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As China is one of high MDR-TB burden countries, it is important to determine the drug resistant pattern and clinical characteristics of multidrug resistant tuberculosis (MDR-TB). We conducted a comprehensive and nationwide study on MDR-TB in 17 provinces for the period from June 2009 to June 2015, and a total of 1154 cases of MDR-TB were finally investigated. The study sought to assess the clinical features and contrast drug susceptibility profiles of MDR-TB patients in China. Cavitary disease, young age, and long duration of TB disease among MDR-TB patients were important predictors. A high resistance proportion of first-line drugs was observed in Beijing, Shanghai and Tianjin. Resistant proportions of second-line anti-TB drugs in western region for amikacin, aminosalicylic acid, and levofloxacin were higher than eastern and central regions. High levels of drug resistance were seen in earlier cases (before 2011) and outpatients. We found high levels of resistance to 1st- and 2nd-line drugs in all settings, with considerable variabilities in terms of different Directly Observed Treatment Short Course (DOTS) programme, level of economic development(eastern, central and western regions) and patient source (inpatients and outpatients). Timely drug susceptibility testing (DST) and effective management are necessary to ensure an early detection of MDR-TB and its proper treatment. [ABSTRACT FROM AUTHOR]

Land-use change and the associated influences on the carbon metabolism system should not be overlooked in the context of rapid urbanization. By combing carbon emissions/sequestrations accounting and ecological network analysis, this paper quantitatively described the general situation and spatial distribution evolution of carbon metabolism in the Beijing-Tianjin-Hebei (BTH) urban agglomeration from 2015 to 2019, investigated carbon flows induced by land-use change, and revealed the ecological relationships between the components of the system. The spatial distribution of carbon emissions showed a trend of high in the southeast and low in the northwest, while carbon sequestrations were the opposite. At the early stage of regional coordinate development, the migration of enterprises with heavy energy consumption and emission and expansion of the transportation network has promoted the economic development in the surrounding area of Beijing, but also lead to the carbon emission transfer and the severe imbalance of carbon metabolism. Despite that a slight improvement can be found in the carbon metabolism system of Beijing and Tianjin, Hebei province still faces intensely competitive ecological relationships between industrial land and other land use, and has a relatively low mutualism index. It is suggested that integrated land use planning, strict cultivated land protection policies, and proper ecological compensation mechanism are the key measures to facilitate the sustainable development of the BTH urban agglomeration. • A temporal-spatial evolution of carbon metabolism in the BTH urban agglomeration is presented. • The impacts of land use change on urban carbon metabolism system are investigated. • Ecological relationships between land-use changes are explored based on the ENA method. • Industrial transfer and expanded transportation exacerbate carbon metabolism imbalance. [ABSTRACT FROM AUTHOR]