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Background: Early prediction of delayed cerebral ischemia (DCI) is critical to improving the prognosis of aneurysmal subarachnoid hemorrhage (aSAH). Machine learning (ML) algorithms can learn from intricate information unbiasedly and facilitate the early identification of clinical outcomes. This study aimed to construct and compare the ability of different ML models to predict DCI after aSAH. Then, we identified and analyzed the essential risk of DCI occurrence by preoperative clinical scores and postoperative laboratory test results. Methods: This was a multicenter, retrospective cohort study. A total of 1039 post-operation patients with aSAH were finally included from three hospitals in China. The training group contained 919 patients, and the test group comprised 120 patients. We used five popular machine-learning algorithms to construct the models. The area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, precision, and f1 score were used to evaluate and compare the five models. Finally, we performed a Shapley Additive exPlanations analysis for the model with the best performance and significance analysis for each feature. Results: A total of 239 patients with aSAH (23.003%) developed DCI after the operation. Our results showed that in the test cohort, Random Forest (RF) had an AUC of 0.79, which was better than other models. The five most important features for predicting DCI in the RF model were the admitted modified Rankin Scale, D-Dimer, intracranial parenchymal hematoma, neutrophil/lymphocyte ratio, and Fisher score. Interestingly, clamping or embolization for the aneurysm treatment was the fourth button-down risk factor in the ML model. Conclusions: In this multicenter study, we compared five ML methods, among which RF performed the best in DCI prediction. In addition, the essential risks were identified to help clinicians monitor the patients at high risk for DCI more precisely and facilitate timely intervention. [ABSTRACT FROM AUTHOR]

The significance of CO2 emissions at the water–air interface from inland water bodies in the global carbon cycle has been recognized and is being studied more and more. Although it is important to accurately assess CO2 emission flux in a catchment, little research has been carried out to investigate the spatio-temporal variations in CO2 emissions in view of a water continuum. Here, we systematically compared the differences and control factors of CO2 degassing across the water–air interface of a spring–river–lake continuum in the discharge area of Baotuquan Spring in July 2017, which is a typical temperate karst spring area in Jinan city, northern China, using hydrogeochemical parameters, stable carbon isotope values, and CO2 degassing flux. Affected by the pCO2 concentration gradient between the water and ambient air, the spring water showed a high CO2 degassing flux (166.19 ± 91.91 mmol/(m2 d)). After the spring outlet, the CO2 degassing flux in the spring-fed river showed a slight increase (181.05 ± 155.61 mmol/(m2 d)) due to river flow rate disturbance. The river flow rate was significantly reduced by the "blockage" of the lake, which promoted the survival and reproduction of phytoplankton and provided favorable conditions for aquatic plant photosynthesis, increasing the plankton biomass in the lake to 3383.79 × 104/L. In addition, the significant decrease in the dissolved inorganic carbon (DIC) concentration and the increase in the δ13CDIC values in the lake also indicated that the photosynthesis of the lake's aquatic plants resulted in a significant decrease in the pCO2 concentration, thus limiting the amount of CO2 off-gassing (90.56 ± 55.03 mmol/(m2 d)). [ABSTRACT FROM AUTHOR]

Rapid urbanization in China in recent years has led to a dramatic increase in the number of construction engineering projects and amount of construction waste, and the resource utilization of construction waste is an effective way to low-carbon and energy conservation construction. However, the nation has experienced a low utilization rate of construction waste resources, slow development of its construction waste recycling industry chain in various areas, low coordination of various stakeholders in the industry chain, and incomplete industry chain management. Therefore, in this study, a game model is first used to analyze the decision-making game and its stability strategy among multiple stakeholders in the recycling of construction waste. An income matrix of the three parties, i.e., the government, construction companies, and recycling enterprises, in the construction waste industry chain is then established and the Jacobi matrix used to obtain their evolution and stability strategy (economic incentives, green production, and scale-up). Finally, conclusions are drawn from the simulation analysis of the model: (1) The ratio between fine and subsidy should be reasonably controlled such that the recycling of construction waste by the construction companies is positively related to government supervision. (2) The inflow of renewable products into the market should be promoted to change the perception of the public. (3) A new mode of construction waste management should be developed to link various stakeholders in the industry chain. This study provides scientific and reasonable management suggestions in line with the actual situation of China and provides a useful reference for local government to choose appropriate policies to address the problem of construction waste recycling industry chain. [ABSTRACT FROM AUTHOR]

Background: With progress being made in the treatment of cancer, various clinical and treatment options are being pursued. In China, Traditional Chinese Medicine (TCM) is used widely in the treatment of cancer. Objective: To estimate TCM treatment preferences and SDM mode of physicians in China. Methods: This study was conducted among physicians (n=185) from nine tertiary hospitals in China by discrete-choice experiment (DCE) survey and Shared Decision-Making Questionnaire-physician version (SDM-Q-Doc) survey. The DCE was developed with the inclusion of the most relevant attributes at appropriate levels for the TCM treatment of lung cancer. The empirical data analyses of physicians were performed using mixed logit models. Additionally, subgroup analysis was conducted. Results: In total, 185 respondents completed the questionnaire. All attributes were statistically significant except out-of-pocket costs. Physicians showed the strongest preferences for increasing disease control rate, relieving nausea and vomiting, and reducing the risk of side effects. Most of the physicians (78.38%) self-reported a high willingness to use SDM during the decision-making process. The physicians with a higher SDM-Q-Doc score had more preference for improving all three attributes than those with a lower score. Little variation was found in preferences among the physicians with other sociodemographic characteristics. Conclusion: In China, physicians considered disease control rate as the most essential attribute in the TCM treatment of lung cancer. The physicians in China mainly preferred SDM, and the preference was different according to SDM mode when involving the TCM therapy for patients with lung cancer. The study findings could inform future TCM therapy for lung cancer and promote SDM. [ABSTRACT FROM AUTHOR]

