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Blastocystis is one of the most common zoonotic intestinal protozoa with global distribution and can cause gastrointestinal syndrome mainly characterized by diarrhea. School children are the main susceptible population. No epidemiological data on Blastocystis among school children in Hainan, the only tropical island province in China. Between March 2021 and June 2023, 1973 fecal samples were collected from school children across three regions in Hainan province. Blastocystis was examined by amplifying the small subunit ribosomal RNA (SSU rRNA) gene via polymerase chain reaction (PCR), and subtypes were identified through DNA sequencing and phylogenetic analysis. The overall prevalence of Blastocystis was 7.3 % (144/1973). The differences in infection rates across different regions, nationalities, and educational stages are statistically significant (P < 0.001). Five subtypes were identified, of which ST3 was the dominant subtype (60.4 %; 87/144), followed by ST1 (27.8 %; 40/144), ST7 (10.4 %; 15/144), ST6 (0.7 %; 1/144), and ST2 (0.7 %; 1/144). 42 known sequences and 15 novel sequences were identified including eight new variations of the ST1 (ST1-16∼ST1-23) with similarities ranging from 98.3 % to 99.78 % and seven new variations of the ST7 (ST7-7∼ST7-13) with similarities ranging from 97.7 % to 99.79 % by intra-subtype genetic polymorphisms analysis. The results evaluate the public health risks of Blastocystis among school children in Hainan and the sources of infection were discussed, providing important basic data for the effective prevention and control of intestinal parasitic diseases in Hainan., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Straw incorporation with nitrogen (N) fertilization is crucial for enhancing soil fertility and minimizing negative environmental impacts by altering the magnitude and direction of soil N transformation processes. However, the response of soil N transformations to long-term carbon (C) and N inputs, and their primary driving factors, remain poorly understood. Thus, a 15 N tracing study was conducted to investigate the effects of straw incorporation (AS) and straw removal (NS) with N levels of 0, 150 and 250 kg N ha -1 per season (N0, N150 and N250) on gross N transformation rates in the North China Plain after 6-year trial. Results indicated that at N0, AS significantly increased soil microbial immobilization of nitrate (NO 3 - -N, I NO3 ) and autotrophic nitrification rates (O NH4 ) compared to NS. With N fertilization, AS increased gross N immobilization (I total ), ammonium-N immobilization (NH 4 + -N, I NH4 ), net NH 4 + -N immobilization (I netNH4 ) and net NH 4 + -N absorption rates (A netNH4 ). Specifically, at N150, AS significantly increased recalcitrant organic N mineralization rate (M Nrec ), while significantly reducing O NH4 , labile organic N mineralization (M Nlab ), and gross N mineralization rates (M total ). At N250, A netNH4 , M Nlab , M Nrec and O NH4 under AS were significantly higher than under NS. Nitrogen application significantly increased O NH4 , I total and I NO3 under two straw management practices, and enhanced I NH4 and I netNH4 under AS. Compared to N250, N150 significantly increased I NH4 and I netNH4 under AS, while decreasing M total . Opposite results were observed under NS. Meanwhile, NO 3 - -N and dissolved organic carbon (DOC) were master factors controlling immobilization, total nitrogen (TN), hydrolysable NH 4 + -N (HNN) and stable organic N significantly affected A netNH4 , while labile organic N were the key environmental factors affecting M Nrec , all of which positively influenced the rates of assimilation, mineralization and clay mineral adsorption. Overall, this study provides new insights into reducing N fertilization under straw incorporation by quantifying soil N transformation processes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Delivery riders are more vulnerable than other traffic participants, especially in vehicle-involved delivery crashes. This study aims at identifying the unobserved heterogeneities in different factors, based on 4251 vehicle-scooter-style electric bicycle (SSEB) crashes. First, some potential factors are selected from seven perspectives, and the spatiotemporal characteristics are analysed. Second, a latent class clustering method is proposed to clarify the optimal number of clusters by maximizing the heterogeneities across clusters. Third, partial proportional odds (PPO) models for the whole dataset and sub-datasets are developed to explore the heterogeneities across various clusters. Besides, marginal effects are implemented to quantify the heterogeneities. The results evidence that there are remarkable heterogeneities across different clusters, especially in riding behaviours and road conditions. Several factors only significantly affect particular clusters but not the whole dataset. The PPO models for the sub-datasets perform better in identifying the underlying heterogeneities. The results also highlight the greater roles of riding behaviours and road conditions in delivery SSEB-vehicle crashes. The top five influencing factors are running red light, using cell phones, vehicle type, reverse riding and bike lane (their maximum marginal effects exceeding +35%). The findings could support to mitigate the related crash losses.

Bats stand as one of the most diverse groups in the animal kingdom and are key players in the global transmission of emerging pathogens. However, their role in transmitting Enterocytozoon bieneusi and Cryptosporidium spp. remains unclear. This study aimed to evaluate the occurrence and genetic diversity of the two pathogens in fruit bats (Rousettus leschenaultii) in Hainan, China. Ten fresh fecal specimens of fruit bats were collected from Wanlvyuan Gardens, Haikou, China. The fecal samples were tested for E. bieneusi and Cryptosporidium spp. using Polymerase Chain Reaction (PCR) analysis and sequencing the internal transcribed spacer (ITS) region and partial small subunit of ribosomal RNA (SSU rRNA) gene, respectively. Genetic heterogeneity across Cryptosporidium spp. isolates was assessed by sequencing 4 microsatellite/minisatellite loci (MS1, MS2, MS3, and MS16). The findings showed that out of the ten specimens analyzed, 2 (20 %) and seven (70.0 %) were tested positive for E. bieneusi and Cryptosporidium spp., respectively. DNA sequence analysis revealed the presence of two novel Cryptosporidium genotypes with 94.4 to 98.6 % sequence similarity to C. andersoni, named as Cryptosporidium bat-genotype-XXI and bat-genotype-XXII. Three novel sequences of MS1, MS2 and MS16 loci identified here had 95.4 to 96.9 % similarity to the known sequences, which were deposited in the GenBank. Two genotypes of E. bieneusi were identified, including a novel genotype named HNB-I and a zoonotic genotype PigEbITS7. The discovery of these novel sequences provides meaningful data for epidemiological studies of the both pathogens. Meanwhile our results are also presented that the fruit bats infected with E. bieneusi, but not with Cryptosporidium, should be considered potential public health threats., Competing Interests: Declaration of competing interest The authors do not have a commercial or other association that represents a conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Although climate change has convincingly been linked to the evolution of human civilization on different temporal scales, its role in influencing the spatial patterns of ancient civilizations has rarely been investigated. The northward shift of the ancient Silk Road (SR) route from the Tarim Basin (TB) to the Junggar Basin during ∼420-850 CE provides the opportunity to investigate the relationship between climate change and the spatial evolution of human societies. Here, we use a new high-resolution chironomid-based temperature reconstruction from arid China, combined with hydroclimatic and historical datasets, to assess the possible effects of climate fluctuations on the shift of the ancient SR route. We found that a cooling/drying climate in the TB triggered the SR route shift during ∼420-600 CE. However, a warming/wetting climate during ∼600-850 CE did not inhibit this shift, but instead promoted it, because of the favorable climate-induced geopolitical conflicts between the Tubo Kingdom and the Tang Dynasty in the TB. Our findings reveal two distinct ways in which climate change drove the spatial evolution of human civilization, and they demonstrate the flexibility of societal responses to climate change., (Copyright © 2024 Science China Press. Published by Elsevier B.V. All rights reserved.)

Background: Cryptosporidium is a highly pathogenic parasite responsible for diarrhea in children worldwide. Here, the epidemiological status and genetic characteristics of Cryptosporidium in children with or without diarrhea were investigated with tracking of potential sources in Wenzhou City, China., Methods: A total of 1032 children were recruited, 684 of whom had diarrhea and 348 without, from Yuying Children's Hospital in Wenzhou, China. Samples of stool were collected from each participant, followed by extraction of DNA, genotyping, and molecular identification of Cryptosporidium species and subtypes., Results: Twenty-two of the 1032 (2.1%) children were infected with Cryptosporidium spp. with 2.5% (17/684) and 1.4% (5/348) in diarrhoeic and asymptomatic children, respectively. Four Cryptosporidium species were identified, including C. parvum (68.2%; 15/22), C. felis (13.6%; 3/22), C. viatorum (9.1%; 2/22), and C. baileyi (9.1%; 2/22). Two C. parvum subtypes named IIdA19G1 (n = 14) and IInA10 (n = 1), and one each of C. felis (XIXa) and C. viatorum (XVaA3g) subtype was found as well., Conclusions: This is the first research that identified Cryptosporidium in children of Wenzhou, China, using PCR. Identification of zoonotic C. parvum, C. felis, C. viatorum, and their subtypes indicate potential cross-species transmission of Cryptosporidium between children and animals. Additionally, the presence of C. baileyi in children suggests that this species has a wider host range than previously believed and that it possesses the capacity to infect humans., (© 2024. The Author(s).)

