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Background: Ureaplasma spp. can be classified into different serovars. It is unknown whether distinct serovars are associated with clinical signs and symptoms., Methods: We conducted a multicentre cross-sectional study. U. parvum serovars were identified on the basis of their multiple-banded antigen (MBA) genes. After adjusting for demographic variables and other reproductive tract infections, the odds ratio (OR) and 95% confidence interval (CI) were calculated to determine the impact of U. parvum serovars on clinical symptoms., Results: Among 5,277 individuals, U. parvum serovars 3 and 6 were the most prevalent serovars (17.9% and 16.0%, respectively). Potential confounders, such as age, body mass index (BMI), ethnicity, education level, contraceptive methods, number of sexual partners, gravidity, parity, and other sexually transmitted infections (STIs) that are associated with clinical symptoms (P < 0.1) were adjusted for in the univariate analysis. U. parvum serovar 14 was strongly positively associated with certain clinical symptoms, including redness and swelling of the vaginal wall (crude OR: 3.53, 95% CI: 1.92-6.49; adjusted OR: 5.21, 95% CI: 2.56-10.58), cervical bleeding and swelling (crude OR: 3.89, 95% CI: 2.38-6.36; adjusted OR: 7.37, 95% CI: 3.82-14.23), and cervical ectropion (crude OR: 2.08, 95% CI: 1.25-3.45; adjusted OR: 3.04, 95% CI: 1.60-5.74). In contrast, U. parvum serovar 3 was negatively associated with a variety of clinical symptoms, whereas no correlations were detected between U. parvum serovars 1and 6 with clinical symptoms., Conclusions: Different U. parvum serovars exhibit distinct correlations with clinical symptoms, suggesting that U. parvum serovars are pathogenically heterogeneous and that further differentiation of serovars may be necessary., Trial Registration: The study was registered with ClinicalTrials.gov ( https://www., Clinicaltrials: gov ; ID: NCT04694495; Registration Date: 2021-01-05)., (© 2024. The Author(s).)

Hospital staff in the COVID-19 local outbreak were facing different situations, their mental status and influencing factors were also different. The aim of this study is to investigate the anxiety and depression of hospital staff and its potential influence factors during the COVID-19 local outbreak. This was a cross-sectional survey based on a hospital with a local outbreak of COVID-19. We collected the demographic characteristics, COVID-19-related issues, self-rating anxiety scale (SAS), and self-rating depression scale (SDS) of participants through an anonymous questionnaire. Factors associated with anxiety and depression were explored through univariate and multivariate analyses. We also constructed nomograms and calibration curves to predict the probability of anxiety and depression. A total of 800 people completed the questionnaire. 239 (29.9%) of them were doctors, 249 (31.1%) of them were nurses and 312 (39.0%) of them were others. There were 173 (21.6%) cases had anxiety, including 36 (20.8%) doctors, 76 (43.9%) nurses and 61 (35.3%) from other occupations and 281 (35.1%) cases had depression, including 64 (22.8%) doctors, 101 (35.9%) nurses, and 116 (41.3%) from other occupations. Nurses had higher SAS and SDS score than doctors and others (F = 17.856, P < .001 and F = 14.376, P < .001). In addition, multivariate analysis found that occupation, education level, health condition, and reduced sleep were significant influences on anxiety and depression. At the same time, reduced income was also significantly associated with anxiety. During the local outbreak of COVID-19, hospital staff still had varying degrees anxiety and depression. Occupation, education level, health condition and reduced sleep were both significant influencing factors for anxiety and depression. The mental state of hospital staff, including nonmedical-related staff should still be taken seriously., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Influenza outbreaks have occurred frequently these years, especially in the summer of 2022 when the number of influenza cases in southern provinces of China increased abnormally. However, the exact evidence of the driving factors involved in the prodrome period is unclear, posing great difficulties for early and accurate prediction in practical work., Methods: In order to avoid the serious interference of strict prevention and control measures on the analysis of influenza influencing factors during the COVID-19 epidemic period, only the impact of meteorological and air quality factors on influenza A (H3N2) in Xiamen during the non coronavirus disease 2019 (COVID-19) period (2013/01/01-202/01/24) was analyzed using the distribution lag non-linear model. Phylogenetic analysis of influenza A (H3N2) during 2013-2022 was also performed. Influenza A (H3N2) was predicted through a random forest and long short-term memory (RF-LSTM) model via actual and forecasted meteorological and influenza A (H3N2) values., Results: Twenty nine thousand four hundred thirty five influenza cases were reported in 2022, accounting for 58.54% of the total cases during 2013-2022. A (H3N2) dominated the 2022 summer epidemic season, accounting for 95.60%. The influenza cases in the summer of 2022 accounted for 83.72% of the year and 49.02% of all influenza reported from 2013 to 2022. Among them, the A (H3N2) cases in the summer of 2022 accounted for 83.90% of all A (H3N2) reported from 2013 to 2022. Daily precipitation(20-50 mm), relative humidity (70-78%), low (≤ 3 h) and high (≥ 7 h) sunshine duration, air temperature (≤ 21 °C) and O 3 concentration (≤ 30 µg/m 3 , > 85 µg/m 3 ) had significant cumulative effects on influenza A (H3N2) during the non-COVID-19 period. The daily values of PRE, RHU, SSD, and TEM in the prodrome period of the abnormal influenza A (H3N2) epidemic (19-22 weeks) in the summer of 2022 were significantly different from the average values of the same period from 2013 to 2019 (P < 0.05). The minimum RHU value was 70.5%, the lowest TEM value was 16.0 °C, and there was no sunlight exposure for 9 consecutive days. The highest O 3 concentration reached 164 µg/m 3 . The range of these factors were consistent with the risk factor range of A (H3N2). The common influenza A (H3N2) variant genotype in 2022 was 3 C.2a1b.2a.1a. It was more accurate to predict influenza A (H3N2) with meteorological forecast values than with actual values only., Conclusion: The extreme weather conditions of sustained low temperature and wet rain may have been important driving factors for the abnormal influenza A (H3N2) epidemic. A low vaccination rate, new mutated strains, and insufficient immune barriers formed by natural infections may have exacerbated this epidemic. Meteorological forecast values can aid in the early prediction of influenza outbreaks. This study can help relevant departments prepare for influenza outbreaks during extreme weather, provide a scientific basis for prevention strategies and risk warnings, better adapt to climate change, and improve public health., (© 2024. The Author(s).)

Human adenovirus type 41 (HAdV-F41) usually causes pediatrics gastroenteritis. However, it was reported to be associated with the outbreaks of severe acute hepatitis of unknown aetiology (SAHUA) in pediatrics during COVID-19 pandemic. In this study, we investigated the prevalence of enteric HAdV-F41 in 37,920 paediatric gastroenteritis cases from 2017 to 2022 in Guangzhou, China. All children presented were tested negative for SARS-CoV-2 during the "zero-COVID" period. The main clinical symptom of the children was diarrhea (96.5%). No fatalities nor liver abnormal symptoms was found. In 2021, one year since the pandemic of COVID-19, the prevalence of HAdV-F41 abruptly increased from 3.71% to 8.64% (P < 0.001). All of HAdV-F41 circulating worldwide were classified into eight different subtypes (G1-G8) based on the phylogenetic clustering permutation of the four capsid genes of HAdV-F41. G3 was the predominant subtype (56.2%; 77/137). CRV5 isolates from SAHUA cases belong to this subtype, in which N312D and H335D mutations in the short fiber knob were identified in both Guangzhou and CRV5 isolates, presumably changing the virus tropism by directly interacting with the heparin sulfate (HS) receptor. Additionally, a novel recombinant G6 subtype, which is unique and only circulating in China was first identified in this study. This is the first study highlighting the prevalence of HAdV-F41 in paediatric cases of gastroenteritis during COVID-19 pandemic in China. The clinical and viral evolution finding of HAdV-F41 provide insight into the clinical characteristics of children with HAdV-F41 infections as well as the uncertain role of HAdV-F41 in the cause of SAHUA., 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.)

The imperative to preserve environmental resources has transcended traditional conservation efforts, becoming a crucial element for sustaining life. Our deep interconnectedness with the natural environment, which directly impacts our well-being, emphasizes this urgency. Contaminants such as leachate from landfills are increasingly threatening groundwater, a vital resource that provides drinking water for nearly half of the global population. This critical environmental threat requires advanced detection and monitoring solutions to effectively safeguard our groundwater resources. To address this pressing need, we introduce the Multifaceted Anomaly Detection Framework (MADF), which integrates Electrical Resistivity Tomography (ERT) with advanced machine learning models-Isolation Forest (IF), One-Class Support Vector Machines (OC-SVM), and Local Outlier Factor (LOF). MADF processes and analyzes ERT data, employing these hybrid machine learning models to identify and quantify anomaly signals accurately via the majority vote strategy. Applied to the Chaling landfill site in Zhuzhou, China, MADF demonstrated significant improvements in detection capability. The framework enhanced the precision of anomaly detection, evidenced by higher Youden Index values (≈ 6.216%), with a 30% increase in sensitivity and a 25% reduction in false positives compared to traditional ERT inversion methods. Indeed, these enhancements are crucial for effective environmental monitoring, where the cost of missing a leak could be catastrophic, and for reducing unnecessary interventions that can be resource-intensive. These results underscore MADF's potential as a robust tool for proactive environmental management, offering a scalable and adaptable solution for comprehensive landfill monitoring and pollution prevention across varied environmental settings., 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 Ltd. All rights reserved.)

