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The resonant compaction method using a crisscross-shaped probe was implemented in highway engineering projects for eliminating liquefaction in the east coastal region of China. To evaluate the compaction effectiveness in the treatment of liquefiable sand deposits with clay lenses, seismic piezocone tests (SCPTUs) and standard penetration tests (SPTs) were performed, as well as excess pore water pressure measurements. The results showed that the cone stress, sleeve friction, shear wave velocity and SPT blows increased due to vibratory compaction, and the soil liquefiable potential was eliminated. The execution of projects was highly efficient due to the simple compaction procedure and the quick dissipation of excess pore water pressure. However, the existence of a clay lens reduced the compaction effectiveness, particularly the development of SPT blows. Nevertheless, the resonant compaction method was still applicable for the treatment of soils with low to mild liquefaction levels and provided an alternative soil liquefaction countermeasure with remarkable benefits in efficiency and convenience. [ABSTRACT FROM AUTHOR]

Objective: To examine the longitudinal associations of fetal growth with adverse child growth outcomes and to assess whether maternal metabolic factors modify the associations. Design: Prospective cohort study. Setting: Born in Guangzhou Cohort Study, China. Population: A total of 4818 mother–child pairs. Methods: Fetal growth was assessed according to estimated fetal weight (EFW) from 22 weeks of gestation until birth and the measurement of the birthweight. Fetal growth Z‐scores were computed from random effects in the multilevel linear spline models to represent fetal size in early pregnancy (22 weeks of gestation) and growth in mid‐pregnancy (22–27 weeks of gestation), early third trimester (28–36 weeks of gestation) and late third trimester (≥37 weeks of gestation). Main outcome measures: Z‐scores for childhood stunting, low weight, overweight or obesity, length/height for age (LAZ/HAZ), weight for age (WAZ) and body mass index for age (BMIZ) at the age of 3 years. Adjusted associations were examined using multiple Poisson or linear regression models. Results: Increased Z‐scores of fetal size in early pregnancy and growth in mid‐pregnancy and early third trimester were associated with a higher risk of childhood overweight or obesity (risk ratios 1.25–1.45). Fetal growth in each period was negatively associated with stunting and low weight, with the strongest associations observed for fetal size in early pregnancy and growth in mid‐pregnancy. The results for continuous outcomes (LAZ/HAZ, WAZ and BMIZ) were similar. The associations of fetal growth with overweight or obesity in childhood were stronger among mothers who were underweight and who were overweight or obese than among mothers of normal weight. Conclusions: Accelerated fetal growth before 37 weeks of gestation is associated with children who are overweight or obese, whereas the critical period for stunting and low weight occurs before 28 weeks of gestation. Fetal growth during different periods is differentially associated with childhood stunting, underweight and overweight or obesity. Fetal growth during different periods is differentially associated with childhood stunting, underweight and overweight or obesity. [ABSTRACT FROM AUTHOR]

Objective: To estimate a stillbirth rate at 24 or more gestational weeks in 2015–2016 and to explore potentially preventable causes in China. Design: A multi‐centre cross‐sectional study. Setting: Ninety‐six hospitals distributed in 24 (of 34) provinces in China. Population: A total of 75 132 births at 24 completed weeks of gestation or more. Methods: COX Proportional Hazard Models were performed to examine risk factors for antepartum and intrapartum stillbirths. Population attributable risk percentage was calculated for major risk factors. Correspondence analysis was used to explore region‐specific risk factors for stillbirths. Main outcome measures: Stillbirth rate and risk factors for stillbirth. Results: A total of 75 132 births including 949 stillbirths were used for the final analysis, giving a weighted stillbirth rate of 13.2 per 1000 births (95% CI 7.9–18.5). Small for gestational age (SGA) and pre‐eclampsia/eclampsia increased antepartum stillbirths by 26.2% and 11.7%, respectively. Fetal anomalies increased antepartum and intrapartum stillbirths by 17.9% and 7.4%, respectively. Overall, 31.4% of all stillbirths were potentially preventable. Advanced maternal age, pre‐pregnant obesity, chronic hypertension and diabetes mellitus were important risk factors in East China; low education and SGA were major risk factors in Northwest, Southwest, Northeast and South China; and pre‐eclampsia/eclampsia and intrapartum complications were significant risk factors in Central China. Conclusions: The prevalence of stillbirth was 13.2 per 1000 births in China in 2015–2016. Nearly one‐third of all stillbirths may be preventable. Strategies based on regional characteristics should be considered to reduce further the burden of stillbirths in China. The stillbirth rate was 13.2 per 1000 births in China in 2015–2016 and nearly one‐third of all stillbirths may be preventable. The stillbirth rate was 13.2 per 1000 births in China in 2015–2016 and nearly one‐third of all stillbirths may be preventable. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to test community-based nursing education about breast self-examination to see whether self-examination frequency could be increased. Background: Breast cancer rates in China are rising rapidly, especially in cities. The majority of Chinese women does not know about breast self-examination, and the Chinese health care system cannot provide mammograms for the millions of at-risk women throughout China. Method: This study was a randomized clinical trial of nurse-provided, community-based teaching of breast self-examination in the urban and rural areas of Tianjin and urban and suburban areas of Shanghai. Women ( n = 1510) never diagnosed with breast cancer and 40 years and older were randomized by community and stratified by urban vs. other residences. Results: At baseline, 9% of the intervention and 6% of the control groups did breast self-examination at least every other month. After 12 months, 34% of the intervention, but only 11% of the control, group did breast self-examination that often ( P < 0.001). There was a significant impact in urban, suburban and rural areas, and intervention effects were stronger than any of the other influences tested. Conclusion: The clinical trial showed a statistically significant increase in breast self-examination after the nursing education intervention. As no other breast cancer screening method is available in most of China, this method is best suited for the masses of people currently at risk in China. [ABSTRACT FROM AUTHOR]

Peptic ulcer disease is mainly caused by Helicobacter pylori infection and the use of non-steroidal anti-inflammatory drugs. To investigate the trends in the prevalence of peptic ulcer disease, H. pylori infection and non-steroidal anti-inflammatory drug use in uninvestigated dyspeptic patients over recent years in Hong Kong. Data from consecutive patients with uninvestigated dyspeptic symptoms referred by family physicians for open access upper endoscopy during 1997 and 2003 were analysed in relation to peptic ulcer disease, H. pylori infection and non-steroidal anti-inflammatory drug use. Among 2700 patients included, 405 (15%) had peptic ulcer disease and 14 (0.5%) had gastric cancer. There was a reduced trend from 1997 to 2003 in the prevalence of peptic ulcer disease (17, 20, 14, 16, 13, 14 and 14%, respectively, χ2 = 5.80, P = 0.016) (mainly because of decrease in duodenal ulcers), H. pylori infection (44, 50, 49, 44, 40, 40, 36 and 43%, respectively, χ2 = 13.55, P < 0.001) and non-steroidal anti-inflammatory drug use (13, 5, 5, 6, 3, 4, 4 and 5% respectively, χ2 = 13.61, P < 0.001). The prevalence of peptic ulcer disease, H. pylori infection and non-steroidal anti-inflammatory drug use between 2001 and 2003 were significantly lower than that between 1997 and 2000 (17% vs. 13%, OR = 0.78, 95% CI: 0.63–0.96, P = 0.020 for peptic ulcer disease; 47% vs. 39%, OR =0.72, 95% CI: 0.60–0.86, P < 0.001 for H. pylori infection; and 6% vs. 4%, OR = 0.56, 95% CI: 0.39–0.82, P = 0.002 for non-steroidal anti-inflammatory drug use). H. pylori infection was associated with both duodenal ulcer (OR = 15.87, 95% CI: 10.60–23.76, P < 0.001) and gastric ulcer (OR = 3.12, 95% CI: 2.15–4.53, P < 0.001) whereas non-steroidal anti-inflammatory drug use was only associated with gastric ulcer (OR = 2.97, 95% CI: 1.70–5.20, P < 0.001). The prevalence of peptic ulcer disease, mainly duodenal ulcers, was reduced in association with a decreasing trend in the prevalence of H. pylori infection and non-steroidal anti-inflammatory drug use from 1997 to 2003. [ABSTRACT FROM AUTHOR]

