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Capillary malformation-arteriovenous malformation (CM-AVM) is a genetic condition predominantly attributed to variations in the RASA1 or EPHB4 genes. We identified three genetic variations: a variation in the RASA1 (c.2603+1G>A) and two novel variations in the EPHB4 (c.53-2A>G and c.2222T>C), expanding the spectrum of variants associated with CM-AVM. Additionally, we found that the presence of EPHB4 variations in these two families, alongside a documented history of Bier spots, highlights the impact of genetic factors on disease phenotype. We also conducted 595 nm pulsed dye laser therapy on the proband 2, and observed that facial telangiectasia was significantly reduced after the laser treatment. We aim to enhance the understanding of the disease through case studies of three families., (© 2024 Japanese Dermatological Association.)

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor's professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Residents' satisfaction perceptions of ecosystem services (ESs) are essential for the ecological protection and high-quality development of the Yellow River Basin (YRB). Existing studies lacks large-scale survey of local residents' satisfaction perception at urban scale within river basins, and has not effectively explored the matching relationship between the ESs supply and the perceptions of local residents. To address this gap, this study develops a database on nine ESs supply and individual perceptions of the YRB, constructs a comprehensive framework to quantify the matching of ESs supply and local residents' satisfaction perceptions, and proposes targeted strategy. The results reveal that: (1) Provisioning services are higher in cities along the river, while regulating services are higher in the south and west, both showing spatial clustering (p < 0.05). Cultural services are unevenly distributed, with higher quality of life and leisure tourism in the east and south. Provisioning and regulating services exhibit a spatial clustering (p < 0.05). (2) Residents' perceptions of provisioning services are the highest [3.86, 4.28], followed by cultural services [3.85, 3.98], and regulating services are lowest [3.53, 3.69]. Only provisioning services show significant spatial correlation (p < 0.05). (3) There are trade-offs and synergies in the ESs supply, but no significant correlation between the supply and perceptions. (4) A significant mismatch between ESs supply and local residents' perceptions in 15-24 cities, with 33.33%-71.79% of cities showing underestimation or overestimation of ESs supply. These findings provide feasible references for formulating and implementing tailored strategies for coordinated human and nature development., 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 © 2025 Elsevier Ltd. All rights reserved.)

Current knowledge about public climate change perception mainly covers belief, concern, and attitudes. However, how this discourse is interpreted using individuals' own frame of reference remains largely unknown, particularly in many large emitters from non-Annex I countries such as China. This study, for the first time, performs a nationwide open-ended survey covering 4,037 respondents and collected 12,100 textual answers. Using a semiautomated coding method, we find seven mental images that exclusively represent the Chinese interpretation of the climate change issue, including global warming, distant icons, natural disasters, environmental degradation, cause, solution, and weather. Analysis of influencing factors shows that females, those with lower education levels, lower income, and older individuals tend to connect climate change with natural weather phenomena. Younger and well-educated residents in developed cities are more aware of various consequences and anthropogenic causes of climate change. People with stronger climate change beliefs, policy support, and personal experience of extreme weather are more likely to mention disastrous impacts, carbon emission as causes, and potential solutions. Employing the multilevel regression and post-stratification technique, we map the prevalence of mental images in China at the prefecture-city level. The results reveal significant geographical heterogeneity, with estimated national means ranging from a high of 55% (weather) to a low of 11% (solution). Our findings reveal diverse perspectives and a widespread misconception of climate change in China, suggesting the need for tailored clarification strategies to gain public consent., (© 2024 Society for Risk Analysis.)

Objective: To identify the principal factors influencing the implementation of high-value healthcare performance evaluation and to examine the interrelationships among these factors., Background: Value-based health care (VBHC) is gaining momentum as a model that focuses on improving patient outcomes. However, there is still a lack of understanding of the multifaceted factors that contribute to its successful implementation., Design: Theoretical modelling and mixed research methods., Methods: First, this study constructed a framework of influencing factors on the implementation of VBHC performance evaluation based on the Technology-Organization-Environment model. Second, a representative set of influencing factors for healthcare performance evaluation was identified. The implementation of performance evaluation was identified based on a literature analysis and a case study in China. Finally, experts were invited to assess the relevance of the aforementioned influencing factors, and the collected data were analysed using Interpretative Structural Model. The PRISMA-ScR checklist guided the reporting of this study., Results: We initially constructed the theory framework with the objective of categorising and summarising the influential factors and potential problems revealed in the implementation of patient VBHC performance evaluation in general hospitals. Subsequently, 15 key factors were identified through interviews with 10 experts. Then, a six-level hierarchy was developed to construct a visual structure diagram, the purpose of which was to clarify the hierarchy of roles of each influencing factor. Finally, we categorise the influencing factors into four clusters based on their driving power and dependency within the system., Conclusion: The insights from this research will assist hospital managers in identifying and prioritising the key factors that influence high-value healthcare performance., Relevance to Clinical Practice: This study provides a reliable pathway reference for clinical and nursing performance value enhancement and provides important insights into resource allocation and decision-making for clinical practitioners., Patient or Public Contribution: No patient or public contribution., (© 2024 John Wiley & Sons Ltd.)

Background: The COVID-19 pandemic has become a serious global public health problem. Although the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor type 1 blockers (ARBs) has been recommended in patients with COVID-19 and cardiovascular diseases (CVDs), according to the results of some small-sample retrospective analyses, there remains a lack of sufficient evidence to validate their efficacy. This multicenter retrospective study investigated whether ACEI/ARB administration was beneficial in patients with COVID-19 and CVDs., Methods: A total of 11,231 patients with confirmed COVID-19 and CVDs, from 138 hospitals in Hubei Province, were included in this multicenter retrospective study. We compared the clinical characteristics and outcomes between the ARB and non-ARB groups and analyzed the risk factors for in-hospital death using univariate and multivariate Cox regression analyses and Kaplan-Meier curves., Results: In the multivariate Cox regression model, after adjusting for age, gender, comorbidities, and in-hospital medications, ARB use was associated with lower all-cause mortality (adjusted HR, 0.53; 95% CI, 0.38-0.73; P < 0.001). After propensity score-matched analysis, the adjusted HR for the use of ARB associated with all-cause mortality was 0.62 (95% CI, 0.40-0.88; P = 0.02). Further subgroup analyses found that the adjusted HRs for the use of ARB associated with all-cause mortality were 0.52 (95% CI, 0.30-0.89; P = 0.016), 0.37 (95% CI, 0.21-0.64; P < 0.001), 0.42 (95% CI, 0.28-0.64; P < 0.001), and 0.55 (95% CI, 0.37-0.84; P = 0.005) in patients with heart failure, diabetes, and hypercholesterolemia, and severe COVID-19, respectively., Conclusions: ARB administration was significantly associated with a lower risk of all-cause mortality in patients with COVID-19 and CVDs., Trial Registration: ClinicalTrials.gov NCT05615792. https://www., Clinicaltrials: gov/ct2/show/NCT05615792., Competing Interests: Declarations. Ethics Approval: This study was conducted in accordance with the principles of the Declaration of Helsinki and approved by the Research Ethics Committee of Tongji Medical College (no. TJ-IRB20210138). Consent to Participate: Not applicable. Consent for Publication: The authors declare that this manuscript is being submitted for consideration for publication. Conflict of Interest: The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The readiness of leaf-litter to burn in the presence of fire differs greatly between species. Thus, forests composed of different species vary in their susceptibility to fire. Fire susceptibility of forests may also differ from the arithmetic means of flammability of their component species, i.e., non-additive effects exist. Here, we assessed nine indices of flammability and five physicochemical properties of the leaf litter of eight common subtropical tree species in China. We then tested the net effects on litter flammability of different mixtures of the eight species. We measured the following variables: time to ignition, combustion time, spread rate, ignition temperature, mass loss, maximum flame height and three temperature indices, moisture, cellulose, lignin and ash contents, and specific leaf area (SLA). Our results show that the flammability of leaf litter: time to ignition, combustion time, ignition temperature, and flame height, varies widely between the eight species. Time to ignition was short (<3 s) for the three conifer species and Quercus variabilis and Q. aliena, but long (3.5-8.8 s) for Q. fabri, Q. glauca, and Liquidambar formosana. The five species with a short time to ignition all have high cellulose and lignin contents, and SLA, and are highly flammable. In contrast, the three species with long time to ignition have low cellulose and lignin contents, and SLA, and high ash content. Cellulose and lignin contents, and SLA are the major drivers of litter flammability, and ash and moisture contents are important negative drivers. Mixed litters containing species with high cellulose and lignin contents and SLA have positive non-additive effects (synergistic) on overall flammability whereas those containing species with low cellulose and lignin contents, and SLA have negative non-additive effects (antagonistic) on flammability. These results are essential for assessing forest fire-risks and assisting species selection in plantations or fire-break forests as a part of a forest fire-management strategy., Competing Interests: Declaration of competing interest In submitting the manuscript, we would like to make the following statements: (1) No conflict of interest exists in the submission of this manuscript; (2) The manuscript is approved by all authors; (3) The work described was original that has not been published previously, and is not under consideration for publication elsewhere, in whole or in part; (4) All the authors listed have made substantial contributions to research design, or the acquisition, analysis or interpretation of data, or drafting the paper or revising it critically; and (5) Nobody who qualifies for authorship has been excluded., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

Background: Normal weight obesity (NWO) is characterized by excess body fat in individuals with normal body mass index (BMI). This study aimed to investigate gut microbiota alterations in NWO and their potential associations with cardiometabolic diseases (CMD) risk in two independent cohorts., Methods: Our NWO-CMD mortality analysis included 168 099 adults with normal BMI from two large open-access databases, while our NWO-gut microbiota study involved 5467 adults with normal BMI from two independent cohorts: the WELL-China cohort and the Lanxi cohort. NWO was defined as having a normal BMI (18.5-23.9 kg/m 2 ) but an excess per cent body fat (PBF, ≥ 25% in men and ≥ 35% in women). Normal weight lean was defined as having a normal BMI and normal PBF. The 16S rRNA gene sequencing method was used to analyse gut microbiota data., Results: The study comprised 3620 (64.0% female, median age 58 years) and 1847 (64.3% female, median age 56 years) participants from the WELL-China and Lanxi cohorts. In our meta-analysis, NWO is associated with 26% (95% CI: 1.07-1.41) higher risk of CMD mortality. Gut microbial analyses indicated that the NWO group exhibited reduced levels of observed species (p = 0.009 and p = 0.013) and Chao 1 index (p = 0.002 and p = 0.002) and altered gut microbial compositions (p = 0.009 and p < 0.001) compared with the NWL group. Seven genera were consistently observed to be associated with NWO in both two cohorts (all Q < 0.25). Among them, five (Fusobacterium, Ruminococcus gnavus group, Ruminococcus torques group, Coprococcus and Christensenellaceae&#95;R7&#95;group) have been previously linked to obesity, while the other two (Phascolarctobacterium and Clostridia&#95;UCG-014) were minimally reported. We also found statistically significant differences in the microbial composition between the NWO group and the obesity group (p = 0.001 and p = 0.001). Furthermore, the NWO-related gut microbiome was associated with an elevated risk of hypertension, dyslipidaemia and metabolic syndrome, the corresponding HR (95% CIs) were 1.11 (1.01-1.22), 1.19 (1.10-1.29) and 1.17 (1.05-1.30) in the WELL-China cohort and 1.14 (1.02-1.27), 1.15 (1.02-1.29) and 1.16 (1.02-1.32) in the Lanxi cohort., Conclusions: These two large cohorts provided reliable evidence that gut microbiota alterations in NWO resemble those found in obesity, yet also display unique aspects. This distinct microbiota profile may contribute to heightened cardiometabolic risks in adults with normal BMI., (© 2024 The Author(s). Journal of Cachexia, Sarcopenia and Muscle published by Wiley Periodicals LLC.)

