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Comorbidity in mental disorders is prevalent among adolescents, with evidence suggesting a general psychopathology factor ("p" factor) that reflects shared mechanisms across different disorders. However, the association between the "p" factor and protective factors remains understudied. The current study aimed to explore the "p" factor, and its associations with psycho-social functioning, in Chinese adolescents. 2052 students, aged 9–17, were recruited from primary and secondary schools in Shanghai, China. Multiple rating scales were used to assess psychological symptoms and psycho-social functioning. Confirmatory factor analysis was conducted to verify the fit of models involving different psychopathology domains such as externalizing, internalizing, and the "p" factor. Subsequently, structural equation models were used to explore associations between the extracted factors and psycho-social functioning, including emotion regulation, mindful attention awareness, self-esteem, self-efficacy, resilience, and perceived support. The bi-factor model demonstrated a good fit, with a "p" factor accounting for 46 % of symptom variation, indicating that the psychological symptoms of Chinese adolescents could be explained by internalizing, externalizing, and the "p" factor. Psychologically, a higher "p" was positively correlated with emotion suppression and negatively correlated with mindful attention awareness, emotion reappraisal, self-esteem, and resilience. Socially, a higher "p" was associated with decreased perceived support. Only common symptoms were included as this study was conducted at school. Furthermore, the cross-sectional design limited our ability to investigate causal relationships. A "p" factor exists among Chinese adolescents. Individuals with higher "p" factor levels were prone to experience lower levels of psycho-social functions. • This study aimed to explore the "p" factor and its associations with psycho-social functioning in Chinese adolescents. • The psychological symptoms of Chinese adolescents could be explained by internalizing, externalizing, and the "p" factor. • Individuals with higher "p" factor levels were prone to experiencing lower psycho-social functioning. • This study highlights the "p" factor's role in protective factors and identifies variables for trans-diagnostic interventions. [ABSTRACT FROM AUTHOR]

Purpose: Night lighting reflects the prosperous development of economic and the increasingly rich and colorful cultural life. Currently, various technical standards, protocols and management specifications have been developed to build a safe, comfortable and economical lighting environment. However, prevailing evaluation systems focus on objective indexes of illumination and have ignored environmental characteristics and subjective feelings and lacked consideration of regional culture, economic benefit, management and maintenance. In this context, a lighting evaluation system combining subjective and objective is proposed for the first time in this study to explore approaches to guide the development of a healthy and comfortable urban night-time environment. Design/methodology/approach: Existing research and relevant lighting standards are analyzed and an evaluation model with a logical hierarchy is constructed by combining with the evaluation theory that is set based on people and the environment. The index weights were scientifically determined on the basis of the analytic hierarchy process (AHP) and fuzzy comprehensive evaluation method. The rationality and validity of the proposed evaluation system is verified in accordance with field projects and case studies. Findings: Taking into account traditional and cultural factors, the evaluation model established has an acceptable accuracy. Evaluation based on subjective-objective combination can provide a scientific basis for the management and optimization of night lighting. Originality/value: The proposed evaluation system can serve as a guiding reference for other areas of cultural identity and esthetic perspective. [ABSTRACT FROM AUTHOR]

The article discusses research which examined the seroprevalence of neutralizing antibodies against hand, foot and mouth disease (HFMD) associated enteroviruses among health individuals in Shanghain, China. The study observed different trends in the seroprevalence of four serotypes of coxsackieviruses in different age groups. It analyzed the seroprevalence of protective and high-level neutralizing antibodies (NtAb) titers and the seroprotection rates of coxsackieviruses.

Background Low-frequency intrahost single-nucleotide variants of SARS-CoV-2 have been recognized as predictive indicators of selection. However, the impact of vaccination on the intrahost evolution of SARS-CoV-2 remains uncertain at present. Methods We investigated the genetic variation of SARS-CoV-2 in individuals who were unvaccinated, partially vaccinated, or fully vaccinated during Shanghai's Omicron BA.2.2 wave. We substantiated the connection between particular amino acid substitutions and immune-mediated selection through a pseudovirus neutralization assay or by cross-verification with the human leukocyte antigen–associated T-cell epitopes. Results In contrast to those with immunologic naivety or partial vaccination, participants who were fully vaccinated had intrahost variant spectra characterized by reduced diversity. Nevertheless, the distribution of mutations in the fully vaccinated group was enriched in the spike protein. The distribution of intrahost single-nucleotide variants in individuals who were immunocompetent did not demonstrate notable signs of positive selection, in contrast to the observed adaptation in 2 participants who were immunocompromised who had an extended period of viral shedding. Conclusions In SARS-CoV-2 infections, vaccine-induced immunity was associated with decreased diversity of within-host variant spectra, with milder inflammatory pathophysiology. The enrichment of mutations in the spike protein gene indicates selection pressure exerted by vaccination on the evolution of SARS-CoV-2. [ABSTRACT FROM AUTHOR]

Objective: The aim was to evaluate and optimize the performance of sensor monitors in measuring PM2.5 and PM10 under typical emission scenarios both indoors and outdoors. Method: Parallel measurements and comparisons of PM2.5 and PM10 were carried out between sensor monitors and standard instruments in typical indoor (2 months) and outdoor environments (1 year) in Shanghai, respectively. The optimized validation model was determined by comparing six machining learning models, adjusting for meteorological and related factors. The intra- and inter-device variation, measurement accuracy, and stability of sensor monitors were calculated and compared before and after validation. Results: Indoor particles were measured in a range of 0.8–370.7 μg/m3 and 1.9–465.2 μg/m3 for PM2.5 and PM10, respectively, while the outdoor ones were in the ranges of 1.0–211.0 μg/m3 and 0.0–493.0 μg/m3, correspondingly. Compared to machine learning models including multivariate linear model (ML), K-nearest neighbor model (KNN), support vector machine model (SVM), decision tree model (DT), and neural network model (MLP), the random forest (RF) model showed the best validation after adjusting for temperature, relative humidity (RH), PM2.5/PM10 ratios, and measurement time lengths (months) for both PM2.5 and PM10, in indoor (R2: 0.97 and 0.91, root-mean-square error (RMSE) of 1.91 μg/m3 and 4.56 μg/m3, respectively) and outdoor environments (R2: 0.90 and 0.80, RMSE of 5.61 μg/m3 and 17.54 μg/m3, respectively), respectively. Conclusions: Sensor monitors could provide reliable measurements of PM2.5 and PM10 with high accuracy and acceptable inter and intra-device consistency under typical indoor and outdoor scenarios after validation by RF model. Adjusting for both climate factors and the ratio of PM2.5/PM10 could improve the validation performance. [ABSTRACT FROM AUTHOR]

Captive breeding programs play an important role in preserving the genetic diversity of endangered species. It is of utmost importance to conduct genetic assessment for captive populations in order to develop scientific breeding plans and conservation management strategies. Here, we genotyped 10 microsatellite loci and sequenced 368 bp of mitochondrial DNA control region for the golden snub‐nosed monkey (Rhinopithecus roxellana) from eight captive populations in China, and compared the genetic indices of captive populations with a wild population. Meanwhile, we performed paternity tests to verify the genealogical records and established genetic lineages. A total of 157 individuals were identified from 161 fecal samples, including 135 captive individuals (approximately 25% of captive individuals in China). Microsatellite analysis showed that the nine populations had moderate levels of genetic diversity, with polymorphism information content (PIC) ranging from 0.43 to 0.542; the genetic diversity of captive populations (average PIC: 0.503) was slightly higher than that of the wild population (PIC: 0.438). The Structure analysis indicated that individuals of the eight captive populations contained two different genetic components. We conducted either single‐blind or double‐blind paternity testing on 40 offspring of captive individuals and found that five offspring from two zoos (Nanjing Hongshan Forest Zoo and Shanghai Wild Animal Park) showed discrepant kinships from their pedigree records, probably due to the inaccuracies in pedigree records. By constructing genetic pedigrees, inbred offspring were found in Beijing Zoo, Shanghai Zoo, Hangzhou Zoo, and Chengdu Zoo. Analysis based on mitochondrial DNA showed a high level of genetic diversity in the eight captive populations (mean nucleotide diversity: 0.047). However, no nucleotide diversity was found in the wild population. This study conducted a genetic survey for captive golden snub‐nosed monkeys and will significantly benefit the genetic conservation management for captive populations in the future. [ABSTRACT FROM AUTHOR]

To improve the anti-interference ability of maglev trains, a dynamic model of the high-speed maglev train with a nonlinear suspension controller for the guideway system is proposed in this paper. Based on the nonlinear characteristics of the magnetic suspension system, a nonlinear decoupling controller is designed using the feedback linearization theory. Then, a high-speed maglev train model is refined with a guideway coupling system, consisting of a maglev train simulated as a multi-body dynamics model with 537 degrees of freedom and a spatial finite element model of the guideway. Taking the Shanghai high-speed maglev train as an example, the correctness of the computational model is verified by comparing the modeling results with field measurement data, and the control effectiveness of the nonlinear controllers and the traditional PD controllers is compared considering different train speeds and disturbance forces. The results show that the suspension gap under the decoupling control is smaller than that under the PD control during the train operations. Under the same disturbance force, the decoupling control exhibits better control performance than the PD control. The variation amplitudes of the magnetic pole gaps are generally linearly related to the disturbance force. [ABSTRACT FROM AUTHOR]

