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China has to perform high-intensity and high-chemical input agricultural production to improve its food security, which has caused uncertainty in the development of ecological agriculture. This study utilizes bibliometrics and spatial statistical methods to examine the representative literature on ecological agriculture published in the CNKI database from 2012 to 2023. The findings reveal that keywords such as rural revitalization, modern agriculture, and ecological tourism are frequently mentioned while emerging interests include carbon neutrality, eco-circular agriculture, and industrial integration. The main clusters of keywords can be classified into specific practical research, general studies, and countermeasures orderly. The themes of ecological tourism, developing mode, and rural revitalization have attracted long-lasting concerns in research over the past decade. Spatial statistical analysis indicates that, aside from the Eastern coastal areas, most provinces in China exhibit insufficient collaboration and limited spill-over effects in research of ecological agriculture, highlighting the necessity for enhanced integration. This study also provides recommendations to address the prevailing challenges to food security through the promotion of ecological agriculture in China. [ABSTRACT FROM AUTHOR]

We detected presence of 23 types of organochlorine pesticides (OCPs) in 21 mixed samples obtained along the banks of Dawen River in China by gas chromatography. we analyzed the spatial distribution of OC residues, potential source, and the ecological and health risks. The results show that OCPs were detected in all the 21 sampling sites, and 86.6% of the 23 types of OCPs had a detection rate above 90%. Furthermore, the analysis of the single-factor pollution index shows that 14% of the sampling sites were mildly polluted, whereas 4.8% had medium-level pollution. Analysis of the Nemerow's multi-factor index shows that 9.5% of the sampling sites were mildly polluted. We found that Dawenkou Town and Wenyang Town are severely polluted, whereas Ciyao Town and Jiangji Town are less polluted by arcgis12.0 spatial analysis. Compared to other regions in China, the HCHs content is at a low level but DDTs at a high level in the study area. Assessment of health risks of OCP residues shows that the carcinogenic risk and the non-carcinogenic risk caused by exposure to OCPs is negligible. OCPs are primarily obtained from previous residues and recent use of lindane. [ABSTRACT FROM AUTHOR]

A Bonner sphere spectrometer (BSS) was developed compensating for the lack of active BSSs for intense neutron field characterization. The spectrometer combines the merits of present active and passive BSSs, namely, online data acquisition capability and intense neutron field resistance, respectively. The key elements of the development are the utilization of diamond detectors as thermal neutron sensors of BSSs and the incorporation of the air gap into the design of the diamond detector for optimizing the pulse height spectrum in order to enhance the rejection capability to γ ray backgrounds and to decrease the impacts of spectrometer instabilities. A two-step method capable of >100 times of calculation time saving compared to the whole geometry model was suggested to establish the response function for neutrons below 20 MeV whose reliability was verified by the two other models. The applicability of the BSS to intense neutron field characterization was demonstrated by the good performance in the Experimental Advanced Superconducting Tokamak (EAST) neutron field with an emission rate of ∼1013–1014 neutrons/s. The spectrometer is dedicated to the characterization of intense neutron fields around tokamaks. These devices may find an application in future tokamaks, such as the International Thermonuclear Experimental Reactor, the Demonstration Power Station, and the China Fusion Engineering Test Reactor, whose neutron emission rates will be >104 times higher than those of current tokamaks. [ABSTRACT FROM AUTHOR]

The prevalence of BRCA1/2 large genomic rearrangements (LGRs) and their underlying mechanisms have not been fully evaluated in Chinese women with breast cancer. In this study, we determined the prevalence of BRCA1/2 LGRs in 834 patients with familial breast cancer (FBC) and 660 patients with sporadic triple‐negative breast cancer (TNBC) who were negative for BRCA1/2 small‐range mutations using the multiplex ligation‐dependent probe amplification method. We found that 20 index patients (2.4%) in the FBC group carried a BRCA1 or BRCA2 LGR, and the frequencies of BRCA1 and BRCA2 LGRs were 1.6% and 0.8%, respectively. Seven index patients (1.1%) carried a BRCA1 LGR in 660 sporadic TNBC patients, whereas no BRCA2 LGRs were found in these patients. Among the BRCA1/2 LGRs, 48.1% (13/27) were novel, and the breakpoints of the majority of the LGRs were identified. ΨBRCA1‐mediated homologous recombination (HR) and Alu‐mediated HR/non‐homologous end‐joining (NHEJ) accounted for 40% and 30% of the BRCA1 LGRs, respectively. Alu‐mediated HR accounted for 71.4% of the BRCA2 LGRs, and the remaining one‐third was generated through Long interspersed nuclear elements (LINE)‐mediated NHEJ. Our findings suggest that both FBC patients and sporadic TNBC patients should be tested for BRCA1/2 LGRs. [ABSTRACT FROM AUTHOR]

Background: Suicide is a global public health crisis, and little evidence has focused on associations between suicide attempts and childhood maltreatment (CM) in Chinese middle school students., Objective: This study aimed to explore the relationship between childhood maltreatment and suicide attempts and the sex difference in Chinese middle school students., Participants and Setting: In this prospective cohort study, students in grades 7 and 8 filled out the questionnaire at baseline and 6-month follow-up., Methods: Demographic data, childhood maltreatment, and suicide attempts were surveyed. Depression, anxiety, and stress were measured at baseline as covariates. Logistic regression was employed to measure the impact of childhood maltreatment and its sex differences on suicide attempts., Results: Among 782 students, 39.6 % suffered from childhood maltreatment, and the incidence rate of suicide attempts in 6 months was 4.60 % (36/782). After controlling for covariates, childhood maltreatment (adjusted odds ratio, OR = 2.899, 95%CI = 1.349-6.227) and its subtypes, physical abuse (adjusted OR = 4.077, 95%CI = 1.593-10.505) and emotional neglect (adjusted OR = 2.179, 95%CI = 1.059-4.481) were independent risk factors of suicide attempts. The association remained significant in females but not males, while no interactions between sex and childhood maltreatment were found., Conclusions: Childhood maltreatment was prevalent in Chinese middle school students and closely associated with the incidence of suicide attempts, which provided valuable evidence for suicide prevention., Competing Interests: Competing interest There is no conflict of interest for all authors., (Copyright © 2024. Published by Elsevier Ltd.)

This study aims to explore the application value of the Bayesian Time Structure Sequence (BSTS) model in estimating the acute hemorrhagic conjunctivitis (AHC) epidemics. The reported AHC cases spanning from January 2011 to October 2022 in China were collated. Utilizing R software, the BSTS and Autoregressive Integrated Moving Average (ARIMA) models were constructed using the data from January 2011 to December 2021. The prediction effect of both models was compared using the data from January to October 2022, and finally the AHC incidence from November 2022 to December 2023 was predicted. The results indicated that forecast errors under the BSTS model were lower than those under the ARIMA model. The actual AHC incidence in July 2022 from the ARIMA model deviated from the 95% confidence interval (CI) of the predicted value. However, the observed AHC incidence from the BSTS model fell within the 95% CI of the predicted value. Notably, the BSTS model predicted 26,474 new AHC cases in China from November 2022 to December 2023, exhibiting better prediction performance compared to the ARIMA model. This indicates that the BSTS model possesses a high application value for forecasting the epidemic trends of AHC, making it a valuable tool for disease surveillance and prevention strategies., (© 2024. The Author(s).)

Surface-active organics lower the aerosol surface tension (σ s/a ), leading to enhanced cloud condensation nuclei (CCN) activity and potentially exerting impacts on the climate. Quantification of σ s/a is mainly limited to laboratory or modeling work for particles with selected sizes and known chemical compositions. Inferred values from ambient aerosol populations are deficient. In this study, we propose a new method to derive σ s/a by combining field measurements made at an urban site in northern China with the κ-Köhler theory. The results present new evidence that organics remarkably lower the surface tension of aerosols in a polluted atmosphere. Particles sized around 40 nm have an averaged σ s/a of 53.8 mN m -1 , while particles sized up to 100 nm show σ s/a values approaching that of pure water. The dependence curve of σ s/a with the organic mass resembles the behavior of dicarboxylic acids, suggesting their critical role in reducing the surface tension. The study further reveals that neglecting the σ s/a lowering effect would result in lowered ultrafine CCN (diameter <100 nm) concentrations by 6.8-42.1% at a typical range of supersaturations in clouds, demonstrating the significant impact of surface tension on the CCN concentrations of urban aerosols.