Lakes are sources of atmospheric carbon dioxide (CO 2 ), contributing to global climate change. Temporal variations in lake CO 2 emissions are pronounced, with algal growth and precipitation identified as important drivers. Eutrophic lakes often act as atmospheric CO 2 sinks during the growing season. However, these lakes can also emit CO 2 during the same period, a paradox that we hypothesize is driven by precipitation. This study tests this hypothesis and examines how rainstorms influence lake CO 2 emissions. To investigate, seven buoys were deployed in eutrophic Lake Taihu and a major inflow river to monitor water quality at 4-h intervals throughout 2021. CO 2 flux (FCO 2 ) was calculated using integrated methods, including gas diffusion models, the CO2calc program, and machine learning algorithms, based on water quality and meteorological data. Results revealed that only rainstorms (daily rainfall >50 mm) significantly increased FCO 2 . Although only three rainstorm events occurred, they accounted for 12.15% of the annual CO 2 emissions. During the growing season, the lake was a net CO 2 source, but without rainstorm-induced emissions, it would have functioned as a CO 2 sink, highlighting the crucial role of rainstorms in shifting lake dynamics. Piecewise structural equation modeling indicated that both abiotic factors (e.g., gas transfer velocity) and biotic factors (e.g., aquatic metabolism) influenced by rainstorms contributed to the elevated FCO 2 . These findings suggest that future reductions in lake FCO 2 due to eutrophication, combined with more frequent rainstorms under climate change, could amplify the impact of extreme precipitation on CO 2 emissions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Traditional Chinese medicine (TCM) is commonly used alongside Western medicine for stroke management in China. However, there is significant variation in TCM practice, and the utilisation of evidence-based clinical practice guidelines is inadequate. This study aims to evaluate the effectiveness of three popular frameworks-Consolidated Framework for Implementation Research (CFIR), Theoretical Domains Framework (TDF) and Normalization Process Theory (NPT)-in improving implementation outcomes for the integrated TCM and Western medicine clinical practice guideline for stroke management., Methods and Analysis: This study employs a hybrid type III design with a factorial randomised controlled trial, where 45 TCM hospitals will be randomly assigned to one of eight experimental conditions based on the use or non-use of each framework (CFIR, TDF, NPT). The factorial design allows for the evaluation of the main effects of each framework and their two-way and three-way interactions, offering insights into which combination of frameworks is most effective in enhancing implementation outcomes. The factorial design provides greater efficiency compared with traditional designs by enabling the simultaneous testing of multiple interventions and their combinations with the same sample size, which increases statistical power. Implementation facilitators will be trained to support the guideline adoption process, with interventions aligned to specific framework components (eg, CFIR for identifying barriers and facilitators, TDF for understanding behavioural influences and NPT for normalising practices within organisational routines). Outcomes will be evaluated using the RE-AIM framework (reach, effectiveness, adoption, implementation and maintenance). Hierarchical logistic regression models will test the study hypotheses, and qualitative methods, such as interviews and focus groups, will provide contextual understanding. Additionally, a cost-effectiveness analysis will be conducted to assess the economic feasibility of the implementation strategies., Ethics and Dissemination: This trial has been approved by the Institutional Review Board of Southern Medical University (approval number: #202261) and follows all relevant ethical guidelines for research involving human participants. On completion, the findings will be shared with patients, healthcare providers and stakeholders through various dissemination activities, including workshops and presentations within relevant TCM and stroke management networks. The results will be published in peer-reviewed academic journals and presented at national and international conferences to inform future practice and policy on the integration of TCM and Western medicine for stroke management., Trial Registration Details: This study has been registered on the Open Science Framework with the DOI: 10.17605/OSF.IO/NJEVB., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Introduction: Bronchopulmonary dysplasia (BPD) is one of the most common and significant complications of preterm birth. It ultimately leads to a decrease in the quality of life for preterm infants and impacts their long-term health. Early prediction and timely intervention are crucial to halting the development of BPD. This study aims to identify the biomarkers that can predict the early occurrence and development of BPD by screening serum metabolites in preterm infants. This will provide strong support for the early prediction of BPD and targeted interventions in future research., Methods and Analysis: This is a prospective, multicentre, open-label, observational cohort study spanning 3 years. It will be conducted in six major neonatal intensive care units in Shenzhen, China, involving preterm infants born at gestational ages <32 weeks. Demographic data and treatment information will be collected prospectively. Serum samples will be collected at five distinct time points: within 24 hours after birth, at 1 week, 2 weeks, 28 days and at 36 weeks postmenstrual age. These samples will undergo analysis using liquid chromatography-tandem mass spectrometry for untargeted metabolomics studies. Participants will be categorised into BPD and non-BPD groups based on their final diagnosis, and metabolite differences between these groups will be analysed. The study aims to enrol 1500 preterm infants with gestational ages <32 weeks over 3 years. A three-step analysis strategy-discovery, validation and clinical testing-will be used to identify and validate the clinical utility of novel biomarkers. Additionally, a nested case-control study will be conducted, matching participants 1:1 with a control group sharing similar BPD risk factors., Ethics and Dissemination: Our protocol has been approved by the Medical Ethics Committees of all participating hospitals, including Peking University Shenzhen Hospital, Shenzhen People's Hospital, Shenzhen Baoan Women's and Children's Hospital, Longgang District Maternity and Child Healthcare Hospital, Nanshan Maternity and Child Healthcare Hospital and Shenzhen Luohu People's Hospital. We will disseminate our study results through academic conferences and peer-reviewed public journals., Trial Registration Number: ChiCTR2400081615., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Overexpression of tear matrix metalloproteinases-9 (MMP-9) on the ocular surface tissues has been reported to result in ocular surface damage. MMP-9 levels in tears have been listed as one of many tools for confirming dry eye disease (DED)., Objective: This investigation aimed to compare MMP-9 levels and ocular surface parameters in diabetic patients with and without DED., Design: A cross-sectional study., Setting: He Eye Specialist Hospital, Shenyang, China., Participants: This study recruited 144 right eyes of 144 diabetic patients between November and December of 2023, and 110 patients with similar propensity scores were included in the analyses., Main Outcome Measures: Non-invasive breakup time (NITBUT), tear film lipid layer (TFLL), conjunctival hyperaemia (redness score (RS)), corneoconjunctival staining (CS), corneal sensitivity and Ocular Surface Disease Index (OSDI) questionnaire were evaluated. MMP-9 was measured using an immunochromatography assay., Results: In total, 55 patients (55 eyes) were grouped as diabetic dry eye (DDE) and 55 patients (55 eyes) as diabetic non-dry eye (DNDE). The mean MMP-9 concentrations were higher in patients with DDE than DNDE (70.63±52.06 ng/mL vs 33.98±33.93 ng/mL; p<0.001). The optimal cut-off value of MMP-9 to predict DED in diabetic patients was>52.5 ng/mL, with 58.2% sensitivity and 78.2% specificity., Conclusions: MMP-9 concentration was higher in patients with DDE than DNDE. The MMP-9 test is a potential diagnostic tool for DDE. It may help follow-up diabetic patients with DED and guide clinicians in deciding on anti-inflammatory treatments for these patients., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objectives: Avian influenza (AI) H5N6 has replaced H5N1 as the predominant strain, and the increasing number of cases and complex recombination patterns pose significant threats to human health., Methods: The data were collected on human cases of AI H5N6 from the National Surveillance of Notifiable Infectious Disease Programme in Guangxi and used MEGA software to conduct phylogenetic analysis with published reference strains obtained from the GISAID database., Results: Between January 1 and December 31, 2021, 11 cases of human AI H5N6 infection were reported in Guangxi. All HA genes belonged to clade 2.3.4.4, with only one virus belonging to 2.3.4.4h and the remaining viruses falling into 2.3.4.4b. Phylogenetic analysis of the genes was conducted, and some substitutions were detected in the HA gene, M1 protein, and NS1 protein. A close relationship between Guangxi viruses and AI viruses of poultry origin has been observed., Conclusion: Given the contamination of live poultry markets and backyard poultry, AI H5N6 variants and genotypes will continuously emerge; therefore, enhancing surveillance is crucial for pandemic preparedness., Competing Interests: Declarations 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 article., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

This research comprehensively investigates the epidemiological features and pathogen profile of acute respiratory infections (ARI) in Shihezi City, Xinjiang. A pivotal aspect of this study is the construction of a Bayes discriminant function for principal pathogen infections. This innovative methodology aims to furnish a robust scientific basis for the prevention and clinical management of ARI, potentially guiding more effective strategies in both public health and clinical settings. We compiled and examined data from January 2020 to June 2023, pertaining to patients admitted with acute respiratory infections at the First Affiliated Hospital of Shihezi University. This investigation focused on discerning patterns in epidemiology and pathogen etiology. Among 2110 cases of acute respiratory infections (ARI), 1736 underwent pathogenetic testing. Of these, 595 cases tested positive for at least one pathogen, marking a positivity rate of 34.27%. Viral detections, at a rate of 27.47%, were notably higher than bacterial detections, which stood at 6.51%. The most prevalent viruses identified were Human respiratory syncytial virus (hRSV), Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), and Human adenovirus (HAdV), while the dominant bacterial pathogens included Klebsiella pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. Co-infections were observed in 76 cases, accounting for 12.77% of positive diagnoses, predominantly involving hRSV in conjunction with other pathogens. In cases of acute bronchiolitis, hRSV was the most frequent pathogen, contributing to 23.10% of such cases. Similarly, in severe pneumonia cases, SARS-CoV-2 was predominant, accounting for 25.4% of these infections. The group with bacterial positivity exhibited elevated levels of C-reactive protein (CRP, 19.17 mg/L) and neutrophilic granulocyte percentage (NE%, 54.7%). The Bayes discriminant function demonstrated an initial validation accuracy of 74.9% and a cross-validation accuracy of 63.7%. The study underscores that hRSV, SARS-CoV-2, and HAdV are the primary pathogens in acute respiratory infections in the Shihezi region. Pathogen susceptibility exhibits variation across different age groups, with a higher pathogen detection rate in children compared to adults. The Bayes discriminant function shows significant promise in the classification and diagnosis of major pathogenic infections., (© 2024 Scandinavian Societies for Pathology, Medical Microbiology and Immunology.)

