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Background: In China, acupuncture has been widely used in treating cerebrovascular diseases since time immemorial. Scalp acupuncture using the long-stay method is a traditional acupuncture treatment. However, previous studies have concluded that the clinical efficacy of scalp acupuncture for the treatment of stroke remains uncertain. In addition, no randomized controlled trials have been conducted on scalp acupuncture using the long-stay method. This study aimed to evaluate the efficacy and safety of the long-stay method of scalp acupuncture for limb movement dysfunction in patients after acute ischemic stroke (AIS). Methods: Seventy-two patients with acute strokes were randomly divided into treatment and control groups. The control group received conventional acupuncture with a half-hour needle stay each time, whereas the treatment group underwent scalp needling using a long retention method, with each retention of needles lasting 24 hours. Both groups received acupuncture treatment for 2 weeks and were followed up for 6 months. Cerebrovascular reserve (CVR), breath-holding index (BHI), pulsatility index (PI), Fugl–Meyer, and Barthel index (BI) were assessed at baseline, week 1, week 2, and during follow-up. Results: Compared with the baseline, both groups showed a significant improvement in CVR, Fugl–Meyer, BI, PI, and BHI (P < 0.05). Compared with the control group, the treatment group showed more significant improvements in Fugl–Meyer scores, BI, CVR, PI, and BHI (P < 0.05). Correlation analysis showed that Fugl–Meyer and BI scores increased significantly with CVR recovery over the course of treatment. Conclusion: Scalp acupuncture with the long-stay method can improve neurological deficits and the ability to perform daily activities among AIS patients, which may be related to the improvement of CVR function in patients. [ABSTRACT FROM AUTHOR]

The paleosedimentary environment and paleoclimate of the Neogene Guantao Formation in the Liaodong sub-uplift of Bohai Bay Basin in China, which is an important oil and gas exploration horizon, are not clear owing to the lack of quantitative analysis. The paleosedimentary environment and paleoclimate can be qualitatively or semi-quantitatively reconstructed by sedimentary geochemical indicators sensitive to the environment and climate. Based on the evaluation of whether the elements and isotopes can effectively record paleosedimentary environment and paleoclimate information or not, the paleoclimate (temperature and humidity), paleoenvironment (salinity, water depth, redox conditions), and evolution of the paleoenvironment and paleoclimate are studied by analyzing the trace elements, carbon and oxygen isotopes, strontium isotopes, whole-rock mineral compositions, and clay minerals of mudstones of the Guantao Formation in the Liaodong sub-uplift, Bohai Bay Basin. The study results show that (1) according to the trace element distribution patterns, high concentrations of continental elements (Ti, Zr, Th), clay minerals, and detrital content, the Guantao Formation is a product of proximal deposits, and the provenance mainly originates from the intermediate–acidic magmatic rocks near surrounding uplifts. (2) The paleoclimate during the sedimentation of the Guantao Formation was mainly semi-arid and semi-humid, as revealed by the Sr/Cu ratio. However, the high Rb/Sr and 87Sr/86Sr ratios demonstrate that the paleoclimate is relatively warm and humid. (3) The paleosedimentary temperature calculated by the Sr content and δ18O is roughly 30 °C, indicating that the Guantao Formation was deposited in a subtropical to tropical climate. (4) The Guantao Formation was deposited in continental freshwater according to the Li, Ni, and Sr content, Sr/Ba ratios, 87Sr/86Sr ratios, and salinity index Z. (5) The water depth of the paleoenvironment of the Guantao Formation is mainly in nearshore shallow water, reflected by the Mn/Ti ratio and calculated by the Co content, and the oxidizing condition of the paleoenvironment of the Guantao Formation, reflected by the U/Th, V/Cr, and Ni/Co ratios, is in a good coupling relationship with this environment. (6) As revealed by the variations in the geochemical data in the section, the temperature, humidity, and water depth of the Guantao Formation gradually increased from the early to late period, while the salinity gradually decreased, and the chemical weathering effect gradually increased. [ABSTRACT FROM AUTHOR]

As a commonly used food preservative, glycerol monocaprylate (GMC) has limited information and lacked a comprehensive risk assessment. In this study, we conducted in vitro genotoxicity tests, a 90-day subchronic toxicity study, and dietary exposure assessment in China. Rats (n = 10/sex/group) were orally administered GMC at doses of 1.02, 2.04, and 4.08 g/kg BW/day along with a water and corn oil for 90 days, including satellite groups (n = 5/sex/group) in the control groups and 4.08 g/kg BW dose group for observation after 90 days. Body weight, food consumption, hematology, serum biochemistry, urinalysis, endocrine hormone level and other metrics were examined. GMC did not exhibit genotoxicity based on the genotoxicity tests results, and an acceptable daily intake (ADI) of 40.8 mg/kg BW/day was established based on the 90-day subchronic toxicity study. Estimated daily intake of GMC for general population and consumer population in China were 0.99 mg/kg BW/day and 3.19 mg/kg BW/day respectively, which were significantly lower than the ADI. Our findings suggest that GMC does not pose a known health risk to Chinese consumers at the current usage level. • The dietary exposure assessment of GMC in China was conducted. • No significant toxicity was detected after 90 days of GMC exposure. • The current dietary exposure of GMC in China is safe for consumers. [ABSTRACT FROM AUTHOR]