Purpose: To assess health-related quality of life (HRQoL) and utility scores of lung cancer patients treated with traditional Chinese medicine (TCM) in China. Methods: This cross-sectional study included lung cancer patients treated with TCM in seven tertiary hospitals in Shanghai, China. The HRQoL and utility scores of these patients were measured using the five-level EQ-5D (EQ-5D-5L). The EQ-5D-5L utility scores were derived from the Chinese EQ-5D-5L Value Set. The relationships between HRQoL and the socio-demographic and clinical characteristics of these patients were further explored by Tobit regression. Results: This study included a total of 347 patients. Their mean ± SD and median EQ-5D-5L utility scores were 0.851 ± 0.198 and 0.893, respectively. The highest proportion of participants reporting problems was observed in pain/discomfort dimension (57.9%) and anxiety/depression (45.5%). Lung cancer patients treated with TCM had poor HRQoL, influenced by cancer clinical stage. Conclusion: Lung cancer patients treated with TCM have poor HRQoL, with many patients reporting problems in the pain/discomfort and anxiety/depression dimensions. The information on health utility scores and HRQoL of lung cancer patients treated with TCM could be useful for future supportive care, economic evaluations and decision-making in China. [ABSTRACT FROM AUTHOR]

Objective. To better understand the status of medical treatment for human epidermal growth factor receptor 2 (HER2)-positive breast cancer and the differences between the Chinese and the international clinical practice. Methods. This was a retrospective, nationwide, multicenter, epidemiological study of advanced breast cancer patients from China. Between January 01, 2012, and December 31, 2014, a total of 3649 patients, covering 7 geographic regions and 21 institutions, participated in this series of studies. HER2-positive breast cancer was selected among the group and adopted into this study. In comparison, we summarized the demographics and clinical characteristics of HER2-positive breast cancer from the Surveillance, Epidemiology, and End Results (SEER) database. Results. A total of 918 patients diagnosed as HER2-positive breast cancer patients were included. The median age at diagnosis was 46 years (ranging, 23 to 78) with a single-peak incidence. The proportions of stages II–IV at diagnosis and distance metastasis in viscera were more than half of the participants. In comparison, the prevalence of estrogen or progesterone receptor-positive expression and luminalB subtype was relatively lower than that of the United States. The receipt of chemotherapy was fairly higher, while the usage of targeted therapy was seriously insufficient. Tumor size was in significantly positive associations with the duration of targeted therapy (Kendall's correlation coefficient = 0.3, P < 0.0001), while no prohibitive variables among clinical characteristics were detected. Conclusion. Our study suggested that HER2-positive breast cancer patients were characterized as a younger trend, a lower prevalence of hormonal receptor (HR)-positive expression, and less accessible to anti-HER2 targeted therapy with insufficient duration over the past few years in China. Concerted efforts should be exerted for promising survival benefits in the future. The trial registration number is https://clinicaltrials.gov/ct2/show/NCT03047889. [ABSTRACT FROM AUTHOR]

In the North China Plain (NCP), groundwater is an important source of water supply and plays a pivotal role in social and economic development. This study investigated the hydrochemical characteristics and genetic mechanism of groundwater in the southeastern part of the NCP using hydrogeochemical and GIS methods, and evaluated groundwater quality using the entropy weighted water quality index (EWQI). To this end, groundwater quality data were collected from 47 locations in 2016 (dry season) and 2017 (wet season). The results showed that the main anion and cation in groundwater in the study area are Na+ and HCO3−. The pH value of all the water samples exceeded 7, and most of the samples were classified as hard-brackish water. In terms of the spatial distribution, areas with relatively high values of the main components (TH, TDS, NO3−, Na+, Cl− and SO42−) of groundwater were mainly distributed in the northeast of the study area and east of Liaocheng. According to the Piper diagram, the groundwater can be mainly classified as HCO3-Ca, Cl-Na, and mixed types. The hydrochemical characteristics of groundwater is mainly controlled by rock weathering (silicates, carbonates and sulfates), and affected significantly by evaporation and cation exchange processes, and to a certain extent by anthropogenic inputs. According to the EWQI, groundwater quality in the study area can be mainly divided into good water and poor water. In addition, the range of areas with very poor water was significantly larger in 2017 than in 2016. [ABSTRACT FROM AUTHOR]

Objective: To establish optimal gestational weight gain (GWG) in Chinese pregnant women by Chinese-specific BMI categories and compare the new recommendations with the Institute of Medicine (IOM) 2009 guidelines.Design: Multicentre, prospective cohort study. Unconditional logistic regression analysis was used to evaluate the OR, 95 % CI and the predicted probabilities of adverse pregnancy outcomes. The optimal GWG range was defined as the range that did not exceed a 1 % increase from the lowest predicted probability in each pre-pregnancy BMI group.Setting: From nine cities in mainland China.Participants: A total of 3731 women with singleton pregnancy were recruited from April 2013 to December 2014.Results: The optimal GWG (ranges) by Chinese-specific BMI was 15·0 (12·8-17·1), 14·2 (12·1-16·4) and 12·6 (10·4-14·9) kg for underweight, normal weight and overweight pregnant women, respectively. Inappropriate GWG was associated with several adverse pregnancy outcomes. Compared with women gaining weight within our proposed recommendations, women with excessive GWG had higher risk for macrosomia, large for gestational age and caesarean section, whereas those with inadequate GWG had higher risk for low birth weight, small for gestational age and preterm delivery. The comparison between our proposed recommendations and IOM 2009 guidelines showed that our recommendations were comparable with the IOM 2009 guidelines and could well predict the risk of several adverse pregnancy outcomes.Conclusions: Inappropriate GWG was associated with higher risk of several adverse pregnancy outcomes. Optimal GWG recommendations proposed in the present study could be applied to Chinese pregnant women. [ABSTRACT FROM AUTHOR]

Although receptor status including estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) of the primary breast tumors was related to the prognosis of breast cancer patients, little information is yet available on whether patient management and survival are impacted by receptor conversion in breast cancer metastases. Using data from the nation‐wide multicenter clinical epidemiology study of advanced breast cancer in China (NCT03047889), we report the situation of retesting ER, PR and HER2 status for breast cancer metastases and evaluate the patient management and prognostic value of receptor conversion. In total, 3295 patients were analyzed and 1583 (48.0%) patients retesting receptor status for metastasis. Discordance in one or more receptors between the primary and the metastatic biopsy was found in 37.7% of women. Patients who remained hormone receptor (HR) positive in their metastases had similar progression‐free survival of first‐line and second‐line treatment compared to patients with HR conversion (P >.05). In multivariate analysis, patients who showed ER conversion from negative to positive had longer disease‐free survival (DFS) than patients who remained negative in their metastases (hazard ratio, 2.05; 95% confidence interval [CI], 1.45‐2.90; P <.001). Patients with PR remained positive and had longer DFS than patients with PR conversion from negative to positive (hazard ratio, 0.56; 95% CI, 0.38‐0.83; P =.004). Patients with PR conversion have shorter overall survival than patients with PR remained positive or negative (P =.016 and P =.041, respectively). Our findings showed that the receptors' conversions were common in metastatic breast cancer, and the conversion impacted the survival. What's new? Tumor metastasis is still the main cause of breast cancer mortality. Treatment of metastatic tumors is often based on the hormone receptor and human epidermal growth factor receptor 2 status of the primary tumor. However, as many as a third of patients with metastases have altered receptor status. Does this receptor conversion affect prognosis? In this large Chinese study, the authors found that, in many cases, the answer is yes. These results indicate that it is clinically important to biopsy distant metastases and assess receptor status whenever possible and to use these results to guide treatment. [ABSTRACT FROM AUTHOR]