Recent screening surveys have shown the presence of unknown source halogenated organic compounds (HOCs) in shale gas wastewater. However, their occurrence, profile, transport in surrounding surface water and environmental risk potentials remain unclear. Here, a method for the extraction and quantitative determination of 13 HOCs in water by solid phase extraction combined with gas chromatography-mass spectrometry (GC-MS) was established. All of the targeted HOCs were detected and peaked at the outfall, while these contaminants were generally not detected in samples upstream of the outfall, suggesting that these contaminants originated from the discharge of shale gas wastewater; this was further supported by the fact that these pollutants were generally detected in downstream samples, with a tendency for pollutant concentrations to decrease progressively with increasing distance from the outfall. However，different HOCs had different transport potential in water. In addition, the toxicological effects of typical HOCs were evaluated using HepG2 as a model cell. The results indicated that diiodoalkanes suppressed HepG2 cell proliferation and induced ROS generation in a concentration-dependent manner. Mechanistic studies showed that diiodoalkanes induced apoptosis in HepG2 cells via the ROS-mediated mitochondrial pathway, decreasing mitochondrial membrane potential and increasing intercellular ATP and Ca 2+ levels. On the other hand, RT-qPCR and Western blot assays revealed that the SLC7A11/GPX4 signaling pathway and HO-1 regulation of ferritin autophagy-dependent degradation (HO-1/FTL) pathway were involved in the ferroptosis pathway induced by diiodoalkane in HepG2 cells. Our study not only elucidates the contamination profiles and transport of HOCs in surface water of typical shale gas extraction areas in China, but also reveals the toxicity mechanism of typical diiodoalkane., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Jaywalker-vehicle (J-V) conflicts at mid-blocks without crossing facilities in China are frequent and hazardous. Due to the unexpected and sudden nature of jaywalking activity, it is crucial to develop predictive models for J-V conflicts to offer pre-conflict warnings for road users. This study introduces a novel encoder-decoder framework that utilizes multi-source data to predict J-V conflict severity. We define three encoders to represent three types of input data, (1) J-V interaction encoder (Bi-LSTM), (2) jaywalker motion encoder (Bi-LSTM) and (3) background information encoder (MLP). Subsequently, features extracted by these three encoders are concatenated and transferred to the conflict severity decoder (MLP) to obtain the predicted severity level. We further conduct a case study using the surveyed video data at three mid-blocks without crossing facilities in Nanjing, China. The experimental results indicate that, compared to classical models, our proposed encoder-decoder (Proposed ED) model exhibits the best and stable predictive metrics. Furthermore, the results of the ablation study suggest that the incorporation of background information significantly enhances the four evaluative metrics of the Proposed ED model, with an average improvement of 24.291%. Additionally, the results of transferability analysis suggest that, when the ratio of added samples from the new mid-block reaches 40% to 50%, the predictive metrics of the updated models could stabilize at around 80% to 95%, indicating a notably good performance. Eventually, we derive several practical suggestions from the above findings, in order to help with J-V conflict prediction and jaywalking safety improvement., 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.)

Since data on Per- and polyfluoroalkyl substances (PFASs) in mangrove ecosystems are very limited. This study investigated the occurrence, distribution, sources, and ecological risk of 24 PFASs in the overlying waters and sediments of mangrove systems in Hainan Island, China. The concentration levels of PFASs in water and sediment ranged from 6.3 to 35.3 ng/L and from 0.33 to 10.2 ng/g dw, respectively. In terms of spatial distribution, firstly, the mangrove forests in Haikou and Sanya contained higher levels of PFASs; secondly, the eastern region contained higher levels of PFASs than the western region. The reasons for this may be related to the population size and development level of the region. For the organic carbon normalized sediment-water partition coefficient (log K oc ), the results showed that log K oc decreased with increasing carbon chains for short-chain PFASs (with ≤6 CF 2 units) and increased with increasing carbon chains for long-chain PFASs (with ˃6 CF 2 units). Principal Component Analysis (PCA) and correlation analysis were employed to pinpoint specific origins of PFASs, namely firefighting, metal plating, food packaging, textiles, and fluoropolymer manufacturing. The risk quotient (RQ) values of PFASs in mangrove ecosystems on Hainan Island were all <1, but the existence of potential risks cannot be excluded. Hence, further investigations related to the bioaccumulation effects of PFASs in organisms in mangrove forests should be conducted to gain a more comprehensive understanding of their environmental behavior., 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. Published by Elsevier B.V.)

The accumulation of nitrogen (N) from straw and fertilizer in soil effectively reduces N losses, which is vital for protecting dryland farming environments. However, the quantification of exogenous N contributions to soil organic nitrogen (SON) under different carbon (C) and N management practices in maize-wheat cropping systems remains unknown. Here, a 15 N in situ labelling experiment was conducted, based on continuous 5-year N levels (0, 150, 250 kg N ha -1 applied for each crop) and two straw management practices (NS, straw removal; AS, straw incorporation) to investigate the allocation of exogenous N to SON and its underlying accumulation mechanisms. The atom% excess in SON was determined after fractionating it into active and stable fractions by the acid hydrolysis method. Compared to NS, AS significantly increased the distribution of fertilizer N into stable SON by 168.4 %-223.6 % in the maize season, and into active and stable SON by 256.7 %-278.4 % and 142.0 %-167.6 %, respectively, in the wheat season. The content and retention rate of fertilizer N in SON were highest at the N250 and N150 levels, respectively, under both NS and AS treatments in the two crop seasons. In contrast, N addition decreased the allocation of straw N to SON, especially in the wheat season. Notably, the content and residual rate of exogenous N in SON between the N150 and N250 levels showed no significant differences. Straw incorporation exerted the most significant direct and positive impact on the immobilization of fertilizer N in the soil, whereas N application indirectly influenced straw N accumulation, primarily by altering labile C and N contents, subsequently selecting specific microbial communities. Gram-positive bacteria and actinomycetes exhibited a significant positive correlation with straw N content in SON. This study provides a new perspective on N nutrient management by quantifying exogenous N accumulation in the soil., 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. Published by Elsevier B.V.)

Blastocystis sp., a significant zoonotic parasite with a global distribution, was the focus of this study, which aimed to investigate its prevalence and genetic diversity among diarrheic and asymptomatic children in Wenzhou, China. We collected 1,032 fecal samples from Yuying Children's Hospital, Wenzhou, China, comprising 684 from children with diarrhea and 348 from asymptomatic children. Genomic DNA extracted from these samples was used to detect Blastocystis spp. by PCR, targeting the small subunit ribosomal RNA gene. Subsequently, a phylogenetic tree was constructed, applying the maximum likelihood method. Blastocystis spp. were detected in 67 (6.5%) of the fecal samples. The prevalence rate of Blastocystis spp. in diarrheic children (8.8%; 60/684) was significantly higher than that in asymptomatic children (2.0%; 7/348) (χ 2  = 17.3, p < 0.001). Sequence analysis of the SSU rRNA gene identified five known Blastocystis spp. subtypes, ST1 (n = 12), ST2 (n = 5), ST3 (n = 35), ST4 (n = 12), and ST7 (n = 3). ST1 and ST3 were present in both diarrheic and asymptomatic children, while ST2, ST4, and ST7 were exclusive to diarrheic children. Intra-subtype genetic polymorphisms were identified, comprising four variations in ST1 (ST1-1 to ST1-4), five in ST3 (ST3-1 to ST3-5), two in ST4 (ST4-1 and ST4-2), and two in ST7 (ST7-1 and ST7-2). Notably, ST1-2 to ST1-4, ST3-3 to ST3-5, and ST7-1 and ST7-2 represent newly identified variations. The composition and genetic characteristics of subtypes among children in this region suggest various sources of infection, including human-to-human and animal-to-human transmission., (© W. Zhao et al., published by EDP Sciences, 2024.)

Wild rodents serve as reservoirs for Cryptosporidium and are overpopulated globally. However, genetic data regarding Cryptosporidium in these animals from China are limited. Here, we have determined the prevalence and genetic characteristics of Cryptosporidium among 370 wild rodents captured from three distinct locations in the southern region of Zhejiang Province, China. Fresh feces were collected from the rectum of each rodent, and DNA was extracted from them. The rodent species was identified by PCR amplifying the vertebrate cytochrome b gene. Cryptosporidium was detected by PCR amplification and amplicon sequencing the small subunit of ribosomal RNA gene. Positive samples of C. viatorum and C. parvum were further subtyped by analyzing the 60-kDa glycoprotein gene. A positive Cryptosporidium result was found in 7% (26/370) of samples, involving five rodent species: Apodemus agrarius (36), Niviventer niviventer (75), Rattus losea (18), R. norvegicus (155), and R. tanezumi (86). Their respective Cryptosporidium positive rates were 8.3%, 5.3%, 11.1%, 7.1%, and 7.0%. Sequence analysis confirmed the presence of three Cryptosporidium species: C. parvum (4), C. viatorum (1), and C. muris (1), and two genotypes: Cryptosporidium rat genotype IV (16) and C. mortiferum-like (4). Additionally, two subtypes of C. parvum (IIdA15G1 and IIpA19) and one subtype of C. viatorum (XVdA3) were detected. These results demonstrate that various wild rodent species in Zhejiang were concurrently infected with rodent-adapted and zoonotic species/genotypes of Cryptosporidium, indicating that these rodents can play a role in maintaining and dispersing this parasite into the environment and other hosts, including humans., (© Y. Jiang et al., published by EDP Sciences, 2024.)

