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Aims To identify and group hospitalization trajectory of alcohol use disorder (AUD) patients and its associations with service utilization, healthcare quality and hospital-level variations. Methods Inpatients with AUD as the primary diagnosis from 2012 to 2014 in Beijing, China, were identified. Their discharge medical records were extracted and analyzed using the sequence analysis and the cluster analysis. Results Eight-hundred thirty-one patients were included, and their hospitalization patterns were grouped into four clusters: short stay (n  = 565 (67.99%)), mean psychiatric length of stay in 3 years: (32.25 ± 18.69), repeated short stay (n  = 211 (25.39%), 137.76 ± 88.8 days), repeated long stay (n  = 41 (4.93%), 405.44 ± 146.54 days), permanent stay (n  = 14 (1.68%), 818.14 ± 225.22 days). The latter two clusters (6.61% patients) used 37.26% of the total psychiatric hospital days and 33.65% of the total psychiatric hospitalization expenses. All the patients in the permanent stay cluster and 41.77% of the patients in the short stay cluster were readmitted at least once within 3 years. Two-hundred thirty-four patients (28.16%) were admitted at least once for non-psychiatric reasons, primarily for diseases of circulatory and digestive systems. Cluster composition varied significantly among different hospitals. Conclusion Hospitalization pattern of patients with AUD varies greatly, and while most (>2/3) hospitalizations were short stay, those with repeated long stay and permanent stay used more than one third of the hospital days and expenses. Our findings suggest interventions targeting at certain patients may be more effective in reducing resource utilization. [ABSTRACT FROM AUTHOR]

Here, TiO 2 (w)-containing MgO ceramics were sintered at 1450 °C using a solid-phase method, and the effect of TiO 2 (w) addition on the sintering, dielectric, and mechanical properties of MgO ceramics was investigated. The results indicate that TiO 2 (w) reacts with MgO during sintering to form a new phase, Mg 2 TiO 4 , and a 'special' structure of Mg 2 TiO 4 surrounds the MgO grains. This structure contributes to the densification of the MgO ceramics during sintering, thereby improving the dielectric and mechanical properties. The dielectric constants of MgO ceramic samples with different TiO 2 (w) additions fluctuated between 10.6 and 11.9, and the loss tangent values fluctuated between 1.3 × 10-4 and 4.0 × 10–4; when TiO 2 (w) was added at 12 wt%, the relative density, flexural strength, fracture toughness, nanohardness, elastic modulus, and Vickers hardness of the sintered samples achieved a maximums of 97.4%, 221.0 MPa, 3.2 MPa m1/2, 4.2 GPa, 383.1 GPa, and 1048.7 HV, respectively. The introduction of TiO 2 (w) resulted in the formation of continuous and uniformly distributed intermediate phases inside the material, which improved the MgO ceramic densities, and dielectric and mechanical properties. [ABSTRACT FROM AUTHOR]

Photocatalytic technology has been playing a key role in energy conversion and environmental remediation. It is critical and challenging that understanding and modulating the local structure effect on accelerating each rate-dependent step during the photocatalytic process. Herein, we utilize the highly ordered and structurally tunable COFs as a favorable platform for integrating multiple modulations of photochemical properties, including light capture, exciton dissociation, charge separation, and mass transfer by structural cationization strategy. Moreover, it is found that the cationized COF has a strong enrichment ability on the sulfide substrates, exhibiting an extremely fast selective oxidation rate of sulfides even in air. The calculation results indicate that the structural cationization successfully aggregates reaction substrates and increases the molecular collision probability, generating a reaction environment to promote the photocatalytic performances. This study will be expected to facilitate the new insights for the exploration of highly active COFs heterogeneous photocatalysts. [Display omitted] • Insight into the effect of cationization modulation in COFs on accelerating the photocatalytic process. • Cationizied COF enhance light capture, charge separation and transfer, and exciton dissociation. • Cationized structure shows a strong enrichment ability on the sulfide substrate. • An extremely fast selective oxidation rate of mustard gas simulant is achieved in air. • The cationization strategy promotes the formation of photocatalytic reaction environment. [ABSTRACT FROM AUTHOR]

