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Use of real-world data (RWD) is gaining wide attention. To bridge the gap between diverse healthcare stakeholders and to leverage the impact of Chinese real-world evidence (RWE) globally, a multi-stakeholder External Advisory Committee (EAC) and EAC meetings were initiated, aiming to elucidate the current and evolving RWD landscape in China, articulate the values of RWE in ensuring Chinese patients' equitable access to affordable medicines and solutions, and identify strategic opportunities and partnerships for expansion of RWE generation in China. Chinese and international experts who are clinicians and academic researchers were selected as EAC members based on their professional background and familiarity with RWD/RWE. Three EAC meetings were held quarterly in 2023. Various topics were presented and discussed for insights and suggestions. Nine experts from China, one from South Korea, and two from Europe were selected as EAC members and attended these meetings. Experts' presentations were summarized by theme, including the RWD landscape and RWE enablement in China, as well as global development of a patient-centric ecosystem. Experts' insights and suggestions on maximizing the RWD/RWE value to accelerate healthcare transformation in China were collected. We concluded that though data access, sharing, and quality are still challenging, RWD is developing to support evidence generation in the medicinal product lifecycle, inform clinical practice, and empower patient management in China. RWD/RWE creates value, accelerates healthcare transformation, and improves patient outcomes. Fostering a patient-centric ecosystem across healthcare stakeholders and maintaining global partnerships and collaboration are essential for unlocking the power of RWD/RWE. [ABSTRACT FROM AUTHOR]

Improving energy efficiency is crucial for China's power industry to meet global energy conservation and emission reduction goals. The rapid development of photovoltaic (PV) and hydropower has greatly assisted in the construction of China's novel power system. The stochastic characteristics of PV power generation pose significant challenges to the reliable and economical scheduling of power systems. In fact, the cascade hydropower station can effectively address the issue. To fully utilize the advantages of hydropower, this paper proposes a bi-layer scheduling optimization model for the cascade hydro-PV complementary system considering power market. The upper-layer model simultaneously maximizes the benefit and minimizes the output volatility of the complementary system. The lower-layer model carries out market clearing with the objective of social cost. Besides, PV uncertainty and market price volatility are considered in the decision-making process for power market transactions. To solve the bi-layer model, a novel meta-heuristic algorithm (geometric mean optimizer) is applied, demonstrating excellent performance compared to similar methods. For the complementary system, the results show that its total power output can be improved, and its output volatility can be effectively alleviated. [ABSTRACT FROM AUTHOR]

Existing macroeconomic forecasting methods primarily focus on the characteristics of economic data, but they overlook the energy-related features concealed behind these economic characteristics, which may lead to inaccurate GDP predictions. Therefore, this paper meticulously analyzes the relationship between energy big data and economic data indicators, explores the coupling feature mining of energy big data and economic data, and constructs features coupling economic and energy data. Targeting the nonlinear variation coupling features in China's quarterly GDP data and using the long short-term memory (LSTM) neural network model based on deep learning, we employ wavelet analysis technology (WA) to decompose selected macroeconomic variables and construct a prediction model combining LSTM and WA, which is further compared with multiple benchmark models. The research findings show that, in terms of quarterly GDP data prediction, the combined deep learning model and wavelet analysis significantly outperform other methods. When processing structurally complex, nonlinear, and multi-variable data, the LSTM and WA combined prediction model demonstrate better generalization capabilities, with its prediction accuracy generally surpassing other benchmark models. [ABSTRACT FROM AUTHOR]

Purpose: Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease worldwide. Risk assessment provides information about patient prognosis, contributing to the risk stratification of patients and the rational allocation of medical resources. We aimed to develop a model for individualized prediction of renal function decline in patients with type 2 DKD (T2DKD). Patients and Methods: In a retrospective observational study, we followed 307 T2DKD patients and evaluated the determinants of 1) risk of doubling in serum creatinine (Scr), 2) risk of eGFR< 15 mL/min/1.73m2 using potential risk factors at baseline. A prediction model represented by a nomogram and a risk table was developed using Cox regression and externally validated in another cohort with 206 T2DKD patients. The discrimination and calibration of the prediction model were evaluated by the concordance index (C-index) and calibration curve, respectively. Results: Four predictors were selected to establish the final model: Scr, urinary albumin/creatinine ratio, plasma albumin, and insulin treatment. The nomogram achieved satisfactory prediction performance, with a C-index of 0.791 [95% confidence interval (CI) 0.762– 0.820] in the derivation cohort and 0.793 (95% CI 0.746– 0.840) in the external validation cohort. Then, all predictors were scored according to their weightings. A risk table with the highest score of 11.5 was developed. The C-index of the risk table was 0.764 (95% CI: 0.731– 0.797), which was similar to the external validation cohort (0.763; 95% CI: 0.714– 0.812). Additionally, the patients were divided into two groups based on the risk table, and significant differences in the probability of outcome events were observed between the high-risk (score > 2) and low-risk (score ≤ 2) groups in the derivation and external validation cohorts (P < 0.001). Conclusion: The nomogram and the risk table using readily available clinical parameters could be new tools for bedside prediction of renal function decline in T2DKD patients. Graphical [ABSTRACT FROM AUTHOR]