: The performance of commercialHelicobacter pyloridiagnostic kits developed for particular geographic regions has often been found to be of poor diagnostic value when applied to other regions, possibly because of infections being caused by differentH. pyloristrains in different regions.: To evaluate the performance of an IgG2 anti-H. pylorienzyme-linked immunoassay test (Helirad Alert) for detection ofH. pyloriinfection in both Australian and Hong Kong (Chinese) subjects.: Serum samples were tested forH. pylorispecific IgG2 and IgG antibodies by enzyme-linked immunoassay kits using identical antigen preparation in 168 Australian and 160 Hong Kong (Chinese) subjects diagnosed with dyspepsia.: Using a cut-off value determined by analysis ofH. pylori-negative Australian samples, the sensitivity, specificity and accuracy of the IgG2 assay were 77.8, 97.4 and 91.1%, respectively, for the Australian samples and 96.3, 83.8 and 90% for Hong Kong samples. For the IgG assay, sensitivity, specificity and accuracy were 87.0, 99.1 and 95.2% for Australian samples and 97.5, 75 and 86.3% for Hong Kong samples respectively. Receiver-operating characteristic analysis showed better discrimination ofH. pyloristatus when the IgG2 assay was applied to Hong Kong samples, while the IgG assay was better in the Australian samples.: These data demonstrate that the Helirad Alert enzyme-linked immunoassay could provide a reliable method for screeningH. pyloriinfection in both western and Chinese populations. [ABSTRACT FROM AUTHOR]

: The natural history of gastro-oesophageal reflux disease in Asian population has not been studied before.: To study the onset and disappearances of reflux symptoms over a 1-year period in the Chinese population.: A population-based telephone survey was performed in 2002 and repeated 1 year later. The change in prevalence rate, onset and disappearance of gastro-oesophageal reflux disease, and the change in diagnoses were assessed. Factors associated with the onset and disappearance of gastro-oesophageal reflux disease were studied.: A total of 712 subjects completed the first and second survey. The annual, monthly and weekly prevalence of gastro-oesophageal reflux disease were 34.1%, 10.1% and 2.7% respectively. The onset rate (per 1000 person-year) and disappearance rate of any gastro-oesophageal reflux disease and frequent gastro-oesophageal reflux disease (≥ monthly symptoms) were 209, 40; and 395, 243 respectively. Forty-four percentage of gastro-oesophageal reflux disease subjects changed their diagnoses in 2003. By multiple logistic regression analysis, high anxiety score (OR: 1.2, 95% CI: 1.1–1.2) and higher educational level (OR: 2.7, 95% CI: 1.3–6.3) were associated with the onset of gastro-oesophageal reflux disease; while the frequency of acid regurgitation (OR: 0.35, 95% CI: 0.17–0.70) and use of antisecretory therapy (OR: 0.50, 95% CI: 0.28–0.89) were associated with the disappearance of gastro-oesophageal reflux disease.: The prevalence of gastro-oesophageal reflux disease is stable over 1 year. Higher anxiety score and higher educational level were associated with the onset of gastro-oesophageal reflux disease, while lower frequency of reflux symptoms and infrequent use of antisecretory therapy were associated with the disappearance of gastro-oesophageal reflux disease in a Chinese population. [ABSTRACT FROM AUTHOR]

: Previous studies have suggested that the acid secretory capacity of the Chinese population is lower than that of the Western population. : To compare the effect of lansoprazole 30 mg and 15 mg once daily on the 24-h oesophageal and intragastric pH profiles in Chinese patients with gastro-oesophageal reflux disease. : Forty-four patients (male to female ratio, 27 : 17; mean age, 53 years; 55% with oesophagitis) with gastro-oesophageal reflux disease were randomized to receive lansoprazole 30 mg or 15 mg once daily for 4 weeks. Measurement of the 24-h oesophageal and intragastric pH, gastro-oesophageal reflux disease symptoms and quality of life was performed at baseline and during the last week of each dosing period. : Lansoprazole 30 mg maintained an intragastric pH > 4 for 10.5 h vs. 9.6 h for lansoprazole 15 mg ( P = 0.44). The percentage total time at oesophageal pH < 4 was similar for lansoprazole 30 mg and 15 mg (2.0% vs. 2.3%, P = 0.30). The proportion of patients with complete cure of heartburn and acid regurgitation and the quality of life assessment were similar for lansoprazole 30 mg and 15 mg. Both dosages of lansoprazole were well tolerated and the compliance was 100% in both groups. : Lansoprazole dosages of 30 mg and 15 mg once daily provide a satisfactory decrease for oesophageal acid exposure and are equally effective for the treatment of gastro-oesophageal reflux disease in the Chinese population. [ABSTRACT FROM AUTHOR]

Summary Background : Population-based data on gastro-oesophageal reflux disease in Chinese are lacking. The prevalence, clinical spectrum and health care-seeking behaviour of subjects with gastro-oesophageal reflux disease were studied. Methods : Ethnic Chinese (3605) were invited to participate in a telephone survey using a validated gastro-oesophageal reflux disease questionnaire and the Hospital Anxiety and Depression Scale. Results : A total of 2209 subjects (58% female; mean age, 40.3 years) completed the interview. The annual, monthly and weekly prevalence rates of gastro-oesophageal reflux disease were 29.8%, 8.9% and 2.5%, respectively. Gastro-oesophageal reflux disease symptoms were associated with non-cardiac chest pain [odds ratio (OR), 2.3; 95% confidence interval (95% CI), 1.7–3.1], dyspepsia (OR, 1.9; 95% CI, 1.4–2.5), globus (OR, 1.8; 95% CI, 1.2–2.7), acid feeling in the stomach (OR, 5.8; 95% CI, 4.5–7.5) and the use of non-steroidal anti-inflammatory drugs (OR, 2.3; 95% CI, 1.5–3.6), but not with dysphagia, bronchitis, asthma, hoarseness and pneumonia. Patients with gastro-oesophageal reflux disease had a significantly higher anxiety and depression score and required more days off work when compared with subjects without. The frequency of heartburn (P = 0.032), female gender (P < 0.001), degree of depression (P = 0.004) and social morbidity (P < 0.001) were independent factors associated with health care-seeking behaviour. Conclusion : The prevalence of gastro-oesophageal reflux disease was lower than that in Western populations, but carried a significant socio-economic burden in the studied Chinese population. The frequency of heartburn, female gender and psychosocial factors were associated with health care utilization in gastro-oesophageal reflux disease. [ABSTRACT FROM AUTHOR]

Summary Background and aims: To develop a validated gastro-oesophageal disease (GERD) symptom questionnaire for the Chinese population. Methods: One hundred Chinese patients with GERD and 101 healthy Chinese controls were presented with a 20-item GERD questionnaire in the Chinese language (Chinese GERDQ). Quality of life in GERD patients was assessed by SF-36. A standard dose of proton pump inhibitors for 4 weeks was prescribed to 35 patients with newly diagnosed GERD. The Chinese GERDQ was performed before, 4 weeks and 8 weeks after treatment. Concept, content, construct, discriminant validity and reliability of the questionnaire were assessed. Results: Seven items were selected by logistic regression to account for most of the differences between controls and GERD patients with a good reproducibility and internal consistency. A cut-off score of equal or greater than 12 was determined to discriminate between controls and GERD patients with a sensitivity of 82% and a specificity of 84%. The Chinese GERDQ correlated negatively with five domains of the SF-36 and discriminated between GERD patients who reported symptomatic improvement during proton pump inhibitor treatment and symptoms deterioration upon withdrawal of proton pump inhibitor treatment. Conclusions: The Chinese GERDQ could be used in epidemiological studies to assess the frequency and severity of GERD in patient populations and in interventional studies of GERD. [ABSTRACT FROM AUTHOR]

Summary Aims : To study the prevalence of dyspepsia and irritable bowel syndrome and the effects of co-existing anxiety and depression on health care utilization by a population survey in Chinese. Methods : Ethnic Chinese households were invited to participate in a telephone survey using a validated bowel symptom questionnaire and the hospital anxiety and depression scale. Gastrointestinal symptoms were classified as dyspepsia and irritable bowel syndrome according to the Rome I criteria and gastro-oesophageal reflux disease by the presence of weekly heartburn or acid regurgitation. The anxiety and depression scores were compared between patients who sought medical attention and those who did not, using multiple logistic regression analysis. Results : One thousand, six hundred and forty-nine subjects completed the interview (response rate, 62%). The population prevalences of dyspepsia, irritable bowel syndrome and gastro-oesophageal reflux disease were 18.4%, 4.1% and 4.8%, respectively. Dyspepsia and irritable bowel syndrome were associated with anxiety, depression, medical consultation, sick leave and adverse effects on social life. The degree of anxiety was an independent factor associated with health care-seeking behaviour in both dyspeptics (P =0.003) and irritable bowel syndrome patients ( P =0.036). Conclusions : Irritable bowel syndrome and dyspepsia are associated with anxiety, depression, significant social morbidity, health care utilization and days off work. Anxiety is an independent factor in determining health care utilization in patients with dyspepsia and irritable bowel syndrome. [ABSTRACT FROM AUTHOR]

Background: A new rapid urine test was developed to detect anti-Helicobacter pylori antibody in urine using the principle of immunochromatography. The accuracy of this test in the Chinese population remains to be defined. Aim: To evaluate a new rapid urine test for the diagnosis of H. pylori infection in the Chinese population. Methods: Eligible patients without previous treatment of H. pylori were recruited. In-house rapid urease test and histology were used as the gold standard. The rapid urine test (RAPIRUN H. pylori antibody) was performed and the results were compared with the gold standard. Results: One hundred and twenty-three patients were eligible for analysis and 61 (50%) were H. pylori positive by the gold standard. The rapid urine test showed a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 96.7%, 95.2%, 95.2%, 96.7% and 95.9%, respectively. Results were obtained within 20 min and no special laboratory support was required. Conclusions: The rapid urine test by immunochromatography is highly accurate for the diagnosis of H. pylori infection in untreated Chinese patients. [ABSTRACT FROM AUTHOR]