China is facing a serious land resource mismatch problem, which will profoundly affect the acceleration of economic growth and technological innovation. Reform of the industrial land allocation system can solve the mismatch of land resources, and that also has an important impact on the promotion of economic and technological development. This paper selects the data of Chinese A-share listed companies in Shanghai and Shenzhen from 2007 to 2020 as the research sample, constructs a double machine learning model, and empirically investigates the impact of a new industrial land use policy on firms' green innovation behavior. The study shows that: (1) the new industrial land use policy significantly promotes firms' substantive and strategic green technological innovation, and the effect on substantive green technological innovation is greater than that on strategic green technological innovation. (2) The enhancement of R&D investment sustainability and the "talent pool" effect are important mechanisms through which the new industrial land use policy influences firms' substantive and strategic green technological innovation. Meanwhile, the new industrial land use policy is conducive to firms' green coinnovation. (3) There is heterogeneity in the effect of the new industrial land use policy, which can significantly promote green technological innovation of firms in the eastern region, while it does not play a significant role in the green innovation behavior of firms in the central and western regions. The above research results enrich the research in the field of industrial land and innovation, help to understand more comprehensively the mechanism of new industrial land affecting firms' green technological innovation, and provide policy insights for strengthening the application of industrial land allocation reform in firms' green innovation. [ABSTRACT FROM AUTHOR]

Background: Decitabine (DAC), a DNA methyltransferase inhibitor, has shown efficacy combined with chemotherapy for relapsed or refractory (R/R) acute myeloid leukemia (AML) in adults, but less is known about its efficacy in children. Accordingly, we conducted a study which involved a priming regimen consisting of DAC with cladribine, cytarabine, and granulocyte-stimulating factor (DAC-CLAG) and compared the efficacy and safety of this regimen with CLAG alone. Methods: A total of 39 R/R AML children who received the CLAG or DAC-CLAG regimen in Shanghai Children's Hospital were retrospectively enrolled in this non-randomized study. These regimens were studied sequentially over time. Twenty-two patients received CLAG from 2015, while 17 patients were administered epigenetic priming with DAC before CLAG from 2020. Patients were subsequently bridged to stem cell transplantation (SCT) or consolidation chemotherapy. Complete remission (CR) and adverse effects were analyzed by Fisher's exact test, and survival was analyzed by the Kaplan–Meier method. Results: DAC-CLAG conferred a numerically higher CR compared to CLAG (70.59% vs 63.64%; P = 0.740). High CR rates occurred in patients with good cytogenetics (P = 0.029) and prior induction without cladribine (P = 0.099). The 1-year event-free survival (EFS) was 64.71% ± 11.59% and 63.31% ± 10.35% in the DAC-CLAG and CLAG group (P = 0.595), and 1-year overall survival (OS) was 81.45% ± 9.72% and 77.01% ± 9.04%, respectively (P = 0.265). The 1-year OS and EFS after SCT were higher in the DAC-CLAG than in the CLAG cohort (100% vs 92.31% ± 7.39%, P = 0.072; 92.31% ± 7.39% vs 85.71% ± 9.35%, P = 0.158). Univariate analysis revealed that a good prognosis included good cytogenetics (P = 0.002), non-complex karyotype (P = 0.056), CR on reinduction (P < 0.0001), and bridging to SCT (P = 0.0007). Use of a hypomethylating agent (P = 0.049) and bridging to SCT (P = 0.011) were independent prognostic factors. Grade 3/4 hematologic toxicity and infection were the main adverse events. Conclusions: DAC prior to the CLAG regimen improved remission in pediatric R/R AML, and was feasible and well tolerated. CLAG ± DAC as a salvage therapy prior to SCT induced improved survival. [ABSTRACT FROM AUTHOR]

Aim: This study aims to investigate the association of glycemia risk index (GRI), a novel composite metric derived from continuous glucose monitoring (CGM), with arterial stiffness in patients with type 2 diabetes. Materials and Methods: A total of 342 adults with type 2 diabetes were enrolled between April and June 2023 from 11 communities in Shanghai, China. Medical examinations, including measurements of anthropometric parameters, blood pressure, and venous blood samples were conducted. Brachial‐ankle pulse wave velocity (baPWV) was examined to evaluate arterial stiffness. All the participants underwent a 14 day CGM recording and GRI was calculated from the CGM data. Results: The mean age was 70.3 ± 6.8 years, and 162 (47.4%) were male. Participants with a higher baPWV had significantly higher levels of GRI and hyperglycemia component (both P for trend < 0.05). Linear regression revealed the significant positive linear associations of the GRI with baPWV in unadjusted or adjusted models (All P < 0.05). In the multivariable logistic analysis, each increase in the GRI quartile was associated with a 1.30‐fold (95% CI 1.01–1.68, P for trend < 0.05) higher prevalence of increased arterial stiffness after adjustment for age, sex, BMI, diabetes duration, current smoking status, blood pressure, and lipid profile. Subgroup analyses showed that the association between the GRI quartiles and increased arterial stiffness was stronger among participants with a diabetes duration ≥15 years (P for interaction = 0.014). Conclusion: Glycemia risk index assessed by continuous glucose monitoring is associated with increased arterial stiffness in type 2 diabetes. [ABSTRACT FROM AUTHOR]

Objectives: Amyloid deposition is considered the initial pathology in Alzheimer's disease (AD). Personalized management requires investigation of amyloid pathology and the risk factors for both amyloid pathology and cognitive decline in the Chinese population. We aimed to investigate amyloid positivity and deposition in AD patients, as well as factors related to amyloid pathology in Chinese cities. Methods: This cross-sectional multicenter study was conducted in Shanghai and Zhengzhou, China. All participants were recruited from urban communities and memory clinics. Amyloid positivity and deposition were analyzed based on amyloid positron emission tomography (PET). We used partial least squares (PLS) models to investigate how related factors contributed to amyloid deposition and cognitive decline. Results: In total, 1026 participants were included: 768 participants from the community-based cohort (COMC) and 258 participants from the clinic-based cohort (CLIC). The overall amyloid-positive rates in individuals with clinically diagnosed AD, mild cognitive impairment (MCI), and normal cognition (NC) were 85.8%, 44.5%, and 26.9%, respectively. The global amyloid deposition standardized uptake value ratios (SUVr) (reference: cerebellar crus) were 1.44 ± 0.24, 1.30 ± 0.22, and 1.24 ± 0.14, respectively. CLIC status, apolipoprotein E (ApoE) ε4, and older age were strongly associated with amyloid pathology by PLS modeling. Conclusion: The overall amyloid-positive rates accompanying AD, MCI, and NC in the Chinese population were similar to those in published cohorts of other populations. ApoE ε4 and CLIC status were risk factors for amyloid pathology across the AD continuum. Education was a risk factor for amyloid pathology in MCI. Female sex and age were risk factors for amyloid pathology in NC. Clinical relevance statement: This study provides new details about amyloid pathology in the Chinese population. Factors related to amyloid deposition and cognitive decline can help to assess patients' AD risk. Key Points: • We studied amyloid pathology and related risk factors in the Chinese population. •·The overall amyloid-positive rates in individuals with clinically diagnosed AD, MCI, and NC were 85.8%, 44.5%, and 26.9%, respectively. • These overall amyloid-positive rates were in close agreement with the corresponding prevalence for other populations. [ABSTRACT FROM AUTHOR]

Background: The urban ambient air quality has been largely improved in the past decade. It is unknown whether childhood asthma prevalence is still increasing in ever top‐ranking city of Shanghai, whether the improved air quality is beneficial for children's asthma and what time window of exposure plays critical roles. Methods: Using a repeat cross‐sectional design, we analyzed the association between early life exposure to particles and wheezing/asthma in each individual and combined surveys in 2011 and 2019, respectively, in 11,825 preschool children in Shanghai. Results: A significantly lower prevalence of doctor‐diagnosed asthma (DDA) (6.6% vs. 10.5%, p < 0.001) and wheezing (10.5% vs. 23.2%, p < 0.001) was observed in 2019 compared to 2011. Exposure to fine particulate matter (PM2.5), coarse particles (PM2.5–10) and inhalable particles (PM10) was decreased in 2019 by 6.3%, 35.4%, and 44.7% in uterus and 24.3%, 20.2%, and 31.8% in infancy, respectively. Multilevel log‐binomial regression analysis showed exposure in infancy had independent association with wheezing/DDA adjusting for exposure in uterus. For each interquartile range (IQR) increase of infancy PM2.5, PM2.5–10 and PM10 exposure, the odds ratios were 1.39 (95% confidence interval (CI): 1.24–1.56), 1.51 (95% CI:1.15–1.98) and 1.53 (95% CI:1.27–1.85) for DDA, respectively. The distributed lag non‐linear model showed the sensitive exposure window (SEW) was 5.5–11 months after birth. Stratified analysis showed the SEWs were at or shortly after weaning, but only in those with <6 months of exclusive breastfeeding. Conclusions: Improved ambient PM benefits in decreasing childhood asthma prevalence. We firstly reported the finding of SEW to PM at or closely after weaning on childhood asthma. [ABSTRACT FROM AUTHOR]