Background: There are limited data on the trends of incidence or prevalence of end stage renal disease (ESRD) in China. To assist in future planning for the ESRD program, the trends of incidence, prevalence and health care costs were analyzed and forecasted to the year 2025 by modeling of historical data from 2004 through 2014.Methods: Nanjing urban employee basic medical insurance (NJUEBMI) data were obtained from the Nanjing Medical Insurance Information System from 2004 to 2014. The time series forecasting system in SAS 9.4 was used. Each variable was independently forecasted by the fittest model, which was selected automatically or manually.Results: The forecasting models demonstrated mean percent errors of -2.49 to 5.62 %, relative to the observed values. The R-square values for the forecasting models ranged from 0.756 to 0.997. On the basis of trends in the historical data, the models projected that the average annual increase in the NJUEBMI population was 4.77 %, with forecasted values of 5,029,270 in 2025 (95 % CI, 4,960,423-5,098,117). The incidence and prevalence of ESRD were projected to increase by 1.19 and 1.95 % annually and were expected to reach 250.5 pmp (95 % CI, 247.7-253.3) and 1505 pmp(95 % CI, 1450-1560) by 2025. Additionally, the costs associated with ESRD were forecasted to increase at a growth rate of 5.80 % for healthcare costs and 7.25‰ for per capita medical expenses, with forecasted values of ¥600.3 million ($92.4 million) (95 % CI, 541.8-658.9) and ¥99.0 thousand ($15.2 thousand) (95 % CI, 98.6-99.3), respectively, by 2025. The incidence and prevalence of kidney transplantation were projected to decrease by 6.58 and 9.79 % annually.Conclusions: These projections suggest that the incidence, prevalence, healthcare costs, and per capita medical expenses of ESRD would increase in the NJUEBMI population. They provide a basis for discussing the trends of ESRD in China and facing the challenges from the ESRD program. [ABSTRACT FROM AUTHOR]

Variations are present in common clinical practices regarding best practice in managing hyperkalaemia (HK), there is therefore a need to establish a multi-specialty approach to optimal rennin-angiotension-aldosterone system inhibitors (RAASi) usage and HK management in patients with chronic kidney disease (CKD) & heart failure (HF). This study aimed to establish a multi-speciality approach to the optimal use of RAASi and the management of HK in patients with CKD and HF. A steering expert group of cardiology and nephrology experts across China were convened to discuss challenges to HK management through a nominal group technique. The group then created a list of 41 statements for a consensus questionnaire, which was distributed for a further survey in extended panel group of cardiologists and nephrologists across China. Consensus was assessed using a modified Delphi technique, with agreement defined as "strong" (≥75% and <90%) and "very strong" (≥90%). The steering group, data collection, and analysis were aided by an independent facilitator. A total of 150 responses from 21 provinces across China were recruited in the survey. Respondents were comprised of an even split (n =75, 50%) between cardiologists and nephrologists. All 41 statements achieved the 75% consensus agreement threshold, of which 27 statements attained very strong consensus (≥90% agreement) and 14 attained strong consensus (agreement between 75% and 90%). Based on the agreement levels from respondents, the steering group agreed a set of recommendations intended to improve patient outcomes in the use of RAASi therapy and HK management in China. [ABSTRACT FROM AUTHOR]

The allelic distribution of nine short tandem repeats (STRs) loci (vWA, FGA, PentaE, D3S1358, D13S317, D5S818, D6S1043, D2S1772 and D7S3048) was examined in 286 Ximeng–Mongolian and 293 Wumeng–Mongolian unrelated individuals living in the Inner Mongolia province, PR China. [Copyright &y& Elsevier]

