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Increased attention has been paid to effects of coal mining subsidence on the growth of plants. Studying the changes of plants photosynthetic physiology under the disturbance of coal mining subsidence is the basis for understanding dynamic exchanges of plant energy and water at that mining area. The 52302 working face of the Shendong mining area was selected as the experimental site, with Artemisia ordosica, Caragana korshinskii, and Populus spp. as the research targets. Changes in leaf photosynthesis were monitored in plants at a subsidence crack area. We showed collapse cracks decreased soil moisture and caused drought stress. The photosynthetic capacity of leaves was reduced. Compared with plants from the control area, stomatal conductance, photosynthetic CO2 assimilation, and transpiration rate were reduced in all three plant species. The activity of PSII reaction center and electron transport at the donor and acceptor sites significantly decreased. [ABSTRACT FROM AUTHOR]

Objectives:We aim to evaluate the ethnic-specific relationship of total fat mass and anthropometric indices in Chinese.Design:Cross-section study.Setting:This study was performed at the College of Life Sciences, Hunan Normal University, P.R. China.Subjects and method:To increase our understanding of the relationship of total fat mass and anthropometric indices in Chinese, 793 females and 1091 males aged 20–40 years were randomly recruited from Changsha city of P. R. China. Hip circumference (HC) and waist circumference (WC) were measured using standardized equipments, and other three anthropometric indices of body mass index (BMI), waist-to-hip ratio (WHR), and conicity index (CI) were calculated using weight, height, HC and WC. Total body fatness (TBF) in kg was measured using a Hologic QDR 4500 W dual-energy X-ray absorptiometry (DEXA) scanner.Results:There was an increasing trend of TBF, %TBF (percent total body fatness) and the five anthropometric indices in successively older age groups. Compared with females, males generally had high average BMI, WC, HC, WHR and CI, but had low average TBF and %TBF. Except for some correlations in 25–29 years age groups, TBF and %TBF were significantly correlated with five anthropometric indices with the Pearson's correlation coefficients ranging from 0.07 to 0.87. Principal component analysis (PCA) was performed to form four principal components (PCs) that interpreted over 99% of the total variation of the five related anthropometric indices in all age groups, with over 53% of the total variation accounted for by the PC1. Multiple regression analyses showed that four PCs combined explained a greater variance (R 2=55.2–80.8%) in TBF than did BMI alone (R 2=40–74.9%).Conclusion:Our results suggest that there is an increasing trend of total fat mass and five anthropometric indices with aging; that age and sex have the important effects on influencing the correlations of TBF and the studied anthropometric indices; and that the accuracy of predicting the TBF using five anthropometric indices is higher than using BMI alone.European Journal of Clinical Nutrition (2006) 60, 511–518. doi:10.1038/sj.ejcn.1602345; published online 30 November 2005 [ABSTRACT FROM AUTHOR]

The main source of fat in the diet in rural areas of northern China is soybean oil, therefore the pattern of essential fatty acids in human milk may be assumed to differ from that in milk from women in Western countries and to be similar to that of vegans. The concentrations of long chain polyunsaturated fatty acids in human milk and information on diet were analysed for 41 lactating women in rural areas of north China, and the growth of their infants was measured. The subjects were divided into two groups (group I, 1 mo postpartum; group II, 3 mo postpartum). The dietary intake of the mothers was high in carbohydrate and low in fat, protein and energy. The concentrations of linoleic acid (LA) and α-linolenic acid (LNA) were high. The ratio of LA to LNA, (21.6), was higher than has been reported from other countries. The concentration of docosahexaenoic acid (DHA) was low and the ratio of arachidonic acid (AA) to DHA was much higher (2.8) than recommended and similar to that found in vegans. The concentrations of AA and DHA in the milk correlated positively with the infants' weight gain at the third month p < 0.05) and of DHA with length gain at the first and third months (p < 0.01). Since the concentration of AA and, particularly, DHA in the milk declined during lactation, DHA deficiency may appear after 3-4 mo of age in breastfed Chinese rural infants. Further studies of Chinese rural mother-infant pairs are necessary to prove whether supplementation with suitable sources of AA and DHA, such as fish oil, should be recommended as lactation is lengthened to ensure optimal infant growth and development. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is ranked among the most prevalent malignancies in the Chinese female population. However, comprehensive reports detailing the latest epidemiological data and attributable disease burden have not been extensively documented., Methods: In 2018, high-quality cancer surveillance data were recorded in 700 population-based cancer registries in China. We extracted data on female breast cancers (International Classification of Diseases, Tenth Revision [ICD-10]: C50) and estimated the incidence and mortality in 2022 according to the baseline data and corresponding trends from 2010 to 2018. Pathological types were classified according to the ICD for Oncology, 3rd Edition codes. Disability-adjusted life years (DALYs) were calculated as the sum of the years of life lost (YLLs) and years lived with disability (YLDs)., Results: In 2022, approximately 357,200 new female breast cancer cases and 75,000 deaths occurred in China, accounting for 15.59% and 7.94% of total new cancer cases and deaths, respectively. The age-standardized incidence rate (ASIR) was 33.04 per 100,000. When analyzed by pathological type, the ASIRs for papillary neoplasms, invasive breast carcinoma, rare and salivary gland-type tumors, and other types were 1.13, 29.79, 0.24, and 1.88 per 100,000, respectively. The age-standardized mortality rate (ASMR) was 6.10 per 100,000. A total of 2,628,000 DALYs were found to be attributable to female breast cancer in China, comprising 2,278,300 YLLs and 349,700 YLDs. The ASIR, ASMR, and age-standardized rate (ASR) for DALYs in urban areas were consistently higher than those in rural areas. We observed a four-fold increase in the ASIR and ASR for DALYs and an eight-fold increase in the ASMR among females over 55 years compared with those aged under 55 years., Conclusion: These data provide invaluable insights into the latest epidemiology of female breast cancer in China and highlight the urgency for disease prevention and control strategy formulation., (Copyright © 2024 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.)

Objective: To investigate the factors influencing the severity of acute ischaemic stroke (AIS) and short-term prognosis after endovascular treatment., Study Design: Observational study. Place and Duration of the Study: Department of Cerebrovascular Diseases, The First People's Hospital of Qujing City, Yunnan Province, China, from June 2020 to December 2022., Methodology: An analysis was conducted on 160 AIS patients undergoing endovascular treatment, classified into atherosclerosis subtype (AS) and cardioembolic subtype (CE) based on the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification, each comprising 80 cases. The association among baseline and endovascular treatment parameters, clinical characteristics, postoperative complications, and short-term outcomes (risks of mortality and poor prognosis) was tested., Results: Univariate analysis revealed significant positive correlations between increased fasting glucose, diastolic pressure, and the number of thrombectomy procedures with the frequency of cerebral haemorrhage in CE-type stroke. The time from femoral artery puncture to vessel opening was positively associated with the degree of brain oedema. In the AS subtype, univariate regression analysis demonstrated a significant association between heart rate, fasting glucose, cholesterol, time from femoral artery puncture to vessel opening, and degree of brain oedema with short-term prognosis. Fasting glucose and the number of thrombectomy procedures were significantly linked to short-term prognosis in CE-type AIS. A predictive model using line charts was developed for factors associated with postoperative complications and short-term prognosis, achieving predictive accuracies of 95.5% for the risk of death and 92.7% for poor prognosis (mRS >2), notably surpassing traditional prediction methods., Conclusion: Clinical characteristics and endovascular treatment-related factors are important for the short-term prognosis of AIS patients. Development of predictive models can efficiently identify high-risk patients at an early stage., Key Words: Acute ischaemic stroke, Atherosclerosis, Cardioembolic, Severity, Prognosis.