Background: Hemiplegic shoulder pain (HSP) is a common complication after stroke. It severely affects the recovery of upper limb motor function. Early shoulder pain in hemiplegic patients is mainly neuropathic caused by central nerve injury or neuroplasticity. Commonly used corticosteroid injections in the shoulder joint can reduce shoulder pain; however, the side effects also include soft tissue degeneration or increased tendon fragility, and the long-term effects remain controversial. Botulinum toxin injections are relatively new and are thought to block the transmission of pain receptors in the shoulder joint cavity and inhibit the production of neuropathogenic substances to reduce neurogenic inflammation. Some studies suggest that the shoulder pain of hemiplegia after stroke is caused by changes in the central system related to shoulder joint pain, and persistent pain may induce the reorganization of the cortical sensory center or motor center. However, there is no conclusive evidence as to whether or not the amelioration of pain by botulinum toxin affects brain function. In previous studies of botulinum toxin versus glucocorticoids (triamcinolone acetonide injection) in the treatment of shoulder pain, there is a lack of observation of differences in changes in brain function. As the content of previous assessments of pain improvement was predominantly subjective, objective quantitative assessment indicators were lacking. Functional near-infrared imaging (fNIRS) can remedy this problem., Methods: This study protocol is designed for a double-blind, randomized controlled clinical trial of patients with post-stroke HSP without biceps longus tenosynovitis or acromion bursitis. Seventy-eight patients will be randomly assigned to either the botulinum toxin type A or glucocorticoid group. At baseline, patients in each group will receive shoulder cavity injections of either botulinum toxin or glucocorticoids and will be followed for 1 and 4 weeks. The primary outcome is change in shoulder pain on the visual analog scale (VAS). The secondary outcome is the assessment of changes in oxyhemoglobin levels in the corresponding brain regions by fNIRS imaging, shoulder flexion, external rotation range of motion, upper extremity Fugl-Meyer, and modified Ashworth score., Discussion: Ultrasound-guided botulinum toxin type A shoulder joint cavity injections may provide evidence of pain improvement in patients with HSP. The results of this trial are also help to analyze the correlation between changes in shoulder pain and changes in cerebral hemodynamics and shoulder joint motor function., Trial Registration: Chinese clinical Trial Registry, ChiCTR2300070132. Registered 03 April 2023, https://www.chictr.org.cn/showproj.html?proj=193722 ., (© 2024. The Author(s).)

Cucumber leaf spot (CLS), caused by Corynespora cassiicola , is a serious disease of greenhouse cucumbers. With frequent use of existing fungicides, C. cassiicola has developed resistance to some of them, with serious implications for the control of CLS in the field. With a lack of new fungicides, it is necessary to use existing fungicides for effective control. Therefore, this study monitored the resistance of C. cassiicola to three commonly used and effective fungicides, boscalid, trifloxystrobin, and carbendazim, from 2017 to 2021. The frequency of resistance to boscalid showed an increasing trend, and the highest frequency was 85.85% in 2020. The frequency of resistance to trifloxystrobin was greater than 85%, and resistance to carbendazim was maintained at 100%. Among these fungicides, strains with multiple resistance to boscalid, trifloxystrobin, and carbendazim were found, accounting for 32.00, 25.25, 33.33, 43.06, and 37.24%, respectively. Of the strains that were resistant to boscalid, 87% had CcSdh mutations, including seven genotypes: B-H278L/Y, B-I280V, C-N75S, C-S73P, D-D95E, and D-G109V. Also, six mutation patterns of the Cc β -tubulin gene were detected: E198A, F167Y, E198A&M163I, E198A&F167Y, M163I&F167Y, and E198A&F200C. Detection of mutations of the CcCytb gene in resistant strains showed that 98.8% were found to have only the G143A mutation. A total of 27 mutation combinations were found and divided into 14 groups for analysis. The resistance levels differed according to genotype. The development of genotypes showed a complex trend, increasing from 4 in 2017 to 13 in 2021 and varying by region. Multiple fungicide resistance is gradually increasing. Therefore, it is necessary to understand the types of mutations and the trend of resistance to guide the use of fungicides to achieve disease control., Competing Interests: The author(s) declare no conflict of interest.

Purpose: The aim of this study was to examine the level of health-related quality of life (HRQOL) of lung cancer patients receiving immune checkpoint inhibitors (ICIs) and analyze its influencing factors., Method: A cross-sectional study was conducted. From April 2022 to March 2023, 560 lung cancer patients receiving ICIs at three medical bases in Guangzhou, China were recruited using a convenient sampling method. A general information questionnaire, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), the Social Support Rating Scale (SSRS) and the Medical Coping Modes Questionnaire (MCMQ) were used for collecting data on sociodemographic and clinical characteristics, HRQOL, social support and medical coping mode. A descriptive analysis was conducted to describe HRQOL. Multiple regression analysis was applied to determine the factors influencing HRQOL., Results: For lung cancer patients receiving ICIs, the mean score of HRQOL was 59.21 ± 19.86. Multivariate analysis indicated that acceptance-resignation coping mode (β = -0.37, P < 0.01), Eastern Cooperative Oncology Group (ECOG) score (β = -0.35, P < 0.01), combination of chemotherapy and/or bevacizumab (β = -0.14, P < 0.01), and subjective support (β = 0.07, P = 0.04) all contributed to 42.7% of the variance in HRQOL of the patients receiving ICIs., Conclusions: It is imperative to address and resolve the HRQOL issue for lung cancer patients receiving ICIs. The findings suggest nurse practitioners should be aware of a variety of factors that influence HRQOL and provide tailored inventions to patients as early as possible to help them achieve better HRQOL., 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.)

Mulching and biochar are increasingly used individually in agriculture, but little is known about their combined effects on N 2 O distribution and dispersion in ridge and furrow profiles. We conducted a 2-year field experiment in northern China to determine soil N 2 O concentrations using the in situ gas well technique and calculate N 2 O fluxes from ridge and furrow profiles by the concentration gradient method. The results showed that mulch and biochar increased soil temperature and moisture and altered the mineral nitrogen status, leading to a decrease in the relative abundance of nitrification genes in the furrow area and an increase in the relative abundance of denitrification genes, with denitrification remaining as the main source of N 2 O production. N 2 O concentrations in the soil profile increased significantly after fertiliser application, and N 2 O concentrations in the ridge area of the mulch treatment were much higher than those in the furrow area, where vertical and horizontal diffusion occurred. Biochar addition was effective in reducing N 2 O concentrations but had no effect on the N 2 O distribution and diffusion pattern. Soil temperature and moisture, but not soil mineral nitrogen, explained the variation in soil N 2 O fluxes during the non-fertiliser application period. Compared to furrow-ridge planting (RF), furrow-ridge mulch planting (RFFM), furrow-ridge planting with biochar (RBRF) and furrow-ridge mulch planting with biochar (RFRB) resulted in 9.2%, 11.8% and 20.8% increases in yield per unit area and 1.9%, 26.3% and 27.4% decreases in N 2 O fluxes per unit of yield, respectively. The interaction between mulching and biochar significantly affected the N 2 O fluxes per unit of yield. Biochar costs aside, RFRB is very promising for increasing alfalfa yields and reducing N 2 O fluxes per unit of yield., 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.)

Improving the efficiency of converting natural resources into social benefits is an important issue for sustainable development in today's world. Based on this background this paper applies the super-efficient SBM model with non-expected output to measure the ecological welfare performance (EWP) of Chinese provinces from 2005-2019, and explores the relationship between government competition and EWP under different assessment systems. The research results show that government competition under economic performance assessment is self-interested and short-sighted, which can negatively affect ecological welfare performance in the current period as well as in the next four years. In contrast, government competition under the environmental assessment system promotes EWP in both the current and long term, balancing short-term and long-term benefits. The results of the spatial GMM found that government competition under economic performance appraisal can deteriorate EWP in local as well as surrounding areas, but government competition under the environmental assessment system can achieve an increase in local ecological welfare performance and the spillover effect is not significant. To alleviate the limitations of a single appraisal system, this paper incorporates both economic and ecological appraisals into the multidimensional appraisal system. When the weights of both are between 1:9 and 3:7, the government competition under multidimensional performance appraisal can promote both current and longer-term EWP, and achieve its own ecological welfare performance without affecting the surrounding areas., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Li 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.)

Severe fever with thrombocytopenia syndrome (SFTS) is a life-threatening infectious disease caused by the SFTS virus (SFTSV). This study aimed to evaluate the predictive power of C-reactive protein to lymphocyte ratio (CLR) and establish an early-warning model for SFTS mortality. We retrospectively analyzed hospitalized SFTS patients in six clinical centers from May 2011 to 2022. The efficacy of CLR prediction was evaluated by the receiver operating characteristic (ROC) analysis. A nomogram was established and validated. Eight hundred and eighty-two SFTS patients (median age 64 years, 48.5% male) were enrolled in this study, with a mortality rate of 17.8%. The area under the ROC curve (AUC) of CLR was 0.878 (95% confidence interval [CI]: 0.850-0.903, p < 0.001), which demonstrates high predictive strength. The least absolute shrinkage and selection operator regression selected seven potential predictors. Multivariate logistic regression analysis determined three independent risk factors, including CLR, to construct the nomogram. The performance of the nomogram displayed excellent discrimination and calibration, with significant net benefits in clinical uses. CLR is a brand-new predictor for SFTS mortality. The nomogram based on CLR can serve as a convenient tool for physicians to identify critical SFTS cases in clinical practice., (© 2023 The Authors. Journal of Medical Virology published by Wiley Periodicals LLC.)

