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Background and purpose: The chemokine monocyte chemoattractant protein‐1 (MCP‐1) is involved in the pathogenesis of Alzheimer's disease (AD). This study aimed to investigate whether urinary MCP‐1 can distinguish patients with AD, patients with amnestic mild cognitive impairment (aMCI) and cognitively normal (CN) subjects. Methods: A total of 754 participants, including 97 patients with AD, 50 patients with aMCI and 84 age‐ and sex‐matched CN controls as well as a cohort of 523 CN subjects of different ages, were enrolled from five hospitals located in different areas of China. Urinary MCP‐1 levels were determined using enzyme‐linked immunosorbent assays. The correlations between urinary MCP‐1 levels and cognition test scores or age were analysed. The optimal diagnostic sensitivity and specificity were determined using receiver operating characteristic curve analysis. Results: In the cohort of CN subjects of different ages, urinary MCP‐1 levels increased with ageing and were correlated with age. The urinary MCP‐1 levels were higher in females than in males. In the cohort composed of patients with AD, aMCI and age‐ and sex‐matched CN controls, urinary MCP‐1 levels were significantly higher in patients with AD and aMCI than in CN controls. There were no differences in urine MCP‐1 levels between the AD group and the aMCI group. The urinary MCP‐1 levels were correlated with the Mini‐Mental State Examination scores and age, and were able to differentiate patients with AD and aMCI from CN subjects. Conclusions: Urinary MCP‐1 is a potential biomarker for the diagnosis of AD and aMCI. [ABSTRACT FROM AUTHOR]

Summary: Porcine teschoviruses (PTVs) have been shown to be widely distributed in pig populations. In this study, 261 faecal and 91 intestinal content samples collected from pigs at 29 farms in Hunan, China, were tested for the presence of PTV by reverse transcription‐polymerase chain reaction (RT‐PCR). An overall PTV‐positivity rate of 19.03% was detected by RT‐PCR, and a high PTV infection rate was circulating in asymptomatic fattening and nursery pigs. In total, 40 PTV isolates (PTV‐HuNs) were obtained. Alignment of their coding sequences with those of other known PTVs revealed that the genomic sequence of the polyprotein contains 6,606–6,621 nucleotides, encoding a 2,202–2,207‐amino acid sequence. Phylogenetic analyses based on the VP1 gene and capsid protein gene exhibited 13 main lineages corresponding to PTV serotypes 1–13, and seven PTV serotypes (PTV 2–6, 9, and 11) were identified in the isolates obtained in our study; this is the first report of PTV 5, 9 and 11 in China. Recombination analysis among the PTV‐HuNs indicated that nine recombination events have occurred, including both inter‐ and intraserotype events. In addition, results demonstrated that only limited positive selection is acting on the global population of PTV isolates, and purifying selection is predominant. In conclusion, this study revealed a high infection rate of PTVs circulating in asymptomatic fattening and nursery pigs. The 40 PTV‐HuNs showed high genetic diversity, and genetic analysis of all available PTV sequences revealed that strong purifying selection and recombination play important roles in the genetic diversity and evolution of the virus. [ABSTRACT FROM AUTHOR]

Diabet. Med. 29, 515-521 (2012) Abstract Aim To describe the status of glycaemic control, self-reported adherence to treatments, psychological well-being and quality of life in Chinese patients with Type 2 diabetes in 2006. Methods Subjects having registered for care for > 12 months at a diabetes clinic were enrolled in this study. Glycaemic control was determined by HbA1c and plasma glucose levels; information about self-reported adherence to treatments was obtained by questionnaire; psychological well-being was assessed by use of a modified World Health Organization-5 Well-being Index; and quality of life was measured by use of a modified Diabetes Attitudes, Wishes and Needs (DAWN) survey. All data were tabulated and statistical analyses were performed. Results A total of 2702 patients were enrolled during 2006. Only 23% of patients achieved an HbA1c level of < 48 mmol/mol (6.5%) as per the 2007 China guideline for Type 2 diabetes and only 16.2% followed all treatment recommendations from healthcare providers. Of the patients, 46.0-68.6% of the patients showed positive psychological well-being. A quality-of-life survey showed that 28.5-50.6% of the patients experienced various diabetes-related emotional problems. Large percentages (approximately 50%) of patients were experiencing psychological insulin resistance. Conclusions Although in China therapies for Type 2 diabetes are more effective and available than ever before, the patient outcomes remain disappointing. Problems with glycaemic control, self-reported adherence to treatments, psychological well-being and quality of life, all of which are key to diabetes control, are common among Chinese patients with Type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: Transfusion-dependent β-thalassemia (TDT) is a severe inherited disorder. Without regular treatment, patients with TDT experience complications that can significantly shorten life expectancy and severely impact both their quality of life and that of their families. The condition has attracted significant attention in global health discussions. Due to the challenges of blood supply shortages, the high costs of iron chelation therapy, and hematopoietic stem cell transplantation (HSCT), TDT presents a serious health risk to patients and imposes a substantial burden on families and society. However, research on the health-related quality of life (HRQoL) of thalassemia patients in China remains limited. This study evaluated the factors affecting the HRQoL of these patients, with the goal of developing strategies to improve their quality of life., Methods: In this cross-sectional study, children with TDT were recruited from five treatment centers in Guangxi, a province with a high prevalence of thalassemia in China. Structured questionnaires were employed to gather relevant data on sociodemographic variables, disease characteristics, treatments, and associated costs. The HRQoL was assessed using the Transfusion-Dependent Quality of Life (TranQoL) questionnaire, with a proxy version for patients aged 0-11 years and a child version for those aged 12-18 years., Results: The study included 418 participants, yielding an overall TranQoL score of 60.6 ± 16.3 among thalassemia patients. Multiple linear regression analysis revealed a negative correlation (P < 0.05) between overall TranQoL scores and several factors: increasing patient age, the presence of multiple thalassemia patients within a family, and undergoing HSCT. Conversely, adherence to regular treatment was positively correlated with higher TranQoL scores (P < 0.05)., Conclusion: The study demonstrates that HRQoL among Chinese patients with TDT is at a low level. Age, treatment adherence, family support, and socioeconomic status were identified as key determinants influencing HRQoL. It is essential to further enhance and optimize health insurance policies and medical services to support comprehensive treatment strategies for these patients., (© 2024. The Author(s).)

Background: Handgrip strength (HGS) is a simple and non-invasive measure of muscle strength, which has been proposed as a potential predictor of cardiovascular disease (CVD) risk. However, the association between HGS and CVD risk in the Chinese population remains underexplored. This study aims to investigate the relationship between handgrip strength and the risk of cardiovascular disease using data from the 2015-2018 China Health and Retirement Longitudinal Study (CHARLS)., Methods: We included 9369 participants aged 45 years and older from the CHARLS dataset. HGS was measured using a dynamometer, and the average of three measurements for each hand was recorded. Participants were categorized into quartile based on their HGS levels. The primary outcome was the incidence of CVD, including heart diseases, and stroke, obtained through self-reports and verified by medical records. Cox proportional hazards models were used to estimate hazard ratio (HR) and 95% confidence interval (95% CI) for the association between HGS and CVD risk, and using restricted cubic spline to construct a linear relationship, adjusting for potential covariates including demographic factors, lifestyle factors, body composition, and health status. The robustness of the results was determined by stratified analysis., Results: During a mean follow-up of 3 years, 1198 CVD events were reported, including 851 heart diseases and 427 strokes. After multivariate adjustment, the HR and 95% CI corresponding to CVD risk for participants in the HGS 2nd, 3rd, and 4th quartiles compared with those in the lowest quartile were 0.824 (95% CI: 0.692-0.981), 0.756 (95% CI: 0.614-0.929), 0.625 (95% CI: 0.484-0.807) (P for trend : <0.001), respectively. All subgroups analyzed found similar results. For CVD components, HGS was similarly linearly associated with heart disease, and had an inverted U-shape relationship with the risk of stroke, with a potential threshold of 23.16 kg., Conclusions: Higher HGS was significantly associated with decreased risk of CVD, including heart disease and stroke, in middle-aged and older adults, suggesting that HGS may be a promising measurable predictor of CVD in this population., (© 2024. The Author(s).)

Objective: To investigate the pollution levels and influencing factors of polybrominated diphenyl ethers (PBDEs) in household dust in five cities in northern China. Methods: Based on the "Chinese Indoor Environment and Health Surveillance" project carried out by the National Institute of Environmental Health, Chinese Center for Disease Control and Prevention in 2018-2019, during the warm season (April 2018 to September 2018) and the cold season (November 2018 to March 2019), Lanzhou in Northwest China, Shijiazhuang in North China, Panjin in Northeast China, Luoyang in Central China, and Qingdao in East China were selected as the research sites. A total of 87 families were recruited to study residences in real-life scenarios. At the same time, dust samples were collected to detect the concentration of PBDEs. The level of household environmental indicators was measured, and the residential building characteristics and family behavior habits were collected through questionnaires. A total of 142 valid dust samples and 140 valid questionnaires were obtained. The differences in PBDE concentrations across seasons, wind zones, residential building characteristics, and family habits were analyzed. The exploratory factor analysis was performed to investigate the possible sources of PBDEs, and multivariate linear regression was used to explore the factors influencing PBDEs in household dust. Results: The M ( Q 1, Q 3 ) of total PBDE concentrations in 142 household dust samples in five cities was 144.51 (106.61, 222.65) ng/g in the warm season and 145.10 (98.57, 180.65) ng/g in the cold season, respectively. There were seasonal differences in the concentration of ∑ 12 PBDEs in Luoyang and Shijiazhuang ( P <0.01). The concentration of BDE-71 was highest among PBDE homologues, followed by BDE-66 and BDE-47. Three factors were extracted by exploratory factor analysis in the warm season, and the cumulative variance contribution rate was 67.90%. The multivariate linear regression showed that the house completion less than ten years [ β (95% CI ): 0.186 (0.013, 0.359)], infrequent home cooking [ β (95% CI ):-0.342 (-0.570, -0.114)], and increased residential PM 10 concentration [ β (95% CI ): 0.001 (0.000, 0.002)] during the warm season, as well as the house far from driveway [ β (95% CI ): 0.093 (0.013, 0.172)], house area less than 90 m 2 [ β (95% CI ):-0.138 (-0.264, -0.013)], and lower residential xylene concentration [ β (95% CI ):-0.006 (-0.011, -0.001)] during the cold season might be related to the elevated concentrations of ∑ 12 PBDEs in household dust. Conclusion: The pollution of PBDEs in household dust in five northern cities is at a medium to high level. Years of house completion, frequency of cooking at home, residential PM 10 concentration, distance from house to driveway, house area, and residential xylene concentration may influence household PBDE concentrations.

