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This cross-sectional study aims to assess the level of academic burnout among Chinese medical students during the controlled COVID-19 pandemic and identify the potential demographic factors affecting academic burnout. It also explored the relationship between career calling, family functioning, resource support, and academic burnout, as well as investigated whether family functioning and resource support could moderate the relationship between career calling and academic burnout among Chinese medical students. The study was conducted in five Chinese cities in 2021. A total of 3614 valid questionnaires were collected to assess the relationship between academic burnout, career calling, family functioning, and resource support, and determine whether demographic factors contribute to academic burnout. Hierarchical multiple regression analysis was used to explore factors correlated with academic burnout and test the moderating effect of family functioning and resource support on the relationship between career calling and academic burnout. The mean academic burnout score was 3.29 ± 1.17. Sex, major, academic performance ranking, monthly living expenses, physical health, and sleep quality significantly affected academic burnout (p < 0.05). Academic burnout was negatively correlated with career calling, resource support, and family functioning. Family functioning and resource support moderated the relationship between career calling and academic burnout. Simple slope analysis revealed that high family functioning and resource support strengthened the impact of career calling on academic burnout. Most medical students in China experienced relatively high levels of academic burnout during the controlled COVID-19 pandemic. Furthermore, specific demographic factors contribute to academic burnout. Family functioning and resource support moderate the relationship between career calling and academic burnout. These findings emphasize the importance of implementing career-calling education, supplementing family functioning in the form of school support, and providing sufficient smart learning resources among medical students in the post-pandemic era. The results revealed that career calling was strongly and negatively correlated with academic burnout during the controlled COVID-19 pandemic. High family functioning and resource support strengthened the impact of career calling on academic burnout during the controlled COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Integrated traditional Chinese medicine (TCM) and Western medicine (WM) is a new medical science grounded in the knowledge bases of both TCM and WM, which then forms a unique modern medical system in China. Integrated TCM and WM has a long history in China, and has made important achievements in the process of clinical diagnosis and treatment. However, the methodological defects in currently published clinical practice guidelines limit its development. The organic integration of TCM and WM is a deeper integration of TCM and WM. To realize the progression of "integration" to "organic integration", a targeted and standardized guideline development methodology is needed. Therefore, the purpose of this study is to establish a standardized development procedure for clinical practice guidelines for the organic integration of TCM and WM to promote the systematic integration of TCM and WM research results into clinical practice guidelines in order to achieve optimal results as the whole is greater than the sum of the parts. [ABSTRACT FROM AUTHOR]

Objectives: To summarize the measures and rules of Chinese medicine (CM) and provide reference for clinical application in the prevention and treatment of coronavirus disease (COVID-19). Methods: The data source was from CM COVID-19 prevention and treatment programs on government websites and official media websites of the different provinces and cities. The search lasted from December 8, 2019 to March 10, 2020. Main variables were medication frequency and combinations of medicines. Cluster analysis and complex network analysis were used by prevention and treatment stage and by area. Results: Among 27 CM diagnosis and treatment plans, 203 therapeutic prescriptions were enrolled, of which the top 4 herbs were: Radix glycyrrhizae, Semen armeniacae amarum, Herba ephedrae, and Herba agastachis, respectively. The core combinations were Herba ephedrae and Semen armeniacae amarum. Forty-eight preventive formulae were identified. Ten herbs, including Radix Astragali seu hedysari, Radix glycyrrhizae, Radix saposhnikoviae, Flos lonicerae, etc. were most frequently used. The core prescription of CM compatibility was Radix astragali seu hedysari, Radix glycyrrhizae, and Radix saposhnikoviae, which is the main component of Yu Ping Feng San. There were 45 prevention and treatment prescriptions in East China; the most used CM was Radix glycyrrhizae, Herba agastachis, Pericarpium citri reticulatae, and Gypsum fibrosum. Fifty prescriptions were identified in North China. According to CM analyses, Herba agastachis, Semen armeniacae amarum, Herba ephedrae, and Poria were most frequently used. Conclusions: CM for COVID-19 prevention mainly focuses on improving human immunity; for treatment, prescription focuses on clearing the lungs and removing dampness. Prescriptions vary with regions, perhaps due to climatic and environmental differences, which help clinicians to quickly make CM plans and treat patients according to clinical status, further minimizing resource wastage. [ABSTRACT FROM AUTHOR]

Climate change and pesticide resistance are two of the most imminent challenges human society is facing today. Knowledge of how the evolution of pesticide resistance may be affected by climate change such as increasing air temperature on the planet is important for agricultural production and ecological sustainability in the future but is lack in scientific literatures reported from empirical research. Here, we used the azoxystrobin‐Phytophthora infestans interaction in agricultural systems to investigate the contributions of environmental temperature to the evolution of pesticide resistance and infer the impacts of global warming on pesticide efficacy and future agricultural production and ecological sustainability. We achieved this by comparing azoxystrobin sensitivity of 180 P. infestans isolates sampled from nine geographic locations in China under five temperature schemes ranging from 13 to 25°C. We found that local air temperature contributed greatly to the difference of azoxystrobin tolerance among geographic populations of the pathogen. Both among‐population and within‐population variations in azoxystrobin tolerance increased as experimental temperatures increased. We also found that isolates with higher azoxystrobin tolerance adapted to a broader thermal niche. These results suggest that global warming may enhance the risk of developing pesticide resistance in plant pathogens and highlight the increased challenges of administering pesticides for effective management of plant diseases to support agricultural production and ecological sustainability under future thermal conditions. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical effects of thick-needle therapy (TNT) and acupuncture therapy (AT) on patients with Bell's palsy (BP) at the recovery stage. Methods: A total of 146 eligible participants from 3 hospitals in China were randomized into the TNT group (73 cases) and the AT group (73 cases) using a central randomization. Both groups received Western medicine thrice a day for 4 weeks. Moreover, patients in the TNT group received subcutaneous insertion of a thick needle into Shendao (GV 11) acupoint, while patients in the AT group received AT at acupoints of Cuanzhu (BL 2), Yangbai (GB 14), Dicang (ST 4), Xiaguan (ST 7), Jiache (ST 6), Yingxiang (LI 20) and Hegu (LI 4), 4 times a week, for 4 weeks. Both groups received 2 follow-up visits, which were arranged at 1 month and 3 months after treatment, respectively. The primary outcome measure was House-Brackmann Facial Nerve Grading System (HBFNGS) grade. And the clinical recovery rates of both groups were evaluated according to the HBFNGS grades after treatment. The secondary outcome measures included the facial disability index (FDI) and electroneurogram (EnoG). The adverse events were observed and recorded in both groups. Results: Three cases withdrew from the trial, 2 in the TNT group and 1 in the AT group. There was no signifificant difference in the clinical recovery rates between the TNT and AT groups after 4-week treatment [40.85% (29/71) vs. 34.72% (25/72), P>0.05]. At the 2nd follow-up visit, more patients in the TNT group showed reduced HBFNGS grades than those in the AT group (P<0.01). No significant difference was observed between the two groups in FDI score, EnoG latency and maximum amplitude ratio at all time points (all P>0.05). Conclusion: The clinical effect of TNT was equivalent to that of AT in patients with BP at recovery stage, while the post-treatment effect of TNT was superior to that of AT. (Registration No. ChiCTR-INR-16008409) [ABSTRACT FROM AUTHOR]

Gene flow is an important evolutionary force that enables adaptive responses of plant pathogens in response to changes in the environment and plant disease management strategies. In this study, we made a direct inference concerning gene flow in the Irish famine pathogen Phytophthora infestans between two of its hosts (potato and tomato) as well as between China and India. This was done by comparing sequence characteristics of the eukaryotic translation elongation factor 1 alpha (eEF‐1α) gene, generated from 245 P. infestans isolates sampled from two countries and hosts. Consistent with previous results, we found that eEF‐1α gene was highly conserved and point mutation was the only mechanism generating any sequence variation. Higher genetic variation was found in the eEF‐1α sequences in the P. infestans populations sampled from tomato compared to those sampled from potato. We also found the P. infestans population from India displayed a higher genetic variation in the eEF‐1α sequences compared to China. No gene flow was detected between the pathogen populations from the two countries, which is possibly attributed to the geographic barrier caused by Himalaya Plateau and the minimum cross‐border trade of potato and tomato products. The implications of these results for a sustainable management of late blight diseases are discussed. [ABSTRACT FROM AUTHOR]