Organic matter (OM) and nutrient inputs generated by human activities promote the development of eutrophication. Amino acids (AAs) are an integral part of OM, and studying their patterns will provide new insights into organic matter dynamics in lakes. Four seasonal field campaigns in eutrophic Lake Taihu and a 14-day phytoplankton degradation experiment were carried out to determine the variability and bioavailability of amino acids. The quality and quantity of AAs varied among different seasons and lake types. The concentrations of particulate (PAA) and dissolved (DAA) AA were 14.67 ± 13.25 μM (carbon- and nitrogen-normalized PAA yields: PAA-C%, 23.8 ± 13.5%; PAA-N%, 22.8 ± 2.1%) and 2.95 ± 1.05 μM (carbon- and nitrogen-normalized DAA yields: DAA-C%, 3.7 ± 1.1%; DAA-N%, 12.6 ± 11.2%) in Lake Taihu, respectively. PAA and DAA showed high mean values in the algal-dominated northern area in summer. Glutamic acid (Glu), alanine (Ala), aspartic acid (Asp) and glycine (Gly) contributed to nearly 50% of PAA, while Gly, accounting for 17-24%, was the main component of DAA. During a 14-day phytoplankton degradation period, 98% of Chl a, 63% of POC and 92% of PAA were removed in the dark treatment, and a more obvious downward trend was recorded than in the light treatment. Principal component analysis of the indices of PAA indicated that Glu, arginine (Arg) and histidine (His) were dominant on day 0, while Gly and lysine (Lys) were dominant on day 14. There were notable serine + threonine (Ser + Thr [mol%]) and aspartic acid/glycine ratio (Asp/Gly [mol%]) end-member divisions among different organic matter sources. DAA had higher Ser + Thr [mol%] and lower Asp/Gly [mol%] values than PAA. The amino acid degradation index (DI) of PAA and DAA was 0.97 ± 0.28 and - 1.04 ± 0.43, respectively. The fresh DAA from the algae degradation incubation also had DI values similar to those of field DAA in the northern algae-dominated lake region. Amino acid parameters (AA-C%, DI values, Ser + Thr [mol%] and Asp/Gly [mol%]) were calculated to indicate the source, freshness and bioavailability of organic matter in eutrophic shallow Lake Taihu., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Some studies have reported using ultrasonic evaluations to assess diaphragm function in patients with chronic obstructive pulmonary disease (COPD). However, they have limitations and thus cannot provide strong evidence to support ultrasound evaluations for diaphragm function and dysfunction severity assessments in this patient population. Additionally, quantitative studies on the relationship between ultrasound evaluations and diaphragm function do not exist. Therefore, we performed a systematic review and meta-analysis to explore the usefulness of ultrasonography for evaluating diaphragm function in patients with COPD., Methods: The Cochrane Library, PubMed, Embase, Web of Science, Chinese Biomedical Literature Database, Wanfang Data, China National Knowledge Network, and Chinese Scientific Journal Database (i.e., VIP) databases were searched for literature about ultrasonic evaluations of diaphragm function in patients with COPD for systematic review. We extracted patient demographic, diaphragm mobility, diaphragm thickness, diaphragm thickening score, and other related parameter data using RevMan 5.3 software for the meta-analysis., Results: We included 13 articles in the systematic review, 8 of which (494 participants) were included in the meta-analysis. The degree of diaphragm offset in patients with COPD was significantly lower than that in healthy controls (weighted mean difference [WMD] = -1.34; 95% confidence interval [CI]: -2.15, 0.53; P < .05). The diaphragm deviation was lower in the severe COPD group than in the mild-to-moderate COPD group (WMD = 0.50; 95% CI: -0.01, 1.01; P = .06), but the difference was not significant., Conclusion: Ultrasonography effectively evaluates diaphragm function in patients with COPD. The diaphragm offset can be used as an auxiliary diagnostic index for COPD, which is also related to disease severity., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

To study the influence of open-pit coal mining on the surrounding soil environment and human health, this study selected the Hongshaquan coal mine in Xinjiang as the research area and took 31 soil samples from the dump and artificial forest of the mining area. The contents of seven heavy metals (As, Cd, Cr, Cu, Ni, Pb and Zn) in the soil were analyzed. The pollution index method, geoaccumulation index method (I geo ), potential ecological risk index method, health ecological risk assessment model and principal component analysis (PCA) were used to evaluate and analyze the heavy metal pollution, potential ecological risk and health ecological risk of the soil. The results showed that compared with the background value of soil in Xinjiang, except for Pb, other heavy metal elements were essentially pollution-free and belonged to the low ecological risk area. The health risk assessment model showed that Pb and As were the main pollution factors of noncarcinogenic risk, and that exposure to Ni, Pb and As had a lower carcinogenic risk. The PCA showed that Cu, Cr, Ni, Pb, As and Zn in the dump were from transportation and industrial activities, Cd was from natural resources, and Cr, Zn, Ni, Cd and Pb were from transportation in the artificial forest. Cu came from industrial sources and As from soil parent material. The dump was more seriously disturbed by human factors than by artificial forests. Our research provides a reference for heavy metal pollution and source analysis caused by mining.

Introduction: Eating disorders are regarded to be associated with many psychological and behavioral problems. Moreover, adolescence has been reported to be the key period for developing eating habits, and eating disorders typically emerge in adolescence and early adulthood. This study aimed to investigate the prevalence of eating disorders and explore the associated factors among adolescents in Hunan province, China METHODS: A total of 1610 middle school students from Hunan province, China, were enrolled in this study. The participants were aged from 11 to 16 years old. The following data were collected: demographic variables, Body Mass Index (BMI), suicidal behaviors, non-suicidal self-injury, depression, anxiety, stress (depression - anxiety - stress scale, DASS-21), childhood trauma (Childhood Trauma Questionnaire, CTQ), symptoms of social anxiety (Social Anxiety Scale-Adolescents, SAS-A), and eating problems (Eating Attitudes Test, EAT-26)., Results: The estimated prevalence of eating disorders was 8.9%. Compared with participants without eating disorders, participants with eating disorders were more likely to be at a younger age, obese and overweight, and have a history of non-suicidal self-injury, suicidal ideation, suicidal plans, suicide attempts, emotional abuse, physical abuse, emotional neglect, and physical neglect; more likely to experience stress, anxiety or depression as well as have high scores of social avoidance and distress related to general social contexts. Anxiety, emotional neglect, physical neglect, obesity, and overweight were still significant in the binary logistic regression model after controlling for confounding factors. Additionally, younger age, emotional abuse, physical abuse, stress, anxiety, depression, social avoidance, and distress related to general social contexts were significantly correlated with the EAT-26 scores in correlation analysis CONCLUSIONS: Eating disorders are quite common among middle school students. Moreover, eating disorders are associated with younger age, non-suicidal self-injury, suicidal ideation, suicide attempts, stress, anxiety, depression, emotional abuse, physical abuse, emotional neglect, physical neglect, social avoidance, and distress related to general social contents and BMI. This study provides a reference for school counselors and clinicians in the prevention and treatment of eating disorders., Competing Interests: Declaration of Conflicts of interest None., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Heavy metal pollution of agricultural soil, especially Cd, has become a global threat to food safety and human health. Analysis of Cd fluxes through different input/output pathways is widely used to predict the change of Cd content in agricultural soil, identify the critical pathways, and assist in developing effective management strategies to protect the environmental quality of agricultural soils. In the present study, literature recording input/output fluxes of Cd through different pathways in agricultural soils were investigated, with study areas primarily located in China, Japan, and Europe. Fluxes of Cd at the study sites were calculated, and comparative analyses were carried out. Results indicated that the dominant input pathway of Cd was strongly associated with the intensity of local industrial activities. Atmospheric deposition was the predominant input pathway of Cd for 75% of the study cases. Irrigation and livestock manure were also major pathways of Cd input in China. The main output pathways were influenced by the planting structure, precipitation, topography, etc. Crop harvesting and leaching to groundwater played important roles among all Cd output pathways in China, and crop harvesting alone could remove a significant amount of Cd from the soil, with an estimated average flux of 6.27 g/ha/yr. Leaching was the dominant Cd output pathway in Europe, accounting for 77%-93% of total outflux. To mitigate the accumulation of Cd in agricultural soil, standards to regulate Cd in the atmospheric environment, irrigation water, and agricultural additives should be tightened, and regulated removal and disposal of crops harvested from the heavily contaminated field should be promoted., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Smelting activities are considered as the primary cause of heavy metal (HM) accumulation in soils, and the human health around the smelter has been a great concern worldwide. In this study, a total of 242 agricultural soil samples were collected around a large scale Pb/Zn smelter in China, and eight HMs (As, Cd, Cr, Cu, Hg, Ni, Pb and Zn) were analyzed to assess HMs status, ecological -health risks, and identify source. Monte Carlo simulation was utilized to evaluate the probabilistic health risks, and positive matrix factorization (PMF) was employed to identify sources. The results revealed the average contents of five heavy metals (Cd 5.28 mg/kg, Pb 203.36 mg/kg, Hg 0.39 mg/kg, Zn 293.45 mg/kg, Cu 37.14 mg/kg) are higher than their background values in Hunan province. Cd had the highest mean pollution index (PI) of 41.8 and the greatest average ecological risk index (E r ) of 1256.34, indicating that Cd was the primary enriched pollutant and had a higher ecological risk than other HMs. The mean hazard index (HI) through exposure to eight HMs was 2.95E-01 and 9.74E-01 for adults and children, respectively, with 35.94% of HI values for children exceeding the risk threshold of 1. Moreover, the mean total cancer risks (TCR) were 2.75E-05 and 2.37E-04 for adults and children, respectively, with 75.48% of TCR values for children exceeding the guideline value of 1E-04. In addition, the positive matrix factorization results showed smelting activities, natural sources, agricultural activities and atmospheric deposition were the three sources in soils, with the contribution rate of 48.62%, 22.35%, and 29.03%, respectively. The uncertainty analysis of the PMF indicated that the three-factor solution is reliable. This work will provide scientific reference for the comprehensive prevention of soil HM pollution adjacent to the large smelter., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Widespread presence of plastic mulch has led to macroplastic (MaP) pollution. While this issue is widely explored in aquatic ecosystems, MaP pollution on land has been neglected. In 2019, we conducted a large-scale survey of MaPs in Northwest China in 0-30 cm soil with long-term mulching. Samples of MaP debris were collected from 67 sites across Gansu, east Qinghai, and north Shannxi Provinces. All visible MaP pieces for each site were separated and weighed. The mass of each MaP piece was calibrated by size measured in digital images. The MaP mass averaged 47.2 kg ha -1 , and the number of MaPs averaged 266.2 pieces ha -1 . The mass and number of MaPs varied from site to site. The mean size of MaPs was 19.5 cm 2 piece -1 or 28.0 mg piece -1 . More importantly, the number of small MaP pieces (<5 and 5-20 cm 2 piece -1 ) accounted for 76.7% of the total number of MaPs detected, and small-sized plastic debris (<10 and 10-25 mg piece -1 ) were detected in 70.1% of the sampling sites. The percentage of small fragments increased before 15-year of mulching and then declined. However, the amount of medium-large debris (20-50 and >50 cm 2 piece -1 ) showed a trend opposite to that of small fragments. The percentage of MaPs was greater in the small size group than in the medium-large size group. The arid to semi-arid area exhibited higher MaP contamination compared with the semi-arid to the semi-humid area. These observations indicate that plastic debris residing in soil tend to be fragmented, making plastic film recovery more challenging and causing severe soil pollution. Further studies are required to regulate plastic mulch methods and explore the degradation process., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest including any financial, personal, or other relationships that could inappropriately influence their work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Carbon emissions have become a new threat to sustainable development in China, and local government actions can play an important role in energy conservation and emission reduction. This paper explores the theoretical mechanisms and transmission paths of economic growth targets affecting carbon emissions from the perspective of economic growth targets and conducts an empirical analysis based on 30 provincial panel data in China from 2003 to 2019. The results show that: economic growth targets are positively correlated with carbon emissions under a series of endogeneity and robustness; there are regional heterogeneity, target heterogeneity and structural heterogeneity in the impact of economic growth targets on carbon emissions; after economic growth targets are set, government actions can influence carbon emissions by affecting resource mismatch and industrial restructuring; It is further found that there is a "U" shaped relationship between economic pressure and carbon emissions. Based on the above findings, this paper further proposes that a high-quality performance assessment mechanism should be developed to bring into play the active role of local governments in achieving carbon reduction goals, and thus contribute to high-quality economic development.

