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Objective: To evaluate the outcomes and risk factors for trial of labor after cesarean delivery (TOLAC) failure in patients in China.Methods: Consecutive patients who had a previous cesarean delivery (CD) and attempted TOLAC were included from 2014 to 2020. Patients who successfully delivered were classified into the TOLAC success group. Patients who attempted TOLAC but had a repeat CD due to medical issues were classified into the TOLAC failure group. Multiple logistic regression analyses were performed to examine the risk factors for TOLAC failure.Results: In total, 720 women who had a previous CD and attempted TOLAC were identified and included. The success rate of TOLAC was 84.2%(606/720). Seven patients were diagnosed with uterine rupture, none of whom underwent hysterectomy. Multiple logistic regression analysis showed that the induction of labor (OR = 2.843, 95% CI: 1.571-5.145, P < 0.001) was positively associated with TOLAC failure, but the thickness of the lower uterine segment (LUS) (OR = 0.215, 95% CI: 0.103-0.448, P < 0.001) was negatively associated with TOLAC failure.Conclusions: This study suggested that TOLAC was effective in decreasing CD rates in the Chinese population. The induction of labor was positively associated with TOLAC failure, but the thickness of the LUS was negatively associated with TOLAC failure. Our findings need to be confirmed in larger samples with patients of different ethnicities. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) has emerged as a primary health problem and threat to global mortality, especially in China. Since pyroptosis as a new field for HCC prognosis is not well studied, it is important to open a specific prognostic model. In this study, consensus clustering method for 42 pyroptosis-related genes to classify 374 HCC patients in the TCGA database. After cox regression analysis of the differentially expressed genes between the two clusters, LASSO-Cox analysis was then performed to construct a pyroptosis-related prognostic model with 11 genes including MMP1, KPNA2, LPCAT1, NEIL3, CDCA8, SLC2A1, PSRC1, CBX2, HAVCR1, G6PD, MEX3A. The ICGC dataset was served as the validation cohort. Patients in the high-risk group had significantly lower overall survival (OS) rates than those in the low-risk group (p < 0.05). COX regression analysis showed that our model could be used as an independent prognostic factor to predict prognosis of patients and was significantly correlated with clinicopathological characteristics. Nomogram showing the stability of the model predicting the 1, 3, 5 year survival probability of patients. In addition, based on the risk model, ssGSEA analysis revealed significant differences in the level of immune cell infiltration and activation of immune-related functional pathways between high and low-risk groups, and patients with the high-risk score may benefit more from treatment with immune checkpoint inhibitors. Furthermore, patients in the high-risk group were more tend to develop chemoresistance. Overall, we identified a novel pyroptosis-related risk signature for prognosis prediction in HCC patients and revealed the overall immune response intensity of the tumor microenvironment. All these findings make the pyroptosis signature shed light upon a latent therapeutic strategy aimed at the treatment and prevention of cancers. [ABSTRACT FROM AUTHOR]

• A thin and flat LAB is observed in Central Eastern China, suggesting uniform destruction. • We attribute the destruction to lithospheric delamination along a mid-lithospheric discontinuity. • After the destruction, slab rollback and trench retreat further stretched the lithosphere. Detailed knowledge of the lithospheric thickness is important for understanding the tectonic evolution in central Eastern China, characterized by ore deposits in the Middle-Lower Yangtze Metallogenic Belt (MLYMB). We realize this goal by applying the common conversion point (CCP) stacking to Sp receiver functions (SRF) computed from 234 broadband seismic stations in central Eastern China. Distinct negative signals are identified below the Moho in all the CCP stacking profiles, which we interpret as the S-to-P conversions from the lithosphere-asthenosphere boundary (LAB). The imaged LAB is as shallow as ∼60 km with a standard deviation of ∼5 km in the whole region, in contrast to the typical cratonic lithosphere root down to 200 km depth or more, indicating the widespread lithospheric thinning in the study region. Such a flat LAB indicates that the regional lithosphere has been destructed uniformly, shedding light on its destructive mechanism, which we attribute to lithospheric delamination along a mid-lithospheric discontinuity (MLD). Compared to the MLD (∼80–100 km) observed in the western North China Craton, our observations suggest that the destructed lithosphere probably has been further stretched due to slab rollback and trench retreat. In contrast, lithospheric cooling-induced accretion plays a minor role in the lithospheric evolution after destruction. [ABSTRACT FROM AUTHOR]