Phenotypic evaluation and molecular biotechnology are both important in the identification and utilization of crop germplasm resources. In this study, the phenotypic variation and genetic diversity of 149 main potato cultivars in China were investigated with 12 phenotypic traits and 24 SSR markers. The coefficient of variation of 12 phenotypic traits ranged from 12.11% to 156.93%. The results of SSR markers exhibited a relatively high level of genetic variation (Na =5.458 ± 1.499, Ne =3.300 ± 1.087, I =1.397 ± 0.298, Ho =0.797 ± 0.178, He = 0.660 ± 0.117, and PIC=0.702 ± 0.087). Population structure and phylogenetic tree analysis divided the varieties into three subgroups. The results indicated that ninety percent of the molecular variance was attributed to within-group differences, and the remaining 10% was attributed to variation among groups. Consistent with previous report, alleles of the STI032 marker were significantly associated with tuber starch content and growth period traits in the population. The results of this study could facilitate the utilization of potato germplasm resources, molecular genetic breeding and improvement. [ABSTRACT FROM AUTHOR]

Background: The prevalence of exclusive breastfeeding (EBF) is suboptimal in China. There is limited evidence of effective interventions to increase EBF in China. Therefore, it is urgent to explore the potential factors that may be effective in promoting exclusive breastfeeding. Previous studies have mainly focused on socio-demographic factors and the Han ethnic group. This study explores more modifiable influencing factors of EBF in the Guangxi Zhuang Autonomous Region of China. Methods: The cross-sectional data used in this study were collected to provide baseline information on EBF prevalence for a breastfeeding promotion project. A total of 494 mothers of infants aged 0–5 months were recruited from nine community health centres in Nanning, China, in October 2019. Data were collected through face-to-face interviews using structured questionnaires. Infant feeding was measured by 24-h recall. The Chinese version of the Breastfeeding Self-Efficacy Scale–Short Form was used to examine the maternal breastfeeding self-efficacy. Univariate and multivariate logistic regressions were used to examine the factors associated with EBF practices. Results: In the present study, the prevalence of exclusive breastfeeding was 37.0%. Higher breastfeeding self-efficacy scores (adjusted odds ratio [AOR] 1.93; 95% confidence interval [CI] 1.25, 2.98), a college degree or above (AOR 2.15; 95% CI 1.24, 3.71), and early initiation of breastfeeding (AOR 2.06; 95% CI 1.29, 3.29) were positively associated with EBF practice. However, the preparation for infant formula before childbirth (AOR 0.30; 95% CI 0.17, 0.52) and premature birth (AOR 0.30; 95% CI 0.10, 0.87) were negatively associated with EBF practice. Conclusions: Exclusive breastfeeding practice was suboptimal and associated with various factors in the study area. The prevalence of EBF was positively associated with higher breastfeeding self-efficacy, education level of mothers, and early initiation of breastfeeding, whereas premature birth and preparation for infant formula before childbirth were barriers to exclusive breastfeeding. Future intervention projects should target mothers with premature babies, lower levels of education, and breastfeeding self-efficacy. Breastfeeding-friendly practices, such as the early initiation of breastfeeding and regulations on breastmilk substitutes, should also be encouraged. [ABSTRACT FROM AUTHOR]

Background: Breast milk is the best source of essential nutrients and bioactive components for infants under 6 months. However, little is known about what affects breastfeeding intentions and practices of Chinese mothers. With measures of individual, setting, and sociocultural factors, this study examined determinants of exclusive breastfeeding in the first 6 months of infancy in China. Methods: Data were obtained from a national cross-sectional survey in China in 2018 that included 5237 infants under 6 months with available measurements of breastfeeding. A 24-h reported food recall method was applied to assess breastfeeding and complementary food intake in the past 24 h. Potential breastfeeding determinants categorized into six aspects were measured: (1) infant health, (2) maternal sociodemographic characteristics, (3) maternal health, (4) breastfeeding support from family, friends, and workplace, (5) social support for breastfeeding, and (6) maternal breastfeeding experiences and knowledge. Reasons for non-commencement or early cessation of breastfeeding were evaluated for non-breastfed infants. For breastfed infants, multivariate logistic regression was used to explore the determinants of exclusive breastfeeding. Results: About 30 % (29.5%) of infants under 6 months were exclusively breastfed; 2.3% (2.3%) had never been breastfed and 3.2% had ceased breastfeeding. No breast milk (60.7%), maternal illness (13.9%), and infant illness (13.1%) were the top three reasons for non-commencement of breastfeeding. Insufficient breast milk was the reason given for ceasing breastfeeding early by almost two thirds of caregivers who had stopped breastfeeding. The following factors were associated with exclusive breastfeeding: maternal higher education, formal employment with ≥6 months of paid maternity leave, support of the husband and best friends for breastfeeding, a breastfeeding-supportive society, and better breastfeeding knowledge and experiences (a previous successful breastfeeding experience ≥6 months and early initiation of breastfeeding). Maternal age of ≥40 years, caesarean delivery, and infant disease history were associated with non-exclusive breastfeeding. Conclusions: The exclusive breastfeeding rate is still very low in China. Multidimensional barriers contribute to this situation. A comprehensive intervention framework is needed to increase optimal breastfeeding and achieve substantial public health gains. [ABSTRACT FROM AUTHOR]