Although previous studies have investigated the ability of traditional Chinese health exercises (TCHEs) to improve cognitive function, few have utilized bibliometric analyses to address this topic. We aimed to investigate the current status of and developmental trends in this field from 2001 to 2020. We searched the Web of Science Core Collection (WoSCC) for all research publications on cognitive function in relation to TCHEs. CiteSpace V was used to analyze the number of papers, countries, institutions, journals, authors, and citations. We identified hotspots and trends in the field by drawing co-citation reference and co-occurrence keyword maps. From 2001 to 2020, 406 relevant articles were published in the WoSCC, with a gradual increase in the annual number of publications. The three countries/regions with the most publications were the Chinese mainland, the United States, and Canada. Six universities from China and four from the United States were identified as the top 10 institutions. Most research was conducted at universities. Evidence-based Complementary and Alternative Medicine was identified as the most productive journal. Together, these findings indicate that TCHEs have received increasing attention as a method for improving cognition., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Li, Weng, Xiang and Fan.)

Background: Lung function is highly age-dependent as it decreases in varying degrees with age, even in healthy people. Decreased lung function results in less elastic lung tissue, reduced chest wall compliance, reduced area for gas exchange, and even a variety of chronic diseases. Traditional Chinese health exercise (TCHE) has three components: "breath regulation," "body regulation," and "heart regulation," which play an important role in the improvement of lung function. However, which component has the most significant effect on lung functioning remains unclear. Therefore, depending on the modality of conditioning, TCHEs will be divided into three exercise intervention groups: breath regulation group, body regulation group, and heart regulation group, in order to explore the magnitude of the effect of the different modalities of conditioning on the improvement of lung function., Methods: The prospective, parallel, single-blind, randomized controlled trial will evaluate the effects of different conditioning methods of TCHE on lung function in middle-aged and elderly people. The study subjects are healthy middle-aged and elderly adults, who will be randomly divided into the "breath regulation group," "body regulation group," "heart regulation group," and "control group." The control group will receive health education. Health education and exercise intervention in the three intervention groups will be provided for 6 months, 5 times a week, with each session lasting 60 min. The outcomes of interest include changes in the pulmonary function tests measured at baseline and 3 and 6 months after the beginning of the intervention. The primary outcome is the forced vital capacity (FVC), while the secondary outcomes include forced expiratory volume in 1 s (FEV1), FVC/FEV1 ratio, vital capacity (VC), and maximal voluntary ventilation (MVV)., Discussion: This study will assess the effects of different conditioning methods of TCHE on lung function in middle-aged and elderly people. The final findings of this study will validate the effectiveness and safety of TCHE on lung function interventions in middle-aged and elderly people., Trial Registration: China Clinical Trial Registry ChiCTR2100052687 . Registered on November 3, 2021., (© 2021. The Author(s).)

Nansi Lake is the largest lake along the eastern route of China's South-to-North Water Diversion Project (SNWDP). It is divided into the upper lake and the lower lake by a dam. By using UV-Vis spectroscopy, synchronous fluorescence (SF) spectroscopy, excitation-emission matrix and parallel factor analysis (EEM-PARAFAC), spatial, and temporal differences in the properties of dissolved organic matter (DOM) were found in the 2 areas of Nansi Lake under different hydrological conditions. A total of 5 fluorescence components were obtained by EEM-PARAFAC, which included 3 humic-like components (C1-C3) and 2 protein-like components (C4 and C5). On the spatial scale, the fluorescence intensities (F max ) of humic-like substances and the ratio of the fluorescence intensity of humic-like components to the total fluorescence intensity (%F max ) and degree of humification (HIX) in the upper lake were higher than those in the lower lake. This indicated the strong contributions of terrestrial sources to the upper lake, while DOM properties in the lower lake were more endogenous than those in the upper lake. On the temporal scale, protein-like substances played a more important role in DOM properties in April (F max =0.72±0.03 in the upper lake and 1.84±0.13 in the lower lake) and July (F max =1.10±0.05 in the upper lake and 1.49±0.04 in the lower lake) than in October. This result might be related to the water transfer of the eastern route of the SNWDP and to the death of submerged plants. However, the contents of humic-like substances (ranging from 55.61±1.23% to 66.56±0.58% for the upper lake and 29.98±1.56% to 61.98±0.99% for the lower lake) and degree of humification (from 2.23±0.06 to 3.10±0.05 for the upper lake and 1.06±0.05 to 2.62±0.08 for the lower lake) in Nansi Lake showed an increasing trend from April to October. In addition, significant correlations and good linear relationships between humic-like components, a 254 , and DOC in the 3 months reflected the continuous contribution of humic-like substances to DOM properties in Nansi Lake. Rapid changes in the fluorescence signal were largely dependent on changes in water quality. The fluorescence signal could be a tool for the management of water quality in Nansi Lake., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Esophageal squamous cell carcinoma (ESCC) is the major type of esophageal cancer in China. The role of the bacteria present in ESCC tissue in neoplastic progression has not been fully elucidated. This study aimed to uncover different bacterial communities in ESCC tissues and examine the correlation between the abundance of the esophageal flora and clinicopathologic characteristics of ESCC., Results: Microorganisms in tumors and normal tissues showed obvious clustering characteristics. The abundance of Fusobacterium (P = 0.0052) was increased in tumor tissues. The high level of Fusobacterium nucleatum was significantly associated with pT stage (P = 0.039) and clinical stage (P = 0.0039). The WES data showed that COL22A1, TRBV10-1, CSMD3, SCN7A and PSG11 were present in only the F. nucleatum-positive ESCC samples. GO and protein domain enrichment results suggested that epidermal growth factor might be involved in the regulation of cell apoptosis in F. nucleatum-positive ESCC. Both a higher mutational burden and F. nucleatum-positive was observed in tumors with metastasis than in tumors without metastasis., Conclusion: F. nucleatum is closely related to the pT stage and clinical stage of ESCC. The abundance of F. nucleatum and tumor mutation burden may be used in combination as a potential method to predict metastasis in ESCC., (© 2021. The Author(s).)

