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To investigate the composition variation of planktonic fungal communities, and their relationship with water physical and chemical parameters in the Xijiang River in China, the compositions of planktonic fungal communities in the high-water and low-water period of the Xijiang River were studied in this paper by high-throughput sequencing of fungal internal transcribed spacer amplicons. Ascomycota, Basidiomycota, Chytridiomycota, Glomeromycota, Rozellomycota, and Zygomycota were detected from the planktonic fungal communities. However, most high-quality sequences (59.58 ± 0.03%) could not accurately identify fungal phyla. Alpha-diversity indexes of the fungal communities and the relative abundances of Phoma brasiliensis, Pseudozyma sp., Psathyrella sp., Haematonectria haematococca, Podoscypha sp. in the high-water period were significantly higher than those in the low-water period, while the relative abundances of Basidiobolus sp., Rhizophydium littoreum, Teratosphaeria jonkershoekensis, Malassezia globosa, Malassezia restricta, Malassezia sp., Alternaria eichhorniae, Knufia epidermidis, and Scedosporium prolificans were significantly lower. No significant correlation has been found between the fungal community distance and geographical distance along the river. Water temperature and dissolved oxygen significantly influenced the fungal community structure in the high-water period. These results provide information for us to understand the composition and influencing factors of the planktonic fungal community in rivers. [ABSTRACT FROM AUTHOR]

Recent Experimental Advanced Superconducting Tokamak (EAST) experiments have successfully demonstrated a long-pulse steady-state scenario with improved plasma performance through integrated operation since the last IAEA FEC in 2016. A discharge with a duration over 100 s using pure radio frequency (RF) power heating and current drive has been obtained with the required characteristics for future long-pulse tokamak reactors such as good energy confinement quality (H98y2 ~ 1.1) with electron internal transport barrier inside ρ  <  0.4, small ELMs (frequency ~100–200 Hz), and good control of impurity and heat exhaust with the tungsten divertor. The optimization of X-point, plasma shape, the outer gap and local gas puffing near the low hybrid wave (LHW) antenna were integrated with global parameters of BT and line-averaged electron density for higher current drive efficiency of LHW and on-axis deposition of electron cyclotron heating in the long-pulse operation. More recently, a high βP RF-only discharge (βP ~ 1.9 and βN ~ 1.5, /nGW ~ 0.80, f bs ~ 45% at q95 ~ 6.8) was successfully maintained over 24 s with improved hardware capabilities, demonstrating performance levels needed for the China Fusion Engineering Test Reactor steady-state operation. A higher energy confinement is observed at higher βP and with favorable toroidal field direction. Towards the next goal (⩾400 s long-pulse H-mode operations with ~50% bootstrap current fraction) on EAST, an integrated control of the current density profile, pressure profile and radiated divertor will be addressed in the near future. [ABSTRACT FROM AUTHOR]

The distribution of bamboo forest in south and south-eastern Asia is increasing. Based on Landsat satellite imagery data, rates and causes of change in bamboo forests and changes associated with biomass carbon stocks were analysed in Anji county, Zhejiang province, China. Results indicated notable increase in bamboo forest area and simultaneous loss in needleleaf and broadleaf forests as well as farm land between 1986 and 2008. Annual net flux of atmospheric carbon release from the increase in bamboo forest area was -66.5 x 10² to -117.6 x 10² Mg C year-1. One of the most significant causative factors of biomass carbon stock losses was the conversions of needleleaf and broadleaf forests into bamboo forest. In this area of study, bamboo harvested for production accumulated carbon at a rate of 0.86 to 1.83 Mg C ha-1 year-1. When carbon sequestration estimate in harvested bamboo was taken into consideration, the contribution of bamboo forest to the local carbon balance became significant. [ABSTRACT FROM AUTHOR]

Objective: Children born small for gestational age (SGA) are at increased risk of health issues. This study evaluated the efficacy, safety and optimal dose of PEGylated-recombinant human growth hormone (PEG-rhGH) in these children., Design: In this multicentre, randomised, open-label, Phase 2 trial conducted at nine clinical sites in China, patients were randomised 1:1 to receive subcutaneous injections of PEG-rhGH at 0.1 mg/kg/week (low dose) or 0.2 mg/kg/week (high dose) for 52 weeks., Patients: Ninety-six children were born SGA., Measurements: The primary endpoint was the change in height standard deviation score (HT-SDS) at Week 52., Results: At Week 52, the change in HT-SDS in the high- and low-dose groups was 0.923 ± 0.352 (p < 0.0001) and 0.511 ± 0.336 (p < 0.0001), respectively (least-squares means difference, 0.410; 95% confidence interval 0.270-0.551; p < 0.0001). Height velocity (9.94 ± 1.55 vs. 8.37 ± 1.50 cm/year) was also significantly higher in the high-dose than in the low-dose group (p < 0.0001). Change in insulin-like growth factor (IGF)-1 SDS was 1.867 ± 1.747 and 1.168 ± 1.193 in the high- and low-dose groups, respectively (p = 0.0189). IGF-1/IGF binding protein-3 and bone maturity were improved in both groups at Week 52. Most treatment-emergent adverse events were mild to moderate; the safety profile was similar in both groups., Conclusions: PEG-rhGH at either dose for 52 weeks was effective and well tolerated in children born SGA. Patients in the high-dose group achieved greater improvement in HT-SDS than in the low-dose group., Trial Registration: ClinicalTrials. gov identifier: NCT02375620., (© 2024 The Author(s). Clinical Endocrinology published by John Wiley & Sons Ltd.)

Objective: To summarize the Solute Carrier Family 26 Member 4 (SLC26A4) mutations and clinical phenotypic characteristics of patients with Pendred syndrome/nonsyndromic enlarged vestibular aqueduct (PS/NSEVA)., Design: A retrospective cohort study for the Chinese population was performed to analyze the hearing test results of 406 patients with PS/NSEVA who had a SLC26A4 mutation and the relationship between inner ear imaging and audiology., Results: There was a significant difference in the mean hearing threshold in patients with biallelic mutations (M2), monoallelic mutations (M1), and nonallelic mutations (M0) and between patients with isolated vestibular aqueduct enlargement (IEVA) and patients with IEVA combined with Mondini malformation. There was no significant difference between patients with different gene mutation types or different sexes, or between the width of the vestibular aqueduct (VA) and the mean hearing threshold. The degree of hearing loss was linearly correlated with age., Conclusions: We propose that the presence and absence of SLC26A4 mutation, whether combined with Mondini malformation and patient age, are essential factors affecting the degree of hearing loss in the Chinese population. However, the number and type of mutations, degree of VA expansion, and sex of the patients did not affect the clinical audiological phenotype., Level of Evidence: 3 Laryngoscope, 135:848-856, 2025., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: There is limited evidence about the association of muscle mass, strength and quality with respiratory disease, especially in Chinese populations. We aimed to comprehensively examine such associations and identify better metrics with more clinical and public health relevance., Methods: We conducted a prospective cohort study based on data from the second resurvey of the China Kadoorie Biobank (CKB) study in participants with no prevalent respiratory disease or cancer. Arm muscle quality was calculated as the ratio of grip strength to arm muscle mass. Low muscle mass, grip strength and arm muscle quality were defined as the sex-specific lowest quintiles of corresponding variables. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for respiratory disease., Results: In total, 17 510 participants aged 38-88 (65.4% women; mean age 57.8 ± 9.6) were enrolled in 2013-2014 and followed up until 31 December 2018. During a median follow-up of 4.82 years, 1346 participants developed respiratory disease. After adjustment for sociodemographic characteristics, lifestyle factors and medical histories, the elevated HR of respiratory disease was 1.31 (1.14-1.51) for low grip strength and 1.25 (1.09-1.44) for low arm muscle quality. Grip strength and arm muscle quality exhibited a linearly inverse association between respiratory disease (p = 0.137 and 0.102), with each standard deviation (SD) decrease in grip strength and arm muscle quality associated with a 22% (95% CI: 11%-34%) and 14% (95% CI: 7%-22%) increased risk of respiratory disease. No association was found for low total muscle mass index and low appendicular muscle mass index., Conclusion: Low grip strength and arm muscle quality are associated with increased risks of respiratory disease, and they are better muscle-related metrics for identifying adults at high risk of respiratory disease. Chinese adults may need to maintain normal muscle mass, strength and quality to achieve better respiratory health, but this needs to be validated in appropriately designed clinical trials., (© 2025 The Author(s). Journal of Cachexia, Sarcopenia and Muscle published by Wiley Periodicals LLC.)

Background: Night sweats are a condition in which an individual sweats excessively during sleep without awareness, and stops when they wake up. Prolonged episodes of night sweats might result in the depletion of trace elements and nutrients, affecting the growth and development of children., Purpose: To investigate the relationship between sweat nights and season., Method: The Internet search index for night sweats in Zhengzhou, China was obtained from the Baidu index during 2011-2022. Meteorological factors, including ambient temperature, humidity, pressure, precipitation and average wind speed in Zhengzhou were obtained from the website https://en.tutiempo.net/climate. A time series decomposition model was used to study the relationship between night sweats and seasonality. Continuous wavelet transform and cross wavelet transform were utilized to explore the relationship between night sweats and meteorological factors., Result: A typical periodic pattern is evident in the seasonal trend. Specifically, following a peak in January each year, there is a rapid decline followed by a secondary peak, after which a trough occurs. The search index of night sweats increased rapidly in the first stage, slowed down in the second stage, and showed negative growth from 2011 to 2014. The correlation coefficients between the search index for night sweats and atmospheric pressure as well as average temperature, are 0.25 and-0.26, respectively., Conclusion: Night sweat was connected with season. Specifically, the number of night sweat search index increased in the cold season and declined in the summer season. Night sweat was negatively connected with temperature but favorably correlated with air pressure., 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 © 2025 Chen, Li, Peng, Lv, Ding, Tian, Ren, Meng, Sun, Wang, Du, Wu, Li and Wang.)

