Search

Background: People are exposed to metals in various ways during their daily lives. However, the association between metal exposure and gallstones remains unclear., Objectives: To investigate the relationship between serum elemental concentrations and the risk of gallstones., Methods: Participants (n = 4204) were drawn from the Henan Rural Cohort. Gallstone diagnosis was based on abdominal ultrasound reports during follow-up. Baseline serum elemental concentrations were measured using inductively coupled plasma mass spectrometry. The relationship between serum elemental levels and gallstones was evaluated using robust Poisson regression, restricted cubic spline (RCS), quantile g-computation (Qgcomp), grouped weighted quantile sum (GWQS) and Bayesian kernel machine regression (BKMR)., Results: 121 individuals were diagnosed with gallstone (incidence rate of 2.88 %). In robust Poisson regression, after adjusting for confounding factors, the highest quartile of arsenic concentration compared to the lowest quartile had a 1.90 times higher relative risk (RR) [95 % confidence interval (CI): 1.05, 3.44]. Conversely, the highest quartile of zinc concentration compared to the lowest quartile had a 0.50 times lower RR (95 % CI: 0.28, 0.89). RCS showed an approximately "S"-shaped nonlinear relationship between serum arsenic levels and gallstones, with increasing arsenic concentration leading to a higher risk of gallstones; however, the risk plateaued when arsenic concentration exceeded 0.62 μg/L. Both the Qgcomp and GWQS indicated that arsenic plays a significant role in increasing the risk of gallstones, whereas zinc plays a significant role in reducing the risk of gallstones. BKMR showed that raising arsenic exposure from the 25th to the 75th percentile increased the risk of gallstones, while raising serum zinc concentration reduced it., Conclusions: Higher serum arsenic concentration increases the risk of gallstones, whereas higher zinc concentration may reduce the risk. Effective prevention of gallstones may require further reduction of arsenic exposure and appropriate increases in zinc intake., Competing Interests: Declaration of competing interest All authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this study., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Xinglong buffalo, as an indigenous breed in Hainan province of China, possesses characteristics such as high humidity tolerance, disease resistance and high reproductive capacity. Combined with whole genome sequencing technology, comprehensive investigation can be undertaken to elucidate the genomic characteristics, functions and genetic variation of Xinglong buffalo population., Results: Xinglong buffalo has the highest genetic diversity, lowest runs of homozygosity average length, and fasted decay of linkage disequilibrium in our study population. Phylogenetic tree results revealed that Xinglong buffalo was gathered together with Fuzhong buffalo firstly. The population genetic structure analysis indicates that at K = 3, the Xinglong buffalo for the first time showed a distinct ancestral origin from other water buffalo. Furthermore, compared to different populations, candidate genes displaying significantly distinct patterns of single nucleotide polymorphisms (SNPs) (e.g., RYR2, COX15, PCDH9, DTWD2, FCRL5) distribution have been identified in the Xinglong buffalo., Conclusions: Based on the whole genome sequencing data, this study identified a substantial number of SNPs and assessed the genetic diversity and selection signatures within the Xinglong buffalo population. These results contribute to understanding the genomic characteristics of Xinglong buffalo and their genetic evolutionary status. However, the practical significance of these signatures for genetic enhancement still requires confirmation through additional samples and further experimental validation., (© 2024. The Author(s).)

Previous animal studies found beneficial effects of choline and betaine on maternal glucose metabolism during pregnancy, but few human studies explored the association between choline or betaine intake and incident gestational diabetes mellitus (GDM). We aimed to explore the correlation of dietary choline or betaine intake with GDM risk among Chinese pregnant women. A total of 168 pregnant women with GDM cases and 375 healthy controls were enrolled at the Seventh People's Hospital in Shanghai during their GDM screening at 24-28 gestational weeks. A validated semi-quantitative FFQ was used to estimate choline and betaine consumption through face-to-face interviews. An unconditional logistic regression model was adopted to examine OR and 95 % CI. Compared with the controls, those women with GDM incidence were likely to have higher pre-pregnancy BMI, be older, have more parities and have higher plasma TAG and lower plasma HDL-cholesterol. No significant correlation was observed between the consumption of choline or betaine and incident GDM (adjusted OR (95 % CI), 0·77 (0·41, 1·43) for choline; 0·80 (0·42, 1·52) for betaine). However, there was a significant interaction between betaine intake and parity on the risk of GDM ( P for interaction = 0·01). Among those women with no parity history, there was a significantly inverse correlation between betaine intake and GDM risk (adjusted OR (95 % CI), 0·25 (0·06, 0·81)). These findings indicated that higher dietary betaine intake during pregnancy might be considered a protective factor for GDM among Chinese women with no parity history.

Background: Fewer studies have examined the relationship between air pollution and depressive or anxiety symptoms in rural residents. Social economic status (SES), as an important indicator of the current state of socioeconomic development, we know little about how it modifies the relationship between air pollution and symptoms of depression or anxiety., Methods: The patient health questionnaire (PHQ-2) and generalized anxiety scale (GAD-2) were used to learn about the prevalence of depressive and anxiety symptoms, the social economic status of the participants was categorized into two levels: lower and higher, and a binary logistic regression model was used to analyze the relationship between air pollution and residents' symptoms of depression or anxiety., Results: A total of 10,670 adults were enrolled in this study, of which a total of 1292 participants suffered from depressive symptoms and 860 suffered from anxiety symptoms. Short-term exposure to PM 2.5 and O 3 , singly or in combination, may be associated with the onset of depression symptoms, and there was a significant interaction between SES and exposure to PM 2.5 or O 3 . Residents of areas with higher SES may have a lower risk of suffering from anxiety symptoms after O 3 exposure compared to participants living in lower SES., Limitations: The study was a cross-sectional study, which may have lowered the quality level of the evidence., Conclusions: Short-term PM 2.5 and O 3 exposure may be associated with an increased prevalence risk of depressive symptoms. Higher levels of SES may reduce the adverse effects of air pollution on depressive or anxiety symptoms., Competing Interests: Declaration of competing interest The authors declare that there are no conflict of interests., (Copyright © 2024. Published by Elsevier B.V.)

Background: Accumulating evidence suggests that exposure to air pollution acts as a potential trigger for neurological diseases (NDs), yet the current knowledge regarding the impact of ambient nitrogen dioxide (NO 2 ) on the patients with NDs remains limited. In this study, we conducted a time-series study to evaluate the association between short-term exposure to NO 2 and hospital visits for NDs in Xinxiang, China., Methods: An over-dispersed Poisson generalized additive model was used to analyze the association between ambient NO 2 concentrations and daily outpatient visits for NDs from January 1, 2015 to December 31, 2017. The model adjusted for meteorological factors, temporal trends, day of the week, and public holidays. The concentrations of air pollutants were collected from four air quality stations in Xinxiang., Results: A total of 38, 865 outpatient visits for NDs were retrieved during the study period. 86.5% of the patients were below the age of 65 years. It was revealed that a 10 µg/m 3 increase in NO 2 at lag 0 was associated with a significant rise of 1.50% (95% CI: 0.45-2.56%) in outpatient visits for NDs, which was stronger during the cold season. However, the overall results from stratified analyses did not reach statistical significance., Conclusions: Short-term exposure to NO 2 is associated with increased outpatient visits for NDs. These findings underscore the need for implementing mitigating measures to reduce the neurological health effects of air pollutants., (© 2024. The Author(s).)

Synthetic Biology, as an emerging discipline, has gained widespread attention and is developing rapidly, profoundly impacting the fields of life sciences and biotechnology. Concurrently, as emerging engineering education programs take shape, accelerated cultivation of multifaceted innovative talents represents a new mission and imperative for higher education in China. In the context of the flourishing development of Synthetic Biology, East China University of Science and Technology has established a curriculum cluster in Synthetic Biology, focusing on microbiological drug discovery and biomanufacturing. The teaching team initially reviewed the curriculum system related to Synthetic Biology and its upstream and downstream courses. Subsequently, they expanded the core courses in Synthetic Biology, creating a curriculum cluster that encompasses not only the theoretical foundations and cutting-edge technologies but also integrates with related disciplines. Moreover, the curriculum cluster leverages lectures from renowned domestic and international professors in the State Key Laboratory of Bioreactor Engineering, and harnesses the rich resources of the Program of Introducing Talents of Discipline to Universities (the "111 plan"), aiming to enhance students' innovation capabilities. With the support of this curriculum cluster and teaching team, undergraduate students actively participate in international Synthetic Biology competitions like international genetic engineering machine competition (iGEM), consistently achieving gold awards. Furthermore, many students have applied for patents and made contributions to research paper publications. This work stands as a valuable exemplar for cultivating multifaceted talents with exceptional innovative capabilities.

Background: The persistent destructive power of cancer-related fatigue (CRF) has been regarded as the biggest influencing factor affecting the postoperative physical and mental health of patients with cervical cancer. During this process, patients might also experience different feelings of disease-related psychological. Therefore, this study aimed to adopt mindfulness-based stress reduction (MBSR) to intervene in patients with cervical cancer, and conducted follow-up for 3 and 6 months to observe the effects of changes in CRF, uncertainty in illness, coping styles, sense of coherence (SOC), and perceived social support (PSS)., Methods: A randomized controlled trial was conducted in ShengJing Hospital of China Medical University. A total of 102 patients were selected, and 78 patients completed the whole process, including 40 in the experimental group and 38 in the control group. Data were collected according to Cancer Fatigue Scale, Medical Coping Modes Questionnaire, Multidimensional Scale of Perceived Social Support, and Sense of Coherence-13. The change trend and difference of the two groups of research data were compared by repeated measurement analysis of variance. Bonferroni test was used for multiple tests between groups., Results: The CRF, SOC, and coping styles of the MBSR group showed a decreasing trend (P < 0.001) at after MBSR, 3 months follow-up, and 6 months follow-up compared to the before MBSR. However, the uncertainty in illness of the MBSR group showed a decreasing trend (P < 0.001) at after MBSR compared to the before MBSR, and it rose in 3 months follow-up and 6 months follow-up., Conclusion: MBSR can effectively alleviate the fatigue of CRF after treatment, while improving their psychological environment. Medical workers can consider implementing online MBSR for patients with cervical cancer in their daily rehabilitation nursing, which is beneficial for their recovery., Trial Registration: China Clinical Trial Registration Center ChiCTR2000040122 (https//www.chictr.org.cn/). Registered on November 21, 2020., (© 2024. The Author(s).)