Background: Numerous serological tests for the detection of Helicobacter pylori infection have been developed. However, many perform poorly when evaluated in the Chinese population. Aim: To search for optimal serological tests for the detection of H. pylori infection in Chinese patients. Methods: Consecutive dyspeptic patients referred for upper endoscopy were recruited. During endoscopy, gastric biopsies were taken for the CLOtest™ and histological examination. Patients were then given a 13 C-urea breath test. Sera were used to test for H. pylori infection, employing three commercial enzyme-linked immunosorbent assay kits (pylori DTect, HP IgG and GAP IgG). Results were compared with the gold standard defined by the CLOtest™, histology and 13 C-urea breath test. Results: Among the 142 patients (47 male, 95 female; mean age, 49 years) recruited, 81 (57%) were H. pylori -positive, 57 (40%) were H. pylori -negative and four (3%) were defined to be indeterminate. Using a self-defined cut-off value after calculation, the best accuracies for the pylori DTect, HP IgG and GAP IgG tests were 97%, 91% and 80%, respectively. Conclusions: The pylori DTect test is an optimal serological test for the detection of H. pylori infection in Hong Kong Chinese patients. The HP IgG test may be used as an alternative. [ABSTRACT FROM AUTHOR]

Aims: To test the usefulness of upper gastrointestinal investigations and quality of life assessment in Chinese patients with non-cardiac chest pain. Methods: Seventy-eight consecutive patients with non-cardiac chest pain underwent upper endoscopy. Eight patients had upper gastrointestinal pathology (10%). The remaining 70 patients received acid perfusion test, oesophageal manometry and 24-h ambulatory oesophageal pH (n =65)/manometry (n =61), and the results were compared with those of healthy controls (n =20). Symptoms and quality of life (SF-36) were assessed by standard validated questionnaire. Results: Significant acid reflux symptoms were present in five (5/70, 7%) patients. Abnormal 24-h oesophageal pH, indicating gastro-oesophageal reflux, was found in 19 (19/65, 29%) patients. The percentage of simultaneous contractions was higher and the percentage peristalsis was lower in patients with non-cardiac chest pain when compared with normal subjects by 24-h ambulatory manometry. Patients with non-cardiac chest pain had a lower SF-36 score when compared to controls. Conclusions: Typical acid reflux symptoms are uncommon in Chinese patients with non-cardiac chest pain, but abnormal 24-h pH results, indicating gastro-oesophageal reflux, were found in 29% of patients. Ineffective contractions were more frequently found in patients with non-cardiac chest pain by 24-h ambulatory manometry, which may have a bearing on the impaired quality of life in such patients. Upper gastrointestinal investigations are useful for the evaluation of Chinese patients with non-cardiac chest pain. [ABSTRACT FROM AUTHOR]

Background: The proportion of duodenal ulcers not associated with Helicobacter pylori infection or the use of non-steroidal anti-inflammatory drugs (NSAIDs) is increasing. Aim: To identify the clinical and endoscopic characteristics of non-H. pylori, non-NSAID duodenal ulcers. Methods: Clinical and endoscopic data and H. pylori status were prospectively collected from consecutive patients who underwent upper endoscopy from 1997 to 1999. Patients with duodenal ulcers were identified, and those with non-H. pylori, non-NSAID duodenal ulcers were analysed further. Results: A total of 11 717 upper endoscopies were performed in 8344 patients. Of these, 1153 (14%) had duodenal ulcers. Of 599 patients with active ulcers and known H. pylori status, 104 (17%) had ulcers not associated with H. pylori or the use of NSAIDs, 393 (66%) had ulcers associated with H. pylori alone, 51 (8.5%) had ulcers associated with the use of NSAIDs alone and 51 (8.5%) had ulcers associated with both. Multivariate logistic regression analysis revealed that the presence of concomitant diseases (odds ratio=15.0; 95% confidence interval, 8.64–25.9; P < 0.001) and the absence of epigastric pain/discomfort (odds ratio=0.52; 95% confidence interval, 0.29–0.91; P=0.022) were independent predictors for non-H. pylori, non-NSAID duodenal ulcers. Conclusions: Non-H. pylori, non-NSAID duodenal ulcers exhibit certain distinct clinical and endoscopic characteristics. The presence of concomitant diseases is an important predictive factor. [ABSTRACT FROM AUTHOR]

Background: We have previously shown that the 75 mg 13C-urea breath test without citrate test meal is highly accurate for the diagnosis of Helicobacter pylori infection in Chinese subjects. A lower dose 50 mg 13C-urea breath test protocol with a sampling time at 20 min has not been validated previously. Aim: To investigate the accuracy of a 20-min 50 mg 13C-urea breath test protocol in Chinese subjects. Methods: Consecutive dyspeptic patients referred for upper endoscopy were recruited. 13C-urea breath test was performed using (a) 75 mg and 50 mg of 13C-urea on two separate days without a test meal, and (b) 50 mg of 13C-urea with 2.4 g citrate as test meal, and compared with the gold standard [rapid urease test (CLO test) and histology]. Baseline, 20-min and 30-min breath samples were collected in all cases. Results: Two hundred and six patients were tested. The accuracy of the 50 mg 13C-urea breath test (no citrate) at 20 min and 30 min was 98%, comparable to that of the 50 mg 13C-urea breath test with citrate (99.1%) and the 75 mg 13C-urea breath test without citrate (100%). Conclusions: A 20-min 50 mg 13C-urea breath test without citrate produced highly accurate results for the diagnosis of Helicobacter pylori infection and is more economical and convenient for the Chinese population. [ABSTRACT FROM AUTHOR]

National-level data on the incidence of retinopathy of prematurity (ROP) in different regions of China is insufficient. This study aimed to compare ROP incidences and care practices in different regions of China and their relationship with regional gross domestic product (GDP) per capita. Retrospective cohort study. All infants born at <32 weeks gestational age (GA) and admitted to 70 neonatal intensive care units (NICUs) from January 1, 2019, to December 31, 2020, were enrolled. Hospitals were categorised into three regional groups according to geographical locations and GDP per capita from high to low: Eastern, Central, and Western China. The incidence of death or ROP, and care practices were compared among the groups. A total of 18,579 infants were enrolled. Median GA was 29.9 (interquartile range 28.4–31.0) weeks and birth weight was 1318.1 (317.2) g. The percentage of GA <28 weeks, complete administration of antenatal steroids, and weight gain velocity during NICU stay were highest in Eastern China and lowest in Western China (all P < 0.01). In Eastern, Central, and Western China, the rates of death or any stage of ROP were 33.3%, 38.5%, and 39.2%, respectively (P < 0.01). There were considerable regional disparities in ROP incidence in preterm infants with GA <32 weeks in China. The incidence of death or ROP ranged from high to low in Western, Central, and Eastern China. [ABSTRACT FROM AUTHOR]

Objective: The identification of risk factors is crucial for the clinical prevention and diagnosis of necrotizing enterocolitis (NEC). Monochorionic twins (MCT), due to the high genetic homogeneity, provided a valuable model for investigating the risk factors of various diseases. This study aimed to explore the risk factors for NEC using MCT., Methods: A retrospective review was conducted on the medical records of monochorionic twins (MCT) treated at Guangzhou Women and Children's Medical Center from January 2012 to March 2023. We compared perinatal condition, feeding and preceding condition between MCT pairs with NEC (NEC MCT) and without NEC(No NEC MCT).Logistic regression analysis was utilized to identify independent risk factors., Result: In 85 pairs of monochorionic twins (MCT), NEC occurred in one twin in 78.8% of cases, whereas both twins were affected in 21.2% of cases. In the final cohort of 60 pairs of MCT, several parameters were found to differ significantly between NEC MCT group and No NEC MCT group. Compared to No NEC MCT group, the incidence of umbilical cord abnormalities was significantly higher in the NEC MCT group (25% vs. 8.3%, P = 0.014). Meanwhile, NEC MCT group showed higher prevalence of SGA infants (48.3% vs. 21.7%, P = 0.002) and sFGR (38.3% vs. 6.7%, P = 0.000). Furthermore, TTTs (13.3% vs. 3.3%, P = 0.027) and septicemia (25% vs. 5%, P = 0.002) were more common in NEC MCT group. In a multivariable logistic regression model, sFGR (OR 6.81,95%CI 2.1-21.9, p = 0.001) was eventually output as an independent risk factor., Conclusion: Non-genetic factors play a predominant role in the pathogenesis of NEC. Umbilical cord abnormalities, SGA, sFGR, TTTs and septicemia significantly increase the risk of NEC. sFGR is an independent risk factor of NEC., Competing Interests: Declarations Ethics approval and consent to participate The research ethics committee of Guangzhou Women and Children’s Medical Center approved the study. Considering the retrospective nature of this study, ethics committee of Guangzhou Women and Children’s Medical Center approved the waiver of parents’ written consent. The waiver will not adversely affect the rights and welfare of the patients. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