The triglyceride-glucose (TyG) index is a crucial marker of insulin resistance, as evidenced by numerous studies related to metabolic diseases. This bibliometric analysis investigates research trends associated with the TyG index over the past 24 years. We collected data on TyG index publications from January 1, 2000, to January 7, 2024, using the Web of Science database. Analysis was conducted utilizing VOSviewer, Scimago Graphica, and CiteSpace to evaluate publication metrics, citations, countries, institutions, authors, journals, and keywords. A total of 1163 publications from 354 journals authored by 6149 researchers across 60 countries were analyzed. China emerged as the leading contributor, with 654 publications (56.23%). Capital Medical University was the most productive institution, and Wu Shouling was the top author. Cardiovascular Diabetology was identified as the most influential journal. Key emerging research directions include the role of the TyG index as a representative marker for insulin resistance, particularly concerning insulin sensitivity; its association with body mass index and hyperuricemia; and its diagnostic and prognostic value in nonalcoholic fatty liver disease and cardiovascular conditions such as acute coronary syndrome, carotid plaque, and hypertension. Current trends favor cohort studies predominantly involving adult populations. Overall, China leads TyG index research, focusing on its connections to insulin sensitivity, body mass index, and hyperuricemia, while the index's diagnostic and prognostic significance for nonalcoholic fatty liver disease and cardiovascular diseases represents an expanding research frontier., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: We aimed to investigate the correlation between long-term blood pressure variability (BPV) and the risk of cardiovascular diseases (CVDs) among population with different blood pressure statuses (normotension, well-controlled hypertension, and uncontrolled hypertension)., Methods: In this ambispective cohort study, CVD-free residents aged over 50 years were consecutively enrolled from two community health service centers (CHCs) in Tianjin, China from April 2017 to May 2017. Information on blood pressure was retrospectively extracted from electronic medical records of CHCs between January 2010 and May 2017, and the occurrence of new-onset CVDs was prospectively observed during follow-up until September 2019. Long-term variation of SBP and DBP was assessed using four indicators: SD, coefficient of variation (CV), average successive variability (ASV), and average real variability (ARV). Cox proportional hazards regression model was developed to identify the potential impact of BPV on the incidence of CVDs. The receiver operating characteristic curve (ROC) was utilized to evaluate the predictive value of BPV indicators for the occurrence of CVDs., Results: Of 1275 participants included, 412 (32.3%) experienced new CVD events during the median 7.7 years of follow-up, with an incidence density of 499/10 000 person-year in the whole cohort. Cox regression analysis revealed that almost all SBP and DBP variability indicators (except for SBP-SD) were significantly related to the risk of CVDs, especially among individuals with well-controlled hypertension. A trend toward an increased risk of CVDs across BPV quartiles was also observed. Moderate predictive abilities of BPV were observed, with the area under ROC curves ranging between 0.649 and 0.736. For SBP variability, SD had the lowest predictive ability, whereas for DBP variability, ARV had the lowest predictive ability. No significant association of CVDs with SBP-SD was found in all analyses, no matter as a continuous or categorical variable., Conclusion: Elevated long-term BPV is associated with an increased risk of CVDs, especially among individuals with well-controlled hypertension. CV and ASV had higher predictive values than SD and ARV., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To understand the contents of aflatoxins(AFs) in foods sold in Shanghai, and to assess the exposure assessment of and its potential health risk among residents over 15 years old in Shanghai., Methods: A total of 8114 samples from 8 categories of food were collected in Shanghai from 2018 to 2023. The samples were detected by GB 5009.24-2016 and GB 5009.22-2016. Combined with the food consumption data of "Shanghai Diet and Health Survey", the dietary exposure assessment of aflatoxin was conducted using the margin of exposure(MOE) and the risk of liver cancer., Results: The detection rates of aflatoxin B&#95;1(AFB&#95;1), aflatoxin B&#95;2(AFB&#95;2), aflatoxin G&#95;1(AFG&#95;1), aflatoxin G&#95;2(AFG&#95;2), and aflatoxin M&#95;(1 )(AFM&#95;1) were 8.6%, 2.0%, 0.9%, 0.2% and 0.2%, respectively. The point assessment showed that the total exposure of AFB&#95;1 in the diet of residents aged 15 and above in Shanghai was 0.783 ng/(kg·BW·d), with the contribution rates of dietary exposure to grains and their products, nuts and their products, and vegetable oils accounting for 60.6%, 25.0% and 8.5% of AFB&#95;1's dietary exposure, respectively. The total exposure of total aflatoxins(the sum of AFB&#95;1, AFB&#95;2, AFG&#95;1 and AFG&#95;2)(AFT) was 7.363 ng/(kg·BW·d), and the dietary exposure of grains and their products, vegetable oils, nuts and their products contribute 77.1%, 8.4% and 7.2% to the dietary exposure of AFT, respectively. The probability assessment result indicated that the average dietary exposure of residents to AFB&#95;1 and AFT were 0.734 and 7.220 ng/(kg·BW·d), respectively, and the P95 exposure of residents were 1.170 and 11.500 ng/(kg·BW·d). The AFB&#95;1 exposure level of residents in suburban areas was higher than that in central urban areas and exurban areas(χ~2= 16.357, P&lt;0.001), the AFT exposure of residents in the central urban area was lower than that in the exurban areas and suburban areas(χ~2= 40.996, P&lt;0.001). According to the MOE method, the MOE values of AFB&#95;1 and AFT average dietary exposure for residents aged 15 and above in Shanghai were 511 and 54. The risk of liver cancer caused by dietary exposure of AFB&#95;1 and AFT among residents aged 15 and above in Shanghai were 0.024 cases/10~5 people and 0.227 cases/10~5 people., Conclusion: There is AFs contamination in food sold in Shanghai, and grains and their products, nuts and their products, and vegetable oils are the main sources of AFs exposure in the diet of residents aged 15 and above in Shanghai.

Aims/hypothesis: The aim of this study was to assess the efficacy and safety of oral semaglutide vs sitagliptin in a predominantly Chinese population with type 2 diabetes inadequately controlled with metformin treatment., Methods: The Peptide Innovation for Early Diabetes Treatment (PIONEER) 12 trial was a randomised, double-dummy, active-controlled, parallel-group, Phase IIIa trial conducted over 26 weeks at 90 sites across the China region (including mainland China, Taiwan and Hong Kong) and five other countries. Adults aged ≥18 years (≥20 years in Taiwan) with a diagnosis of type 2 diabetes, HbA 1c between 53 and 91 mmol/mol (inclusive) and treated with a stable daily dose of metformin were eligible for inclusion. Participants were randomised (1:1:1:1) using a web-based randomisation system to either once-daily oral semaglutide (3 mg, 7 mg or 14 mg) or once-daily oral sitagliptin 100 mg. Treatment allocation was masked to both participants and investigators. Randomisation was stratified according to whether participants were from the China region or elsewhere. The primary endpoint was change in HbA 1c from baseline to week 26. The confirmatory secondary endpoint was change in body weight (kg) from baseline to week 26. All randomised participants were included in the full analysis set (FAS). All participants exposed to at least one dose of trial product were included in the safety analysis (SAS)., Results: Of 1839 participants screened, 1441 were randomly assigned to oral semaglutide 3 mg (n=361), 7 mg (n=360), 14 mg (n=361) or sitagliptin 100 mg (n=359) and included in the FAS. A total of 1438 participants were included in the SAS. In total, 75.2% of participants were from the China region. A total of 1372 (95.2%) participants completed the trial and 130 participants prematurely discontinued treatment (8.3%, 8.6% and 15.0% for oral semaglutide 3 mg, 7 mg and 14 mg, respectively; 4.2% for sitagliptin 100 mg). Significantly greater reductions in HbA 1c from baseline to week 26 were reported for all doses of oral semaglutide vs sitagliptin 100 mg. For oral semaglutide 3 mg, 7 mg and 14 mg vs sitagliptin 100 mg, the estimated treatment differences (ETDs [95% CI]) were -2 (-4, -1) mmol/mol, -8 (-9, -6) mmol/mol and -11 (-12, -9) mmol/mol, respectively. The corresponding ETDs (95% CI) in percentage points vs sitagliptin 100 mg were -0.2 (-0.3, -0.1), -0.7 (-0.8, -0.6) and -1.0 (-1.1, -0.8), respectively. Reductions in body weight were significantly greater for all doses of oral semaglutide vs sitagliptin 100 mg (ETD [95% CI] -0.9 [-1.4, -0.4] kg, -2.3 [-2.8, -1.8] kg and -3.3 [-3.8, -2.8] kg for 3 mg, 7 mg and 14 mg, respectively). In the subpopulation of participants from the China region (75.2% of trial participants), reductions in HbA 1c and body weight from baseline to week 26 were similar to those seen in the overall population. The most frequent adverse events in the semaglutide treatment arms were gastrointestinal, although these were mostly transient and mild/moderate in severity., Conclusions/interpretation: Significantly greater reductions in both HbA 1c and body weight over 26 weeks were seen with oral semaglutide 3 mg, 7 mg and 14 mg than with sitagliptin 100 mg in a predominantly Chinese population with type 2 diabetes inadequately controlled with metformin treatment. Oral semaglutide was generally well tolerated, with a safety profile consistent with that seen in the global PIONEER trials., Trial Registration: ClinicalTrials.gov NCT04017832., Funding: This trial was funded by Novo Nordisk A/S, Søborg, Denmark., (© 2024. The Author(s).)

