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Purpose: The purpose of this paper is to provide a case study of the establishment and development of a minor program in Sustainable Development in Tongji University, China, and how it contributes to embedding sustainable development into higher education system as an alternative platform for researchers and students to involve in a transdisciplinary teaching and learning process. Design/methodology/approach: This case reviews the institutional setting and the different studying models and requirements for postgraduates and undergraduates. Postgraduate students have to take four core courses, select one module with four themed courses (4 + 4 fixed) and complete a transdisciplinary essay, and undergraduates can choose any three courses in all modules apart from the four core courses (4 + 3 open), with a transdisciplinary group project. Findings: The development of the minor program reveals the popularity and decline of different modules, because of the popularity of the schools and institutes behind them, the university legacy and the media influence. The program design spurs transdisciplinary thinking on sustainable development but brings about challenges including time conflict with students' major study. In conclusion, this program explores alternative education practices in embedding sustainable development in education system, contributing to and reflect on Education for Sustainable Development and the education reform in China. Originality/value: The case presents a unique way of implementing Education for Sustainable Development in higher education system, in which minor education stands between formal and informal curriculum to tackle the barriers in undertaking sustainable development initiatives in curricula, through nurturing the culture and providing organizational support.

Aim and objectives: To investigate the nutritional status of older adults in nursing homes in Chongqing, China, compare and analyse the differences in the physical condition, cognitive function and social‐related factors of older adults with different nutritional statuses. Background: Malnurtition in the older people has become a priority concer, and the incidence and factors associated with malnutrition vary somewhat by healthcare setting. In Chongqing ,China, there is lack of research on malnutrition of the older people in nursing homes. Here, we investigated the incidence of malnutrition and analysed the associated factors. Design: A cross‐sectional study. Methods: From January to April 2023, a cross‐sectional survey was conducted in three nursing homes in Chongqing, China. Participants completed a series of questionnaires, including the Demographic Information Questionnaire which included age, gender, education level, previous occupation, marital status and other information. The survey also included validated non‐demographic instruments [Short‐Form Mini‐Nutritional Assessment (MNA‐SF), Barthel Index (BI) and Mini‐mental State Examination (MMSE)] to identify related impact factors. The Guidelines for cross‐sectional studies were used in this study (Data S1). Results: 209 older adults aged 60 and over participated in this study, of whom 121 were women and 88 were men. The average (SD) age of the participants was 84.7 (6.3) years. Of the participants, 46.4% were classified as well nourished. About 39.2% were at risk of malnutrition and 14.4% were malnourished. Compared to those who were well nourished, those who were malnourished or at risk of becoming malnourished were more likely to suffer from comorbidities, polypharmacy, a higher risk of falling, ADL dependence and to receive more nutritional interventions. However, there are no significant differences after adjustment for age, education level, previous occupation, marital status, length of stay, and type of health care payment. Conclusion: Malnutrition is a common problem among older adults innursing homes in Chongqing, China. There are certain differences in physical conditions and nutritional interventions among older adults withdifferent nutritional status. Public Contribution: This study suggests that the problem of malnutrition is very prominent in nursing homes in Chongqing, China. Cognitive impairment, impaired activities of daily living, fall risk and nutritional intervention need to be prevalent in older adults with (risk of) malnutrition. [ABSTRACT FROM AUTHOR]

[Objective] The maximum operating pressure for underground gas storage facilities designed for oil and gas reservoirs, both constructed and under construction in China, is currently set at the original formation pressure. There have yet to be successful cases of overpressure operation, which significantly impacts the economic benefits of converting depleted oil and gas reservoirs into underground gas storage facilities. This article aims to evaluate the maximum operating pressure and storage capacity of the Nanpu 1-29 gas storage facility from the perspective of the ultimate bearing capacity of cap layers and faults, with the goal of effectively enhancing the construction benefits of the facility. [Methods] The evaluation of the maximum operating pressure for the Nanpu 1-29 gas storage facility in eastern Hebei is based on the minimum principal stress measured in situ in the mining wells. Different effective porosity calculation methods are employed to quantitatively evaluate the effective storage capacity of gas and oil reservoirs, as well as the incremental capacity after pressure boosting operation, based on their development differences. [Results] The evaluation of the maximum operating pressure for the Nanpu 1-29 gas storage facility indicates that the minimum principal stress of the cap layers determined by the in-situ measurements in the mining wells is 34.00 MPa. Based on the tensile failure criteria determined by the minimum principal stress, the maximum operating pressure for the tensile failure of the cap layer is 27.20 MPa. Combined with the maximum safe injection pressure corresponding to shear failure of the cap layer (30.60 MPa) and the maximum safe injection pressure corresponding to unstable slip of the fault (27.60 MPa), the final maximum operating pressure for the Nanpu 1-29 gas storage facility is determined to be 27.20 MPa. Based on the effective storage capacity calculation model, considering factors such as the water content of the gas reservoir, residual water and edge porosity as well as the coefficient of influence, the efficiency of gas-driven fluid, and the utilization rate of oil-containing space, the maximum operating pressure increased from the original formation pressure of 22.50 MPa to 27.20 MPa. The practical storage capacity of the gas storage facility increased from 15.46x108 m³ to 18.14x108 m³, an increase of approximately 17.3%. [Conclusion] (1) The construction of gas storage facilities can be re-evaluated for the maximum operating pressure based on the minimum principal stress measured in situ in the mining wells, and overpressure design can be conducted under appropriate conditions. (2) Overpressure design can effectively increase storage capacity and improve the economic benefits of reservoir construction. [Significance] The research results have a certain reference value for the quantitative evaluation of the maximum operating pressure and storage capacity of other underground gas storage facilities, and are expected to significantly improve the economic benefits of overpressure-designed reservoir-type gas storage facilities in China. [ABSTRACT FROM AUTHOR]

Background: Gut microbiota is significantly influenced by altitude. However, the dynamics of gut microbiota in relation to altitude remains undisclosed. Methods: In this study, we investigated the microbiome profile of 610 healthy young men from three different places in China, grouped by altitude, duration of residence, and ethnicity. We conducted widely targeted metabolomic profiling and clinical testing to explore metabolic characteristics. Results: Our findings revealed that as the Han individuals migrated from low altitude to high latitude, the gut microbiota gradually converged towards that of the Tibetan populations but reversed upon returning to lower altitude. Across different cohorts, we identified 51 species specifically enriched during acclimatization and 57 species enriched during deacclimatization to high altitude. Notably, Prevotella copri was found to be the most enriched taxon in both Tibetan and Han populations after ascending to high altitude. Furthermore, significant variations in host plasma metabolome and clinical indices at high altitude could be largely explained by changes in gut microbiota composition. Similar to Tibetans, 41 plasma metabolites, such as lactic acid, sphingosine-1-phosphate, taurine, and inositol, were significantly elevated in Han populations after ascending to high altitude. Germ-free animal experiments demonstrated that certain species, such as Escherichia coli and Klebsiella pneumoniae, which exhibited altitude-dependent variations in human populations, might play crucial roles in host purine metabolism. Conclusions: This study provides insights into the dynamics of gut microbiota and host plasma metabolome with respect to altitude changes, indicating that their dynamics may have implications for host health at high altitude and contribute to host adaptation. 88DwbBo5LkUszxYCpXiUg_ Video Abstract [ABSTRACT FROM AUTHOR]

Neonicotinoid pesticides (NEOs) were initially considered viable alternatives to conventional organo-pesticides extensively used in agriculture, horticulture, and households. However, the increased frequency and concentration of NEOs in waterways have drawn significant attention and concern due to the resulting threats to ecosystems and public health worldwide. The demand for monitoring NEOs in water has led to numerous efforts in many countries and regions. Given occurrence and distribution of these pesticides/insecticides. This study reviews NEOs monitoring in China from 2019 to 2022, aiming to gather and analyse information on China's efforts in NEOs monitoring to provide reference for future research. The study primarily focuses on the southern and southeastern regions of China, specifically on lakes and tributaries of rivers, including Taihu Lake, Pearl River, Yangtze River, Songhua River, and Liao River. This focus can be attributed to the prioritisation and environmental demands related to the local economic status and major developmental tasks. The evaluation of the corresponding ecological risks of human exposure to NEOs ranged from low to medium-high levels. However, despite these findings, contamination from NEOs is still considered to lack sufficient attention and concern. Additionally, the presence of NEOs in other environmental media, such as indoor dust, wheat grains, vegetables, and teas, requires close attention in the future. [ABSTRACT FROM AUTHOR]