Hypoxia and acidification are universal environmental issues in coastal seas, especially in large river dominated shelves, and the East China Sea shelf is a typical case among them. However, the responses of status of hypoxia and acidification in coastal seas to the extremes of river discharges are still to be revealed. This study surveyed the influences of a summer drought on the status of hypoxia and acidification on the inner East China Sea shelf off the Changjiang estuary. In August of 2023 during a summer drought, carbonate system parameters and dissolved oxygen (DO) were surveyed on the East China Sea shelf off the Changjiang estuary. As expected, dissolved inorganic carbon (DIC) removal (up to >40 μmol kg -1 ) and DO over-saturation (up to >110 %) accompanied by high pH (up to >8.15) in the surface water were observed. However, low DO (32-172 μmol kg -1 ), low pH (7.63-8.04) and low saturation state index of aragonite (Ω Ar ) (1.34-3.06) in the bottom water were observed. Relationships of Excess DIC with DO consumption, and pH and Ω Ar with Excess DIC indicated that the hypoxia and acidification in the bottom water was due mainly to the remineralization of the marine-sourced organic matter. Nevertheless, both hypoxia and acidification were mitigated, i.e. the hypoxic area was smaller, the minimum DO concentration, pH and saturation state index of aragonite were higher in August of 2023 than under the general summer condition. The lower Changjiang discharge (∼60 % of the long-term monthly average) mitigated eutrophication of the East China Sea shelf and decreased the phytoplankton biomass in the surface water and subsequently the hypoxia and acidification in the bottom water. However, acidification of the bottom water on the East China Sea shelf was still severe even during the summer drought. Regulating the anthropogenic impact on the coastal marginal seas is still urgently needed to mitigate the acidification status., Competing Interests: Declaration of competing interest The authors declare that the study was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Blastocystis is one of the most common zoonotic intestinal protozoa with global distribution and can cause gastrointestinal syndrome mainly characterized by diarrhea. School children are the main susceptible population. No epidemiological data on Blastocystis among school children in Hainan, the only tropical island province in China. Between March 2021 and June 2023, 1973 fecal samples were collected from school children across three regions in Hainan province. Blastocystis was examined by amplifying the small subunit ribosomal RNA (SSU rRNA) gene via polymerase chain reaction (PCR), and subtypes were identified through DNA sequencing and phylogenetic analysis. The overall prevalence of Blastocystis was 7.3 % (144/1973). The differences in infection rates across different regions, nationalities, and educational stages are statistically significant (P < 0.001). Five subtypes were identified, of which ST3 was the dominant subtype (60.4 %; 87/144), followed by ST1 (27.8 %; 40/144), ST7 (10.4 %; 15/144), ST6 (0.7 %; 1/144), and ST2 (0.7 %; 1/144). 42 known sequences and 15 novel sequences were identified including eight new variations of the ST1 (ST1-16∼ST1-23) with similarities ranging from 98.3 % to 99.78 % and seven new variations of the ST7 (ST7-7∼ST7-13) with similarities ranging from 97.7 % to 99.79 % by intra-subtype genetic polymorphisms analysis. The results evaluate the public health risks of Blastocystis among school children in Hainan and the sources of infection were discussed, providing important basic data for the effective prevention and control of intestinal parasitic diseases in Hainan., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objectives: This study was to assess the lot-to-lot consistency, immunogenicity and safety of three manufacturing lots of a quadrivalent inactivated influenza vaccine (IIV4)., Methods: A randomized, double-blind, phase IV clinical trial was conducted in healthy children, adolescents and adults aged 9-59 years in Guizhou Province, China. Eligible participants were enrolled and randomized into three groups in a ratio of 1:1:1 to receive a single dose of one of three manufacturing lots of IIV4. Serum samples were collected before and 28 days after vaccination for hemagglutination inhibition (HI) antibody testing. Safety data were collected for up to 28 days after vaccination. The primary objective was to evaluate the lot-to-lot consistency of immune response as assessed by the geometric mean titer (GMT) of HI antibody at 28 days after vaccination., Results: Between November 27, 2022 and December 18, 2022, 1260 eligible participants were enrolled, with similar participant demographics among groups. Immune responses after vaccination were comparable across groups, with the 95% confidence intervals (CIs) of GMT ratios for all 4 strains falling into the equivalence criterion of (0.67, 1.5). The seroconversion rates (SCRs) and seroprotection rates (SPRs) met the US Center or Biologics Evaluation and Research (CBER) criteria for all strains for each lot (lower limit of 95% CI of SCR ≥ 40% and SPR ≥ 70%). The incidences of solicited and unsolicited adverse reactions were similar among three groups, most of which (91.9%) were mild or moderate in severity. A total of 11 serious adverse events were reported during the study, and all were considered unrelated to vaccination., Conclusion: The three manufacturing lots of IIV4 demonstrated consistent immunogenicity. IIV4 can elicit satisfactory immune responses for all four strains and no safety concerns were identified., Clinical Trial Registration: Identifier No. NCT05512494., Competing Interests: Declaration of competing interest Yuwei Li, Danyu and Jieru Wang are employed by Sinovac Biotech Co., Ltd. Xinyi Yang, and Siliang Zhou are employed by Sinovac Life Sciences 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 © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In order to study the ecological and atmospheric recovery of the Hexi Corridor region, this paper analyzes the migration changes of land use characteristics and utilizes multivariate data and BenMAP-CE software to study the pollution characteristics of ozone and its precursors and the impact on human health in the Hexi Corridor region. The results showed that the increase of cultivated land area in the Hexi Corridor mainly originated from grassland. The MDA8-O 3 concentrations met the primary and secondary standards of the Ambient Air Quality Standards on 43% and 99% of the days, respectively. NO 2 showed a negative weekend effect with O 3 , and HCHO was opposite to it. Temperature, barometric pressure, and vegetation were highly correlated with O 3 -NO 2 -HCHO. Ozone pollution in the study area caused about 60% of all-cause premature deaths due to cardiovascular diseases. The study suggests that controlling exogenous transport in Wuwei City during the high ozone period (except August) is mainly dominated by the west and northwest, and that synergistic management of VOCs and NO x emissions can reduce O 3 pollution and, consequently, reduce the risk to human health., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Individualized ocular refraction customization (IORC) lenses can be individually adjusted depending on the initial relative peripheral refraction to determine the myopic defocus (MD). We aimed to compare visual performance of children wearing IORC lenses with different amounts of MD to determine whether higher MD resulted in greater visual compromise., Methods: This study included 184 myopic children aged eight to 12 years, and 172 completed the trial. The participants were randomly assigned to wear IORC lenses with low (IORC-L, 2.50 D), medium (IORC-M, 3.50 D), or high (IORC-H, 4.50 D) MD or single-vision spectacle lenses (SVL). Distance and near best-corrected visual acuity (BCVA), contrast sensitivity function (CSF) and questionnaires were evaluated at baseline and after six and 12 months., Results: CSF over all frequencies and distance and near BCVA were not affected by lens design (all P > 0.05). The SVL group outperformed the three IORC lens groups in terms of ghosting images at baseline, and IORC-H and IORC-M groups outperformed IORC-L group (all P < 0.001); however, no differences were observed at the six- or 12-month visit. There were no significant differences among the four groups for any other subjective variables at any of the follow-up visits regarding vision clarity, vision stability, eyestrain, dizziness, headache, or overall vision satisfaction (all P > 0.05)., Conclusions: The IORC lenses with an actual MD of 4.50 D provided acceptable objective and subjective visual performance and were well tolerated by children., Translational Relevance: IORC lenses with an actual MD of 4.50 D provided acceptable visual performance.