Aims/hypothesis: The aim of this study was to evaluate the efficacy and safety of oral semaglutide monotherapy vs placebo in a predominantly Chinese population with type 2 diabetes insufficiently controlled with diet and exercise alone., Methods: The Peptide Innovation for Early Diabetes Treatment (PIONEER) 11 trial was a double-blind, randomised, Phase IIIa trial conducted across 52 sites in the China region (mainland China and Taiwan), Hungary, Serbia and Ukraine. Eligible participants were ≥18 years (≥20 years in Taiwan), had a diagnosis of type 2 diabetes with HbA 1c 53-86 mmol/mol (7.0-10.0%) and were not receiving any glucose-lowering drugs. After a 4-week run-in period in which participants were treated with diet and exercise alone, those who fulfilled the randomisation criteria were randomised (1:1:1:1) using a web-based randomisation system to receive once-daily oral semaglutide 3 mg, 7 mg or 14 mg or placebo for 26 weeks (using a 4-week dose-escalation regimen for the higher doses). Randomisation was stratified according to whether participants were from the China region or elsewhere. The primary and confirmatory secondary endpoints were change from baseline to week 26 in HbA 1c and body weight (kg), respectively. Safety was assessed in all participants exposed to at least one dose of the trial product., Results: Between October 2019 and October 2021, a total of 774 participants were screened and 521 participants were randomised to oral semaglutide 3 mg (n=130), 7 mg (n=130), 14 mg (n=130) or placebo (n=131); most participants (92.5%, n=482) completed the trial, with 39 participants prematurely discontinuing treatment. The number of participants contributing to the trial analyses was based on the total number of participants who were randomised at the beginning of the trial. The majority of participants were male (63.7%), and the mean age of participants was 52 years. At baseline, mean HbA 1c and body weight were 63 mmol/mol (8.0%) and 79.6 kg, respectively. Oral semaglutide resulted in significantly greater reductions in HbA 1c than placebo at week 26 (p<0.001 for all doses). The estimated treatment differences (ETDs [95% CIs]) for oral semaglutide 3 mg, 7 mg and 14 mg vs placebo were -11 (-13, -9) mmol/mol, -16 (-18, -13) mmol/mol and -17 (-19, -15) mmol/mol, respectively. The corresponding ETDs in percentage points (95% CI) vs placebo were -1.0 (-1.2, -0.8), -1.4 (-1.6, -1.2) and -1.5 (-1.8, -1.3), respectively. Significantly greater reductions in body weight were also observed for oral semaglutide 7 mg and 14 mg than for placebo at week 26 (ETD [95% CI] -1.2 kg [-2.0 kg, -0.4 kg; p<0.01] and -2.0 kg [-2.8 kg, -1.2 kg; p<0.001], respectively), but not for oral semaglutide 3 mg (ETD [95% CI] -0.0 kg [-0.9 kg, 0.8 kg; not significant]). Similar reductions in HbA 1c and body weight were observed in the Chinese subpopulation, which represented 74.9% of participants in the overall population. Adverse events (AEs) occurred in between 65.4% and 72.3% of participants receiving oral semaglutide (for all doses) and 57.3% of participants with placebo. Most AEs were mild to moderate in severity, with few serious AEs reported; the most commonly reported AEs were gastrointestinal-related and were more frequent with semaglutide (all doses) than with placebo. The proportion of AEs was slightly higher in the Chinese subpopulation., Conclusions/interpretation: Oral semaglutide resulted in significantly greater reductions in HbA 1c across all doses and in significant body weight reductions for the 7 mg and 14 mg doses when compared with placebo in predominantly Chinese participants with type 2 diabetes insufficiently controlled by diet and exercise alone. Oral semaglutide was generally well tolerated, with a safety profile consistent with that seen in the global PIONEER trials., Trial Registration: ClinicalTrials.gov NCT04109547., Funding: Novo Nordisk A/S., (© 2024. The Author(s).)

This study investigated the influences of mother-daughter communication and social media on mothers' HPV vaccine refusal for their daughters aged 9-17. A cross-sectional online survey among 11,728 mothers of girls aged 9-17 in Shenzhen, China was implemented between July and October 2023. Multi-level logistic regression models were fitted. Among 11,728 participants, 43.2% refused to have their daughters receive an HPV vaccination. In multivariate analysis, more openness in the mother-daughter communication (AOR: 0.99, 95%CI: 0.98, 0.99), perceived more positive outcomes of mother-daughter communication (AOR: 0.77, 95%CI: 0.75, 0.79), higher frequency of exposure to testimonials about daughters' HPV vaccination (AOR: 0.81, 95%CI: 0.78, 0.85) and information encouraging parents to vaccinate their daughters against HPV on social media (AOR: 0.76, 95%CI: 0.73, 0.79), and thoughtful consideration of the veracity of the information specific to HPV vaccines (AOR: 0.80, 95%CI: 0.77, 0.83) were associated with lower vaccine refusal. Mothers who were not the main decision-makers of daughters' HPV vaccination (AOR: 1.28 to 1.46), negative outcome expectancies of mother-daughter communication (AOR: 1.06, 95%CI: 1.04, 1.08), and mothers' HPV vaccine refusal (AOR: 2.81, 95%CI: 2.58, 3.06) were associated with higher vaccine refusal for their daughters. The level of mothers' HPV vaccine refusal for their daughters was high in China. Openness and outcome expectancies of mother-daughter communication and information exposure on social media were considered key determinants of HPV vaccine refusal for daughters. Future HPV vaccination programs should consider these interpersonal factors.

Background: Traditional ecological knowledge (TEK) and practice associated with wild edible plants (WEPs) is an important part of local culture of the Yao people in Jianghua Yao Autonomous County, which possesses the biggest population of Yao ethnic group in China. Economic development, urbanization, and transition of lifestyle and changing interests of the younger generations risk loss of such valuable knowledge. However, no record had been reported about WEPs from the Yao communities of Jianghua County. It is urgent to assemble data on the major WEPs and their uses in Jianghua. This can be used to educate and stimulate new interest in these WEPs, to aid inheritance and improvement of cultural identity and confidence, to enhance local resilience to various changes and to suggest pathways for novel and value-added applications to create new local business opportunities., Methods: To record WEPs associated with TEK and practice, we conducted field surveys in 2018, 2019 and 2023. The ethnobotanical methods such as free-listing, participatory observation, semi-structured interview, and market survey were adopted in the field investigations. Information about WEPs including vernacular names, parts used, ways of use, and collection time were recorded. Voucher specimens were collected, identified, and deposited in the herbarium at Minzu University of China, in Beijing., Results: Totally, 81 Yao people from 12 villages were interviewed. WEPs traditionally play a crucial role in Yao peoples' daily lives. A total of 130 plant species from 89 genera and 49 families were recorded. The plants collected showed great diversity and reflected unique local culture. Most (54.5%) WEPs were also used as medicines. Baba can be defined as a cultural identity food, and WEPs are commonly used as tea substitutes for their health benefits., Conclusions: We conclude that WEPs use is facing great challenges in a rapidly changing era. Preservation of WEPs related practice and knowledge is not only important for conserving local biocultural diversity, but also valuable in providing potential functional and healthy materials for food security and future economic development. Cultivation of young generations' interest in nature and biodiversity, combined with local policy to enhance public awareness are recommended., (© 2024. The Author(s).)

Background: Mothers play a crucial role in influencing their daughters' HPV vaccination decisions. Addressing barriers to receiving HPV vaccination among mothers of girls may achieve two goals in one strike: increasing vaccination coverage among both mothers and their daughters. This study aims to examine the HPV vaccination uptake and its determinants among mothers of girls in China at both the individual and interpersonal levels., Methods: From July to October 2023, a cross-sectional online study was conducted to investigate HPV vaccine refusal for daughters aged 9-17 years among 11,678 mothers in Shenzhen, China. A randomized selection method was employed, targeting 11 primary schools and 13 secondary schools in Shenzhen. The research team invited mothers of girls to participate in an anonymous online survey. Multilevel logistic regression models (level 1: schools; level 2: individual participants) were employed to analyze the data., Results: Among 11,678 mothers, 41.1% self-reported receiving at least one dose of HPV vaccination. Through multilevel logistic regression analysis, eight items measuring illness representations of HPV, which refers to how people think about HPV, were associated with higher HPV vaccination uptake (AOR: 1.02-1.14). These items included identity (identifying symptoms of HPV), timeline (whether HPV is acute/chronic), negative consequences, personal and treatment control (whether HPV is under volitional control), concern, negative emotions, and coherence (overall understanding of HPV). In addition, participants refusing HPV vaccines for the index daughters (AOR: 0.82, 95%CI: 0.76, 0.89) had lower vaccine uptake. Perceived more difficulties in accessing the 9-valent vaccines (AOR: 1.06, 95%CI: 1.04, 1.08) and more satisfaction with vaccine-related promotional materials (AOR: 1.50, 95%CI: 1.46, 1.54) at the individual level were associated with higher vaccine uptake. At the interpersonal factors, higher frequency of exposure to testimonials given by others about HPV vaccination on social media (AOR: 1.19, 95%CI: 1.14, 1.25) and thoughtful consideration of the veracity of the information (AOR: 1.11, 95%CI: 1.07, 1.16) were correlated with higher HPV vaccination uptake., Conclusions: These findings offer essential implications for modifying HPV disease perceptions, addressing difficulties in accessing the 9-valent HPV vaccines, and enhancing health communication needs to improve HPV vaccine uptake among mothers of girls., (© 2024. The Author(s).)

Background: Rehabilitation therapists often perform physically demanding treatments that may result in work-related injuries, yet related studies are scarce. This study aimed to investigate the work-related injuries of rehabilitation therapists and provide feasible preventive measures., Methods: A cross-sectional study was carried out in 34 regions across China using an online questionnaire. The survey gathered responses primarily from 1,198 rehabilitative therapists working in 120 health institutes. Following data collection, descriptive analysis, chi-square tests, logistic regression, and receiver operating characteristic (ROC) curves were employed to analyze the data., Results: In this study, the incidence of work-related injuries was reported to be 87% ( n  = 1,041). The top three musculoskeletal issues reported were low back pain (12%), neck pain (10%), and shoulder pain (9%). Logistic regression and ROC curve analysis identified that working as a physiotherapist and years of work experience (OR [95% CI]: 1.03 [0.99-1.07]) were significant contributors to the incidence of work-related injuries. Specifically, neuro-physiotherapists (OR [95% CI]: 3.04 [1.56-5.92]), musculoskeletal physiotherapists (OR [95% CI]: 2.46 [1.16-5.18]), and intensive care physiotherapists (OR [95% CI]: 4.70 [1.24-17.88]) were at higher risk. Furthermore, five factors were proven to be associated with injury prevention as reported by therapists: patient engagement (OR [95% CI]: 0.38 [0.23-0.62]), improving techniques (OR [95% CI]: 0.59 [0.39-0.90]), maintaining exercise habits (OR [95% CI]: 0.59 [0.40-0.86]), utilizing instruments (OR [95% CI]: 0.80 [0.53-1.19]), and strengthening education (OR [95% CI]: 0.43 [0.21-0.90])., Conclusion: The present study investigated the factors contributing to work-related injuries among rehabilitation therapists, with a focus on identifying both risk and preventive measures. These findings offer new perspectives on decreasing injury risk., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Liu, Tian, Wu, Luo, Yi, Li, Jiang, Wei, Zhang, Zhang, Duan and Zheng.)

