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To assess the impact of human activities on regional nitrogen （N） flow, based on the statistical data of 27 cities in the Yangtze River Delta Region （YRD）, N flow characteristics of the agricultural production and consumption system （APC） in the YRD from 2011 to 2020 were analyzed using substance flow analysis, and driving factors for N flow were analyzed using scenario analysis. The results showed that from 2011 to 2020, the mean N input intensity of the APC in the YRD was 194.6 kg·（hm 2 ·a） -1 , which was more than five times the national average value； thus, the YRD was a hotspot of N input intensity in China. Chemical N fertilizer was the largest component of N input, and the YRD changed from a net export area of grain and animal products to a net import area due to the rapid growth of food consumption demand. The N output of the system was mainly N loss to the environment, accounting for 53.2% on average. The N use efficiency （NUE） of cropland and the N recycling ratio of the APC ranged from 38.7-42.2% and 15.8-21.5%, respectively, which were both at a low level. In addition, the total amount of N input and output of the APC both showed a parabolic decline trend, decreasing by 11.3% and 10.0%, respectively. Spatially, the overall N input intensity showed a pattern of "high in the north and low in the south," and the spatial heterogeneity of N input intensity among cities was significant. Cities with high input intensity were mainly located in the north and east of Jiangsu, Shanghai, and northeast of Zhejiang. A significant positive spatial autocorrelation of the distribution of mean N input intensity was observed. The uncertainty of N flows was estimated using the error propagation equation. The uncertainty interval of N input and output ranged from 4.5% to 34.6%, which was roughly equivalent to the results of related studies, indicating that the model results were reliable. Based on the scenario analysis method, the decrease of the livestock scale led to a decrease of -0.27%-7.53% in the N input, making it the main reason for the decrease of total N input in the APC. Improving the NUE of cropland and re-establishing the linkage between cropland and livestock will help reduce N loss to the environment.

Background: The safety and efficacy of neoadjuvant immunochemotherapy (nICT) for locally advanced gastric cancer (LAGC) remain controversial., Methods: Patients with LAGC who received either nICT or neoadjuvant chemotherapy (nCT) at 3 tertiary referral teaching hospitals in China between January 2016 and October 2022 were analyzed. After propensity-score matching (PSM), comparing the radiological response, pathological response rate, perioperative outcomes, and early recurrence between the two groups., Results: After PSM, 585 patients were included, with 195 and 390 patients comprising the nICT and nCT groups, respectively. The nICT group exhibited a higher objective response rate (79.5% vs. 59.0%; P <0.001), pathological complete response rate (14.36% vs. 6.41%; P =0.002) and major pathological response rate (39.49% vs. 26.15%; P =0.001) compared with the nCT group. The incidence of surgical complications (17.44% vs. 16.15%, P =0.694) and the proportion of perioperative textbook outcomes (80.0% vs. 81.0%; P =0.767) were similar in both groups. The nICT group had a significantly lower proportion of early recurrence than the nCT group (29.7% vs. 40.8%; P =0.047). Furthermore, the multivariable logistic analysis revealed that immunotherapy was an independent protective factor against early recurrence [odds ratio 0.62 (95% CI 0.41-0.92); P =0.018]. No significant difference was found in neoadjuvant therapy drug toxicity between the two groups (51.79% vs. 45.38%; P =0.143)., Conclusions: Compared with nCT, nICT is safe and effective, which significantly enhanced objective and pathological response rates and reduced the risk for early recurrence among patients with LAGC., Trial Registration: Clinical Trials.gov., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Fine particulate matter (PM 2.5 ) harms human health and hinders normal human life. Considering the serious complexity and obvious regional characteristics of PM 2.5 pollution, it is urgent to fill in the comprehensive overview of regional characteristics and interannual evolution of PM 2.5 . This review studied the PM 2.5 pollution in six typical areas between 2014 and 2022 based on the data published by the Chinese government and nearly 120 relevant literature. We analyzed and compared the characteristics of interannual and quarterly changes of PM 2.5 concentration. The Beijing-Tianjin-Hebei region (BTH), Yangtze River Delta (YRD) and Pearl River Delta (PRD) made remarkable progress in improving PM 2.5 pollution, while Fenwei Plain (FWP), Sichuan Basin (SCB) and Northeast Plain (NEP) were slightly inferior mainly due to the relatively lower level of economic development. It was found that the annual average PM 2.5 concentration change versus year curves in the three areas with better pollution control conditions can be merged into a smooth curve. Importantly, this can be fitted for the accurate evaluation of each area and provide reliable prediction of its future evolution. In addition, we analyzed the factors affecting the PM 2.5 in each area and summarize the causes of air pollution in China. They included primary emission, secondary generation, regional transmission, as well as unfavorable air dispersion conditions. We also suggested that the PM 2.5 pollution control should target specific industries and periods, and further research need to be carried out on the process of secondary production. The results provided useful assistance such as effect prediction and strategy guidance for PM 2.5 pollution control in Chinese backward areas., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To understand the loss to follow-up of children born to pregnant women with HIV infection (HIV-exposed children) and analyze its influencing factors in China in 2019. Methods: The data were collected from the follow-up records of pregnant women with HIV infection and their children reported by the national "Management Information System for the Prevention of HIV, syphilis and Hepatitis B Mother-to-Child Transmission" in 2019. HIV-exposed children were defined as those who were not followed up after birth or who were not followed up at 18 months of age and who were not followed up at 21 months of age. The univariate and multivariate influencing factors of loss to follow-up of children born to HIV-infected pregnant women were analyzed by χ 2 test and logistic regression model. SPSS 25.0 software was used for statistical analysis. Results: The number of HIV-infected pregnant women was 5 039, the number of live-born children was 5 035, the number of loss to follow-up children within 18 months of age was 283, and the loss to follow-up rate children was 5.62%(283/5 035). The results of multivariate logistic regression analysis showed that the rate of loss to follow-up of exposed children born to pregnant women who worked as farmers (animal husbandry and fishery) (a OR =0.34, 95% CI : 0.22-0.53), unmarried (a OR =0.47, 95% CI : 0.24-0.93), first marriage (a OR =0.38, 95% CI : 0.22-0.67), remarriage (a OR =0.36, 95% CI : 0.20-0.67) and cohabiting (a OR =0.47, 95% CI : 0.23-0.97), and knew they had HIV infection before this pregnancy (a OR =0.53, 95% CI : 0.40-0.70) was lower. Han nationality (a OR =1.52, 95% CI : 1.09-2.13), primary school (a OR =2.06, 95% CI : 1.10-3.89) and junior middle school (a OR =1.81, 95% CI : 1.03-3.17) educational level, non-use of antiviral drugs (a OR =6.21, 95% CI : 4.32-8.93) and delivery in township (street) level midwifery institutions (a OR =5.72, 95% CI HIV-exposed children still have a specific rate of loss to follow-up in China in 2019. In order to further reduce the rate of loss to follow-up, it is of great significance to improve the detection rate of HIV before pregnancy and the rate of antiviral drugs used in pregnant women with HIV infection, which is of great significance for the effective implementation of comprehensive intervention measures of prevention of mother-to-child transmission of HIV.Conclusions: HIV-exposed children still have a specific rate of loss to follow-up in China in 2019. In order to further reduce the rate of loss to follow-up, it is of great significance to improve the detection rate of HIV before pregnancy and the rate of antiviral drugs used in pregnant women with HIV infection, which is of great significance for the effective implementation of comprehensive intervention measures of prevention of mother-to-child transmission of HIV.

Background: The Guangzhou Nutrition and Health Study (GNHS) aims to assess the determinants of metabolic disease in nutritional aspects, as well as other environmental and genetic factors, and explore possible biomarkers and mechanisms with multi-omics integration., Methods: The population-based sample of adults in Guangzhou, China (baseline: 40-83 years old; n = 5,118) was followed up about every 3 years. All are tracked via on-site follow-up and health information systems. We assessed detailed information on lifestyle factors, physical activities, dietary assessments, psychological health, cognitive function, body measurements, and muscle function. Instrument tests included dual-energy X-ray absorptiometry scanning, carotid artery and liver ultrasonography evaluations, vascular endothelial function evaluation, upper-abdomen and brain magnetic resonance imaging, and 14-day real-time continuous glucose monitoring tests. We also measured multi-omics, including host genome-wide genotyping, serum metabolome and proteome, gut microbiome (16S rRNA sequencing, metagenome, and internal transcribed spacer 2 sequencing), and fecal metabolome and proteome., Results: The baseline surveys were conducted from 2008 to 2015. Now, we have completed 3 waves. The 3rd and 4th follow-ups have started but have yet to end. A total of 5,118 participants aged 40-83 took part in the study. The median age at baseline was approximately 59.0 years and the proportion of female participants was about 69.4%. Among all the participants, 3,628 (71%) completed at least one on-site follow-up, with a median duration of 9.48 years., Conclusion: The cohort will provide data that will be influential in establishing the role of nutrition in metabolic diseases with multi-omics.