Background: In China, less than one third of infants under 6 months of age are being exclusively breastfed. Maternal rural-to-urban migration contributes to these low rates of breastfeeding practices. Therefore, the aim of this study was to assess the prevalence of breastfeeding practices and associated factors among rural-to-urban migrant children and local children with infants aged 0–12 months in China, 2018. Methods: Data were collected from a population-based cross-sectional survey in 2018 that included 6995 infants from eight urban areas (four metropolis and four medium sized/small cities) in China. The prevalence of breastfeeding practices was calculated using a 24-h recall questionnaire for all infants aged under 12 months. Logistic regression was conducted to examine the association between the prevalence of breastfeeding practices and maternal migrant status, after adjusting for sociodemographic characteristics, mother-infant health information and supportive information. For exclusive breastfeeding, we further analyzed its association with maternal rural-to-urban migration, stratified by maternal education level, maternal resident place and maternal ethnicity, respectively. Results: The overall prevalence of ever breastfeeding, exclusive breastfeeding, predominant breastfeeding and age-appropriate breastfeeding (exclusive breastfeeding of infants under 6 months of age and complementary feeding from six to 12 months of age) was 97.51, 29.84, 59.89 and 45.07%, respectively. Rural-to-urban migrant children were less likely to be exclusively breastfed compared to local children (AOR 0.81, 95% CI 0.68, 0.95). Stratified by different sociodemographic variables, a negative association between exclusive breastfeeding and rural-to-urban migration was only found in the group with high education level, in the group living in metropolis and in the group of minorities, respectively. Conclusions: The overall prevalence of breastfeeding practices was low in both rural-to-urban migrant children and local children. Besides common strategies, special approaches should be provided for urban highly educated migrants. [ABSTRACT FROM AUTHOR]

We examined the association between breastfeeding practices and associated factors using cross‐sectional data from face‐to‐face interviews with 9,745 mother–child dyads in China. The study collected information on breastfeeding practices and potential associated factors at the individual, family, health facility and environmental levels in China. We used survey commands in Stata to consider sampling weight and survey design effects. Although breastfeeding was the norm (97.4% ever breastfed), the prevalence of early initiation of breastfeeding (EIBF) in 0–11 months old was 8.2%, exclusive breastfeeding (EBF) in 0–5 months old was 27.8% and breastfeeding on the previous day in 6–11 months old was 77.5%. The prevalence of EIBF was lower for caesarean delivery and among mothers belonging to ethnic minority groups. The prevalence of EBF was higher among mothers who practiced EIBF, received information that encouraged breastfeeding and knew that a baby should be breastfed on demand and exclusively. By contrast, the prevalence of EBF was lower in mothers who received infant formula advice or felt uneasy breastfeeding in public places. The prevalence of breastfeeding on the previous day was higher among mothers whose partners supported breastfeeding and who knew about timing of colostrum production, EBF for 6 months, and to nurse more to stimulate milk production. The prevalence of breastfeeding on the previous day was lower in mothers who received infant formula advice or felt uneasy breastfeeding in public places. In conclusion, we found that the prevalence of EIBF and EBF practices in China was low and associated with factors at individual, family, health facility and environmental levels. [ABSTRACT FROM AUTHOR]

Objective: Pulmonary tuberculosis (TB) is a severe infectious respiratory disease, the burden of which remains high in China. To provide scientific evidence for developing more targeted prevention and control strategies, this study aimed to determine the incidence trends and explore the epidemiological characteristics of pulmonary TB in Anhui Province, Eastern China between 2013 and 2018. Methods: The retrospective study analyzed information regarding pulmonary TB cases reported by the National Infectious Disease Reporting System and census data collected from the Anhui Provincial Bureau of Statistics. Results: Overall, 211,892 cases of TB patients were reported in Anhui Province, China between 2013 and 2018, with an average annual reported incidence rate of 57.7 per 100,000 persons. A significant decrease in the incidence rate of pulmonary TB (p < 0.001) was observed during the study period. Men had a higher incidence rate of pulmonary TB than women (p < 0.001). The highest annual average reported incidence rate was 204.2 per 100,000 persons in those aged 70–74 years. The number of farmers with pulmonary TB, i.e., 155,415, accounted for 73.4% of all cases. Moreover, the peak period of reported cases was from January to March. Four cities along the Yangtze River—Anqing, Tongling, Chizhou, and Wuhu—reported significantly higher incidence rates of pulmonary TB than other cities (p < 0.001). Conclusions: From 2013 to 2018, there was a significant decline in the incidence rate of pulmonary TB in Anhui Province, with peaks occurring from January to March. Prevention and control strategies targeting men, people aged 70–74 years, farmers, and the four cities along the Yangtze River should be strengthened. [ABSTRACT FROM AUTHOR]

The genus-level recognition of monophyletic shortlegged toads (Brachytarsophrys) has been recently implicated in the taxonomic debate of Megophrys sensu lato. In the present study, Brachytarsophrys is reasonably regarded as a distinct genus based on significant morphological differentiations and recent molecular analyses. Furthermore, a comprehensive review of this genus is performed, with two species groups proposed based on morphological differences and phylogenetic relationships. Particularly, Brachytarsophrys platyparietus is removed as a synonym of Brachytarsophrys carinense and considered a valid species due to significant genetic divergence and distinct morphological differences. In addition, a new species, Brachytarsophrys orientalis sp. nov., is described based on a series of specimens collected from southeastern China. This work takes the member species of the genus Brachytarsophrys to seven, suggesting that the diversity of Brachytarsophrys is underestimated. In addition, the genus levels of other monophyletic groups within the subfamily Megophryinae are discussed. [ABSTRACT FROM AUTHOR]

