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Kashin-Beck disease (KBD) is a multifactorial endemic disease that only occurs in specific Asian areas. Mycotoxin contamination, especially from the Fusarium spp., has been considered as one of the environmental risk factors that could provoke chondrocyte and cartilage damage. This study aimed to investigate whether new mycotoxins could be identified in KBD-endemic regions as a potential KBD risk factor. This was investigated on 292 barley samples collected in Tibet during 2009-2016 and 19 wheat samples collected in Inner Mongolia in 2006, as control, from KBD-endemic and non-endemic areas. The LC-HRMS(/MS) data, obtained by a general mycotoxin extraction technic, were interpreted by both untargeted metabolomics and molecular networks, allowing us to identify a discriminating compound, enniatin B, a mycotoxin produced by some Fusarium spp. The presence of Fusarium spp. DNA was detected in KBD-endemic area barley samples. Further studies are required to investigate the role of this mycotoxin in KBD development in vivo.

Background: Congenital heart defects (CHDs) are a major global health problem, yet their crucial environmental risk factors are still unclear. We aimed to explore the associations between maternal periconceptional environmental exposures and all CHDs, isolated and multiple CHDs and CHDs subtypes., Method: A case-control study including 675 infants with CHDs and 1545 healthy controls was conducted. Participating mothers who delivered in Guangzhou from October 2019 to November 2021 were recruited. To examine the independent associations between maternal periconceptional environmental exposure and offspring with CHDs, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariable logistic regression model., Results: Maternal exposure to living near main roads [adjusted OR (aOR) = 1.94, 95% CI = 1.06-3.56] and housing renovation (aOR = 1.94, 95% CI = 1.03-3.67) during the periconceptional period were positively related to a greater risk of all CHDs, similar results were also found in isolated CHDs rather than multiple CHDs. Additionally, living near main roads was positively associated with secundum atrial septal defect/patent foramen ovale (aOR = 2.65, 95% CI = 1.03-6.81) and housing renovation was strongly positively associated with ventricular septal defect (aOR = 5.08, 95% CI = 2.05-12.60). However, no association was observed between incense burning and family relationships and all CHDs, isolated and multiple CHDs and CHDs subtypes., Conclusion: Living near main roads and housing renovation during the periconceptional period are significantly associated with the increased risks for all CHDs and isolated CHDs. Further study is needed to extend sample size to explore the effects of time and frequency of burning incense and family relationships on CHDs in offspring., (© 2023. The Author(s).)

The construction of information infrastructure as well as the transformation and upgrading of the industrial structure are among the major challenges for the Chinese economy. Therefore, it is of great significance to explore how information infrastructure affects the upgrading of industrial structure. Based on the panel data of 31 provinces in China from 2013 to 2020, mediating effect model and non-parametric percentile bootstrap method are used to carry out empirical research, by creating an information infrastructure construction level and industrial structure upgrading indicators. The results show that, in addition to the direct effect of information infrastructure on industrial structure upgrading, information infrastructure can also work indirectly through three paths: (1) information infrastructure acts on industrial structure upgrading by enhancing urbanization level; (2) information infrastructure affects industrial structure upgrading by boosting technological innovation; (3) information infrastructure first enhances urbanization level, then acts on technological innovation, and finally promotes industrial structure upgrading. In addition, the intermediary effect of technological innovation is stronger than urbanization. In general, this study acknowledges that urbanization and technological innovation are partial mediators in the process of information infrastructure affecting industrial structure upgrading, notwithstanding other potential impact pathways being studied further., (© 2022. The Author(s).)

Volatile organic compounds are emitted abundantly from a variety of natural and anthropogenic sources. However, in excess, they can severely degrade air quality. Their fluxes are currently poorly represented in inventories due to a lack of constraints from global measurements. Here, we track from space over 300 worldwide hotspots of ethylene, the most abundant industrially produced organic compound. We identify specific emitters associated with petrochemical clusters, steel plants, coal-related industries, and megacities. Satellite-derived fluxes reveal that the ethylene emissions of the industrial sources are underestimated or missing in the state-of-the-art Emission Database for Global Atmospheric Research (EDGAR) inventory. This work exposes global emission point-sources of a short-lived carbonated gas, complementing the ongoing large-scale efforts on the monitoring of inorganic pollutants., (© 2022. The Author(s).)