The Paleoproterozoic granitoid rocks in the Jiaobei Terrane, which lies in the southern part of the Jiao–Liao–Ji Belt (JLJB) in China, provide valuable information on the tectonic and evolutionary history of the North China Craton (NCC). SHRIMP U–Pb dating of zircons from the Muniushan Monzogranite in the Guocheng gold deposit area, as well as in situ Hf isotope analyses of the zircons, were used to constrain the ages of emplacement and metamorphism, and to understand the petrogenesis of the granite. The geochronological data show emplacement ages of ca. 2.1 Ga and metamorphic ages of ca. 1.85 Ga. The magmatic cores of the zircons have εHf(t) values of −0.51 to 4.00 (average 1.98) and depleted mantle two-stage model ages (T DM2 ) of 2444–2703 Ma (average 2563 Ma). The rocks show the same trends of crustal evolution as ca. 2.5 Ga tonalite–trondhjemite–granodiorite (TTG) rocks in the Jiaobei Terrane, indicating that they were formed by the remelting of those TTG rocks. The Muniushan Monzogranite is part of a linear belt of ca. 2.2–2.0 Ga Paleoproterozoic granitoids within the JLJB. The granitoids are A-types, and are accompanied by coeval mafic intrusions and bimodal volcanic rocks, thus indicating widespread extension along the JLJB in the period 2.2–2.0 Ga. The ca. 1.85 Ga metamorphism was related to the collision of the Longgang and Nangrim blocks. The Paleoproterozoic evolution of the NCC constrains the crustal architecture and the source of Mesozoic granitoids in the Jiaobei–Sulu region. Inherited zircons of Paleoproterozoic age are widespread in the Mesozoic granitoids. In addition, Paleoproterozoic ages have been reported from lower crustal granulite xenoliths in the Sulu Orogen, and the southeastern margin of the NCC mirrors the evolution of the JLJB. It is probable, therefore, that NCC lower crust underlies the Sulu Orogen, and that the NCC was the main source for the Mesozoic granitoids in the Jiaobei–Sulu region. This view is consistent with the appearance of inherited zircons of Archean and Paleoproterozoic age on both sides of the orogen, normal δ 18 O values of magmatic zircons, and Paleoproterozoic to Archean two-stage Hf model ages for the granitoids. [ABSTRACT FROM AUTHOR]

Recently, a novel variant of the CTX-M enzyme, CTX-M-98, was detected in Escherichia coli isolates from food animals. However, few plasmids carrying bla CTX-M-98 have been fully characterized. In this study, we sequenced the complete pHeBE7 plasmid, an 86,015-bp plasmid that contains the bla CTX-M-98b , bla TEM-1 , rmtB , and traT genes, using whole-genome sequencing. The backbone of pHeBE7 shows a high similarity (> 99%) to pMC-NDM, which carries the bla NDM-1 gene, however its mosaic regions remain relatively unique among sequenced plasmids. We discovered that a typical IS Ecp1 - bla CTX-M -IS 903 element in the mosaic region harbors the bla CTX-M-98b gene. Conjugation and growth competition assays indicate that pHeBE7 can be easily transmitted and that it confers a limited fitness cost to the recipient cell. The genetic characterization of pHeBE7 may improve our knowledge of how antibiotic resistance disseminates in enterobacteria. [ABSTRACT FROM AUTHOR]

Introduction: Hyperkalemia is a common complication of chronic kidney disease (CKD), diabetes mellitus (DM), and heart failure (HF) that can lead to severe arrhythmias and sudden death and is associated with a higher risk of mortality. Therefore, the prevention and treatment of hyperkalemia is important. Sodium zirconium cyclosilicate (SZC), a new oral potassium-lowering drug, has offered an additional treatment option for Chinese patients with hyperkalemia since its launch in China in late 2019, and some experience has been accumulated regarding its efficacy and safety., Areas Covered: In this review, the authors summarize the epidemiological features of hyperkalemia in China and review the clinical data regarding the use of sodium zirconium cyclosilicate in Chinese patients., Expert Opinion: The prevalence of hyperkalemia is particularly high in Chinese patients with chronic kidney disease and heart failure. In China, recent clinical studies have shown that SZC rapidly reduces serum potassium, maintains normal potassium concentration, and is well tolerated and safe. Two Chinese expert consensus statements have recommended the use of SZC for the acute correction and chronic maintenance of potassium concentration.

According to a spatial distribution analysis of phosphorus in sediments from Honghu Wetland, it was found that TP content in sediments at the mouth of Honghu Lake was 781.31-1955.84 mg·kg -1 and the average value was(1287.21±437.28)mg·kg -1 . TP content in sediments in the open water area was 438.33-1554.04 mg·kg -1 , with an average value of(718.10±238.15)mg·kg -1 . The TP content of sediments in lake inlet was significantly higher than that of sediments in the open water area( P <0.05), and that in the enclosed aquaculture was higher than in the open water area, although no significant difference was observed ( P >0.05). The TP content of sediments to the northwest and northeast of Honghu Lake was higher than that to the southwest of Honghu Lake, and the TP content of sediments in The Four-lake main canal was significantly higher than that of Luoshan main canal( P <0.05). The phosphorus input in the Four-lake main canal may be the main source of phosphorus in Honghu Lake sediments. The phosphorus fraction composition in sediments from different sampling sites were significantly different. Fe/Al-P and Ca-P were the main forms of phosphorus in sediments from the lake inlet, while OP and Ca-P were the main forms of phosphorus in sediments from the open water area. The variation in spatial phosphorus form composition was related to the influence of human activity and the distribution of aquatic plants. Fe/Al-P and OP contents were used to estimate the content of biological available phosphorus (BAP) in evaluated sediments, and the proportion of BAP in TP was used to estimate the risk of phosphorus release in Honghu sediments. BAP/TP was 39.8%-69%, with an average of(56.5±7.23)%, indicating a high risk of phosphorus release. OP and BAP were significantly correlated with TP in overlying water( P <0.01), and the correlation between BAP and phosphate in the overlying water was the highest. The results showed that phosphorus concentration in the overlying water may be related to the release of Fe/Al-P and OP into water bodies.