China is a major producer and consumer of green tea and possesses numerous high-quality tea cultivars, which can be used to make green tea. However, the green teas produced from these tea cultivars vary markedly in aroma. In this study, a sensory evaluation method and headspace solid-phase microextraction combined with GC-MS were employed to determine the primary substances that contribute to the aromas and key differences in the aroma components of green tea produced from 20 tea cultivars. The results revealed 57 major volatile components, among which aldehydes, alcohols, and esters were the most prevalent. For the volatile components, the linalool, nonanal, and geraniol contents were the highest, followed by dimethyl sulfide, methyl salicylate, heptanal, and caproicacidhexneylester. The volatile components varied considerably among the green tea samples, and some contained substances with a high content that gave off unique aromas. The correlation analysis revealed significant correlations between the sensory evaluation scores and contents of linalool, geraniol, methyl salicylate, cis-linalool oxide, 3-carene, phenethyl alcohol, limonene, (Z)-3-cis-3-hexenyl isovalerate, citral, (E)-β-ocimene, alcohols, esters, and alkenes, as well as between the sensory evaluation scores and total volatile component contents. Aromatic substances with the highest odor activity values were, in descending order, linalool, capraldehyde, dimethyl sulfide, β-ionone, geraniol, nonanal, heptanal, (E)-2-nonenal, and caproicacidhexneylester. These substances were the major contributors to aroma formation in the green tea samples. The principal component analysis and orthogonal projections to the latent structure-discriminant analysis suggested that the 20 tea cultivars could be grouped into 6 categories and that the high content of linalool, nonanal, and geraniol substantially contributed to the categorization of the tea cultivars. A key variable analysis revealed that 23 volatile components played a critical role in the categorization of the tea cultivars. [ABSTRACT FROM AUTHOR]

Purpose: Rupture of an intracranial aneurysm is a life-threatening acute cerebrovascular event. The purpose of this study was to investigate whether aneurysmal subarachnoid haemorrhage (SAH) incidence rate is higher or lower in elderly population than in middle aged population. Materials and methods: Aneurysmal SAH cases were collected retrospectively from the archives of 21 hospitals in Mainland China. All the cases were collected from September 2016 and backward consecutively for a period of time up to 8 years. SAH was initially diagnosed by brain computed tomography (CT). CT angiography (CTA) or digital subtraction angiography (DSA) was followed and SAH was confirmed to be due to cerebral aneurysm rupture. For cases when multiple bleeding occurred, the age of the first SAH was used in this study. The total incidence from all hospitals at each age group were summed together for females and males respectively; then adjusted by the total population number at each age group for females and males which was from the 2010 population census of the People’s Republic of China. Results: In total there were 8,144 cases of intracranial aneurysmal SAH, with 4,861 females and 3,283 males. For females the relative aneurysmal SAH incidence rate started to decrease after around 65 years old, while for males the relative aneurysmal SAH incidence rate started to decrease after around 53 years old. Conclusion: Our data tentatively suggest elderly patients may be at a reduced risk of rupture compared with patients who are younger while have similar other risk factors. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to examine the relationship between nurse staffing and patient outcomes in hospitals in mainland China. Methods: The study was conducted in 181 hospitals across all of the eight economic zones in mainland China using a four-stage sampling design. Two instruments, the China Nurse Survey and the patient satisfaction measurement from the Hospital Consumer Assessment of Healthcare Providers and Systems, were employed in data collection. In this article, 7,802 nurse surveys and 5,430 patient surveys from 600 medical and surgical units were analyzed. Results: The adjusted joint effects of nurse staffing on patient outcomes from logistic regression analyses showed that more nursing staff per patient had statistically significant positive effects on all necessary nursing care, nurses' reports of quality of care, their confidence on patients' self-care ability on discharge from the hospital, patient adverse events, as well as patients' report of satisfaction. When the nurse-to-patient ratio (total number of nurses on all shifts on the unit divided by total number of patients who stay on the unit) increased to the 0.5-<0.6 category, most patient outcomes were significantly improved, considering hospital and patient factors and nurse skill mix in the logistic regression models. Conclusions: The findings provide evidence on how inadequate nurse staffing might result in missed but needed nursing care and negative patient outcomes, while better staffing levels could be an effective strategy for improving patient outcomes. Clinical Relevance: We recommend that the nurse-to-patient ratio on medical and surgical units in Chinese hospitals be increased to at least 0.5-0.6 so as to secure patient safety and the quality of health services. Journal of Nursing Scholarship, 2011; XX:X, XXX-XXX. ©2011 Sigma Theta Tau International. [ABSTRACT FROM AUTHOR]

Abstract: The paper presents the complete design of a photovoltaic noise barrier (PVNB) installation that can be used either to supply local electrical loads or for sale using the premium subsidy awarded by the China government. Possible designs for the PVNB are investigated together with economic and environmental analysis. For the first time, a PVNB has been installed along a metro line in China. The installed power is 8 kWp and the total length of the PV array is 360 m. According to the site and environmental conditions, the form and electrical connections of PVNB have been determined. Net Present Value (NPV) and the Pay-Back Period are chosen as the parameters to determine the profitability of a PVNB installation. At the same time, energy pay-back time (EPBT) is used to evaluate the environmental benefits of PVNB systems; for the specific system analyzed the EPBT is 5.4 years. [Copyright &y& Elsevier]