Research on the association between maternal PM 2.5 exposure and hypospadias risk in male offspring, particularly in highly polluted areas, has been limited and inconsistent. This study leveraged data from China's National Population-based Birth Defects Surveillance System spanning the years 2013 to 2019, and employed sophisticated machine learning models to estimate daily PM 2.5 levels and other pollutants for mothers at a 1-km resolution and a 6-km buffer surrounding maternal residences. Multivariate logistic regression analyses were performed to evaluate the relationship between PM 2.5 exposure and hypospadias risk. For sensitivity analyses, stratification analysis was conducted, and models for one-pollutant and two-pollutants, as well as distributed lag nonlinear models, were constructed. Of the 1194,431 boys studied, 1153 cases of hypospadias were identified. A 10 μg/m 3 increase in maternal PM 2.5 exposure during preconception and the first trimester was associated with an elevated risk of isolated hypospadias, with Odds Ratios (ORs) of 1.102 (95% CI: 1.023-1.188) and 1.089 (95% CI: 1.007-1.177) at the 1-km grid, and 1.122 (95% CI: 1.034-1.218) and 1.143 (95% CI: 1.048-1.246) within the 6-km buffer. Higher quartiles of PM 2.5 exposure were associated with increased odds ratios compared to the lowest quartile. These findings highlight a significant association between PM 2.5 exposure during the critical conception period and an elevated risk of isolated hypospadias in children, emphasizing the need for targeted interventions to reduce PM 2.5 exposure among expectant mothers., 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 Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: Financial toxicity is used to describe the financial hardship experienced by cancer patients. Financial toxicity may cause negative consequences to patients, whereas little is known in Chinese context. This study aimed to explore the level of financial toxicity, coping strategies, and quality of life among Chinese patients with hematologic malignancies., Patients and Methods: We conducted a prospective, observational study among 274 Chinese patients with hematologic malignancies from November 2021 to August 2022 in Sun Yat-sen University Cancer Center. Clinical data were extracted from electronic clinical records. Data on financial toxicity, coping strategies, and quality of life were collected using PRO measures. Chi-square or independent t test and multivariate logistic regression were performed to explore the associated factors of financial toxicity and quality of life, respectively. Effects of financial toxicity on coping strategies were examined using Chi-square., Results: The mean age of the participants was 50.2 (± 14.6) years. Male participants accounted for 57.3%. About half of the participants reported high financial toxicity. An average median of ¥200,000 on total medical expenditures since the diagnosis was reported. The average median monthly out-of-pocket health expenditure relating to cancer treatment was ¥20,000 (range ¥632-¥172,500) after reimbursement. Reduce daily living expenses (64.9%), borrowing money (55.7%), and choosing cheaper regimens (19.6%) were the commonly used strategies to cope with financial burden. Financial toxicity was negatively associated with quality of life (β = 0.071, P = 0.001)., Conclusions: Financial toxicity was not uncommon in patients with hematological malignancies. Reducing daily living expenses, abandoning treatment sessions, and borrowing money were the strategies commonly adopted by participants to defray cancer costs. Additionally, participants with high level of financial toxicity tended to have worse quality of life. Therefore, actions from healthcare providers, policy-makers, and other stakeholders should be taken to help cancer patients mitigate their financial toxicity., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The objective of this study is to investigate whether common genetic variants of the LTBP4 gene are linked to the susceptibility of sudden cardiac death in individuals who have atherosclerotic coronary artery disease (SCD-CAD) in Chinese populations. A total of 208 SCD-CAD cases and 638 controls were included in the analysis, and logistic regression was employed to assess the association between a 4-bp insertion/deletion polymorphism (rs34005443) within LTBP4 and the susceptibility to SCD-CAD among Chinese individuals. Logistic regression analysis demonstrated a notable association between the insertion allele of rs34005443 and an escalated susceptibility to SCD-CAD [odds ratio (OR) = 1.434; 95 % confidence interval:1.14-1.80; P = 1.79 × 10 -3 ]. Genotype-phenotype correlation analysis was performed using Genotype-Tissue expression (GTEx) database and further validated by human myocardium using qPCR. Correlation analysis revealed that LTBP4 expression level was lower in samples with the insertion allele. Furthermore, the dual-luciferase activity assays indicated that rs34005443 may play a regulatory role. Additionally, we predicted 30 transcription factors that are likely to bind to rs34005443 and its highly linked genetic variants via 3DSNP database. Subsequent GO and KEGG analysis indicated that these transcription factors have a significant function in regulating gene expression. Finally, PPI network analysis suggested a tight connection between LTBP4 proteins and TGFβs, highlighting these genes as potential hub genes in the context of SCD-CAD. In summary, our study revealed that rs34005443 might contribute to SCD-CAD susceptibility by regulating LTBP4 expression. These findings revealed that this indel could be a potentially functional marker for molecular diagnosis and risk stratification of SCD-CAD., 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 B.V. All rights reserved.)

Background: This study explores the medicinal plant knowledge of the Baiku Yao, a unique ethnic group in China. Despite existing research on their ethnobotanical practices, a comprehensive understanding of their medicinal flora remains lacking. This study aims to document and analyze the species distribution, utilization, and traditional knowledge of medicinal plants used by Baiku Yao., Methods: Ethnobotanical surveys were conducted in various Baiku Yao villages across different seasons from 2019 to 2023. Informants were interviewed, and plant specimens were collected and identified. Statistical analyses, including the Relative Frequency of Citation (RFC), were employed to understand plant importance in Baiku Yao culture., Results: In an ethnobotanical survey conducted in the Baiku Yao region, 434 medicinal plant species were documented, highlighting significant ethnobotanical diversity and a deep cultural integration of traditional medicinal practices. The study revealed pronounced geographical variations in plant knowledge among villages, with a notable reliance on wild plants, as 85.48% were sourced from the wild, reflecting unique local ethnobotanical knowledge. Predominantly herbs and shrubs were used due to their accessibility and abundance in the local environment. High Relative Frequency of Citation (RFC) values for certain species underscored their importance for local health needs and additional economic value. The utilization of various plant parts, particularly whole plants, roots, and leaves, indicates a holistic approach to medicinal applications, adapted to combat prevalent health issues such as skin and infectious diseases. The study also uncovered the Baiku Yao's cultural practices for countering "Gu" afflictions-a range of pathogenic conditions-with 18 diverse antidote plants used for skin, digestive, and musculoskeletal disorders. The study underscores the imperative of preserving this rich medicinal heritage through innovative models that engage youth and leverage new media, ensuring the inheritance and evolution of Baiku Yao's traditional knowledge., Conclusions: Baiku Yao's medicinal plant use reflects a deep, culturally ingrained knowledge, closely tied to local ecology. The study highlights the importance of preserving this unique ethnobotanical heritage and suggests interdisciplinary approaches for future research., (© 2024. The Author(s).)

Background: The Baiku Yao, primarily residing in Guangxi and Guizhou provinces of China, is a distinctive branch of the Yao ethnic group, known for their profound cultural preservation and unique ethnobotanical knowledge. This study investigates the Baiku Yao community's utilization of traditional food plants, focusing on the relationship between their dietary practices and the local biodiversity within their mountainous living environment. It aims to illuminate the cultural significance and survival strategies embedded in their ethnobotanical knowledge, highlighting the potential for sustainable living and biodiversity conservation., Methods: Through ethnobotanical surveys, key informant interviews, and quantitative analysis techniques such as the cultural food significance index (CFSI) and relative frequency of citations (RFC), this research systematically documents the diversity and cultural importance of edible plants in the Baiku Yao community. The study assesses how these plants contribute to the community's diet, traditional medicine, and overall cultural practices., Results: A total of 195 traditional edible plants were documented, belonging to 142 genera and 68 families, with a significant concentration in certain families such as Asteraceae, Rosaceae, and Fabaceae. The Baiku Yao diet prominently features herbaceous plants, with wild (103 species) and cultivated (89 species) varieties as diverse food sources. They utilize various plant parts, particularly fruits and leaves, for multiple purposes, including nutrition, medicine, and fodder. Their processing techniques, from raw to fermented, showcase a rich culinary tradition and emphasize a holistic use of plants for enhancing diet and health in a concise overview. The RFC and CFSI analyses reveal a deep cultural reliance on a variety of plant species, with a notable emphasis on vegetables, fruits, spices, and medicinal herbs. Specific plants like Zingiber officinale, Zea mays, and Oryza sativa were highlighted for their high cultural significance. The study also uncovers the multifunctional use of these plants, not only as food but also for medicinal purposes, fodder, and other cultural applications, reflecting the Baiku Yao's profound ecological wisdom and their harmonious coexistence with nature., Conclusion: The findings emphasize the rich ethnobotanical knowledge possessed by the Baiku Yao, underscoring the importance of documenting, safeguarding, and transmitting this invaluable traditional knowledge. This study contributes to a deeper understanding of cultural heritage and biodiversity conservation, advocating for concerted efforts to protect such traditional practices against the threats of modernization and cultural erosion., (© 2024. The Author(s).)

Background: Positive development plays an important role in youth when dealing with stressful circumstances. According to the resource dilution theory, adolescents with or without siblings may receive different levels of emotional and material resources from their parents. The purpose of this study is to examine the association between the positive development of adolescents in China today with their family characteristics such as the number of siblings., Methods: A total of 2072 junior high and senior high school students (13 to 18 years old) in Chengdu, Sichuan, China, were investigated by cluster sampling. The Chinese Positive Youth Development scales (CPYDs) were used to measure positive youth development. The generalized linear model was used to explore the relationships among the number of siblings, parent-child relationships and positive youth development., Results: Adolescents from only-child families had better performance on positive development (H = 21.87, P < 0.001) and better relationships with parents (H = 15.1, P < 0.05). The positive development of male and female adolescents does not significantly differ in families with different numbers of siblings. The generalized linear model showed that a positive parent-child relationship is positively correlated with adolescent positive development (P < 0.05)., Conclusion: Positive youth development is not only associated with the number of siblings but also other modifiable familial factors. The positive relationship between parents and adolescents is of great practical value in daily life to improve youth development, and this might be the real lesson the resource dilution theory tells., (© 2024 John Wiley & Sons Ltd.)