Aim: To explore and explain the mechanisms that influence surface acting in nursing students with different characteristics., Background: Nurses are now expected to deliver patient-centered care which necessitates the emotional labor. Surface acting, a form of emotional labor, can lead to negative outcomes. Given that nursing students are the backbone of the future nursing profession, there is an urgent need to investigate their surface acting tendencies and identify potential factors for early intervention., Design: A cross-sectional study., Methods: This study was surveyed in a vocational college in Gansu, China. Participants completed the general information questionnaire, Bem Sex Role Inventory, Professional Identity Questionnaire of Nursing Students and Surface Acting Scale. K-means cluster analysis was performed, followed by random forest algorithm and SHapley Additive exPlanations based on Python program., Results: A total of 1241 nursing students from vocational college were investigated and were clustered into 4 groups. The five dimensions of professional identity had higher feature importance in all four groups, with professional self-image having the highest feature importance in Cluster 3. Professional self-image and understanding retention benefits and turnover risks were negative predictors of surface acting in all four groups. Social comparison and self-reflection, independence of career choice and social modeling regarding nursing profession were positively correlated with surface acting in specific groups. In Cluster 1, there exists a positive correlation between professional self-image and the constructs of social comparison and self-reflection; as well as a negative correlation between maternal education and understanding of retention benefits and turnover risks., Conclusions: Professional identity significantly influences surface acting behaviors among nursing students, with professional self-image serving as a key negative predictor. Positive family conditions, access to educational resources, parental literacy, masculine or feminine gender roles and first-year nursing students, these traits have implications when dimensions of professional identity are used to predict surface acting behaviors., Competing Interests: Declaration of Competing Interest There is nothing to declare., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Four Gram-stain-negative, aerobic, rod-shaped bacteria, designated WL0002 T , WL0024 T , WL0050 T , and WL0075 T , were isolated from sediment in the coastal areas of Nantong City, China. Metagenomic analysis revealed higher relative abundance of taxa closely related to the four strains in sediment (0.79-2.0 %) than in water (0.34-1.3 %) (Mann-Whitney U test: p < 0.001). Phylogenetic analysis based on 16S rRNA gene and the bac120 gene set both suggested that the four strains are closely related to the genus Defluviimonas. Additionally, Albidovulum inexpectatum DSM 12048 T formed a distinct branch within Defluviimonas. The evolutionary distance (ED) and percentage of conserved proteins (POCP) analysis indicated that the four strains and the genus strains of Albidovulum and Defluviimonas should be recognized as a single genus. Genomic relatedness analysis among the four strains and type strains of the genera Albidovulum and Defluviimonas was below species delimitation thresholds, except for strains WL0024 T and "D. salinarum" CAU 1641 T , which should belong to the same species. Based on phenotypic and genotypic characterization, the four strains should be recognized as novel species in Albidovulum, and it is reasonable to reclassify the genus Defluviimonas as a later heterotypic synonym of Albidovulum, consistent with the classification of the Genome Taxonomy Database (GTDB). Four names are proposed as follows: Albidovulum marisflavi sp. nov. (type strain WL0002 T  = MCCC 1K06013 T  = JCM 34653 T  = GDMCC 1.2437 T ), Albidovulum salinarum sp. nov. (WL0024 T  = MCCC 1K06062 T  = JCM 34656 T  = GDMCC 1.2438 T ), Albidovulum litorale sp. nov. (WL0050 T  = MCCC 1K07524 T  = JCM 35566 T  = GDMCC 1.3084 T ), and Albidovulum sediminicola sp. nov. (WL0075 T  = MCCC 1K06064 T  = JCM 34660 T  = GDMCC 1.2419 T )., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier GmbH. All rights reserved.)

To determine the influencing factors of Chinese parents' intention and behavior for children to receive live attenuated influenza vaccine during the 2022-2023 influenza season. A theoretical model was developed and included seven constructs, and structural equation modeling was used to test 11 hypotheses. From October 2022 to December 2023, a survey was conducted across 38 medical institutions in four Chinese cities and their subordinate districts, counties, and rural areas. Parents who accompanied their children for vaccinations were selected through a randomization process based on their child's medical card numbers. Measures were taken to minimize method bias, including a diverse geographical representation and random sampling. The survey resulted in the collection of 936 valid responses, exceeding the recommended sample size for structural equation model analysis and providing robust statistical inferences. During the study period, 936 respondents were included in the study. Perceived ease of use was verified to be a predictor of perceived usefulness and perceived value. Perceived usefulness was verified as a predictor of perceived value and behavioral intention. Knowledge was a significant antecedent of perceived value and risk perception of influenza disease. Risk perception of influenza disease was proved to be a significant predictor of perceived value and self-reported vaccination behavior. Perceived value significantly affected behavioral intention, and behavioral intention significantly affected self-reported vaccination behavior. Six demographic variables significantly moderate the theoretical models. The low vaccination coverage of live attenuated influenza vaccine (LAIV) among children in China suggests a need for a deeper understanding of the factors that influence vaccination rates. Particularly, effective strategies are necessary from policymakers and practitioners to elevate childhood LAIV coverage.

The episymbiotic Candidatus Saccharibacteria is the most studied lineage of candidate phyla radiation. Living an epiparasitic lifestyle, Saccharibacteria might be associated with human mucosal diseases by modulating the structure of the oral microbiome through interactions with host bacteria. However, the knowledge of Saccharibacterial genomic diversity and the potential underlying their adaptation to a wide range of habitats remains limited. Here, we construct a high-quality genome collection of Saccharibacteria from multiple sources, providing 2041 high-quality genomes and previously unidentified taxa. The comparative genomic analysis shows the widespread metabolic defects of Saccharibacteria. Specific metabolic modules are commonly found in Saccharibacteria of different habitats, suggesting Saccharibacteria might have undergone habitat adaptation during the transition from different environments. We additionally show that Saccharibacteria account for ~1% of the Chinese oral microbiome. A preliminary analysis of rheumatoid arthritis individuals and healthy controls implies that Saccharibacteria might be associated with human systemic disease., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Migrant elderly following children (MEFC) is an emerging special elderly mobile migrant population in China. MEFC face multiple dilemmas of distress, which makes their depressive symptoms more prominent. To explore ways to alleviate depressive symptoms, this study aimed to investigate the chain mediating effects of resilience and loneliness on the relationship between social support and depressive symptoms among MEFC., Methods: A cross-sectional study was conducted using purposive sampling from Changsha, Hunan Province, China, and 298 MEFC were included. The 15-item Geriatric Depression Scale, Social Support Rating Scale, University of California Los Angeles Loneliness Scale, and Connor-Davidson Resilience Scale were used to measure depressive symptoms, social support, loneliness, and resilience, respectively. Pearson's correlation analysis was conducted to clarify the association between the variables. The PROCESS macro model 6 was applied to analyze the multiple mediating effects., Results: The prevalence of depressive symptoms among MEFC was 29.86%. Social support (r = -0.354, P < 0.001), resilience (r = -0.373, P < 0.001), and loneliness (r = 0.483, P < 0.001) were significantly associated with depressive symptoms. Social support not only had a direct negative effect (Effect= -0.086, 95% CI: -0.149 to -0.023) on depressive symptoms, but also had an indirect effect on depressive symptoms through resilience (Effect= -0.045, 95% CI: -0.076 to -0.015), loneliness (Effect= -0.053, 95% CI: -0.091 to -0.020), and the chain mediating effects of resilience and loneliness (Effect= -0.019, 95% CI: -0.037 to -0.007), respectively., Conclusions: The prevalence of depressive symptoms was relatively high. Resilience and loneliness partially mediated the association between social support and depressive symptoms. In the future, interventions could focus on increasing social support to enhance resilience and reduce loneliness, thereby reducing depressive symptoms in MEFC., Competing Interests: Declarations. Human Ethics and Consent to participate declarations: The study was conducted according to the guidelines of the Declaration of Helsinki and was approved by the Institutional Review Board of Xiangya School of Nursing, Central South University (No. E202336), and informed consent was obtained from all participants before the study was implemented. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Preexposure prophylaxis (PrEP) is an effective strategy to reduce the risk of HIV infection. However, the efficacy of PrEP is highly dependent on adherence. Meanwhile, adherence changes over time, making it difficult to manage effectively., Objective: Our study aimed to explore and predict the patterns of change in PrEP adherence among men who have sex with men (MSM) and evaluate the impact of the WeChat-based reminder intervention on adherence, thus providing more information for PrEP implementation strategies., Methods: From November 2019 to June 2023, in a randomized controlled longitudinal study of the PrEP demonstration project in Western China (Chongqing, Sichuan, and Xinjiang) based on a mobile health (mHealth) reminder intervention, participants were randomly divided into reminder and no-reminder groups, with those in the reminder group receiving daily reminders based on the WeChat app. Participants were followed up and self-reported their medication adherence every 12 weeks for a total of 5 follow-up visits. We used the growth mixture model (GMM) to explore potential categories and longitudinal trajectories of adherence among MSM, and patterns of change in PrEP adherence were predicted and evaluated based on the decision tree., Results: A total of 446 MSM were included in the analysis. The GMM identified 3 trajectories of adherence: intermediate adherence group (n=34, 7.62%), low adherence ascending group (n=126, 28.25%), and high adherence decline group (n=286, 64.13%). We included 8 variables that were significant in the univariate analysis in the decision tree prediction model. We found 4 factors and 8 prediction rules, and the results showed that HIV knowledge score, education attainment, mHealth intervention, and HIV testing were key nodes in the patterns of change in adherence. After 10-fold cross-validation, the final prediction model had an accuracy of 75%, and the classification accuracy of low and intermediate adherence was 78.12%., Conclusions: The WeChat-based reminder intervention was beneficial for adherence. A short set of questions and prediction rules, which can be applied in future large-scale validation studies, aimed at developing and validating a short adherence assessment tool and implementing it in PrEP practices among MSM., (© Bing Lin, Jiayan Li, Jiaxiu Liu, Wei He, Haiying Pan, Xiaoni Zhong. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org).)