Aiming for clarifying the potential distribution characteristics of canopy rainfall partitioning of the loess area, we explored the process of rainfall partitioning across eight typical forest stands ( Pinus tabuliformis forest, Robinia pseudoacacia forest, Platycladus orientalis forest, mixed forest of Robinia pseudoacacia - Pinus tabuliformis , mixed forest of Platycladus orientalis - Robinia pseudoacacia , Quercus wutaishanica forest, Populus davidiana forest, mixed forest of Quercus wutaishanica - Populus davidiana ), and used boosted regression trees (BRT) to quantify the relative influences of stand structures and meteorological environment factors. We established multiple regression relationships according to the most influential factors extracted by BRT, and applied to the dataset of mining to verify the performance of the BRT-derived predictive model. The results showed that the percentages of throughfall (TF), stemflow (SF), and canopy interception ( I c ) in total precipitation were 24.5%-95.1%, 0-13.6%, and 0.7%-55.7% among eight typical forest stands, respectively. For the individual rainfall threshold of TF, coniferous forest (3.06±1.21 mm) was significantly higher than broad-leaved forest (1.97±0.52 mm), but there was no significant difference between coniferous forest and broad-leaved mixed forest (3.01±0.98 mm). There was no significant difference in the individual rainfall threshold of SF among different composition stands. BRT analysis showed that stand structure factors accounted for a relatively small proportion for TF and SF, respectively. By contrast, stand structure factors dominated the I c . Rainfall was the most important factor in determining TF and SF. Tree height was the most important factor in determining I c , followed by rainfall, canopy area, diameter at breast height, and stand density. Compared with the general linear function and the power function, the prediction effect of BRT prediction model constructed here on TF and SF had been further improved, and the prediction of canopy interception still needed to explore. In conclusion, the BRT model could better quantitatively evaluate the effects of stand structure and meteorological environmental factors on rainfall partitioning components, and the performance of the BRT predictive model could satisfy and lay the foundation for the optimization strategy for stand configuration.

This research aims to study the impact of implicit emotion on the use of theory of mind and enrich the research on emotions and the use of theory of mind, thus allowing adults to apply theory of mind more effectively in the context of social interaction. This study includes 120 college students as participants. A two (level of theory of mind: high vs. low) * three (implicit emotional state: implicit positive emotion, implicit neutral emotion, or implicit negative emotion) * two (private knowledge: endowed vs. unendowed) between-subjects three-factor design was employed. This study obtained the following results: (1) The main effect of different implicit emotional states on college students' use of theory of mind is significant. College students with implicit positive emotions use theory of mind much less than those with implicit neutral and negative emotions. (2) In cases of implicit positive emotions, college students with a low level of theory of mind use theory of mind substantially less than students with a high level of theory of mind. In cases of implicit neutral and negative emotions, college students with the high and low theory of mind do not exhibit substantial differences in their use of theory of mind. This study concludes that different emotional states affect college students' use of theory of mind., (© 2023. The Author(s), under exclusive licence to Marta Olivetti Belardinelli.)

The pharmaceutical manufacturing model is gradually changing from intermittent manufacturing to continuous manufacturing and intelligent manufacturing. This paper briefly reviewed the supervision and research progress in continuous pharmaceutical manufacturing in China and abroad and described the definition and advantages of continuous pharmaceutical manufacturing. The continuous manufacturing of traditional Chinese medicine(TCM) at the current stage was summarized in the following three terms: the enhancement of the continuity of intermittent manufacturing operations, the integration of continuous equipment to improve physical continuity between units, and the application of advanced process control strategies to improve process continuity. To achieve continuous manufacturing of TCM, the corresponding key technologies, such as material property characterization, process modeling and simulation, process analysis technology, and system integration, were analyzed from the process and equipment, respectively. It was proposed that the continuous manufacturing equipment system should have the characteristics of high speed, high response, and high reliability, &quot;three high(H~3)&quot; for short. Considering the characteristics and current situation of TCM manufacturing, based on the two dimensions of product quality control and production efficiency, a maturity assessment model for continuous manufacturing of TCM, consisting of operation continuity, equipment continuity, process continuity, and quality control continuity, was proposed to provide references for the application of continuous manufacturing technology for TCM. The implementation of continuous manufacturing or the application of key continuous manufacturing technologies in TCM can help to systematically integrate advanced pharmaceutical technology elements and promote the uniformity of TCM quality and the improvement of production efficiency.

Objective: To investigate the rate of periprosthetic joint infection (PJI) revision surgeries and clinical information of hip-/knee- PJI cases nationwide from 2015 to 2017 in China. Methods: An epidemiological investigation. A self-designed questionnaire and convenience sampling were used to survey 41 regional joint replacement centers nationwide from November 2018 to December 2019 in China. The PJI was diagnosed according to the Musculoskeletal Infection Association criteria. Data of PJI patients were obtained by searching the inpatient database of each hospital. Questionnaire entries were extracted from the clinical records by specialist. Then the differences in rate of PJI revision surgery between hip- and knee- PJI revision cases were calculated and compared. Results: Total of 36 hospitals (87.8%) nationwide reported data on 99 791 hip and knee arthroplasties performed from 2015 to 2017, with 946 revisions due to PJI (0.96%). The overall hip-PJI revision rate was 0.99% (481/48 574), and it was 0.97% (135/13 963), 0.97% (153/15 730) and 1.07% (193/17 881) in of 2015, 2016, 2017, respectively. The overall knee-PJI revision rate was 0.91% (465/51 271), and it was 0.90% (131/14 650), 0.88% (155/17 693) and 0.94% (179/18 982) in 2015, 2016, 2017, respectively. Heilongjiang (2.2%, 40/1 805), Fujian (2.2%, 45/2 017), Jiangsu (2.1%, 85/3 899), Gansu (2.1%, 29/1 377), Chongqing (1.8%, 64/3 523) reported relatively high revision rates. Conclusions: The overall PJI revision rate in 34 hospitals nationwide from 2015 to 2017 is 0.96%. The hip-PJI revision rate is slightly higher than that in the knee-PJI. There are differences in revision rates among hospitals in different regions.

Based on the crop yield data of China and each region from 1981 to 2020 (excluding data from Hong Kong, Macao, and Taiwan), by using the grain-straw ratio method, this study estimated the total amount of crop straw and collectable amount of crops, including corn, rice, wheat, other cereals, cotton, rapeseeds, peanuts, beans, tubers, sesame, fiber crops, sugarcane, and beetroots, and the spatial and temporal distribution characteristics of resource density and per capita resources of crop straw were analyzed. This study analyzed the current utilization mode, development, and change of crop straw in China. Finally, we used the life circle assessment (LCA) method to estimate the carbon emission reduction potential of biochar prepared from crop straw. The main findings were:from 1981 to 2020, the temporal distribution trend of theoretical crop straw resources and collectable straw resources in China generally showed a steady growth trend, and the two increased from 3.33×10 8 t and 3.04×10 8 t in 1981 to the highest values of 7.70×10 8 t and 6.63×10 8 t in 2020, with a net increase of 4.37×10 8 t and 3.59×10 8 t, respectively. The net increase in rice, wheat, and corn straw resources was 3.69×10 8 t, accounting for between 77% and 85% of the total crop straw and always occupying the main position of straw resources in China. The proportion of wheat straw in the total amount of straw was maintained at approximately 20%, rice straw resources decreased from 44% to 28.4%, and corn straw increased from 19.9% to 34.2% from 1981 to 2020. In 2020, the total theoretical resources of crop straw in China were 7.72×10 8 t, and the source structures were:rice 28.4%, wheat 21.45%, corn 31.45%, other cereals 1.4%, beans 3.4%, tubers 0.82%, cotton 2.28%, peanuts 2.97%, rapeseeds 3.4%, sesame 0.12%, fiber crops 0.06%, beetroots 0.67%, and sugarcane 0.84%. As to the spatial distribution of crop straw resources in China in 2020, the locations with straw resources ≥ 60 million tons included Heilongjiang, Henan, and Shandong, of which Henan had as much as 88.56 million tons; those with between 40 million and 60 million tons included Hebei, Inner Mongolia, Jiangsu, and Anhui; those with between 20 million and 40 million tons included Liaoning, Jilin, Jiangxi, Hubei, Hunan, Sichuan, Yunnan, and Xinjiang; and the straw resources in the rest of the region were below 20 million tons. Rice straw was mostly distributed in the middle and lower reaches of the Yangtze River and the Northeast region, of which the amount of Heilongjiang rice straw was the largest, with 31.86 million tons; wheat straw was mainly distributed in North China, with Henan having the most abundant resources (48.04 million tons). Corn straw was mainly distributed in Northeast China and North China, of which Heilongjiang and Inner Mongolia corn straw resources were relatively rich, with 33.18 million tons and 29.90 million tons, respectively. Crop straw resource density and per capita resources were shared in 2020 in China. The average density of crop straw resources in China was 4.61 t·hm -2 , and the average densities of crop straw resources in various agricultural areas were 5.39 t·hm -2 in Northeast China, 5.42 t·hm -2 in North China, 4.45 t·hm -2 in the Mengxin Region, 4.44 t·hm -2 in the middle and lower reaches of the Yangtze River, 3.92 t·hm -2 in Tibet, 3.40 t·hm -2 in the Loess Plateau, 3.08 t·hm -2 in South China, and 2.91 t·hm -2 in Southwest China. The average per capita share of straw resources was 0.55 t. The average values of per capita straw resources in each region were:1.46 t in the Northeast area, 1.20 t in the Mengxin Region, 0.47 t in North China, 0.44 t in the middle and lower reaches of the Yangtze River, 0.40 t in the Loess Plateau, 0.37 t in the Southwest area, 0.33 t in the Qinghai-Tibet area, and 0.20 t in the South China area. The utilization of crop straw in China was diversified. Fertilizer and feed were the main utilizations, accounting for 62.1% and 15.4%, respectively. In 2020, collectable crop straw resources for the preparation of biochar totaled 2.04×10 8 t in China. Renewable energy replaced fossil fuels in the process of preparing biochar, which could reduce CO 2e (CO 2e :CO 2 equivalent) emissions by 1.45×10 8 t. Biochar could sequester approximately 4.63×10 8 t of CO 2e ; biochar application was able to reduce chemical fertilizer application to achieve a CO 2 emission reduction of 8.58×10 5 t; and biochar application could promote crop yield in order to reduce CO 2e emissions by approximately 7.77×10 6 t. The inhibition of N 2 , respectively. In the process of biochar preparation and application, the total greenhouse gas emission was 3.32×10 7 t, and the net greenhouse effect emission reduction reached 5.86×10 8 t, i.e., it could sequester 0.88 t CO 2e per ton of raw materials. The net greenhouse gas emission reduction of unused straw was 6.73×10 7 t in 2020. With the continuous harvest of grain crops in China, the potential of biochar preparation and carbon sequestration will increase yearly. Using crop straw to prepare biochar has great potential and will be one of the most effective ways to achieve carbon emission reduction in agriculture. It is suggested that government departments should pay attention to the preparation of biochar, support the field experiments of biochar application effects after applying soil on policy and funds, and then introduce relevant biochar standards to ensure the scientific application of biochar prepared by crop straw according to local conditions, so as to achieve the dual benefits of carbon emission reduction and soil remediation and yield increase.