Purpose: Genetic factors play a crucial role in thoracic ossification of the ligamentum flavum (TOLF). This study aimed to better understand the association between single nucleotide polymorphisms (SNP) in functional regions of the collagen VI, alpha 1 gene (COL6A1) and TOLF, and to confirm COL6A1 as a TOLF susceptibility gene., Methods: Ten tag SNPs in COL6A1 were genotyped using the SNaPshot assay, and allele and genotype frequencies were compared between TOLF patients and control individuals. The function of SNPs associated with disease was studied. For COL6A1 promoter SNPs, the transcriptional activity of each haplotype was determined by luciferase reporter assays. For COL6A1 exonic SNPs, the effect of nucleotide substitutions on COL6A1 expression was determined by western blotting. COL6A1 mRNA expression in ligamentum flavum tissues from TOLF patients with different genotypes was examined using reverse transcription real-time PCR., Results: Four SNPs were associated or possibly associated with TOLF, with higher pathogenic allele and genotype frequencies seen in TOLF patients compared with controls. The rs17551710/rs7671-GG/GG genotype appeared to be related to disease severity. Nucleotide substitutions at rs17551710 and rs7671 increased COL6A1 transcriptional activity and nucleotide substitutions at rs1053312 and rs13051496 increased COL6A1 protein expression. COL6A1 mRNA expression was significantly up-regulated in individuals with rs17551710/rs7671-GG/GG and rs1053312/rs13051496-AA+AG/CC genotypes compared with other genotypes., Conclusion: SNPs in the COL6A1 promoter and exonic regions are associated with TOLF in the Chinese Han population, and lead to up-regulated COL6A1 expression. We confirmed COL6A1 as a TOLF susceptibility gene that may be involved in TOLF pathology., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Hazardous materials shipments are integral to the development of industrial countries. Significant casualties and severe environmental pollution quickly ensue when accidents occur. Currently, relevant research on risk assessment of hazardous materials' road transportation remains limited when both the population exposure risk and environmental risk are considered, especially in regard to analyzing the differences of accident impacts in different populations and environments. This paper adopts a Gaussian plume model to simulate dynamic areas at three levels of population exposure and assesses the pollution scope of air, groundwater, lakes, and rivers with a variety of diffusion models. Then, we utilize various costs to analyze the differences of accident impacts in population exposure and environmental pollution. Finally, a risk assessment model of hazardous materials road transportation under time-varying conditions is presented by considering the bearing capacity of the assessed area. Furthermore, this model is applied to a case study involving a risk assessment of hazardous materials transportation of a highly populated metropolitan area of Shanghai, China. The resulting analyses reveal that the safety of hazardous materials transportation could be effectively improved by controlling certain model parameters and avoiding road segments with a high risk of catastrophic accident consequences.

Ethnopharmacological Relevance: The coronavirus disease 2019 (COVID-19) has formed a global pandemic since late 2019. Benefitting from the application experience of Chinese Medicine (CM) for influenza and SARS, CM has been used to save patients at the early stage of COVID-19 outbreak in China., Aim of the Study: In order to evaluate the efficacy and safety of CM, and compare with Western Medicine (WM) for COVID-19, we conducted a retrospective case series study based on the patients in Wuhan Jinyintan Hospital, Wuhan, China., Methods: The inclusion and exclusion criteria of data extraction were set for this retrospective study. All patients who were admitted by the Wuhan Jinyintan Hospital between January 17th and February 25th 2020 were considered. In addition, patients enrolled met the severe defined by the guidelines released by the National Health Commission of the People's Republic of China. In these cases included in the study, CM or WM treatment was selected according to the wishes of the patients at the beginning of hospitalization. The patients in CM group were treated with Huashi Baidu granule (137 g po, bid) combined with the injections of Xiyanping (100 mg iv, bid), Xuebijing (100 ml iv, bid) and Shenmai (60 ml iv, qd) according to the syndrome of epidemic toxin blocking the lung in the theory of Traditional Chinese Medicine. The WM group received antiviral therapy (including abidor capsule 0.2 g po, tid; Lopinavir-Ritonavir tablets, 500 mg po, bid), antibiotics (such as cefoperazone 2 g iv, bid; moxifloxacin hydrochloride tablets, 0.4 g po, qd) or corticosteroid therapy (such as methylprednisolone succinate sodium 40 mg iv, qd; prednisone, 30 mg po, qd). In addition, patients in both groups received routine supportive treatment, including oxygen inhalation, symptomatic therapy, and/or human intravenous immunoglobulin, and/or serum albumin, and treatment for underlying diseases. The clinical outcomes were evaluated based on changes related with clinical manifestations, computer tomography (CT) scan images, and laboratory examinations before and after the treatment., Results: 55 severe COVID-19 patients, with 23 in CM group and 32 in WM group, were included for analyzed. There was no case of death, being transferred to ICU, or receiving invasive mechanical ventilation in two groups during hospitalization. The median time of SARS-CoV-2 RNA clearance in CM and WM group were 12 days and 15.5 days respectively, the ratio of nucleic acid negative conversion of CM group at different follow-up time points was significantly higher than that of WM group (HR: 2.281, P = 0.018). Further, the chest CT imaging showed more widely lung lesion opacity absorbed in the CM group. The high sensitivity C-reactive protein and serum ferritin decreased significantly in the CM group (P<0.05). There was no significant difference in adverse events in terms of liver function and renal function between the two groups., Conclusion: Based on this retrospective analysis from Wuhan Jinyintan Hospital, CM has better effects in SARS-CoV-2 RNA clearance, promoting lung lesion opacity absorbed and reducing inflammation in severe COVID-19 patients, which is effective and safe therapy for treating severe COVID-19 and reducing mortality., (Copyright © 2021. Published by Elsevier B.V.)

Objective: To analyse the clinical application of thoracodorsal artery perforator flaps (TDAPF) in the repair of head and neck defects. Methods: A retrospective review was conducted on 38 patients with oral and maxillofacial head and neck malignant tumors who underwent radical resection of oral and oropharyngeal carcinoma and TDAPF repair in the Department of Oral and Maxillofacial Head and Neck Oncology of the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2017 to November 2018. Among them, 32 were males and 6 were females, aged 30-74 years. Flap size, vessel pedicle length, diameter and number of perforators, and flap fat thickness were recorded and counted. Elasti Meter and Skin Fibro Meter were applied to measure the skin elasticity and hardness in the donor areas of 4 kinds of skin flaps before the flap preparation. SPSS 19.0 statistical software was used for statistical analysis of the data. Results: All the flaps survived (100%). The mean elasticity of TDAPF [(41.2±12.9) N/m] was significantly lower than that of anterolateral thigh [(77.6±23.3) N/m, χ²=88.89, P <0.05], anterolateral thigh [(62.6±17.7) N/m, χ²=59.99, P <0.05] and or forearm flap [(51.7±8.6) N/m, χ²=37.82, P <0.05]. The hardness of TDAPF [(0.037±0.016) N] was also significantly lower than that of anterolateral femoral [(0.088±0.019) N, F =93.27, P <0.05], anteromedial femoral [(0.059±0.020) N, F =25.71, P <0.05] or forearm flap [(0.062±0.016) N, F =29.11, P <0.05]. Follow-up period ranged from 2 to 14 months. The 38 patients treated with TDAPF had a good recovery of the functions in the recipient areas, and the scars of the donor areas were not obvious after surgery, without serious complications. Conclusion: TDAPF is suitable for reconstruction of head and neck defect, with ductile texture and good recovery of the morphology and function of head and neck.

Objective: To investigate the expression of miR-22-3p in breast cancer and the mechanism of targeting PLAGL2 to inhibit the invasion and migration in human breast cancer., Study Design: An experimental study., Place and Duration of Study: Department of Oncology and Department of General Surgery, The People's Hospital of China Three Gorges University, China, from March 2019 to December 2020., Methodology: The miR-22-3p expression level in 41 paired human primary breast invasive ductal carcinoma tissues and para-cancer tissues was obtained by real-time fluorescence quantitative reverse transcriptase PCR (qRT-PCR). The effect of miR-22-3p on the proliferation of breast cancer cells was detected by growth curve method. Online software TargetScan was used to predict the target genes of miR-22-3p. The prediction results were verified by luciferase reporter gene assay and qRT⁃PCR., Results: MiR-22-3p expression was significantly decreased in the breast cancer tissues than in para⁃carcinoma normal breast tissues (p<0.05). Over-expression of miR-22-3p can inhibit the proliferation of MCF-7 cells significantly. Pleomorphic adenoma gene-like protein 2(PLAGL2) is the predicted target gene of miR-22-3p. MiR-22-3p binds to its predicted target gene PLAGL2-3'UTR. The expression of miR-22-3p was negatively correlated with PLAGL2 in MCF-7 cells., Conclusion: MiR-22-3p could suppress the proliferation of breast cancer by targeting PLAGL2. This suggests that miR-22-3p may be a strategy of choice for targeted therapy of breast cancer. Key Words: Breast cancer, MiR-22-3p, PLAGL2, Cell proliferation.

Background: Currently, coronavirus disease-2019 (COVID-19) is continuously and rapidly circulating, resulting in serious and extensive effects on human health. Due to the absence of antiviral medicine for COVID-19 thus far, there is a desperate need to develop effective medicine. Traditional Chinese medicine (TCM) has been widely applied in the treatment of epidemic diseases in China, with the aim of achieving clinical efficacy and decreasing the use of antibiotics and glucocorticoids. The aim of this study was to evaluate the efficacy and safety of Baidu Jieduan granules in treating COVID-19., Methods/design: This multicentre, open-label, randomized controlled trial will be conducted in 300 patients with COVID-19. The patients will be randomly (1:1) divided into a treatment group and a control group. All patients will receive standard therapy at the same time. Patients in the experimental group will receive Baidu Jieduan granule treatment twice a day for 14 days. The outcomes will be assessed at baseline and at 3, 5, 7 and 14 days after treatment initiation. The primary outcome will be the rate of symptom (fever, fatigue and coughing) recovery. Adverse events (AEs) will be monitored throughout the trial., Discussion: The study will provide high-quality clinical evidence to support the efficacy and safety of Baidu Jieduan granules in the treatment of moderate COVID-19, and enrich the theory and practice of TCM in treating COVID-19., Trial Registration: Chinese Clinical Trial Registry ChiCTR2000029869 . Registered on 15 February 2020., (© 2021. The Author(s).)