In the context of delayed marriage and parenthood, decreased willingness in having children, and population aging in China, maternal and child health has become an important and urgent issue. Being essential platforms for research in maternal and child health, the importance of birth cohorts has been widely recognized. In the past 20 years, tens of birth cohorts have been established in major cities and regions of China, with cohorts ranging from thousands to hundreds of thousands. These cohorts, particularly those large ones launched in recent years, have collected a wide spectrum of data and biological samples from mothers and children. Although they have made considerable preliminary achievements, there remain difficulties and challenges. The significant challenges include small and medium-sized cohorts' lacking of clear research themes; insufficient recognition of and emphasis on behavioral and social determinants of health while emphasizing biological determinants of health; variations in types of variables and quality of data collected, which make it difficult for cohorts to be merged and shared; lack of and difficulties in long-term follow-up; significant uncertainties in resources for long-term sustention of the cohorts, and so on. So, we argue that birth cohorts should focus on essential and urgent issues in maternal and child health in the country and seek recognition and support from the government and the entire society. Last but not least, the overall success of birth cohorts in the country requires scientists to be not only academically capable, but also realistic, persistent, altruistic, and collaborative.

Background: Sepsis is a leading cause of mortality in critically ill patients, and the liver is a key organ affected by sepsis. Sepsis-related liver injury (SRLI) is an independent risk factor for multiple organ dysfunction syndrome (MODS) and mortality. However, there is no clear diagnostic standard for SRLI, making early detection and intervention challenging., Objective: This study aimed to investigate the predictive value of serum indices for the occurrence of SRLI in adults to guide clinical practice., Methods: In this study, we investigated the predictive value of serum indices for SRLI in adults. We retrospectively analyzed data from 1,573 sepsis patients admitted to West China Hospital, Sichuan University, from January 2015 to December 2019. Patients were divided into those with and without liver injury. Stepwise logistic regression identified independent risk factors for SRLI, and a predictive model was constructed. The model's diagnostic efficacy was assessed using receiver operating characteristic (ROC) curve analysis., Results: Our results showed that alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), carbon dioxide combining power (CO 2 -CP), antithrombin III (AT III), fibrin/fibrinogen degradation products (FDP), and red blood cell distribution width (RDW-CV) were independent predictors of SRLI. The area under the curve (AUC) of the predictive model was 0.890, with a sensitivity of 80.0% and a specificity of 82.91%, indicating excellent diagnostic value., Conclusion: In conclusion, this study developed a highly accurate predictive model for SRLI using clinically accessible serum indicators, which could aid in early detection and intervention, potentially reducing mortality rates., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 He, Wang, He, Zhang, Ding, Liu, He, Ying and Nie.)

China, with the third largest share of global tuberculosis cases, faces a substantial challenge in its healthcare system as a result of the high burden of multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB). This study employs a genomic epidemiological approach to assess recent tuberculosis transmissions between individuals, identifying potential risk factors and discerning the role of transmitted resistant isolates in the emergence of drug-resistant tuberculosis in China. We conducted a population-based retrospective study on 5052 Mycobacterium tuberculosis (MTB) isolates from 70 surveillance sites using whole genome sequencing (WGS). Minimum spanning tree analysis identified resistance mutations, while epidemiological data analysis pinpointed transmission risk factors. Of the 5052 isolates, 23% (1160) formed 452 genomic clusters, with 85.6% (387) of the transmissions occurring within the same counties. Individuals with younger age, larger family size, new cases, smear positive, and MDR/RR were at higher odds for recent transmission, while higher education (university and above) and occupation as a non-physical workers emerged as protective factors. At least 61.4% (251/409) of MDR/RR-TB were likely a result of recent transmission of MDR/RR isolates, with previous treatment (crude OR =   2.77), smear-positive (cOR =   2.07) and larger family population (cOR = 1.13) established as risk factors. Our findings highlight that local transmission remains the predominant form of TB transmission in China. Correspondingly, drug-resistant tuberculosis is primarily driven by the transmission of resistant tuberculosis isolates. Targeted interventions for high-risk populations to interrupt transmission within the country will likely provide an opportunity to reduce the prevalence of both tuberculosis and drug-resistant tuberculosis.

Background: Single-nucleotide polymorphism (SNP) allele frequencies, dietary habits, and folate status and their associations vary across ethnic populations. Little is known about the SNPs accounting for variations of folate-related biomarkers for Chinese preparing-for-pregnant females., Objectives: We aimed to identify SNPs contributing to RBC and serum folate, vitamin B-12, and homocysteine concentrations in Chinese female preconception population., Methods: A genome-wide association study was conducted on 1000 randomly selected preconception Chinese women from the Shanghai Preconception Cohort. SNPs were genotyped using Illumina chips, and associations with biomarkers were assessed using simple linear regression models under the assumption of an additive genetic model. Genome-wide significance was considered at P < 10 -7 ., Results: The MTHFR rs1801133 was the major genetic coding variant contributing to RBC folate, serum folate, and homocysteine concentrations (P = 2.28 × 10 -16 ; P = 8.85 × 10 -8 , and P = 2.46 × 10 -13 , repsectively). It is associated with increased RBC folate (β: 0.154 per additional risk allele after log transform), decreased serum folate (β: -0.951 per additional risk allele), and increased serum homocysteine concentrations (β: 1.153 per additional risk allele). The predominant SNP associated with serum folate was rs147162222 in NTRK2 (P = 2.55 × 10 -8 ), although that associated with homocysteine was rs77025184 located between PDE7B and LINC00271 (P = 4.91 × 10 -17 ). For vitamin B-12, FUT2 rs1047781 was the dominant genetic variant (P = 1.59 × 10 -10 ). The numbers of signals with a P value of <10 -7 for RBC folate, serum folate, vitamin B-12, and homocysteine were 12, 18, 8, and 614, respectively., Conclusions: This study represents the first genome-wide association study focusing on folate-related biomarkers in a Chinese preparing-for-pregnant female population. The contributions of dominent SNPs to each biomarker are partly different from other populations. The rs1801133 (C677T) in MTHFR is the predominant genetic variant contributing to RBC folate and rs1047781 (A385T) in FUT2 as the primary one explaining vitamin B-12. Notably, the intronic rs147162222 and noncoding rs77025184 are the predominant SNPs for serum folate and homocysteine, respectively., Competing Interests: Conflict of interest GH reports financial support was provided by the National Key Research and Development Program of China (grant numbers 2021YFC2701000 and 2016YFC1000500); CAMS Innovation Fund for Medical Sciences (grant number 2019-I2M-5-002); and National Natural Science Foundation of China (grant number 82270312). The other authors report no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

Background: Socioeconomic status is a key social determinant of health. Compared with individual-level socioeconomic status, the association between area-level socioeconomic status and mortality has not been well investigated in China. We aimed to assess associations between area-level socioeconomic status and all-cause mortality and cause-specific mortality in China, as well as the interplay of area-level and individual-level socioeconomic status on mortality., Methods: In this nationwide cohort study, residents aged 35-75 years from 453 districts and counties were included in the China Health Evaluation and Risk Reduction Through Nationwide Teamwork (ChinaHEART) Study. The composite value of area-level socioeconomic status was generated from national census data and categorised into tertiles. Mortality rates and their 95% CIs were calculated using the Clopper-Pearson method. Cox frailty models were fitted to calculate adjusted hazard ratios and 95% CIs for area-level socioeconomic status with the risk of all-cause mortality and cause-specific mortality and their disparities across different population. We also assessed the roles of multiple individual factors as potential mediators., Findings: Between December, 2015, and December, 2022, 1 119 027 participants were included, for whom the mean age was 56·1 (SD 9·9) years and 672 385 (60·1%) were female. 24 426 (5·24 [95% CI 5·18-5·31] per 1000 person-years) deaths occurred during the median 4·5-year follow-up. Compared with high area-level socioeconomic status, low area-level socioeconomic status was significantly associated with an increased risk of all-cause (hazard ratio 1·11, 95% CI 1·07-1·16), cardiovascular disease (1·38, 1·29-1·48), and respiratory disease (1·44, 1·22-1·71) mortality. The stronger associations were observed in people older than 60 years, females, and participants with lower individual-level socioeconomic status. The individual-level socioeconomic, behavioural, and metabolic factors mediated 39·5% of the association between area-level socioeconomic status and mortality, of which individual-level socioeconomic status made the largest contribution., Interpretation: There are substantial area-level socioeconomic status-related inequalities in mortality in China. Individual-level socioeconomic, behavioural, and metabolic factors had mediating effects. Actions to improve area-level circumstances and individual factors are needed to improve health equity., Funding: The Chinese Academy of Medical Sciences Innovation Fund for Medical Science, the National High Level Hospital Clinical Research Funding, the Ministry of Finance of China, and the National Health Commission of China., Translation: For the Chinese translation of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objective: To establish and validate a set of best nursing practice indicators for medical groups in Chinese general hospitals based on value-based healthcare (VBHC) theory., Design: A modified Delphi method., Methods: This study engaged experienced clinical nurses from public hospitals and multidisciplinary experts in operations management. Through a literature review and structured brainstorming, a comprehensive framework for assessing best nursing practices in Chinese general hospital medical groups was developed. A modified Delphi method was then employed to establish an indicator framework, followed by the Combined Empowerment-MABAC method to weight and validate the indicators using empirical data collected between June 2023 and October 2023. The CREDES checklist guided the reporting of this study., Results: Sixteen experts, each with at least 10 years of experience in nurse management from nine healthcare organizations, participated in two rounds of consultation. The experts' responses and suggestions for rewording, deleting and adding items were incorporated into each round. Of the 34 proposed indicators, 25 were approved, covering healthcare service capacity, efficiency, quality and safety, patient experience and cost., Conclusion: The Delphi survey reached a consensus on necessary actions to improve nursing performance. The developed indicator system provides a foundational framework for standardizing the monitoring of care quality and performance assessment in Chinese clinical healthcare groups, with broad applicability., Relevance to Clinical Practice: This study provides a reliable basis for developing a nursing performance assessment database, offering crucial insights for measuring quality of care and improving patient value., Patient or Public Contribution: No Patient or Public Contribution., (© 2024 John Wiley & Sons Ltd.)