Gastrointestinal (GI) endoscope is one of the instruments used extensively in the diagnosis and treatment of digestive tract disorders. China is confronted with a great demand for endoscopists working in grassroots healthcare facilities. Furthermore, endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS), and endoscopic submucosal dissection (ESD) are becoming the prevailing methods of endoscopic treatment of digestive diseases. Therefore, there is a growing demand for senior endoscopists. Currently, an important focus of GI endoscopy training is the acceleration of standardized training for endoscopists working in grassroots health facilities and advanced training for senior endoscopists. Simulation devices based on virtual reality technology exhibit strengths in objectivity, authenticity, and an immersive experience. These devices show advantages in the training method, the number of participants, and assessment over traditional training programs for GI endoscopy. Their application provides a new approach to the training and teaching of GI endoscopy. Herein, we summarized the explorations and practices of using virtual reality technology in the training and teaching of GI endoscopy, analyzed its application status in China, and discussed its prospects for future application., Competing Interests: 利益冲突　所有作者均声明不存在利益冲突, (© 2024《四川大学学报（医学版）》编辑部 版权所有Copyright ©2024 Editorial Board of Journal of Sichuan University (Medical Sciences).)

Recycling livestock manure in agroecosystems can maintain crop production, improve soil fertility, and reduce environmental losses. However, there has been no comprehensive assessment of synergies and trade-offs in the food-energy-soil-environment nexus under manure application. Here, we evaluate the sustainability of maize production under four fertilization regimes (mineral, mineral and manure mixed, manure, and no fertilization) from the aspect of food security, energy output, soil quality, and environmental impact based on a five-year field experiment. Manure and mineral mixed fertilization maintained grain and straw quantity and quality compared with mineral fertilization. Manure and mineral mixed fertilization increased stem/leaf ratio and field residue index by 9.1-28.9% and 4.5-17.9%, respectively. Manure also maintained the theoretical ethanol yield but reduced the straw biomass quality index by increasing ash. Further, manure application increased the soil quality index by 40.5% and reduced N 2 O emissions by 55.0% compared with mineral fertilization. Manure application showed the highest sustainability performance index of 19, followed by mineral (15), mixed (13), and without fertilization (8). In conclusion, manure application maintains food production and energy output, enhances soil quality, and reduces environmental impact, thereby improving the sustainability of maize production., 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., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)

To understand the environmental adaptations among sessile bivalves lacking adaptive immunity, a series of analyses were conducted, with special emphasis on the widely distributed C. ariakensis. Employing Pacbio sequencing and Hi-C technologies, whole genome for each of a C. ariakensis (southern China) and C. hongkongensis individual was generated, with the contig N50 reaching 6.2 and 13.0 Mb, respectively. Each genome harbored over 30,000 protein-coding genes, with approximately half of each genome consisting of repeats. Genome alignment suggested possible introgression between C. gigas and C. ariakensis (northern China), and re-sequencing data corroborated this result and indicated significant gene flow between C. gigas and C. ariakensis. These introgressed candidates, well-represented by genes related to immunity and osmotic pressure, may be associated with environmental stresses. Gene family dynamics modeling suggested immune-related genes were well represented among the expanded genes in C. ariakensis. These outcomes could be attributed to the spread of C. ariakensis., Competing Interests: Declaration of Competing Interest The authors declared that they have no competing interests., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: To explore the use of complementary and alternative medicine (CAM) by Chinese gynaecological oncology patients undergoing chemotherapy and discuss measures to address the existing gaps., Design: Qualitative phenomenology. Semistructured in-depth interview. Colaizzi's method data analysis., Setting: A tertiary general hospital., Participants: 16 gynaecological oncology patients (mean age 51.7) having undergone ≥1 chemotherapy cycle were recruited by purposive sampling., Results: Six themes were generated. The participants were under-informed about CAM concept and options. They were open to explore various modalities after chemotherapy as long as it could alleviate symptoms. The gynaecological patients with cancer sought information about CAM from diverse sources, with professional expertise being the most desirable way to seek information. They used CAM as a strategy to support continued chemotherapy and for symptom alleviation. Financial burden was not stressed but they had concerns about sustainability of some therapies. Their attitudes toward different CAM types varied. Some were sceptical about the efficacy., Conclusions: The Chinese gynaecological oncology patients may be under-informed about CAM. They are open to use various CAM therapies for symptom relief and as a support strategy. However, their attitudes toward specific therapies may vary. Some may host scepticism about certain CAM modalities. The patients actively seek information on CAM and treatment resources but prefer professional expertise to other sources. Financial burden due to continued CAM use is inconclusive due to possible sampling bias. Sustainability of CAM therapies is a common concern because of limited resources and access. Education on CAM should be incorporated into the curriculum of healthcare professionals. Oncologists and nurses should educate gynaecological patients with cancer on the concept and options of CAM, preferably with information tailored to patient's individual needs. Health authorities should advocate provisions of diverse CAM services and develop the necessary technologies such as network of local care resources., 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.)

The aim of this study is to investigate the core competencies of midwives in China. Combination of qualitative research and quantitative research. A total of 100 midwives in 3 tertiary (Grade 3) hospitals in Shijiazhuang were investigated by using the Midwife Core Competency Scale, and simultaneously followed by semi-structured interviews with 12 midwives. The questionnaire survey showed that the average score of core competencies of midwives was 4.17 ± 0.17. The scores of midwives' competency for labor and delivery care (4.31 ± 0.09), new-born care (4.29 ± 0.04), and postpartum care (4.25 ± 0.13) were relatively high, while the prepregnancy care had the lowest score (3.88 ± 0.07). The interview results showed that the self-perception of core midwifery competencies was not bad, the limitations of midwives' work scope affect the core competencies, and midwifery education needs to strengthen the humanistic care and the training of obstetric knowledge and technology., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The Luchuan pig is an indigenous breed from Luchuan County, China, with cultural and genetic significance. However, traditional knowledge and conservation status have not been systematically documented., Methods: Using ethnobiological methods, we surveyed 72 Luchuan pig farmers in 7 townships during 2021-2023. Semi-structured interviews and participant observation were conducted to document traditional knowledge and management practices., Results: The locals reported 51 plant species used as pig feed, with 30 wild species. Growth-stage-specific feeding and seasonal adjustment practices were documented. We recorded 62 ethnoveterinary plant uses, mainly for treating pigs' heat stress and skin conditions. Luchuan pigs play central roles in local Hakka customs, rituals, and cuisine. Additonally, the new ecological farming models minimize the environmental impacts to the local community. However, there are still some challenges remained for conserving and promoting Luchuan pigs., Conclusions: The Luchuan Hakka people possess rich traditional knowledge and management experience in raising Luchuan pigs. Our study provides extensive documentation of traditional knowledge and recommends integrating cultural and genetic aspects for sustaining this biocultural heritage. Findings can inform initiatives supporting local breed conservation globally., (© 2023. BioMed Central Ltd., part of Springer Nature.)

(1) Background: Female body composition undergoes significant changes to support fetal growth and development during pregnancy. This study investigated the association of maternal body composition in the second trimester and macrosomia and explored whether body-composition-related indicators could be used to predict macrosomia. (2) Methods: This study was conducted in China from December 2016 to December 2021. Women with singleton pregnancies, gestational ages between 37 and 42 weeks, and an absence of pregnancy complications were included. In the second trimester, bioelectric impedance analysis (BIA) was used to measure body-composition-related indicators. Logistic regression analysis was performed to explore the risk factors for macrosomia. The predictive performance of maternal body composition and clinical indicators for macrosomia were assessed using the area under the receiver-operating-characteristics curve (AUC). (3) Results: This retrospective study involved 43,020 pregnant women; we collected 2008 cases of macrosomia. Gravidity, gestational age, body mass index (BMI), gestational weight gain (GWG), total body water, fat mass, fat-free mass (FFM), skeletal muscle mass, and visceral fat level were risk factors for macrosomia ( p < 0.05 for all). In the prediction model, the AUC of FFM for predicting macrosomia was the largest (0.742). (4) Conclusions: Body-composition-related indicators associated with macrosomia and body composition measurements in the second trimester can predict the risk of macrosomia, enabling clinicians to implement interventions earlier to reduce adverse perinatal outcomes.