• A total of 131 ERF genes were identified and characterized in Actinidia valvata based on transcriptome analysis data. • AvERF73 and AvERF78 may play key roles for waterlogging responses in A. valvata. • This study furthers understanding the role of ERF and waterlogging-tolerance mechanism of A. valvata. Recently, there has been a tremendous increase in the cultivated area of kiwifruit in China. However, the low tolerance of most cultivars to waterlogging largely halted its expansion in waterlogged areas. Previously, some genotypes from Actinidia valvata , like KR5, were proved to be highly tolerant for waterlogging stress. ERF transcription factors, belong to the AP2/ERF superfamily, have played key roles in adaptation to waterlogging stress in numerous plant species. In this study, a total of 131 AvERF genes were identified based on the full-length transcriptome analysis data from KR5. By clustering with Arabidopsis thaliana ERFs, 131 AvERF proteins were sorted into eleven clades and renamed as AvERF1 to AvERF131. Within the same group, similar motifs for AvERFs were found in all members by MEME online tool. According to FPKM analysis, the expression of AvERF-VIIs in KR5 under waterlogging conditions was strongly promoted compared to other group members. Six genes from AvERF-VIIs (AvERF73 , AvERF75 , AvERF77 , AvERF78 , AvERF79 , and AvERF80) were chosen based on the higher fold changes in their expression against waterlogging. Moreover, their expression was evaluated in two tolerant genotypes: KR5 and KR1 from A. valvata , and two sensitive genotypes 'Xuxiang' and 'Hayward' from A. chinensis var. deliciosa during waterlogging stress by qRT-PCR. AvERF73 and AvERF78 were specifically induced in waterlogging-tolerant genotypes, but relatively low in the sensitive genotypes, indicating their positive roles in waterlogging tolerance. Both AvERF73 and AvERF78 had transcriptional activation activity. In the present study, we identified and characterized AvERFs into KR5 to reveal their importance in determining the waterlogging tolerance of kiwifruit. [ABSTRACT FROM AUTHOR]

Objective: To explore and compare the predictors for exclusive breast feeding (EBF) among migrant and non-migrant mothers in China., Design: A large-scale cross-sectional study., Setting: 12 counties/districts were covered in China., Participants: A total number of 10 408 mothers were recruited, of whom 3571 mothers of infants aged 0-5 months in urban China were used for analysis., Outcome: The practice of EBF was calculated based on the foods and drinks consumed in the last 24 hours, as recommended by WHO., Results: Around 30% of Chinese mothers with infants aged 0-5 months practised EBF in urban areas, with no significant difference between migrant and non-migrant mothers (p=0.433). Among the migrant mothers, factors associated with EBF included residence in big cities (adjusted OR, AOR 1.68 (95% CI 1.20 to 2.34)), premature birth (AOR 0.27 (95% CI 0.09 to 0.81)), knowledge about EBF (AOR 2.00 (95% CI 1.51 to 2.65)), low intention of breast feeding in the first month postpartum (AOR 0.59 (95% CI 0.36 to 0.97)) and mothers working in agriculture-related fields or as casual workers (AOR 1.77 (95% CI 1.18 to 2.64)). Among non-migrant mothers, in addition to similar predictors including residence in big cities (AOR 1.40 (95% CI 1.13 to 1.73)), knowledge about EBF (AOR 1.25 (95% CI 1.02 to 1.53)) and low intention of breast feeding in the first month post partum (AOR 0.46 (95% CI 0.31 to 0.70)], early initiation of breast feeding (EIBF) (AOR 1.78 (95% CI 1.35 to 2.33)) and caesarean delivery (AOR 0.74 (95% CI 0.60 to 0.89)) were also factors associated with EBF., Conclusions: There was no significant difference in the prevalence of EBF between migrant and non-migrant mothers in urban China. Premature birth and maternal occupation in agriculture-related fields or casual work were distinctive factors associated with EBF for migrants, while EIBF and caesarean delivery were unique predictors for non-migrants., Trial Registration Number: ChiCTR-ROC-17014148; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Importance: Accurate identification of lymph node metastasis preoperatively and noninvasively in patients with cervical cancer can avoid unnecessary surgical intervention and benefit treatment planning., Objective: To develop a deep learning model using preoperative magnetic resonance imaging for prediction of lymph node metastasis in cervical cancer., Design, Setting, and Participants: This diagnostic study developed an end-to-end deep learning model to identify lymph node metastasis in cervical cancer using magnetic resonance imaging (MRI). A total of 894 patients with stage IB to IIB cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy were reviewed. All patients underwent radical hysterectomy and pelvic lymphadenectomy, received pelvic MRI within 2 weeks before the operations, had no concurrent cancers, and received no preoperative treatment. To achieve the optimal model, the diagnostic value of 3 MRI sequences was compared, and the outcomes in the intratumoral and peritumoral regions were explored. To mine tumor information from both image and clinicopathologic levels, a hybrid model was built and its prognostic value was assessed by Kaplan-Meier analysis. The deep learning model and hybrid model were developed on a primary cohort consisting of 338 patients (218 patients from Sun Yat-sen University Cancer Center, Guangzhou, China, between January 2011 and December 2017 and 120 patients from Henan Provincial People's Hospital, Zhengzhou, China, between December 2016 and June 2018). The models then were evaluated on an independent validation cohort consisting of 141 patients from Yunnan Cancer Hospital, Kunming, China, between January 2011 and December 2017., Main Outcomes and Measures: The primary diagnostic outcome was lymph node metastasis status, with the pathologic characteristics diagnosed by lymphadenectomy. The secondary primary clinical outcome was survival. The primary diagnostic outcome was assessed by receiver operating characteristic (area under the curve [AUC]) analysis; the primary clinical outcome was assessed by Kaplan-Meier survival analysis., Results: A total of 479 patients (mean [SD] age, 49.1 [9.7] years) fulfilled the eligibility criteria and were enrolled in the primary (n = 338) and validation (n = 141) cohorts. A total of 71 patients (21.0%) in the primary cohort and 32 patients (22.7%) in the validation cohort had lymph node metastais confirmed by lymphadenectomy. Among the 3 image sequences, the deep learning model that used both intratumoral and peritumoral regions on contrast-enhanced T1-weighted imaging showed the best performance (AUC, 0.844; 95% CI, 0.780-0.907). These results were further improved in a hybrid model that combined tumor image information mined by deep learning model and MRI-reported lymph node status (AUC, 0.933; 95% CI, 0.887-0.979). Moreover, the hybrid model was significantly associated with disease-free survival from cervical cancer (hazard ratio, 4.59; 95% CI, 2.04-10.31; P < .001)., Conclusions and Relevance: The findings of this study suggest that deep learning can be used as a preoperative noninvasive tool to diagnose lymph node metastasis in cervical cancer.