Purpose: This study aims to identify self-management behavior profiles in multimorbid patients, and explore how workload, capacity, and their interactions influence these profiles., Patients and Methods: A sequential explanatory mixed-methods design was employed. In the quantitative phase (August 2022 to May 2023), data were collected from 1,920 multimorbid patients across nine healthcare facilities in Zhejiang Province. Latent Profile Analysis (LPA) was used to identify distinct self-management behavior profiles. Multinomial logistic regression was then used to assess the influence of workload and capacity dimensions (independent variables in Model 1), as well as their interaction (independent variables in Model 2), on these profiles (dependent variables in two models). The qualitative phase (May to August 2023) included semi-structured interviews with 16 participants, and the Giorgi analysis method was used for data categorization and coding., Results: Quantitative analysis revealed three self-management behavior profiles: Symptom-driven Profile (8.0%), Passive-engagement Profile (29.5%), and Active-cooperation Profile (62.5%). Compared to the Active-cooperation Profile, both the Symptom-driven and Passive-engagement Profiles were associated with a higher workload ( OR > 1, P < 0.05) and lower capacity ( OR < 1, P < 0.05). An interaction of the overall workload and capacity showed a synergistic effect in the Passive-engagement Profile ( OR = 1.08, 95% CI = 1.03-1.13, P < 0.05). Qualitative analysis identified six workload themes, and related coping strategies of three self-management behavior profiles. The integrated results highlighted distinct characteristics: Symptom-driven Profile patients exhibited reactive behaviors with limited health awareness, Passive-engagement Profile patients reduced engagement once symptoms stabilized, while Active-cooperation Profile patients proactively managed their conditions., Conclusion: Identifying three distinct self-management behavior profiles and their relationship with workload and capacity provides valuable insights into multimorbid patients' experiences, emphasizing the need for tailored interventions targeting workload and capacity to improve health outcomes., Competing Interests: The authors report no conflicts of interest in this work. © 2008–2020 PROMIS Health Organization (PHO). This material can be reproduced without permission by clinicians for use with their own patients. Any other use, including electronic use, requires written permission of the PHO., (© 2025 Fu et al.)

To investigate the potential of computed tomography (CT) images of median palatine suture (MP) for adult age estimation in the Northern and Southwestern Chinese populations. A total of 1110 cranial CT scans from individuals aged 10-79 years, including 557 northern Chinese and 553 southwestern Chinese, were collected for analysis. After volume reformation and multiplanar reconstruction, a total of 20 slices of median palatine suture were selected from each individual. The closure of sutures was analyzed into four stages, and the cumulative scores of 20 slices were recorded as the suture closure score (SCS). The correlations between SCS and age were compared among the two Chinese populations residing in diverse geographic regions. Regression models were established for age estimation. The estimation accuracy was evaluated based on the test set. The mean absolute error (MAE) and the correlation between predicted age and chronological age were calculated to evaluate estimation accuracy. The SCS of MP exhibited a significant correlation with age (0.613, northern male; 0.678, southwestern male; 0.730, northern female; 0.704, Southwestern female; 0.662, total). Furthermore, there were statistically significant differences in SCS among different regions and sex groups (p < 0.001). The cubic regression model had the highest R2 value in all subjects, especially among Northern females and Southwestern males, while the power and quadratic regression models showed the highest R2 value in Northern males and Southwestern females, respectively. In the test set, the Northern cohort demonstrated a lower MAE (9.06 ± 7.32 years, males; 9.17 ± 5.28 years, females) compared to the Southwestern cohort (9.19 ± 7.49 years, male; 10.61 ± 6.83 years, female). Additionally, it was observed that males exhibited a lower MAE than females in both regional groups. This study demonstrated the potential utility of CT images of the MP for age estimation in Chinese populations, emphasizing the significance of incorporating regional and sex factors within this context., Competing Interests: Declarations. Ethics approval: Approval was obtained from the ethics committee of Sichuan University. Informed consent: Informed consent was waived because of the retrospective nature. The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Research involving human participants and/or animals: Human participants only. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Livestock farming system (LFS) is an important pillar of the agri-food system. With global environmental problems severer, exploring how to improve the eco-environment of LFS through institutional change is receiving increasingly concern. Based on macro and micro data from Inner Mongolia, this study examines the impacts of land titling on the eco-environment of LFS, explores the potential mechanisms, and analyzes the heterogeneity in terms of farm size by applying GIS spatial analysis and time-varying difference-in-difference (TV-DID) model. Main results showed that overall land titling significantly improved the eco-environment represented by GVC. (1) The GIS spatial analysis indicated that land titling considerably increased GVC. The TV-DID model results further verified that land titling increased the GVC by 0.306 grade, and increased vegetation height by 1.27 cm on average; (2) The effects varied across farm sizes, with the GVC increased by 0.745 grade on farms larger than 373 ha and 0.230 grade otherwise; (3) The effects were mainly induced by the enhancement of farmers' attitudes, management capacities and land use behaviors after land titling. These three effects indicate the net effect, scale effect and security effect of land titling on the eco-environment of LFS, respectively. The study highlights that appropriate institutions are conducive to the sustainable management of livestock farming system, and beneficial for the natural resource-based poor worldwide., 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. Published by Elsevier B.V.)

A low dissolved oxygen (DO) concentration in summer has been observed in river-estuary systems worldwide. Many studies have caused our stereotype that biochemical oxygen depletion was higher in summer than in winter; however, there was no direct evidence particularly in the tidal river with complex hydrological and biochemical processes. This study employed natural-abundance and labeled isotopes to quantify seasonal apportionment of biochemical oxygen depletion. In this study, apparent oxygen utilization (AOU) and carbon (C) and nitrogen (N) turnover potentials (nitrification rates and δ 13 C signals) were higher in the wet season than in the dry season. However, calculation results of the nitrification flux demonstrated that actual N turnover was constrained by shorter river residence time in the wet season. Similarly, the δ 13 C end-member mixing and Rayleigh fractionation models revealed that the conservative C behavior was more pronounced than degradation in situ in the river channel. Overall, C- and N-driven oxygen depletion accounted only for ~8% of AOU in the wet season. This substantiated that the hydrological control regulated C and N behaviors to "the conservative transport" to mitigate O 2 depletion in the wet season. In contrast, a good correspondence between C and N turnover and low oxygen was recorded in the dry season. Therefore, the "nutrient- and non-nutrient-constrained DO cold spots" during the dry and wet seasons provided new insights into oxygen deficits in tidal rivers. Our study provided compelling evidence that seasonal apportionment of C- and N-driven oxygen depletion in situ has changed in tidal rivers. Biochemical oxygen depletion was more evident in the dry season than in the wet season; thus, it had been previously overestimated in the wet season, which will provide implications for using different water management strategies in different seasons., 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.)

This study aims to provide technical support for the development of a rational administration strategy for indoor environment and passenger flow of stations. The analysis was conducted monitor data of long distance bus stations and train/high speed railway stations from the National project. The monitor and surveyed data included indoor airborne culturable bacteria (IAB), passenger flow, area and height of stations. Data analysis involved the use of paired non-parametric tests, correlation analysis, and mixed linear regression methods. A total of 132 pairs of stations were examined in this study. Additionally, significant variations were observed in the monitoring results for the IAB and passenger flow between 2019 and 2020 (p < 0.05). Specifically, the median values of these two factors in 2020 decreased by 50.52% and 48.33%, respectively, compared to 2019. (p < 0.05). A positive relationship between the daily average passenger flow and the IAB in long distance bus stations and train stations, particularly pronounced with medium sized waiting rooms, which located in subtropical cities with a general level of economic development. The mixed effect regression analysis revealed a significant association between passenger flow (OR = 1.564, 1.288-1.898), per capita volume (OR = 0.856, 0.733-0.998), and per capita area (OR = 0.806, 0.678-0.956) with the IAB (p < 0.05) just in long distance bus stations. It is crucial to regulate passenger flow and per capita area in the waiting room of long distance bus stations to mitigate the spread of airborne culturable bacteria during infectious disease epidemics., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Wangxianliang reports financial support, administrative support, and article publishing charges were provided by the National Key Research and Development Program of China. Lili reports financial support was provided by the Special fund of Beijing Key Laboratory of Indoor Air Quality Evaluation and Control. Lili reports administrative support and statistical analysis were provided by the Opening Funds of Healthy Building Industry Technology Innovation Strategic Alliance. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: The aim of the study is to validate the applicability and performance of the 2019 US risk-based guideline for Chinese women., Materials and Methods: The authors analyzed 10,055 cases with data on human papillomavirus testing, cytology, and pathologically confirmed diagnosis (analysis-set). According to the 2019 US risk-based guideline, the authors recorded the risk value and triage recommendations for each case. Then, they assessed the concordance of the guideline triage recommendations with pathology diagnosis for the relevant case from the real-world projects., Results: Among the analysis-set, 9,495 cases with an estimated risk value were identified as analysis cohort while the remaining 560 cases were cataloged as "special cases." Among the analysis cohort, 960 and 526 cases were pathologically confirmed as cervical intraepithelial neoplasia (CIN) 2+ and CIN3+, respectively. The US risk-based guideline recommended colposcopy or more aggressive interventions (Colp+) for 86.8% (833/960) of the CIN2+ and 95.8% (504/526) of the CIN3+ cases, with 87.1% sensitivity and 82.5% specificity for CIN3+ cases (AUC = 0.926, p < .0001). The US risk-based recommended no-Colp for 98.0% (6,142/6,269) of the pathologically confirmed CIN1 or benign cases. In addition, 97.3% (545/560) of the "special cases" cases were recommended as Colp+., Conclusions: The 2019 US risk-based guideline works well with satisfied clinical sensitivity for CIN2+ and CIN3+ and seems applicable for cervical cancer screening in China., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the ASCCP.)

China is a major cycling nation with nearly 400 million bicycles, significantly alleviating urban traffic congestion. However, safety concerns are prominent, with approximately 35% of cyclists forming groups with family, friends, or colleagues, exerting a significant impact on the traffic system. This study focuses on group cycling, employing urban cycling experiments, GPS trajectory tracking, and eye-tracking to analyze the visual search, and cycling control of both groups and individuals. Findings reveal that group cyclists tend to focus more on companions, leading to a dispersed gaze pattern compared to individual riders who focus more on the direct path and surroundings. Group riders also exhibit shorter fixation times on traffic signs, potentially indicating decreased attention to traffic regulations. Despite similar lateral position deviation, group cyclists exhibit higher steering entropy, indicating greater variability in their steering choices. Additionally, group riders demonstrate varied passing times, suggesting a collective advantage in navigating complex traffic conditions. This study enhances our understanding of bicycles within traffic dynamics, offering valuable insights for traffic management systems., 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. Published by Elsevier Ltd.)