• Existence of two-dimensional line defect solitons (LDSs) in nonlinear fractional Schrödinger equations (NLFSE) are calculated numerically. • Linear stability of LDSs with both negative and positive line defect lattice are analyzed in detail in the frame of NLFSE. • Stability and power of LDSs depend strongly on the Lévy index, defect depth, and different bandgaps. • Stability of LDSs in the semi-infinite bandgap can be improved by adjusting the Lévy index and the defect depth. The existence, stability, and propagation dynamics of two-dimensional line defect lattice solitons (LDLSs) in a photorefractive crystal with focusing saturable nonlinearity under fractional diffraction effect are numerically investigated. It is shown that, the LDLSs stability domain narrows with increasing Lévy index in the semi-infinite bandgap either in the negative or positive defect lattice. While in the first bandgap, LDLSs are stable for the negative defect lattice and unstable for the positive defect lattice. Additionally, linear stability analysis indicates that the stability and power of LDLSs depend strongly on the Lévy index, defect depth, and propagation constant in different bandgaps. For LDLSs in the semi-infinite bandgap, the stability can be improved by decreasing either the Lévy index or the negative defect depth. [ABSTRACT FROM AUTHOR]

• A novel multi-stage fusion framework is proposed, achieving fusion through progressive learning of mappings. • Novel encoder-decoder architectures denoted as FSFR and SLNet are proposed to enhance the network's learning performance. • A multi-information supervision guidance mechanism has been designed to enable adjustments to fusion effects. • Detailed experiments verified the framework's robustness and excellent performance. The fusion of infrared and visible images aims to synthesize an image that combines the advantageous characteristics of both image sources. Nevertheless, existing image fusion algorithms often struggle to extract relevant feature information from the source images and find it challenging to balance the significance of different modality information within the source images. This leads to suboptimal fusion results and inadequately serve advanced downstream visual tasks. In order to confront this challenge, a novel image fusion algorithm, denoted as Multiple Information Supervised Progressive Fusion Network (MISP-Fuse), has been proposed. Specifically, MISP-Fuse employs an innovative and robust multi-stage encoder-decoder network called Full Scale Feature Residual network (FSFR) to extract spatial context and detailed feature information corresponding to infrared and visible images. Within this encoder-decoder network, source image feature information is progressively extracted at different stages, which are recombined at multiple scales and distilled for crucial information. Finally, the fusion image is generated through a spatial localization module named as Spatial Localization Network (SLNet). MISP-Fuse incorporates a multi-information supervision mechanism to establish a linkage between different modality information in the infrared and visible source images. It ensures that the resulting fused image not only aligns with human visual perception but also effectively serves advanced downstream visual tasks. The comparative experiments utilizing diverse image fusion benchmark datasets has been conducted. In comparison to other algorithms, MISP-Fuse demonstrated significant enhancements in comprehensive image fusion metrics, including Average Gradient (AG), Sum of Correlated Differences (SCD), and Correlation Coefficient (CC). [ABSTRACT FROM AUTHOR]

