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Background: Immune checkpoint inhibitors (ICI) combined with chemotherapy are efficacious for treating advanced non-small cell lung cancer (NSCLC); however, the effectiveness of this approach in the malignant pleural effusion (MPE) population is unclear. This study evaluated ICI plus chemotherapy in NSCLC patients with MPE. Methods: Patients from 3 centers in China with NSCLC and MPE who received ICI plus chemotherapy (ICI Plus Chemo) or chemotherapy alone (Chemo) between December 2014 and June 2023 were enrolled. Clinical outcomes and adverse events (AEs) were compared. Results: Of 155 eligible patients, the median age was 61.0 years old. Males and never-smokers accounted for 73.5% and 39.4%, respectively. Fifty-seven and 98 patients received ICI Plus Chemo or Chemo, respectively. With a median study follow-up of 10.8 months, progression-free survival (PFS) was significantly longer with ICI Plus Chemo than with Chemo (median PFS: 7.4 versus 5.7 months; HR = 0.594 [95% CI: 0.403–0.874], P = 0.008). Median overall survival (OS) did not differ between groups (ICI Plus Chemo: 34.2 versus Chemo: 28.3 months; HR = 0.746 [95% CI: 0.420–1.325], P = 0.317). The most common grade 3 or worse AEs included decreased neutrophil count (3 [5.3%] patients in the ICI Plus Chemo group vs. 5 [5.1%] patients in the Chemo group) and decreased hemoglobin (3 [5.3%] versus 10 [10.2%]). Conclusions: In patients with untreated NSCLC with MPE, ICI plus chemotherapy resulted in significantly longer PFS than chemotherapy and had a manageable tolerability profile, but the effect on OS may be limited. [ABSTRACT FROM AUTHOR]

The pharmacokinetic (PK) characteristics of drugs were altered under high‐altitude hypoxia. We aim to describe the population PK of atorvastatin (ATV) to identify patient characteristics that are predictive of variability in the PK parameters of the ATV and investigate the effects of high‐altitude hypoxia on the blood concentration of ATV in patients with hyperlipidemia. A total of 160 plasma concentrations were collected from 40 patients with hyperlipidemia in plateau areas and 40 in plain areas. The population pharmacokinetic model of patients with hyperlipidemia in plateau and plain areas of China was established by a nonlinear mixed‐effects model. The PK of ATV were described by a 1‐compartment model with first‐order elimination. The main PK parameters of ATV were the first‐order absorption rate (0.76 hour−1 fixed); clearance (174.22 L/h) and apparent volume of distribution (1119.62 L). The values of area and age were identified as significant covariates for the clearance, area, age, and urea for the volume of distribution. The steady‐state peak concentration in the plateau area was higher than that in the plain area. This study may suggest dose reduction is necessary for patients with hyperlipidemia in high altitudes. [ABSTRACT FROM AUTHOR]

The existing literature primarily examined the impact of unexpected events on the stock market at a single scale, posing the challenge of a lack of multiscale analysis. This paper investigates the impact of COVID-19 on stock markets (China, the U.S., and Hong Kong) from a multiscale perspective using an improved ensemble empirical mode decomposition (EEMD)-based event analysis method. First, the stock price series is decomposed into several independent intrinsic mode functions (IMFs) and a residue. Second, a novel composition method is proposed to reconstruct the IMFs into three components: high-frequency, low-frequency, and long-term trend. We find that the composition of low-frequency and long-term trend components is dominant, which is used to estimate the strength of COVID-19 impact on the stock markets. In addition, the outbreak of COVID-19 significantly increased the intensity of short-term fluctuations in stock prices. Finally, the high-frequency component is analyzed to capture the volatility spillover effects among the three stock markets by the BEKK(Baba-Engle-Kraft-Kroner)-GARCH model. The results show that before the outbreak, there are two-way volatility spillovers between any two of the three markets. After the outbreak, there is no spillover effect between China and Hong Kong, and Hong Kong has no spillover effect on the U.S. However, volatility in the U.S. market still has a significant spillover effect on the other two markets, implying that a mature market can absorb new information more quickly. [ABSTRACT FROM AUTHOR]

Background: Evidence of the effects of metabolically healthy obesity (MHO) on atherosclerosis is limited; the transition effects of metabolic health and obesity phenotypes have been ignored. We examined the association between metabolic health and the transition to atherosclerosis risk across body mass index (BMI) categories in a community population. Methods: This cross‐sectional study was based on a national representative survey that included 50,885 community participants aged ≥40 years. It was conducted from 01 December 2017 to 31 December 2020, in 13 urban and 13 rural regions across Hunan China. Metabolic health was defined as meeting less than three abnormalities in blood pressure, glucose, high‐density lipoprotein cholesterol, triglycerides, or waist circumference. The participants were cross‐classified at baseline based on their metabolic health and obesity. In addition, the relationship between atherosclerosis and transitions in metabolic health status based on 4733 participants from baseline to the second survey after 2 years was considered. The relationship between metabolic health status and the risk of transition to Carotid atherosclerosis (CA) was assessed using logistic regression and Cox proportional hazards regression analyses. Results: In this study, the mean age of the participants was 60.7 years (standard deviation [SD], 10.91), 53.0% were female, and 51.2% had CA. As compared with metabolically healthy normal weight (MHN), those with MHO phenotype (odd ratio [OR] 1.10, 95% confidence interval [CI] 1.02–1.21), metabolically unhealthy normal weight (OR 1.27, 95% CI 1.19–1.35), metabolically unhealthy overweight (OR 1.41, 95% CI 1.33–1.48), and metabolically unhealthy obese (OR 1.54, 95% CI 1.44–1.64) had higher risk for CA. However, during the follow‐up of 2 years, almost 33% of the participants transitioned to a metabolically unhealthy status. As compared with stable healthy normal weight, transition from metabolically healthy to unhealthy status (hazard ratios [HR] 1.21, 95% [CI] 1.02–1.43) and stable metabolically unhealthy overweight or obesity (MUOO) (HR 1.32, 95% CI 1.17–1.48) were associated with higher risk of CA. Conclusions: In the community population, obesity remains a risk factor for CA despite metabolic health. However, the risks were highest for metabolically unhealthy status across all BMI categories. A large proportion of metabolically healthy overweight or participants with obesity converts to an unhealthy phenotype over time, which is associated with an increased risk of CA. [ABSTRACT FROM AUTHOR]

Background: The atherogenic index of plasma (AIP) is an important alternative metabolic biomarker of atherosclerosis and cardiovascular diseases. Nevertheless, the correlation between the AIP and carotid atherosclerosis is unknown among the general population. Methods: A total of 52,380 community residents, aged ≥ 40 years who underwentcervical vascular ultrasound from December 2017 to December 2020 in Hunan China, were selected for retrospective analysis. The AIP was calculated as a logarithmically converted ratio of triglycerides (TG) to high-density lipoprotein-cholesterol (HDL-C). The participants were divided into AIP quartile groups (Q1-Q4). Logistic regression models and restricted cubic spline analyses were used to examine the association of the AIP with carotid atherosclerosis. Stratified analyses were applied to control for confounding factors. The incremental predictive value of the AIP was further assessed. Results: After adjusting for traditional risk factors, an increased AIP was associated with a higher rate of carotid atherosclerosis (CA), increased carotid intima-media thickness (CIMT), and plaques [odds ratio, OR (95% confidence interval, CI): 1.06 (1.04, 1.08), 1.07 (1.05, 1.09), and 1.04 (1.02, 1.06) per 1-SD increase in the AIP, respectively]. Compared with those participants in the quartile 1 group, those in the quartile 4 group had a greater risk of CA [OR 1.18, 95% CI (1.12, 1.25)], increased CIMT [OR 1.20, 95% CI (1.13, 1.26)], and plaques [OR 1.13, 95% CI (1.06, 1.19)]. However, we did not observe an association between the AIP and stenosis [0.97 (0.77, 1.23), p for trend = 0.758]. Restricted cubic spline analyses also showed a cumulative increase in the risk of CA, increased CIMT, and plaques but not stenosis severity (> 50%) with an increase of the AIP. Subgroup analyses showed that a more significant association between the AIP and the prevalence of increased CA was detected in younger subjects (aged < 60 years) with a body mass index (BMI) of ≥ 24 and fewer comorbidities. Additionally, the AIP provided incremental predictive capacity over established risk factors for CA, as shown by an improvement in the net reclassification index (NRI) and integrated discrimination index (IDI) (all P < 0.05). Conclusions: An elevated AIP in a community-based population is associated with a higher rate of CA. the AIP could serve as a potential biomarker for CA risk assessment. [ABSTRACT FROM AUTHOR]