Introduction: Hyperuricemia has been associated with increased cardiovascular events in the general population. However, the role of serum uric acid (SUA) level on the severity of coronary artery stenosis (CAS) in nondialysis chronic kidney disease (CKD) patients is obscure. Methods: We implement a retrospective cohort study of 734 patients diagnosed with stage 3-5 CKD. All selected patients underwent coronary artery angiography. The associations of SUA with the present, and severity of coronary artery disease (CAD) were analyzed. Results: Of these 734 patients, 511 patients had angiographically proven CAD. Compared with non-CAD group, the SUA level in CAD group was much higher (388.00 vs. 363.00 μmol/l, P  < 0.01). After adjusting for multiple confounding factors, a multivariate logistic regression analysis demonstrated that SUA was relevant to the presence of CAD when SUA as a continuous variable. However, this relationship was not observed with SUA as a categorical variable. In a subgroup analysis for the CAD group, we found that the rates of severe CAS in the third tertile of SUA (58.6%) was higher than that in the first tertile (41.6%) ( P  < 0.01). Compared with the first tertile of SUA, the third tertile of SUA was an independent risk factor for severe arterial stenosis (odds ratio, OR, 1.976 [1.203-3.248]), a pattern that was recapitulated by multivariate logistic regression analysis with SUA as a continuous variable (1.002 [1.000-1.004]). Conclusions: The SUA level may serve as a predictor of the severity of CAS among nondialysis CKD patients with CAD.

Backgroud: Given the increasing morbidity and mortality of colorectal cancer (CRC), it is urgent to develop a noninvasive screening strategy for early diagnosis of CRC. Altered IgG glycosylation is associated with CRC progression, whereas the association of IgG isomeric glycosylation with CRC were not investigated., Methods: Methylamidation of IgG N-glycans was conducted prior to PGC-based nanoLC-ESI-MS/MS analysis. Data processing was operated by a self-developed application based on MATLAB solution. Statistical analysis including K-S test, t-test, ROC curve and OPLS-DA were successively performed. Additionally, an independent set was utilized to validate the results., Results: Total 28 IgG glycans and 79 compositional isomers were identified, over half of which are firstly identified so far. Statistical analysis showed that CRC associates with increase in IgG agalactosylation, decrease in IgG sialylation and fucosylation of sialylated glycans. Additionally, it was found that three compositional isomers (H3N4F1-a, H3N4F1-b and H4N3S1F1-e) could distinguish CRC and early stages from controls with an accurate area under the receiver operating characteristic curve. Significantly, these results were validated in an independent set by multivariate statistical analysis., Conclusions: This is the first comprehensively profiling of isomer-specific IgG N-glycosylation, which could differentiate normal controls from colorectal disease patients. The candidate IgG glyco-biomarkers provide important screening indicators for early diagnosis of CRC., General Significance: Colorectal cancer progression is strongly associated with isomer-specific IgG N-glycosylation., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Aim: Lipoprotein(a) [Lp(a)] is considered a risk factor for cardiovascular disease. However, the role of Lp(a) in chronic kidney disease (CKD) patients is not well understood. The aim of this study was to evaluate the association between Lp(a) levels and the presence of coronary artery disease (CAD) and the severity of coronary artery stenosis (CAS) in patients with stage 3-5 CKD., Patients and Methods: We retrospectively studied patients who were diagnosed with stage 3-5 CKD and underwent coronary artery angiography in Zhongda Hospital. The Gensini scoring system was used to assess the severity of coronary stenosis., Results: A total of 1003 patients were enrolled in this cross-sectional study, and 776 of these patients were diagnosed with CAD. The Lp(a) levels were significantly higher in the CAD group than the non-CAD group [271.50 (168.00-459.25) vs. 195.00 (131.00-347.00) mg/l, P<0.001]. Multivariate logistic regression analysis showed that the Lp(a) tertiles were associated independently with the presence of CAD [tertile 2 vs. tertile 1 [adjusted odds ratio (OR)=2.063, 95% confidence interval (CI): 1.394-3.053, P<0.001] and tertile 3 vs. tertile 1 (adjusted OR=2.022, 95% CI: 1.345-3.040, P=0.001)]. After adjusting for potential confounders, the Lp(a) levels were associated independently with severe CAS [tertile 2 vs. tertile 1 (adjusted OR=1.603, 95% CI: 1.040-2.472, P=0.033); tertile 3 vs. tertile 1 (adjusted OR=1.743, 95% CI: 1.128-2.693, P=0.012)]., Conclusion: Higher Lp(a) levels were associated the presence of CAD and the severe CAS among patients with stage 3-5 CKD independently.