Objective: At different times, public health faces various challenges and the degree of intervention measures varies. The research on the impact and prediction of meteorology factors on influenza is increasing gradually, however, there is currently no evidence on whether its research results are affected by different periods. This study aims to provide limited evidence to reveal this issue., Methods: Daily data on influencing factors and influenza in Xiamen were divided into three parts: overall period (phase AB), non-COVID-19 epidemic period (phase A), and COVID-19 epidemic period (phase B). The association between influencing factors and influenza was analysed using generalized additive models (GAMs). The excess risk (ER) was used to represent the percentage change in influenza as the interquartile interval (IQR) of meteorology factors increases. The 7-day average daily influenza cases were predicted using the combination of bi-directional long short memory (Bi-LSTM) and random forest (RF) through multi-step rolling input of the daily multifactor values of the previous 7-day., Results: In periods A and AB, air temperature below 22 °C was a risk factor for influenza. However, in phase B, temperature showed a U-shaped effect on it. Relative humidity had a more significant cumulative effect on influenza in phase AB than in phase A (peak: accumulate 14d, AB: ER = 281.54, 95% CI = 245.47 ~ 321.37; A: ER = 120.48, 95% CI = 100.37 ~ 142.60). Compared to other age groups, children aged 4-12 were more affected by pressure, precipitation, sunshine, and day light, while those aged ≥ 13 were more affected by the accumulation of humidity over multiple days. The accuracy of predicting influenza was highest in phase A and lowest in phase B., Conclusions: The varying degrees of intervention measures adopted during different phases led to significant differences in the impact of meteorology factors on influenza and in the influenza prediction. In association studies of respiratory infectious diseases, especially influenza, and environmental factors, it is advisable to exclude periods with more external interventions to reduce interference with environmental factors and influenza related research, or to refine the model to accommodate the alterations brought about by intervention measures. In addition, the RF-Bi-LSTM model has good predictive performance for influenza., (© 2024. The Author(s).)

Objective: To explore the association between green space, multiple ambient air pollutants and depressive/anxiety symptoms and the mediating role of physical activity (PA) in Chinese adolescents., Method: A school-based health survey was conducted in eight provinces in China in 2021. 22,868 students aged 14.64 (±1.77) years completed standard questionnaires to record details of depressive, anxiety symptoms and PA. We calculated the average normalized difference vegetation index (NDVI) in circular buffers of 200 m, 500 m and 1000 m and estimated the concentrations of PM 10 , PM 2.5 , CO, NO 2 , O 3 , SO 2 around the adolescents' school addresses., Results: The exposure-response curves showed that the lower the NDVI value, the higher the risk of depressive and anxiety symptoms. CO, PM 2.5 and SO 2 and air pollution score were associated with increased risk of depressive and anxiety symptoms. NDVI in all circular buffers decreased the risk of depressive and anxiety symptoms at low levels of PA, but the associations were not significant at high levels of PA. In the subgroup analysis, PM 10 , PM 2.5 , CO, NO 2 , SO 2 , AQI and air pollution score increased the risk of depressive and anxiety symptoms at low PA levels, but the associations were not significant at high levels of PA. Mediation analysis indicated that the mediating effect of PA on the association between NDVI, NDVI-200 m NDVI-500 m, CO, PM 10 , PM 2.5 , SO 2 , AQI and depressive/anxiety symptoms was statistically significant（p < 0.05）., Conclusion: Middle-high level PA could reduce the strength of association between air pollution and depressive and anxiety symptoms. Meanwhile, the association between green space/air pollution and depressive/anxiety symptoms was partly mediated by PA., 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 Ltd.. All rights reserved.)

Background: In the practical application of sarcopenia screening, there is a need for faster, time-saving, and community-friendly detection methods. The primary purpose of this study was to perform sarcopenia screening in community-dwelling older adults and investigate whether surface electromyogram (sEMG) from hand grip could potentially be used to detect sarcopenia using machine learning (ML) methods with reasonable features extracted from sEMG signals. The secondary aim was to provide the interpretability of the obtained ML models using a novel feature importance estimation method., Methods: A total of 158 community-dwelling older residents (≥ 60 years old) were recruited. After screening through the diagnostic criteria of the Asian Working Group for Sarcopenia in 2019 (AWGS 2019) and data quality check, participants were assigned to the healthy group (n = 45) and the sarcopenic group (n = 48). sEMG signals from six forearm muscles were recorded during the hand grip task at 20% maximal voluntary contraction (MVC) and 50% MVC. After filtering recorded signals, nine representative features were extracted, including six time-domain features plus three time-frequency domain features. Then, a voting classifier ensembled by a support vector machine (SVM), a random forest (RF), and a gradient boosting machine (GBM) was implemented to classify healthy versus sarcopenic participants. Finally, the SHapley Additive exPlanations (SHAP) method was utilized to investigate feature importance during classification., Results: Seven out of the nine features exhibited statistically significant differences between healthy and sarcopenic participants in both 20% and 50% MVC tests. Using these features, the voting classifier achieved 80% sensitivity and 73% accuracy through a five-fold cross-validation. Such performance was better than each of the SVM, RF, and GBM models alone. Lastly, SHAP results revealed that the wavelength (WL) and the kurtosis of continuous wavelet transform coefficients (CWT&#95;kurtosis) had the highest feature impact scores., Conclusion: This study proposed a method for community-based sarcopenia screening using sEMG signals of forearm muscles. Using a voting classifier with nine representative features, the accuracy exceeds 70% and the sensitivity exceeds 75%, indicating moderate classification performance. Interpretable results obtained from the SHAP model suggest that motor unit (MU) activation mode may be a key factor affecting sarcopenia., (© 2024. The Author(s).)

Photochemical ozone (O 3 ) formation in the atmospheric boundary layer occurs at both the surface and elevated altitudes. Therefore, the O 3 formation sensitivity is needed to be evaluated at different altitudes before formulating an effective O 3 pollution prevention and control strategy. Herein, we explore the vertical evolution of O 3 formation sensitivity via synchronous observations of the vertical profiles of O 3 and proxies for its precursors, formaldehyde (HCHO) and nitrogen dioxide (NO 2 ), using multi-axis differential optical absorption spectroscopy (MAX-DOAS) in urban areas of the Beijing-Tianjin-Hebei (BTH), Yangtze River Delta (YRD), and Pearl River Delta (PRD) regions in China. The sensitivity thresholds indicated by the HCHO/NO 2 ratio (FNR) varied with altitude. The VOC-limited regime dominated at the ground level, whereas the contribution of the NO x -limited regime increased with altitude, particularly on heavily polluted days. The NO x -limited and transition regimes played more important roles throughout the entire boundary layer than at the surface. The feasibility of extreme NO x reduction to mitigate the extent of the O 3 pollution was evaluated using the FNR-O 3 curve. Based on the surface sensitivity, the critical NO x reduction percentage for the transition from a VOC-limited to a NO x -limited regime is 45-72%, which will decrease to 27-61% when vertical evolution is considered. With the combined effects of clean air action and carbon neutrality, O 3 pollution in the YRD and PRD regions will transition to the NO x -limited regime before 2030 and be mitigated with further NO x reduction.

Objective: To analyze the incidence trend and epidemiological characteristics of typhoid fever in Fujian Province from 2011 to 2022, and understand the high-incidence population and hotspot areas, and provide evidences to develop more targeted prevention and control measures. Methods: The surveillance data of typhoid fever during 2011-2022 in Fujian Province were obtained from the National Disease Reporting Information System and analyzed with SAS 9.4. The spatial autocorrelation analysis of typhoid fever incidence at county/district levels was performed with ArcGlS 10.8. Results: A total of 5 126 cases of typhoid fever were reported in Fujian Province from 2011 to 2022, with an average annual incidence rate of 1.10/100 000. The average annual incidence rate was 0.96/100 000 from 2011 to 2015, 1.49/100 000 from 2016 to 2019, and 0.81/100 000 from 2020 to 2022. The disease occurred all the year round, with high epidemic season from May to September. A total of 23.59% (1 209/5 126) of the cases occurred at the age of 0-4, and 9.62% (493/5 126) at the age of 5-9. The male to female ratio of the cases was 0.97∶1 (2 524∶2 602) for the whole population, 1.19∶1 (925∶777) for people under 10 years old, 0.75∶1 (1 060∶1 404) for people between 10 and 54 years old, and 1.28∶1 (539∶421) for people over 55 years old. Cases in Ningde City accounted for 30.65% (1 571/5 126) of the total cases. Most hotspots were occurred in Ningde City. Recurrent and clustered cases were found in family members. Conclusions: Typhoid fever was prevalent at a low level in Fujian Province during 2011-2022, indicating that strengthening the prevention and control measures should target key areas and populations. The incidence of typhoid fever in Fujian Province showed spatial aggregation phenomenon, and most cases gathered in Ningde City. Intensive study for the influencing factors of spatial clustering should be conducted.