Vegetation restoration can be effective in containing gully head advance. However, the effect of vegetation restoration type on soil aggregate stability and erosion resistance at the head of the gully is unclear. In this study, five types of vegetation restoration-Pinus tabulaeformis (PT), Prunus sibirica (PS), Caragana korshinskii (CKS), Hippophae rhamnoides (HR), and natural grassland (NG, the dominant species is Leymus chinensis)-in the gully head were studied. Soil aggregate composition and nutrient contents in the 0-20, 20-40, and 40-60 cm soil layers were also determined, and the soil stability parameters were used to evaluate the soil conditions. The soil erodibility (K) was then determined by measuring the granulometric composition and organic matter. The results showed that the particle size of soil aggregates under different vegetation restoration types was mainly < 0.25 mm, and the percentage of aggregate disruption (PAD) was 22.08-76.07%. This further indicated that in Loess hilly and gully regions, water-stable aggregates were more reflective of the stability of soil aggregates in a gully head under vegetation restoration. The > 0.25 mm aggregates (R > 0.25 mm ), geometric mean diameter (GMD), and mean weight diameter (MWD) values of the three soil layers were the highest in PT and the lowest in NG, while the opposite was true for fractal dimension (D) and the percentage of aggregate disruption (PAD). The K ranged from 0.052 to 0.065 t·hm 2 ·h·MJ - 1 mm - 1 ·hm - 2 . GMD can be used to characterize the anti-erosion ability of soil, and increasing the soil organic carbon, total nitrogen, and clay content can effectively reduce soil erodibility. The comprehensive analysis indicated that the soil aggregates of arbors planted in the gully head had the highest stability and anti-erodibility, followed by shrubs and grasslands, and can be used to evaluate vegetation restoration measures in gully heads., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

The Yangtze Finless Porpoise (YFP) is one of the 13 global flagship species identified by the World Wildlife Fund and is classified as "Critically Endangered." It is also the only extant aquatic mammal in the Yangtze River. In this study, 44 sampling points were deployed across the middle and lower reaches of the Yangtze River, with vertical sampling sections established in four key areas. Using environmental DNA (eDNA) and species distribution model(SDM), we explored the spatiotemporal distribution of YFPs and predicted their potential suitable habitats. The results indicate that the YFP has a relatively wide distribution during the flood season but exhibits clustering behavior during the dry season, showing a patchy distribution and a migratory trend from the midstream to downstream of the main channel. Predictions using the MAXENT model reveal varying trends in suitable habitat under different scenarios. Overall, YFP's potential habitat is expected to expand by 2050, but due to rising temperatures, it will contract by 2070. Elevation (dem, 65.4%), human footprint index (hfp, 8.8%), and isothermality (bio3, 8%) are key factors influencing habitat suitability. These findings demonstrate that eDNA is an effective tool for monitoring large aquatic organisms and provide scientific evidence for the conservation of the YFP., 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 Inc. All rights reserved.)

Background: Recent guidelines recommend antihypertensive drug treatment for prehypertensive individuals with blood pressure between 130/80 and 139/89 mm Hg. This study evaluates the cost-effectiveness of 3 interventions in Chinese prehypertensive adults: salt substitution, antihypertensive drug treatment, and their combination., Methods: We developed a Markov cohort model to estimate cardiovascular disease (CVD) events, costs, and quality-adjusted life years (QALYs) over a lifetime. Data from the China Kadoorie Biobank informed the simulation. Costs and utilities were drawn from published sources. We evaluated the cost-effectiveness of salt substitution alone, antihypertensive drug treatment alone, and a combination of the 2, focusing on the overall prehypertensive population, those at high CVD risk, and different starting ages (40, 50, 60, and 70 years). Incremental cost-effectiveness ratios (ICERs) were calculated per QALY gained., Results: Salt substitution at age 40 years is the only cost-effective strategy for prehypertensive individuals, with an ICER of $6413.62/QALY. For those at high CVD risk, the combination intervention starting at age 40 years is most cost-effective, with an ICER of $2913.30/QALY. Interventions initiated at younger ages yielded greater CVD reductions and lower ICERs. For example, a combined intervention at age 40 years reduces CVD events by 5.3% with an ICER of $2913.30/QALY, compared with 4.9% and $32 635.33/QALY at age 70 years. These results were consistent across sensitivity analyses., Conclusions: In China, replacing usual salt with a salt substitute is more cost-effective than treating prehypertensive individuals over the age of 40 years with antihypertensive drugs. Furthermore, starting intervention at a younger age in prehypertensive adults can result in even greater cost savings., Competing Interests: None.

The emerging human fungal pathogen Candida auris has become a serious threat to public health. This pathogen has spread to 10 provinces in China as of December 2023. Here we describe 312 C. auris -associated hospitalizations and 4 outbreaks in healthcare settings in China from 2018 to 2023. Three genetic clades of C. auris have been identified during this period. Molecular epidemiological analyses indicate that C. auris has been introduced and local transmission has occurred in multiple instances in China. Most C. auris isolated from China (98.7%) exhibited resistance to fluconazole, while only a small subset of strains were resistant to amphotericin B (4.2%) and caspofungin (2.2%).

Human parainfluenza virus (PIV) is a main cause of acute lower respiratory tract infections (ALRTIs), which contributes to childrens' mortality worldwide; however, the epidemiology of PIVs following the SARS-CoV-2 pandemic is still not clarified, and poses risks of potential outbreaks. Herein, we conducted a retrospective observational study from September 26, 2020 to September 30, 2023 to assess PIV epidemiology in Wuhan, China, as well as the clinical characteristics of PIV infections. In total, 14,065 inpatients with ALRTIs were enrolled, of which 936 were identified to have PIV infection. We also obtained 69 PIV3 RNA to reveal its molecular traits. An alteration in PIV season pattern away from spring and summer prevalence was noted, as well as a progressive rise in its detection rate. PIV-related ALRTIs were more prevalent in male patients. PIV3 was the dominant PIV type in recent years. In comparison with the phase before the cancellation of Dynamic Zero-COVID Policy in December 2022, symptoms after its repeal were milder. All Wuhan strains were classified with C3f lineage and possibly evolved from native strains in China. Additionally, some mutations, such as Q499P in protein hemagglutinin-neuraminidase, should be given further attention. In summary, our study demonstrates the clinical characteristics of PIVs and genomic traits of PIV3 in Wuhan, China, thus holds importance for the diagnosis and control of PIV infections in the post-pandemic era., (© 2024 The Author(s). Journal of Medical Virology published by Wiley Periodicals LLC.)

Background: The literature is replete with favorable face-lift results, yet the objective facial rejuvenation outcome measures in Chinese women have remained poorly understood., Objective: The purpose of the study is to objectively evaluate the apparent age (AA) reduction in Chinese women following face-lift by artificial intelligence (AI) and objective observers., Methods: Standardized pre- and postoperative (1-year) images of 48 patients undergoing face-lift procedures were analyzed by AI to estimate AA. Additionally, 10 blinded, naive observers viewed each patient's images and assessed AA. The accuracy of AA and reduction in AA were evaluated and compared between the two methods. FACE-Q surveys were employed to measure patient-reported facial esthetic outcomes., Results: The AI demonstrated higher precision than the observers in age estimation, with a mean absolute error of 3.34 years and 90% Pearson correlation. AA reduction generated by AI was significantly lower than that by observers, with a mean reduction of 3.75 ± 3.93 and 4.51 ± 1.20, respectively (p < 0.05). However, both methods showed less AA reduction than patient self-appraisal (- 7.3 years). Improvements in facial rejuvenation following face-lift surgery is relevant to the patient's preoperative aging status. Patients whose pre-AA was greater than chronological age (CA) became "back to normal," while those whose pre-AA was less than CA became "turning back the clock.", Conclusion: The utilization of AI could provide objective, evidence-based data in the field of face-lift surgery. As a simple, complete, and time-sparing method, AI is expected to be routinely used in clinical trials and practice., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., Competing Interests: Declarations. Conflict of interest: The authors declared no potential conflicts of interest concerning the research, authorship, and publication of this article. Ethical Approval: All procedures performed in studies involving human participants were following the ethical standards of the clinical research committee of plastic surgery hospital (12100000400266049B) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed Consent: Informed consent was obtained from all patients and can be seen by the editors., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Little evidence is available on the long-term health effects of nitrogen dioxide (NO 2 ) in low-income and middle-income populations. We investigated the associations of long-term NO 2 exposure with the incidence of a wide spectrum of disease outcomes, based on data from the China Kadoorie Biobank., Methods: This prospective cohort study involved 512 724 Chinese adults aged 30-79 years recruited from ten areas of China during 2004-08. Time-varying Cox regression models yielded adjusted hazard ratios (HRs) for the associations of long-term NO 2 exposure with aggregated disease incidence endpoints classified by 14 ICD-10 chapters, and incidences of 12 specific diseases selected from three key ICD-10 chapters (cardiovascular, respiratory, and musculoskeletal diseases) found to be robustly associated with NO 2 in the analyses of aggregated endpoints. All models were stratified by age-at-risk (in 1-year scale), study area, and sex, and were adjusted for education, household income, smoking status, alcohol intake, cooking fuel type, heating fuel type, self-reported health status, BMI, physical activity level, temperature, and relative humidity., Findings: The analysis of 512 709 participants (mean baseline age 52·0 years [SD 10·7]; 59·0% female and 41·0% male) included approximately 6·5 million person-years of follow-up. Between 5285 and 144 852 incident events were recorded for each of the 14 aggregated endpoints. Each 10 μg/m 3 higher annual average NO 2 exposure was associated with higher risks of chapter-specific endpoints, especially cardiovascular (n=144 852; HR 1·04 [95% CI 1·02-1·05]), respiratory (n=73 232; 1·03 [1·01-1·05]), musculoskeletal (n=54 409; 1·11 [1·09-1·14]), and mental and behavioural (n=5361; 1·12 [1·05-1·21]) disorders. Further in-depth analyses on specific diseases found significant positive supra-linear associations with hypertensive disease (1·08 [1·05-1·11]), lower respiratory tract infection (1·03 [1·01-1·06]), arthrosis (1·15 [1·09-1·21]), intervertebral disc disorders (1·13 [1·09-1·17]), and spondylopathies (1·05 [1·01-1·10]), and linear associations with ischaemic heart disease (1·03 [1·00-1·05]), ischaemic stroke (1·08 [1·06-1·11]), and asthma (1·15 [1·04-1·27]), whereas intracerebral haemorrhage (1·00 [0·95-1·06]), other cerebrovascular disease (0·98 [0·96-1·01]), acute upper respiratory infection (1·03 [0·96-1·09]), and chronic lower respiratory disease (0·98 [0·95-1·02]) showed no significant association. NO 2 exposure showed robust null association with external causes (n=32 907; 0·98 [0·95-1·02]) as a negative control., Interpretation: In China, long-term NO 2 exposure was associated with a range of diseases, particularly cardiovascular, respiratory, and musculoskeletal diseases. These associations underscore the pressing need to implement the recently tightened WHO air quality guidelines., Funding: Wellcome Trust, UK Medical Research Council, Cancer Research UK, British Heart Foundation, National Natural Science Foundation of China, National Key Research and Development Program of China, Sino-British Fellowship Trust, and Kadoorie Charitable Foundation., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Severe exacerbation is the predominant cause of COPD hospitalisation. We investigated sex-specific risk factors of severe exacerbation and explored the potential interactions of regions, smoking status, and age.The present study included 13,641 males and 13,051 females with spirometry-defined COPD at baseline from the China Kadoorie Biobank. Hazard ratios (HRs) and 95% confidence intervals (CIs) of risk factors with severe exacerbation were estimated using the Cox models.During a median of 11.5 years follow-up, 5,967 cases of COPD hospitalisation were recorded. GOLD (Global Initiative for Obstructive Lung Disease) stage, tobacco smoking, and underweight were positively associated with COPD hospitalisation in both sexes. Stronger associations were observed in females than in males; the corresponding HRs for males and females were respectively 1.87 (95% CI 1.73-2.03) and 2.47 (95% CI 2.24-2.72) for a history of respiratory diseases and 1.46 (95% CI 1.33-1.60) and 1.65 (95% CI 1.46-1.87) for coughing frequently and coughing up sputum after getting up in the morning for ≥3 months. Higher risks were found among urban residents, non-current smokers, and patients <60 years old.Our findings may help clinicians and the public to identify COPD patients at high risk of exacerbation requiring hospitalisation and take targeted measures in time..