This study collected 49 topsoil samples in agricultural soil from Panxi district (Sichuan, China), investigating the contamination status and probabilistic health risk of their heavy metal(loid)s (HMs). The average concentrations (mg/kg) of As, Cd, Cr, Cu, Ni, Pb and Zn were 18.18, 1.66, 294.05, 143.37, 70.18, 31.70 and 139.18, respectively. The pollution index (Pi) of the seven HMs were in the descending order of Cd > Cr > Cu > As > Zn > Ni > Pb, and the comprehensive Nemeiro risk index (PN) was 2.67, indicating that the study area was a moderate pollution by HMs. Meanwhile, Cd showed major contribution to the soil pollution among these HMs. The spatial distribution of HMs revealed that the southwestern part of the study area was the contamination hotspots. The hazard index (Hi) for children and adults were 1.621 and 0.346, respectively, and the total non-carcinogenic risk for children exceeded the threshold of 1. The carcinogenic risks associated with Cr (adults:, children:) and Ni (adults:) far exceeded the safe level of 1E-04; Monte Carlo simulations showed that humans locating in the study area suffered from a relatively significant carcinogenic risk; and the children were at higher risk than the adults. Among the three exposure pathways (ingestion, inhalation, and dermal contact), the ingestion was the most important way for HMs to harm human health. Overall, this study provides a scientific basis for both controlling HMs contamination and reducing the potential health risks in studied soils. [ABSTRACT FROM AUTHOR]

Backgrounds: Melanoma is a malignant tumor that originates from melanocytes and is known for its aggressive behavior and high metastatic potential. In recent years, vaccine therapy has emerged as a promising approach for the treatment of melanoma, offering targeted and individualized immunotherapy options. In this study, we conducted a bibliometric analysis to assess the global research trends and impact of publications related to melanoma and vaccine therapy. Methods: We retrieved relevant literature from the Web of Science database from the past decade (2013–2023) using keywords such as "melanoma", "vaccine therapy", and "cancer vaccines". We used bibliometric indicators including publication trends, citation analysis, co-authorship analysis, and journal analysis to evaluate the research landscape of this field. Results: After screening, a total of 493 publications were included in the analysis. We found that melanoma and vaccine therapy have gained significant attention in the field of cancer immunotherapy, as evidenced by the numerous research output and increasing citation impact. The United States, China, and their organizations are the leading countries/institutes in terms of publication output, and collaborative research networks are prominent in this field. Clinical trials evaluating the safety and efficacy of vaccination treatment in melanoma patients are the focus of research. Conclusions: This study provide valuable insights into the novel research landscape of vaccine treatment of melanoma, which could inform future research directions and facilitate knowledge exchange among researchers in this field. [ABSTRACT FROM AUTHOR]

There is significant enterohepatic circulation (EHC) during the disposition of mycophenolic acid (MPA). The aim of this study was to elucidate factors influencing the EHC of MPA in Chinese adult renal allograft recipients. After 2 weeks of therapy with mycophenolate mofetil or enteric‐coated mycophenolate sodium, blood samples were collected from 125 patients at 0 to 12 hours post‐administration and MPA concentrations were determined. The influence of calcineurin inhibitors (CNIs) and genetic polymorphisms on MPA exposure and EHC was studied. The Shapley additive explanations method was used to estimate the impact of various factors on the area under the plasma drug concentration–time curve (AUC0–12h) for MPA. An extreme gradient boosting (XGboost) machine learning‐based model was established to predict AUC0–12h. Results showed that the dose‐normalized AUC6–12h (dn‐AUC6–12h) of MPA was significantly lower in patients co‐administered with cyclosporine (CsA) than in patients co‐administered with tacrolimus (TAC) (P <.05). For patients co‐administered with TAC, patients with ABCC2 C‐24T CC or SLCO1B1 T521C TT genotypes had significantly higher values of dn‐AUC6‐12h (P <.05). Patients with SLCO1B3 334T/699G alleles had significantly lower dn‐AUC6–12h values than homozygotes (P <.05). By introducing body weight, age, and EHC‐related factors, including co‐administered CNIs and genetic polymorphism of drug transporters, as covariates in the XGboost machine learning model, the prediction performance of AUC0–12h for MPA in Chinese adult renal allograft recipients can be improved. [ABSTRACT FROM AUTHOR]

The objective of this scoping review was to synthesize the available evidence and evaluate the effectiveness of chronoradiotherapy interventions in cervical cancer patients. This scoping review was performed by searching in the PubMed, Cochrane Library, Embase, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), Wanfang, Wenpu, and Chinese Biomedical Literature (CBM) databases. Databases were searched for studies published in English or Chinese from inception to 21 May 2021, and reference lists of relevant reports were scanned. Two investigators independently screened eligible studies in accordance with predetermined eligibility criteria and extracted data. The included studies were summarized and analyzed. Five studies including a total of 422 patients with cervical cancer were included in the scoping review; four studies were Chinese, and one was Indian. Main themes identified included the efficiency of chronoradiotherapy and relevant toxic and side effects, including diarrhea toxicity, hematologic toxicity, myelosuppression, gastrointestinal mucositis, and skin reactions. Administration of radiotherapy at different times of the day resulted in similar efficacy. However, the toxic side effects of morning radiotherapy (MR) and evening radiotherapy (ER) differed, with radiotherapy in the evening leading to more severe hematologic toxicity and myelosuppression. There were conflicting conclusions about gastrointestinal reactions with chronoradiotherapy, and further studies are needed. Radiation responses may be associated with circadian genes, through the influence of cell cycles and apoptosis. [ABSTRACT FROM AUTHOR]

Objective The most used drug for the treatment of rheumatoid arthritis (RA) remains methotrexate (MTX). Unfortunately, up to 50% of patients do not achieve a clinically adequate outcome. Here we study whether the gut microbiota patterns can aid in the prediction of MTX efficacy for RA. Method To dissect gut microbiome profiles of RA patients (n  = 145), 16S rRNA gene sequencing was performed. Dirichlet multinomial mixture (DMM) clustering was used to identify enterotypes at genus level. The relationships between enterotypes and clinical measures (such as lymphocyte subsets and cytokines detected by flow cytometry) were explored. Then, enterotype stability was evaluated by the stratification of the RA patient cohort (n  = 66) in Shanghai, China, using the same method. Finally, the enterotype-based gut microbial human index classifier was applied to another independent RA patient cohort (n  = 27) to identify the factors associated with MTX clinical response. Results Our analysis revealed that the RA patients always displayed two different dysbiotic microbiota patterns: RA E1 comprised predominantly Prevotella and RA E2 comprised predominantly Bacteroides. Among all of the lymphocyte subsets and cytokines, only the number of CD8+ T cells showed a significant difference between RA E1 and RA E2. These results were validated in the RA patient cohort in Shanghai, China. Significant associations of RA E1 with clinical response to subsequent MTX treatment were confirmed by another independent RA patient cohort. Conclusion Together, the enterotype-based gut microbial human index (EGMI) classifier was useful to precisely and effectively identify enterotypes of individual RA patients, which could effectively evaluate MTX clinical responses. [ABSTRACT FROM AUTHOR]

More accurate source analysis of potentially toxic elements (PTEs) in atmospheric fallout that endanger biodiversity and human health remains needed. This study determined the concentrations of seven PTEs, including Pb, Cd, As, Cu, Zn, Ni, and Cr, by inductively coupled plasma mass spectrometry (ICP-MS), and the sources of PTE pollution were quantified using multivariate statistical analysis, including principal component analysis (PCA), cluster analysis (CA), and Pearson correlation analysis, and Moran index was applied for mutual verification and supplementation. PCA and CA revealed that the same mixed sources of Pb, Cd, As, Cu, and Zn were found in the atmospheric dust fall in the study area, while Ni and Cr had the same source of pollution. Pearson correlation analysis provided that there were strong correlations between Pb–Cd, Pb-As, Pb-Cu, Cd-As, Cd-Cu, As-Cu, and Ni–Cr, indicating commonality between the two sources of heavy metal pollution. Additionally, the Moran index showed that strong spatial correlations were observed between Pb, Cd, As, Cu, and Zn, whose sources were mainly related to non-ferrous metal processing smelter smelting slag sites and an environmental company in the study area. However, no spatial correlation was found between Ni and Cr, which mainly originated from the local geological background. [ABSTRACT FROM AUTHOR]