Nephrotic syndrome (NS) is characterized by proteinuria, hypoalbuminemia and edema. The disorder of sodium and water metabolism is a critical mechanism regulating the origination and progression of NS. Zhen-wu-tang (ZWT) has been traditionally used to treat edema disease in China and Japan. The present study was carried out to assess the protective effect of ZWT in Adriamycin-induced (ADR) NS rats and investigate the potential anti-NS mechanisms of ZWT. We found that ZWT treatment ameliorate impaired kidney function and regulate water balance of kidney. Importantly, ZWT increased the expression of Aquaporin-2 (AQP2) which play key roles in maintaining body water homeostasis. Additionally, we determined miRNAs expression patterns in NS rats. Using bioinformatics prediction and miR-92b mimic or inhibitor in vitro, we identified miR-92b as a possible modulator of AQP2. Also we found that ZWT can decrease the expression of miR-92b and reverse the effect of miR-92b on AQP2 in vitro. We further demonstrated that miR-92b directly regulated AQP2 expression by targeting 3'-UTR of AQP2. These finding suggest that ZWT may reduce renal edema in Adriamycin-induced nephropathy via regulating AQP2 and miR-92b., (Copyright © 2018. Published by Elsevier Masson SAS.)

Background and Objectives: High-quality epidemiologic data on AKI in children are particularly lacking in developing countries. This study aimed to assess the epidemiology and clinical correlates of AKI among hospitalized children in China., Design, Setting, Participants, & Measurements: We performed a multicenter study, in a cohort of hospitalized children aged 1 month to 18 years, from 25 general and children's hospitals in China during 2013-2015. We obtained patient-level data from the electronic hospitalization information system and laboratory databases of all children who had at least two serum creatinine tests within any 7-day window during their first 30 days of hospitalization. We identified AKI events according to the creatinine criteria of Kidney Disease Improving Global Outcomes. The in-hospital outcomes of AKI, including mortality, kidney recovery, and length of stay, were assessed. We estimated the corresponding hazard ratios using a Cox proportional hazard model, with adjustment for age, sex, comorbidities, and clinical procedures., Results: A total of 19,908 (20%) patients with AKI were identified among 101,836 pediatric inpatients, of which 7220 (7%) were community acquired and 12,688 (13%) were hospital acquired. Up to 96% of these AKI events were not diagnosed on the discharge records. The cumulative incidence of AKI in infants (28%) was twice that in adolescents (12%). The profiles of risk factors differed between community-acquired and hospital-acquired AKI and varied with age. Diarrhea and sepsis were the top risk factors for community-acquired AKI, each contributing 6% of the risk. Congenital heart disease/cardiac surgery was the major risk factor for hospital-acquired AKI, contributing to 19% of cases. Exposure to nephrotoxic drugs, mostly nonsteroidal anti-inflammatory drugs and proton pump inhibitors, was common in hospitalized children and was associated with a higher risk of AKI. Death occurred in 842 out of 19,908 patients (4%) with AKI versus 450 out of 81,478 children (0.5%) without AKI. The risk of in-hospital death was higher among children with severe AKI, shock, and respiratory failure. Pediatric AKI was associated with longer hospital stay and higher daily cost, even after adjustment for covariates., Conclusions: Pediatric AKI is common and is substantially underdiagnosed in China., (Copyright © 2018 by the American Society of Nephrology.)

Background: Current definitions of AKI do not take into account serum creatinine's high variability in children., Methods: We analyzed data from 156,075 hospitalized children with at least two creatinine tests within 30 days. We estimated reference change value (RCV) of creatinine on the basis of age and initial creatinine level in children without kidney disease or known AKI risk, and we used these data to develop a model for detecting pediatric AKI on the basis of RCV of creatinine. We defined pediatric AKI according to pediatric reference change value optimized for AKI in children (pROCK) as creatinine increase beyond RCV of creatinine, which was estimated as the greater of 20 μ mol/L or 30% of the initial creatinine level., Results: Of 102,817 children with at least two serum creatinine tests within 7 days, 5432 (5.3%) had AKI as defined by pROCK compared with 15,647 (15.2%) and 10,446 (10.2%) as defined by pediatric RIFLE (pRIFLE) and Kidney Disease Improving Global Outcomes (KDIGO), respectively. Children with pROCK-defined AKI had significantly increased risk of death (hazard ratio, 3.56; 95% confidence interval, 3.15 to 4.04) compared with those without AKI. About 66% of patients with pRIFLE-defined AKI and 51% of patients with KDIGO-defined AKI, mostly children with initial creatinine level of <30 μ mol/L, were reclassified as non-AKI by pROCK, and mortality risk in these children was comparable with risk in those without AKI by all definitions., Conclusions: pROCK criterion improves detection of "true" AKI in children compared with earlier definitions that may lead to pediatric AKI overdiagnosis., (Copyright © 2018 by the American Society of Nephrology.)