Few studies have assessed the association between perceived availability of home- and community-based services (HCBSs) and self-reported depression among Chinese older adults, which the present study attempts to rectify. This cross-sectional study enrolled 11,941 participants aged 65 and older from the Chinese Longitudinal Healthy Longevity Survey 2018 wave. The 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) was used to evaluate depression, and perceived availability was measured for four categories of HCBSs: daily life assistance, medical care services, emotional support and social services, and other. These four categories and the number of services in each were used to represent the perceived availability of service provision. Binary logistic models were used to explore the relationship between perceived availability of HCBSs and depression in older adults. Perceived daily life assistance was found to be negatively associated with depression symptoms among Chinese older adults in both urban and rural areas [rural: OR (95%CI) = 0.66 (0.55-0.78), p < 0.001; urban: OR (95% CI) = 0.69(0.60-0.79), p < 0.001], while perceived levels of medical care services, emotional support and social services, and other were not associated with depression symptoms in rural or urban areas. Our primary finding was that providing daily life assistance at the community level may help to meet more older adults' daily needs, thus potentially decreasing the risk of depression., (© 2022 John Wiley & Sons Ltd.)

Chinese character recognition is based on a limited set of recurrent stroke patterns. Most Chinese characters are a combination of two or more of these components. To test whether readers are sensitive to combinations of components (or multi-component units [MCUs]) within a character, we conducted two probe detection tasks where participants had to detect the presence of a component in a target character. Critically, some targets contained an MCU that can stand as a character on its own, with its own meaning and sound, while other targets contained an MCU that only exists embedded within other characters (no associated meaning and sound). Participants had more difficulty detecting component probes that were a part of an existing MCU, compared to component probes that belonged to a non-existing MCU. These findings suggest that existing MCUs are a perceptual unit in Chinese character recognition.

Objectives: Repeat induced abortion is a significant public health problem in China. International knowledge about repeat induced abortion and its associated risk factors in Chinese women is scarce, and existing studies are hard to access for international scholars because most are published in Chinese. A systematic review was conducted to analyse the prevalence of repeat induced abortion among Chinese women and determine correlated risk factors., Methods: Seven electronic databases were systematically searched. Data on the prevalence of repeat induced abortion and related factors were extracted and pooled using a meta-analysis and narrative approach., Results: Of 2458 articles retrieved from seven databases, 21 were included in the study. The overall pooled prevalence of repeat induced abortion was 43.1% (95% confidence interval 36.7%, 49.5%). Of 25 exposures extracted, 15 factors were significantly correlated with repeat induced abortion, comprising seven individual demographic factors (i.e., age, education, employment, migrant status, parity, unhealthy lifestyle habits and region of residence), four reproductive health- and contraception-related factors (i.e., age at sexual debut, history of sexual activity, contraceptive knowledge and having a regular sexual life) and four sexual partner-related factors (i.e., multiple sexual partners, age of sexual partner, educational level of sexual partner and cohabitation with sexual partner)., Conclusion: The study findings highlight the problem of repeat induced abortion in China and suggest the need for government and civil society to increase efforts to reduce the alarming risks of repeat induced abortion in Chinese women and make them and their sexual partners more aware and protective of their sexual and reproductive health.