Copyright of Advances in Atmospheric Sciences is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

While studies have demonstrated that certain COVID-19 vaccines administered during pregnancy did not affect neonatal or maternal outcomes significantly, the safety of inactivated SARS-CoV-2 vaccines in China, given during the first trimester, remains to be fully elucidated. A retrospective cohort study was conducted involving female participants who gave birth from January to October 2021. The study compared pregnancy, delivery, and neonatal outcomes between subjects who received one or two doses of the inactivated COVID-19 vaccines during their first trimester and unvaccinated control subjects. A total of 2658 pregnant women was recruited. Among them, 2358 (88.7%) reported ongoing pregnancies; 326 (13.8%) of these were vaccinated. Additionally, 277 (10.4%) experienced spontaneous miscarriages between 6 to 20 gestational weeks; 40 (14.4%) of these were vaccinated, yielding an odds ratio of 0.67–1.36 (95% confidence interval) for COVID-19 vaccination. The comparison of neonatal complications, including an Apgar score less than 7, preterm birth, low birth weight, and newborn respiratory complications, between unvaccinated and vaccinated participants revealed no statistical significance. The administration of COVID-19 inactivated vaccines during the first trimester of pregnancy is not associated with adverse pregnancy or neonatal outcomes, providing a substantial ground for pertinent health education. [ABSTRACT FROM AUTHOR]

Males and females often exhibit differences in behaviour, life histories, and ecology, many of which are typically reflected in their brains. Neuronal protection and maintenance include complex processes led by the microglia, which also interacts with metabolites such as hormones or immune components. Despite increasing interest in sex-specific brain function in laboratory animals, the significance of sex-specific immune activation in the brain of wild animals along with the variables that could affect it is widely lacking. Here, we use the Kentish plover (Charadrius alexandrinus) to study sex differences in expression of immune genes in the brain of adult males and females, in two wild populations breeding in contrasting habitats: a coastal sea-level population and a high-altitude inland population in China. Our analysis yielded 379 genes associated with immune function. We show a significant male-biased immune gene upregulation. Immune gene expression in the brain did not differ in upregulation between the coastal and inland populations. We discuss the role of dosage compensation in our findings and their evolutionary significance mediated by sex-specific survival and neuronal deterioration. Similar expression profiles in the coastal and inland populations suggest comparable genetic control by the microglia and possible similarities in pathogen pressures between habitats. We call for further studies on gene expression of males and females in wild population to understand the implications of immune function for life-histories and demography in natural systems. [ABSTRACT FROM AUTHOR]

This paper takes 105 disabled children from the Disabled Rehabilitation Research Center of the South China minority autonomous region as the survey objects. Based on the Gesell scale, it collects health data such as exercise ability and health status of disabled children, analyzes the data in accordance with SPSS software, and constructs comprehensive disease analysis model of 105 disabled children. Moreover, according to five indicator data collected and tested for disabled children (adaptability, big movements, fine movements, language, and personal-social) in Gesell scale, comprehensive disease indicators of the disabled children are calculated and statistically analyzed together with age and gender information. This study analyzed comprehensive diseases and the correlation among various indicators, concluding that most disabled children aged 3–7 are diagnosed with moderate and severe developmental retardation, and retardation level is in obvious normal distribution. At the same time, there is a significant correlation between indicators of ability test interval and measurement indicators with age. This study suggests that targeted treatment and rehabilitation plans should be implemented for disabled children of different ages according to different indicators of ability test interval, which has reference value and significance for improving the treatment level of disabled children and realizing targeted rehabilitation. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Diabetes is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To investigate the effect on pregnancy outcome of integrating a comprehensive management plan for patients with type 1 diabetes (T1D) into the World Health Organization universal maternal care infrastructure.Research Design and Methods: A comprehensive preconception-to-pregnancy management plan for women with T1D was implemented in 11 centers from 8 Chinese cities from 2015 to 2017. Sequential eligible pregnant women (n = 133 out of 137 initially enrolled) with T1D and singleton pregnancies attending these management centers formed the prospective cohort. The main outcome was severe adverse pregnancy outcome comprising maternal mortality, neonatal death, congenital malformations, miscarriage in the second trimester, and stillbirth. We compared pregnancy outcomes in this prospective cohort with two control groups with the same inclusion and exclusion criteria: a retrospective cohort (n = 153) of all eligible pregnant women with T1D attending the same management centers from 2012 to 2014 and a comparison cohort (n = 116) of all eligible pregnant women with T1D receiving routine care from 2015 to 2017 in 11 different centers from 7 cities.Results: The rate of severe adverse pregnancy outcome was lower in the prospective cohort (6.02%) than in either the retrospective cohort (18.30%; adjusted odds ratio [aOR] 0.31 [95% CI 0.13-0.74]) or the contemporaneous comparison cohort (25.00%; aOR 0.22 [95% CI 0.09-0.52]).Conclusions: The substantial improvements in the prospective cohort are evidence of a potentially clinically important effect of the comprehensive management plan on pregnancy outcomes among Chinese pregnant women with pregestational T1D. This supports the development of similar approaches in other countries. [ABSTRACT FROM AUTHOR]

The online version of the original article can be found at https://doi.org/10.1186/s12933-023-01839-y B Correction to: Cardiovascular Diabetology (2023) 22:125 b https://doi.org/10.1186/s12933-023-01839-y Following publication of the original article [[1]], the author noticed the error in figure. In the image of Figure 1D, the forest plot of Figure 1D does not match the corresponding odds ratio (OR) and 95% confidence interval (CI). [Extracted from the article]

Background: Hereditary medullary thyroid carcinoma (MTC) is mainly caused by germline mutations in the RET proto-oncogene, which accounts for 20–30% of all MTC according to foreign studies. However, no English literatures have reported Chinese hereditary MTC. Here, we reported two Chinese brothers with MTC that caused by germline RET mutation. Case presentation: The younger brother was diagnosed with MTC at 29 years ago and suffered recurrence more than 10 years. For elder brother, the diagnosis of MTC was made by postoperative pathological examination at age 61. Both patients received total thyroidectomy and lymph node dissection. Since they had a significant family history for MTC, genetic detection was performed and identified a germline mutation in RET exon 10 (p.C620Y). This mutation was also detected in their offspring, indicating a moderate risk of MTC. Conclusions: This is the first report presenting a Chinese family with hereditary MTC caused by the RET p.C620Y variant. This case series emphasize the importance of genetic detection of RET proto-oncogene for MTC patients, and bring out managements for individuals after detection of RET mutations. [ABSTRACT FROM AUTHOR]

Mercury pollution is a global problem and of particular concern in high emissions areas, such as China. We studied the migratory Kentish Plover, Charadrius alexandrinus, which breeds in coastal northern/central China and the inland Qinghai Lake, and the White-faced Plover C. dealbatus, a year-round resident of coastal southern China. We measured total mercury (THg) concentrations in feather and blood samples of breeding females. We expected low levels at the remote Qinghai Lake, but we found instead that feather THg concentrations were highest there (3.89 ± 1.53 [SD] μg/g DW [n = 34]; compared to 1.29 ± 0.61 μg/g of Kentish Plover elsewhere [n = 35] and 2.08 ± 1.45 μg/g for White-faced Plover [n = 56]), a result is consistent over 2 years. When including only coastal populations in the analysis, there were no differences in THg concentrations between the two species, although White-faced Plover had more variation. Feather THg concentrations for the coastal populations are similar to other studies on plovers and sandpipers globally, with most birds under the threshold of adverse effects (3 μg/g, an estimate that itself may be too low). Nevertheless, the Qinghai Kentish Plover population has mean feather concentrations above this threshold, indicating high exposure during the nonbreeding season, and some individuals have extreme values (e.g., a bird with a blood level of 7.63 μg/g DW from Zhanjiang, south China), so further research and monitoring are needed. [ABSTRACT FROM AUTHOR]

