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Land use types have a significant impact on river ecosystems. The Yiluo River is the largest tributary below Xiaolangdi Reservoir in the middle reaches of the Yellow River, and is one of the important water conservation areas in the Yellow River Basin. Studying the ecological status of the Yiluo River under varied land use types in this basin is crucial for both ecological protection and the high-quality development of the Yellow River Basin. This study investigated the impacts of land use types on the macroinvertebrate community and functional structure in the Yiluo River Basin and introduced the concept of the land use health index (LUI). During the survey period, a total of 11,894 macroinvertebrates were collected, and 143 species were identified, belonging to 4 phyla, 7 orders, 22 families, and 75 families. The results showed that LUI had the most significant impact on macroinvertebrate community structure, with substrate type, dry plant weight, total phosphorus, turbidity, and attached algae biomass also playing significant roles in affecting macroinvertebrate communities. The species richness, the Shannon-Wiener index, and the Margalef richness index exhibited a nonlinear positive correlation with LUI of the sampling site, increasing as LUI enhancing and eventually reaching a plateau. Functional richness showed a linear and positive correlation with LUI, increasing with its enhancement, while functional evenness and functional divergence exhibited a nonlinear correlation with LUI. Functional evenness initially increased and then decreased with the enhancement of LUI, while functional divergence decreased with LUI enhancement. This study can provide a scientific reference for river ecological management under various land use scenarios.The Yiluo River is the largest tributary below Xiaolangdi Reservoir in the middle reaches of the Yellow River, and is one of the important water conservation areas in the Yellow River Basin. Studying the ecological status of the Yiluo River under varied land use types in this basin is crucial for both ecological protection and the high-quality development of the Yellow River Basin. This study investigated the impacts of land use types on the macroinvertebrate community and functional structure in the Yiluo River Basin and introduced the concept of the land use health index (LUI). During the survey period, a total of 11,894 macroinvertebrates were collected, and 143 species were identified, belonging to 4 phyla, 7 orders, 22 families, and 75 families. The results showed that LUI had the most significant impact on macroinvertebrate community structure, with substrate type, dry plant weight, total phosphorus, turbidity, and attached algae biomass also playing significant roles in affecting macroinvertebrate communities. The species richness, the Shannon-Wiener index, and the Margalef richness index exhibited a nonlinear positive correlation with LUI of the sampling site, increasing as LUI enhancing and eventually reaching a plateau. Functional richness showed a linear and positive correlation with LUI, increasing with its enhancement, while functional evenness and functional divergence exhibited a nonlinear correlation with LUI. Functional evenness initially increased and then decreased with the enhancement of LUI, while functional divergence decreased with LUI enhancement. This study can provide a scientific reference for river ecological management under various land use scenarios., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Na Zhao reports financial support, administrative support, article publishing charges, equipment, drugs, or supplies, statistical analysis, travel, and writing assistance were provided by National Natural Science Foundation of China (51809086). Na Zhao reports financial support, administrative support, article publishing charges, equipment, drugs, or supplies, statistical analysis, travel, and writing assistance were provided by Henan Provincial Science and Technology Research Project (222102320144). Na Zhao reports financial support, administrative support, article publishing charges, equipment, drugs, or supplies, statistical analysis, travel, and writing assistance were provided by Young Backbone Teacher Project of Henan University of Science and Technology (13450005). Weijun Chen reports financial support, administrative support, article publishing charges, equipment, drugs, or supplies, statistical analysis, travel, and writing assistance were provided by National Natural Science Foundation of China32202952). If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: It is still unclear whether small left ventricle (LV) is an adverse structural prognostic feature in patients with atrial fibrillation (AF)., Objectives: The purpose of this study was to evaluate the association between small LV and risk of cardiovascular events in AF population., Methods: From the China-AF registry, 7,764 patients with AF were enrolled and divided into groups with normal, small, and large LV size based on left ventricular end-diastolic dimension (LVEDD) measurement per the American Society of Echocardiography references. Cox models were used to assess the association between LV size or LVEDD with composite cardiovascular events (cardiovascular death, ischemic stroke or systemic embolism, or major bleeding)., Results: There were 308 (4.0%) participants assessed with small LV who were older, with lower body mass and blood pressure, and fewer comorbidities, and 429 (5.5%) were identified with large LV. Compared with the normal LV group, small LV and large LV were significantly associated with higher incidence of composite cardiovascular events (adjusted HR [aHR]: 1.54 [95% CI: 1.07-2.20] for small LV; aHR: 1.36 [95% CI: 1.02-1.81] for large LV) and cardiovascular death (aHR: 1.94 [95% CI: 1.14-3.28] for small LV; aHR: 1.83 [95% CI: 1.24-2.69] for large LV). Small LV was also associated with increased risk of major bleeding [aHR: 2.21 [95% CI: 1.01-4.86]). A U-shaped relationship between LVEDD and composite cardiovascular events was identified (P nonlinear  < 0.001)., Conclusions: In a prospective AF cohort, small LV was independently associated with an increased risk of cardiovascular events, which needed consideration in risk stratification and management for patients with AF. (ChiCTR-OCH-13003729)., Competing Interests: Funding Support and Author Disclosures This work was supported by Beijing Hospitals Authority Yangfan Program (No. ZLRK202315), the National Key Research and Development Program of China (2022YFC3601303), and grant from Science and Technology Program of Guangdong Province (No. 2019B020230004). Dr Ma has received honoraria for presentations from AstraZeneca, Bayer Healthcare, Boehringer Ingelheim, Bristol Myers Squibb, Johnson and Johnson, and Pfizer. Dr Dong has received honoraria for presentations from Johnson and Johnson. All other authors have reported that they have no relationships relevant to the contents of this paper., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