Background and Objectives: To explore the regional discrepancy of the adherence to guideline-recommended stroke interventions for the stroke belt division (north vs south), the economic development division (east vs middle vs west), and potential interaction., Methods: We conducted a retrospective observational study using data from the Chinese Stroke Center Alliance from August 2015 to August 2019. The primary outcome was hospital personnel adherence to 11 individual guideline-recommended treatments. The coprimary outcomes included 2 summary measures: a composite score (range, 0 [nonadherence] to 1 [perfect adherence]) and an all-or-none binary outcome for adherence to evidence-based stroke. Regional disparities were assessed according to the stroke belt division and the economic development division and the interaction between these 2 divisions. Multivariate regression models with generalized estimating equations were used to analyze the outcomes., Results: This study included 838,229 patients with acute ischemic stroke from 1,473 hospitals. The overall quality of care in the nonbelt regions (southern China) was higher than in the stroke belt regions (northern China), as reflected by a higher composite score (0.77 vs 0.75; adjusted odds ratio 1.03 [95% CI 1.02-1.04]; p < 0.001) and a higher all-or-none measure (25.5% vs 22.0%; 1.32 [1.17-1.49], p < 0.001). Patients in the East and Central had higher odds of using intravenous tissue-type plasminogen activator (East: 1.81 [95% CI 1.51-2.18], p < 0.001; Central: 1.57 [95% CI 1.26-1.95], p < 0.001), early antithrombotic medications (East: 1.77 [1.49-2.11], p < 0.001; Central: 1.37 [1.12-1.66], p < 0.001), lipid-lowering medications (East: 1.29 [1.08-1.53], p < 0.001), and deep vein thrombosis prophylaxis (East: 1.28 [1.08-1.50], p = 0.003) compared with those in the West. Patients in the nonbelt regions had higher odds of getting dysphagia screening (1.82 [1.55-2.13], p < 0.001) and rehabilitation assessment (which though varied among different economic development levels). Reflected by significant interaction effects, for patients in the East, those in the nonbelt regions had greater odds of receiving anticoagulation (1.62 [1.34-1.96]; p < 0.001) but lower odds of receiving antithrombotic (0.63 [0.52-0.77]; p < 0.001) and antidiabetic medications (0.87 [0.77-0.99]; p = 0.03); for patients in the West, those in the nonbelt regions were less likely to receive antihypertensive (0.64 [0.46-0.88]; p = 0.004) and antidiabetic (0.66 [0.54-0.81]; p < 0.001) medications., Discussion: Stroke care performance measures differed across regions, along the stroke belt division, and the economic development division. The overall quality of care in the non-stroke belt regions was higher than that in the stroke belt regions. The 2 divisions had interaction effects on several individual measures., (© 2022 American Academy of Neurology.)

Objective: To explore the promotion effect of laparoscopic standardized surgery for gastric cancer observational in some regional medical centers in Shanghai. Methods: A retrospective cohort study was carried out. Eleven regional medical centers in Shanghai received the promotion program of laparoscopic standardized surgery for gastric cancer, which was led by Ruijin Hospital, Shanghai Jiaotong University School of Medicine (Shanghai Minimally Invasive Surgery Center) from January to December 2020. Clinicopathological data of gastric cancer patients treated at these 11 regional medical centers before and after the promotion program were collected. Inclusion criteria were as follows: patients undergoing laparoscopic distal gastrectomy or total gastrectomy; gastric cancer confirmed by pathology; without distant metastasis or peritoneal metastasis. Patients who did not undergo laparoscopic D2 radical resection, or received neoadjuvant chemotherapy before surgery, or without complete clinical data were excluded. Patients undergoing laparoscopic surgery from January to December 2019 were included in the pre-promotion group (46 cases). Patients undergoing laparoscopic surgery from January to December 2021 were included in the post-promotion group (102 cases). In addition, patients undergoing laparoscopic surgery at Ruijin Hospital from January 2021 to December were included in the control group (138 cases). The baseline data, perioperative measurements postoperative complications, and pathological results of the three groups were analyzed and compared. Results: There were no significant differences in baseline characteristics among the three groups (all P >0.05). Compared with the pre-promotion group, the operation time in post-promotion group was significantly shorter [(207.3±36.0) minutes vs. (254.2±47.1) minutes, t =7.038, P <0.001], and the number of harvested lymph node was significantly more (24.4±12.2 vs. 18.9±5.5, t =2.900, P =0.004). However, there were no significant differences in the extent of resection, time to fluid intake, and postoperative hospital stay between the two groups (all P >0.05). Compared with the control group, the operation time [(207.3±36.0) minutes vs (172.6±26.0) minutes, t =8.281, P <0.001], time to fluid intake [(6.3±3.2) days than (5.5±3.0) days, t =2.029, P =0.044], and the postoperative hospital stay [(14.3±5.6) days vs. (10.1±4.8) days, t =6.036, P <0.001] in the post- promotion group were still longer. Total gastrectomy was less common in the post-promotion group compared with the control group [18 cases (17.6%) vs. 41 cases (29.7%), χ 2 =7.380, P =0.007]. However, there was no significant difference in the number of harvested lymph node between the two groups ( P >0.05). The morbidity of postoperative complication in the post-promotion group (9.8%, 10/102) was significantly lower than that in the pre-promotion group (23.9%, 11/46) (χ 2 =5.183, P =0.023), while above morbidity was not significantly different between the post-promotion group and the control group [9.8% vs. 6.5% (9/138), χ 2 =0.867, P =0.352]. Conclusion: After the promotion of laparoscopic standardized surgery for gastric cancer in regional medical centers, the standardization degree of surgery has been improved, and the morbidity of postoperative complication decreases. Laparoscopic standardized surgery for gastric cancer can be promoted to more regional medical centers.

The prediction of soil organic carbon (SOC) changes in response to environmental change is often limited by a scarcity of revisited temporal data, which constrains scientific understanding and realistic predictions of soil carbon change. The present study improved the potential of nonrevisited temporal data in the prediction of SOC stocks (SOCS) variations. We proposed a method to develop predictions of SOCS change using two independent temporal data sets (pertaining to the 1980s and 2010s) in China based on the digital soil mapping technique. Changes in SOCS over time at the site level were analyzed via the interpolation of missing SOCS values in each data set. Quantitative SOCS change predictions were generated by modeling the relationship between SOCS change and variables that represent changes in climate, vegetation indices, and land cover. The scale-dependent response of SOCS change to these environmental dynamics was assessed. On average, a slight increase was observed from 3.70 kg m -2 in the 1980s to 4.53 kg m -2 in the 2010s. The proposed approach attained moderate accuracy with an R 2 value of 0.32 and a root mean squared error (RMSE) of 1.73 kg m -2 . We found that changes in climate factors were dominant controls of SOCS change over time at the country scale. At the regional scale, the controlling factors of SOCS change were distinct and variable. Our case study may be of value in the application of independent temporal data sets to analyze soil carbon change on multiple scales. The method may be used to resolve questions of soil carbon change projections and provide an alternative solution to predict likely changes in soil carbon in response to future environmental change when no temporal data are available., Competing Interests: Declaration of competing interest The authors declared that they have no conflicts of interest to this work., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Eco-tourism is rapidly developing in giant panda nature reserves in China, and is considered a popular tool for biodiversity conservation and the welfare of local communities. However, there is lack of empirical evidence on whether eco-tourism promotes the conservation behavior of local communities members, who live around nature reserves. To this end, this study constructed a framework to measure households' forest conservation activities, and conducted a questionnaire survey in 12 giant panda nature reserves in Sichuan Province, China. A total of 686 valid samples were obtained. A logit model was used to confirm whether income from community-based ecotourism (CBET) could enhance households' conservation behavior. The results show that households prefer three types of conservation practices, and CBET could significantly improve the income of households engaged in it. Income from CBET has motivated local households to participate in conservation activities; however, but the effects are different. In all three conservation activities, income from CBET has shown significant effects on promoting forest maintenance and protection activities, but not on reforestation ones. The results of this research could help us better understand the relationship between CBET and local households' conservation behavior. It also provides information for policymakers seeking for the best way to balance conservation and development., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Real-life data on guselkumab in psoriasis are limited and not available in China hitherto. This study aimed to evaluate the short-term effectiveness and safety of guselkumab in patients with psoriasis under Chinese real-life conditions and to explore the effect of guselkumab on CD4 + CD25 + Foxp3 + regulatory T cells (Tregs). A Chinese prospective and real-life study involving patients with psoriasis in Dermatology Hospital of Southern Medical University, Guangzhou, China from April to September 2020 was conducted. A total of 45 patients with psoriasis were finally enrolled in the study. Psoriasis Area Severity Index (PASI) 90 and 100 responses at week 16 were achieved by 88.6% and 45.5% of patients, respectively. The analysis of PASI response in different subgroups showed no statistically significant difference. Univariate logistic regression analysis revealed that at week 16, none of the variables were associated with decreasing PASI 90 response, whereas age at onset of disease was a predictor of PASI 100 response. Dynamic detection of CD4 + CD25 + Foxp3 + Tregs frequency from peripheral blood suggested a stable maintained trend in terms of guselkumab treatment duration. No severe adverse events occurred during the follow-up period. This study confirmed the short-term effectiveness and safety of guselkumab, as well as its good tolerance against psoriasis, in the Chinese population. Guselkumab treatment maintains levels of Tregs in patients with psoriasis., (© 2021 Wiley Periodicals LLC.)