Background: The associations of early adulthood BMI with cardiovascular diseases have yet to be completely delineated. There is little reliable evidence about these associations among east Asian populations, that differ in fat distribution, disease patterns, and lifestyle factors from other populations. We aimed to study the associations between early adulthood BMI and cardiovascular diseases in a Chinese population, and the effect of midlife lifestyle factors on outcomes., Methods: In this prospective analysis, we used data from the China Kadoorie Biobank, a large and long-term cohort from five urban areas and five rural areas, using participants aged 35-70 years. The primary outcome was the incidence of cardiovascular diseases as a group, ischaemic heart disease, haemorrhagic stroke, and ischaemic stroke, which were obtained mainly through linkage to disease registries and the national database for health insurance claims. Early adulthood BMI was assessed through self-report at baseline survey. We used Cox proportional hazards regression models to examine the prospective associations. We also undertook multiplicative and additive interaction analyses to investigate the potential modification effect of midlife healthy lifestyle factors (a combined score covering smoking, drinking, physical activity, and diet)., Findings: Participants were recruited for baseline survey between June, 2004, and July, 2008. During a median follow-up of 12·0 years (IQR 11·3-13·1), we documented 57 203 (15·9%) of incident cardiovascular diseases in 360 855 participants. After adjustment for potential confounders, monotonic dose-response associations were observed between higher early adulthood BMI and increased risks of incident cardiovascular diseases. Compared with an early adulthood BMI of 20·5-22·4 kg/m 2 (the reference group), the hazard ratios for a BMI of less than 18·5 kg/m 2 was 0·97 (95% CI 0·94-1·00), 18·5-20·4 kg/m 2 was 0·97 (0·95-0·99), 22·5-23·9 kg/m 2 was 1·04 (1·02-1·07), 24·0-25·9 kg/m 2 was 1·12 (1·09-1·15), 26·0-27·9 kg/m 2 was 1·19 (1·14-1·24), 28·0-29·9 kg/m 2 was 1·34 (1·25-1·44), and ≥30·0 kg/m 2 was 1·58 (1·42-1·75). Except for haemorrhagic stroke, lower early adulthood BMI (<20·5 kg/m 2 ) was associated with decreased incident cardiovascular disease risks. No significant interaction was found between midlife healthy lifestyle factors and early adulthood BMI on cardiovascular disease risks., Interpretation: Increased risks of cardiovascular disease incidence were found among participants with high early adulthood adiposity, including ischaemic heart disease, haemorrhagic stroke, and ischaemic stroke. Our findings suggest early adulthood as an important time to focus on weight management and obesity prevention for cardiovascular health later in life., Funding: National Natural Science Foundation of China, National Key Research and Development Program of China, Chinese Ministry of Science and Technology, Kadoorie Charitable Foundation, and the Wellcome Trust., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Pigs play a central role in human livelihoods in China, but a lack of systematic large-scale whole-genome sequencing of Chinese domestic pigs has hindered genetic studies. Here, we present the 1000 Chinese Indigenous Pig Genomes Project sequencing dataset, comprising 1011 indigenous individuals from 50 pig populations covering approximately two-thirds of China's administrative divisions. Based on the deep sequencing (~25.95×) of these pigs, we identify 63.62 million genomic variants, and provide a population-specific reference panel to improve the imputation performance of Chinese domestic pig populations. Using a combination of methods, we detect an ancient admixture event related to a human immigration climax in the 13 th century, which may have contributed to the formation of southeast-central Chinese pig populations. Analyzing the haplotypes of the Y chromosome shows that the indigenous populations residing around the Taihu Lake Basin exhibit a unique haplotype. Furthermore, we find a 13 kb region in the THSD7A gene that may relate to high-altitude adaptation, and a 0.47 Mb region on chromosome 7 that is significantly associated with body size traits. These results highlight the value of our genomic resource in facilitating genomic architecture and complex traits studies in pigs., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: This study aimed to assess the associations of two common types of preserved vegetables in China, salted and sour pickled vegetables, with the risk of gastrointestinal tract (GI) cancers, including oesophageal cancer, stomach cancer, and colorectal cancer., Methods: The China Kadoorie Biobank collected intake frequency of preserved vegetables among 510 143 adults without self-reported cancer during 2004-2008, and followed up till 31 December 2018. The second resurvey further collected intake frequencies of salted and sour pickled vegetables, which classified the 10 study areas into three types of regions, including the regions never/rarely consuming preserved vegetables (number of participants at baseline = 201 844), mainly consuming salted vegetables (n = 202 927), and mainly consuming sour pickled vegetables (n = 105 372). Cox proportional models were respectively performed to calculate hazard ratios (HRs) for GI cancers with preserved vegetables in the latter two types of regions among baseline participants., Results: In the regions mainly consuming salted vegetables, preserved vegetable consumption was positively associated with stomach cancer (HR = 1.17; 95% confidence interval = 1.00-1.37; P for trend = 0.039). In the regions mainly consuming sour pickled vegetables, a dose-response positive relationship was observed between preserved vegetable consumption and the risk of oesophageal cancer (P for trend = 0.013), with adjusted HR of 1.35 (95% CI 1.02-1.80) for those who daily consumed compared with never consumed., Conclusions: Our findings suggest that different types of preserved vegetables might have different effects on GI cancers, and limiting preserved vegetable consumption might be protective against developing GI cancers., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

Background: AICyte has previously demonstrated a potential role in cervical cytology screening for reducing the workload by using a 50% negative cutoff value. The aim of the current study is to evaluate this hypothesis., Methods: The authors used the Ruiqian WSI-2400 (with the registered trademark AICyte) to evaluate a collection of 163,848 original cervical cytology cases from 2018 to 2023 that were collected from four different hospital systems in China. A breakdown of cases included 46,060 from Shenzhen, 67,472 from Zhengzhou, 25,667 from Shijiazhuang, and 24,649 from Jinan. These collected cases were evaluated using the AICyte system, and the data collected were statistically compared with the original interpretative results., Results: In 98.80% of all artificial intelligence cases that were designated as not needing further review, the corresponding original diagnosis was also determined to be negative. For any cases that were designated atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion or higher, the sensitivity and negative predictive value were 90.77% and 98.80%, respectively. The sensitivity and negative predictive value were greater in cases designated as low-grade squamous intraepithelial lesion or higher at 98.92% and 99.94%, respectively. Of the 49 low-grade squamous intraepithelial lesion or higher that were designed by AICyte as not needing further review, the cytohistologic correlation revealed eight cases of cervical intraepithelial neoplasia 1 and 18 negative cases; and the remaining cases were without histologic follow-up. In practice, AICyte used at a 50% negative cutoff value could reduce the anticipated workload if a protocol were implemented to label cases that qualified within the negative cutoff value as not needing further review, thereby finalizing the case as negative for intraepithelial lesions and malignancy., Conclusions: For pathologic practices that do not have cytotechnologists or in which the workflow is sought to be optimized, the artificial intelligence system AICyte alone to be an independent screening tool by using a 50% negative cutoff value, which is a potential assistive method for cervical cancer screening., (© 2024 The Author(s). Cancer Cytopathology published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Coronary artery disease (CAD) is often accompanied by abnormal cardiac structure and function, leading to an increased prognostic risk. However, less is known about the associations of mixed metals with abnormal cardiac structure and function in CAD patients. Here, we aimed to investigate the associations of exposure to metal mixtures with cardiac structure and function and potential interactions in a CAD population. We conducted a cross-sectional study from Southwest China that included 1555 CAD patients. The blood concentrations of 14 metals were measured via inductively coupled plasma spectrometry. CAD was defined as at least one vessel having stenosis ≥50% the vessel diameter. Echocardiography was used for cardiac structural and functional measurements. Bayesian kernel machine regression was applied to explore the overall effect, metal weight, and dose effect. Linear regression analysis was used to analyze the effects of single metals, metal‒metal interactions and metal‒traditional interactions. Finally, we found that the negative associations of mixed metals with cardiac structure was significant when the levels of all metals were below the 60th percentile. For cardiac function, changes in metals from 50th to 75th were associated with 0.954% and 0.683% decrease in left ventricular ejection fraction and left ventricular fractional shortening, respectively. Negative associations of copper and manganese with cardiac structure and function, whereas positive associations of titanium, selenium and molybdenum with several parameters were found. Antagonistic interactions between copper and tin and between selenium and several metals (manganese, copper and aluminum) (all P interaction terms < 0.05) were found. In conclusion, mixed metal exposure was negatively associated with cardiac structure and function in CAD patients. The main metals contributing to this negative associations were copper and manganese. Selenium or tin supplementation may reduce the adverse associations of copper and manganese with cardiac structure and function., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: The aim of the study is to describe the season of RSV prevalence in China during the COVID-19 pandemic., Methods: This multicenter retrospective study analyzed the epidemiology of pediatric RSV infections and the possible factors contributing to its variations in China from January 1, 2019, to October 31, 2022., Results: A total of 872,565 children were included. During the pandemic, RSV detection rate increased across various regions, including South China, East China, Central China, and Northeast China. From 2019 to 2021, the detection rates of RSV showed an increasing trend among children aged <1 year, 1-2 years, and 3-5 years, but decreased in 2022. Among those tested positive for RSV, the proportion of children under 1 year old significantly decreased during the pandemic. The spring season of RSV in China in 2020 was shortened, and most regions experienced a summer season of RSV in 2021. This shift led to a year-round RSV outbreak throughout 2021. After April 2022, RSV positive rate significantly decreased, and no clear seasonal pattern was observed., Conclusion: Our study found that the COVID-19 pandemic has disrupted the seasonal pattern of RSV outbreaks in China, leading to increased RSV positive rate and off-season outbreaks., Competing Interests: Declaration of competing interest This project is supported in part by MSD R&D (CHINA) CO., LTD. We declare that we have no conflicts of interest related to this research work., (Copyright © 2024. Published by Elsevier Ltd.)