Background: Substance use and adverse sexual and reproductive health (SRH) outcomes continue to be significant threats to female adolescents' health and wellbeing, particularly to these marginalized subpopulations. Our research aimed to tackle knowledge gaps regarding the prevalence of concurrent substance use including alcohol, tobacco, illicit drug among Chinese adolescent female sex workers (AFSWs), while to assess the correlates between substance use and SRH risks; the needs for comprehensive SRH services were also examined in this study., Methods: A cross-sectional study enrolled 310 AFSWs aged 15-19 years by using cluster sampling method in Kunming, China. Descriptive analysis was employed to characterize the participants who were regular-alcohol users, regular-tobacco users, illicit drug users and polysubstance users. Multivariable logistic regression analysis was performed to detect the SRH correlates of regular-alcohol use, regular-tobacco use, illicit drugs and polysubstance use respectively., Results: There is a high prevalence of regular-alcohol drinking (83%, 257/310) among AFSWs, with 44% (136/310) smoking cigarettes regularly and 9% using illicit drug (27/310) in the past year. In multivariate analysis, AFSWs who had middle and high school education, had higher monthly income, experienced of sexual and gender based violence (SGBV) and prior abortion, and regular-tobacco smoking were associated with increased odds of regular-alcohol drinking; engaging in unprotected sex while drunk, having STIs symptoms and using illicit drugs were significantly associated with regular-tobacco smoking; while AFSWs who had an illicit drug using- intimate partner, experienced forced sexual initiation, accessed unsafe medical providers for STIs treatment were associate with increased odds of illicit drug use. Moreover, 35% (105/298) AFSWs sought unsafe medical care for STIs treatment, or no treatment at all, among them, majority were using polysubstance (87%; 91/105)., Conclusions: Our findings reveal combined threats of substance use to AFSWs' SRH and wellbeing in China, this study emphasises that the coordinated efforts are needed to integrate SRH promotion and harm reduction service across sectors, and not only fragmented measures. An effective response should include an agreed framework, indicators and targets supported by political will, solid leadership and policy reform to deal with AFSWs' overlapping vulnerabilities in a systematic way.

Background: To explore the association between different types of childhood maltreatment and sleep disturbance among Chinese adolescents, with a particular focus on gender differences., Methods: A cross-sectional study was conducted in 7 randomly selected provinces of China via the 2015 School-Based Chinese Adolescents Health Survey. Questionnaires from 153,547 students were completed and were eligible for this study. The Chinese Version of the Pittsburgh Sleep Quality Index (CPSQI) and Childhood Trauma Questionnaire-Short Form (CTQ-SF) were used to assess sleep disturbance and childhood maltreatment, respectively., Results: The prevalence of sleep disturbance among adolescents in China was 21.6%. A significantly increased risk of sleep disturbance was associated with physical abuse (aOR=1.22, 95% CI=1.21-1.24), emotional abuse (aOR=1.15, 95% CI=1.14-1.15), sexual abuse (aOR=1.16, 95% CI=1.15-1.18), physical neglect (aOR=1.04, 95% CI=1.03-1.05), and emotional neglect (aOR=1.03, 95% CI=1.02-1.03). A significant dose-response relationship was found between cumulative childhood maltreatment experiences and sleep disturbance. The interaction terms (between physical abuse/emotional abuse/sexual abuse/physical neglect/emotional neglect/number of childhood traumas and gender) were significantly associated with sleep disturbance. Further stratification analyses by gender showed that girls who reported experiencing one or more of these five types of childhood maltreatment had a higher risk of sleep disturbance than boys., Limitations: The study only included school students, and the cross-sectional design limited our ability to make causal inferences., Conclusions: The study findings suggest that childhood maltreatment increases the risk of sleep disturbance in adolescents. Furthermore, exposure to single and multiple types of childhood maltreatment predicts lower sleep quality in girls., (Copyright © 2019. Published by Elsevier B.V.)