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 environmental impact of dissolved trace element (DTE) pollution is becoming increasingly well understood. The southeastern edge of the Qinghai-Tibet Plateau is a region with high environmental vulnerability, making it highly susceptible to various anthropogenic disturbances. The Lancang River (LCR), as the most representative river in this area, serving as the largest international river in Southeast Asia, the LCR is crucial for the downstream regions, supporting fisheries, agriculture, and even economic development, earning it the title of the "water tower" for these areas. This study mainly focuses on the upstream unbuilt dam area. In this study, we gathered 25 surface water samples from the upstream of the LCR and examined the geographical distribution, primary sources, and associated human health risks of seven dissolved trace elements (Mn, Cr, Fe, Co, Cu, Ni, Zn). Cr, Fe, Co, Ni, and Cu in the main stream are primarily associated with natural sources, including rock weathering, soil erosion, and similar processes. Mn, however, predominantly originates from human activities such as industrial construction and road transportation. Zn mainly originates from the specialized fertilizers used for highland barley in plateau regions. Almost all DTE concentrations exhibited a downward trend from upstream to downstream. However, due to inputs from various sources along the way, there will be some abnormal points. The concentrations of DTE in the study area were within the acceptable limits set by drinking water standards in China, the USA, and the WHO. Overall, the water quality in this region is considered good. The results from a Monte Carlo simulation assessing health risks indicate that the non-carcinogenic health risk caused by DTE in the upper reaches of Lancang River was very weak. The primary pathway through which DTE can harm human health is ingestion, with children being particularly vulnerable. These findings offer a critical scientific basis for understanding the migration of DTE in aquatic environments and for the ecological stewardship of the Lancang River., 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. Published by Elsevier Inc.)

We conducted a large-scale survey of arboviruses in mosquitoes and biting midges to assess the presence and spread of mosquito-borne pathogens currently circulating on Hainan Island, China. RT-PCR assays were used to detect the arbovirus species, distribution, and infection rates in mosquitoes and biting midges. Cell inoculation and high throughput sequencing were performed to isolate the viruses and assemble full viral genomes. Phylogenetic analysis was conducted to identify the viral genotypes and evolutionary relationships with known viruses. During 2019-2023, 32,632 mosquitoes and 21,000 biting midges were collected from 14 of 18 cities/counties on Hainan Island. Japanese encephalitis virus (JEV) was detected in Culex mosquitoes from five cities/counties, where the minimum infection rate (MIR) was 1.6 (0.6-2.6) per 1,000 females tested. Tembusu virus (TMUV) was detected in Culex mosquitoes from three cities/counties with MIR1.0 (0-2.2) per 1,000. Getah virus (GETV) was detected in Armigeres mosquitoes from Qionghai city with MIR 7.1 (0-15.2) per 1,000. Oya virus (OYAV) and Bluetongue virus (BTV) were detected in biting midges from Wanning city with MIRs of 0.4 (0-1.2) and 0.1 (0-10.2) per 1,000, respectively. Three JEV strains were isolated and clustered within the genotype I group, which is presently the dominant genotype in China. Three TMUV strains were isolated for the first time on Hainan Island that belonged to Cluster 3. Three isolated GETVs were identified as Group 3. BTV was reported for the first time on Hainan Island, and the complete genome for one BTV strain was successfully assembled, which was classified as serotype 1 based on the sequences of segment 2. These results stress the need to develop adequate surveillance plan measures to better control the public health threat of arboviruses carried by mosquitoes and biting midges in local regions., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To evaluate the prevalence, resistance and risk factors of community-onset urinary tract infections (COUTIs) caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) for providing a basis for the selection of clinical therapeutic agents., Design: A retrospective case-control study., Setting: The Affiliated Dazu Hospital of Chongqing Medical University (also known as The People's Hospital of Dazu Chongqing), a 1000-bed tertiary hospital in China., Data and Participants: This study encompassed adult patients diagnosed with community-acquired urinary tract infections (UTIs) caused by E. coli between May 2017 and December 2022 with exclusion criteria including incomplete clinical data, disagreement to participate in the study, hospitalisation duration exceeding 48 hours prior to confirmation of diagnosis and prior history of urinary tract infection caused by E. coli ., Outcome Measures: The risk factors for COUTIs caused by ESBL-EC were evaluated using a case-control design, defining patients who were diagnosed with UTIs and had an ESBL-positive urine culture as the case group and patients who were diagnosed with UTIs and had an ESBL-negative urine culture as the control group. Perform drug susceptibility testing and resistance analysis on isolated ESBL-EC., Results: In total, 394 cases of COUTIs caused by E. coli were included; 192 cases were ESBL-positive with a detection rate of 48.7% (192/394). Parenchymal tumour, history of urolithiasis stone fragmentation, history of urological surgery, hospitalisation within 6 months, indwelling catheter outside the hospital and antibiotic use (mainly third-generation cephalosporins) were the factors significantly associated with COUTIs caused by ESBL-EC (p<0.05) through logistic regression for univariate analysis. Multivariate analysis revealed that a history of urolithiasis stone fragmentation (OR=2.450; 95% CI: 1.342 to 4.473; p=0.004), urological surgery (OR=3.102; 95% CI: 1.534 to 6.270; p=0.002), indwelling catheter outside hospital (OR=2.059; 95% CI: 1.025 to 4.133; p=0.042), hospitalisation within 6 months (OR=2.127; 95% CI: 1.207 to 3.748; p=0.009) and use of third-generation cephalosporins (OR=1.903; 95% CI: 1.069 to 3.389; p=0.029) were the independent risk factors for COUTIs caused by ESBL-EC. The results of the drug susceptibility testing revealed that ESBL-EC exhibited the highest resistance rates to ampicillin, ceftriaxone and cefixime, all at 100%. Mezlocillin followed with a resistance rate of 98.7%. On the other hand, ESBL-EC strains displayed the highest sensitivity to carbapenem antibiotics (imipenem, meropenem, ertapenem) and amikacin, all at 100%. Sensitivity rates were also high for cefotetan at 96.6%, piperacillin/tazobactam at 95.3% and nitrofurantoin at 87.9%., Conclusions: Our results revealed high ESBL-EC detection rates. COUTIs caused by ESBL-EC are more likely to occur in patients with parenchymal tumour, a history of urolithiasis stone fragmentation, a history of urological surgery, hospitalisation within 6 months, indwelling catheter outside the hospital and use of third-generation cephalosporins. These patients were highly resistant to penicillins, cephalosporins and quinolones., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Intensive Care Unit (ICU) nurses frequently confront significant psychological challenges, including compassion fatigue, moral distress, and diminished moral resilience. These issues not only affect their well-being but also impact the quality of care provided to patients. The interplay of these factors is complex and not fully understood, particularly how compassion fatigue influences the relationship between moral resilience and moral distress., Objectives: To explore the complex interplay between compassion fatigue and moral distress among ICU nurses, and to elucidate how compassion fatigue influences the protective role of moral resilience against moral distress., Research Design: A cross-sectional study was conducted using a nationwide random sample of ICU nurses in China. Latent profile analysis identified subgroups based on levels of compassion fatigue. Moderation analysis examined whether compassion fatigue moderated the association between moral resilience and moral distress., Results: Among 612 ICU nurses, latent profile analysis revealed three distinct groups with high, moderate, and low levels of compassion fatigue. Being female was protective against high compassion fatigue, while ages 30-49 yrs., lack of bachelor's degree, and dissatisfaction with salary increased compassion fatigue risk. Moderation analysis showed compassion fatigue significantly moderated the relationship between moral resilience and moral distress. Nurses with higher compassion fatigue exhibited a stronger association between low moral resilience and high moral distress., Conclusion: Compassion fatigue and moral distress are interconnected phenomena among ICU nurses. Demographic factors like gender, age, education, and income satisfaction impact compassion fatigue risk. High compassion fatigue impairs moral resilience, exacerbating moral distress. Comprehensive interventions targeting both compassion fatigue and moral resilience, tailored to nurses' demographic profiles, are needed to support this workforce., 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 Yin, Zhao, Zhang and Xia.)