Policy synergy plays a crucial role in managing regional air pollution. However, the current process of formulating collaborative policies often focuses too heavily on achieving optimal emission reduction outcomes, while neglecting the execution costs at the local level. This not only leads to a lack of coordination between existing governance measures and new policies but may also result in inefficient policy implementation and the wastage of administrative resources. To address this issue, we have conducted a thorough analysis of the latent interconnections in local governance and explored the possibility of formulating collaborative policies based on latent policy synergies. Utilizing a dataset of 12,764 policy documents from China spanning from 2000 to 2023, we employed unsupervised learning techniques and panel regression models to investigate the impacts of latent policy synergies among local governments. Our findings reveal that local governments initially relied on rigid command-and-control strategies to address air pollution, which were later enhanced with economic incentives like emissions trading and subsidies, thus broadening the scope of policy tools and improving compliance flexibility. Subsequently, as comprehensive monitoring networks were established, enabling real-time data acquisition and more accurate pollution assessments, the focus of policy efforts shifted towards a more integrated approach to regional air pollution management. This similar evolution facilitated latent policy synergy among local governments, leading to significant reductions in air pollution emissions. Notably, regions such as the Central Plains and coastal cities, characterized by their dense industrial activity and high energy consumption, have shown remarkable potential for collaborative efforts, achieving greater pollution control efficiencies. This study provides a valuable reference for the coordinated governance of air pollution policies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Plasma proteomics could enhance risk prediction for multiple diseases beyond conventional risk factors or polygenic scores (PS). To assess utility of proteomics for risk prediction of ischemic heart disease (IHD) compared with conventional risk factors and PS in Chinese and European populations. A nested case-cohort study measured plasma levels of 2923 proteins using Olink Explore panel in ~ 4000 Chinese adults (1976 incident IHD cases and 2001 sub-cohort controls). We used conventional and machine learning (Boruta) methods to develop proteomics-based prediction models of IHD, with discrimination assessed using area under the curve (AUC), C-statistics and net reclassification index (NRI). These were compared with conventional risk factors and PS in Chinese and in 37,187 Europeans. Overall, 446 proteins were associated with IHD (false discovery rate < 0.05) in Chinese after adjustment for conventional cardiovascular disease risk factors. Proteomic risk models alone yielded higher C-statistics for IHD than conventional risk factors or PS (0.855 [95%CI 0.841-0.868] vs. 0.845 [0.829-0.860] vs 0.553 [0.528-0.578], respectively). Addition of 446 proteins to PS improved C-statistics to 0.857 (0.843-0.871) and NRI by 109.1%; and addition to conventional risk factors improved C-statistics to 0.868 (0.854-0.882) and NRI by 86.9%. Boruta analysis identified 30 proteins accounting for ~ 90% of improvement in NRI for IHD conferred by all 2923 proteins. Similar proteomic panels yielded comparable improvements in risk prediction of IHD in Europeans. Plasma proteomics improved risk prediction of IHD beyond conventional risk factors and PS and could enhance precision medicine approaches for primary prevention of IHD., Competing Interests: Declarations. Conflict of interest: None of the authors have any conflicts of interest in relation to this report. Ethical approval: The China Kadoorie Biobank (CKB) complies with all required ethical standards for medical research on human subjects. Ethical approvals were obtained and been maintained by the relevant institutional ethical research committees in the UK and China. Consent to participate/publication: All participants provided written informed consent., (© 2024. The Author(s).)

Adiposity is an established risk factor for multiple diseases, but the causal relationships of different adiposity types with circulating protein biomarkers have not been systematically investigated. We examine the causal associations of general and central adiposity with 2923 plasma proteins among 3977 Chinese adults (mean BMI = 23.9 kg/m²). Genetically-predicted body mass index (BMI), body fat percentage (BF%), waist circumference (WC), and waist-to-hip ratio (WHR) are significantly (FDR < 0.05) associated with 399, 239, 436, and 283 proteins, respectively, with 80 proteins associated with all four and 275 with only one adiposity trait. WHR is associated with the most proteins (n = 90) after adjusting for other adiposity traits. These associations are largely replicated in Europeans (mean BMI = 27.4 kg/m²). Two-sample Mendelian randomisation (MR) analyses in East Asians using cis-protein quantitative trait locus (cis-pQTLs) identified in GWAS find 30/2 proteins significantly affect levels of BMI/WC, respectively, with 10 showing evidence of colocalisation, and seven (inter-alpha-trypsin inhibitor heavy chain H3, complement factor B, EGF-containing fibulin-like extracellular matrix protein 1, thioredoxin domain-containing protein 15, alpha-2-antiplasmin, fibronectin, mimecan) are replicated in separate MR using different cis-pQTLs identified in Europeans. These findings identified potential novel mechanisms and targets, to our knowledge, for improved treatment and prevention of obesity and associated diseases., (© 2024. The Author(s).)

Background: Alterations in lipid metabolism and DNA methylation are 2 hallmarks of aging. Connecting metabolomic, epigenomic, and aging outcomes help unravel the complex mechanisms underlying aging. We aimed to assess whether DNA methylation clocks mediate the association of circulating metabolites with incident atherosclerotic cardiovascular disease (ASCVD) and frailty., Methods: The China Kadoorie Biobank is a prospective cohort study with a baseline survey from 2004 to 2008 and a follow-up period until December 31, 2018. We used the Infinium Methylation EPIC BeadChip to measure the methylation levels of 988 participants' baseline blood leukocyte DNA. Metabolite profiles, including lipoprotein particles, lipid constituents, and various circulating metabolites, were measured using quantitative nuclear magnetic resonance. The pace of DNA methylation age acceleration (AA) was calculated using 5 widely used epigenetic clocks (the first generation: Horvath, Hannum, and Li; the second generation: Grim and Pheno). Incident ASCVD was ascertained through linkage with local death and disease registries and national health insurance databases, supplemented by active follow-up. The frailty index was constructed using medical conditions, symptoms, signs, and physical measurements collected at baseline., Results: A total of 508 incident cases of ASCVD were documented during a median follow-up of 9.5 years. The first generation of epigenetic clocks was associated with the risk of ASCVD ( P <0.05). For each SD increment in LiAA, HorvathAA, and HannumAA, the corresponding hazard ratios for ASCVD risk were 1.16 (1.05-1.28), 1.10 (1.00-1.22), and 1.17 (1.04-1.31), respectively. Only LiAA mediated the association of various metabolites (lipids, fatty acids, histidine, and inflammatory biomarkers) with ASCVD, with the mediating proportion reaching up to 15% for the diameter of low-density lipoprotein ( P =1.2×10 -2 ). Regarding general aging, a 1-SD increase in GrimAA was associated with an average increase of 0.10 in the frailty index ( P =2.0×10 -3 ), and a 33% and 63% increased risk of prefrailty and frailty at baseline ( P =1.5×10 -2 and 5.8×10 -2 ), respectively; this association was not observed with other clocks. GrimAA mediated the effect of various lipids, fatty acids, glucose, lactate, and inflammatory biomarkers on the frailty index, with the mediating proportion reaching up to 22% for triglycerides in very small-sized very low-density lipoprotein ( P =6.0×10 -3 )., Conclusions: These findings suggest that epigenomic mechanisms may play a role in the associations between circulating metabolites and the aging process. Different mechanisms underlie the first and second generations of DNA methylation age in cardiovascular and general aging., Competing Interests: None.

