between January 2019 and March 2022 were retrospectively analyzed. The patients were divided into two groups: "CS group" patients who required CS to attempt fascial closure, and "non-CS" group patients who required only Rives-Stoppa retro-muscular release to achieve fascial closure. Hernia defect width, hernia defect angle, rectus width, abdominal wall muscle area and CT attenuation, hernia volume (HV), and abdominal cavity volume (ACV) were measured on CT images. The rectus width to defect width ratio (RDR), HV/ACV, and HV/peritoneal volume (PV; i.e., HV + ACV) were calculated. Differences between the indices of the two groups were compared. Logistic regression models were applied to analyze the relationships between the above CT parameters and CS. Receiver operator characteristic (ROC) curves were generated to evaluate the potential utility of CT parameters in predicting CS. Results: Of the102 patients, 69 were in the non-CS group and 33 were in the CS group. Compared with the non-CS group, hernia defect width (P < 0.001), hernia defect angle (P < 0.001), and hernia volume (P < 0.001) were larger in the CS group, while RDR (P < 0.001) was smaller. The abdominal wall muscle area in the CS group was slightly greater than that in the non-CS group (P = 0.046), and there was no significant difference in the CT attenuation of the abdominal wall muscle between the two groups (P = 0.089). Multivariate logistic regression identified hernia defect width (OR 1.815, 95% CI 1.428–2.308, P < 0.001), RDR (OR 0.018, 95% CI 0.003–0.106, P < 0.001), hernia defect angle (OR 1.077, 95% CI 1.042–1.114, P < 0.001), hernia volume (OR 1.002, 95% CI 1.001–1.003, P < 0.001), and CT attenuation of abdominal wall muscle (OR 0.962, 95% CI 0.927–0.998, P = 0.037) as independent predictors of CS. Hernia defect width was the best predictor for CS, with a cut-off point of 9.2 cm and an area under the curve (AUC) of 0.890. The AUCs of RDR, hernia defect angle, hernia volume, and abdominal wall muscle CT attenuation were 0.843, 0.812, 0.747, and 0.572, respectively. Conclusion: Quantitative CT measurements are of great value for preoperative prediction of CS. Hernia defect size, hernia volume, and the CT attenuation of abdominal wall muscle are all preoperative predictive indicators of CS. [ABSTRACT FROM AUTHOR]

The concentrations and stoichiometry of soil carbon (C), nitrogen (N), and phosphorus (P) have critical implications for nutrient cycling and ecosystem function. While their high sensitivity to atmospheric N deposition is well known, it remains unclear for the soil depth-dependence of such responses to N deposition. Here, we examined the responses of soil C : N : P stoichiometry at three soil depths in the upper humus horizon (0–5, 5–10, and 10–20 cm) of Haplic Chernozem (Loamic) across a gradient of urea addition rates (0, 2, 10, 20, and 50 g N m–2 year–1) after five years treatments in a hay-harvest meadow steppe of northern China. We found that the effects of increasing N addition rates on the concentrations and stoichiometry of soil C, N and P did not depend on soil depth, though those parameters varied greatly across different soil layers. Across all soil depths, the concentrations of soil C and N increased with increasing N addition rates, but soil P concentration was not affected by N addition. The higher sensitivity of soil N than soil C to N enrichment resulted in decreasing soil C : N ratio across the N addition gradient, especially for the surface soil layer. Soil N : P ratio showed a positive response to the increases of N addition rates. The unbalanced responses of soil C, N, and P concentrations to N enrichment, as indicated by the decreases of soil C : N ratio and the increases of soil N : P ratio across the N addition gradient, highlighted the role of N enrichment in decoupling soil nutrient cycling in the temperate steppe. [ABSTRACT FROM AUTHOR]

Copyright of SHILAP Revista de Lepidopterologia is the property of Sociedad Hispano-Luso-Americana de Lepidopterologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The study was conducted to identify relationships between single nucleotide polymorphisms (SNPs) in the NOD1 and NLRP9 genes and resistance to H. contortus infestation in goats in China and Bangladesh. A total of 507 unrelated goats from 6 different populations were sampled. Fecal egg count (FEC) was determined and genomic DNA was extracted from those goats. Touchdown PCR assays were used to genotype each of the target SNP. An association study was carried out using a generalized linear model and R software after transforming the FEC as log10 (FEC + 25). All breeds of goat in Bangladesh had lower mean FEC than any of the Chinese breeds. Two single nucleotide polymorphisms (SNPs) viz. NOD1_146_A>G (p<0.001) and NLRP9_43_A>G (p<0.003) were significantly associated with FEC trait after H. contortus infection. Goats with the GG genotype for NOD1_146_A>G (904.43 ± 140.65epg) and the AA genotype for NLRP9_43_A>G (1129.57 ± 196.5 epg) had higher FEC than goats with the AA genotype (396.68 ± 67.22 epg) or the GG genotype (399.12 ± 106.4 epg) at the respective loci. NOD1 and NLRP9 genes were significantly associated with FEC and might be related to resistance to H. contortus infection in goats. [ABSTRACT FROM AUTHOR]

Objectives: Few studies have explored the optimal dosing for efavirenz in individuals from China. We investigated plasma efavirenz concentrations and their association with efficacy and tolerance of efavirenz 600 mg daily in Chinese HIV‐infected adults. Methods: An analysis was performed using plasma samples from 455 patients enrolled in a prospective multicentre trial in China. A total of 1198 plasma samples collected at weeks 4, 24 and 48 following antiretroviral therapy initiation were analysed. The mid‐dose interval efavirenz concentrations (C12) were determined using high‐performance liquid chromatography. Results: The median efavirenz concentration (interquartile range) steadily increased over time from 3.02 (2.28–4.23) to 3.71 (2.91–4.91) mg/L from week 4 to 48 (P < 0.001). The proportion of patients with C12 > 4.0 mg/L also rose from 28.0% to 34.2% and 43.8%, measured at 4, 24 and 48 weeks, respectively (P < 0.001). Five patients had efavirenz concentrations < 1.0 mg/L at week 4, 24 or 48. In the multivariable regression analysis, lower body weight and non‐Han ethnicities were associated with higher efavirenz concentrations over time. At each time‐point, patients with a body weight < 60 kg had significantly higher efavirenz C12 compared with those with body weight ≥ 60 kg (P < 0.05). Conclusions: Efavirenz concentrations increased steadily over 48 weeks, and a substantial proportion of participants had efavirenz C12 above the upper limit of the proposed therapeutic window, especially those with low body weight (< 60 kg). Based upon these findings, a dosage reduction of efavirenz to 400 mg daily may warrant consideration in this population, especially for those with lower body weight. [ABSTRACT FROM AUTHOR]

The Chinese government implemented the ambitious south-north water transfer project ( SNWTP), which aims to transport water from the Yangtze to the north of China where water shortages are severe. Although the ecological impacts of this project have been addressed publically, there remains a poor understanding of the effects of such large-scale water transfers on the populations of aquatic species. The potential ecological impacts of such water transfers on the Hongze Lake fish assemblages are assessed here using Self-Organizing Map ( SOM) and Random Forest ( RF) modeling. Using SOM, twenty-three fish species in 15 sampling sites were classified into two assemblages and four sub-assemblages corresponding to four distinct habitats (deep water macrophytes, deep water bare silt, shallow water bare silt, and shallow water macrophytes). The RF model further showed that water depth and transparency were the abiotic drivers underpinning fish assemblages in Hongze Lake. As the SNWTP is forecasted to modify the distribution of water depth and water clarity, major knock-on effects are expected on downstream lake fish assemblages. [ABSTRACT FROM AUTHOR]