A novel 65.8-kb multidrug resistance transposon, designated Tn 6450 , was characterized in a Proteus mirabilis isolate from chicken in China. Tn 6450 contains 18 different antimicrobial resistance genes, including cephalosporinase gene bla DHA-1 and fluoroquinolone resistance genes qnrA1 and aac(6 ' )-Ib-cr It carries a class 1/2 hybrid integron composed of intI2 and a 3' conserved segment of the class 1 integron. Tn 6450 is derived from Tn 7 via acquisition of new mobile elements and resistance genes., (Copyright © 2018 American Society for Microbiology.)

IncC plasmids are of great concern as vehicles of broad-spectrum cephalosporins and carbapenems resistance genes bla CMY and bla NDM . The aim of this study was to sequence and characterize a multidrug resistance (MDR) IncC plasmid (pPm14C18) recovered from Proteus mirabilis. pPm14C18 was identified in a CMY-2-producing P. mirabilis isolate from chicken in China in 2014, and could be transferred to Escherichia coli conferring an MDR phenotype. Whole genome sequencing confirmed pPm14C18 was a novel type 1/2 hybrid IncC plasmid 165,992bp in size, containing fifteen antimicrobial resistance genes. It harboured a novel MDR mosaic region comprised of a hybrid Tn21 tnp -pDU mer , in which bla CTX-M-65 , dfrA32 and ereA were firstly reported in IncC plasmid. Phylogenetic relationship reconstruction based on the nucleotide sequences of the 52 IncC backbones showed all type 1 IncC plasmids were clustered into one clade, and then merged with pPm14C18 and finally with the type 2 IncC plasmids and another type 1/2 hybrid IncC plasmid pYR1. The MDR IncC plasmids in P. mirabilis of animal origin might threaten public health, which should be drawn more attention., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The mcr-1 gene was detected in 5.11% (58/1136) of Escherichia coli isolates of chicken origin from 13 provinces in China. A novel mcr-1 variant, named mcr-1.3 , encoding an Ile-to-Val functional variant of MCR-1 was identified in a sequence type 155 (ST155) strain. An mcr-1.3 -containing IncI2 plasmid, pHeN867 (60,757 bp), was identified. The transfer of pHeN867 led to a 32-fold increase in the MIC of colistin in the recipient, exhibiting an effect on colistin resistance that was similar to that of mcr-1 ., (Copyright © 2017 American Society for Microbiology.)

Sixteen different sequence types (STs) of Escherichia coli isolates from a commercial swine farm in China were confirmed to coharbor the carbapenem resistance gene bla NDM-5 and the colistin resistance gene mcr-1 Whole-genome sequencing revealed that bla NDM-5 and mcr-1 were located on a 46-kb IncX3 plasmid and a 32-kb IncX4 plasmid, respectively. The two plasmids can transfer together with a low fitness cost, which might explain the presence of various STs of E. coli coharboring bla NDM-5 and mcr-1 ., (Copyright © 2017 American Society for Microbiology.)

Background: The growing burden of end-stage renal disease (ESRD) has been a great challenge to the health care system of China. However, the exact epidemiological data for ESRD in China remain unclear. We aimed to investigate the epidemiology of ESRD treated by renal replacement therapy (RRT) in Nanjing based on analysing ten-year data of Nanjing three million insurance covered population., Methods: Using the electronic registry system of Urban Employee Basic Medical Insurance (UEBMI), we included all subjects insured by UEBMI in Nanjing from 2005 to 2014 and identified subjects who developed ESRD and started RRT in this cohort., Results: The UEBMI population in Nanjing increased from 1,301,882 in 2005 to 2,921,065 in 2014, among which a total of 5,840 subjects developed ESRD and received RRT. Over the 10-year period, the adjusted incidence rates of RRT in the UEBMI cohort gradually decreased from 289.3pmp in 2005 to 218.8pmp in 2014. However, the adjusted prevalence rate increased steadily from 891.7pmp in 2005 to 1,228.6pmp in 2014. The adjusted annual mortality rate decreased from 138.4 per 1000 patient-years in 2005 to 97.8 per 1000 patient-years in 2014. The long-term survival rate fluctuated over the past decade, with the 1-year survival rate ranging from 85.1% to 91.7%, the 3-year survival rate from 69.9% to 78.3% and the 5-year survival rate from 58% to 65.4%., Conclusion: Nanjing is facing an increasing burden of ESRD with its improvement of medical reform. The ten-year complete registry data on RRT in urban employees in Nanjing provided a unique opportunity to understand the real threat of ESRD confronting China during its process of health care transition.