Backgroud and purpose: Triglyceride-glucose (TyG) index has been considered a surrogate marker of insulin resistance. We investigated the association between TyG index and stroke recurrence and compared the effectiveness of TyG index with homeostasis model assessment of insulin resistance (HOMA-IR) in predicting stroke recurrence and death in nondiabetic acute ischemic stroke patients. Methods: Nondiabetic acute ischemic stroke patients from the ACROSS-China (Abnormal Glucose Regulation in Patients with Acute Stroke across China) registry were included. TyG index was performed and classified into four groups by quartiles. The outcomes were stroke recurrence and death within 1 year. The association between TyG index and the risk of stroke recurrence and death were analyzed by Cox regression models. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the prediction of TyG index and HOMA-IR for stroke recurrence and death. Delong test was used for comparing the differences between area under the curve (AUC) of TyG index and HOMA-IR. Results: Among the 1226 patients included, the median (interquartile range) of TyG index was 5.8 (5.5–6.2). Both the third and fourth quartiles of TyG index were associated with an increased risk of stroke recurrence (adjusted hazard ratio 2.04, 95% confidence interval 1.26–3.31; adjusted hazard ratio 1.86, 95% confidence interval 1.13–3.06). Patients with fourth quartiles of TyG index were associated with a higher mortality risk (adjusted hazard ratio, 2.91; 95% confidence interval, 1.62–2.53). Regarding stroke recurrence within 1 year, the AUC (95% confidence interval) of the ROC curve for the TyG index was similar to that of the HOMA-IR[0.56 (0.52–0.61) vs 0.57 (0.52–0.61); P = 0.93]. Regarding death within 1 year, the AUCs (95% confidence interval) of the ROC curve for the TyG index and HOMA-IR were 0.55 (0.50–0.61) and 0.59 (0.53–0.64), respectively (P = 0.32). Conclusions: Elevated TyG index was associated with an increased risk of stroke recurrence and death. However, neither of TyG nor HOMA-IR can be a qualified predictor of stroke recurrence and death in nondiabetic acute ischemic stroke patients. [ABSTRACT FROM AUTHOR]

By exploring a unique setting wherein all Chinese listed firms were mandated to specify dividend provisions, we find such dividend regulation generates costs to firms. In particular, low agency cost firms tend to strengthen their dividend provisions. Firms strengthening dividend provisions raise more equity than other firms, at least in a subsample with high dependence on equity. These firms incur higher costs than other firms when issuing equity. All these findings highlight the regulatory cost imposed by dividend regulation. In addition, investors downward revise their valuation of earnings if a firm misses its dividend provision, maintaining the observed separating equilibrium. [ABSTRACT FROM AUTHOR]

Taking the 30 Chinese provinces in 2000–2018 as the objects, this paper measures their agricultural environmental efficiencies (AEEs) with slack-based measure (SBM) containing an undesired output. Then, the features of the spatiotemporal evolution of AEE in China were explored on ArcGIS, and the factors affecting the AEE were analyzed with a geodetector. The results show that there is a huge provincial gap in AEE across China; most provinces with a high AEE belong to eastern coastal region, while most inland provinces had a relatively low AEE. Except for a few years, the AEEs in eastern, central, and western regions changed very slightly, and the eastern region had a higher AEE level than central and western regions. The results of spatiotemporal evolution show that, with the elapse of time, the high-AEE provinces gradually shifted to the inland; the AEE trend varied from province to province; the provinces were highly polarized in terms of AEE. The AEE is mainly affected by the following factors: fiscal expenditure, fertilizer intensity, pesticide intensity, and economic growth. [ABSTRACT FROM AUTHOR]

Valganciclovir (VGCV) is the prodrug of ganciclovir (GCV). The objective of this study was to establish a population pharmacokinetic model (PPK) of GCV to investigate the PK characteristics of GCV after administration of VGCV in adult Chinese renal allograft recipients. Seventy Chinese renal allograft recipients were given 450 mg (n = 41) or 900 mg (n = 29) VGCV daily. Blood samples were drawn 0‐24 hours after 5 days' therapy, and GCV plasma levels were determined. The PPK model was constructed using nonlinear mixed‐effects modeling, and the Bayesian estimation of AUC0‐24h was constructed for an individual patient based on limited plasma samples. The PK of GCV was best described by a 2‐compartment model with a first‐order absorption process. The CL/F, V2/F, Q/F, V3/F, Ka, and lag time of GCV were 15.8 ± 0.71 L/h, 10.9 ± 2.38 L, 3.98 ± 0.40 L/h, 167 ± 44.0 L, 0.23 ± 0.0078 1/h, and 0.93 ± 0.017 hours, respectively. Clearance of creatinine was found to have a significant impact on the CL/F of GCV (P <.01). Sampling strategies consisted of plasma concentrations 0 and 2 and 0, 2, and 4 hours after VGCV administration were shown to be suitable for the estimation of the GCV AUC0‐24h. The PPK model was acceptable and can describe the PK of GCV in Chinese renal transplant patients administered VGCV. The AUC0‐24h of GCV in Chinese renal transplant patients can be calculated by a limited sampling strategy method. [ABSTRACT FROM AUTHOR]

Using the panel data of China's provinces from 2005 to 2016, the paper adopts the ultra-efficiency model to measure the green economy efficiency of each province. Then, the paper used the panel threshold model to study the impact of science and technological input on the green economy efficiency with the energy consumption intensity as a threshold variable. The results show that the green economy efficiency in China's provinces is low and is in a downward trend. When the energy consumption intensity is the threshold variable, the single-threshold effect is significant. When the energy consumption intensity is lower than the threshold value, the impact of science and technological input on green economic efficiency is not significant, and the energy consumption intensity has a significant impact on green economic efficiency with science and technological input and energy consumption intensity as the core explanatory variables and with energy consumption intensity as the threshold variable. When the energy consumption intensity crosses the threshold value, the impact of science and technological input and energy consumption intensity on green economic efficiency becomes significant. According to the above empirical results, this paper proposes corresponding countermeasures and suggestions. [ABSTRACT FROM AUTHOR]

Background In this study, we investigated the effects of prior influenza exposure on vaccine-elicited humor immune responses to circulating influenza variants. Method We randomly selected 360 participants in previous clinical trials stratified by age. Blood samples were collected and tested by hemagglutination-inhibition tests during the 2015–2016 influenza seasons in China. The antigenic map was plotted and antigenic distance was calculated. Results Subjects with H1-priming had higher cross-reactive antibodies titers against A/JiangsuTinghu/11019/2015(H3N2) compared with subjects with B-priming did (P adjusted = .038). Subjects with H1-priming also had higher cross-reactive antibodies titers against A/Jiangsu Qinhuai/11059/2015(H3N2) than subjects with both H1 and B priming (P adjusted = .036). Nevertheless, subjects with no H1 and B-priming had higher cross-reactive antibodies titers against A/Jiangsu Qinhuai/11059/2015(H3N2) than subjects with both H1 and B priming (P adjusted =.012). Antigenic distance was well matched with serological results. Moeover, age-specific differences in human postvaccination responses against the identical circulating strain was noted. In addition, children had the most cross-reactive response to both H3N2 and B-yamagata subtypes. Conclusions Our results suggest that prior exposure to H1 or B influenza virus may influence cross-reactivity of H3-specific postvaccination responses and consequently could influence the vaccine effectiveness. Our findings also support that there are age-specific differences in human postvaccination responses. [ABSTRACT FROM AUTHOR]