Electrocardiogram (ECG) outcomes serve as early manifestations of cardiovascular functional or structural changes. While temperature fluctuation has been demonstrated to be a risk factor for cardiovascular diseases, few epidemiological studies have reported its relationship with ECG outcomes. In this study, we employed temperature anomaly (TA) as an innovative indicator of temperature fluctuation to quantify its detrimental impacts on ECG outcomes. A longitudinal study design was conducted using the repeated ECG records of the China National Stroke Screening Survey from 2013 to 2019. Only individuals undergoing at least two ECG tests were included. The daily temperature was assimilated by combining three kinds of data: in situ observations, satellite remote sensing measurements and weather research forecast simulations. We used generalized estimating equations to control for autocorrelation among repeated records and to estimate the association between TA and the risk of ECG abnormalities. We found 6837 events of ECG abnormalities in 47,286 individuals with 102,030 visits. Each unit increment of TA increased the risk of ECG abnormalities [odds ratio (OR) = 1.009, 95% confidence interval (CI): 1.001–1.017] and the risk of myocardial ischemia (OR = 1.061, 95% CI: 1.012–1.111). Hierarchic analyses presented a similar association of TA with both ECG abnormalities (OR = 1.017, 95% CI: 1.008–1.026) and myocardial ischemia (OR = 1.061, 95%CI: 1.011–1.114) in Northern China, but not in Southern China. The exposure-response relationship was estimated as a U-shaped curve centered at the TA value of zero. Sudden warming tended to increase the risk of ECG abnormalities and myocardial ischemia, and sudden cooling tended to increase the risk of atrial fibrillation. All these detrimental effects of TA could be modified by specific individual characteristics. In summary, ambient temperature fluctuation increased the risk of ECG abnormalities. This result indicated that regular ECG tests could be an early-warning measure for monitoring the adverse health effects of temperature fluctuations. • Temperature anomaly (TA) is an innovative index reflecting temperature fluctuations. • Each unit increment of TA increases the risk of ECG abnormalities. • The exposure-response curve is U-shaped which centered at the TA value of zero. • ECG tests can be used to monitor the health effects of temperature fluctuations. [ABSTRACT FROM AUTHOR]

In this study, we conducted measurements of the independent fission cross-sections of 238U(n, f)97m+gNb, 238U(n, f)133gTe reactions and the cumulative cross section of 238U(n, f)130gSb reactions induced by neutron at energies around 14 MeV, i.e. , 14.1 ± 0.3, 14.5 ± 0.3 and 14.7 ± 0.3 MeV. The measurement results were obtained by the neutron activation method in combination with off-line γ-ray spectrometry techniques. The neutron flux was monitored on line by the accompanying α-particle from T(d, n)4He reaction, and the neutron energies were determined by the cross-section ratio of 90Zr(n, 2n)8+gZr to 93Nb(n, 2n)92mNb reactions. The independent fission cross-sections of the fission reactions were obtained by subtracting the influence of precursor nuclei or excited states. The obtained results are as follows: for 238U(n, f)97m+gNb, the independent cross sections are 1.0 ± 0.89, 0.98 ± 0.85 and 0.78 ± 0.70 mb at the specified neutron energy points. For 238U(n, f)133gTe, the independent fission cross-sections are 26.8 ± 2.8, 27.7 ± 2.9 and 20.5 ± 2.3 mb, respectively, at the same neutron energy points. As for 238U(n, f)130gSb, the obtained cumulative fission cross-sections are 5.35 ± 0.58, 5.05 ± 0.53 and 4.03 ± 0.44 mb, respectively, at the specified neutron energy points. • Neutron-induced fission cross sections of 238U was measure for production 97m+gNb, 133gTe, and 130gSb using D-T neutrons. • The method used were neutron activation and off-line gamma-ray spectrometry. • The neutron energies used for the measurement of reaction cross section are 14.1 ± 0.3, 14.5 ± 0.3 and 14.7 ± 0.3 MeV. [ABSTRACT FROM AUTHOR]