Aims: The relationships between long-term blood pressure (BP) measures and intracerebral haemorrhage (ICH), as well as their predictive ability on ICH, are unclear. In this study, we aim to investigate the independent associations of multiple BP measures with subsequent 5-year ICH risk, as well as the incremental value of these measures over a single-point BP measurement in ICH risk prediction., Methods and Results: We included 12 398 participants from the China Kadoorie Biobank (CKB) who completed three surveys every 4-5 years. The following long-term BP measures were calculated: mean, minimum, maximum, standard deviation, coefficient of variation, average real variability, and cumulative BP exposure (cumBP). Cox proportional hazard models were used to examine the associations between these measures and ICH. The potential incremental value of these measures in ICH risk prediction was assessed using Harrell's C statistics, continuous net reclassification improvement (cNRI), and relative integrated discrimination improvement (rIDI). The hazard ratios (95% confidence intervals) of incident ICH associated with per standard deviation increase in cumulative systolic BP and cumulative diastolic BP were 1.62 (1.25-2.10) and 1.59 (1.23-2.07), respectively. When cumBP was added to the conventional 5-year ICH risk prediction model, the C-statistic change was 0.009 (-0.001, 0.019), the cNRI was 0.267 (0.070-0.464), and the rIDI was 18.2% (5.8-30.7%). Further subgroup analyses revealed a consistent increase in cNRI and rIDI in men, rural residents, and participants without diabetes. Other long-term BP measures showed no statistically significant associations with incident ICH and generally did not improve model performance., Conclusion: The nearly 10-year cumBP was positively associated with an increased 5-year risk of ICH and could significantly improve risk reclassification for the ICH risk prediction model that included single-point BP measurement., Competing Interests: Conflict of interest: none declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Field determination of the metal adsorption capacity of microplastics (MPs) by using a passive sampler had been done in typical subtropical mariculture area in China. The adsorption of eight metals (Fe, Mn, Cu, Zn, As, Pb, Cr and Cd) by five types of MPs (low-density polyethylene, polypropylene, polystyrene, poly(ethylene terephthalate) and poly(vinyl chloride) (PVC) was compared, including metal types, mariculture types (cage and longline culture), metal residue content in ambient environment, polymer types and particle sizes of MPs. The results showed that Cu, Zn, As, Cd, Pb and Cr in the mariculture environment were contaminated compared with the quality criteria. The concentrations of these six metals adsorbed on five MPs increased linearly with those in seawater. More enriched Cu and As in MPs in marine cage culture than in longline culture, due to the obvious endogenous pollution emissions for the artificial diets, fish medicine and disinfectants. Aged PVC with more cracks and pores showed higher metal adsorption capacity than any other polymers. MPs with a smaller size range of 50-74 μm tended to accumulate higher amounts of metals than those with a larger size range of 74-178 μm, consisting with the surface characteristics of MPs. The significant positive relationship between the concentrations of nutrients in seawater and the adsorption amounts of Cu, Zn and As on MPs implies that the eutrophication would promote their pollution. Based on the ecological risk assessment, the occurrence of MPs could aggravate the potential risk of metals to marine organisms in intensive mariculture areas. This is the first time to reveal the impacts of the adsorption of metals on aged MPs on the potential ecological risks of metals to organisms under the realistic environmental condition., 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.)

Background: Little is known about the underlying relationship between mosaic loss of chromosome Y (mLOY), the most common chromosomal alterations in older men, and the risk of age-related lung diseases., Methods: We included 217 780 participants from the UK Biobank (UKB) and 42 859 participants from the China Kadoorie Biobank. The mLOY events were detected using the Mosaic Chromosomal Alterations (MoChA) pipeline. Outcomes included all lung diseases, COPD, lung cancer and idiopathic pulmonary fibrosis (IPF). Cox proportional hazard models were fitted to estimate the hazard ratios and 95% confidence intervals of mLOY with lung diseases in both cohorts. The combined hazard ratios were derived from meta-analysis., Results: Results from the two cohorts showed that expanded mLOY was associated with increased risks of all lung diseases (HR 1.19 (95% CI 1.04-1.36)), COPD (HR 1.20 (95% CI 1.13-1.28)), lung cancer (HR 1.34 (95% CI 1.21-1.48)) and IPF (HR 1.34 (95% CI 1.16-1.56) in the UKB). There was evidence of positive interactions between mLOY and smoking behaviour (relative excess risk due to interaction (97.5% CI) >0). Additionally, we observed that current smokers with expanded mLOY had the highest risk of incident lung diseases in both cohorts., Conclusions: mLOY may be a novel predictor for age-related lung diseases. For current smokers carrying mLOY, adopting quitting smoking behaviour may contribute to substantially reducing their risk of incident lung diseases., Competing Interests: Conflict of interest: The authors have no potential conflicts of interest to disclose., (Copyright ©The authors 2024.)

Objective: To investigate the pollution levels and influencing factors of polybrominated diphenyl ethers (PBDEs) in household dust in five cities in northern China. Methods: Based on the "Chinese Indoor Environment and Health Surveillance" project carried out by the National Institute of Environmental Health, Chinese Center for Disease Control and Prevention in 2018-2019, during the warm season (April 2018 to September 2018) and the cold season (November 2018 to March 2019), Lanzhou in Northwest China, Shijiazhuang in North China, Panjin in Northeast China, Luoyang in Central China, and Qingdao in East China were selected as the research sites. A total of 87 families were recruited to study residences in real-life scenarios. At the same time, dust samples were collected to detect the concentration of PBDEs. The level of household environmental indicators was measured, and the residential building characteristics and family behavior habits were collected through questionnaires. A total of 142 valid dust samples and 140 valid questionnaires were obtained. The differences in PBDE concentrations across seasons, wind zones, residential building characteristics, and family habits were analyzed. The exploratory factor analysis was performed to investigate the possible sources of PBDEs, and multivariate linear regression was used to explore the factors influencing PBDEs in household dust. Results: The M ( Q 1, Q 3 ) of total PBDE concentrations in 142 household dust samples in five cities was 144.51 (106.61, 222.65) ng/g in the warm season and 145.10 (98.57, 180.65) ng/g in the cold season, respectively. There were seasonal differences in the concentration of ∑ 12 PBDEs in Luoyang and Shijiazhuang ( P <0.01). The concentration of BDE-71 was highest among PBDE homologues, followed by BDE-66 and BDE-47. Three factors were extracted by exploratory factor analysis in the warm season, and the cumulative variance contribution rate was 67.90%. The multivariate linear regression showed that the house completion less than ten years [ β (95% CI ): 0.186 (0.013, 0.359)], infrequent home cooking [ β (95% CI ):-0.342 (-0.570, -0.114)], and increased residential PM 10 concentration [ β (95% CI ): 0.001 (0.000, 0.002)] during the warm season, as well as the house far from driveway [ β (95% CI ): 0.093 (0.013, 0.172)], house area less than 90 m 2 [ β (95% CI ):-0.138 (-0.264, -0.013)], and lower residential xylene concentration [ β (95% CI ):-0.006 (-0.011, -0.001)] during the cold season might be related to the elevated concentrations of ∑ 12 PBDEs in household dust. Conclusion: The pollution of PBDEs in household dust in five northern cities is at a medium to high level. Years of house completion, frequency of cooking at home, residential PM 10 concentration, distance from house to driveway, house area, and residential xylene concentration may influence household PBDE concentrations.

Background: Infectious diseases remain a major global health concern, including in China, with an estimated >10 million cases of infectious disease in 2019. We describe the burden of site-specific infectious diseases among Chinese adults., Methods: From 2004 to 2008, the prospective China Kadoorie Biobank enrolled 512,726 adults aged 30-79 years from 10 diverse areas (5 rural, 5 urban) of China. During the 12 years of follow-up, 101,673 participants were hospitalized for any infectious disease. Descriptive analyses examined standardized incidence, mortality and case fatality of infections., Findings: The incidence of any infectious disease was 1856 per 100,000 person-years; respiratory tract infections (1069) were most common. The infectious disease mortality rate was 31.8 per 100,000 person-years (20.3 and 9.4 for respiratory and non-respiratory infections, respectively) and case fatality was 2.2% (2.6% and 1.6% for respiratory and non-respiratory infections, respectively). Infectious disease incidence and mortality rates were higher at older ages and in rural areas. There were no clear sex differences in infectious disease incidence rates, but mortality and case fatality rates were twice as high in men as in women., Interpretation: Infectious diseases were common in Chinese adults. The observed burden of, and disparities in, site-specific infections can inform targeted prevention efforts., Funding: Kadoorie Foundation, Wellcome Trust, MRC, BHF, CR-UK, MoST, NNSF., Competing Interests: Declarations of Competing Interest The authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: Anesthesia nurses play an important postsurgical role during the anesthesia recovery period, which is characterized by a high incidence of complications related to anesthesia and surgery. Strengthening staff allocation and skill management in the postanesthesia care unit (PACU) is therefore particularly important in managing length of stay. We aimed to investigate the effect of two schedule modes for anesthesia nurses on PACU efficiency., Design: A retrospective observational cohort study., Methods: We conducted a retrospective study in a large tertiary academic medical center. In 2018, the PACU operated with traditional scheduling and the nurse-to-patient ratio was 1.2:1. The PACU implemented intensive scheduling and this ratio was adjusted to 1:1 in 2019 by adjusting the anesthesia nurse allocation scheme. We compared the number of admitted patients, length of PACU stay, the incidence of anesthesia-related complications, and nurse satisfaction with the two modes., Findings: The total number of admitted patients was 10,531 in 2018 and 10,914 in 2019. PACU admitted 401 more patients in 2019 than in 2018, even with two fewer nurses per day. Nevertheless, the median length of PACU stay in 2019 was statistically significantly shorter than in 2018 (29 [22-40] vs 28 [21-39], P < .001], while the incidence of anesthesia-related complications including postoperative pain, nausea and vomiting, hypertension, and shivering were comparable in the 2 years (P > .091). The intensive scheduling implemented in 2019 received more satisfaction from nurses than the traditional scheduling applied in 2018 (P < .01)., Conclusions: The scheduling of anesthesia nurses affects PACU efficiency. The intensive scheduling mode implemented in 2019 resulted in a comparable number of admitted patients, a better quality of care, and higher nurse satisfaction than those under the traditional scheduling mode., 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 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Little is known about the prospective association between autosomal mosaic chromosomal alterations (mCAs), a group of large-scale somatic mutations on autosomes, and bladder cancer. Here we utilized data from 99,877 participants who were free of physician-diagnosed cancer at baseline (2004-2008) of the China Kadoorie Biobank to estimate the associations between autosomal mCAs and bladder cancer (ICD-10: C67). A total of 2874 autosomal mCAs events among 2612 carriers (2.6%) were detected. After a median follow-up of 12.4 years, we discovered that participants with all autosomal mCAs exhibited higher risks of bladder cancer, with a multivariable-adjusted hazard ratio (HR) (95% confidence interval [CI]) of 2.60 (1.44, 4.70). The estimate of such association was even stronger for mosaic loss events (HR [95% CI]: 6.68 [2.92, 15.30]), while it was not significant for CN-LOH events. Both expanded (cell fraction ≥10%) and non-expanded autosomal mCAs, as well as mosaic loss, were associated with increased risks of bladder cancer. Of interest, physical activity (PA) significantly modified the associations of autosomal mCAs and mosaic loss (P interaction  = 0.038 and 0.012, respectively) with bladder cancer. The increased risks of bladder cancer were only observed with mCAs and mosaic loss among participants with a lower level of PA (HR [95% CI]: 5.11 [2.36, 11.09] and 16.30 [6.06, 43.81]), but not among participants with a higher level of PA. Our findings suggest that peripheral leukocyte autosomal mCAs may represent a novel risk factor for bladder cancer, and PA may serve as a potential intervention target for mCAs carriers., (© 2024. The Author(s).)