Church General Hospital in Wuchang, China planned to establish a psychiatric hospital in 1930. Chi-liang Kwei, received his PhD at Johns Hopkins Medical School of America and was appointed to be in charge of the preparation. After working out a draft plan for the hospital, Dr. Kwei applied for the Henderson Research Scholarship on Mental Diseases. She planned to study under the guidance of Dr. D.K. Henderson in the Glasgow Mental Royal Hospital for a full year in preparation for the establishment of the hospital. By drawing on the correspondence files of Chi-liang Kwei and psychiatrists Adolf Meyer and David Kennedy Henderson, the paper describes the background conditions and planning for the hospital establishment and interprets the significance and value of Chi-liang Kwei's efforts to establish a psychiatric hospital from the perspective of the historic development of modern psychiatry in China.

Neurodevelopmental disorders (NDDs) are a set of complex disorders characterized by diverse and co-occurring clinical symptoms. The genetic contribution in patients with NDDs remains largely unknown. Here, we sequence 519 NDD-related genes in 3,195 Chinese probands with neurodevelopmental phenotypes and identify 2,522 putative functional mutations consisting of 137 de novo mutations (DNMs) in 86 genes and 2,385 rare inherited mutations (RIMs) with 22 X-linked hemizygotes in 13 genes, 2 homozygous mutations in 2 genes and 23 compound heterozygous mutations in 10 genes. Furthermore, the DNMs of 16,807 probands with NDDs are retrieved from public datasets and combine in an integrated analysis with the mutation data of our Chinese NDD probands by taking 3,582 in-house controls of Chinese origin as background. We prioritize 26 novel candidate genes. Notably, six of these genes - ITSN1, UBR3, CADM1, RYR3, FLNA, and PLXNA3 - preferably contribute to autism spectrum disorders (ASDs), as demonstrated by high co-expression and/or interaction with ASD genes confirmed via rescue experiments in a mouse model. Importantly, these genes are differentially expressed in the ASD cortex in a significant manner and involved in ASD-associated networks. Together, our study expands the genetic spectrum of Chinese NDDs, further facilitating both basic and translational research., (Copyright © 2021 Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, and Genetics Society of China. Published by Elsevier Ltd. All rights reserved.)

Importance: Whether patients with breast cancer who carry a BRCA1/2 variant can safely undergo breast-conserving therapy (BCT) remains controversial., Objective: To compare survival rates after BCT vs mastectomy in BRCA1/2 variant carriers and noncarriers in a large series of unselected patients with breast cancer., Design, Setting, and Participants: In this cohort study, a large consecutive series of 8396 unselected patients with primary breast cancer underwent either BCT, mastectomy with radiotherapy, or mastectomy alone from October 1, 2003, to May 31, 2015, at the Breast Center of Peking University Cancer Hospital in China. All patients were assessed for BRCA1/2 germline variant status. Statistical analysis was performed from May 1 to September 30, 2020., Main Outcomes and Measures: The primary outcomes were breast cancer-specific survival (BCSS) and overall survival (OS); secondary outcomes included recurrence-free survival, distant recurrence-free survival, and ipsilateral breast tumor recurrence., Results: Of these 8396 Chinese patients (8378 women [99.8% women]; mean [SD] age, 50.8 [11.4] years; 187 BRCA1 carriers, 304 BRCA2 carriers, and 7905 noncarriers), 3135 (37.3%) received BCT, 1511 (18.0%) received mastectomy with radiotherapy, and 3750 (44.7%) received mastectomy alone. After a median follow-up of 7.5 years (range, 0.3-16.6 years), both BRCA1 and BRCA2 variant carriers treated with BCT had similar rates of survival compared with those treated with mastectomy with radiotherapy (BCSS: hazard ratio [HR] for BRCA1, 0.58 [95% CI, 0.16-2.10]; P = .41; HR for BRCA2, 0.46 [95% CI, 0.15-1.41]; P = .17; OS: HR for BRCA1, 0.61 [95% CI, 0.18-2.12]; P = .44; HR for BRCA2, 0.72 [95% CI, 0.26-1.96]; P = .52) or mastectomy alone (BCSS: HR for BRCA1, 0.70 [95% CI, 0.22-2.20]; P = .54; HR for BRCA2, 0.59 [95% CI, 0.18-1.93]; P = .39; OS: HR for BRCA1, 0.77 [95% CI, 0.27-2.21]; P = .63; HR for BRCA2, 0.62 [95% CI, 0.22-1.73]; P = .37) after adjusting for clinicopathologic factors and adjuvant therapy. For noncarriers, patients receiving BCT had significantly better survival than those receiving mastectomy with radiotherapy (BCSS: HR, 0.45 [95% CI, 0.36-0.57]; P < .001; OS: HR, 0.46 [95% CI, 0.37-0.58]; P < .001) or mastectomy alone (BCSS: HR, 0.71 [95% CI, 0.57-0.89]; P = .003; OS: HR, 0.71 [95% CI, 0.58-0.87]; P < .001) in multivariable analyses., Conclusions and Relevance: This study suggests that BRCA1/2 variant carriers treated with BCT have survival rates at least comparable to those treated with mastectomy with radiotherapy or mastectomy alone and that BCT could be an option for BRCA1/2 variant carriers when the tumor is clinically appropriate for BCT.

Background: There is limited information on the difference in epidemiology, clinical characteristics and outcomes of the initial outbreak of the coronavirus disease (COVID-19) in Wuhan (the epicenter) and Sichuan (the peripheral area) in the early phase of the COVID-19 pandemic. This study was conducted to investigate the differences in the epidemiological and clinical characteristics of patients with COVID-19 between the epicenter and peripheral areas of pandemic and thereby generate information that would be potentially helpful in formulating clinical practice recommendations to tackle the COVID-19 pandemic., Methods: The Sichuan & Wuhan Collaboration Research Group for COVID-19 established two retrospective cohorts that separately reflect the epicenter and peripheral area during the early pandemic. The epidemiology, clinical characteristics and outcomes of patients in the two groups were compared. Multivariate regression analyses were used to estimate the adjusted odds ratios (aOR) with regard to the outcomes., Results: The Wuhan (epicenter) cohort included 710 randomly selected patients, and the peripheral (Sichuan) cohort included 474 consecutive patients. A higher proportion of patients from the periphery had upper airway symptoms, whereas a lower proportion of patients in the epicenter had lower airway symptoms and comorbidities. Patients in the epicenter had a higher risk of death (aOR=7.64), intensive care unit (ICU) admission (aOR=1.66), delayed time from illness onset to hospital and ICU admission (aOR=6.29 and aOR=8.03, respectively), and prolonged duration of viral shedding (aOR=1.64)., Conclusions: The worse outcomes in the epicenter could be explained by the prolonged time from illness onset to hospital and ICU admission. This could potentially have been associated with elevated systemic inflammation secondary to organ dysfunction and prolonged duration of virus shedding independent of age and comorbidities. Thus, early supportive care could achieve better clinical outcomes.

Respirable particles with aerodynamic diameters ≤ 10 µm (PM 10 ) have important impacts on the atmospheric environment and human health. Available PM 10 datasets have coarse spatial resolutions, limiting their applications, especially at the city level. A tree-based ensemble learning model, which accounts for spatiotemporal information (i.e., space-time extremely randomized trees, denoted as the STET model), is designed to estimate near-surface PM 10 concentrations. The 1-km resolution Multi-Angle Implementation of Atmospheric Correction (MAIAC) aerosol product and auxiliary factors, including meteorology, land-use cover, surface elevation, population distribution, and pollutant emissions, are used in the STET model to generate the high-resolution (1 km) and high-quality PM 10 dataset for China (i.e., ChinaHighPM 10 ) from 2015 to 2019. The product has an out-of-sample (out-of-station) cross-validation coefficient of determination (CV-R 2 ) of 0.86 (0.82) and a root-mean-square error (RMSE) of 24.28 (27.07) μg/m 3 , outperforming most widely used models from previous related studies. High levels of PM 10 concentration occurred in northwest China (e.g., the Tarim Basin) and the Northern China Plain. Overall, PM 10 concentrations had a significant declining trend of 5.81 μg/m 3 per year (p < 0.001) over the past five years in China, especially in three key urban agglomerations. The ChinaHighPM 10 dataset is potentially useful for future small- and medium-scale air pollution studies by virtue of its higher spatial resolution and overall accuracy., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The number of corona virus disease 2019 cases is increasing rapidly. However, the comparison of clinical characteristics between patients ≥ 70 and those < 70 has not been implemented yet. To achieve that, we collected clinical data of consecutive 222 patients in Renmin Hospital of Wuhan University diagnosed between January 13, 2020 and February 4, 2020. We divided them into an under-70 group and an over-70 group according to their ages, comparing their clinical characteristics. Meanwhile, univariate and multivariate Cox regression analyses were performed to identify the prognostic factors. Among the patients enrolled, 37 (16.67%) were 70 or older and 185 (83.33%) were younger than 70. Higher proportions of dyspnoea, expectoration, chronic cardiovascular disease, diabetes, organ complications, severe-to-critical cases, a higher death rate, a longer hospital stay and decreased immune status were observed in the over-70 group patients compared with their younger counterparts. The risk factors for death included dyspnoea, muscle ache, elevated myocardial enzymes, elevated C3 in over-70 patients and dyspnoea, pharyngalgia, chronic cardiac disease, increased C-reactive protein, IgA, decreased platelets in under-70 patients. Overall, our research compared the clinical characteristics of the two populations with different immune status and illustrated differentiated risk factors for death in them.