Aims To evaluate the prevalence and risk of diabetes based on family history in high-risk subjects and also to evaluate insulin sensitivity and insulin secretion in these subjects. Methods Data were analysed from 9756 participants in the Shanghai High-Risk Diabetic Screen ( SHi DS) Project. Family history of diabetes was classified according to parental and sibling diabetes status. The prevalence and odds ratios were calculated for each grouping after adjusting for other risk factors. Insulin resistance and sensitivity were evaluated using oral glucose tolerance test-derived indices that were validated by hyperinsulinaemic-euglycaemic and hyperglycaemic clamps. Results A total of 30.4% of the subjects had a family history of diabetes in a first-degree relative. The proportions of subjects with a father, mother or sibling with diabetes were 7.5, 11.9 and 5.5%, respectively. The prevalence rates of diabetes in subjects with sibling history, maternal history or paternal history of diabetes were 39.3, 38.3 and 36.4%, respectively. Sibling history was a strong risk factor for diabetes (odds ratio 1.53, 95% CI 1.27-1.84; P < 0.05). Insulin secretion was significantly lower in those with a maternal or sibling history of diabetes; however, insulin sensitivity was not significantly different among subjects with a family history of diabetes. Conclusions Sibling history of diabetes was more strongly associated with diabetes risk than parental history among high-risk subjects. Subjects with a sibling or maternal history of diabetes had significantly lower insulin secretion. Sibling history is an important and independent risk factor for diabetes even among multi-risk populations. Those with a sibling history of diabetes warrant intensive care and follow-up screening. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study aims to evaluate the role of age and comorbidities on postoperative complications in the patients with advanced gastric cancer (AGC) following laparoscopy-assisted gastrectomy (LAG) and D2 lymphadenectomy based on the results from the Chinese Laparoscropic Gastrointestinal Surgery Study (CLASS) Group. Methodology: From February 2003 and December 2009 at twenty-seven medical centers, 1184 AGC patients after LAG with D2 lymphadenectomy were entered and followed in a retrospective recorded database. The postoperative complications were recorded by using the Accordion Severity Grading System. Results: Postoperative morbidity and mortality after LAG and D2 dissection in the AGC patients was 10.1% and 0.1%, respectively. Multivariable analysis identified age ≥65 years (OR = 1.72, P = 0.024) and having two or more comorbidities (OR = 2.76, P = 0.009) as the significant predictors of the development of postoperative complications. Meanwhile, age ≥65 years (OR = 1.95, P = 0.016) and having two or more comorbidities (OR = 3.62, P = 0.001) were also the significant predictors of moderate or severe complications. In stratified analysis by the number of comorbidities, age ≥65 years was significantly associated with an excess risk of postoperative complications (OR = 2.35, P = 0.033), and the moderate or severe complications (OR = 4.36, P = 0.003) when the patients had at least one comorbidity. Conclusions: LAG would be a safe and technically feasible approach for the AGC patients, despite age ≥65 years and having multiple comorbidities were the potential risk factors for postoperative complications. Importantly, elderly patients with resectable gastric cancer should not be excluded from the potential benefits of LAG provided that comorbidities are fully considered. [Copyright &y& Elsevier]

Groundwater contamination caused by petroleum hydrocarbon (PHC) spills mostly from oil industry is a major environmental concern worldwide. However, infiltration into groundwater is decreasing due to the natural attenuation processes of PHCs in vadose zone, which acts as a safeguard of invaluable groundwater resource against contamination. This study was conducted to determine the retardation capacity of vadose zone and its influence factors based on investigations of a petroleum-contaminated site in NE China. Column leaching experiments in homogeneous and heterogeneous soils were utilized to simulate the actual infiltration process, which aimed to understand the variation of PHC compounds in vadose zone and to examine the effects of soil and water properties on the diversification of the compounds by using gas chromatography-mass spectrometry (GC-MS). The results showed that adsorption and biodegradation are dominant processes and 84 %, 76 %, and 66 % of the organic contaminants were entrapped in fine, medium, and coarse sands, respectively. This was mainly caused by the adsorption coefficient ( K), which was linked with the soil properties; more specifically, smaller soil aggregates mean a higher K value and such discrimination also exists among petroleum compounds. Real-time polymerase chain reaction (RT-PCR) and culture-based methods were applied to identify the degrading microorganisms. Results demonstrate that these microorganisms could degrade compounds such as chainalkanes (ChA), cycloalkanes (CyA), and aromatic (Ars) into asphaltenes (Asp). The microorganism population increased with biodegradation products and the consequence of biodegrading capacity was (from high to low): ChA, CyA, and Ars; chemical analyses in the heterogeneous soil experiment indicated that concentration of the biodegradation products in leachate was negatively correlated to dissolved oxygen (DO) as a consumption of oxidants but positively correlated to electrical conductivity (EC) and pH of water. Enzyme activities and microorganism population of soil were positively correlated to concentration of biodegradation products. [ABSTRACT FROM AUTHOR]

Peak bone mass is an important factor influencing the occurrence of osteoporosis and osteoporotic fracture in adulthood. We measured the areal bone mineral density (BMD) in a Chinese male infantry recruit group ranging in age from 17 to 23 years and subsequently assessed peak BMD at the lumbar vertebrae and hip. This study included 812 Chinese men of Han ethnicity from 11 provinces and municipalities of China. The BMD, bone mineral content and the bone area of the lumbar vertebrae (L1-4), left femoral neck and total hip were measured using dual-energy X-ray absorptiometry. Height, weight, waist and hip circumference were also measured at the same time. BMD at the lumbar vertebrae, femoral neck and total hip reached a plateau at 22 years of age. The peak value of BMD at these 3 sites was 1.209 ± 0.175, 1.098 ± 0.177 and 1.122 ± 0.151 (g/cm2 ), respectively. Stepwise regression analysis showed that age and weight most contributed to the variance in BMD (P < 0.001). The average age when reaching peak BMD in this study is earlier than the ages reported in previous studies, and the value of peak BMD is higher than that reported previously in Chinese males. This study provides the newest peak BMD data on Chinese men. [ABSTRACT FROM AUTHOR]

This study was conducted to determine the potential of in situ biodegradation and identify the geochemical and microbial processes of the petroleum-contaminated subsurface environment using integrated hydro-bio-geochemical markers so that the risk of contamination to subsurface environment can be better understood. The contamination process and corresponding bio-geo-chemistry were analysed in parallel with geochemical and multi-variant statistical modelling at a petroleum-contaminated site in the northeast China. The total petroleum hydrocarbon analysed in the monitoring wells and soil profile demonstrated heavy contamination with potential risk to human health and eco-environment. Further detailed analysis of petroleum fractions revealed a clear spatial variation of organic compositions in groundwater. It was evident that biodegradation and preferential biodegradability contributed considerably to the fraction distribution pattern, which can also be implicated by carbon and microbial respiration in the subsurface environment. The steady decrease in SO concentration, detection of S, and increase in pH and alkalinity (HCO) in groundwater during the monitoring period demonstrated that sulphate reduction was the dominant biodegradation process in most contaminated zones. The results of statistical analysis further suggested that the hydro-geochemical environment was mainly controlled by the regional hydro-geochemical and sulphate reduction process associated closely with the total petroleum hydrocarbon. Knowledge from the comprehensive study provides useful insight on fate, transport and risk assessment of the petroleum contaminants in the shallow subsurface environment. [ABSTRACT FROM AUTHOR]

The imipenem and meropenem-resistant strains Citrobacter freundii HS70 and Escherichia coli HS510 were isolated from patients in Shanghai, China. By isoelectric focusing, PCR amplification and sequencing, these strains were each found to produce four β-lactamases: TEM-1, KPC-3, SHV-7 and CTX-M-14. A conjugation experiment and plasmid restriction digestion revealed that the bla gene was located on the same plasmid in both isolates. Bidirectional primer walking sequencing showed that the nucleotide sequence surrounding the 3.8 kb bla contained a 671-bp insertion similar to that previously characterized in China. The insertion was located between the promoter and the coding region of the bla gene. Susceptibility testing performed on recombinant strains carrying the bla gene with or without the insertion revealed that minimum inhibitory concentrations of imipenem, meropenem, cefepime, and cefotaxime for E. coli EMU-KPC3 (without insertion) were four times higher than that of E. coli EKPC3 (with insertion). The 671 bp insertion reduced bla expression significantly. Taken together, these results suggest that KPC-3-producing C. freundii and E. coli have begun to emerge in our hospital. [ABSTRACT FROM AUTHOR]

Abstract: Four soils were collected from different sites of China in Lechang (LC, Guangdong province), Changsha (CS, Hunan province), Jiaxing (JX, Zhejiang province) and Hangzhou (HZ, Zhejiang province), and were spiked with Cu (50 mg kg−1) and Cd (5 mg kg−1). The effects of rice straw addition (6%) on the chemical distribution of both metal ions were studied by measuring the soluble metal ion concentrations and the free metal ion concentrations (using the Donnan membrane technique) after 1-, 3- and 6-month incubation. Results show that the addition of rice straw increased soil pH by about 0.4 pH unit on average, and increased DOC significantly in soil LC, CS and JX, but not in soil HZ. With the addition of rice straw, total soluble Cu concentration increased from 0.82 µmol l−1 (0.26–2.4 µmol l−1) to 1.22 µmol l−1 (0.70–3.60 µmol l−1), whereas total soluble Cd concentration decreased from 20 nmol l−1 (2–70 nmol l−1) to 15 nmol l−1 (2–56 nmol l−1). When rice straw was added, both free Cu2+ and Cd2+ concentrations decreased, for free Cu2+ concentration from 217 nmol l−1 (31 to 369 nmol l−1) to 124 nmol l−1 (22 to 263 nmol l−1) and for free Cd2+ concentration from 16 nmol l−1 (1–55 nmol l−1) to 12 nmol l−1 (1–43 nmol l−1). With the increase of incubation time, free Cu2+ concentration tended to increase but free Cd2+ concentration decreased. Speciation model calculations show that compared to the binding capacity of soil organic matter, the capacity of rice straw is much less important. The decrease of free metal ion concentration upon rice straw addition can be attributed mainly to the increased pH. The higher DOC content in the rice straw treatment could be the reason for higher soluble Cu concentration when rice straw was added. Adsorption to DOC is much less important for Cd than for Cu. Calculation also shows that adsorption to clay minerals plays a more important role for Cd than for Cu, which may explain the stronger ageing effects on Cd distribution. [Copyright &y& Elsevier]

