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Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive pulmonary vascular disorder with substantial morbidity and mortality, also a disease underdiagnosed and undertreated. It is potentially curable by pulmonary endarterectomy (PEA) in patients with surgically accessible thrombi. Balloon pulmonary angioplasty (BPA) and targeted medical therapy are options for patients with distal lesions or persistent/recurrent pulmonary hypertension after PEA. There is an urgent need to increase the awareness of CTEPH. Qualified CTEPH centers are still quite limited. Baseline characteristics, management pattern and clinical outcome of CTEPH in China needs to be reported. Methods and design: The CHinese reAl-world study to iNvestigate the manaGEment pattern and outcomes of chronic thromboembolic pulmonary hypertension (CHANGE) study is designed to provide the multimodality treatment pattern and clinical outcomes of CTEPH in China. Consecutive patients who are ≥ 14 year-old and diagnosed with CTEPH are enrolled. The diagnosis of CTEPH is confirmed in right heart catheterization and imaging examinations. The multimodality therapeutic strategy, which consists of PEA, BPA and targeted medical therapy, is made by a multidisciplinary team. The blood sample and tissue from PEA are stored in the central biobank for further research. The patients receive regular follow-up every 3 or 6 months for at least 3 years. The primary outcomes include all-cause mortality and changes in functional and hemodynamic parameters from baseline. The secondary outcomes include the proportion of patients experiencing lung transplantation, the proportion of patients experiencing heart and lung transplantation, and changes in health-related quality of life. Up to 31 December 2023, the study has enrolled 1500 eligible patients from 18 expert centers. Conclusions: As a real-world study, the CHANGE study is expected to increase our understanding of CTEPH, and to fill the gap between guidelines and the clinical practice in the diagnosis, assessment and treatment of patients with CTEPH. Registration Number in ClinicalTrials.gov: NCT05311072. [ABSTRACT FROM AUTHOR]

Anaerobic digestion is a prevailing technology for the treatment and utilization of municipal organic solid waste (MOSW). In this technology, the macromolecular organic matter in waste degrades into small molecular substances through the anaerobic decomposition of microorganisms, producing biogas that can provide enormous energy. This paper focuses on the research progress of anaerobic digestion of various organic wastes for biogas production. The principle and process of anaerobic digestion for biogas production are introduced, along with the key factors affecting anaerobic digestion efficiency, such as temperature, pH, and sealing conditions. At the same time, the current cycle treatment technology and comprehensive treatment system of MOSW are also summarized. Furthermore, the paper explores biogas purification technologies, including desulfurization, deoxidation, drying, and decarbonization. Finally, the state-of-the-art of the utilization of MOSW for biogas production in the world and the problems faced by the utilization of MOSW for biogas production in China are reviewed. By summarizing the anaerobic digestion technology of MOSW, this review hopes to provide some reasonable solutions for the high-value utilization of MOSW. [ABSTRACT FROM AUTHOR]

The deepening rapprochement between China and Russia, those two formidable continental powers, constitutes one of the most noteworthy phenomena in post-Cold War world affairs. Through detailed investigation of this vital bilateral relationship over a variety of issue areas, we characterize the current Sino-Russian relations as a limited defensive strategic partnership, with strategicness constituting the core of the Sino-Russian relationship. More than that, we further argue that the Sino-Russian rapprochement is externally-driven rather than internally-driven. More specifically, realism's balance of power theory, or its variety balance of threat theory, provides a relatively convincing explanation regarding the increasingly strengthened Sino-Russian strategic partnership. In a roughly chronological way, this paper will demonstrate how America's increasing unilateralism in its foreign policy approaches was correlated with, and thus contributed to, the deepening rapprochement between China and Russia. [ABSTRACT FROM AUTHOR]