Background: Environmental and lifestyle factors play an etiological role in the pathogenesis of different glomerular diseases. Thus, exploring the epidemic characteristics of renal disease in different nationalities and regions is important., Materials and Methods: Patients who underwent renal biopsy from October 2008 to October 2022 were included. The proportion and change tendency of glomerular diseases and the differences between the sexes and different ages and races were analyzed., Results: There were 15,146 cases of glomerular diseases (98.5%), involving 7538 males (49.8%) and 7608 females (50.2%). The mean age was 37.0 years (range 0-80 years). The proportion of membranous nephropathy (MN) and diabetic nephropathy (DN) showed an increased trend. The most common primary glomerulonephritis (PGN) was IgA nephropathy (IgAN, 44.6%), followed by minimal-change disease (MCD, 24.3%) and MN (15.4%). Lupus nephritis (LN, 30%) accounted for the largest proportion of SGNs, followed by Henoch-Schonlein purpura nephritis (HSPN, 20.9%) and DN (19.8%). Compared with adults aged 18-60 years old, MCD and HSPN were more common in children and MN and DN in elderly individuals, statistically significant differences. Additionally, the sex and age distribution of PGN and SGN between the Tibetan and Han populations differed significantly, whereby LN was higher in the Han population and HSPN in the Tibetan population., Conclusion: The distribution of glomerular diseases showed age, sex and race differences. This research will be beneficial for providing epidemiological evidence for clinical diagnosis, disease prevention and public health decision-making., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Early identification of high-risk patients with Major depressive disorder (MDD) having suicide attempts (SAs) is essential for timely targeted and tailored psychological interventions and medications. This study aimed to develop and validate a web-based dynamic nomogram as a personalized predictor of SA in MDD patients. A dynamic nomogram was developed using data collected from 1718 patients in China. The dynamic model was established based on a machine learning-based regression technique in the training cohort. We validated the nomogram internally using 1000 bootstrap replications. The nomogram performance was assessed using estimates of discrimination (via the concordance index) and calibration (calibration plots). The nomogram incorporated five predictors, including Hamilton anxiety rating scale (odds ratio [OR]: 1.255), marital status (OR: 0.618), clinical global impressions (OR: 2.242), anti-thyroid peroxidase antibodies (OR: 1.002), and systolic pressure levels (OR: 1.037). The model demonstrated good overall discrimination (Harrell's C-index = 0.823). Using decision curve analysis, this model also demonstrated good clinical applicability. An online web server was constructed ( https://odywong.shinyapps.io/PRSM/ ) to facilitate the use of the nomogram. Based on these results, our study developed a nomogram to predict SA in MDD patients. The application of this nomogram may help for patients and clinicians to make decisions., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Phthalate exposure can adversely impact ovarian reserve, yet investigation on the influence of its alternative substance, the non-phthalate plasticizer diisononyl-cyclohexane-1,2-dicarboxylate (DINCH), on ovarian reserve is very sparce. We aimed to investigate the associations of phthalate and DINCH exposure as well as their combined mixture with ovarian reserve. This present study included 657 women seeking infertility care in Jiangsu, China (2015-2018). Urine samples during enrollment prior to infertility treatment were analyzed using high-performance liquid chromatography-isotope dilution tandem mass spectrometry (UPLC-MS/MS) to quantify 17 phthalate metabolites and 3 DINCH metabolites. Multivariate linear regression models, Poisson regression models and weighted quantile sum (WQS) regression were performed to access the associations of 17 urinary phthalate metabolites and 3 DINCH metabolites with ovarian reserve markers, including antral follicle count (AFC), anti-Mullerian hormone (AMH), and follicle-stimulating hormone (FSH). We found that the most conventional phthalates metabolites (DMP, DnBP, DiBP, DBP and DEHP) were inversely associated with AFC, and the DINCH metabolites were positively associated with serum FSH levels. The WQS index of phthalate and DINCH mixtures was inversely associated with AFC (% change = -8.56, 95 % CI: -12.63, -4.31) and positively associated with FSH levels (% change =7.71, 95 % CI: 0.21, 15.78). Our findings suggest that exposure to environmental levels of phthalate and DINCH mixtures is inversely associated with ovarian reserve., Competing Interests: Declaration of competing interest The authors have no conflict of interest to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The aim is to establish and verify reference intervals (RIs) for serum tumor markers for an apparently healthy elderly population in Southwestern China using an indirect method., Methods: Data from 35,635 apparently healthy elderly individuals aged 60 years and above were obtained in West China Hospital from April 2020 to December 2021. We utilized the Box-Cox conversion combined with the Tukey method to normalize the data and eliminate outliers. Subgroups are divided according to gender and age to examine the division of RIs. The Z-test was used to compare differences between groups, and 95% distribution RIs were calculated using a nonparametric method., Results: In the study, we observed that the RIs for serum ferritin and Des-γ-carboxy prothrombin (DCP) were wider for men, ranging from 64.18 to 865.80 ng/ml and 14.00 to 33.00 mAU/ml, respectively, compared to women, whose ranges were 52.58 to 585.88 ng/ml and 13.00 to 29.00 mAU/ml. For other biomarkers, the overall RIs were established as follows: alpha-fetoprotein (AFP) 0-6.75 ng/ml, carcinoembryonic antigen (CEA) 0-4.85 ng/ml, carbohydrate antigen15-3 (CA15-3) for females 0-22.00 U/ml, carbohydrate antigen19-9 (CA19-9) 0-28.10 U/ml, carbohydrate antigen125 (CA125) 0-20.96 U/ml, cytokeratin 19 fragment (CYFRA21-1) 0-4.66 U/ml, neuron-specific enolase (NSE) 0-19.41 ng/ml, total and free prostate-specific antigens (tPSA and fPSA) for males 0-5.26 ng/ml and 0-1.09 ng/ml. The RIs for all these biomarkers have been validated through our rigorous processes., Conclusion: This study preliminarily established 95% RIs for an apparently healthy elderly population in Southwestern China. Using real-world data and an indirect method, simple and reliable RIs for an elderly population can be both established and verified, which are suitable for application in various clinical laboratories., (© 2024. The Author(s).)

Information on long-term trends in total suspended solids (TSS) is critical for assessing aquatic ecosystems. However, the long-term patterns of TSS concentration (C TSS ) and its latent drivers have not been well investigated. In this study, we developed and validated three semi-analysis algorithms for deriving C TSS using Landsat images. Subsequently, the long-term trends in C TSS in the Pearl River Estuary (PRE) from 1987 to 2022 and the driving factors were clarified. The developed algorithms yielded excellent performance in estimating C TSS , with mean absolute percentage errors <25% and root mean square errors of <13 mg/L. Long-term Landsat observations showed an overall decreasing trend and significant spatiotemporal dynamics of the C TSS in the PRE from 1987 to 2022. The analysis of driving factors suggested that industrial sewage, cropland, forests and grasslands, and built-up land were the four potential driving forces that explained 87.81% of the long-term variation in C TSS . This study not only provides 36-year recorded datasets of C TSS in estuary water, but also offers new insights into the complex mechanisms that regulate C TSS spatiotemporal dynamics for water resource management., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Despite the prevalence of discharge of large volumes of heavy-metal-bearing seawater from coal-fired power plants into adjacent seas, studies on the associated ecological risks remain limited. This study continuously monitored concentrations of seven heavy metals (i.e. As, Cd, Cr, Cu, Hg, Pb, and Zn) in surface seawater near the outfall of a coal-fired power plant in Qingdao, China over three years. The results showed average concentrations of As, Cd, Cr, Cu, Hg, Pb, and Zn of 2.63, 0.33, 2.97, 4.63, 0.008, 0.85, and 25.00 μg/L, respectively. Given the lack of data on metal toxicity to local species, this study investigated species composition and biomass near discharge outfalls and constructed species sensitivity distribution (SSD) curves with biological flora characteristics. Hazardous concentrations for 5% of species (HC 5 ) for As, Cd, Cr, Cu, Hg, Pb, and Zn derived from SSDs constructed from chronic toxicity data for native species were 3.23, 2.22, 0.06, 2.83, 0.66, 4.70, and 11.07 μg/L, respectively. This study further assessed ecological risk of heavy metals by applying the Hazard Quotient (HQ) and Joint Probability Curve (JPC) based on long-term heavy metal exposure data and chronic toxicity data for local species. The results revealed acceptable levels of ecological risk for As, Cd, Hg, and Pb, but unacceptable levels for Cr, Cu, and Zn. The order of studied heavy metals in terms of ecological risk was Cr > Cu ≈ Zn > As > Cd ≈ Pb > Hg. The results of this study can guide the assessment of ecological risk at heavy metal contaminated sites characterized by relatively low heavy metal concentrations and high discharge volumes, such as receiving waters of coal-fired power plant effluents., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Under the influence of intensive human activities and global climate change, the sources and compositions of dissolved organic matter (DOM) in the eastern plain lake (EPL) region in China have fluctuated sharply. It has been successfully proven that the humification index (HIX), which can be derived from three-dimensional excitation-emission matrix fluorescence spectroscopy, can be an effective proxy for the sources and compositions of DOM. Therefore, combined with remote sensing technology, the sources and compositions of DOM can be tracked on a large scale by associating the HIX with optically active components. Here, we proposed a novel HIX remote sensing retrieval (IR HIX ) model suitable for Landsat series sensors based on the comprehensive analysis of the covariation mechanism between HIX and optically active components in different water types. The validation results showed that the model runs well on the independent validation dataset and the satellite-ground synchronous sampling dataset, with an uncertainty ranging from 30.85 % to 36.92 % (average ± standard deviation = 33.6 % ± 3.07 %). The image-derived HIX revealed substantial spatiotemporal variations in the sources and compositions of DOM in 474 lakes in the EPL during 1986-2021. Subsequently, we obtained three long-term change modes of the HIX trend, namely, significant decline, gentle change, and significant rise, accounting for 74.68 %, 17.09 %, and 8.23 % of the lake number, respectively. The driving factor analysis showed that human activities had the most extensive influence on the DOM humification level. In addition, we also found that the HIX increased slightly with increasing lake area (R 2  = 0.07, P < 0.05) or significantly with decreasing trophic state (R 2  = 0.83, P < 0.05). Our results provide a new exploration for the effective acquisition of long-term dynamic information about the sources and compositions of DOM in inland lakes and provide important support for lake water quality management and restoration., Competing Interests: Declaration of Competing Interest We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Large land consolidation projects modify the structures and functions of regional ecosystems through the reshaping of the territorial spatial pattern, thereby affecting the ecological environmental quality (EEQ). To investigate the effects of large-scale land consolidation projects on EEQ, this study takes the major land consolidation project of "bulldoze mountains to create land" (BMCL) in Yan'an City as a research object and evaluates the change of EEQ based on Remote Sensing Ecological Index (RSEI). The consolidated area and the control area were set up to comparatively analyze the EEQ change processes and spatial distribution characteristics of these two areas in the full life cycle of BMCL. According to the results, the mean RSEI of the consolidated area was 0.128 lower than that of the control area, and the EEQ of the consolidated area was always lower than that of the control area. BMCL had a strong negative impact on the EEQ grade of the consolidated area, especially in the early stage. However, the positive effect of BMCL on EEQ gradually emerged in the late stage of the large land consolidation project. The overall EEQ grade of the consolidated area has also improved. The results of the stepwise regression analysis indicated that the wetness component and the normalized differential vegetation index played key roles in improving the EEQ of the BMCL. Overall, the local BMCL strongly affected the EEQ of the consolidated area but would not cause the EEQ of the whole region to experience any dramatic, abrupt change in the short term. This study provided references for the evaluation and analysis of the ecological effects of land consolidation at the regional scale, offering a feasible way to evaluate the spatio-temporal change of EEQ in BMCL., 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 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: China has the highest proportion of lung cancer-related deaths. Drug therapy is the main tool of comprehensive anticancer treatment. However, most studies to date have focused on certain types of targets or immunotherapeutic modalities for drug safety; few studies have addressed the factors that influence ADRs for each type of drug in patients with lung cancer, and even fewer studies have explored the risk factors for certain types of ADRs. Based on it, we comprehensively evaluate the drug safety of patients and provide a clinical reference with a focus on lung cancer., Research Design and Methods: We examined 767 reports of adverse drug reactions (ADRs) in patients with lung cancer and conducted a logistic regression analysis on the risk factors that may cause different types of organ system damage and serious ADRs., Results: The logistic regression identified various independent risk factors for system organ damage, and ADRs involving erythrocyte abnormalities (P < 0.001), respiratory system damage (P < 0.001), and leukocyte and reticuloendothelial system abnormalities (P < 0.001) were more likely to be severe., Conclusions: Rare adverse reactions and different Clinical medication guidelines for molecular-targeted drugs were identified. These findings had certain practical significance in clinical safe drug use.

