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In the central Tarim Basin, numerous hydrocarbon deposits were found along ultra-deep strike-slip faults, and its evolving progress and formation mechanism are research hotspots. The Paleozoic small-angle X-type strike-slip fault in the Tabei Uplift is the research subject in this article. Based on high-precision three-dimensional seismic data, three structural deformation layers were revealed: the rift system, weak strike-slip deformation and salt tectonics in the deep structural layer (Sinian-Middle Cambrian), the strong strike-slip deformation and karst-dissolution structure in the middle structural layer (Upper Cambrian-Middle Ordovician), and echelon normal faults in the shallow structural layer (Upper Ordovician-Carboniferous). The formation and evolution of strike-slip faults is jointly controlled by the distribution pattern of basement rift and the activities of surrounding orogenic belts, which can be divided into three stages. In the Middle to Late Cambrian, the initial subduction of the Paleo-Asian and Proto-Tethyan oceans precipitated the emergence of two sets of small-angle X-type strike-slip faults, striking NW and NE above the grooves of Precambrian rifts, influenced by local weak compressive stress. Affected by the closure of peripheral paleo-ocean, strike-slip faults deformed considerably in the Middle-Late Ordovician and were reactivated in the Silurian-Carboniferous, forming en-echelon normal faults in the shallow layer. The layered deformation structure of the strike-slip faults significantly affects the accumulation of hydrocarbons. The differential hydrocarbon enrichment of faults in the Tabei Uplift is collectively influenced by the distribution of source rocks and the migration of oil and gas. The topographical features of the Tabei Uplift, along with the distribution of strike-slip faults across tectonic units, have rendered the NE direction the preferential pathway for hydrocarbon migration. Additionally, impacted by the development of en echelon faults, the NE-trending faults offer superior conditions for hydrocarbon preservation and charging condition, compared to the NW-trending faults. [ABSTRACT FROM AUTHOR]

Background: Hip fracture creates a major burden on society due to high mortality, loss of independence and excess medical costs for older people. A multidisciplinary co-managed model of care is widely considered as the best practice for the management of older patients with hip fracture. The study aims to develop a conceptual framework to inform the future scale-up of this model of care through the identification of barriers and enablers that may influence successful uptake. Methods: This qualitative study was conducted within an interventional study, which aimed to test the effectiveness of co-managed model of care for older patients with hip fracture. Health providers and health administrators from three hospitals were purposively selected and interviewed in-depth. The Consolidated Framework for Implementation Research (CFIR) was used to develop interview guides, collect and analyse data. Inductive and deductive approaches were used to generate enablers or barriers, aligned with the CFIR constructs. All barriers or enablers were inductively summarised to a conceptual framework with essential components to guide the implementation of co-managed model of care in other hospitals. Results: A total of 13 health providers and 3 health administrators were recruited. The main barriers to co-managed care implementation included perceived complexity of implementation, insufficient international collaboration and incentives, the absence of national guideline support and lack of digital health applications for communication between health providers, insufficient number of health providers and beds, and poor understanding about the effectiveness of this care model. A conceptual framework for future scale-up was then developed, consisting of the following essential components: hospital authority support, enabling environment, adequate number of beds, sufficient and skilled health providers, use of digital health technology, regular quality supervision, evaluation and feedback, and external collaborations. Conclusions: Despite the complexity of the intervention, the co-managed model of care has the potential to be implemented and promoted in China and in similar settings, although there is a need to demonstrate feasibility in different settings. [ABSTRACT FROM AUTHOR]

Aims: To compare the effects of the adoption of lateral positions and lithotomy positions during the passive and active phases of the second stage of labour on perineal outcomes. Design: An observational study with prospectively collected data, conducted in three hospitals in China. Method: Attending midwives recorded the perineal outcomes and characteristics of women giving birth between July–November 2020. Binary logistic regression was performed to explore the effects of lateral positions on perineal outcomes during different phases of the second stage of labour. The STROBE guidelines guided the reporting of this study. Results: Among primiparous women, when compared with those who adopted lateral positions during the passive phase of the second stage of labour and changed to lithotomy positions during the active phase, women who assumed lateral positions during both the passive and active phases had a higher rate of intact perineum/first‐degree perineal tears and a reduced risk of episiotomy, and episiotomy/second‐degree perineal tears. No significant difference was found in perineal outcomes between those who assumed lithotomy positions during the passive and active phases and those who adopted lateral positions during the passive phase and changed to lithotomy positions during the active phase. No significant difference was found in perineal outcomes among multiparous women, regardless of different positions adopted at the passive and/or the active phase. Conclusion: Lateral positions during the active phase may have protective effects on the perineum in primiparous women. However, adopting lateral positions only during the passive phase did not promote better perineal outcomes, regardless of parity. Relevance to clinical practice: This study will provide a further reference for the use of lateral positions during different phases of the second stage of labour among primiparous and multiparous women in clinical practice, contributing to the perineal protection during childbirth. [ABSTRACT FROM AUTHOR]

Background: There is well-established evidence to understand the characteristics of falls among the older patients with hip fracture in many countries, but very little knowledge existed in China. This study described the characteristics of falls in older patients with hip fractures from six Chinese hospitals. Methods: This cross-sectional study is a post-hoc descriptive analysis of a recently completed trial. Eligible patients were aged 65 years and older, with confirmed hip fractures due to falls, and were admitted to the hospital within 21 days of the fracture. All patients were consecutively enrolled and screened within one year (November 15, 2018, to November 14, 2019). The collected data included patient demographics and fall-related information. Results: A total of 1,892 patients' fall-related information were described. Most patients with hip fractures caused by falls were in the oldest old age group (60.4% in age group ≥ 80), with an overall average age of 80.7 (7.6) years. There were more females (n = 1,325, 70.0%) than males (n = 567, 30.0%). The majority lived in urban (n = 1,409, 74.5%). Most falls (n = 1,237, 67.3%) occurred during the daytime (6:01–18:00). There were 1,451 patients had their falls occurring at home (76.7%). Lost balance (n = 1,031, 54.5%) was reported as the primary reason to cause falls. The most common activity during a fall was walking (n = 1,079, 57.0%). Conclusions: Although the incidence of fall-related hip fractures in China is unclear, preventing falls and fall-related hip fractures in older people remains an urgent health concern as the ageing society increases. Studies with larger sample size and diverse population are needed to robustly understand this growing epidemic. [ABSTRACT FROM AUTHOR]