Background: This study aims to assess the associations of admission systolic blood pressure (SBP) level with spontaneous reperfusion (SR) and long-term prognosis in ST-elevation myocardial infarction (STEMI) patients., Methods: Data from 3809 STEMI patients who underwent primary percutaneous coronary intervention within 24 h, as recorded in the Chinese STEMI PPCI Registry (NCT04996901), were analyzed. The primary endpoint was SR, defined as thrombolysis in myocardial infarction grade 2-3 flow of IRA according to emergency angiography. The second endpoint was 2-year all-cause mortality. The association between admission BP and outcomes was evaluated using Logistic regression or Cox proportional hazards models with restricted cubic splines, adjusting for clinical characteristics., Results: Admission SBP rather than diastolic BP was associated with SR after adjustment. Notably, this relationship exhibits a nonlinear pattern. Below 120mmHg, There existed a significant positive correlation between admission SBP and the incidence of SR (adjusted OR per 10-mmHg decrease for SBP ≤ 120 mm Hg: 0.800; 95% CI: 0.706-0.907; p<0.001); whereas above 120mmHg, no further improvement in SR was observed (adjusted OR per 10-mmHg increase for SBP >120 mm Hg: 1.019; 95% CI: 0.958-1.084, p = 0.552). In the analysis of the endpoint event of mortality, patients admitted with SBP ranging from 121 to 150 mmHg exhibited the lowest mortality compared with those SBP ≤ 120mmHg (adjusted HR: 0.653; 95% CI: 0.495-0.862; p = 0.003). In addition, subgroups analysis with Killip class I-II showed SBP ≤ 120mmHg was still associated with increased risk of mortality., Conclusion: The present study revealed admission SBP above 120 mmHg was associated with higher SR,30-d and 2-y survival rate in STEMI patients. The admission SBP could be a marker to provide clinical assessment and treatment., Trial Registration: ClinicalTrials.gov (NCT04996901), 07/27/2021., (© 2024. The Author(s).)

Background: At present, preterm infants with respiratory distress syndrome (RDS) in China present higher mortality and morbidity rates than those in high-income countries. The aim of this nationwide survey was to assess the clinical management of RDS in China., Methods: A nationwide cross-sectional survey to assess adherence to RDS management recommendations was performed. One neonatologist per hospital was randomly selected. The primary outcome was the key care of RDS management., Results: Among the 394 participating hospitals, 88·3% were birthing centres. The number of doctors and nurses per bed were 0·27 and 0·72, respectively. Antenatal corticosteroids (any dose) were administered to 90% of the women at risk of preterm birth at < 34 weeks of gestation (90·0% inborn vs. 50·0% outborn, p < 0·001). The median fraction of inspired oxygen (FiO 2 ) for initial resuscitation was 0·30 for babies born at ≤ 32 weeks of gestation and 0·25 for those born at > 32 weeks. T-piece resuscitators were available in 77·8% of delivery rooms (DRs) (tertiary hospitals: 82·5% vs. secondary hospitals: 63·0%, p < 0·001). Surfactant was used in 51·6% of the DRs. Less invasive surfactant administration (LISA) was used in 49·7% of the hospitals (tertiary hospitals: 55·3% vs. secondary hospitals: 31·5%, p < 0·001). Primary non-invasive ventilation was initiated in approximately 80·0% of the patients. High-frequency oscillation ventilation was primarily reserved for rescue after conventional mechanical ventilation (MV) failure. Caffeine was routinely used during MV in 59·1% of the hospitals. Bedside lung ultrasonography was performed in 54·3% of the health facilities (tertiary hospitals: 61·6% vs. secondary hospitals: 30·4%, p < 0·001). Qualified breast milk banks and Family Integrated Care (FICare) were present in 30·2% and 63·7% of the hospitals, respectively., Conclusions: Significant disparities in resource availability and guidelines adherence were evident across hospitals. Future strategies should address DR facilities and medication access, technical training, staff allocation, and ancillary facility development for a better management of RDS patients in China., (© 2024. The Author(s).)

Aims: This investigation aims to elucidate the treatment status of advanced HR+/HER2- breast cancer patients in Hunan Province of Central Southern China from November 2021 to December 2022., Methods: Data from 301 patients with advanced HR+/HER2- breast cancer were collected from the breast cancer investigation project in Hunan under the guidance of the Chinese Society of Clinical Oncolfogy (CSCO). The data included the clinical characteristics of patients and the status of first-line and second-line rescue treatment., Results: First-line chemotherapy and endocrine therapy for mBC accounted for 40% (121/301) and 60% (180/301) of treatments, respectively. AI (21%), AI plus CDK4/6 inhibitor (28%), and fulvestrant (24%) or fulvestrant plus CDK4/6 inhibitor (18%) were the most common first-line endocrine therapies. Taxane-based chemotherapy was the most common first-line chemotherapy (59%). Second-line chemotherapy and endocrine therapy for mBC accounted for 43% (72/166) and 57% (94/166) of treatments, respectively. Fulvestrant (23%) or fulvestrant plus CDK4/6 inhibitor (29%) were the most common second-line endocrine therapies. The prevalences of AI and AI plus CDK4/6 inhibitor decreased to 19% and 11%, respectively. T (taxane)-based chemotherapy was still the most common chemotherapy regimen (46%). Third-line chemotherapy was more prevalent than endocrine therapy (57% vs. 41%). T (taxane)-based chemotherapy was still the most common chemotherapy regimen (46%). Fulvestrant plus CDK4/6 inhibitor was the most common endocrine therapy (33%). AI, AI plus CDK4/6 inhibitor, and fulvestrant accounted for 21%, 12% and 18% of third-line endocrine therapies, respectively., Conclusions: Compared to chemotherapy, endocrine therapy was a more favorable choice for first-line and second-line treatment for HR+/HER2- advanced breast cancer patients in Hunan Province., (© 2024. The Author(s).)

Background: Nosocomial infections with heavy disease burden are becoming a major threat to the health care system around the world. Through long-term, systematic, continuous data collection and analysis, Nosocomial infection surveillance (NIS) systems are constructed in each hospital; while these data are only used as real-time surveillance but fail to realize the prediction and early warning function. Study is to screen effective predictors from the routine NIS data, through integrating the multiple risk factors and Machine learning (ML) methods, and eventually realize the trend prediction and risk threshold of Incidence of Nosocomial infection (INI)., Methods: We selected two representative hospitals in southern and northern China, and collected NIS data from 2014 to 2021. Thirty-nine factors including hospital operation volume, nosocomial infection, antibacterial drug use and outdoor temperature data, etc. Five ML methods were used to fit the INI prediction model respectively, and to evaluate and compare their performance., Results: Compared with other models, Random Forest showed the best performance (5-fold AUC = 0.983) in both hospitals, followed by Support Vector Machine. Among all the factors, 12 indicators were significantly different between high-risk and low-risk groups for INI (P < 0.05). After screening the effective predictors through importance analysis, prediction model of the time trend was successfully constructed (R 2  = 0.473 and 0.780, BIC = -1.537 and -0.731)., Conclusions: The number of surgeries, antibiotics use density, critical disease rate and unreasonable prescription rate and other key indicators could be fitted to be the threshold predictions of INI and quantitative early warning., (© 2024. The Author(s).)

Effects of short-term exposure to ambient air pollution on systemic immunological and inflammatory biomarkers in rural population have not been adequately characterized. From May to July 2021, 5816 participants in rural villages of northern Henan Province, China, participated in this cross-sectional study. Blood biomarkers of systemic inflammation were determined including peripheral white blood cells (WBC), eosinophils (EOS), basophils (BAS), monocytes (MON), lymphocytes (LYM), neutrophils (NEU), neutrophil-lymphocyte ratio (NLR), and serum high-sensitivity C-reactive protein (hs-CRP). The concentrations of ambient fine particulate matter (PM 2.5 ), PM 10 , nitrogen dioxide (NO 2 ), carbon monoxide (CO), and ozone (O 3 ) were assessed up to 7 days prior to the blood draw. A generalized linear model was used to analyze the associations between air pollution exposure and the above-mentioned blood biomarkers. Significantly positive associations were revealed between PM 2.5 , CO and WBC; CO, O 3 and LYM; PM 2.5 , PM 10 , SO 2 , CO and NEU; PM 2.5 , PM 10, SO 2 , CO and NLR; PM 2.5 , PM 10 , SO 2 , NO 2 , CO, O 3 and hs-CRP. Meanwhile, negative associations were found between SO 2 and WBC; PM 2.5 , PM 10 , NO 2 , CO, or O 3 and EOS; PM 2.5 , SO 2 , or CO and BAS; SO 2 , NO 2 or O 3 and MON; PM 2.5 , PM 10 , SO 2 , or NO 2 and LYM. Moreover, men, individuals with normal body mass index (BMI), current smokers, and those older than 60 years were found vulnerable to air pollution effects. Taken together, short-term exposure to air pollution was associated with systemic inflammatory responses, providing insight into the potential mechanisms for air pollution-induced detrimental systemic effects in rural residents., (© 2024. The Author(s).)

The causal relationship between Packed red blood cell (RBC) transfusion and necrotizing enterocolitis (NEC) remains uncertain. This study aims to provide an exploration of transfusion and NEC in very preterm infants. Using data from the Chinese Neonatal Network cohort study between 2019 and 2021, the analysis focused on very preterm infants (with a birth weight of < 1500 g or a gestational age of < 32 weeks) who developed NEC after receiving transfusions. The time interval between the prior transfusion and NEC was analyzed. An uneven distribution of the time interval implies an association of transfusion and NEC. Additionally, multivariable logistic analysis was conducted to detect the prognosis of defined transfusion-associated NEC(TANEC). Of the 16,494 infants received RBC transfusions, NEC was noted in 1281 (7.7%) cases, including 409 occurred after transfusion. Notably, 36.4% (149/409) of post-transfusion NEC occurred within 2 days after transfusion. The time interval distribution showed a non-normal pattern (Shapiro-Wilk test, W = 0.513, P < 0.001), indicating a possible link between transfusion and NEC. TANEC was defined as NEC occurred within 2 days after transfusion. Infants with TANEC had a higher incidence of death (adjusted OR 1.69; 95% CI 1.08 to 2.64), severe bronchopulmonary dysplasia (adjusted OR 2.03; 95% CI 1.41 to 2.91) and late-onset sepsis (adjusted OR 2.06; 95% CI 1.37 to 3.09) compared with infants without NEC after transfusion. Unevenly high number of NEC cases after RBC transfusions implies transfusion is associated with NEC. TANEC is associated with a poor prognosis. Further research is warranted to enhance our understanding of TANEC., (© 2024. The Author(s).)