China's stimulus policies have caused overleveraging and overcapacity for the sustainable development of most industries (particularly high-pollution and energy-intensive industries). Thus, deleveraging and decapacity have become the two best options for the above industries to achieve long-term sustainable development. Based on China's A-share listed companies from 2009 to 2019, this study investigated the effect of deleveraging and decapacity on corporate capital allocation using fixed effects, propensity score matching (PSM) and difference-in-differences (DID). A homogeneity analysis of geographical and firm characteristics was also conducted. The results show that: (1) Deleveraging and decapacity can significantly increase financial capital allocation by 3.67%, and decapacity can increase investment-related capital allocation by 0.63%. This indicates asset allocation optimization for sustainable development. (2) High asset reversibility can weaken the effect of deleveraging on financial capital allocation while strengthening the effect of decapacity on capital investment. (3) The impact of deleveraging and decapacity may vary among companies due to heterogeneous asset reversibility resulting from geographical locations and technological intensities. Given the current global energy crisis, optimizing capital allocation has become essential in addressing resource shortages and achieving long-term sustainable development. This study may provide a reference for alleviating corporate capital misallocation., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Jia et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: Explore the association between atrial fibrillation (AF) reoccurrence and new-onset ischemic stroke (IS) in patients with nonvalvular AF, and explore whether there is a high-risk period of IS after recurrent episodes of AF. Methods: A nested case-control study design was used. A total of 565 nonvalvular AF patients with new-onset IS after a follow-up of at least 2 years in the China-AF cohort were enrolled as the case group, and 1 693 nonvalvular AF patients without new-onset IS were matched as the control group at a ratio of 1∶3. Frequency and types of recurrent AF in the previous 1 or 2 years were compared between two groups, and the adjusted associations of AF reoccurrence with new onset IS were explored using conditional logistic regression analysis. The proportion of recurrent AF was compared between the case period and control period, and conditional logistic regression analysis was performed to calculate adjusted associations of case-period AF with IS. Results: The nested case-control study design results showed that the proportion of at least one record of recurrent AF in the previous 1 year was higher in the case group than in the control group (72.0% vs. 60.8%, P <0.05), and the recurrent AF was positively correlated with new-onset IS (adjusted OR =1.80, P <0.001). Similar results were also observed in the previous 2 years period. The case-crossover study design analysis showed that among 565 patients with new-onset IS, recurrent AF in the case period was positively correlated with IS (adjusted OR =1.61, P =0.003). Conclusion: Recurrent AF is associated with IS, and there may be a high-risk period of IS after recurrent episodes of AF.

Objective: To investigate current use of oral anticoagulant (OAC) therapy and influencing factors among coronary artery disease (CAD) patients with nonvalvular atrial fibrillation (NVAF) in China. Methods: Results of this study derived from "China Atrial Fibrillation Registry Study", the study prospectively enrolled atrial fibrillation (AF) patients from 31 hospitals, and patients with valvular AF or treated with catheter ablation were excluded. Baseline data such as age, sex and type of atrial fibrillation were collected, and drug history, history of concomitant diseases, laboratory results and echocardiography results were recorded. CHA 2 DS 2 -VASc score and HAS-BLED score were calculated. The patients were followed up at the 3rd and 6th months after enrollment and every 6 months thereafter. Patients were divided according to whether they had coronary artery disease and whether they took OAC. Results: 11 067 NVAF patients fulfilling guideline criteria for OAC treatment were included in this study, including 1 837 patients with CAD. 95.4% of NVAF patients with CAD had CHA 2 DS 2 -VASc score≥2, and 59.7% of patients had HAS-BLED≥3, which was significantly higher than NVAF patients without CAD ( P <0.001). Only 34.6% of NVAF patients with CAD were treated with OAC at enrollment. The proportion of HAS-BLED≥3 in the OAC group was significantly lower than in the no-OAC group (36.7% vs. 71.8%, P <0.001). After adjustment with multivariable logistic regression analysis, thromboembolism( OR =2.48,95% CI 1.50-4.10, P <0.001), left atrial diameter≥40 mm( OR =1.89,95% CI 1.23-2.91, P =0.004), stain use ( OR =1.83,95% CI 1.01-3.03, P =0.020) and β blocker use ( OR =1.74,95% CI 1.13-2.68, P =0.012)were influence factors of OAC treatment. However, the influence factors of no-OAC use were female( OR =0.54,95% CI 0.34-0.86, P =0.001), HAS-BLED≥3 ( OR =0.33,95% CI 0.19-0.57, P <0.001), and antiplatelet drug( OR =0.04,95% CI 0.03-0.07, P <0.001). Conclusion: The rate of OAC treatment in NVAF patients with CAD is still low and needs to be further improved. The training and assessment of medical personnel should be strengthened to improve the utilization rate of OAC in these patients.