SXT/R391 integrative and conjugative elements (ICEs) were detected in 8 out of 125 Proteus mirabilis isolates from food-producing animals in China. Whole-genome sequencing revealed that seven ICEs were identical to ICEPmiJpn1, carrying the cephalosporinase gene blaCMY-2. Another one, designated ICEPmiChn1, carried five resistance genes. All eight ICEs could be transferred to Escherichia coli via conjugation. The results highlight the idea that animal farms are important reservoir of the SXT/R391 ICE-containing P. mirabilis., (Copyright © 2016, American Society for Microbiology. All Rights Reserved.)

Four different Salmonella genomic island 1 (SGI1) variants, including two novel variants, were characterized in one Salmonella enterica serovar Rissen sequence type ST1917 isolate and three Proteus mirabilis isolates from swine farms in China. One novel variant was derived from SGI1-B with the backbone gene S021 disrupted by a 12.72-kb IS26 composite transposon containing the dfrA17-aadA5 cassettes and macrolide inactivation gene cluster mphA-mrx-mphR. The other one was an integron-free SGI1 and contained a 183-bp truncated S025 next to IS6100 and S044., (Copyright © 2015, American Society for Microbiology. All Rights Reserved.)

Six out of the 64 studied Proteus mirabilis isolates from 11 poultry farms in China contained Salmonella genomic island 1 (SGI1). PCR mapping showed that the complete nucleotide sequences of SGI1s ranged from 33.2 to 42.5 kb. Three novel variants, SGI1-W, SGI1-X, and SGI1-Y, have been characterized. Resistance genes lnuF, dfrA25, and qnrB2 were identified in SGI1 for the first time., (Copyright © 2014, American Society for Microbiology. All Rights Reserved.)

Objective: To evaluate the efficacy and safety of bevacizumab in the treatment of patients with metastatic colorectal cancer (mCRC)., Methods: In a single-center, observational study of 91 Chinese patients with mCRC who received bevacizumab in combination with chemotherapy was conducted. OBJECTIVE response rates (ORRs), progression-free survival (PFS), overall survival (OS) and adverse events were recorded, and the relationships between various clinical factors and PFS or OS were evaluated by Cox proportional hazards models., Results: Treatment with bevacizumab and chemotherapy was effective and tolerable. Univariate analysis showed that PFS and OS were significantly associated with the Eastern Cooperative Oncology Group performance status (ECOG- PS) score, duration of bevacizumab exposure, and whether chemotherapy was continued after discontinuation of bevacizumab treatment. A multivariate analysis showed that the duration of bevacizumab exposure and whether chemotherapy was continued after discontinuation of bevacizumab were independent prognostic factors for PFS and OS., Conclusion: In Chinese mCRC population, the shorter the duration of exposure to bevacizumab and chemotherapy, the worse the prognosis is.

The concentration levels of antimony, arsenic and mercury in human hair collected from Xikuangshan antimony mining area and Guiyang City were determined by hydride generation-atomic fluorescence spectrometry after having been digested by nitric acid and perchloric acid. The contents of Sb, As and Hg are 15.9, 4.21, 1.79 microg/g in the samples from Xikuangshan antimony mining area and 0.532, 0.280, 0.338 microg/g in the samples from Guiyang City respectively. The contents of Sb, As and Hg in human hair of Xikuangshan antimony area are much higher than those of Guiyang City. The independent-samples t-test shows that there are no marked differences in the contents of Sb and As between male and female hair samples from both Xikuangshan antimony mining area and Guiyang City (p > 0.05), while Hg contents in male hair are apparently higher than those in female hair from Guiyang City (p < or = 0.05). There is positive correlation observed between As and Sb, as well as between As and Hg, while Sb is weakly correlated with Hg (p < or = 0.01). These results show that the heavy metals (Sb, As and Hg) in antimony mining area may significantly affect human health than in the un-mining areas.