Background. Alzheimer’ disease (AD) is an ultimately fatal degenerative brain disorder that has an increasingly large burden on health and social care systems. There are only five drugs for AD on the market, and no new effective medicines have been discovered for many years. Chinese medicinal plants have been used to treat diseases for thousands of years, and screening herbal remedies is a way to develop new drugs. Methods. We used molecular docking to screen 30,438 compounds from Traditional Chinese Medicine (TCM) against a comprehensive list of AD target proteins. TCM compounds in the top 0.5% of binding affinity scores for each target protein were selected as our research objects. Structural similarities between existing drugs from DrugBank database and selected TCM compounds as well as the druggability of our candidate compounds were studied. Finally, we searched the CNKI database to obtain studies on anti-AD Chinese plants from 2007 to 2017, and only clinical studies were included. Results. A total of 1,476 compounds (top 0.5%) were selected as drug candidates. Most of these compounds are abundantly found in plants used for treating AD in China, especially the plants from two genera Panax and Morus. We classified the compounds by single target and multiple targets and analyzed the interactions between target proteins and compounds. Analysis of structural similarity revealed that 17 candidate anti-AD compounds were structurally identical to 14 existing approved drugs. Most of them have been reported to have a positive effect in AD. After filtering for compound druggability, we identified 11 anti-AD compounds with favorable properties, seven of which are found in anti-AD Chinese plants. Of 11 anti-AD compounds, four compounds 5,862, 5,863, 5,868, 5,869 have anti-inflammatory activity. The compound 28,814 mainly has immunoregulatory activity. The other six compounds have not yet been reported for any biology activity at present. Discussion. Natural compounds from TCM provide a broad prospect for the screening of anti-AD drugs. In this work, we established networks to systematically study the connections among natural compounds, approved drugs, TCM plants and AD target proteins with the goal of identifying promising drug candidates. We hope that our study will facilitate in-depth research for the treatment of AD in Chinese medicine. [ABSTRACT FROM AUTHOR]

We aimed to investigate the prevalence and distribution of abnormal glucose regulation, including prediabetes and newly diagnosed diabetes, according to different criteria in ischaemic stroke patients without a history of diabetes. Data were derived from a representative cohort across China. Prediabetes was defined as fasting plasma glucose (FPG) 5.6–6.9 mmol/L or 2-hour oral glucose tolerance test (OGTT) 7.8–11.0 mmol/L or haemoglobin A1c (HbA1c) 5.7–6.4%. Newly diagnosed diabetes was defined as FPG ≥ 7.0 mmol/L, 2 h OGTT ≥ 11.1 mmol/L or HbA1c ≥ 6.5%. Among 1251 ischaemic stroke patients, 471 (37.5%) were detected as prediabetes and 539 (43.1%) were detected as newly diagnosed diabetes. Prediabetes was present in 118 (9.4%), 290 (23.2%) and 314 (25.1%) stroke patients, and newly diagnosed diabetes was present in 138 (11.0%), 370 (29.6%), and 365 (29.2%) stroke patients, based on FPG, 2 h OGTT, and HbA1c criteria, respectively. Dependency on FPG alone would have missed 74.9% of patients in the prediabetes range and 74.4% of patients in the diabetes range. Our study demonstrated a high prevalence of prediabetes and diabetes in ischaemic stroke patients without a history of diabetes. OGTT and HbA1c helped detect the majority of prediabetes and newly diagnosed diabetes in ischaemic stroke patients. [ABSTRACT FROM AUTHOR]

Background. Alzheimer’ disease (AD) is an ultimately fatal degenerative brain disorder that has an increasingly large burden on health and social care systems. There are only five drugs for AD on the market, and no new effective medicines have been discovered for many years. Chinese medicinal plants have been used to treat diseases for thousands of years, and screening herbal remedies is a way to develop new drugs. Methods. We used molecular docking to screen 30,438 compounds from Traditional Chinese Medicine (TCM) against a comprehensive list of AD target proteins. TCM compounds in the top 0.5% of binding affinity scores for each target protein were selected as our research objects. Structural similarities between existing drugs from DrugBank database and selected TCM compounds as well as the druggability of our candidate compounds were studied. Finally, we searched the CNKI database to obtain studies on anti-AD Chinese plants from 2007 to 2017, and only clinical studies were included. Results. A total of 1,476 compounds (top 0.5%) were selected as drug candidates. Most of these compounds are abundantly found in plants used for treating AD in China, especially the plants from two genera Panax and Morus. We classified the compounds by single target and multiple targets and analyzed the interactions between target proteins and compounds. Analysis of structural similarity revealed that 17 candidate anti-AD compounds were structurally identical to 14 existing approved drugs. Most of them have been reported to have a positive effect in AD. After filtering for compound druggability, we identified 11 anti-AD compounds with favorable properties, seven of which are found in anti-AD Chinese plants. Of 11 anti-AD compounds, four compounds 5,862, 5,863, 5,868, 5,869 have anti-inflammatory activity. The compound 28,814 mainly has immunoregulatory activity. The other six compounds have not yet been reported for any biology activity at present. Discussion. Natural compounds from TCM provide a broad prospect for the screening of anti-AD drugs. In this work, we established networks to systematically study the connections among natural compounds, approved drugs, TCM plants and AD target proteins with the goal of identifying promising drug candidates. We hope that our study will facilitate in-depth research for the treatment of AD in Chinese medicine. [ABSTRACT FROM AUTHOR]

Background. Changes of N-terminal probrain natriuretic peptide (NT-proBNP) have been studied whether in the long term or the short term in patients of acute heart failure (AHF); however, changes of NT-proBNP in the first five days and their association with other factors have not been investigated. Aims. To describe the dynamic changes of relevant laboratory indexes in the first five days between different outcomes of AHF patients and their associations. Methods and Results. 284 AHF with dynamic values recorded were analyzed. Changes of NT-proBNP, troponin T, and C-reactive protein were different between patients with different outcomes, with higher values in adverse group than in control group at the same time points (p<0.05). Then, prognostic use and risk stratification of NT-proBNP were assessed by receiver-operating characteristic curve and logistic regression. NT-proBNP levels at day 3 showed the best prognostic power (area under the curve = 0.730, 95% confidence interval (CI): 0.657 to 0.794) and was an independent risk factor for adverse outcome (odds ratio, OR: 2.185, 95% CI: 1.584–3.015). Classified changes of NT-proBNP may be predictive for adverse outcomes in AHF patients. Conclusions. Sequential monitoring of laboratory indexes within the first 5 days may be helpful for management of AHF patients. [ABSTRACT FROM AUTHOR]

1. Following rapid economic development in China, the epidemiological characteristics, management and prevention strategies for stroke are changing. In the present article, we review recent epidemiological data, as well as studies into the management and prevention of stroke in China. 2. The main findings of the studies reviewed suggest that stroke mortality in China has been reduced significantly. The percentage of haemorrhagic strokes in China is significantly higher than that reported in Western countries. The incidence and subtype of stroke varied widely in different regions in China. Some of the modifiable risk factors for stroke are on the increase in China, including hypertension. 3. Management of stroke is slowly being developed and standardized, as evidenced by the establishment of stroke units and improvements in emergency care. Studies on primary and secondary stroke prevention remain insufficient. Well-designed epidemiological surveys and clinical trials for stroke prevention and management are urgently needed in China. [ABSTRACT FROM AUTHOR]

The study was designed to investigate the infection status and to finish the preliminary eradication of avian leukosis virus (ALV) and Salmonella pullorum (SP) in breeders of Chinese local "ShouGuang" chickens. ALV antigen and antibody was tested via ELISA, and SP antibody was detected by serum plate agglutination test (SPAT). The etiology and pathology was also studied. The ALV-P27 antigen, ALV-A/B and SP antibody positive chickens were eliminated in turn, and then the negative were retained as the breeder flocks. The results showed that the positive rate of antigen to ALV-P27, antibody to ALV-A/B, ALV-J and SP was 57.8, 6.7, 0 and 17.8% in this breeder farm, respectively. The co-infection of ALV and SP was confirmed and the positive rate of both SP and ALV-P27 or ALV-A/B was 10 and 1%, respectively. There were obvious tumor nodules and lymphoid tumor cells in the comb, liver and spleen of the co-infected chickens. The degenerative and atrophic ovarian follicles, inflammatory cell infiltration in muscle biopsies were also found. The elimination rate of ALV-p27, ALV-A/B and SP positive chickens was 55.4, 13 and 6.1%, respectively. The final amount of the breeder conservation was 309 chickens. In conclusion, the co-infection of ALV-B and SP was found and more emphasis should be given on its prevention; the preliminary eradication of "ShouGuang" breeder chickens was finished. [ABSTRACT FROM AUTHOR]