Cold injury refers to local or systemic injury caused by a rapid, massive loss of body heat in a cold environment. The incidence of cold injury is high. However, the current situation regarding the diagnosis and treatment of cold injury in our country is not ideal. To standardize and improve the level of clinical diagnosis and treatment of cold injury in China, it is necessary to make a consensus that is practical and adapted to the conditions in China. We used the latest population-level epidemiological and clinical research data, combined with relevant literature from China and foreign countries. The consensus was developed by a joint committee of multidisciplinary experts. This expert consensus addresses the epidemiology, diagnosis, on-site emergency procedures, in-hospital treatment, and prevention of cold injury. [ABSTRACT FROM AUTHOR]

With the acceleration of China's urbanization process, construction activities have led to a substantial increase in construction waste. However, as China's construction waste recycling rate is low, it is difficult to convert construction waste into valuable products for the sustainable development of waste resources. The biggest reason for this is the construction waste industrial chain, which is imperfect and has many problems. In this study, a simulation model is established using system dynamics software Vensim PLE. The analogue simulation shows that (1) China generates a large amount of construction waste every year. If construction waste source reduction measures are implemented, it will inhibit 50% of the waste generated. Upstream enterprises in the industry chain should actively develop waste reduction technology and improve waste reduction management; (2) marginal effect exists in the single waste reduction measure, but the government should implement more portfolio reduction measures to enhance the reduction effect, which is often three times that of the single policy; (3) the middle stream recycling enterprises in the industry chain cannot solely rely on government subsidies to reduce the cost of waste recycling. It is necessary to create synergistic linkages with more responsible entities upstream and downstream of the industry chain, thus creating a new model in construction waste management. (4) Government policies tend to drive the purchasing power of building material market. The government should actively exert its subjective initiative, supervise and provide policies to help the downstream enterprises that supply recycled building materials in the industry chain, and change the rigid understanding of contractors and owners about recycled building materials. The research conclusions can provide theoretical guidance for industry chain-related enterprises and government management departments in policy formulation, so that construction waste is sustainably developed. [ABSTRACT FROM AUTHOR]

The total amount of resources and energy consumed by long-lifespan residential buildings (RBs) is far less than that of short-lifespan RBs with repeated demolitions and constructions. This study aims to expand revealing of comprehensive influencing of the service lifespan of RBs beyond the previous approach that focused only on the one aspect of physical conditions with RBs. This study proposed these latent variables (i.e., physical, functional, economic, environmental and social lifespans), which made a better understanding of the service lifespan of RBs. To analyze the influence mechanism of the service lifespan of RBs, an empirical RB's lifespan dataset was established and tested utilizing a two-stage structural equation modeling (SEM) method. The results indicated that: (1) functional lifespan (total effects = 2.15) and environmental lifespan (total effects = 1.46) have an obvious positive impact on the service lifespan of RBs; (2) the influencing factors including structure design, land finance, employment of migrant workers, planning forward, and technical measures have a significant impact in corresponding lifespan dimension; and (3) improving construction technology and guaranteeing land value are regarded as the fundamental extending measure for the service lifespan of RBs. This study complements the connotation of RB service lifespan to a certain extent and further improves the sustainable development theory. Policy implications derived from the results were discussed at the end of the study. • The service lifespan of residential buildings conceptual and structure model is constructed. • The influence mechanism of service lifespan of residential buildings is revealed. • Functional lifespan and environmental lifespans have a significant impact influence. • Key influence factors is proposed for the service lifespan of residential buildings. • Extending countermeasure correspond to key influence factors one by one. [ABSTRACT FROM AUTHOR]

This paper investigates a large-scale vehicle routing and scheduling problem of B2C e-commerce urban logistics distribution in China. A qualitative and quantitative combined online intelligent scheduling approach is developed by means of incorporating operations research methods and artificial intelligence technologies. This approach aims to make good use of advantages of qualitative and quantitative methods by the complementarity of model-based computing in operations research and knowledge-based searching in artificial intelligence. A case study from a Chinese e-commerce company demonstrates its effectiveness. [ABSTRACT FROM AUTHOR]

The UN Security Council has made great contributions to global peace and security over the past 70 years. The five permanent members and ten non‐permanent members of the council share the responsibility by voting for the Security Council resolutions together. In this paper, we study whether Chinese outward foreign direct investment (OFDI) has been influenced by political incentives from perspective of the UN Security Council. Using China's Global Investment Data from 2005 to 2015 provided by the Heritage Foundation, we find that a country attracts more Chinese OFDI when it rotates onto the council. Such an effect increases during the important years when member's votes should be more valuable and among the countries which do not have close cooperation with China. [ABSTRACT FROM AUTHOR]

With the development of digitalization in China, the social assistance environment has also undergone tremendous changes in the digital era, which requires social managers to achieve high-quality and efficient assistance through digital transformation. The research introduces the theory of entropy change, constructs a two-dimensional quadrant method, and demonstrates that the orderly digital transformation of social assistance is achieved by negative entropy reduction offsetting positive entropy increase. Based on the current situation and case study of the digital transformation of social assistance in China, the entropy change of social assistance system has the characteristics of variability, uncertainty and complexity. Based on these three characteristics, the optimization path of the digital transformation of the social assistance system is proposed from the perspectives of negative entropy increase and positive entropy flow. [ABSTRACT FROM AUTHOR]