The purpose is to ascertain the clinical impact of Castleman disease (CD) by reassessment of the real-world data from Peking University First Hospital (PKUFH). The results will contribute to the standardization of diagnosis and treatment on CDs. Based on the last 15-year retrospective real-world data from Peking University First Hospital (PKUFH), we reclassified and re-evaluated the clinical and pathological information of patients with pathologically suspected diagnosis of CD. A total of 203 patients were included in our study, in which the diagnosis of CD was confirmed in 189 cases, including 118 patients with unicentric CD (UCD, n = 118, 62.4%) and 71 patients with multicentric CD (MCD, n = 71, 37.6%). A total of 44.1% (n = 52) of UCDs in our cohort were complicated with paraneoplastic pemphigus (PNP). The treatment of UCD is primarily surgical, with a 5-year overall survival (OS) of 88.1%. Patients with PNP had a poorer prognosis than those without PNP (82.9% (95% CI 123-178) vs 92.8% (95% CI 168-196), log-rank p = 0.041). The rate of concurrent systemic symptoms was 74.6% (n = 53), and renal involvement occurred in 49.3% (n = 35) MCD patients. The MCD treatments were mainly chemotherapy regimens, with a 5-year OS of 77.6% (95% CI, 143-213). Patients with UCD demonstrate a better overall prognosis than patients with MCD. But the prognosis of those complicated with PNP was poor. The differential diagnosis of MCD is extensive. MCD treatment in China is heterogeneous. The inaccessibility of anti-IL-6-targeted drugs in China may contribute to the poor prognosis for patients with MCD.A preprint has previously been published (Guo et al. 34)., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: More than 90% of the Chinese population have completed 2 doses of inactivated COVID-19 vaccines in Mainland China. However, after China government abandoned strict control measures, many breakthrough infections appeared, and vaccine effectiveness against Omicron BA.2 infection was uncertain. This study aims to investigate the real-world effectiveness of widely used inactivated vaccines during the wave of Omicron variants., Methods: Test-negative case-control study was conducted in this study to analyze the vaccine effectiveness against symptomatic disease caused by the Omicron variant (BA.2) in Fujian, China. Conditional logistic regression was selected to estimate the vaccine effectiveness., Results: The study found the vaccine effectiveness against symptomatic COVID-19 is 32.46% (95% CI, 8.08% to 50.37%) at 2 to 8 weeks, and 27.05% (95% CI, 1.23% to 46.12%) at 12 to 24 weeks after receiving booster doses of the inactivated vaccine. Notably, the 3-17 years group had higher vaccine effectiveness after 2 doses than the 18-64 years and over 65 years groups who received booster doses., Conclusion: Inactivated vaccines alone may not offer sufficient protection for all age groups before the summer of 2022. To enhance protection, other types of vaccines or bivalent vaccines should be considered., 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 Ye, Li, Zhao, Wu, Qu, Guo, Abudunaibi, Chen, Cai, Chen, Lin, Xie, Zhan, Ou, Deng, Chen and Zheng.)

Objectives: To evaluate the impact of early implementation of public health and social measures (PHSMs) on contact rates over time and explore contact behavior of asymptomatic versus symptomatic cases., Methods: We used the largest contact tracing data in China thus far to estimate the mean contacts over time by age groups and contact settings. We used bootstrap with replacement to quantify the uncertainty of contact matrixes. The Pearson correlation was performed to demonstrate the number of contacts over time in relation to the evolution of restrictions. In addition, we analyzed the index cases with a high number of contacts and index cases that produced a high number of secondary cases., Results: Rapidly adapted PHSMs can reduce the mean contact rates in public places while increasing the mean contact rates within households. The mean contact rates were 11.81 (95% confidence interval, 11.61-12.01) for asymptomatic (at the time of investigation) cases and 6.70 (95% confidence interval, 6.54-6.87) for symptomatic cases. The percentage of asymptomatic cases (at the time of investigation) meeting >50 close contacts make up more than 65% of the overall cases. The percentage of asymptomatic cases producing >10 secondary cases account for more than 80% of the overall cases., Conclusion: PHSMs may increase the contacts within the household, necessitating the need for pertinent prevention strategies at home. Asymptomatic cases can contribute significantly to Omicron transmission. By making asymptomatic people aware that they are already contagious, hence limiting their social contacts, it is possible to lower the transmission risk., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: This study adopted complete meteorological indicators, including eight items, to explore their impact on hand, foot, and mouth disease (HFMD) in Fuzhou, and predict the incidence of HFMD through the long short-term memory (LSTM) neural network algorithm of artificial intelligence., Method: A distributed lag nonlinear model (DLNM) was used to analyse the influence of meteorological factors on HFMD in Fuzhou from 2010 to 2021. Then, the numbers of HFMD cases in 2019, 2020 and 2021 were predicted using the LSTM model through multifactor single-step and multistep rolling methods. The root mean square error (RMSE), mean absolute error (MAE), mean absolute percentage error (MAPE) and symmetric mean absolute percentage error (SMAPE) were used to evaluate the accuracy of the model predictions., Results: Overall, the effect of daily precipitation on HFMD was not significant. Low (4 hPa) and high (≥ 21 hPa) daily air pressure difference (PRSD) and low (< 7 °C) and high (> 12 °C) daily air temperature difference (TEMD) were risk factors for HFMD. The RMSE, MAE, MAPE and SMAPE of using the weekly multifactor data to predict the cases of HFMD on the following day, from 2019 to 2021, were lower than those of using the daily multifactor data to predict the cases of HFMD on the following day. In particular, the RMSE, MAE, MAPE and SMAPE of using weekly multifactor data to predict the following week's daily average cases of HFMD were much lower, and similar results were also found in urban and rural areas, which indicating that this approach was more accurate., Conclusion: This study's LSTM models combined with meteorological factors (excluding PRE) can be used to accurately predict HFMD in Fuzhou, especially the method of predicting the daily average cases of HFMD in the following week using weekly multifactor data., (© 2023. The Author(s).)

Green innovation is an important strategy in seeking sustainable competitive advantages. This paper investigates the impact of enterprise digitization on green innovation and its mechanisms. We find that enterprise digital transformation has a significant effect on the promotion of green innovation. This positive effect mainly stems from the advantage of resource reallocation generated by enterprise digitalization that can alleviate financing constraints and raise risk-taking levels. Furthermore, the level of economic development strengthens the impact of enterprise digitization on green innovation, and the positive relationship between enterprise digitization and green innovation is stronger in regions with stronger environmental regulation and higher intellectual property protection, as well as in state-owned and heavily polluting enterprises. Digitization can optimize resource utilization, strengthen the capacity of green innovation in pollution reduction and promote the clean production of enterprises. Our results show that enterprise digitization plays a positive role in innovation activities. Furthermore, our results show that enterprise digitization plays a positive role in innovation activities.

Formaldehyde (HCHO) plays a critical role in atmospheric photochemistry and public health. While existing studies have suggested that vehicular exhaust is an important source of HCHO, the operating condition-based diesel truck HCHO emission measurements remain severely limited due to the limited temporal resolution and accuracy of measurement techniques. In this study, we characterized the second-by-second HCHO emissions from 29 light-duty diesel trucks (LDDTs) in China over dynamometer and real-world driving tests using a portable online HCHO emission measurement system (PEMS-HCHO), considering various operating conditions. Our results suggested that the HCHO emissions from LDDTs might be underestimated by the widely used offline DNPH-HPLC method. The HCHO emissions at a 200 s cold start from China V LDDT can be up to 50 mg/start. Different driving conditions over dynamometer and real-world driving tests led to a 2-4 times difference in the HCHO emission factors (EFs). Under real-world hot-running conditions, the HCHO EFs of China III, IV, V, and VI LDDTs were 43.5 ± 35.7, 10.6 ± 14.2, 8.8 ± 5.1, and 3.2 ± 1.2 mg/km, respectively, which significantly exceeded the latest California low emission vehicle III HCHO emission standard (2.5 mg/km). These findings highlighted the significant impact of vehicle operating conditions on HCHO emissions and the urgency of regulating HCHO emissions from LDDTs in China.