Background and Objective: Because of the narrow therapeutic window and huge inter-individual variation, the individual precision on anticoagulant therapy of warfarin is challenging. In our study, we aimed to construct a Back Propagation Neural Network (BPNN) model to predict the individual warfarin maintenance dose among Chinese patients who have undergone heart valve replacement, and validate its prediction accuracy., Methods: In this study, we analyzed 13,639 eligible patients extracted from the Chinese Low Intensity Anticoagulant Therapy after Heart Valve Replacement database, which collected data on patients using warfarin after heart valve replacement from 15 centers all over China. Ten percent of patients who were finally enrolled in the database were used as the external validation, while the remaining were randomly divided into the training and internal validation groups at a ratio of 3:1. Input variables were selected by univariate analysis of the general linear model; 2.0, the mean value of the international normalized ratio (INR) range 1.5-2.5, was used as the mandatory variable. The BPNN model and the multiple linear regression (MLR) model were constructed by the training group and validated through comparisons of the mean absolute error (MAE), mean squared error (MSE), root mean squared error (RMSE), and ideal predicted percentage., Results: Finally, 10 input variables were selected and a three-layer BPNN model was constructed. In the BPNN model, the value of MAE (0.688 mg/day and 0.740 mg/day in internal and external validation, respectively), MSE (0.580 mg/day and 0.599 mg/day in internal and external validation, respectively), and RMSE (0.761 mg/day and 0.774 mg/day in internal and external validation, respectively) were achieved. Ideal predicted percentages were high in both internal (63.0%) and external validation (59.7%), respectively. Compared with the MLR model, the BPNN model showed a higher ideal prediction percentage in the external validation group (59.7% vs. 56.6%), and showed the best prediction accuracy in the intermediate-dose subgroup (internal validation group: 85.2%; external validation group: 84.7%) and a high predicted percentage in the high-dose subgroup (internal validation group: 36.2%; external validation group: 39.8%), but poor performance in the low-dose subgroup (internal validation group: 0%; external validation group: 0.3%). Meanwhile, the BPNN model showed better ideal prediction percentage in the high-dose group than the MLR model (internal validation: 36.2% vs. 31.6%; external validation: 42.8% vs. 37.8%)., Conclusion: The BPNN model shows promise for predicting the warfarin maintenance dose after heart valve replacement.

The global scale-up in demand for animal protein is the most notable dietary trend of our time. Antimicrobial consumption in animals is threefold that of humans and has enabled large-scale animal protein production. The consequences for the development of antimicrobial resistance in animals have received comparatively less attention than in humans. We analyzed 901 point prevalence surveys of pathogens in developing countries to map resistance in animals. China and India represented the largest hotspots of resistance, with new hotspots emerging in Brazil and Kenya. From 2000 to 2018, the proportion of antimicrobials showing resistance above 50% increased from 0.15 to 0.41 in chickens and from 0.13 to 0.34 in pigs. Escalating resistance in animals is anticipated to have important consequences for animal health and, eventually, for human health., (Copyright © 2019 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

Purpose: Suicidality (ranging from suicidal ideation to suicidal attempts and completed suicide) is a major and preventable public health concern, and body weight is considered a modifiable factor which might be helpful to the early risk assessment of suicidal ideation. This study aimed to comprehensively evaluate the association of body weight status with suicidal ideation across sex among Chinese adolescents., Methods: Data were drawn from the 2015 National School-based Chinese Adolescents Health Survey, and 54,640 students' questionnaires were completed and qualified for the survey. Body mass index z scores were calculated and categorized into four levels: underweight (less than the 5th percentile for sex and age), normal weight (between the 5th and 85th percentile), overweight (between the 85th and 95th percentile), and obese (above the 95th percentile)., Results: Of the total sample, 47.3% (25,852) were boys. The weighted prevalence of suicidal ideation among Chinese adolescents is 15.7% (14.6% in boys and 17.3% in girls). After adjusting for demographics, smoking, drinking, and depressive symptoms, our final multivariate logistic regression models demonstrated that only boys identified as underweight (Adjusted odds ratio [AOR] = 1.23, 95% CI = 1.06-1.44) or obese (AOR = 1.19, 95% CI = 1.02-1.38) were at a higher risk of suicidal ideation. Additionally, the association between weight status and suicidal ideation among boys might be moderated by academic pressure, smoking, and depressive symptoms., Conclusions: There was a significant J-shaped association between relative body weight and suicidal ideation in boys. The child's sex should be taken into consideration when developing interventions against unhealthy weight and suicidal ideation.