Background: Numerous studies have suggested that Baduanjin, a traditional Chinese exercise, can alleviate fatigue symptoms in patients with various illnesses. The aim of this review was to evaluate the efficacy of Baduanjin in reducing fatigue symptoms., Methods: A comprehensive literature search was conducted using several databases, including PubMed, Web of Science, Embase, Medline, China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang, from inception to June 2023. Relevant studies reporting on the effects of Baduanjin on fatigue symptoms were included. A random-effects meta-analysis model with standardized mean differences was used to estimate the treatment effects. Moderator analyses were conducted using continuous variables and meta-regression. This review was registered in the International Prospective Register of Systematic Reviews (identifier CRD42023411532). Grading of recommendations, assessment, development and evaluations framework was used to assess the certainty of evidence., Results: Ten randomized controlled trials with patients diagnosed with 9 different diseases were included in the meta-analysis. The Baduanjin intervention groups showed significant improvements in total fatigue intensity (standard mean difference = -0.49, 95% confidence interval = -0.69 to -0.30, P = .000; I2 = 56%, P = .009). The statistically significant differences in the subgroup analyses, including intervention durations, age of participants, fatigue types, and practice location, remained unchanged. Meta-regression showed that practice place might have significant effect on the results. The certainty of the evidence was moderate for participants 55-year younger or in hospital training. However, fatigue, different groups, participants 55-year or older, training at home, and different fatigue types had lower evidence certainty., Conclusion: Baduanjin can effectively alleviate fatigue symptoms with relatively flexible requirements. However, studies investigating the same disease types and including non-Chinese populations are scarce. Therefore, further studies with long-term interventions, larger sample sizes, and well-designed methodologies are warranted., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Backgrounds: Guangxi Fangcheng Golden Camellias national nature reserve, situated in Fangcheng City, Guangxi Province, China, is a coastal region renowned for its exceptional natural environment. Over time, the residents of this area have acquired extensive knowledge regarding medicinal plants, owing to their close association with the abundant flora. Our study aims to document the medicinal plants used by the local community near the Guangxi Fangcheng Golden Camellias national nature reserve. We seek to investigate the unique regional properties, cultural significance, and potential connections between medicinal plants used in surrounding villages and those sold in markets., Methods: During 2019-2021, 96 informants, including 36 key informants, were interviewed in the study area. The snowball sampling method was used to select respondents from medicinal markets and villages. Local therapists were defaulted as key informants. A panel discussion was held on the protection and threat of medicinal plants and traditional knowledge. In this study, two quantitative indicators, relative frequency citation (RFC) and informant consensus factor (ICF), were used to analyze the traditional medicinal plants in the study area., Results: According to the investigation, a total of 396 species of medicinal plants belonging to 295 genera and 116 families were recorded. From the perspective of Lifeform, herbs accounted for 38.9%, followed by shrubs. Most of the medicinal parts are whole plant (120 species, 25.59%), branches and leaves (116 species, 24.73%), and roots (101 species, 21.54%). Medicinal bath is the most commonly used therapeutic method. Among the 13 therapeutic targets recorded, rheumatic drugs accounted for the highest proportion, followed by muscular system diseases and skin-related diseases, which are closely related to local climate and livelihood. ICF shows that the use of local medicinal plants and related knowledge is very diverse, so local people have more options for treating diseases. Melicope pteleifolia, Clerodendrum cyrtophyllum, Lygodium flexuosum, Elephantopus scaber, Artemisia argyi, Plantago asiatica, Centella asiatica, Grangea maderaspatana, and Liquidambar formosana have high RFC, which are closely connected to local people's daily lives and are potentially vital to them. The wild vegetation, mostly around the nature reserve, is the primary source of medicinal materials sold in the urban medicinal market. Urban areas have fewer varieties of medicinal plants compared to villages near protected areas. However, there is consistency in their usage and application., Conclusion: The medicinal plants used in the villages near the Golden Camellia Nature Reserve are diverse, and the relevant traditional knowledge is relatively well preserved. The collection of medicinal materials by local people is sustainable. This study suggests that the local government should also protect relevant traditional knowledge in the decision-making process., (© 2023. The Author(s).)

Background: Pu'er Traditional Tea Agroecosystem is one of the projects included in the United Nations' Globally Important Agricultural Heritage Systems (GIAHS) since 2012. Against the background of having rich biodiversity and a long history of tea culture, the ancient tea trees in Pu'er have experienced from wild-transition-cultivation for thousands of years, and the local people's knowledge about the management of ancient teagardens has not been rigorously recorded. For this reason, it is important to study and record the traditional management knowledge of Pu'er ancient teagardens and the influence on the formation of tea trees and communities. This study focuses on the traditional management knowledge of ancient teagardens in Jingmai Mountains, Pu'er, and monoculture teagardens (monoculture and intensively managed planting base for tea cultivation) were used as the control, through the community structure, composition and biodiversity of ancient teagardens to respond to the influence of traditional management, and this work with a view to providing a reference for further research on the stability and sustainable development of tea agroecosystem., Methods: From 2021 to 2022, information on traditional management of ancient teagardens was obtained through semi-structured interviews with 93 local people in the Jingmai Mountains area of Pu'er. Informed consent was obtained from each participant before conducting the interview process. The communities, tea trees and biodiversity of Jingmai Mountains ancient teagardens (JMATGs) and monoculture teagardens (MTGs) were examined through field surveys, measurements and biodiversity survey methods. The Shannon-Weiner (H), Pielou (E) and Margalef (M) indices were calculated for the biodiversity of the teagardens within the unit sample, using monoculture teagardens as a control., Results: The tea tree morphology, community structure and composition of Pu'er ancient teagardens are significantly different from those of monoculture teagardens, and the biodiversity is significantly higher than that of monoculture teagardens. The local people mainly manage the ancient tea trees mainly using several methods, including weeding (96.8%), pruning (48.4%) and pest control (33.3%). The pest control mainly relies on the removal of diseased branches. JMATGs annual gross output is approximately 6.5 times that of MTGs. The traditional management of ancient teagardens is through setting up forest isolation zones as protected areas, planting tea trees in the understory on the sunny side, keeping tea trees 1.5-7 m apart, as well as consciously protecting forest animals such as spiders, birds and bees, and reasonably rearing livestock in the teagardens., Conclusions: This study shows that local people have rich traditional knowledge and experience in the management of ancient teagardens in Pu'er, and that this traditional management knowledge has impacted the growth of ancient tea trees, enriched the structure and composition of tea plantation communities and actively protected the biodiversity within ancient teagardens., (© 2023. The Author(s).)

Background: The true incidence of acute gastrointestinal illness in China is underrecognized by surveillance systems. The aims of this study were to estimate the incidence and prevalence of self-reported AGI in the community of China, and to investigate sociodemographic and epidemiological determinants of AGI., Methods: We conducted a 12-months cross-sectional population-based survey in eight provinces of China during 2014-2015. The survey determined the prevalence and incidence of acute gastrointestinal illness (AGI) in the total permanent resident population in China according to the census of the population in 2010. The random multilevel population sample was stratified by geographic, population, and socioeconomic status. We used a recommended case definition of AGI, with diarrhea (three loose or watery stools) and/or any vomiting in a four-week recall. A face-to-face survey was conducted by selecting the member in the household with the most recent birthday., Results: Among 56,704 sampled individuals, 948 (1,134 person-time) fulfilled the case definition; 98.5% reported diarrhea. This corresponds to 2.3% (95% CI:1.9%-2.8%) of an overall standardized four-week prevalence and 0.3 (95% CI: 0.23-0.34) episodes per person-year of annual adjusted incidence rate. There was no significant difference between males and females. The incidence rates were higher among urban residents, and in the spring and summer. In the whole study period, 50% of the cases sought medical care, of which 3.9% were hospitalized and 14.3% provided a biological sample for laboratory identification of the causative agent. Children aged 0-4 and young adults aged 15-24, people living in rural areas and people who traveled frequently had higher prevalence of AGI., Conclusion: Results showed that AGI represents a substantial burden in China, and will contribute to the estimation of the global burden of AGI. Complemented with data on the etiologies of AGI, these estimates will form the basis to estimate the burden of foodborne diseases in China., (© 2023. The Author(s).)

Background: Heavy metal exposure is acknowledged to be associated with decrease of lung function, but the relationship between metals co-exposure and lung function in rural areas of Northwest China remains unclear, particularly in an area famous for heavy metal pollution and solid fuel use. Therefore, the purpose of this study is to explore the effects of heavy metal exposure on lung function and the potential impacts of living habit in a rural cohort of Northwest China., Methods: The study area included five villages of two regions in Northwestern China-Gansu province. All participants were recruited from the Dongdagou-Xinglong (DDG-XL) rural cohort in the study area. Urine levels of 10 common and representative heavy metals were detected by ICP-MS, including Cobalt (Co), Nickel (Ni), Molybdenum (Mo), Cadmium (Cd), Stibium (Sb), Copper (Cu), Zinc (Zn), Mercury (Hg), Lead (Pb), and Manganese (Mn). The lung function was detected by measuring percentages of predicted forced vital capacity (FVC%) and predicted forced expiratory volume in one second (FEV1%) as well as the ratio of FEV1/FVC. We also analyzed the association between heavy metals and pulmonary ventilation dysfunction (PVD). Restricted cubic spline, logistic regression, linear regression, and bayesian kernel machine regression (BKMR) model were used to analyze the relationship between heavy metal exposure and lung function., Results: Finally, a total of 382 participants were included in this study with an average age of 56.69 ± 7.32 years, and 82.46% of them used solid fuels for heating and cooking. Single metal exposure analysis showed that the higher concentration of Hg, Mn, Sb, and lower Mo may be risk factors for PVD. We also found that FEV1% and FVC% were negatively correlated with Sb, Hg, and Mn, but positively correlated with Mo. The effect of mixed heavy metals exposure could be observed through BKMR model, through which we found the lung function decreased with the increase of heavy metal concentration. Furthermore, the males, BMI ≥ 24 kg/m 2 and who used solid fuels showed a higher risk of PVD when exposed to Co, Zn, and Hg., Conclusions: Our results suggested that heavy metal exposure was associated with decrease of lung function regardless of single exposure or mixed exposure, particularly for Sb, Hg, Mn and those who use solid fuels., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Fish and shellfish contain nutrients essential for fetal health, especially docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). The concern of mercury (Hg) pollution limits fish consumption among women in pregnancy, which could adversely affect child development. This study aimed to conduct risk-benefit assessment and provide recommendations for fish intake by pregnant women in Shanghai, China., Methods: Secondary analysis was conducted using cross-sectional data from a representative sample of the Shanghai Diet and Health Survey (SDHS) (2016-2017), China. Dietary intakes of Hg and DHA + EPA were calculated from the food frequency questionnaire (FFQ) on fish items and 24hr recall record. Raw fish samples (59 common species of fish in Shanghai) were purchased in local markets and their concentrations of DHA, EPA and Hg were measured. Net IQ points gain was used to evaluate the health risk and benefit at a population level by FAO/WHO model. Recommended fish (i.e., high- DHA + EPA and low-level MeHg) were defined, and then the proportion of those hit 5.8 IQ points were simulated with their consumption frequency for 1, 2 and 3 times per week., Results: The average consumption of fish and shellfish was 66.24 g/d among pregnant women in Shanghai. The mean concentrations of Hg and EPA + DHA in fish species most commonly consumed in Shanghai were 0.179 mg/kg and 0.374 g/100 g, respectively. Only 1.4% of the population exceeded the MeHg reference dose of 0.1 μg/kg·bw/d, whereas 81.3% of those who did not meet the recommended daily intakes of 250 mg EPA + DHA. In FAO/WHO model, the proportion of 28.4% reached the maximum IQ points gain. Along with the increase of "recommended fish" consumed, the simulated values of the proportion raised to 74.5, 87.3 and 91.9%, respectively., Conclusion: The pregnant women in Shanghai, China had an adequate fish consumption with low-level Hg exposure, but balancing the benefits of fish intake and risk of potential Hg exposure was still a challenge. It is necessary to define a local level of "recommended fish" consumption for developing dietary recommendations for pregnant women., 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.)