Background: Reactive cutaneous capillary endothelial proliferation (RCCEP), a special adverse event (AE) only observed in patients treated with camrelizumab, was reported to be correlated with the efficacy of camrelizumab in patients with advanced hepatocellular carcinoma. This study to analyze the possible correlation between the occurrence of RCCEP and efficacy of camrelizumab in patients with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC)., Material and Methods: In this study, we retrospectively analyzed the efficacy and RCCEP occurrence of camrelizumab in 58 patients with R/M HNSCC in the Shanghai Ninth People's Hospital affiliated to Shanghai JiaoTong University School of Medicine between January 2019 and June 2022. Kaplan-Meier analysis was used to assess the correlation between the occurrence of RCCEP and the survival of enrolled patients, and COX multifactor analysis was adopted to evaluate associated factors that affected the efficacy of camrelizumab immunotherapy., Results: A significant correlation between the incidence of RCCEP and a higher objective response rate was observed in this study (p=0.008). The occurrence of RCCEP was associated with better median overall survival (17.0 months vs. 8.7 months, p<0.0001, HR=5.944, 95% CI:2.097-16.84) and better median progression-free survival (15.1 months vs. 4.0 months, p<0.0001, HR=4.329,95% CI:1.683-11.13). In COX multifactor analysis, RCCEP occurrence was also an independent prognostic factor affecting OS and PFS in patients with R/M HNSCC., Conclusions: The occurrence of RCCEP can show a better prognosis, it could be used as a clinical biomarker to predict the efficacy of camrelizumab treatment.

Under the context of territorial spatial planning in the new era, it is of great significance to analyze the future land use competition pattern to construct a sustainable and adaptive management strategy for territorial spatial development and utilization protection. Taking Shenyang, a megacity in Northeast China, as the case study area, and the geographic information system technologies and the patch-generation land use simulation (PLUS) model was used to simulate the land use competition pattern in 2030 under four scenarios. Meanwhile, the dynamic evolution of territorial spatial structure competition was monitored based on the perspective of agricultural, ecological, and construction land space. The results show that land use competition was driven by food security, economic growth, and ecological protection. The results showed that (1) the most frequent changes in cultivated land and construction land were found in 1980, 1990, 2000, 2010, and 2020, and their competitive advantage among land use types was obvious. As for the driving mechanism, the influencing effect of socioeconomic factors on land use type competition was more significant than that of natural factors. (2) The competitive dominance scenario of cultivated land protection and the synergistic dominance scenario of cultivated land, ecological, and construction could help optimize and control the land use competition pattern. (3) The information entropy and equilibrium index of the territorial spatial structure increase in both scenarios; the dominance index decreases, and the proportion of agricultural, ecological, and construction space is more coordinated. The results may assist a holistic understanding of land use change to coordinate the competition among agricultural, ecological, and construction space and facilitate the realization of high-quality territorial spatial development goals., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Structural variations (SVs) in individual genomes are major determinants of complex traits, including adaptability to environmental variables. The Mongolian and Hainan cattle breeds in East Asia are of taurine and indicine origins that have evolved to adapt to cold and hot environments, respectively. However, few studies have investigated SVs in East Asian cattle genomes and their roles in environmental adaptation, and little is known about adaptively introgressed SVs in East Asian cattle., Results: In this study, we examine the roles of SVs in the climate adaptation of these two cattle lineages by generating highly contiguous chromosome-scale genome assemblies. Comparison of the two assemblies along with 18 Mongolian and Hainan cattle genomes obtained by long-read sequencing data provides a catalog of 123,898 nonredundant SVs. Several SVs detected from long reads are in exons of genes associated with epidermal differentiation, skin barrier, and bovine tuberculosis resistance. Functional investigations show that a 108-bp exonic insertion in SPN may affect the uptake of Mycobacterium tuberculosis by macrophages, which might contribute to the low susceptibility of Hainan cattle to bovine tuberculosis. Genotyping of 373 whole genomes from 39 breeds identifies 2610 SVs that are differentiated along a "north-south" gradient in China and overlap with 862 related genes that are enriched in pathways related to environmental adaptation. We identify 1457 Chinese indicine-stratified SVs that possibly originate from banteng and are frequent in Chinese indicine cattle., Conclusions: Our findings highlight the unique contribution of SVs in East Asian cattle to environmental adaptation and disease resistance., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Per- and polyfluoroalkyl substances (PFASs) have attracted worldwide attention due to their high stability, refractory degradation, and bioaccumulation. The Dongjiang River is one of the most important water sources in the Pearl River Delta region. It flows from Jiangxi Province to Guangdong Province and finally into the Pearl River, providing domestic water for cities such as Guangzhou, Shenzhen, and Hong Kong. In this study, 17 PFASs in water, sediment, and fish in the Dongjiang River Basin in southern China were investigated using high-performance liquid chromatography-mass spectrometry. Total PFAS concentrations ranged from 20.83 to 372.8 ng/L in water, from 1.050 to 3.050 ng/g in sediments, and from 12.28 to 117.4 ng/g in fish. Among six species of fish, Oreochromis mossambicus (mean: 68.55 ng/g) had the highest concentration of PFASs, while Tilapia zillii (36.90 ng/g) had the lowest concentration. Perfluorooctanoic acid (PFOA) predominates in water and sediments, while perfluorooctanesulfonic acid (PFOS) predominates in fish. Long-chain perfluorocarboxylates (PFCAs) and perfluorosulfonates (PFSAs) showed higher bioaccumulation, and the field-sourced sediment-water partition coefficients (K d ) and bioaccumulation factors (BAFs) of PFASs increased with the length of perfluorocarbon chains. PFAS concentration in the lower reaches (urban area) of the Dongjiang River is higher than that in the upper and middle reaches (rural area). The calculated hazard ratio (HR) of PFOS and PFOA levels in fish in the Dongjiang River Basin was far less than 1; hence, the potential risk to human health was limited., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

To understand the characteristics, source apportionment, and regional transport of volatile organic compounds (VOCs) and ozone (O 3 ) in a typical city with severe air pollution in central China, we observed and analyzed 115 VOC species at an urban site in Zhengzhou from 29 July to 26 September 2021. During this period, observation- and emission-based approaches revealed that Zhengzhou was in a VOC-limited regime. The average concentration of total VOCs (TVOCs) was 162.25 ± 71.42 μg/m 3 , dominated by oxygenated VOCs (OVOCs, 34.49%), alkanes (24.29%), and aromatics (19.49%). Six VOC sources were identified using positive matrix factorization (PMF) model, including paint solvent usage (25.32%), secondary production (24.11%), industrial production (19.22%), vehicle exhaust (16.18%), biogenic emission (8.87%), and combustion (6.30%). To assess the regional contribution and source apportionment of VOCs and O 3 , Comprehensive Air Quality Model with Extensions (CAMx) with the Ozone Source Apportionment Technology (OSAT) was used for simulation. Results showed that the VOCs were significantly affected by local emissions (about 70%), while O 3 was mainly attributed to regional and super-regional transport. Regarding multi-directional regional transport of VOCs and O 3 , dominant contributions were from the northeast and east-northeast directions, and O 3 contributions were also predominantly from the east and east-southeast directions. In terms of source apportionment, the transportation and industrial sectors (including solvent usage) were the major contributors to O 3 and VOCs. To alleviate VOCs and O 3 pollution, transportation and industrial emission reduction should be strengthened, and regional coordination, especially from the northeast to east-southeast directions, should be emphasized in addition to local management., 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.)

Background: There is a high incidence rate of age-related hearing loss. Severe hearing loss may increase the prevalence of mental illness, cognitive impairment, and even the risk of all-cause death., Purpose: Construction of the three-level and two-stage screening mode for age-related hearing loss of the community and to evaluate its effectiveness., Materials and Methods: A total of 401 participants (aged 60 years or older) from five typical communities were enrolled in the study. The risk factors assessment of age-related hearing loss was completed by using a cross-sectional survey and receiver operating characteristic (ROC) curve. Multiple screening method was adopted and verified by serial and parallel tests, respectively. Based on research data, incorporate risk factors assessment, the Hearing Handicap Inventory for the Elderly Screening Version (HHIE-s) and pure tone audiometry (PTA) were used to construct the screening mode., Results: Multiple screening series testing and multiple screening parallel testing, including risk factors assessment, HHIE-s, and PTA, were used for verification: the sensitivity, specificity, and Kappa index were 70.5% and 9.2%, 95.0% and 71.6%, 0.26 and 0.63, respectively. Finally, the three-level and two-stage screening mode for age-related hearing loss was established. "Three-level" was defined as the risk factors assessment/HHIE-s (high-risk population), PTA (suspect population), and comprehensive hearing loss assessment (confirmed population). "Two-stage" was defined as the population screening by general practitioner in the community and target screening by otolaryngologist of the tertiary hospitals., Conclusion: The three-level and two-stage screening mode for age-related hearing loss consists of the following framework: from population screening to target screening, from suspicious diagnosis to accurate diagnosis, from primary health care to tertiary hospitals. The study objective is to structure a new secondary prevention and treatment mode for age-related hearing loss with primary health care as the core, so as to help the front-end management of healthy aging., Competing Interests: The authors report no competing interests in this work., (© 2023 Ge et al.)