This study aims to investigate whether the costs spent on corporate social responsibility (CSR) can be offset, and identify the inflection point when financial returns from CSR exceed the spending. By using Principal Component Analysis, we developed the Carroll's CSR model to measure actual CSR spending. Drawing on data of 315 listed pharmaceutical firms from China, the quadratic effect was used to examine the inflection point, and the panel data regression was employed to examine the impact of CSR spending on current and subsequent financial performance. The results show that CSR spending cannot be offset in the short-term. After two years of CSR implementation, ethical-domain and overall CSR spending positively relate to return on assets (ROA), whereas legal-domain CSR spending positively affects ROA after three years of CSR implementation, all justifying that CSR spending can be offset in the long-term. This research contributes to literature by precisely recognizing the time-based inflection point in financial performance arises, which is less discussed in existing CSR studies. The study findings imply that corporate managers need to view CSR spending as capital investment rather than operating costs, and policy makers should mandate institutional arrangements to facilitate CSR. [ABSTRACT FROM AUTHOR]

Globally, populations are ageing and the estimated number of hip fractures will increase from 1.7 million in 1990 to more than 6 million in 2050. The greatest increase in hip fractures is predicted in Low- and Middle-Income Countries (LMICs), largely in the Asia-Pacific region where direct costs are expected to exceed $US15 billion by 2050. The aims of this qualitative study are to identify barriers to, and enablers of, evidence-informed hip fracture care in LMICs, and to determine if the Blue Book standards, developed by the British Orthopaedic Association and British Geriatrics Society to facilitate evidence-informed care of patients with fragility fractures, are applicable to these settings. This study utilized semi-structured interviews with clinical and administrative hospital staff to explore current hip fracture care in LMICs. Transcribed interviews were imported into NVivo 12 and analysed thematically. Interviews were conducted with 35 participants from 11 hospitals in 5 countries. We identified five themes-costs of care and the capacity of patients to pay, timely hospital presentation, competing demands on limited resources, delegation and defined responsibility and utilization of available data-and within each theme, barriers and enablers were distinguished. We found a mismatch between patient needs and provision of recommended hip fracture care, which in LMICs must commence at the time of injury. This study describes clinician and administrator perspectives of the barriers to, and enablers of, high-quality hip fracture care in LMICs; results indicate that initiatives to overcome barriers (in particular, delays to definitive treatment) are required. While the Blue Book offers a starting point for clinicians and administrators looking to provide high-quality hip fracture care to older people in LMICs, locally developed interventions are likely to provide the most successful solutions to improving hip fracture care. [ABSTRACT FROM AUTHOR]

Background: Muscle weakness is a key factor in the increase risk of falls and might also play a significant role in the increase of risk of hip fracture. Computed tomography‐measured muscle size and muscle density are well‐established imaging biomarkers used in studies of physical function, frailty or cancer, but limited to hip fracture. In particular, it is warranted to have a better understanding of the performance of muscle size and density in the discrimination of acute hip fractures. We also aim to determine age‐related differences of muscle size and density in healthy controls and hip fracture patients. Methods: Four hundred thirty‐eight low‐energy acute hip fracture cases and 316 healthy controls from the China Action on Spine and Hip Status study were included in the study. Muscle cross‐sectional area and density were measured for the gluteus maximus and gluteus medius and minimus. Areal bone mineral density (aBMD) of the femoral neck and total hip was measured. Using propensity score matching, we generated three samples with cases and controls matched for age, body mass index, and gender: femoral neck fracture (FNF), intertrochanteric fracture (ITF), and any hip fracture vs. controls, respectively. Results: Handgrip strength, gluteus muscle area and density, and bone parameters of the matched hip fracture groups were lower than those of the correspondence control groups, respectively (P < 0.05). The univariate analysis showed that associations of aBMD with FNF and with ITF were significantly weaker than associations between fracture and muscle parameters. Gluteus medius and minimus muscle density showed the highest areas under the curve (AUC) with FNF (0.88, 95% confidence interval, 0.85–0.92) and trochanteric fracture (0.95, 95% confidence interval, 0.92–0.97). The model including all muscle and bone parameters provided the highest AUC (FNF: AUC 0.912; ITF: AUC 0.958), and AUC results of another selected model without muscle density showed that association with fracture significantly dropped (FNF: AUC 0.755; ITF: AUC 0.858). Separate results for the two age groups younger and older than 70 years showed no age‐related significant differences in discriminate models. Conclusions: Muscle density performs better than aBMD from hip computed tomography X‐ray absorptiometry and muscle size in discrimination of hip fracture. Combination of aBMD and muscle density provided the best discrimination. The integration of muscle assessments may trigger a paradigm shift in hip fracture prediction. Gluteus muscle density should also be evaluated as treatment outcome. [ABSTRACT FROM AUTHOR]

Objective. To investigate the predictive factors associated with rapid progressive chronic kidney disease (CKD) in patients with primary glomerular disease (PGD). Methods. Baseline data, clinical biochemistry, laboratory data, and imaging data were collected from 112 PGD patients in CKD stages 3 and 4 who were hospitalized at the Third Xiangya Hospital. Patients were divided into rapid progression group (Group R) and no rapid progression group (NR) according to the definition of rapid progression of CKD. Results. The age, systolic blood pressure (SBP), serum β2-microglobulin (sβ2-MG), urinary α1-microglobulin (uα1-MG), and cardiothoracic ratio (CTR) of the R group were significantly higher than the NR group. However, the size of the kidney, high-dense lipoprotein (HDL), hemoglobin (Hb), and hematocrit of the R group were significantly lower than the NR group (P < 0.05). Binary logistic regression analysis showed that baseline CTR, SBP, size of the kidney, and HDL were independent risk factors for rapid progression of PGD. At the end of follow-up, CTR and SBP of group R were higher than the NR group, and the size of the kidney and HDL of group R were lower than the NR group. Conclusion. Increased baseline CTR and SBP and decreased baseline HDL and renal volume could be the predictors of rapid progression in patients of PGD at the CKD stages 3 and 4. [ABSTRACT FROM AUTHOR]

Background and Purpose: In recent years, the frequent occurrence of occupational accidents, illness, and injuries has become a major issue in China. This study aims to investigate the relationship between the adoption of Occupational Health and Safety Management System (OHSMS) standards and financial performance, with a particular focus on the pharmaceutical firms in China. Methods: The study is based on a sample consisting of 125 pharmaceutical firms listed on the Shanghai and the Shenzhen stock exchanges in China for the period 2010– 2018. Each sample firm was evaluated by whether and when it is certified by an OHSMS standard depending on secondary data collected from an independent certification database. Panel-based regression models were employed to explore whether adoption of an OHSMS standard has had an impact on financial performance. Results: The regression results reveal that the adoption of an OHSMS standard positively affects contemporaneous financial performance measured by return on assets (ROA), return on equity (ROE), and earnings per share (EPS). Mixed results were found when financial performance indicators were extended by two years, suggesting that ROE will increase in the second year after a firm is certified with the standard, but EPS will decline in the third year. Conclusion: The study findings empirically show that adoption of an OHSMS standard contributes to better financial performance for pharmaceutical firms of China in the short term. However, executives of pharmaceutical firms need to be aware of the increased costs related to certification renewal and audit in the following periods and exercise their management discretion to achieve a win–win situation between OHSMS implementation and financial benefit. [ABSTRACT FROM AUTHOR]