Context: Coptidis rhizome (CR), also known as Huanglian in Chinese, is the rhizome of Coptis chinensis Franch., C. deltoidea C.Y. Cheng et Hsiao, or C. teeta Wall (Ranunculaceae). It has been widely used to treat bacillary dysentery, diabetes, pertussis, sore throat, aphtha, and eczema in China. Objectives: The present paper reviews the latest advances of CR, focusing on the botany, phytochemistry, traditional usages, pharmacokinetics, pharmacology and toxicology of CR and its future perspectives. Methods: Studies from 1985 to 2018 were reviewed from books; PhD. and MSc. dissertations; the state and local drug standards; PubMed; CNKI; Scopus; the Web of Science; and Google Scholar using the keywords Coptis, Coptidis Rhizoma, Huanglian, and goldthread. Results: Currently, 128 chemical constituents have been isolated and identified from CR. Alkaloids are the characteristic components, together with organic acids, coumarins, phenylpropanoids and quinones. The extracts/compounds isolated from CR cover a wide pharmacological spectrum, including antibacterial, antivirus, antifungal, antidiabetic, anticancer and cardioprotective effects. Berberine is the most important active constituent and the primary toxic component of CR. Conclusions: As an important herbal medicine in Chinese medicine, CR has the potential to treat various diseases. However, further research should be undertaken to investigate the clinical effects, toxic constituents, target organs and pharmacokinetics, and to establish criteria for quality control, for CR and its related medications. In addition, the active constituents, other than alkaloids, in both raw and processed products of CR should be investigated. [ABSTRACT FROM AUTHOR]

Diabetes mellitus, especially type 2 diabetes mellitus (T2DM), has become a significant public health burden. Rhizoma coptidis (RC), known as Huang Lian , is widely used for treating diabetes in China. The bioactive compounds of RC, especially alkaloids, have the potential to suppress T2DM-induced lesions, including diabetic vascular dysfunction, diabetic heart disease, diabetic hyperlipidemia, diabetic nephropathy, diabetic encephalopathy, diabetic osteopathy, diabetic enteropathy, and diabetic retinopathy. This review summarizes the effects of RC and its bioactive compounds on T2DM and T2DM complications. Less research has been conducted on non-alkaloid fractions of RC, which may exert synergistic action with alkaloids. Moreover, we summarized the pharmacokinetic properties and structure-activity relationships of RC on T2DM with reference to extant literature and showed clearly that RC has potential therapeutic effect on T2DM. [ABSTRACT FROM AUTHOR]

Gastric cancer is common in China. At present, early detection with prompt resection of early gastric carcinoma (EGC) is crucial for improving patient's survival. Because of high heterogeneity of EGC in Chinese patients we reviewed recent clinicopathological and molecular evidence and proposed a grouping EGC in three subgroups according to their location for appropriate management. In group 1 (cardia), most patients with EGC in this small location were elderly men. The tumors originated in the cardiac mucosa with a high proportion of cases with slightly elevated gross patterns and intestinal adenocarcinoma histology with moderate to well differentiation. Poorly cohesive carcinoma was infrequent. As the risk for lymph node metastasis in this kind of tumor was significantly lower than that in the distal stomach, endoscopic therapy is preferred. Group 2 (fundus‐corpus), many patients with EGC in this large location were young women. The EGCs originated in the oxyntic mucosa with pure and mixed poorly cohesive carcinomas that are more commonly present in this area than in any other. Most tumors were poorly differentiated with a high risk for lymph node metastasis. Thus, endoscopic therapy may be appropriate for intramucosal, but not for submucosal, carcinoma. Group 3 (antrum‐pylorus). EGC tumors arose from the antral mucosa, primarily because of Helicobacter pylori infection, following the Correa gastric cancer tumorigenetic pathway. Erosive and ulcerated gross patterns were most frequently observed. While most EGCs in this location were mainly intestinal adenocarcinomas, poorly differentiated EGCs were substantial in number. Because the risk of lymph node metastasis remains to be illustrated, clinical management requires an individualized approach. This preliminary observation requires verification in large nationwide multicenter studies. [ABSTRACT FROM AUTHOR]

We collected multi‐locus data to test whether hybridization has occurred between a critically endangered waterbird, the Chinese Crested Tern Thalasseus bernsteini, and the Greater Crested Tern Thalasseus bergii. Phylogenetic analysis shows these two tern species are sister species, having diverged < 1 million years ago. Our findings suggest a grave threat to the survival of the Chinese Crested Tern, and illustrate the need for conservation managers to monitor further hybridization of this endangered tern species. [ABSTRACT FROM AUTHOR]

Antecedent anomalies of sea surface temperature and atmospheric circulation are important signals for making long-term streamflow forecasts. In this study, four groups of ocean-atmospheric indices, i.e, El Niño Southern Oscillation (ENSO), the Northern Hemisphere atmospheric circulation, the Southern Hemisphere atmospheric circulation (SAC), and the Western Pacific and Indian Ocean SST (WPI), are evaluated for forecasting summer streamflow of the Yangtze River. The gradient boosting regression tree (GBRT) is used to forecast streamflow based on each group of indices. The score based on receiver operating characteristics (ROC) curves, i.e., area under the ROC curve (AUC), is used to evaluate skills of models for identifying the high category and the low category of summer streamflow. It is found that the ENSO group and the SAC group show higher AUC values. Furthermore, both AUC values of GBRT models and individual indices show that the low flow years are easier to be identified than the high flow years. The result of this study highlights the skill from the Southern Hemisphere circulation systems for forecasting summer streamflow of the Yangtze River. Results of relative influences of predictors in GBRT models and AUC of individual indices indicate some key ocean-atmospheric indices, such as the Multivariate ENSO Index and the 500-hPa height of the east of Australia. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore independent associations between serum uric acid and hypoglycaemia, and whether mildly increased serum uric acid exacerbated the association between mild decline in estimated glomerular filtration rate (eGFR) and hypoglycaemia.Methods: A cross-sectional survey of 6713 inpatients with type 2 diabetes and eGFR ≥60 mL/min/1.73 m2 and admitted to 81 tertiary care hospitals in China was conducted. Self-reported asymptotic hypoglycaemia with plasma glucose ≤3.9 mmol/L, hypoglycaemia episodes with symptoms in 1 month or hypoglycaemia that needed assistance from other people in 3 months before hospitalization was used to define hypoglycaemia. Binary logistic regression was used to estimate odds ratios of serum uric acid for hypoglycaemia. Three measures, that is, relative excess risk due to interaction (RERI), attributable proportion due to interaction and synergy index (S) were used to estimate the effect of mildly decreased eGFR on the association of serum uric acid with hypoglycaemia.Results: Serum uric acid was associated with hypoglycaemia in an ordinal manner (P for trend <0.01) with an odds ratio of top quartile versus the lowest quartile up to 3.03 (95% confidence interval: 2.13-4.32). The odds ratio of serum uric acid levels ≥ versus <283 µmol/L (i.e. the median) was 1.98 (95% confidence interval:1.58-2.48). Serum uric acid levels ≥ versus <283 µmol/L greatly enhanced the association between mild decline in eGFR (eGFR < 90 mL/min/1.73 m2 ) and hypoglycaemia from 0.94 (0.36-2.43) to 3.90 (2.55-5.95), with a significant additive interaction (P < 0.05 for RERI, AP and S).Conclusions: Mildly increased serum uric acid was associated with increased risk of hypoglycaemia and enhanced the association between mildly decreased eGFR and hypoglycaemia in type 2 diabetes. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Differences in pathologic diagnosis between endoscopic forceps biopsy (EFB) and endoscopic submucosal dissection (ESD) for gastric intraepithelial neoplasia (GIN) and early gastric carcinoma (EGC) in Chinese patients remain unknown. The aim of the study was to investigate risk factors for under-diagnosed pathology in initial EFB, compared to final ESD. We reviewed endoscopic and histopathologic findings for tumor location, size, macroscopic pattern, nodularity, erythema, erosion, GIN (low and high grade), and EGC diagnosed with the WHO criteria. Differences in those features between EFB and ESD were compared and risk factors for under-diagnosis by EFB were analyzed. Although concordant in most (74.9 %) cases between EFBs and ESDs, pathological diagnoses in 57 (25.1 %) cases were upgraded in ESDs. Compared to the concordant group, the lesion size ≥2 cm, and depressed and excavated patterns were significantly more frequent in the upgraded group. Further multivariate regression analysis demonstrated the depressed pattern and lesion size ≥2 cm as independent risk factors for upgraded pathology with the odds ratio of 5.778 (95 % confidence interval 2.893-11.542) and 2.535 (95 % confidence interval 1.257-5.111), respectively. Lesion size ≥2.0 cm and the depressed pattern at initial EFB were independent risk factors for pathologic upgrade to advanced diseases in ESD. Therefore, these endoscopic characteristics should be considered together with the initial EFB diagnosis to guide the optimal clinical management of patients with GIN and EGC. [ABSTRACT FROM AUTHOR]