Monocyclic aromatic hydrocarbons (MAHs) and polycyclic aromatic hydrocarbons (PAHs) are both well known as hazardous air pollutants and also important anthropogenic precursors of tropospheric ozone (O 3 ) and secondary organic aerosols (SOA). In recent years, there have been intensive studies covering MAHs emission from various sources and their behavior under stimulated photochemical conditions. Yet in-situ measurements of PAHs presence and variations in ambient air are sparse. Herein we conducted large geometrical scale mobile measurements for 16 aromatic hydrocarbons (AHs, including 7 MAHs and 9 PAHs) in eastern China between October 27 and November 8, 2019. This unique dataset has allowed for some insights in terms of AHs concentration variations, accompanying chemical composition, source contributions and spatial distributions in eastern China. In general, AHs showed a clear concentration variability between the south and the north of the Yangtze River Delta (YRD). The concentrations of PAHs were approximately 9% of AHs, but contributed 23% of SOA formation potential. Source apportionment via positive matrix factorization (PMF) model revealed that industrial processes as the largest source (44%) of observed AHs, followed by solvent usage (21%), vehicle exhaust (19%), coal combustion (11%) and coking processes (6%). In the perspective of PAHs sources, coal combustion emissions were identified as the dominating factor of a share of 41%-52% in eastern China. Our findings complemented the simultaneously monitoring information of PAHs and MAHs in eastern China, revealed the importance of PAHs to SOA formation and highlighted the necessity of formulating strategies to reduce emissions from anthropogenic sources and reduce risks to human health., (Copyright © 2022. Published by Elsevier B.V.)

Green innovation is an important way for manufacturing enterprises to achieve green and high-quality development. The existing literature has ignored the heterogeneous motivations for enterprise green innovation. The strategic green innovation behavior (SGIB) aiming at seeking strategic differences and building core competitiveness is the necessary measure for enterprises to realize green transformation. Furthermore, the existing research studies the influencing factors of green innovation from a single perspective, ignoring the interaction of institutional and resource factors. Based on this, this study uses QCA to identify the driving mechanism of enterprise SGIB. The research collected questionnaire data from 199 manufacturing enterprises in China. The main results show that a single factor will not constitute a necessary condition for positive SGIB, but the not-high green dynamic capability is a necessary condition for negative SGIB. Positive SGIB includes four configuration paths: institution-ethics synergy, normative pressure oriented, environmental ethics oriented, and institutional incentive oriented. Lack of institutional pressure is the only configuration path that leads to negative SGIB. Further analysis found that environmental ethics and institutional pressure are the main forces to promote SGIB. After a series of robustness tests, the above basic conclusions did not change significantly. Based on the above conclusions, we believe that government departments, industry associations, and enterprises should form a joint force to enhance the level of institutional pressure and enterprise environmental ethics, promoting the implementation of strategic green innovation., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Speciation is a central topic in evolutionary biology. However, how genomic divergence originates and accumulates in the face of gene flow during ecological adaptation remains poorly understood. Closely related species that have adapted to distinct environments but inhabit some overlapping ranges provide an ideal system to evaluate this issue. Here, we combine population genomics and species distribution models (SDMs) to examine genomic divergences between two sister plant species, Medicago ruthenica and M. archiducis-nicolai, that occur in northern China and the northeast Qinghai-Tibet Plateau, respectively, with overlapping distributions in the border of the two regions. M. ruthenica and M. archiducis-nicolai are well-delimited based on population genomic data, although hybrids exist in sympatric sampling locations. Coalescent simulations and SDMs suggest that the two species diverged from each other in the Quaternary but have been in continuous contact with gene flow occurring between the two species since then. We also discovered positive selection signatures associated with genes both outside and within genomic islands in both species that are probably involved in adaptations to arid and high-altitude environments. Our findings provide insights into how natural selection and climatic changes in the Quaternary initiated and maintained interspecific divergence of these two sister species., (© 2023 John Wiley & Sons Ltd.)

We investigated the occurrence and genotypic diversity of E. bieneusi in farmed Asiatic brush-tailed porcupines and bamboo rats from Hainan Province, China. Four hundred and sixty-seven fresh feces were collected from 164 Asiatic brush-tailed porcupines and 303 bamboo rats. DNA extraction from the feces and genotyping of E. bieneusi were performed by the amplification of the internal transcribed spacer (ITS) region of rDNA of E. bieneusi using PCR. A neighbor-joining tree was constructed based on the sequences obtained here and other sequences of E. bieneusi genotypes stored in Genbank. The total rate of infection with E. bieneusi was 32.5% (152/467), with 14.6% (24/164) in Asiatic brush-tailed porcupines and 42.2% (128/303) in bamboo rats infected. Seventeen genotypes of E. bieneusi were identified including 12 known genotypes, i.e., D (n = 78), Henan-III (n = 21), SHW7 (n = 19), KIN-1 (n = 11), ETMK5 (n = 7), TypeIV (n = 4), EbpD (n = 2), EbpA (n = 1), EbpC (n = 1), S7 (n = 1), HNPL-III (n = 1), HNR-VII (n = 1), and five novel genotypes named as HNZS-I (n = 1) and HNHZ-I to HNHZ-IV (n = 1 per genotype). Phylogenetic analysis revealed that all the genotypes found here except genotype S7 fell into Group 1. The present study demonstrated a relatively high prevalence of E. bieneusi infection (32.5%) and a large genetic variation of E. bieneusi (seventeen genotypes) in farmed Asiatic brush-tailed porcupines and bamboo rats in Hainan, China. The high proportion (78.3%) of zoonotic genotypes identified in the animals investigated here suggests that there is the potential for zoonotic or cross-species transmission which may pose a serious public health threat in the area. Public education on the management of Asiatic brush-tailed porcupines and bamboo rats should be implemented in the investigated areas., Competing Interests: Declaration of Competing Interest The authors have no confict of interest. The authors do not have a commercial or other association that has a confict of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

The stability of cultivated land ecosystem is crucial to the green and high-quality development of agriculture. Revealing its spatio-temporal differentiation is an important scientific issue to improve the resilience of cultivated land and ensure food security. In this paper, Shenyang, a typical region of Lower Liaohe Plain, is the study area. Starting from the stress buffer response process of cultivated land ecosystem stability, USLE, RWEQ, SDI, RSEI and grey relational model are used to clarify the relationship between the three, and depict the temporal and spatial differentiation pattern of cultivated land ecosystem stability. The results showed that the external stress intensity of cultivated land in Shenyang decreased as a whole, but the stress intensity of cultivated land distributed in the northern and southeast hilly areas increased. Most of the endogenous buffer strength has been improved, and the buffer capacity of cultivated land in the northern hilly region has declined on a large scale. More than half of the response intensity to the effect has been improved, while the response intensity of cultivated land in the west and north has generally declined. The stability of cultivated land ecosystem in Shenyang has been improved for the most part, but in the hilly areas in the north and southeast, the stability in the lower reaches of Liaohe River plain in the south has declined. Terrain conditions and high-intensity cultivation patterns are the important reasons for the temporal and spatial differentiation of cultivated land ecosystem stability in the study area. The study clarified the dynamic process of cultivated land ecosystem stability and provided an important way to grasp the scientific law of stability change., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Due to differences in the soil environment and grassland management measures, the change characteristics of soil microbial entropy and soil comprehensive quality in different types of grassland may vary significantly. In this study, the spatial variation characteristics of grassland soil microbial entropy under shallow plowing and nutrient addition measures were studied using a networking experimental platform established in a temperate meadow steppe, typical steppe, and desert steppe in northern China. The grassland soil quality was comprehensively evaluated to provide a theoretical basis for the scientific and reasonable management of grasslands under global climate change. The results show that in the meadow steppe, shallow plowing and nutrient addition significantly decreased the soil microbial biomass carbon and microbial entropy in the region, resulting in a decrease in the comprehensive score of soil quality. In the typical steppe, due to the influence of shallow tillage measures, the microbial biomass of the grassland soil in the region was higher than that of the control group and its two treatments, and the comprehensive score of soil quality was ranked first among the four treatments. In the desert steppe, the interaction of shallow plowing and nutrient addition significantly increased the soil microbial entropy in the region. Under the nutrient addition measures, the soil microbial entropy of the desert steppe showed a downward trend. In addition, the soil C/N ratio of the desert grassland under nutrient addition measures increased significantly, and the comprehensive score of soil quality ranked first among the four treatments as the microbial entropy decreased significantly.