Introduction: An unprecedented surge of Omicron infections appeared nationwide in China in December 2022 after the adjustment of the COVID-19 response policy. Here, we report the clinical and genomic characteristics of SARS-CoV-2 infections among children in Shanghai during this outbreak. Methods: A total of 64 children with symptomatic COVID-19 were enrolled. SARS-CoV-2 whole genome sequences were obtained using next-generation sequencing (NGS) technology. Patient demographics and clinical characteristics were compared between variants. Phylogenetic tree, mutation spectrum, and the impact of unique mutations on SARS-CoV-2 proteins were analysed in silico. Results: The genomic monitoring revealed that the emerging BA.5.2.48 and BF.7.14 were the dominant variants. The BA.5.2.48 infections were more frequently observed to experience vomiting/diarrhea and less frequently present cough compared to the BF.7.14 infections among patients without comorbidities in the study. The high-frequency unique non-synonymous mutations were present in BA.5.2.48 (N:Q241K) and BF.7.14 (nsp2:V94L, nsp12:L247F, S:C1243F, ORF7a:H47Y) with respect to their parental lineages. Of these mutations, S:C1243F, nsp12:L247F, and ORF7a:H47Y protein were predicted to have a deleterious effect on the protein function. Besides, nsp2:V94L and nsp12:L247F were predicted to destabilize the proteins. Discussion: Further in vitro to in vivo studies are needed to verify the role of these specific mutations in viral fitness. In addition, continuous genomic monitoring and clinical manifestation assessments of the emerging variants will still be crucial for the effective responses to the ongoing COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: We aimed to unbiasedly map the genetic mutation profile of HNSC and CESC associated with HPV status in the Chinese population (SYSU‐cohort) and compare them with Western population (TCGA‐cohort). Methods: Fifty‐one HNSC patients (SYSU‐HNSC) and 38 CESC patients (SYSU‐CESC) were enrolled in this study. Genomic alterations were examined, and the profile was produced using the YuanSuTM450 gene panel (OrigiMed, Shanghai, China). The altered genes were inferred and compared to Western patients from TCGA cohorts. Results: Compared to the TCGA‐HNSC cohort, FGFR3 mutation was identified as a novel target in SYSU‐HNSC with therapeutic potential. Compared to the TCGA‐CESC cohort, some epigenetic regulation‐associated genes were frequently mutated in SYSU‐CESC cohort (KMT2C, KMT2D, KDM5C, KMT2A). Conclusion: In summary, our study provides unbiased insights into the genetic landscape of HNSC and CESC in the Chinese population and highlights potential novel therapeutic targets that may benefit Chinese patients. [ABSTRACT FROM AUTHOR]

The dynamic performance of high-speed maglev trains, a next-generation rapid transit system, has received continuous attention in recent years. In this study, a dynamic reliability analysis method for a high-speed maglev train–guideway coupled system was proposed. First, a refined model of the maglev vehicle–bridge interaction system was established, where the vehicle subsystem was simulated as a rigid body-spring-damper model with 101 degrees of freedom. The guideway subsystem was simulated as a finite element model, and these two subsystems were coupled as an entire system through a magnet–rail interaction model with a proportional-derivative (PD) controller. Second, a dimension-reduction method for the simulation of representative samples of track irregularities was developed, and thus the number of random variables in the system was reduced to four. Finally, an efficient method for the calculation of the dynamic reliability of a maglev train–guideway coupled system was proposed using the probability density evolution method-based equivalent extreme value principle. With numerical examples, the accuracy of the maglev train–guideway interaction model was verified by comparing it with field measurement data from the Shanghai high-speed maglev line. The accuracy of the proposed dynamic reliability analysis method was confirmed by comparing three types of results, that is, the mean value time-history curve, the probability density function, and the cumulative distribution function of extreme values, obtained by the Monte Carlo method. Finally, the dynamic reliability of the running safety and stability of the maglev vehicle at a speed of 430 km/h and the variation laws of the dynamic reliabilities with train speed were examined in detail. [ABSTRACT FROM AUTHOR]

Background: Functional role of filum terminale (FT) was not well studied though it contains structure basis for nerve impulse conduction. We aimed to explore the possible functions of the FT from the perspective of triggered electromyography (EMG) during surgery. Methods: We retrospectively reviewed intraoperative neurophysiological monitoring data from pediatric patients who underwent intradural surgeries at the lumbar level in Shanghai Children's. Hospital from January 2018 to March 2023. Altogether 168 cases with complete intraoperative neurophysiological recordings of the FT were selected for further analysis. Triggered EMG recordings of the filum originated from two main types of surgeries: selective dorsal rhizotomy (SDR) and fatty filum transection. Results: 96 cases underwent SDR and 72 cases underwent fatty filum transection. Electrical stimulation of the FT with fatty infiltration did not elicit electromyographic activity in the monitored muscles with the maximum stimulus intensity of 4.0 mA, while the average threshold for FT with normal appearance was 0.68 mA, and 89 out of 91 FT could elicit electromyographic responses in monitored channels. The threshold ratio of filum to motor nerve roots at the same surgical segment was significantly higher in patients with fatty filum, and a cut-off point of 21.03 yielded an area under curve of 0.943, with 100% sensitivity and 85.71% specificity. Conclusion: Filum with normal appearance can elicit electromyographic activity in the lower limbs/anal sphincter similar to the performance of the cauda equina nerve roots. The threshold of fatty filum is different from that of normal appearing FT. Triggered EMG plays an important role in untethering surgeries. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to explore the influence of high altitude on myopia, macular choroidal thickness (mCT), and macular retinal thickness (mRT) in adolescents. Methods: Two schools, one in Shanghai (at sea level) and one in Shigatse, Tibet (more than 4000 m above sea level), were selected. Refractive error was measured by an autorefractor instrument and subjective refraction, and mCT and mRT were measured at three concentric circles by optical coherence tomography. Student's t-test, Chi-square test, and multiple linear regression analyses were used to analyze the data. Results: A total of 1114 participants (657 and 457 in Shanghai and Tibet, respectively) were enrolled in this cross-sectional study. The average age of the participants was 18.81 ± 1.10 years, and 44.34% were males. The spherical equivalent (SE) of adolescents in Shanghai was significantly lower than that of adolescents in Tibet (-4.14 ± 2.37 D and -2.12 ± 1.87 D, P < 0.01). The prevalence of myopia and high myopia among adolescents in Shanghai (94.52%, 19.48%) was significantly higher than those among adolescents in Tibet (44.74%, 2.41%) (P < 0.01). The mCT of Tibetan adolescents was significantly thicker than that of Shanghai adolescents (295.80 ± 62.46 μm and 218.71 ± 61.42 μm, P < 0.01), especially the central mCT. The mRT of Tibetan adolescents was also thicker than that of Shanghai adolescents (301.42 ± 23.26 μm and 281.04 ± 12.24 μm, P < 0.01). Conclusions: Compared with Shanghai adolescents, the choroid of Tibet adolescents is thicker, and the myopia prevalence is lower. It is speculated that increased altitude is associated with the thickening of mCT and a low myopia prevalence. [ABSTRACT FROM AUTHOR]

Background: Existing studies have already shown a connection between nitrogen dioxide (NO2) exposure and cerebrovascular mortality. However, the differential effects of NO2 on cerebrovascular disease and its subtypes remain unclear and require further exploration. Methods: Daily stroke mortality data between 2013 and 2021 in Shanghai, China were collected. Residential daily air pollution data for each decedent were predicted from a satellite model. An individual-level, time-stratified, case-crossover design was applied to examine the relationship between NO2 exposure and cerebrovascular mortality. A combination of conditional logistic regression and distributed lag models with a maximum lag of 7 days was used for data analysis. Results: A total of 219,147 cases of cerebrovascular mortality were recorded. Among them, the proportion of sequelae of cerebrovascular disease, hemorrhagic stroke and ischemic stroke was 50.7%, 17.1% and 27.5%, respectively. The monotonic increases in mortality risks of cerebrovascular diseases, sequelae of cerebrovascular disease and ischemic stroke were observed, without any discernible thresholds. Each 10 μg/m3 increase in NO2 concentration was associated with increments of 3.62% [95% confidence interval (CI): 2.56%, 4.69%] for total cerebrovascular mortality, 4.29% (95% CI: 2.81%, 5.80%) for sequelae of cerebrovascular disease mortality and 4.30% (95% CI: 2.30%, 6.33%) for ischemic stroke mortality. No positive associations between NO2 exposure and hemorrhagic stroke mortality were observed. A greater risk of NO2 was observed in the warm season, in patients with less than 9 years of education and in those with single marital status. The effects of NO2 were robust to mutual adjustment of co-pollutants. Conclusions: Short-term exposures to NO2 may increase the risk of cerebrovascular mortality, specifically for ischemic stroke and sequelae of cerebrovascular disease. [ABSTRACT FROM AUTHOR]

Formative assessment has been considered an essential concept for motivating and improving learning. However, implementing formative assessment has been confronted with challenges in Confucian-heritage culture (CHC) contexts such as Hong Kong and Shanghai, where the atmosphere of high-stakes tests dominates at policy and classroom levels. Whether formative assessment can lead to learning achievement in examination-oriented contexts remains an open issue. To unleash the potential benefits of formative assessment, CHC cities such as Hong Kong have been making great efforts to create conditions that can bring about the positive effect of formative assessment on learning achievement. To test this potential benefit of formative assessment in CHC contexts, the current study compared the impact of formative assessment on reading achievement in Hong Kong and Shanghai by including the mediation of motivation between formative assessment and achievement. Results of multi-group path analysis with the Programme for International Student Assessment (PISA) 2009 data showed: (a) a positive direct effect of formative assessment on achievement in Hong Kong and a negative direct effect in Shanghai, (b) a positive indirect effect through motivation both in Hong Kong and Shanghai, and (c) a total positive effect in both Hong Kong and Shanghai, but this total effect was more substantial in Hong Kong whereas trivial in Shanghai. The positive impact of formative assessment, particularly the relatively more significant total effect on the Hong Kong side, supports the potential of using formative assessment to enhance student learning in CHCs through local policy reform on assessment and teacher training on assessment literacy. [ABSTRACT FROM AUTHOR]