The status of technical efficiency (TE) of environmental protection enterprises is crucial to the sustainable economic development. Based on the micro-survey data of China's environmental protection enterprises from 2003 to 2013, through a systematic calculation and comparison about TE level under stochastic frontier analysis, this article investigated the distribution characteristics and heterogeneous sources of them comprehensively and found that first, there are wide-ranging technical efficiency differences among sub-sectors, ownership, and regions within China's environmental protection industry, and this type of heterogeneity was significantly interfered by the institution and policy environment. Second, there is obvious scale economy effect and no scope economy effect in the TE distribution of China's environmental protection enterprises, and their TE level has a positive response to management improvement and competition enhancement, but has a negative feedback on heavy asset expansion and debt-driven growth mode. Third, the overall TE levels of non-state-owned enterprises are higher than that of state-owned enterprises; the overall TE levels of enterprises located in the eastern provinces are higher than those of enterprises located in the central and western provinces. Fourth, reducing tax burdens of environmental protection enterprises is more effective to promote their TE level than providing governmental subsidies directly. Therefore, to promote the quality of the development for China's environmental protection industry, it is necessary to emphasize the market mechanism. Based on the market power, we should accelerate the industry integration, cultivate the market demand, and promote market competition. Furthermore, the government should also need to design a targeted support system and differentiated policy arrangements for the development of environmental protection enterprises. [ABSTRACT FROM AUTHOR]

Using population census data, this paper examines the causal effect of a second child on married women's labour force participation in urban China. To ameliorate the endogeneity of fertility, we exploited twin births as the source of variation in fertility. Although the ordinary least squares estimates indicate that having one more child significantly reduces female labour force participation by around 6 and 9 percentage points in 1990 and 2000, respectively, our causal analyses suggest very small negative effects in 1990 (around 2 percentage points) and an insignificant effect in 2000. [ABSTRACT FROM AUTHOR]

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This article examines the effects of road tolls on economic growth in China. Using a provincial panel data and pool mean group method, we find that a 1% rise in road tolls leads to 0.005% and 0.03% reduction in GDP growth and GDP per capita, respectively. Moreover, it shows that although more road tolls may contribute to financing local transportation networks, they hinder inter-regional trade thus result in more serious market segmentation. [ABSTRACT FROM AUTHOR]

This paper uses a unique micro dataset of Chinese private firms surveyed in 2000 to investigate whether having a more highly educated entrepreneur affects a firm's performance. Identifying educational effects has been shown to be empirically challenging because it is difficult to overcome the likely omitted variable bias problem. We use the propensity score matching method to get around this identification problem. Matching results imply that on average, the firms whose owners received higher education had 5.2-5.8 percentage points higher return on equity, 115-126 percentage points higher profits, and 102-111 percentage points higher sales revenue, respectively, than firms that did not have higher educated entrepreneurs. [ABSTRACT FROM AUTHOR]

The glaciers on Tibetan Plateau play an important role in the catchment hydrology of this region. However, our knowledge with respect to water circulation in this remote area is scarce. In this study, the HBV light model, which adopts the degree-day model for glacial melting, was employed to simulate the total runoff, the glacier runoff and glacier mass balance (GMB) of the Dongkemadi River Basin (DRB) at the headwater of the Yangtze River on the Tibetan Plateau, China. Firstly, the daily temperature and precipitation of the DRB from 1955 to 2008 were obtained by statistical methods, based on daily meteorological data observed in the DRB (2005-2008) and recorded by four national meteorological stations near the DRB (1955-2008). Secondly, we used 4-year daily air temperature, precipitation, runoff depth and monthly evaporation, which were observed in the DRB, as input to obtain a set of proper parameters. Then, the annual runoff, the glacier runoff and GMB (1955-2008) were calculated using the HBV model driven by interpolated meteorological data. The calculated GMB fits well with the observed results. At last, using the temperature and precipitation predicted by climate models, we predicted the changes of runoff depth and GMB of the DRB in the next 40 years. Under all climate-change scenarios, annual glacier runoff shows a significant increase due to intensified ice melting. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The high quality of the environmental protection industry (EPI) plays an important role in China's economic transformation. However, to date, no studies have conducted a comprehensive exploration of the factors that affect the input-output efficiency (IOE) of environmental protection enterprises (EPEs). Accordingly, this research uses the 2014 to 2018 unbalanced panel data of China's EPEs listed on the Shanghai and Shenzhen Stock Exchanges and on the New Third Board as the research sample to measure the IOE of these enterprises under the framework of stochastic frontier analysis (SFA). This research also comprehensively examines various factors that affect efficiency. We found the following. (1) Although the improvement of the IOE of China's EPEs superimposes the characteristics of market-driven and policy-driven efficiency drivers, there is negative feedback on fund-driven drivers. (2) The development of China's EPI exhibits the characteristics of a blue ocean market, but efficiency enhancement must rely more on benign scale expansion and improvements in operations and management while simultaneously avoiding low-quality expansion. (3) As different types of influencing factors have obvious heterogeneous effects at the ownership, regional and segmented industry levels, to promote the improvement of the IOE of China's EPEs, it is necessary to build a differentiated policy support system and assess its regulations and role in market leadership. At the same time, it is necessary to strengthen the supervision and control of blind expansion and increased leverage in certain areas. • Sorting out the characteristics of the IOE structure of EPEs. • Systematic presentation of the historical logic and influencing factors of the IOE of China's EPEs. • The development of EPEs in China exhibits strong market-driven and policy-driven characteristics. • Providing a first comprehensive exploration of the factors affecting the IOE of China's EPEs. [ABSTRACT FROM AUTHOR]