Objective: Dual energy X-ray absorptiometry (DXA) was used to analyze body composition, bone mineral density (BMD) parameters and the trabecular bone score (TBS) in patients with obesity before, 3 months after and 1 year after bariatric surgery as a method to evaluate the changes in BMD and skeletal microarchitecture (MA) in patients with obesity after bariatric surgery and to provide a basis for further accurate assessment of the bone health status of this population and subsequent treatment., Methods: This study was a retrospective analysis of 41 patients that underwent DXA imaging before, 3 months after and maximum 1 year after bariatric surgery. The follow-up rate in both periods was 100%. First, the changes in BMD and TBS before and after surgery were compared between patients grouped by sex and obesity degree. Secondly, the correlations between the TBS or BMD and body composition 1 year after surgery were analyzed., Results: The BMD and TBS were within the normal range after bariatric surgery. Changes in the BMD and TBS were related to time, the degree of obesity and sex. Changes in the TBS were closely related to changes in the BMD, and the trends in the changes in the BMD were basically the same among the different groups of individuals with obesity of different sexes. A negative correlation was observed between the TBS and fat percentage (total body, leg, trunk, android area), as well as the lumbar spine Z-score in patients 1 year after bariatric surgery (p < 0.05)., Conclusions: Bariatric surgery in patients with obesity has no obvious adverse effects on BMD or TBS. DXA can be used to better evaluate the changes in BMD and MA in patients with obesity after bariatric surgery, providing a basis for the clinical evaluation of post-bariatric surgery efficacy in these individuals and subsequent accurate assessment of the bone health status and treatment of this population., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Handgrip strength (HGS) weakness and asymmetry are both abnormal conditions of upper-limb muscle strength. The association between HGS weakness and physical performance is controversial, and the link between HGS asymmetry and physical performance remains unclear., Aims: This study aimed to investigate the associations of HGS weakness and asymmetry separately and concurrently with low physical performance among Chinese older people., Methods: The study used two waves of data from China Health and Retirement Longitudinal Study (CHARLS) in 2013 and 2015. HGS weakness and asymmetry were defined according to the maximal HGS and the HGS ratio, respectively. Participants were classified into 4 groups according to HGS status: normal, asymmetry only, weakness only, and concurrent weakness and asymmetry. The logistic regression model was used to investigate the cross-sectional association between low physical performance and each of maximal HGS, HGS ratio, and HGS status, as well as the prospective association between baseline HGS status and new-onset physical performance decline after two years., Results: Participants with HGS asymmetry only, weakness only, and two abnormalities showed a higher prevalence of low physical performance when asymmetry defined as an HGS ratio exceeding 1.20 and 1.30 (all, p < 0.001), with the greatest odds in those with two abnormalities (20% threshold: OR 3.83; 30% threshold: OR 5.41). The longitudinal analysis found that HGS weakness can predict the new-onset low physical performance over a two-year period, with concurrent HGS asymmetry further increased the future risk of physical performance decline., Conclusions: Both HGS weakness and asymmetry were associated with a higher prevalence of low physical performance, in an additive way. This study will help screen older people with low physical performance more efficiently, and identify those at higher risk of developing new-onset physical performance decline within two years., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Despite the recognition of the impact of Fear of Missing Out (FoMO) on learning engagement, research conclusions remain inconsistent. This inconsistency may be due to a lack of exploration of the underlying mechanisms and the singularity of research perspectives., Methods: Drawing from motivational dynamics model for learning engagement, this study investigated the relationship between FoMO and learning engagement from both variable-centered and person-centered perspectives, and further explored the mediating role of self-control. A total of 1,510 college students from eastern China were selected via an online platform, including 642 males and 868 females., Results: The results from the variable-centered analysis indicated that FoMO had a significant positive direct effect on learning engagement (effect = 0.293, 95% CI = [0.185, 0.401]). FoMO negatively predicted self-control, which in turn had a negative impact on learning engagement (effect = -0.375, 95% CI = [-0.456, -0.295]). This suggests that self-control acts as a masking effect between FoMO and learning engagement. The person-centered results suggest the presence of four latent profiles of FoMO: the low trait-FoMO low state-FoMO group, the high trait-FoMO low state-FoMO group, the low trait-FoMO high state-FoMO group, and the high trait-FoMO high state-FoMO group. Specifically, compared to the low trait-FoMO low state-FoMO group, self-control acts as a masking role between the low trait-FoMO high state-FoMO group, the high trait-FoMO high state-FoMO group and learning engagement., Conclusions: FoMO exhibits a "dual-edged sword effect". Educators should adopt diverse instructional methods to leverage the positive aspects of FoMO while guiding students in self-control training to mitigate its negative effects to enhance college students' learning engagement., Competing Interests: Declarations. Ethics approval and consent to participate: All methods were carried out in accordance with relevant guidelines and regulations.The studies involving human participants were reviewed and approved by Jining university. Each participant provided informed consent and was fully aware of the study details before participating in the survey. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

The association between plasma low-density lipoprotein cholesterol (LDL-C) and atrial fibrillation (AF) recurrence after catheter ablation remains unclear. We aimed to assess the relationship between preprocedural LDL-C and the AF recurrence in patients undergoing catheter ablation. The cohort study consecutively included AF patients who underwent de novo catheter ablation between April 2021 and January 2023 in the Second Affiliated Hospital of Nanchang University in Jiangxi Province, China. Patients were divided into quartiles based on their baseline fasting LDL-C level (Q1-Q4). Multivariable Cox proportional hazards models were used to evaluate the relationship between LDL-C and AF recurrence. Our analysis included the use of a generalized additive model and smooth curve fitting (penalized spline method), and two-piecewise Cox proportional hazards models, to address the nonlinearity between preprocedural LDL-C and AF recurrence. A total of 482 AF patients with de novo catheter ablation were enrolled, with a median follow-up period of 15.00 months, AF recurrence occurred in 96 (19.92%) patients. The relationship between preprocedural LDL-C and AF recurrence after ablation presented as an L-shape, and the inflection point for the curve was found at the LDL-C level of 3.20 mmol/L (Log likelihood ratio P = 0.031). The hazard ratios (HR) [(95% confidence intervals (CI)] for AF recurrence were 0.50 (0.33-0.74) and 2.11 (0.76-5.89) to the left and right of the inflection point, respectively. Lower LDL-C level is associated with increased AF recurrence risk after catheter ablation were consistent across all subgroups., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

In this study, the impact of surfactants on the adsorption behavior of Pb(II) onto microplastics-sediment (MPs-S) complexes was investigated. Firstly, virgin polyamide (VPA) and polyethylene (VPE) were placed in Xiangjiang River sediment for six months to conduct in-situ aging. The results indicated that the biofilm-developed polyamide (BPA) and polyethylene (BPE) formed new oxygen-containing functional groups and different biofilm species. Furthermore, the adsorption capacity of Pb(II) in sediment (S) and MPs-S complexes was in the following order: S > BPA-S > VPE-S > VPA-S > BPE-S. The addition of sodium dodecyl benzenesulfonate (SDBS) promoted the adsorption of Pb(II), and the adsorption amount of Pb(II) increased with the higher concentration of SDBS, while adding cetyltrimethylammonium bromide (CTAB) showed the opposite result. The adsorption process of MPs-S complexes to Pb(II) was dominated by chemical adsorption, and the interaction between MPs-S complexes and Pb(II) was multilayer adsorption involving physical and chemical adsorption when the surfactants were added. Besides, the pH exerts a significant effect on Pb(II) adsorption in different MPs-S complexes, and the highest adsorption amount occurred at pH 6. Noteworthy, CTAB promoted the adsorption ability of Pb(II) when the exogenous FA was added. The binding characteristic of sediment endogenous DOM components and Pb(II) was influenced by the addition of MPs and surfactants. Finally, it confirmed that adsorption mechanisms mainly involve electrostatic and hydrophobic interaction. This study provides a new perspective to explore the environmental behaviors of Pb(II) by MPs and sediments with the addition of surfactants, which was conducive to evaluating the ecological risks of MPs and heavy metals in aquatic environments., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Establishing the interaction between aeroallergens and air pollution in children with house dust mite induced allergic rhinitis (HDM-AR) remains challenging, especially in urban areas. The coronavirus disease 2019 (COVID-19) pandemic and the subsequent lockdown measures provided a valuable opportunity., Methods: We analyzed the clinical data of HDM-AR children between March and August in 2018-2020, and classified the children according to the type and the degree of HDM sensitization. The records of patients' hospital visits, allergic rhinitis symptoms assessments, and air pollution measurements in Shanghai were used to assess the differences before (2018-2019) and during the pandemic (2020), as well as during lockdown (March-June) and unlockdown (July-August) period in 2020., Results: The study included 1570 HDM-AR children aged 2 to 8 years old, 815 (51.9%) were monosensitized to HDM (mono-HDM-AR), and 755 (48.1%) were polysensitized to HDM (poly-HDM-AR). There was a significant increase in the rate of clinical visits among children with HDM-AR during the COVID-19 pandemic compared to pre-pandemic (P < 0.001), particularly among older children aged 7-8 years (P = 0.01). During the unlockdown period, there was a notable decrease in clinical visits for children with poly-HDM-AR (P < 0.001). Children with high levels of HDM sensitization exhibited significant symptom improvement in unlockdown period (P < 0.001). Although the air pollutants concentration had improved during the study, there was no effect on the improvement of HDM-AR children as expected., Conclusions: The COVID-19 pandemic and its associated lockdown measures provided a unique context to observe the dynamics of management in children with HDM-AR. The findings underscore the complexity of managing allergic conditions in pediatric populations, highlighting the influence of environmental and lifestyle changes on disease presentation and the need for tailored approaches to treatment during periods of societal disruption., (© 2024. The Author(s).)