• The TTG, sanukitoids, and plagioclase-amphibolite gneiss were formed at ∼ 2.51–2.46 Ga. • The NOB might be in a transition stage from a compressional regime to an extensional regime during ∼ 2.51–2.46 Ga. • The NOB is in a long-term active continental margin setting during ∼ 2.51–1.95 Ga. The most poorly exposed and least understood in the North China Craton (NCC) lies largely hidden beneath the Ordos Basin, severely limiting the cognition of the Precambrian tectonic evolution in the western NCC and the tectonic division. Diverse orthogneiss samples collected from four boreholes drilled into the basement of the north side of Hangjinqi Fault Zone (HFZ) in the North Ordos Basin (NOB) are investigated by integrating zircon U-Pb dating, Hf-Nd isotopes, and whole-rock geochemical analyses. The TTG gneiss, quartz-monzonite gneiss, granodiorite gneiss, and amphibolite were emplaced at ca. 2.51–2.46 Ga, of which the amphibolite also recorded the metamorphic age of ca. 1.95 Ga. The TTG gneisses display low MgO, Mg#, Cr, and Ni, high HREE and Rb/Sr, enrichment of LILEs and depletion of Nb, Ta, and Ti, and positive εNd(t) (2.04–4.06) and εHf(t) (3.04–7.59) values, suggesting that they were mainly originated from partial melting of the tectonically thickened mafic island-arc crust. In contrast, the quartz monzonite gneisses and granodiorite gneisses show the geochemical features of Archean sanukitoids with higher MgO, Mg#, Cr, and Ni, and similar ε Nd (t) (1.34–3.82) and ε Hf (t) values (3.94–7.32), suggesting that they were derived from the partial melting of the mantle metasomatized by fluids and melts of the subduction. The amphibolites exhibit a mixed characteristic of E-MORB and arc-like geochemical affinities resembling the Mariana back-arc basin, which was derived from the partial melting of spinel lherzolite. The arc and arc-back lithological assemblages suggest that the north margin of the NOB might be in a geodynamic transition period from a compressional regime correlated with plate subduction to an extensional regime correlated with slab rollback during ca. 2.51–2.46 Ga. Combined with previous analytical results, the northern margin of the NOB was most likely in a long-term active continental margin setting during 2.51–1.95 Ga and involved in the collision event between the Yinshan Block and Ordos Block at ca. 1.95 Ga. [ABSTRACT FROM AUTHOR]

Highlights: [•] A right-lateral transtentional fault zone of the northern Ordos basin is described. [•] The segments of HFZ separated by relay ramps are established. [•] Two distinct tectonic phases of the HFZ in the negative inversion is identified. [•] Inversion is related to activity of South China and paleo-Pacific plates, respectively. [Copyright &y& Elsevier]

Abstract: Three biphenanthrene compounds (1–3) and a triphenanthrene compound (4), together with six known biphenanthrene compounds (5–10), were isolated from the tubers of Monomeria barbata Lindl. Their structures were elucidated on the basis of extensive spectroscopic analysis (1D-, 2D-NMR, and HR-ESI-MS). These four new compounds were tested in vitro for the cytotoxic activity against liver carcinoma (HepG-2), promyelocytic leukaemia (HL60), ovarian carcinoma (Skov-3) and epidermoid carcinoma (A431) cancer cell lines and the antioxidant activity in DPPH radical scavenging. Compounds 1–4 exhibited significant cytotoxic activity against HepG-2 and HL60 cell lines, and potent antioxidant activity in DPPH radical scavenging. [Copyright &y& Elsevier]

Sustainability of the workforce becomes a crucial issue, of which responsible care for employees can increase job satisfaction and human capital that impact corporate ability to absorb and generate new knowledge. Firms are obligated to provide a healthy and safe working environment for their employees, but it may in turn hinder innovation due to rigid and structured institutional regulations. Drawing on data of 308 China's pharmaceutical firms from 2010 to 2017, we investigated whether employee care can trigger innovation under corporate adoption of the occupational health and safety management system (OHSMS). Our results suggest that both employee care and OHSMS adoption have a positive impact on innovation. Moreover, the positive relationship between employee care and innovation was more pronounced in firms that had adopted the OHSMS certification. These findings are valuable to policymakers and corporate managers in emerging economies through corroborating the important role of workforce sustainability in facilitating firm innovation. [ABSTRACT FROM AUTHOR]

A giant gas field has been discovered in the Lower Shihezi Formation in the Hangjinqi area, northern Ordos Basin, China. Coal seams and mudstone in the Taiyuan and Shanxi Formation are considered as source rocks and sandstone in the Lower Shihezi Formation is treated as reservoirs for gas. The charging time in the sandstone reservoirs was studied based on the homogenization temperature of aqueous inclusions, thermal and burial history simulation and K-Ar dating of authigenic illite. Two episodes of gas charging in the northern part and one episode in the southern part were delineated in the reservoirs of the Hangjinqi area, evidenced by microscopic observation of the occurrence of fluid inclusions and the analysis of salinity in aqueous inclusions. In the southern part of the study area gas charging occurred between circa 171-162 Ma, whereas in the northern part gas charging was between 158-144 Ma and 120-109 Ma, respectively. The gas charging events appeared to be influenced by the tectonic evolution of northern Ordos Basin. Paleo topography caused reduction in thickness of source rocks northwards, and contributed to differences in hydrocarbon generation potential and thermal evolution between the northern and the southern part of the study area. Therefore, gas charging occurred in the southern part prior to that in the northern part. Furthermore, tilting occurred in Middle Jurassic and provided the driver and pathways for gas, leading to a first charging event in the northern part of the study area. • Porjianghaizi Fault was affirmed as demarcation in discussion on gas charging stages. • Effect of paleo topography and uplift on gas charging stages was confirmed. • Two stages and one stage of gas charging were ascertained, respectively in northern part and southern part of research area. • Hydrocarbon source of two stages in northern part was considered as southern part hydrocarbon and local source rock. [ABSTRACT FROM AUTHOR]