The presence of heavy metals in soil has gained considerable attention due to their potential risks to ecosystems and human health. In this study, a thorough soil investigation was performed in the hilly region of central Hainan, which was formerly regarded as an area with the highest ecological environmental quality. A total of 7094 soil samples were systematically collected with high density over a large area. Simultaneously, a detailed investigation was conducted on the surrounding environment of each sampling point, including environmental factors such as soil, land use and crop types. The soil samples were analysed for heavy metals, pH, organic matter, and other parameters. The soil heavy metal pollution level, ecological risk and health risk were evaluated using the geo-accumulation index and the potential ecological risk index. The findings showed that the average contents of the heavy metals As, Cd, Cr, Cu, Hg, Ni, Pb and Zn in the soil were 1.68, 0.042, 24.2, 6.49, 0.0319, 7.06, 29.6 and 49.8 mg·kg -1 respectively. Except for Hg, the mean values of the other heavy metals were either lower than or similar to the background values of Hainan. Also, only a few localised areas showed contamination by heavy metals. The primary sources of heavy metals, identified by a positive matrix factorisation model, could be categorised into four types: natural sources related to the soil formation process from acidic intrusive rocks (such as granite); natural sources primarily influenced by atmospheric deposition; anthropogenic sources associated with agricultural activities; and natural sources related to the soil formation process from middle-mafic intrusive rocks and black shales. The correlation analysis and variance analysis findings suggested that the content of heavy metals in the soil was primarily associated with the parent rock. The study area generally had low heavy metal levels and was not significantly polluted. However, agricultural activities still affected the enrichment of heavy metals. Therefore, it is imperative to remain vigilant about the ecological risks linked to soil heavy metals while continuing land development and expanding agricultural activities in the future. These findings indicate that conducting high-density soil surveys can enhance our understanding of regional soil heavy metals and enable reliable recommendations for agricultural planning. Whether in areas with low pollution risk or potential pollution risk, it is recommended that high-density soil surveys be conducted provide scientific guidance for further agricultural development., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Ethnopharmacological Relevance: Goiters are enlargements of the thyroid gland and are a global public issue. Quemeiteng granule (QMTG) is a traditional Chinese medicine (TCM) formula used to treat goiter in Yunnan Province. However, the effectiveness and underlying mechanism of these treatments have not been fully elucidated., Aim of the Study: This study aimed to investigate the therapeutic effects of QMTG on goiter and the downstream regulatory mechanisms., Materials and Methods: In this study, we first evaluated the antigoiter efficacy of QMTG through biochemical indices [body weight, thyroid coefficient, triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH)] and hematoxylin-eosin (HE) staining in a Propylthiouracil (PTU)-induced model. Based on microRNA sequencing (miRNA-seq) and bioinformatics analysis, key miRNA was screened out. A dual-luciferase reporter assay was performed to confirm the transcriptional regulation of the target gene by the miRNA. The viability of rat thyroid microvascular endothelial cells (RTMECs) and human thyroid microvascular endothelial cells (HTMECs) was assessed using the CCK-8 assays. The migration and angiogenesis of RTMECs and HTMECs were visualized through tube formation and wound scratch assays. Proteins involved in angiogenesis and the ERK pathway were assessed via Western blotting., Results: QMTG significantly increased body weight, decreased the thyroid coefficient, increased the levels of T3, T4, FT3 and FT4 and reduced TSH levels in rats with goiter. QMTG also promoted the morphological recovery of thyroid follicles. MiR-217-5p was identified as a key miRNA. Our studies revealed that miR-217-5p directly targets FGF2 and that QMTG promotes the recovery of thyroid hormone (TH) levels and morphological changes in the thyroid, suppresses thyroid microvascular endothelial cell vitality, tube formation and migration, and reduces the expression of VEGF, Ang-1 and VCAM-1 triggered by miR-217-5p, thereby inhibiting the Ras/MEK/ERK cascade through FGF2., Conclusions: Our experiments demonstrated that the QMTG had therapeutic effects on goiter. These effects were attributed to the inhibition of ERK pathway-induced proliferation and angiogenesis through the targeting of FGF2 by miR-217-5p., Competing Interests: Declaration of competing interest We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: To examine the risk factors for severe bronchopulmonary dysplasia (BPD) in a cohort of very preterm infants (VPIs) in China, as BPD is common among VPIs and associated with a high mortality rate., Methods: In this multicenter retrospective study, medical records from infants with BPD born at gestation age (GA) of <32 weeks with birth weight (BW) of <1,500 grams (g) in 7 regions of China were included. The cohort was stratified into different BPD severity groups based on their fraction of inspired oxygen requirement at a modified GA of 36 weeks or post discharge. Risk factors were identified using logistic regression analysis., Results: A significant inverse correlation was revealed between BPD severity and both GA and BW ( p <0.001). Independent risk factors for severe BPD (sBPD) were identified as invasive mechanical ventilation (≥7d), multiple blood transfusion (≥3), nosocomial infection (NI), hemodynamically significant patent ductus arteriosus (hsPDA), delayed initiation of enteral nutrition, and longer time to achieve total caloric intake of 110 kcal/kg. Conversely, administration of antenatal steroids was associated with reduced risk of sBPD., Conclusion: Our study not only reaffirmed the established risk factors of low GA and BW for sBPD in VPIs, but also identified additional, potentially modifiable risk factors. Further research is warranted to explore whether intervention in these modifiable factors might reduce the risk of sBPD. Clinical Trial Reg. No.: ChiCTR1900023418 ., (Copyright: © Saudi Medical Journal.)

Background: A stable public health workforce plays an indispensable role in the realization of the goal of health for all. However, there is an exodus of public health workers from the Centers for Disease Control and Prevention (CDC). Given the limited evidence on the mechanisms shaping turnover intention (TI) among public health workers, the study aims to investigate the triggering mechanisms of high and low turnover intention by combining job demands, job resources, and personal resources through a set theory perspective based on the Job-Demand-Resources (JD-R) model., Methods: The cross-sectional study was conducted from September 7 to 18, 2020 at district (county) level CDC in Liaoning Province, China. A total of 584 public health professionals were included. Overcommitment, effort, social respect, occupational identity, job rewards, self-efficacy, and psychological resilience were included in the study as configuration factors. The data were gathered through an online questionnaire and were analyzed using multiple regression and fuzzy-set Qualitative Comparative Analysis (fsQCA)., Results: Social respect (B = -0.682, P < 0.001), occupational identity (B = -0.168, P < 0.001), and effort (B = 0.114, P < 0.001) were associated with turnover intention. Five configurations for high turnover intention and five for low turnover intention were obtained through the fsQCA, with occupational identity and effort playing an essential role in all pathways. Moreover, the configurations for low turnover intention are not the antithesis of the configurations for high turnover intention., Conclusion: Managers should synthesize the combined effects of factors when implementing interventions and formulating policies. Given the vital role of occupational identity and effort, mechanisms for the rational distribution of work to avoid excessive efforts and measures to promote occupational identity should be implemented to reduce the turnover intentions of primary public health workers and encourage their intention to stay., (© 2024. The Author(s).)