Abstract: The impact of sewage irrigation on the uptake and translocation of mercury (Hg) in corn plants (Zea mays) was investigated. Corn plants were harvested the same day from two nearby fields in suburban Beijing, one irrigated historically with sewage effluent, and one irrigated solely with groundwater. Hg content was analyzed in the soil, roots and stems, while percent moisture and soil organic content were analyzed in the soil samples. The concentration of Hg in the soil and roots, and the soil organic content were not significantly different between the two fields, despite the historic practice of sewage irrigation. Hg content in roots was positively correlated with soil Hg concentration (r =0.95, n =6). The transfer coefficients between roots and stems were significantly higher in the control site (control: 2.06, sewage-irrigated: 0.44, p <0.05), indicating that the barrier effect of the roots was not consistent between the two fields. [Copyright &y& Elsevier]

Objective: To investigate the prevalence of low body weight in Beijing pubertal girls and to establish the cut-off for body mass index (BMI) for underweight for Chinese pubertal girls. Design: Cross-sectional study. Setting: Three socioeconomic areas (rural, suburban and urban) in Beijing, China. Subjects: Random sample of 1214 adolescent girls aged 12-14y from 13 middle schools. Results: Using a modified Chinese reference, the rate of low body weight (BMI < 18) was 32.2% (95% CI 29.6-34.8%). Compared with desirable weight girls (BMI = 18-21), girls with low body weight had a lower bone age, delayed breast and pubic hair development, a lower rate of menarche, lower distal one-third radius and ulna bone mineral content (BMC), bone mineral density and bone width. Logistic regression showed that BMI was one of the predictors of one-third ulna BMC after adjustment for confounding variables. When comparing BMI < 18 vs BMI = 18-21, the risk of BMC being less than the median increased by 82% (odds ratio 1.82, 95% CI 1.06-3.13). Thinness and stunting rates assessed by WHO recommended cut-offs are also reported. Conclusions: High prevalence of low body weight (BMI < 18) was found to be a major health problem among Beijing pubertal girls. BMI < 18 is confirmed as the cut-off for delayed general growth and development for Chinese girls and for screening girls at risk of lower bone mineral status. Sponsorship: The research was supported in part by the Dairy Research and Development Corporation, Australia. [ABSTRACT FROM AUTHOR]

Prostate cancer (PCa) is one of the most common cancer and one of the leading causes of mortality among males worldwide. This study was to estimate the budget impact of degarelix for the treatment of prostate cancer from Chinese healthcare payer's perspective. A budget impact model was established to estimate the potential economic impact of adding degarelix to Chinese national reimbursement drug list (NRDL) over a 5-year time horizon (2019-2023). [Extracted from the article]

Octopus minor is an economically important resource commonly found in Chinese coastal waters. Mitochondrial DNA NADH dehydrogenase subunit 2 (ND2) gene were applied to assess genetic variation among eight populations collected from northern to southern part of China coast. Twenty four haplotypes were detected from 112 individuals of eight populations. Overall high haplotype (0.813) and low nucleotide diversity (0.044) was observed. AMOVA revealed (88.78%) variation among population and (11.22%) within population. The pairwise FST ranged between (-0.011 to 0.992. Gene flow (Nm) of Wenzhou and Dongshan population was much lower among others. Neighbour joining (NJ) tree clustered eight populations into three clades. Network analysis revealed that two (Hap1-Hap 9) haplotypes appeared in six and four populations respectively. The mismatch distribution showed unimodal pattern in calde two and three which suggested population expansion while clade one showed stability. The deviation might be result of several causes including low dissemination ability, influenced by late Pleistocene geological period or Changiang River outflow on population structure of O.minor. These results will enhance our understanding for better exploitation, protection and management of O.minor. [ABSTRACT FROM AUTHOR]

Although a number of cases of importation with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported, there are still no data available concerning the characteristics in the coronavirus disease 2019 (COVID-19) cluster of charter flight importation. Here, we provide an analysis of COVID-19 cases and their close contacts who worked for the same company on a project in Karbala, Iraq, and returned back to Chengdu, China, by a charter flight. The data of imported COVID-19 cases and their close contacts were obtained from National Notifiable Disease Report System of Chinese Center for Disease Control and Prevention and field epidemiological investigation reports by Centers for Disease Control and Prevention (CDCs) in Chengdu. The information of general characteristics and laboratory findings of this cluster were collected and summarized. One hundred and six (66.67%) of 159 charter flight passengers tested positive for COVID-19 before entry. Through treatment, all 159 people tested negative and meet the requirements of taking flights bound for China before boarding. However, there has been still 36 (22.64%) of them tested positive after entry. The median time from entry to confirmation was 1.0 day (Interquartile Range (IQR): 0–4.3). The Cycle threshold value (Ct value) of 36 patients' positive samples are all above 30 and most values are above 35. In conclusion, there is still a risk that a number of COVID-19 cases can be imported through charter flight. However, the infectivity of confirmed patients of the charter flight was considered to be low. [ABSTRACT FROM AUTHOR]

Studies allele frequencies of STR loci in Chinese population living in Jiangsu Sheng, China. Collection of blood samples from unrelated Han ethnic group; Sufficiency of the size of the study population for the research purpose; Safety and reliability of the Chelex 100 method in the extraction of DNA from the blood specimen; Results of the verification whether the genotype distribution conformed to Hardy-Weinberg equilibrium predictions.

Background: A phase 2 study was done to evaluate the safety and efficacy of clofarabine in paediatric patients with refractory or relapsed acute lymphoblastic leukaemia (ALL) in China. Methods: Patients aged 1-21years with histologically confirmed, relapsed or refractory ALL were eligible. Clofarabine was administered intravenously for 5days at 52mg/m² per day during induction and consolidation. The primary endpoint was overall remission rate (ORR; complete remission [CR] plus CR with incomplete counts [CRi]). Blood samples were collected for pharmacokinetic analysis. Findings: A total of 44 patients were enrolled, of whom 43 were evaluable for response. The median age was 13years (range 5-22years), and the majority were B cell-ALL (75%, 33/44). The ORR was 44.2% (19/43), including two CR and 17 CRi. 39 patients had progressive disease at cut-off time; the overall median remission duration was 2.9months, and 3.4months for patients achieved CR or CRi. Subgroup analysis showed that efficacy differed significantly by age and phenotype of the cell (age <14years versus age ≥14years: 60.9% versus 25%, p=0.0308; B-cell ALL versus T-cell ALL: 57.6% versus 0, p=0.002). The most common (≥10%) adverse reactions (ADRs) were haematological toxicity, gastrointestinal reaction, and abnormal liver function, and the most common grade 3 or 4 non-haematological ADR was ALT elevation (13.6%). PK analysis showed that after multiple administrations the mean elimination half-life of clofarabine was 6.43h, and the Tmax was around 2h. The mean Cmax and exposure to clofarabine over the dosing period (AUC 0-24) were 581µg/L and 2602.56µg/L, respectively. Interpretation: Single-agent clofarabine treatment is effective in Chinese paediatric patients with multiple relapsed or refractory ALL, with an acceptable safety profile. [ABSTRACT FROM AUTHOR]

The aim was to investigate the activity of ceftazidime/avibactam (CAZ/AVI) against carbapenem-resistant Klebsiella pneumoniae (CRKP) and identify the resistance mechanisms before CAZ/AVI coming to Chinese market. Clinical CRKP isolates were continuously collected from 36 tertiary hospitals in China from 1 March 2017 to 31 July 2017. CAZ/AVI MICs were determined by agar dilution method. CAZ/AVI resistant isolates were submitted to whole genome sequencing. The copy number and relative expression of bla KPC were determined by quantitative PCR. A total of 872 CRKP isolates were collected, and MIC 50 and MIC 90 of CAZ/AVI were 4 and 8 mg/L. The resistant rate of CAZ/AVI was 3.7% (32/872). Among the resistant isolates, 53.1% (17/32) were metallo-β-lactamase-producing K. pneumoniae (MBL-KP), 40.6% (13/32) were Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-KP) and 6.3% (2/32) produced both MBL and KPC. One of the KPC-KP with high level CAZ/AVI resistance (>128 mg/L) harboured mutated bla KPC-2 (D179Y). In 12 wild-type bla KPC-2 isolates, the relative copy number and expression of bla KPC-2 gene were 2.5-fold and 2.7-fold higher than that in the CAZ/AVI MIC ≤0.5 mg/L group (p < 0.05), and when added avibactam at a fixed concentration of 8 mg/L, 91.7% (11/12) isolates could restore susceptibility. Resistance against CAZ/AVI in CRKP emerged before clinical use of CAZ/AVI in China, although most of the CRKP isolates maintained the susceptibility. MBL production, bla KPC-2 point mutation and high KPC expression played an important role in CAZ/AVI resistance. [ABSTRACT FROM AUTHOR]