Background: Nurse burnout and low job satisfaction are main reasons that cause nurses to leave their current position. Improving the nursing work environment may reduce the severity of job burnout and of job dissatisfaction and thus decrease the turnover intention of nursing staff., Purpose: The aim of this study was to explore the correlation between the nursing work environment and the outcome variables of burnout, job satisfaction, and turnover intention in the western region of Mainland China., Methods: This is a cross-sectional descriptive study. Survey data were collected between February and December 2012 from 1,112 clinical nurses working at 83 medical, surgical, and intensive care units in 20 hospitals across the western region of Mainland China. Multistage sampling was conducted on some of the participants. The research instruments that were used included the Practice Environment Scale of the Nursing Work Index, Maslach Burnout Inventory, Nurse Job Satisfaction Scale, and the self-developed basic information and turnover intention questionnaire. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 19.0. The level of statistical significance was set at p<.05., Results: Among the five dimensions of the nursing work environment, collegial nurse-physician relations earned the most favorable mean scores (3.57±0.68; total=4 points), whereas adequacy of staffing and resources earned the lowest (3.21±0.82). Over half of the participants (58.4%) reported experiencing a high level of emotional exhaustion (EE) burnout, 45.2% reported experiencing a high level of depersonalization (DP) burnout, and 24.6% reported experiencing a high level of personal accomplishment (PA) burnout. About 59% of the participants were satisfied with their work and 3.8% reported intention to leave. Participants in self-reported "favorable" work environments were less likely to report high burnout, less likely to report intention to leave, and more likely to report job satisfaction than their peers in self-reported "poor" work environments. The odds ratio (OR) values were 0.64 (EE), 0.66 (DP), 0.57 (PA), 0.19, and 2.26., Conclusions/implications for Practice: The results of the present study support that the nursing work environment affects nurse burnout, job satisfaction, and turnover intention. Therefore, nursing managers should work to improve nursing work environments in order to reduce the turnover intent among their nursing staff.

The purpose of this study was to describe nurse burnout, job satisfaction, and intention to leave and to explore the relationship of work environment to nursing outcomes in a sample of 9,698 nurses from 181 hospitals in China. Nurses reported moderate levels of emotional exhaustion and depersonalization and high levels of reduced personal accomplishment. Nearly one-fifth of the nurses reported high levels of burnout on all three dimensions. Forty-five percent of the nurses were dissatisfied with their current job; these nurses were most dissatisfied with their salary. Five percent of nurses reported an intention to leave. Nurses reporting mixed and good work environments were less likely to report high burnout, job dissatisfaction, and intention to leave compared with those in poor work environments. The results suggest that high burnout and low job satisfaction are prominent problems for Chinese nurses, and improving work environment might be an effective strategy for better nursing outcomes in Chinese hospitals., (Copyright © 2014 Elsevier Inc. All rights reserved.)

This descriptive cross-sectional study was conducted with 536 Chinese nursing students to explore students' readiness for self-directed learning (SDL). The Self-Directed Learning Readiness (SDLR) Scale for nursing education (Chinese translation version) was used. The value of the content validity index tested by five experts was 0.915. A measure of internal consistency (Cronbach's alpha) was 0.925 on the total scale. Students possessed readiness for SDL with a mean score of 157.72 (S.D.=15.08, 62.3% in high level, and 37.7% in low level). The attributes of Chinese students, such as a strong sense of responsibility and perseverance, due diligence and rigorous self-discipline, enable students to take the initiative and responsibility for their own learning. The existing variation in students' readiness for SDL is helpful in identifying student characteristics that might be used to modify learning activities for these students. Senior students had higher scores for SDLR than junior students. This finding likely reflects the maturational process of developing self-directedness. Promoting SDL skills is a challenging process for faculty members and students. It is helpful if nurse educators assess the learning styles and preferences of their students in order to determine the level of SDL activities to include from year to year in the curriculum., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