Evolution of fungicide resistance in plant pathogens is one of major concerns in sustainable plant disease management. In this study, the genetics and potential of developing resistance to a demethylation inhibitor (DMI) fungicide, difenoconazole, in the fungal pathogen Alternaria alternata was investigated using a comparative analysis of genetic variation in molecular (Single Sequence Repeats, SSR) and phenotypic (fungicide tolerance) markers. No difenoconazole resistance was found in the 215 A. alternata isolates sampled from seven different ecological zones in China despite the widespread use of the fungicide for more than 20 years. This result suggests that the risk of developing resistance to difenoconazole in A. alternata is low and we hypothesize that the low risk is likely caused by fitness penalties incurred by resistant mutants and the multiple mechanisms involving in developing resistance. Heritability and plasticity account for ∼24 and 3% of phenotypic variation, respectively, indicating that genetic adaptation by sequence variation plays a more important role in the evolution of difenoconazole resistance than physiological adaptation by altering gene expression. Constraining selection in the evolution of A. alternata resistance to difenoconazole was documented by different patterns of population differentiation and isolate-by-distance between SSR markers and difenoconazole tolerance. Though the risk of developing resistance is low, the findings of significant differences in difenoconazole tolerance among isolates and populations, and a skewing distribution toward higher tolerance suggests that a stepwise accumulation of tolerance to the fungicide might be occurring in the pathogen populations. As a consequence, dynamic management programs guided by evolutionary principles such as spatiotemporal rotations of fungicides with different modes of action are critical to prevent the continued accumulation of tolerance or the evolution of resistance to difenoconazole and other DMI fungicides. [ABSTRACT FROM AUTHOR]

Background: Phlegm and blood stasis syndrome (PBSS) is one of the main syndromes in coronary heart disease (CHD). Syndromes of Chinese medicine (CM) are lack of quantitative and easy-implementation diagnosis standards. To quantify and standardize the diagnosis of PBSS, scales are usually applied. Objective: To evaluate the diagnostic accuracy of CM diagnosis scale of PBSS in CHD. Methods: Six hundred patients with stable angina pectoris of CHD, 300 in case group and 300 in control group, will be recruited from 5 hospitals across China. Diagnosis from 2 experts will be considered as the "gold standard". The study design consists of 2 phases: pilot test is used to evaluate the reliability and validity, and diagnostic test is used to assess the diagnostic accuracy of the scale, including sensitivity, specificity, likelihood ratio and area under the receiver operator characteristic (ROC) curve. Discussion: This study will evaluate the diagnostic accuracy of CM diagnosis scale of PBSS in CHD. The consensus of 2 experts may not be ideal as a "gold standard", and itself still requires further study. (No. ChiCTR-OOC-15006599). [ABSTRACT FROM AUTHOR]

Aims To compare the once-daily rivastigmine patch 9.5 mg/24 h (10 cm2) versus twice-daily capsule (12 mg/day) in Chinese patients with probable Alzheimer's disease ( AD) (mini-mental state examination [ MMSE] scores of 10-20). Methods The primary objective was to demonstrate the noninferiority of patch to capsule in Alzheimer's Disease Assessment Scale-Cognitive subscale ( ADAS-Cog) change from baseline to 24 week. Secondary endpoints included cognition ( MMSE), overall clinical response (Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change [ ADCS- CGIC]), activities of daily living (Alzheimer's Disease Cooperative Study-Activities of Daily Living [ ADCS- ADL]), behavior (Neuropsychiatric Inventory [ NPI-12]), and safety. Results Similar cognitive improvement was observed in both patch (n = 248) and capsule (n = 253) groups. Statistical noninferiority for ADAS-Cog was not established (least-square means difference, 0.1; 95% confidence interval, −1.2; 1.5). Considering all efficacy parameters into account, both treatments showed similar performance at Week 24. Treatment-related adverse events ( AEs) were lower for patch (39.7%) compared with capsule (49.8%). Application site pruritus was reported in 10.9% of patients receiving patch; most cases were mild. Gastrointestinal AEs including nausea, vomiting, and diarrhea occurred less frequently in the patch group (15.8% vs. 28.7%). Conclusion Rivastigmine patch 9.5 mg/24 h is effective and well tolerated in Chinese patients with probable AD. [ABSTRACT FROM AUTHOR]

Objectives. To investigate changes in pulsograph caused by pain in primary dysmenorrhea (PD) patients. Methods. Pulsograph and pain level of PD patients were detected using electropulsograph and Visual-Analogue Scale (VAS), respectively, at four time points, 7–10 days before menstruation (T0), maximal pain during menstruation (T1), immediately after acupuncture analgesia (T2), and 30 mins after acupuncture analgesia (T3). Parameters (t, h, w) and normalized time parameters (t′) of pulsograph were analyzed. Results. VAS pain scores decreased from 6.40 ± 1.13 at T1 to 0.70 ± 0.75 at T2 to 0.11 ± 0.32 at T3 (P<0.001 and 0.001). At T1, compared with those at T0, w1, h3, and h4 significantly increased (P<0.01), and t2, t2′, t3′, and h(d) significantly decreased (P<0.01, 0.001, 0.05, and 0.001). At T2, compared with those at T1, t1, w1, w2, h2, h3, t1′, and t4′ significantly decreased (P<0.05, 0.01, 0.01, 0.001, 0.01, 0.001, and 0.05), and h(d) significantly increased (P<0.001). There was no difference between T2 and T3. Conclusions. There are almost opposite changing trends in pulsographic parameters when pain occurs and when it is relieved in PD patients. [ABSTRACT FROM AUTHOR]

Trollius chinensis Bunge is a traditional edible and medicinal plant utilized popularly in north China. This study is intended to evaluate the antioxidant and antimicrobial properties of extracts obtained with different processing methods from Trollius chinensis Bunge. The results showed that all extract displayed moderate or great potential of antioxidant and antibacterial activity, especially ultrasound-assisted ethanol extracts (UAE). It exhibited the highest 2, 2-diphenyl-1-picrylhydrazyl (DPPH; EC50 0.215 ± 1.10 mg/mL), 2, 2-azino-bis (3-ethylbenzo-thiazoline-6-sulfonic acid) (ABTS; EC50 < 10 μg/mL) and reducing power (RP; EC50 0.25 ± 0.02 mg/mL) with the highest level of flavonoids content (71.56 ± 0.35 mg/g) and total phenolic (35.75 ± 0.35 mg/g). In addition, the UAE had high antibacterial activity against Staphylococcus aureus (19.7 ± 0.6 mm inhibition zone) , Bacillus subtilis (16.4 ± 0.3 mm inhibition zone), Escherichia coli (15.3 ± 0.2 mm inhibition zone), respectively. The HPLC analysis show that the main flavonoids components in T. chinensis Bunge were revealed to be 2″-O-β-L-galactopyranosylorientin, orientin, vitexin, hyperin. These results suggested the extracts of T. chinensis Bunge could be potentially used as a promising source of antioxidant and antibacterial agents for using in the food or drug industries. [ABSTRACT FROM AUTHOR]

Improving the utilization efficiency of rainwater resources was a key issue for apple orchards in semi-arid areas. The RCIP-SA system combined rainwater collection systems, infiltration promoting tube and soil anti-seepage layer to gather limited rainwater resources into the soil layer where the roots of apple tree were concentrated. To evaluate the effect of the RCIP-SA system on soil moisture change and fine root distribution, a field experiment was completed in a hilly apple orchard on the Loess Plateau of China from 2017 to 2019. The results showed that the soil moisture of the RCIP-SA system was 24.0–43.9% higher than CK in the 0–60 cm soil layer in the rainwater collection ditch, and generated a larger area with higher moisture content near the impermeable layer during the apple tree growth period. The RCIP-SA system also expanded the dense distribution zone of apple tree roots. The dry fine root densities of apple trees in the RCIP-SA system in the 0–200 cm soil layer was 11.7–59.6% and 18.2–30.3% higher than CK under the plastic film (60 cm from the trunk) and edge of the rainwater collection ditch (100 cm from the trunk), respectively. Soil moisture and root distribution of apple trees were significantly different under different impermeable layers, and compacted red clay as the impermeable layer was the best anti-seepage strategy in RCIP-SA systems. The RCIP-SA system brought higher economic benefits; the average yield per tree was recorded for red clay compaction treatment (38.1 kg·tree−1), equating to a production level of 22 800 kg·ha−1, and a difference of 9.6 kg·tree−1 with CK treatment, equating to 5700 kg·ha−1. This strategy should be recommended as an agricultural measurement for apple production on the Loess Plateau of China. ga1 • RCIP-SA integrated rainwater collection, infiltration promoting and soil anti-seepage. • RCIP-SA generated a higher moisture zone, increased soil moisture in rainwater ditch by 24.0–43.9%. • RCIP-SA improved fine root densities by 11.7–59.6% in 0–200 cm soil layer. • Compacted red clay was a better anti-seepage strategy. [ABSTRACT FROM AUTHOR]