To compare the effects of short-term exposure to particulate matter (PM) with different particle sizes on first-ever stroke risk in the middle-aged and elderly Chinese population. Health information was collected from the China National Stroke Screening Survey (CNSSS) from March 1, 2013, to April 10, 2015. Ambient exposures to PM 1 , PM 2.5 , and PM 10 were obtained from ChinaHighAirPollutants (CHAP) Grid data. Case-crossover design was used to estimate the increase of first-ever stroke risk per 10 μg/m3 increase in ambient exposures to different size particles. We used distributed lag linear model (DLM) to estimate the hysteresis effects of particle exposures. In addition, in order to assess the effect modification of long-term exposure, we did a stratified analysis using median exposure as the dividing line. We included 1326 first-ever stroke events from 242 communities in the present study. We found that effects on first-ever stroke risk increased with the decrease in particle size. The percent increases of first-ever stroke risk increased by 6.6% (95% CI: 1.4, 12.0), 3.3% (95% CI: 0.5, 6.1), and 0.6% (95% CI: -1.2, 2.6) per 10 g/m3 increases in PM 1 , PM 2.5 , and PM 10 exposures in lag 0–2 days, respectively. Furthermore, the cumulative effect of PM on first-ever stroke reached its peak at distinct time points under different layers of long-term PM exposure. In areas with low PM exposure, the cumulative effects of the three kinds of particles on stroke reached their peak in lag1 day, while the cumulative effect peaked in lag3 day in areas with high PM exposure. This study found that smaller particles had a stronger short-term effect on first-ever stroke. We also found that people in areas with long-term exposures to lower levels were more sensitive to short-term exposures. These results have public health significance for stroke prevention and air pollution reduction. [Display omitted] • The effects of PM on first-ever stroke in a large area were evaluated. • The impacts of PM increase with decreasing particle size. • The short-term effects of PM were larger in areas with lower long-term exposure levels. [ABSTRACT FROM AUTHOR]

EIN3-binding F-box 1 (EBF1) is involved in cold tolerance in Arabidopsis ; however, its exact roles in cold signaling in Brassica rapa remain uncertain. Herein, we demonstrated that EBF1 homologs are highly conserved in Brassica species, but their copy numbers are diverse, with some motifs being species specific. Cold treatment activated the expression of EBF1 homologs BrEBF1 and BrEBF2 in B. rapa ; however, their expression schemas were diverse in different cold-resistant varieties of the plant. Subcellular localization analysis revealed that BrEBF1 is a nuclear-localized F-box protein, and cold treatment did not alter its localization but induced its degradation. BrEBF1 overexpression enhanced cold tolerance, reduced cold-induced ROS accumulation, and enhanced MPK3 and MPK6 kinase activity in Arabidopsis. Our study revealed that BrEBF1 positively regulates cold tolerance in B. rapa and that BrEBF1 -regulated cold tolerance is associated with ROS scavenging and MPK3 and MPK6 kinase activity through the C-repeat binding factor pathway. [ABSTRACT FROM AUTHOR]

Background: Greenspace is an important modifiable environmental factor that is associated with health and well-being. Although previous research has shown that exposure to greenspace is beneficial for cardiovascular diseases, studies have rarely focused on early subclinical health outcomes such as electrocardiogram (ECG) abnormality., Methods: We developed a longitudinal study using data from the China National Stroke Screening Survey (2013-2019). Monthly exposure to greenspace was assessed by the Normalized Difference Vegetation Index (NDVI) values. ECG abnormality was diagnosed by physicians based on the results of the 12-lead electrocardiogram. We used fixed-effects logistic regression with participant-specific intercepts to estimate the association between exposure to greenspace and ECG abnormalities., Results: A total of 132,108 visits from 61,029 participants with ≥ 2 ECG measurements were included. At baseline, the lag-1 month average NDVI value was 0.29 (SD = 0.15). In the fully adjusted model, per 0.1-unit increment in lag-1 month average NDVI value was associated with a 3.0% (95% CI -1.6 ∼ 7.4%) decreased risk of ECG abnormality. In urban areas, the decreased risk associated with per 0.1-unit increment in NDVI was 14.81% (95% CI 9.38 ∼ 19.92%)., Conclusion: Our study found that higher exposure to greenspace was associated with a decreased risk of ECG abnormality, especially in urban areas. Our findings suggested that monthly exposure to greenspace might be beneficial to cardiovascular health, and greenspace provision and maintenance could be considered an important public health intervention in urban planning., (© 2024. The Author(s).)