The Chinese Family Planning (FP) programme mainly focuses on married couples, and young unmarried women have limited access. This cross-sectional study aims to identify risk factors related to repeat abortions in Chinese adolescents receiving abortions. Data were collected using a questionnaire for all women seeking abortions within 12 weeks of pregnancy during a period of 2 months in 297 participating hospitals randomly selected across 30 provinces of China in 2013. Only the adolescents (younger than the minimum legal married age of 20 years) were included in this study. Of the 2370 adolescents who were receiving abortions, 927 (39%) were undergoing repeat abortions. The primary reason for the current unintended pregnancies was non-use of contraception (68%). Adolescents receiving abortions who had an increased risk of repeat abortions were those who had children (OR 2.57, 95% CI 1.80⁻3.67), those who resided in a middle-developed region (OR 1.81, 95% CI 1.30⁻2.50), those who resided in a relatively poor region (OR 2.40, 95% CI 1.78⁻3.23), and those who had used contraception during the 6 months preceding the survey (OR 1.38, 95% CI 1.12⁻1.71 for condom use). The occupation as a student was a protective factor for adolescents (OR 0.64, 95% CI 0.50⁻0.83). Adolescents should be offered equal access to FP to that of married women in China to reduce unintended pregnancies and repeat abortions. Correct and consistent contraception practice should be promoted.

Objective: To develop a predictive model for fetal loss in women with systemic lupus erythematosus (SLE)., Design: A retrospective cohort study., Setting: Data were collected in a tertiary medical centre, located in Shanghai, China, from September 2011 to May 2017., Participants: 338 pregnancies with SLE were analysed retrospectively. Cases of multiple pregnancy and those in which artificial abortion was performed for personal reasons were excluded., Primary Outcome Measures: Fetal loss was the primary outcome. A stepwise regression to identify the predictors related to the fetal loss and coefficient B of each variable was used to develop a predictive model and make a corresponding risk classification. The Hosmer-Lemeshow test, Omnibus test and area under the receiver-operating characteristic curve (AUC) were used to assess the goodness-of-fit and discrimination of the predictive model. A 10-fold cross validation was used to assess the model for overfitting., Results: Unplanned pregnancies (OR 2.84, 95% CI 1.12 to 7.22), C 3 hypocomplementemia (OR 5.46, 95% CI 2.30 to 12.97) and 24 hour-urinary protein level (0.3≤protein<1.0 g/24 hours: OR 2.10, 95% CI 0.63 to 6.95; protein≥1.0 g/24 hours: OR 5.89, 95% CI 2.30 to 15.06) were selected by the stepwise regression. The Hosmer-Lemeshow test resulted in p=0.325; the Omnibus test resulted in p<0.001 and the AUC was 0.829 (95% CI 0.744 to 0.91) in the regression model. The corresponding risk score classification was divided into low risk (0-3) and high risk groups (>3), with a sensitivity of 60.5%, a specificity of 93.3%, positive likelihood ratio of 9.03 and negative likelihood ratio of 0.42., Conclusions: A predictive model for fetal loss in women with SLE was developed using the timing of conception, C 3 complement and 24 hour-urinary protein level. This model may help clinicians in identifying women with high risk pregnancies, thereby carrying out monitoring or/and interventions for improving fetal outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Aims: This large-scale study aimed to test (a) associations of problematic Internet use (PIU) and sleep disturbance with suicidal ideation and suicide attempts among Chinese adolescents and (b) whether sleep disturbance mediates the association between PIU and suicidal behavior., Methods: Data were drawn from the 2017 National School-based Chinese Adolescents Health Survey. A total of 20,895 students' questionnaires were qualified for analysis. The Young's Internet Addiction Test was used to assess PIU, and level of sleep disturbance was measured by the Pittsburgh Sleep Quality Index. Multilevel logistic regression models and path models were utilized in analyses., Results: Of the total sample, 2,864 (13.7%) reported having suicidal ideation, and 537 (2.6%) reported having suicide attempts. After adjusting for control variables and sleep disturbance, PIU was associated with an increased risk of suicidal ideation (AOR = 1.04, 95% CI = 1.03-1.04) and suicide attempts (AOR = 1.03, 95% CI = 1.02-1.04). Findings of the path models showed that the standardized indirect effects of PIU on suicidal ideation (standardized β estimate = 0.092, 95% CI = 0.082-0.102) and on suicide attempts (standardized β estimate = 0.082, 95% CI = 0.068-0.096) through sleep disturbance were significant. Conversely, sleep disturbance significantly mediated the association of suicidal behavior on PIU., Discussion and Conclusions: There may be a complex transactional association between PIU, sleep disturbance, and suicidal behavior. The estimates of the mediator role of sleep disturbance provide evidence for the current understanding of the mechanism of the association between PIU and suicidal behavior. Possible concomitant treatment services for PIU, sleep disturbance, and suicidal behavior were recommended.