Municipal wastewater treatment plants (WWTPs) can reflect the pollution status of per- and polyfluoroalkyl substances (PFASs) pollution. Here, matched influent, effluent, and sludge samples were collected from 58 municipal WWTPs in China, South Sudan, Tanzania, and Kenya. Target and suspect screening of PFASs was performed to explore their profiles in WWTPs and assess removal efficiency and environmental emissions. In total, 155 and 58 PFASs were identified in WWTPs in China and Africa, respectively; 146 and 126 PFASs were identified in wastewater and sludge, respectively. Novel compounds belonging to per- and polyfluoroalkyl ether carboxylic acids (PFECAs) and sulfonic acids (PFESAs), hydrogen-substituted polyfluorocarboxylic acids (H-PFCAs), and perfluoroalkyl sulfonamides (PFSMs) accounted for a considerable proportion of total PFASs (ΣPFASs) in Chinese WWTPs and were also widely detected in African samples. In China, estimated national emissions of ΣPFASs in WWTPs exceeded 16.8 t in 2015, with >60 % originating from emerging PFASs. Notably, current treatment processes are not effective at removing PFASs, with 35 of the 54 WWTPs showing emissions higher than mass loads. PFAS removal was also structure dependent. Based on machine learning models, we found that molecular descriptors (e.g., LogP and molecular weight) may affect adsorption behavior by increasing hydrophobicity, while other factors (e.g., polar surface area and molar refractivity) may play critical roles in PFAS removal and provide novel insights into PFAS pollution control. In conclusion, this study comprehensively screened PFASs in municipal WWTPs and determined the drivers affecting PFAS behavior in WWTPs based on machine learning models., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The rapid growth of industrial digitalization and financial support are the main driving forces for the green transformation of China's economy. Aiming to explore how digitalization and financial development impact ecological efficiency (eco-efficiency), this study proposes a unified research framework by integrating multiple technologies using the panel data that covered 30 China's provinces from 2006 to 2018. First, China's provincial digital development index is constructed to measure the level of digitalization, and regional eco-efficiency is estimated by a non-radial data envelope analysis (DEA) model. Based on that, the panel data regression model and panel vector autoregression (PVAR) model are used to explore the direct effects and dynamic effect of digitalization and financial development on eco-efficiency, respectively. Then, the threshold regression model is employed to check the threshold effect of the two variables on eco-efficiency. The following conclusions are drawn: (1) Both digitalization and financial development have a significantly positive correlation with regional eco-efficiency, indicating that China's digitalization and financial development in recent years have both improved regional eco-efficiency. (2) Eco-efficiency has positive and longer responses to the impulse coming from digitalization and financial development, and the response of ecological efficiency to financial development is greater than its response to digitalization. (3) Threshold effects exist in the impact mechanism of digitalization on regional eco-efficiency. This indicates that the level of financial support is too low to promote the improvement in ecological efficiency. Eco-efficiency can be improved only to a certain extent. The research conclusions provide a policy reference for improving eco-efficiency and promoting China's green development., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Blastocystis sp. is an important gastrointestinal parasite with global distribution, prevalent in humans, farmed animals, and wildlife. Therefore, this study aimed to investigate the prevalence and genetic diversity of Blastocystis sp. in Asiatic brush-tailed porcupines (Atherurus macrourus), bamboo rats (Rhizomys pruinosus), and masked palm civets (Paguma larvata) in Hainan Province, China. A total of 900 fecal samples were collected from three farmed animal species including 257 porcupines, 360 rats, and 283 civets. Genomic DNA was extracted from each fecal sample and Blastocystis sp. was detected by PCR at the small subunit ribosomal RNA (SSU rRNA) gene. A phylogenetic tree was constructed using the maximum likelihood method. Blastocystis sp. was detected in 47 (5.2%) fecal samples: 12 (4.7%) Asiatic brush-tailed porcupines, 8 (2.2%) bamboo rats, and 27 (9.5%) masked palm civets. Three known Blastocystis sp. subtypes, including ST1, ST4, ST5, and one unnamed subtype (unST), were found in one, 19, 26, and one animal, respectively. Subtypes ST4 and unST were detected in porcupines, ST4 in rats, and ST1 and ST5 in civets. Our results suggest that the three farmed animal species reported in this study could serve as reservoirs for potentially zoonotic Blastocystis sp. subtypes and transmit this parasite to humans, other farmed animals, and wildlife., (© W. Zhao et al., published by EDP Sciences, 2023.)

Mitigating e-bicycle crash occurrence has become a great challenge across the world. It is of paramount importance for improving traffic safety to characterize the relationship between e-bicycle crash injury severities and contributing factors. This study positions itself at clarifying the roles of the factors in e-bicycle crashes from time, space, road, environment, rider and object characteristics. The partial proportional odds (PPOs) model as well as its elasticity analysis was employed to identify the influences based on 15,138 police-reported e-bicycle crashes in Shangyu District of Shaoxin City, China. The results evidenced that there were 12 factors having significant effects. Especially, the results emphasized the greater influences of rider gender, age, object hit and road type. Their maximum of the absolutes of elasticities was greater than 24%. Increased crash severity was associated with females, younger riders, and higher speed collisions. However, the remaining significant variables had minor effects (no more than 10%). The findings provide meaningful insights for advancing e-bicycle development, when making related policies and prioritizing safety countermeasures.

Introduction: With a significant increase in accidents involving cyclists, more attention has been paid to cycling safety. Previous studies on traffic accident revealed that red-light violations of non-motorized vehicles have become the leading cause of crashes at signalized intersections. The objective of this study is to investigate the impact of non-motorized traffic enforcement cameras (NTECs) on the red-light running behavior of cyclists, including ordinary e-bike riders, delivery e-bike riders, and bicyclists., Method: An observational study of 5,217 cyclists was conducted at six primary intersections in the downtown areas of Nanjing, China. A random parameter logit model was used to explore the safety effect of the NTECs and other factors related to red-light violation behavior., Results: The results indicate higher reductions in red-light violations at intersections with the NTECs compared than at the non-adjacent intersections without the NTECs. Furthermore, the NTECs demonstrated a beneficial but smaller impact on the reduction of violations at adjacent intersections. Another primary finding was that the effects of the NTECs varied among three types of cyclists (ordinary e-bike riders, delivery e-bike riders, and bicyclists)., Conclusions: The NTECs were found to be most effective in the case of delivery e-bike riders, followed by ordinary e-bike riders and bicyclists. In addition, the factors associated with the red-light violation behaviors of these three groups were also found to be different. In general, group size, maximum waiting time, waiting position, and visual search were significantly related to the probability of red-light violations in all three groups., Practical Applications: Based on these findings, this study provides some feasible suggestions for improving the effect of the NTECs and for the future extension of the NTECs installation, such as the randomization of the enforcement and publicity campaigns., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 National Safety Council and Elsevier Ltd. All rights reserved.)

Returning manure to the land is a critical link in the internal cycle of agricultural systems, but excess manure leads to water eutrophication. The traditional manure re-use method brings pathogenic microorganisms, heavy metals, antibiotic resistance genes (ARGs), insect eggs, and other contaminants into the soil, posing a great threat to the ecological environment and human health. Clarifying the spatial distribution patterns of manure nutrient supply and farmland nutrient demand can help guide a more efficient and harmless way to return manure to farmland. This work counted data on cultivation and breeding in 356 cities on the Chinese mainland from 2015 to 2019 and calculated the livestock breeding volume (LB), total environmental capacity (C), and remaining environmental capacity (RC) accordingly. The Spatial Autocorrelation Model (SAC) was used to analyze the distribution patterns of the three. Data results show that China currently has the potential to double LB, but most cities in the west have excess manure due to the mismatched distribution of LB and C. The hot spot analysis results demonstrate the priority/general areas of manure management and the export/import areas of manure resources. The results of the outlier analysis show that some cities located at the boundary of RC Cold/Hot spot areas (e.g., Chengdu City) can perform resource replacement nearby to relieve local environmental pressure. This study analyzes the potential and realistic resistance to utilizing manure as an organic nutrient resource and provides a reference for developing manure management links., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

To explore the spectrum, clinicopathological features and prognosis of patients with inflammatory bowel disease (IBD) including Crohn's disease (CD) and ulcerative colitis (UC) with renal involvement. Included in this cross-sectional study were 36 IBD patients, in whom renal biopsy was performed to analyze the histological pattern and prognosis. Renal histopathology was examined by light microscopy and immunofluorescence using the standard procedures. Renal function decline was defined as a twofold increase in serum creatinine (SCr) after biopsy, initiation of dialysis and transplantation. Of the 36 IBD patients (22 UC and 14 CD), renal biopsy was performed in 33 cases. Compared with UC patients, CD patients were significantly younger at presentation and had a higher proportion of chronic renal insufficiency (CRI). The most common renal histological pattern in the 33 biopsy cases was IgA nephropathy (66.6%), followed by membrane nephropathy (9.1%), amyloidosis (9.1%), tubulointerstitial nephritis (9.1%), and membranoproliferative glomerulonephritis (6.1%). Renal function decline occurred in 4 patients (1 with amyloidosis, 1 with TIN and 2 with CRI). Factors associated with renal function decline included CD and a higher SCr level at presentation. Urinalysis and renal function test should be routinely examined in IBD patients. Renal biopsy can provide useful information about the histological patterns and therefore should be considered in IBD patients with renal lesions., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