Background: The relationship of iron deficiency and thyroid hormone has been researched a lot among pregnant or other healthy population. However, invisible iron deficiency, namely shortage of serum ferritin (sFer) level, has been barely investigated among Chinese pregnant women. This study aimed to explore the effects of sFer status on thyroid function and pregnancy outcomes in a population-based upper first-class hospital.Methods: A total of 781 singleton pregnant women of gestation in Shanghai General Hospital took part in this retrospective cohort study. The participants were divided into four groups by quartiles of serum ferritin levels (Q1– 4). Binary logistic regressions were used to examine the strength of association between the different traits and the serum ferritin (sFer) quartiles separately, where Q1 (lowest ferritin quartile) was taken as the base reference. One-way ANOVA was adopted to compare the averages of the different variables across sFer quartiles. Categorical measures were compared by Fisher exact test or chi-square test.Results: As the sFer concentration rises, incidence of premature birth (15.8%vs 12.3% vs 9.20% vs 6.20% p = 0.016) as well as threatened miscarriage (14.8% vs 7.2% vs 8.70% vs 6.70% p = 0.021) presented a downward trend. Compared with the other sFer group, subjects of the low sFer group were older, more often to be found to have lower serum γT3 and FT4 levels in early pregnancy but not in middle pregnancy.Conclusion: sFer concentration in the first trimester can affect thyroid function. The correction of invisible iron deficiency with inadequate sFer status prior to pregnancy or during early pregnancy is imperative, not only to prevent anemia, but also for maintaining optimum thyroid function and normal fetal development. For clinicians, sFer status of pregnant women should be attached great importance apart from attention to iron level. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the efficiency of tri-ponderal mass index (TMI) in determining obesity in Chinese children aged 6-9 years, using the criteria of percentage of body fat (PBF) and body mass index z-scores (BMI-Z). Methods: The cross-sectional study included 5365 children, aged 6–9 years, who participated in the project survey “Group prevention and treatment of obesity among students and school health promotion in Shanghai” from September 2007 to September 2009. Height, weight, waist circumference, body mass index (BMI), TMI, waist-to-height ratio (WHtR), and PBF were recorded. Statistical analyses including Kolmogorov–Smirnov test, chi-square test, receiver operating characteristics curve, and kappa chi-square test were performed. Results: TMI for both sexes was relatively constant with increasing age, and statistically significant differences were not observed at some ages (P > 0.05 at 6, 7, 8, and 9 years). WHtR showed subtle changes, while BMI and PBF increased significantly with age in boys and girls (P < 0.01). Using BMI-Z criteria as the measure of general obesity, the results indicated that TMI cutoff values for 6–9 years were 14.60 kg/m³ for boys and 14.84 kg/m³ for girls (P < 0.001). Analysis of the agreement between TMI and BMI-Z showed that the kappa statistic was 0.826 in boys and 0.709 in girls (P < 0.001). Conclusion: TMI, as a constant tool, holds great potential as an alternative screening method for identifying children aged 6-9 years who may be at risk of obesity at an early stage. [ABSTRACT FROM AUTHOR]

Objective To investigate how economic development and health resource input impact infant mortality in Shanghai. Methods Data on GDP per capita, the number of health facility beds per 10,000 population, and the infant mortality rate in Shanghai from 1991 to 2020 were selected and analyzed using the vector error correction model. Results A long-term equilibrium relationship existed between infant mortality, GDP per capita, and the number of health beds per 10,000 persons, with the elasticity coefficient of infant mortality being-2. 83 (95% CI:-3. 86-1. 80) for GDP per capita and-3. 02 (95% CI: -5. 03-- 1. 01) for the number of health beds per 10,000 persons. The maximum value is reached in the 5th and 6th year respectively and has a long-term negative impact. Conclusion The improvement of infant health cannot be achieved without the two-way promotion of socio-economic and health resource investment. It is necessary to promote the effective combination of investment in health resources and economic development, improve the construction of the maternal and child healthcare service system, strengthen the leading role of the Government, and build an efficient mechanism for the investment of health resources. [ABSTRACT FROM AUTHOR]

Background: Previous studies reported that tuberculosis (TB) is associated with an increased risk of lung cancer or the survival and mortality of lung cancer. However, the impact of coexisting TB on the survival of lung cancer patients was controversial. We aimed to identify risk factors on the survival rate of patients with co-existent active TB and lung cancer. Methods: One hundred seventy-three patients diagnosed with active TB and lung cancer from January 2016 to August 2021 in Shanghai pulmonary hospital were selected and divided into two groups (≤ 6 months, > 6 months) according to the diagnosis interval between active TB and lung cancer (the order of diagnosis is not considered). The clinical characteristics and survival were analyzed. Univariate and multivariate logistic regression analyses were used to identify the risk factors for overall survival (OS). Results: One hundred seventy-three patients were diagnosed with lung cancer and active TB. The study population exhibited a median age of 64 years, with a majority of 81.5% being male, 58.0% of patients had a history of smoking. Among those involved, 93.6% had pulmonary TB, 91.9% were diagnosed with non-small cell lung cancer (NSCLC), 76.9% were Eastern Cooperative Oncology Group (ECOG) 0–2 and 12.7% were ECOG 3–4. We observed better survival in the > 6 months group compared with the ≤ 6 months group (hazard ratio [HR] 0.456, 95% confidence interval [CI]:0.234–0.889, P = 0.017). The 1-, 3-, and 5- year OS rates were 94.2%, 80.3%, and 77.6%, respectively, in the > 6 months group and 88.3%, 63.8%, and 58.5%, respectively, in the ≤ 6 months group. Surgery (HR 0.193, [95% CI, 0.038–0.097]; P = 0.046) and ECOG Performance Status (HR 12.866, [95% CI, 2.730–60.638]; P = 0.001) were independent prognostic factors in the > 6 months group. Conclusions: Patients diagnosed with lung cancer and active TB for more than half a year have a significantly better prognosis than those diagnosed within half a year. ECOG Performance Status and surgery might possibly affect the outcomes of patients with co-existent active TB and lung cancer. [ABSTRACT FROM AUTHOR]

Viruses in aquatic ecosystems exhibit remarkable abundance and diversity. However, scattered studies have been conducted to mine uncultured viruses and identify them taxonomically in lake water. Here, whole genomes (29–173 kbp) of seven uncultured dsDNA bacteriophages were discovered in Dishui Lake, the largest artificial lake in Shanghai. We analyzed their genomic signatures and found a series of viral auxiliary metabolic genes closely associated with protein synthesis and host metabolism. Dishui Lake phages shared more genes with uncultivated environmental viruses than with reference viruses based on the gene-sharing network classification. Phylogeny of proteomes and comparative genomics delineated three new genera within two known viral families of Kyanoviridae and Autographiviridae, and four new families in Caudoviricetes for these seven novel phages. Their potential hosts appeared to be from the dominant bacterial phyla in Dishui Lake. Altogether, our study provides initial insights into the composition and diversity of bacteriophage communities in Dishui Lake, contributing valuable knowledge to the ongoing research on the roles played by viruses in freshwater ecosystems. [ABSTRACT FROM AUTHOR]

The poor prognosis of pancreatic ductal adenocarcinoma (PDAC) is mainly attributed to late diagnosis. We assessed the predictive performance of our previously reported urine biomarker panel for earlier detection of PDAC (LYVE1, REG1B and TFF1) in prediagnostic samples, alone and in combination with plasma CA19‐9. This nested case‐control study included 99 PDAC cases with urine samples prospectively collected up to 5 years prior to PDAC diagnosis and 198 matched controls. The samples were obtained from the Shanghai Women's Health Study (SWHS), the Shanghai Men's Health Studies (SMHS) and the Southern Community Cohort Study (SCCS). The urine biomarkers were measured by ELISA. Plasma CA19‐9 was quantified by Luminex. Multiple logistic regression and Wilcoxon rank‐sum and Mann‐Whitney test were used for analysis. The internal validation approach was applied and the validated AUC estimators are reported on. The algorithm of urinary protein panel, urine creatinine and age named PancRISK, displayed similar AUC as CA19‐9 up to 1 year before PDAC diagnosis (AUC = 0.79); however, the combination enhanced the AUCs to 0.89, and showed good discriminative ability (AUC = 0.77) up to 2 years. The combination showed sensitivity (SN) of 72% at 90% specificity (SP), and SP of 59% at 90% SN up to 1 year and 60% SN with 80% SP and 53% SP with 80% SN up to 2 years before PDAC diagnosis. Adding the clinical information on BMI value resulted in the overall improvement in performance of the PancRISK score. When combined with CA19‐9, the urinary panel reached a workable model for detecting PDAC cases up to 2 years prior to diagnosis. [ABSTRACT FROM AUTHOR]