A descriptive study was conducted with 28 nursing students in Macao and 23 nursing students in Shanghai to explore students' views on the effectiveness of problem-based learning (PBL). The PBL Evaluation Questionnaire was used. It used a 20-item self-report Likert scale with a 5-point response choice (1=ineffective and 5=very effective). The value of the content validity index tested by five experts was determined as one and the internal consistency (Cronbach's alpha) was 0.90. The test-retest reliability with a two-week internal check was 0.89. Two open-ended questions were asked to determine students' comments on the positive and negative features of PBL. The response rate was 100%. Overall, students considered PBL to be moderately effective with a mean of 3.58 (S.D.=0.52). Students from Macao considered PBL to be less effective than students from Shanghai. However, half of the Macao students and 21.74% of the Shanghai students indicated that PBL was a time-consuming and stressful process that involved an increased workload. A small number of students indicated that sometimes the information they received was vague and this resulted in a lack of student confidence. It is clear that the initial implementation of PBL is not always a smooth process. Tutors should be prepared to provide students with substantial support in developing their understanding of PBL, and help students develop appropriate strategies for coping and engaging in the PBL learning process., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Objective: To assess the safety, immunogenicity and efficacy of group A and C meningococcal polysaccharide vaccine (A/C MPV) in response to an outbreak of group C meningococcal disease., Methods: A vaccination campaign with A/C MPV was prompted 6 weeks after the use of group A MPV in Laibin city, Guangxi, where an outbreak of group C meningococcal meningitis occurred in 2002. Vaccinees were observed for local and systemic reactions after the vaccination and followed up for the meningococcal disease for 5 years. Blood samples were collected from 71 people in the epidemic and 43 in the non-epidemic areas before and 1 month after the vaccination and examined by ELISA to detect IgG antibodies to group A and C polysaccharides., Results: The vaccination coverage was 97%. No significant adverse reactions were observed. The positive rates of group C antibodies after vaccination was between 97.67% and 100% among the populations in the epidemic and non-epidemic areas, as well as among those negative and positive for group C antibodies prior to the vaccination. The geometric mean anti-C concentrations ranged 30.81 microg/ml to 37.44 microg/ml, showing no significant difference between groups. The incidence rate of meningococcal disease in students with timely immunization (218.58/100,000) dropped by 69.02%, when compared to that in those with delayed immunization (705.72/100,000). No clinical cases were identified during the follow-up period of 15,760 person-years., Conclusion: The vaccination campaign with the Chinese group A/C MPV seemed successful in controlling the group C meningococcal outbreak. The vaccine was shown to be safe even administered after the group A vaccine only 6 weeks apart. It could induce high levels of antibodies in vulnerable population and significantly increase antibody levels in seropositive individuals, thus providing a protection of at least 5 years.

Objective: To compare the lipid levels, dyslipidemia prevalence and the influencing factors between Korean and Han nationalities in Yanbian state., Methods: A population-based cross-sectional study was conducted. Totally 3011 subjects, ranging from 30 to 70 years old, were included. Height, weight, waist and hip circumference, serum lipids were measured., Results: The HDL-C concentration of male and female Korean (1.04 +/- 0.45 mmol/L and 1.07 +/- 0.43 mmol/L, respectively) was significantly lower than those of Han (1.16 +/- 0.52 mmol/L and 1.19 +/- 0.56 mmol/L, F = 14.423 and 20.827; P < 0.001). The TG concentration of male Korean (2.10 +/- 2.08 mmol/L) was significantly higher than that of Han male (1.72 +/- 1.73 mmol/L, F = 13.543; P < 0.001) and the prevalence of high triglyceride among male Korean (23.3%) was also significantly higher than that of male Han (15.0%, chi2 = 12,720; P < 0.001). However, the prevalence of high total cholesterol among male Korean (2.3%) was significantly lower than that of Han male (5.2%, chi2 = 6.639; P < 0.01). The prevalence of high TC and TG among female Korean (6.7%) was significantly higher than those of female Han (4.1%, chi2 = 6.394; P<0.05). The crude rate of dyslipidemia of Korean was 31.5%, while that of Han was 24.4%, and the age-adjusted prevalence was 28.7% and 23.0%, respectively, which showed significant ethnic differences in male. The crude rate of dyslipidemia of Korean was 28.9%, while that of Han was 21.7%, and the age-adjusted prevalence was 21.5% and 20.5%, respectively, which also showed significant ethnic differences in female. The prevalence of dyslipidemia was positively correlated with sex, age, WHR, WHtR, and nationality., Conclusion: There were significant differences in the lipid profiles and the prevalence of dyslipidemia between Korean and Han nationalities. Sex, age,WHR, WHtR, and nationality in this state should be risk factors of the dyslipidemia.

This paper discusses an intersectoral health-related intervention, using cartoons and video-recording, print materials and face-to-face educational methods, to increase children's knowledge of schistosomiasis, which in turn might improve the case management of early diagnosis and treatment. The main components of the project were (i) the collaboration between the departments of public health and education and (ii) a randomized, controlled, school-based field trial conducted in the Dongting Lake region, China. Children in the experimental group (n=604) and their parents participated in the educational programme. Control children (n=527) received a 2 hour lecture about the disease. All participants were pre-tested, and retested five months after the conduct of the educational intervention. The results show significant changes among children and their parents in the experimental group related to knowledge about schistosomiasis and beliefs towards screening and treatment of the disease. Children in the experimental group also had better compliance than children in the control group for regular screening for schistosomiasis. These findings indicate that carefully designed education programmes are useful for providing both children and their families with information about the prevention and treatment of schistosomiasis. Intersectoral collaboration holds promise to deliver research-based interventions for enhanced knowledge of schistosomiasis and improved case management.