Purpose: Tuberculosis is one of the oldest diseases in human history, and spinal tuberculosis (STB) is the most common form of extrapulmonary tuberculosis. A large number of research has been conducted in this field. However, there has been no bibliometric analysis performed in recent years in STB. The aim of this study was to analyze trends and hotspots in research on STB., Methods: Publications regarding STB between 1980 and 2022 were extracted from the Web of Science database. CiteSpace (V5.7.R2) and VOSviewer (1.6.10) were used to perform global analyses of the number of publications, countries, institutions, authors, journals, keywords, and cited references., Results: A total of 1262 articles were published between 1980 and 2022. We observed rapid growth in the number of publications since 2010. Spine had the highest number of publications (47, 3.7%). Zhang HQ and Wang XY were key researchers. The Central South University published the most papers (90, 7.1%). China was the leading contributor in this field with 459 publications and 29 H-index. National partnerships are dominated by the USA, and there is a lack of active cooperation between other countries and authors., Conclusion: research on STB has achieved great progress, with an increasing number of publications since 2010. Surgical treatment and debridement are current research hots pots, and diagnosis, drug resistance, and kyphosis are likely research frontiers. Cooperation between countries and authors needs to be further strengthened., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To analyze the epidemiological characteristics of reinfection of 2019-nCoV and influencing factors, and provide evidence for effective prevention and control of COVID-19 epidemic. Methods: The incidence data of COVID-19 in Ningbo from January 1, 2020 to November 30, 2022 were collected from the infectious disease surveillance system of Chinese information system for disease control and prevention. The incidence of reinfection of 2019-nCoV was investigated by using questionnaire. logistic regression analysis was used to analyze the influences of gender, age, time interval from the first infection, history of underlying disease, 2019-nCoV vaccination dose and disease severity on the reinfection. Results: A total of 897 previous 2019-nCoV infection cases were investigated, of which 115 experienced the reinfection of 2019-nCoV, the reinfection rate was 12.82%. The interval between the two infections M ( Q 1 , Q 3 ) was 1 052 (504, 1 056) days. Univariate analysis showed that age, 2019-nCoV vaccination dose, history of underlying disease, type of 2019-nCoV variant causing the first infection, time interval from the first infection and severity of the first infection were associated with the reinfection rate (all P <0.05). Multivariate logistic regression analysis showed that the risk for reinfection in age group 30- years was higher than that in age group ≥60 years ( OR =2.10, 95% CI : 1.11-3.97). No reinfection occurred in those with time interval from the first infection of <6 months, and the risk for reinfection was higher in those with the time interval of ≥12 months than in those with the time interval of 6- months ( OR =6.68, 95% CI : 3.46-12.90). The risk for reinfection was higher in the common or mild cases than in the asymptomatic cases ( OR =2.64, 95% CI : 1.18-5.88; OR =2.79, 95% CI : 1.27-6.11). Conclusion: The time interval from the first infection was an important influencing factor for the reinfection of 2019-nCoV, and the probability of the reinfection within 6 months was low.

Monitoring the long-term spatiotemporal variations in particulate organic phosphorus concentration (C POP ) is imperative for clarifying the phosphorus cycle and its biogeochemical behavior in waters. However, little attention has been devoted to this owing to a lack of suitable bio-optical algorithms that allow the application of remote sensing data. In this study, based on Moderate Resolution Imaging Spectroradiometer (MODIS) data, a novel absorption-based algorithm of C POP was developed for eutrophic Lake Taihu, China. The algorithm yielded a promising performance with a mean absolute percentage error of 27.75% and root mean square error of 21.09 μg/L. The long-term MODIS-derived C POP demonstrated an overall increasing pattern over the past 19 years (2003-2021) and a significant temporal heterogeneity in Lake Taihu, with higher value in summer (81.97 ± 3.81 μg/L) and autumn (82.07 ± 3.8 μg/L), and lower C POP  in spring (79.52 ± 3.81 μg/L) and winter (78.74 ± 3.8 μg/L). Spatially, relatively higher C POP was observed in the Zhushan Bay (85.87 ± 7.5 μg/L), whereas the lower value was observed in the Xukou Bay (78.95 ± 3.48 μg/L). In addition, significant correlations (r > 0.6, P < 0.05) were observed between C POP and air temperature, chlorophyll-a concentration and cyanobacterial blooms areas, demonstrating that C POP was greatly influenced by air temperature and algal metabolism. This study provides the first record of the spatial-temporal characteristics of C POP in Lake Taihu over the past 19 years, and the C POP results and regulatory factors analyses could provide valuable insights for aquatic ecosystem conservation., 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.)

HIV-1 molecular surveillance provides a new approach to explore transmission risks and targeted interventions. From January to June 2021, 663 newly reported HIV-1 cases were recruited in Zhaotong City, Yunnan Province, China. The distribution characteristics of HIV-1 subtypes and HIV-1 molecular network were analysed. Of 542 successfully subtyped samples, 12 HIV-1 strains were identified. The main strains were CRF08&#95;BC (47.0%, 255/542), CRF01&#95;AE (17.0%, 92/542), CRF07&#95;BC (17.0%, 92/542), URFs (8.7%, 47/542), and CRF85&#95;BC (6.5%, 35/542). CRF08&#95;BC was commonly detected among Zhaotong natives, illiterates, and non-farmers and was mostly detected in Zhaoyang County. CRF01&#95;AE was frequently detected among married and homosexual individuals and mostly detected in Weixin and Zhenxiong counties. Among the 516 pol sequences, 187 (36.2%) were clustered. Zhaotong natives, individuals aged ≥60 years, and illiterate individuals were more likely to be found in the network. Assortativity analysis showed that individuals were more likely to be genetically associated when stratified by age, education level, occupation, and reporting area. The genetic diversity of HIV-1 reflects the complexity of local HIV epidemics. Molecular network analyses revealed the subpopulations to focus on and the characteristics of the risk networks. The results will help optimise local prevention and control strategies.

Disability weights are crucial for quantifying health loss associated with non-fatal outcomes and were not well assessed in different countries, especially for specific cancer. Therefore, this study aimed to identify disability weights with a focus on specific cancer in a large Chinese population. Two types of web surveys were conducted, and 254 health states, including 30 new states for specific cancer, were investigated using paired comparison methods. The years lived with disability (YLDs) of cancer were calculated as the sum of the prevalence of each sequela of cancer multiplied by its relative disability weight. In total, 44,069 participants were eligible for the disability weights study. The disability weights of 254 health states were estimated. Among those, the disability weights of 18 specific cancer types varied greatly at diagnosis and primary treatment stage, with the value ranging from 0.619 (95% uncertainty interval (UI) 0.606-0.632) for brain cancer to 0.167 (95% UI 0.158-0.176) for oropharyngeal cancer. The discrepancy in YLDs calculated by different disability weights was high, and the largest gap for all cancer combined was approximately 30.14%. When calculated using the cancer-specific disability weights, a total of 1,967,830 (95% UI 1,928,880-2,008,060) YLDs of cancer were recorded in China. The disability weights of cancer varied greatly among cancer types and populations, which had considerable influence on the estimation of the disease burden. Cancer-specific disability weights could provide a more accurate evaluation of the cancer burden., Competing Interests: Conflict of interest The authors declare that they have no conflict of interest., (Copyright © 2023. Published by Elsevier B.V.)

Background: Lung cancer has been the leading cause of cancer-related deaths worldwide for many years. This study aimed to investigate the global patterns and trends of lung cancer., Methods: Lung cancer incidence and mortality were derived from the GLOBOCAN 2020 database. Continuous data from Cancer Incidence in Five Continents Time Trends were used to analyze the temporal trends from 2000 to 2012 using Joinpoint regression, and average annual percent changes were calculated. The association between the Human Development Index and lung cancer incidence and mortality was assessed by linear regression., Results: An estimated 2.2 million new lung cancer cases and 1.8 million lung cancer-related deaths occurred in 2020. The age-standardized incidence rate (ASIR) ranged from 36.8 per 100,000 in Demark to 5.9 per 100,000 in Mexico. The age-standardized mortality rate (ASMR) varied from 32.8 per 100,000 in Poland to 4.9 per 100,000 in Mexico. Both ASIR and ASMR were approximately twice higher in men than in women. The ASIR of lung cancer showed a downward trend in the United States of America (USA) between 2000 and 2012, and was more prominent in men. The age-specific incidence rates of lung cancer for ages of 50 to 59 years showed an upward trend in China for both men and women., Conclusions: The burden of lung cancer is still unsatisfactory, especially in developing countries like China. Considering the effectiveness of tobacco control and screening in developed countries, such as the USA, there is a need to strengthen health education, accelerate the establishment of tobacco control policies and regulations, and improve early cancer screening awareness to reduce the future burden of lung cancer., (Copyright © 2023 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.)