Corticosteroids have always been recommended for severe cases of COVID-19. However, the efficacy of treatment with corticosteroids for COVID-19 during the SARS-CoV-2 omicron outbreak in China has not been reported. Clinical data from 406 patients hospitalized for severe/critical COVID-19 from December 2022 to January 2023 at six hospitals in Chongqing were retrospectively analyzed. The primary outcome was all-cause mortality at 28 days in the groups with and without corticosteroids treatment after propensity score matching (PSM). Secondary outcomes were to compare in-hospital mortality and length of survival time with corticosteroids and those without corticosteroids. This study included 406 patients with severe or critical COVID-19, divided into the corticosteroids group (231, 56.9%) and non-corticosteroids group (175, 43.1%). After PSM, the use of corticosteroids did not reduce all-cause mortality at 28 days (42.5% vs. 39.1%). Univariate analysis showed that corticosteroids were not associated with improved all-cause mortality at 28 days [hazard ratio (HR), 1.019; 95% confidence interval (CI), 0.639-1.623; p = 0.938]. Multivariate analysis showed similar results (HR, 1.047; 95% CI, 0.633-1.732; p = 0.858). Among non-survivors, the survival time was significantly larger in those who received corticosteroids compared with the non-corticosteroid users [median 13 (IQR 6.5-15.5) vs. 6 (4-11.25), p = 0.007]. The use of systemic corticosteroids in severe/critical COVID-19 may provide certain potential survival benefits but does not improve prognosis., (© 2024. The Author(s).)

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: With the release of the coronavirus disease 2019 (COVID-19) pandemic in late 2022 in China, the number of people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) roared, including neonatal cases. However, there were few studies on neonatal COVID-19, especially multi-center case reports. This study aimed to explore clinical characteristics and short-term outcomes of neonatal COVID-19 in China., Methods: We reviewed 187 cases of neonatal COVID-19 between December 11, 2022, and January 12, 2023. The diagnosis was assessed by symptoms, laboratory tests, X-ray manifestations, and diagnosis code. Clinical characteristics and outcomes were evaluated., Results: In 187 neonatal cases with COVID-19, 84 (44.9%) had severe SARS-CoV-2 infection. Most patients had confirmed exposure to SARS-CoV-2. Fever and respiratory symptoms were common (75.4% and 71.7%, respectively). Severe patients were more likely to have high alanine transaminase (ALT) (> 40U/L) (11.9% vs. 3.9%) and high N-terminal pro-brain natriuretic peptide (NT-proBNP) (> 2000pg/mL) (38.0% vs. 19.6%), compared with nonsevere ones (P < 0.05). None of the patients received COVID-19-specific medical interventions. A few severe patients received corticosteroids (1.1%), and immunoglobulin (0.5%), respectively. All patients were discharged home after the medical care with a median length of stay (LOS) of four days and none of them met the criteria of multisystem inflammatory syndrome in neonates (MIS-N)., Conclusions: After the release of the epidemic situation of COVID-19 in late 2022 in China, more neonatal cases with severe COVID-19 had high ALT and NT-proBNP level. Few specific medical interventions were given, and the outcome was satisfying., (© 2024. The Author(s).)

The community structure of natural mature forests is determined by long-term forest succession, characterized by rational structure, rich biodiversity, and high ecological function. Understanding the spatial structure and formation mechanisms of mature forests is a fundamental prerequisite for forest management. We analyzed four structure parameters, including diameter structure, angular scale, size ratio, and mixture degree, as well as the Hegyi competition index, of secondary Quercus mongolica (Mongolian oak) mature forests in the mountainous area of eastern Liaoning Province. The results showed that Q. mongolica predominated the tree layer. In the sapling layer, Q. mongolica , Tilia amurensis , and Acer pictum were the dominant species. In the seedling layer, Acer pseudosieboldianum , T. amurensis , and A. amurensis dominated, with very few Q. mongolica seedlings. The overall diameter distribution of the stand showed an inverse "J" shape, while the diameter distribution of Q. mongolica , the dominant tree species, followed a normal distribution. The horizontal spatial structure of the stand was generally randomly distributed, with an average angle scale of 0.505, size ratio of 0.219, and mixture degree of 0.670 for Q. mongolica . From the perspective of spatial structure binary distribution, Q. mongolica individuals which had a random distribution exhibited greater growth advantages and higher levels of mixing, in comparison to other distribution types. Randomly distributed dominant and subdominant individuals made up nearly half individuals in the stand, and showed a high degree of mixing with surrounding trees. The stand-level individual tree competition index decreased with increasing diameter classes. When the diameter at breast height exceeded 20 cm, the competition index tended to stabilize (ΔCI<2). The competitive radius of individual Q. mongolica trees was 8 m, with intraspecific competition as the main pressure. Other species experienced competition pressure primarily from interspecific sources. Our results suggested that competition played an important role in shaping the spatial structure of secondary Q. mongolica mature forests.

Microplastics (MPs) are emerging as anthropogenic vectors to form plastisphere, facilitating microbiome colonization and pathogenic dissemination, thus contributing to environmental and health crises across various ecosystems. However, a knowledge gap persists regarding MPs risks and their driving factors in certain unique and vulnerable ecosystems, such as Karst travertine lakes, some of which are renowned World Natural Heritage Sites under ever-increasing tourism pressure. We hypothesized that tourism activities serve as the most important factor of MPs pollution, whereas intrinsic features, including travertine deposition can exacerbate potential environmental risks. Thus, metagenomic approaches were employed to investigate the geographical distribution of the microbiome, antibiotic resistance genes (ARGs), virulence factor genes (VFGs), and their combined environmental risks in Jiuzhaigou and Huanglong, two famous tourism destinations in Southwest China. The plastisphere risks were higher in Huanglong, contradicting our hypothesis that Jiuzhaigou would face more crucial antibiotic risks due to its higher tourist activities. Specifically, the levels of Lipopolysaccharide Lewis and fosD increased by sevenfold and 20-fold, respectively, from upstream to downstream in Huanglong, whereas in Jiuzhaigou, no significant accrual was observed. Structural equation modeling results showed that travertine deposition was the primary contributor to MPs risks in alpine karstic lakes. Our findings suggest that tourism has low impact on MPs risks, possibly because of proper management, and that travertine deposition might act as an MPs hotspot, emphasizing the importance of considering the unique aspects of travertine lakes in mitigating MPs pollution and promoting the sustainable development of World Natural Heritage Sites., 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: Research on the effectiveness of pharmacist-led antimicrobial stewardship programmes (ASPs) in the urology department is limited., Aim: To evaluate the impact of pharmacist-led multi-faceted ASPs on antibiotic use and clinical outcomes., Methods: A prescription review of inpatients receiving one or more antibiotics in the urology department of a large teaching hospital in Guangzhou, China, was conducted from April 2019 to March 2023. The pharmacist-led multi-faceted ASP intervention included guideline development, training, medication consultation, review of medical orders, indicator monitoring, and consultation. The primary outcome was antibiotic consumption. The data were analysed using interrupted time-series (ITS) analysis., Findings: Following the implementation of ASPs, an immediate decrease was observed in total antibiotic consumption, antibiotic use rate, second-generation cephalosporins, third-generation cephalosporins, fluoroquinolones, and WHO Watch category antibiotics. No differences were observed in mortality rate before and after the intervention, and no significant short- or long-term effects were found on length of hospital stay (LOS) using ITS. However, there was a significant short-term effect on average antibiotic cost., Conclusion: The implementation of pharmacist-led multi-faceted ASPs had positive impacts on reducing antimicrobial consumption without increasing LOS, antibiotic cost, or mortality rate., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

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.

Identifying the key influencing factors in soil available cadmium (Cd) is crucial for preventing the Cd accumulation in the food chain. However, current experimental methods and traditional prediction models for assessing available Cd are time-consuming and ineffective. In this study, machine learning (ML) models were developed to investigate the intricate interactions among soil properties, climate features, and available Cd, aiming to identify the key influencing factors. The optimal model was obtained through a combination of stratified sampling, Bayesian optimization, and 10-fold cross-validation. It was further explained through the utilization of permutation feature importance, 2D partial dependence plot, and 3D interaction plot. The findings revealed that pH, surface pressure, sensible heat net flux and organic matter content significantly influenced the Cd accumulation in the soil. By utilizing historical soil surveys and climate change data from China, this study predicted the spatial distribution trend of available Cd in the Chinese region, highlighting the primary areas with heightened Cd activity. These areas were primarily located in the eastern, southern, central, and northeastern China. This study introduces a novel methodology for comprehending the process of available Cd accumulation in soil. Furthermore, it provides recommendations and directions for the remediation and control of soil Cd pollution., 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: Pseudomonas juntendi is a newly identified opportunistic pathogen, of which we have limited understanding. P. juntendi strains are often multidrug resistant, which complicates clinical management of infection., Methods: A strain of Pseudomonas juntendi (strain L4326) isolated from feces was characterized by MALDI-TOF-MS and Average Nucleotide Identity BLAST. This strain was further subject to whole-genome sequencing and Maximum Likelihood phylogenetic analysis. The strain was phenotypically characterized by antimicrobial susceptibility testing and conjugation assays., Results: We have isolated the novel P. juntendi strain L4236, which was multidrug resistant, but retained sensitivity to amikacin. L4236 harbored a megaplasmid that encoded bla OXA-1 and a novel bla IMP-1 resistance gene variant. P. juntendi strain L4236 was phylogenetically related to P. juntendi strain SAMN30525517., Conclusion: A rare P. juntendi strain was isolated from human feces in southern China with a megaplasmid coharboring bla IMP-1-like and bla OXA-1 . Antimicrobial selection pressures may have driven acquisition of drug-resistance gene mutations and carriage of the megaplasmid., (© 2024. The Author(s).)