Tungsten (W) contamination presents emerging environmental challenges, necessitating the need to establish soil screening levels (SSLs), especially for residential soils. This study assessed the health exposure risk and derived national and regional residential SSLs for W in Chinese residential soils, incorporating machine-learning prediction of in-vitro soil W bioaccessibility. We analyzed 204 residential soil samples collected across 24 provinces, recording a wide range of W concentrations (0.01-3063.2 mg/kg). Synchrotron-based X-ray fluorescence spectroscopy, chemical extractions, and random forest modeling indicated that the key determinants of soil W bioaccessibility were soil pH, cation exchange capacity, organic matter, and clay contents. Monte Carlo simulations demonstrated that soil W contamination predominantly results in noncarcinogenic health risks to residents via oral exposure, especially in mining-affected regions. A national residential SSL (NRSSL) of 35.5 mg/kg and regional residential SSLs (RRSSLs) of 34.5-49.2 mg/kg were established. Incorporating predicted bioaccessibility increased the NRSSL to 73.8 mg/kg and the RRSSLs to 69.8-112.5 mg/kg. Southern China, which is rich in W ore, exhibited lower RRSSLs, underscoring a need for enhanced safety management. Our framework and findings provide a robust scientific foundation for future soil contamination risk assessment studies, and we present customized SSLs that can guide targeted W risk control strategies., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Huihui Du reports financial support was provided by National Key Research and Development Program of China. Huihui Du reports financial support was provided by Science and Technology Innovation Program of Hunan Province. Huihui Du reports financial support was provided by National Natural Science Foundation of China. If there are other authors, they 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.)

The extinction risk of the giant panda has been demoted from "endangered" to "vulnerable" on the International Union for Conservation of Nature Red List, but its habitat is more fragmented than ever before, resulting in 33 isolated giant panda populations according to the fourth national survey released by the Chinese government. Further comprehensive investigations of the genetic background and in-depth assessments of the conservation status of wild populations are still necessary and urgently needed. Here, we sequenced the genomes of 612 giant pandas with an average depth of ~26× and generated a high-resolution map of genomic variation with more than 20 million variants covering wild individuals from six mountain ranges and captive representatives in China. We identified distinct genetic clusters within the Minshan population by performing a fine-grained genetic structure. The estimation of inbreeding and genetic load associated with historical population dynamics suggested that future conservation efforts should pay special attention to the Qinling and Liangshan populations. Releasing captive individuals with a genetic background similar to the recipient population appears to be an advantageous genetic rescue strategy for recovering the wild giant panda populations, as this approach introduces fewer deleterious mutations into the wild population than mating with differentiated lineages. These findings emphasize the superiority of large-scale population genomics to provide precise guidelines for future conservation of the giant panda., Competing Interests: Competing interests statement:The authors declare no competing interest.

Background: Since 2016, diquat has replaced paraquat in China, resulting in increased diquat poisoning cases. However, understanding of diquat poisoning is still limited. This study aimed to investigate the relationship between initial diquat plasma concentration, severity index, and in-hospital mortality in acute diquat poisoning cases., Methods: This retrospective cohort study, conducted from January 2016 to July 2023 in a tertiary care hospital, used univariate logistic regression to examine the link between the initial diquat plasma concentration, severity index, and in-hospital mortality in acute diquat poisoned patients. A receiver operating characteristic curve assessed the predictive value of these parameters for prognosis., Results: Among the 87 participants, the median age was 32 years, 35 (40.2%) were female. The overall mortality rate was 37.9%. Logistic regression analysis revealed that the initial diquat plasma concentration and severity index were associated with increased in-hospital mortality. These factors also effectively predicted the prognosis of acute diquat poisoning, with an area under the receiver operating characteristic curve of 0.851 and an optimal diquat concentration threshold of 2.25 mg/L (sensitivity 90.9%, specificity 74.1%, P  < 0.05) and an area under the receiver operating characteristic curve of 0.845 with an optimal cut-off value for the sevity index of 9.1 mg/L*min (sensitivity 97%, specificity 74.1%, P  < 0.05)., Discussion: Our results are limited by the retrospective design of this study. However, if validated, these results could impact management strategies, especially in East Asia. Further research is needed due to potential confounding factors., Conclusions: The findings suggest that a higher initial plasma concentration and severity index in patients with acute diquat poisoning were correlated with higher in-hospital mortality. Prospective validation will confirm the predicative value of these findings.

As a strategic resource, big data has become a key force affecting carbon emission reduction in agriculture. However, its impacts remain controversial, and relevant empirical evidence remains to be explored. Based on quasi-natural experimental analysis, this study explored the impact and mechanism of the construction of the National Big Data Comprehensive Pilot Zone (NBDCPZ) on agricultural carbon emissions (ACE) in China and adopted a difference-in-difference (DID) model using China's provincial panel data from 2003 to 2020. The results showed that the ACE in the NBDCPZ establishment area was significantly reduced by 11.91%, a finding that remained robust following the parallel trend test and the placebo test, among others. Mechanism analysis showed that the ACE was reduced through industrial upgrading and technological innovation. Heterogeneity analysis showed that more pronounced policy gains were achieved in China's central-eastern regions as well as in non-major grain-producing areas compared to western and major grain-producing areas. This research provided supporting evidence for the prospect of big data application in ACE and provided useful guidance regarding the promotion of green and sustainable agricultural development., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Automated bone age assessment (BAA) is of growing interest because of its accuracy and time efficiency in daily practice. In this study, we validated the clinical applicability of a commercially available artificial intelligence (AI)-powered X-ray bone age analyzer equipped with a deep learning-based automated BAA system and compared its performance with that of the Tanner-Whitehouse 3 (TW-3) method., Methods: Radiographs prospectively collected from 30 centers across various regions in China, including 900 Chinese children and adolescents, were assessed independently by six doctors (three experts and three residents) and an AI analyzer for TW3 radius, ulna, and short bones (RUS) and TW3 carpal bone age. The experts' mean estimates were accepted as the gold standard. The performance of the AI analyzer was compared with that of each resident., Results: For the estimation of TW3-RUS, the AI analyzer had a mean absolute error (MAE) of 0.48 ± 0.42. The percentage of patients with an absolute error of < 1.0 years was 86.78%. The MAE was significantly lower than that of rater 1 (0.54 ± 0.49, P = 0.0068); however, it was not significant for rater 2 (0.48 ± 0.48) or rater 3 (0.49 ± 0.46). For TW3 carpal, the AI analyzer had an MAE of 0.48 ± 0.65. The percentage of patients with an absolute error of < 1.0 years was 88.78%. The MAE was significantly lower than that of rater 2 (0.58 ± 0.67, P = 0.0018) and numerically lower for rater 1 (0.54 ± 0.64) and rater 3 (0.50 ± 0.53). These results were consistent for the subgroups according to sex, and differences between the age groups were observed., Conclusion: In this comprehensive validation study conducted in China, an AI-powered X-ray bone age analyzer showed accuracies that matched or exceeded those of doctor raters. This method may improve the efficiency of clinical routines by reducing reading time without compromising accuracy., (© 2024. The Author(s), under exclusive licence to Springer Healthcare Ltd., part of Springer Nature.)

Background: There is no consensus on the cause and effect of systemic chronic inflammation (SCI) regarding chronic obstructive pulmonary disease (COPD). The impact of second-hand smoke (SHS) on COPD has reached inconsistent conclusions., Methods: The China Kadoorie Biobank cohort was followed up from the 2004-08 baseline survey to 31 December 2018. Among the selected 445,523 participants in the final analysis, Cox and linear regressions were performed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of tobacco exposure with COPD risk and baseline levels of log-transformed inflammatory factors [βs (95% CIs)], respectively., Results: Participants were followed up for a median of 12.1 years and 11,825 incident COPD events were documented. Ever-smokers were associated with a higher risk of COPD than non-smokers with non-weekly SHS exposure. A younger age to start smoking, a greater amount of daily tobacco consumption, and deeper inhalation were associated with increased risk of COPD and correlated with elevated levels of plasma high-sensitivity C-reactive protein (hs-CRP, all P trend  < 0.001) even two years before COPD onset. Among former smokers, COPD risk declined with longer smoking cessation (P trend  < 0.001) and those quitting smoking for over ten years presented no difference in COPD risk and hs-CRP level from non-smokers [HR (95% CI) = 1.05 (0.89, 1.25), β (95% CI) = 0.17 (- 0.09, 0.43)]. Among non-smokers, weekly SHS exposure was associated with a slightly higher COPD risk [HR (95% CI) = 1.06 (1.01, 1.12)]., Conclusions: Incremental exposure to tobacco smoke was related to elevated SCI level before COPD onset, then an increase in COPD susceptibility. Quitting smoking as early as possible is suggested as a practical approach to reducing COPD risk in smokers. Given the high prevalence of both COPD and SHS exposure, the risk associated with SHS exposure deserves attention., (© 2024. The Author(s).)