Background: Medical disputes remain a global public health problem. However, an analysis of the characteristics and risk factors affecting the judgment results of medical damage liability disputes in second-instance and retrial cases in China has yet to be conducted., Methods: We conducted a systematic search and evaluation of second-instance and retrial cases among all medical damage liability disputes in China Judgments Online; SPSS 22.0 was used for the statistical analysis. A χ 2 test or likelihood ratio Chi-square test was used to compare differences between groups, and multivariate logistic regression analysis was performed to determine independent risk factors that could affect the judgment results of medical disputes., Results: We included 3172 second-instance and retrial cases among all medical damage liability disputes in the analysis. The results showed that 48.04% of cases were unilateral appeals by the patient, and medical institutions were responsible for providing compensation in 80.64% of these cases. Cases involving compensation ranged from Chinese Yuan (CNY) 100 000 to 500 000 ranked first (40.95%); 21.66% were non-compensation cases. Cases involving mental damage compensation of less than CNY 20 000 accounted for 39.03%. Violations of medical treatment and nursing routines accounted for 64.25% of all cases. In addition, re-identification in 54.59% of cases changed the initial appraisal opinion. Independent risk factors for medical personnel to lose a lawsuit in a multivariate logistic regression model included appeal originator [patient side: OR = 18.809 (95% CI 11.854-29.845); both sides: OR = 22.168 (95% CI 12.249-40.117)], change of the original verdict (OR = 5.936, 95% CI 3.875-9.095), judicial identification (OR = 6.395, 95% CI 4.818-8.487), violations of medical treatment and nursing routines (OR = 8.783, 95% CI 6.658-11.588), and non-standard medical document writing (OR = 8.500, 95% CI 4.805-15.037)., Conclusion: Our study clarifies the characteristics of second-instance and retrial cases among all medical damage liability disputes in China from multiple perspectives and identifies the independent risk factors for medical personnel losing a lawsuit. This study could help medical institutions prevent and reduce medical disputes, at the same time, it could be helpful for medical institutions to provide better medical treatment and nursing services for patients., (© 2023. The Author(s).)

Objective: According to the Global Tuberculosis Report for three consecutive years, tuberculosis (TB) is the second leading infectious killer. Primary pulmonary tuberculosis (PTB) leads to the highest mortality among TB diseases. Regretfully, no previous studies targeted the PTB of a specific type or in a specific course, so models established in previous studies cannot be accurately feasible for clinical treatments. This study aimed to construct a nomogram prognostic model to quickly recognize death-related risk factors in patients initially diagnosed with PTB to intervene and treat high-risk patients as early as possible in the clinic to reduce mortality., Methods: We retrospectively analyzed the clinical data of 1,809 in-hospital patients initially diagnosed with primary PTB at Hunan Chest Hospital from January 1, 2019, to December 31, 2019. Binary logistic regression analysis was used to identify the risk factors. A nomogram prognostic model for mortality prediction was constructed using R software and was validated using a validation set., Results: Univariate and multivariate logistic regression analyses revealed that drinking, hepatitis B virus (HBV), body mass index (BMI), age, albumin (ALB), and hemoglobin (Hb) were six independent predictors of death in in-hospital patients initially diagnosed with primary PTB. Based on these predictors, a nomogram prognostic model was established with high prediction accuracy, of which the area under the curve (AUC) was 0.881 (95% confidence interval [Cl]: 0.777-0.847), the sensitivity was 84.7%, and the specificity was 77.7%.Internal and external validations confirmed that the constructed model fit the real situation well., Conclusion: The constructed nomogram prognostic model can recognize risk factors and accurately predict the mortality of patients initially diagnosed with primary PTB. This is expected to guide early clinical intervention and treatment for high-risk patients., 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 © 2023 Li, Tang, Lei, Xie and Li.)

Objective: To explore the associations between the consumption frequencies of alcohol, tea and sugar-sweetened beverages (SSBs) and the hypertension risk among Chinese adults., Design: A longitudinal study of the effect of beverage consumption on hypertension risk., Setting: Nine provinces in China, including Jiangsu, Hubei, Hunan, Guangxi, Guizhou, Liaoning, Heilongjiang, Shandong and Henan., Participants: The longitudinal data of the China Health and Nutrition Survey from 2004 to 2015 were used. A total of 4427 participants from 9 provinces were included at baseline., Outcome: First incidence of hypertension., Results: During a mean follow-up of 8.7 years, 1478 participants developed hypertension. Alcohol consumption more than twice a week in young men (HR 1.86, 95% CI 1.09 to 3.18) or middle-aged men (HR 1.37, 95% CI 1.01 to 1.87) was associated with a higher hypertension risk. Middle-aged women who consumed tea frequently (HR 0.71, 95% CI 0.52 to 0.97), or young women who consumed SSBs less than once a week (HR 0.31, 95% CI 0.14 to 0.67) had a lower risk of hypertension., Conclusions: High-frequency alcohol consumption increased the risk of hypertension in men, and frequent tea consumption and low-frequency SSBs consumption were associated with lower risk of hypertension in women. Consumption frequency of beverages was also suggested to be considered in the prevention and control of hypertension., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Sweet sorghum is a high-yield crop with strong resistance, which has the potential to support the development of the forage farming industry in China where vast salt-affected lands are potentially arable. Nutrient management is imperative for sweet sorghum growing on salt-affected lands. Although nitrogen (N) synthetic fertilizers have long been recognized as a key factor for increasing crop yields, their effects on sweet sorghum cultivation are under debate. Consequently, this study integrated the current available observations of yield (n = 255) and partial factor productivity of nitrogen (NPFP, n = 242) of sweet sorghum in salt-affected lands, which included both inland (n = 189) and coastal (n = 66) areas. We quantitatively analyzed the effects of climatic, soil properties and management measures on biomass yield and NPFP of sweet sorghum, comparing the differences between inland and coastal salt-affected lands. We found that average biomass yield and NPFP of sweet sorghum in coastal areas were 19,082.48 ± 8262.75 kg/ha and 107.29 ± 51.44 kg/kg respectively, both significantly lower than that in inland areas (p < 0.05). The N application rate did not have significant promoting effect on the biomass yield of sweet sorghum in inland salt-affected areas (p > 0.05), whereas in coastal salt-affected areas, N application significantly increased the biomass yield of sweet sorghum. Increasing soil organic matter content could promote NPFP in inland areas. The recommended N application rate for inland salt-affected and coastal salt-affected areas were 100 kg/ha and 150 kg/ha respectively. The results indicate that it is crucial to apply nutrient management measures based on the local climatic and soil conditions, since the causes of salinity differ in coastal and inland salt-affected lands. More systematic field studies are required in the future to optimize the management of water and nutrients for sweet sorghum planting in salt-affected lands., 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 Inc. All rights reserved.)

Particulate phosphorus (PP) plays an important biological role in the eutrophication process, and is thus an important water quality parameter for assessing climatic change and anthropogenic activity factors that affect aquatic ecosystems. Here, we used 20-year Moderate Resolution Imaging Spectroradiometer (MODIS) data to explore the patterns and trends of PP concentration (C PP ) in eutrophic Lake Chaohu based on a new empirical model. The validation results indicated that the developed model performed satisfactorily in estimating C PP , with a mean absolute percentage error of 31.89% and root mean square error of 0.022 mg/L. Long-term MODIS observations (2000-2019) revealed that the C PP of Lake Chaohu has experienced an overall increasing trend and distinct spatiotemporal heterogeneity. The driving factor analysis revealed that the chemical fertilizer consumption, municipal wastewater, industrial sewage, precipitation, and air temperature were the five potential driving factors and collectively explained more than 81% of the long-term variation in C PP . This study provides the long-term datasets of C PP in inland waters and new insights for future water eutrophication control and restoration efforts., 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 Inc. All rights reserved.)