Intracorporeal classic gastrointestinal anastomosis using circular stapler in totally laparoscopic gastrectomy (TLG) for gastric cancer requires intracorporeal anvil placement and suitable access for introduction of the circular stapler to the abdominal cavity without gas leak. The novel techniques for anvil placement have been updated, but there is no progress for proper access for circular stapler. In the study, intracorporeal circular-stapled gastrointestinal anastomosis were successfully accomplished using a novel device of sealed cap access with a central hole (WLB-60/70-60/100, Wuhan Widerep Medical Instrument Co.,Ltd, China) customized to the incision protection retractor for the simple and accessible introduction of the circular stapler and anvil under the optimal maintenance of pneumoperitoneum pressure in TLG. In these 3 cases, there was no gas leakage and the pneumoperitoneum was well maintained when performing the gastrointestinal anastomosis, and there was no transition to laparotomy or other anastomosis techniques. The result suggests that the sealed cap access could be a novel choice for introduction of the circular stapler to the abdominal cavity in order to obtain laparoscopic circular-stapled gastroin-testinal anastomosis in TLG.

One new bisesquiterpenoid, biepiasreorlid II (1), three new sesquiterpene lactones 8α-methoxy-epiasterolid (4), 3β-acetoxyl-8-epiasterolid (5), and 3β-acetoxyl-atractylenolide I (6), along with five known analogues (2-3 and 7-9), were obtained from rhizome of Atractylodes macrocephala Koidz. All structures were assigned on the basis of detailed spectroscopic analyses. The absolute configuration of 1 was established by the analysis of single-crystal X-ray diffraction with Ga Kα radiation, and 4-6 were elucidated by TDDFT-ECD calculations. The CREB agonistic activity was investigated in HEK293T cells using dual luciferase reporter assay. Compounds 1, 2, 5, and 7-9 exhibited strong to agonistic activities on CREB., (Copyright © 2020. Published by Elsevier B.V.)

BACKGROUND The aim of this study was to analyze the risk factors of pressure injury (PI) in critically ill patients with cancer to build a risk prediction model for PI. MATERIAL AND METHODS Between January 2018 and December 2019, a total of 486 critically ill patients with cancer were enrolled in the study. Univariate analysis and binary logistic regression analysis were used to explore risk factors. Then, a risk prediction equation was constructed and a receiver operator characteristic (ROC) curve analysis model was used for prediction. RESULTS Of the 486 critically ill patients with cancer, 15 patients developed PI. Risk factors found to have a significant impact on PI in critically ill patients with cancer included the APACHE II score (P<0.001), semi-reclining position (P=0.006), humid environment/moist skin (P<0.001), and edema (P<0.001). These 4 independent risk factors were used in the regression equation, and the risk prediction equation was constructed as Z=0.112×APACHE II score +2.549×semi-reclining position +2.757×moist skin +1.795×edema-9.086. From the ROC curve analysis, the area under the curve (AUC) was 0.938, sensitivity was 100.00%, specificity was 83.40%, and Youden index was 0.834. CONCLUSIONS The PI risk prediction model developed in this study has a high predictive value and provides a basis for PI prevention and treatment measures for critically ill patients with cancer.

Objectives: Plant oil for cooking typically provides 40% to 50% of dietary fat, 65% of linoleic acid, 44% of α-linolenic acid and 41% of oleic acid in the Chinese diet. However, the comparative effects of fatty acids derived from plant oil on cardiovascular risk factors in Chinese are still inconclusive. Hence, the aim of this study is to investigate whether cardiovascular risk factors are altered depending on various types of plant oils such as peanut oil rich in oleic acid, corn oil rich in linoleic acid, and blend oil fortified by α-linolenic acid., Design: A randomized, double-blinded, parallel-designed trial., Setting: The First and the Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, China., Participants: A total of 251 volunteers with fasting blood total cholesterol between 5.13 and 8.00 mmol L -1 were enrolled., Intervention: Volunteers received peanut oil, corn oil or blend oil to use for cooking for one year., Main Outcome Measures: The erythrocyte membrane fatty acid composition, fasting plasma lipids, glucose and insulin concentrations and high sensitivity C-reactive protein (hsCRP) levels were measured before, during and after the intervention. The level of α-linolenic acid in erythrocyte membranes was significantly increased in the blend oil group after the intervention (P < 0.001). The level of other fatty acids did not show any statistically significant differences between the three groups. No significant differences were observed in the concentrations of fasting plasma lipids, hsCRP, glucose, and insulin among the three groups using different types of plant oils., Conclusions: The results suggest that although ingesting cooking oil with different fatty acid composition for one year could change erythrocyte membrane fatty acid compositions, it did not significantly modify cardiovascular risk factors in moderately hypercholesteremic people.

Objective: To evaluate the effect of cholecystectomy on the occurrence of knee osteoarthritis (KOA)., Methods: The present study was a case-control study with a retrospective, cross-sectional, and longitudinal study design. The clinical data for knee osteoarthritis in the Second Hospital of Shanxi Medical University from January 2016 to September 2018 was analyzed. Clinical data, including gender, age, height, weight, smoking, alcohol abuse, prior medical history, and previous surgical history, were recorded. A logistic regression model was used for the univariate and multivariate analysis., Results: A total of 1659 patients with KOA (KOA group) and 1195 limb fracture patients (control group) were included in this study. Among the 1659 patients with KOA, 388 patients were male and 1271 were female, while among the 1195 patients in the control group, 638 patients were male and 557 patients were female. The period between cholecystectomy and knee osteoarthritis onset ranged from 0.5 years to 17 years; the average interval time was 8.73 ± 2.11 years. The age at disease onset was significantly older when compared to the control group, while the body mass index in the KOA group was significantly higher when compared to the control group (P < 0.05). There were 97 patients undergoing cholecystectomy in the KOA group and there were 15 patients undergoing cholecystectomy in the control group. The proportion of cholecystectomy in the two groups was statistically significant. After the univariate analysis, there was a statistically significant difference in distribution between the two groups (P < 0.05). The multivariate logistic regression analysis revealed that there was a significant difference in the distribution of these two groups (P < 0.05), indicating that cholecystectomy is associated with the occurrence of KOA., Conclusion: There is a close relationship between cholecystectomy and KOA. However, the specific mechanism remains unknown and should be further researched., (© 2020 The Authors. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.)

Purpose: Many studies have examined the association of isoflavone intake with type 2 diabetes (T2D), and produced inconsistent results. Few studies, however, explored the association using objective biomarkers (particular for daidzein metabolite-equol) of isoflavones. We aimed to explore the association of urinary equol, daidzein and genistein concentrations with T2D and examine the mediating roles of high-sensitivity C-reactive protein (hsCRP) and retinol binding protein 4 (RBP4)., Methods: This prospective study included 2818 subjects. Urinary concentrations of equol, daidzein and genistein were measured by high-performance liquid chromatography-tandem mass spectrometry. The associations between urinary isoflavones and T2D incidence were evaluated by cox proportional hazards model., Results: After adjustment for covariates, urinary equol except daidzein and genistein was inversely associated with T2D incidence. In comparison with the first tertile, multivariable adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for T2D incidence in the second and third tertile of equol concentration were 0.52 (0.37, 0.73) and 0.72 (0.53, 0.97), respectively. In stratified analyses by sex, the HR (95% CI) of men in the second vs. first tertile of equol was 0.29 (0.14, 0.58). Equivalent estimation in women was 0.67 (0.45, 1.01). Neither women nor men in the third tertile showed significant difference of T2D incidence compared with the first tertile. In path analyses, there was no evidence of mediating effects of hsCRP and RBP4 on the "equol-T2D" relationship., Conclusions: Urinary equol was favorably associated with a decreased T2D incidence in Chinese adults. The equol-T2D relationship might not be mediated by hsCRP and RBP4., Trial Registration: This study has been registered at http://www.clinicaltrials.gov as NCT03179657.

Background: The loss of functional ability of patients after stroke is mostly caused by dysfunction of the upper limbs, especially the hands. Hand functional exercise is the premise of alleviating hand dysfunction, and the relief of hand spasm is the basis of timely and effective hand functional exercise. Previous clinical observation have shown that fascial-point needling can effectively alleviate hand spasm immediately after stroke, but further evidence from large-sample studies is needed. The overall objective of this trial is to further evaluate the clinical efficacy of fascial-point acupuncture on hand spasm after stroke., Methods/design: This multicenter randomized controlled trial will compare the efficacy of fascial-point acupuncture versus sham acupuncture and routine rehabilitation therapy in stroke patients with hand spasm. Patients will be randomized to undergo either the fascial-point acupuncture, the sham acupuncture or the control (routine rehabilitation therapy). We will recruit 210 stroke inpatients who meet the trial criteria and observe the remission of hand spasm and improvement of limb function after 4 weeks of intervention. The first evaluation indices are the remission of hand spasm and the duration of spasm remission. The second evaluation indices are the hand function of the affected limbs and the activities of daily living. When the accumulative total number of cases included reaches 120, a mid-term analysis will be conducted to determine any evidence that experimental intervention does have an advantage., Discussion: Our aim is to evaluate the efficacy of fascial-point acupuncture in relieving hand spasm after stroke. The results should provide more evidence for the clinical application of this therapy in the future., Trial Registration: Chinese Clinical Trial Registry (ChiCTR), ID: ChiCTR1900022379. Registered on 9 April 2019.