Background: Although converging lines of research have pointed to the adverse neural effects of air pollution, evidence linking ozone (O 3 ) and neural damage remains limited., Objectives: To investigate the subclinical neural effects of short-term ozone (O 3 ) exposure in elderly adults., Methods: A panel of healthy elderly individuals was recruited, and five repeated measurements were conducted from December 2018 to April 2019 in Xinxiang, China. Serum neural damage biomarkers, including brain-derived neurotrophic factor (BDNF), neurofilament light chain (NfL), neuron-specific enolase (NSE), protein gene product 9.5 (PGP9.5), and S100 calcium-binding protein B (S100B) were measured at each follow-up session. Personal O 3 exposure levels were calculated based on outdoor monitoring and sampling times. A linear mixed-effects model was adopted to quantify the acute effect of O 3 on serum neural damage biomarkers. Stratification analysis based on sex, education level, physical activity, and glutathione S-transferases (GST) gene polymorphism analysis was performed to explore their potential modifying effects., Results: A total of 34 healthy volunteers aged 63.7 ± 5.7 y were enlisted and completed the study. The concentration of the daily maximum 8-h average O 3 (O 3 -8h) ranged from 19.5 to 160.5 μg/m 3 during the study period. Regression analysis showed that short-term O 3 exposure was associated positively with serum concentrations of neural damage biomarkers. A 10 μg/m 3 increase in O 3 -8h exposure was associated with an increment of 74 % (95 % CI:1 %-146 %) and 197 % (95 % CI:39 %-356 %) in BDNF (lag 2 d) and NfL (lag 1 d), respectively. The stratification results suggest that males, people with lower education levels, lower physical activity, and GST theta 1 (GSTT1)-sufficient genotype might be marginally more vulnerable., Conclusions: This study provides new evidence for the neural damage risk posed by O 3 exposure, even at relatively low concentrations, which, therefore, requires that stringent air quality standards be developed and implemented., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Mention of trade names or commercial products does not constitute endorsement or recommendation for use., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Aims: Suboptimal perfusion leading to heart failure (HF) often occurs after ST-segment elevation myocardial infarction (STEMI), despite restoration of epicardial coronary flow in primary percutaneous coronary intervention (PPCI) era. We determined the clinical implications of angio-based coronary functional assessment in evaluation of suboptimal perfusion and further outcomes among STEMI patients after successful PPCI., Methods and Results: In this study, STEMI patients in the Chinese STEMI PPCI registry trial (NCT04996901) who achieved post-PPCI thrombolysis in myocardial infarction grade 3 flow were retrospectively screened. Post-procedural quantitative flow ratio (QFR), angio-based microvascular resistance (AMR), and coronary flow velocity (CFV) of the infarct-related artery were calculated. QFR and AMR measure epicardial stenosis severity and microvascular resistance, respectively. QFR+ was defined as QFR < 0.90 while QFR- was QFR ≥ 0.90. AMR+ was defined as AMR ≥ 250 mmHg*s/m while AMR- was AMR < 250 mmHg*s/m. The primary outcome was 30-day new-onset HF. The Kaplan-Meier curves were used to establish the associations between QFR, AMR, CFV, and HF incidences. The relationship between CFV and combined QFR and AMR indices was further assessed. Independent predictors were determined using Cox regression analysis. The receiver-operating characteristic curve was used to assess discriminant ability to predict HF. A total of 942 patients (mean age was 57.8 ± 11.7 years and 84.6% were men) were enrolled. Among them, 129 patients had new-onset HF episodes. Patients in the QFR-/AMR- group had a low risk of HF compared with those in the QFR+/AMR+ group (10.5% vs. 27.3%, P = 0.027). A higher CFV ≥ 17.4 cm/s was associated with low HF incidences as compared with CFV < 17.4 cm/s (10.3% vs. 16.8%, P = 0.005), whereas isolated QFR or AMR did not reveal any marked differences in HF incidences (P = 0.150 and 0.079, respectively). The highest and lowest medians of CFV were observed in the QFR-/AMR- and QFR+/AMR+ groups, respectively. CFV correlated well with the QFR/AMR ratio (adjusted R 2  = 1, P < 0.001) and post-PPCI CFV was found to be an independent predictor of post-STEMI HF (adjusted hazard ratio: 0.61, 95% confidence interval: 0.41-0.90, P = 0.012). The area under curve estimate of the multivariable regression model was 0.749., Conclusions: CFV is an integrated coronary physiological assessment approach that incorporates epicardial and microcirculatory contributions. Patients with post-PPCI CFV < 17.4 cm/s were strongly associated with a high risk for post-STEMI HF, even achieving thrombolysis in myocardial infarction grade 3 flow. The immediate angio-based coronary functional assessment is a feasible tool for evaluating suboptimal perfusion and risk stratification., (© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Background: For female breast cancer patients, the psychological status after surgery, especially the social and family psychological-related factors, deserves more attention. This study analyzed the influence of social constraints, social support, social isolation, family conflict, and family emotion expression on depression. At the same time, this study conducted the relationship between the variables and the mechanism of action., Methods: We conducted a cross-sectional study and 522 breast cancer patients finished questionnaires consisting of Self-Rating Depression Scale (SDS), General Self-Efficacy Scale (GSES), Multi-Dimensional Scale of Perceived Social Support (MSPSS), Social Constraints Scale-5 (SCS-5), Family Environment Scale (FES), and Lubben Social Network Scale (LSNS-6). Multivariable logical regression was used to explore influencing factors. Pearson's correlation, hierarchical regression, and simple slope analysis were conducted to verify the role of self-efficacy., Results: 71.6% of patients had depressive symptoms. Family contradiction (OR = 10.086), social constraints (OR = 2.522), social isolation (OR = 2.507), and high blood glucose (OR = 2.156) were risk factors of depressive symptoms. Family emotional expression (OR = 0.480), family intimacy (OR = 0.235), and self-efficacy (OR = 0.246) were protective factors against depressive symptoms. The interactive items interpretation quantity were as follows: Contradiction*Self-efficacy (ΔR 2  = 2.3%, P < 0.001), Emotional expression*Self-efficacy (ΔR 2  = 2.6%, P < 0.001), Intimacy*Self-efficacy (ΔR 2  = 1.0%, P = 0.018), Social constraints*Self-efficacy (ΔR 2  = 1.0%, P = 0.008), Social networks*Self-efficacy (ΔR 2  = 1.0%, P = 0.010), Blood Glucose*Self-efficacy (ΔR 2  = 0.6%, P = 0.023). The influence of independent variables on depressive symptoms was gradually decreased in the low, mean, and high groups of self-efficacy., Conclusion: Postoperative Chinese breast cancer survivors reported higher depressive symptoms. Social, family, and physiological factors could affect depressive symptoms, in which self-factor played moderator roles., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: To analyze the real-world growth pattern of very premature infants (VPI) with small for gestational age (SGA) after birth by using the ΔZ value of weight at discharge., Methods: The clinical data were collected from 28 hospitals in China from September 2019 to December 2020. They were divided into the EUGR(Extrauterine Growth Restriction) and the non-EUGR group according to the criterion of ΔZ value of weight at discharge < -1.28., Results: This study included 133 eligible VPI with SGA. Following the criterion of ΔZ value, the incidence of EUGR was 36.84% (49/133). The birth weight, the 5-min Apgar score, and the proportion of male infants in the EUGR group were lower (P < 0.05). The average invasive ventilation time, cumulative duration of the administration of antibiotics, blood transfusion time, blood transfusion ratio, and total days of hospitalization were significantly higher in the EUGR group (P < 0.05). In the EUGR group, several factors exhibited higher values (P < 0.05), including the initiation of enteral feeding, the volume of milk supplemented with human milk fortifier (HMF), the duration to achieve complete fortification, the cumulative duration of fasting, the duration to achieve full enteral feeding, the length of parenteral nutrition (PN), the number of days required to attain the desired total calorie intake and oral calorie intake, as well as the age at which birth weight was regained. The average weight growth velocity (GV) was significantly lower in the EUGR group (P < 0.001). The incidences of patent ductus arteriosus with hemodynamic changes (hsPDA), neonatal necrotizing enterocolitis (NEC) stage≥ 2, late-onset sepsis (LOS), and feeding intolerance (FI) in the EUGR group were higher (P < 0.05). Multivariate logistic regression analysis showed that birth weight, male, and GV were the protective factors, while a long time to achieve full-dose fortification, slow recovery of birth weight, and NEC stage ≥2 were the independent risk factors., Conclusion: SGA in VPI can reflect the occurrence of EUGR more accurately by using the ΔZ value of weight at discharge. Enhancing enteral nutrition support, achieving prompt and complete fortification of breast milk, promoting greater GV, reducing the duration of birth weight recovery, and minimizing the risk of NEC can contribute to a decreased occurrence of EUGR., Trial Registration: CHICTR, ChiCTR1900023418. Registered 26/05/2019, http://www.chictr.org.cn ., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Early studies have shown a relationship between activities of daily living (ADL) disability and depressive symptoms in older people. However, discussions on the direction of this relationship are insufficient. The study's objective was to assess the reciprocal relationship between ADL disability and depressive symptoms among middle-aged and older Chinese people., Method: Data was collected in four waves of a nationwide survey, the China Health and Retirement Longitudinal Study (CHARLS), which was carried out in 2011, 2013, 2015, and 2018. In total, this study included 4,124 participants aged ≥ 45 years at baseline. A summing score of the eleven items for basic activities of daily living (BADL) and instrumental activities of daily living (IADL) was calculated to indicate the degree of ADL disability. The 10-item Centre for Epidemiological Studies Depression Scale (CESD-10) was adopted to measure depressive symptoms. The reciprocal relationship between ADL disability and depressive symptoms was tested by cross-lagged models., Result: At baseline, 911 (22.1%) participants were classified as having difficulties with ADL, and the prevalence of depressive symptoms was 34.4% (1,418). Among middle-aged and older people in China, there was a significant reciprocal and longitudinal relationship between ADL disability and depressive symptoms. People who had difficulty with ADL faced a higher risk of depressive symptoms, and those who suffered from depressive symptoms were accompanied by an increase in ADL disability in the following years. The subgroup analysis on age also showed that ADL disability was reciprocally and longitudinally related to depressive symptoms. However, only women showed similar results in the subgroup analysis on gender., Conclusion: This study shows that ADL disability is bi-directionally related to depressive symptoms in middle-aged and older Chinese people over time. The results suggest we should identify ADL disability and bad psychological conditions in time to prevent subsequent mutual damage among middle-aged and older Chinese people, a vulnerable group rising in the future., (© 2023. The Author(s).)

Riverine microplastic (MP) discharge into the ocean contributes greatly to global MP contamination, yet our understanding of this process remains primitive. To deepen our interpretation of the dynamic MP variation throughout the estuarine water columns, we sampled at Xuliujing, the saltwater intrusion node of the Yangtze River Estuary, over the course of ebb and flood tides in four seasons (July and October 2017, January and May 2018 respectively). We observed that the collision of downstream and upstream currents contributed to the high MP concentration and that the mean MP abundance fluctuated with the tide. A model of microplastics residual net flux (MPRF-MODEL), taking the seasonal abundance and vertical distribution of MP along with current velocity into consideration, was developed to predict the net flux of MP throughout the full water columns. 2154 ± 359.7 t/year of MP was estimated to flow into the East China Sea via the River in 2017-2018. Our study suggests that riverine MP flux can be overestimated due to reciprocating current carried MP from the estuary. Using the tidal and seasonal variation in MP distribution, we calculated the tide impact factor index (TIFI) for the Yangtze River Estuary to be between 38.11% and 58.05%. In summary, this study provides a baseline of MP flux research in the Yangtze River for similar tidal-controlled rivers and a contextual understanding of how to appropriately sample and accurately estimate in a dynamic estuary system. The redistribution of microplastics may be impacted by complex tide processes. Although not observed in this study, it may merit investigation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

An ambitious new Post-2020 Global Biodiversity Framework "Kunming-Montreal Global Biodiversity Framework" has been developed. However, the combined effects of climate change and human modification can undermine the potential benefits of the global post-2020 conservation efforts. The co-benefits of stabilizing the climate, conserving biodiversity, and maintaining intact wilderness areas may help to persuade the general public of the need to quickly expand existing protected areas (PAs). To maximize the co-benefits after 2020, the careful optimization of existing (PAs) network and scientific identification of conservation targets are both essential. Here, we mapped hotspots of biodiversity, climate vulnerability, and wilderness in Southwest China (SWC). By analyzing the representativeness and gaps of the existing PAs network in SWC, we devised post-2020 conservation targets and highlighted their implications for decision-makers. Our results showed that the incongruence between hotspots of different species exists, indicating that habitats suitable for one taxon may not fully harbor other taxa. According to our assessment, the five jurisdictions of SWC have warmed on average by 0.4°C-1.1 °C over the past 60 years alone. In particular, biodiversity hotspots in SWC are undergoing stark climatic changes. We uncovered prominent conservation gaps in SWC's network of PAs, especially in terms of climate vulnerability and biodiversity. Due to their insufficient number and unreasonable spatial distribution, the PAs network in SWC may be not capable of meeting its biodiversity, climate vulnerability, and wilderness conservation objectives. To rectify this, we proposed a 3-step mission: milestone 2025, milestone 2030, and goal 2050, which aims to protect 23%, 28%, and 60% of the terrestrial area in SWC, respectively. Taken together, our study derived conservation priority areas with relatively clear spatial boundaries and importance levels, thus providing detailed, timely information for decision-makers to expand the PAs network and implement conservation measures varying in strictness in post-2020 conservation practice., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objectives: The management of enteral nutrition in very preterm infants (VPIs) is still controversial, and there is no consensus on the optimal time point after birth at which enteral nutrition can be started. The aim of this study was to investigate the effect of early initiation of enteral nutrition on the short-term clinical outcomes of VPIs., Methods: Data of infants (n = 2514) born before 32 wk of gestation were collected from 28 hospitals located in seven different regions of China. Based on whether enteral feeding was initiated within or after 24 h since birth, the infants were divided into an early initiation of enteral feeding (EIEF) group and a delayed initiation of enteral feeding (DIEF) group., Results: Compared with the DIEF group, the EIEF group was more likely to tolerate enteral nutrition and had less need for parenteral nutrition (all P < 0.05). The EIEF group was associated with lower incidence rates of feeding intolerance, extrauterine growth restriction (EUGR), and late-onset sepsis (LOS) (all P < 0.05). There was no significant difference in the incidence of necrotizing enterocolitis (NEC) (Bell stage ≥2) between the two groups (P = 0.118). The multivariate logistic regression analysis revealed that EIEF was a protective factor against EUGR (odds ratio [OR], 0.621; 95% confidence interval [CI], 0.544-0.735; P < 0.001), feeding intolerance (OR, 0.658; 95% CI, 0.554-0.782; P < 0.001), and LOS (OR, 0.706; 95% CI, 0.550-0.906; P = 0.006)., Conclusions: Early initiation of enteral feeding was associated with less frequency of feeding intolerance, EUGR, and LOS, and it may shorten the time to reach total enteral feeding without increasing the risk of NEC., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