Objective To understand the current situation and influencing factors of kindergarten teachers' participation in training for preschool sex education in Luzhou city,and provide a basis for improving the sex education literacy of kindergarten teachers in the future. Methods A multi-stage stratified cluster sampling method was adopted,and a questionnaire survey was conducted from December 2021 to January 2022 on the knowledge,attitude,and practice of preschool sex education among all the teachers in 24 kindergartens in Luzhou city. Results Among the 461 teachers,43.0% had participated in lectures/courses/training activities related to preschool sex education;99.1% hoped to participate in lectures/courses/training activities related to preschool sex education;82.6% learned about child sexual knowledge through school education;75.5% expressed the hope to learn about child sexual knowledge through expert training.The results of multivariate Logistic regression showed that except private kindergartens as an inhibiting factor ( OR =0.57,95% CI =0.37-0.87, P =0.008),high monthly income ( OR =3.52,95% CI =1.13-9.30, P =0.011),more ways to know about sex education knowledge ( OR =2.87,95% CI =1.76-4.70, P <0.001),and social support ( OR =1.58,95% CI =1.04-2.38, P =0.030) were promoting factors for teachers to participate in the training for preschool sex education. Conclusion The kindergarten teachers presented a participation rate but a high demand for the training for preschool sex education.They mainly obtain the sex education knowledge from school education.The nature of kindergarten,monthly income of teachers,social support situation,and ways of understanding sex education knowledge are the key factors influencing the teachers' participation in the training for preschool sex education.

Background: Stroke etiology could influence the outcomes in patients with basilar-artery occlusion (BAO). This study aimed to evaluate the differences in efficacy and safety of best medical treatment (BMT) plus endovascular treatment (EVT) versus BMT alone in acute BAO across different stroke etiologies., Methods: The study was a post hoc analysis of the ATTENTION trial (Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion), which was a multicenter, randomized trial at 36 centers in China from February 2021 to September 2022. Patients with acute BAO were classified into 3 groups according to stroke etiology (large-artery atherosclerosis [LAA], cardioembolism, and undetermined cause/other determined cause [UC/ODC]). The primary outcome was a favorable outcome (modified Rankin Scale score of 0-3) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage and 90-day mortality., Results: A total of 340 patients with BAO were included, 150 (44.1%) had LAA, 72 (21.2%) had cardioembolism, and 118 (34.7%) had UC/ODC. For patients treated with BMT plus EVT and BMT alone, respectively, the rate of favorable outcome at 90 days was 49.1% and 23.8% in the LAA group (odds ratio, 3.08 [95% CI, 1.38-6.89]); 52.2% and 30.8% in the cardioembolism group (odds ratio, 2.45 [95% CI, 0.89-6.77]); and 37.5% and 17.4% in the UC/ODC group (odds ratio, 2.85 [95% CI, 1.16-7.01]), with P =0.89 for the stroke etiology×treatment interaction. The rate of symptomatic intracranial hemorrhage in EVT-treated patients with LAA, cardioembolism, and UC/ODC was 8.3%, 2.2%, and 3.2%, respectively, and none of the BMT-treated patients. Lower 90-day mortality was observed in patients with EVT compared with BMT alone across 3 etiology groups., Conclusions: Among patients with acute BAO, EVT compared with BMT alone might be associated with favorable outcomes and lower 90-day mortality, regardless of cardioembolism, LAA, or UC/ODC etiologies. The influence of stroke etiology on the benefit of EVT should be explored by further trials., Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04751708., Competing Interests: Dr Nguyen discloses advisory board with Brainomix, Aruna Bio; associate editor of Stroke. The other authors report no conflicts.

Objective: This study aims to 1) explore the association between autistic traits and eating behaviors in Chinese preschoolers; 2) explore the mediating role of sensory processing patterns on the relation of autistic traits and eating-related behaviors; and 3) examine home nurturing environment as a moderator between autistic traits and eating-related behaviors. We hypothesize that there is a significant association between autistic traits and eating behaviors, which is mediated by sensory processing patterns and moderated by the home nurturing environment., Method: 509 children aged 3-4 years participated in this cross-sectional research. They were assessed using the Social Responsiveness Scale-Second Edition (SRS-2) for autistic traits, the Chinese Preschoolers' Eating Behavior Questionnaire (CPEBQ) for eating-related behaviors, the Short Sensory Profile-Second Edition (SSP-2) for sensory processing patterns, and the Children Home Nurture Environment Questionnaire (CHNEQ) for home nurturing environment. Mediation regression analyses were used to examine the role of sensory processing patterns, while moderation analyses to examine the role of home nurturing environment., Results: We observed a positive association between autistic traits and eating behavior problems among typically developed children. Sensory processing patterns significantly mediated the impact of autistic traits on children's eating-related behaviors and home nurturing environment also moderated this relationship., Discussion: Our research suggests that Chinese preschoolers with higher autistic traits may face more eating challenges when they possess more heightened sensory processing patterns, while living in supportive home environments helps to improve their eating behaviors. These findings contribute to the understanding of how and to what extent eating problems are influenced by autistic traits, and they offer insight into the alleviation of eating problems from the perspectives of sensory patterns and family nurturing environments., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: With the profound changes in the global climate, the issue of grassland degradation is becoming increasingly prominent. Grassland degradation poses a severe threat to the carbon cycle and carbon storage within grassland ecosystems. Additionally, it will adversely affect the sustainability of food production. The grassland ecosystem in the northwest region of Liaoning Province, China, is particularly vulnerable due to factors such as erosion from the northern Horqin Sandy Land, persistent arid climate, and issues related to overgrazing and mismanagement of grassland. The degradation issue is especially pronounced in this ecological environment. However, previous research on the carbon density of degraded grasslands in Northeast China has predominantly focused on Inner Mongolia, neglecting the impact on the grasslands in the northwest of Liaoning Province. Therefore, this experiment aims to assess the influence of grassland degradation intensity on the vegetation and soil carbon density in the northwest of Liaoning Province. The objective is to investigate the changes in grassland vegetation and soil carbon density resulting from different degrees of grassland degradation., Methodology: This study focuses on the carbon density of grasslands at different degrees of degradation in the northwest of Liaoning Province, exploring the variations in vegetation and soil carbon density under different levels of degradation. This experiment employed field sampling techniques to establish 100 × 100 m plots in grasslands exhibiting varying degrees of degradation. Six replications of 100 × 100 m plots per degradation intensity were sampled. Vegetation and soil samples were collected for analysis of carbon density., Results: The results indicate that in the context of grassland degradation, there is a significant reduction in vegetation carbon density. Furthermore, it was found that root carbon density is the primary contributor to vegetation carbon density. In comparison to mildly degraded grasslands, moderately and severely degraded grasslands experience a reduction in vegetation carbon density by 25.6% and 52.6%, respectively. However, with regard to the impact of grassland degradation on soil carbon density, it was observed that while grassland degradation leads to a slight decrease in soil carbon density, there is no significant change in soil carbon density in the short term under the influence of grassland degradation., Conclusions: Therefore, grassland degradation has exerted a negative impact on aboveground vegetation carbon density, reducing the carbon storage of above-ground vegetation in grasslands. However, there was no significant effect on grassland soil carbon density., (© 2024. The Author(s).)

Objectives: The emergency response to the COVID-19 pandemic may disrupt hospital management activities of antimicrobial resistance (AMR). This study aimed to determine the changing AMR trend over the period in China when stringent COVID-19 response measures were implemented., Methods: This retrospective study was conducted in a designated hospital for COVID-19 patients in Guangzhou, China from April 2018 to September 2021. The prevalence of 13 antimicrobial-resistant bacteria was compared before and after the COVID-19 responses through Chi-square tests. Interrupted time series (ITS) models on the weekly prevalence of AMR were established to determine the changing trend. Controlled ITS models were performed to compare the differences between subgroups., Results: A total of 10,134 isolates over 1,265 days were collected. And antimicrobial-resistant strains presented in 38.6% of the testing isolates. The weekly AMR prevalence decreased by 0.29 percentage point (95% CI [0.05-0.80]) after antimicrobial stewardship (AMS) policy, despite an increase in the prevalence of penicillin-resistant Streptococcus pneumoniae (from 0/43 to 15/43, p  < 0.001), carbapenem-resistant Escherichia coli (from 20/1254 to 41/1184, p  = 0.005), and carbapenem-resistant Klebsiella pneumoniae (from 93/889 to 114/828, p  = 0.042). And the changing trend did not vary by gender (male vs. female), age (<65 vs. ≥65 years), service setting (outpatient vs. inpatient), care unit (ICU vs. non-ICU), the primary site of infection (Lung vs. others), and Gram type of bacteria (positive vs. negative)., Conclusion: The response to COVID-19 did not lead to an increase in overall AMR; however, it appears that management strategy on the prudent use of antimicrobials likely contributed to a sizable long-term drop. The frequency of several multidrug-resistant bacteria continues to increase after the COVID-19 epidemic. It is crucial to continue to monitor AMR when COVID-19 cases have surged in China after the relaxation of restriction measures., 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 Li, Yang, Liu, Liu, Shi, Zeng, Xia, Li, Zhao, Yang, Li, Hu and Yang.)