• TBL theory was used to analyze the comprehensive benefit of prefabricated buildings. • System dynamics extracted the correlation between the sub-systems and parameters. • Constructing prefabricated buildings improves the utilization rate of resources. • Cluster development of the prefabricated building adjust the employment structure. • Combined CO 2 reduction measures eliminate the boundary effect of single measure. With the increase of urban development in China, new construction, extension, renovation, and demolition of prefabricated buildings have also increased, leading to a huge amount of carbon emissions, which poses a great threat to the natural environment and ecological civilization, and goes against the ideas of creating a low-carbon city and sustainable development. How to develop prefabricated buildings efficiently and sustainably is a question governments and environmental organizations around the world wish to solve quickly. However, the sustainable development of prefabricated buildings is an issue with complexity and fuzziness. Thereby, to sustainably develop prefabricated buildings should consider the comprehensive benefits systematically instead of just considering from one certain perspective. In this study, TBL theory was applied to set the boundary of the comprehensive benefits of the prefabricated building system model (CBPBSM), thus the model was divided into three subsystems: economic, environmental, and social. System dynamics (SD) was utilized to identify and quantify the relationships between relevant parameters in the subsystems. This study emulated different scenarios using the CBPBSM and simulated the main parameters with sensitivity analysis. The results indicate that: (1) the greatest advantage of prefabricated building construction is a positive impact on the environment. CO 2 emission from the construction of prefabricated buildings is 37% of the emission generated from the construction of traditional buildings. (2) The construction of prefabricated buildings improves the resource utilization rate. When the resource utilization rate increases by 20%, the amount of construction waste will be reduced by 34.55% and the land will be conserved by 29.29%. (3) The development of the market for prefabricated buildings can promote local economic growth. (4) Cluster development of the prefabricated building industry can adjust the employment structure of workers and increase about 132% of their jobs. (5) The quantity of CO 2 reduced by applying combined measures is 6.08 times that of applying a single measure. These conclusions can serve as guides for related enterprises and government departments that work with the construction industry and help them create policies to ensure the sustainable development of prefabricated buildings. [ABSTRACT FROM AUTHOR]

China is committed to peaking its carbon emissions by 2030 and become a carbon-neutral society by 2060. The building sector that accounts for over one-third of the total carbon emissions is expected to face a great challenge in helping China achieve this goal. Shenzhen, as a low-carbon pilot city, whether its low-carbon work of urban buildings reaches the target is crucial. An attempt has been made in this study to assess the intensity of carbon emissions and associated reduction efficiency of urban buildings (operation stage) in Shenzhen by using the life cycle assessment method. The results show that the total carbon emissions generated from the buildings' operation stage have increased from 22 million metric tons (Mt) CO 2 eq in 2005 to 42 (±13%) Mt. CO 2 eq in 2019. Carbon emissions mainly result from the buildings' electricity use (79%), followed by refrigerant release emissions (12%). The energy conservation and carbon emissions reduction intensity in Shenzhen is at the middle level in China, and there is considerable space for improvement. According to scenario-based analysis, the carbon emission of the buildings sector can probably reach its peak by 2025 with the implementation of suitable policies – 5 years earlier than national target by 2030. Overall, this study makes a systemic analysis of the characteristics of urban buildings energy consumption and carbon emissions reduction, which can provide supportings for justifying the effectiveness of low-carbon activities in Shenzhen and beyond. • This paper evaluated the emissions reduction of civil buildings in Shenzhen city. • LCA method is employed to quantify the efficiency of emissions reduction. • Public buildings consume more energy per unit area than residential buildings. • Electricity use is the focus of buildings emission, accounting for 79% of the total. • Current efforts cannot meet the ambitious carbon peak and neutrality target. [ABSTRACT FROM AUTHOR]

AIDS is a serious health burden globally. In China, despite great efforts, AIDS continues to be a substantial public health challenge. We aimed to provide a systematic analysis of changes in the epidemiology of AIDS by examining incidence and mortality of AIDS in China in the past decade. We calculated crude incidence and mortality of AIDS in urban and rural areas in China from a publicly accessible Chinese Ministry of Health database between 1997 and 2017, specifically examining differences in mortality for men versus women (including children), rural versus urban, and differing age groups (<1 year, every 5 years, and ≥85 years old). Using locally weighted scatterplot smoothing (or LOWESS) regression curves and calculating p-values for each epidemiological profile, we analysed the changes in epidemiology over time. We compared specific mortality via Wilcoxon match-pairs signed-rank tests. The incidence of patients with AIDS gradually increased from 0·01 to 4·15 (p trend <0·0001) and mortality gradually increased from 0·01 to 1·11 (p trend <0·0001). Meanwhile, the mortality–incidence ratio decreased from 1·00 to 0·27 (p trend =0·0022), but has been relatively stable since 2002. Corresponding proportions of AIDS among all-cause mortality increased in both urban (p trend =0·0002) and rural (p trend =0·0065) areas. Men consistently had a higher AIDS mortality than women in urban (p=0·0017) and rural areas (p=0·0008). AIDS mortality for women was higher in rural areas (p=0·0021) and stable over time (p trend =0·74), but mortality by region did not differ for men (p=0·20). AIDS mortality, especially among a younger population, has been increasing over time in the 15 years and older age groups (p trend =0·018), whereas in the urban population, AIDS mortality has been increasing over time in the 20 years and older age groups (p trend =0·0006). The burden of AIDS is increasing in China, with higher mortality among men, rural women, and youth. Understanding these epidemiological changes might allow for more focused prevention and treatment of AIDS in China. The 1-3-5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (ZY2017304). [ABSTRACT FROM AUTHOR]

The purpose of this study was to obtain the morphological data of the maxillofacial region of Han nationality adults in Northeast China, and to explore the methods and appropriate variables of three-dimensional reconstruction technology for sex determination using Cone beam computer tomography (CBCT). The CBCT images of 420 adults (210 males, 210 females) aged 18-70years were reconstructed by MIMICS 17.0 software and sixteen observation indexes were measured and analyzed statistically. The results demonstrated that twelve of sixteen variables expressed significant sexual difference (p<0.01) which were as follows: mandibular angle (X1),area of mandibular foramen (X2), bi-gonial breadth (X3), koronoidbreite (X4), Height of symphysis (X5), Min-height of mandibular notch (X6), Min-breadth of mandibular ramus (X7), Buccal side bone thickness of MF (X8), Horizontal diameter of MF (X11), Vertical from prosthion to palatal breadth (X12), palatal breadth (X13), The ratio of HD-MF and VD-MF (X15). Then the sexual discriminant equation which was suitable for people at the age of 18-70 was established using stepwise method: Y=-0.059X1+0.313X2+0.1X3+0.061X4+0.044X5+0.041X6+0.076X13-17.215. It was found that the cross-validated grouped overall predictive accuracy was 87.4%. It could correctly identify males in 85.7% and females in 89% of the cases. This study has accumulated morphological data of maxillofacial skeleton from adults of Han nationality in Northeast China, which provided guiding significance for sex determination and clinical application in forensic science, archaeology, criminal investigation, iconography and clinical three-dimensional (3D) print. Evaluation variables and related discriminant functions of sex determination using CBCT for three-dimensional reconstruction technology provided a new theoretical basis and practical means for sex determination. [ABSTRACT FROM AUTHOR]