As the primary industry, agriculture is a prerequisite for human survival and a basic industry of the national economy. As a result, the growth of agriculture is vital for the nation's socioeconomic development. The construction of ecological civilization and the reform and innovation of farmers' digital entrepreneurial behavior in the region are intimately correlated with the agricultural eco-environmental quality. Therefore, it is crucial for us to improve control and maintenance of the agricultural eco-environment. A requirement for directing the sustainable growth of the agricultural economy is evaluating and identifying the quality of the regional eco-environment and the issues it faces. In view of this, the study employs Jiangsu Province as a research example, builds a comprehensive index evaluation system, and uses the modified BP neural network to evaluate the agricultural eco-environmental quality in the target area between 2010 and 2020. First, the evaluation system is constructed from four dimensions: ecological resource status, environmental pollution degree, eco-environmental protection efforts, and agricultural development level, and 14 influencing factors are then screened out as specific secondary evaluation indicators. Second, a GA-BP model will be applied to comprehensively assess the quality of the agricultural eco-environment in the province over the past 10 years. The comprehensive score of the province's agricultural eco-environmental quality was calculated, and the quality level was classified by this. Meanwhile, the indicators' scores were paired with an analysis of each contributing factor's degree of change. The findings indicate that from 2010 to 2020, Jiangsu Province's agricultural eco-environment demonstrated a favorable trend, a reasonably high-quality level, and a tendency of continuous improvement from bad to good. The results of each indicator measuring the quality of the agricultural environment fluctuated, but overall they showed an upward trend. Finally, in order to offer a reference for agricultural eco-environment control and protection and a good ecological environment for farmers' digital entrepreneurship in the near future, countermeasures and suggestions are proposed for the restoration of the agricultural eco-environment in Jiangsu Province referring to the results of the research and the problems already present in the area., Competing Interests: The authors declare no competing interests., (Copyright © 2022 Xiangmin Meng et al.)

Enterocytozoon bieneusi is a zoonotic pathogen commonly found in humans and animals all over the world. Here, we investigated the occurrence and genotype constitute of E. bieneusi among the individuals from Haikou city of Hainan, China. A total of 1,264 fecal samples of humans were collected, including 628 samples from patients with diarrhea (325 adults and 303 children) and 636 samples from the asymptomatic population (383 college students and 253 kindergarten children). E. bieneusi was detected using nested polymerase chain reaction (PCR) amplification of the internal transcribed spacer (ITS) region. A phylogenetic tree was constructed using a neighbor-joining tree construction method. The overall prevalence of E. bieneusi was 3.7% (47/1,264), while it was 5.6% in the patients with diarrhea (5.8% in adults and 5.3% in children) and 1.9% in the asymptomatic population (2.9% in college students and 0.4% in kindergarten children). The prevalence of E. bieneusi in humans with diarrhea was significantly higher than that in the asymptomatic population (χ 2 = 36.9; P < 0.05). A total of 28 genotypes were identified, including ten known genotypes: CHG2 ( n = 3), CHG3 ( n = 5), CHG5 ( n = 10), CM21 ( n = 1), EbpA ( n = 1), EbpC ( n = 1), PigEBITS4 ( n = 1), PigEBITS7 ( n = 1), SHR1 ( n = 4), Type IV ( n = 2), and 18 novel genotypes (HNH-1 to HNH-18; one each). All these genotypes were categorized into three groups, including group 1 ( n = 6), group 2 ( n = 14), and group 13 ( n = 8). This was the first study on the identification of E. bieneusi among humans in Hainan, China. The correlation between E. bieneusi infection and diarrhea was observed. The high diversity and distinctive distribution of E. bieneusi genotypes found in this study reflected the unique epidemic genetic characteristics of E. bieneusi in humans living in Hainan., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zhang, Ren, Zhou, Qiang, Li, Zhang, Li, Zhou, Wang, Lai, Lei, Tan, Liu, Li, He, Zhao, Zhu and Lu.)

The Yellow River Basin in Shaanxi (YRBS) has a relatively fragile ecological environment, with severe soil erosion and a high incidence of natural and geological disasters. In this study, a river basin landscape ecological risk assessment model was constructed using landscape ecology principles to investigate the temporal and spatial evolution, as well as the spatial autocorrelation characteristics of landscape ecological risks in the YRBS over a 20-year period. The main findings from the YRBS were that the land use types changed significantly over the span of 20 years, there was spatial heterogeneity of the landscape pattern, and the ecological risk value was positively correlated. The threat of landscape ecological risks in YRBS is easing, but the pressure on the ecological environment is considerable. This study provides theoretical support administrative policies for future ecological risk assessment and protection, restoration measures, and control in the Yellow River Basin of Shaanxi Province.

Background: Former single center studies indicated that HER2 assessment with two primary tumor blocks (dual block HER2 assessment) could be an efficient and practical approach to overcome the adverse impact of heterogeneity and acquire a HER2 positive rate in gastric cancer (GC). This multicenter prospective clinical trial (NCT02843412) was launched to verify its value and generality., Methods: A total of 3806 participants with primary GCs have been enrolled from 8 hospitals in China. Two primary tumor blocks were selected and recorded as block 1 and block 2 after histological evaluation. An HER2 (4B5) rabbit monoclonal antibody was used for the immunohistochemistry (IHC) analysis., Results: In total patients, HER2 IHC positive (3+) rate with dual block assessment (9.4%) was higher than that with single block assessment (block 1: 7.8%, block 2: 7.8%) (P < 0.001). Compared with single-block assessment, dual-block assessment increased the positive rate by approximate 20%. Similarly, HER2 equivocal (2+) rate was increased in dual block assessment (25.8%), which was higher than that in single block assessment (block 1: 20.3%, block 2: 20.9%) (P < 0.001). Conversely, dual block assessment demonstrated a lower HER2 negative (0/1+) rate (64.8%) than single block assessment (block1: 71.9%, block 2: 71.3%) (P < 0.001). These findings were also confirmed in individual hospitals., Conclusions: Dual block HER2 assessment effectively increased HER2 IHC positive rate in resected specimens of GC. We recommended dual block HER2 assessment be promoted in routine clinical practice in GC., Trial Registration: ClinicalTrials.gov, NCT02843412 . Registered 1 July 2016 - Retrospectively registered., (© 2022. The Author(s).)

Background: The prevalence of uncontrolled hypertension is high and increasing in low-income and middle-income countries. We tested the effectiveness of a multifaceted intervention for blood pressure control in rural China led by village doctors (community health workers on the front line of primary health care)., Methods: In this open, cluster randomised trial (China Rural Hypertension Control Project), 326 villages that had a regular village doctor and participated in the China New Rural Cooperative Medical Scheme were randomly assigned (1:1) to either village doctor-led multifaceted intervention or enhanced usual care (control), with stratification by provinces, counties, and townships. We recruited individuals aged 40 years or older with an untreated blood pressure of 140/90 mm Hg or higher (≥130/80 mm Hg among those with a history of cardiovascular disease, diabetes, or chronic kidney disease) or a treated blood pressure of 130/80 mm Hg or higher. In the intervention group, trained village doctors initiated and titrated antihypertensive medications according to a standard protocol with supervision from primary care physicians. Village doctors also conducted health coaching on home blood pressure monitoring, lifestyle changes, and medication adherence. The primary outcome (reported here) was the proportion of patients with a blood pressure of less than 130/80 mm Hg at 18 months. The analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT03527719, and is ongoing., Findings: Between May 8 and November 28, 2018, we enrolled 33 995 individuals from 163 intervention and 163 control villages. At 18 months, 8865 (57·0%) of 15 414 patients in the intervention group and 2895 (19·9%) of 14 500 patients in the control group had a blood pressure of less than 130/80 mm Hg, with a group difference of 37·0% (95% CI 34·9 to 39·1%; p<0·0001). Mean systolic blood pressure decreased by -26·3 mm Hg (95% CI -27·1 to -25·4) from baseline to 18 months in the intervention group and by -11·8 mm Hg (-12·6 to -11·0) in the control group, with a group difference of -14·5 mm Hg (95% CI -15·7 to -13·3 mm Hg; p<0·0001). Mean diastolic blood pressure decreased by -14·6 mm Hg (-15·1 to -14·2) from baseline to 18 months in the intervention group and by -7·5 mm Hg (-7·9 to -7·2) in the control group, with a group difference of -7·1 mm Hg (-7·7 to -6·5 mm Hg; p<0·0001). No treatment-related serious adverse events were reported in either group., Interpretation: Compared with enhanced usual care, village doctor-led intervention resulted in statistically significant improvements in blood pressure control among rural residents in China. This feasible, effective, and sustainable implementation strategy could be scaled up in rural China and other low-income and middle-income countries for hypertension control., Funding: Ministry of Science and Technology of China., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: It has been widely reported that the key biomarkers of homocysteine metabolic pathways have emerged as markers or independent risk factors for cardiovascular disease and many other diseases. To improve the accuracy of evaluation in China, we establish the reference intervals of serum homocysteine (Hcy), cysteine (Cys), and methionine (Met) in apparently healthy Chinese adults., Methods: We examined 1553 subjects aged ≥20 years who underwent Hcy metabolic pathway tests, in the Chaoyang Central Hospital between January 2019 and December 2020. The serum Hcy, Cys, and Met levels were simultaneously determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Multiple regression analysis was performed to identify sources of variation. A nonparametric method was used to establish the reference intervals., Results: Gender differences were observed in Hcy and Met, with higher levels in males. Reference intervals for males were 6.09-17.00 μmol/L (Hcy) and 19.31-33.68 μmol/L (Met); conversely, the reference intervals for females were 4.61-14.61 μmol/L (Hcy) and 16.16-30.35 μmol/L (Met). The serum Cys reference intervals were seen to be gender-independent, but age-dependent reference intervals were needed; those for Cys were 188.85-334.27 μmol/L, 200.48-340.66 μmol/L, and 216.03-349.67 μmol/L in <40, 40-50, and ≥50 years, respectively., Conclusions: By this study, the gender- or age-specific reference intervals of Hcy, Cys, and Met that were matched with the Chinese population were established, providing valuable references for clinical work and laboratory researches.