An investigation of EtOAc extract from the roots of Paeonia lactiflora yielded three new 30-noroleanane triterpenoids paeonenoides L-N (1-3) and one new oleanane triterpenoid paeonenoide O (4) together with 7 known compounds (5-11). Extensive spectrographic experiments were applied to identify the structures of 1-4, and their absolute configurations were unambiguously determined by theoretical calculations of ECD spectra, as well as the single-crystal X-ray diffraction analysis. Compounds 8, 9 and 10 were isolated from the Paeonia genus for the first time. Moreover, compounds 8, 9 and 11 showed inhibitory activities against LPS-induced nitric oxide (NO) production in RAW264.7 macrophages with the IC 50 values of 72. 17 ± 4.74, 30.02 ± 2.03 and 28.34 ± 1.85 μM, respectively., 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 © 2023. Published by Elsevier B.V.)

Ground-level ozone (O 3 ) pollution has emerged as a significant concern impacting air quality in urban agglomerations, primarily driven by meteorological conditions and social-economic factors. However, previous studies have neglected to comprehensively reveal the spatial distribution and driving mechanism of O 3 pollution. Based on the O 3 monitoring data of 41 cities in the Yangtze River Delta (YRD) from 2014 to 2021, a comprehensive analysis framework of spatial analysis-spatial econometric regression was constructed to reveal the driving mechanism of O 3 pollution. The results revealed the following: (1) O 3 concentrations in the YRD exhibited a general increasing and then decreasing trend, indicating an improvement in pollution levels. The areas with higher O 3 concentration are mainly the cities concentrated in central and southern Jiangsu, Shanghai, and northern Zhejiang. (2) The change of O 3 concentration and distribution is the result of various factors. The effect of urbanization on O 3 concentrations followed an inverted U-shaped curve, which implies that achieving higher quality urbanization is essential for effectively controlling urban O 3 pollution. Traffic conditions and energy consumption have significant direct positive influences on O 3 concentrations and spatial spillover effects. The indirect pollution contribution, considering economic weight, accounted for about 35%. Thus, addressing overall regional energy consumption and implementing traffic source regulations are crucial paths for O 3 pollution control in the YRD. (3) Meteorological conditions play a certain role in regulating the O 3 concentration. Higher wind speed will promote the diffusion of O 3 and increase the O 3 concentration in the surrounding city. These findings provide valuable insights for designing effective policies to improve air quality and mitigate ozone pollution in urban agglomeration area., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Lung cancer is the most common cancer and the leading cause of death in China. The current gold standard for clinical lung cancer diagnosis is based on histopathological examination of tumors, but it has the limitation for easy operation and convenient applications. Therefore, researchers are still striving to develop other tools and methods for non-invasive and rapid assessment of the health conditions of lung cancer patients. Hair, as a reflection of the metabolism of the body, is closely related to human health conditions. In principle, Fourier-transform infrared (FTIR) spectroscopy can probe the major chemical compositions in the hair. However, as indicated by previous studies, there is still the challenge to make good use of FTIR spectroscopy for achieving reliable analysis of hair from cancer patients. In this study, hair samples from 82 lung cancer patients were collected and subjected to FTIR measurements and analysis, which showed the protein content in the hair is closely related to the protein content in the blood serum of patients, and the contents of protein and lipid are statistically lower in the lung cancer patients. Furthermore, we demonstrated that FTIR spectroscopy could be employed to monitor the hair of lung cancer patients undergoing chemotherapy, and confirmed that the FTIR spectra of the hair may reflect the resultant effect of the chemotherapy. As such, this work validates the way of using FTIR spectroscopy in hair analysis for the assistance of medical diagnosis of lung cancer as well as monitoring the conditions of the patients under the medical treatment., 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.)

To analyze the results of proficiency testing for anti-tuberculosis drug susceptibility testing (DST) in China. Number of laboratory participating the proficiency testing performed DST, and the sensitivity, specificity, reproducibility, and accordance rate were calculated from data of 13 rounds proficiency testing results for DST from 2008 to 2021. A total of 30 and 20 strains of Mycobacterium tuberculosis with known susceptibility results were sent to each laboratory in 2008 to 2019, 2020 and 2021, respectively. The number of participating laboratories ranged from 30 in 2009 to 546 in 2021. L-J DST was the predominant method. The specificity presented relatively higher than sensitivity. Improvement of specificity were observed for all drugs through the years, while sensitivity did not show improvement for amikacin and capreomycin. Accordance rate of pyrazinamide and kanamycin and reproducibility of capreomycin and pyrazinamide were not significantly improved through the years. Most of the participating laboratories significantly improved the quality of their DST through the consecutive rounds of proficiency testing except for second-line injectable drugs and pyrazinamide. The results highlight the importance of developing novel and/or improving existing methods for phenotypic DST for certain drugs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Song et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Cryptococcus neoformans is the most common cause of fungal meningitis and is associated with a high mortality. The clinical significance of concurrent Epstein-Barr virus (EBV) in the cerebrospinal fluid (CSF) of human immunodeficiency virus (HIV)-negative patients with cryptococcal meningitis (CM) remains unclear. A retrospective cohort study was performed by analyzing CSF samples from 79 HIV-negative Chinese Han patients with confirmed CM. We identified CSF viral DNA in these patients by metagenomic next-generation sequencing (mNGS) and compared 10-week survival rates among those with and without EBV DNA in CSF. Of the 79 CSF samples tested, 44.3% (35/79) had detectable viral DNA in CSF, while 55.7% (44/79) were virus-negative. The most frequent viral pathogen was EBV, which was detected in 22.8% (18/79) patients. The median number of CSF-EBV DNA reads was 4 reads with a range from 1 to 149 reads. The 10-week mortality rates were 22.2% (4/18) in those with positive CSF-EBV and 2.3% (1/44) in those with negative CSF-virus (hazard ratio 8.20, 95% confidence interval [CI] 1.52-81.80; P = 0.014), which remained significant after a multivariate adjustment for the known risk factors of mortality (adjusted hazard ratio 8.15, 95% CI 1.14-92.87; P = 0.037). mNGS can identify viruses that coexist in CSF of HIV-negative patients with CM. EBV DNA is most commonly found together with C. neoformans in CSF and its presence is associated with increased mortality in HIV-negative CM patients., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.)

Objective: To determine whether the presence of preoperative subchondral bone marrow oedema (SBME) is associated with inferior outcomes after lateral unicompartmental knee arthroplasty (LUKA)., Study Design: Descriptive study. Place and Duration of the Study: Department of Orthopaedic Surgery, Chongqing Orthopaedic Hospital of Traditional Chinese Medicine, Chongqing, China, from January 2019 to June 2022., Methodology: Data on patients treated with LUKA were obtained from the Medical Registry Database. Two groups were made based on the presence and absence of SBME on preoperative magnetic resonance imaging (MRI). The visual analogue scale (VAS), American Knee Society Scores (AKSS), and rate of patient satisfaction were compared between the two groups., Results: A total of 20 patients treated with LUKA were reviewed. The SBME was present in 9 cases and absent in 11 cases. Patients with SBME had inferior scores at preoperative evaluation and at 1, 3, and 6 months postoperatively. However, there was no significant difference between the groups at the 12-month follow-up. Eight (88.9%) patients with SBME were satisfied with the LUKA surgery versus 9 (81.8%) patients without SBME, showing no significant differences between groups., Conclusion: Presence of preoperative SBME is associated with inferior functional outcomes after LUKA within six months of follow-up., Key Words: Bone marrow, Oedema, Knee, Arthroplasty, Outcome, Patient satisfaction.