We aimed to investigate and compare the psychometric properties of the Chinese Mandarin Social Responsiveness Scale-2 (SRS-2) and its shortened version. The study assessed 670 children with autism spectrum disorder (ASD) aged 30-54 months and 138 typical developmental (TD) children of the same age in mainland China. Our item reliability test revealed that only 36 items of the 65 items in the Chinese Mandarin SRS-2 (Preschool) met the reliability criteria. Moreover, the shortened version of SRS-2 (Preschool) with four subscales and 30 items maintained strong correlations (r = 0.961) with the Chinese Mandarin SRS-2 (Preschool), and demonstrated improved psychometric performance on the 4-week test-retest reliability (intraclass correlations was 0.70), internal consistency (Cronbach's alpha 0.71-0.91), construct validity, and convergent validity with the Autism Diagnostic Observation Schedule, Autism Diagnostic Interview-Revised, and Child Behavior Checklist. Receiver operating characteristics (ROC) analyses showed excellent and comparable discriminant validity of the shortened version with an area under the curve of 0.992. Our data suggested a cutoff ≥ 22.5 for the shortened version, with good accuracy in screening autism symptoms (sensitivity=96.9 %, specificity=94.2 %). Our findings demonstrated that the shortened version of SRS-2 (Preschool) was a reliable and valid instrument for identifying preschoolers with ASD in mainland China., Competing Interests: Conflict of interest The authors declare no conflict of interest. Conflict of interest Ph.D. Ou had access to the SRS-2 (Preschool) from Western Psychological Services (Licence #: WPS-001646)., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Influenza epidemics pose a threat to human health. It has been reported that meteorological factors (MFs) are associated with influenza. This study aimed to explore the similarities and differences between the influences of more comprehensive MFs on influenza in cities with different economic, geographical and climatic characteristics in Fujian Province. Then, the information was used to predict the daily number of cases of influenza in various cities based on MFs to provide bases for early warning systems and outbreak prevention., Method: Distributed lag nonlinear models (DLNMs) were used to analyse the influence of MFs on influenza in different regions of Fujian Province from 2010 to 2021. Long short-term memory (LSTM) was used to train and model daily cases of influenza in 2010-2018, 2010-2019, and 2010-2020 based on meteorological daily values. Daily cases of influenza in 2019, 2020 and 2021 were predicted. The root mean squared error (RMSE), mean absolute error (MAE), mean absolute percentage error (MAPE) and symmetric mean absolute percentage error (SMAPE) were used to quantify the accuracy of model predictions., Results: The cumulative effect of low and high values of air pressure (PRS), air temperature (TEM), air temperature difference (TEMD) and sunshine duration (SSD) on the risk of influenza was obvious. Low (< 979 hPa), medium (983 to 987 hPa) and high (> 112 hPa) PRS were associated with a higher risk of influenza in women, children aged 0 to 12 years, and rural populations. Low (< 9 °C) and high (> 23 °C) TEM were risk factors for influenza in four cities. Wind speed (WIN) had a more significant effect on the risk of influenza in the ≥ 60-year-old group. Low (< 40%) and high (> 80%) relative humidity (RHU) in Fuzhou and Xiamen had a significant effect on influenza. When PRS was between 1005-1015 hPa, RHU > 60%, PRE was low, TEM was between 10-20 °C, and WIN was low, the interaction between different MFs and influenza was most obvious. The RMSE, MAE, MAPE, and SMAPE evaluation indices of the predictions in 2019, 2020 and 2021 were low, and the prediction accuracy was high., Conclusion: All eight MFs studied had an impact on influenza in four cities, but there were similarities and differences. The LSTM model, combined with these eight MFs, was highly accurate in predicting the daily cases of influenza. These MFs and prediction models could be incorporated into the influenza early warning and prediction system of each city and used as a reference to formulate prevention strategies for relevant departments., (© 2022. The Author(s).)

Background: Based on the theory of postural control and the role of cognitive capacity, this study analyses how physical ability and somatosensory impairment influence affective symptoms in patients with stroke., Methods: The cross-sectional study with a consecutive sampling approach was conducted in 10 different rehabilitation departments in Yunnan Province, China between August 2019 and February 2021. A total of 1,058 patients with stroke were included according to the inclusion criteria and exclusive criteria. Their important functions were evaluated including somatosensory measurement, Brunnstrom recovery stage, manual muscle testing (MMT), Barthel index (BI), mini-balance evaluation systems test (Mini-BEST), Montreal Cognitive Assessment (MoCA), Hamilton Anxiety Scale (HAM-A), and Hamilton Depression Scale (HAM-D). Exploratory Factor Analysis was used to construct the measure models. A path analysis was performed to estimate the role of balance impairment and cognitive capacity as mediators in the relationships between somatosensory impairment, physical ability and affective symptoms., Results: By comparing two models, the final model indicated a good global model fit to the data [χ2=243.5, χ2/df=5.181, goodness-of-fit index (GFI) =0.977, comparative five index (CFI) =0.944, Tucker-Lewis index (TLI) =0.922, standardized root mean square residual (SRMR) =0.063, and root mean square error of approximation (RMSEA) =0.063, Akaike information criterion (AIC) =303.51, Bayesian information criterion (BIC) =304.26], although Chi-square test was not significant due to the large sample size. In the path analysis, somatosensory impairment significantly negative influenced balance impairment (P<0.05, β=-0.061), and physical ability significantly positively affected balance impairment (P<0.001, β=0.893). A mediation analysis was conducted to show that balance impairment mainly mediated the relationship between physical ability and affective symptoms (R2=0.996), while the relationship between physical ability and affective symptoms was mediated slightly by cognitive capability (R2=0.108)., Conclusions: These results suggest that balance impairment mainly mediates the relationship between physical ability and affective symptoms, while cognitive capacity slightly medicates this relationship. Rehabilitation professionals and family caregivers should pay more attention to balance function, which will help to strengthen the physical ability and improve post-stroke mood disorders.

Background: For patients taking esophagogastroduodenoscopy (EGD), sedation should ideally be used individually based on patients' comfort and tolerance level. However, currently there is no valid predictive tool. We undertook this study to develop and temporally validate a self-assessment tool for predicting discomfort and tolerance in Chinese patients undergoing EGD., Methods: We recruited 1522 patients undergoing routine diagnostic EGD without sedation. We collected candidate predictor variables before endoscopy and evaluated discomfort and tolerance with a 5-point visual analogue scale after the procedure. We developed logistic regression predictive models based on the first 2/3 of participants, and evaluated the calibration and discrimination of the models in the later 1/3 of patients., Results: 30.2% and 23.0% participants reported severe discomfort or poor tolerance to EGD respectively. The predictive factors in the model for discomfort included sex, education, expected level of discomfort, and anxiety before endoscopy. The model for tolerance included income, expected level of discomfort, and anxiety before endoscopy. In the validation population, the established models showed a moderate discriminative ability with a c-index of 0.74 for discomfort and 0.78 for tolerance. Hosmer-Lemeshow test suggested the models had fine calibration ability (discomfort: P = 0.37, tolerance: P = 0.41)., Conclusions: Equations for predicting discomfort and tolerance in Chinese patients undergoing EGD demonstrated moderate discrimination and variable calibration. Further studies are still required to validate these tools in other population., Trial Registration: Chinese Clinical Trial Registry (ChiCTR1800020236)., (© 2022. The Author(s).)

Open biomass burning (OBB) is an important source of air pollutants and greenhouse gases, but its dynamic emission estimation remains challenging. Existing OBB emission datasets normally provide daily estimates based upon Moderate Resolution Imaging Spectroradiometer (MODIS) retrievals but tend to underestimate the emissions due to the coarse spatial resolution and sparse observation frequency. In this study, we proposed a novel approach to improve OBB emission estimations by fusing multiple active fires detected by MODIS, Visible Infrared Imaging Radiometer onboard the Suomi National Polar-orbiting Partnership (VIIRS S-NPP) and Himawari-8. The fusion of multiple active fires can capture the missing small fires and the large fires take place during the non-overpass time of MODIS observations. Also, regional-based fire radiative power (FRP) cycle reconstruction models and OBB emission coefficients were developed to address the large spatial discrepancies of OBB emission estimations across China and to promote the estimate to an hourly resolution. Using the new approach, hourly gridded OBB emissions in China were developed and can be updated with a lag of 1-day, or even near-real-time when real-time multiple active fires are available. OBB emissions in China based on this approach were more than 3 times of those in previous datasets. Evaluations revealed that the spatial distribution of the estimated PM 2.5 emissions from this study was more consistent with the ambient PM 2.5 concentrations during several episodes than existing datasets. The hourly OBB emissions provide new insight into its spatiotemporal variations, enhance timely and reliable air quality modeling and forecast, and support the formulation of accurate prevention and control policies of OBB., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier B.V.)