A widely observed pollinator decline around the world has led to the prediction that terrestrial ecosystems could be disrupted as plant pollination suffers, but declining pollination success has not been tested rigorously in wild plants, and it still remains unclear how pollination success of plant species responds differently in the context of pollinator decline. By viewing the number of seeds per pod as a quantitative measure of successful pollination, we examined seed pods in 4637 herbarium specimens of 109 obligately outcrossing legumes collected over the past century. We found that only 13 species showed significant temporal change with nine of those as an increase. None of the three subfamilies of legumes showed a consistent trend, and the subfamily Papilionoideae with the most specialized flowers, had increasing seed number per pod more often than decreasing. We conclude that legume pollination in China shows no sign of disruption and the effects of plant-pollinator disruption may be more complicated than simplistic predictions have allowed., (© 2019 The Authors. New Phytologist © 2019 New Phytologist Trust.)

Introduction: X-linked adrenoleukodystrophy (ALD) and Zellweger spectrum disorder (ZSD) are peroxisomal diseases characterized by accumulation of very long chain fatty acids (VLCFA) in plasma and tissues. Considering the wide variability of manifestation, patients of ALD and atypical ZSD are easily misdiagnosed as hereditary spastic paraplegia (HSP) on their clinical grounds. Here, we aimed to determine the frequency of peroxisome diseases and compare their phenotypic spectra with HSP., Methods: We first applied targeted sequencing in 120 pedigrees with spastic paraplegia, and subsequently confirmed 74 HSP families. We then performed whole exome sequencing for the probands of the 46 remaining pedigrees lacking known HSP-causal genes. Detailed clinical, radiological features, and VLCFA analyses are presented., Results: Seven ALD pedigrees with ABCD1 mutations and one ZSD family harboring bi-allelic mutations of PEX16 were identified. Clinically, in addition to spastic paraplegia, four ALD probands presented adrenocortical insufficiency, and the ZSD proband and her affected sister both developed thyroid problems. VLCFA analysis showed that ratios of C24/C22 and C26/C22 were specifically increased in ALD probands. Moreover, three ALD probands and the ZSD proband had abnormalities in brain or spinal imaging., Conclusions: Our study reports the first ZSD case in China that manifested spastic paraplegia, and emphasized the finding that peroxisomal diseases comprise a significant proportion (8/120) of spastic paraplegia entities. These findings extend our current understanding of the ALD and ZSD diseases., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background and Aims: The impact of portal hypertension (PH) on postoperative short-term outcomes and long-term survival in hepatocellular carcinoma (HCC) patients has lately been discussed controversially. This study aimed to explore the influence of PH on postoperative outcomes in HCC patients undergoing surgical resection., Methods: Patients undergoing hepatectomy for HCC from 2010 to 2014 were enrolled. The impact of PH on postoperative complications, posthepatectomy liver failure (PHLF) and overall survival (OS) was evaluated., Results: A total of 355 HCC patients were enrolled; 129 (36.3%) experienced postoperative complications and 21 (5.9%) developed PHLF. PH was identified as an independent predictor of PHLF. Patients with PH experienced a higher incidence of complications and PHLF than patients without PH. On the Cox proportional hazards regression model, PH was verified as a risk factor of OS for BCLC stage 0/A and B patients. Patients without PH had significantly better long-term survival compared to patients with PH both in the total cohort and in cirrhosis subgroup., Conclusion: Liver resection in HCC patients with PH showed a significantly increased postoperative complications and PHLF, and revealed a decreasing long-term survival than non-PH patients. Besides, tumor burden also played an important role in determining the OS. However, due to the improvement in surgical technique and perioperative management, surgery was feasible in carefully selected HCC patients with PH.

Benign prostatic hyperplasia (BPH) is a common disorder in the aging male population. Despite evidence that thyroid status impacts the prostate, the objective of this study was to examine whether patients with hyperthyroidism were at a greater risk for BPH.This study is a retrospective nationwide population-based cohort study of the Chinese population. Data for this study were retrieved from the Taiwan National Health Insurance Research Database (NHIRD). Overall, 1032 male patients aged 40 years or older with hyperthyroidism diagnosed between 2000 and 2006 were included in the hyperthyroidism group, and 4128 matched controls without hyperthyroidism were included in the non-hyperthyroidism group. Both groups were monitored until the end of 2011. A Cox proportional hazards regression model was used to compute and compare the risk of BPH between study participants with and those without hyperthyroidism.Patients with hyperthyroidism exhibited a greater incidence of BPH (18.51% vs 15.53%) than did the controls. Furthermore, the hazard ratio (HR) of the hyperthyroidism group was 1.24 times that of the control group [95% confidence interval (95% CI 1.05-1.46)] signifying that there is a significant 24% increase in the risk of BPH with the presence of hyperthyroidism. This increased risk of BPH with hyperthyroidism, however, failed to remain significant (adjusted HR = 1.11, 95% CI = 0.94-1.3) after adjusting for covariates of age (adjusted HR = 2.72, 95% CI = 2.32-3.2), diabetes (adjusted HR = 1.4, 95% CI = 1.17-1.68), hypertension (adjusted HR = 1.74, 95% CI = 1.49-2.03), hyperlipidemia (adjusted HR = 1.25, 95% CI = 1.03-1.53), neurogenic bladder, cystitis (adjusted HR = 1.23, 95% CI = 0.58-2.59), urethral stricture (adjusted HR = 2.01, 95% CI = 0.28-14.47), urethritis (adjusted HR = 1.52, 95% CI = 0.72-3.21), and urinary tract infection (adjusted HR = 1.77, 95% CI = 1.31-2.39).After adjustment for comorbidities and covariates, hyperthyroidism was not found to be a significant risk factor of BPH in our male study subjects. Further research is warranted to validate our results and elucidate the association of the pathophysiology of these 2 diseases.

Due to the increased safety and efficiency of virus vectors, virus vector-mediated gene therapy is now widely used for various diseases, including monogenic diseases, complex disorders, and infectious diseases. Recent gene therapy trials have shown significant therapeutic benefits, and Chinese researchers have contributed significantly to this progress. This review highlights disease applications and strategies for virus vector-mediated gene therapy in preclinical studies and clinical trials in China.

Objective: To evaluate the accuracy of simple anthropometric parameters in diagnosing obesity in children in Guangzhou. Methods: A cross-sectional study, including 465 children aged 6-9 years, was carried out in Guangzhou. Their body height and weight, waist circumference (WC) and hip circumference were measured according to standard procedure. Body mass index (BMI), waist to hip ratio (WHR) and waist-to-height ratio (WHtR) were calculated. Body fat percentage (BF%) was determined by dual-energy X-ray absorptiometry. Multiple regression analysis was applied to evaluate the correlations between age-adjusted physical indicators and BF%, after the adjustment for age. Obesity was defined by BF%. Receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic accuracy of the indicators for childhood obesity. Area under-ROC curves (AUCs) were calculated and the best cut-off point that maximizing 'sensitivity + specificity-1' was determined. Results: BMI showed the strongest association with BF% through multiple regression analysis. For 'per-standard deviation increase' of BMI, BF% increased by 5.3% ( t =23.1, P <0.01) in boys and 4.6% ( t =17.5, P <0.01) in girls, respectively. The ROC curve analysis indicated that BMI exhibited the largest AUC in both boys (AUC=0.908) and girls (AUC=0.895). The sensitivity was 80.8% in boys and 81.8% in girls, and the specificity was 88.2% in boys and 87.1% in girls. Both the AUCs for WHtR and WC were less than 0.8 in boys and girls. WHR had the smallest AUCs (<0.8) in both boys and girls. Conclusion: BMI appeared to be a good predicator for BF% in children aged 6-9 years in Guangzhou.

Background: The free fibula flap has become popular for mandibular reconstruction. The purpose of this study was to propose comprehensive functional assessments of the donor site., Methods: Thirty free fibula flaps for mandible reconstruction were prospectively enrolled in the study. Objective assessments included isokinetic testing of the ankle joint, electromyographic examination of the superficial peroneal nerve (SPN), and preoperative and postoperative foot scans. The Patient and Observer Scar Assessment Scale (POSAS) was used to subjectively assess the donor site., Results: The isokinetic values of the donor side showed a significant decrease 1 year postoperatively. The results of the electromyographic test of the SPN were categorized as 3 types. The plantar center pressure shifted to the heel on the donor side 6 months postoperatively. The aesthetic outcome was satisfactory., Conclusion: The functional parameters of the donor site indeed declined in our assessments. Further refinements in the surgical technique are needed to improve the donor site status. © 2016 Wiley Periodicals, Inc. Head Neck 39: 279-287, 2017., (© 2016 Wiley Periodicals, Inc.)

Mitochondrial hypervariable region sequences including HVI and HVII (15,751-520) were investigated from 174 unrelated Tibetan individuals living in Tibet Autonomous Region in People's Republic of China. The resulted sequences were aligned and compared with revised Cambridge sequence (rCRS). This sequence variability rendered a high gene diversity value (0.9940 ± 0.0021) and a high random match probability (0.0118) was determined with PIC of 0.9882. Among a total of 174 samples, 217 polymorphic sites were identified, which defined 135 haplotypes. A total of 135 different haplotypes were detected, 113 of them were unique and 22 were shared. The most common haplogroup was M9a1a1c1b1 (16.09%), followed by A11 (6.32%), A (5.17%), R (4.60%), A15 (4.60%), and G3a1 (3.45). The proportions of macro-haplogroups M, N, and L were 54.60%, 42.53%, and 2.87%, respectively. By principal component analysis (PCA), there was no special cluster between Tibetans and other populations except that the structure of Tibetans closely resembled that of Uygur in component 2.