Microbial activity has been proposed to play an important role in the genesis of manganese (Mn) carbonate deposition in natural sediments, with microbial reduction of Mn(IV) oxides as a crucial factor that enhances the saturation state of Mn carbonates in pore waters. Recently, the nucleation of Mn carbonates on cellular templates has been suggested to represent a further microbial control. However, microstructural evidence for this model remains tentative and the Mn carbonate nucleation pathway is still unconstrained. Here we report petrographic and in-situ chemistry that supports the direct role(s) of microbes in the formation of Mn carbonates in the giant Malkansu Mn metallogenic belt at West Kunlun, Northwest China. The Mn carbonate ores exhibit negative δ13C values (−10.2 to −12.7‰) that indicate the microbial reduction of Mn oxide. Microscopic data show that the Mn carbonates exhibit spheroidal rod and dumbbell-like shaped morphologies with a well-defined core-shell structure. These carbonates are intimately associated with net-like organic matter. An incubation experiment was also carried out showing that biogenic Mn carbonate minerals share a strikingly similar crystal form with the natural Mn ore samples. Together, these results provide further evidence for a dual role of microbes in Mn‑carbonate ore formation: Mn(II) and carbonate produced by the microbial reduction of Mn(IV) oxides, and the nucleation of Mn carbonate minerals on cellular surfaces and/or organic matrices. Potentially, these Mn carbonates may have self-assembled to form rod- and dumbbell-like shaped morphologies, analogous to other carbonate systems. The unique core-shell structure observed herein also indicates that the formation of Mn‑carbonates mediated by microbes follows a heterogeneous nucleation pathway. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinicopathological features of columnar-lined esophagus ( CLE) in Chinese patients. Methods Among 182 consecutive resections of proximal gastric cancer with residual esophageal tissue, 114 were eligible for the study. The maximal lengths of CLE and superficial esophageal glands ( SEG) and the presence or absence of chronic inflammation ( CI), lymphoid follicles ( LF), Helicobacter pylori ( H. pylori) infection, intestinal metaplasia ( IM), pancreatic metaplasia ( PM) and dysplasia were analyzed and compared with those in the adjacent proximal gastric mucosa. Results SEG were present in 110 cases with a mean length of 5.4 mm (range 1-16 mm, 90% equal to or under 10 mm and 10% between 11-16 mm). These glands were associated with CI (95%), LF (85%), H. pylori infection (42%), IM (25%), PM (36%) and dysplasia (10%). CLE was found in 65% of the cases and was associated with SEG (mean length of 4.0 mm, range 1-13 mm, 97% within 10 mm and 3% between 11-13 mm). The frequencies of CI (97%), LF (86%), H. pylori infection (65%) and PM (46%) in CLE were similar to those in the proximal stomach ( CI 90%, LF 54%, H. pylori infection 58%, PM 39%). In contrast, the frequencies of IM (37%) and dysplasia (15%) in CLE were significantly lower than those in the proximal stomach (66% and 31%, respectively; P < 0.01). Conclusions CLE in Chinese patients was within 10 mm in length in 97% of cases, and with SEG and H. pylori infection-related changes similar to those in the proximal stomach. [ABSTRACT FROM AUTHOR]

Barrett's esophagus (BE)-related esophageal adenocarcinoma (EAC) has shown the fastest rise in incidence in Western countries; however, research data on BE-related diseases from China are inconclusive. We aimed to review and analyze the published results on these diseases in China. We searched PubMed and Chinese medical literature for key words: BE, EAC, Chinese and China. Relevant research papers along with the study results from our own groups were reviewed and analyzed. Using standardized criteria, columnar-lined esophagus (CLE) was found in as many as 29% of resection specimens in Chinese patients with proximal gastric cancer. However, BE with intestinal metaplasia was rare, ranging from 0.06% in the general population to <2% in referral patients. Risk factors included advancing age, hiatal hernia and probably gastroesophageal reflux disease and tobacco or alcohol abuse, but not male gender or obesity. At endoscopy, most CLE/BE were <2 cm in length, and appeared tongue-like and island-like. The long-segment BE was rare, especially in women. Population-based studies conducted in Taiwan and Hong Kong SAR, China showed that EAC was not only rare but also stable or had decreased in incidence over the past decade. By histopathology, EAC accounted for only 1% of all distal esophageal cancers and almost all gastroesophageal junction (GEJ) cancers were centered in the proximal stomach. BE-related diseases, except for CLE, are rare in China. The clinical significance and malignant potential of CLE in the Chinese population remain elusive. Further investigation on these diseases is in progress. [ABSTRACT FROM AUTHOR]

To standardize the diagnosis and management of Barrett's esophagus (BE) in China, the Chinese Society of Gastroenterology convened the Second National Conference on BE in June 2011 in Chongqing, China. After intense discussion among experts in this field and an extensive review of the literature, a revised consensus on the diagnosis and management of BE was generated. [ABSTRACT FROM AUTHOR]

Invasive fungal infections (IFIs) have become a major cause of morbidity and mortality among people with acquired immune deficiency syndrome (AIDS), however, little is known about the clinical features and prognosis of IFI in AIDS in China. This study aimed to characterise the clinical features and prognosis of IFI in AIDS patients in China. We retrospectively reviewed the records of all HIV-infected patients at a Chinese university hospital between December 2004 and May 2006. We identified 35 patients with IFI. IFIs included thrush, oesophageal candidiasis, fungal pneumonia, cryptococcosis, penicilliosis and fungaemia, 44.4% of IFIs occurred in the digestive tract, 71.8% of IFIs occurred in patients with CD4+T-lymphocyte counts <100 cells mm−3. Candida albicans accounted for 57.4% of fungal pathogens isolated. All the patients received both antiretroviral and antifungal therapy; 27 patients were cured and eight died. IFI is one of the most common opportunistic infections in AIDS patients in China. IFIs mainly occur in patients with low CD4+T-lymphocyte counts. The majority of IFIs occur in the digestive tract. The most common pathogen causing IFI is C. albicans. The mortality rate remains high although antiretroviral therapy and many newer antifungals are available in China. [ABSTRACT FROM AUTHOR]

The western Pacific subtropical high (WPSH) is one of the key systems affecting the summer rainfall over the Yangtze River Valley in China. In this study, the forecasting capacity of the WPSH for summer rainfall and streamflow is evaluated based on the WPSH index (WPSHI) derived from the NCEP/NCAR reanalysis dataset. It has been found that WPSHI can identify extreme flood years with a higher skill than normal wet years. Specifically, exceedance probability forecasting based on WPSHI has higher skills for higher thresholds of rainfall. For streamflow, adding WPSHI as a predictor only enhances the skill for higher thresholds of streamflow relative to models based on antecedent streamflow. Under the same framework, performances of two postprocessing approaches for dynamical forecasts, i.e., the model output statistics (MOS) approach and the reanalysis-based (RAN) approach are compared. Hindcasts from Climate Forecast System version 2 from the National Center for Environmental Prediction (CFSv2) are used to calculate WPSHI, which is used as the predictor for rainfall and streamflow. The result shows that the RAN approach performs better than the MOS approach. This study emphasizes the fact that the forecasting skill of exceedance probability would largely depend on the selected threshold of the predictand, and this fact should be noticed in future studies in the long-term forecasting field. [ABSTRACT FROM AUTHOR]

Background: The allocation of resources between offspring size and number is a central question of life-history theory. Although several studies have tested the existence of this trade-off, few studies have investigated how environmental variation influences the allocation of resources to offspring size and offspring number. Additionally, the relationship between population dynamics and the offspring size and number allocation is far less understood. Methods: We investigate whether resource allocation between egg size and clutch size is influenced by the ambient temperature and whether it may be related to apparent nest survival rate. We measured 1548 eggs from 541 nests of two closely related shorebird species, the Kentish Plover (Charadrius alexandrinus) and the White-faced Plover (C. dealbatus) in China, in four populations that exhibit contrasting ambient environments. We weighed females, monitored nest survival, and calculated the variance of ambient temperature. Results: Although we found that egg size and clutch size were all different between the four breeding populations, the reproductive investment (i.e. total clutch volume) was similar between populations. We also found that populations with a high survival rate had relatively larger eggs and a smaller clutch than populations with a low nest survival rate. The latter result is in line with a conservative/diversified bet-hedging strategy. Conclusions: Our findings suggest that plovers may increasing fitness by investing fewer, larger or many, small according local nest survival rate to make a similar investment in reproduction, and thereby may have an impact on population demography. [ABSTRACT FROM AUTHOR]