Public health emergencies influence urban carbon emissions, yet an in-depth understanding of deviations between regional emissions under such emergencies and normal levels is lacking. Inspired by the concept of resilience, we introduce the concept of regional carbon resilience and propose four resilience indicators covering periods during and after emergencies. A synthetic difference-in-differences model is employed to compute these indicators, providing a more suitable approach than traditional methods assuming unchanged levels before and after emergencies. Using the COVID-19 pandemic in China as a case study, focusing on the power and industry sectors, we find that over 40% regions exhibit strong resilience (> 0.9). Average in-resilience (0.764 and 0.783) is higher than post-resilience (0.534 and 0.598) in both sectors, indicating lower resilience during than after emergencies. Significant differences in resilience performance exist across regions, with Hebei (0.93) and Hangzhou (0.92) as top performers, and Qinghai (0.29) and Guiyang (0.36) as the least resilient. Furthermore, a preliminary correlation analysis identifies 22 factors affecting carbon resilience; higher energy consumption, stronger industrial production, and a healthier regional economy positively contribute to resilience with coefficients over + 0.3, while pandemic severity negatively impacts resilience, with coefficients up to -0.58. These findings provide valuable references for policymaking to achieve carbon neutrality goals., (© 2024. The Author(s).)

Objective: To investigate the water intake and its influence factors of pregnant and lactating women., Methods: From May to August 2020, a convenience sampling method was used to investigate questionnaires in the obstetrics and pediatric care departments of maternal and Child Health Hospitals in Beijing, Tianjin, Shandong and Jiangsu Provinces(Cities) among pregnant and lactating women who received prenatal health care and postpartum follow-up. The questionnaire included general conditions, physical activity and water-related surveys. The data was exported from the Questionnaire Star System and analyzed by Wilcoxon rank sum test and multiple linear regression for different types of daily fluid intake., Results: The median daily water intake of pregnant and lactating women was 1321 mL and 1271 mL, respectively, meanwhile, plain water was the most highest(both 1000 mL), followed by milk and milk products(179 mL and 86 mL), other beverages(29 mL and 86 mL). The one-way analysis showed that daily water intake of pregnant women was increased with increasing gestation, literacy, and household disposable income, and the difference were statistically significant(P&lt;0.05) across gestation, literacy, physical activity intensity, and household disposable income groups, as well as significant differences in lactating women(P&lt;0.05). Multiple linear regression analysis showed that pregnancy was the most influential factor for daily water intake, plain water and liquid milk and yogurt intake among pregnant women, while household disposable income was the most influential factor for other beverages. For lactating women, household disposable income was the most influential factor for daily water intake, liquid milk and yogurt and other beverages, and literacy was the most influential factor for daily intake of plain water., Conclusion: Pregnant and lactating women had insufficient water intake, so it is necessary to consider different pregnancy status, family income and literacy for drinking water health education and improve drinking behavior.

Continuing urbanization and significant improvement of lifestyle have ushered in high demand for building floor area, inevitably leading to a rapid increase of interior decoration and renovation activities, which in turn produce a massive quantity of decoration and renovation waste (DRW). However, like many other countries with unremitting demand for building space and infrastructure, China has failed to attach adequate attention to DRW management. Using the yield-per-area method and life cycle assessment approach, this study aims to characterize the generation, flows, management and environmental impacts of DRW from commercial housing in nine cities in the Greater Bay Area (GBA), a highly developed economic zone in China. The results show that the production of DRW in the GBA increased from 0.16 million metric tons (Mt) in 1999 to 2.6 (±10%) Mt in 2018, with an annual growth rate of 16%. Ninety-five percent of the DRW is directly disposed of via simple landfilling. Although the recycling rate is relatively low, it still generated a benefit of 119,000 tons CO 2 eq mitigation in 2018. According to scenario-based analysis, improving the recycling rate and encouraging the use of prefabricated decoration could go a long way toward tackling the DRW problem. These findings can help reveal the full impacts of DRW in the GBA, and also provide a reference for other cities to take action., 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.)

Abstract: Coronavirus disease (COVID-19) patients frequently develop liver biochemical abnormality. However, liver biochemical abnormality in COVID-19 patients with liver cirrhosis is under-recognized.Patients hospitalized during COVID-19 pandemic in China (ie, from February to April 2020) were screened. All of 17 COVID-19 patients with liver cirrhosis consecutively admitted to the Wuhan Huoshenshan Hospital were identified. Meanwhile, 17 age-, sex-, and severity-matched COVID-19 patients without liver cirrhosis admitted to this hospital were selected as a control group; all of 14 cirrhotic patients without COVID-19 consecutively admitted to the Department of Gastroenterology of the General Hospital of Northern Theater Command were selected as another control group. Incidence of liver biochemical abnormality and decompensated events were primarily compared.Among the COVID-19 patients with liver cirrhosis, the incidence of liver biochemical abnormality at admission and during hospitalization were 76.50% and 84.60%, respectively; 7 (41.20%) had decompensated events at admission; 1 was transferred to intensive care unit due to gastrointestinal bleeding. Among the COVID-19 patients without liver cirrhosis, the incidence of liver biochemical abnormality at admission and during hospitalization were 58.80% (P = .271) and 60.00% (P = .150), respectively. Among the cirrhotic patients without COVID-19, the incidence of liver biochemical abnormality at admission and during hospitalization were 69.20% (P = .657) and 81.80% (P = .855), respectively; 11 (78.60%) had decompensated events at admission (P = .036). None died during hospitalization among the three groups.Liver biochemical abnormality is common in COVID-19 patients with liver cirrhosis. Management of decompensated events in cirrhotic patients without COVID-19 should not be neglected during COVID-19 pandemic., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Rice straw is a potential material for bioenergy production. Elevated atmospheric carbon dioxide (CO 2 ) concentration changed the quantity and quality of rice straw, thus changing its bioenergy production potential. In this experiment, we collected rice straw from China Free Air CO 2 Enrichment Platform (FACE). Three rice varieties, Wuyunjing 27, Y Liangyou 900 and Nipponbare N16, were selected from the FACE platform (the CO 2 concentration in the experimental group was controlled at 570 μmol ·mol -1 , which was 200 μmol ·mol -1 higher than the control group), the chemical composition of which was analyzed. The results showed that elevated CO 2 concentration significantly increased C content, C/N, and the content of non-structural carbohydrates in straw. Elevated CO 2 concentration significantly increased total sugar release by 8.8%, 6.7% and 9.9% in Wuyunjing 27, Y liangyou 900 and N16, respectively. Elevated CO 2 concentration significantly enhanced the biomass of N16 straw, but had no effect on the straw biomass of the other two rice varieties. The total sugar yield of N16 increased most significantly with elevated CO 2 concentration, reaching 19.2%. Our results indicated that elevated CO 2 concentration could improve the quality and quantity of rice straw, thereby increasing the utilization potential of biofuel.