Sewage sludge (SS) is commonly used as agricultural fertilizer worldwide. However, the toxic metal(loid)s in SS raises concerns about soil contamination and the potential risks to human health. This study, conducted since 2007 on the North China Plain, examines the impact of SS use on crops. An experiment was designed with five treatments: conventional fertilization (CK) and four levels of SS application (W1, W2, W3, and W4: 4.5, 9.0, 18.0, and 36.0 t ha -1 , respectively). Soil concentrations of eight toxic metal(loid)s (Zn, Cu, Cr, Cd, Ni, Pb, As, and Hg) were analyzed to assess pollution risk using various indices. Health risks associated with maize and wheat grains were also evaluated. Additionally, the impact of long-term SS application on crop yield, soil quality, and human health within a wheat-maize rotation system was examined. SS application increased wheat and maize yields by 5.37 to 19.08 % and 6.97 to 17.94 %, respectively, across treatments W2 to W4. Despite the toxic metal(loid)s in the grains remaining within safe limits, their concentrations showed an upward trend, especially under the W4 treatment. Moreover, SS application significantly increased the soil Zn, Cu, Cr, Cd, Pb, and Hg levels (P < 0.05) without exceeding the national standards. The geo-accumulation index values revealed rising pollution levels for Zn, Cu, Cd, and Hg, which shifted from no contamination to moderate contamination and then to moderate-to-high contamination, yet the overall pollution level remained safe. Soil ecological risks increased from moderate to serious, with Hg posing the greatest risk, particularly under the W4 treatment. Long-term crop intake from the area significantly exposed children and adults to As, contributing 42.12 % and 34.62 % to hazard index (HI), respectively. The HI values for toxic metal(loid)s in these grains surpassed one in both age groups, suggesting health risks from long-term SS cultivated crops., 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.)

Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are emerging environmental endocrine disruptors that may adversely affect the human endocrine system, particularly the thyroid gland, the largest endocrine gland in the human body. An epidemiologic survey was conducted involving 318 community residents in Shanghai, China, to assess PFAS exposure levels. The relationship between PFAS exposure and five thyroid function indicators was analyzed using Bayesian Kernel Regression (BKMR) and Weighted Quantile Sum Regression (WQS). Ten effector genes related to PFAS and thyroid diseases were identified through the Comparative Toxicogenomics Database (CTD) for bioinformatics analysis and pathways involved were explored through mediation analysis. In vivo validation of these effector genes was conducted using PCR, complemented by in vitro cellular experiments involving transcriptome sequencing and the construction of animal models to simulate mixed PFAS exposure in the general population. Mixed PFAS exposure was found to impact thyroid health primarily through pathways related to lipid metabolism in toxicogenomic studies and resulted in the upregulation of key genes associated with lipid metabolism in animal models. Our results demonstrate that PFAS exposure could affect the expression of lipid metabolism pathways through the modulation of transcription factors, contributing to the development of thyroid disease.

In recent years, cell therapy research and commercialization have significantly accelerated, especially after the US FDA approved CAR-T therapy. While cell therapy now leads immuno-oncology in clinical trials, challenges such as redundant R&D, target clustering, and unmet clinical need remain. Since 2017, China has established a dual-track regulatory framework, facilitating rapid growth in its cell therapy pipeline, making it the second largest in the world. Despite this progress, China faces similar global challenges. Our study covers 2,794 registered cell therapy clinical trials in China, including 2,045 for immune cell, 683 for stem cell, and 66 for other somatic cell. It compares cell therapy products approved in China, the US, EU, and Japan, analyzes the evolving clinical trials landscape, and highlights the characteristics of investigator-initiated trials (IITs) and industry-sponsored trials (ISTs) in China. Our findings indicate that despite the high disease burden and unmet clinical needs for solid tumors in China, over 38% of trials between 2021 and 2023 focused on hematologic malignancies with established targets like CD19 and BCMA. Over 90% of trials are IITs, which show notable clinical differences from ISTs. We recommend that Chinese regulators establish specific guidelines to promote clinical-value-driven research. Stricter regulatory standards should also be implemented to minimize redundant R&D. Additionally, a value-based reimbursement system for within-class targeted cell therapy products may further reduce duplicated R&D efforts. Given the prevalence of IITs, specifying requirements for IITs could create a new pathway to accelerate product development and better address unmet clinical needs in China., (© 2024. The Author(s).)

Background: Transfusion-dependent β-thalassemia (TDT) is one of the global public health concerns highlighted by the World Health Organization. Patients with TDT require regular blood transfusion to survive. However, the availability of blood resources is extremely limited. The purpose of this study was to investigate transfusion burden and willingness to pay (WTP) for temporary remission of anemia status among patients with TDT and to explore the associated factors., Methods: Adult patients with TDT were recruited through cluster sampling across several high-incidence provinces in China. Consenting patients completed online questionnaires on demographic information, transfusion burden and WTP with real-time WeChat communication assistance from researchers. The guiding techniques of double-bounded dichotomous choices and open-ended questions in the contingent valuation method (CVM) were used to obtain participants' WTP for 1 unit of leukocyte-depleted red blood cells. WTP calculations were performed using maximum likelihood estimation, with further insights gained through subgroup analysis based on gender, family monthly income level and convenience of blood transfusion., Results: The analysis included 149 TDT patients from five high-incidence provinces, with an average monthly income of $198.5. Patients received an average of 3.7 units per transfusion, 15.4 times annually, with an average WTP of $70.4 per unit (95% CI [62.0, 78.9]). Estimated WTP for temporary anemia alleviation per transfusion totaled $260.6, exceeding monthly income by 1.32 times. Higher WTP was observed among males, higher-income households, and those with at least junior education. Lower WTP was noted among patients with lower transfusion volumes and those needing to travel for transfusion or during hospitalization for blood transfusion., Conclusion: High WTP indicated a strong desire for temporary anemia relief. Most TDT patients faced significant economic and transfusion burden. The evident gap in meeting clinical needed underscores the urgent demand for innovative treatments to reduce transfusion dependency, potentially transforming TDT care and improving socioeconomic well-being and clinical outcomes. These findings supported evidence-based decision-making for TDT pharmacoeconomics and efficient healthcare resource allocation in China., (© 2024. The Author(s).)

Accessibility is one of the crucial criteria for measuring the ease of access to public services in a region. Given China's historical rural-urban dualism and rapid urbanization process, there exist significant disparities in public services within metropolises. This study selects Nanjing as a representative metropolis and employs the Gaussian two-step floating catchment area method and an improved potential model to calculate the accessibility of comprehensive hospitals. Spatial autocorrelation and urban-rural disparities are analyzed, confirming spatial variations in healthcare service equity. The results show that: ①The spatial variability of accessibility to comprehensive hospitals is significant. The Gaussian two-step floating catchment method overestimates overall accessibility, and for Nanjing, the improved potential model with β = 1.5 proves more suitable. ②Accessibility exhibits pronounced clustering characteristics. Healthcare conditions for residents in the northern part of Liuhe District, eastern part of Qixia District, western part of Pukou District, peripheral areas of Jiangning District, eastern part of Gaochun District, and residents in Lishui District need improvement. ③Comprehensive healthcare services are relatively lacking in nearly 60% of rural areas. Our research findings provide valuable insights for improving spatial justice in public infrastructure in metropolises of developing countries., (© 2024. The Author(s).)

Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) is a significant pathogen causing major public health problems worldwide. This study characterized a novel sequence type 6417 (ST6471) CR-hvKP strain recovered from the blood of a male patient with septicemia. Strain CR2021 is not susceptible to carbapenems, cephalosporin, sulfonamides, quinolones, or levofloxacin and is susceptible to amikacin and tigecycline. Molecular typing indicated that ST6417 is derived from the most dominant hypervirulent K. pneumoniae (hvKP) clone in China, ST23, with a single-locus variation in tonB . The genomic characterization of CR2021, which contains three plasmids, was performed through whole-genome sequencing. The plasmid pCR2021&#95;IncFII contains 12 antibiotic resistance genes [ bla CTX-M-3 , bla TEM-1B , bla DHA-1 , aac (3)-Ild , aadA16 , sul1 , sul2 , qnrB4 , ARR-3 , dfrA27 , qacE , merACDE ], all of which are associated with genetic elements. The plasmid pCR2021&#95;IncFIB carries crucial virulence-related genes, while the plasmid pCR2021&#95;IncX3 only harbors the bla larvae infection model. CR-hvKP is becoming more prevalent in China; however, the majority have evolved from the multidrug resistance clone ST11 and its variants by acquiring virulence factors. Conversely, CR-hvKP derived from hvKP, such as the clone ST23, remains relatively rare. Therefore, the discovery of ST6417 underscores the need for further research into the genetic characteristics and evolution of bacteria.NDM-5 resistance gene and exhibits 99% similarity with two other bla NDM-5 -carrying IncX3 plasmids (pSHX180-NDM5, pNDM-K725), with coverage of 87% and 100%, respectively. The bla NDM-5 genetic region contains an additional IS26-Tn3 genetic module. Serum killing and anti-human neutrophil phagocytosis tests indicated that CR2021 exhibits high virulence, which was further confirmed in a Galleria mellonella larvae infection model. CR-hvKP is becoming more prevalent in China; however, the majority have evolved from the multidrug resistance clone ST11 and its variants by acquiring virulence factors. Conversely, CR-hvKP derived from hvKP, such as the clone ST23, remains relatively rare. Therefore, the discovery of ST6417 underscores the need for further research into the genetic characteristics and evolution of bacteria., Importance: ST11 and its variants, which often exhibit drug resistance, represent popular clones of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) in China, often leading to high morbidity and mortality rates owing to their high virulence and robust drug resistance. Conversely, CR-hvKP, originating from the high-virulence sequence type ST23, remains rarely reported. In this study, we identified a novel ST6417 CR-hvKP strain derived from ST23, carrying bla NDM-5 on an IncX3 plasmid conferring resistance to carbapenems. In addition, we elucidate its virulence, resistance to drugs, and genetic characteristics. The discovery of ST6417 highlights the diverse pathways in the evolution of CR-hvKP, warranting increased attention., Competing Interests: The authors declare no conflict of interest.