The activation of the complement system may be involved in the pathology of stroke and type 2 diabetes (T2DM). We therefore evaluated the long-term prognostic value of early measurement of serum mannose-binding lectin (MBL) levels, an activator of the complement system, in Chinese T2DM with acute ischemic stroke (AIS). Serum MBL levels were determined in T2DM patients with AIS (N = 188). The adjudicated end points were 1-year functional outcomes and mortality. The prognostic value of MBL was compared with the National Institutes of Health Stroke Scale score and with other known outcome predictors. Patients with an unfavorable outcomes and nonsurvivors had significantly increased MBL levels on admission (P < 0.0001 and P < 0.0001). Multivariate logistic regression analysis adjusted for common risk factors showed that MBL was an independent predictor of functional outcome (odds ratio (OR) = 8.99, 95% CI 2.21-30.12) and mortality (OR = 13.22, 95% CI 2.05-41.21). The area under the receiver operating characteristic curve of MBL was 0.75 (95% CI 0.68-0.83) for functional outcome and 0.85 (95% CI 0.80-0.90) for mortality. In type 2 diabetic patients with stroke, high levels of MBL predict future functional outcomes and mortality. This indicated that the elevated MBL levels may play a significant role in the pathology of the subsequent damage and that the pathways leading to complement activation warrant further exploration as potential therapeutic targets to improve the prognosis for these patients.

Background: The value of percutaneous transluminal angioplasty and stenting (PTAS) in the context of aggressive medical treatment for severe intracranial artery stenosis (ICAS) is under debate. This study compared the effects of PTAS and aggressive medical treatment in patients with severe ICAS and transient ischemic attack or stroke., Material and Methods: A retrospective cohort study was performed. Patients with severe ICAS were assigned to a PTAS group or aggressive medical treatment group, according to the angiographic features of the stenotic lesions. The primary outcome was defined as stroke or death within 30 days or cerebral ischemia occurring ipsilaterally to the qualifying artery beyond 30 days., Results: We included 220 patients: 48 in the PTAS group and 172 in the medical group. The median follow-up was 32 months. PTAS was not associated with an increased incidence of the primary outcomes (10/42 vs. 39/172, p=0.96) or increased risks of the secondary outcomes of stroke, cardiovascular events, major bleeding, or mortality. The results of log-rank tests did not support a significant difference in event-free survival as a primary outcome between the 2 groups (chi-square=0.07, p=0.79). Moreover, although not significantly greater, the mean survival of patients in the PTAS group appeared to be better than that among patients in the medical group, as indicated by the curve for cumulative survival., Conclusions: A suitable PTAS procedure is safe for patients with severe ICAS, and no significant differences in incidence of recurrent stroke or death were found between PTAS and aggressive medication treatment.

Objective: To evaluate the field molluscicidal effect of 5% niclosamide ethanolamine granules, so as to provide a novel Oncomelania hupensis snail control approach for emergency treatment of high-risk settings., Methods: Snail control tests with spraying of 5% niclosamide ethanolamine granules were conducted in two settings of 2 counties, and the dose-, time- and setting-specific field molluscicidal effects were tested., Results: In the small-scale setting, spraying of 5% niclosamide ethanolamine granules at doses of 30, 40 and 50 g/m2 resulted in 54.55%, 68.41% and 73.45% 1-day snail mortality, 57.27%, 68.59% and 80.28% 3-day snail mortality, and 63.49%, 77.58% and 85.55% 7-day snail mortality, respectively, and no significant differences were detected in 1- and 3-day snail mortality caused by spraying of 5% niclosamide ethanolamine granules at doses of 30 and 40 g/m2 (all P > 0.05), while significant difference was found in the 7-day snail mortality (χ2 = 4.549, P < 0.05). In addition, spraying of 5% niclosamide ethanolamine granules at doses of 40 and 50 g/m2 resulted in comparable 1-, 3- and 7-day snail mortality (all P > 0.05). In the large-scale setting, spraying of 5% niclosamide ethanolamine granules at a dose of 40 g/m2 resulted in 85.29% and 87.70% 3-day snail mortality, 83.89% and 91.02% 7-day snail mortality, and 83.41% and 91.84% 15-day snail mortality in the environment-cleaning group and non-cleaning group, respectively. The overall snail mortality was 90.02% in the environment-cleaning group 3 to 15 days after spraying, which was significantly higher than that (84.28%) in the non-cleaning group (χ2 = 9.950, P < 0.05). After 15 days of spraying with 5% niclosamide ethanolamine granules at a dose of 40 g/m2, the densities of living snails reduced from 19.90 and 19.83 snails/0.1 m2 to 0.60 and 2.60 snails/0.1 m2 in the environment-cleaning group and non-cleaning group, with 96.98% and 86.89% reductions, respectively., Conclusion: The appropriate dose of 5% niclosamide ethanolamine granules is 40 g/m2 for snail control in the field, and environment cleaning of vegetation with a height of more than 50 cm may improve the molluscicidal efficacy.

Heterostyly is a floral polymorphism characterized by reciprocal herkogamy maintained through high levels of mating between morphs, serviced by appropriate pollinators. We studied how differential efficiency and abundance of distinct pollinators affect plant female reproduction in self- and intra-morph incompatible distylous Primula secundiflora. Bumblebees and syrphid flies were found to be the most abundant floral visitors. Bumblebees frequently exhibited nectar-robbing behavior. Because the robbing holes were always situated between the high- and low-level organs on both morphs, nectar-robbing bumblebees only pollinated S-styled flowers. L-styled flowers set four times as many seeds as did S-styled flowers after being visited by pollen-collecting syrphid flies. The natural female fecundity and the magnitude of pollen limitation varied between the morphs within populations because of the mosaic distribution of nectar-robbing bumblebees and syrphid flies. L-styled flowers and S-styled flowers set the same number of seeds after supplemental hand pollination, indicating equivalent female reproductive potential. We suggest that bumblebee nectar robbers and syrphid flies play an important role in sustaining the floral dimorphism of heterostyly in P. secundiflora because of their complementary roles in the pollination system.

Background: Recent studies have shown that extralevator abdominoperineal resection has the potential for reduced circumferential resection margin involvement, intraoperative bowl perforation, and local recurrence rates; however, it has been suggested that extended resection may be associated with increased morbidity because of the formation of a larger perineal defect., Objective: This study was undertaken to demonstrate the feasibility and complications of extralevator abdominoperineal resection for locally advanced low rectal cancer in China., Design: This was a prospective cohort study., Setting: The study was conducted at 7 university hospitals throughout China., Patients: A total of 102 patients underwent this procedure for primary locally advanced low rectal cancer between August 2008 and October 2011., Main Outcome Measures: The main outcome measures comprised circumferential resection margin involvement, intraoperative perforation, postoperative complications, and local recurrence., Results: The most common complications included sexual dysfunction (40.5%), perineal complications (23.5%), urinary retention (18.6%), and chronic perineal pain (13.7%). Chronic perineal pain was associated with coccygectomy (p < 0.001), and the pain gradually eased over time. Reconstruction of the pelvic floor with biological mesh was associated with a lower rate of perineal dehiscence (p = 0.006) and overall perineal wound complications (p = 0.02) in comparison with primary closure. A positive circumferential margin was demonstrated in 6 (5.9%) patients, and intraoperative perforations occurred in 4 (3.9%) patients. All circumferential margin involvements and intraoperative perforations were located anteriorly. The local recurrence was 4.9% at a median follow-up of 44 months (range, 18-68 months)., Limitations: This was a nonrandomized, uncontrolled study., Conclusions: Extralevator abdominoperineal resection performed in the prone position for low rectal cancer is a relatively safe approach with acceptable circumferential resection margin involvement, intraoperative perforations, and local recurrences. Reconstruction of the pelvic floor with biological mesh might lower the rate of perineal wound complications (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A161).

Summary: This large cross-sectional study examined the associations of dietary intakes of total flavonoids and their subtypes with bone density in women and men. We found that greater flavonoid intake was associated with higher bone density in women but not in men., Introduction: Studies in vitro and in animal models suggest a potential effect of flavonoids on bone health. Few studies have examined the association between the habitual intake of flavonoids and bone mineral density (BMD) in humans., Methods: The cross-sectional study recruited 2,239 women and 1,078 men. A semiquantitative food frequency questionnaire was administered in face-to-face interviews to assess habitual dietary flavonoid intake using food composition databases. BMD was measured over the whole body (WB) and in the femoral neck (FN) and lumbar spine (LS) by dual-energy X-ray absorptiometry (DXA)., Results: After adjusting for covariates, women who consumed higher total flavonoids, and the subtypes of flavonols, flavan-3-ols, flavones, and proanthocyanidins tended to have greater BMD at the WB, LS, and FN (all P-trend < 0.05). Women in the highest (vs. the lowest) quartile of total flavonoids intake had 0.020 (1.91 %), 0.021 (2.51 %), and 0.013 (1.99 %) g/cm(2) greater BMD at the whole body, LS, and FN, respectively. For the subtypes of flavonoids, the corresponding differences in BMD (in g/cm(2)) were 0.012-0.021 (flavan-3-ols), 0.013-0.020 (flavonols), 0.016-0.019 (flavones), and 0.014-0.016 (proanthocyanidins), respectively. A higher intake of flavonones was associated with a greater BMD at the whole body (P-trend 0.041) and the FN (P-trend 0.022). In men, there were no significant positive associations between the consumption of total flavonoids and the subclasses and BMD at any sites., Conclusion: Dietary flavonoids intake was positively associated with BMD in women. Further large studies are needed to clarify this issue in men.