Introduction: The health impact of retirement is controversial. Most previous studies have been based on self-reported health indicators or the endpoints of some chronic diseases (e.g., morbidity or mortality), but objective physiological indicators (e.g., blood pressure) have rarely been used. The objective of this study is to elucidate the health effects of retirement on blood pressure, thereby offering empirical evidence to facilitate the health of retirees and to optimize retirement policies., Methods: From 2012 to 2015, 84,696 participants of the Chinese Hypertension Survey (CHS) were included in this study. We applied the fuzzy regression discontinuity design (FRDD) to identify retirement's causal effect on systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure. We also explored the heterogeneity in the effects of retirement across different sex and education level groups., Results: Based on the fully adjusted model, we estimated that retirement increased SBP by 5.047 mm Hg (95% CI: -2.628-12.723, P value: 0.197), DBP by 0.614 mm Hg (95% CI: -3.879-5.108, P value: 0.789) and pulse pressure by 4.433 mm Hg (95% CI: -0.985-9.851, P value: 0.109). We found that retirement led to a significant increase in male participants' SBP and pulse pressure as well as a possible decrease in female participants' blood pressure. Additionally, the blood pressure levels of low-educated participants were more vulnerable to the shock of retirement., Conclusion: Retirement is associated with an increase in blood pressure level. There is a causal relationship between the increase in blood pressure levels of men and retirement. Policy-makers should pay extra attention to the health status of men and less educated people when adjusting retirement policies in the future., (© 2024. The Author(s).)

Objectives: The aim of this study was to examine the dose-response associations of physical activity with blood pressure (BP) and hypertension risk among Chinese adults., Methods: Derived from the national community-based China Hypertension Survey database during 2012--2015, a total of 203 108 residents aged at least 18 years were included. Individual-level physical activity was evaluated using a standardized questionnaire, and minutes of metabolic equivalent tasks per week (MET-min/week) were calculated, integrating domain, intensity, frequency, and duration. Multivariable linear and logistic regressions were used to estimate associations of physical activity with BP and hypertension risk, and restricted cubic spline regressions were performed for their nonlinear dose-response relationships., Results: Overall, the median total physical activity (TPA) was 3213.0 MET-min/week and the prevalence of physical inactivity was 14.8%. TPA was negatively associated with BP. Increasing TPA levels was related to a steep decrease in systolic BP, up to approximately 2500 MET-min/week, with more modest benefits above that level of TPA. Higher levels of domain-specific and intensity-specific physical activity were found to be associated with lower BP levels and hypertension risk, except for the association between vigorous-intensity physical activity and systolic BP. We found that TPA within the range of 2000--4000 MET-min/week, a higher frequency and shorter duration were inversely associated with diastolic BP levels., Conclusion: Total, domain-specific, and intensity-specific physical activity were inversely related to BP levels, respectively, in a dose-response fashion. Of a given amount, higher-frequency, shorter-duration, and lower-intensity physical activity produced more beneficial effects., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

The health effects of urbanization are controversial. The association between urbanization and reversible subclinical risks of cardiovascular diseases (e.g., electrocardiogram (ECG) abnormalities) has rarely been studied. This study aimed to assess the association between urbanization and ECG abnormalities in China based on the China National Stroke Screening Survey (CNSSS). We used changes in the satellite-measured impervious surfaces rate and nighttime light data to assess the level of urbanization. Every interquartile increment in the impervious surfaces rate or nighttime light was related to a decreased risk of ECG abnormalities, with odds ratios of 0.894 (95% CI, 0.869-0.920) or 0.809 (95% CI, 0.772-0.847), respectively. And we observed a U-shaped nonlinear exposure-response relationship curve between the impervious surfaces rate and ECG abnormalities. In conclusion, the current average level of urbanization among the studied Chinese adults remains a beneficial factor for reducing cardiovascular risks., (© 2024. The Author(s).)