The conventional Ensemble Kalman filter (EnKF), which is now widely used to calibrate emission inventories and to improve air quality simulations, is susceptible to simulation errors of meteorological inputs, making accurate updates of high temporal-resolution emission inventories challenging. In this study, we developed a novel meteorologically adjusted inversion method (MAEInv) based on the EnKF to improve daily emission estimations. The new method combines sensitivity analysis and bias correction to alleviate the inversion biases caused by errors of meteorological inputs. For demonstration, we used the MAEInv to inverse daily carbon monoxide (CO) emissions in the Pearl River Delta (PRD) region, China. In the case study, 60% of the total CO simulation biases were associated with sensitive meteorological inputs, which would lead to the overestimation of daily variations of posterior emissions. Using the new inversion method, daily variations of emissions shrank dramatically, with the percentage change decreased by 30%. Also, the total amount of posterior CO emissions estimated by the MAEInv decreased by 14%, indicating that posterior CO emissions might be overestimated using the conventional EnKF. Model evaluations using independent observations revealed that daily CO emissions estimated by MAEInv better reproduce the magnitude and temporal patterns of ambient CO concentration, with a higher correlation coefficient (R, +37.0%) and lower normalized mean bias (NMB, -17.9%). Since errors of meteorological inputs are major sources of simulation biases for both low-reactive and reactive pollutants, the MAEInv is also applicable to improve the daily emission inversions of reactive pollutants., (Copyright © 2021. Published by Elsevier B.V.)

Bovine hepacivirus (BovHepV) is a novel virus that was recently discovered in Ghana and Germany in 2015. Until now, this virus has been identified in cattle population worldwide and is classified into subtypes A-G. To fully understand the epidemic situation and genetic characteristic of BovHepV in China, a total of 612 cattle serum samples were collected from 20 farms in seven provinces and municipality in China between 2018 and 2020 and were tested for the presence of BovHepV RNA via semi-nested PCR. The results demonstrated that 49 (8.0%) samples were BovHepV RNA-positive. It is noted that BovHepV infection in yak was confirmed for the first time. BovHepV was detected in all the seven provinces, with the positive rate ranging from 3.1% to 13.3%, which indicates a wide geographical distribution pattern of BovHepV in China. Sequencing results revealed that 5' UTR of the 49 field BovHepV strains have a nucleotide similarity of 96.3%-100% between each other and 93.9%-100% with previously reported BovHepV strains. In addition, genetic analysis identified five critical nucleotide sites in 5' UTR to distinguish different subtypes, which was further verified by genomic sequencing and nucleotide similarity analysis. All the 49 Chinese field BovHepV strains were classified into subtype G and this subtype is only determined in cattle in China currently. This study will provide insights for us to better understand the epidemiology and genetic diversity of BovHepV., Competing Interests: Conflict of interest The authors declare that they have no conflict of interest., (Copyright © 2022 The Authors. Publishing services by Elsevier B.V. All rights reserved.)

Objective: To analyze the repetitive reporting of hepatitis B in Fujian province during 2016-2020, and provide evidence for the improvement of hepatitis B surveillance. Methods: The reporting cards from the China Information System for Disease Control and Prevention were collected and divided into repetitive reporting cards and non-repetitive reporting cards from the report cards collected according to the valid ID number on the cards, and the proportion of repetitive report cards and related factors were analyzed by using software SAS 9.4. Results: A total of 314 551 hepatitis B reporting cards were submitted in Fujian from 2016 to 2020, in which 90.93% (286 020/314 551) were included in the analysis. The repetitive reporting cards accounted for 10.48% (29 982/286 020). The annual proportion of the repetitive reporting cards from 2016 to 2020 was between 2.98% and 3.71%, showing an overall increasing trend year by year ( Z =2.26, P =0.024). The proportions of the repetitive reporting cards in 1-5 years were 3.17%, 5.40%, 7.74%, 9.27% and 10.48%, respectively, showing an increase trend with year ( Z =128.16, P <0.001). The proportions of the repetitive reporting cards in 10 areas of Fujian ranged from 5.44% to 13.48% with significant difference ( χ 2 =2 050.41, P <0.001) and increased with the increase of reported incidence of hepatitis B ( Z =26.92, P <0.001). There were significant differences in relationships between repetitive reporting proportion and sex, age and type of the cases between the areas with high incidence and low incidence of hepatitis B. Conclusions: The reported incidence of hepatitis B was seriously affected by the repetitive reporting in Fujian from 2016 to 2020. A cross-year and cross-area surveillance mechanism for hepatitis B should be established and targeted measures should be taken to strengthen the control of the repetitive reporting and improve the surveillance for hepatitis B.

Abundant behavioral studies have demonstrated high comorbidity of reading and handwriting difficulties in developmental dyslexia (DD), a neurological condition characterized by unexpectedly low reading ability despite adequate nonverbal intelligence and typical schooling. The neural correlates of handwriting deficits remain largely unknown; however, as well as the extent that handwriting deficits share common neural bases with reading deficits in DD. The present work used functional magnetic resonance imaging to examine brain activity during handwriting and reading tasks in Chinese dyslexic children (n = 18) and age-matched controls (n = 23). Compared to controls, dyslexic children exhibited reduced activation during handwriting tasks in brain regions supporting sensory-motor processing (including supplementary motor area and postcentral gyrus) and visual-orthography processing (including bilateral precuneus and right cuneus). Among these regions, the left supplementary motor area and the right precuneus also showed a trend of reduced activation during reading tasks in dyslexics. Moreover, increased activation was found in the left inferior frontal gyrus and anterior cingulate cortex in dyslexics, which may reflect more efforts of executive control to compensate for the impairments of motor and visual-orthographic processing. Finally, dyslexic children exhibited aberrant functional connectivity among brain areas for cognitive control and sensory-motor processes during handwriting tasks. Together, these findings suggest that handwriting deficits in DD are associated with functional abnormalities of multiple brain regions implicated in motor execution, visual-orthographic processing, and cognitive control, providing important implications for the diagnosis and treatment of dyslexia., (© 2021 The Authors. Developmental Science published by John Wiley & Sons Ltd.)

The enrichment of heavy metals in air-borne particulate matters poses a great threat to health. In order to understand the mineralogical characteristics and sources of heavy metals in atmospheric particulate matter in coal mining cities, PM 2.5 (particulate matter with an aerodynamic diameter less than 2.5 μm), PM 10 (particulate matter with an aerodynamic diameter less than 10 μm) and TSP (total suspended particulates) were sampled from Huainan city, China in December 2016 and May 2017. The contents of heavy metals in TSP are the highest, while those in PM 2.5 are the lowest. Zn, Mn, and Pb are the main components of heavy metals in Huainan atmospheric particulates. Straw burning activities may result in relatively higher atmospheric particulate matter content in summer than that in winter. The proportion of mineral particles in the studied particulate matters was the highest (40.79%), followed by soot aggregates (35.55%) and coal fly ash (19.74%). The results of energy spectrum analysis show that the main component of soot aggregates is C, and other contents are contributed by elements such as O and Si. Coal fly ash mainly contains C, O, Si, and a small amount of Al and Na. As, Cd, and Hg are the most easily enriched heavy metals. Industrial emissions, traffic discharges, coal combustion and dust emissions were found to be the main sources of heavy metals in atmospheric particulates., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

New particle formation (NPF) events are an increasingly interesting topic in air quality and climate science. In this study, the particle number size distributions, and the frequency of NPF events over Hefei were investigated from November 2018 to February 2019. The proportions of the nucleation mode, Aitken mode, and accumulation mode were 24.59%, 53.10%, and 22.30%, respectively, which indicates the presence of abundant ultrafine particles in Hefei. Forty-six NPF events occurred during the observation days, accounting for 41.82% of the entire observation period. Moreover, the favorable meteorological conditions, potential precursor gases, and PM 2.5 range of the NPF events were analyzed. Compared to non-NPF days, the NPF events preferentially occurred on days with lower relative humidity, higher wind speeds, and higher temperatures. When the PM 2.5 was 15-20, 70-80, and 105-115 μg/m 3 , the frequency of the NPF events was higher. Nucleation mode particles were positively related to atmospheric oxidation indicated by ozone when PM 2.5 ranged from 15 to 20 μg/m 3 , and related to gaseous precursors like SO 2 and NO 2 when PM 2.5 was located at 70-80 and 105-115 μg/m 3 . On pollution days, NPF events did not directly contribute to the increase in the PM 2.5 in the daytime, however, NPF events would occur during the night and the growth of particulate matter contributes to the nighttime PM 2.5 contents. This could lead to pollution that lasted into the next day. These findings are significant to the improvement of our understanding of the effects of aerosols on air quality., (Copyright © 2021. Published by Elsevier B.V.)