Construction and demolition waste (C&D waste) is a worldwide issue that concerns the sustainable development of the construction industry. In this paper, detailed formulas are listed for calculating the costs of four typical kinds of disposal routes of C&D waste. They are illegal dumping, controlled dumping (landfill), centralized recycling, and on-site recycling. Through the specific formulas, the costs of the new construction project in Guangzhou are also estimated. Then, a cost compensation model of construction waste disposal is constructed, which serves to calculate the amount of compensation that the government shall make to the contractor's disposal cost. The results of this study include the following: (1) steps taken to ensure the appropriate measures for C&D waste disposal sites and recycling centers; (2) the on-site recycling will become the future trend of C&D waste disposal due to its lowest cost; (3) the brick cement mortar and scattered concrete take a relatively larger proportion in the total C&D waste generated during the new construction project, and their disposal costs are higher; (4) we find that the cost of illegal dumping is the lowest among four varieties of waste treatment options if only the direct cost of waste treatment is taken account. However, the cost of on-site recycling becomes the lowest if the total cost is considered; (5) according to the case study, the full estimated cost of construction waste disposal is 9074.56 CNY and the total cost compensation is 15,084.21 CNY. The amount of compensation is greater than the disposal cost and contractors make a profit, thus stimulating them to recycle and reuse construction waste. Based on the empirical findings, we make several policy proposals. The research puts forward some operational advice as a reference for decision-makers of C&D waste management.

The transmission pattern of hemorrhagic fever with renal syndrome (HFRS) is associated with environmental conditions, including meteorological factors and land-cover. In the present study, the association between HFRS and environmental factors (including maximum temperature, relative humidity, rainfall, and normalized difference vegetation index) were explored in two typical counties in Northeast and two counties in Northwest China with severe HFRS outbreaks by using seasonal autoregressive integrated moving average model with exogenous variables (SARIMAX). The results showed that rainfall with 3- to 4-month lag was closely associated with HFRS in the two counties in Northeast China, whereas relative humidity with 1- or 5-month lag significantly impacts HFRS transmission in the two counties in Northwest China. Moreover, the SARIMAX models exhibit accurate forecasting ability of HFRS cases. Our findings provide scientific support for local HFRS monitoring and control, and the development of a HFRS early warning system.

An early steep increase in the number of humans infected with avian influenza A(H7N9) virus was observed in China, raising great public concern domestically and internationally. Little is known about the dynamics of the transmission contacts between poultry and human populations, although such understanding is essential for developing effective strategies to control this zoonosis. In this study, we evaluated the effects of contact reductions from live poultry markets (LPMs) closures on the transmission of H7N9 virus during epidemics in Guangdong Province, China. A mathematical model of the poultry-to-person transmission dynamics of H7N9 virus was constructed. The parameters in the model were estimated from publicly available data on confirmed cases of human infection and information on LPMs closure during 2013-2017. By fitting the model, we measured the time-dependent contact quantity of the susceptible population to LPMs. The results showed that periodic intervention strategies can greatly reduce the magnitude of outbreaks, and the earlier interventions for policy are implemented, the smaller is the outbreak. The control efforts for LPMs to decrease the contact quantity are critical in preventing epidemics in the long term. This model should provide important insights for the development of a national intervention strategy for the long-term control of avian influenza virus epidemics., (Copyright © 2018 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)