In recent decades, China has implemented ecological restoration projects (ERPs) to improve biodiversity and ecosystem services (ESs), accordingly, a series of environmental laws were issued to guide ecological restoration. However, quantitative evaluation of the effectiveness of ERPs remains ambiguous. To respond to the UN Decade on Ecosystem Restoration (UNDER), we conducted a meta-analysis of 85 peer-reviewed publications and an interdisciplinary evaluation framework based on China's environmental protection and land administration laws (EPLALs) were established to assess the effectiveness of ERPs. We found that ERPs enhanced ESs by 15-58%. Specifically, ERPs implemented in industrial/mining, and wetland regions significantly increased regulating and cultural services, and in arid and semi-arid regions mainly enhance provisioning services (72.98%). Climate factors were found to be crucial for ecological restoration effectiveness (temperature: r = -0.582, significance <0.05; precipitation: r = 0.635, significance <0.05). China's environmental laws emphasized management and investment in ecological restoration. However, the disclosure, public participation and real-time monitoring of ecological conditions need to be improved urgently. We therefore developed ERP-related policy recommendations and global lessons to help improve the effectiveness of ecological restoration., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

As the most biodiversity-rich part of the protected areas system, habitats within the pilot national parks have long been threatened by drastic human-induced land use and land cover changes. The growing concern about habitat loss has spurred China's national park project to shift from pilot to construction phase with the official establishment of China's first group of national parks (CFGNPs) in October 2021. But far too little attention has been paid to the synergistic work concerning the habitat quality (HQ) dynamics of all five national parks. Here, the InVEST model, combined with a satellite-derived land use and land cover product and a hot spot analysis (HSA) method, was used to investigate the HQ dynamics at the park- and pixel-scale within the CFGNPs. Our results demonstrate that the past ecological conservation practices within national parks have been unpromising, especially in Giant Panda National Park, Northeast China Tiger and Leopard National Park (NCTL), and Wuyi Mountain National Park (WYM), where HQ as a whole showed a significant decline. Furthermore, more than half of Hainan Tropical Rainforest National Park (87.2%), WYM (77.4%), and NCTL (52.9%) showed significant HQ degradation from 1980 to 2019. Besides, increasing trends in the area shares of HQ degraded pixels were observed in all five national parks from 1980-1999 to 2000-2019. The HSA implied that the hot spots of high HQ degradation rates tend to occur in areas closer to urban settlements or on the edge of national parks, where human activities are intensive. Despite these disappointing findings, we highlighted from the observed local successes and the HQ plateau that the construction of CFGNPs is expected to reverse the deteriorating HQ trends. Thus, we concluded our paper by proposing an HSA-based regulatory zoning scheme that includes five subzones to guide the future construction of China's national park system., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Ambient nitrogen dioxide (NO 2 )-induced adverse health effects have been studied, but documented evidence on neural systems is limited. This study aimed to determine the acute effect of NO 2 exposure on nervous system damage biomarker levels in healthy older adults. Five rounds of follow-up among 34 healthy retired people were scheduled from December 2018 to April 2019 in Xinxiang, China. The real-time NO 2 concentrations were measured using a fixed site monitor. Serum samples were acquired during each round to measure nervous system damage biomarker levels: brain-derived neurotrophic factor (BDNF), neurofilament light chain (NfL), neuron-specific enolase (NSE), protein gene product 9.5 (PGP9.5), and S100 calcium-binding protein B (S100B). A linear mixed-effect model was incorporated to analyze the association between short-term NO 2 exposure and serum concentrations of the above-mentioned biomarkers. Stratification analysis based on sex, educational attainment, glutathione S-transferase theta 1 gene (GSTT1) polymorphism, and physical activity intensity was conducted to explore their potential modification effect. The NO 2 concentration ranged from 34.7 to 59.0 µg/m 3 during the study period. Acute exposure to ambient NO 2 was significantly associated with elevated serum levels of NfL, PGP9.5, and BDNF. In response to a 10 µg/m 3 increase in NO 2 concentration, NfL and PGP9.5 levels increased by 76 % (95 % confidence interval [CI]: 12-140 %) and 54 % (95 % CI: 1-107 %) on the lag0 day, respectively, while BDNF levels increased by 49 % (95 % CI: 2-96 %) at lag4 day. The estimated effect of NO 2 on NSE levels in GSTT1-sufficient participants was significantly higher than that in GSTT1-null participants. Intriguingly, the estimation of NO 2 on PGP9.5 levels in females was significantly higher than that in males. Most two-pollutant models showed robust results, except for O 3 , which might have had confounding effects on NO 2 -induced BDNF stimulation. In summary, acute exposure to NO 2 was associated with increased levels of serum nervous system damage biomarker levels including NFL, PGP9.5, and BDNF. The present study provided insights into NO 2 exposure-induced adverse neural effects., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: There are many one-child families in China due to the one-child policy. Parents who have lost their only child and are unable to conceive another child or unwilling to adopt a child are called Shidu parents in China. The death of an only child puts Shidu parents at the risk of mental illness and even suicide. Few studies have explored the influence of cultural beliefs and prolonged grief disorder on suicide ideation., Methods: This study involved rural Shidu parents from Sujiatun district of Shenyang, China. Questionnaires consisted of the Prolonged Grief questionnaire - 13 (PG-13), the Culture-related Grief Beliefs of Shidu Parents Questionnaire (CBSQ), one question from the baseline National Comorbidity Survey (NCS) to measure suicide ideation and demographic and bereavement-related information. Bivariate logistic regression analyses were conducted to explore associated factors of suicide ideation., Results: Sixty-nine (28.8%) of the 240 Shidu parents reported having suicide ideation. Having chronic disease (OR = 5.509, p < 0.01), having religious belief (OR = 3.923, p < 0.05) and having a grandchild (OR = 2.552, p < 0.05) were associated with an increased risk of suicide ideation. Destiny belief (a subscale of CBSQ) was negatively associated with suicide ideation (OR = 0.818, p < 0.05). Prolonged grief disorder (OR = 9.280, p < 0.01) and perceived stigma (a subscale of CBSQ) (OR = 1.200, p < 0.05) was positively associated with suicide ideation after adjusting for controlling variables., Conclusions: Suicide ideation is prevalent in rural Shidu parents. Reducing perceived stigma and alleviating prolonged grief disorder may decrease the risk of suicide among rural Shidu parents., (© 2022 John Wiley & Sons Ltd.)

Nitrogen (N) enrichment poses threats to biodiversity and ecosystem stability, while arbuscular mycorrhizal (AM) fungi play important roles in ecosystem stability and functioning. However, the ecological impacts, especially thresholds of N enrichment potentially causing AM fungal community shifts have not been adequately characterized. Based on a long-term field experiment with nine N addition levels ranging from 0 to 50 g N m -2  yr -1 in a temperate grassland, we characterized the community response patterns of AM fungi to N enrichment. Arbuscular mycorrhizal fungal biomass continuously decreased with increasing N addition levels. However, AM fungal diversity did not significantly change below 20 g N m -2  yr -1 , but dramatically decreased at higher N levels, which drove the AM fungal community to a potentially unstable state. Structural equation modeling showed that the decline in AM fungal biomass could be well explained by soil acidification, whereas key driving factors for AM fungal diversity shifted from soil nitrogen : phosphorus (N : P) ratio to soil pH with increasing N levels. Different aspects of AM fungal communities (biomass, diversity and community composition) respond differently to increasing N addition levels. Thresholds for substantial community shifts in response to N enrichment in this grassland ecosystem are identified., (© 2022 The Authors. New Phytologist © 2022 New Phytologist Foundation.)

Previously, a case series study was conducted on our part in which 5 patients with Graves' disease (GD) were collected from a 3-generation family to screen for susceptibility genes responsible for GD. The single nucleotide variants of Microtubule-associated protein 7 domain containing 2 c. 452C > T, p. Ala151Val, Solute carrier family 1 member 7 c. 1204C > T, p. Arg402Cys, tumor necrosis factor receptor-associated factor 3 interacting protein 3 (TRAF3IP3) c. 209A > T, p. Asn70Ile, protein tyrosine phosphatase receptor type B (PTPRB) c. 3472A > G, p. Ser1158Gly, Phosphoinositide-3-kinase regulatory subunit 3 c. 121C > T, p. Pro41Ser, disrupted in schizophrenia 1 (DISC1), c. 1591G > C p. Gly531Arg were associated with the familial GD. We then further confirmed these variants and investigated whether other mutations render susceptibility to GD. The case-control study collected patients with sporadic GD or no GD family history. A snapshot program was used for genotyping the selected SNPs in 235 GD patients (GD group 1) and 284 healthy patients (control group). Furthermore, another 184 GD patients were recruited (GD group 2) to sequence the specified exons of these genes. The sequenced data was compared with Chinese Millionome Database (CMDB). Several variants of PTPRB, phosphoinositide-3-kinase regulatory subunit 3, TRAF3IP3, and DISC1 were found in GD group 2 but not in CMDB. Moreover, the allele frequency of SNP rs2076150 (TRAF3IP3) and rs2492367 DISC1 in GD group 2 was significantly higher than that of in CMDB (all P < .05). When the control group or CMDB was set as a reference group, a significantly higher frequency in alter allele C of SNP rs186466118 PTPRB was observed in GD group 1 and GD group (constituted by GD group 1 and GD group 2). Equally importantly, there was a correlation between the allele C of SNP rs186466118 and the increased risk of GD susceptibility (all P < .05). PTPRB, TRAF3IP3, and DISC1 may be susceptibility genes for GD, and more variants of PTPRB, TRAF3IP3, and DISC1 were found in GD patients., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Microbiology is a key basic professional course for all the students specializing in biology, biotechnology and related majors. To date, microbiology is mainly taught in Chinese within colleges and universities in China. Development of a microbiology course that is taught in English may satisfy the diversified learning needs of the students and promote the "Double First-Class" initiative. We started to teach the microbiology course in English at the East China University of Science and Technology since 2016. This practice was associated with reform and innovation in the teaching methods and contents. The microbiology course taught in English greatly attracted the interest of the attending students and helped improve their professional English learning as well as scientific research. This course provided important support for fostering innovative professional first-class undergraduates under the context of the "Double First-Class" initiative.