The microeconomic behavior of enterprises is influenced by the government system and its policies. In this article, we investigate how environmental regulation and environmental decentralization affect enterprise environmental protection investment using the data of China's listed companies from 2009 to 2020 and examine the effect of environmental decentralization on the relationship between environmental regulation and environmental protection investment. First, we find that there is a "U-shaped" relationship between environmental regulation and enterprise environmental protection investment. Second, the estimation results indicate that environmental decentralization can promote enterprise environmental protection investment. Finally, we further provide evidence to show that environmental decentralization has a negative moderating impact on the relationship between environmental regulation and enterprise environmental protection investment. Accordingly, the conclusion of this study is helpful to optimize the environmental decentralization management system, reasonably guide the local government behavior, alleviate the contradiction between environmental protection and economic development, and promote the green transformation of economic development mode., 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 Liu, Ren, He and Zheng.)

Objectives: Early-onset anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDARE) differs from late-onset anti-NMDARE regarding clinical characteristics. Until recently, research focusing on prognosis of elder adults has been scarce and showed inconsistent results. This study aims to evaluate the prognosis of late-onset anti-NMDARE in China., Materials & Methods: One hundred and twelve adults diagnosed as anti-NMDARE in four hospitals in China were reviewed retrospectively. Outcome data were assessed using modified Rankin Scale (mRS) score in short term (3 months after discharge) and long term (≥12 months after discharge). The relapse rate was also computed. Multivariable logistic regression was used to evaluate whether there are substantial differences in functional outcomes and recurrence rate across two groups., Results: Of the 112 patients with anti-NMDARE, 81 (72.3%) were early-onset disease and 31 (27.7%) were late-onset disease. Of these, all had short-term follow-up and 70 completed long-term follow-up. Late-onset anti-NMDARE group showed better short-term (OR 2.70, 95% CI 1.09-6.71) and long-term prognoses (OR 10.25, 95% CI 1.90-55.15). Recurrence rates were statistically different between the groups (OR 4.25, 95% CI 1.22-14.75)., Conclusion: The prognosis for anti-NMDARE in China was poorer for older adults relative to younger adults. The relapse rates were higher in late-onset group compared to early-onset group., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Exploring the fate of nitrogen pollutants in constructed wetlands (CWs) fed by industrial tailwater is significant to strengthen its pollution control and promoting the development of CWs in the field of micro-polluted water treatment. In this study, the distribution coefficients and the environmental risks of nitrogen pollutants between water and sediment of the hybrid CW in Tianjin were systematically investigated. From a spatial perspective, the nitrogen pollutants could be removed in this hybrid CW, and subsurface flow wetland played a key role in nitrogen pollutant removal. From a temporal perspective, the concentration of nitrogen pollutants was largely affected by the dissolved oxygen (DO) and temperature. The distribution coefficient of nitrogen pollutants between water and sediment was further clarified, suggesting that NH 4 + -N was more likely to be enriched in sediments due to microbial process. The overall level of pollution in hybrid CW was moderate according to the nutritional pollution index (NPI) analysis. The risk assessment indicated that timely dredging control measures should be considered to maintain the performance of hybrid CW., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

In the "Tutorial for outline of the healthy China 2030 plan", biomedicine was listed as a key planning and development area. Shanghai government also lists biomedicine as an emerging pillar industry. The rapid development of biomedicine industry put higher requirement for talents. Taking the idea of cross integration, mutually beneficial development, inheritance and innovation, the School of Biotechnology of East China University of Science and Technology organically integrates bioengineering and pharmaceutical majors to develop a new undergraduate engineering program of biomedicine, which specially reforms the talent training practice from the aspects of developing a "trinity teaching" standard system, a "three integration, three convergence" curriculum system, and a "three comprehensive education" innovative talent training system. We put forward the trinity of "value guidance, knowledge system, technology and non-technical core competence literacy" to foster emerging biomedicine engineering talents, and developed a comprehensive innovative talents training mode featured by "covering class-in and class-out, covering every student, and covering ideology and curriculum". Moreover, we established effective connections between courses and training goals, between general education courses and professional courses, and between top-notch talent training systems and training programs. Based on the achievements of teaching reform of the emerging engineering program "intelligent bio-manufacturing", the experience we obtained may provide ideas for development of the first-class bioengineering major in China.

Decrease in light precipitation (LP) frequency has been reported in many regions. However, reason for the decrease remains poorly understood. Here, we quantify urbanization effect on LP (< 3.0 mm day -1 ) trend in China over the period 1960-2018. We show that urbanization has significantly affected the decreasing LP trend. The urbanization effect becomes more significant as the definition of LP becomes stricter, with the largest effect appearing in trace precipitation change (< 0.3 mm day -1 ) (LP 0.3 ) during summer and autumn. We estimate that at least 25% of the decreases in LP 0.3  days and amount are due to urbanization near the observational stations. Our analysis thus confirms that urbanization has largely contributed to the observed downward trend in LP, and the large-scale change in LP is less than previously believed., (© 2022. The Author(s).)

Accurately revealing and predicting the presence and risks of per-/poly-fluoroalkyl substances (PFASs) in constructed wetlands (CWs) is great significant for the construction and management of CWs, but very challenging. In this work, a novel fate and transport model was for the first time established to evaluate the spatially continuous distribution and environmental risks of PFASs among multi-media in Lingang hybrid CW fed by industry tailwater. 20 PFASs were detected from the Lingang CW, and the total concentration of the detected PFASs in water and sediments were in the range of 38.94-81.65 ng/L and 1.23-4.31 ng/g, respectively. PFOA, PFOS and PFBS were the main pollutants in water and sediments. A fate and transport model describing the distribution characteristics and fate of PFASs in Lingang hybrid CW was constructed, and its reliability was verified. The simulated results suggested that PFASs were mainly accumulated in sediments and long-chain PFASs were more easily adsorbed by sediments compared with short-chain PFASs. According to the principal component analysis-multiple linear regression (PCA-MLR), PFASs mainly came from the tailwater from the surrounding sewage treatment plants. Besides, the environmental risks were predicted by this novel model, suggesting that the risks still cannot be neglected due to the accumulation and continuous input of PFASs although the environmental risks of Lingang CW were low. This work provides a novel model for the understanding of presence and risks of PFASs among multi-media in CWs., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Obvious epigenetic differentiation occurred on Lycium barbarum in different cultivation areas in China. To investigate the difference and change rule of DNA methylation level and pattern of L. barbarum from different cultivation areas in China, the present study employed fluorescence-assisted methylation-sensitive amplified polymorphism(MSAP) to analyze the methylation level and polymorphism of 53 genomic DNA samples from Yinchuan Plain in Ningxia, Bayannur city in Inner Mongolia, Jingyuan county and Yumen city in Gansu, Delingha city in Qinghai, and Jinghe county in Xinjiang. The MSAP technical system suitable for the methylation analysis of L. barbarum genomic DNA was established and ten pairs of selective primers were selected. Among amplified 5'-CCGG-3' methylated sites, there were 35.85% full-methylated sites and 39.88% hemi-methylated sites, showing a high degree of epigenetic differentiation. Stoichiometric analysis showed that the ecological environment was the main factor affecting the epigenetic characteristics of L. barbarum, followed by cultivated varieties. Precipitation, air temperature, and soil pH were the main ecological factors affecting DNA methylation in different areas. This study provided a theoretical basis for the analysis of the epigenetic mechanism of L. barbarum to adapt to the diffe-rent ecological environments and research ideas for the introduction, cultivation, and germplasm traceability of L. barbarum.