The rapid development of urbanization in China has contributed to traffic events, such as traffic accidents and delays. It is difficult to detect and resolve highway traffic congestion in a timely manner using traditional methods because they are slow, require a large number of workers, and require the installation of a large amount of monitoring equipment. Therefore, it is imperative to introduce advanced technology to address these challenges. Recently, deep learning technology has made significant breakthroughs and has been widely applied to various fields with satisfactory results. Deep learning is among the most important technologies for the detection and evaluation of traffic congestion, enabling the accurate detection of the state of the expressway network's traffic congestion, the evaluation of traffic congestion, and the prediction of possible traffic congestion. This enables management to formulate traffic dredging strategies in advance to prevent the negative impact of traffic congestion on normal traffic flow. This paper proposes a framework based on deep learning for next-generation highway traffic management. This framework selects traffic congestion indicators to construct an index model, and then constructs a deep learning model based on self-coding. It predicts and classifies highway traffic environment data and excavates sample data based on the characteristics of traffic parameters. As soon as traffic data were classified, a prediction model based on SoftMax was established to detect and predict highway traffic congestion. We conducted a traffic congestion analysis of the Shanghai expressway network based on the speed performance data obtained from the China Traffic Management Bureau. As a result of their research, we developed an index to measure highway traffic congestion. For traffic control and management organizations to function effectively, it is crucial to have an accurate and clear picture of traffic network operations. We evaluated the proposed framework using data gathered from highway monitoring scenes, and the results indicated that 98.6% of the data could be correctly detected. Using the prediction model based on SoftMax for expressway vehicles during peak hours, the accuracy was 92%, and the misjudgment rate was 8%. This study demonstrates that detecting and evaluating the state of highway traffic environments using deep learning has high accuracy, can be applied to actual highway traffic systems, and is extremely useful for detecting highway congestion. This framework is a promising solution for next-generation highway traffic management and provides accurate and timely traffic congestion detection and evaluation. [ABSTRACT FROM AUTHOR]

Purpose: With advancements in medical technology and the growth of an aging society, the number of immunocompromised patients has increased progressively. Klebsiella pneumoniae (K. pneumoniae) is one of the most common opportunistic pathogens, causing a severe disease burden. We aimed to further clarify the differences in respiratory tract K. pneumoniae infections between immunocompromised and immunocompetent populations. Methods: We retrospectively compared cases of respiratory tract K. pneumoniae infection in immunocompromised and immunocompetent patients admitted to Ruijin Hospital in Shanghai between January 2019 and August 2020 to clarify the differences between the two groups. Results: We enrolled 400 immunocompromised patients and 386 immunocompetent patients. Compared to the immunocompetent group, immunocompromised patients were more likely to develop bacteremia and shock and to require mechanical ventilation support during hospitalization. Immunocompromised patients also had a greater probability of polymicrobial infection and a higher rate of antibacterial resistance to carbapenem, which resulted in a higher intensive care unit admission rate, 30-day case fatality rate (CFR), and 6-month CFR. Multivariate analysis indicated that immunocompromised patients with respiratory diseases (odds ratio [OR], 2.189; 95% confidence interval [CI], 1.103-4.344; P = 0.025) and cardiovascular diseases (OR, 2.008; 95% CI, 1.055-3.822; P = 0.034), usingmechanical ventilation (OR, 3.982; 95% CI, 2.053-7.722; P = 0.000), or infected withmultidrug-resistant K. pneumoniae (OR, 3.870; 95%, 1.577-9.498; P = 0.003) were more likely to have a higher 30-day CFR. Conclusion: The disease burden of K. pneumoniae infection in immunocompromised patients is high. Immunocompromised patients who presented with respiratory diseases and cardiovascular diseases, used mechanical ventilation, or were infected with multidrug-resistant K. pneumoniae experienced a higher 30-day mortality rate. [ABSTRACT FROM AUTHOR]

Background: Fatigue is the most frequent and distressing symptom affecting the physical, cognitive, and affective domains of breast cancer patients. The Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT–F) has been widely used in patients with chronic diseases and has shown satisfactory reliability and validity. This study aimed to examine the psychometric properties of the FACIT–F among Chinese patients with breast cancer. Methods: Using a convenience sampling method, a cross–sectional survey (January 2020 and September 2022) was used with patients recruited from two tertiary hospitals in Shanghai, Mainland China, and a total of 597 patients completed a demographic information questionnaire, the FACIT–F and the Functional Assessment of Cancer Therapy for Breast Cancer (FACT–B). Convergent validity was estimated by calculating the Pearson correlation coefficient of the FACIT–F with the FACT–B. Measurement invariance across age was performed by examining differential item functioning (DIF) across age groups (≤ 60 and > 60 years). The internal consistency and split–half reliability were performed for reliability analysis. Unidimensionality of the scale was evaluated by the principal component analysis by Rasch analysis. Additionally, Rasch analysis was performed for item difficulty levels, and an item–person map was used. Results: No floor/ceiling effects were observed for the FACIT–F. Moderate correlations were found between FACIT–F and FACT–B (r = − 0.342, p < 0.01). Most items showed an absence of DIF regarding age, except for one item. In addition, the FACIT–F showed acceptable internal consistency. Principal component analysis of Rasch residuals showed that the proportion of variance explained by the FACIT–F was 53.3%, and the outfit mean square statistics for the items ranged from 0.68 to 1.90 and the infit MNSQ from 0.63 to 1.73. Additionally, an acceptable response between items and persons was found. Conclusions: The findings indicate that the Chinese version of the FACIT–F is a valid tool for the measurement of fatigue in breast cancer patients. [ABSTRACT FROM AUTHOR]

Summary: Insomnia displays heterogeneous trajectories across adolescence, which may induce addictive behaviours, including internet gaming disorder and substance use. This study aimed to investigate the latent trajectory classes of insomnia symptoms over 2 years and to examine the associations between insomnia trajectories and these addictive behaviours. Participants were 910 adolescents from six middle schools in Shanghai, China (52.7% males; mean age = 13.17 years). The three‐wave survey measured insomnia symptoms, internet gaming disorder, substance use, depressive symptoms, and sociodemographic characteristics from 7th to 9th grade. Latent class growth modelling was performed to identify the latent trajectory classes of insomnia symptoms. Then multivariable logistic regressions were conducted within the best‐fitting latent class growth model to examine the associations of insomnia trajectories with internet gaming disorder and substance use. Two latent trajectory classes of insomnia symptoms were recognised: the non‐insomnia group (71.8%) and the insomnia group (28.2%). In the multivariable analysis controlling for baseline demographic variables and depressive symptoms, the insomnia group had a higher risk of developing internet gaming disorder (OR = 2.203 [95% CI: 1.258–3.858]) and substance use (OR = 2.215 [95% CI: 1.324–3.705]) compared with the non‐insomnia group. These findings add to a growing body of research on heterogeneous trajectories of insomnia symptoms during adolescence, suggesting that intervention strategies are needed to target the characteristics or developmental patterns of different insomnia subgroups. The ultimate goal is to mitigate the impact of insomnia symptoms on adolescent addictive behaviours. [ABSTRACT FROM AUTHOR]

Background: Although highly heterogeneous among countries, the incidence rates of low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA) have been increasing globally over the past two decades. To better understand the cause of these secular trends, this study aimed to investigate the effects of age, period, and birth cohort on LBW, PTB, and SGA rates in Shanghai. Methods: Data from 2,958,695 singleton live births at 24–41 gestational weeks between 2004 and 2020 were obtained for this study. Age-period-cohort models based on Poisson regression were used to evaluate the independent effects of maternal age, delivery period, and maternal birth cohort on the trends in LBW, PTB, and SGA. Results: The overall prevalence rates of LBW, PTB, and SGA were 2.9%, 4.7%, and 9.3%, respectively, and significant changes were observed (average annual change: + 10.7‰, + 9.1‰, -11.9‰) from 2004 to 2020. Cohort effect increased steadily, from 1960 (risk ratio [RR] = 0.71, 95% confidence interval [CI]: 0.65–0.78) to 1993 (RR = 0.97, 95% CI: 0.94–1.01) for LBW and from 1960 (RR = 0.69, 95% CI: 0.64–0.75) to 2004 (RR = 1.02, 95% CI: 0.94–1.12) for PTB. A strong cohort effect was found with the highest risk of SGA (RR = 1.82, 95% CI: 1.72–1.93) in 1960 and the lowest risk (RR = 0.57, 95% CI: 0.54–0.61) in 2004, compared with the reference cohort of 1985. There was a "U-shaped" maternal age effect on LBW and PTB and a weak period effect on the three birth outcomes. Conclusions: Our findings suggested a significant independent effect of age, period, and birth cohort on the three birth outcomes. The increasing rates of LBW and PTB motivated us to focus on young and advanced pregnant women. Meanwhile, the prevalence of SGA decreased steadily, illustrating the need for further research on the mechanisms underlying these trends. [ABSTRACT FROM AUTHOR]