Fluorinated liquid-crystal monomers (FLCMs) widely used in liquid crystal displays are considered to be a new generation of persistent, bioaccumulative, and toxic contaminants. They have been widely detected in the environment. However, little is known about their occurrence in food and human dietary exposure until now. Herein, we provided an evaluation of dietary exposure and health risks of FLCMs in the Chinese adult population based on the fifth and sixth total diet studies (TDSs). The detection frequencies of FLCMs in the two surveys were 90.5 and 99.5%, with concentrations ranging from not detected ∼72.6 μg/kg wet weight (ww) and ND ∼74.7 μg/kg ww, respectively. All TDS samples contained the multiresidue of FLCMs. The mean estimated daily intakes (EDIs) of FLCMs were 172.86 and 163.10 ng/kg bw/day in the fifth and sixth TDS, respectively. Meats, vegetables, and cereals contributed the most to the EDI of FLCMs. According to the threshold of toxicological concern (TTC) method, the EDIs of 1-fluoro-4-[2-(4-propylphenyl)ethynyl]benzene (4.56 and 3.26 ng/kg bw/day) and 2-fluoro-4-[4'-propyl-1,1'-bi(cyclohexyl)-4-yl]phenyl trifluoromethyl ether (3.12 and 3.28 ng/kg bw/day) were above their TTC value (2.5 ng/kg bw/day), suggesting their potential health risk. This is the first comprehensive national dietary exposure assessment of FLCMs.

Background: Anemia is a common comorbidity in patients with atrial fibrillation (AF). Reports on the association of anemia and adverse events in patients with AF, especially from Asia, are limited., Methods and Results: Based on data from the Chinese Atrial Fibrillation Registry Study (CAFR), a total of 18,106 AF patients enrolled between August 2011 and December 2018 had hemoglobin (Hb) values recorded at baseline. Patients were classified into three groups according to Hb levels: 15,606 patients (86.2%) into the no anemia group (male Hb≥130 g/L; female Hb≥120 g/L), 1800 (9.9%) with mild anemia (male 110≤Hb<129 g/L; female 110≤Hb<119 g/L), and 700 (3.9%) with moderate to severe anemia (Hb≤109 g/L). Multivariable Cox regression models were used to determine if anemia was independently associated with all-cause death, cardiovascular death, or major bleeding, after adjusting for confounders. Anemia was present in 13.8% of the population at baseline. During a median follow-up of 4.01 years, the incidences of all-cause death (1.8, 4.9, and 8.9 per 100 person-years), cardiovascular death (1.0, 2.9, and 4.5 per 100 person-years), and major bleeding (0.5, 0.6, and 0.7 per 100 person-years) were gradually accentuated in patients with no anemia, mild anemia, and moderate to severe anemia, respectively. Compared with patients with no anemia, those with anemia had higher risks for all-cause death (mild anemia; adjusted hazard ratio [HR]: 1.22, 95% confidence interval [CI]: 1.08-1.38; moderate to severe anemia; adjusted HR: 1.53, 95% CI: 1.31-1.77); and cardiovascular death (mild anemia; adjusted HR: 1.29, 95% CI: 1.10-1.52; moderate to severe anemia; adjusted HR: 1.27, 95% CI: 1.03-1.57), but not for major bleeding. The association between anemia and all-cause death was similar among subgroups stratified by sex, kidney function, anticoagulant, or ablation therapy., Conclusions: Anemia was associated with increased risks of all-cause death, cardiovascular death, but no major bleeding in AF patients. The effect of anemia correction on the prognosis of patients with AF requires further study., (© 2021 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.)