Background: This study aimed to describe the design and present the baseline characteristics of a web-based lifestyle intervention program, which comprises of sequentially and simultaneously delivered intervention modules targeting physical activity (PA) and fruit and vegetable consumption (FVC) in Chinese college students.Methods: The study adopted a randomized placebo-controlled trial, using the Health Action Process Approach (HAPA) and the Compensatory Carry-Over Action Model (CCAM) as the theoretical backdrops. 556 Chinese college students participated in the 8-week web-based lifestyle intervention program. All eligible participants were randomly assigned to one of four groups: 1) the PA-first arm which received a 4-week intervention addressing PA followed by a 4-week intervention addressing FVC; 2) the FVC-first arm which received a 4-week intervention addressing FVC followed by a 4-week intervention addressing PA; 3) the PA + FVC simultaneous arm that received an 8-week intervention addressing both PA and FVC at the same time; and 4) the placebo-control arm that received 8 weeks of general health information, which is not relevant for changing actual PA and FVC behaviors. Data collection includes four time-points: at the beginning and end of the intervention, and a 3-month and 12-month follow-up after the intervention.Results: At baseline, 41.7% of participants were male and 58.3% were female. 41.0% of the participants did not meet the standard PA-recommendations, while 69.6% did not adhere to the standard FVC-recommendations. In total, only 19.6% of participants met both PA and FVC recommendations. Baseline characteristics across the four groups had no significant differences (all P = .17-.99), indicating successful randomization.Conclusions: The preliminary results indicate a high prevalence of unhealthy lifestyles in college students in China, which further supports the need for web-based health intervention programs. This is also the first study that examines the comparative effectiveness of simultaneously and sequentially delivered lifestyle interventions in the Chinese population. These findings may contribute to the creation of future web-based health behavior change interventions.Trial Registration: ClinicalTrails.gov: NCT03627949 , 14 August, 2018. [ABSTRACT FROM AUTHOR]

Background: As the global trend of population aging intensifies, the health and well-being of the older population has gradually become a focus of attention for the global community. This study assessed the status of thriving in life among Chinese urban older adults and identified its relationship with attitude toward own aging and quality of life (QoL). It also tested whether attitude toward own aging moderates the association between thriving in life and Qol or between thriving in life and suicidal ideation., Methods: Primary data were collected through a cross-sectional survey among urban older adults from three provinces in China. They were invited to complete an anonymous survey using face-to-face interviews from December 2019 to January 2020. Data from 764 older adults were analyzed., Results: Approximately 44.39% of participants reported positive responses toward the four domains of thriving in life. Thriving in life and attitude toward own aging had a significant association with QoL. Thriving in life was a protective factor for suicidal ideation for older adults. Moreover, attitude toward own aging moderated the association between thriving in life and QoL and that between thriving in life and suicidal ideation., Conclusions: Chinese urban older adults were reportedly thriving in life, which contributed to increased QoL and reduced suicidal ideation. Notably, the study revealed that more positive attitudes towards own aging were associated with higher levels of thriving in life, better QoL, and reduced suicidal ideation. Targeted interventions for older adults should be devised to promote thriving in life and prevent negative attitudes of older people towards their own aging, further raising QoL and reducing suicidal ideation., (© 2024. The Author(s).)

Background: Ageism is a global challenge, which leads to a range of adverse outcomes for elderly people worldwide, which maybe more severe among urban older adults in a competitive society. However, how self-perceived ageism influences the quality of life in a sample of urban older adults remains inconclusive., Objectives: The current study aims to assess the status of self-perceived stigma among urban Chinese older adults, identify its relationship with quality of life, and further explore whether both attitude toward own aging and traditionality moderate this relationship., Materials and Methods: Primary data were collected through cross-sectional surveys among urban older adults in three provinces of China from October 2019 to December 2020. A total of 764 urban older adults were valid participants (effective response rate = 81.28%) and completed questionnaires via anonymous face-to-face interviews. Socio-demographic factors, self-perceived stigma, attitude toward own aging, traditionality, and quality of life were assessed using questionnaires that included the Self-perceived Stigma, Attitude Toward Own Aging, Traditionality, and SF-8 Scales., Results: For urban Chinese older adults, the average score of self-perceived stigma was 2.041 ± 0.726. Self-perceived stigma (β = -0.391, p < 0.05) and attitude toward own aging (β = -0.211, p < 0.05) both influenced quality of life. Additionally, attitude toward own aging (β = -0.530, p < 0.05) and traditionality (β = -0.525, p < 0.05) moderated the association between self-perceived stigma and quality of life. Simple slope analysis revealed that when the level of negative attitude toward own aging and traditionality was higher, the strength of the influence of self-perceived stigma on quality of life was stronger., Conclusion: Urban Chinese older adults were aware of the self-perceived stigma, which contributes to decreased quality of life. Attitude toward own aging and traditionality could moderate the association between self-perceived stigma and quality of life. When negative attitudes toward own aging and traditionality are higher, self-perceived stigma has a greater effect on the quality of life. More interventions related to relieving self-perceived stigma, traditionality, and negative attitude toward own aging should be considered to build a new modern society that emphasizes health, friendliness, well-being, and dignity for all ages., 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 © 2022 Sun, Zhang, Yan, Lian, Yu, Yin, Zhao, Wang, Chang, Ji, Cheng, Wang, Huang and Cao.)

Objective: Previous studies mainly reported the clinical characteristics of novel coronavirus 2019 (COVID-19) infections, but the research on clinical characteristics and treatment outcomes of COVID-19 patients with stroke is still rare., Methods: A multi-center retrospective study was conducted at 11 hospitals in 4 provinces of China, and COVID-19 patients with stroke were enrolled from February 24 to May 4, 2020. We analyzed epidemiological, demographic, and clinical characteristics of cases as well as the laboratory test results, treatment regimens and outcomes, and the clinical characteristics and therapeutic outcomes were compared between severe and nonsevere patients, and by age group, respectively., Results: A total of 27 patients [mean age: 66.41 (SD 12.1) years] were enrolled. Among them, 9 (33.3%) were severe patients and 18 (66.7%) were nonsevere patients; 17 (63.0%) were female; 19 (70.4%) were aged 60 years and above. The most common symptoms were fever [19 (70.4%)], fatigue [12 (44.4%)] and cough [11 (40.7%)], respectively. Abnormal laboratory findings of COVID-19 patients with stroke included high levels of C-reactive protein [19 (73.1%)], D-dimer [14 (58.3%)], blood glucose [14 (53.8%)], fibrinogen [13 (50.0%)], and decreased lymphocytes [12 (44.4%)]. Comparing to nonsevere cases with stroke, severe patients with stroke were likely to be older, susceptible to receiving oxygen inhalation, and had more complications (p < 0.05). In addition, there were significant differences in lymphocytes, neutrophils, lactate dehydrogenase, C-reactive protein, creatine kinase between the severe cases and nonsevere cases (p < 0.05). The older patients had a decreased platelet count and elevated fibrinogen, compared with the younger (p < 0.05). All patients (100%) received antiviral treatment, 12 (44.4%) received antibiotics treatment, 26 (96.3%) received Traditional Chinese Medicine (Lung cleansing & detoxifying decoction), and oxygen inhalation was in 18 (66.7%). The median duration of hospitalization was 16 days. By May 4, 2020, a total of 26 (96.3%) patients were cured and discharged, and 1 (3.7%) patients died., Conclusion: COVID-19 patients with stroke had poor indicators of coagulation system, and severe and older patients might have a higher risk of complications and unfavorable coagulation system. However, the overall treatment outcome is favorable., (Copyright © 2020. Published by Elsevier GmbH.)

Objective: Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear., Methods: A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients' medical records. Multivariable logistic regression models were used to estimate the odds ratio ( OR ) and 95% confidence interval (95% CI ) of the associations between comorbidities (cardiometabolic or non-cardiometabolic diseases), clinical severity, and treatment outcomes of COVID-19., Results: Overall, 158 (13.6%) patients were diagnosed with severe illness and 32 (2.7%) had unfavorable outcomes. Hypertension (2.87, 1.30-6.32), type 2 diabetes (T2DM) (3.57, 2.32-5.49), cardiovascular disease (CVD) (3.78, 1.81-7.89), fatty liver disease (7.53, 1.96-28.96), hyperlipidemia (2.15, 1.26-3.67), other lung diseases (6.00, 3.01-11.96), and electrolyte imbalance (10.40, 3.00-26.10) were independently linked to increased odds of being severely ill. T2DM (6.07, 2.89-12.75), CVD (8.47, 6.03-11.89), and electrolyte imbalance (19.44, 11.47-32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission (5.46, 3.25-9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes (6.58, 1.46-29.64) within two weeks., Conclusion: Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes., (Copyright © 2020 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.)

In March 2020, China had periodically controlled the coronavirus disease-19 (COVID-19) epidemic. We reported the results of health screening for COVID-19 among returned staff of a hospital and conducted a summary analysis to provide valuable experience for curbing the COVID-19 epidemic and rebound. In total, 4729 returned staff from Zhongnan Hospital of Wuhan University, Wuhan, China were examined for COVID-19, and the basic information, radiology and laboratory test results were obtained and systematically analysed. Among the 4729 employees, medical staff (62.93%) and rear-service personnel (30.73%) were the majority. The results of the first physical examination showed that 4557 (96.36%) were normal, 172 (3.64%) had abnormal radiological or laboratory test results. After reexamination and evaluation, four were at high risk (asymptomatic infections) and were scheduled to transfer to a designated hospital, and three were at low risk (infectivity could not be determined) and were scheduled for home isolation observation. Close contacts were tracked and managed by the Center for Disease Control and Prevention (CDC) in China. Asymptomatic infections are a major risk factor for returning to work. Extensive health screening combined with multiple detection methods helps to identify asymptomatic infections early, which is an important guarantee in the process of returning to work.