Human gut microbiome is a promising target for managing type 2 diabetes (T2D). Measures altering gut microbiota like oral intake of probiotics or berberine (BBR), a bacteriostatic agent, merit metabolic homoeostasis. We hence conducted a randomized, double-blind, placebo-controlled trial with newly diagnosed T2D patients from 20 centres in China. Four-hundred-nine eligible participants were enroled, randomly assigned (1:1:1:1) and completed a 12-week treatment of either BBR-alone, probiotics+BBR, probiotics-alone, or placebo, after a one-week run-in of gentamycin pretreatment. The changes in glycated haemoglobin, as the primary outcome, in the probiotics+BBR (least-squares mean [95% CI], −1.04[−1.19, −0.89]%) and BBR-alone group (−0.99[−1.16, −0.83]%) were significantly greater than that in the placebo and probiotics-alone groups (−0.59[−0.75, −0.44]%, −0.53[−0.68, −0.37]%, P < 0.001). BBR treatment induced more gastrointestinal side effects. Further metagenomics and metabolomic studies found that the hypoglycaemic effect of BBR is mediated by the inhibition of DCA biotransformation by Ruminococcus bromii. Therefore, our study reports a human microbial related mechanism underlying the antidiabetic effect of BBR on T2D. (Clinicaltrial.gov Identifier: NCT02861261). The gut microbiome affects systemic metabolism and is a therapeutic target for type 2 diabetes. Here the authors demonstrate in a randomized controlled trial that effects of berberine, a plant alkaloid known to lower blood glucose, may be explained by the inhibition of Ruminococcus bromii mediated biotransformation of the bile acid deoxycholic acid. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article about the oration of neurologist Kurupath Radhakrishnan on epilepsy care in developing countries in a 2010 issue.

In coastal areas where many highly developed metropolis and city agglomeration are located, high ozone (O 3) concentrations are one of the most severe environmental problems, which is gravely impacted by the sea-land breeze (SLB) circulation. The complex terrain, such as coastal mountain, complicates SLB circulation and its impact on coastal O 3 pollution. Previous studies have shown that coastal mountain intensifies SLB circulation in various regions worldwide, such as the southern California coastal region, the Mediterranean coastal region, and the Beijing-Tianjin-Hebei region. However, the specific impacts of the underlying mechanism on coastal O 3 levels, along with a quantified contribution analysis, remain insufficiently explored. Here we present that the coastal mountain terrain in the Western Taiwan Strait of South China induces a three-dimensional O 3 transport involving SLB circulation through integrating observational data from 2015 to 2022 and employing WRF-Chem modeling, specifically focusing on the thermally driven sea breeze during the day combined with the up-slope flow generated by the coastal mountain. This flow carries O 3 -rich air mass, which are caused by both photochemical reactions and cross-boundary transport originating from land and offshore sources. As the air moves inland and up the mountainside, it ultimately forming a layer of high-level O 3 aloft. O 3 trapped in the layer acts as a reservoir of elevated O 3 for the coastal plain and aggravates O 3 pollution on the following day via vertical mixing by over 40 μg m−3 h−1. Based on the sensitivity simulation, this work quantifies that the coastal mountain contributes 23.4 % of surface O 3 concentrations increase in the coastal urban area. This recirculated transport of O 3 has important implications for understanding meteorological drivers on atmospheric environment in complex terrain. • The mountain-plain/urban-sea terrain induces a recirculated ozone transport involving SLB circulation. • The recirculated transport mechanism aggravates O 3 pollution over the mountainous coastal region by increasing vertical mixing contribution. • The coastal mountain contributes 23.4 % of surface O 3 concentrations increase in the coastal urban area. [ABSTRACT FROM AUTHOR]

The Ediacaran period witnessed events that were of significance to the evolution of Earth's environment and early life, especially the Neoproterozoic Oxygenation Event during the Shuram Event (ca. 570–562 Ma) that was followed by the rise of animal life. However, the nature of the climate change that followed the Shuram Event in South China remains unclear. Black shale-hosted Mn‑carbonate deposits have the potential to reveal valuable information about paleo-seawater conditions and paleoclimate. This paper presents results of an investigation of the unique Ediacaran mudstone succession of South China, especially black shale-hosted Mn‑carbonate deposits, and offers a new perspective of the interconnected nature of paleoclimate and Ediacaran deposits. Relying on detailed petrological, sedimentological, and geochemical data, we posit that Ediacaran Mn‑carbonates accumulated in a semi-enclosed basin that experienced oscillating water column redox conditions and enhanced primary productivity. Chemical index of alteration (CIA) values, Rb/Sr ratios, and δ13C − δ15N stratigraphy of the analyzed deposits provide evidence of episodic warming during an otherwise protracted cooling trend following the Shuram Event (ca. 562–551 Ma). This study highlights the significant utility of black shale-hosted Mn‑carbonate strata in reconstructing Earth's paleoclimate during transitions. • New chemostratigraphic data of the Late Ediacaran in northern Yangtze margin. • Genesis of the late Ediacaran black shale-hosted Mn-carbonates in South China. • Climate fluctuation events during the Late Ediacaran in South China. • Climate-controlled "episodic ventilation" model of the black shale-hosted Mn-deposit. [ABSTRACT FROM AUTHOR]

• Wulonggou porphyries include granodiorite and coeval quartz diorite. • Post-collisional magmas derived from subducted slab and overlying sediments. • Lower to upper crustal magmatic differentiation process demonstrated. • Sulfide saturation and subsequent volatile exsolution at the upper crust are crucial. Major controls on the generation of ore-forming magmas for porphyry Cu systems remain controversial. This study provides a comprehensive dataset for the Wulonggou porphyries, which host intrusion-related gold deposits without any porphyry-skarn Cu mineralization, in the eastern Kunlun Orogen to investigate the influence of magmatic sources and differentiation processes on ore-forming magmas. The Wulonggou porphyries have a parental magma of basaltic andesite in composition derived from the oceanic crust in a post-collisional setting, which supplied sufficient Cu to the transcrustal magma plumbing system. The first-type amphibole crystallized after spinel, olivine and clinopyroxene at the lower crust. Spinel crystallization resulted in a decreased oxygen fugacity responsible for the formation of monosulfide solid solution that locked some Cu at the lower crust. At the upper crust, crystallization of calcic plagioclase cores and clinopyroxene was followed by magnetite, biotite, the second-type amphibole, and the mantles of normally zoned plagioclase. Magnetite and sulfide inclusions in the second-, third-type amphiboles and in patchy zoned plagioclase indicate reduced oxygen fugacities as well as the magnetite crystallization and sulfide saturation. Volatile exsolution was suggested by Cl and F variations in the second-type amphibole. The copper contents of corresponding melts calculated from amphibole phenocrysts are similar to those of normal arc magmas. Copper-rich sulfide saturation and subsequent volatile exsolution at the upper crust favor Cu-Au mineralization whereas the countryrocks and structures prefer intrusion-related gold deposits. Upper crustal magmatic differentiation processes are important for the generation of ore-forming magmas in post-collisional and subduction settings where a thick crust exists. [ABSTRACT FROM AUTHOR]

In this study, we first evaluated a satellite-based precipitation product (3B42V7) using gauge observations and then investigated its utility in supporting reservoir operation and water resources management in Hanjiang basin from January 1998 to December 2013. Direct comparison of 3B42V7 with gauge observations shows that it can well capture the spatial and temporal characteristics of precipitation over the study basin. However, the 3B42V7 estimates generally show slight underestimation of precipitation, especially for extreme precipitation events, which need be considered in the future algorithm development. Next, we conducted the long-term (2008–2013) hydrologic evaluation of the 3B42V7 product using a calibrated monthly hydrologic model. The results show that the performance of the monthly hydrologic model driven by 3B42V7 is compatible to the results driven by gauge-based simulations according to high values of Nash-Sutcliffe coefficients (0.83 and 0.66 for observation-driven and 3B47V7 driven simulations, respectively) and small values of biases (−8.16% and −3.98%). We further evaluated the applicability of 3B42V7 in reservoir operation through a set of operation experiments, in which modeled inflow series were used to make decisions. The results indicate that reservoir operations based on modeled streamflow using the 3B42V7 estimates perform well in water allocation decision-making and strongly agree with actual inflow based operations. Despite that 3B42V7 tends to slightly underestimate precipitation, the resultant operations do not impact the functions and benefits of reservoir operation much. This suggests that the 3B42V7 precipitation estimates are valuable and useful for monthly streamflow simulation and long-term reservoir operation in Hanjiang basin. This study provides a new insight on the evaluation and utility of the remote sensing based precipitation estimates. [ABSTRACT FROM AUTHOR]