Abstract: The Chinese-Russian Oil Pipeline (CROP), from Mohe to Daqing has a length of about 965km and traverses the Da Hinggan Mountains and part of Song(hua)-Nen(jiang) Plain in Northeastern China. This paper attempts to estimate some of the important elements concerning the environmental hazards and contingency plans along the pipeline. The first part reviews the potential impacts of the Mohe-Daqing Pipeline on the cold regions environment. It includes 1) the major environmental characteristics such as complicated permafrost, rugged terrain, harsh weather, and the diverse flora and fauna, vegetation the pipeline passes through; 2) the consideration of route selection; 3) potential environmental impacts of the CROP on the environmental factors; 4) countermeasures to alleviate changes to the local environment during the design, construction and operation stages. The second part presents the risk of oil spills, the subsequent environmental challenges after the start of operation of CROP, and contingency plans in response to potential oil spills. [Copyright &y& Elsevier]

Three new meroterpenoids (1-3) and ten known ones (4-13) were obtained from the endophytic fungus Talaromyces primulinus H21 isolated from the plant of Euphorbia sikkimensis. Their structures including their absolute configurations were elucidated by extensive analysis of spectroscopic data such as HR-ESI-MS, 1D/2D NMR, and X-ray diffraction of single crystal together with comparison of experimental ECD with calculated ECD. All compounds were examined for their inhibitory effects on nitric oxide (NO) production induced by lipopolysaccharide (LPS) in RAW264.7 cells, and compounds 3, 9, 12, and 13 exhibited certain inhibition on NO production, with IC 50 values of 27.19, 41.55, 25.23, and 24.71 μM, respectively., Competing Interests: Declaration of competing interest The authors declare that there are no competing interests associated with this work., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Cutaneous tuberculosis (CTB) and nontuberculous mycobacteria (NTM) infections present considerable diagnostic and therapeutic challenges. This study aims to provide a comprehensive clinicopathological analysis of CTB and NTM infections., Methods: We conducted a retrospective analysis of 103 patients diagnosed with cutaneous tuberculosis (CTB) and nontuberculous mycobacteria (NTM) infections at a Beijing dermatology department from January 2000 to January 2024. Demographic, clinical, histological, and laboratory finding data were collected. Diagnostic methods and histopathological examination were recorded. Treatment regimens and outcomes were reviewed. Descriptive statistics were used to summarize demographic and clinical data, and continuous variables expressed as means and standard deviations (SD), and categorical variables as frequencies and percentages. Statistical analyses were conducted using SPSS version 25.0., Results: The cohort included 103 patients (40.8% males and 59.2% females), with a mean age of 51.86 years. Common clinical manifestations included nodules (97.1%), erythema (74.8%), and plaques (68.9%). Histological examination revealed hyperkeratosis (68.9%), parakeratosis (23.3%), and extensive neutrophil infiltration (95.1%) were observed. Acid fast bacteria (AFB) stains and nucleic acid tests exhibited respective positivity rates of 39.6% and 52.3%, respectively. Most patients were treated with a combination of three drugs; 77.1% of patients showed improvement, with the cure rate for CTB being 20.0%., Discussion: This study highlights the diverse clinical and histological presentations of CTB and NTM infections, emphasizing the need for comprehensive diagnostic approaches. The variability in treatment regimens reflects the complex management of these infections., Conclusion: The implementation of advanced molecular techniques and standardized treatment protocols is imperative for enhancing diagnostic precision and therapeutic outcomes., 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 © 2024 Wang, Jia, Li and Zheng.)

Potentially toxic elements (PTEs) in the dustfall-soil-crop system pose a serious threat to the ecological environment and agricultural production. However, there is still a knowledge gap in terms of better understanding the distinctive sources of PTEs by integrating various models and technologies. In this study, we comprehensively investigated the concentrations, distribution, and sources of seven PTEs in a dustfall-soil-crop system (424 samples in total) near a typical non-ferrous mining area, using absolute principal component score/multiple linear regression (APCS/MLR) combined with X-ray diffraction (XRD) and microscopy techniques. Our results showed that the mean values of As, Cd, Cr, Cu, Ni, Pb, and Zn in the soils were 211, 14, 105, 91, 65, 232, and 325 mg/kg, respectively. These values were significantly higher than the background soil values in Yunnan. Except for Ni and Cr, all elements in the soil were significantly higher than the screening values of agricultural lands in China. The spatial distribution of PTE concentrations was similar among the three media. The ACPS/MLR, XRD, and microscopy analyses further indicated that soil PTEs mainly originated from industrial activities (37 %), vehicle emissions and agricultural activities (29 %), respectively. Dustfall PTEs mainly originated from vehicle emissions and industrial activities, accounting for 40 % and 37 %, respectively. Crop PTEs mainly originated from vehicle emissions and soil (57 %), and agricultural activities (11 %), respectively. PTEs seriously threaten the safety of agricultural products and the ecological environment once they settle from the atmosphere to soil and crop leaves, further accumulate in crops, and spread through the food chain. Therefore, our study provides scientific evidence for government regulators to control PTE pollution and reduce their environmental risks in dustfall-soil-crop systems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

The objective of this scoping review was to synthesize the available evidence and evaluate the effectiveness of chronoradiotherapy interventions in cervical cancer patients. This scoping review was performed by searching in the PubMed, Cochrane Library, Embase, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), Wanfang, Wenpu, and Chinese Biomedical Literature (CBM) databases. Databases were searched for studies published in English or Chinese from inception to 21 May 2021, and reference lists of relevant reports were scanned. Two investigators independently screened eligible studies in accordance with predetermined eligibility criteria and extracted data. The included studies were summarized and analyzed. Five studies including a total of 422 patients with cervical cancer were included in the scoping review; four studies were Chinese, and one was Indian. Main themes identified included the efficiency of chronoradiotherapy and relevant toxic and side effects, including diarrhea toxicity, hematologic toxicity, myelosuppression, gastrointestinal mucositis, and skin reactions. Administration of radiotherapy at different times of the day resulted in similar efficacy. However, the toxic side effects of morning radiotherapy (MR) and evening radiotherapy (ER) differed, with radiotherapy in the evening leading to more severe hematologic toxicity and myelosuppression. There were conflicting conclusions about gastrointestinal reactions with chronoradiotherapy, and further studies are needed. Radiation responses may be associated with circadian genes, through the influence of cell cycles and apoptosis.

Peripheral artery disease (PAD) is a common, yet serious, circulatory condition that can increase the risk of amputation, heart attack or stroke. Accurate identification of PAD and dynamic monitoring of the treatment efficacy of PAD in real time are crucial for optimizing therapeutic outcomes. However, current imaging techniques do not enable these requirements. Methods: A lanthanide-based nanoprobe with emission in the second near-infrared window b (NIR-IIb, 1500-1700 nm), Er-DCNPs, was utilized for continuous imaging of dynamic vascular structures and hemodynamic alterations in real time using PAD-related mouse models. The NIR-IIb imaging capability, stability, and biocompatibility of Er-DCNPs were evaluated in vitro and in vivo . Results: Owing to their high temporal-spatial resolution in the NIR-IIb imaging window, Er-DCNPs not only exhibited superior capability in visualizing anatomical and pathophysiological features of the vasculature of mice but also provided dynamic information on blood perfusion for quantitative assessment of blood recovery, thereby achieving the synergistic integration of diagnostic and therapeutic imaging functions, which is very meaningful for the successful management of PAD. Conclusion: Our findings indicate that Er-DCNPs can serve as a promising system to facilitate the diagnosis and treatment of PAD as well as other vasculature-related diseases., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Background: We encourage Hepatitis B virus-infected mothers to breastfeed postpartum, even when continuing pregnancy category B nucleos(t)ide analogs (NAs) treatment. However, a large proportion of the Hepatitis B virus-infected mothers were noncompliant with this breastfeeding recommendation. This study aimed to investigate the factors associated with noncompliance with breastfeeding recommendation in Hepatitis B virus-infected mothers who had received NAs treatment during pregnancy., Methods: A total of 155 mothers with chronic hepatitis B receiving NAs treatment for preventing mother-to-child transmission during the late gestation period were included and divided into exclusive breastfeeding (n = 63), mixed feeding (n = 34), and artificial feeding (n = 58) groups according to the postpartum feeding methods. Independent variables associated with feeding methods were analyzed using logistic regression analysis., Results: Compared to the breastfeeding and mixed feeding groups, the artificial feeding group had significantly more multiparity, later postpartum timing of stopping NAs treatment, and a lower proportion of having knowledge of NAs medications (all P < 0.05). In addition, multivariable logistic regression analysis confirmed that multiparity, later postpartum timing of stopping NAs treatment, and lacking knowledge of medication were independent factors associated with noncompliance with breastfeeding recommendation., Conclusions: Hepatitis B virus-infected mothers who stopped NAs treatment at late postpartum period or had less knowledge of medication were more likely to be noncompliant with breastfeeding recommendation. Strengthening health education for participants taking NAs may be an important method to improve compliance with breastfeeding recommendation., (© 2021. The Author(s).)