Pesticides are pollutants of high concern in drinking water. Several approaches aimed to promote pesticide risk management in drinking water have been brought forward by diverse ways, however, these methods usually take too many indicators into consideration, which are complex and non-universal. In this study, a more focused and data driven ranking model was proposed for the purpose of development of the priority control list in drinking water. By determining three parameters including the total health risks of dietary exposure pathways, drinking water contribution rates, and the drinking water health risks, pesticides could be divided into four categories including the priority control list, secondary control list, candidate control list, and non-regulatory list. As a case study, the proposed model was implemented for 23 pesticides detected in drinking water from 36 major cities across China during two major science and technology program for water pollution control and treatment. Totally 13 kinds of pesticides including carbofuran, dicofol, chlorpyrifos, 2,4-D, acetochlor, deltamethrin, dimethoate, heptachlor, parathion, hexachlorobenzene, DDT, hexachlorocyclohexane and atrazine are selected for priority control, methyl parathion, dichlorvos and chlorothalonil are recommended for secondary control, butachlor and malathion are classified into candidate control list, and fenobucarb is suggested to be removed from the pesticide control list., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: There is an increasing trend of skipping meals, especially breakfast and dinner, in China. Previous studies on the association of meal skipping with lipid profiles and blood glucose have yielded inconsistent results., Methods: A national representative survey of 47 841 adults (age ≥ 45 y) was conducted in China. Frequency of breakfast, lunch, and dinner consumption were assessed with a questionnaire. Blood triacylglycerols, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and fasting blood glucose were measured using standard methods. Generalized linear models were used to estimate relative concentrations and 95% confidence intervals (CIs)., Results: Of 37 355 participants included in the analysis, the prevalence of skipping breakfast, lunch, and dinner was 9.06%, 0.67%, and 0.67%, respectively. Breakfast skippers are more likely to reside in rural areas, while lunch and dinner skippers tend to be urban residents. Compared with regular breakfast consumption, skipping breakfast was associated with 10.6% (95% CI, 8.3-12.9%) higher concentrations of triacylglycerols, 5.5% (95% CI, 4.7-6.3%) higher total cholesterol, 7.7% (95% CI, 6.5-8.9%) higher low-density lipoprotein cholesterol, 2.4% (95% CI, 1.5-3.4%) lower high-density lipoprotein cholesterol, and 1.6% (95% CI, 1.0-2.1%) lower fasting blood glucose. Significant linear trends were observed for days of skipping breakfast per week and biomarker concentrations. No association was found for lunch or dinner skipping. The higher triacylglycerols and lower high-density lipoprotein cholesterol associated with skipping breakfast were more evident in participants who were overweight or obese, and those who were physically inactive., Conclusions: Our findings suggest a worse lipid profile of breakfast skippers. Not skipping breakfast might benefit cardiovascular disease prevention in Chinese adults., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Babesia species (Apicomplexa: Piroplasmorida) are tick-borne protozoan hemoparasites, which pose a significant threat to domestic animals, wildlife and humans. This study aimed to determine and characterize Babesia species in red foxes (Vulpes vulpes), Asian badgers (Meles leucurus) and their ticks. Blood, heart, liver, spleen, lung, kidney, large intestine and small intestine were collected from 19 wild carnivores (12 red foxes and 7 Asian badgers). All ticks were removed from these animals and identified according to morphological and molecular characteristics. The samples were tested for the presence of Babesia species using the 18S rRNA gene. Molecular analyses showed that the DNA of Babesia vogeli and Babesia vulpes was present in red fox organs/tissues and blood samples. A total of 54 hard ticks (38 Ixodes canisuga, 6 Haemaphysalis erinacei, 9 Ixodes kaiseri and 1 Dermacentor marginatus) were collected from red foxes and 12 (I. kaiseri) from Asian badgers. All ticks were adults. Among them, one I. kaiseri parasiting a red fox contained the DNA of B. vulpes while one I. canisuga was positive for Babesia sp. belonging to the clade "Babesia sensu stricto". Molecular and phylogenetic analyses indicated the presence of a novel genotype, Babesia sp. "badger China". Babesia sp. badger type A and type B from Asian badgers were different from those in European badgers. Co-infection with three Babesia genotypes was found in one Asian badger. This study provides the first data on Babesia infection in red foxes, Asian badgers and their ticks in China. Babesia vogeli was detected for the first time in red foxes in Asia. Co-infection and genetic diversity of Babesia genotypes in Asian badgers were also demonstrated., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Objective: To investigate the causes of death and predictors in patients with nonvalvular atrial fibrillation (AF) undergoing anticoagulation therapy. Methods: Consecutive anticoagulated nonvalvular AF patients were recruited from the China Atrial Fibrillation Registry (China-AF) Study from August 2011 to December 2018. After exclusion of patients with hypertrophic cardiomyopathy, dilated cardiomyopathy, or loss of follow-up within 1 year, 2 248 patients were included in this analysis. Enrolled patients were followed up were followed up for 3 and 6 months, and then every 6 months. The primary endpoint was death, including cardiovascular death, non-cardiovascular death and undetermined death. The patients were divided into survival group and death group according to the survival status after follow-up. Clinical information such as age and sex was collected. Cox proportional hazards regression was performed to identify associated risk factors for all-cause mortality, and Fine-Gray competing risk model was used to identify associated risk factors for cardiovascular mortality. Results: A total of 2 248 patients with atrial fibrillation receiving anticoagulant therapy died over a mean follow-up of (42±24) months, mean age was (67±10) years old and 41.1% (923/2 248) patients were female. The mortality rate was 2.8 deaths per 100 patient-years. The most common cause of death was cardiovascular deaths, accounted for 55.0% (120/218). Worsening heart failure was the most common cause of cardiovascular deaths (18.3% (40/218)), followed by bleeding events (12.9% (28/218)) and ischemic stroke (8.7% (19/218)). Multivariate Cox regression analysis showed that age ( HR = 1.05, 95% CI 1.04-1.07, P <0.001), anemia ( HR = 1.81, 95% CI 1.02-3.18, P = 0.041), heart failure ( HR =2.40, 95% CI 1.75-3.30, P <0.001), ischemic stroke/transient ischemic attack (TIA)( HR = 1.59, 95% CI 1.21-2.13, P = 0.001) and myocardial infarction ( HR = 2.93, 95% CI 1.79-4.81, P <0.001) were independently associated with all-cause death. Fine-Gray competing risk model showed that age ( HR =1.05, 95% CI 1.02-1.08, P <0.001), heart failure ( HR =2.81, 95% CI 1.79-4.39, P <0.001), ischemic stroke/TIA ( HR =1.50, 95% CI 1.02-2.22, P =0.041) and myocardial infarction ( HR =3.31, 95% CI 1.72-6.37, P <0.001) were independently associated with cardiovascular death. Conclusions: In anticoagulated nonvalvular AF patients, ischemic stroke represents only a small subset of deaths, whereas worsening heart failure is the most common cause of cardiovascular deaths. Heart failure, ischemic stroke/TIA, and myocardial infarction are associated with increased mortality.