Artificial sweeteners discharged into aquatic environments have raised concern because of their ubiquitous occurrence and potential biological effect. And some of them, such as sucralose (SUC) and acesulfame (ACE), have been identified as emerging contaminants. Wastewater treatment plants (WWTPs) are considered as important sources and sinks of artificial sweeteners discharged into the environment. In this study, the occurrence and removal of four representative artificial sweeteners in 12 WWTPs located in different provinces of China were investigated. The results showed that artificial sweeteners were detected widely in the investigated WWTPs. The median concentrations of the four target artificial sweeteners were detected in influents at levels of 0.03-3.85 μg L -1 and decreased in the order of SUC > ACE > aspartame (APM) > neotame (NTM). Additionally, the per capita mass loads of total artificial sweeteners in the WWTPs could be affected by the location of the WWTPs and were higher in southern cities than in northern cities. It was also found that there was a distinct linear correlation between the per capita mass load of ACE in influents and population density. During the treatment of WWTPs, the overall removal efficiency of artificial sweeteners ranged from -116% to 99.1%. Among the target artificial sweeteners, SUC and ACE might have potential risk to aquatic environments based on the calculation of the risk quotient. Thus, advanced treatment processes were carried to further remove SUC and ACE to reduce their long-term cumulative effect. Overall, UV/H 2 O 2 and UV/PDS showed a better effect than granular activated carbon (GAC) adsorption in the removal of artificial sweeteners. The reaction constants of ACE by UV/H 2 O 2 and UV/PDS were higher than those of SUC, which is related to molar extinction coefficients. Meanwhile, the adsorption ability of GAC adsorption for SUC was better than that of ACE, which is in correlation with the octanol-water partition coefficient. By comparison of removal efficiency, UV/PDS was considered as the most suitable advanced treatment process to remove ACE and SUC.

Chemical oxygen demand concentration (C COD ) is widely used to indicate the degree of organic pollution of lakes, reservoirs and rivers. Mastering the spatiotemporal distribution of C COD is imperative for understanding the variation mechanism and controlling of organic pollution in water. In this study, a hybrid approach suitable for Sentinel 3A/Ocean and Land Colour Instrument (OLCI) data was developed to estimate C COD in inland optically complex waters embedding the interaction between C COD and the absorption coefficients of optically active constituents (OACs). Based on in-situ sampling in different waters, the independent validations of the proposed model performed satisfactorily in Lake Taihu (MAPE = 23.52 %, RMSE = 0.95 mg/L, and R 2 = 0.81), Lake Qiandaohu (MAPE = 21.63 %, RMSE = 0.50 mg/L and R 2 = 0.69), and Yangtze River (MAPE = 29.34 %, RMSE = 0.83 mg/L, and R 2 = 0.64). In addition, the approach not only showed significant superiority compared with previous algorithms, but also was suitable for other common satellite sensors equipped same or similar bands. The hybrid approach was applied to OLCI images to retrieve C COD of Lake Taihu from 2016 to 2020 and reveals substantial interannual and seasonal variations. The above results indicate that the proposed approach is effective and stable for studying spatiotemporal dynamic of C COD in optically complex waters, and that satellite-derived products can provide reliable information for lake water quality management., Competing Interests: Declaration of competing interest We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Blastocystis sp. is an important gastrointestinal parasite with global distribution, prevalent in humans, farmed animals, and wildlife. Therefore, this study aimed to investigate the prevalence and genetic diversity of Blastocystis sp. in Asiatic brush-tailed porcupines (Atherurus macrourus), bamboo rats (Rhizomys pruinosus), and masked palm civets (Paguma larvata) in Hainan Province, China. A total of 900 fecal samples were collected from three farmed animal species including 257 porcupines, 360 rats, and 283 civets. Genomic DNA was extracted from each fecal sample and Blastocystis sp. was detected by PCR at the small subunit ribosomal RNA (SSU rRNA) gene. A phylogenetic tree was constructed using the maximum likelihood method. Blastocystis sp. was detected in 47 (5.2%) fecal samples: 12 (4.7%) Asiatic brush-tailed porcupines, 8 (2.2%) bamboo rats, and 27 (9.5%) masked palm civets. Three known Blastocystis sp. subtypes, including ST1, ST4, ST5, and one unnamed subtype (unST), were found in one, 19, 26, and one animal, respectively. Subtypes ST4 and unST were detected in porcupines, ST4 in rats, and ST1 and ST5 in civets. Our results suggest that the three farmed animal species reported in this study could serve as reservoirs for potentially zoonotic Blastocystis sp. subtypes and transmit this parasite to humans, other farmed animals, and wildlife., (© W. Zhao et al., published by EDP Sciences, 2023.)

Enterocytozoon bieneusi is a zoonotic pathogen commonly found in humans and animals all over the world. Here, we investigated the occurrence and genotype constitute of E. bieneusi among the individuals from Haikou city of Hainan, China. A total of 1,264 fecal samples of humans were collected, including 628 samples from patients with diarrhea (325 adults and 303 children) and 636 samples from the asymptomatic population (383 college students and 253 kindergarten children). E. bieneusi was detected using nested polymerase chain reaction (PCR) amplification of the internal transcribed spacer (ITS) region. A phylogenetic tree was constructed using a neighbor-joining tree construction method. The overall prevalence of E. bieneusi was 3.7% (47/1,264), while it was 5.6% in the patients with diarrhea (5.8% in adults and 5.3% in children) and 1.9% in the asymptomatic population (2.9% in college students and 0.4% in kindergarten children). The prevalence of E. bieneusi in humans with diarrhea was significantly higher than that in the asymptomatic population (χ 2 = 36.9; P < 0.05). A total of 28 genotypes were identified, including ten known genotypes: CHG2 ( n = 3), CHG3 ( n = 5), CHG5 ( n = 10), CM21 ( n = 1), EbpA ( n = 1), EbpC ( n = 1), PigEBITS4 ( n = 1), PigEBITS7 ( n = 1), SHR1 ( n = 4), Type IV ( n = 2), and 18 novel genotypes (HNH-1 to HNH-18; one each). All these genotypes were categorized into three groups, including group 1 ( n = 6), group 2 ( n = 14), and group 13 ( n = 8). This was the first study on the identification of E. bieneusi among humans in Hainan, China. The correlation between E. bieneusi infection and diarrhea was observed. The high diversity and distinctive distribution of E. bieneusi genotypes found in this study reflected the unique epidemic genetic characteristics of E. bieneusi in humans living in Hainan., 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 Zhang, Ren, Zhou, Qiang, Li, Zhang, Li, Zhou, Wang, Lai, Lei, Tan, Liu, Li, He, Zhao, Zhu and Lu.)

Objective: To evaluate the efficacy and safety of pulmonary rehabilitation for exercise tolerance and quality of life improvement in idiopathic pulmonary fibrosis., Methods: We searched PubMed, Cochrane Library, Embase, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Database, and Chongqing VIP for randomized controlled trials that compared pulmonary rehabilitation with usual care for idiopathic pulmonary fibrosis. The risk of bias and certainty of evidence were assessed using Cochrane Collaboration's Risk of Bias tool and the Grading of Recommendations, Assessment, Development and Evaluation criteria., Results: Eleven trials in total with 549 participants. Compared with usual care, pulmonary rehabilitation significantly increased 6-minute walking distance (mean difference: 35.2m, 95% confidence intervals: 25.4m-44.9m; ten trials; 447 participants; moderate), decreased the St George's Respiratory Questionnaire total scores (mean difference: -9.11, 95% confidence intervals: -10.78 to -7.43; six trials; 303 participants; moderate), and reduced the modified Medical Research Council scores were lower (mean difference: -0.76, 95% confidence intervals: -1.25 to -0.27; three trials; 196 participants; low). Improvements were noted in forced vital capacity percent-predicted (mean difference: 4.88, 95% confidence intervals: 2.67 to 7.10; four trials; 214 participants; moderate) and diffusing capacity for carbon monoxide (mean difference: 4.71, 95% confidence intervals: 0.96 to 8.46; six trials; 358 participants; low)., Conclusions: Pulmonary rehabilitation may significantly improve exercise tolerance and quality of life in idiopathic pulmonary fibrosis patients, but the quality of evidence was low to moderate. Large sample, multicenter, randomized controlled trials are needed to verify the efficacy and safety of pulmonary rehabilitation.