Objective : This study aims to discover whether insulin resistance is an independent predictor for antiplatelet drug resistance in patients with ischemic cerebrovascular disease. Methods : This study used a prospective cohort method. Patients diagnosed as minor ischemic stroke or transient ischemic attack (TIA) were enrolled successively. All patients have been administrated aspirin and/or clopidogrel and were tested for fasting glucose and insulin and platelet aggregation inhibition tests which was detected by light transmission aggregometry (LTA). The maximum platelet aggregation rate (AA) of ≥20% or the maximum platelet aggregation rate (ADP) of ≥50% was defined as antiplatelet drug resistance. Multivariable logistic regression was performed to estimate the association between HOMA-IR and antiplatelet drug resistance. Results : This study recruited successively 237 patients with mild-to-moderate ischemic stroke or TIA in Beijing Tiantan Hospital from 2018 to 2019. Of them 60 cases were recognized as having insulin resistance. There are 46 patients in insulin resistance group (76.7%) developed antiplatelet drug resistance, which was significantly more frequent than patients without insulin resistance (35%,  P  < 0.0001). Insulin resistance was an independent risk factor for antiplatelet drug resistance in patients with recent ischemic stroke/TIA after adjusted for confounding factors (Odds Ratio 5.281; 95%CI, 2.15 to 13.01,  P  < 0.0001). Conclusions : Insulin resistance was an independent predictor for development of antiplatelet drug resistance in patients with recent minor ischemic stroke or TIA. More attention should be paid to recognize these patients and antithrombotic effect should be monitored when antiplatelet drugs were applied to these patients.

The pandemic of Coronavirus Disease 2019 (COVID-19) is causing enormous loss of life globally. Prompt case identification is critical. The reference method is the real-time reverse transcription PCR (RT-PCR) assay, whose limitations may curb its prompt large-scale application. COVID-19 manifests with chest computed tomography (CT) abnormalities, some even before the onset of symptoms. We tested the hypothesis that the application of deep learning (DL) to 3D CT images could help identify COVID-19 infections. Using data from 920 COVID-19 and 1,073 non-COVID-19 pneumonia patients, we developed a modified DenseNet-264 model, COVIDNet, to classify CT images to either class. When tested on an independent set of 233 COVID-19 and 289 non-COVID-19 pneumonia patients, COVIDNet achieved an accuracy rate of 94.3% and an area under the curve of 0.98. As of March 23, 2020, the COVIDNet system had been used 11,966 times with a sensitivity of 91.12% and a specificity of 88.50% in six hospitals with PCR confirmation. Application of DL to CT images may improve both efficiency and capacity of case detection and long-term surveillance.

BACKGROUND Although mutations and dysfunction of mitochondrial DNA (mtDNA) are related to a variety of diseases, few studies have focused on the relationship between mtDNA and coronary artery disease (CAD), especially the relationship between rare variants and CAD. MATERIAL AND METHODS Two-stage high-throughput sequencing was performed to detect mtDNA variants or heteroplasmy and the relationship between them and CAD phenotypes. In the discovery stage, mtDNA was analyzed by high-throughput sequencing of long-range PCR products generated from the peripheral blood of 85 CAD patients and 80 demographically matched controls. In the validation stage, high-throughput sequencing for mtDNA target regions captured by GenCap Kit was performed on 100 CAD samples and 100 controls. Finally, tRNA fine mapping was performed between our study and the reported Chinese CAD study. RESULTS Among the tRNA genes, we confirmed a highly conserved rare variant, A5592G, previously reported in the Chinese CAD study, and 2 novel rare mutations that reached Bonferroni's correction significance in the combined analysis were found (P=7.39×10-4 for T5628C in tRNAAla and P=1.01×10-5 for T681C in 12S rRNA) in the CAD study. Both of them were predicted to be pathological, with T5628C disrupting an extremely conservative base-pairing at the AC stem of tRNAAla. Furthermore, we confirmed the controversial issue that the number of non-synonymous heteroplasmic sites per sample was significantly higher in CAD patients. CONCLUSIONS In conclusion, our study confirmed the contribution of rare variants in CAD and showed that CAD patients had more non-synonymous heterogeneity mutations, which may be helpful in identifying the genetic and molecular basis of CAD.

Aim: Cerebrovascular disease is the leading cause of death and disability in China, causing a huge burden among patients and their families. Hence, stroke prevention is critical, especially in the high-risk population. Here, we present the evidence-based guideline suitable for the Chinese population., Methods: Literature search of PubMed and Cochrane library (from January 1964 to June 2019) was done. After thorough discussion among the writing group members, recommendations were listed and summarised. This guideline was reviewed and discussed by the fellow writing committees of the Chinese Stroke Association's Stroke., Results: This evidence-based guideline was written in three parts: controlling the risk factors of stroke, utilisation of antiplatelet agents and assessing the risks of first-ever stroke. All recommendations were listed along with the recommending classes and levels of evidence., Conclusions: This guideline provides recommendations for primary prevention of cerebrovascular disease among high-risk population in China. Controlling related risk factors, appropriately using antiplatelet agents, assessing the risk of developing first-ever stroke should help reduce the rate of cerebrovascular disease in China., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The role of lymph node ratio (LNR, ratio of metastatic to examined nodes) in the staging of multiple human malignancies has been reported. We aim to evaluate its value in salivary gland cancer (SGC)., Methods: Records of SGC patients from Surveillance, Epidemiology, and End Results database (SEER, training set, N = 4262) and Fudan University Shanghai Cancer Center (FUSCC, validating set, N = 154) were analyzed for the prognostic value of LNR. Kaplan-Meier survival estimates, the Log-rank χ 2 test and Cox proportional hazards model were used for univariate and multivariate analysis. Optimal LNR cutoff points were identified by X-tile., Results: Optimal LNR cutoff points classified patients into four risk groups, R0, R1 (≤ 0.17), R2 (0.17-0.56) and R3 (> 0.56), corresponding to 5-year cause-specific survival in SEER patients of 88.6%, 57.2%, 53.1% and 39.7%, disease-free survival in FUSCC patients of 69.2%, 63.3%, 34.6% and 0%, and disease-specific survival in FUSCC patients of 92.3%, 90.0%, 71.4% and 0%, respectively. Compared with TNM staging, TNM + R staging showed smaller AIC values and higher C-index values in the Cox regression model in both patient sets., Conclusions: LNR classification should be considered as a complementary system to TNM staging and LNR classification based clinical trials deserve further research.

Background: We aimed to explore whether the anatomic extent of lymph node metastases (AE-LNM) could independently predict prognosis of node-positive major salivary gland carcinoma (MaSGC)., Methods: A total of 376 pathologically node-positive MaSGC patients were identified from the Surveillance, Epidemiology and End Results database and constituted the training cohort. Using the X-Tile program, these patients were divided into three groups based on AE-LNM degrees. Discrimination of overall survival (OS) and disease-specific survival (DSS) was evaluated and compared with the 8th American Joint Committee on Cancer (AJCC) pN classification. The results were externally validated by 220 patients in a Chinese multicenter cohort (Validation cohort)., Results: Using the training cohort, AE-LNM was divided into Extent 1 (spread to parotid LNs or level I), Extent 2 (spread to level II-IV) and Extent 3 (spread to level V or bilateral LNs or rare LNs). Regarding both OS and DSS, the AE-LNM model revealed clear separation of survival curves, while the pN classification failed to discriminate the prognosis of pN1 and pN2 patients. When we incorporated both the AE-LNM model and AJCC pN classification into the same multivariate Cox analyses, AE-LNM was still an independent prognostic factor, while the AJCC pN classification lost its significance. These results were externally validated by the validation cohort., Conclusion: AE-LNM is an independent nodal prognosticator for node-positive MaSGC and may have improved discriminative ability over the current AJCC pN classification. Integration of anatomic extent of LNM into the current AJCC N classification could be considered., (Copyright © 2019. Published by Elsevier Ltd.)