Background and Aims: Variation in the relative female and male reproductive success of flowering plants is widespread, despite the fundamental hermaphroditic condition of the majority of species. In many hermaphroditic populations, environmental conditions and their influence on development and size can influence the gender expression of individuals through the formation of hermaphroditic and unisexual flowers. This study investigates the hypothesis that the bulbous, animal-pollinated, perennial Lilium apertum (Liliaceae) exhibits a form of size-dependent gender modification known as gender diphasy, in which the sexual expression of individuals depends on their size, with plants often changing sex between seasons., Methods: Variation in floral traits was examined in relation to their size using marked individuals in natural populations, and also under glasshouse conditions. Measurements were taken of the height, flower number, floral sex expression, flower size, flower biomass and pollen production of individuals over consecutive years between 2009 and 2012 in seven populations in south-west China., Key Results: Flowers of L. apertum are either perfect (hermaphroditic) or staminate (male) and, in any given season, plants exhibit one of three sex phenotypes: only hermaphrodite flowers, a mixture of hermaphroditic and male flowers, or only male flowers. Transitions between each of these sex phenotypes were observed over consecutive years and were commonly size-dependent, particularly transitions from small plants bearing only male flowers to those that were taller with hermaphroditic flowers. Hermaphroditic flowers were significantly larger, heavier and produced more pollen than male flowers., Conclusions: The results for L. apertum are consistent with the 'size advantage hypothesis' developed for animal species with sex change. The theory predicts that when individuals are small they should exhibit the sex for which the costs of reproduction are less, and this usually involves the male phase. L. apertum provides an example of gender diphasy, a rare sexual system in flowering plants., (© The Author 2014. Published by Oxford University Press on behalf of the Annals of Botany Company. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Objective: The discriminatory capability of different adiposity indices for atherosclerosis and lipid abnormalities remains uncertain. This study aimed to identify the best adiposity index for predicting early atherosclerosis and abnormal lipid profiles among anthropometric parameters and body fat measures in middle-aged and elderly Chinese., Method: A total of 2,063 women and 814 men (57.6±5.2 y) were recruited for this community-based cross-sectional study. Body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were assessed. Body fat mass and its percentage values for the whole body and trunk were measured by bioelectrical impedance analysis (BIA). The intima-media thicknesses (IMTs) of the common carotid arteries (CCA), internal carotid arteries (ICA) and bifurcation (BIF) were determined via B-mode ultrasound. The fasting lipid profiles were assessed., Results: With per SD increase of adiposity indices, the magnitude of the changes of IMT values and lipid profiles was more substantial for WC, WHR and WHtR in both genders. A multivariate logistic regression analysis indicated that WC, WHR and WHtR were more sensitive in predicting the presence of intima-media thickening at the three segments as well as the lipids disturbances in women and men. In general, BIA-derived measures have no added predictive value for IMT-thickening as opposed to those three traditional abdominal measures., Conclusion: Our findings suggest that abdominal anthropometric measures including WC, WHR and WHtR are sensitive for discriminating carotid atherosclerosis and lipids abnormalities. WC is the best index because of its simplicity in routine use.

Background/objective: Adequate calcium intakes may enhance bone mineral accumulation during childhood. Little is known about the optimal calcium intake in Chinese adolescents. We examined the effects of three levels of calcium intake on bone mineral accretion in adolescents., Methods: This was a 2-year randomized, double-blind, controlled trial. The subjects were randomly assigned to receive 40 g of milk powder containing 300 mg of calcium and 200 IU of vitamin D (Low-Ca group), or same milk powder additionally fortified with 300 mg of calcium (Mid-Ca group) or 600 mg of calcium (High-Ca group) for 2 years. The subjects' bone mineral density (BMD) and bone mineral content (BMC) at the total body, lumbar spine and left hip were determined by dual-energy X-ray absorptiometry at baseline and after the second year of treatment. Of the 111 girls and 109 boys (aged 12-14 years) enrolled, 91 girls and 91 boys completed the trial., Results: The girls in the High-Ca group (1,110 mg/d) had 2.3%, 2.7% and 2.6% greater BMD accretion at the total hip, femoral neck and shaft (P<0.05) but not at total body less head and spine than those in the Low-Ca group (655 mg/d). A significant effect of higher calcium intake was also observed for percentage change of size-adjusted BMC at femur neck (P=0.047). Bonferroni tests indicated no significant differences in the percentage changes in BMD, BMC or size-adjusted BMC between the Mid- and Low-Ca groups and between the High- and Mid-Ca groups. Extra calcium had no observable additional effect in the boys (P>0.05)., Conclusion: An intake of 1000 mg/d or more might be helpful in maximizing bone mineral accretion in the hip for girls. But further large studies are required to identify its long-term effects and the optimal calcium intake for boys., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Unlabelled: We pooled bone mineral density (BMD) data published in 91 articles including 139,912 Chinese adults and then established a national-wide BMD reference database at the lumbar spine and femur neck for Chinese adults. The prevalence of osteoporosis in the middle-aged and elderly Chinese population was also estimated., Introduction: Well-accepted reference value of BMD is lacking in Chinese. We established the reference database and assessed osteoporosis prevalence based on published literature conducted in the Mainland China, Taiwan, and Hong Kong Chinese., Methods: We searched for all published articles indexed in MEDLINE, PubMed, CNKI, and SinoMed up to January 2013. We included cross-sectional studies that examined BMD using a dual-energy X-ray absorptiometry at the femur neck (FN) and/or lumbar spine (LS) in healthy adults. Overall age-specific mean (SD) BMD were pooled after standardization., Results: Ninety-one studies including 51,906 males and 88,006 females (≥ 20 years) in 38 cities in China were included in this pooling study. Gender- and age-specific reference curves of standardized BMD (sBMD) at the LS and FN were constructed. The sBMD cutoffs for osteoporosis classification were 0.746 and 0.549 in women, and 0.680 and 0.568 g/cm(2) in men; age-standardized prevalence of osteoporosis was 23.9 % and 12.5 % in women and 3.2 % and 5.3 % in men aged ≥ 50 years at the LS and FN, respectively. Meta-regression analysis showed that greater age and altitude, lower latitude, smaller city size, earlier detection time, and random sample were correlated to lower sBMD in at least one gender-specific bone sites; the Hologic DXA produced a higher value of FN sBMD than the other two devices (Lunar and Norland)., Conclusion: We have established a national-wide BMD reference database at the LS and FN for Chinese adults and estimated the prevalence of osteoporosis in the middle-aged and elderly Chinese population.

Objective: To explore the proportion and prevention status of venous thromboembolism (VTE) among hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Beijing., Methods: Based on a multi-center retrospective study, a total of 636 hospitalized AECOPD patients from 17 class 2/3 hospitals in Beijing were examined from September 1, 2011 to March 31, 2012. They fulfilled one of the following criteria: respiratory failure type II, on invasive or non-invasive mechanical ventilation, hospitalization for pulmonary infection, bedridden duration ≥ 3 days and congestive heart failure. All investigators received standardized training and used a standardized questionnaire to collect data on VTE risk factors, the diagnosis of VTE and the utilization of VTE prophylaxis. According to Caprini score, they were categorized into 3 groups of lower risk (Caprini score ≤ 3), moderate risk (Caprini score 4-6) and high risk ( ≥ 7) to compare the intergroup differences in the VTE proportion and the utilization of VTE prophylaxis., Results: A total of 636 patients were assessed. There were 416 males and 220 females with a mean (SD) age of 74.9 ± 9.3 years. Among them, 133 patients received lower extremity venous ultrasonic examination and 92 were diagnosed with deep venous thrombosis (DVT) including 2 patients with pulmonary thromboembolism (PTE). Thus the overall incidence of VTE was 14.5% (92/636) and increased with age (Ptrend = 0.044). The proportion of VTE in asymptomatic patients was higher in those symptomatic ones (21.1% vs 8.0%, P = 0.000). And it was the highest in high risk group, followed by lower risk and moderate risk groups at 17.9% (14/78), 16.0% (26/163) and 13.2% (52/395) respectively, There was no statistical significance (P = 0.450 for group difference, Ptrend = 0.946). Among 544 patients without VTE, only 19.1% (104/544) employed the pharmacologic and/or mechanical methods for preventing VTE. The prevention proportion gradually increased with rising Caprini score, i.e. 17.5%, 18.4% and 26.6% for lower, moderate and higher risk group respectively. There was no statistical significance (P = 0.266 for group difference, Ptrend = 0.201)., Conclusions: The proportion of VTE is relatively higher. However, the preventive methods are significantly underutilized among hospitalized AECOPD patients in Beijing.

Background: Although many adiposity indices may be used to predict obesity-related health risks, uncertainty remains over which of them performs best., Objective: This study compared the predictive capability of direct and indirect adiposity measures in identifying people at higher risk of metabolic abnormalities., Methods: This population-based cross-sectional study recruited 2780 women and 1160 men. Body weight and height, waist circumference (WC), and hip circumference (HC) were measured and body mass index (BMI), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were calculated. Body fat (and percentage of fat) over the whole body and the trunk were determined by bioelectrical impedance analysis (BIA). Blood pressure, fasting lipid profiles, and glucose and urine acid levels were assessed., Results: In women, the ROC and the multivariate logistic regression analyses both showed that WHtR consistently had the best performance in identifying hypertension, dyslipidemia, hyperuricemia, diabetes/IFG, and metabolic syndrome (MetS). In men, the ROC analysis showed that WHtR was the best predictor of hypertension, WHtR and WC were equally good predictors of dyslipidemia and MetS, and WHtR was the second-best predictor of hyperuricemia and diabetes/IFG. The multivariate logistic regression also found WHtR to be superior in discriminating between MetS, diabetes/IFG, and dyslipidemia while BMI performed better in predicting hypertension and hyperuricemia in men. The BIA-derived indices were the second-worst predictors for all of the endpoints, and HC was the worst., Conclusion: WHtR was the best predictor of various metabolic abnormalities. BMI may be used as an alternative measure of obesity for identifying hypertension in both sexes.