Background: Recently, professionals, such as those from the World Health Organization, have recommended a rigorous standard for nitrogen dioxide (NO 2 ), a typical urban air pollutant affected by regular traffic emissions, based on its short-term and long-term cardiorespiratory effects. However, the association between middle-term NO 2 exposure and cardiovascular disorders remains unknown., Objectives: This study was conducted to examine the relationship between NO 2 exposure and its middle-term cardiovascular risks indicated by electrocardiogram (ECG) abnormalities., Method: We included 61,094 subjects (132,249 visits) with repeated ECG observations based on longitudinal data from the China National Stroke Screening Survey (CNSSS). The NO 2 exposure concentration was derived from a predictive model, measured as the monthly average concentration in the 6 months of preceding the ECG measurement. We used the generalized estimation equation to assess the association between NO 2 exposure and ECG abnormalities., Result: For each 10 µg/m 3 increase in monthly average NO 2 concentration, the odds ratio of ECG abnormalities was 1.10 (95% confidence interval [CI] 1.09-1.12) after multiple adjustments. Stratified regression analyses of urban and rural residents showed associations between middle-term NO 2 exposure and ECG abnormalities in urban (OR 1.09 [95% CI 1.08-1.11]) and rural residents (OR 1.14 [95% CI 1.10-1.19]). The association was robust within different subpopulations. Associations generally remained statistically significant (OR 1.03 [95% CI 1.02-1.05]) after extra adjustment for PM 2.5 . Exposure-response relationship analysis revealed a nearly linear relationship between NO 2 exposure and the risk for ECG abnormalities., Conclusion: Using the variation in ECG signals as a potentially reversible indicator for subclinical risk in cardiovascular systems, our study provides additional evidence on the increased risk posed by middle-term NO 2 exposure. Our study showed that policies controlling for NO 2 concentrations are beneficial to prevent cardiovascular diseases among Chinese adults., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Ambient ozone (O 3 ) pollution has been associated with an increased risk of cardiovascular diseases. However, few studies have addressed the effect of O 3 exposure on electrocardiogram (ECG) abnormalities, a subclinical indicator of early damage to the cardiovascular system. This study aimed to examine the association between short-term exposure to O 3 and ECG abnormalities. We included 102,027 visits of 47,290 participants over 40 years old who had a normal ECG at baseline and then visited again at least once from the China National Stroke Screening Survey (CNSSS). Short-term ozone exposure concentrations were measured as averages of maximum daily 8-h O 3 concentrations over the two weeks prior to ECG measurements. The generalized estimation equations models were used to evaluate the association between O 3 exposure and ECG abnormalities. For every 10 µg/m 3 increment in short-term O 3 concentration, the odds ratio of any ECG abnormality was 1.055 (95% confidence interval [CI] 1.045-1.064). For ECG-diagnosed cardiac arrhythmia, the odds ratio was 1.062 (95% CI 1.052-1.072). A nonlinear analysis showed a sublinear relationship between O 3 exposure and risk for ECG abnormalities. The association between O 3 exposure and ECG abnormalities varied by subpopulation. Our study provided new epidemiological evidence on the association between short-term O 3 exposure and ECG abnormalities. There is an urgent need to control ambient O 3 pollution to prevent cardiovascular events., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The aim of the study was to identify case-mix adjusters for the Chinese version of the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child-HCAHPS) and assess the impact of case-mix adjustment on patient experience measures in China., Methods: This study analyzed data collected from six National Regional Center for Pediatric across China retrospectively. Participants were children aged ≤17 years and their guardians who completed the survey. The Chinese Child-HCAHPS was used to measure pediatric inpatient care experience. Candidate case-mix adjusters were assessed using a summary measure of explanatory power. Changes in scores and rankings of the six centers were quantified to assess the impact of adjustment., Results: A total of 2708 respondents completed the survey from January to March 2021, with a response rate of 7-15%. The child's global health status and the respondent being the child's mother were identified as case-mix adjusters, and case-mix adjustment models for 18 patient experience items were constructed. Kendall's τ correlation of hospital rankings before and after adjustment ranged from 0.73 to 1.00., Conclusions: Although the impact of case-mix adjustment may appear modest in our sample, it demonstrated the feasibility, necessity, and methodology for further development of case-mix adjustment models in pediatric healthcare facilities in China., Impact: Case-mix adjustment models adjust for factors that are unamendable by healthcare providers that may affect patient experience ratings, thereby improving the comparability of institutional-level ratings. Standardized case-mix adjustment protocols for quality measures need to be modified in different settings. This is the first study to identify adjustment variables and the possible impact of case-mix adjustment on pediatric inpatients' experience measures in a Chinese population. This study provided evidence on the feasibility and necessity for further development of case-mix adjustment models for pediatric healthcare facilities in China., (© 2023. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