Background: Platinum chemotherapy has a role in the treatment of metastatic triple-negative breast cancer but its full potential has probably not yet been reached. We assessed whether a cisplatin plus gemcitabine regimen was non-inferior to or superior to paclitaxel plus gemcitabine as first-line therapy for patients with metastatic triple-negative breast cancer., Methods: For this open-label, randomised, phase 3, hybrid-designed trial undertaken at 12 institutions or hospitals in China, we included Chinese patients aged 18-70 years with previously untreated, histologically confirmed metastatic triple-negative breast cancer, and an ECOG performance status of 0-1. These patients were randomly assigned (1:1) to receive either cisplatin plus gemcitabine (cisplatin 75 mg/m(2) on day 1 and gemcitabine 1250 mg/m(2) on days 1 and 8) or paclitaxel plus gemcitabine (paclitaxel 175 mg/m(2) on day 1 and gemcitabine 1250 mg/m(2) on days 1 and 8) given intravenously every 3 weeks for a maximum of eight cycles. Randomisation was done centrally via an interactive web response system using block randomisation with a size of eight, with no stratification factors. Patients and investigator were aware of group assignments. The primary endpoint was progression-free survival and analyses were based on all patients who received at least one dose of assigned treatment. The margin used to establish non-inferiority was 1·2. If non-inferiority of cisplatin plus gemcitabine compared with paclitaxel plus gemcitabine was achieved, we would then test for superiority. The trial is registered with ClinicalTrials.gov, number NCT01287624., Findings: From Jan 14, 2011, to Nov 14, 2013, 240 patients were assessed for eligibility and randomly assigned to treatment (120 in the cisplatin plus gemcitabine group and 120 in the paclitaxel plus gemcitabine group). 236 patients received at least one dose of assigned chemotherapy and were included in the modified intention-to-treat analysis (118 per group). After a median follow-up of 16·3 months (IQR 14·4-26·8) in the cisplatin plus gemcitabine group and 15·9 months (10·7-25·4) in the paclitaxel plus gemcitabine group, the hazard ratio for progression-free survival was 0·692 (95% CI 0·523-0·915; pnon-inferiority<0·0001, psuperiority=0·009, thus cisplatin plus gemcitabine was both non-inferior to and superior to paclitaxel plus gemcitabine. Median progression-free survival was 7·73 months (95% CI 6·16-9·30) in the cisplatin plus gemcitabine group and 6·47 months (5·76-7·18) in the paclitaxel plus gemcitabine group. Grade 3 or 4 adverse events that differed significantly between the two groups included nausea (eight [7%] vs one [<1%]), vomiting (13 [11%] vs one [<1%]), musculoskeletal pain (none vs ten [8%]), anaemia (39 [33%] vs six [5%]), and thrombocytopenia (38 [32%] vs three [3%]), for the cisplatin plus gemcitabine compared with the paclitaxel plus gemcitabine groups, respectively. In addition, patients in the cisplatin plus gemcitabine group had significantly fewer events of grade 1-4 alopecia (12 [10%] vs 42 [36%]) and peripheral neuropathy (27 [23%] vs 60 [51%]), but more grade 1-4 anorexia (33 [28%] vs 10 [8%]), constipation (29 [25%] vs 11 [9%]), hypomagnesaemia (27 [23%] vs five [4%]), and hypokalaemia (10 [8%] vs two [2%]). Serious drug-related adverse events were seen in three patients in the paclitaxel plus gemcitabine group (interstitial pneumonia, anaphylaxis, and severe neutropenia) and four in the cisplatin plus gemcitabine group (pathological bone fracture, thrombocytopenia with subcutaneous haemorrhage, severe anaemia, and cardiogenic syncope). There were no treatment-related deaths., Interpretation: Cisplatin plus gemcitabine could be an alternative or even the preferred first-line chemotherapy strategy for patients with metastatic triple-negative breast cancer., Funding: Shanghai Natural Science Foundation., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Information tracking changes of birthweight is scarce in China. To examine trends of low birthweight (birthweight < 2500 g) and macrosomia (birthweight ≥ 4000 g) and potential risk factors in Beijing, hospital records from two major obstetrics and gynecology hospitals in urban districts in Beijing were analyzed., Methods: Hospital records from 1996 to 2010 were retrieved. Information of prenatal examination and birth outcomes was entered into a structured database. Live births were used for trend analysis. Information of live births in 2010 was used to identify potential risk factors., Results: A total of 63 661 live births were delivered during 1996-2010 in the study hospitals. The average birthweight increased from 3271 g in 1996 to 3 359 g in 2000 and slightly declined to 3 331 in 2010. The percentage of low birthweight fluctuated around 4.0%. No significant increase or decrease was observed. Preterm birth was the main cause of low birthweight, accounting for more than 73% of low birthweight. The average percentage of macrosomia was 7.6%. The percentages of macrosomia increased from 6.6% in 1996 to 9.5% in 2000 and declined to 7.0% in 2010. Excessive gestational weight gain and gestational diabetes were significantly associated with macrosomia., Conclusions: Continuously monitoring abnormal birthweight is needed and intervention should focus on appropriate gestational weight gain and reduction of preterm birth and gestational diabetes.

Objective: To describe the trend of multiple pregnancies and to compare the results with single pregnancy in Beijing from 1996 to 2010. Prevalence rates of pregnancy complications were compared between multiple and single pregnancies., Methods: In 1996, 1997, 1998, 1999, 2000, 2005, 2010, live births in two hospitals in Beijing were included to describe the trend of multiple and single pregnancy. Case-retrospective analyses were used. Information was collected, including maternal age, fetus number, delivery mode, with/without pregnancy induced diseases as hypertension, diabetes or anemia, gender of the baby, birth-weight and gestation etc. Linear regression analyses were applied to assess the trend of birth-weight and the rates of prevalence., Results: 63 661 babies and 62 895 puerperal were involved in this study. From 1996 to 2010, prevalence of multiple pregnancies increased by 0.02%, prevalence of cesarean delivery among multiple pregnancy women increased by 2.25% and the proportion of women older than 30 years increased by 3.52% and 2.89% among multiple or single pregnancy women, annually. However, the birth-weight did not show obvious change in both multiple and single birth babies. No obvious change was observed in the prevalence of low birth weight. Prevalence rates of premature birth increased by 1.62% and 0.16% among multiple and single pregnancy women, annually. From 1996 to 2010, the mean values of birth-weight among single birth babies were larger than 3 250 grams and under 2 500 gram among multiple birth babies. Rates of prevalence on pregnancy induced hypertension and anemia were higher in multiple pregnancy women than in single pregnancy women. Differences of rates on prevalence rates of pregnancy diabetes between multiple and single pregnancy women were not statistically significant., Conclusion: Prevalence of multiple pregnancies increased from 1995 to 2010 in Beijing. Mothers of multiples were more likely to get pregnancy complication than the single pregnancy women.

Objective: Idiopathic short stature (ISS) refers to extreme short stature without any diagnostic explanation. Recently, three genome-wide association studies discovered associations between the ZBTB38 and adult height in different populations. Therefore, variations in the ZBTB38 might contribute to ISS. Furthermore, one study in Korean population showed that ZBTB38 gene was significantly associated with adult height, but not with ISS. We want to examine whether the variants in ZBTB38 are associated with ISS in Chinese Han., Methods: A case-control association study was performed in 268 ISS patients and 513 healthy controls from Chinese Han population. Fourteen tag SNPs were selected and genotyped using SNaPshot method. Furthermore, expression of mRNA was quantified by RT-qPCR, and assessment of allelic expression imbalance was conducted with SNaPshot method., Results: Seven ZBTB38 SNPs were significantly associated with ISS by allele tests (rs724016, rs1582874, rs11919556, rs6440006, rs7612543, rs62282002, rs18651435). And five loci were associated with ISS according to genotype (rs11919556, rs16851419, rs6440006, rs62282002, rs18651435). Notably, after applying the stringent Bonferroni correction for multiple testing, one SNP, rs16851435, remained significantly associated by allele and genotype (P = 5·30 × 10⁻⁴ for allele and P = 0·002 for genotype). Furthermore, the rs16851435 alleles were investigated association with ZTBT38 mRNA expression levels. The G allele showed a higher transcriptional activity than the T allele (P = 0·002)., Conclusions: Our study indicated that the nonsynonymous SNP (rs16851435:T > G,p.Ser319Ala) of ZBTB38 was contributed to susceptibility of ISS in the Chinese Han population., (© 2013 John Wiley & Sons Ltd.)