To provide an overview of the current situation, challenges, and trends in online medical services from the perspective of andrology and promote the development of online medical services. Users of the Learning Alliance of Urology, who mainly worked in central regions of China, were invited to complete the questionnaire that included information on the participants and their institutions and their involvement in and concerns for online medical services. We received 875 complete responses. The percentage of online andrology patients at most institutions was less than 30%. The most common services were online appointment registration (92.7%) and online payment (81.8%). Online chat consultation (77.7%) was the most common form of consultation. Only 1 in 5 of the institutions had constructed their Internet hospital. Factors related to the percentage of online andrology patients included specialized andrology clinics and wards, sufficient time for doctors to provide online services, more diversified services, and online clinic training. The biggest challenge for online medical services was diagnosis and treatment safety. It is essential to raise awareness of online medical services for hospitals and patients and strengthen standardized management and training of online medical services, especially applicable to central regions of China. However, online medical services cannot wholly replace offline services due to insufficient diagnosis and treatment.

Parvovirus is a common element of the feline virus group and usually causes gastroenteritis and leukopenia in cats. In this study, we identified a novel protoparvovirus from the Chinese domestic cats, which is genetically similar to canine bufavirus (98.0%-99.8%), but sharing low amino acid identities in the viral structural proteins 2 (VP2) (36.1-37.2%) to the well-known canine parvovirus type 2 and feline panleukopenia virus. This virus was provisionally designated as feline bufavirus (FBuV). Screening of fecal samples revealed a prevalence of 7.4% (19/257) in domestic cats. Diarrhea was present in 52.6% (10/19) of cats positive for FBuV. However, statistical analysis showed no association between FBuV and clinical signs. VP2 gene of the 19 field FBuV was sequenced and phylogenetic analysis demonstrated that FBuV determined from China had a genetic diversity. This study will strengthen the understanding of the epidemiology and genetic diversity of bufavirus and provide a foundation for further studies., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Abstract: We aimed to investigate the genetic and demographic differences and interactions between areas where observed genomic variations in Mycobacterium tuberculosis (M. tb) were distributed uniformly in cold and hot spots.The cold and hot spot areas were identified using the reported incidence of TB over the previous 5 years. Whole genome sequencing was performed on 291 M. tb isolates between January and June 2018. Analysis of molecular variance and a multifactor dimensionality reduction (MDR) model was applied to test gene-gene-environment interactions. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were computed to test the extent to which genetic mutation affects the TB epidemic using a multivariate logistic regression model.The percentage of the Beijing family strain in hot spots was significantly higher than that in cold spots (64.63% vs 50.69%, P = .022), among the elderly, people with a low BMI, and those having a history of contact with a TB patient (all P < .05). Individuals from cold spot areas had a higher frequency of out-of-town traveling (P < .05). The mutation of Rv1186c, Rv3900c, Rv1508c, Rv0210, and an Intergenic Region (SNP site: 3847237) showed a significant difference between cold and hot spots. (P < .001). The MDR model displayed a clear negative interaction effect of age groups with BMI (interaction entropy: -3.55%) and mutation of Rv0210 (interaction entropy: -2.39%). Through the mutations of Rv0210 and BMI had a low independent effect (interaction entropy: -1.46%).Our data suggests a statistically significant role of age, BMI and the polymorphisms of Rv0210 genes in the transmission and development of M. tb. The results provide clues for the study of susceptibility genes of M. tb in different populations. The characteristic strains showed a local epidemic. Strengthening genotype monitoring of strains in various regions can be used as an early warning signal of epidemic spillover., Competing Interests: The authors have no conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Studying the characteristics of new particle formation (NPF) is conducive to exploring the impact of atmospheric particulate matter on the climate, environment, and human health. The particle number size distributions (5.6-560 nm) of aerosols were measured using a fast mobility particle sizer (FMPS) from 1 to 11 May 2019. The clean atmosphere was one of the basic conditions for the occurrence of this continuous new particle formation events. It started between 9:00 and 12:00, and it mainly ended after 20:00. The growth rate (GR) and condensation sink (CS) values in Hefei were 2.98 ± 0.97 nm·h -1 and (3.0 ± 0.4) × 10 -2 s -1 , respectively. Back trajectory clustering analysis revealed that the mass concentration of the air masses from the southeastern part of Henan Province and the southern part of Anhui Province surrounding the study area were relatively high. The analysis results of the potential source contribution function (PSCF) and the concentration weighted trajectory (CWT) methods show that in addition to local pollution, the long-distance transport of pollutants in the Yangtze River Delta (YRD) greatly contributed to the accumulation modal particulate concentration in Hefei. Moreover, the population affected by PM 2.5 during the observation period reached 8.19 × 10 4 , accounting for 1.08% to the total population in Hefei. The premature death cases associated with PM 2.5 reached 8.35 × 10 2 . This study is helpful to understand the main influencing factors of consecutive NPF events and the health risks of fine particles., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis (Mtb). China is the third in top 8 high TB burden countries and Guangxi is one of the high incidence areas in South China. Determine bacterial factors that affected TB incidence rate is a step toward Ending the TB epidemic., Results: Genomes of M. tuberculosis cultures from a relatively high and low incidence region in Guangxi have been sequenced. 347 of 358(96.9%) were identified as M. tuberculosis. All the strains belong to Lineage 2 and Lineage 4, except for one in Lineage 1. We found that the genetic structure of the M. tuberculosis population in each county varies enormously. Low incidence rate regions have a lower prevalence of Beijing genotypes than other regions. Four isolates which harbored mutT4-48 also had mutT2-58 mutations. It is suggested that strains from the ancestors of modern Beijing lineage is circulating in Guangxi. Strains of modern Beijing lineage (OR=2.04) were more likely to acquire drug resistances than Lineage 4. Most of the lineage differentiation SNPs are related to cell wall biosynthetic pathways., Conclusions: These results provided a higher resolution to better understand the history of transmission of M. tuberculosis from/to South China. And the incidence rate of tuberculosis might be affected by bacterial population structure shaped by demographic history. Our findings also support the hypothesis that Modern Beijing lineage originated in South China., (© 2021. The Author(s).)

Assessing the vertical distribution of aerosols in the atmosphere can elucidate the regional sources of accumulated pollutants at different altitudes. Although studies in Hefei have mainly focused on aerosols in the near-surface atmosphere, few studies have assessed the vertical variability in aerosol concentrations. In this study, the vertical aerosol distribution in Hefei was analyzed continuously for one year (from March 2018 to February 2019) using multi-axis differential optical absorption spectroscopy. The aerosol extinction coefficient was the highest in winter (0.94 km -1 ), followed by autumn (0.63 km -1 ), spring (0.57 km -1 ), and summer (0.47 km -1 ). Local pollution caused the accumulation of aerosols near the surface. The rate of decrease of the aerosol extinction coefficient was higher in autumn and winter than in spring and summer. The diurnal variations of aerosol extinction coefficient in the different seasons were affected by the planetary boundary layer height, and we observed notable high-altitude transport of aerosols in autumn. We assessed the vertical distribution of the aerosol extinction coefficient under different pollution concentrations and identified peak values mainly below a height of 0.5 km. With increasing height, the extinction coefficient decreased linearly and slowly under low PM 2.5 concentrations, whereas decreased more rapidly under high PM 2.5 concentrations. Clustering analysis, the weight potential source concentration function, and the concentration weighted trajectory model inferred different seasonal characteristics in the potential source areas of aerosols at different heights. In addition to local pollution sources, Jiangsu Province was found to be the main source of pollution in Hefei at a height of 0.4 km, whereas Hubei Province was the main source of pollution at a height of 2 km., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Broad Autism Phenotype (BAP) refers to a set of symptoms or personality traits which similar but not meet the diagnostic criteria for autism in relatives of individuals with Autism Spetrum Disorders (ASD).The Broad Autism Phenotype Questionnaire (BAPQ) is one of the new and widely used assessment tools to measure BAP.It has been translated into 8 different languages and some versions were investigated the psychometric properties but not including Chinese version (BAPQ-C).This study aimed to analyze the reliability and validity of the BAPQ-C and explore its applicability in the Chinese population. 1,618 families were included in the study consisting of 890 ASD children and 728 typically developed(TD)children. Our results did not find a well-fitting three-factor(Aloof,Rigid,Pragmatic language) structure which is consistent with previous studies.But we formed a model that only included Aloof and Pragmatic language dimensions.The parameter after removing the rigid dimension was significantly better.This study indicated that the short version of Aloof and Pragmatic language sub-scales has good reliability and validity and can be used to study BAP in the Chinese population. Nevertheless, more studies are still needed to improve the psychometric properties of the BAPQ-C., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: The outbreak of COVID-19 that commenced in December 2019 in Wuhan, China, has caused extensive public health concerns and posed substantial challenges to health professionals, especially for those in the center of the epidemic. The current study aimed to assess the prevalence, related factors, and mechanism of acute stress disorder (ASD) among health professionals in Wuhan during this critical period., Methods: The study used a cross-sectional design. Self-administered questionnaires were distributed to the frontline health professionals in Wuhan hospitals from January 28 to February 1, 2020. Mental health-related measurements included ASD, depression, anxiety, conflict experiences, hostility, and psychosomatic symptoms. Structural equation modeling was used to analyze the factors associated with ASD among health professionals., Results: A total of 332 frontline health professionals were included in the analysis (mean [standard deviation] age = 32.21 [8.77] years; 78.0% women). ASD was a prominent mental health problem in the health professionals surveyed, with a prevalence of 38.3%. Anxiety (24.7%) and depression (20.2%) were also common. Structural equation modeling analyses revealed that emotional distress (i.e., anxiety and depressive symptoms) fully mediated the association between conflicts with ASD (the standardized indirect coefficient β = 0.47, p = .016). The most common reported symptom was chest pain (51.2%). ASD was significantly associated with psychosomatic symptoms. The majority (67.8%) reported being easily annoyed or irritated, and ASD was associated with hostility., Conclusions: During the COVID-19 outbreak, a substantial number of health professionals in Wuhan suffered from ASD. Furthermore, ASD was found to be associated with psychosomatic symptoms as well as the hostility. The poor mental health of health professionals has detrimental impacts both on the well-being of staff in health care systems and may adversely affect the quality of patient care. We call for interventions that aim to relieve the psychological and occupational stress. Considering that most of our participants were young, female frontline health professionals, the results may not be generalized to more heterogenous samples., (Copyright © 2020 by the American Psychosomatic Society.)