Introduction: Although physical activity (PA) has multiple health benefits, the inhaled dose of fine particulate matter (PM 2.5 ) during PA may increase. The trade-off between harmful effects of PM 2.5 exposure and protective effects of PA remain unclear. Our study aims to examine the joint effects of PA and PM 2.5 exposure on blood pressure (BP) in Chinese adults., Methods: A total of 203,108 adults aged ≥ 18 years from the China Hypertension Survey study (2012-2015) were included. Individual-level PA was assessed as minutes of metabolic equivalent tasks per week (MET-min/week). The average weekly PM 2.5 exposures were estimated by using a spatial resolution of 10 km, integrating multiple data sources, including monitoring values, satellite measurements and model simulations. BP was measured with a professional portable BP monitor. Generalized linear regressions were used to estimate joint associations and to further explore two-dimensional nonlinear associations., Results: The median PA and 4-week PM 2.5 average exposures were 3213.0 MET-min/week and 47.8 μg/m 3 , respectively. PA was negatively associated with BP, while PM 2.5 exposure was positively with BP. The associations between PA and systolic BP were significantly modified by PM 2.5 exposure (P interaction < 0.001). Compared with inactive participants under low PM 2.5 exposure, those with highest level of PA under low PM 2.5 exposure had a 0.90 (95 % CI: 0.53, 1.26) mmHg decrease in systolic BP, whereas they had a 0.48 (95 % CI: 0.07, 0.89) mmHg increase under high PM 2.5 exposure. When PM 2.5 exposure was approximately > 25 μg/m 3 , the joint exposure to total PA and PM 2.5 was associated with an increase in systolic BP., Conclusions: The benefits of PA on BP were counteracted by high PM 2.5 levels., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Electrocardiogram (ECG) abnormalities are known to have prognostic value for heart conditions, while evidence on the relationship between long-term exposure to PM 2.5 constituents and electrocardiographic (ECG) abnormalities is limited. This study aimed to quantify the association between long-term exposure to PM 2.5 constituents and changes in ECG diagnoses., Methods: We designed a longitudinal study among participants with repeated records of ECG examination based on the China National Stroke Screening Survey 2013-2018. Logistic regressions with multiple adjustment, estimated by the generalized estimating equation to incorporate repeated measurements, were used to assess the associations between the occurrence of any physician-diagnosed ECG abnormalities and long-term exposure to PM 2.5 constituents., Results: We included 61,094 participants with 132,249 visits. All five constituents (sulfate, nitrate, ammonium, organic matter, and black carbon) were significantly associated with an increased risk of ECG abnormalities. The excess risk of ECG abnormalities per interquartile-range increase in exposure was the highest for sulfate (26%, 95% confidence interval [CI] 23-29%), followed by ammonium (22%, 19-26%), nitrate (21%, 17-24%), black carbon (16%, 13-10%) and organic matter (9%,6%-11%). We also found that atrial fibrillation patients might be susceptible to the adverse effects of PM 2.5 constituents on ECG., Conclusion: Differential associations between various constituents of PM 2.5 and ECG abnormalities were found. The unequal toxicities for different chemical constituents of ambient particles on cardiovascular electrophysiological endpoints should be taken into consideration when considering the biological pathways linking PM 2.5 and cardiovascular conditions., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Importance: Knowing the scale of rare inborn errors is important for screening and resource allocation. Evidence on the prevalence of methylmalonic acidemia (MMA) among newborns and the clinical-suspected population from large-scale screening programs needs to be systematically synthesized., Objective: To estimate the worldwide prevalence of MMA for newborns and the clinical-suspected population and explore the differences in different regions, periods, and diagnostic technologies., Data Sources: MEDLINE, Embase, CRD, Cochrane Library, Scopus, CINAHL, and PROSPERO. Study Selection: All studies reporting the epidemiology characteristics of MMA were selected., Data Extraction and Synthesis: Characteristics of study, subjects, and epidemiology were extracted, random-effect models were used for meta-analyses., Main Outcome and Measure: Pooled prevalence of MMA., Results: This study included 111 studies. The pooled prevalence of MMA worldwide was 1.14 per 100,000 newborns (1516/190,229,777 newborns, 95% CI: 0.99-1.29) and 652.11 per 100,000 clinical-suspected patients (1360/4,805,665 clinical-suspected individuals, CI: 544.14-760.07). Asia and Africa got a higher pooled prevalence of MMA. The prevalence of MMA in newborns increased through the years, while that in the clinical-suspected population decreased. Collecting blood ≥ 72 h after birth had a higher pooled prevalence of MMA than collecting during 24 h-72 h after birth. The combining-use of MS/MS and GC/MS had a higher pooled prevalence than the single-use of MS/MS or GC/MS. Prevalence of cbl C, mut, cbl B, cbl A, isolated MMA, combined MMA and homocystinuria, vitamin B12-responsive MMA was synthesized., Conclusions and Relevance: Prevalence of MMA among newborns was extremely low, but considerably high in the clinical-suspected population, indicating the need for more efficient newborn screening strategies and closer monitoring of the high-risk population for the early signs of MMA. Asia and Africa should attach importance to the high prevalence of MMA. Further diagnostic tests were recommended for the combining-use vs single-use of MS/MS and GC/MS and for collecting blood after 72 h vs during 24-72 h after birth.