To analyse the clinical features, imaging manifestation, pathological typing and genetic testing results of patients undergoing surgery for ground‐glass opacity (GGO) nodules, and explore the reasonable diagnosis and treatment program for GGO patients as to provide the basis for the establishment of GGO treatment process. This study is an exploratory study. 465 cases with GGO confirmed by HRCT, undergoing surgery and approved by pathologic diagnosis in Shanghai pulmonary hospital were enrolled in this study. All the patients with GGO were cases with single lesion. The relationship between the clinical, imaging, pathological and molecular biological data of single GGO were statistically studied. (1) Among 465 cases, the median age was 58 years and females were 315 (67.7%); there were 397 (85.4%) non‐smoking, and 354 cases (76.1%) had no clinical symptoms. There were 33 cases of benign and 432 cases of malignant GGO. Significant differences were observed on the size, vacuole sign, pleural indentation and blood vessel sign of GGO between two groups (p < 0.05). Of 230 mGGO, there were no AAH, 13 cases of AIS, 25 cases of MIA and 173 cases of invasive adenocarcinoma. The probability of solid nodules in invasive adenocarcinoma was higher than that in micro invasive carcinoma, and the difference was statistically significant (p < 0.05). 360 cases were followed up with the average follow‐up time of 6.05 months, and GGO of 34 cases (9.4%) increased. (2) In 428 adenocarcinoma samples approved by pathologic diagnosis, there were 262 (61.2%) lesions of EGFR mutation, 14 (3.3%) lesions of KRAS mutation, 1 (0.2%) lesion of Braf mutation, 9 (2.1%) lesions of EML4‐ALK gene fusion and 2 (0.5%) lesions of ROS1 fusion. The detection rate of gene mutation in mGGO was higher than that of pGGO. During the follow‐up period, genetic testing results of 32 GGO showed that EGFR mutation rate was 53.1%, ALK positive rate of 6.3%, KRAS mutation rate of 3.1% and no ros1 and BRAF gene mutation. No statistically significant difference was observed in comparison with unchanged GGO. (3) EGFR mutation rate of invasive adenocarcinoma was the highest (168/228, 73.7%), mainly in the 19Del and L858R point mutations. No KRAS mutation was found in atypical adenoma hyperplasia. No significant difference was observed on the mutation rate of KRAS between different types of GGO (p = 0.811). EML4‐ALK fusion gene was mainly detected in invasive adenocarcinoma (7/9). GGO tends to occur in young, non‐smoking women. The size of GGO is related to the degree of malignancy. Pleural depression sign, vacuole sign and vascular cluster sign are all characteristic images of malignant GGO. pGGO and mGGO reflect the pathological development of GGO. During the follow‐up, it is found that GGO increases and solid components appear, which is the indication of surgical resection. The detection rate of EGFR mutations in mGGO and invasive adenocarcinoma is high. pGGO has heterogeneity in imaging, pathology and molecular biology. Heterogeneity research helps to formulate correct individualized diagnosis and treatment plans. [ABSTRACT FROM AUTHOR]

Purpose: Faced with the challenges of rural population decline, combined with the widespread expansion of homesteads in rural areas, local Chinese governments hope to strictly control and minimize rural housing land. Accurately decomposing the process of rural housing expansion and revealing its driving factors will be helpful for land-use regulation by the government. Design/methodology/approach: In this study, an unusually rich dataset of rural housing registration from Pudong New Area in Shanghai is employed. The study aimed to decompose the fragmented accumulation process and its expansion determinants on rural housing assets. The dataset covers all samples of rural households and housing plots at 72 surveyed villages in six towns. Findings: Housing offers profitable capital and earning assets to villagers at the urban fringe, so they have a powerful incentive to build and expand more. The results of this analysis showed that the expansion of rural housing is largely due to the haphazard construction of auxiliary rooms by villagers, especially on plots of arable land that are adjacent to their houses that have been stealthily converted into auxiliary rooms and sheds. Low costs and weak penalties have led to an increase in rent-seeking expansions to rural houses. Houses with the smaller initial areas, families with more laborers and household heads, and the proximity of villages to downtown with convenient living services were the main driving factors for expanding houses. A concerted effort is needed to control the disorganized and unlicensed expansion of housing. This effort should include formulating areas for free use by villagers, high taxes on overused areas, serious penalties for unlicensed housing expansion and effective land-use planning. Research limitations/implications: An understanding of the expansion status and control measures related to rural houses in Shanghai provides an important reference that can help to guide the formulation of rural housing policies, and the sustainable development of cities worldwide. Of course, this study cannot generalize about housing distribution and expansion status worldwide based on the study area in China, because China's land tenure policies are unique. But land registry data exists that makes research like this feasible. There is a need to carefully examine the detailed housing distribution in each country before it can be decided on how best to address the disorderly increase in rural housing stock, and promote the reduction of rural residential expansion. Originality/value: First, the process of rural housing expansion by using an unique dataset which covers ten thousands of samples is revealed. Second, the results have policy implications for reducing the amount of idle and inefficiently rural homestead. The focus is on rural housing growth and its driving factors in Shanghai, and the villagers' motivations for housing expansion are explored. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic increases the risk of psychological problems, especially for the infected population. Sleep disturbance and feelings of defeat and entrapment are well-documented risk factors of anxiety symptoms. Exploring the psychological mechanism of the development of anxiety symptoms is essential for effective prevention. This study aimed to examine the mediating effects of entrapment and defeat in the association between sleep disturbance and anxiety symptoms among asymptomatic COVID-19 carriers in Shanghai, China. Methods: A cross-sectional study was conducted from March to April, 2022. Participants were 1,283 asymptomatic COVID-19 carriers enrolled from the Ruijin Jiahe Fangcang Shelter Hospital, Shanghai (59.6% male; mean age = 39.6 years). Questionnaire measures of sleep disturbance, entrapment, defeat, anxiety symptoms, and background characteristics were obtained. A mediation model was constructed to test the mediating effects of entrapment and defeat in the association between sleep disturbance and anxiety symptoms. Results: The prevalence rates of sleep disturbance and anxiety symptoms were 34.3% and 18.8%. Sleep disturbance was positively associated with anxiety symptoms (OR [95%CI] = 5.013 [3.721–6.753]). The relationship between sleep disturbance and anxiety symptoms (total effect: Std. Estimate = 0.509) was partially mediated by entrapment (indirect effect: Std. Estimate = 0.129) and defeat (indirect effect: Std. Estimate = 0.126). The mediating effect of entrapment and defeat accounted for 50.3% of the association between sleep disturbance and anxiety symptoms. Conclusion: Sleep disturbance and anxiety symptoms were prevalent among asymptomatic COVID-19 carriers. Entrapment and defeat mediate the association between sleep disturbance and anxiety symptoms. More attention is needed to monitoring sleep conditions and feelings of defeat and entrapment to reduce the risk of anxiety. Highlights: A cross-sectional study was conducted among 1,283 asymptomatic COVID-19 carriers during the 2022 SARS-CoV-2 Omicron outbreak in Shanghai. Asymptomatic COVID-19 carriers had a high risk of developing anxiety symptoms and sleep disturbance during the pandemic. Feelings of entrapment and defeat mediated the association between sleep disturbance and anxiety symptoms. [ABSTRACT FROM AUTHOR]

Background: The Körperkoordinationstest Für Kinder (KTK) is a reliable and low-cost motor coordination test tool that has been used in several countries. However, whether the KTK is a reliable and valid instrument for use in Chinese children has not been assessed. Additionally, because the KTK was designed to incorporate locomotor, object control, and stability skills, and there is a lack of measurement tools that include stability skills assessment for Chinese children, the KTK's value and validity are worth discussing. Methods: A total of 249 primary school children (131 boys; 118 girls) aged 9-10 years from Shanghai were recruited in this study. Against the Test of Gross Motor Development-3 (TGMD-3), the concurrent validity of the KTK was assessed. We also tested the retest reliability and internal consistency of the KTK. Results: The test-retest reliability of the KTK was excellent (overall: r = 0.951; balancing backwards: r = 0.869; hopping for height: r = 0.918; jumping sideways: r = 0.877; moving sideways: r = 0.647). Except for the boys, the internal consistency of the KTK was higher than the acceptable level of Cronbach's α > 0.60 (overall: α = 0.618; boys: α = 0.583; girls: α = 0.664). Acceptable concurrent validity was found between the total scores for the KTK and TGMD-3 (overall: r = 0.420, p < 0.001; boys: r = 0.411, p < 0.001; girls: r = 0.437, p < 0.001). Discussion: The KTK is a reliable instrument for assessing the motor coordination of children in China. As such, the KTK can be used to monitor the level of motor coordination in Chinese children. [ABSTRACT FROM AUTHOR]

Background: In China, disparities in the quality of stroke care still exist and implementing quality improvement is still a challenge. Aim: The aim of the study was to determine whether the intervention by Shanghai Stroke Service System (4S) has helped improve adherence to stroke care guidelines and patient outcome. Methods: The 4S is a regional stroke network with real-time data extraction among its 61 stroke centers in Shanghai. A total of 11 key performance indicators (KPIs) were evaluated. The primary outcomes were a composite measure and an all-or-none measure of adherence to 11 KPIs. The secondary outcomes were length of hospital stay and in-hospital mortality. Results: The study enrolled 92,395 patients (mean age 69.0 ± 12.5 years, 65.2% men) with acute ischemic stroke hospitalized within 7 days of onset in Shanghai from January 2015 to December 2020. More patients received guideline recommended care between 2018 and 2020 than those between 2015 and 2017 (composite measure 87.1% vs 83.6%; absolute difference 2.9%, 95% confidence interval (CI) = [2.7%, 3.2%], p < 0.001; all-or-none measure 49.2% vs 44.8% patients; absolute difference 3.5%, 95% CI = [2.7%, 4.2%], p < 0.001). Further analysis of individual KPIs showed an absolute increase in six KPIs ranging from 3.4% to 8.9% (p < 0.001 for all comparisons). Compared with 2015–2017, hospital length of stay was shorter (10.95 vs 11.90 days; absolute difference –1.08, 95% CI = [–1.18, –0.99], p < 0.001), and in-hospital mortality was significantly reduced (risk ratio (RR) = 0.88, 95% CI = [0.79, 0.98], p = 0.01) in 2018–2020. Conclusion: The 4S intervention was associated with increased adherence to the stroke care guidelines, which further translated to improved clinical outcomes. Trial registration: ClinicalTrials.gov identifier: NCT02735226. [ABSTRACT FROM AUTHOR]