Background: To evaluate morphologic features of symptomatic and ruptured abdominal aortic aneurysms in Asian patients., Methods: Two hundred sixty four continuous candidates with an abdominal aortic aneurysm (AAA) were retrospectively identified from a tertiary hospital database between January 2017 and May 2019. The patients meeting inclusion criteria were divided into symptomatic or ruptured AAA (srAAA) and asymptomatic AAA (asAAA) groups. Their computed tomography angiographies were reconstructed using centerline technique and the geometric features of AAAs between the 2 groups were compared., Results: One hundred two patients fulfilled selection criteria (mean age 71 years, 80 men), comprising 35 srAAAs and 67 asAAAs. There was no essential association between gender, smoking or hypertension, and AAA-associated symptoms or rupture. The maximum diameter (5.8 ± 1.4 cm vs. 5.0 ± 0.9 cm; P = 0.001), length (8.8 ± 0.6 cm vs. 7.0 ± 0.3 cm; P = 0.002), and intraluminal thrombus (ILT) thickness (1.7 ± 0.2 cm vs. 1.3 ± 0.1 cm; P = 0.039) of AAAs were independent risk factors for AAA-associated symptoms or rupture (binary logistic regression, P < 0.05), but AAA length and ILT were strongly correlated with the AAA diameter (Pearson correlation coefficient value of 0.591 and 0.444) whereas other factors such as aneurysmal tortuosity, aneurysmal neck anatomy, or common iliac artery geometry were nonsignificant., Conclusions: AAA diameter, length, and intraluminal thrombus thickness were identified as risk factors for AAA-associated symptoms in Asian patients. While the diameter is regarded as the most important predictor for symptoms and rupture, AAA length and ILT thickness should also be taken into consideration when contemplating intervention, particularly for borderline and smaller aneurysms., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Esophageal cancer is the fourth most common cause of cancer death in China. Patients with esophageal cancer are more likely to suffer from malnutrition. The purpose of this study is to assess nutritional status of patients with esophageal cancer from multiple perspectives and analyze the risk factors., Methods: A total of 1482 esophageal cancer patients were enrolled in the study. We investigated the Scored Patient Generated Subjective Global Assessment (PG-SGA) scores, NRS-2002 scores, Karnofsky performance status scores, anthropometric, and laboratory indicators of patients. Unconditional logistic regression analysis was applied to identify the risk factors of nutritional status., Results: PG-SGA (≥4) and NRS-2002 (≥3) showed the incidence of malnutrition were 76% and 50%, respectively. In the patients with PG-SGA score ≥4, the proportion of patients who did not receive any nutritional support was 60%. The incidence of malnutrition in females was significantly higher than that in males. Besides, abnormality rates of Red blood cell (P < 0.001), MAC (P = 0.037), and MAMC (P < 0.001) in males was significantly higher than that in females, while abnormality rates of TSF (P < 0.001) was lower than that in females. After adjusted with the other potential risk factors listed, unconditional logistic regression analysis indicated smoking (odds ratio: 2.868, 95% confidence interval: 1.660-4.954), drinking (OR: 1.726, 95% CI: 1.099-2.712), family history (OR: 1.840, 95% CI: 1.132-2.992), radiotherapy or chemotherapy (OR: 1.594, 95% CI: 1.065-2.387), and pathological stage (OR: 2.263, 95% CI: 1.084-4.726) might be the risk factors of nutritional status, while nutritional support can reduce the risk of malnutrition., Conclusion: Effective nutritional risk assessment methods and nutritional intervention measures can be adopted according to the research data to improve quality of life of esophageal cancer patients., (Copyright © 2020. Published by Elsevier Inc.)

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with an unclear etiology and pathophysiology. Previous studies have indicated that the dysregulation of cytokines may be involved in the pathogenesis of ASD and that the levels of cytokines may serve as potential biomarkers of this disorder., Methods: The current study employed a family triad-based case-control design to study the levels of plasma cytokines in families with ASD (n = 45 triads) and controls (n = 38 triads) with a Human Cytokine Twenty-Five-Plex Kit. The Social Responsiveness Scale (SRS) was used to measure social impairment of ASD children., Results: After controlling for the levels of parental cytokines, we identified that interferon-α (IFN-α), interleukin-7 (IL-7), IL-8, IFN-γ-inducible protein-10, and macrophage inflammatory protein-1β were associated with ASD, and IL-8 was the only cytokine also associated with the levels of both parental cytokines in the offspring-parents regression analysis and three subdomains of SRS (social awareness, cognition, and motivations) in the children with ASD. The receiver operating characteristic curve showed that the log-transformed IL-8 level discriminated children with autism from controls with an area under the curve of 0.858 (95% confidence interval: 0.777-0.939)., Conclusions: Our study suggests that IL-8 is a potential biomarker for ASD and may be involved in the pathogenesis of ASD., Impact: The study suggests that IL-8 is a promising biomarker for ASD and may be involved in the pathogenesis of ASD. Only a very few studies have reported the parental cytokine levels. The significant strength of this article is that we applied the family triad-based approach to explore cytokine levels in families with autism and controls. There are no objective biomarkers, making the accurate diagnosis, prognostic prediction and effective treatment difficult, and our study provides promising results.

Background: Currently, there is increasing awareness of suicide-related behaviors. Mental health services are a key location for assisting people with suicide-related behaviors. However, few studies focused on the evaluation and experience of the mental health care system from families and the medical staff's perspective in China. The study aims to explore parents' and the front-line medical staff's experience of an adolescent with suicide-related behaviors admitted to the psychiatry department of a general hospital in China., Design: Qualitative study was employed in the study. Participants were recruited from a general hospital in China characterized by high levels in the Chinese mental health system., Methods: Semi-structured in-depth interviews were conducted exploring their experience and perceptions when an adolescent was admitted to the hospital. The theme analysis method is used for data analysis., Results: Participants expressed dissatisfaction in the psychiatric department. Other barriers in their work were identified, such as the shortage of staff and difficulties in caring or communicating with patients. Besides, the imperfect treatment system also contributes to the low satisfaction of patients and their families. Two themes and six subthemes were identified: 1) staff perceive patients with SRBs as difficult to engage (feelings of helplessness, the need for compassion, challenges of professional self-efficacy, the recommendations to the health care service); 2) parents not satisfied with the existing hospital services (doubt the hospitalization treatment and the advice to the health care service)., Conclusion: This study found that insufficient staffing and lacking of systematic professional treatment models are the major challenges. We suggest increasing the input of mental health resources to expand and train the mental health service team and establish a complete set of a treatment model for SRBs.