Background: Neonatal hearing screening (NHS) has been routinely offered as a vital component of early childhood care in developed countries, whereas such a screening program is still at the pilot or preliminary stage as regards its nationwide implementation in developing countries. To provide significant evidence for health policy making in China, this study aims to determine the cost-effectiveness of NHS program implementation in case of eight provinces of China., Methods: A cost-effectiveness model was conducted and all neonates annually born from 2007 to 2009 in eight provinces of China were simulated in this model. The model parameters were estimated from the established databases in the general hospitals or maternal and child health hospitals of these eight provinces, supplemented from the published literature. The model estimated changes in program implementation costs, disability-adjusted life years (DALYs), average cost-effectiveness ratio (ACER), and incremental cost-effectiveness ratio (ICER) for universal screening compared to targeted screening in eight provinces., Results and Discussion: A multivariate sensitivity analysis was performed to determine uncertainty in health effect estimates and cost-effectiveness ratios using a probabilistic modeling technique. Targeted strategy trended to be cost-effective in Guangxi, Jiangxi, Henan, Guangdong, Zhejiang, Hebei, Shandong, and Beijing from the level of 9%, 9%, 8%, 4%, 3%, 7%, 5%, and 2%, respectively; while universal strategy trended to be cost-effective in those provinces from the level of 70%, 70%, 48%, 10%, 8%, 28%, 15%, 4%, respectively. This study showed although there was a huge disparity in the implementation of the NHS program in the surveyed provinces, both universal strategy and targeted strategy showed cost-effectiveness in those relatively developed provinces, while neither of the screening strategy showed cost-effectiveness in those relatively developing provinces. This study also showed that both strategies especially universal strategy achieve a good economic effect in the long term costs., Conclusions: Universal screening might be considered as the prioritized implementation goal especially in those relatively developed provinces of China as it provides the best health and economic effects, while targeted screening might be temporarily more realistic than universal screening in those relatively developing provinces of China.

Objective: To investigate the relationship of pre-pregnancy body weight, gestational weight gain and postpartum weight retention among women in Beijing., Methods: Using a cohort design, 600 pregnant women who went to district obstetrics and gynecology hospital in Beijing to establish preconception health care card from 5(th) February to 15(th) March 2009 were recruited. A total of 112 subjects (109 with valid data), 20% of that in baseline, were followed up at 6 months after delivery.70 subjects (66 with valid data) were followed up at one year after delivery. Weight, weight changes and postpartum weight retention were measured for low weight (BMI < 18.5 kg/m(2)), normal weight (18.5 kg/m(2) ≤ BMI ≤ 24.0 kg/m(2)) and overweight or obesity (BMI > 24.0 kg/m(2)) group., Results: The pre-pregnancy weight and antenatal weight were (54.8 ± 8.0) and (70.8 ± 9.3) kg respectively. Gestational weight gain was (16.0 ± 7.0) kg. The postpartum weight of 6 and 12 months were (60.5 ± 9.4) and (57.6 ± 8.6) kg respectively. Comparing to pre-pregnancy, postpartum weight retention in 6 months and 12 months were (5.7 ± 4.5) and (2.7 ± 4.5) kg, weight retention rates were (10.6 ± 8.6)% and (5.2 ± 9.3)%. Antenatal weight among low pre-pregnancy weight group, normal weight and overweight and obese women were (62.6 ± 5.7), (69.9 ± 6.6) and (84.2 ± 9.9) kg, and weight at postpartum 12 months among 3 groups were (49.3 ± 3.2), (56.5 ± 6.9) and (70.5 ± 6.0) kg respectively (F = 25.3, P < 0.01); At postpartum 12 months, low pre-pregnancy weight group ((5.6 ± 5.9) kg), overweight and obese women group ((4.7 ± 1.9) kg) postpartum weight retention was significantly higher than that of the normal weight group ((1.8 ± 4.3) kg) (F = 3.82, P < 0.05)., Conclusion: The pre-pregnancy body weight is a key risk factor in weight gain during pregnancy and postpartum weight retention.

Objective: To investigate the effect of pre-pregnancy body mass index (BMI) on blood glucose, blood pressure and body weight during pregnancy in women., Methods: 600 pregnant women in Beijing Haidian Maternal and Child Health Hospital were followed from 5th, Feb. 2009 to 15th, Mar. 2009 as a cohort study. Height, weight, blood glucose and blood pressure were detected in all the pregnant period., Results: The pre-pregnancy BMI correlated significantly with gestational weight in different pregnancy phases (P < 0.05). The rates of impaired glucose tolerance, diabetes mellitus and hypertension during pregnant in overweight and obesity women are much higher than the rates in low and normal body weight women (P < 0.05)., Conclusion: The pre-pregnancy BMI is a crucial risk factor of gestational hypertension, gestational high blood glucose and the gestational body weight. To carry out pre-pregnancy health education is an important measure to prevent complications of pregnancy.

Aim: To study the relationship between the cytotoxin-associated gene-A (CagA) status of H pylori strains and cerebral infarction among European Caucasians and Chinese Han by conducting a meta-analysis., Methods: Ten case-control studies, with data on a total of 907 cases and 966 controls, were retrieved and considered; disqualified studies were excluded. The included studies were then tested for heterogeneity, and a meta-analysis was performed., Results: The combined data revealed CagA-bearing strains of H pylori which cause chronic infection are associated with an increased risk of cerebral infarction (OR = 2.66, 95% CI: 2.17-3.26), but no such relationship was found with CagA-negative strains (OR = 0.74, 95% CI: 0.49-1.10) in the overall population. We performed subgroup analyses, dividing the overall population into European Caucasians and Chinese Han subgroups, and analyzed the studies according to their subgroup classification. Through the subgroup analysis, an association between cerebral infarction and CagA-bearing strains was found in both subgroups (OR = 2.60, 95% CI: 1.93-3.49 in Chinese Han; OR = 2.71, 95% CI: 2.05-3.59 in European Caucasians), but no significant association was found between cerebral infarction and CagA-negative strains (OR = 0.81, 95% CI: 0.45-1.48 in Chinese Han; OR = 0.64, 95% CI: 0.37-1.09 in European Caucasians)., Conclusion: These results suggest CagA-bearing strains of H pylori are significantly associated with susceptibility to cerebral infarction in Chinese Han and European Caucasians, but that CagA-negative strains are not a definite predisposing factor in either subgroup. The magnitude of this association with cerebral infarction needs to be confirmed by prospective studies and combined studies of H pylori eradication.