Background: There is an increase prevalence of chronic kidney disease (CKD)worldwide. However, the exact incidence of CKD in China is still uncertain. In this cross-sectional study, we retrospectively investigated the prevalence and distribution of CKD in Chinese hospitalised adult patients., Methods: Totally, 13,383 adults patients who were hospitalised at our hospital were included in this study. They included 6215 males and 7168 females. Patients' gender, age, blood pressure, serum creatinine, blood urea nitrogen, uric acid, triglyceride, total cholesterol, albumin, hemoglobin, hemotocrit, urine protein, and history of hypertension, diabetes, and smoking were investigated. CKD was defined as eGFR<60 ML/ MIN PER 1.73 m(2) and/or proteinuria, GFR was estimated by using of the simplified MDRD equation., Results: The prevalence rate of CKD was 14.82% in our group, which was respectively distributed from 1 to stage 5 at the following percentage, 3.33% (stage 1), 2.49% ( stage 2), 7.07% (stage 3), 1.08% (stage 4), and 0.86% (stage 5). Elderly patients (age >65 y) accounted for 53.07%, which had a higher CKD prevalence (29.47%) than middle and young-aged patients (9.49%). It was noted that 39.06% patients at stage 1-3 were undiagnosed with CKD during their hospitalization. The common etiology for CKD was hypertension (29.49%), diabetes (11.64%) and primary glomerulonephritis (4.39%). Hypertension, diabetes and ages were main associated factors for CKD., Conclusions: CKD is a very common disease among the hospitalised patients in China. With the increasing of aging population, elderly people will be the highest risk group for CKD. More strategies have to be made for its early detection and prevention.

Objective: To retrospectively investigate the prevalence and distribution of chronic kidney disease (CKD) in hospitalized Chinese adult patients., Methods: The medical histories of 13,383 adult patients hospitalized in Zhongda Hospital from September 2004 to August 2005, 6215 males and 7168 female, aged (51 +/- 19) (18 - 103), were reviewed. The blood pressure, serum creatinine, proteinuria were investigated. CKD was defined and classified according to the NKF/DOQI guideline. Glomerular filtration rate (GFR) was estimated by using the simplified modification of diet in renal disease study (MDRD) equation. eGFR = 186.3 x serum creatinine(-1.154) x age(-0.203) x (0.742 for women) ml.min(-1).(1.7 3 m2)(-1)., Results: The prevalence rate of CKD was 14.82% in this group, and the prevalence rates of CKD of stage 1 to 5 were 3.33%, 2.49%, 7.07%, 1.08%, and 0.86% respectively. 53.07% of the CKD patients were elderly patients (age > 65) with a CKD prevalence rate of 29.47%, significantly higher than that of the middle-aged and young patients (9.49%, P < 0.01). The eGFR levels of 9.01% of the hospitalized patients were below 60 ml.min(-1).(1.73 m2)(-1). The prevalence rate of proteinuria was 8.87%. 39.06% of the patients at stages 1 - 3 failed to be diagnosed as with CKD during their hospitalization. The most common causes of CKD were hypertension (29.49%), diabetes (11.64%), and primary glomerulonephritis (4.39%). Hypertension, diabetes and being elderly were main risk factors for CKD., Conclusion: CKD is a very common disease among the hospitalized patients in China. With the increasing number of aging populations, elderly people will be the highest risk group for CKD. More strategies have to be made for its early detection and prevention.

Background: There is an increasing prevalence of ischemic nephropathy in the aging population of the world. However, the exact incidence of ischemic nephropathy in the Chinese population is still uncertain. The present study investigated the incidence of renal artery stenosis (RAS) in patients with suspected coronary artery disease (CAD) using renal angiography., Methods: Renal angiography was performed immediately after coronary artery angiography in 141 patients with suspected CAD, including 59 males and 82 females whose mean ages were 59 +/- 10 years. Comorbidities included hypertension (n = 69), diabetes mellitus (n = 21), hyperlipidemia (n = 19), hypokalemia (n = 7) and preoperative renal insufficiency (Cr >132 micromol/l; n = 14). The patients were divided into CAD (luminal narrowing of > or =50%) and non-CAD (luminal narrowing of <50%) subgroups, and RAS (luminal narrowing of > or =50%) and non-RAS subgroups. In the RAS group, there were 11 patients (5 males, 6 females) in whom percutaneous transluminal renal angioplasty was performed in conjunction with stent implantation due to refractory hypertension., Results: The incidence of RAS was 18.4% (26/141) in all cases and 30.8% (16/52) in patients with CAD identified by coronary artery angiography. Ten cases with RAS were found among the 89 cases with normal coronary arteries (11.2%). The incidence of RAS in patients with CAD was higher than that in patients without CAD (30.8 vs. 11.2%, p< 0.05). In 52 cases with CAD, the incidence of RAS with three vessel lesions was significantly higher than that with one or two vessel lesions. Hypertension, CAD, renal insufficiency, hyperlipidemia and hypokalemia were associated with a higher risk of RAS., Conclusions: This study suggests that RAS is very common in the elderly Chinese population, specifically for those with three vessel lesions in CAD. For early detection of potential ischemic nephropathy, renal angiography is necessary in patients who receive coronary artery angiography., (Copyright 2004 S. Karger AG, Basel)