As the world is increasingly witnessing an aging society, the demand for elderly care facilities has gradually increased. However, there is controversy regarding the impact of 'establishing elderly care facilities on surrounding residents' in both academia and urban governance practices. To clarify this debate and introduce innovation to the discussion, this paper addresses the influence mechanism (that is, the amenity effect or the 'not-in-my-back-yard' effect) of the establishment of elderly care facilities on surrounding housing prices. Based on the data of 26,215 gated residential communities and 595 elderly care facilities in Shanghai and using a fixed-effect regression, we find that elderly care facilities have nonlinear effects. After considering distances from residential communities, establishment time, and different types of elderly care facilities, the results indicate significant heterogeneity. The conclusions have important policy implications for selecting suitable locations to build elderly care facilities and balance the dual interests of local governments and the private sector. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to quantify the preferences of Chinese patients with schizophrenia and their caregivers for antipsychotic treatment. Patients and Methods: Patients with schizophrenia (aged 18– 35) and their caregivers were recruited via six outpatient mental health clinics in Shanghai, People's Republic of China. In a discrete choice experiment (DCE), participants chose between two hypothetical treatment scenarios that varied regarding the type of treatment, rate of hospitalization, severity of positive symptoms, treatment cost and rates of improvement in daily and social functioning. Data for each group were analyzed using the modelling approach that yielded the lower deviance information criterion. The relative importance score (RIS) for each treatment attribute was also determined. Results: A total of 162 patients and 167 caregivers participated. Frequency of hospital admission was the most important treatment attribute for patients (average scaled RIS=27%), followed by mode and frequency of treatment administration (24%). Improvement in ability to carry out daily activities (8%) and improvement in social functioning (8%) were least important. Patients in full-time employment placed more importance on the frequency of hospital admission than unemployed patients (p< 0.01). Frequency of hospital admission was also the most important attribute for caregivers (RIS=33%), followed by improvement in positive symptoms (20%), while improvement in daily activities (7%) was the least important. Conclusion: Patients with Schizophrenia in China prefer treatments that help reduce the number of times they are admitted to hospital, as do their caregivers. These results may bring insight for physicians and health authorities in China regarding the treatment characteristics that patients value the most. [ABSTRACT FROM AUTHOR]

Phthalic acid esters (PAEs), a class of typical endocrine disruptors, have received considerable attention due to their widespread applications and adverse effects on biological health. In this study, 30 water samples, along the mainstream of the Yangtze River (YR), were collected from Chongqing (upper stream) to Shanghai (estuary) from May to June in 2019. The total concentrations of 16 targeted PAEs ranged from 0.437 to 20.5 μg/L, with an average of 1.93 μg/L, where dibutyl phthalate (DBP, 0.222–20.2 μg/L), bis (2-ethylhexyl) phthalate (DEHP, 0.254–7.03 μg/L), and diisobutyl phthalate (DIBP, 0.0645–0.621 μg/L) were the most abundant PAEs. According to the pollution level in the YR to assess the ecological risk posed by PAEs, the results showed medium risk level of PAEs in the YR, among which DBP and DEHP posed a high ecological risk to aquatic organisms. The optimal solution for DBP and DEHP is found in ten fitting curves. The PNECSSD of them is 2.50 μg/L and 0.34 μg/L, respectively. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the longitudinal circulating eosinophil (EOS) data impacted by the COVID-19 vaccine, the predictive role of circulating EOS in the disease severity, and its association with T cell immunity in patients with SARS-CoV-2 Omicron BA.2 variant infection in Shanghai, China. Methods: We collected a cohort of 1,157 patients infected with SARS-CoV-2 Omicron/BA.2 variant in Shanghai, China. These patients were diagnosed or admitted between Feb 20, 2022, and May 10, 2022, and were classified as asymptomatic (n = 705), mild (n = 286) and severe (n = 166) groups. We compiled and analyzed data of patients' clinical demographic characteristics, laboratory findings, and clinical outcomes. Results: COVID-19 vaccine reduced the incidence of severe cases. Severe patients were shown to have declined peripheral blood EOS. Both the 2 doses and 3 doses of inactivated COVID-19 vaccines promoted the circulating EOS levels. In particular, the 3rd booster shot of inactivated COVID-19 vaccine was shown to have a sustained promoting effect on circulating EOS. Univariate analysis showed that there was a significant difference in age, underlying comorbidities, EOS, lymphocytes, CRP, CD4, and CD8 T cell counts between the mild and the severe patients. Multivariate logistic regression analysis and ROC curve analysis indicate that circulating EOS (AUC = 0.828, p = 0.025), the combination of EOS and CD4 T cell (AUC = 0.920, p = 0.017) can predict the risk of disease severity in patients with SARS-CoV-2 Omicron BA.2 variant infection. Conclusions: COVID-19 vaccine promotes circulating EOS and reduces the risk of severe illness, and particularly the 3rd booster dose of COVID-19 vaccine sustainedly promotes EOS. Circulating EOS, along with T cell immunity, may have a predictive value for the disease severity in SARS-CoV-2 Omicron infected patients. [ABSTRACT FROM AUTHOR]

The prevalence of high birth weight or large for gestational age (LGA) infants is increasing, with increasing evidence of pregnancy-related factors that may have long-term impacts on the health of the mother and baby. We aimed to determine the association between excessive fetal growth, specifically LGA and macrosomia, and subsequent maternal cancer by performing a prospective population-based cohort study. The data set was based on the Shanghai Birth Registry and Shanghai Cancer Registry, with medical records from the Shanghai Health Information Network as a supplement. Macrosomia and LGA prevalence was higher in women who developed cancer than in women who did not. Having an LGA child in the first delivery was associated with a subsequently increased risk of maternal cancer (hazard ratio [HR] = 1.08, 95% confidence interval [CI] 1.04–1.11). Additionally, in the last and heaviest deliveries, there were similar associations between LGA births and maternal cancer rates (HR = 1.08, 95% CI 1.04–1.12; HR = 1.08, 95% CI 1.05–1.12, respectively). Furthermore, a substantially increased trend in the risk of maternal cancer was associated with birth weights exceeding 2500 g. Our study supports the association between LGA births and increased risks of maternal cancer, but this risk requires further investigation. [ABSTRACT FROM AUTHOR]

Vernacular architecture has always captured professionals' attention for its unique approaches to construction, its typical way of integrating man and nature and the way it is used. Being a combination of traditional courtyard houses in China with townhouses in the West, Lilong houses or Shikumen houses are representatives of Shanghai vernacular housing. In terms of applying UAV oblique photogrammetry to preserving and documenting historic architectures, some studies have been done in China, but scant literatures are found on Lilong houses. This research is an attempt to preserve and document Lilong houses by adopting UAV in 3D modelling, to explore a rational approach for the application of UAV oblique photogrammetry to narrow lanes and to establish a collection of models to document the ongoing changes as well as nuances of each building more carefully. In this research, Meilan Lane is chosen as an example. Aided by AutoCAD drawings, flight routes and angles are designed. parameters for each flight are pre-set in GoodStation to send quantified instructions to the drone. A total of 4,531 photos are gathered and 4 models are built by ContextCapture Master. Two models with flight height at 40m and 115m are generated for macro-level study and two models with flight height from 20m to 32m are for micro-level study. Through this research, this paper elaborates the pros and cons of using UAV techniques in documenting Lilong residences and tries to find an applicable approach to building other Lilong complex models for more comprehensive studies in the long run. [ABSTRACT FROM AUTHOR]

Purpose: The Omicron variant of SARS-CoV-2 has emerged as a significant global concern, characterized by its rapid transmission and resistance to existing treatments and vaccines. However, the specific hematological and biochemical factors that may impact the clearance of Omicron variant infection remain unclear. The present study aimed to identify easily accessible laboratory markers that are associated with prolonged virus shedding in non-severe patients with COVID-19 caused by the Omicron variant. Patients and Methods: A retrospective cohort study was conducted on 882 non-severe COVID-19 patients who were diagnosed with the Omicron variant in Shanghai between March and June 2022. The least absolute shrinkage and selection operator regression model was used for feature selection and dimensional reduction, and multivariate logistic regression analysis was performed to construct a nomogram for predicting the risk of prolonged SARS-CoV-2 RNA positivity lasting for more than 7 days. The receiver operating characteristic (ROC) curve and calibration curves were used to assess predictive discrimination and accuracy, with bootstrap validation. Results: Patients were randomly divided into derivation (70%, n = 618) and validation (30%, n = 264) cohorts. Optimal independent markers for prolonged viral shedding time (VST) over 7 days were identified as Age, C-reactive protein (CRP), platelet count, leukocyte count, lymphocyte count, and eosinophil count. These factors were subsequently incorporated into the nomogram utilizing bootstrap validation. The area under the curve (AUC) in the derivation (0.761) and validation (0.756) cohorts indicated good discriminative ability. The calibration curve showed good agreement between the nomogram-predicted and actual patients with VST over 7 days. Conclusion: Our study confirmed six factors associated with delayed VST in non-severe SARS-CoV-2 Omicron infection and constructed a Nomogram which may assist non-severely affected patients to better estimate the appropriate length of self-isolation and optimize their self-management strategies. [ABSTRACT FROM AUTHOR]

Values have a direct impact on adolescents' mental health. However, its potential mediated mechanism has received little attention. A 1-year longitudinal survey design was used to explore the mediating role of emotion regulation in the relationships between self-transcendence (vs. self-enhancement) values and emotional adjustment among adolescents. Participants were 863 senior school students from Shanghai and Qingdao, Shandong Province. Data on selftranscendence and self-enhancement values, loneliness, depression, and emotion regulation were collected at 2019 and 2020 by using self-report measures. The results showed that (1) adolescents' endorsement with self-transcendence values decreased and self-enhancement values increased; compared to adolescents in Qingdao, adolescents in Shanghai were more depressed, (2) emotion regulation only mediated the effect of self-transcendence values on loneliness, and (3) not only the relationship between self-transcendence values and depression, but also the relationships between self-enhancement values and loneliness and depression were suppressed by emotion regulation. The study may provide more empirical evidences for the benefits of self-transcendence values and may also give more references on how to improve adolescents' emotional adjustment. [ABSTRACT FROM AUTHOR]