Background and Purpose: Insulin resistance was common in patients with stroke. This study investigated the association between insulin resistance and outcomes in nondiabetic patients with first-ever acute ischemic stroke., Methods: Patients with ischemic stroke without history of diabetes mellitus in the ACROSS-China registry (Abnormal Glucose Regulation in Patients With Acute Stroke Across China) were included. Insulin resistance was defined as a homeostatis model assessment-insulin resistance (HOMA-IR) index in the top quartile (Q4). HOMA-IR was calculated as fasting insulin (μU/mL)×fasting glucose (mmol/L)/22.5. Multivariable logistic regression or Cox regression was performed to estimate the association between HOMA-IR and 1-year prognosis (mortality, stroke recurrence, poor functional outcome [modified Rankin scale score 3-6], and dependence [modified Rankin scale score 3-5])., Results: Among the 1245 patients with acute ischemic stroke enrolled in this study, the median HOMA-IR was 1.9 (interquartile range, 1.1-3.1). Patients with insulin resistance were associated with a higher mortality risk than those without (adjusted hazard ratio, 1.68; 95% confidence interval, 1.12-2.53; P =0.01), stroke recurrence (adjusted hazard ratio, 1.57, 95% confidence interval, 1.12-2.19; P =0.008), and poor outcome (adjusted odds ratio, 1.42; 95% confidence interval, 1.03-1.95; P =0.03) but not dependence after adjustment for potential confounders. Higher HOMA-IR quartile categories were associated with a higher risk of 1-year death, stroke recurrence, and poor outcome ( P for trend =0.005, 0.005, and 0.001, respectively)., Conclusions: Insulin resistance was associated with an increased risk of death, stroke recurrence, and poor outcome but not dependence in nondiabetic patients with acute ischemic stroke., (© 2017 American Heart Association, Inc.)

Introduction: Vascular cognitive impairment without dementia is very common among the aged and tends to progress to dementia, but there have been no proper large-scale intervention trials dedicated to it. Vascular cognitive impairment without dementia caused by subcortical ischemic small vessel disease (hereinafter, subcortical Vascular cognitive impairment without dementia) represents a relatively homogeneous disease process and is a suitable target for therapeutic trials investigating Vascular cognitive impairment without dementia. Preclinical trials showed that dl-3-n-butylphthalide (NBP) is effective for cognitive impairment of vascular origin., Methods: In this randomized, double-blind, placebo-controlled trial, we enrolled patients aged 50-70 years who had a diagnosis of subcortical Vascular cognitive impairment without dementia at 15 academic medical centers in China. Inclusion criteria included a clinical dementia rating ≥0.5 on at least one domain and global score ≤0.5; a mini-mental state examination score ≥20 (primary school) or ≥24 (junior school or above); and brain magnetic resonance imaging consistent with subcortical ischemic small vessel disease. Patients were randomly assigned to NBP 200 mg three times daily or matched placebo (1:1) for 24 weeks according to a computer-generated randomization protocol. All patients and study personnel were masked to treatment assignment. Primary outcome measures were the changes in Alzheimer's disease assessment scale-cognitive subscale (ADAS-cog) and clinician's interview-based impression of change plus caregiver input (CIBIC-plus) after 24 weeks. All patients were monitored for adverse events (AEs). Outcome measures were analyzed for both the intention-to-treat (ITT) population and the per protocol population., Results: This study enrolled 281 patients. NBP showed greater effects than placebo on ADAS-cog (NBP change -2.46 vs. placebo -1.39; P = .03; ITT) and CIBIC-plus (80 [57.1%] vs. 59 [42.1%] patients improved; P = .01; ITT). NBP-related AE were uncommon and primarily consisted of mild gastrointestinal symptoms., Discussion: Over the 6-month treatment period, NBP was effective for improving cognitive and global functioning in patients with subcortical vascular cognitive impairment without dementia and exhibited good safety., (Copyright © 2016 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.)

Alanine aminotransferase (ALT), aspartate transaminase (AST), and glutamyl transpeptidase (GGT) were three key enzymes in the hepatic metabolism. This study aimed to investigate the effect of homocysteine (Hcy) metabolism gene polymorphisms and serum Hcy and folate level on the hepatic functions in a Chinese hypertensive population. A representative sample with 480 subjects aged 28-75 was enrolled in 2005.9-2005.12 from six hospitals in different Chinese regions. Serum ALT, AST and GGT were measured by using an automatic biochemistry analyzer. Serum Hcy was measured by high-performance liquid chromatography, and serum folate was measured by chemiluminescent immunoassay. Known genotypes were detected by PCR-RFLP methods. The results showed that the MTHFR C677T mutation was related a decreased serum AST level (r=-0.11, p=0.026), whereas the MTHFR A1298C mutation elevated serum AST level (r=0.11, p=0.032). Furthermore, multiple regression analysis showed that folate deficiency was associated with higher serum ALT (β (SE): 0.13 (0.06), p=0.031) and GGT level (β (SE): 0.18 (0.07), p=0.011). However, serum Hcy level may not affect the hepatic functions. Our data suggested that hepatic functions were affected by MTHFR gene polymorphisms and serum folate level. Further studies are needed to confirm these correlations in a larger population.

Background and Purpose: Low estimated glomerular filtration rate (eGFR) is known to be associated with clinical adverse outcomes. However, whether diabetes mellitus influences the association between eGFR and prognosis of stroke is still not elucidated., Methods: Prospective cohort of 17,280 (nondiabetic 12,498 and diabetic 4782) Chinese patients with acute stroke from the China National Stroke Registry and from abnormal glucose regulation in patients with acute stroke across China (ACROSS) between 2007 and 2009 were followed-up for 1 year for all-cause mortality, stroke recurrence, and stroke disability related to baseline eGFR in the presence and absence of diabetes mellitus., Results: Among nondiabetic patients, as compared with eGFR of 90 to 119 mL/min per 1.73 m2, the adjusted odds ratio of lower eGFR of <45 mL/min per 1.73 m2 was 2.79 (95% confidence interval, 2.09-3.73) for all-cause mortality, 2.28 (1.74-2.98) for stroke recurrence, and 1.53 (1.16-2.01) for stroke disability; higher eGFR of ≥120 mL/min per 1.73 m2 was just significantly associated with higher risk of all-cause mortality (odds ratio, 1.38; 95% confidence interval, 1.02-1.86) but not with other outcomes. In diabetic patients, the adjusted odds ratios of all-cause mortality, stroke recurrence, and stroke disability in lower eGFR were 2.16 (1.51-3.08), 1.43 (1.02-2.00), and 1.38 (0.98-1.95), respectively; higher eGFR was significantly associated with higher risks of all stroke outcomes., Conclusions: Decreased eGFR (<45 mL/min per 1.73 m2) is a strong predictor of all-cause mortality, stroke recurrence, and stroke disability in diabetic and nondiabetic patients with acute stroke. Increased eGFR (≥120 mL/min per 1.73 m2) is associated with all of stroke outcomes in diabetic patients and linked to all-cause mortality in nondiabetic patients., (© 2014 American Heart Association, Inc.)

Background and Purpose: It remains uncertain if impaired glucose regulation (IGR) as a predictor for stroke outcomes. This study aimed at observing the effect of IGR on the 1-year outcomes in Chinese patients with ischemic stroke., Methods: Patients with acute ischemic stroke were recruited consecutively in multihospitals across China. Oral glucose tolerance test was performed to identify IGR. Cox proportion hazard model was performed to investigate the effect of IGR on 1-year mortality or stroke recurrence in patients with ischemic stroke., Results: The study recruited 2639 patients with ischemic stroke. IGR was shown as an independent risk factor for the mortality of patients with ischemic stroke (hazard ratio [95% confidence interval], 3.088 [1.386-6.884]; P=0.006). However, IGR showed no significant effects on the dependency or stroke recurrence of patients (P=0.540 and 0.618, respectively)., Conclusions: IGR was an independent predictor for the mortality of patients with ischemic stroke. IGR should be highlighted and intervened actively in the patients with ischemic stroke.