The COVID-19 outbreak is becoming a public health emergency. Data are limited on the clinical characteristics and causes of death. A retrospective analysis of COVID-19 deaths were performed for patients' clinical characteristics, laboratory results, and causes of death. In total, 56 patients (72.7%) of the decedents (male-female ratio 51:26, mean age 71 ± 13, mean survival time 17.4 ± 8.4 days) had comorbidities. Acute respiratory failure (ARF) and sepsis were the main causes of death. Increases in C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer and lactic acid and decreases in lymphocytes were common laboratory results. Intergroup analysis showed that (1) most female decedents had cough and diabetes. (2) The proportion of young- and middle-aged deaths was higher than elderly deaths for males, while elderly decedents were more prone to myocardial injury and elevated CRP. (3) CRP and LDH increased and cluster of differentiation (CD) 4+ and CD8+ cells decreased significantly in patients with hypertension. The majority of COVID-19 decedents are male, especially elderly people with comorbidities. The main causes of death are ARF and sepsis. Most female decedents have cough and diabetes. Myocardial injury is common in elderly decedents. Patients with hypertension are prone to an increased inflammatory index, tissue hypoxia and cellular immune injury.

Objective: This study aims to discuss the unique clinical features of patients with 2019-nCoV in Zhengzhou City to provide references for clinical diagnosis and treatment., Patients and Methods: Seventeen patients with 2019-nCoV in Zhengzhou People's Hospital from February to March 2020 were collected. Their epidemiology, clinical symptoms, laboratory examinations, and chest CT images were reviewed. All 17 patients were aged between 12-83 years, with an average age of 47 years, and consisted of 10 males (58.8%) and 7 females (41.2%). Two patients had histories of living or traveling in Wuhan, and 9 patients were attacked locally. The 6 remaining patients were unknown about incidence reasons., Results: The average incubation period was 10 days, and the average time of the course of the disease was 9 days. Among the participants, 12 patients had fever as the first symptoms and 5 patients had normal body temperature. One patient was symptom-free carrier, and one patient had serious symptoms. One patient developed from mild symptoms to severe symptoms, and 14 patients had mild symptoms. Moreover, 7 patients had complications of cardiovascular and cerebrovascular diseases and hypertension, 1 patient was in the advanced stage of squamous cell lung carcinoma, and 1 patient had diabetes mellitus, renal failure, and late-stage uremia. According to novel coronavirus nucleic acid test, 8 patients were positive, accounting for 47.1%. All patients were negative in the novel coronavirus IgM antibody test and negative in other common respiratory pathogen detection. All 17 patients had ground glass-like high-density shadow or stripped high-density shadow on lung CT images, accompanied with many affected lesions on two lungs. The average stay in hospital was 10 days, and the average time of the course of the disease was 9 days. After hospitalization, 15 patients were discharged from the hospital upon recovery, 1 patient was transferred to superior hospital for continuous treatment, and 1 patient died. Patients with 2019-nCoV in Zhengzhou People's Hospital were mainly attacked in local areas, and most of them had mild symptoms. The positive rate of the nucleic acid test was 47.1%., Conclusions: The main clinical characteristics are increased neutrophil granulocytes, increased C-reactive proteins, decreased lymphocytes, ground glass-like or stripped lesions on lung CT image, common complications of cardiovascular and cerebrovascular diseases, and favorable prognosis.

Introduction: Known atrial fibrillation (AF) rate and appropriate prescription of oral anticoagulants (OACs) in acute ischemic stroke (AIS) patients with AF in China are not as well known as in Western countries., Methods: Known AF and unknown AF, rate and adequacy of OACs use of AIS patients with AF attending five hospitals from April 2018 to August 2019 in the northwest region of China were investigated., Results: A total of 344 patients were enrolled. Of these, 237 (AF-known group; 237/344, 68.9%) and 107 patients (AF-unknown group; 107/344, 31.1%) were diagnosed with AF before and after AIS during this hospitalization, respectively. In the AF-known group with echocardiography results (178 patients, including 103 female and 75 male patients), 154 of overall, 88 of female and 66 of male patients, respectively, were indicated to be taking OACs. However, the actual OACs proportion was much lower [overall (30.5%, 47/154); female (31.8%, 28/88) and male (28.8%, 19/66) patients] than indicated. Only one female patient met the guideline-based criteria for OACs. As for patients diagnosed with massive cerebral infraction (MCI; 43.0%, 148/344), the known AF rate was 65.5% (97/148). Among the MCI patients in the AF-known group with echocardiography results (61 patients), 50 patients had an OACs indication. However, only 22.0% (11/50) of these patients took OACs, and none met the guideline-based criteria for OACs., Conclusions: This study revealed a low known AF rate, low OACs use rate and low rate of meeting the guideline-based criteria for OACs in AIS patients with AF in the northwest region of China. These findings indicated the importance of AF as a public health problem in China.

Purpose: Thoracic spinal stenosis (TSS) is a rare disease secondary to multiple pathological changes that differ in prevalence and clinical characteristics. The epidemiological characteristics of these pathologies are largely unknown due to the limited case samples and regional differences. Therefore, a systematic review was conducted to elucidate the prevalence and clinical characteristics of TSS., Methods: Case series and case reports on the ossification of the posterior longitudinal ligaments (OPLL), ossification of the ligamentum flavum (OLF) and thoracic disk herniation (TDH) were screened from PubMed, Embase and Web of Science databases and systematically reviewed. Epidemiological, demographic and segmental distribution data were extracted and analyzed., Results: A total of 129 studies including 1935 subjects were selected, of which 361 (18.7%) were diagnosed with OPLL, 804 (41.5%) with OLF, 143 (7.4%) with OPLL + OLF and 627 (32.4%) with TDH. Most reports were from China, Japan and USA. Thoracic OPLL occurred mostly at the middle-thoracic spine (43.4%), while OLF predominately occurred at the lower-thoracic spine (63.1%). TDH was mainly localized in the middle (46.0%) and lower-thoracic (50.3%) spine. Thirty-two studies involving 524 patients described tandem spinal stenosis, of which 52.1% had accompanying cervical diseases and 35.9% lumbar diseases., Conclusions: There are significant differences in the age, sex and segment distribution characteristics of different pathologies leading to TSS. Tandem spinal stenosis is not uncommon and should be considered when diagnosing TSS. Our findings provide new insights into the prevalence and clinical characteristics of TSS and can help reduce misdiagnosis.

Background: Echo-guided percutaneous procedures have been reported reliable and advantageous. However, the learning curve is difficult for junior doctors. We aimed to evaluate the safety and efficacy of a novel guidewire (Panna wire) in percutaneous atrial septal defect closure under transthoracic echocardiography guidance only., Methods: The Panna wire is designed for echo-guide procedure with a retractable spindle-shaped tip. A multicenter, randomized, controlled trial was conducted to evaluate the safety and efficacy of the Panna wire versus the conventional guidewire for junior doctors with <100 cases experience. The primary outcome was operative success rate. The secondary outcomes were incidence of major adverse events, operation time, time needed to enter the left atrium, number of arrhythmia episodes, number of misguidance to tricuspid valve, and incidence of peripheral vascular complications., Results: Between July 2018 and September 2019, 100 patients with atrial septal defect were randomized to either the Panna wire group (n=52) or the conventional wire group (n=48) at 3 centers. The baseline clinical characteristics were similarly distributed. The operative success rate (primary outcome) was 100% in the Panna wire group versus 68.75% in the conventional wire group ( P <0.001). No major adverse events occurred in either group. Significant differences in favor of the Panna wire group were found in operation time ( P =0.004), time needed to enter the left atrium ( P <0.001), number of arrhythmia episodes ( P <0.001), and number of misguidance to tricuspid valve ( P =0.005)., Conclusions: The Panna wire is safe and effective and reduces the learning curve in percutaneous atrial septal defect closure under transthoracic echocardiography guidance only. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT04096924.