In order to detect the source and controlling factors of hydrochemical ions in glacier meltwater-recharged rivers, the chemical characteristics of the river water, precipitation, and meltwater of the Dongkemadi River Basin, China, in 2014 (from May to October) were systematically analyzed, and combined with the hydrological and meteorological data. The results show that the hydrochemical pattern of the typical river was HCO3−-Ca2+. The most cations were Ca2+ and Mg2+, and the predominant anions were HCO3− and SO42−, in the river. The concentration of major ions and total dissolved solids (TDS) in the river water were much larger than that in the precipitation and meltwater. The TDS concentration was ordered: River water > precipitation > meltwater. The water-rock interaction and the dilution effect of the precipitation and meltwater on the runoff ions resulted in a negative correlation between the ion concentration of the river water and the river flow. The chemical ions of the river runoff mainly originated from rock weathering and the erosion (abrasion) caused by glacier movement. In addition, the contributions of different sources to the dissolved components of the Dongkemadi River were ordered: Carbonate (75.8%) > silicate (15.5%) > hydatogenic rock (5.7%) > atmospheric precipitation (3%), calculated by a forward geochemical model. And the hydrochemical weathering rates of carbonate and silicate minerals were 12.30 t·km−2·a−1 and 1.98 t·km−2·a−1, respectively. The CO2 fluxes, consumed by the chemical weathering of carbonate and silicate, were 3.28 × 105 mol·km−2·a−1 and 0.91 × 105 mol·km−2·a−1, respectively. [ABSTRACT FROM AUTHOR]

The high-quality development of the environmental protection industry (EPI) requires the support of the corresponding industrial policy system. Taking the input-output efficiency of China's environmental protection enterprises (EPE) as the starting point, this paper conducts a micro-empirical analysis (including random frontier calculation, structural feature combing, and driving mechanism analysis) on the effects of and structural differences in different policy support measures such as taxation, subsidies, and credit. The study finds that first, there are significant ownership and regional differences in the technical efficiency (TE) of Chinese EPE, and the TE level of state-owned and central and western EPE is relatively low. Second, tax relief measures have significant efficiency enhancement effects, especially for non-state-owned enterprises. Third, government subsidies for non-state-owned enterprises and credit support for the central and western regions can produce efficiency improvements. Therefore, constructing a structured policy support system is an important measure to improve the high-quality development of China's EPI. • From the input-output perspective, the TE of EPE has ownership differences and regional heterogeneity. • The effects of different policy support methods are significantly different. • Tax reductions and government subsidies for non-state-owned enterprises have the effect of improving efficiency. • Credit support for the central and western regions can produce efficiency improvements. [ABSTRACT FROM AUTHOR]

Background: To retrospectively analyze the pulmonary computed tomography (CT) characteristics and dynamic changes in the lungs of cured coronavirus disease 2019 (COVID-19) patients at discharge and reexamination., Methods: A total of 155 cured COVID-19 patients admitted to designated hospitals in Yunnan Province, China, from February 1, 2020, to March 20, 2020, were included. All patients underwent pulmonary CT at discharge and at 2 weeks after discharge (during reexamination at hospital). A retrospective analysis was performed using these two pulmonary CT scans of the cured patients to observe changes in the number, distribution, morphology, and density of lesions., Results: At discharge, the lung CT images of 15 cured patients showed no obvious lesions, while those of the remaining 140 patients showed different degrees of residual lesions. Patients with moderate disease mostly had multiple pulmonary lesions, mainly in the lower lobes of both lungs. At reexamination, the lung lesions in the patients with moderate disease had significantly improved (P<0.05), and the lung lesions in the patients with severe disease had partially improved, especially in patients with multi-lobe involvement (χ 2 =3.956, P<0.05). At reexamination, the lung lesions of patients with severe disease did not show significant changes (P>0.05)., Conclusions: The pulmonary CT manifestations of cured COVID-19 patients had certain characteristics and variation patterns, providing a reference for the clinical evaluation of treatment efficacy and prognosis of patients.