Soil amendment is an important strategy for improving soil quality and crop yield. From 2014 to 2019, we conducted a study to investigate the effects of tobacco straw return with lime on soil nutrients, soil microbial community structure, tobacco leaf yield, and quality in southern Anhui, China. A field experiment was conducted with four treatments: straw removed (CK), straw return (St), straw return with dolomite (St + D), and straw return with lime (St + L). Results showed that after 5 years of application, the St + L significantly increased the soil pH by 16.9%, and the contents of soil alkaline nitrogen (N) and available potassium (K) by 17.2% and 23.0%, respectively, compared with the CK. Moreover, the St + L significantly increased tobacco leaf yield (24.0%) and the appearance (9.1%) and sensory (5.9%) quality of flue-cured tobacco leaves. The addition of soil conditioners (straw, dolomite, and lime) increased both the total reads and effective sequences of soil microorganisms. Bacterial diversity was more sensitive to changes in the external environment compared to soil fungi. The application of soil amendments (lime and straw) promoted the growth of beneficial microorganisms in the soil. Additionally, bacterial species had greater competition and limited availability of resources for survival compared to fungi. The results showed that soil microorganisms were significantly influenced by the presence of AK, AN, and pH contents. These findings can provide an effective method for improving the quality of flue-cured tobacco leaves and guiding the amelioration of acidic soil in regions where tobacco-rice rotation is practiced., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Hypertension is one of the major public health problems in China. Limited evidence exists regarding sex differences in the association between hypertension and air pollutants, as well as the impact of dietary factors on the relationship between air pollutants and hypertension. The aim of this study was to investigate the sex-specific effects of dietary patterns on the association between fine particulate matter (PM 2.5 ), ozone(O 3 ) and hypertension in adults residing in Jiangsu Province of China., Methods: A total of 3189 adults from the 2015 China Adult Chronic Disease and Nutrition Surveillance in Jiangsu Province were included in this study. PM 2.5 and O 3 concentrations were estimated using satellite space-time models and assigned to each participant. Dietary patterns were determined by reduced rank regression (RRR), and multivariate logistic regression was used to assess the associations of the obtained dietary patterns with air pollutants and hypertension risk., Results: After adjusting for confounding variables, we found that males were more sensitive to long-term exposure to PM 2.5 (Odds ratio (OR) = 1.42 95%CI:1.08,1.87), and females were more sensitive to long-term exposure to O 3 (OR = 1.61 95%CI:1.15,2.23). Traditional southern pattern identified through RRR exhibited a protective effect against hypertension in males (OR = 0.73 95%CI: 0.56,1.00). The results of the interaction between dietary pattern score and PM 2.5 revealed that adherence to traditional southern pattern was significantly associated with a decreased risk of hypertension in males (P < 0.05), while no significant association was observed among females., Conclusions: Our findings suggested that sex differences existed in the association between dietary patterns, air pollutants and hypertension. Furthermore, we found that adherence to traditional southern pattern may mitigate the risk of long-term PM 2.5 exposure-induced hypertension in males., (© 2024. The Author(s).)

Robotic surgery is known as the "third technological revolution" in the field of surgery, and is an important milestone in the development of modern surgery. However, our country's innovative surgical robot industry is still in its early stages, and it is only being utilized in certain surgical fields. To explore the effectiveness of the application of domestic surgical robot in oral and maxillofacial surgery, the author successfully completed a case of benign parotid tumor resection with the assistance of a domestic autonomous robot. The operation was successful, facial nerve function was preserved, and postoperative wound healing was good.

Following the World Health Organization's guidelines for rapid antiretroviral therapy (ART) initiation [≤7 days after human immunodeficiency virus (HIV) diagnosis], China implemented Treat-All in 2016 and has made significant efforts to provide timely ART since 2017. This study included newly diagnosed HIV adults from Tianjin, China, between 2016 and 2022. Our primary outcome was loss to follow-up (LTFU) at 12 months after enrollment. The secondary outcome was 12-month virological failure. The association between rapid ART and LTFU, as well as virological failure, was assessed via Cox regression and logistic regression. A total of 896 (19.1%) of 4688 participants received ART ≤7 days postdiagnosis. The rate of rapid ART has increased from 7.5% in 2016 to 33.3% by 2022. The rapid ART group had an LTFU rate of 3.3%, as opposed to 5.0% in the delayed group. The rapid ART group had a much reduced virological failure rate (0.6% vs. 1.8%). Rapid ART individuals had a reduced likelihood of LTFU [adjusted hazard ratio: 0.65, 95% confidence intervals (CI): 0.44-0.96] and virological failure (adjusted odds ratio: 0.35, 95% CI: 0.12-0.80). The real-world data indicated that rapid ART is practicable and beneficial for Chinese people with HIV, providing evidence for its widespread implementation and scaling up.

Purpose: This study aimed to examine associations between the employment of older people and mental health across demographic characteristics, socioeconomic conditions, and health status, with a focus on pensions., Methods: This study included 4,512 participants aged 60-69 from the CLASS in 2014. A multiple linear regression was conducted to investigate the association between employment and mental health. A causal forest model was applied to estimate the heterogeneous treatment effects., Results: Employed individuals (n = 1,295) reported better mental health than their non-employed counterparts. This association displayed significant heterogeneity, primarily attributed to pensions. Those with lower pensions may be compelled to work due to financial reasons, thus offsetting the health-promotion effect of employment., Conclusion: Employment may benefit the mental health of older adults, which has a more significant marginal effect on those who are men, older, urban residents, without a spouse, below primary education, receiving more pensions, and less family and friend support., 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. Published by Elsevier Inc.)

Objectives: This study aimed to assess the internal law and time trend of hospitalisation for oesophagogastric variceal bleeding (EGVB) in cirrhosis and develop an effective model to predict the trend of hospitalisation time., Design: We used a time series covering 72 months to analyse the hospitalisation for EGVB in cirrhosis. The number of inpatients in the first 60 months was used as the training set to establish the autoregressive integrated moving average (ARIMA) model, and the number over the next 12 months was used as the test set to predict and observe their fitting effect., Setting and Data: Case data of patients with EGVB between January 2014 and December 2019 were collected from the Affiliated Hospital of Southwest Medical University., Outcome Measures: The number of monthly hospitalised patients with EGVB in our hospital., Results: A total of 877 patients were included in the analysis. The proportion of EGVB in patients with cirrhosis was 73% among men and 27% among women. The peak age at hospitalisation was 40-60 years. The incidence of EGVB varied seasonally with two peaks from January to February and October to November, while the lowest number was observed between April and August. Time-series analysis showed that the number of inpatients with EGVB in our hospital increased annually. The sequence after the first-order difference was a stationary series (augmented Dickey-Fuller test p=0.02). ARIMA (0,1,0) (0,1,1) 12 with a minimum Akaike Information Criterion value of 260.18 could fit the time trend of EGVB inpatients and had a good short-term prediction effect. The root mean square error and mean absolute error were 2.4347 and 1.9017, respectively., Conclusions: The number of hospitalised patients with EGVB at our hospital is increasing annually, with seasonal changes. The ARIMA model has a good prediction effect on the number of hospitalised patients with EGVB in cirrhosis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Healthcare-associated infections (HAIs) represent a major threat to patient safety and are associated with significant economic burden. Calculating the costs attributable to HAIs is challenging given the various sources of bias. Although HAIs as a reasonably preventable medical harm should have been closely linked to medical insurance incentives, there was little linkage between HAIs and medicare in western China owing to the lack of economic evaluation data. The present study aimed to generate estimates of the attributable costs associated with HAIs and the magnitude of costs growth., Methods: In this cohort study designed horizontally and vertically from 2016 to 2022, we compared outcomes of randomly sampling patients with HAIs and individually matched patients without HAIs in two cohorts at a 6-year interval at 34 hospitals in western China. The primary outcome was the direct medical cost for the entire hospital stay, converted to US dollars ($ for the benchmark year), discounted at 3% annually, and estimated separately in the full analysis set (FAS) and the per protocol set (PPS). We used multiple linear regression to adjust the discounted costs and to assess subgroups effects within each cohort. We nested a dynamic vertical comparison of costs attributable to HAIs between the front and rear cohorts., Results: A total of 230 patients with HAIs in 2016 and 204 patients with HAIs in 2022 were enrolled. After a 1:1 match, all 431 pairs were recruited as FAS, of which 332 pairs as PPS met all matching restrictions. Compared to the 2016 cohort in FAS, the patients with HAIs in 2022 had a significantly older age (64.40 ± 16.45 years), higher repeat hospitalization rate (65 [32.02%] of 203), and lower immune function (69 [33.99%] of 203). The discounted costs and adjusted-discounted costs for patients with HAIs in the 2022 cohort were found to be significantly higher than those of patients without HAIs (discounted costs: $5484.60 [IQR 8426.03] vs $2554.04(4530.82), P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3040.21(1823.36), P < 0.001, respectively), and also higher than those of patients with HAIs in the 2016 cohort (discounted costs: $5484.60 [8426.03] vs $3553.00 [6127.79], P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3703.82 [3159.14], P < 0.001, respectively). In vertical comparison of PPS, the incremental costs of the 2022 cohort are 1.48 times higher than those of the 2016 cohort ($964.63(4076.15) vs $652.43 [2533.44], P = 0.084)., Conclusions: This meticulously designed study in western China has successfully and accurately examined the economic burden attributable to HAIs. Their rapidly increasing tendency poses a serious challenge to patients, hospitals, and the medical insurance. A closer linkage between HAIs and ongoing motivating system changes is urgently needed in western China., 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 © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)