The literature has shown that mobile phone addiction is an important risk factor for depression. However, the internal mechanisms of mobile phone addiction leading to depression are still not clear. This study examined the mediating role of sleep quality and moderating role of peer relationships in the association between mobile phone addiction and depression. A sample of 450 Chinese medical students were recruited to complete measures of mobile phone addiction, depression, sleep quality and peer relationships. In this study, SPSS 25.0 and macro PROCESS were used to conduct statistical analysis on the collected data. The results showed that sleep quality partially mediated the association between mobile phone addiction and depression. Moreover, the effect of sleep quality on depression was moderated by peer relationships. The present study can advance our understanding of how and when mobile phone addiction leads to depression. Limitations and implications of this study are discussed., (© 2022. The Author(s).)

Introduction: Parents who have lost their only child and over the age of 60 are known as elderly shidu parents. This study aimed to investigate predictors of prolonged grief disorder (PGD) among Chinese elderly shidu parents., Methods: Two hundred and ninety-eight elderly shidu parents from Shenyang were included in this cross-sectional study. Participants completed a questionnaire including the Prolonged Grief questionnaire-13 (PG-13), the PTSD (post-traumatic stress disorder) Checklist for DSM-5 (PCL-5), the Center for Epidemiologic Studies Depression Scales (CES-D), the Self-Rating Anxiety Scale (SAS), and the Perceived Stress Scale-10 (PSS-10). Multiple linear regression was used to examine socio-demographic, bereavement-related and perceived stress associated with PGD symptoms., Results: The prevalence of PGD among Chinese elderly shidu parents was 13.8%. Among the 41 PGD patients, 29, 39, 36 patients had comorbidity of PTSD, depressive symptoms and anxiety, respectively. Perceived stress, higher educational level, lower annual household income, perceived stigma, violent death of the child, and being in debt were associated with severer PGD symptoms., Discussion: The present study revealed the prevalence of PGD and the important role of PGD in diagnosing other mental disorders in Chinese elderly shidu parents. Providing financial help, eliminating social stigma, and stress should be included in PGD prevention among Chinese elderly shidu parents., (© 2021 John Wiley & Sons Australia, Ltd.)

Introduction: The objective of the Chinese Neonatal Network (CHNN) is to provide a platform for collaborative research, outcomes evaluation and quality improvement for preterm infants with gestational age less than 32 weeks in China. The CHNN is the first national neonatal network and has the largest geographically representative cohort from neonatal intensive care units (NICUs) in China., Methods and Analysis: Individual-level data from participating NICUs will be collected using a unique database developed by the CHNN on an ongoing basis from January 2019. Data will be prospectively collected from all infants <32 weeks gestation or <1500 g birth weight at 58 participating NICUs. Infant outcomes and inter-institutional variations in outcomes will be examined and used to inform quality improvement measures aimed at improving outcomes. Information about NICU environmental and human resource factors and processes of neonatal care will also be collected and analysed for association with outcomes. Clinical studies, including randomised controlled trials will be conducted using the CHNN data platform., Ethics and Dissemination: This study was approved by the ethics review board of Children's Hospital of Fudan University, which was recognised by all participating hospitals. Waiver of consent were granted at all sites. Only non-identifiable patient level data will be transmitted and only aggregate data will be reported in CHNN reports and publications., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

There is an urgent need for scientific management of agricultural water and land resources to cope with global warming and water shortages. Therefore, a stochastic multi-objective non-linear programming model was established under the society-economy-ecology framework in this study, which is capable of (1) considering the carbon sink function of farmland vegetation and the carbon emissions produced from the input of production materials; (2) dealing with the potential impact of agricultural water use on ecology by the indexes of water scarcity and degradation footprint (3) weighing the conflicts and contradictions among different developing targets with economic benefits, and water productivity as well as ecological considerations; (4) obtaining the planting structure, irrigation water allocation schemes and irrigation schedules. In order to verify the applicability and effectiveness of the model, it was applied to Huangyang Irrigation District in Shiyang River Basin, northwest China. After optimization, the net carbon sink increased by 2.55 × 10 4  t of which fertilizer contributed nearly 50% of carbon emission, while the water footprint reduced by 0.48 × 10 8  m 3 . To analyze the impact of the different allocation schemes of water and land resources on the ecological, economic and social subsystems as well as their interaction, coupling coordination degree (CCD) models were introduced to evaluate status quo and the optimization results of different models. The results showed that, compared with the single-objective models and the status quo, the proposed model has improved the value of CCD from 0.428 to 0.674. The proposed model can promote the harmonious and sustainable development of agricultural production and is equally applicable to agricultural management systems in the regions with similar conditions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Unlike chemical drugs with a single or a few kinds of active compounds, traditional Chinese medicines (TCMs)uses herbal formulas composed of numerous kinds of chemical constituents. Therefore, TCM clinical trials require unique and stricter standards for collecting, preserving, and transporting fecal samples than those used for chemical drugs. Unfortunately, there are no special standards for processing fecal samples in TCM clinical trials., Methods: We invited interdisciplinary experts within TCM clinical trials and gut microbiome research to help formulate this standard. After more than a year's in-depth discussion and amendments, we achieved a standard via expert interviews, literature research, questionnaire surveys, and public opinion solicitation. This standard has been reviewed and approved by the Standards Office of China of the Association of Chinese medicine., Results: We established a sample information processing method prior to TCM clinical sample collection, which is adapted to the unique features of TCM. The method formulates detailed processing requirements for TCM information in addition to the factors that may disturb the gut microbiome. We also constructed a set of methods for collecting, preserving, and transporting fecal samples that meet the characteristics of TCM. These methods formulate detailed operating specifications on the collection approaches, storage conditions, transportation requirements, and management of fecal samples., Conclusions: This standard guides the information processing prior to sample collection and the standard operating procedures for the collection, preservation, and transportation of fecal samples in TCM clinical trials, which also can be used as a reference by clinicians and researchers in modern medicines., Competing Interests: Author BZ was employed by Beijing QuantiHealth Technology Co, Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Su, Du, Lian, Wu, Zhang, Yang, Duan, Pan, Liu, Wu, Zhao, Wu and Wu.)

Objective: This study aimed to investigate the status quo and the influencing factors of fatigue and professional identity among the Centers for Disease Control and Prevention (CDC) workers in China during the pandemic., Design: A cross-sectional design., Setting: CDC workers employed by the Liaoning CDC system were enrolled (administrative staffs were excluded)., Participants: 1020 CDC workers., Primary Outcome Measures: Fatigue scores and professional identity scores., Secondary Outcome Measures: Postcompetency scores, respect scores, occupational stress scores, resilience scores and self-efficacy scores., Results: The average scores of fatigue and professional identity were 8.23, 38.88, respectively. Factors including perceived public respect ( β =-0.129, p<0.01), resilience ( β =-0.104, p<0.05) and self-efficacy ( β =-0.22, p<0.01) were negatively associated with fatigue. Educational background (bachelor vs junior college or below) ( β =0.105, p<0.01), (master or above vs junior college or below) ( β =0.092, p<0.05), workplace (county vs district) ( β =0.067, p<0.05), (city vs district) ( β =0.085, p<0.05), fighting the COVID-19 on the front line ( β =0.059, p<0.05) and occupational stress ( β =0.166, p<0.01) were positively correlated with fatigue. Educational background (bachelor vs junior college or below) ( β =-0.097, p<0.01), (master or above vs junior college or below) ( β =-0.114, p<0.01), workplace (city vs district) ( β =-0.114, p<0.01), fighting the COVID-19 on the front line ( β =-0.047, p<0.05) and occupational stress ( β =-0.105, p<0.01) were negatively associated with professional identity. Factors including postcompetency ( β =0.362, p<0.01), perceived public respect (general vs low) ( β =0.219, p<0.01), (high vs low) ( β =0.288, p<0.01), resilience ( β =0.097, p<0.05) and self-efficacy ( β =0.113, p<0.01) were positively connected with professional identity., Conclusion: The fatigue among the CDC workers was at a higher level. The level of professional identity was high, and administrators should take measures to alleviate fatigue and maintain professional identity. In addition, methods aiming to attenuate occupational stress, and improve resilience and self-efficacy should be immediately put into action., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Stroke is a major health threat and the leading cause of mortality and disability in China. The aims of this study were to identify the possible influencing factors of health-related quality of life (HRQoL) and its domain-specific contents in stroke patients in rural areas in China., Methods: A total of 1,709 stroke patients aged 36-79 years from the baseline data of Henan Rural Cohort study ( n = 39,259) were included in the cross-sectional study. The Chinese version of the European Quality of Life Five Dimension (including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) Five Level Scale (EQ-5D-5L) and visual analog scale (VAS) were used to evaluate HRQoL in stroke patients. Tobit regression models, generalized linear models and binary logistic regression models were constructed to determine potential influencing factors of the EQ-5D utility index, as well as influencing factors of each domain and VAS score., Results: The mean utility index and VAS scores of stroke patients were 0.885 (SD, 0.204), and 68.39 (SD, 17.31), respectively. Pain/discomfort (PD, 35.2%) and mobility (MO, 30.4%) were the most frequently reported issues. Regression models revealed that illiterate; a low monthly income; low physical activity intensity; and diabetes, anxiety, depression, or poor sleep quality were significantly associated with lower utility index and VAS scores among stroke patients. In addition, patients with stroke who were older, female, drinking, smoking, and consuming a high-fat diet, had a higher BMI, and lived with a stroke for a longer time, were also significantly associated with different dimensions of the EQ-5D., Conclusion: Patients with stroke in rural areas in China had a low HRQoL. Factors associated with the EQ-5D utility index as well as each domain and VAS score, need to be considered by health providers in rural areas. Patients with stroke in rural areas need to be included in national basic public medical services and managed systematically by medical institutions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Mei, Zhang, Wu, Hou, Liu, Sang, Mao, Zhang, Yang and Wang.)