Importance: The China National Drug Administration (NMPA) established the breakthrough therapy designation (BTD) in 2020 to encourage the accelerated development of drugs for the prevention and treatment of diseases that are life-threatening. However, the differences between BTD and non-BTD cancer drugs regarding clinical benefit, regulatory approval, and price are unclear., Objectives: To compare BTD and non-BTD cancer drugs in clinical benefit (defined as efficacy and safety), novelty, time to approval, and average monthly treatment price., Design, Setting, and Participants: This cross-sectional study analyzes the original indication of BTD and non-BTD novel cancer drugs approved by the NMPA between July 8, 2020, and July 8, 2024. Data on efficacy, safety, regulatory approval, and price of cancer drugs were extracted from pivotal clinical trials based on review reports published by the NMPA, peer-reviewed articles or meeting reports, and winning bid prices for cancer drugs in the Chinese provincial-level centralized procurement process., Main Outcomes and Measures: The main outcome was the efficacy and safety associated with BTD vs non-BTD cancer drugs, including progression-free survival (PFS), response rate (RR), duration of response, serious adverse events, grade 3 or higher adverse events, and treatment-related deaths. In addition, the time to approval, novelty, and initial and latest average monthly treatment prices were evaluated, as well as the average annual reduction rate (AARR; the sum of the reduction rates divided by the number of years for the monthly treatment price) for these cancer drugs., Results: Between July 2020 and July 2024, 18 BTD (36%) and 32 non-BTD (64%) cancer drugs were approved by the NMPA. The median (IQR) clinical development time for BTD drugs was significantly shorter than for non-BTD drugs (5.6 [95% CI, 4.3-7.3] vs 6.6 [95% CI, 6.0-8.5] years; P = .02). No significant differences were observed in PFS (HR, 0.44 [95% CI, 0.38-0.52] vs HR, 0.51 [95% CI, 0.40-0.65]; P = .20), PFS gained (median [IQR], 5.4 [3.9-7.0] vs 2.7 [2.6-5.9] months; P = .77), RR (58% [95% CI, 45%-74%] vs 59% [95% CI, 51%-69%]; P = .85), and duration of response (median [IQR], 18.0 [15.0-21.6] vs 11.1 [7.4-17.4] months; P = .09) between BTD and non-BTD drugs. The rates of serious adverse events (37% [95% CI, 26%-52%] vs 32% [95% CI, 27%-36%]; P = .45), adverse events grade 3 or higher (64% [95% CI, 53%-77%] vs 55% [95% CI, 45%-68%]; P = .31), and treatment-related deaths (2% [95% CI, 1%-4%] vs 1% [95% CI, 1%-2%]; P = .10) were similar between BTD and non-BTD drugs. BTD drugs are more likely to be first-in-class drugs (5 of 18 [28%] vs 1 of 32 [3%]; P = .02). Differences in the median (IQR) initial ($5665 [$3542-$9321] vs $3361 [$2604-$5474]; P = .06) and latest ($5665 [$1553-$9321] vs $2145 [$1318-$4276]; P = .18) average monthly treatment prices for BTD drugs and non-BTD drugs were not significant. The median (IQR) AARRs for BTD drugs and non-BTD drugs were 15.2% (0%-46.9%) and 19.8% (1.0%-42.9%), respectively., Conclusions and Relevance: The findings of this cross-sectional study suggest that BTD has facilitated faster time to market for cancer drugs and improved novelty, but the price of treatment is relatively higher. There was no significant difference on comparative efficacy and safety.

Background: Spot urine collection offers a convenient alternative to the more cumbersome 24-h urine collection. However, the widely recognized estimation models, such as Tanaka and International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT), have not been adequately adapted for widespread use in the general Chinese population., Objectives: This study was designed to evaluate the precision of the Tanaka and INTERSALT calibration models, alongside a locally Zhejiang Province-formulated model, in predicting 24-h urinary sodium (24-hUNa) excretion among the Chinese population., Methods: The study comprised 1424 participants, aged 18-69 y, who provided both comprehensive 24-h urine and fasting morning urine samples. The researchers assessed the accuracy of the measured 24-hUNa against the estimates obtained from the Tanaka, INTERSALT, and Zhejiang models. This evaluation was conducted at both population and individual levels, employing a range of statistical techniques, including bias analysis, correlation coefficients, intraclass correlation coefficients, receiver operating characteristic curves, Bland-Altman plots, as well as relative and absolute difference calculations, and misclassification rates., Results: The measured average 24-hUNa excretion was found to be 165.7 ± 71.5 mmol/24-h. Notably, there was a significant deviation between the estimated and measured values for the Tanaka-adjusted model [-11.7 mmol, 95% confidence interval (CI): -16.7, -6.7 mmol/24-h], indicating a statistically significant difference. In contrast, the deviations for the INTERSALT-adjusted model (0.6 mmol, 95% CI: -4.2, 5.4 mmol/24-h) and the Zhejiang model (0.2 mmol, 95% CI: -4.6, 5.0 mmol/24-h) were nonsignificant. The correlation coefficients for the models were 0.303, 0.398, and 0.391, respectively, with the INTERSALT-adjusted and Zhejiang models showing superior performance at the population level., Conclusions: The 3 evaluation models may serve as effective, low-burden alternatives for assessing urinary sodium levels in the population. However, to enhance the accuracy and reliability of predictions at the individual level, further repeated measurements are necessary to minimize measurement errors and augment the validity of the estimations., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Municipal solid waste (MSW) management is a critical concern in megacities that depend heavily on external material and energy inputs but lack space for waste disposal. MSW treatment is a significant contributor to carbon emissions. The implementation of source classification improved the overall MSW management system and enhanced resource recovery from MSW. However, the precise contribution of source classification to carbon emissions reduction remains unclear. This study aimed to analyze the carbon emissions evolution in the MSW management of Shenzhen, a prototypical megacity in China, using data from 2006 to 2020 and employing carbon footprint assessment methodologies. The results demonstrated that source classification reduced the carbon emissions from 0.19-0.25 to 0.14-0.18 t CO 2 -eq/t MSW when considering the contribution of the urban environmental sanitation management department. The entire MSW management system becomes a carbon sink when considering recyclables collected by commercial enterprises. Although the source classification complicated the collection and transportation of MSW, the carbon offset effect of recycling food waste and recyclables was more significant than that of carbon emissions from collection and transport. Moreover, the landfill gas recovery rate critically influenced the carbon emissions of landfill-based MSW management systems. In contrast, the recovery of plastics was crucial for determining carbon emissions from incineration-based MSW management systems., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Huan Li reports financial support was provided by National Key R&D Program of China. Huan Li reports financial support was provided by Shenzhen Science and Technology Innovation Committee., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Research into the pivotal role of potassium in chronic diseases and their comorbidities remains scarce. Our aim is to elucidate the relationship between potassium and chronic diseases, including comorbid conditions, and to provide evidence-based recommendations for potassium intake in patients., Methods: This study is anchored in a representative, population-based survey conducted in Zhejiang Province, China, in 2017, encompassing participants aged 18 to 69 years. Data collection included questionnaire responses, physical measurements, and biological samples, obtained through a multistage cluster random sampling method. A subset of 1496 participants provided complete 24 h urine samples., Results: The median age of the participants was 48.0 years (interquartile range [IQR] 24.0), with 51.1% being female, and hypertension was identified in more than one third (35.6%) of the participants. The prevalence of diabetes was approximately 9.0%, dyslipidemia was found in 34.2%, and microalbuminuria in 8.8%. The 24 h urinary excretion levels were 3613.3 mg/24 h (IQR 2161.7) for sodium and 1366.0 mg/24 h (IQR 824.9) for potassium, respectively. Potassium excretion exhibited an inverse relationship with blood pressure. Furthermore, a positive correlation was observed between potassium excretion and high-density lipoprotein cholesterol (HDL-C) levels, with an elevation of 0.03 mmol/L (95% confidence interval [CI] 0.00 to 0.05). In binary logistic regression analysis, individuals in the fourth quartile of potassium excretion (Q4) exhibited an odds ratio (OR) of 0.56 (95% CI 0.36-0.87) for hypertension compared to those in the first quartile (Q1). Urinary potassium excretion was inversely associated with low HDL-C levels, with Q4 individuals having 0.62 times the odds of having low HDL-C levels (OR, 0.62; 95% CI 0.39-1.00) compared to Q1., Conclusions: Potassium excretion demonstrated a direct negative correlation with certain comorbidities. This study underscores the pivotal role of potassium in the management of chronic diseases and associated comorbidities, thereby highlighting the significance of potassium in both public health initiatives and clinical practice.