Organic-rich rocks have received increasing attention for they are essential for evaluating hydrocarbon potential and unravelling the interaction between Earth surface environments and the biosphere. In this paper, we performed a combination of mineralogical, inorganic and organic geochemical analyses on a 200-m core of the Permian Lucaogou Formation organic-rich rocks obtained from Santanghu Basin, NW China, to investigate paleoenvironmental conditions, organic matter accumulation, and hydrocarbon potential. The redox- and salinity-sensitive proxies (e.g. V/Cr, V/(V + Ni) and Sr/Ba, Rb/K, B/Ga, and B content), together with the wide distribution of pyrite and carbonate minerals in these dark, thinly laminated organic-rich rocks, suggest that dysoxic-anoxic, brackish-saline, alkaline conditions prevailed during the deposition of the Lucaogou Formation in the Santanghu Basin. The occurrence of hydrothermal minerals, including strontianite and barite, and enrichments of B (up to 158.0 ppm), Mn (up to 1291 ppm), and certain incompatible elements (Li (up to 923 ppm), Rb (up to 848 ppm), Sr (up to 1760 ppm), Hf (up to 12.7 ppm)) as well as Ni vs. Co vs. Zn and Fe vs. Mn vs. (Cu + Co + Ni) × 10 ternary diagrams demonstrate that the Lucaogou Formation received hydrothermal input during deposition, which suggests hydrothermalism was the source of brine that has caused the salinization of the water column. The positive correlation of HI value and TOC content, together with redox-sensitive proxies, illustrates primary productivity in surface water and preservation in anoxic bottom water collectively contributed to the enrichment of organic matter. Moreover, the positive correlation between silicate mineral content and TOC content and the negative correlation between carbonate content and TOC content suggest that terrigenous input as the main source of nutrients promoted organic matter accumulation, while carbonate constituents acted as a diluent to organic matter accumulation during deposition of the Lucaogou Formation. The faint positive correlation between TOC content and hydrothermal intensity indicator (Cr/Zr) seems to indicate that hydrothermal fluids may provide an additional source of nutrients for organic matter accumulation. In addition, the oil generation capacity of Lucaogou Formation, with abundant oil-prone organic matter (Type I/II 1 kerogen with HI values ranging from 421.18–918.41 mg HC/g TOC) in the early mature to mature stage (T max values ranging from 435 to 451 °C), is considerable. The Rock-Eval oil saturation index (OSI S 1 /TOC × 100) values range from 6.04–164.07 mg HC/g TOC, suggesting the Lucaogou Formation contains producible oil. The high brittle mineral (including quartz and carbonates) contents (> 50% wt%) and traces of clay minerals (< 5 wt%) imply that the Lucaogou Formation is likely to respond well to hydraulic stimulation. Consequently, the Lucaogou Formation in Santanghu Basin is expected to be a potential lacustrine shale oil play. [ABSTRACT FROM AUTHOR]

Objective To assess the effectiveness of a three-stage intervention to reduce caesarean deliveries in a Chinese tertiary hospital. Methods A retrospective study was conducted to assess whether educating staff, educating patients and auditing surgeon practices (introduced in 2005) had reduced caesarean delivery rates. Multiple logistic regression was used to check for a potential association between caesarean rates and rates of admission to the neonatal intensive care unit (NICU). Findings The caesarean delivery rate ranged from 53.5% to 56.1% in 2001-2004 and from 43.9% to 36.1% in 2005-2011. When 2001-2004 and 2005-2011 were treated as "before" and "after" periods to evaluate the intervention's impact on the mean caesarean section rate, a significant reduction was noted: from 54.8% to 40.3% (odds ratio, OR: 0.56; 95% confidence interval, CI: 0.52-0.59; χ2 test: P < 0.001). The overall drop in the caesarean section rate was significant (χ2 test: P < 0.001) and inversely correlated with the years (Spearman's p: -0.096; P < 0.001). Although complicated pregnancies increased after 2004, the primary caesarean section rate decreased annually by 20% on average in 2005-2011, after practice audits were implemented. Multiple logistic regression showed a positive association between the caesarean delivery rate and the rate of admission to the NICU (adjusted OR: 1.26; 95% CI: 1.14-1.40). Conclusion Patient and staff education and practice audits reduced the Caesarean section rate in a tertiary referral hospital without an increase in admissions to the NICU. [ABSTRACT FROM AUTHOR]

China has made impressive progress in improving maternal and child health nationally, although national progress might conceal inequality across regions within China. Mortality ratios in western counties remains high, and midwives in western areas are in extreme shortage as guarantors of maternal and child safety. This study aims to investigate the current situation for the midwifery service in western China and to explore the demand for midwifery human resources in the area using the Birthrate Plus workforce planning methodology. First, we did a cross-sectional survey in 28 hospitals in three western provinces—Yunnan (southwest China), Inner Mongolia (northern China), and Xinjiang (northwest China)—to investigate the status of the midwifery service and midwifery human resources using a tailored questionnaire. We selected two tertiary hospitals in each province, as well as eight secondary hospitals in Yunnan, six in Inner Mongolia, and 14 in Xinjiang, to reflect population sizes (according to the National Health and Family Planning statistical yearbook). Questionnaires were sent to midwifery managers in the 34 hospitals, and 28 returned the questionnaire (all six tertiary hospitals, seven secondary hospitals in Yunnan, five in Inner Mongolia, and ten in Xinjiang). Second, we analysed medical records from all women attending the midwifery departments of the 28 hospitals (n=18 520) who received midwifery services in 2017 and 2018, and the Birthrate Plus workforce planning methodology was used, with modifications, to calculate demand for midwives in each hospital. Women were divided into five categories according to the Birthrate Plus guidelines (of which categories I and II were natural deliveries with no need for intervention, and categories III–V required different levels of intervention). Two core elements were analysed: the percentage of maternity patients in each category and midwifery service time (time in the delivery suite, from admission in labour to leaving for the postnatal unit or operating room for caesarean section) in each category. Each hospital gave informed verbal consent. The study was approved by the Peking University institutional review board office. The maximum and minimum annual delivery volumes per hospital were 12 048 and 192, respectively. The highest and lowest caesarean section rates were 59·00% (472 of 794) and 20·86% (907 of 4345), respectively, and the average caesarean section rate was 38·49% (SD 10·33). A total of 476 midwives in 28 hospitals were included. 94·34% (417 of 476) of the midwives had an initial educational level below a bachelor's degree, and 69·75% (332 of 476) had less than 10 years of work experience. Data from a total of 18 520 maternity patients from 28 hospitals were eligible for analysis. According to the Birthrate Plus results, 37·2% (6890 of 18 520) maternity patients were in category I/II (grouped together for comparison), 42·1% (7804 of 18 520) in category III, 18·1% (3343 of 18 520) in category IV, and 2·6% (483 of 18 520) in category V, and midwifery service times of each category were 6·79 h, 9·92 h, 9·89 h, and 11·93 h, respectively. The actual number of midwives in the majority of hospitals (67·86%, 19 of 28) exceeded the calculated demand, while that in 21·43% of hospitals (six of 28) was less than the calculated demand, and in 10·71% of hospitals (three of 28) the actual number of midwives was consistent with the calculated demand. The midwifery service varied between hospitals in western China. Given that inexperience or lack of education negatively affect the core competencies of midwives, it is likely that these factors affected the midwifery service that patients received. Efforts are needed to promote the construction of midwifery teams. Most maternity patients belonged to categories I–III, and gave birth naturally or with less need for interventions. However, women in categories IV and V, who represented a small proportion of the overall data set, experienced pregnancy complications or required more interventions than those in categories I–III, and thus tended to require longer midwifery hours. The surveyed hospitals varied in type (general hospitals, and maternity and child health hospitals) and level, and provided services for different numbers of each category of maternity patient, and thus the midwifery service time varied accordingly. For example, there were more maternity patients in categories IV and V in general hospitals than in maternal and child health hospitals, which suggests that more midwives may be required in general hospitals to care for the same number of maternity patients. Therefore, it is necessary to fully consider the service characteristics of hospitals when allocating midwifery human resources. Our findings suggest that Birthrate Plus workforce planning methodology can be used to accurately assess workload of midwives based on the status of the midwifery service in China. Its applicability as a midwifery demand assessment tool in western China should be explored further. This study was funded by the UN Children's Fund (Maternal and Child Health Management Information System). [ABSTRACT FROM AUTHOR]