Objective: To completely and quantifiably determine the effect of systemic lupus erythematosus (SLE) on pregnancy outcomes in a Chinese cohort., Design: A retrospective cohort study., Setting: Data were collected at a tertiary medical centre located in Shanghai, China, from September 2011 to May 2017., Participants: We assigned 338 pregnant women with SLE to the study cohort and 1014 randomly selected pregnant women without SLE (three for every woman with SLE) to a comparison cohort. The relevant medical records of all pregnant women were retrospectively reviewed. Cases of multiple pregnancy and cases in which an artificial abortion was performed for personal reasons were excluded., Primary and Secondary Outcome Measures: Maternal and fetal outcomes were primary outcomes, and management of antenatal care was the secondary outcome., Results: The risks of pregnancy-induced hypertension (OR 2.68, 95% CI 1.75 to 4.09), pre-eclampsia (OR 3.13, 95% CI 1.95 to 5.03) and premature rupture of membranes (OR 2.53, 95% CI 1.46 to 4.40) were significantly different between women with and without SLE. Gestational diabetes was negatively associated with SLE in pregnant women (OR 0.49, 95% CI 0.28 to 0.85). Pregnant women with SLE displayed significantly higher rates of fetal loss (OR 10.23, 95% CI 5.08 to 20.59), including spontaneous abortion (OR 4.42, 95% CI 1.52 to 12.80), therapeutic abortion (OR 16.57, 95% CI 5.80 to 47.35) and stillbirth (OR 13.25, 95% CI 1.49 to 118.11), and a higher risk of preterm birth (OR 3.15, 95% CI 2.21 to 4.50), intrauterine growth restriction (OR 2.20, 95% CI 1.35 to 3.58), a child who was small for the gestational age (OR 1.86, 95% CI 1.11 to 3.13), a caesarean section (OR 4.73, 95% CI 3.30 to 6.80) or a neonatal intensive care unit admission (OR 3.48, 95% CI 2.21 to 5.48) than women in the non-SLE population after adjusting for confounding factors., Conclusions: In this study, SLE significantly increased the risk of adverse pregnancy outcomes. Therefore, a preconception assessment and close antenatal monitoring by both rheumatologists and obstetricians should be performed in pregnant women with SLE., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Suicidal ideation and attempts are still currently serious problems among adolescents worldwide, and there is evidence that sleep problem may be associated with increased rates of mental disorder. This study aimed to examine the associations between sleep duration and suicidal ideation and attempts among adolescents and to test whether depressive symptoms have moderating effects on the associations., Methods: A 3-stage, stratified cluster, random sampling method was used to collect data from 20,130 high school students in southeast China., Results: The weighted prevalence of short sleep among Chinese adolescents was 5.6% (95% CI, 5.3-6.0%), and the weighted prevalence of long sleep was 2.7% (95% CI, 2.5-3.0%). The final results demonstrated that short sleep was positively associated with suicidal ideation (AOR=2.28, 95% CI=1.96-2.66) and suicidal attempts (AOR=3.20, 95% CI=2.46-4.16), and long sleep was only significantly associated with suicidal attempts (AOR=2.47, 95% CI=1.70-3.58). Stratification analyses conducted separately for students with and without depressive symptoms demonstrated that depressive symptoms may have moderating effects on the associations between sleep duration and suicidality., Limitations: Our study sample only included school students, and causal inference could not be examined due to the cross-sectional design., Conclusions: Sleep duration was associated with suicidal ideation and attempts, and the association between sleep duration and suicidal attempts was U-shaped. These findings support that proper treatments services with the potential to restore adolescent normal sleep would be helpful in preventing suicidality among adolescents., (Copyright © 2016 Elsevier B.V. All rights reserved.)