Abstract: Experiments were carried out to test the viability of growing Pleurotus geesteranus on media containing varying amounts of crushed water hyacinth slices, which were soaked in pig farm biogas fluid and dried. The water hyacinth material was utilized to substitute sawdust in the media for mushroom cultivation. Mushroom fruiting bodies harvested were evaluated for yield, amino acid and heavy metal contents. Among the eight treatment groups, the greatest yield and highest amino acid content in the mushrooms were obtained when the proportions of water hyacinth and sawdust in the medium were equal. The concentrations of heavy metals, Hg, Pb and Cd, in most of the present mushroom samples did not exceed the maximum allowed levels according to the limits set forth by the food hygienic and safety regulations for edible mushrooms in China. The proposed waste utilization of water hyacinth could conceivably benefit the environment in various aspects including conservation of forest by reducing the demand on natural woods for mushroom production. [Copyright &y& Elsevier]

Abstract: Background: In recent years there has been an increase in adult measles cases in Shanghai, and an outbreak occurred in 2005. Although there have been many studies analyzing the genotype of measles virus from pediatric patients in various parts of China, there is little information on the clinical findings and genetic makeup of adult measles. Objectives: Clinical information and phylogenetic analysis of adult measles infection in Shanghai. Study design: Blood, urine, throat swabs, and clinical information were collected from adult measles patients reporting to three major hospitals in Shanghai. Measles virus was isolated in Vero-SLAM cells. The C-terminus of the N gene of the isolates was sequenced and analyzed with reference to sequences obtained from GenBank. Results: More than half of the patients developed severe clinical symptoms. None of the patients knew their measles vaccination history. All measles virus isolates had the same amino acid substitutions as the two standard H1a measles strains at position 484 and were classified as H1a genotype and could be further divided into three small clusters. Conclusions: The genotype of the predominant measles virus causing disease in adults in Shanghai is H1a. [Copyright &y& Elsevier]

We modified the Rothamsted carbon model (RothC) to simulate soil carbon (C) dynamics indouble rice cropping systems in China by adding a parameter to account for the effect ofcarbon input amounts on the decomposition rate of soil organic carbon (SOC). Threelong-term experiments (28-31 years) were conducted under various amounts of C inputs anddifferent fertilizer types in double rice systems in southern China and were used for thecalibration and validation of the modified RothC model. The results showed that the previousRothC model, with a soil moisture modifying factor of 0.2 for the rice phase in summer and0.6 for the upland cropping phase in winter for paddy soils, could not adequately simulate theSOC dynamics of all treatments in double rice soils. In particular, the simulations wereworse with high C inputs, which produced a normalized root mean squared error(NRMSE) and model efficiency (EF) ranging from 18.0 to 53.5% and -95.20 to -1.42,respectively, for the treatments with C inputs ranging from 4.20 to 8.29 t C ha−1. We usedan inverse modelling approach to calibrate one site for an additional factor p andfound this factor was well described as a function of the amount of C input (p =0.146C2 + 0.697C + 0.175, R2=0.997). The modified version with the p functiongreatly improved the simulations, resulting in an NRMSE of 2.6 –15.3% and EF of-1.05 – 0.69 for the three sites. We concluded that this modified RothC model canbe used to estimate soil carbon dynamics in double rice cropping systems with alarge amount of organic carbon inputs, at least in Chinese paddy soils where theapplication of harvested crop residues and animal manure is commonly practiced. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the factors influencing pregnant women's participation in perinatal education and their demand for educational courses., Design: A cross-sectional study., Setting: Tertiary hospital in Suzhou, China, July-September 2022., Participants: Pregnant women from a general grade A tertiary hospital in Suzhou were recruited via online survey invitations during the specified period., Measures: A self-designed scale was used to evaluate pregnant women's demand for perinatal education. Multiple response sets were employed for the assessment of multiple-choice items and analyses included frequency and cross-tabulation. Logistic regression analysis was conducted to assess the factors influencing pregnant women's participation in perinatal education., Outcome: The primary outcome measured was the demand for perinatal education among pregnant women., Results: A majority (53.8%) of pregnant women expressed a preference for a mixed teaching mode combining online and offline formats. Logistic regression analysis showed that education level significantly influenced pregnant women's participation in online learning. Specifically, women with higher education levels were more likely to participate actively in online courses. Additionally, compared with those with first-born children, pregnant women with second-born children participated less actively in online learning. Pregnant women in their second and third trimesters showed greater engagement in online learning compared with those in their first trimester., Conclusions: These findings indicate that Chinese pregnant women's preferences for perinatal education are influenced by their educational background, pregnancy history and the mode of teaching employed. The variability in educational needs underscores the importance of regularly updating course content based on participant feedback., 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/aims: Hepatitis E virus (HEV)-triggered acute-on-chronic liver failure (ACLF) has unacceptably high short-term mortality. However, it is unclear whether the existing predictive scoring models are applicable to evaluate the prognosis of HEV-triggered ACLF., Methods: We screened datasets of patients with HEV-triggered ACLF from a regional tertiary hospital for infectious diseases in Shanghai, China, between January 2011 and January 2021. Clinical and laboratory parameters were recorded and compared to determine a variety of short-term mortality risk factors, which were used to develop and validate a new prognostic scoring model., Results: Out of 4952 HEV-infected patients, 817 patients with underlying chronic liver disease were enrolled in this study. Among these, 371 patients with HEV-triggered ACLF were identified and allocated to the training set (n = 254) and test set (n = 117). The analysis revealed that hepatic encephalopathy (HE), ascites, triacylglycerol and apolipoprotein A (apoA) were associated with 90-day mortality (P < 0.05). Based on these significant indicators, we designed and calculated a new prognostic score = 0.632 × (ascites: no, 1 point; mild to moderate, 2 points; severe, 3 points) + 0.865 × (HE: no, 1 point; grade 1-2, 2 points; grade 3-4, 3 points) - 0.413 × triacylglycerol (mmol/L) - 2.171 × apoA (g/L). Compared to four well-known prognostic models (MELD score, CTP score, CLIF-C OFs and CLIF-C ACLFs), the new scoring model is more accurate, with the highest auROCs of 0.878 and 0.896, respectively, to predict 28- and 90-day transplantation-free survival from HEV-triggered ACLF. When our model was compared to COSSH ACLF IIs, there was no significant difference. The test data also demonstrated good concordance., Conclusions: This study is one of the first to address the correlation between hepatitis E and serum lipids and provides a new simple and efficient prognostic scoring model for HEV-triggered ACLF., (© 2023. The Author(s).)

Background & Aims: Previous experimental studies demonstrated that either deficient or excessive trace elements, such as manganese (Mn), iron (Fe), copper (Cu) and selenium (Se), are detrimental to bone health. Epidemiologic evidence for the effect of the four trace elements on osteoporosis (OP) risk remains inadequate. This cross-sectional study aimed to examine their associations with the OP risk among Chinese adults., Methods: Concentrations of Mn, Fe, Cu, and Se were measured in plasma using an inductively coupled plasma mass spectrometer among 627 Chinese adults aged ≥ 50 years. Individual effect of the four elements on OP risk was analyzed by logistic regression and Bayesian Kernel Machine Regression (BKMR) models. The latter model was also adopted to examine the exposure-response relationships and joint effects of the four elements on OP risk., Results: The median Mn, Fe, Cu, and Se levels were 4.78, 1026.63, 904.55, and 105.39 μg/L, respectively, in all participants. Inverse associations of Fe and Se levels with OP risk were observed in the logistic regression model. BKMR analysis revealed a U-shape pattern for the Fe-OP association, and a reduced OP risk in response to co-exposure of the four elements above the 50th percentiles but an elevated one in response to that below the 50th percentiles. Sex discrepancy existed in the findings. No interactions were found for the four elements affecting OP risk., Conclusions: Co-exposure to Mn, Fe, Cu, and Se was associated with improved bone density, where Fe contributed most to the beneficial effect. Further studies are needed to verify these findings and explore the underlying biological mechanism., (Copyright © 2022 Elsevier GmbH. All rights reserved.)