Background: Associations of dietary sodium and potassium intake with fracture risk are inconsistent and the effects of salt substitute on fracture incidence are unknown. We assessed the effect of salt substitute compared to regular salt intake on fracture incidence using data from the Salt Substitute and Stroke Study (SSaSS)., Methods: SSaSS was a cluster-randomized controlled trial conducted in 600 villages in northern China. Villages were randomly allocated into intervention and control groups in a 1:1 ratio. Salt substitute was provided to intervention villages and control villages continued regular salt use for 5 years. The primary outcome for this secondary analysis was the incidence of all fractures. Secondary outcomes included incidence of vertebral fracture, non-vertebral fracture, and fracture of unknown or non-specific location., Results: 20,995 participants were included in this study, and 821 fractures occurred during follow-up. Intention-to-treat analyses showed no differences between the salt substitute and regular salt groups in the incidence of all fractures (rate ratio (RR) 0.96; 95% CI 0.81 to 1.14), vertebral fracture (RR 0.82; 95% CI 0.53 to 1.26), non-vertebral fracture (RR 1.05; 95% CI 0.86 to 1.29), or fracture of unknown or non-specific location (RR 0.80; 95% CI 0.54 to 1.18)., Conclusions: Use of salt substitute compared to regular salt had no detectable effect on the incidence of fracture in a population at high risk of cardiovascular disease and fracture., Trial Registration: ClinicalTrials.gov, NCT02092090. Registered on March 12, 2014., (© 2024. The Author(s).)

Aims: Maternal positions during childbirth play an important role in safe vaginal births and might also influence women's childbirth experiences greatly. Lateral positions, as a potential position to reduce negative maternal and neonatal outcomes, have become popular in recent years, especially in China where the adoption of conventional lithotomy positions is still common. However, the childbirth experience of those who gave birth in lateral positions has been rarely studied. This study aimed to describe and compare women's childbirth experiences of adopting the newly introduced lateral positions and the conventional lithotomy positions during the second stage of labour., Study Design: A cross-sectional study was conducted in two tertiary hospitals in China involving a total of 658 primiparous and parous women who adopted lateral and lithotomy positions during the second stage of labour from July to November 2020. Sociodemographic characteristics, maternal and neonatal outcomes as well as childbirth experience assessed by the Childbirth Experience Questionnaire (CEQ) were collected. This study followed the STROBE guidelines., Results: Women who once adopted lateral positions during the second stage of labour had better positive childbirth experiences compared with those in the lithotomy positions group, as demonstrated by their overall higher CEQ scores. Women in the lateral position group also reported better participation and perceived safety, and a greater sense of control during childbirth. Lateral positions remained an influential factor in CEQ scores after controlling for potential confounders. In this study, adverse maternal and neonatal outcomes were rare. Women in lateral positions had comparatively better perineal outcomes., Conclusion: This study described and compared women's childbirth experiences of adopting conventional lithotomy positions and lateral positions during the second stage of labour using a valid instrument. Women who adopted lateral positions during the second stage of labour reported better childbirth experiences than those giving birth in the conventional lithotomy positions. Thus, assisting women in giving birth in lateral positions might be a promising way to improve women's childbirth experience., 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 Ltd.)

Accurate cannulation of the adrenal vein is challenging during adrenal venous sampling (AVS) because of the variations in adrenal vein anatomy. This study aimed to investigate the adrenal venous morphology in Chinese and improve the success rate of AVS. A total of 221 participants with primary aldosteronism (PA) who underwent AVS were enrolled. Compare the morphology among subgroups divided according to sex, body mass index (BMI), and with or without adenoma. The success rate of right, left, and bilateral AVS was 98.60%, 97.20%, and 96.85%, respectively. The triangular pattern was the most common (39.37%) on the right side, while the glandlike pattern (70.14%) on the left. The proportion of adrenal venous morphology varies among patients with different sexes (χ 2  = 21.335, P < .001), BMI (χ 2  = 10.642 P = .031), and with or without adenoma (χ 2  = 10.637, P = .031) on the right side, and the male, obese and adenoma group showed a higher proportion of glandlike pattern than triangular pattern. If only dependent on computed tomography, 9.05% of patients incorrectly diagnose the dominant side, 14.48% of patients would have inappropriate surgery meanwhile 25.34% of patients would miss the surgical opportunity. In conclusion, the most common types of right and left adrenal venous morphology were triangular pattern and glandlike pattern, respectively. Sex, BMI, and the presence of adenoma affected right adrenal venous morphology. Adequate knowledge of the adrenal venous morphology is critical for improving the success rate of AVS and making an appropriate treatment for PA., (© 2024 The Author(s). The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

Methods: Related studies on PD and ferroptosis were searched in Web of Science Core Collection (WOSCC) from inception to 2023. VOSviewer, CiteSpace, RStudio, and Scimago Graphica were employed as bibliometric analysis tools to generate network maps about the collaborations between authors, countries, and institutions and to visualize the co-occurrence and trends of co-cited references and keywords., Results: A total of 160 original articles and reviews related to PD and ferroptosis were retrieved, produced by from 958 authors from 162 institutions. Devos David was the most prolific author, with 9 articles. China and the University of Melbourne had leading positions in publication volume with 84 and 12 publications, respectively. Current hot topics focus on excavating potential new targets for treating PD based on ferroptosis by gaining insight into specific molecular mechanisms, including iron metabolism disorders, lipid peroxidation, and imbalanced antioxidant regulation. Clinical studies aimed at treating PD by targeting ferroptosis remain in their preliminary stages., Conclusion: A continued increase was shown in the literature within the related field over the past decade. The current study suggested active collaborations among authors, countries, and institutions. Research into the pathogenesis and treatment of PD based on ferroptosis has remained a prominent topic in the field in recent years, indicating that ferroptosis-targeted therapy is a potential approach to halting the progression of PD., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Chen et al.)