Selenium is an essential micronutrient for the human body, given its various health benefits. However, Se deficiency is widespread globally, and dietary adjustment is a feasible way to supplement people's Se daily intake. The Multi-purpose Regional Geochemical Survey (NMPRGS) conducted in Hainan Island found an abundance of Se-rich soil. These Se resources have been utilized to grow naturally Se-rich produce. However, insufficient research has been conducted into the spatial distribution and enrichment of soil Se in Hainan Island. This paper analysed the effect of the environmental impact factors (parent rock, precipitation, etc.) on soil Se, using data from the NMPRGS database. The results showed that, in comparison to the baseline value of Chinese soil, the enrichment degree of Se in the topsoil of Hainan Island was higher, but its distribution was uneven. The parent rock, precipitation, soil type, and soil characteristics all affect the concentration and spatial distribution of regional soil Se. Geographically weighted regression showed that Iodine, pH, SOC, and TFe 2 O 3 have a non-stationarity spatial relationship with Se. There was a significant correlation between soil Se and Chemical alteration index (CIA) in granite areas, while CIA was also related to mean annual precipitation (MAP). The concentration enrichment factor values of Se show that the external input of Se in high MAP areas is significantly higher than that in low MAP areas. Based on these results, three important environmental impact factors on soil Se enrichment at the regional scale in Hainan Island were defined: 1) Se-rich rocks; 2) precipitation; 3) SOC. These results can provide guidance for the planning and layout of Se-rich agriculture., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier B.V.)

Inborn errors of immunity (IEIs) result from mutations in genes involved in host immune defense and immune regulation. Herein, we report the identification of a novel IRF8 mutation in a neonate with an IEI. DNA samples from both the neonate and her parents were subjected to DNA sequencing, and the immune status of the patient was assessed. We identified a mutation (c.331C > T, p. Arg111*) in the interferon regulatory factor 8 (IRF8) gene that manifested as sever dysfunctional neutrophilia (96.53 × 10 9 /l) and monocytopenia (0.02 × 10 9 /l). The patient's CD3 + T cell and CD8 + T cell counts were decreased. Her levels of IFN-γ were low even during severe infection. The mRNA expression levels of IRF8 were lower than normal. Her clinical manifestations included a recurrent and progressively fatal infection. Since IRF8 plays a key role in the differentiation and development of immune cells, we suspected that the novel mutation (c.331C > T, p. Arg111*) may be consistent with a severe loss of IRF8 function and result in a failure of immune cells to differentiate and maturation, and lead to a severe infection with early onset., (Copyright © 2021. Published by Elsevier B.V.)

Background: China's National Free Antiretroviral Treatment Program (NFATP) has substantially reduced morbidity and HIV/AIDS incidence since 2003. However, HIV resistance to antiretroviral drugs (ARVs) has been a major challenge for the current treatment of HIV/AIDS in China., Methods: In the current study, we established a nested dynamic model to predict the multi-drug resistance dynamics of HIV among the heterosexual population and evaluated the impact of intervention measures on the transmission of drug resistance. We obtained an effective reproductive number [Formula: see text] from each sub-model held at different stages of the dynamic model. Meanwhile, we applied Bayesian phylogenetic methods to infer the weighted average effective reproductive number [Formula: see text] from four HIV subtypes that sampled from 912 HIV-positive patients in China. It is an original and innovative method by fitting [Formula: see text] to [Formula: see text] by Markov Chain Monte Carlo (MCMC) to generate unknown parameters in [Formula: see text]., Results: By analyzing the HIV gene sequences, we inferred that the most recent common ancestor of CRF01AE, CRF07BC, CRF08BC, and CRFBC dated from 1994, 1990, 1993 and 1990, respectively. The weighted average effective reproductive number [Formula: see text] dropped from 1.95 in 1994 to 1.73 in 2018. Considering different interventions, we used a macro dynamic model to predict the trend of HIV resistance. The results show that the number of new infections and total drug resistance under the baseline parameter (S1) are 253,422 and 213,250 in 2025, respectively. Comparing with the numbers under the target treatment rate (S2), they were 219,717 and 236,890, respectively. However, under the ideal treatment target (S3, the treatment rate reaches 90% and the treatment success rate reaches 90%), the number of new infections shows a declining trend and will decrease to 46,559 by 2025. Compared with S1 and S2, the total number of resistance also decreased to 160,899 in 2025., Conclusion: With the promotion of NFATP in China, HIV resistance to ARVs is inevitable. The strategy of increasing the treatment rate would not only ineffectively curb the epidemic, but also deteriorate drug resistance issue. Whereas, a combination of intervention strategies (the treatment rate reaches 90% and the treatment success rate reaches 90%) can greatly reduce both infection and drug resistance rate than applying one strategy alone., Competing Interests: We declare there is no conflict of interest.

Numerous cohort studies have reported the association of long-term exposure to particulate matter <10 μm in diameter (PM 10 ) and hypertension in American and European countries. However, these results have been inconsistent and subject to various confounding factors. The study aimed to explore the effect of long-term exposure to high-level concentrations of PM 10 on incident hypertension in a large-scale cohort from northern China. A retrospective cohort study of 39,054 participants aged between 23 and 98 years old from four cities in northern China was followed from 1998 to 2009. Excluding those with hypertension, 37,386 non-hypertensive participants (overall population) were followed for self-reported hypertension. The individuals' exposure to PM 10 was the mean concentration during the follow-up period, according to the data of local environmental monitoring centers. Hazard ratios (HRs) were calculated by Cox proportional hazards models. The adjusted potential confounding factors included sociodemographic information, lifestyle, and diet. There were 2619 (7.0%) incident cases of hypertension among the overall population. In multivariable models, the HR (95% CI) of incident hypertension was 1.537 (1.515, 1.560) for each 10 μg/m 3 increase in PM 10 . Stratified analyses showed individuals (age <65) were prone to developing hypertension. Moreover, the effects of PM 10 increased and produced an HR (95% CI) of 1.555 (1.527, 1.584) for the healthy population in the sensitivity analysis. We found that the association between long-term exposure to PM 10 air pollution and incident hypertension was significantly positive., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited part of Springer Nature.)

Nasopharyngeal carcinoma (NPC) is a malignant epithelial tumor originating in the nasopharynx and has a high incidence in Southeast Asia and North Africa. To develop these comprehensive guidelines for the diagnosis and management of NPC, the Chinese Society of Clinical Oncology (CSCO) arranged a multi-disciplinary team comprising of experts from all sub-specialties of NPC to write, discuss, and revise the guidelines. Based on the findings of evidence-based medicine in China and abroad, domestic experts have iteratively developed these guidelines to provide proper management of NPC. Overall, the guidelines describe the screening, clinical and pathological diagnosis, staging and risk assessment, therapies, and follow-up of NPC, which aim to improve the management of NPC., (© 2021 The Authors. Cancer Communications published by John Wiley & Sons Australia, Ltd. on behalf of Sun Yat-sen University Cancer Center.)

Importance: The Chinese Neonatal Network was established in 2018 and maintains a standardized national clinical database of very preterm or very low-birth-weight infants in tertiary neonatal intensive care units (NICUs) throughout China. National-level data on outcomes and care practices of very preterm infants (VPIs) in China are lacking., Objective: To assess the care practices in NICUs and outcomes among VPIs in China., Design, Setting, and Participants: A cohort study was conducted comprising 57 tertiary hospitals from 25 provinces throughout China. All infants with gestational age (GA) less than 32 weeks who were admitted to the 57 NICUs between January 1 and December 31, 2019, were included., Main Outcomes and Measures: Care practices, morbidities, and survival were the primary outcomes of the study. Major morbidities included bronchopulmonary dysplasia, severe intraventricular hemorrhage (grade ≥3) and/or periventricular leukomalacia, necrotizing enterocolitis (stage ≥2), sepsis, and severe retinopathy of prematurity (stage ≥3)., Results: A total of 9552 VPIs were included, with mean (SD) GA of 29.5 (1.7) weeks and mean (SD) birth weight of 1321 (321) g; 5404 infants (56.6%) were male. Antenatal corticosteroids were used in 75.6% (6505 of 8601) of VPIs, and 54.8% (5211 of 9503)were born through cesarean delivery. In the delivery room, 12.1% of VPIs received continuous positive airway pressure and 26.7% (2378 or 8923) were intubated. Surfactant was prescribed for 52.7% of the infants, and postnatal dexamethasone was prescribed to 9.5% (636 of 6675) of the infants. A total of 85.5% (8171) of the infants received complete care, and 14.5% (1381) were discharged against medical advice. The incidences of the major morbidities were bronchopulmonary dysplasia, 29.2% (2379 of 8148); severe intraventricular hemorrhage and/or periventricular leukomalacia, 10.4% (745 of 7189); necrotizing enterocolitis, 4.9% (403 of 8171 ); sepsis, 9.4% (764 of 8171); and severe retinopathy of prematurity, 4.3% (296 of 6851) among infants who received complete care. Among VPIs with complete care, 95.4% (7792 of 8171) survived: 65.6% (155 of 236) at 25 weeks' or less GA, 89.0% (880 of 988) at 26 to 27 weeks' GA, 94.9% (2635 of 2755)at 28 to 29 weeks' GA, and 98.3% (4122 of 4192) at 30 to 31 weeks' GA. Only 57.2% (4677 of 8171) of infants survived without major morbidity: 10.5% (25 of 236) at 25 weeks' or less GA, 26.8% (48 of 179) at 26 to 27 weeks' GA, 51.1% (1409 of 2755) at 28 to 29 weeks' GA, and 69.3% (2904 of 4192) at 30 to 31 weeks' GA. Among all infants admitted, the survival rate was 87.6% (8370 of 9552)and survival without major morbidities was 51.8% (4947 of 9552)., Conclusions and Relevance: The findings of this study suggest that survival and survival without major morbidity of VPIs in Chinese NICUs have improved but remain lower than in high-income countries. Comprehensive and targeted quality improvement efforts are needed to provide complete care for all VPIs, optimize obstetrical and neonatal care practices, and improve outcomes.