Objective: Suicidal ideation (SI) among college students is frequently reported. However, the mediating roles of depressive and anxiety symptoms between attention-deficit/hyperactivity disorder (ADHD) symptoms and SI has yet to be explored among college students., Method: A cross-sectional survey of college freshmen in China was conducted between October 2018 and December 2018. Standardized questionnaires were used to collect information on basic sociodemographic characteristics, including SI, ADHD symptoms, and anxiety and depressive symptoms. A structural equation model (SEM) was then constructed., Results: A total of 904 college freshmen were included in the analysis. The prevalence of ADHD symptoms and lifetime SI were 11.9% (95% CI: 9.9%-14.2%) and 29.2% (95% CI: 26.3%-32.2%), respectively. The SEM revealed that there were no direct paths from inattention, executive dysfunction, and hyperactivity to SI. Under the mediating role of anxiety and depressive symptoms, executive dysfunction (β = 0.011, p < 0.05) and hyperactivity (β = 0.015, p < 0.05) had indirect relationships with the risk of SI, and the role of inattention was not identified. Depressive and anxiety symptoms had direct influences on increasing SI. There also were indirect effects from anxiety symptoms to SI, which were mediated by depressive symptoms (β = 0.023, p < 0.001)., Conclusions: The current study indicated the indirect relationships between ADHD symptoms and SI among college freshmen. The findings could provide useful clues for clinical treatment and school-based prevention that aims to improve college students' mental well-being., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: This study investigated the prevalence and factors associated with counselling and psychotherapy service use among Chinese sexual minority populations., Methods: A nationwide cross-sectional study was performed using snowball sampling method, which led to the inclusion of 18,193 participants. Participants' sociodemographic background, clinical, and psychological data were gathered. Multivariate logistic regression analysis was performed to explore any associated factors., Results: There were 2007 participants who had used counselling and psychotherapy service out of the total population. Among those who had used psychotherapy services, 80.2% participants perceived discrimination, 1.1% reported that they had been refused treatment by a counsellor and/or psychotherapist, 1.6% had experienced verbal harassment, and 8.4% reported that their counsellor and/or psychotherapist lacked knowledge and experience in treating sexual minorities. In addition, regression analyses indicated that those who were divorced/widowed, had religious beliefs, and those who had experienced discrimination, verbal harassment, and rejection for treatment by health professionals all had an increased likelihood of utilising counselling and psychotherapy service., Conclusions: Service providers and policy makers in China should improve the quality and availability of counselling and psychotherapy services to address the mental health needs of sexual minority populations.

Nitrous acid (HONO) plays an important role in the budget of hydroxyl radical ( • OH) in the atmosphere. Vehicular emissions are a crucial primary source of atmospheric HONO, yet remain poorly investigated, especially for diesel trucks. In this study, we developed a novel portable online vehicular HONO exhaust measurement system featuring an innovative dilution technique. Using this system coupled with a chassis dynamometer, we for the first time investigated the HONO emission characteristics of 17 light-duty diesel trucks (LDDTs) and 16 light-duty gasoline vehicles in China. Emissions of HONO from LDDTs were found to be significantly higher than previous studies and gasoline vehicles tested in this study. The HONO emission factors of LDDTs decrease significantly with stringent control standards: 1.85 ± 1.17, 0.59 ± 0.25, and 0.15 ± 0.14 g/kg for China III, China IV, and China V, respectively. In addition, we found poor correlations between HONO and NOx emissions, which indicate that using the ratio of HONO to NOx emissions to infer HONO emissions might lead to high uncertainty of HONO source budget in previous studies. Lastly, the HONO emissions are found to be influenced by driving conditions, highlighting the importance of conducting on-road measurements of HONO emissions under real-world driving conditions. More direct measurements of the HONO emissions are needed to improve the understanding of the HONO emissions from mobile and other primary sources.

Assessing dominance is important for effective social interactions, and prior research suggests that testosterone is associated with men's dominance perceptions. The present study tested for a causal effect of exogenous testosterone on men's sensitivity to vocal cues of other men's dominance, an important parameter in male-male competition across species. One hundred and thirty-nine Chinese men received a single dose (150 mg) of testosterone or placebo gel in a double-blind, placebo-controlled, between-participant design. Participants reported their own dominance and judged other men's dominance from voices. Men's dominance sensitivity was significantly weaker in the testosterone group compared to those in the placebo group. Moreover, men's dominance sensitivity was negatively associated with their self-reported dominance in our Chinese sample, consistent with findings from Western populations. These results indicate that exogenous testosterone has a causal effect in decreasing men's dominance sensitivity, consistent with the Challenge Hypothesis, suggesting that the fluctuation of testosterone concentration mediates individuals' behaviors. Additionally, the present study could motivate further work on vocal assessment in the context of competition in humans and other species., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Phenazines, a large group of nitrogen-containing heterocycles with promising bioactivities, can be widely used as medicines and pesticides. But phenazines also generate toxicity risks due to their non-selective DNA binding. The environmental fate of phenazines in soils is the key to assess their risks; however, hitherto, there have been very few related studies. Therefore in the present study, the degradation, adsorption and leaching behaviors of a typical natural phenazine-phenazine-1-carboxamide (PCN) in agricultural soils from three representative places in China with different physicochemical properties were, for the first time, systematically studied in laboratory simulation experiments. Our results indicated that the degradation of PCN in all the tested soils followed the first order kinetics, with half-lives ranging from 14.4 to 57.8 d under different conditions. Soil anaerobic microorganisms, organic matter content and pH conditions are important factors that regulating PCN degradation. The adsorption data of PCN were found to be well fitted using the Freundlich model, with the r 2 values above 0.978. Freundlich adsorption coefficient K f of PCN ranged from 5.75 to 12.8 [(mg/kg)/(mg/L) 1/n ] in soils. The retention factor R f values ranged from 0.0833 to 0.354, which means that the mobility of PCN in the three types of soil is between immobile to moderately mobile. Our results demonstrate that PCN is easily degraded, has high adsorption affinity and low mobility in high organic matter content and clay soils, thus resulting in lower risks of contamination to groundwater systems. In contrast, it degraded slowly, has low adsorption affinity and moderately mobile in soils with low organic matter and clay content, therefore it has higher polluting potential to groundwater systems. Overall, these findings provide useful insights into the future evaluation of environmental as well as health risks of PCN., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Equine Hepacivirus (EqHV) is a newly discovered equine virus that is classified under the Hepacivirus genus of the Flaviviridae family. There are three sub-types of EqHV worldwide namely; sub-types 1-3. The majority of EqHV sub-type 1 strains were found in China. While different sub-types have been found in Japan and USA, therefore, to investigate whether the other sub-types of EqHV strains were present in China, a total of 60 horse serum samples were collected and screened for EqHV RNA through RT-PCR. The results revealed that 19 serum samples were RNA-positive (19/60) and the EqHV detection rate was 31.67%. One EqHV strain named GD23 was obtained and its near-complete genome sequence was acquired. Analysis of nucleotide p-distance with reference to the entire polyprotein gene revealed that GD23 was classified into sub-type 3. In addition, the phylogenetic analysis demonstrated that GD23 was clustered together with EqHV strains of sub-type 3 in other countries. The present study is the first to identify an EqHV sub-type 3 strain in China.

Canine bufavirus (CBuV) is a novel protoparvovirus of dogs that was first reported in 2018 in Italy. The prevalence and genetic diversity of CBuV in China are not clear. In this study, a total of 115 canine fecal samples were collected from northern China in 2019, and two of the samples tested positive for CBuV DNA by PCR. These two field CBuV strains were designated Henan38 and Henan44. The complete genomic sequences of Henan38 and Henan44 were obtained by gap-filling PCR, sequenced, and assembled. Phylogenetic analysis demonstrated that the two strains clustered together in a novel group that was distant from previously reported CBuV strains. This study will strengthen our understanding of the epidemiology and genetic diversity of CBuV in China.

Feline morbillivirus (FeMV) is an emerging member of the family Paramyxoviridae that is suspected to be involved in chronic kidney disease (CKD). FeMV was first discovered in Hong Kong in 2012 and has subsequently been detected in many countries. However, the prevalence of FeMV in mainland China is still unclear. To clarify the present status and examine the genetic diversity of FeMV in mainland China, in this study, we collected cat urine samples in veterinary hospitals in Guangdong Province in 2017 and 2018. Using reverse transcription (RT)-PCR, we found that the urine of six out of 64 cats tested positive for FeMV RNA. Sequencing and genetic analysis of the FeMV L gene showed that FeMV in mainland China is genetically diverse, and phylogenetic analysis showed that the viruses segregated into two clusters. Two isolates, GD5 and GD6, grouped in a branch that was separate from the one containing other previously reported FeMV isolates. These results will contribute to a better understanding of the evolution of FeMV in China.

The current study aimed to explore mental health problems in patients diagnosed with cancer during the COVID-19 pandemic. A cluster sampling, cross-sectional survey with 6213 cancer patients was conducted in one of the largest cancer centers in China. The socio-demographic and clinical characteristics, psychosomatic conditions, interpersonal relationships and social support, COVID-19 infection-related psychological stress, and mental health status were measured. Medical conditions were extracted from patients' electronic healthcare records. Among the 6213 cancer patients, 23.4% had depression, 17.7% had anxiety, 9.3% had PTSD, and 13.5% had hostility. Hierarchical liner regression models showed that having a history of mental disorder, excessive alcohol consumption, having a higher frequency of worrying about cancer management due to COVID-19, having a higher frequency feeling of overwhelming psychological pressure from COVID-19, and having a higher level of fatigue and pain were the predominant risk factors for mental health problems in cancer patients. However, there were only 1.6% of them were seeking psychological counseling during COVID-19. We also revealed the protective factors associated with lower risk of mental health problems among cancer patients. The present study revealed a high prevalence of mental health problems and gaps in mental health services for cancer patients, which also indicated high distress from COVID-19-elevated risks. We call for systematic screening of mental health status for all cancer patients, and developing specific psychological interventions for this vulnerable population.