Background: To explore the diagnostic accuracy and the optimal cutoff value between the saline infusion test (SIT) and captopril challenge test (CCT) [including the value and suppression of plasma aldosterone concentration (PAC)] for primary aldosteronism (PA) diagnosing., Methods: A total of 318 patients with hypertension were consecutively enrolled, including 126 patients with PA and 192 patients with essential hypertension (EH), in this observational study. The characteristics of patients and laboratory examinations were collected and compared. The comparison between SIT and CCT was carried by drawing the receiver operator characteristic curve (ROC) and calculating the area under the curve (AUC) to explore the diagnostic accuracy and the optimal cutoff value., Results: The average age was 51.59 ± 10.43 in the PA group and 45.72 ± 12.44 in the EH group ( p <0.05). The optimal cutoff value was 10.7 ng/dL for post-CCT PAC, 6.8 ng/dL for post-SIT PAC, and 26.9% for suppression of post-CCT PAC. The diagnostic value of post-CCT PAC was the highest with 0.831 for the AUC and 0.552 for the Youden index. The optimal cutoff value for patients who were <50 years old was 11.5 ng/dL for post-CCT PAC and 8.4 ng/dL for post-SIT PAC. The suppression of post-CCT PAC turned to 18.2% for those of age 50 or older., Conclusion: Compared with SIT, CCT had a higher diagnostic value when post-CCT PAC was used as the diagnostic criterion in Chinese people, while the selection of diagnostic thresholds depended on patient age., 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 Sun, Gong, Yu, Yang, Zhang, Jiang and Song.)

Objective: To evaluate the clinical effectiveness of orthogeriatric co-management care in long-lived elderly hip fracture patients (age ≥ 90)., Methods: Secondary analysis was conducted in long-lived hip fracture patients between 2018 to 2019 in 6 hospitals in Beijing, China. Patients were divided into the orthogeriatric co-management group (CM group) and traditional consultation mode group (TC group) depending on the management mode. With 30-day mortality as the primary outcome, multivariate regression analyses were performed after adjusting for potential covariates. 30-day mobility and quality of life were compared between groups., Results: A total of 233 patients were included, 223 of whom completed follow-up (125 in CM group, 98 in TC group). The average age was 92.4 ± 2.5 years old (range 90-102). The 30-day mortality in CM group was significantly lower than that in TC group after adjustments for (2.4% vs. 10.2%; OR = 0.231; 95% CI 0.059 ~ 0.896; P = 0.034). The proportion of patients undergoing surgery and surgery performed within 48 h also favored the CM group (97.6% vs. 85.7%, P = 0.002; 74.4% vs. 24.5%, P < 0.001; respectively). In addition, much more patients in CM group could walk with or without aids in postoperative 30 days than in the TC group (87.7% vs. 60.2%, P < 0.05), although differences were not found after 1-year follow-up. And there was no significant difference in total cost between the two groups (P > 0.05)., Conclusions: For long-lived elderly hip fracture patients, orthogeriatric co-management care lowered early mortality, improved early mobility and compared with the traditional consultation mode., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Ecosystem services (ESs) have received widespread attention worldwide for their potential to solve sustainability issues. However, extensive land use and land cover change (LUCC) driven by human activities has raised concerns regarding its impacts on ESs, especially in coastal zones. More importantly, spatial-temporal changes, their coupling relationships with LUCC, and their underlying drivers have not been thoroughly analyzed. This study focuses on China's coastal zones to investigate the spatial-temporal changes of ecosystem service multifunctionality (ESM) from 2000 to 2018. Coupling coordination degree (CCD) analysis of the relationship between ESM and comprehensive intensity of land use was applied to identify coastal cities with low-level coordination and their main drivers in 2018. The results show that: (1) the proportion with high levels of ESM decreased by 1.01% from 2000 to 2010 and then increased by 3.29% from 2010 to 2018; (2) the ESM of China's coastal zones present significant spatial heterogeneity, and the low levels of ESM are mainly distributed in the north and urban areas, while most areas in the southern coastal zones have high levels of ESM; (3) forest land is the leading land cover type for ESM, and China's forest conservation policies significantly contribute to the increase in ESM; (4) the CCD of most cities in the southern coastal zones, apart from Shanghai and the Pearl River Delta, is at a relatively high level and experiences no significant changes, while most cities in the northern coastal zones display an improving trend; (5) the land use type, landform type, and leaf area index are the determinants of ESM, and the annual average temperature, population density, and surface elevation are the greatest influences on the CCD. The findings of this study can inform ecological conservation and landscape planning and are beneficial to the sustainable development of coastal zones in 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 © 2021 Elsevier B.V. All rights reserved.)

Background: The incidence of hand foot and mouth disease (HFMD) has increased in recent years, making it a very common childhood illness worldwide. The relationship between different enterovirus genotypes and disease severity is not clearly understood. Given that enteroviruses are transmitted through the gastrointestinal tract, we hypothesized that variation in intestinal microorganisms of the host might play a role in the prognosis of HFMD., Methods: We carried out a meta-transcriptomic-wide association study of fecal samples obtained from a cohort of children (254 patients, 227 tested positive for enterovirus, including 16 patients co-infectied with 2 kinds of enterovirus) with mild and severe HFMD and healthy controls., Results: We found there was no significant difference in the amount of each virus type between the mild and severe cases. Genes of enterovirus 71 (EV71) and coxsackievirus A (CV-A) from the severe and mild cases did not show significant clustering. Clostridium sp. L2-50 and Bacteroides stercoris ATCC 43183 were enriched in the guts of children with severe HFMD and KEGG enrichment was found between mild and severe cases., Conclusions: Intestinal microorganisms appear to interact with enterovirus to determine the progression of HFMD. Genes of Bacteroides and Clostridium may be used as predictive markers for a more efficient prognosis and intervention. The enrichment of intestinal bacteria genes with functions may facilitate the development of severe symptoms for HFMD patients., (© 2021. The Author(s).)