Background This study was conducted to assess the clinicopathological characteristics of biopsy lesions in the lacrimal gland, in response to evolving pathological technologies and the emergence of new diseases. A retrospective review of case notes was conducted for 582 patients with biopsied lacrimal gland lesions at West China Hospital of Sichuan University in China. This study, spanning from January 1, 2010, to December 31, 2021, recorded demographics, clinical features, imaging findings, histopathological diagnoses, and recurrence rates. In a cohort of 582 patients, the mean age was 47.5 years, with 318 being female. Bilateral disease was present in 127 patients. Common signs and symptoms included a palpable mass, lid swelling, proptosis, and decreased ocular movements or diplopia. The predominant pathologies identified were inflammation, epithelial tumors, and lymphoproliferative lesions. Patients with inflammation (mean 32.8 months) experienced symptoms for a longer period compared to those with lymphoproliferative lesions (mean 22.2 months) (95% confidence interval [CI] 1.53-19.27, P = 0.022). Younger patients tended to have structural lesions (mean 42.5 years) (95%CI 4.74-21.59, P = 0.003), inflammation (mean 42.9 years) (95%CI 0.46-6.57, P<0.001), or epithelial tumors (mean 46.4 years) (95%CI 6.21-12.38, P<0.001), while older patients more frequently had lymphoproliferative lesions (mean 55.7 years). The period from 2016 to 2021 saw a higher diagnosis rate of biopsied lacrimal gland lesions than from 2010 to 2015. During this later period, there was an increase in cases of immunoglobulin G4-related ophthalmic disease (IgG4-ROD) and malignant epithelial tumors, while lymphoid hyperplasia cases declined. Adenoid cystic carcinoma showed the highest recurrence rate, with lesion extent and Ki-67 index identified as independent risk factors in our study. Inflammation, epithelial tumors, and lymphoproliferative lesions were the three primary causes of lacrimal gland lesions in our study group. Among the inflammatory conditions, IgG4-ROD was the most specific. The incidence of lacrimal gland lesions has risen, particularly for IgG4-ROD. Adenoid cystic carcinoma among the lacrimal gland lesions was prone to recurrence, with the extent of the lesion and Ki-67 index serving as independent risk factors., (© 2024. The Author(s).)

Hops, extensively cultivated in China for their food and medicinal applications, currently lack well-defined chemical markers to evaluate variations in their quality. The study aimed to explore variations in the quality of Chinese hops by the chemical characteristics of hops, employing UPLC-Q-TOF/MS, integrated with chemical fingerprinting and chemometrics. The results indicated that Chinese hops are abundant in polyphenols and bitter acids. The integration of UPLC-Q-TOF/MS, Chemical fingerprinting, and chemometrics revealed to be an accurate and effective approach for assessing the quality of Chinese hops. In this study, ten important chemical markers were found to be useful in differentiating various hop varieties. Moreover, the support vector machine showed a prediction accuracy of 92.3077% in identifying Chinese hop varieties. The strategy of the study lays the groundwork for classifying Chinese hop varieties and serves as a prerequisite for future quality control studies, particularly focusing on chemical compositions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: WHO issued the first edition catalogue of Mycobacterium tuberculosis complex (MTBC) mutations associated with drug resistance in 2021. However, country-specific issues might lead to arising complex and additional drug-resistant mutations. We aimed to fully reflect the characteristics of drug resistance mutations in China., Methods: We analysed MTBC isolates from the nationwide drug-resistant tuberculosis surveillance with 70 counties in 31 provinces, municipalities, and autonomous regions in China. Three types of MYCOTB plates were used to perform drug susceptibility testing for 12 antibiotics (rifampicin, isoniazid, ethambutol, levofloxacin, moxifloxacin, amikacin, kanamycin, ethionamide, clofazimine, linezolid, delamanid, and bedaquiline). Mutations were divided into five groups according to their odds ratios, positive predictive values, false discovery rate-corrected p values, and 95% CIs: (1) associated with resistance; (2) associated with resistance-interim; (3) uncertain significance; (4) not associated with resistance-interim; and (5) not associated with resistance. The Wilcoxon rank-sum and Kruskal-Wallis tests were used to quantify the association between mutations and minimum inhibitory concentrations (MICs). Our dataset was compared with the first edition of the WHO catalogue., Findings: We analysed 10 146 MTBC isolates, of which 9071 (89·4%) isolates were included in the final analysis. 744 (8·2%) isolates were resistant to rifampicin and 1339 (14·8%) to isoniazid. 208 (1·9%) of 11 065 mutations were classified as associated with resistance or associated with resistance-interim. 33 (97·1%) of 34 mutations in group 1 and 92 (52·9%) of 174 in group 2 also appeared in groups 1 or 2 of the WHO catalogue. Of 81 indel mutations in group 2, 15 (18·5%) were in the WHO catalogue. The newly discovered mutation gyrA&#95;Ala288Asp was associated with levofloxacin resistance. MIC values for rifampicin, isoniazid, moxifloxacin, and levofloxacin corresponding to resistance mutations in group 1 were significantly different (p<0·0001), and 12 high-level resistance mutations were detected. 61 mutations in group 3 occurred as solo in at least five phenotypically susceptible isolates, but with MIC values moderately higher than other susceptible isolates. Among 945 phenotypically resistant but genotypically susceptible isolates, 433 (45·8%) were mutated for at least one efflux pump gene., Interpretation: Our analysis reflects the complexity of drug resistance mutations in China and suggests that indel mutations, efflux pump genes, protein structure, and MICs should be fully considered in the WHO catalogue, especially in countries with a high tuberculosis burden., Funding: National Key Research and Development Program of China and the Science and Technology Major Project of Tibetan Autonomous Region of China., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The aim of this study was to examine how positive meta-stereotypes impacted cognitive performance among disadvantaged groups and the mediating effect of negative emotions. In Experiments 1 and 2, Chinese migrant children and rural college students were randomly allocated to the positive meta-stereotype, negative meta-stereotype, or a non-meta-stereotype activation group to examine positive meta-stereotypes' effect on creativity and working memory performance. Both experiments revealed that positive meta-stereotypes had a choking under-pressure effect on cognitive performance, and negative emotions may act as significant mediators between meta-stereotypes and cognitive performance. The choking under pressure effect may occur under positive meta-stereotypes, necessitating more clarification on meta-stereotypes' negative effects.

Limited evidence was available on ambient air pollution and pediatric atopic dermatitis (AD). The study aimed to evaluate the associations between short-term exposure to air pollutants and outpatient visits for pediatric AD. From 2016-2018, we collected data on six criteria air pollutants (PM 2.5 , PM 10 , NO 2 , SO 2 , CO and O 3 ) and daily outpatient visits for pediatric AD in 66 hospitals, covering all districts in Shanghai, China. The over-dispersed Poisson generalized additive model (GAM) was applied to fit the associations of criteria air pollutants with hospital visits. Two-pollutant models were fitted and stratified analyses by sex, age and season were conducted. We identified 477,833 outpatient visits for pediatric AD. Each interquartile range (IQR) increase in PM 2.5 (IQR: 30.9 μg/m 3 ), PM 10 (8.9 μg/m 3 ), NO 2 (25.5 μg/m 3 ), SO 2 (5.8 μg/m 3 ) and CO (0.283 mg/m 3 ) on the concurrent day was significantly associated with increments of 2.08 % (95 % CI: 0.53 %, 3.65 %), 2.53 % (95 % CI: 0.87 %, 4.22 %), 8.14 % (95 % CI: 6.24 %, 10.08 %), 5.67 % (95 % CI: 3.58 %, 7.80 %), and 2.27 % (95 % CI: 0.70 %, 3.87 %) in pediatric AD outpatient visits, respectively. The effects of NO 2 remained robust after adjustment for other air pollutants. The exposure-response curves for PM 2.5 and PM 10 were steeper for moderate-lower concentrations, with a flatten curves at high concentration; nearly linear relationships were found for NO 2 . Higher associations of NO 2 exposure on AD were detected in children under 6 years old (p=0.01); and we observed larger effect of air pollutants in cool seasons (p<0.001 for PM 2.5 , PM 10 , NO 2 and CO; p=0.043 for SO 2 ). This study indicated that short-term exposure to air pollution could increase risk of outpatient visits for pediatric AD., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Ginger, a vegetable export from China, is well-known for its spicy flavour and use in traditional Chinese medicine. By examining the interactions of ginger plants' microbiome and metabolome, we can gain insights to advance agriculture, the environment, and other fields. Our study used metataxonomic analysis to investigate ginger plants' prokaryotic and fungal microbiomes in open fields and greenhouses. We also conducted untargeted metabolomic analysis to identify specific metabolites closely associated with ginger microbiome assembly under both agricultural conditions. Various bacteria and fungi were classified as generalists or specialists based on their ability to thrive in different environments and microbial niches. Our results indicate that ginger plants grown in greenhouses have a greater prokaryotic diversity, while those grown in open fields exhibit a greater fungal diversity. We have identified specific co-occurring prokaryotic and fungal genera associated with ginger plant agroecosystems that can enhance the health and growth of ginger plants while maintaining a healthy environment. In the open field these genera include Sphingomonas, Methylobacterium-Methylorubrum, Bacillus, Acidovorax, Rhizobium, Microbacterium, unclassified&#95;f&#95;Comamonadaceae, Herbaspirillum, Klebsiella, Enterobacter, Chryseobacterium, Nocardioides, Subgroup&#95;10, Enterococcus, Pseudomonas, Devosia, g&#95;unclassified&#95;f&#95;Chaetomiaceae, Pseudaleuria, Mortierella, Cheilymenia, and Pseudogymnoascus. In the greenhouse, the enriched genera were Rhizobium, Stenotrophomonas, Aureimonas, Bacillus, Nocardioides, Pseudomonas, Enterobacter, Delftia, Trichoderma, Mortierella, Cheilymenia, Schizothecium, and Actinomucor. Our research has identified several previously unknown microbial genera for ginger plant agroecosystems. Furthermore, our study has important implications for understanding the correlation between ginger's microbiome and metabolome profiles in diverse environments and may pave the way for future research. Specific microbial genera in crop production environments are associated with essential metabolites, including Safingol, Docosatrienoic acid, P-acetaminophen, and Hypoglycin B., Competing Interests: Declaration of competing interest There is no conflict of interest in the manuscript, which is approved by all authors for publication. We also declare that the work described is original research that has not been published previously, and not under consideration for publication elsewhere, in whole or in part., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: We aimed to evaluate the predictors for early and interim culture conversion within 2 months and 6 months of treatment in multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) patients in China., Methods: This study included adult MDR/RR-TB patients with a positive baseline sputum culture from 8 institutions located in different cities in China from May 2018 to January 2022. We mainly used logistic regression model to derive possible predictors of early and interim culture conversion., Results: A total of 813 patients were enrolled and 28.5% of them received multidrug-resistant treatment regimens containing bedaquiline. Of these, 362 (44.5%) patients experienced culture conversion within 2 months of treatment, and 649 (79.8%) within 6 months. The results of the multivariable logistic regression analysis revealed that acid-fast bacilli smear positive (adjusted odds ratio [aOR] = 1.637, 95% confidence interval [CI] = 1.197-2.238), cavities (aOR = 1.539, 95% CI = 1.132-2.092), bilateral disease (aOR = 1.638, 95% CI = 1.183-2.269), and viral hepatitis (aOR = 2.585, 95% CI = 1.189-5.622) were identified as risk factors for early culture un-conversion within 2 months of treatment. Additionally, smoking history (aOR = 2.197, 95% CI = 1.475-3.273), previous treatment for tuberculosis (aOR = 1.909, 95% CI = 1.282-2.844), bilateral disease (aOR = 2.201, 95% CI = 1.369-3.537), viral hepatitis (aOR = 2.329, 95% CI = 1.094-4.962) were identified as risk factors for interim culture un-conversion within 6 months of treatment, while patients with regimen containing bedaquiline (aOR = 0.310, 95% CI = 0.191-0.502) was a protective factor., Conclusions: A history of smoking, a baseline sputum AFB smear positive, lung cavities, bilateral disease, previous anti-tuberculosis treatment, or a comorbidity of viral hepatitis can be used as the predictors for early and interim culture un-conversion in MDR/RR-TB patients, while bedaquiline was a protective factor ., (© 2024. The Author(s).)