Purpose: To quantify financial toxicity of female patients with breast cancer in China and investigate its factors and patients' coping strategies., Methods: The Comprehensive Score for Financial Toxicity (COST) is defined by using a structured questionnaire containing 12 items measuring perceived affordability of healthcare services, with the range of scoring of which being from 0 to 44 (higher score indicates lower financial toxicity). From January to March 2021, a total of 664 female patients diagnosed with stage 0-IV breast cancer were recruited from 33 public tertiary cancer hospitals located in 31 provinces of China. Multivariate linear regression models were used., Results: The median age of patients was 48 years (range: 26-84 years), and 62.04% lived in urban areas. The median COST score was 21.00 (interquartile range: 15-26). Older age, higher household income, and better self-reported health status were associated with lower financial toxicity, while a bigger household size, being retired or unemployed, stage IV cancer, and a history of targeted therapy were associated with higher financial toxicity (all P < 0.05). Nearly half of the patients reported using at least one coping strategy, including considering quitting treatment, delaying treatment, and failing to take medicine or attend medical visits as instructed. The people with increased financial toxicity seem to adopt more coping strategies., Conclusions: Financial toxicity and coping strategies are common among Chinese women with breast cancer. An understanding of the factors regarding financial toxicity may help oncologists and policy-makers identify at-risk patients and develop targeted interventions., (© 2022. The Author(s).)