Objective: The prognosis of mild and severe patients has prominent differences during the prevalence of COVID-19, and it will be significant to identify patients' potential risk of progressing to severe cases according to their first clinical presentations. Therefore, we aim to review the clinical symptoms of the COVID-19 epidemic systematically. Methods: We searched PubMed, Embase, Web of Science, and CNKI (Chinese Database) for studies about the clinical features of COVID-19 in China from March 18 to April 18. Then we used REVMAN to conduct a meta-analysis. Results: After screening, 20 articles including 3,326 COVID-19 confirmed cases were selected from 142 articles we retrieved at the beginning of our research. We divided all the cases into a severe group (including severe and critically severe patients) and a mild group according to the "Diagnosis and Treatment Protocol for Novel Coronavirus Infection-Induced Pneumonia" version 4 (trial). Of all the initial symptoms (including fever, cough, abdominal pain, anorexia, chest tightness, diarrhea, dyspnea, expectoration, fatigue, headache, hemoptysis, myalgia, nausea or vomiting, and pharyngalgia) we studied, we found that cough (odds ratio [OR] = 1.4, 95% confidence interval [CI]: 1.2-1.7; p < 0.001), fever (OR = 1.5, 95% CI: 1.2-1.9; p < 0.001), dyspnea (OR = 6.2, 95% CI: 3.6-10.6; p < 0.001), diarrhea (OR = 2.6, 95% CI: 1.3-4.9; p < 0.001), fatigue (OR = 2.1, 95% CI: 1.3-3.3; p < 0.01), expectoration (OR = 1.7, 95% CI: 1.2-2.6; p < 0.01), myalgia (OR = 1.6, 95% CI: 0.8-3.1; p < 0.001), hemoptysis (OR = 4.0, 95% CI: 1.5-11.3; p < 0.001), abdominal pain (OR = 7.5, 95% CI: 2.4-23.4; p < 0.001), and anorexia (OR = 2.8, 95% CI: 1.5-5.1; p < 0.001) had a different distribution in two groups and were statistically significant ( p < 0.05). Conclusion: COVID-19 patients whose initial manifestation is dyspnea, hemoptysis, anorexia, diarrhea, or fatigue, especially abdominal pain should be closely monitored to prevent disease deterioration., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 He, Cheng, Feng, Wan, Chen and Xiong.)

Objective: To investigate the association between three single nucleotide polymorphisms (SNPs) of the ATP-binding cassette (ABC) gene family and susceptibility to type 2 diabetes mellitus in a Chinese Han population., Methods: A total of 1086 type 2 diabetes patients and 1122 healthy controls were included in this retrospective study. Three genetic variants, rs1800977 and rs4149313 in ABCA1 , and rs1128503 in ABCB1 were included in the study. Susceptibility to type 2 diabetes was evaluated under three genetic models., Results: A significant association between rs1800977 and type 2 diabetes was identified in three different genetic models (TT vs CC, odds ratio [OR] = 0.611 [95% confidence interval (CI), 0.469-0.798]; T vs C, OR = 0.841 [95% CI, 0.745-0.950]; and the recessive model, OR = 0.606 [95% CI, 0.474-0.774]). Additionally, a significant association between rs4149313 and type 2 diabetes was identified in three different genetic models (AA vs GG, OR = 0.467 [95% CI, 0.326-0.670]; A vs G, OR = 0.819 [95% CI, 0.717-0.935]; and the recessive model, OR = 0.478 [95% CI, 0.336-0.680])., Conclusion: We found that SNPs rs1800977 and rs4149313 in ABCA1 are significantly associated with susceptibility to type 2 diabetes in a Chinese population, although this should be confirmed in a larger study.