Qingfei Paidu Decoction is a traditional Chinese medicine compound recommended by National Health Commission of the People's Republic of China and National Administration of Traditional Chinese Medicine for clinical therapies of coronavirus disease 2019(COVID-19). Qingfei Paidu Decoction consists of 21 traditional Chinese medicines, such as Asari Radix et Rhizoma. However, the dosage of Asari Radix et Rhizoma has been questioned by some people, because of one ancient proverb. To explore the rationality of the dosage of Asari Radix et Rhizoma in Qingfei Paidu Decoction, this study systematically examined the ancient and modern physicians' understanding of the toxicity of Asari Radix et Rhizoma, and collated the application and dosage of Asari Radix et Rhizoma in ancient prescriptions and modern clinics based on literature analysis. As a result, we found that ancient and modern physicians have different understanding on the toxicity of Asari Radix et Rhizoma and that the theory about the dosage of Asari Radix et Rhizoma is flawed. We also found that the dose of Asari Radix et Rhizoma in ancient and modern clinical applications was not constrained by ancient experience. Physicians usually increase the dosage of Asari Radix et Rhizoma in clinical therapy according to the actual conditions, and there were no adverse reactions. Additionally, according to laws and regulations concerning medical affairs, physician could increase or decrease the dosage of the drug under special circumstances. Based on the analysis of safety and effectiveness of Asari Radix et Rhizoma in Qingfei Paidu Decoction, we conclude that the dose of Asari Radix et Rhizoma in Qingfei Paidu Decoction is safe, effective and reasonable.

Coronavirus disease 2019(COVID-19) triggered a severe and complicated epidemic situation, and it is of great significance to discuss the rules and characteristics of the prescription of COVID-19 in traditional Chinese medicine. This study collected prevention and treatment approaches of traditional Chinese medicine for COVID-19 released from the National Health Committee of China, 7 provinces and municipal health committees, the Chinese Medicine Administration and Handbook of Traditional Chinese Medicine Diagnosis and Treatment of COVID-19 between January 1 and February 18, 2020, and prescriptions prepared by 3 masters of Chinese medicine and 4 well-known Chinese medicine experts. These information were selected according to the inclusion and exclusion criteria, and EpiData 3.0 software was used to establish the &quot;Traditional Chinese Medicine Prescription Library for the Prevention and Treatment of COVID-19&quot; and the &quot;Common Database of Traditional Chinese Medicine for the Prevention and Treatment of COVID-19&quot;. A total of 93 effective Chinese medicine prescriptions and a total of 157 kinds of constituent medicines were collected. Data analysis was performed by SPSS 18.0 software. The results showed that: ①most of the medicines are with cold and warm properties, 69 with cold medicines, accounting for 43.95%, 57 with warm medicines, accounting for 36.31%, and less with hot medicines, taking up 1.27%; ②there are many pungent, bitter and sweet medicines, and the distribution of medicinal flavors is different at different disease stage. The pungent medicines are mostly found in the early stage, the bitter drugs are the main flavor in the middle and severe stage, and the sweet medicines are mostly used in the recovery stage; ③the meridian of the drug is more concentrated at the lung, stomach, and heart, and most of drugs are into the lung meridian, accounting for 24.55%; these medicines are mostly into the lungs and stomach in the initial and middle stages, and into the heart and kidney in severe stages; ④oral drugs are mostly non-toxic, among which only 6 kinds are toxic, namely Armeniacae Semen Amarum, Dryopteridis Crassirhizomatis Rhizoma, Paridis Rhizoma, Pinelliae Rhizoma, Aconiti Lateralis Radix Praeparaia; ⑤most of the drugs have five types of functions: treating exterior syndromes, resolving dampness, clearing heat, replenishing deficiency, resolving phlegm, cough, and asthma. In the early stage, both drugs for treating exterior syndromes and heat clearing drugs were equally used, accounting for 18.81% each. In the middle stage, drugs resolving phlegm, cough, and asthma drugs are more often used, accounting for 29.61%. In the severe stage, heat clearing drugs are mostly used, accounting for 33.33%. During the recovery period, tonic deficiency drugs are used the most, accounting for 36.47%. The medical characteristics and efficacy of Chinese medicine in preventing and treating COVID-19 are closely related to the understanding of the etiology of Chinese medicine and the location and pathogenesis of the disease. Staged medication and local conditions need attention during the identification and treatment of COVID-19 clinical syndromes.

Using WinEPIC and partial least squares regression model, we compared the driving factors of water productivity and soil moisture dynamics of several mature apple plantations in Shaanxi from 1981 to 2016. For the hilly and gully region of northern Shaanxi, the residual loess platform region in Weibei, and Guanzhong Plain, the average annual yield of mature apple forests was 16.94, 22.62 and 25.70 t·hm -2 , the annual average evapotranspiration was 511.2, 614.9 and 889.88 mm, and the water productivity was 3.81, 3.82 and 3.24 kg·m -3 , respectively. In northern Shaanxi and Weibei regions, water stress was the most serious, with the average annual stress days being 54.89 and 28.38 d, respectively. The N-level stress in Guanzhong region was severe, with an average annual stress day of 25.87 d. The largest factor affecting the yield of apple plantations in the northern Shaanxi and northern Weibei regions was the precipitation. The standardized regression coefficients were 0.274 and 0.235, respectively, the amount of N applied had a significant impact on the yield, with regression coefficients of 0.224 and 0.232, respectively. The maximum impact factor in Guanzhong region was the amount of N applied, with a regression coefficient of 0.335, followed by the amount of water supplied and the amount of applied P. The regression coefficients were 0.154 and 0.147, respectively. The dominant factor affecting the water productivity of apple plantations in northern Shaanxi and Weibei was precipitation, and the standardized regression coefficients were 0.238 and 0.194, respectively. The most important impact factors in Guanzhong region were the amount of N applied and the amount of water supplied, and the regression coefficients were 0.182 and 0.178, respectively. During the simulation period, the total water consumption of apple plantations in the northern Shaanxi, Weibei and Guanzhong regions was 1152.17, 1342.95 and 1372.42 mm, respectively. The effective water content decline rates of 2-15 m soil layers were 63.44, 57.08 and 51.41 mm·a -1 , respectively. The dry layer of deep soil appeared after 8, 13 and 17 years, and the dry layer was stable to 11 m deep for 18, 21 and 26 years, respectively, suggesting the drying status was severe. The management focus of apple plantations in different regions should be determined by the dominant factors of water productivity.

Background: Knee osteoarthritis (KOA) is commonly seen and has a high occurrence in the middle-aged and elderly. It is characterized by the degeneration and secondary bone hyperplasia of the articular cartilage; the pathologic changes are irreversible. Therefore, treatment of KOA is mainly focused on relieving pain, reducing inflammation, improving or restoring joint function, delaying disease progression, and increasing quality of life. Crossbow needle therapy of the Miao ethnic minority group is intended for KOA treatment and has been widely used. Studies of small sample size have seen significant improvement on pain relief, stiffness, and joint function., Methods/design: The trial is a randomized, multicenter, parallel, non-inferiority study. Three hundred and six patients will be randomly assigned to a crossbow needle group (n = 153) and an acupuncture group (n = 153). Patients in each group will receive treatment every other day, three times a week, 20 times in total. Follow-up will be conducted 15 days and 30 days after treatment. The primary outcome will be the Western Ontario and McMaster Osteoarthritis Index (WOMAC) score at baseline, the end of treatment, first follow-up, and second follow-up. The secondary outcomes will include Lysholm knee score, Japanese Orthopedic Association (JOA) knee score, visual analogue scale (VAS), and the MOS 36-item short-form health survey (SF-36)., Discussion: The results of the trial will compare the efficacy on KOA between crossbow needle group and acupuncture group and will be expected to make a systematic and objective evaluation of crossbow needle therapy., Trial Registration: ChiCTR, ChiCTR-INR-16008032 . Registered on 12 March 2016.

To study the perfluoroalkyl acid (PFAAs) contamination in seven major drainage basins of China and the exposure risk to resident populations via drinking water sourced from these basins, a risk assessment model of the US EPA and a scenario-based risk assessment method were applied to analyze the PFAA pollution characteristics and to evaluate the average daily dose and health risk to adults, adolescents, and children. In the intermediate-exposure scenario, results showed that the ∑PFAAs median for the seven major drainage basins was 14 ng·L -1 , with perfluorooctanoic acid (PFOA), perfluorobutanoic acid (PFBA), and perfluorooctane sulfonic acid (PFOS) the main contaminants, and that the contamination levels were the highest in the Songliao River and Taihu Lake basins. In the high-exposure scenario, the discharge proportion of perfluoroalkyl carboxylic acids with ≤ 6 carbon chains among the ∑PFAAs was higher than that in the intermediate-exposure scenario. In addition, certain sections tended to be more polluted than others in the Yellow River and Yangtze River basins. Risk assessment showed that PFOA and PFOS exposure via drinking water posed no health risk to Chinese residents, and that the average daily ingestion of drinking water of Chinese adolescents was below the suggested amount.