Papillary early gastric carcinoma (EGC) is believed to have a low risk of lymph node metastasis (LNM) and thus can be resected endoscopically. We observed anecdotally that some papillary EGC tumors showed conspicuous high-grade dysplastic features, but the significance of these observations is unknown. In this bicenter study we investigated papillary EGCs that were divided into high-grade (n=96) and low-grade (n=118) groups among 1136 consecutive EGC radical resection cases. Concurrent 464 well-moderately differentiated tubular EGCs were served as the control group. Compared with low-grade papillary and well-moderately differentiated tubular EGCs, high-grade papillary EGC displayed significantly larger sizes (mean 2.51 cm), higher frequencies of the elevated macroscopic type (51%), lymphovascular invasion (LVI) (38.5%), and LNM (31.2%). Low-grade papillary EGCs exhibited a higher prevalence of the elevated macroscopic type, but not LVI nor LNM, compared with tubular EGC. Independent risk factors for LNM included high-grade histology, female sex, distal location, submucosal invasion, and LVI. The 5-year overall survival rate was significantly lower in high-grade (79.6%) papillary than in low-grade (88.9%) papillary or tubular (92.8%) EGCs, while no significant difference in prognosis was observed in the latter 2 groups. Age of 66 years or older and LNM were independent risk factors for overall survival. In conclusions, high-grade papillary EGC was associated with high frequencies of LVI, LNM, and poor prognosis, and thus unsuitable for endoscopic therapy, while low-grade papillary EGC showed clinicopathologic features and prognosis similar to well-moderately differentiated tubular EGC and may be treated endoscopically in appropriate clinical settings., Competing Interests: Conflicts of Interest and Source of Funding: Supported by a research grant from the Youth Talents Program of the Health Commission of the Changzhou City (QN201935 to Yuqing Cheng) and a research grant from the Recruited Foreign Talents Program of the Science and Technology Bureau of the Changzhou City (CQ20204036 to Yuqing Cheng) in China. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Context: Continuous glucose monitoring (CGM) overcomes the limitations of glycated hemoglobin (HbA1c)., Objective: This study aimed to investigate the relationship between CGM metrics and laboratory HbA1c in pregnant women with type 1 diabetes., Methods: An observational study enrolled pregnant women with type 1 diabetes who wore CGM devices during pregnancy and postpartum from 11 hospitals in China from January 2015 to June 2019. CGM data were collected to calculate time in range (TIR), time above range (TAR), time below range (TBR), and glycemic variability parameters. Relationships between the CGM metrics and HbA1c were explored. Linear and curvilinear regressions were conducted to investigate the best-fitting model to clarify the influence of HbA1c on the TIR-HbA1c relationship during pregnancy., Results: A total of 272 CGM data and corresponding HbA1c from 98 pregnant women with type 1 diabetes and their clinical characteristics were analyzed in this study. Mean HbA1c and TIR were 6.49 ± 1.29% and 76.16 ± 17.97% during pregnancy, respectively. HbA1c was moderately correlated with TIR3.5-7.8(R = -0.429, P = .001), mean glucose (R = 0.405, P = .001) and TAR7.8 (R = 0.435, P = .001), but was weakly correlated with TBR3.5 (R = 0.034, P = .001) during pregnancy. On average, a 1% (11 mmol/mol) decrease in HbA1c corresponded to an 8.5% increase in TIR3.5-7.8. During pregnancy, HbA1c of 6.0%, 6.5%, and 7.0% were equivalent to a TIR3.5-7.8 of 78%, 74%, and 69%, respectively., Conclusion: We found there was a moderate correlation between HbA1c and TIR3.5-7.8 during pregnancy. To achieve the HbA1c target of less than 6.0%, pregnant women with type 1 diabetes should strive for a TIR3.5-7.8 of greater than 78% (18 hours 43 minutes) during pregnancy., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society.)

The origins of 9 species of the Chinese medicinal materials in the 2015 edition of the Chinese pharmacopoeia(ChP) has revised in the 2020 edition of ChP. The revision is based on the investigation and textual research on the problems found after screening the original plants, animals or minerals of all the Chinese medicinal materials in the 2015 edition. Among them the Chinese names of Alismatis Rhizoma, Cassiae Semen, Coicis Semen, Corydalis Bungeanae Herba and Echinopsis Radix all do not match to the Latin scientific names, and also do not match the name of the actual medicinal origins. In addition, Alismatis Rhizoma has the omission of original plant. There is confusion about the Chinese name and the family name of the original insect of Cera Chinensis. The original mineral of Gypsum Fibrosum has the wrong group names. Alumstone and melanterite, the original mineral of Alumen and Melanteritum respectively, of which the group names are missing. To solve these problems, field survey and literature research were conducted on the medicinal materials and their origins. The source of these problems are explored. The correct origins and the Chinese names or Latin names are all determined according to the research results to the situation, in which the Chinese and Latin names of the original plants of the medicinal materials do not match. The correct family name and group name are obtained through textual research by taxonomy if the names are confused or mis-sing. The scientific evidence and correct results of revision in the 2020 edition of ChP are determined at last.

Objective: Accumulative evidence suggests that gut microbiota play an important role in bone remodeling and hence bone health maintenance. This study aimed to explore the association of gut microbiota with the risk of osteoporosis and to identify potential disease-related taxa, which may be promising targets in osteoporosis prevention and treatment in the future., Methods: Absolute quantification 16S ribosomal RNA gene sequencing was used to detect absolute and relative abundances of gut microbiota in 44 patients with osteoporosis and 64 controls. In combination with one of our previous studies, a total of 175 samples were involved in the relative abundance analysis., Results: Compared with the controls, the patients with osteoporosis had higher absolute and relative abundances of Bacteroidetes phylum, and Bacteroides and Eisenbergiella genera. The absolute abundances of Clostridium&#95;XlVa , Coprococcus , Lactobacillus , and Eggerthella genera increased, and that of the Veillonella genus decreased in the osteoporosis group. As for relative abundance, that of the Parabacteroides and Flavonifractor genera increased, whereas that of the Raoultella genus decreased in the osteoporosis group. Controlling for potential confounders, the associations of Clostridium&#95;XlVa , Coprococcus , and Veillonella genera with the risk of osteoporosis did not maintain significance. Ridge regression analysis suggested that Bacteroides is associated with reduced bone mineral density (BMD) and T-score at lumbar spines, and Anaerovorax is associated with increased BMD at the femoral neck. Functional predictions revealed that 10 Kyoto Encyclopedia of Genes and Genomes pathways were enriched in the osteoporosis group., Conclusions: Gut microbiota compositions may contribute to the risk of osteoporosis. Several specific taxa and functional pathways are identified to associate with reduced bone density, thus providing epidemiologic evidence for the potential role of aberrant gut microbiota in osteoporosis pathogenesis., 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 Wei, Li, Dai, Zhou, Cui, Zeng, Huang and Wang.)

The processing of Chinese herbal medicine is a form of pharmaceutical technology developed over thousands of years, in order to increase efficiency and decrease toxicity of herbs in traditional Chinese medicine (TCM). Herbal processing is essential for safe and effective application of TCM in clinical practice, as it alters the active chemical components and therefore the functions of herbal medicines. Alkaloid-rich herbal medicines in TCM are commonly processed by cleansing, cutting, processing by dry stir-frying, stir-frying with liquid adjuvants, and processing by water decoction. In addition, commonly used adjuvants for processing alkaloid-rich herbal medicines are river sand, wine, vinegar, brine, honey and herbal juice. For alkaloid-rich herbal medicines, the main chemical reactions that occur during processing include hydrolysis, oxidation, replacement, decomposition and condensation. This paper aimed to summarize the processing methods and mechanisms for alkaloid-rich Chinese herbal medicines, and provide much-needed theoretical support and scientific evidence for understanding those mechanisms and effects. Information on processing methods for alkaloid-rich herbal medicines was collected from classic books of herbal medicine, PhD and MSc dissertations, online scientific databases including PubMed, SciFinder, Scopus, Web of Science, Baidu Scholar and Google Scholar. This paper should help to advance our knowledge of the processing mechanisms and aid in the development of processing methods for alkaloid-rich Chinese herbal medicines., (Copyright © 2020 Shanghai Changhai Hospital. Published by Elsevier B.V. All rights reserved.)