Background: Data on persistent candidemia (PC), a recognized complication of candidemia, are lacking in China. This study aimed to investigate the clinical characteristics and risk factors for the mortality of PC among adults in China. Methods: This 6-year retrospective study analyzed the prevalence, species distribution, antifungal susceptibility, risk factors, and patient mortality of PC among adults in three regional tertiary teaching hospitals in China from 2016 to 2021. We collected electronic laboratory records data of PC and non-PC patients and used the Student test or Mann–Whitney U test for a retrospective study. Logistic regression was used to identify risk factors associated with persistent candidemia. Results: The definition of PC was fulfilled by 36 patients (13.7%, 36/263). The mean age of the patients was 59.9 years (60 years for patients with PC; 59.8 years for those with non-PC; P > 0.05) and 131 (60.1%) were men [16 with PC (44.4%), 115 with non-PC (63.2%), P < 0.05]. The mean annual incidence was 0.15/1000 admissions (including PC 0.03/1000 admissions vs. non-PC 0.12/1000 admissions, P < 0.05). Candida parapsilosis (14/36, 38.9%) and Candida albicans (81/182, 44.5%) were the predominant pathogens in patients with PC and non-PC, respectively. Most isolates were susceptible to flucytosine (99.0%) and amphotericin B (99.5%), and the activity of antifungal agents against Candida species was not statistically significantly different between patients with PC and non-PC (P > 0.05). The 30-day mortality rate was 20.2% (16.7% with PC vs. 20.9% with non-PC, P > 0.05). Multivariable regression analysis showed that use of broad-spectrum antibiotics (odds ratio (OR), 5.925; 95% confidence interval (CI), 1.886–18.616, P = 0.002), fluconazole (OR, 3.389; 95% CI, 1.302–8.820, P = 0.012) and C. parapsilosis infection (OR, 6.143; 95% CI, 2.093–18.031, P = 0.001) were independent predictors of PC, sex (male) (OR, 0.199; 95% CI, 0.077–0.518, P = 0.001) was the protective factor for PC. Respiratory dysfunction (OR, 5.763; 95% CI, 1.592–20.864, P = 0.008) and length of hospital stay(OR, 0.925; 95% CI, 0.880–0.973, P = 0.002) were independent predictors of 30-day mortality in patients with non-PC. C. tropicalis bloodstream infection (OR, 12.642; 95% CI, 1.059–150.951; P = 0.045) was an independent predictor of 30-day mortality in patients with PC. Conclusions: The epidemiological data of patients with PC and non-PC were different in the distribution of Candida species, the mean annual incidence and independent predictors of 30-day mortality. Flucytosine and amphotericin B could be used as first-choice drugs in the presence of PC infections. [ABSTRACT FROM AUTHOR]

This article examines a largely unexplored component of China's classical garden system—the gardens of salt merchants in Tianjin during the Qing Dynasty (1636–1911). Beyond existing works, which tend to focus on imperial and scholar gardens—gardens of the ruling elites—this examination of merchant gardens contributes to garden history by revealing that merchants created gardens to improve their low social status. It further reveals shifts in the functions, architectural design and flora of the gardens which reflects both individual aesthetics and the changing fortunes of Tianjin's salt merchants in general. Salt merchant gardens in Tianjin initially presented idyllic scenery to create literary-based, self-immersed spaces. Then beginning in the 1720s, they evolved into a showcase of rising merchant power displaying affluence, thereby enabling merchants to improve their social rank. Finally, from the 1840s, salt merchant gardens gradually became extravagant enclosures as the collapse of the established social structure unfolded. [ABSTRACT FROM AUTHOR]

Over the post–Cold War era, China and Russia have been committed to creating a strategic partnership in an attempt to contain the US hegemony and bring the world a new international order. As a part of this partnership and their efforts in achieving the above goals, these two states have increasingly intensified their military cooperation over the past two decades. The rapidly enhanced military cooperation is a visible manifestation of China's quest for military modernization to meet the challenges of a potentially military intervention launched by the USA in Taiwan and the disputed South China Sea as well as for a delicate moment of global power shift caused by the rise of China. It also shows China's strategic intention of enhancing its "hard" power in order to elevate its status at the systemic (global) level. In so doing, China wishes to achieve two interconnected objectives. One is related to China's strategic and security environment that, from the Chinese perspectives, has been drastically aggravated by the US containment of its rise. The other relates to China's long cherished dream of restoring its past glory of "Fuqiang" (wealth and power) by enhancing its national power and rising in the global power hierarchy. [ABSTRACT FROM AUTHOR]

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Russia and China are two big players in the international system, both of which share interests and concerns and compete for preponderance and affirmation at the regional level. As a framework for political-military cooperation, the Shanghai Cooperation Organisation (SCO) frames this relationship in an institutional setting that might be understood as a tool for rapprochement between Moscow and Beijing or as a strategic manoeuvre for balancing an unbalanced international order. Thus the following question arises: is Russian-Chinese cooperation discourse mere political rhetoric or does it imply the intentional forging of a goal-orientated partnership? The relationship between Russia and China in political and security terms reveals identifiable common concerns, such as counter-terrorism or the fight against organised crime, while simultaneously masking the underpinning drivers, based on realpolitik dynamics and image construction on both sides (power projection, regional affirmation). This means that the strategic partnership dialogue between Moscow and Beijing is still far from being real. Realpolitik considerations rise above institutional goals, showing the lines of (dis)continuity in discourse and practice in this bilateral relationship. [ABSTRACT FROM AUTHOR]