Background: Abnormal activation of PI3K/AKT/mTOR (PAM) pathway, caused by PIK3CA mutation, KRAS mutation, PTEN loss, or AKT1 mutation, is one of the most frequent signaling abnormalities in breast carcinoma. However, distribution and frequencies of mutations in PAM pathway are unclear in breast cancer patients from the mainland of China and the correlation between these mutations and breast cancer outcome remains to be identified., Methods: A total of 288 patients with invasive ductal breast cancer were recruited in this study. Mutations in PIK3CA (exons 4, 9 and 20), KRAS (exon 2) and AKT1 (exon 3) were detected using Sanger sequencing. PTEN loss was measured by immunohistochemistry assay. Correlations between these genetic aberrations and clinicopathological features were analyzed., Results: The frequencies of PIK3CA mutation, KRAS mutation, AKT1 mutation and PTEN loss were 15.6%, 1.8%, 4.4% and 35.3%, respectively. However, except for PTEN loss, which was tied to estrogen receptor (ER) status, these alterations were not associated with other clinicopathological features. Survival analysis demonstrated that PIK3CA mutation, PTEN loss and PAM pathway activation were not associated with disease-free survival (DFS). Subgroup analysis of patients with ER positive tumors revealed that PIK3CA mutation more strongly reduced DFS compared to wild-type PIK3CA (76.2% vs. 54.2%; P = 0.011). PIK3CA mutation was also an independent factor for bad prognosis in ER positive patients., Conclusions: AKT1, KRAS and PIK3CA mutations and PTEN loss all exist in women with breast cancer in the mainland China. PIK3CA mutation may contribute to the poor outcome of ER positive breast carcinomas, providing evidence for the combination of PI3K/AKT/mTOR inhibitors and endocrine therapy.

The purpose of this study was to evaluate the associations of CYP1A1 genetic polymorphisms with the risk of developing esophageal cancer (EC). A case-control study was carried out in a Chinese population in which 157 hospital based EC cases and 157 population based healthy controls with 1:1 match by age and sex were included. PCR based restriction fragment length polymorphisms (PCR-RFLP) were used to detect genotypes in case and control groups. For the CYP1A1 Ile/Val polymorphism, comparing with wild genotype Ile/Ile, both the heterozygote genotype Ile/Val and the combined variant genotype Ile/Val+Val/Val increased the risk of esophageal cancer (OR: 2.05, 95%CI: 1.19-3.54, OR: 1.86, 95%CI: 1.11-3.12). No significant association was found between the CYP1A1 MspI polymorphism and EC. According to analysis of combined genotypes, the TC/AG combined genotype which contained both variant alleles of these two polymorphisms increased the risk of developing EC (OR: 2.12, 95%CI: 1.16-3.85). Our results suggested that genetic polymorphisms of CYP1A1 may increase the susceptibility to EC.

Selecting acupoints according to channel pathway is the major point selection principle in acupuncture treatment for which there is a consensus. However, defining the disease location remains the premise of acupoint selection based on channel pathway. What is the substance of disease location identification in clinical acupuncture? Besides indicating acupoint selection according to channel pathway, what guidance can it provide for acupuncture treatment? This is the main topic discussed in this article.

Habitat fragmentation is a main cause for the loss of biological diversity. Combining line-transect methods to survey the amphibians and reptiles on 23 islands on Thousand Island Lake in Zhejiang province, along with survey data on nearby plant species and habitat variables collected by GIS, we used the"BINMATNEST (binary matrix nestedness temperature calculator)" software and the Spearman rank correlation to examine whether amphibians and reptiles followed nested subsets and their influencing factors. The results showed that amphibians and reptiles were significantly nested, and that the island area and habitat type were significantly associated with their nested ranks. Therefore, to effectively protect amphibians and reptiles in the Thousand Islands Lake area we should pay prior attention to islands with larger areas and more habitat types.

Objective: To assess the changes and the leading cause of deaths for children under 5 years old, in China, during 2000 - 2010, with the aim of evaluation on the progress in achieving the relative goal set by "National Program of Action for Child Development in China (2001 - 2010)", and understanding the related challenges., Methods: Data used in this study were collected from the population-based National Maternal and Child's Health Surveillance Network of China. Infant Mortality Rate (IMR), Under-5-mortality rate (U5MR) and the leading cause of deaths for under-5 children were analyzed., Results: Nationwide IMR and U5MR in 2010 dropped by 59.3% and 58.7% respectively, compared to that in 2000. Decreases by 50.8% and 47.1% in IMR and U5MR were observed in urban areas, and 56.5% and 56.0% in rural areas during this period. Compared with data from 2000, the leading causes-specific U5MR in 2010 had significantly declined. The top 5 leading causes of death in 2010 were premature birth/low birth weight, pneumonia, birth asphyxia, congenital heart disease and accidental suffocation, but were different in urban and rural areas. In 2010, both IMR and U5MR from the rural areas were 2.8-folds than that of the urban areas. In addition, IMRs in the Middle and Western parts of China were 1.5 and 2.3-folds respectively of that in the East, and U5MR in Middle and West was 1.5 and 2.2-folds respectively of that in East., Conclusion: IMR, U5MR and the leading causes specific mortality rate in China declined remarkably from 2000 to 2010, and the goal set by "National Program of Action for Child Development in China (2001 - 2010)" had been successfully achieved. However, the disparity on child's health in regions and in urban or rural areas, still remained a challenge.

A Bayesian geostatistical model was used to identify factors related to topographical variation in the analysis of mortality risk for children less than 5 years of age in the 2008 Wenchuan earthquake in the People's Republic of China. Epidemiological data from a standardized survey were available from 115 locations across the study area. Physical and demographic factors measured directly at the township level were examined with respect to risk. The geostatistical model explicitly accounted for spatial correlation present in child mortality by fitting a Gaussian linear model to the data. Results identified the role of several factors in explaining geographical heterogeneity in child mortality and show that it was significantly correlated with earthquake intensity, population density, migrant labour, and the percentage of collapsed houses.

Objective: To investigate the prevalence of malignant tumor and its influencing factor among rubber workers in Hainan Province of China, and to study the high incidence of cancer and type of work., Methods: A retrospective cohort study on registered workers over 1 working age among partial rubber factories in Hainan Province in the period from 2005 to 2010., Result: There was a remarkable difference in the incidence between nature exposed rubber group and non-exposed group (χ(2) = 52.13,P < 0.01). Occupational exposure induced a high risk in malignant tumors (OR = 2.47, P < 0.05). The incidence of tumor may be associated with occupational exposure: the longer occupational exposure time, the higher was the incidence of tumor (χ(2) = 11.40, P < 0.05)., Conclusions: The occupational exposure in rubber workers can induce a high incidence of malignant tumor.

We discuss here the complexity of the doses of traditional Chinese medicine (TCM) prescriptions and herbs from different viewpoints, including the heterogeneity of drug quality, the flexibility of prescriptions, and the diversity of drug effects. Then, the corresponding research ideas and strategies are proposed. We can reveal the actual situation of clinical doses based on in-depth "real-world study" of the safety and effectiveness of TCM prescriptions, create an analytical method for dose-effect relationships in accordance with the features of TCM, and reveal the correlated regular nature of the effectiveness and dosage of TCM prescriptions and herbs.

Background: Birth defects are a global public health problem because of their large contribution to infant mortalities and disabilities. It is estimated that 4%-6% of Chinese newborns are affected by birth defects every year. Surveillance is a basic approach to understanding the occurrence and associated factors of birth defects. The Ministry of Health of China initiated a national hospital-based birth defects monitoring system 20 years ago. Nearly every province in this country has established its own surveillance system in the past. The authors reviewed the result of the monitoring system at different administrative levels in China., Data Sources: Available publications on the surveillance of birth defects and data from national and provincial birth defects surveillance systems were reviewed to evaluate the effectiveness of the surveillance systems., Results: According to the 2009 data, the national hospital-based birth defects surveillance system monitored over 1.3 million births, which accounted for more than 8% of births in China. In addition, 30 provincial hospital-based surveillance programs covered a birth population of more than 3.6 million (22% of births in China). Great achievements have been made in terms of case ascertainment, data quality control, and online reporting. But the surveillance systems in China still have some limitations. A short ascertainment period may miss some internal anomalies, inherited metabolic diseases, and malformed fetus aborted before the 28th gestational week. Discrepancies in antenatal or postnatal diagnosis of birth defects between surveillance institutes may affect the detection rate and introduce biases. Absence of baseline data and lack of integrated database systems limit the application of surveillance data to etiological studies and affect the process of decision-making., Conclusions: The surveillance system for birth defects is prerequisite to propose, conduct and assess any interventions for the disease. To meet the need of study and prevention of birth defects, measures should be taken to improve the national and provincial birth defects surveillance systems in China.