The altitudinal distribution of biodiversity in alpine ecosystems has captured academic attention, especially in streams because of their sensitivity to climate change. In the past years, research mainly focused on understanding the role played by alpine streams' internal factors such as aquatic environmental variables, as well as physical and hydrological conditions, on the shaping of benthic macroinvertebrate communities. More recently, external factors such as terrestrial environments were included in analyses worldwide. In particular, the inherent properties constituting the ecological niche of specific species were considered as factors regulating dispersal and influencing community construction. The objective of this study was to reveal the distribution pattern and the driving factors regulating aquatic biodiversity in alpine streams. We hypothesized that the altitudinal distribution of aquatic macroinvertebrates could be explained by the interaction of the aquatic environment with both species' ecological niche and the terrestrial environment surrounding their habitat, and that rare species display a more pronounced pattern than widespread dominant species. To test these hypotheses, samples were collected from two alpine streams situated on opposite slopes of Biluo Snow Mountain in Yunnan Province, China. Results of statistical analyses showed poor explanatory power from aquatic environmental factors, while the differences in vegetation type and the ecological niche of the species played an important role in determining the distribution pattern of aquatic biodiversity. Furthermore, we found that the altitudinal distribution pattern of aquatic biodiversity exhibits a bimodal type, with rare species fitting the bimodal peaks. These findings call for a better inclusion and further investigation on the effects of the terrestrial environment on aquatic ecosystems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier B.V.)

In-depth understanding and accurately predicting the occurrence and fate of polycyclic aromatic hydrocarbons (PAHs) in constructed wetlands (CWs) is extremely crucial for optimizing the CWs construction and strengthening the risk control. However, few studies have focused on the PAHs among sediment-water-plant and model simulation in CWs. In this study, sediment, surface water and reed samples were gathered and analyzed from a typical CW. The concentrations of 16 PAHs (Σ 16 PAHs) in sediments, surface water and reeds ranged from 620 to 4277 μg/kg, 114 to 443 ng/L and 74.5 to 362 μg/kg, respectively. The coefficients of variation (CV) were calculated as 0.796, 0.431 and 0.473 for the above three media respectively, indicating that the spatial distribution variation was medium intensity. The fugacity fraction (ff) suggested that sediments might act as the secondary release source of most PAHs. According to the diagnostic ratios and principal component analysis-multiple linear regression (PCA-MLR), PAHs in this CW mainly come from fossil fuels combustion and petroleum leakage. PAHs in sediments showed high ecological risk at water inlet and moderate risk at the other functional zones, while low risks for surface water at all functional zones. Although the human health risk assessment indicated relatively low cancer risk, the health risk still cannot be ignored with the continuous input and accumulation of exogenous PAHs. A mathematical model covering the hydraulics parameters and composition characteristics of the wetland was established, and its reliability was verified. The simulated results obtained by the established model were basically consistent with the measured values. In addition, the total remove efficiency of PAHs in surface water was 40.2%, which calculated by the simulated model. This work provides helpful insight into the comprehension of occurrence and fate of PAHs among multi-media in CWs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

There is global concern regarding the public health hazards of environmental exposure to multiple toxic heavy metals. The effects of toxic heavy metals on liver function have been suggested in previous reports, but the association between exposure to multiple toxic heavy metals and liver function has not been elucidated. The aim of this study was to investigate the effects of exposure to multiple toxic heavy metals, arsenic(As), lead(Pb), and cadmium(Cd), on liver function through population-based and animal studies. A total of 3590 participants were enrolled from the mining areas in Western Hunan Province. The concentrations of As, Pb, and Cd in the urine and plasma samples were determined using quadrupole inductively coupled plasma mass spectrometry (ICP-MS). Bayesian kernel machine regression (BKMR) was employed for the joint association assay. An animal study was conducted to further verify the cumulative effects of metals on liver damage-related parameters such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) levels. Research trends regarding toxic metals were also explored to obtain in-depth understanding of the current knowledge in this field. Typically, for single-exposure analysis, in most mines, Pb exhibited a significantly negative association with ALT levels, whereas for cumulative effects analysis, when As, Pb, and Cd concentrations were at the 50 th percentile, a significantly negative effect on liver ALT levels was observed. Furthermore, animal studies have shown that co-exposure to As, Pb, and Cd could aggravate liver dysfunction in mice compared to that in the single-metal treated group (p < 0.05). From 1990 to 2019, 1965 projects relating to As, Pb, and Cd research have been initiated, and the total RMB(RenMingBi) funded was approximately 800 million in China, as opposed to 2500 projects in the US with an approximate amount of US$ 1 billion, which is substantially greater than that of China. Finally, from a global viewpoint, scientists should continue to substantially contribute to the field of heavy metal contamination through more extensive academic investigation, global cooperation, and the development of novel control methods. Overall, this study identified that elevated combined concentrations of As, Pb, and Cd were significantly negatively associated with liver function., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To investigate the effects of health education combined with dietary guidance on nutritional indicators, immune level, and quality of life of patients with pulmonary tuberculosis., Method: A total of 123 patients with pulmonary tuberculosis who were hospitalized to our hospital between October 2019 and October 2020 were chosen for the study and were separated into 60 control cases and 63 observation cases based on the ward they were assigned to. Patients in the two groups were compared in terms of nutritional risk, nutritional indicator levels in serum, immunological function, treatment compliance, sputum culture conversion rate, and quality of life., Result: With the prolongation of patients' illness, the total NRS 2002 score gradually increased in both groups and the total NRS 2002 score of patients in the control group was higher than that of patients in the observation group at the same time point after discharge. The difference between the total NRS 2002 score of patients in both groups was significant at 3 and 6 months after discharge. After the intervention, the Hb, ALB, CD4+, and CD4+/CD8+ levels of patients in both groups were higher than those at the time of admission, and the CD8+ levels were lower than those at the time of admission. At 6 months after discharge, the Hb, ALB, CD4+, and CD4+/CD8+ levels of patients in the observation group were significantly higher than those in the control group, and the CD8+ levels were significantly lower than those in the control group. The treatment compliance rate of patients in the observation group (96.83%) was significantly higher than that of the control group (75%), and the negative sputum culture transfer rate (85.71%) was significantly higher than that in the control group (60%). The overall quality of life scores of patients in the observation group was significantly higher than that in the control group., Conclusion: Health education combined with dietary guidance for patients with pulmonary tuberculosis can deepen patients' understanding of disease and nutritional knowledge, improve treatment compliance, improve their nutritional status, enhance their immune function, accelerate sputum bacterial conversion, enhance treatment effect, and improve their quality of life., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Baojuan Hu et al.)

Background: Hypertension remains the major modifiable risk factor of stroke recurrence. The study aimed to determine the up-to-date epidemiological features of hypertension among the survivors of ischemic stroke., Methods: Our cross-sectional study included 18,796 adults aged ≥40 years and residing in northeast China. Ischemic stroke was diagnosed according to the World Health Organization's criteria, which requires the clinical record, computed tomography (CT) and/or magnetic resonance imaging (MRI) during the hospital stay. Hypertension was defined according to the Chinese hypertension guidelines (mean SBP ≥140 mmHg and/or mean DBP ≥90 mmHg, and/or self-reported use of anti-hypertensive medication in the past 2 weeks)., Results: Of the 986 survivors of ischemic stroke, 819 (83.1%) were identified with hypertension (535 were pre-stroke hypertension and 284 were post-stroke hypertension). Among hypertensive patients, the awareness and treatment rates were 76.8 and 66.7% respectively. Only 11.0% achieved an appropriate blood pressure (< 140 mmHg and < 90 mmHg) among those who took hypertensive medications. 16.8% of treated hypertensive patients received combination therapy, and calcium channel blockers were the most frequently used anti-hypertensive medication as monotherapy. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the stroke population was 155.3 ± 22.9 mmHg and 89.2 ± 12.3 mmHg. Both SBP and DBP were higher in rural patients than in urban patients (158.5 ± 23.8 mmHg vs. 146.4 ± 17.5 mmHg and 90.3 ± 12.9 mmHg vs. 85.9 ± 10.1 mmHg, respectively; p < 0.001). The rates of stage 2 and above hypertension in the ischemic stroke population were 32.5 and 18.7%, and was significantly higher in rural areas than in urban areas., Conclusions: The prevalence of poorly-controlled hypertension and the high rates of blood pressures at stages 2 and above in patients with prior ischemic stroke demonstrated an alarming situation in northeast China., (© 2021. The Author(s).)

This study expands on the impact of local government environmental regulation on enterprise environmental protection investment. Furthermore, it analyzes the influence promotion pressure of officials has on the scale of enterprise environmental investment. The results show that the environmental protection investment of companies in China is generally insufficient. The attitude of companies toward environmental protection is passive under the policy regulation. The environmental supervision of the government is also still at a low level. Both of these observations are far from the intentions of the government. There is a U-shaped relationship between the pressure of official promotion and the scale of enterprise environmental protection investment. Only when the pressure of official promotion exceeds a certain limit can it positively stimulate enterprises to invest in environmental protection. Environmental regulation also exerts a threshold effect on the environmental protection investment by enterprises. This research provides a new way to understand the decision-making behavior of local officials and the environmental protection responsibility of enterprises. This study provides recommendations for improving the environment appraisal and government supervision system in China., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Chang, Wang, Lu, Chang, Ren, Liu and Zhou.)