Study Question: Does vitrification cryopreservation of embryos for more than 5 years affect the pregnancy outcomes after frozen embryo transfer (FET)?, Summary Answer: Vitrification cryopreservation of good-quality blastocysts for more than 5 years is associated with a decrease in the implantation rate (IR) and live birth rate (LBR)., What Is Known Already: Previous studies have predominantly focused on embryos cryopreserved for relatively short durations (less than 5 years), yet the impact of extended cryopreservation duration on pregnancy outcomes remains a controversial issue. There is a relative scarcity of data regarding the efficacy and safety of storing embryos for 5 years or longer., Study Design, Size, Duration: This retrospective study involved 36 665 eligible vitrified-thawed embryo transfer cycles from 1 January 2016 to 31 December 2022, at a single fertility center in China., Participants/materials, Setting, Methods: Patients were divided into three groups according to embryo storage time: Group 1 consisted of 31 565 cycles, with storage time of 0-2 years; Group 2 consisted of 4458 cycles, with a storage time of 2-5 years; and Group 3 included 642 cycles, with storage time exceeding 5 years. The main outcome measures were IR and LBR. Secondary outcome variables included rates of biochemical pregnancy, multiple pregnancy, ectopic pregnancy, and miscarriage, as well as neonatal outcomes. Reproductive outcomes were analyzed as binary variables. Multivariate logistic regression analysis was used to explore the effect of preservation time on pregnancy outcomes after correcting for confounding factors. In addition, we also assessed neonatal outcomes, such as large for gestational age (LGA) and small for gestational age (SGA)., Main Results and the Role of Chance: IRs in the three groups (0-2, 2-5, and >5 years) were 37.37%, 39.03%, and 35.78%, respectively (P = 0.017), and LBRs in the three groups were 37.29%, 39.09%, and 34.91%, respectively (P = 0.028). After adjustment for potential confounding factors, compared with the 0-2 years storage group, prolonged embryo vitrification preservation time (2-5 years or >5 years) did not affect secondary outcomes such as rates of biochemical pregnancy, multiple pregnancy, ectopic pregnancy, and miscarriage (P > 0.05). But cryopreservation of embryos for more than 5 years reduced the IR (adjusted odds ratio (aOR) 0.82, 95% CI 0.69-0.97, P = 0.020) and LBR (aOR 0.76, 95% CI 0.64-0.91, P = 0.002). Multivariate stratified analysis also showed that prolonging the cryopreservation time of blastocysts (>5 years) reduced the IR (aOR 0.78, 95% CI 0.62-0.98, P = 0.033) and LBR (aOR 0.68, 95% CI 0.53-0.87, P = 0.002). However, no effect on cleavage embryos was observed (P > 0.05). We further conducted stratified analyses based on the number and quality of frozen blastocysts transferred, and the results showed that the FET results after transfers of good-quality blastocysts in the >5 years storage group were negatively affected. However, the storage time of non-good-quality blastocysts was not significantly associated with pregnancy outcomes. Regarding the neonatal outcomes (of singletons), embryo vitrification preservation time had no effect on preterm birth rates, fetal birth weight, or neonatal sex ratios. However, as the storage time increased, rates of SGA (5.60%, 4.10%, and 1.18%) decreased, while rates of LGA (5.22%, 6.75%, and 9.47%) increased (P < 0.05). After adjusting for confounding factors, the increase in LGA and the decrease in SGA were significantly correlated with the duration of storage time., Limitations, Reasons for Caution: This was a retrospective study using data from a single fertility center, even though the data had been adjusted, our findings still need to be validated in further studies., Wider Implications of the Findings: With the full implementation of the two-child policy in China, there may be more patients whose embryos have been frozen for a longer time in the future. Patients should be aware that the IR and LBR of blastocysts are negatively affected when the cryopreservation time is longer than 5 years. Couples may therefore consider shortening the time until FET treatment., Study Funding/competing Interest(s): This study was supported by the National Nature Science Foundation of China (No. 82101672), Science and Technology Projects in Guangzhou (No. 2024A03J0180), General Guidance Program for Western Medicine of Guangzhou Municipal Health Commission (No. 20231A011096), and the Medical Key Discipline of Guangzhou (2021-2023). None of the authors have any conflicts of interest to declare., Trial Registration Number: N/A., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.)

Background and Purpose: Previous studies, mostly focusing on the European population, have reported polygenic risk scores (PRSs) might achieve risk stratification of stroke. We aimed to examine the association strengths of PRSs with risks of stroke and its subtypes in the Chinese population., Methods: Participants with genome-wide genotypic data in China Kadoorie Biobank were split into a potential training set (n=22 191) and a population-based testing set (n=72 150). Four previously developed PRSs were included, and new PRSs for stroke and its subtypes were developed. The PRSs showing the strongest association with risks of stroke or its subtypes in the training set were further evaluated in the testing set. Cox proportional hazards regression models were used to estimate the association strengths of different PRSs with risks of stroke and its subtypes (ischaemic stroke (IS), intracerebral haemorrhage (ICH) and subarachnoid haemorrhage (SAH))., Results: In the testing set, during 872 919 person-years of follow-up, 8514 incident stroke events were documented. The PRSs of any stroke (AS) and IS were both positively associated with risks of AS, IS and ICH (p<0.05). The HR for per SD increment (HR SD ) of PRS AS was 1.10 (95% CI 1.07 to 1.12), 1.10 (95% CI 1.07 to 1.12) and 1.13 (95% CI 1.07 to 1.20) for AS, IS and ICH, respectively. The corresponding HR SD of PRS IS was 1.08 (95% CI 1.06 to 1.11), 1.08 (95% CI 1.06 to 1.11) and 1.09 (95% CI 1.03 to 1.15). PRS ICH was positively associated with the risk of ICH (HR SD =1.07, 95% CI 1.01 to 1.14). PRS SAH was not associated with risks of stroke and its subtypes. The addition of current PRSs offered little to no improvement in stroke risk prediction and risk stratification., Conclusions: In this Chinese population, the association strengths of current PRSs with risks of stroke and its subtypes were moderate, suggesting a limited value for improving risk prediction over traditional risk factors in the context of current genome-wide association study under-representing the East Asian population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Despite readiness for hospital discharge widespread popularity since readiness for hospital discharge introduction in 1979 and extensive study, readiness for hospital discharge among pulmonary tuberculosis (PTB) patients has not yet been investigated. Moreover, the factors influencing this process remain unclear., Objective: The objective of this study was to investigate the factors influencing readiness for hospital discharge in initially treated PTB patients using the capability, opportunity, motivation-behavior (COM-B) model., Methods: This phenomenological study was conducted from December 2023 to March 2024. Face-to-face individual interviews were conducted with 18 initially treated patients with PTB according to a semistructured interview guide developed on the basis of the COM-B model. The interview data were subjected to analysis using NVivo 14 software and Colaizzi's method., Results: As a result, 6 themes and 14 subthemes were identified. Physical capability for readiness for hospital discharge (subthemes included poor health status, early acquisition of adequate knowledge about PTB, inadequate knowledge about readiness for hospital discharge), psychological capability for readiness for hospital discharge(subthemes included false perceptions about readiness for hospital discharge, high treatment adherence), physical opportunity for readiness for hospital discharge (subthemes included high continuity of transition healthcare, insufficient financial support, insufficient informational support), social opportunity for readiness for hospital discharge (subthemes included stigmatization, inadequate emotional support), reflective motivation for readiness for hospital discharge (subthemes included lack of reflection on coping with difficulties, intention to develop a readiness for hospital discharge plan), and automatic motivation for readiness for hospital discharge (subthemes included strong desire to be cured, negative emotions)., Conclusion: We established factors related to readiness for hospital discharge in initially treated PTB patients in terms of capability, opportunity and motivation, which can inform the future development of readiness for hospital discharge plans. To improve patients' readiness for hospital discharge, patients need to be motivated to plan and desire readiness for hospital discharge, patients' knowledge and treatment adherence should be improved, and patients' transition healthcare continuity and emotional support should be focused on. Moreover, the quality of readiness for hospital discharge and discharge education should be assessed in a timely manner to identify impeding factors and provide interventions., (© 2024. The Author(s).)

The genus Zygoneura Meigen is revised thoroughly from China, and 14 species are recognized and illustrated, including four new species: Zygoneura (Allozygoneura) xizangensis Shah & Huang sp. nov., Zygoneura (Pharetratula) minuscula sp. nov., Zygoneura (Pharetratula) motuoensis sp. nov. and Zygoneura (Pharetratula) yangi sp. nov. In addition, Zygoneura (Pharetratula) divergens (Mamaev), Zygoneura (Pharetratula) flavicornis (Mamaev), and Zygoneura (Pharetratula) subdivergens (Mohrig & Mamaev) are reported for the first time from China. The identification of these species is supported by both morphological characteristics and sequence data obtained from cytochrome oxidase subunit one (COI) in the DNA barcode analysis. Furthermore, a checklist of the known Zygoneura species in China is also provided, along with an identification key for males.

Background: Higher body mass index (BMI) is associated with higher incidence of cardiovascular and some non-cardiovascular diseases (CVDs/non-CVDs). However, uncertainty remains about its associations with mortality, particularly at lower BMI levels., Methods: The prospective China Kadoorie Biobank recruited >512 000 adults aged 30-79 years in 2004-08 and genotyped a random subset of 76 000 participants. In conventional and Mendelian randomization (MR) analyses, Cox regression yielded adjusted hazard ratios (HRs) associating measured and genetically predicted BMI levels with incident risks of major vascular events (MVEs; conventional/MR 68 431/23 621), ischaemic heart disease (IHD; 50 698/12 177), ischaemic stroke (IS; 42 427/11 897) and intracerebral haemorrhage (ICH; 7644/4712), and with mortality risks of CVD (15 427/6781), non-CVD (26 915/4355) and all causes (42 342/6784), recorded during ∼12 years of follow-up., Results: Overall, the mean BMI was 23.8 (standard deviation: 3.2) kg/m2 and 13% had BMIs of <20 kg/m2. Measured and genetically predicted BMI showed positive log-linear associations with MVE, IHD and IS, but a shallower positive association with ICH in conventional analyses. Adjusted HRs per 5 kg/m2 higher genetically predicted BMI were 1.50 (95% CI 1.41-1.58), 1.49 (1.38-1.61), 1.42 (1.31-1.54) and 1.64 (1.58-1.69) for MVE, IHD, IS and ICH, respectively. These were stronger than associations in conventional analyses [1.21 (1.20-1.23), 1.28 (1.26-1.29), 1.31 (1.29-1.33) and 1.14 (1.10-1.18), respectively]. At BMIs of ≥20 kg/m2, there were stronger positive log-linear associations of BMI with CVD, non-CVD and all-cause mortality in MR than in conventional analyses., Conclusions: Among relatively lean Chinese adults, higher genetically predicted BMI was associated with higher risks of incident CVDs. Excess mortality risks at lower BMI in conventional analyses are likely not causal and may reflect residual reverse causality., (© The Author(s) 2024. Published by Oxford University Press on behalf of the International Epidemiological Association.)