Objective: To investigate the malignancy incidence among rubber manufacture and preliminary processing industrial workers in Hainan Province of China., Methods: A retrospective survey was conducted on 9 farms in Hainan covering workers who got malignant tumor between January 1, 2005 and October 31, 2010., Result: On average there were 10 320 workers worked on the 9 farms each year. Among them, 167 cases of malignancy were found. The morbidity was 279.01 every a hundred thousand and standardized morbidity was 159.03 every a hundred thousand; In comparison, we also investigated 14228 non-rubber-industry-related workers. 94 malignancy cases were found. The morbidity was 113.91 every a hundred thousand and standardized morbidity was 64.93 every a hundred thousand. The difference was statistically significant (P<0.01) meaning that rubber industrial workers in Hainan Province had a higher possibility of getting malignancy. Top 5 types of cancer found in this study were lung cancer (17.96%), liver cancer (17.36%), stomach cancer (13.17%), rectal cancer and nasopharyngeal carcinoma. 116 cases of these five types of cancer took up 69.45% of the total., Conclusions: Rubber industrial workers in Hainan have a higher morbidity of malignancy than other local industries. But it is similar to other areas in China.

Objective: To analyze time trend and regional disparities in maternal mortality ratio (MMR) and major causes of maternal death in China from 1996 to 2010., Methods: Data used in this study were based on national maternal mortality surveillance system. From 1996 to 2005, it included 176 monitoring districts (countries) in 31 provinces, autonomous regions and municipalities in the inner land. From 2006 to the present, it covered 336 districts (countries). MMR, major causes of maternal death and their reduction margin, average annual reduction rate in different times and regions from 1996 to 2010 were analyzed. The trend and regional differences in MMRs and major causes of mortality were analyzed using Cochran-Armitage trend and Poisson Test., Results: From 1996 to 2010, Chinese MMR has decreased by 53.2% from 64.7 in 1996 to 30.0 per 100 000 live births in 2010. MMR was higher in rural areas (30.1/100 000) than in urban areas (29.7/100 000), and highest in the west region (46.1/100 000) followed by the middle region (29.1/100 000) and the east region (17.8/100 000) in 2010. MMR in east, middle and west regions have decreased by 37.76%, 57.02% and 66.27% respectively from 1996 to 2010. The disparities between different regions were decreasing. From 2006 to 2010, MMR in rural areas has dropped to 1.82 times of the city, and that in the west was 3 times of the east. Obstetric hemorrhage was still the leading cause of maternal death, responsible for 47.9% maternal deaths in 1996 and 27.8% in 2010. The risk of death due to obstetric hemorrhage was decreasing., Conclusion: The MMR in China showed the decreasing trends. Although the regional disparities were still remarkable, they demonstrated narrowing trends. Interventions on maternal death should be focused in rural areas and west regions.

Objective: To investigate the incidence and its secular trends of gastroschisis in Chinese perinatal infants., Methods: Data on perinatal infants was collected at hospitals under surveillance program in Chinese Birth Defects Monitoring Network from 1996 to 2007. Data on incidence, trend and related factors of gastroschisis in perinatal infants were carried out. Both χ(2) test and Poisson regression model were used to test the differences between residential areas, sex and maternal age. Both χ(2) trends test and Poisson regression model were applied to analyze the trends., Results: A total of 6 308 594 perinatal infants were monitored during 1996 - 2007, including 1601 infants with gastroschisis to show the incidence as 2.54 per 10 000 births. The overall prevalence of gastroschisis in China did not change remarkably during the period of our research. The incidence rates of gastroschisis were significantly different between urban and rural areas, between different sex and different maternal age groups. The incidence of gastroschisis was lower in urban area than in rural area (RR = 0.58) and lower in female fetuses than in male fetuses (RR = 0.76), highest in the group younger than 20 years of age, which was 11.43 times than incidence of the 30 - 34 age group (RR = 11.432)., Conclusion: The overall prevalence of gastroschisis in China did not show remarkable change during 1996 - 2007 but the incidence of gastroschisis a bit increased in the area of study and significant differences were seen in different sex, regions and maternal age groups. Mothers aged younger than 20 years old appeared to be a significant risk factor for the occurrence of gastroschisis.

Objective: To understand the trends of diarrhea mortality rate, pre-death diagnosis and treatment of children under-5 in China, from 1996 to 2006., Methods: We used data obtained from the 1996 to 2006 national child mortality surveillance network, including 116 counties (cities) throughout China, to evaluate the under 5 mortality rate (U5MR) due to diarrhea in different geographical areas, and related factors of under 5 children mortality due to diarrhea., Results: Data from the national U5MR due to diarrhea fell from 249.8 in 1996 to 75.6 per 100 000 live births, in 2006. The U5MR due to diarrhea in urban reduces from 11.6 in 1996 to 6.1 per 100 000 live births in 2006, with a reduction of 47.4%. The U5MR due to diarrhea in rural decreased from 304.7 in 1996 to 94.3 per 100 000 live births in 2006, with a reduction of 69.1%. The U5MR due to diarrhea in coastal, inland and remote areas fell from 48.9, 178.9 and 566.9 in 1996 to 6.2, 30.4 and 199.2 per 100 000 live births in 2006, with a reduction of 87.3%, 83.0% and 64.9%, respectively. Among the rural children died of diarrhea, about 37.9% were diagnosed in a village clinic, 15.1% never received any diagnostic procedure. Nearly 20% of the patients had not been treated, with 50% - 60% of them had only been treated in an outpatient department., Conclusion: During 1996 - 2006, the U5MR due to diarrhea showed a substantially downward trend in China but the disparities between urban and rural, remote and coastal, areas were increasing.

Objective: To study the epidemiological and clinical features of congenital split hand/split foot malformation (SHFM) in Chinese population., Methods: Data used in this study were provided by the Chinese Birth Defects Monitoring Network. The SHFM cases were categorized into two groups: isolated (SHFM only and SHFM with other limb defects) and syndromic (SHFM with non-limb defects). Prevalence rates were calculated by residential area (urban versus rural) and by gender. Further analyses were conducted to identify the characteristics of SHFM with related to gestational age, birth weight, perinatal outcome and affected limbs., Results: A total of 736 newborn babies were identified with SHFM among 4,489,692 births, with a prevalence of 1.64/10,000. The prevalence of isolated SHFM and syndromic SHFM were 0.64 and 1.00 per 10,000 births, respectively. The prevalence of SHFM in male and female babies were 1.79 and 1.25 per 10,000 births, respectively. The prevalence of SHFM in urban and rural areas were 1.51 and 1.86 per 10,000 births, respectively. Preterm birth and low birth weight accounted for 30.20% and 43.93% of the SHFM cases, respectively. The perinatal mortality for the SHFM, isolated SHFM, and syndromic SHFM were 50.27%, 24.74%, and 66.59%, respectively. SHFM occurred more often in upper limbs., Conclusion: The prevalence of SHFM in Chinese population is greater than foreign populations. The high perinatal mortality rate of SHFM is associated with the severity of accompanied malformations.

Objective: To identify the trend and pattern of mortality from congenital malformations in children under 5 years old in China., Methods: Data from 1996 to 2006 were obtained from the national child mortality surveillance network, which included 116 counties (cities) throughout China. A descriptive analysis was performed on birth defect-specific mortality (U5MR) in children under 5 years old., Results: The national birth defect-specific U5MR decreased from 412.0 per 100,000 live births in 1996 to 342.2 per 100,000 live births in 2006. The declining trend in birth defect-specific U5MR was more obvious from 2003 to 2006. The same pattern was observed in urban areas, in coastal regions and in inner land regions of China. Rural areas had higher birth defect-specific U5MR than urban areas. Remote regions had higher birth defect-specific U5MR than coastal regions and inner land regions. The proportion of mortality due to congenital malformations in total U5MR increased from 9.2% in 1996 to 14.4% in 2006., Conclusion: The proportion of mortality due to congenital malformations in children under 5 years old is increasing in China.