Background: Nursing literature suggested that patient mistreatment has significant impacts on nurses' emotions and job burnout. Yet, further research is needed to understand the underlying mechanism and the spillover effect on nurses' families. Leveraging the goal progress theory, this study aimed to examine the association between patient mistreatment, nurses' emotional exhaustion, and work-family conflict, as well as the mediating role of social sharing of negative work events and the moderating role of perceived organizational support., Methods: During the COVID-19 pandemic in China, a cross-sectional study was conducted with a sample of 1627 nurses from the Hematology Specialist Alliance of Chongqing from October to November 2022. Questionnaires were administered to measure patient mistreatment, perceived organizational support, social sharing of negative work events, emotional exhaustion, and work-family conflict. Hierarchical linear regression and conditional processes were used for statistical analyses., Results: Patient mistreatment was positively associated with emotional exhaustion (β = 0.354, p < 0.001) and work-family conflict (β = 0.314, p < 0.001). Social sharing of negative work events played a partial mediating role in the relationship between patient mistreatment and emotional exhaustion (effect = 0.067, SE = 0.013), and work-family conflict (effect = 0.077, SE = 0.014). Moderated mediation analysis found that the mediation effect was stronger when the perceived organizational support was high., Conclusion: Our findings reveal the amplifying effect of social sharing of negative work events on nurses' emotional exhaustion and work-family conflict. Perceived organizational support strengthens the positive effect of patient mistreatment on the social sharing of negative work events, thus resulting in increased emotional exhaustion and work-family conflict. We also discuss practical implications, limitations, and directions for future research., (© 2024. The Author(s).)

This study investigates the economic resilience of cities in Hubei province during the COVID-19 pandemic, utilizing highway nighttime lights as a proxy indicator. By February 2020, the pandemic had caused a significant economic contraction in Hubei. However, by May 2021, a strong recovery was observed, with most cities experiencing growth rates of over 20%. Despite initially similar responses to the crisis, this study reveals significant heterogeneity in economic resilience across the examined cities in Hubei. The spatial distribution follows a core-periphery structure, with Wuhan exhibiting greater resistance to economic shocks compared to peripheral cities. Furthermore, the response capacity within the Wuhan urban agglomeration area exhibits regional variations. In summary, lockdown policies had spatially varied impacts on economic resilience across Hubei's cities. These results offer valuable insights into regional economic resilience and contribute to the formulation of strategies aimed at effectively addressing future unforeseen events., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Despite major primary health care (PHC) reforms in China with the 2009 launch of the National Essential Public Health Service Package, the country experiences many challenges in improving the management of non-communicable diseases in PHC facilities. "EMERALD" is a multifaceted implementation strategy to strengthen the management of hypertension and type-2 diabetes mellitus (T2DM) in PHC facilities. The study aims to: (1) examine the effectiveness of EMERALD in improving hypertension and T2DM management; (2) evaluate the implementation of the interventions; and (3) use the study findings to model the long-term health economic impact of the interventions., Methods: The EMERALD intervention components include: (1) empowerment for PHC providers through training and capacity building; (2) empowerment for patient communities through multi-media health education; and  (3) empowerment for local health administrators through health data monitoring and strengthening governance of local PHC programs. An interrupted time series design will be used to determine the effectiveness of the interventions based on routinely collected health data extracted from local health information systems. The primary effectiveness outcome is the guideline-recommended treatment rates for people with hypertension and T2DM. Secondary effectiveness outcomes include hypertension and T2DM diagnosis and control rates, and enrolment and adherence rates to the recommended care processes in the National Essential Public Health Service Package. A mixed-methods process evaluation will be conducted to evaluate the implementation of the interventions, including the reach of the target population, adequacy of adoption, level of implementation fidelity, and maintenance. Qualitative interviews with policy makers, health administrators, PHC providers, and patients with hypertension and/or T2DM will be conducted to further identify factors influencing the implementation. In addition, health economic modelling will be performed to explore the long-term incremental costs and benefits of the interventions., Discussion: This study is expected to generate important evidence on the effectiveness, implementation, and health economic impact of complex PHC interventions to strengthen the primary care sector's contribution to addressing the growing burden of non-communicable diseases in China., Trial Registration: The study has been registered on Chinese Clinical Trial Registry at https://www.chictr.org.cn/ (Registration number ChiCTR2400082036, on March 19th 2024)., (© 2024. The Author(s).)

Background: Clinical practice guidelines (CPGs) inform healthcare decisions and improve patient care. However, an evaluation of guidelines on gastrointestinal diseases (GIDs) is lacking. This study aimed to systematically analyze the level of evidence (LOE) supporting Chinese CPGs for GIDs., Methods: CPGs for GIDs were identified by systematically searching major databases. Data on LOEs and classes of recommendations (CORs) were extracted. According to the Grades of Recommendation, Assessment, Development, and Evaluation system, LOEs were categorized as high, moderate, low, or very low, whereas CORs were classified as strong or weak. Statistical analyses were conducted to determine the distribution of LOEs and CORs across different subtopics and assess changes in evidence quality over time., Findings: Only 27.9% of these recommendations were supported by a high LOE, whereas approximately 70% were strong recommendations. There was a significant disparity among different subtopics in the proportion of strong recommendations supported by a high LOE. The number of guidelines has increased in the past 5 years, but there has been a concomitant decline in the proportion of recommendations supported by a high LOE., Conclusions: There is a general lack of high-quality evidence supporting Chinese CPGs for GIDs, and there are inconsistencies in strong recommendations that have not improved. This study identified areas requiring further research, emphasizing the need to bridge these gaps and promote the conduct of high-quality clinical trials., Funding: This study was supported by the National Key R&D Program of China (2022YFC2503604 and 2022YFC2503605) and Special Topics in Military Health Care (22BJZ25)., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

In this study, health risk attitude and health locus of control were included as dispositional factors in the Protection Motivation Theory (PMT) to explain people's protective behavior in the context of COVID-19 pandemic. Empirical data involved two waves of data with a sample of 526 adults with full-time jobs from Beijing, China, and structural equation model results confirmed a partial successful extension of the PMT. Specifically, health risk attitude had a direct effect on citizens' protective behavior, but without an indirect effect mediated by threat appraisal toward the COVID-19 pandemic; health locus of control did not directly associate with citizens' protective behavior, but had an indirect effect on it fully via coping appraisal toward the COVID-19 pandemic. Thus, the PMT has been extended by adding a distal dispositional factor on the impact of coping appraisal on protective behavior. Implications for advancing the government's anti-epidemic strategy are discussed., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Fu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a major nosocomial infectious pathogen with rapidly increasing prevalence. The genomic epidemiological characteristics of CRKP nationwide, especially the evolving trends within the predominant clones, should be evaluated clearly., Methods: We collected 3415 K. pneumoniae strains from 28 hospitals across China. Antimicrobial susceptibility testing and WGS were performed. Subsequent genomic analyses, including sequence typing, K-locus (KL) identification, antimicrobial resistance gene screening, and virulence score assessment were performed. The phylogenetic relationship of clonal group 11 was determined based on core-genome analysis, and the presence of the pLVPK-like virulence plasmid in ST11 isolates was confirmed using plasmid core-gene analysis. Additionally, the trends of the ST11 lineage with different KL types on a global scale were investigated using Beast2., Results: Of the K. pneumoniae strains, 708 were identified as CRKP isolates (20.7%), of which 97.7% were MDR. ST11 was the predominant clone, and KPC-2 was the prevalent carbapenemase in China, although the prevalence of specific clones and carbapenemases varied by geographic region. Among ST11 isolates, KL47 and KL64 were the predominant KL types, and KL64 gradually replaced KL47, with a higher percentage of KL64 isolates harbouring the pLVPK-like plasmid. Global genome data showed a significant increase in the effective population size of KL64 over the last 5 years., Conclusions: The prevalence of CRKP was very high in certain regions in China. The increasing convergence of virulence and resistance, particularly in ST11-KL64 isolates, should be given more attention and further investigation., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Importance: Ovine pulmonary adenomatosis (OPA) and maedi-visna disease (MVD) are chronic and progressive infectious diseases in sheep caused by Jaagsiekte sheep retrovirus (JSRV) and maedi-visna virus (MVV), respectively., Objective: To investigate the pathological changes and conduct viral gene analysis of OPA and MVD co-occurrence in Inner Mongolia, China., Methods: Using gross pathology, histopathology, immunohistochemistry, ultrastructural pathology, PCR, and sequence analysis, we investigated the concurrent infection of JSRV and MVV in 319 Dorper rams slaughtered in a private slaughterhouse in Inner Mongolia, in 2022., Results: Of the 319 rams included, 3 showed concurrent JSRV and MVV infection. Gross lung pathology showed diffuse enlargement, consolidation, and greyish-white miliary nodules on the lung surface; the trachea was filled with a white foamy fluid; hilar and mediastinal lymph nodes were significantly enlarged. Histopathology results revealed typical OPA and MVD lesions in the lung tissue. Immunohistochemical results were positive for JSRV envelope protein (Env) in the tumor cells and MVV CA in alveolar macrophages. Transmission electron microscopy showed several virions and autophagosomes in the lung tissue, severely damaged mitochondria, and the induced mitophagy. Nucleotide sequences obtained for JSRV env and MVV gag showed the highest homology with the Inner Mongolian strains of JSRV env (JQ837489) and MVV gag (MW248464)., Conclusions and Relevance: Our study confirmed that OPA and MVD co-occurrence and identified the pathological changes in Inner Mongolia, China, thereby providing references for the identification of concurrent JSRV and MVV infections., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Korean Society of Veterinary Science.)