Background: The relationship between uric acid and stroke prognosis is ambiguous. Some studies have explored this relationship in acute stroke but have different results. In this study, we explored the relationship between uric acid levels and 1-year outcomes and vascular events of acute ischemic stroke patients and cerebral hemorrhage patients., Methods: In all, 1452 continued first, acute ischemic stroke patients and 380 continued cerebral hemorrhage patients were admitted to our hospitals. Serum uric acid concentrations were measured in 1351 ischemic stroke patients and 380 cerebral hemorrhage patients at admission. We evaluated the relationship between uric acid levels and outcomes (modified Rankin scale [mRS] > 2, all-cause death, vascular events, stroke recurrent) at 14 days, 90 days, and 1 year after stroke onset., Results: The median uric acid concentration was 303.0 μmol/L in ischemic stroke patients and 269 μmol/L in cerebral hemorrhage patients. In univariate analysis, uric acid levels were not correlated with outcomes in cerebral hemorrhage patients. We used multiple logistic regression analysis to show that lower serum uric acid levels independently predicted poor functional outcomes (mRS >2) at 1 year after ischemic stroke onset (odds ratio [OR] = .335, 95% confidence interval [CI]: .164-.684, P = .003). Also, lower serum uric acid levels were independently correlated with vascular events in the first year in ischemic stroke patients. By multiple cox proportional hazards analysis, we obtained data which reveal that serum uric acid levels were not correlated with all-cause death (OR = .992, 95% CI: .683-1.443, P = .969) in ischemic stroke patients., Conclusions: Serum uric acid may be neuroprotective in acute ischemic stroke patients., (Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: Previous studies showed an inverse association between ideal cardiovascular health (CVH) metrics and the total risk of cardiovascular diseases and stroke. This study aimed to investigate the relationship between ideal CVH metrics and the risks of ischemic and hemorrhagic stroke, respectively., Methods: We collected information on the 7 ideal CVH metrics (including smoking status, body mass index, dietary intake, physical activity, blood pressure, total cholesterol, and fasting blood glucose) among 91 698 participants from the Kailuan study, China (72 826 men and 18 872 women between the ages of 18 and 98 years), free of myocardial infarction and stroke at baseline (2006-2007). Cox proportional hazards models were used to estimate stroke risk., Results: During the 4-year follow-up, we identified 1486 incident stroke events (1057 ischemic, 386 intracerebral hemorrhagic, and 43 subarachnoid hemorrhagic). The hazard ratios (95% confidence interval) for total stroke with adherence to 0 (reference), 1, 2, 3, 4, 5, and 6/7 ideal CVH metrics were: 1, 0.92 (0.69-1.23), 0.69 (0.52-0.92), 0.52 (0.39-0.68), 0.38 (0.28-0.51), 0.27 (0.18-0.40), and 0.24 (0.11-0.54), respectively (P trend <0.01), after adjusting for age, sex, education, income, and hospital. Similar inverse associations were observed for both ischemic and intracerebral hemorrhagic stroke (both P trend <0.01)., Conclusions: We observed a clear inverse gradient relationship between the number of ideal CVH metrics and the risk of stroke in a Chinese population, supporting the importance of ideal health behaviors and factors in stroke prevention.

As the whole society gradually realizes the scarcity of nature resources and environmental value, countries all over the world have evolved and improved the system of environmental damage assessment through the practices of pollution prevention and ecological environmental protection. On one hand, in the research prospective, the practices of environmental damage assessment brought new challenges to environmental law, environmental economics, environmental science, environmental engineering, etc. On the other hand, they constantly promoted and developed relevant laws and regulations, techniques, working mechanism, and guidelines on procedure in practice. On the hasis of comparison and analysis of international practices and experiences from US, EU, and Japan, etc., this article identified relevant concepts, content, and scope of environmental damage assessment, and presented its scientific positioning and development direction. At present, both theory and practice of environmental damage assessment in China are in their infancy period. Considering current environmental situation and socioeconomic development features of China, learning international practices and experiences and raising the orientation of environmental damage assessment have great meaning in exploring the suitable environmental damage assessment system.

Background and Purpose: The prevalence of diabetes is high among patients with ischemic stroke. However, the prevalence of abnormal glucose regulation and clinical characteristics among patients with stroke in the Chinese population is uncertain. We investigated the prevalence of prediabetes and diabetes in Chinese patients after stroke onset in a nationwide cohort study and investigated abnormal glucose regulation in patients with acute stroke across China (ACROSS-China)., Methods: The ACROSS-China study consecutively recruited patients hospitalized for acute stroke in 2008 to 2009 and investigated the prevalence of impaired glucose tolerance and diabetes among the patients on day 14 after stroke onset. Oral glucose tolerance test was performed in the diagnosis of abnormal glucose regulation., Results: The prevalence of abnormal glucose regulation was 68.7% among all the patients with stroke. Diabetes was identified in 42.3% of all the patients (45.8% for patients with ischemic stroke, 31.2% for patients with intracerebral hemorrhage, and 26.4% for patients with subarachnoid hemorrhage, respectively). Prediabetes (impaired fasting glucose and impaired glucose tolerance) was identified in 26.4% of all the patients with stroke. The prevalence of diabetes and impaired glucose tolerance was the highest in the patients with atherothrombotic infarction (73.4%)., Conclusions: The prevalence of abnormal glucose regulation was high in Chinese patients with acute stroke, especially in patients with atherothrombotic infarction. Oral glucose tolerance test identified a large percentage of patients with newly diagnosed diabetes or impaired glucose tolerance after stroke onset.

Objective: Metabolic syndrome has emerged as a novel risk factor in cardiovascular disease due to its potential for predicting stroke in population-based studies. We investigated the relationship of metabolic syndrome with stroke recurrence., Methods: This was a retrospective analysis of Chinese patients enrolled in the prospective Abnormal gluCose Regulation in patients with acute strOke acroSS China (ACROSS-China) study after their first ischemic stroke. Metabolic syndrome was defined using the International Diabetes Federation (IDF) criteria. Vascular risk factors were assessed. Outcome was defined as recurrence of stroke within one year after the index ischemic stroke. Cox proportional hazards regression was performed to identify potential predictors of stroke recurrence., Results: The prevalence of metabolic syndrome among 2639 ischemic stroke patients was 51.35%. During the one-year follow-up, 195 strokes (7.4%) recurred. The multivariate hazard ratio (95% CI) of stroke recurrence was 1.94 (1.39-2.73) for metabolic syndrome. After adjustment for components, metabolic syndrome lost its association with stroke recurrence; in this model, high fasting plasma glucose (IDF definition) was a predictor for stroke recurrence., Conclusion: Metabolic syndrome may not be predictive for stroke recurrence beyond its component individual factors for Chinese ischemic stroke patients.

Background and Purpose: Diabetes mellitus (DM) is an independent risk factor for ischemic stroke. However, controversy exists with regard to the impact of DM on prognosis after ischemic stroke in the Chinese population. We investigated the associations between DM and death, dependency, and stroke recurrence in patients after ischemic stroke onset in a nationwide, prospective registry, the China National Stroke Registry., Methods: The China National Stroke Registry consecutively recruited patients hospitalized for acute ischemic stroke in 2007 to 2008 and who were prospectively followed up for clinical and functional outcomes (death, dependency, and stroke recurrence) at 3 and 6 months after disease onset. Multivariable logistic regression was performed to analyze the association between DM and stroke outcomes after adjusting for potential confounding including age, sex, National Institutes of Health Stroke Scale score, glucose level at admission, hypertension, coronary heart disease, smoking, urinary tract infection, and other factors., Results: DM was identified in 3483 (27.0%) of stroke patients. Compared with stroke patients without DM, patients with DM had a significantly higher incidence of death or dependency and of recurrent stroke at 3 and 6 months after stroke onset. DM was an independent risk factor for death or dependency (adjusted odds ratio=1.23; 95% confidence interval, 1.10 to 1.37) in patients with ischemic stroke at 6 months after onset., Conclusions: DM independently predicted poor outcomes in Chinese patients after acute ischemic stroke.

Stroke is the leading cause of long-term disability and the second-leading cause of death in China. Stroke is now a major public health burden for China. Hypertension, diabetes mellitus, abnormal lipid metabolism, smoking, and other definite risk factors of stroke are becoming of increasing concern. Prevention strategies for stroke occurrence and recurrence in China remain insufficient. This article reviews recent studies on modifiable risk factors and strategies for primary and secondary prevention of stroke in the Chinese population., (Copyright © 2011 National Stroke Association. Published by Elsevier Inc. All rights reserved.)