Objective: To investigate the secular trend of advanced maternal age woman (>or= 35 year-old) in our country., Methods: Data on maternal woman at different age were collected at surveillance hospital in Chinese Birth Defects Monitoring Network from 1996 to 2007 and retrospective analysis of the trend of advanced maternal women were carried out. Trend analysis of the advanced maternal age in urban and rural areas of west, middle and east areas was also conducted. Chi-square test was applied to test the differences and the fitting model analysis was also applied., Results: A total of 6,308,594 parturient woman were monitored, included 354,511 woman (5.62%) of advanced maternal age. In 1996 and 2007, the proportion of the advanced maternal woman were 2.96% (12,508/422,486) and 8.56% (66,351/775,333), respectively. It showed an increasing trend for the national woman proportion of advanced maternal age from 1996 to 2007 (chi(2) = 45 376.16, P < 0.01). In city, the proportion of advanced maternal age woman were 2.95% (8755/296,975) and 7.69% (40,197/522,596) in 1996 and 2007, respectively. In rural region, the proportion of advanced maternal age woman were 2.99% (3753/125,511) and 10.35% (26,154/252,737) in 1996 and 2007, respectively. It showed increasing both in city and rural areas (chi(2)(city) = 24,152.86, P < 0.01; chi(2)(rural) = 20,809.79, P < 0.01). And the proportions in urban area and rural area were 5.13% (221,655/4,317,533) and 6.67% (132,856/1,991,061), the proportions difference was significant in statistics (chi(2) = 1536.260, P < 0.01). An Exponential model was established, ln(Y) = ln(2.52) + (0.103 x t). In east areas, the proportion were 3.90%and 8.81% in 1996 and 2007, respectively, in middle areas the respective proportions were 2.49% and 8.56%, in west areas were 2.11% and 8.21%. They all showed increasing trend in proportion of advanced maternal age from 1996 to 2007 year in east areas, middle areas and west areas (chi(2)(east) = 11,746.87, P < 0.01; chi(2)(middle) = 17,350.21, P < 0.01; chi(2)(west) = 16,432.68, P < 0.01). But the proportions of city and rural were different in those areas., Conclusion: The proportion of advanced maternal woman had secular increasing trend and the rates were lower in city than in rural areas.

Aim: To investigate the spatial distribution patterns of anorectal atresia/stenosis in China., Methods: Data were collected from the Chinese Birth Defects Monitoring Network (CBDMN), a hospital-based congenital malformations registry system. All fetuses more than 28 wk of gestation and neonates up to 7 d of age in hospitals within the monitoring sites of the CBDMN were monitored from 2001 to 2005. Two-dimensional graph-theoretical clustering was used to divide monitoring sites of the CBDMN into different clusters according to the average incidences of anorectal atresia/stenosis in the different monitoring sites., Results: The overall average incidence of anorectal atresia/stenosis in China was 3.17 per 10,000 from 2001 to 2005. The areas with the highest average incidences of anorectal atresia/stenosis were almost always focused in Eastern China. The monitoring sites were grouped into 6 clusters of areas. Cluster 1 comprised the monitoring sites in Heilongjiang Province, Jilin Province, and Liaoning Province; Cluster 2 was composed of those in Fujian Province, Guangdong Province, Hainan Province, Guangxi Zhuang Autonomous Region, south Hunan Province, and south Jiangxi Province; Cluster 3 consisted of those in Beijing Municipal City, Tianjin Municipal City, Hebei Province, Shandong Province, north Jiangsu Province, and north Anhui Province; Cluster 4 was made up of those in Zhejiang Province, Shanghai Municipal City, south Anhui Province, south Jiangsu Province, north Hunan Province, north Jiangxi Province, Hubei Province, Henan Province, Shanxi Province and Inner Mongolia Autonomous Region; Cluster 5 consisted of those in Ningxia Hui Autonomous Region, Gansu Province and Qinghai Province; and Cluster 6 included those in Shaanxi Province, Sichuan Province, Chongqing Municipal City, Yunnan Province, Guizhou Province, Xinjiang Uygur Autonomous Province and Tibet Autonomous Region., Conclusion: The findings in this research allow the display of the spatial distribution patterns of anorectal atresia/stenosis in China. These will have important guiding significance for further analysis of relevant environmental factors regarding anorectal atresia/stenosis and for achieving regional monitoring for anorectal atresia/stenosis.

Objective: To study the changing pattern of infant mortality and under-5 mortality rate in China from 2000 to 2006, and to evaluate China's progress in achieving the United Nations' Millennium Development Goal 4., Methods: A population-based survey was conducted through a nationwide multi-level surveillance network. The mortality rate and the proportion of death for children under 5 were analyzed., Results: The infant mortality rate (IMR), under-5 mortality rate (U5MR) in China dropped to 17.2, 20.6 per 1000 live births in 2006, respectively, comparing to 32.2 and 39.7 per 1000 live births in 2000. In urban areas, IMR, U5MR dropped to 8.0, 9.6 per 1000 live births in 2006, respectively while they were 11.8 and 13.8 per 1000 live births respectively in 2000. In rural areas, IMR, U5MR dropped to 19.7 and 23.6 per 1000 live births in 2006, respectively but they were 37.0 and 45.7 per 1000 live births respectively in 2000. During this period, the mortality rates due to pneumonia and diarrhea had dropped sharply. The proportion of deaths due to pneumonia, diarrhea also dropped from 19.5%, 4.9% in 2000 to 15.6%, 3.7% in 2006, respectively. In urban areas, the proportion of deaths due to pneumonia dropped from 9.9% in 2000 to 9.8% in 2006, In rural areas, the proportion of deaths due to pneumonia, diarrhea dropped from 20.1%, 5.2% in 2000 to 16.2%, 4.0% in 2006, respectively., Conclusion: The U5MR in China remarkably dropped from 2000 to 2006. Based on data through the surveillance program, China should be able to accomplish the Millennium Development Goals 4 of the United Nations as planned.

Objective: To analyzes the characteristics, the trend and the leading causes of maternal deaths in China between 2000 and 2005., Methods: Data under analysis were those from a population-based epidemiological survey conducted by the national maternal mortality surveillance network which covered a total population of about 80 000 000 in China., Results: Maternal mortality ratio (MMR) was both higher in the countryside than that in the city and in the remote area than that in the inland and in the coastal region. From 2000 to 2005, the overall MMR in China dropped from 53.0/100 000 livebirths to 47.6/100 000 livebirths, from 67.2/100 000 livebirths to 59.2/100 000 livebirths in rural area, from 28.8/100 000 livebirths to 27.6/100 000 livebirths in urban area. The descending ranges of maternal mortality were 10.2%, 11.9%, 4.2%, respectively. The top three leading causes of maternal deaths in China were obstetric hemorrhage, pregnancy induced hypertension and amniotic fluid embolism in 2000, but minor changes in the ranking of top three leading causes: hemorrhage, cardiac disorders and pregnancy induced hypertension in 2005. The main causes led to hemorrhage were retention of placenta, uterine inertia and rupture of uterine., Conclusion: MMR in China appeared a trend less change during 2000- 2005. The number one cause of maternal deaths was obstetric hemorrhage. Reducing MMR in rural area and improving the skill of treating obstetric hemorrhage were essential to achieve the goal of reducing maternal death in the Outline of Chinese Women's Development (2000-2010).

Objective: To investigate the geographic distribution pattern of patients with anorectal atresia/stenosis in China, in order to provide clue for research on its etiology., Methods: Data were collected from Chinese Birth Defects Monitoring Network (CBDMN), which was a hospital-based congenital malformations registry system. From 2001 to 2005, all fetuses with more than 28 weeks of gestation and neonates up to 7 days of age, were monitored. Two-dimensional graphic cluster method was used to divide monitoring stations into different classes with the incidence rates of anorectal atresia/stenosis., Results: The overall incidence of anorectal atresia/stenosis was 3.17 per 10,000 during 2001 to 2005. The incidence was higher in Eastern than that in Mid or Western parts of China and the difference was statistically significant (z = 2.50, 3.69; P = 0.012, < 0.001). The monitoring stations were grouped into 6 classes. Class I was with Heilongjiang, Jilin and Liaoling; Class II was with Fujian, Guangdong, Hainan, Guangxi, and South Hunan and Jiangxi; Class III was with Beijing, Tianjin, Hebei, Shandong, and North Jiangsu and Anhui; Class IV was with Zhejiang, Shanghai, South Anhui and Jiangsu, North Hunan and Jiangxi, Hubei, Henan, Shanxi and Inner Mongolia, Class V was with Ningxia, Gansu and Qinghai; and Class VI was with Shaanxi, Sichuan, Chongqing, Yunnan, Guizhou, Xinjiang and Tibet., Conclusion: Our findings discovered the geographic distribution patterns of patients with anorectal atresia/stenosis in China. It is important to further analyze the relevant environmental factors attached to it so a better regional monitoring system for anorectal atresia/stenosis can be operated.

Objective: To investigate the factors related to maternal mortality rate in 1000 counties of projects on reducing maternal mortality rate (MMR) and eliminating tetanus neonates in China, 2003., Methods: Study on the association was performed using data on average income per capita, hospital delivery rate and MMR., Results: Data showed that income per capita and hospital delivery rate had strong association with MMR. MMR for women with income less than 1000 Chinese Yuan per capita was 100.9 per 100 000 live births, and with income over 2000 Yuan per capita was 61.8 per 100 000 live births. MMR was 107.2 per 100 000 live births for women with hospital delivery rate less than 50%, and 54.1 per 100 000 live births with hospital delivery rate over 75%. The hospital delivery rate was less than 50% in the counties with income less than 1000 Yuan per capita, and over 75% with income over 2000 Yuan per capita. Only 19.1% of the counties with income less than 1000 Yuan per capita and 66.7% over 2000 Yuan per capita reached 75% hospital delivery rate., Conclusion: MMR and hospital delivery rate were affected by economic level of individuals. MMR seemed inversely proportional to income per capita and hospital delivery rate. The hospital delivery rate in 1000 counties was closely associated with income per capita. MMR could be reduced by enhancing hospital delivery rate.