Wave-induced liquefaction is a geological hazard under the action of cyclic wave load on seabed. Liquefaction influences the suspended sediment concentration (SSC), which is essential for sediment dynamics and marine water quality. Till now, the identification of liquefaction state and the effect of liquefaction on SSC have not been sufficiently accounted for in the sediment model. In this study, we introduced a method for simulating the liquefaction-induced resuspension flux into an ocean model. We then simulated a storm north of the Yellow River Delta, China, and validated the results using observational data, including significant wave heights, water levels, excess pore water pressures, and SSCs. The liquefaction areas were mainly distributed in coastal zones with water depths less than 12 m, and the simulated maximum potential soil liquefaction depth was 1.39 m. The liquefaction-induced SSC was separated from the total SSC of both liquefaction- and shear-induced SSCs by the model, yielding a maximum liquefaction-induced SSC of 1.07 kg·m -3 . The simulated maximum proportion of liquefaction-induced SSC was 26.2% in regions with water depths of 6-12 m, with a maximum significant wave height of 3.4 m along the 12 m depth contour. The erosion zone at water depths of 8-12 m was reproduced by the model. Within 52.5 h of the storm, the maximum erosion thickness along the 10 m depth contour was enhanced by 33.9%. The model is applicable in the prediction of liquefaction, and provides a new method to simulate the SSC and seabed erosion influenced by liquefaction. Model results show that liquefaction has significant effects on SSC and seabed erosion in the coastal area with depth of 6-12 m. The validity of this method is confined to certain conditions, including a fully saturated seabed exhibiting homogeneity and isotropic properties, small liquefaction depth, residual liquefaction dominating the development of pore pressures, no influence by structures, and the sediment composed of silt and mud that experiences frequent wave-induced liquefaction., 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.)

Hydrological models are vital tools in environmental management. Weaknesses in model robustness for hydrological parameters transfer uncertainties to the model outputs. For streamflow, the optimized parameters are the primary source of uncertainty. A reliable calibration approach that reduces prediction uncertainty in model simulations is crucial for enhancing model robustness and reliability. The optimization of parameter ranges is a key aspect of parameter calibration, yet there is a lack of literature addressing the optimization of parameter ranges in hydrological models. In this paper, we introduce a parameter calibration strategy that applies a clustering technique, specifically the Self-Organizing Map (SM), to intelligently navigate the parameter space during the calibration of the Soil and Water Assessment Tool (SWAT) model for monthly streamflow simulation in the Baishan Basin, Jilin Province, China. We selected the representative algorithm, the Sequential Uncertainty Fitting version 2 (SUFI-2), from the commonly used SWAT Calibration and Uncertainty Programs for comparison. We developed three schemes: SUFI-2, SUFI-2-Narrowing Down (SUFI-2-ND), and SM. Multiple diagnostic error metrics were used to compare simulation accuracy and prediction uncertainty. Among all schemes, SM outperformed the others in describing watershed streamflow, particularly excelling in the simulation of spring snowmelt runoff (baseflow period). Additionally, the prediction uncertainty was effectively controlled, demonstrating the SM's adaptability and reliability in the interval optimization process. This provides managers with more credible prediction results, highlighting its potential as a valuable calibration tool in hydrological modeling., 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.)

Global irrigation areas face the contradictory challenges of controlling nitrate inputs and ensuring food-safe production. To prevent and control nitrate pollution in irrigation areas, the study using the Yellow River basin (Ningxia section) of China as a case study, employed nitrogen and oxygen dual isotope tracing and extensive field investigations to analyze the sources, fate, and influencing factors of nitrate in agricultural drainage ditches. The results of source tracing of nitrate showed that annual proportions of nitrate sources entering the Yellow River in the ditches are as follows: for manure & sewage, fertilizer, and natural sources, the ratios are 33%, 35%, and 32% overall. The results of nitrate fate showed that nitrates derived from nitrate fertilizer exhibit a lower residual rate in drainage ditches (ecological ditches) compared to ammonium fertilizer, which can undergo self-ecological restoration within one year. The results of influencing factors showed that crops with high water and nutrient requirements, such as vegetables, the nitrate pollution and environmental harm resulting from "exploitative cultivation" are five times more than normal cultivation practices in dryland and paddy fields, especially winter irrigation without crop interception exacerbates the leaching of nitrate from the soil. Therefore, nitrate management in irrigation areas should focus on preventing and controlling "exploitative cultivation" and losses during winter irrigation, while appropriately adjusting the application ratio of ammonium nitrogen fertilizers. The results of the study can guide strategies to mitigate nitrate pollution in irrigated areas such as livestock farming, fertilizer application, irrigation management, ditch optimization, and crop cultivation., 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.)

Comprehensive Air Quality Model with extensions (CAMx)-Decoupled Direct Method (DDM) simulations of first-order ozone (O 3 ) sensitivity to nitrogen oxides (NO x ) and volatile organic compounds (VOCs) emissions were performed and combined with modelled [Formula: see text] ratios to obtain a range of thresholds for determining O 3 -sensitivity regimes for different areas of China. Utilising the new threshold ranges for photochemical indicators, the method for determining O 3 formation in the Ozone Source Apportionment Technology (OSAT) module within CAMx was improved by a dynamically varied threshold of [Formula: see text] ratio. The O 3 concentration contributions in the newly added transition regime were apportioned to NO x and VOCs emissions in proportion to the relationship between the [Formula: see text] ratio and first-order O 3 sensitivity. The source contributions of O 3 concentrations from different emission sectors from June to September 2019 were compared using the original and improved CAMx-OSAT. The results showed that the O 3 concentration contributions changed significantly in the NO x -limited regime, with a maximum decrease of 21.89%, while the contributions increased by up to 7.57% in the VOC-limited regime, and were within 15 µg/m 3 in the transition regime. The modified OSAT module enabled a more sophisticated attribution of O 3 to precursor emissions and may have far-reaching implications for informing O 3 pollution control policy., 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 article., (Copyright © 2023. Published by Elsevier B.V.)

Background: Second victims, defined as healthcare providers enduring emotional and psychological distress after patient safety incidents (PSIs). The potential for positive transformation through these experiences is underexplored but is essential for fostering a culture of error learning and enhancing patient care., Objective: To explore the level and determinants of post-traumatic growth (PTG), applying the stress process model., Methods: The study was conducted at a tertiary general hospital in Chongqing, China. A descriptive, cross-sectional study design was used. A total of 474 s victims were included. An online survey was conducted in November 2021 to assess various factors related to the second victim experience. These factors included PSIs (considered as stressors), coping styles, perceived threats, and social support (acting as mediators), as well as the outcomes of second victim syndrome (SVS) and PTG. Statistical description, correlation analysis, and structural equation modeling were utilized for the data analysis. A p-value ≤ 0.05 was considered to indicate statistical significance., Results: The participants reported moderate distress (SVS = 2.84 ± 0.85) and PTG (2.72 ± 0.85). The total effects on SVS of perceived threat, negative coping, social support, positive coping, and PSIs were 0.387, 0.359, -0.355, -0.220, and 0.115, respectively, accounting for 47% of the variation in SVS. The total effects of social support, positive coping, and PSIs on PTG were 0.355, 0.203, and - 0.053, respectively, accounting for 19% of the variation in PTG., Conclusions: The study provides novel insights into the complex interplay between perceived threats, coping styles, and social support in facilitating PTG among second victims. By bolstering social support and promoting adaptive coping strategies, the adverse effects of PSIs can be mitigated, transforming them into opportunities for resilience and growth, and offering a fresh perspective on managing PSIs in healthcare settings., (© 2024. The Author(s).)