Background: Nirmatrelvir/ritonavir has demonstrated effectiveness in high-risk patients with coronavirus disease 2019 (COVID-19). However, investigations on the efficacy and safety of nirmatrelvir/ritonavir in patients with kidney dysfunction are limited. Methods: Data were collected from the patients admitted to a COVID-19 referral center in Shanghai, China. Patients were at least 18 years of age and had a baseline estimated glomerular filtration rate (eGFR) of <60 ml/min/1·73m2. The primary endpoint was a composite of all-cause mortality, intensive care unit admission, or cardiovascular events. The secondary endpoint was viral shedding. Results: Among the 195 participants, 73 received nirmatrelvir/ritonavir. A lower risk of the primary endpoint was observed in nirmatrelvir/ritonavir recipients compared with non-recipients [adjusted HR 0.56 (95% CI: 0.32--0.96); p = 0.035]. Nirmatrelvir/ritonavir recipients experienced a shorter duration of viral shedding [adjusted HR 3·70 (95%CI: 2.60--5.28); p < 0.001) and faster viral load clearance versus non-recipients. Among the nirmatrelvir/ritonavir users, earlier initiation of nirmatrelvir/ritonavir within 5 days since COVID-19 diagnosis was related with shorter viral shedding time (adjusted HR 7.84 [95% CI: 3.28--18.76]; p < 0.001) compared to late initiation. No patients reported serious adverse events during treatment. Conclusion: Our findings support the early initiation of nirmatrelvir/ritonavir for high-risk patients with impaired kidney function. This could improve patient outcomes and shorten the viral shedding period. [ABSTRACT FROM AUTHOR]

Objective: To investigated the influence of illness perceptions and other risk factors related to poor asthma control and quality of life in adult outpatients with asthma in China. Methods: Patients with a confirmed asthma diagnosis were recruited from the outpatient clinic at Zhongshan Hospital, Fudan University in Shanghai. Sociodemographic, psychological, and asthma related variables were assessed in all participants. Patients' illness perceptions, medication adherence, asthma control, and quality of life were assessed using validated questionnaires, such as the Brief Illness Perception Questionnaire, Medication Adherence Rating Scale (MARS-A), the Asthma Control Test, and the Mini Asthma Quality of Life Questionnaire. Multiple linear regressions and logistic regressions were used to examine the associations between illness perceptions, medication adherence behaviors, and disease outcome (i.e., asthma control and quality of life). Results: A total of two hundred thirty-one (231) outpatients with asthma were included in this cross-sectional study, 80 of whom (34.6%) had asthma that was uncontrolled. Patients who perceived their life (β = − 0.197, p < 0.001) and emotions (β = − 0.294, p < 0.001) as severely affected by the illness were more likely to have a lower quality of life, findings that were statistically significant. Also, patients who believed they had a higher degree of personal control over their illness (β = 0.333, p < 0.001), and had better medication adherence (β = 0.250, p < 0.001) were found to have a better quality of life. Conclusion: Our study indicated that illness perceptions and medication adherence have a significant impact on disease outcome. Both of these factors should be considered when determining the best health care practices or constructing a predictive intervention model for patients with uncontrolled asthma. [ABSTRACT FROM AUTHOR]

Over the years, the development of marine economy has been an important component of coastal cities' total economic growth in China. Whether the coastal cities had paid enough attention to the coordination of marine economic development and ecological environment protection in the process of marine development activities needed to be evaluated accordingly. An index evaluation system for the coordination between marine ecological environment protection and marine economic development in coastal cities of China was established in this work by using the analytic hierarchy process. The statistical analysis results from 2006 to 2018 showed that much more attention had been paid on marine ecological environment protection since the year 2012 in China. The evaluated results showed that among all coastal provinces and cities, Shanghai and Shandong Provinces had the best coordination between marine economic development and marine ecological environment protection in the year 2016. Years of data showed that marine economic development and marine ecological environmental protection complement each other and promote each other. At the same time, the analysis results of this indicator evaluation system showed that marine ecological environment protection in China should further strengthen the protection by preventing and controlling marine pollution and carrying out ecological restoration. [ABSTRACT FROM AUTHOR]

Background: Considerable attention has been paid to reproductive toxicity of fine particulate matter (PM2.5). However, the relationship between prenatal PM2.5 exposure and anogenital distance (AGD) has not been well studied. We aim to investigate the potential effects of prenatal exposure to PM2.5 on newborn AGD. Methods: Prenatal PM2.5 exposure of 2332 participates in Shanghai (2013–2016) was estimated using high-performance machine learning models. Anoscrotal distance (AGDas) in male infants and anofourchette distance (AGDaf) in female infants were measured by well-trained examiners within 3 days after birth. We applied multiple linear regression models and multiple informant models to estimate the association between prenatal PM2.5 exposure and AGD. Results: Multiple linear regression models showed that a 10 μg/m3 increase in PM2.5 exposure during full pregnancy, the second and third trimesters was inversely associated with AGDas (adjusted beta = − 1.76, 95% CI: − 2.21, − 1.31; − 0.73, 95% CI: − 1.06, − 0.40; and − 0.52; 95% CI: − 0.87, − 0.18, respectively) in males. A 10 μg/m3 increase in PM2.5 exposure during the full pregnancy, the first, second, and third trimesters was inversely associated with AGDaf (adjusted beta = − 4.55; 95% CI: − 5.18, − 3.92; − 0.78; 95% CI: − 1.10, − 0.46; − 1.11; 95% CI: − 1.46, − 0.77; − 1.45; 95% CI: − 1.78, − 1.12, respectively) in females after adjusting for potential confounders. Multiple informant models showed consistent but slightly attenuated associations. Conclusion: Our study observed a significant association between gestational PM2.5 exposure during pregnancy and shortened AGD in newborns, and provided new evidence on potential reproductive toxicity of prenatal PM2.5 exposure. [ABSTRACT FROM AUTHOR]

Weedy rice (Oryza spp.) is a notorious weed in direct‐seeding paddy fields. Because it has anatomical and physiological traits similar to those of cultivated rice, no selective herbicide is effective in controlling weedy rice growing among conventional rice cultivars. Imidazolinone (IMI)‐resistant rice lines JD372 and JJ818 have been planted with imazamox to control weedy rice in Jiangsu and Shanghai, China. Whole‐plant dose–response analysis showed that imazamox exhibited high efficacy against three populations of weedy rice. The ED90 of weedy rice populations FN‐5, GY‐8, and HY‐3 were 46.87, 61.43, and 52.17 g a.i. ha−1, respectively, close to the recommended field dose (50 g a.i. ha−1) of imazamox. Conversely, the ED10 values of JD372 and JJ818 were slightly lower than 50 g a.i. ha−1. These findings indicate that imazamox can control weedy rice production in JD372 and JJ818 fields. The acetolactate synthase (ALS) sensitivity of JD372 in vitro was 1714.89‐fold lower to imazamox than was that of FN‐5. ALS gene sequencing revealed a Ser653Asn point mutation—a common mutation that confers resistance to IMI herbicides in JD372. In addition, higher ALS expression levels in JD372 were found at 24 and 72 h after imazamox treatment. ALS overexpression might partially compensate for the ALS activity of JD372 that was suppressed by imazamox. [ABSTRACT FROM AUTHOR]

Purpose: Studies of the association between body mass index (BMI) at diagnosis and treatment outcome in children with acute lymphoblastic leukemia (ALL) have yielded inconsistent results. Hence, we conducted a retrospective study in a large cohort of Chinese children with ALL treated with contemporary protocols. Patients and Methods: A total of 1437 children (62.1% male; median age at diagnosis 5.7 years, range: 2.3–16.3 years) were enrolled in two consecutive clinical trials at the Shanghai Children's Medical Center. The rates of overall survival, event‐free survival, relapse, treatment‐related mortality, and adverse events were compared among patients who were underweight (BMI < 5th percentile), at a healthy weight (5th to 85th percentile), overweight (>85th to <95th percentile), and obese (≥95th percentile). Results: At diagnosis, 91 (6.3%) patients were underweight, 1070 (74.5%) were at a healthy weight, 91 (6.3%) were overweight, and 185 (12.9%) were obese. No significant association was found between weight status and 5‐year overall survival, event‐free survival, or relapse in the overall cohort. When analyzed as a continuous variable, a higher BMI Z‐score was associated with treatment‐related mortality (hazard ratio 1.33 (95% confidence interval [CI], 1.05–1.68%), p = 0.02). The treatment‐related mortality rate was higher in the overweight (5.5%, 95% CI 0.8–10.2%) and obese (3.2%, 95% CI 0.6–5.8%) groups compared with the underweight (0.0%) and healthy‐weight groups (1.9%, 95% CI 1.1–2.7%; p = 0.04). Multivariable analysis showed that children who were overweight had a higher risk of treatment‐related mortality (hazard ratio 3.8, 95% CI 1.3–11.4). Conclusion: While body weight status was not associated with event‐free survival or overall survival, overweight patients were at higher risk of treatment‐related mortality. We found that overweight/obese children were at higher risk of treatment‐related mortality and developing severe toxicities than underweight or health‐weight children. Our findings reinforce the importance of the normalizing weight during the treatment period to improve survival and treatment outcomes. [ABSTRACT FROM AUTHOR]