Objective: To develop a strategy for interrupting the transmission of schistosomiasis japonica in a hilly new endemic area., Methods: Since 1996, chemotherapy with praziquantel (adult 40 mg/kg, child 50 mg/kg, cattle 30 mg/kg, once a year) on human beings in Taoyuan County who had ever contacted with infectious water and cattle which were herded in endemic situation was the major intervention, with focal control of Oncomelania snails in susceptible areas as supplementary one., Results: The positive rate of stool examination for schistosomiasis in human and cattle reduced from 5.69% and 6.76% in 1996 to 0.04% and 0 in 2005 respectively. The positive rate of indirect hemagglutination test (IHA) in human dropped from 7.45% in 1996 to 1.61% in 2004. Though living snails were still found in most habitats, the density of infected snails decreased from 0.0036/0.11m2 in 1997 to 0 in 2005 and no infected snails were found since 2000., Conclusion: Due to less movement of human and cattle populations and the hilly area relatively isolated, chemotherapy combined with focal mollusciciding have been highly effective in eliminating the infection sources and interrupting transmission of schistosomiasis.

Facing the relative lag of forest ecosystem service and estimation in China, this paper proposed to quickly carry out the research on the evaluation of forest ecosystem service. On the basis of the classification of forest ecosystem types in China, the service of artificial and semi-artificial forest ecosystems was investigated, which was divided into eight types, i.e., timber and other products, recreation and eco-tourism, water storage, C fixation and O2 release, nutrient cycling, air quality purifying, erosion control, and habitat provision. According to the assessment index system for global ecosystem service proposed by Costanza et al., a series of assessment index system suitable for Chinese forest ecosystem service was set up, by which, the total value of forest ecosystem service in China was estimated to be 30 601.20 x 10(8) yuan x yr(-1), including direct and indirect economic value about 1 920.23 x 10(8) and 28 680.97 x 10(8) yuan x yr(-1), respectively. The indirect value was as 14.94 times as the direct one. The research aimed to bring natural resources and environment factors into the account system of national economy quickly, and to realize the green GDP at last, which would be helpful to realize sustainable development and environment protection.

Objective: To explore factors related to current prevention and treatment of Advanced cases on schistosomiasis., Methods: In-depth interviews were introduced to the qualitative study on 61 Advenced cases of schistosomiasis in Dongting Lake regions. Sampling was accidentally and judgmentally performed., Results: Related factors on prevention and treatment of Advenced cases of schistosomiasis would include: higher degree of social support for patients (61/61), excessive dependence on the past pattern of schistosomiasis control, lack of the idea that one should be responsible for his/her own health, lack of knowledge about prevention and treatment of schistosomiasis (28/61), older age (57.40 +/- 10.80), lower education (4.70 years), less family income, lack of effective medical insurance system and efficient close-to-client system., Conclusion: Active participation from patients, medical institutions and society was needed to control Late Stage Schistosomiasis. Health education campaign should be intensified to improve the health awareness for schistosomiasis among residents in the heavy endemic areas. Medical insurance system should be set up in epidemic areas, while public health and cure systems for important diseases should be intensified in rural areas. The ability of public health system to be responsive and the accessibility of residents to health service system should be improved in rural areas as well.

Objective: To characterize the incidence, epidemiologic features, etiologic agents and sequelae of bacterial meningitis in children under 5 years of age in Nanning, Guangxi., Methods: A population-based surveillance was conducted to evaluate children with signs and symptoms of meningitis. All hospitals, township health centers and village clinics in the surveillance area were structured to participate in the case referral and evaluation. Cerebrospinal fluid (CSF) and blood specimens were obtained and processed using standardized microbiologic methods., Results: During the 26-month surveillance period, among the children under 5 years old, a total of 1272 cases who met the screening criteria of meningitis were studied. 265 of 1272 cases were identified as clinically diagnosed meningitis, with an incidence rate of 86.36 per 100 000 population. The annual incidence rate under the 38 cases of confirmed bacterial meningitis appeared to be 12.38/100 000. Staphylococcus species accounted for the largest proportion of laboratory-confirmed bacterial meningitis, followed by E. coli and S. pneumoniae. The highest attack rate occurred in neonates < 1 month, followed by children aged 1 - 12 months in the confirmed patients. Meningitis caused by Sp and Hi mainly occurred in children aged 1 - 12 months. All cases of meningitis due to Hi and Sp were children aged 1 - 24 months. 13.16% and 0.00% of the cases survived with complications and sequelae, and the case-fatality rate was 18.42%. 40 bacterial isolates were identified from 1193 blood cultures and 23 from 1211 cerebrospinal fluid samples, but no Neisseria meningitidis was found., Conclusion: Meningitis due to Hi was first confirmed in Guangxi with the incidence of 0.98 per 100 000 population. The annual incidence rate of confirmed bacterial meningitis was 12.38 per 100 000, which was considered an important public health problem in children. Staphylococci was the predominant pathogen in confirmed bacterial meningitis.