Background: There is a lack of evidence regarding the effectiveness of empowerment healthy education for caregivers of Alzheimer's patients., Objective: To explore the effectiveness of the intervention of health education guided by empowerment theory on dementia knowledge, caregiving readiness, positive caregiving emotions, anxiety, and depression in informal Alzheimer's disease caregivers., Design: A single-blinded, randomized controlled trial., Setting: A teaching hospital in Tianjin, China., Participants: Eighty caregivers of Alzheimer's disease patients., Methods: Participants were recruited from the hospital and randomly assigned to either experimental or control group. The experimental group underwent a 12-weeks, one-to-one intervention of six session lasting 45-60 min each. The control group received conventional health education. Outcome measures included dementia knowledge, caregiver readiness (primary outcomes), positive caregiving emotions, anxiety, and depression (secondary outcomes)., Results: After 12 weeks, the intervention group exhibited significantly higher levels of dementia knowledge, caregiver readiness, and positive caregiving emotions compared with the control group. Furthermore, levels of hospitalization-related anxiety and depression were lower in the intervention group. All study results of this study showed statistically significant differences ( p  < 0.05)., Discussion: Empowerment theory-based health education appears to be an effective intervention for improving caregiver and readiness to care for caregivers of Alzheimer's disease individuals. The intervention may help reduce caregivers' anxiety and depression levels., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Liu, Wang, Wei, Liu, Bian, Wang and Du.)

Lake Erhai is a potentially phosphorus (P)-limited lake and its water quality may have been affected by atmospheric P deposition. However, there have been few studies on atmospheric P deposition in this lake. In this study, we established five wet deposition monitoring sites and two dry deposition monitoring sites around Lake Erhai to quantify the wet and dry deposition of total phosphorus (TP), including dissolved inorganic phosphorus (DIP), dissolved organic phosphorus (DOP) and particulate phosphorus (PP) from July 2022 to June 2023. Wet deposition fluxes of P species were collected by automatic rainfall collection instrument, and dry deposition fluxes were estimated using airborne concentration measurements and inferential models. The results reveal that among the different P components, DOP had the highest contribution (50%) to wet TP deposition (average all sites 12.7 ± 0.7 mg P m 2 /yr), followed by PP (40%) and DIP (10%). Similarly, DOP (51%) was the major contributor to dry TP deposition (average two sites 2.4 ± 0.9 mg P m 2 /yr), followed by DIP (35%) and PP (14%). Wet deposition dominated the annual total TP deposition (wet plus dry), accounting for approximately 83%. The key seasons for dry deposition were spring and autumn, which accounted for 64% of the annual total dry TP deposition. In comparison, wet deposition was significantly higher in the summer, accounting for 73% of the annual total wet TP deposition. The results of the potential source contribution function and concentration-weighted trajectories analysis indicate that local source emission and long-range transport from surrounding cities jointly exerted a substantial influence on aerosol P concentrations, particularly in the eastern and northwestern regions of the lake. These findings provide a comprehensive understanding of the different P components in atmospheric deposition, which is beneficial for developing effective strategies to manage the P cycle in Lake Erhai., 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.)

Importance: Despite posing a significant challenge to global tuberculosis (TB) elimination efforts, recurrent TB remains understudied due to the challenges of long-term observation., Objective: To investigate the burden of recurrent TB using data from patients with pulmonary TB (PTB) in China., Design, Setting, and Participants: This retrospective cohort study included all bacteriologically confirmed or clinically diagnosed PTB cases reported to the Tuberculosis Information Management System with completed or successful treatment outcomes from January 1, 2005, to December 31, 2021. Data were analyzed from July 15, 2022, to October 28, 2023., Exposures: Newly diagnosed PTB was classified into primary, hematogenous disseminated, or secondary PTB., Main Outcomes and Measures: The primary outcome was the annual recurrence rate, stratified by disease classification, over the 17-year observation period. The recurrence rate for year n was calculated by dividing the number of patients with recurrent TB in year n by observed person-years in year n. The secondary outcome was the annual proportion of recurrent TB among reported cases and associated risk factors., Results: Of 13 833 249 patients with TB reported to the Tuberculosis Information Management System, 10 482 271 with PTB met the inclusion criteria. Of these, 68.9% were male, 22.3% were 65 years or older, 89.6% were of Han ethnicity, and 68.4% were agricultural workers. A total of 413 936 patients experienced a recurrent TB episode after successful treatment, resulting in an overall recurrence rate of 0.47 (95% CI, 0.47-0.48) per 100 person-years. The recurrence rate for patients with primary PTB was 0.24 (95% CI, 0.22-0.26) per 100 person-years; for hematogenous disseminated PTB, 0.37 (95% CI, 0.36-0.38) per 100 person-years; and for secondary PTB, 0.48 (95% CI, 0.47-0.48) per 100 person-years. The cumulative proportion of recurrences within the first 2 years accounted for 48.9% of all recurrent cases. The proportion of recurrent cases among notified incident cases increased 1.9-fold from 4.7% in 2015 to 8.8% in 2021. Among other factors, ages 45 to 64 years (adjusted hazard ratio, 1.77 [95% CI, 1.65-1.89]) and having completed treatment (adjusted hazard ratio, 1.16 [95% CI, 1.14-1.18]) were identified as associated with recurrence., Conclusions and Relevance: In this retrospective cohort study, the PTB recurrence rate was substantially higher than the incidence, and the proportion of recurrent cases increased. Almost half of the recurrence occurred within the first 2 years, suggesting that routine posttreatment follow-up may represent an important strategy for accelerating TB elimination.

Abnormal plasma uric acid (UA) levels, the lipid profile, and plasma proteins in blood are associated with a range of adverse health outcomes. This multicenter, prospective cohort study aimed to determine the possible effects of multiple apheresis plasma donations on plasma UA levels, the lipid profile, and major proteins in plasma donors. Participants were enrolled from 1 April 2021 to 31 August 2022. When their plasma UA (men: >420 µmol/L, women: >360 µmol/L) and/or lipid levels (total cholesterol [TC]: ≥6.2 mmol/L, triglycerides [TGs]: ≥2.3 mmol/L, low-density lipoprotein cholesterol: ≥4.1 mmol/L, or high-density lipoprotein cholesterol [HDL-C]: <1.0 mmol/L) were abnormal at their first plasma donation, the enrolled participants were followed up until they had completed 10 plasma donations. A total of 11485 participants were enrolled, of whom 1861 met the inclusion criteria. During the study period, 320 donors completed 10 plasma donations. None of the participants took any corrective medicine for their abnormal index. The measured parameters were significantly different from the first to the tenth plasma donations (donors with asymptomatic hyperuricemia: UA, P < 0.001; donors with asymptomatic hyperlipidemia: HDL-C, P < 0.001; TC, P = 0.025; TGs, P < 0.001; apolipoprotein B, P = 0.025; all of the plasma donors, immunoglobulin G, P < 0.001). The levels of HDL-C, TC, and apolipoprotein B were increased, and the levels of UA, TGs, and immunoglobulin G were decreased over this time. However, immunoglobulin G levels were still in the normal range. Moreover, the changes in these parameters were closely associated with the frequency of plasma donation during the study period. Repeated apheresis plasma donations can reduce plasma UA and TG levels and increase HDL-C levels; and further evaluation of the clinical significance with a larger sample size is required., Competing Interests: Conflict of interest statement The authors declare no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The sustained circulation of H9N2 avian influenza viruses (AIVs) poses a significant threat for contributing to a new pandemic. Given the temporal and spatial uncertainty in the antigenicity of H9N2 AIVs, the immune protection efficiency of vaccines remains challenging. By developing an antigenicity prediction method for H9N2 AIVs, named PREDAC-H9, the global antigenic landscape of H9N2 AIVs was mapped. PREDAC-H9 utilizes the XGBoost model with 14 well-designed features. The XGBoost model was built and evaluated to predict the antigenic relationship between any two viruses with high values of 81.1 %, 81.4 %, 81.3 %, 81.1 %, and 89.4 % in accuracy, precision, recall, F1 value, and area under curve (AUC), respectively. Then the antigenic correlation network (ACnet) was constructed based on the predicted antigenic relationship for H9N2 AIVs from 1966 to 2022, and ten major antigenic clusters were identified. Of these, four novel clusters were generated in China in the past decade, demonstrating the unique complex situation there. To help tackle this situation, we applied PREDAC-H9 to calculate the cluster-transition determining sites and screen out virus strains with the high cross-protective spectrum, thus providing an in silico reference for vaccine recommendation. The proposed model will reduce the clinical monitoring workload and provide a useful tool for surveillance and control of H9N2 AIVs., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests. There is no financial/personal interest or belief that could affect their objectivity., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)