Aim: The aim of this study was to investigate the predictive role of lymphocyte subsets and other laboratory measurements in patients with COVID-19., Methods: Electronic medical records of adult patients with confirmed diagnosis of COVID-19 from the Shanghai Public Health Clinical Center were reviewed retrospectively to obtain relevant data., Results: The mean age of patients was 40.98 ± 15.95 years, with 58% of the patients being males. The cutoff values at the intensive care unit (ICU) admission, mechanical ventilation, and mortality were CD4+ cells (267, 198, and 405), CD8+ cells (263, 203, and 182), and CD4+ /CD8+ cells (1.4, 1.8, and 1.4). The cutoffs below these values indicate the higher chances of disease progression. Higher CD4+ cell count led to lesser chances for ICU admission [odds ratio (OR) (95% confidence interval (CI): 0.994 (0.991, 0.997); p  = 0.0002] and mortality [OR (95% CI): 0.988 (0.979, 0.99); p  = 0.001], higher CD8+ count was an independent risk factor for ICU admission. T-cell count positively correlated with total lymphocyte count and platelets, while negatively correlated with D-dimer and lactate dehydrogenase (LDH). Among patients with non-severe COVID-19, median CD8+ T cell, CD4+ T cell, total lymphocyte count, and platelets were 570, 362, 1.45, and 211, respectively, while median values decreased to 149, 106, 0.64, and 172, respectively, in patients with severe COVID-19., Conclusion: Lower T lymphocyte subsets were significantly associated with higher admission to ICU, mechanical ventilation, and mortality among patients with COVID-19. A cutoff value of ICU admission, mechanical ventilation, and mortality below CD4+ cells (267, 198, and 405), CD8+ cells (263, 203, 182), and CD4+/CD8+ cells (1.4, 1.8, 1.4) may help identify patients at high risk of disease progression. The continuous evaluation of laboratory indices may help with dismal prognosis and prompt intervention to improve outcomes.

Purpose: The aim of this study was screening for single nucleotide polymorphisms (SNPs) associated with white matter hyperintensities (WMHs) in symptomatic intracranial atherosclerotic stenosis (sICAS) patients and exploring a possible connection in the genetic background between macrovascular disease and small vessel disease., Methods: There were 400 sICAS patients enrolled in the study. Fazekas scores were applied to WMH classification. Healthy controls were referred to 1,000 Genome Project and GeneSky company who provided 1,007 Chinese healthy controls. Fast target sequencing technology was used to select the SNPs of 102 genes related to the pathogenesis of sICAS in the sICAS patients., Results: The allele frequencies of 88 SNPs were significantly different between the sICAS group and the healthy controls (p < 0.05). The allele frequencies of 53 SNPs were significantly different between the sICAS patients with and without WMHs (p < 0.05). Further analysis found that matrix metalloproteinase 9 (MMP9) rs17576 was simultaneously related to sICAS and WMHs. The frequency of the rs17576 A allele was significantly lower in sICAS patients when compared to the normal controls (p = 0.03, OR [95% CI] = 0.75 [0.625-0.91]). Also, the frequency of the rs17576 genotypes was significantly different under codominant (p = 0.009), dominant (p = 0.014), and recessive (p= 0.023) models. The frequency of the rs17576 A allele was significantly higher in sICAS with WMH patients, compared to those without WMHs (p = 0.022, OR [95% CI] = 1.54 [1.06-2.22]); the frequency of the rs17576 genotypes was significantly different under codominant (p = 0.019) and recessive (p = 0.032) models. Logistic regression analysis showed that age, hypertension, and MMP9 rs17576 AA genotype were independent risk factors for sICAS with WMHs., Conclusion: MMP9 rs17576 may be simultaneously associated with the risk of sICAS and WMHs., (© 2020 S. Karger AG, Basel.)

Background: Novel coronavirus pneumonia (COVID-19) is prevalent around the world. We aimed to describe epidemiological features and clinical course in Shanghai. Methods: We retrospectively analysed 325 cases admitted at Shanghai Public Health Clinical Center, between January 20 and February 29, 2020. Results: 47.4% (154/325) had visited Wuhan within 2 weeks of illness onset. 57.2% occurred in 67 clusters; 40% were situated within 53 family clusters. 83.7% developed fever during the disease course. Median times from onset to first medical care, hospitalization and negative detection of nucleic acid by nasopharyngeal swab were 1, 4 and 8 days. Patients with mild disease using glucocorticoid tended to have longer viral shedding in blood and feces. At admission, 69.8% presented with lymphopenia and 38.8% had elevated D-dimers. Pneumonia was identified in 97.5% (314/322) of cases by chest CT scan. Severe-critical patients were 8% with a median time from onset to critical disease of 10.5 days. Half required oxygen therapy and 7.1% high-flow nasal oxygen. The case fatality rate was 0.92% with median time from onset to death of 16 days. Conclusion: COVID-19 cases in Shanghai were imported. Rapid identification, and effective control measures helped to contain the outbreak and prevent community transmission.

Background: Neurological symptoms are increasingly being noted among COVID-19 patients. Currently, there is little data on the mental health of neurological healthcare workers. The aim of this study was to identify the prevalence and influencing factors on anxiety and depression in neurological healthcare workers in Hunan Province, China during the early stage of the Coronavirus Disease 2019 (COVID-19) outbreak., Methods: An online cross-sectional study was conducted among neurological doctors and nurses in early February 2020 in Hunan Province. Symptoms of anxiety and depression were assessed by the Chinese version of the Self-Rating Anxiety Scale (SAS) (defined as a total score ≥ 50) and Self-Rating Depression Scale (SDS) (defined as a total score ≥ 53). The prevalences of probable anxiety and depression were compared between different groups, and multivariate logistic regression analysis was used to understand the independent influencing factors on anxiety and depression., Results: The prevalence of probable anxiety and depression in neurological nurses (20.3 and 30.2%, respectively) was higher than that in doctors (12.6 and 20.2%, respectively). Female healthcare workers (18.4%) had a higher proportion of anxiety than males (10.8%). Probable anxiety and depression were more prevalent among nurses, younger workers (≤ 40 years), and medical staff with junior titles. Logistic regression analysis showed that a shortage of protective equipment was independently associated with probable anxiety (OR = 1.980, 95% CI: 1.241-3.160, P = 0.004), while young age was a risk factor for probable depression (OR = 2.293, 95% CI: 1.137-4.623, P = 0.020) among neurological healthcare workers., Conclusions: Probable anxiety and depression were more prevalent among neurological nurses than doctors in Hunan Province. The shortage of protective equipment led to probable anxiety, and young age led to probable depression in healthcare workers in neurology departments, which merits attention during the battle against COVID-19.

Objectives: Mesenchymal stem cells (MSCs) are potentially ideal for type 2 diabetes treatment, owing to their multidirectional differentiation ability and immunomodulatory properties. Here we investigated whether the stem cells from human exfoliated deciduous teeth (SHED) in combination with hyperbaric oxygen (HBO) could treat type 2 diabetic rats, and explored the underlying mechanism., Methods: SD rats were used to generate a type 2 diabetes model, which received stem cell therapy, HBO therapy, or both together. Before and after treatment, body weight, blood glucose, and serum insulin, blood lipid, pro-inflammatory cytokines (tumor necrosis factor-alpha and interleukin-6), and urinary proteins were measured and compared. After 6 weeks, rats were sacrificed and their organs were subjected to hematoxylin and eosin staining and immunofluorescence staining for insulin and glucagon; apoptosis and proliferation were analyzed in islet cells. Structural changes in islets were observed under an electron microscope. Expression levels of Pdx1, Ngn3, and Pax4 mRNAs in the pancreas were assessed by real-time quantitative polymerase chain reaction (RT-qPCR)., Results: In comparison with diabetic mice, those treated with the combination or SHE therapy showed decreased blood glucose, insulin resistance, serum lipids, and pro-inflammatory cytokines and increased body weight and serum insulin. The morphology and structure of pancreatic islets improved, as evident from an increase in insulin-positive cells and a decrease in glucagon-positive cells. Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining of islet cells revealed the decreased apoptosis index, while Ki67 and proliferating cell nuclear antigen staining showed increased proliferation index. Pancreatic expression of Pdx1, Ngn3, and Pax4 was upregulated., Conclusion: SHED combined with HBO therapy was effective for treating type 2 diabetic rats. The underlying mechanism may involve SHED-mediated increase in the proliferation and trans-differentiation of islet β-cells and decrease in pro-inflammatory cytokines and apoptosis of islets.