Ticks are well known as vectors of many viruses which usually do great harm to human and animal health. Yunnan Province, widely covered by flourishing vegetation and mainly relying on farming husbandry, is abundant with Rhipicephalus microplus ticks. Therefore, it is of great significance to characterize the viral profile present in R. microplus parasitizing on cattle in Yunnan Province. In this study, a total of 7387 R. microplus ticks were collected from cattle and buffalo in the northwest and southeast areas of Yunnan Province from 2015 to 2017. We investigated the virome of R. microplus using next-generation sequencing (NGS) and the prevalence of important identified viruses among tick groups by RT-PCR. It revealed the presence of diverse virus concerning chu-, rhabdo-, phlebo-, flavi- and parvo- viruses in Yunnan. These viruses consist of single-stranded, circular and segmented sense RNAs, showing a greatly diversity in genomic organization. Furthermore, continuous epidemiological survey among ticks reveals broad prevalence of three viruses (Yunnan mivirus 1, Wuhan tick vrius 1 and YN tick-associated phlebovirus 1) and two possible prevalent viruses including a flavivirus-like segmented virus (Jingmen tick virus) and a bovine hokovirus 2 in Yunnan. Serological investigation among cattle indicates that these identified viruses may be infectious to cattle and can elicit corresponding antibody. Our findings on R. microplus-associated viral community will contribute to the prevention of viral disease and tracking the viral evolution. Further analysis is needed to better elucidate the pathogenicity and natural circulation of these viruses., (© 2021. Wuhan Institute of Virology, CAS.)

Background: Women with breast cancer are prone to have mental stress and be stimulated by the fear of progression (FOP), then giving rise to a lower quality of life (QOL). The study aimed to examine the relationships between FOP, social support and QOL, and further explore whether social support mediates the association between FOP and QOL among Chinese patients with breast cancer., Methods: The cross-sectional study was conducted from October 2019 to May 2020 at Anshan Cancer Hospital in Liaoning, China. 244 female breast cancer patients completed questionnaires including the Functional Assessment of Cancer Therapy for Breast (FACT-B), Multi-Dimensional Scale of Perceived Social Support (MSPSS), and Fear of Progression (FOP). Hierarchical multiple regression analysis was performed to assess the associations between FOP, social support and QOL. Asymptotic and resampling strategies were used to explore the mediating role of social support., Results: The mean QOL score was 90.6 ± 17.0 among the patients with breast cancer. FOP was negatively correlated with QOL, while social support was positively related to QOL. Social support partly mediated the association between FOP and QOL, and the proportion of the mediating effect accounted for by social support was 25%., Conclusions: Chinese breast cancer patients expressed low QOL. Social support could mediate the association between FOP and QOL. Medical staffs and cancer caregivers should alleviate patients' FOP to improve their QOL by facilitating social support., (© 2021. The Author(s).)

Objective: To analyze the prevalence of diabetes mellitus among middle-aged and older rural adults of Xinxiang county, Henan Province and its correlation with dietary patterns., Methods: The study was done based on the data collected from a cross-sectional survey of Xinxiang County, which was part of the Prospective Cohort Study on the Common Chronic Non-Communicable Diseases in Rural areas of Henan Province. Randomized cluster sampling was used to select adult respondents (≥18 years old) from among the residents of 17 villages in Xinxiang county. The respondents completed questionnaires, and underwent physical examinations and laboratory tests between April, 2017 and June, 2017. A total of 7604 individuals aged between 45 and 79 were included in our study. Dietary patterns were established through factor analysis and the dietary pattern factor scores were divided into quartiles (Q1-Q4). The relationship between dietary patterns and diabetes mellitus was analyzed with multivariate logistic regression model., Results: Out of the total of 7604 middle-aged and older rural adults in Xinxiang County, Henan Province, 1604 had diabetes mellitus, suggesting a 21.1% prevalence of diabetes mellitus. Factor analysis was used to establish four dietary patterns, namely animal-based diet, vegetable-egg diet, mixed diet and traditional diet. Subjects of these four dietary patterns displayed different demographic characteristics. There were no statistical difference in anthropometricor clinical indicators between the quartile with the lowest dietary pattern factor score (Q1) and the quartile with the highest dietary pattern factor score (Q4) for subjects with animal-based diet ( P >0.05). Compared with those in the Q1 quartile of vegetable-egg diet, subjects in the Q4 quartile of vegetable-egg diet showed lower levels of high-density lipoprotein cholesterol (HDL-C), along with different distribution of fasting blood glucose (FBG), showing statistically significant difference ( P <0.05). In comparison to subjects in Q1 quartile of mixed diet, those in Q4 quartile showed lower levels of systolic blood pressure (SBP), the difference being statistically significant ( P <0.05). In the traditional diet group, subjects in the Q4 quartile had lower waist circumference (WC), but higher levels of HDL-C than those of subjects in Q1 quartile. In addition, the distribution of glycated-hemoglobin (HbA1c) and FBG were different, the difference being statistically significant ( P <0.05). The results of multivariate logistic regression analysis demonstrated that traditional diet could be a protective factor of diabetes mellitus (odds ratio [ OR ]=0.810, 95% CI : 0.690-0.952, P trend <0.05) after adjusting for multiple confounding factors., Conclusion: The prevalence of diabetes in middle-aged and older rural residents is relatively high in Xinxiang County, Henan Province, and there may be a protective relationship between traditional diet and diabetes mellitus., (Copyright© by Editorial Board of Journal of Sichuan University (Medical Sciences).)

Importance: Extreme prematurity is associated with a substantial burden on health care systems worldwide. However, little is known about the prognosis of infants born extremely preterm in developing countries, such as China., Objective: To describe survival and major morbidity among infants born extremely preterm in China over the past decade., Design, Setting, and Participants: This retrospective cohort study was conducted from January 1, 2010, through December 31, 2019. Included individuals were infants with gestational age less than 28 weeks discharged from 1 of 68 neonatal intensive care units located in 31 provinces in China. Data were analyzed from August through October 2020., Exposure: Extremely preterm birth., Main Outcomes and Measures: Survival to discharge and major morbidity (ie, bronchopulmonary dysplasia, grades III-IV intraventricular hemorrhage, white matter injury, stage II-III necrotizing enterocolitis, sepsis, or severe retinopathy of prematurity) were measured., Results: Among 8514 eligible infants, 5295 (62.2%) were male and 116 infants (2.0%) were small for gestational age (SGA). Overall, 5302 infants (62.3%) survived to discharge. The survival rate was 1 of 21 infants (4.8%) at 22 weeks, 13 of 71 infants (18.3%) at 23 weeks, 144 of 408 infants (35.3%) at 24 weeks, 480 of 987 infants (48.6%) at 25 weeks, 1423 of 2331 infants (61.0%) at 26 weeks, and 3241 of 4692 infants (69.1%) at 27 weeks. Survival increased from 136 of 241 infants (56.4%; 95% CI, 50.1%-62.7%) in 2010 to 1110 of 1633 infants (68.0%; 95% CI, 65.7%-70.2%) in 2019 for infants born at 24 to 27 weeks (mean difference, 11.5%; 95% CI, 4.9%-18.2%; P < .001), without a significant change for infants born at less than 24 weeks. Major morbidity was found in 5999 of 8281 infants overall, for a rate of 72.4%, which increased from 116 of 223 infants (52.0%; 95% CI, 45.4%-58.6%) to 1363 of 1656 infants (82.3%; 95% CI, 80.5%-84.1%) from 2010 to 2019 (mean difference, 30.3%; 95% CI, 23.5%-37.1%, P < .001). Regional variations in survival were identified, with an almost 2-fold increase (1.94-fold; 95% CI, 1.66-2.27; P < .001) from 188 of 474 infants (39.7%) in northwest China to 887 of 1153 infants (76.9%) in north China. Gestational age (adjusted risk ratio [aRR], 1.084; 95% CI, 1.063-1.105; P < .001), birth weight (aRR, 1.028; 95% CI, 1.020-1.036; P < .001), premature rupture of membranes (aRR, 1.025; 95% CI, 1.002-1.048; P = .03), and antenatal steroids (aRR, 1.029; 95% CI, 1.004-1.055; P = .02) were associated with improved survival, while being born SGA (aRR, 0.801; 95% CI, 0.679-0.945; P = .01), being male (aRR, 0.975; 95% CI, 0.954-0.997; P = .02), multiple birth (aRR, 0.955; 95% CI, 0.929-0.982; P = .001), having a mother with gestational diabetes (aRR, 0.946; 95% CI, 0.913-0.981; P = .002), and low Apgar score (aRR, 0.951; 95% CI, 0.925-0.977; P < .001) were found to be risk factors associated with decreased chances of survival., Conclusions and Relevance: This study found that infants born extremely preterm were at increased risk of mortality and morbidity in China, with a survival rate that improved over time and a major morbidity rate that increased. These findings suggest that more active and effective treatment strategies are needed, especially for infants born at gestational age 25 to 27 weeks.

Evidence is still limited for the role of long-term PM 2.5 exposure in cerebrovascular diseases among residents in high pollution regions. The study is aimed to investigate the long-term effects of PM 2.5 exposure on stroke mortality, and further explore the effect modification of temperature variation on the PM 2.5 -mortality association in northern China. Based on a cohort data with an average follow-up of 9.8 years among 38,435 urban adults, high-resolution estimates of PM 2.5 derived from a satellite-based model were assigned to each participant. A Cox regression model with time-varying exposures and strata of geographic regions was employed to assess the risks of stroke mortality associated with PM 2.5 , after adjusting for individual risk factors. The cross-product term of PM 2.5 exposure and annual temperature range was further added into the regression model to test whether the long-term temperature variation would modify the association of PM 2.5 with stroke mortality. Among the study participants, the annual mean level of PM 2.5 concentration was 66.3 μg/m 3 ranging from 39.0 μg/m 3 to 100.6 μg/m 3 . For each 10 μg/m 3 increment in PM 2.5 , the hazard ratio (HR) was 1.31 (95% CI: 1.04-1.65) for stroke mortality after multivariable adjustment. In addition, the HRs of PM 2.5 decreased gradually as the increase of annual temperature range with the HRs of 1.95 (95% CI: 1.36-2.81), 1.53 (95% CI: 1.06-2.22), and 1.11 (95% CI: 0.75-1.63) in the low, middle, and high group of annual temperature range, respectively. The findings provided further evidence of long-term PM 2.5 exposure on stroke mortality in high-exposure settings such as northern China, and also highlighted the view that assessing the adverse health effects of air pollution might not ignore the role of temperature variations in the context of climate change., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)