Objective: To explore the interaction effect between overweight/obesity and alcohol consumption on hypertension risk., Design: A longitudinal study of the independent and combined effects of hypertension risk factors., Setting: Twelve provinces in China, including Beijing Liaoning, Heilongjiang, Shanghai, Jiangsu, Shandong, Henan, Hubei, Hunan, Guangxi, Guizhou and Chongqing., Participants: Longitudinal data of China Health and Nutrition Survey, collected between 2011 and 2015, were used in this study. A total of 13 121 residents from 12 provinces were included and completed physical examinations and questionnaires at baseline., Outcome: First incidence of hypertension., Results: Over a mean follow-up of 4 years, 690 incident hypertension cases were reported. After adjusting for age, gender, education level, marital status, physical activity, diabetes and smoking, high body mass index (BMI) and light drinking (OR=5.07, 95% CI 3.06 to 8.41), high waist circumference (WC) and light drinking (OR=4.81, 95% CI 2.92 to 7.91), high waist hip ratio and light drinking (OR=2.85, 95% CI 1.84 to 4.42) were the highest risk of all participants in the three combinations. Multiplicative interaction measures were statistically significant in overweight/obesity and drinking/light drinking/heavy drinking categories in men (p<0.05). Additive interactions were observed between high BMI and drinking in men (relative excess risk due to interaction=1.75, 95% CI 0.85 to 2.65, attributable proportion due to interaction=0.56, 95% CI 0.36 to 0.76, synergy index=6.43, 95% CI 1.02 to 28.84)., Conclusions: Measures of body weight and size, particularly BMI and WC, appear to interact synergistically with alcohol consumption to increase the risk of hypertension in the Chinese population. Given that approximately 245 million people in China have hypertension, and that hypertension is a major cause of cardiovascular disease worldwide, our results may have implications for chronic disease prevention., 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: Hereditary angioedema (HAE) is a rare disease characterized by recurrent attacks of severe swellings of the skin and submucosa. More than 900 variants of the SERPING1 gene associated with HAE have been identified. However, only approximately 50 variants have been identified in the Chinese population. This study aimed to update the mutational spectrum in Chinese HAE patients and provide evidence for the accurate diagnosis of HAE., Methods: A total of 97 unrelated HAE patients were enrolled in the study. Sanger sequencing and multiple ligation-dependent probe amplification analysis were used to identify the variants in the SERPING1 gene. The variants were reviewed in a number of databases, including the Human Gene Mutation Database (HGMD) ( http://www.hgmd.cf.ac.uk/ ) and the Leiden Open Variation Database (LOVD, https://databases.lovd.nl/shared/variants/SERPING1 ). The American College of Medical Genetics and Genomics-Association for Molecular Pathology (ACMG-AMP) criteria was used to determine the pathogenicity of the variants., Results: Of the 97 patients, 76 different variants were identified in 90 of them and no disease-causing variants were identified in the remaining 7 patients. Among the 76 variants, 35 variants were novel and submitted to ClinVar. Missense and in-frame variants were the most common variants (36.8%), followed by frameshift (28.9%), nonsense (14.5%), splice site (13.2%) variants, and gross deletions/duplications (6.6%)., Conclusions: Our findings broaden the mutational spectrum of SERPING1 and provide evidence for accurate diagnosis and predictive genetic counseling., (© 2022. The Author(s).)

Objective: To investigate the local epidemic of COVID-19 caused by 2019-nCoV Delta variant in Zhenhai district of Ningbo, identify the transmission chain and provide reference for the prevention and control of COVID-19 epidemic. Methods: The incidence data of COVID-19 in Zhenhai from 6 to 18 December, 2021 were collected in field investigation. Field epidemiological investigation was conducted to understand the epidemiological characteristics of COVID-19 cases and analyze the transmission chains. Results: The first case might be infected with 2019-nCoV through direct or indirect exposure when passing through a medium-risk area, then a family cluster was caused, and the epidemic spread through close contacts of family members with others such as work, daily life, and moxibustion. The epidemic lasted for 14 days, and 74 confirmed COVID-19 cases were reported. The median incubation period was 4.0(3.0,5.8)d. All the cases were in a chain of transmission for more than 6 generations, and the intergenerational interval was 3.5(2.0,5.3)d. The gene sequencing result indicated that the pathogen was Delta AY.4 variant of 2019-nCoV. Both the epidemiological investigation and the gene sequencing results supported that the local COVID-19 epidemic in Zhenhai was associated with the COVID-19 epidemic in Shanghai. Conclusions: The transmission chain of this epidemic was clear. Delta AY.4 variant has obvious characteristic to cause case clusters in families, places with poor ventilation, and residential communities. It is suggested to strengthen the health management in key areas and key populations, and increase the frequency of nucleic acid testing.

Cross-boundary transport of air pollution is a difficult issue in pollution control for the North China Plain. In this study, an industrial district (Shahe City) with a large glass manufacturing sector was investigated to clarify the relative contribution of fine particulate matter (PM 2.5 ) to the city's high levels of pollution. The Nest Air Quality Prediction Model System (NAQPMS), paired with Weather Research and Forecasting (WRF), was adopted and applied with a spatial resolution of 5 km. During the study period, the mean mass concentrations of PM 2.5 , SO 2 , and NO 2 were observed to be 132.0, 76.1, and 55.5 μg/m 3 , respectively. The model reproduced the variations in pollutant concentrations in Shahe at an acceptable level. The simulation of online source-tagging revealed that pollutants emitted within a 50-km radius of downtown Shahe contributed 63.4% of the city's total PM 2.5 concentration. This contribution increased to 73.9±21.2% when unfavorable meteorological conditions (high relative humidity, weak wind, and low planetary boundary layer height) were present; such conditions are more frequently associated with severe pollution (PM 2.5 ≥ 250 μg/m 3 ). The contribution from Shahe was 52.3±21.6%. The source apportionment results showed that industry (47%), transportation (10%), power (17%), and residential (26%) sectors were the most important sources of PM 2.5 in Shahe. The glass factories (where chimney stack heights were normally < 70 m) in Shahe contributed 32.1% of the total PM 2.5 concentration in Shahe. With an increase in PM 2.5 concentration, the emissions from glass factories accumulated vertically and narrowed horizontally. At times when pollution levels were severe, the horizontally influenced area mainly covered Shahe. Furthermore, sensitivity tests indicated that reducing emissions by 20%, 40%, and 60% could lead to a decrease in the mass concentration of PM 2.5 of of 12.0%, 23.8%, and 35.5%, respectively., (Copyright © 2021. Published by Elsevier B.V.)

The open-pit coal mine dump in the study area contains many low-concentration heavy metal pollutants, which may cause pollution to the soil interface. Firstly, statistical analysis and geostatistical spatial interpolation methods described heavy metal pollution's spatial distribution. The mine dump heavy metal pollution distribution is strongly random due to disorderly piles, but it is closely related to slope soil erosion. Furthermore, the soil deposition area is where pollutants accumulate. For example, all heavy metal elements converge at the bottom of the dump. Usually, the pollution in the lower part is higher than that in the upper part; the pollution in the lower step is higher than the upper step; the pollution in the soil deposition locations such as flat plate and slope bottom is higher than the soil erosion locations such as slope tip and middle slope. Finally, the hyperspectral remote sensing method described heavy metals pollution's migration characteristics, that the pollutants could affect the soil interface by at least 1 km. This study provides a basis for preventing and controlling critical parts of mine dump heavy metal pollution and pollution path control.

Background: Gastric and esophageal cancer (GEC) have made a great contribution to the cancer burden in China. This study aims to report GEC incidence and mortality trends in 2000-2015 and their predictions to 2030., Methods: We collected GEC data from 22 cancer registries for Joinpoint temporal trend analysis between 2000 and 2015 and average annual percent change was calculated. Based on the historical changes, combined with the 2015 GEC national incidence and mortality rate, the rate from 2016 to 2030 was predicted grouped by sex and age. The crude rate, standardized rate, and cumulative rate were calculated. The number of cases were obtained by multiplying the United Nations' World Population Prospects and the predicted rate of corresponding years. Attribution changes between 2015 and 2030 were apportioned into demographics and risk factors., Results: There were decreasing trends of age-standardized incidence rate world (ASIRW) and age-standardized mortality rate world (ASMRW) during 2000-2015 in China (p < 0.05), the decline was more significant for the age group of 40-49 years in men and the age group of 50-59 years in women. It was predicted that in 2030, about 549,724 new cases and 394,576 deaths of GEC would occur in China. Compared with 2015, the numbers of new GEC cases and deaths in 2030 decreased by 15.24% and 17.62%, respectively. From 2020 to 2030, GEC ASIRW and ASMRW were predicted to decline from 24.98 to 17.47 and from 17.41 to 11.82 per 100,000, respectively. The number of new cases decreased by about 15.24% with changing demographic (44.48%) and risk (-59.72%) and the number of deaths decreased by about 17.62% with changing demographic (47.18%) and risk (-64.80%)., Conclusions: Although GEC incidence and mortality rates showed downward trends, the disease burden remains heavy in China. The current prevention and control strategy are effective which need to be carried on., (© 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Background: Altered regulatory-associated protein of mTOR, complex 1 (RPTOR) methylation levels in peripheral blood was originally discovered as breast cancer (BC)-associated risk factor in Caucasians., Objective: To explore the relationship between RPTOR methylation and BC in the Chinese population, we conducted two independent case-control studies., Methods: Peripheral blood samples were collected from a total of 333 sporadic BC cases and 378 healthy female controls for the DNA extraction and bisulfite-specific PCR amplification. Mass spectrometry was applied to quantitatively measure the levels of methylation. The logistic regression, Spearman's rank correlation, and Non-parametric tests were used for the statistical analyses., Results: In our study, we found an association between BC and RPTOR&#95;CpG&#95;4 hypomethylation in the general population (per-10% of methylation, OR 1.29, P = 0.012), and a weak association between BC and RPTOR&#95;CpG&#95;8 hypomethylation in the women with older age (per-10% of methylation, OR 2.34, P = 0.006). We also identified age as a confounder for the change of RPTOR methylation patterns, especially at RPTOR&#95;CpG&#95;4, which represented differential methylation comparing age groups especially in the BC cases (age < 50 years vs age ≥ 50 years by Mann-Whitney U test, P < 0.0001 for BC cases and P = 0.079 for controls)., Conclusion: Our study validated the association between hypomethylation of RPTOR and BC risk in the Chinese population also with weak effect and mostly for postmenopausal women. In addition, our findings provided novel insight for the regulation of DNA methylation upon aging or the change of hormone levels., (© 2021. The Genetics Society of Korea.)