Background: Thousands of Coronavirus Disease 2019 (COVID-19) patients have been discharged from hospitals Persistent follow-up studies are required to evaluate the prevalence of post-COVID-19 fibrosis., Methods: This study involves 462 laboratory-confirmed patients with COVID-19 who were admitted to Shenzhen Third People's Hospital from January 11, 2020 to April 26, 2020. A total of 457 patients underwent thin-section chest CT scans during the hospitalization or after discharge to identify the pulmonary lesion. A total of 287 patients were followed up from 90 to 150 days after the onset of the disease, and lung function tests were conducted about three months after the onset. The risk factors affecting the persistence of pulmonary fibrosis were identified through regression analysis and the prediction model of the persistence of pulmonary fibrosis was established., Results: Parenchymal bands, irregular interfaces, reticulation and traction bronchiectasis were the most common CT features in all COVID-19 patients. During the 0-30, 31-60, 61-90, 91-120 and > 120 days after onset, 86.87%, 74.40%, 79.56%, 68.12% and 62.03% patients developed with pulmonary fibrosis and 4.53%, 19.61%, 18.02%, 38.30% and 48.98% patients reversed pulmonary fibrosis, respectively. It was observed that Age, BMI, Fever, and Highest PCT were predictive factors for sustaining fibrosis even after 90 days from onset. A predictive model of the persistence with pulmonary fibrosis was developed based-on the Logistic Regression method with an accuracy, PPV, NPV, Sensitivity and Specificity of the model of 76%, 71%, 79%, 67%, and 82%, respectively. More than half of the COVID-19 patients revealed abnormal conditions in lung function after 90 days from onset, and the ratio of abnormal lung function did not differ on a statistically significant level between the fibrotic and non-fibrotic groups., Conclusions: Persistent pulmonary fibrosis was more likely to develop in patients with older age, higher BMI, severe/critical condition, fever, a longer viral clearance time, pre-existing disease and delayed hospitalization. Fibrosis developed in COVID-19 patients could be reversed in about a third of the patients after 120 days from onset. The pulmonary function of less than half of COVID-19 patients could turn to normal condition after three months from onset. An effective prediction model with an average area under the curve (AUC) of 0.84 was established to predict the persistence of pulmonary fibrosis in COVID-19 patients for early diagnosis., (© 2021. The Author(s).)

Objective: Upright positions are recommended by many international organizations due to their positive effects on improving birth outcomes. The effects can only be achieved when upright positions are properly adopted by women under the guidance of midwives. However, whether midwives in China have a clear understanding of upright positions during the second stage of labour is an issue that has not been explored. The aim of this study was to explore midwives' perceptions on assisting women in upright positions during the second stage of labour in the context of China., Design: A qualitative descriptive design was adopted. We analysed the data using the conventional content analysis and reported the study in line with the COREQ checklist., Setting: The study was conducted at the labour wards of two maternity hospitals and two general hospitals in China where the adoption of upright positions was encouraged during the second stage of labour., Participants: Semi-structured individual interviews with 17 midwives were conducted between May and July 2020., Findings: Three main themes were identified: (1) safety and availability; (2) unclear method of implementation; (3) lack of knowledge of the potential risks and precautions. Midwives' perceptions were based primarily on clinical experience rather than evidence-based practice. Their perceptions on the indications and contraindications of upright positions were divergent and ambiguous. Midwives' suggested that the indications and contraindications should be adjusted in the context of China. Time limit for keeping an upright position and maternal pushing during uterine contractions were two questions that still confused midwives. Midwives lacked knowledge of the potential risks of upright positions and rarely systematically summarized the precautions., Key Conclusions: This study shows that assisting women to give birth in upright positions during the second stage of labour can be a challenge for midwives in China, and also highlights the need for clarifying the detailed implementation methods of upright positions in the context of China by evidence-based approaches., Implications for Practice: An evidence-based protocol for implementing upright positions during the second stage of labour should be developed to guide midwives' practice and facilitate the successful use of upright positions in China., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2021. Published by Elsevier Ltd.)

Ecological conservation red line (ECRL) is gaining increasing academic attention as delimiting the minimum space scope of ecological protection and the bottom line of ecological security. Taking Nanjing as a case study, we divided the territory into ecological and non-ecological redline areas (ERAs and NERAs, respectively). This paper highlights two key research issues based on the 2005, 2010, 2015 and 2018 annual remote sensing data: (i) quantitative analysis of the Ecological Redline Policy (ERP) validity by conducting a horizontal comparison of the ERAs and NERAs; and (ii) exploration of the land-use transitions and spatial pattern changes affecting ecosystem service value (ESV). Results showed that delineating ECRL could effectively slow down the decline rate of ESV. The trend of eco-quality deterioration was greater than eco-quality improvement in Nanjing, presenting an ESV that declined slightly in the whole. According to our findings, we suggest that reasonably increasing eco-lands (woodland and water area) and decreasing construction land will enhance the regional ESV. Meanwhile, promoting the transition from production space to ecological space and depressing the encroachment of living space on other space types, will be instrumental in mitigating the ESV decline. The results of this study are expected to provide valuable implications for spatial planning and sustainable development in Nanjing.

In elderly subjects and in particular in those with osteoporosis the evidence on age related volume changes of the hip is still very limited. Even less is known about bone changes of the femoral head. The aim of this study is to explore associations of bone size of the femoral head and neck with age in postmenopausal women with very high risk of hip fracture and to investigate associations of femoral head and neck bone mineral density. MIAF (medical image analysis framework)-Femur was used for the analysis of CT datasets from 319 females with acute hip fractures age 50 to 98. Integral BMD and volume of the head and neck were assessed. The femoral head was divided into four quadrants to address differential vBMD and volume responses of its superior, inferior, posterior and anterior parts. Areal BMD (aBMD) of femoral neck was also obtained. In this population of postmenopausal women we did not observe age-related changes in bone volume of the femoral head or neck between ages 50 and 98 years. Integral vBMD in the head in the 90-98 year group was 48.0 mg/cm 3 lower than that in 50-59 year group, which accounts for nearly 30% decrease in vBMD with 40 years increase. Age-related vBMD changes in the head quadrants were similar to that in total. With age, the trend line correlation coefficients for vBMD in quadrants were relatively small, but significant (p < 0.001) for all. The femoral head integral vBMD correlates well with neck vBMD and FN aBMD. FN aBMD explained 45% of head integral vBMD variance (p < 0.0001). Elderly women had relative preservation of femoral head and neck bone volume from 50 yrs. over four decades but markedly lower integral vBMD of proximal femur. The findings of our study call in question about the concept of bone expansion with aging even in elderly age., Competing Interests: Declaration of competing interest Klaus Engelke is a part time employee of BioClinica, Inc. Other authors declare that they have no conflict of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)

This qualitative study identified the barriers to the implementation of a multidisciplinary co-management program for older hip fracture patients and provided evidence for future intervention improvement and scale-up., Introduction: Multidisciplinary co-management has been recommended as an effective intervention for hip fracture management in older people. This study is a process evaluation of a multidisciplinary co-management program in an orthopaedic hospital in Beijing, China, to better understand the barriers to implementation., Methods: Data collection involved semi-structured interviews with key implementers of the co-management intervention (surgeon, geriatrician, physician, nurse, physiotherapist and anaesthetist) and observations of patients' journey to map the care processes were conducted in Beijing Jishuitan Hospital. Data were transcribed, qualitatively coded and analysed using normalization process theory to understand the intervention process from four constructs: coherence, cognitive participation, collective action and reflexive monitoring., Results: Ten stakeholder interviews were conducted. Despite multidisciplinary co-management intervention was meaningful and valued by participants, barriers to its implementation were identified. These included unmatched investment and benefit (cognitive participation), challenges of facing increased workload (collective action), deficient training and supervision system (collective action), limited accommodating capacity of hospital (collective action) and difficulties in accessing information about the effect of the intervention (reflexive monitoring)., Conclusions: Multiple barriers to the effective implementation of the multidisciplinary co-management program in China were identified. The process evaluation highlights key aspects in less willingness to fully invest in the program, inappropriate workload allocation and lack of training and supervision which need to be addressed before scaling up.