Specialized bracts are thought to be important for the successful reproduction of some plants and are regarded as adaptations to diverse driving forces. However, few empirical studies have quantified the adaptive significance of bracts within a cost-benefit framework. We explored the adaptive significance of large and showy bracts for reproduction in Rheum nobile, a giant herb endemic to the high Himalayas. We examined whether the bracts enhance reproductive success during flowering and seed development. Bracts increased flower and fruit temperature on sunny days, greatly decreased the intensity of ultraviolet-B (UV-B) radiation reaching flowers and fruits, and prevented pollen grains being washed away by rain. Experiments indicated that high temperature could promote pollen germination, while pollen grains exposed to rain and UV-B radiation at ambient levels were seriously damaged. Furthermore, bract removal decreased the number of pollinators visiting flowers. When bracts were removed before or after flowering, fecundity and progeny quality were adversely affected, but seed predation by larvae of pollinators decreased. A cost-benefit analysis demonstrated that the cost of bracts, i.e., increased seed predation, is modest. Our results suggest that the bracts of R. nobile promote pollen germination, protect pollen grains from rain and intense UV-B radiation, enhance pollinator visitation during flowering, and facilitate the development of fertilized ovules during seed development. We conclude that multifunctional bracts of R. nobile are an effective adaptive strategy in alpine environments and might have been selected for because of abiotic environmental conditions as well as for enhancing pollination success.

The scaly-sided merganser (Mergus squamatus), found in temperate East Asia, has been reduced to a very small population. Central and southern China are its main wintering habitat. However, populations have declined greatly since the 1980s due to habitat loss and degradation, and poaching. To meet the urgent need for up-to-date conservation information, we examined RAPD DNA markers from 156 specimens in 6 populations in Jiangxi Province. We found that genetic diversity (based on individual similarities) is in fact low; molecular variance between populations ranged from 0.137 to 0.347. Genetic similarity ranged from 0.683 to 0.866. In conclusion, the geographical pattern of genetic diversity supports the long-term refugial status of the scaly-sided merganser in central-southern China; strong conservation measures should be taken to maintain the merganser in this region.

Objective: The aim of this survey is to determine the main barriers of geriatric health care from the physicians' point of view and compare the improvement before and after the Continue Medical Education (CME) provided by International Association of Gerontology and Geriatrics (IAGG)., Design: Cross-sectional survey., Setting and Participants: Five hundred samples were generated using systematic random sampling from the address lists of physicians in Southwest China who had received the IAGG CME or been trained in Sichuan Association of Geriatrics (SAG) CME., Measurements: The interview instrument examined demographics and information on geriatric education., Results: Of the 500 physician sampled, 461(92.2 percent) responded. 34.3 percent of the respondents reported that over 70 percent of their patients were older persons. 76.8 percent of the respondents felt that they lacked geriatric knowledge. Only 15.6 percent of the respondents had geriatric curriculum before graduation, and 26.0 percent received geriatric trainings after graduation. Most physicians felt that "Language barrier" and "Insufficient geriatric education in undergraduate medical school and postgraduate education" were the main challenges in practicing geriatric medicine. Geriatric training and knowledge are inadequate due to the lack of geriatric curriculums in medical schools and CME for physicians who practice geriatrics. With the help of IAGG, CME in Southwest China provided more workshops on geriatric progress in year 2011 than in year 2007-2010. Eighty percent of the physicians acknowledged that the IAGG CME was helpful for their clinical practice. The physicians paid more attention to geriatric syndromes rather than age-related pathophysiology alone., Conclusion: CME provided by geriatric associations is helpful. Collaboration between different geriatric societies such as IAGG and SAG may be a good model for spreading geriatric knowledge and should be considered by medical educational administration.

Objective: Previous studies showed an inconsistent association of fruit and vegetable consumption with bone health. We assessed the associations in Chinese adolescents, young and postmenopausal women., Design: A cross-sectional study conducted in China during July 2009 to May 2010., Setting: Bone mineral density (BMD) and content (BMC) at the whole body, lumbar spine and left hip were measured with dual-energy X-ray absorptiometry. Dietary intakes were assessed using an FFQ. All these values were separately standardized into Z-scores in each population subgroup., Subjects: One hundred and ten boys and 112 girls (11-14 years), 371 young women (20-34 years, postpartum within 2 weeks) and 333 postmenopausal women (50-70 years)., Results: After adjustment for potential covariates, analysis of covariance showed a significantly positive association between fruit intake and BMD and BMC in all participants combined (P-trend: < 0.001 to 0.002). BMD Z-score increased by 0.25 (or 2.1 % of the mean), 0.22 (3.5 %), 0.23 (3.0 %) and 0.25 (3.5 %), and BMC Z-score increased by 0.33 (5.7 %), 0.25 (5.8 %), 0.34 (5.9 %) and 0.29 (4.7 %), at the total body, lumbar spine, total hip and femoral neck in participants belonging to the top tertile compared with the bottom tertile of fruit intake (all P < 0.05), respectively. There was no significant association between vegetable intake and bone mass at all bone sites studied except for total body BMD (P = 0.030). Relatively more pronounced effects were observed in boys and postmenopausal women., Conclusion: Our findings add to the existing evidence that fruits and vegetables may have a bone sparing effect.

Objective: To evaluate the effect of the water conservancy schistosomiasis control projects in rivers and estuaries connecting with the Yangtze River on Oncomelania snail control., Methods: Three water conservancy schistosomiasis control projects of Laobianmin River, Panjia River and Bianmin River were chosen for the objects of the study. The concrete slope protection and the overflow dam, the concrete slope protection and the check sluice, and the simple concrete slope protection were built respectively in above mentioned three rivers. The changes of the area with snails and density of snails were investigated before and after the interventions, and the results were compared among the three projects., Results: In the condition of the routine snail control with the molluscicide, the snails were eliminated in the main riverway of the Laobianmin River, but the snails still existed in the target protected area (tributaries of the river and irrigation areas); the snails were eliminated in the Panjia River and its irrigation areas; in the Bianmin River, the areas with snails dropped by 89.22% in the main river and still remained in the tributaries and irrigation areas after the project implementation., Conclusions: The sluice and overflow dam more contribute to control and eliminate snails in the project areas and the target protected areas in the rivers and estuaries connecting with the Yangtze River. The priority of consideration should be given to the water level control and prevention of snail spreading in the water level instability rivers connecting with the Yangtze River.

The sympatric occurrence of some species in Roscoea is very common, but little information is available on natural hybridization. However, some intermediate individuals were found on the sympatric population of Roscoea humeana and R. cautleoides at Ganhaizi population in northwestern Yunnan Province, China. We suspected that these intermediate individuals were the hybrids of R. humeana and R. cautleoides from the previous evidence, but could not confirm them. In this study, morphometric analysis was followed by examination of HAT-RAPD polymorphisms to determine the occurrence of natural hybridization between sympatric R. humeana and R. cautleoides. The results showed that most morphological characters of the putative hybrids were found to be intermediate between those of R. humeana and R. cautleoides. Meanwhile, molecular analysis confirmed that the morphological intermediates were derived from hybridization between the two species. From the analysis of the NewHybrids, the hybridization individuals were mainly F₁s. These results indicated that interspecific hybridization between R. humeana and R. cautleoides indeed occurred in sympatric population.

A clinical investigation was conducted to demonstrate the epidemiology of cranio-facial injuries inflicted by animals in southern-central part of China-the World's most populous eastern country. It consisted of a retrospective study of 149 patients and was carried out in our department. All the patients were attacked by animals, such as buffalo, cattle, donkey, horse, dog, cat, and rat. There were 91 males and 58 females patients, aged from 5 to 65 years. 113 patients were from rural areas, and 36 from urban districts. Dogs, cattle, donkeys and buffalo, were the most common animals involved in this study. Bite was the predominant mechanism of injury, followed by kick, fall, trample, knock and scratch. The lip, chin and cheek were the commonest sites of soft tissue injury; Condylar process, symphysis, parasymphysis, and angle of mandible were the sites of fractures. Regarding the severity of injury, nearly half of the patients belonged to I and II classifications. The treatment results were satisfactory except for obvious scar formation, facial nerve palsy, and dysocclusion in a few patients. Facial injuries caused by animals are common in China, especially in rural areas. Timely treatment should be performed as soon as possible. Special attention should be paid to the prescription of antibiotics and vaccines. Psychotherapy may also be considered when necessary. It is suggested that adequate protective measures should be taken when animals are used for agricultural activities or kept as pets to minimize the incidence of facial injury., (Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: To analyze the causes and consequence of treatment refusal and abandonment in childhood acute lymphoblastic leukemia (ALL) treated in Wuhan Union Hospital of China., Methods: We collected recorded data and interviewed families of the children with ALL diagnosed between January 1997 and August 2007, who refused or abandoned treatment., Results: 323 patients were diagnosed with ALL. 173 patients (173/323, 53.6%) refused therapy and 35 (35/323, 10.8%) cases abandoned treatment. 191 (191/208, 91.8%) of these children were telephone/mail-visited. Different people had different reasons for refusal or abandonment. Financial difficulty and belief of ALL incurability were the main reasons for abandonment. Transportation difficulties and fear of severe side effects were also important reasons. Of the 173 patients who refused treatment, 13 patients lost follow-up. 160 parents were interviewed and 1 (6.3%) child was still alive at the date of last follow-up. Of the 35 patients who abandoned treatment, 4 patients lost follow-up. 31 parents were interviewed and 2 (6.5%) children were still alive at the date of last follow-up., Conclusion: Medical insurance and a systemic health education are extremely required for childhood ALL in low middle income countries., (Copyright © 2011 Elsevier Ltd. All rights reserved.)