Importance: Stroke is the leading cause of death in China. However, recent data about the up-to-date stroke burden in China are limited., Objective: To investigate the urban-rural disparity of stroke burden in the Chinese adult population, including prevalence, incidence, and mortality rate, and disparities between urban and rural populations., Design, Setting, and Participants: This cross-sectional study was based on a nationally representative survey that included 676 394 participants aged 40 years and older. It was conducted from July 2020 to December 2020 in 31 provinces in mainland China., Main Outcomes and Measures: Primary outcome was self-reported stroke verified by trained neurologists during a face-to-face interviews using a standardized protocol. Stroke incidence were assessed by defining first-ever strokes that occurred during 1 year preceding the survey. Strokes causing death that occurred during the 1 year preceding the survey were considered as death cases., Results: The study included 676 394 Chinese adults (395 122 [58.4%] females; mean [SD] age, 59.7 [11.0] years). In 2020, the weighted prevalence, incidence, and mortality rates of stroke in China were 2.6% (95% CI, 2.6%-2.6%), 505.2 (95% CI, 488.5-522.0) per 100 000 person-years, and 343.4 (95% CI, 329.6-357.2) per 100 000 person-years, respectively. It was estimated that among the Chinese population aged 40 years and older in 2020, there were 3.4 (95% CI, 3.3-3.6) million incident cases of stroke, 17.8 (95% CI, 17.5-18.0) million prevalent cases of stroke, and 2.3 (95% CI, 2.2-2.4) million deaths from stroke. Ischemic stroke constituted 15.5 (95% CI, 15.2-15.6) million (86.8%) of all incident strokes in 2020, while intracerebral hemorrhage constituted 2.1 (95% CI, 2.1-2.1) million (11.9%) and subarachnoid hemorrhage constituted 0.2 (95% CI, 0.2-0.2) million (1.3%). The prevalence of stroke was higher in urban than in rural areas (2.7% [95% CI, 2.6%-2.7%] vs 2.5% [95% CI, 2.5%-2.6%]; P = .02), but the incidence rate (485.5 [95% CI, 462.8-508.3] vs 520.8 [95% CI, 496.3-545.2] per 100 000 person-years; P < .001) and mortality rate (309.9 [95% CI, 291.7-328.1] vs 369.7 [95% CI, 349.1-390.3] per 100 000 person-years; P < .001) were lower in urban areas than in rural areas. In 2020, the leading risk factor for stroke was hypertension (OR, 3.20 [95% CI, 3.09-3.32])., Conclusions and Relevance: In a large, nationally representative sample of adults aged 40 years or older, the estimated prevalence, incidence, and mortality rate of stroke in China in 2020 were 2.6%, 505.2 per 100 000 person-years, and 343.4 per 100 000 person-years, respectively, indicating the need for an improved stroke prevention strategy in the general Chinese population.

Few studies have focused on environmental cadmium (Cd) and lead (Pb) exposure while exploring the effect of smoking on blood Cd (BCd) and blood Pb (BPb) levels. Moreover, essential trace elements affect the absorption, accumulation, and toxicity of Cd and Pb. To investigate the effect of smoking on BCd and BPb levels under high Cd and Pb exposure and the influence of essential trace elements on the effect, 301 residents living near a mining and smelting area in Northwest China were included in our study. After collecting health information and measuring BCd, BPb, serum iron, magnesium, and total calcium levels, we analyzed the association between smoking and BCd and BPb levels and the influence of the essential trace elements on the association. The results showed that BCd and BPb levels in smokers were significantly higher than those in non-smokers. There was a dose-response association between pack-years and the odds ratios (ORs) of high BCd and BPb levels in all participants compared with non-smokers. Serum iron, magnesium, and calcium had a negative effect on the elevations of the ORs of high BCd and BPb levels. In addition, smoking-related elevations of BCd and BPb levels vary by sex, age, BMI, and age of smoking initiation. Our findings present evidence for the effect of smoking on BCd and BPb levels under high Cd and Pb exposure and may provide guidance for the prevention and control of BCd and BPb elevations in residents living in Cd- and Pb-polluted areas., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Cadmium (Cd) and lead (Pb) are important environmental endocrine disruptors that are associated with adverse health problems. However, the effects of co-exposure to Cd and Pb on glucocorticoids (GCs) in the body at environmental levels are limited. A total of 468 subjects from the Dongdagou-Xinglong cohort (DDG-XL) were included in this study. We measured the serum levels of two representative endogenous GCs [cortisol (CRL) and cortisone (CRN)], and whole blood levels of Cd and Pb. Multiple linear regression models were constructed to explore the associations of single or combined Cd and Pb exposure with serum CRL and CRN levels. The interactive effects of Cd and Pb on GCs were further assessed using mediation analysis and moderation analysis. Single-heavy metal exposure analysis with adjustment for potential confounders showed that the serum CRL level decreased when the blood Cd or Pb concentration gradually increased (P trend <0.01). Additionally, subjects with high Cd or Pb exposure (Q4) had significantly reduced serum CRN levels compared to those with low Cd or Pb exposure (Q1) (P < 0.05). In Cd and Pb co-exposure analysis, significant negative dose-response relationships were observed between co-exposure to Cd and Pb and serum CRL and CRN levels. Furthermore, mediation analysis showed that Cd completely mediated the relationship between Pb and GCs, and moderation analysis suggested that Pb might weaken the negative relationship between Cd and GCs. These findings suggest that single or combined exposure to Cd and Pb interferes with the homeostasis of serum CRL and CRN levels. Furthermore, we innovatively propose that Cd and Pb may have interactive effects on GCs levels, and Pb can antagonize the negative relationship between Cd and GCs, which may provide clues for further studies on endocrine and metabolic disorders related to these heavy metals., 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.)

Background: Baiku Yao is an ancient branch of the Yao people in China who have the custom of maintaining homegardens. The local government has relocated some villagers to improve their livelihood. To study the characteristics of Baiku Yao homegardens and the impact of relocation, we conducted an ethnobotanical study on homegardens in the relocated villages of Huaili and Yaozhai and in the ancient villages of Yaoshan and Duonu from January 2019 to May 2022., Method: Data on homegarden plants were collected through semi-structured interviews with homegarden households. A total of 4 villages (i.e., two relocated and two ancient villages) were selected for detailed investigation. In each village, 60 homegardens were chosen randomly. In addition, the RFC index and Jaccard value were used to analyze and evaluate the homegarden plants we recorded., Result: The study recorded a total of 213 species of homegarden plants with approximately 11 functions. Baiku Yao homegardens are small in size but rich in species and functions, and their utilization efficiency is extremely high. The Jaccard value shows that the homegarden plants in Huaili and Yaozhai have the highest similarity. Neighborhood sharing and market purchasing are the two most important sources of local homegarden plants. Additionally, medicine and food are the two most important uses of homegarden plants. Ornamental plants also play a significant part, especially in relocated villages. The comparisons indicate that the diversity of homegarden plants in the investigated ancient villages is better preserved than in relocated villages. Due to frequent exchanges between the villages and the outside world, Yaoshan Village, as an older relocated village, maintains a good traditional culture in its homegardens. As a newly relocated village, Duonu Community has developed a complicated homegarden system with only much less plant diversity. The development of local tourism has also impacted the composition of homegarden plants. The study found that plants such as Zea mays, Morus alba, and Capsicum annuum are closely related to local life and livelihood., Conclusion: The traditional knowledge of homegarden plants in investigated ancient villiages maintained good diversity and has been affected much less by the modernization and tourism industry development compared to the relocated villages. The composition of homegarden plants is closely connected to the local livelihood. In the future development of Baiku Yao communities, protecting homegarden plant diversity and functional diversity is crucial., (© 2023. The Author(s).)

Background: Seasonal patterns exist in many disorders and even serve as potential drivers of some disorders, but in schizophrenia and affective disorders, there is no uniform conclusion on the seasonal pattern., Methods: A total of 100,621 inpatients were surveyed in this study over 16 years, and 21,668 inpatients were ultimately included in the count after standard exclusion criteria were applied., Results: There was an uneven seasonal distribution of mental illness admissions (χ2 = 48.299, df = 18, P < .001). The peak of schizophrenia admissions occurred in the winter and the trough in the spring (52.6 % vs 50 %, P < .05). The peaks for depression and bipolar disorder were in the fall and spring, respectively, while the troughs were in the winter and fall, respectively (24.7 % vs 21.7 %, P < .05; 15.2 % vs 13.2 %, P < .05). Admissions for childhood mood disorders peaked in the fall (P < .05). We also found that the length of stay was also correlated with the season of admission, and that this seasonal fluctuation was not consistent across male and female populations., Limitations: To avoid the effect of repeated hospitalizations, we maintained a registry of each patient's first admission only, which also resulted in our inability to explore the seasonal pattern of each disease recurrence at the individual level., Conclusions: We found that the seasonal distribution of psychiatric admissions was not uniform. And there was also an uneven seasonal distribution of length of stay for patients admitted in different seasons. This may imply that certain environmental factors that vary with the seasons are potential drivers of mental illness., Competing Interests: Conflict of interest The authors report no declarations of interest., (Copyright © 2022 Elsevier B.V. All rights reserved.)

With the booming of worldwide agriculture intensification, brucellosis, one of the most neglected zoonotic diseases, has become an increasing challenge for global public health. Although the transmission patterns of human brucellosis (HB) have been studied in many regions, the dynamic transfer processes of risk and its driving factors remain poorly understood, especially in the context of agricultural intensification. This study attempted to explore the risk transfer of HB between the exact epidemic areas and the neighboring or distant low-risk areas to explain the impact of livestock agriculture intensification and foodborne infections on the transmission of HB in Shaanxi Province as a case study. We adopted multiple approaches, including test-based methods, model-based methods, and a geographical detector to detect the spatial-temporal dynamic changes of high-risk epidemic areas of HB at the county scale. We also quantitatively estimated how the related factors drove the risk transfer of the disease. Results confirmed the risk transfer pattern of HB with an expansion from north to south in Shaanxi Province and identified two primary transfer routes. In particular, in the traditional epidemic areas of the Shaanbei plateau, the farm agglomeration effect can significantly increase the risk of HB. Meanwhile, retail outlets for milk and dairy products were partially responsible for the foodborne infections of HB in the emerging epidemic areas of Xi'an. This study not only contributed helpful insights to support HB control and prevention in the rapid transition of livestock agriculture but also provided possible directions for further research on foodborne HB infections in urbanized areas., 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 An, Shen, Sun, Sun, Fan, Zhao, Nie, Luo, Fu, Liu, Shao and Chang.)