Background: Chronic kidney disease (CKD) is a leading public health problem worldwide. Cardiovascular diseases are the primary cause of death in hemodialysis patients with CKD. Therefore, it is necessary to develop a simple risk assessment tool for cardiovascular events in hemodialysis patients with CKD., Methods: A cohort of 370 hemodialysis patients, who were recruited between January 2015 to September 2019 in south China, were involved in the present study. On the basis of routine blood test indicators and ultrasonic cardiogram parameters, the optimal parameter set was determined and a Cox proportional hazards model coupled with a nomogram was used to predict cardiovascular risk over 3, 5, and 10 years. Predictive performance was evaluated using Harrell's concordance index (C-index) and the area under the receiver-operating characteristic curve (AUROC). The results were validated using both 10-fold cross-validation and hold-out validation (70% training and 30% validation, repeated 100 times)., Results: The optimal parameter set consisted of hypertension, diabetes mellitus, age, phosphate, triglyceride, C-reactive protein, white blood cells, and interventricular septum thickness. The time-dependent AUROCs for predicting 3-, 5-, and 10-year cardiovascular event occurrence risk were 0.836, 0.845, and 0.869, respectively. The nomogram showed satisfactory prediction performance (C-index: 0.808, 95% confidence interval: 0.773-0.844) and was well-calibrated. The results were further confirmed by 10-fold cross-validation and hold-out validation (C-index: 0.794 and 0.798, respectively)., Conclusions: On the basis of several easy-to-detect clinical parameters, we developed a simple and useful nomogram for predicting cardiovascular risk in long-term hemodialysis patients that is of potential value for clinical application.

Background: To evaluate the impact of family history of atrial fibrillation (FAF) on postablation atrial tachyarrhythmia (AT) recurrence., Methods: All the 8198 patients undergoing initial AF ablation registered in the Chinese Atrial Fibrillation Registry study were analyzed. FAF was defined as having first-degree relatives diagnosed as AF at age 65 years or younger, and before the time the case in this study was diagnosed. Cox proportional hazards models were used to evaluate the impact of FAF on postablation AT recurrence. Age, sex, body mass index, AF type, history of congestive heart failure, hypertension, diabetes mellitus, prior stroke/transient ischemic attack/systemic embolism, vascular diseases, use of contact force-sensing catheter, and completion of high school were adjusted. The definition of AT recurrence was any documented AF, atrial flutter, or AT lasting more than or equal to 30 s after 3 months blanking period., Results: After a mean follow-up of 26.2 ± 19.6 months, 318 out of the 645 patients (49.3%) with FAF and 3339 out of the 7553 patients (44.2%) without FAF experienced AT recurrence, corresponding to annual recurrence rates of 22.8% and 20.2%, respectively. Patients with FAF had a significant higher risk of AT recurrence (adjusted hazard ratio 1.129, 95% confidence interval 1.005-1.267) in multivariable analysis. Moreover, FAF had a significant higher impact on AT recurrence in the subgroup of patients diagnosed with AF at age 50 years or younger (p for interaction = .036)., Conclusion: FAF is a risk factor for postablation AT recurrence. This is especially true in those with AF diagnosed at 50 years or younger., (© 2021 Wiley Periodicals LLC.)

To date, there is no report on the genetic diversity of ticks in these regions. A total of 370 representative ticks from the south and east regions of Kazakhstan (SERK) and Xinjiang Uygur Autonomous Region (XUAR) were selected for molecular comparison. A fragment of the mitochondrial cytochrome c oxidase subunit I (cox1) gene, ranging from 631 bp to 889 bp, was used to analyze genetic diversity among these ticks. Phylogenetic analyses indicated 7 tick species including Hyalomma asiaticum, Hyalomma detritum, Hyalomma anatolicum, Dermacentor marginatus, Rhipicephalus sanguineus, Rhipicephalus turanicus and Haemaphysalis erinacei from the SERK clustered together with conspecific ticks from the XUAR. The network diagram of haplotypes showed that i) Hy. asiaticum from Almaty and Kyzylorda Oblasts together with that from Yuli County of XUAR constituted haplogroup H-2, and the lineage from Chimkent City of South Kazakhstan was newly evolved; and ii) the R. turanicus ticks sampled in Israel, Almaty, South Kazakhstan, Usu City, Ulugqat and Baicheng Counties of XUAR were derivated from an old lineage in Alataw City of XUAR. These findings indicate that: i) Hy. asiaticum, R. turanicus and Ha. erinacei shared genetic similarities between the SERK and XUAR; and ii) Hy. marginatum and D. reticulatus show differences in their evolution.