Purpose: Aimed to characterize the CT imaging and clinical course of asymptomatic cases with COVID-19 pneumonia., Methods: Asymptomatic cases with COVID-19 pneumonia confirmed by SARS-COV-2 nucleic acid testing in Renmin Hospital of Wuhan University were retrospectively enrolled. The characteristics of CT imaging and clinical feature were collected and analyzed., Results: 58 asymptomatic cases with COVID-19 pneumonia admitted to our hospital between Jan 1, 2020 and Feb 23, 2020 were enrolled. All patients had history of exposure to SARS-CoV-2. On admission, patients had no symptoms and laboratory findings were normal. The predominant feature of CT findings in this cohort was ground glass opacity (GGO) (55, 94.8%) with peripheral (44, 75.9%) distribution, unilateral location (34, 58.6%) and mostly involving one or two lobes (38, 65.5%), often accompanied by characteristic signs. After short-term follow-up, 16 patients (27.6%) presented symptoms with lower lymphocyte count and higher CRP, mainly including fever, cough and fatigue. The evolution of lesions on CT imaging were observed in 10 patients (17.2%). The average days of hospitalization was19.80±10.82 days, and was significantly longer in progression patients (28.60±7.55 day)., Conclusion: CT imaging of asymptomatic cases with COVID-19 pneumonia has definite characteristics. Since asymptomatic infections as "covert transmitter", and some patients can progress rapidly in the short term. It is essential to pay attention to the surveillance of asymptomatic patients with COVID-19. CT scan has great value in screening and detecting patients with COVID-19 pneumonia, especially in the highly suspicious, asymptomatic cases with negative nucleic acid testing., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2020 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)

Objective: Iterative decomposition of water and fat with echo asymmetry and least-squares estimation-iron quantification (IDEAL-IQ) is a noninvasive and objective method used to quantitatively measure fat content. Although this technique has been used in the entire abdomen, IDEAL-IQ findings in the sacroiliac joint (SIJ) have rarely been reported. This preclinical study was performed to quantify the amount of fat in the SIJ in healthy volunteers by IDEAL-IQ., Methods: From April to November 2017, 60 healthy volunteers with low back pain were included in this retrospective study. The participants were allocated into groups by age (15-30, 31-50, and ≥51 years), sex (male and female), and body mass index (BMI) (<18.5, 18.5-23.9, and ≥24.0 kg/m 2 ). The iliac-side (Fi) and sacral-side (Fs) fat fractions were obtained in all groups. Two- and three-factor multivariate analyses were performed to analyze the effects of sex, age, and BMI on the Fi and Fs., Results: The interaction among sex, age, and BMI had no statistically significant effect on the dependent variable. Both Fi and Fs were significantly influenced by age. Fs was significantly influenced by sex., Conclusion: The IDEAL-IQ sequence can be used to quantitatively assess the SIJ fat content in healthy volunteers.

To estimate the cumulative risk of contralateral breast cancer (CBC) in BRCA1/2 carriers in a large cohort of unselected Chinese breast cancer patients. Our study comprised 9,401 unselected Chinese breast cancer patients and BRCA1/2 germline mutations were determined in all patients. After a median follow-up of 5.7 years, 181 patients developed CBC in this cohort. Compared to noncarriers, BRCA1 and BRCA2 carriers had a 4.52-fold (95% CI, 2.63-7.76) and 5.54-fold (95% CI, 3.51-8.74) increased risk of CBC, respectively. The 10-year cumulative risk of CBC was 15.5% (95% CI, 9.9-24.2) for BRCA1 carriers, 17.5% (95% CI, 10.9-28.0) for BRCA2 carriers and 3.2% (95% CI, 2.5-4.1) for noncarriers. Younger age at first breast cancer diagnosis was significantly associated with an increased 10-year risk of CBC for BRCA1 carriers (≤40 years vs. >40 years: 21.5% vs. 11.9%, unadjusted hazard ratio [HR] = 2.51, 95% CI, 1.03-6.15, p = 0.044), but not for BRCA2 carriers and noncarriers. The 10-year cumulative CBC risk was significantly higher in both BRCA1 and BRCA2 carriers who had a family history of breast cancer than in those who did not (BRCA1: 27.5% vs. 9.4%, adjusted HR = 2.64, 95% CI, 1.01-6.97, p = 0.049; BRCA2: 27.1% vs. 12.8%, adjusted HR = 2.29, 95% CI, 1.04-5.06, p = 0.040). In conclusion, the risk of CBC was a substantial high in BRCA1/2 carriers in unselected Chinese breast cancer patients, and CBC risk is much more remarkable in both BRCA1 and BRCA2 carriers who had a family history of breast cancer. Younger age at first breast cancer diagnosis also enhanced CBC risk in BRCA1 carriers., (© 2020 UICC.)

The spectrum and frequency of BRCA1/2 pathogenic variants may be ethnicity-specific. Whether high-frequency founder mutations are present in Chinese women remains largely unknown. In the current study, germline pathogenic variants in the BRCA1/2 genes were determined in 9,505 unselected Chinese Han breast cancer (BC) patients by next-generation and/ or Sanger sequencing. Four hundred and seventy-one (5.0%) BC patients carried BRCA1/2 pathogenic variants in this cohort. A total of 25 recurrent pathogenic variants (at least found in four unrelated patients) were identified in this cohort (8 BRCA1 and 17 BRCA2 recurrent pathogenic variants), 161 patients carried one of these recurrent pathogenic variants in this cohort of 9,505 patients. All of these 25 recurrent pathogenic variants were further explored whether they had founder effect through haplotype analysis. The most common pathogenic variant, BRCA1 c.5470&#95;5477del, was found in 30 BC patients from 29 unrelated families. Twenty-seven of these 29 unrelated patients who carried this BRCA1 c.5470&#95;5477del mutation shared an identical haplotype, indicating that BRCA1 c.5470&#95;5477del was a founder mutation in the Chinese Han population. Furthermore, BRCA1 c.5470&#95;5477del mutation carriers had a significantly worse survival than noncarriers (disease-free survival, p = 0.049; overall survival, p = 0.029). Taken together, our data suggested that BRCA1 c.5470&#95;5477del is a founder mutation in the Chinese Han population and BRCA1 c.5470&#95;5477del mutation carriers have a poor survival., (© 2020 UICC.)

The history of modern psychiatry in China began at the end of the nineteenth century, as a result of the work of missionaries. Soochow was one of the first cities to establish a hospital for the treatment of mental patients, but historians knew little about it. It provided a valuable service from 1898 to 1937. In the 1930s, there were 200 beds in the psychiatry and neurology section, making it the most influential psychiatric hospital in East China. After Soochow was occupied by the Japanese army in 1937, the hospital was destroyed and shut down.

Objective: This study aimed to evaluate the short-term curative effect of computed tomography (CT) guided radioactive 125I (125-Iodine) seed implantation (CTRISI) therapy for advanced pancreatic cancer patients pain., Study Design: Interventional study., Place and Duration of Study: Imaging Department and Oncology Department, First Affiliated Hospital of Zhengzhou University, China, from January 2015 to March 2017., Methodology: A total of thirty-seven patients with advanced pancreatic cancer pain who underwent CTRISI were enrolled. Exclusion criteria were coagulation disorder, multi-organ failure, co-existent pancreatitis and/or uncontrolled hyperglycemia. Cancer pain levels and daily hydroxycodone dose were compared before and after CTRISI, using the Numerical Rating Scale (NRS). Complication after procedure were also noted., Results: All patients were successfully implanted with 125I seeds via CT. After 1-week, 1-month and 2-month of implantation, the NRS scores were significantly lower than preoperative scores (p<0.05). The daily dose of hydroxycodone in one week and one month after operation were significantly lower than preoperation (p<0.001). However, after 2-month of implantation, the daily hydroxycodone dose was not different from the preoperative dose (p=0.198). No patient experienced serious complications., Conclusion: CTRISI could relieve pain effectively in the patients and suppress local tumor progress. This technique helps to relieve the pain symptoms, reduce the amount of painkillers, and improve the quality of life of patients. Key Words: Pancreatic cancer, 125I, radioactive seed implantation, pain, hydroxycodone.

Background: Severe fever with thrombocytopenia syndrome (SFTS) caused by the SFTS virus is an emerging infectious disease that was first identified in the rural areas of China in 2011. Severe cases often result in death due to multiple organ failure. To date, there are still numerous problems remain unresolved in SFTS, including unclear pathogenesis, lack of specific treatment, and no effective vaccines available., Aim: To analyze the clinical information of patients with early-stage SFTS and to establish a nomogram for the mortality risk., Methods: Between April 2011 and December 2018, data on consecutive patients who were diagnosed with SFTS were prospectively collected from five medical centers distributed in central and northeastern China. Multivariable Cox analyses were used to identify the factors independently associated with mortality. A nomogram for mortality was established using those factors., Results: During the study period, 429 consecutive patients were diagnosed with SFTS at the early stage of the disease (within 7 days of fever), among whom 69 (16.1%) died within 28 days. The multivariable Cox proportional hazard regression analysis showed that low lymphocyte percentage, early-stage encephalopathy, and elevated concentration of serum LDH and BUN were independent risk factors for fatal outcomes. Received-operating characteristic curves for 7-, 14-, and 28-days survival had AUCs of 0.944 (95% CI: 0.920-0.968), 0.924 (95% CI: 0.896-0.953), and 0.924 (95% CI: 0.895-0.952), respectively. Among low-risk patients, 6 patients died (2.2%). Among moderate-risk patients, 25 patients died (24.0%, hazard ratio (HR) = 11.957). Among high-risk patients, the mortality rate was 69.1% (HR = 57.768)., Conclusion: We established a simple and practical clinical scoring system, through which we can identify critically ill patients and provide intensive medical intervention for patients as soon as possible to reduce mortality., Competing Interests: The authors have declared that no competing interests exist.

In this study, a rapid, sensitive, and selective method was established for the detection of oxathiapiprolin and the metabolite IN-E8S72, as well as its glucose conjugate IN-SXS67 in cucumber using modified QuEChERS procedure combined with HPLC-MS/MS. The LOQs for all compounds were 0.02 mg kg -1 , and the average recoveries were 77.4-111.3% with RSDs of 1.0-8.5%. Under the optimized conditions, the established method was successfully used to determine field samples in dissipation and terminal residue studies. The dissipation study results showed that oxathiapiprolin dissipated rapidly in cucumber with half-lives of 2.4-4.0 days. On the basis of the terminal residue results, the risk assessment was conducted, and both the international estimated daily intake (IEDI) or national estimated daily intake (NEDI) of oxathiapiprolin were much less than 100% which indicate a low health risk to consumers. This work provides guidance for establishing MRL of oxathiapiprolin in China and is of great significance for evaluating its dietary risk in cucumber.