As a destructive and economic disaster in the world, drought shows an increasing trend under the continuous global climate change and adverse health effects have been reported. The interactive effects between drought and air pollutants, which may also be harmful to respiratory systems, remain to be discussed. We built the generalized additive model (GAM) and distributed lag nonlinear model (DLNM) to estimate the effects of drought and air pollutants on daily upper respiratory infections (URTI) outpatient visits among children under 6 in three cities of Gansu province. The Standardized Precipitation Index (SPI) based on monthly precipitation (SPI-1) was used as an indicator of drought. A non-stratified model was established to explore the interaction effect of SPI-1 and air pollutants. We illustrated the number of daily pediatric URTI outpatient visits increased with the decrease in SPI-1. The interactive effects between air pollutants and the number of daily pediatric URTIs were significant. According to the non-stratified model, we revealed highly polluted and drought environments had the most significant impact on URTI in children. The occurrence of drought and air pollutants increased URTI in children and exhibited a significant interactive effect.

Very few researches have concentrated on a variety of time scales to evaluate the association between temperature variation (TV) and childhood asthma (CA), and the evidence for the interaction of air pollutants on this association is lacking. In this study, we aim to estimate the relative risks (RRs) of CA due to TV by following metrics: diurnal temperature range (DTR), temperature changes between neighboring days (TCN), and temperature variability (TV 0-t ); to quantify the seasonal attributable fraction (AF) and number (AN) of CA due to TV; to examine the interactive effects of the TV and air pollutants on CA in different seasons. We mainly applied distributed lagged nonlinear model (DLNM) and conditional Poisson models to evaluate the associations between TV and outpatient visits for CA during 2014-2019 in Lanzhou, China. Additionally, the bivariate response surface model was used to examine the interplay effect of air pollutants. We found that in warm season, the risks of DTR maximum at lag5 (RR = 1.073, 95% CI: 1.017-1.133); TCN showed protective effect. In cold season, the risks of DTR peaked at lag8 (RR = 1.063, 95% CI: 1.027-1.100); the risks of TCN maximum at lag0 (RR = 1.058 95% CI: 1.009-1.109); the estimation of total cases maximized at TV 0-4 in cold season (RR = 1.039 at TV 0-3 , 95% CI: 1.001, 1.077) and was the lowest at TV 0-1 in warm season (RR = 0.999, 95% CI: 0.969, 1.030). In addition, the response surface model graphically pictured ambient air pollutants enhanced the DTR/TV 0-4 -CA effect for girls. In conclusion, the RRs of CA are markedly increased by TV exposure, particularly during the colder months. A combined evaluation of DTR, TCN, TV 0-5 ∼TV 0-6 , NO 2 , SO 2 , and PM 2.5 should be used to identify the adverse effects of TV on CA., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Heavy metals are important risk factors for kidney, but their co-exposure effect on kidney and related mechanism remain unclear. This study evaluated the relationship between heavy metals and renal function, and the feasible mediation effect of oxidative stress. Based on the Dongdagou-Xinglong cohort, participants were recruited and their information were collected through questionnaires and physical examinations. The urine concentration of heavy metals like Cobalt, Nickel, Molybdenum, Cadmium, Antimony, Copper, Zinc, Mercury, Lead, Manganese, and renal injury biomarkers like β2-microglobulin, β-N-Acetylglucosaminidase, retinol-binding protein, 8-hydroxyguanine (8-OHG) were measured and corrected by creatinine. Linear regression was conducted to analyze the relationship between metals and renal biomarkers. Bayesian kernel machine regression, weighted quantile sum and quantile-based g-computation were applied to analyze the association between metal mixtures and renal biomarkers. Finally, the mediating effect of 8-OHG was analyzed through the mediation model. We found that these metals were positively related with renal biomarkers, where copper showed the strongest relationship. The co-exposure models showed that renal biomarkers increased with the concentration of mixtures, particularly for cadmium, copper, mercury, manganese. In addition, the proportion of 8-OHG in mediating effect of metals on renal function ranged from 2.6% to 86.9%. Accordingly, the renal function damage is positively associated with metals, and 8-OHG may play an important mediating role., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The RPMS1 gene is the only member of the BamHI-A rightward transcripts (BARTs) family for which a full-length complementary DNA has been identified, and RPMS1 transcript has been confirmed in many Epstein-Barr virus (EBV)-positive malignancies. However, the effects of sequence variations of RPMS1 in hematological malignancies and their biological significance are unclear. To explore the association between RPMS1 gene variations and hematological malignancy, the RPMS1 gene of 391 EBV-positive samples from patients with EBV-positive leukemia, myelodysplastic syndromes and lymphoma in northern China were sequenced. On the basis of phylogenetic tree and mutation characteristics of RPMS1, all the sequences were divided into five major types: RPMS1-A, RPMS1-B, RPMS1-C, RPMS1-E, and RPMS1-F. RPMS1-A type, similar to the prototype B95-8, was identified in 71.87% (281/391) of samples and was the major type in all subpopulations. The frequency of RPMS1-F type was significantly higher in all malignant hematopathy groups than in healthy donors. The Hodgkin lymphoma group contained more RPMS1-F than other malignant hematopathy groups, and acute myeloid leukemia contained more RPMS1-C type than other malignant hematopathy groups. Therefore, RPMS1-A is the main type of RPMS1 gene in northern China, and RPMS1-F may be associated with hematologic malignancies., (© 2022 Wiley Periodicals LLC.)

The current study assessed the effect of the coronavirus disease 2019 (COVID-19) pandemic on resilience among Chinese adolescents and explored its influential factors. A total of 2,359 students were recruited from three middle schools through cluster randomization in Chengdu. Data were collected before and after home confinement due to the COVID-19 pandemic. Resilience, family function, and effect of the pandemic were measured using subscales of the Chinese Positive Youth Development Scale, Chinese Family Assessment Instrument, and Children's Revised Impact of Event Scale. Paired samples t test showed resilience decreased significantly after confinement. According to stepwise multiple linear regression, basal resilience, family dysfunction, higher frequencies of hyperarousal symptoms of posttraumatic stress, increased electronic device use, and relationship with caregivers were independent influential factors of resilience. COVID-19 negatively affected adolescents' resilience; therefore, stakeholders need to focus on improving resilience in this population to mitigate mental health impacts of acute stressful events. [ Journal of Psychosocial Nursing and Mental Health Services, 60 (12), 31-37.].

Phthalates have been shown to have adverse effects on neurodevelopment, which may be gender-specific. However, the association between prenatal mixed exposure to phthalates and children's neurodevelopment remains inconsistent. We measured 15 prenatal serum phthalate levels and evaluated children's neurodevelopmental indicators using Gesell Developmental Schedule (GDS) (n = 750). Generalized linear regression was fitted to examine the association. Among boys, mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP) had adverse effects on gross motor [odds ratio (OR): 7.38, 95% confidence interval (CI):1.42, 38.46]. For gross motor in boys, joint effect was discovered between mono-2-ethylhexyl phthalate (MEHP) and MEHHP. Moreover, synergistic effects were found for MEHP with vanadium and cadmium, and antagonistic effects for MEHP with magnesium, calcium, titanium, iron, copper, selenium, rubidium, and strontium. We did not find statistically significant relationships in girls. In the 1st trimester, adverse effects were identified between mono-2-ethyl-5-oxoyhexyl phthalate (MEOHP) and adaptation (P = 0.024), and monomethyl phthalate (MMP) with social area (P = 0.017). In the 2nd trimester, MEHHP had adverse effects on social area (P = 0.035). In summary, we found boys may be more vulnerable to the neurotoxicity than girls in gross motor, and we also discovered the detrimental effects of phthalates on children's neurodevelopment in the 1st and 2nd trimesters. Therefore, the supplementation of appropriate elements in the 1st and 2nd trimesters may help reduce the adverse effects of phthalates on children's neurodevelopment, especially among boys., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Chronic exposure to environmental cadmium (Cd) and lead (Pb) may have adverse effects on the human health. In this study, we aimed to determine the primary and interactive effects of Cd and Pb exposure on liver function in residents near a mining and smelting area in northwestern China. A total of 451 subjects were recruited, from which blood samples were collected to determine the levels of Cd, Pb, and liver function indices. Additionally, the association between the levels of exposure markers and liver function indices was analysed. Cd and Pb levels were significantly higher in subjects living in the polluted area than in those living in the non-polluted reference area. The liver function levels of subjects in the polluted area were poor compared with those in the reference area. In addition, Cd and Pb levels in the blood were positively associated with gamma glutamyl transpeptidase (GGT) levels and negatively associated with direct bilirubin (DBil) levels. Cd and Pb may be risk factors for abnormal liver function. The risk of abnormal liver function was higher in subjects with moderate Cd and Pb levels, high Cd levels, high Pb levels, and high Cd and Pb levels than in those with low Cd and Pb levels. Our data show that exposure to Cd and/or Pb can cause abnormal liver function. Cd and Pb may have an antagonistic effect on liver function, and high Cd exposure alone has a more profound effect on abnormal liver function compared with co-exposure to Pb and Cd., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

In this study, the data of pediatric diarrhea clinic of Gansu Provincial Maternal and Child Health Hospital from January 1, 2014 to December 31, 2018 and Tianshui First Hospital from January 1, 2015 to December 31, 2018 were collected. Standardized precipitation index (SPI) and meteorological drought composite index (MCI) were used as drought indicators. Quasi-Poisson generalized additive model was used to analyze the correlation between drought and pediatric diarrhea outpatient visits. During the study period, the dry days in Lanzhou city and Tianshui city were 298 and 379 days according to SPI-1, 303 and 398 days according to MCI, respectively. There were 57 147 and 18 703 cases of diarrhea in children aged 0-6 years in Gansu Provincial Maternal and Child Health Hospital and Tianshui First Hospital, respectively. MCI and SPI (SPI-1) based on monthly precipitation were negatively correlated with the number of pediatric diarrhea outpatients. Compared with the non-drought period, SPI-1 showed the strongest correlation between middle drought and pediatric diarrhea outpatients, with an increase of 13.4% (95% CI : 7.9%-19.3%) and 20.0% (95% CI : 12.7%-27.8%) in Lanzhou city and Tianshui city, respectively. According to MCI, the outpatients with diarrhea in Tianshui children increased by 60.5% (95% CI : 3.4%-149.0%) due to extreme drought.