In this study, human health risk derived from radioactive pollution in drinking water of China was assessed based on gross alpha and beta. Considering the presence of numerous data under the detection limits, the left-censored handling methods were employed to deal with the non-detected values in gross alpha and beta radioactive concentrations. Results show that concentrations of gross alpha and beta range from 4.98 × 10 -4 Bq/L to 0.49 Bq/L with a mean value of 0.029 Bq/L and 5.00 × 10 -3 Bq/L to 1.26 Bq/L with a mean value of 0.091 Bq/L, respectively. With the average effective dose being 1.41 × 10 -2 mSv/y, the annual cancer risk due to radioactive pollution in Chinese drinking water is 7.75 × 10 -7 /y. This study aimed to provide an easier method to quantify the radioactive pollution in drinking water and give a scientific basis for making policy decisions on radioactive pollution management., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: This study explored the thromboembolism risk of low-risk atrial fibrillation (AF) patients (CHA 2 DS 2 -VASc score of 0 or 1 for male and 1 or 2 for female) with different clinical characteristics to provide the basis for anticoagulation decision-making in these patients. Methods: We prospectively enrolled consecutive 2 862 nonvalvular low-risk AF patients between August 2011 to December 2018 in China-AF (China Atrial Fibrillation Registry) Study, their CHA 2 DS 2 -VASc score was 0 or 1 for male and 1 or 2 for female. According to their age, sex, presence or absence of hypertension, diabetes mellitus, congestive heart failure, and vascular disease at the time of enrolling, patients were divided into CHA 2 DS 2 -VASc score 0 score group, 1 score group, and 2 score group. Patients were followed up every 6 months by outpatient clinic visit or telephone interview. The outcome was a thromboembolic event, including ischemic stroke and systemic embolism. Univariate Cox regression analysis was used to compare the thromboembolism risk between the patients with different risk factors and CHA 2 DS 2 -VASc score 0 group. Results: A total of 2 862 low-risk atrial fibrillation patients were enrolled in this study. 915 patients (32.0%) were female, and age was (55.0±10.7) years old. There were 933 patients (32.6%) in CHA 2 DS 2 -VASc score 0 group, 1 401 patients (49.0%) in score 1 group and 528 patients (18.5%) in score 2 group. During follow-up (median 1.5 years, 5 811.82 person-years), 33 cases of thromboembolic events were recorded, the annual rate of thromboembolism was 0.57% (95% CI 0.40%~0.80%). The number of thromboembolic events in patients with CHA 2 DS 2 -VASc score 0, 1 and 2 were 8, 11 and 14, respectively, and the annual thromboembolism event rates were 0.40% (95% CI 0.20%-0.81%), 0.39% (95% CI 0.22%-0.71%) and 1.34% (95% CI 0.80%-2.27%), respectively. The risk of thromboembolism of CHA 2 DS 2 -VASc score 2 group ( HR =3.53, 95% CI 1.48-8.44; P =0.005), especially female patients aged 65-74 years in CHA 2 DS 2 -VASc score 2 group ( HR =2.67, 95% CI 1.63-4.38; P <0.000) was significantly higher than that in patients of CHA 2 DS 2 -VASc score 0 group. Conclusion: Low-Risk Atrial Fibrillation patients with CHA 2 DS 2 -VASc score 2, especially female patients aged 65-74 years old with CHA 2 DS 2 -VASc score 2 are at higher risk of thromboembolism in low-risk AF patients. For such patients, intensified oral anticoagulant therapy might be helpful to reduce the risk of thrombolism.

Background: The association between physical activity (PA) and atrial tachyarrhythmia (AT) recurrence after ablation for atrial fibrillation (AF) remains unclear., Methods: We consecutively enrolled 496 patients treated with AF ablation therapy in Beijing Anzhen Hospital. After excluding six patients with valvular heart disease, seven patients with congenital heart disease, 33 patients lost to follow-up, and 14 patients who did not provide PA level during follow-ups, 436 patients had their PA level assessed by the International Physical Activity Questionnaire-Short Form before ablation and each time of follow-up. The association between PA level (measured at the time closest to AT recurrence, or the end of 12-month follow-up if no AT recurrence), as well as active PA during follow-up, and postablation AT recurrence was tested by multivariate logistic regression., Results: Of the enrolled patients, 134 (30.7%) patients experienced AT recurrence in the first 12 months postablation. Compared to patients with low PA, patients with moderate or high PA had a lower risk of AT recurrence (odds ratio [OR] = .44; 95% confidence interval [CI], .25-.80; P = .01 for patients with moderate PA; and OR = .43 [95% CI, .21-.85], P = .02 for patients with high PA). Compared to patients without active PA, patients with active PA had a lower risk of AT recurrence (OR = .44 [95% CI, .27-.70], P < .01)., Conclusions: Moderate and high PA are associated with a lower risk of AT recurrence after AF ablation. Active PA during follow-up is also associated with a significantly lower risk of AT recurrence in the postablation AF population., (© 2020 Wiley Periodicals LLC.)

Co-infection with multiple pathogens, especially the spread of Giardia and Cryptosporidium in source water among those with immunodeficiency, is common worldwide, which will result in an increase in overall risk. In this study, the quantitative microbial risk assessment model was used to estimate the cumulative risk of co-infection with Giardia and Cryptosporidium promoted by HIV, considering age sensitivity. The sensitivity of population segments with different ages was estimated by the optimization method, based on clinical data of cryptosporidiosis and giardiasis with age structure. The factors of co-infection enhancement were used to quantify HIV synergism with the action of other pathogens. The removal rates of Giardia and Cryptosporidium through water treatment were estimated by a model involving turbidity and particles. The results showed that children (0-4 years) were 17.911-fold more sensitive to infection with Giardia than adults (15-64 years), and that with Cryptosporidium was 10.592-fold. Removal rates of these parasites in water treatment plants in major cities in China were estimated to be 2.03 log 10 . Considering the HIV-synergistic and age-susceptibility effects, the cumulative risk of exposure to Giardia or Cryptosporidium was about 38.781 × 10 -6 DALYs (Disability-adjusted life years) per person per year, which was much higher than the reference risk level recommended by the World Health Organization (10 -6 DALYs). The methodology and results of this study will be useful in better evaluating and reducing the burden due to infection of Giardia and/or Cryptosporidium in China and other countries., 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 © 2020 Elsevier Ltd. All rights reserved.)