Objective: To understand the trend of incidence of conjoined twins and its epidemiological characteristics in China during 1996 to 2004., Methods: A descriptive epidemiology of conjoined twinning in China from 1996 to 2004 was investigated by using data from National Center for Birth Defects Monitoring Program (NCBDMP). Data were collected from more than 400 hospital-based units involved in the program. The monitored subjects were the hospitalized births from 28 weeks gestation to a period within 7 days after delivery., Results: 122 conjoined twins were found in 4,282,536 births with an incidence rate of 0. 28 per 10,000. Incidence of conjoined twins was 0.20 per 10,000 and 0.47 per 10,000 in the rural and urban areas, respectively, and the statistical significant difference (P < 0.05) was observed., Incidence of conjoined twins was for 0.17 per 10,000 and 0.36 per 10,000 in boys and girls, respectively. Conjoined twins were more common among females than males, the live-born rate was 41.32%, and the perinatal mortality was 82.6%. 53.7% conjoined twins can be diagnosed prenatally., Conclusion: The results indicate that the incidence of conjoined twins in China is higher than that in Western countries. It is necessary to improve the prenatal diagnostic techniques and management.

Objective: To investigate the epidemiological attributes of maternal mortality in China from 1996 to 2000 and its variance between urban and rural areas., Methods: The data were collected through a population-based epidemiological survey by the national maternal mortality surveillance network, which covered about 80 million people in 31 jurisdictions in China., Results: There were 1704 maternal deaths being reported from 1996 to 2000 by the surveillance network, among which 341 were in urban areas and 1363 in rural areas. In the urban reported deaths, 69.9% happened in those who had completed junior high schools and 74.5% happened in plain areas. In the rural reported deaths, 73.3% happened in those who had only completed primary schools and 65.1% happened in mountain areas. Of the total reported deaths, 76.8% deaths occurred in postpartum, 40% gave birth at home, and 28.9% received no prenatal care at all. By contrast, in the rural areas, homed deliveries were accounted for 58.5% of the reported death; 35.5% died at home; 33.1% were attended by untrained midwives 31.8% had no prenatal care., Conclusion: Poor education, geographic remoteness, insufficient prenatal care, and lower hospitalization rate are main factors contributing to maternal mortality in China.

Objective: To study the epidemiological characteristics of congenital hydrocephalus in Chinese perinatal., Methods: From 1996 to 2004, data gained from Chinese Birth Defects Monitoring Network were used to depict the epidemiology of congenital hydrocephalus in China. All perinatal born in hospitals had an access within 7 days after delivery. The affected cases were divided into two groups-isolated and syndromic hydrocephalus. And prevalence rates were calculated by year, by sex, by birth area (urban versus rural), by maternal age group and by geographic area (north versus south). Of the affected, fetal age at birth, birth weight, perinatal outcome and prenatal diagnosis were analysed., Results: All 3012 perinatal with congenital hydrocephalus were identified among 4,282,536 births, then an overall prevalence rate was 7.03/10,000, rates of isolated and syndromic hydrocephalus were 5.67/10,000 and 1.36/10,000 respectively. Furthermore, the annual prevalence rates of hydrocephalus presented an increasing trend during that period. The rates in male and female births, in urban and rural area, were 7.09/10,000 and 6.76/10,000, 5.49/10,000 and 10.10/10,000 respectively. There were significant differences among maternal-age-specific prevalence rates, the highest (11.42/10,000) was in an age < 20 years group. For total and isolated hydrocephalus, higher rates were found in north part of China. On the contrary, a higher rate of syndromic hydrocephalus was observed in south part of China. Among the infants with hydrocephalus, the ratio of preterm delivery and of low birth weight were 57.97% and 50.92% respectively. The ratio of congenital hydrocephalus diagnosed antenatally, which could be an indicator representing the capability of detecting the malformation both prenatally and postnatally, showed an upward trend similar to the prevalence rates. The perinatal fatality rates of the total, isolated and syndromic hydrocephalus were 87.75%, 88.66% and 83.91% correspondingly., Conclusion: Based on comparison between prevalence rates in China and those reported in foreign countries, our country might be listed into a higher epidemic region of the congenital hydrocephalus. Significant differences were identified between rural and urban areas, between north and south parts of China. The improvement ability in prenatal and postnatal diagnosis should be partly accounted for the increasing prevalence rates of hydrocephalus in Chinese perinatal. The poor birth quality of the affected predicts poor prognosis.

Objective: To study the epidemiological characteristics of gastroschisis in China from 1996 to 2000., Methods: The birth defects monitoring program was undertaken in 450-466 hospitals from 31 provinces, cities and autonomous regions of China. Data about births including intrauterine death and stillbirth of 28 weeks of gestation was collected to report through the medical records over the time period 1996 to 2000. The maximal diagnosis time was up to 1 week after the delivery. The international Classification of Diseases of Ninth Revision with some modifications was used to code the birth defects., Results: A total of 569 cases with gastroschisis was found in 2,218,616 births monitored. The overall birth incidence of gastroschisis was 2.56 per 10,000 births during the monitored period. The increasing trend of incidence of gastroschisis hadn't been found (P > 0.05). The birth incidence of gastroschisis in rural areas was significant higher than that in urban areas (3.93 vs.1.98 per 10,000, P < 0.01). There was also significantly difference on birth incidence between female and male (2.64 vs. 2.15 per 10,000 births, P < 0.05). The birth incidence of gastroschisis in the mothers less than 20 years old was the highest among all mothers age, which were at 5.4 times increased risk relative to that of mother age of 25-29 years old. The overall perinatal mortality rate of gastroschisis was 74.69 percent, and 41.46 percent of gastroschisis were diagnosed before birth. 27.44 percent of cases were accompanied with other major defects., Conclusions: There was no increasing trend on the incidence of gastroschisis to be found in China during 1996 to 2000. The mother age less than 20 years old was at an increasing risk of fetal gastroschisis. The cases with gastroschisis had a high perinatal mortality rate.

Objective: To study the trend of under 5 years old children mortality and the leading cause of the deaths in China from 1996 to 2000., Methods: The data presented in this report were obtained from the national child mortality surveillance network, including 116 counties (cities) throughout China. The target population was all children under 5 years old in the monitored areas whose mothers or fathers had resided in the area for at least one year. The data were collected and reported by health workers at the three-level network., Results: The neonatal mortality rate (NMR), infant mortality rate (IMR) and under 5 years old mortality rate (U(5)MR) in China dropped to 22.8, 32.2, 39.7 per 1,000 live births in 2000, respectively (they were 24.0, 36.0, 45.0 respectively in 1996), which declined 5.0%, 10.6%, 11.8% from 1996 to 2000, respectively. In urban areas, NMR, IMR and U(5)MR dropped to 9.5, 11.8, 13.8 per 1,000 live births in 2000, respectively (they were 12.2, 14.8, 16.9 respectively in 1996), which declined 22.1%, 20.3%, 18.3% from 1996 to 2000, respectively. In rural areas, NMR, IMR and U(5)MR dropped to 25.8, 37.0, 45.7 per 1,000 live births in 2000, respectively (they were 26.7, 40.9, 51.4 respectively in 1996), which declined 3.4%, 9.5%, 11.1% from 1996 to 2000, respectively. There was a steady decline in the U(5)MR due to diarrhea, pneumonia, neural tube defects and drowning in China., Conclusion: In urban/rural areas, the overall decline in NMR, IMR and U(5)MR from 1996 to 2000 was spectacular. Especially the U(5)MR due to avoidable deaths such as pneumonia and diarrhea was dropped markedly in rural areas.

Objective: To investigate the secular trends in the prevalence rate of hypospadias in Chinese perinatals and explore its possible influencing factors., Methods: Data were taken from Chinese Birth Defects Monitoring Network, a hospital-based congenital anomalies registry system. All live or still births at or beyond 28 weeks of gestation were assessed within 7 days after delivery in the period from 1987 to 2001., Results: 1999 cases of hypospadias were identified among 3,769,464 male births, the crude prevalence rate being 5.30 per 10,000 births. And an increasing secular trend was observed both in urban and rural areas. In recent years, an increase in rate of hypospadias was found in coastal provinces and inland provinces, but not in remote border provinces. Faster increase was seen in urban areas and coastal areas, compared with that in rural areas and inland areas respectively., Conclusion: The prevalence rates of hypospadias in Chinese perinatals from 1987 to 2001 showed an upward tendency.