Understanding the spatiotemporal dynamics of total dissolved phosphorus concentration (C TDP ) and its regulatory factors is essential to improving our understanding of its impact on inland water eutrophication, but few studies have assessed this in eutrophic inland lakes due to a lack of suitable bio-optical algorithms allowing the use of remote sensing data. We developed a novel semi-analytical algorithm for this purpose and tested it in the eutrophic Lake Taihu, China. Our algorithm produced robust results with a mean absolute square percentage error of 29.65% and root mean square error of 9.54 μg/L. Meanwhile, the new algorithm demonstrates good portability to other waters with different optical properties and could be applied to various image data, including Moderate Resolution Imaging Spectroradiometer (MODIS), Medium Resolution Imaging Spectrometer (MERIS), and Ocean and Land Color Instrument (OLCI). Further analysis based on Geostationary Ocean Color Imager observations from 2011 to 2020 revealed a significant spatiotemporal heterogeneity of C TDP in Lake Taihu. Correlation analysis of the long-term trend between C TDP and driving factors demonstrated that air temperature is the dominant regulating factor in variations of C TDP . This study provides a novel algorithm allowing remote-sensing monitoring of C TDP in eutrophic lakes and can lead to new insights into the role of dissolved phosphorus in water eutrophication., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Tracking the spatiotemporal dynamics of particulate phosphorus concentration (C PP ) and understanding its regulating factors is essential to improve our understanding of its impact on inland water eutrophication. However, few studies have assessed this in eutrophic inland lakes, owing to a lack of suitable bio-optical algorithms allowing the use of remote sensing data. Herein, a novel semi-analytical algorithm of C PP was developed to estimate C PP in lakes on the Yangtze Plain, China. The independent validations of the proposed algorithm showed a satisfying performance with the mean absolute percentage error and root mean square error less than 27% and 27 μg/L, respectively. The Ocean and Land Color Instrument observations revealed a remarkable spatiotemporal heterogeneity of C PP in 23 lakes on the Yangtze Plain from 2016 to 2020, with the lowest value in December (62.91 ± 34.59 μg/L) and the highest C PP in August (114.9 ± 51.69 μg/L). Among the 23 examined lakes, the highest mean C PP was found in Lake Poyang (124.58 ± 44.71 μg/L), while the lowest value was found in Lake Qiandao (33.51 ± 4.71 μg/L). Additionally, 13 lakes demonstrated significant decreasing or increasing trends (P < 0.05) of annual mean C PP during the observation period. The driving factor analysis revealed that four natural factors (wind speed, air temperature, precipitation, and sunshine duration) and two anthropogenic factors (the normalized difference vegetation index and nighttime light) combined explained more than 91% of the variation in C PP , while the impacts of these factors on C PP showed considerable differences among lakes. This study offered a novel and scalable algorithm for the study of the spatiotemporal variation of C PP in inland waters and provided new insights into the regulating factors in water eutrophication., 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.)

Rationale: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common form of familial cerebral small vessel disease in adults, and is caused by NOTCH3 mutations. However, individual symptom types, onset, and disease severity span a wide range., Patient Concerns: Herein, we report a case of chronic neurological symptoms including slurring of speech, recurrent weakness in both limbs and legs, and progressive memory loss. Cranial magnetic resonance imaging revealed recurrent acute lacunar subcortical infarction and extensive white matter hyperintensities. Skin biopsy revealed granular osmiophilic materials close to the cell surface of smooth muscle cells in an arteriolar vessel. The patient's genomic DNA showed a mutation c.635G>C[p.(Cys212Ser)] in exon 4., Diagnosis: The patient was finally diagnosed with CADASIL., Interventions: The patient was treated with antiplatelet therapy and extremity rehabilitation., Outcomes: There was no improvement in speech, extremity function, or memory., Lessons: Accurate early diagnosis and appropriate treatment are crucial to improve the prognosis of patients with CADASIL., Competing Interests: The authors have no funding and conflicts of interests to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Pulmonary tuberculosis (PTB) and diabetes mellitus (DM) remain high morbidity and mortality, especially when they are comorbid with each other. Screening for diabetes mellitus in tuberculosis is essential as the incidence and mortality of DM in the population with PTB are higher than in the general people. We aimed to examine the gradient association of tuberculosis on developing DM, the additional yield and the number needed to screen (NNS) to find a new diabetes case. A cross-sectional study was conducted on 801 tuberculosis cases and 972 household contacts in Guizhou, China, from April 2019 to October 2020. After screening for PTB among contacts, all participants were screened for DM and interviewed. Kendall's tau-b test and proportional odds logistic regression analysis were applied to identify the gradient associations. Among the 1773 subjects, the additional yield of screening was 21.8%. The NNSs of the non-PTB group, the sputum-culture negative and positive groups were 50, 60 and 113, respectively. The gradient incremental establishment of DM and PTB were positively correlated. The general trend on the gradient of DM significantly increased with the gradient increase of PTB. Age 35 years and over, excessive edible oil intake and DM family history were identified as significant predictors of diabetes. Integrated screening for DM targeted to different gradients of PTB combined with associated factors is necessitated to achieve a higher additional yield., (© 2022. The Author(s).)

Background: The broad continuum between tropical and temperate floras in Eastern Asia (EAS) are thought to be one of the main factors responsible for a prominent species diversity anomaly of temperate plants between EAS and eastern North America (ENS). However, how the broad continuum and niche evolution between tropical and temperate floras in EAS contributes to lineage divergence and species diversity remains largely unknown., Results: Population genetic structure, demography, and determinants of genetic structure [i.e., isolation-by-distance (IBD), isolation-by-resistance (IBR), and isolation-by-environment (IBE)] of Machilus thunbergii Sieb. et Zucc. (Lauraceae) were evaluated by examining sequence variation of ten low-copy nuclear genes across 43 populations in southeast China. Climatic niche difference and potential distributions across four periods (Current, mid-Holocene, the last glacial maximum, the last interglacial) of two genetic clusters were determined by niche modelling. North and south clusters of populations in M. thunbergii were revealed and their demarcation line corresponds well with the northern boundary of tropical zone in China of Zhu & Wan. The divergence time between the clusters and demographic expansion of M. thunbergii occurred after the mid-Pleistocene climate transition (MPT, 0.8-1.2 Ma). Migration rates between clusters were asymmetrical, being much greater from north to south than the reverse. Significant effects of IBE, but non-significant effects of IBD and IBR on population genetic divergence were detected. The two clusters have different ecological niches and require different temperature regimes., Conclusions: The north-south genetic differentiation may be common across the temperate-tropical boundary in southeast China. Divergent selection under different temperature regimes (possibly above and below freezing temperature in winter) could account for this divergence pattern. The broad continuum between tropical and temperate floras in EAS may have provided ample opportunities for tropical plant lineages to acquire freezing tolerance and to colonize the temperate regions during the late-Cenozoic global cooling. Our findings shed deeper insights into the high temperate plant species diversity in EAS., (© 2022. The Author(s).)

Background: Hospital workers have been under intense psychological pressure since the COVID-19 outbreak. We analyzed the psychological status of hospital staff in the late period of the COVID-19 to provide a basis for the construction of global health care after the COVID-19 outbreak., Methods: We used online surveys to assess participants' self-reported symptoms at the late stage of the outbreak. This study collected data on sociodemographic characteristics, epidemic-related factors, psychological status (PHQ-9, GAD-7, and PHQ-15), psychological assistance needs, perceived stress and support, PTSD symptoms (PCL-C) and suicidal and self-injurious ideation (SSI). Participants were hospital workers in all positions from 46 hospitals. Chi-square tests to compare the scales and logistic regression analysis were used to identify risk factors for PTSD and SSI., Results: Among the 33,706 participants, the prevalences of depression, anxiety, somatic symptoms, PTSD symptoms, and SSI were 35.8%, 24.4%, 49.7%, 5.0%, and 1.3%, respectively. Logistic regression analysis showed that work in a general ward, attention to the epidemic, high education, work in non-first-line departments, insufficient social support, and anxiety and somatization symptoms were influencing factors of PTSD (P<0.05). The independent risk factors for SSI were female gender; psychological assistance needs; contact with severe COVID-19 patients; high stress at work; single or divorced marital status; insufficient social support; and depression, anxiety or PTSD symptoms (P<0.05)., Limitations: This cross-sectional study could not reveal causality, and voluntary participation may have led to selection bias. The longer longitudinal studies are needed to determine the long-term psychological impact., Conclusion: This COVID-19 pandemic had a sustained, strong psychological impact on hospital workers, and hospital workers with PTSD symptoms were a high-risk group for SSI in the later period of the epidemic. Continuous attention and positive psychological intervention are of great significance for specific populations., (Copyright © 2021. Published by Elsevier B.V.)