Chlorpyrifos is one of the most heavily used pesticides in domestic and agricultural insect prevention globally. Given the potential neurotoxicity of chlorpyrifos and its high detection rates in food and drinking water, health risks attributable to chlorpyrifos residue in Chinese drinking water and food in both China and Denmark were assessed in this study. Mixed left-censored handling models were used to deal with the non-detected values in chlorpyrifos concentrations. Results show that chronic exposure imputed to chlorpyrifos residue is much lower than the reference dose, and will thus not pose appreciable health risk to the consumer. Compared to the total exposure from chlorpyrifos in drinking water and food sources, chronic exposure from drinking water sources in China accounts for 0-4.4%. Health risk owing to chlorpyrifos in food within China is 6-7-fold higher than in Denmark, and this coincides with the fact that all application of chlorpyrifos is banned in Denmark, in contrast to China. However, the Danish consumers are still exposed from imported food items. The main health risk contributors in China are the food groups of Grains and grain-based products and Vegetable and vegetable products, while the main chronic health risk contributor in Denmark is the food group of imported fruit and fruit products., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Increasing molecular evidence supports that bats and/or their ectoparasites may harbor vector-borne bacteria, such as bartonellae and borreliae. However, the simultaneous occurrence of rickettsiae in bats and bat ticks has been poorly studied., Methods: In this study, 54 bat carcasses and their infesting soft ticks (n = 67) were collected in Shihezi City, northwestern China. The heart, liver, spleen, lung, kidney, small intestine and large intestine of bats were dissected, followed by DNA extraction. Soft ticks were identified both morphologically and molecularly. All samples were examined for the presence of rickettsiae by amplifying four genetic markers (17-kDa, gltA, ompA and ompB)., Results: All bats were identified as Pipistrellus pipistrellus, and their ticks as Argas vespertilionis. Molecular analyses showed that DNA of Rickettsia parkeri, R. lusitaniae, R. slovaca and R. raoultii was present in bat organs/tissues. In addition, nine of the 67 bat soft ticks (13.43%) were positive for R. raoultii (n = 5) and R. rickettsii (n = 4). In the phylogenetic analysis, these bat-associated rickettsiae clustered together with conspecific sequences reported from other host and tick species, confirming the above results., Conclusions: To the best of our knowledge, DNA of R. parkeri, R. slovaca and R. raoultii was detected for the first time in bat organs/tissues. This is also the first molecular evidence for the presence of R. raoultii and R. rickettsii in bat ticks. To our knowledge, R. parkeri was not known to occur in Asia. Our results highlight the need to assess rickettsial agents in a broader range of bat species and associated tick species.

Introduction: Radiofrequency catheter ablation (RFCA) is widely used to treat atrial fibrillation (AF) in China., Objective: We aimed to determine the long-term cost effectiveness of RFCA versus antiarrhythmic drugs (AADs) in treating AF from the perspective of third-party payers., Methods: The model was structured as a 12-month decision tree leading to a Markov model that simulated the follow-up treatment outcomes and costs with time horizons of 8, 15, and 20 years. Comparators were standard-of-care AADs. Clinical parameters captured normal sinus rhythm, AF, stroke, post-stroke, intracranial hemorrhage (ICH), gastrointestinal bleeding, post-ICH, and death. The risk of operative death, procedural complications, and adverse drug toxicity were also considered. The model output was quality-adjusted life-years (QALYs) and incremental cost per QALY gained., Results: RFCA incurred more costs than the AADs but resulted in more QALYs gained than did AADs. The incremental cost per QALY gained with RFCA versus AADs was ¥66,764, ¥36,280, and ¥29,359 at 8, 15, and 20 years, respectively. The sensitivity analyses showed that the results were most sensitive to the changes in RFCA cost and CHADS 2 score (clinical prediction rule for assessing the risk of stroke in patients with non-rheumatic AF)., Conclusion: Compared with AADs, RFCA significantly improves clinical outcomes and QALYs among patients with paroxysmal or persistent AF. From the Chinese payer's perspective, RFCA is a cost-effective therapy over long-term horizons.

The Three Gorges Reservoir (TGR) of China, the largest hydropower project over the world, has attracted much attention to the water impoundment and water-level manipulation. In this study, we evaluated potential effects of water impoundment and seasonal water-level manipulation on the bioaccumulation, trophic transfer and health risk of HMs (Cu, Fe, Zn, Hg, Cd and Pb) in food web components (seston, aquatic invertebrate and fish) in TGR. Our results show that, after the impoundment for eight years (2003-2010), all of the six metal concentrations in aquatic biota fell within the criteria of safety quality guidelines. The concentrations of Cu, Fe, Zn and Hg in fish and aquatic invertebrates were higher than those before impoundment, whereas Cd and Pb were lower than those before impoundment. Nonetheless, Hg, Cd and Pb in aquatic consumers underwent an increasing trend during the entire impoundment, implying potential reservoir effect in the future. Only the concentrations of Hg, Cd and Pb in aquatic consumers exhibited a declining trend towards the dam, showing consistent with the background level at the three reaches. Seasonal variations in HM concentrations of fish and aquatic invertebrates were ascribed to the water-level manipulation associated with reservoir management. Our findings show that Hg or Cd biomagnified through aquatic food web during different hydrological periods, whereas Pb, Cu, Fe and Zn exhibited weak biomagnification power. Overall, Hg, Cd and Pb showed a higher risk than that of Cu, Fe and Zn., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