Evidence of the associations between long-term exposure to PM 2.5 and O 3 and human blood lipid concentrations is abundant yet inconclusive. Whether clean air policies could improve lipid profiles remains unclear. In total, 2979312 participants from a Chinese nationwide prospective study were included. For cross-sectional analyses, linear mixed-effects models were utilized to assess the associations of pollutants with lipid profiles (TC, LDL-C, TG, HDL-C). For longitudinal analyses, a quasi-experimental design and difference-in-differences models were employed to investigate the impact of China's Clean Air Act. In the cross-sectional analyses, each IQR increase in PM 2.5 was associated with 2.49 % (95 % CI: 2.36 %, 2.62 %), 2.51 % (95 % CI: 2.26 %, 2.75 %), 3.94 % (95 % CI: 3.65 %, 4.23 %), and 1.54 % (95 % CI: 1.38 %, 1.70 %) increases in TC, LDL-C, TG, and HDL-C, respectively. For each IQR increase in O 3 , TC, LDL-C, TG, and HDL-C changed by 1.06 % (95 % CI: 0.95 %, 1.17 %), 1.21 % (95 % CI: 1.01 %, 1.42 %), 1.78 % (95 % CI: 1.54 %, 2.02 %), and -0.63 % (95 % CI: -0.76 %, -0.49 %), respectively. Longitudinal analyses showed that the intervention group experienced greater TC, LDL-C, and HDL-C reductions (1.77 %, 4.26 %, and 7.70 %, respectively). Our findings suggest that clean air policies could improve lipid metabolism and should be implemented in countries with heavy air pollution burdens., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Significant individual differences exist in the clinical manifestations of thyroid-associated ophthalmopathy (TAO). Age and gender have an impact on the presentation and severity of TAO., Objective: To evaluate the clinical characteristics of TAO patients, with particular consideration of their age and gender., Methods: Demographic and clinical data of 2479 TAO patients were collected. Patients were divided into 7 groups based on age: Group 1: ≤18 years old; Group 2: 19-29 years old; Group 3: 30-39 years old; Group 4: 40-49 years old; Group 5: 50-59 years old; Group 6: 60-69 years old; Group 7: ≥70 years old. Compared clinical manifestations among different groups and between males and females., Result: In age group 1, the ratio of female to male TAO patients was 3.79, and in age group 7, it was 0.86. As age increased, there was a decline in the percentage of females (γ=-0.168, p <0.001). During the aging process, the proportion of TAO patients with unilateral involvement also gradually decreased (γ=-0.23, p <0.001). In addition, the proportion of TAO patients with upper eyelid retraction ≥2mm and exophthalmometry ≥17mm also decreased (γ=-0.158, p <0.001, γ=-0.23, p <0.001). In comparison to males, females with TAO showed a higher proportion of unilateral eye involvement and upper eyelid retraction ≥2mm ( p =0.038, p <0.001). However, males had a higher proportion of exophthalmometry ≥17mm ( p <0.001). The proportions of patients with eye movement disorder (γ=0.535, p <0.001), diplopia (γ=0.446, p <0.001), intraocular pressure (IOP) ≥30mmHg (γ=0.149, p <0.001), sight-threatening TAO (γ=0.479, p <0.001), and active TAO (γ=0.469, p <0.001) were positively correlated with age in TAO patients. Additionally, the proportion of male patients is higher than that of female patients., Conclusion: TAO Patients exhibit different clinical features depending on age and gender. In elderly and male patients, TAO tends to be more severe, with a higher prevalence of eye muscle involvement, IOP ≥30mmHg, active phases, and a lower proportion of patients with upper eyelid retraction ≥2mm. Elderly female patients also have a lower proportion of exophthalmometry ≥17mm., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Yang and He.)

Two Gram-stain-negative, aerobic, ovoid to short rod-shaped bacterial strains, designated as WL0062 T and WL0115, were isolated from coastal zone of the Yellow Sea, Jiangsu Province, PR China, respectively. Strain WL0062 T grew optimally at 28 °C, pH 7.0-8.0 and with 1.0-3.0% (w/v) NaCl. Strain WL0115 grew optimally at 28 °C, pH 6.0-7.0 and with 1.0-3.0% (w/v) NaCl. In the bac120 tree, strains WL0062 T and WL0115 clustered together with Sedimentimonas flavescens B57 T . The respiratory quinone of both strains was ubiquinone-10. The major polar lipids of both strains were diphosphatidylglycerol, phosphatidylglycerol, phosphatidylcholine, phosphatidylethanolamine, glycolipid, phosphatidylmonomethylethanolamine, and one unidentified polar lipid. The major fatty acids of strain WL0062 T were summed features 8 (C 18 : 1  ω 6 c and/or C 18 : 1  ω 7 c ). The major fatty acids of strain WL0115 were summed features 8 (C 18 : 1  ω 6 c and/or C 18 : 1  ω 7 c ), C 18 : 0 , iso-C 17 : 1  ω 5 c and C 20 : 4  ω 6/9/12/15 c (arachidonic acid). The G+C content of genomic DNA of strains WL0062 T and WL0115 was 64.0 mol% in both of them. Combined with the analysis of average nucleotide identity, average amino acid identity, and digital DNA-DNA hybridization, strain WL0062 T represents a novel species of the genus Rhodobacter , for which the name Rhodobacter flavimaris sp. nov is proposed. The type strain is WL0062 T (=MCCC 1K06014 T =JCM 34676 T =GDMCC 1.2427 T ). Strain WL0115 (=MCCC 1K07531=JCM 35568=GDMCC 1.3088) should belong to the same species as Sedimentimonas flavescens B57 T . In addition, on the basis of phylogenomic relationship and phenotypical characteristics, the genera Paenirhodobacter , Sedimentimonas , and Sinirhodobacter are proposed as synonyms of Rhodobacter .

Objectives: This study investigated the transmission patterns of tuberculosis (TB) and its associated risk factors in Hunan province to inform the development of prevention and control strategies in the region., Methods: An 8-year retrospective population-based genomic epidemiological study was conducted. Genomic clusters were defined using distance thresholds of 12-single-nucletide-polymorphisms. Risk factors associated with TB transmission were analyzed using logistic regression model. Kernel Density analysis was used to locate hotspots where transmission occurred., Results: Among 2649 TB cases included in this study, 275 clusters were identified, with an overall clustering rate of 24.7% (654/2649). Nearly 95% (620/654) of clustered strains were isolated from the same county. Of the 275 clusters, 23 (8.4%, 23/275) had differences in drug-resistant profiles, with FQs resistance mutations occurring most frequently (52.2%, 12/23). Multivariate analysis identified male TB patients, those aged 30-60 years, ethnic minorities, nonfarmers, retreated TB patients, and individuals infected with MDR/RR-TB as independent risk factors for TB transmission (P < 0.05). Kernel density analysis showed that among the 5 drug-resistant surveillance sites, Leiyang had the highest clustering rate, followed by Yongshun, Qidong, Hecheng, and Taojiang., Conclusion: Recent transmission in the region is predominantly occurring within counties. The risk factors related to TB transmission and the hotspots where transmission occurs can provide a scientific basis for the formulation of targeted TB prevention and control strategies., Competing Interests: Declarations 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 article., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Past research has focused on the analysis of the association between sugar-sweetened beverages consumption and screen time, respectively, and an indicator of physical fitness in adolescents. However, no studies have analyzed the interaction between sugar-sweetened beverage consumption and screen time on physical fitness index., Methods: Demographic information, lifestyle, sugar-sweetened beverage consumption and screen time were investigated and physical fitness indicators were tested in 8136 adolescents aged 13-18 years from six geographic regions of China using stage-stratified whole population sampling. The chi-square test and one-way ANOVA were used to compare the covariates. The Kruskal-Wallis test was used to compare physical fitness index between different sugar-sweetened beverage consumption and screen time groups. Generalized linear model ordered logistic regression analysis was used to analyze the interaction between sugar-sweetened beverage consumption and ST on physical fitness index., Results: The differences in physical fitness index among different sugar-sweetened beverage consumers in child adolescents were all statistically significant in boys, girls, and in total (H-value of 72.415, 16.859, and 78.544, P < 0.001). The differences were also statistically significant when comparing the physical fitness index of Chinese adolescents of different screen time in boys, girls, and total (H-Value of 46.307, 21.552, and 65.287, P < 0.001). Overall, using sugar-sweetened beverage consumption ≤ 1time/week and screen time < 60 min/d as the reference group, after adjusting for relevant covariates, adolescents in the group with an sugar-sweetened beverage consumption of ≥ 5 time/week and screen time > 120 min/d (OR = 2.27, 95% CI:1.78, 2.89) had the the highest risk of reduced physical fitness index (P < 0.001 )., Conclusion: Associations of sugar-sweetened beverage consumption and screen time with physical fitness indices among Chinese adolescents. Both increased sugar-sweetened beverage consumption and prolonged ST further increased the risk of lower physical fitness index in adolescents., (© 2024. The Author(s).)