Systemic lupus erythematosus (SLE) is a chronic systematic autoimmune disease. Current methods of diagnosing SLE or evaluating its activity are complex and expensive. Numerous studies have suggested that neutrophil-to-lymphocyte ratio (NLR) is closely correlated with the presence of SLE and its activity, suggesting that it may serve as a diagnostic and monitoring indicator for SLE. Therefore, we performed a meta-analysis to systematically assess the association between NLR and SLE. We performed a literature search until 12 April 2019 in the PubMed, Web of Science, and China National Knowledge Infrastructure databases. Cross-sectional studies comparing the NLR of SLE patients versus those of healthy controls, of active versus inactive SLE patients, and of SLE patients with versus without lupus nephritis were considered for inclusion. Mean intergroup NLR differences were estimated using standardized mean differences and their 95% confidence intervals. Study quality was assessed using the Agency for Healthcare Research and Quality instrument for cross-sectional studies. Fourteen studies with 1,781 SLE patients and 1,330 healthy controls were included in this meta-analysis. The pooled results showed that the NLR was significantly higher in SLE patients than in healthy controls, in active SLE patients than in inactive SLE patients, and in SLE patients with lupus nephritis than in those without lupus nephritis. NLR may be an indicator for monitoring disease activity and reflecting renal involvement in SLE patients. Nevertheless, more high-quality studies are warranted to further validate our findings.

Background: To examine the prevalence of diabetes and prediabetes in Songming county, Yunnan province, South-west China and examine influences of anthropometric indicators on diabetic risk., Methods: This study was a population based cross-sectional study of 1031 subjects in Songming County aged 30 years and older. Age-standardization was performed by using the 2010 Songming population as the standard population. After an overnight fasting, participants underwent an oral glucose tolerance test (OGTT), and venous blood glucose levels were measured to identify diabetes and prediabetes. Physicians completed questionnaires and blood pressure measurements; trained nurses measured anthropometric variables. Age-adjusted logistic regression models were used to assess the association between anthropometric variables and diabetes., Results: Total prevalences of diabetes and prediabetes were 10.0% and 11.6%, respectively. In women, prevalence of diabetes and prediabetes significantly increased with body mass index (BMI),waist hip ratio (WHR), and waist-to-height ratio (WHtR). But in men, prevalence of diabetes and prediabetes only significantly increased with WHR and WHtR. Compared to 1st WHR tertile in women, there was a nearly tenfold increase in the risk of diabetes with 3rd WHR tertile (OR 10.50, 95% CI 3.95-27.86). Men with 3rd BMI tertile had 4.8-fold risk of getting diabetes compared to men with 1st WHtR tertile (OR 4.79, 95% CI 1.88-12.26). Only WHtR had significantly higher receiver operating characteristic (ROC) area than BMI in total men (0.668 vs. 0.561, p < 0.05). And in total women, only WHR had significantly higher ROC area than BMI (0.723 vs. 0.628, p < 0.05). In the partial correlation analysis controlling for waist circumference, only WHR had significant correlation with fasting plasma glucose (r = 0.132, p = 0.002) and 2-h plasma glucose (r = 0.162, p = 0.000) in women, and WHtR had a much stronger association with both fasting plasma glucose (r = 0.305, P = 0.000) and 2 h plasma glucose (r = 0.303, P = 0.000) than WHR in men., Conclusion: High prevalence of diabetes and prediabetes were found in this underdeveloped region. About half of total subjects with diabetes were undiagnosed. The association of obesity indices and diabetic risk factors varied with gender. The strongest predictors of diabetes were WHR for the female subgroup and WHtR for the male subgroup.

There is a lack of epidemiological data on Toxoplasma gondii infection in dogs from eastern China. In the present study, serum samples from 288 dogs were collected from Xuzhou, Huaiyin, and Yianchen in Jiangsu Province, eastern China, in August 2010; T. gondii antibodies were assayed by a modified agglutination test (MAT). Antibodies to T. gondii were found in 62 of 288 (21.5%) with MAT titers of 1∶25 in 21 dogs, 1∶50 in 15, 1∶100 in 11, 1∶200 in 6, and 1∶400 and above in 3 dogs. The seroprevalence in ≥3-yr-old dogs was significantly higher (P < 0.05) than that in dogs less than 3-yr-old. The results of the present study indicated that infection with T. gondii in household dogs in Jiangsu Province is a public health concern.

Background: Genetic variants in TRAF1C5 and PTPN22 genes have been shown to be significantly associated with arthritis rheumatoid in Caucasian populations. This study investigated the association between single nucleotide polymorphisms (SNPs) in TRAF1/C5 and PTPN22 genes and rheumatoid arthritis (RA) in a Han Chinese population. We genotyped SNPs rs3761847 and rs7021206 at the TRAF1/C5 locus and rs2476601 SNP in the PTPN22 gene in a Han Chinese cohort composed of 576 patients with RA and 689 controls. The concentrations of anti-cyclic citrullinated peptide antibodies (CCP) and rheumatoid factor (RF) were determined for all affected patients. The difference between the cases and the controls was compared using χ2 analysis., Results: Significant differences in SNPs rs3761847 and rs7021206 at TRAF1/C5 were observed between the case and control groups in this cohort; the allelic p-value was 0.0018 with an odds ratio of 1.28 for rs3761847 and 0.005 with an odds ratio of 1.27 for rs7021206. This significant association between rs3761847 and RA was independent of the concentrations of anti-CCP and RF. No polymorphism of rs2476601 was observed in this cohort., Conclusions: We first demonstrated that genetic variants at the TRAF1/C5 locus are significantly associated with RA in Han Chinese, suggesting that TRAF1/C5 may play a role in the development of RA in this population, which expands the pathogenesis role of TRAF1/C5 in a different ethnicity.