In this study, a health risk assessment of N-nitrosodimethylamine (NDMA) in drinking water and food was conducted using disability-adjusted life years (DALYs) in major cities of China. Considering the numerous non-detected values found in drinking water samples, a zero-inflated model was employed to obtain a more precise NDMA concentration distribution function in drinking water. With exogenous chronic daily intake of 1.20 × 10 -6 mg/(kg*d), the lifetime cancer risk and disability-adjusted life years of NDMA are 4.01 × 10 -5 and 5.52 × 10 -6 per person-year (ppy). The disease burden attributable to water sources accounts for nearly 9.94% of total exogenous intake. The contribution rate of vegetables is the largest, followed by cereals, milk products, fish and shrimp, and meat. Taking endogenous sources into consideration, the contribution rates of drinking water and food sources decrease to 0.08% and 0.69%. This study provides a scientific basis for making policy decisions on NDMA pollution management., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Numerous studies reported that dyslipidemia was associated with cancer risk. However, few studies investigated the associations between dyslipidemia and non-small cell lung cancer (NSCLC)., Methods: Four hundred twenty-four histologically confirmed NSCLC cases and 414 controls, matched for age and sex, were enrolled to examine the relationship between dyslipidemia and NSCLC. Demographic and clinical data were obtained from patients' medical records and telephone interviews. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression., Results: Abnormal triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) levels showed statistically significant coexistence with NSCLC compared with controls. Higher levels of TG were associated with a higher risk of NSCLC (OR = 1.541, 95% CI, (1.072-2.215)). The odds ratios (ORs) for NSCLC for normal and high levels of HDL-C versus those with a low level of HDL-C were 0.337(95% CI, (0.242-0.468)) and 0.288(95% CI, (0.185-0.448)), respectively. After adjustment for age, sex, smoking status, hypertension, body mass index, diabetes and lipid profiles, the adjusted OR for normal and high levels of HDL-C were 0.320(95% CI, (0.218-0.470)) and 0.233(95% CI, (0.134-0.407)), respectively. However, after adjustment, high levels of TG increased the risk of NSCLC but not significantly (OR = 1.052, 95% CI (0.671-1.649))., Conclusions: This study provided evidence that dyslipidemia increased the risk of NSCLC in Chinese population.

Background: It has been proven that lung cancer in the youth exhibited rapid progression, thus timely and accurate diagnosis is crucial. The aim of this study is to explore the clinicopathological characteristics of lung cancer in the youth, so as to provide clues for diagnosis., Methods: The study enrolled patients aged younger than 40 years with lung cancer diagnosed with histology or cytology in our hospital between 1995-2012. We retrospectively analyzed sex, age, symptoms, smoking history, histology, stage and misdiagnosis., Results: One hundred and thirty patients with lung cancer in the youth were enrolled, which comprise 5.2% of all cases of lung cancer in that period. Among them, 68.5% were male; 53.8% were aged between 36 and 40 years. Common symptoms included cough and hemoptysis, and systematic symptoms were relatively uncommon; and 11.8% showed no symptoms. 63.3% had a smoking history, and the time between initial symptom and final diagnosis averaged 3.9 months. The misdiagnosis rate was 51.5%, with tuberculosis as the leading misdiagnosis. 85.4% were staged III/IV. Primary lesion often located in upper lobes. Adenocarcinoma was the commonest histology, and 72.3% of the whole group was poorly differentiated., Conclusions: Lung cancer in the youth showed some special clinicopathological characteristics. Doctors should consider the possibility of lung cancer in patients with seemly diagnosis of tuberculosis, especially in those without symptomatic symptoms, and perform histological or cytological examinations. The absence of smoking history cannot rule out the possibility of lung cancer in youth patients.

Objective: The present study aimed to evaluate a new method for validation of complete linear block at the left atrial (LA) roof., Background: Linear lesions at the LA roof have been reported to improve the success rate of catheter ablation of atrial fibrillation (AF)., Methods: Complete linear block at the LA roof was evaluated in 31 patients after complete isolation of pulmonary vein antrum (PVA) using a simple method. We hypothesized that complete linear block of the LA roof could be confirmed during sinus rhythm if (1) a continuous line of double potentials could be recorded at the LA roof, and (2) the activation sequence along the posterior wall changed to caudocranial. The results of this method were compared with standard pacing techniques., Results: Thirty-nine lines were assessed using this method: 8 before and 31 after achievement of complete conduction block. After validation of complete linear block at the LA roof, double potentials with a mean interpotential interval of 60 +/- 13 ms were recorded in 25 patients and electroanatomical mapping of the left atrium showed the activation sequence of posterior wall changed to caudocranial in all 31 patients during sinus rhythm. The sensitivity, specificity, positive and negative predictive values of this method for validating complete linear block were 100%, 88.9%, 96.8%, and 100%, respectively., Conclusion: A corridor of double potentials along the roof line and a caudocranial activation sequence along the posterior wall during sinus rhythm can indicate conduction block at the LA roof after PVA isolation.