Excess nitrogen and phosphorus inputs are the main causes of aquatic environmental deterioration. Accurately quantifying and dynamically assessing the regional nitrogen and phosphorus pollution emission (NPPE) loads and influencing factors is crucial for local authorities to implement and formulate refined pollution reduction management strategies. In this study, we constructed a methodological framework for evaluating the spatio-temporal evolution mechanism and dynamic simulation of NPPE. We investigated the spatio-temporal evolution mechanism and influencing factors of NPPE in the Yangtze River Economic Belt (YREB) of China through the pollution load accounting model, spatial correlation analysis model, geographical detector model, back propagation neural network model, and trend analysis model. The results show that the NPPE inputs in the YREB exhibit a general trend of first rising and then falling, with uneven development among various cities in each province. Nonpoint sources are the largest source of land-based NPPE. Overall, positive spatial clustering of NPPE is observed in the cities of the YREB, and there is a certain enhancement in clustering. The GDP of the primary industry and cultivated area are important human activity factors affecting the spatial distribution of NPPE, with economic factors exerting the greatest influence on the NPPE. In the future, the change in NPPE in the YREB at the provincial level is slight, while the nitrogen pollution emissions at the municipal level will develop towards a polarization trend. Most cities in the middle and lower reaches of the YREB in 2035 will exhibit medium to high emissions. This study provides a scientific basis for the control of regional NPPE, and it is necessary to strengthen cooperation and coordination among cities in the future, jointly improve the nitrogen and phosphorus pollution tracing and control management system, and achieve regional sustainable development., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Lead exposure levels are closely linked to human health and can cause damage to multiple organ systems, including the blood system and liver. However, due to insufficient evidence, the effects of lead exposure on hematological and biochemical indices have not been fully established., Objective: This study aims to explore the blood lead levels of permanent residents in Jiangxi Province and analyze the factors affecting blood lead levels and the impact of blood lead levels on hematological and biochemical indices., Methods: We conducted a cross-sectional study including questionnaires, health examinations, and blood sample examinations on 720 randomly selected permanent residents (3-79 years) in Jiangxi Province in 2018. The blood lead levels were measured using inductively coupled plasma mass spectrometry. Routine hematological and biochemical tests were determined by qualified medical institutions using automated hematology analyzers and biochemistry analyzers., Results: The geometric mean of blood lead concentration in permanent residents of Jiangxi Province was 20.45 μg/L. Gender, age, annual household income, smoking, and hypertension were the influencing factors for blood lead levels. For each 1 μg/L increase in blood lead, the risks of elevated red blood cell count (from low to high), platelet volume distribution width, alkaline phosphatase (from low to high), and cholesterol increased by 2.4, 1.6, 3.6, and 2.3%, respectively, whereas the risks of elevation of direct bilirubin and total bilirubin both decreased by 1.7%., Conclusion: The blood lead level in permanent residents of Jiangxi Province is higher than the national average. Higher blood lead levels were found in men than in women; blood lead levels were positively correlated with age but negatively correlated with annual household income; smoking and hypertension are risk factors for elevated blood lead; and blood lead levels affect routine hematological and biochemical markers such as red blood cell count, platelet volume distribution width, direct bilirubin, total bilirubin, alkaline phosphatase, and cholesterol., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 He, Fu, Fu, Song, Huang, Wang, Lu and Wu.)

Background: The association and its population heterogeneities between low-density lipoprotein cholesterol (LDL-C) and all-cause and cardiovascular mortality remain unknown. We aimed to examine the dose-dependent associations of LDL-C levels with specific types of cardiovascular disease (CVD) mortality and heterogeneities in the associations among different population subgroups., Methods: A total of 2,968,462 participants aged 35-75 years from China Health Evaluation And risk Reduction through nationwide Teamwork (ChinaHEART) (2014-2019) were included. Cox proportional hazard models and Fine-Gray subdistribution hazard models were used to estimate associations between LDL-C categories (<70.0, 70.0-99.9, 100.0-129.9 [reference group], 130.0-159.9, 160.0-189.9, and ≥190.0 mg/dL) and all-cause and cause-specific mortality., Results: During a median follow-up of 3.7 years, 57,391 and 23,241 deaths from all-cause and overall CVD were documented. We observed J-shaped associations between LDL-C and death from all-cause, overall CVD, coronary heart disease (CHD), and ischemic stroke, and an L-shaped association between LDL-C and hemorrhagic stroke (HS) mortality ( P for non-linearity <0.001). Compared with the reference group (100.0-129.9 mg/dL), very low LDL-C levels (<70.0 mg/dL) were significantly associated with increased risk of overall CVD (hazard ratio [HR]: 1.10, 95% confidence interval [CI]: 1.06-1.14) and HS mortality (HR: 1.37, 95% CI: 1.29-1.45). Very high LDL-C levels (≥190.0 mg/dL) were associated with increased risk of overall CVD (HR: 1.51, 95% CI: 1.40-1.62) and CHD mortality (HR: 2.08, 95% CI: 1.92-2.24). The stronger associations of very low LDL-C with risk of CVD mortality were observed in individuals with older age, low or normal body mass index, low or moderate 10-year atherosclerotic CVD risk, and those without diagnosed CVD or taking statins. Stronger associations between very high LDL-C levels and all-cause and CVD mortality were observed in younger people., Conclusions: People with very low LDL-C had a higher risk of all-cause, CVD, and HS mortality; those with very high LDL-C had a higher risk of all-cause, CVD, and CHD mortality. On the basis of our findings, comprehensive health assessment is needed to evaluate cardiovascular risk and implement appropriate lipid-lowering therapy for people with very low LDL-C., (Copyright © 2024 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.)

Background: Catheter-associated urinary tract infection (CAUTI) remains the most significant challenge among hospital-acquired infections (HAIs), yet still unresolved. The present study aims to evaluate the preventive effectiveness of JUC Spray Dressing (name of U.S. FDA and CE certifications, while the medical device name in China is Long-acting Antimicrobial Material) alone for CAUTI without combining with antibiotics and to evaluate the impact of bacterial biofilm formation on CAUTI results on the inserted catheters of patients., Methods: In this multicenter, randomized, double-blind study, we enrolled adults who suffered from acute urinary retention (AUR) and required catheterization in 6 hospitals in China. Participants were randomly allocated 1:1 according to a random number table to receive JUC Spray Dressing (JUC group) or normal saline (placebo group). The catheters were pretreated with JUC Spray Dressing or normal saline respectively before catheterization. Urine samples and catheter samples were collected after catheterization by trial staff for further investigation., Results: From April 2012 to April 2020, we enrolled 264 patients and randomly assigned them to the JUC group (n = 132) and the placebo group (n = 132). Clinical symptoms and urine bacterial cultures showed the incidence of CAUTI of the JUC group was significantly lower than the placebo group (P < 0.01). In addition, another 30 patients were enrolled to evaluate the biofilm formation on catheters after catheter insertion in the patients' urethra (10 groups, 3 each). The results of scanning electron microscopy (SEM) showed that bacterial biofilm formed on the 5th day in the placebo group, while no bacterial biofilm formed on the 5th day in the JUC group. In addition, no adverse reactions were reported using JUC Spray Dressing., Conclusion: Continued indwelling urinary catheters for 5 days resulted in bacterial biofilm formation, and pretreatment of urethral catheters with JUC Spray Dressing can prevent bacterial biofilm formation by forming a physical antimicrobial film, and significantly reduce the incidence of CAUTI. This is the first report of a study on inhibiting bacterial biofilm formation on the catheters in CAUTI patients., (© 2024. The Author(s).)

Introduction: The efficacy of pre-exposure prophylaxis (PrEP) is highly dependent on adherence, and adherence behavior is influenced by motivation. The aim of this study was to explore the longitudinal relationship between PrEP motivation and change in adherence among men who have sex with men (MSM) in Western China., Methods: From November 2019 to June 2021, we conducted a PrEP prospective cohort study. Motivation to take medicine was measured by the PrEP Motivation Scale at baseline, and was grouped into different levels of latent categories by Latent Profile Analysis (LPA). A multinomial logistic regression model was used to explore the longitudinal relationship between change in adherence (improvement, decline, no change) and different levels of PrEP motivation., Results: MSM were divided into two categories of PrEP motivation, a "high motivation group" (n = 506, 69.89%) and a "low motivation group" (n = 218, 30.11%). High PrEP motivation had no significant effect on the change in short-term adherence, however, it contributed to the improvement in long-term adherence [odds ratio (OR) = 3.028 (1.100-8.332), p = 0.031]. The predictive power of the adherence model was significantly enhanced with the addition of the PrEP motivation factor., Conclusions: There was a positive correlation between high PrEP motivation at baseline and an improvement in long-term adherence. Surveillance and intervention of PrEP motivation in MSM can increase their adherence, and then promote PrEP efficacy., (© 2024. The Author(s).)

Objective: We aimed to investigate the relationships among nut consumption, gut microbiota, and body fat distribution., Methods: We studied 2255 Chinese adults in the Lanxi Cohort living in urban areas in Lanxi City, China. Fat distribution was assessed by dual-energy x-ray absorptiometry, and nut consumption was assessed using food frequency questionnaires. 16S ribosomal RNA (rRNA) sequencing was performed on stool samples from 1724 participants. Linear regression and Spearman correlation were used in all analyses. A validation study was performed using 1274 participants in the Lanxi Cohort living in rural areas., Results: Nut consumption was beneficially associated with regional fat accumulation. Gut microbial analysis suggested that a high intake of nuts was associated with greater microbial α diversity. Six genera were found to be associated with nut consumption, and the abundance of genera Anaerobutyricum, Anaerotaenia, and Fusobacterium was significantly associated with fat distribution. Favorable relationships between α diversity and fat distribution were also observed. Similar relationships between gut microbiota and fat distribution were obtained in the validation analysis., Conclusions: We have shown that nut consumption is beneficially associated with body fat distribution and gut microbiota diversity and taxonomy. Furthermore, the microbial features related to high nut intake are associated with a favorable pattern of fat distribution., (© 2024 The Obesity Society.)