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are used as standard therapies for advanced nonsmall cell lung cancer (NSCLC) patients with EGFR mutation positive. Because these targeted therapies could cause tumor necrosis and shrinkage, the purpose of the study is to search for a value of optimal tumor shrinkage as an appropriate indicator of outcome for advanced NSCLC.A total of 88 NSCLC enrollees of 3 clinical trials (IRESSA registration clinical trial, TRUST study and ZD6474 study), who received Gefitinib (250 mg, QD), Erlotinib (150 mg, QD), and ZD6474 (100 mg, QD), respectively, during December 2003 and October 2007, were retrospectively analyzed. The response evaluation criteria in solid tumors (RECIST) were used to identify responders, who had complete response (CR) or partial responses (PR) and nonresponders who had stable disease (SD) or progressive disease (PD). Receiver operating characteristics (ROC) analysis was used to find the optimal tumor shrinkage as an indicator for tumor therapeutic outcome. Univariate and multivariate Cox regression analyses were performed to compare the progression-free survival (PFS) and overall survival (OS) between responders and nonresponders stratified based on radiologic criteria.Among the 88 NSCLC patients, 26 were responders and 62 were nonresponders based on RECIST 1.0. ROC indicated that 8.32% tumor diameter shrinkage in the sum of the longest tumor diameter (SLD) was the cutoff point of tumor shrinkage outcomes, resulting in 46 responders (≤8.32%) and 42 nonresponders (≥8.32%). Univariate and multivariate Cox regression analyses indicated that (1) the responders (≤8.32%) and nonresponders (≥ -8.32%) were significantly different in median PFS (13.40 vs 1.17 months, P < 0.001) and OS (19.80 vs 7.90 months, P < 0.001) and (2) -8.32% in SLD could be used as the optimal threshold for PFS (hazard ratio [HR], 8.11, 95% CI, 3.75 to 17.51, P < 0.001) and OS (HR, 2.36, 95% CI, 1.41 to 3.96, P = 0.001).However, 8.32% tumor diameter shrinkage is validated as a reliable outcome predictor of advanced NSCLC patients receiving EGFR-TKIs therapies and may provide a practical measure to guide therapeutic decisions.

Electronic waste (e-waste) has created a worldwide environmental and health problem, by generating a diverse group of hazardous compounds such as persistent organic pollutants (POPs). Our previous studies demonstrated that populations from e-waste exposed region have a significantly higher level of chromosomal aberrancy and incidence of DNA damage. In this study, we further demonstrated that various POPs persisted at a significantly higher concentration in the exposed group than those in the unexposed group. The level of reactive oxygen species and micronucleus rate were also significantly elevated in the exposed group. RNA sequencing analysis revealed 31 genes in DNA damage responses and repair pathways that were differentially expressed between the two groups (Log2 ratio >1 or <-1). Our data demonstrated that both females and males of the exposed group have activated a series of DNA damage response genes; however many important DNA repair pathways have been dysregulated. Expressions of NEIL1/3 and RPA3, which are critical in initiating base pair and nucleotide excision repairs respectively, have been downregulated in both females and males of the exposed group. In contrast, expression of RNF8, an E3 ligase involved in an error prone non-homologous end joining repair for DNA double strand break, was upregulated in both genders of the exposed group. The other genes appeared to be differentially expressed only when the males or females of the two groups were compared respectively. Importantly, the expression of cell cycle regulatory gene CDC25A that has been implicated in multiple kinds of malignant transformation was significantly upregulated among the exposed males while downregulated among the exposed females. In conclusion, our studies have demonstrated significant correlations between e-waste disposing and POPs accumulation, DNA lesions and dysregulation of multiple DNA damage repair mechanisms in the residents of the e-waste exposed region., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To investigate mutation of COL1A1 gene and analyze the relationship between genotype and clinical phenotype in a family with osteogenesis imperfecta (OI)., Methods: The family history of an OI pedigree, along with clinical data, was collected. Blood samples from the proband and his families, as well as 50 normal controls, were collected. Mutation of COL1A1 gene was screened using PCR-high resolution melting (PCR-HRM) and validated by sequencing., Results: PCR HRM method showed an abnormal result in proband COL1A133&#95;34 exons, which Tm was 87.7℃, in contrast to the normal control (wt) Tm of 87.9±0.06℃. There was a significant difference between the proband and the normal control with the standardization curve and the difference curves. DNA sequencing showed that Y9COL1A1 gene exons 33&#95;34 has lost a C base (c.2321delC), which resulted in a frameshift mutation and caused an premature termination codon (UAA) at amino acid 334, i.e., p.Pro774LeufsX334 The father and grandfather of the proband, both suffered from OI, were verified to be heterozygous for the same mutation. The same mutation was not found in 50 normal controls. Database search confirmed this to be a novel mutation. Pedigree analysis suggested that it has an autosomal dominant inheritance. The proband and patients from the family were clinically diagnosed as OI type I., Conclusion: The study has identified a novel mutation of COL1A1 gene, c.2321delC. This frameshift mutation has caused a premature stop codon and reduced collagen type synthesis, characterized by a lighter OI clinical phenotype.