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ObjectiveTo understand the prevalence level and trend of hepatitis C virus (HCV) among 11 specific populations in Yunnan province, and to provide evidence for formulating and evaluating the effectiveness of prevention and control measures. MethodsThe annual report data from 2013 to 2022 on comprehensive prevention and control of hepatitis C were collected from all medical institutions in 16 prefectures/municipalities in Yunnan province and were analyzed using R software and the Cochran-Armitage trend test was used to assess the changing trends in HCV antibody (anti-HCV) positivity rates among different population groups and for different regions. ResultsOf a total of 64 879 772 person-times of anti-HCV detection performed in medical institutions during the period, 392 971 (0.61%) were anti-HCV positive, and the annual anti-HCV positive rates ranged from 0.49% (45 069/9 286 175) to 0.83% (20 819/2 494 869) during the period, with a decreasing trend (Z = – 100.05, P < 0.05). The top three population groups with the highest anti-HCV positive rate were drug users (27.46%, 52 508/191 184), detainees (3.31%, 3 183/96 038), and female sex workers (0.92%, 1 152/125 832). The anti-HCV positive rate showed a decreasing trend in all population groups, including preoperative patients, blood transfusion recipients, other medical clients, pregnant women, blood donors, drug users, female sex workers, detainees, and others (all P < 0.05), except for premarital checkups and men who have sex with men, whose anti-HCV positive rates showed an increasing trend (Z = 2.9252, P < 0.05; Z = 7.0807, P < 0.05). The top three regions with the highest anti-HCV positive rate were Dehong prefecture, Baoshan municipality, Honghe prefecture and Kunming municipality. The anti-HCV positive rate showed a decreasing trend in all prefectures/municipalities of the province during the period (all P < 0.05), except for in Diqing and Nujiang prefectures and Zhaotong municipality, whose anti-HCV positive rate showed an increasing trend (Z = 3.518, P < 0.05; Z = 7.2602, P < 0.05; Z = 4.5373, P < 0.05). ConclusionThe prevalence of anti-HCV positive in Yunnan province from 2013 to 2022 was mainly among key populations such as drug users, detainees, and female sex workers, with regions with higher positive rate including Dehong and Honghe prefectures, and Baoshan and Kunming municipalities, where the prevalence of former drug abuse was also higher.

Abstract Background Mesenchymal stem cells (MSCs) hold immense promise for use in immunomodulation and regenerative medicine. However, their inherent heterogeneity makes it difficult to achieve optimal therapeutic outcomes for a specific clinical disease. Primed MSCs containing a certain cytokine can enhance their particular functions, thereby increasing their therapeutic potential for related diseases. Therefore, understanding the characteristic changes and underlying mechanisms of MSCs primed by various cytokines is highly important. Results In this study, we aimed to reveal the cellular heterogeneity, functional subpopulations, and molecular mechanisms of MSCs primed with IFN-γ, TNF-α, IL-4, IL-6, IL-15, and IL-17 using single-cell RNA sequencing (scRNA-seq). Our results demonstrated that cytokine priming minimized the heterogeneity of the MSC transcriptome, while the expression of MSC surface markers exhibited only slight changes. Notably, compared to IL-6, IL-15, and IL-17; IFN-γ, TNF-α, and IL-4 priming, which stimulated a significantly greater number of differentially expressed genes (DEGs). Functional analysis, which included Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses, indicated that IFN-γ, TNF-α, and IL-4-primed hUC-MSCs are involved in interferon-mediated immune-related processes, leukocyte migration, chemotaxis potential, and extracellular matrix and cell adhesion, respectively. Moreover, an investigation of various biological function scores demonstrated that IFN-γ-primed hUC-MSCs exhibit strong immunomodulatory ability, TNF-α-primed hUC-MSCs exhibit high chemotaxis potential, and IL-4-primed hUC-MSCs express elevated amounts of collagen. Finally, we observed that cytokine priming alters the distribution of functional subpopulations of MSCs, and these subpopulations exhibit various potential biological functions. Taken together, our study revealed the distinct regulatory effects of cytokine priming on MSC heterogeneity, biological function, and functional subpopulations at the single-cell level. Conclusions These findings contribute to a comprehensive understanding of the inflammatory priming of MSCs, paving the way for their precise treatment in clinical applications.

Abstract Intense volcanic and geothermal activities characterize the Great Rift Valley of East Africa. Ground fissure disasters of the Great Rift Valley have garnered increasing attention in recent years. Through field investigations, trenching, geophysical exploration, gas sampling and analysis, we determined the distribution and origin of 22 ground fissures within the Kedong Basin of the Central Kenya Rift. These ground fissures caused varying degrees of damage to roads, culverts, railways, and communities. Trenching and geophysical exploration have shown that ground fissures in sediments are connected to rock fractures with gas escaping. The gases expelled from the rock fractures contained methane and SO2, which were absent in the normal atmosphere, and 3He/4He ratios in gases measured further indicated that the volatiles were derived from the mantle, suggesting that these rock fractures extended deep into the underlying bedrock. Spatial correlations with rock fractures demonstrate the deep origin of these ground fissures, which are associated with active rifting, plate separation, and volcanism. The ground fissures are formed due to movement on the deeper rock fractures, and then the gas escapes through the fissures. Determining the unusual origin of these ground fissures can not only guide infrastructure development and urban planning but also contribute to the safety of local communities.

Abstract Purpose While asthma comorbidities are associated with higher health care utilisation, lower quality of life and poorer asthma control, the impact of asthma comorbidities on hospitalisation for asthma exacerbation (H-AX) remains less recognised. We aim to analyse the impact of asthma comorbidities on H-AX. Methods Based on a national survey on asthma control and disease perception (CARN 2015 study), we analysed the impact of comorbidities on annual incidence and frequency of H-AX in China. Information on demographic characteristics, asthma comorbidities and annual incidence and frequency of H-AX were presented in this study. Results Among 3875 ambulatory asthma patients, 75.9% (2941/3875) had comorbidities, and 26.4% (1017/3858) experienced H-AX during past year. After adjusting for confounding factors such as demographic data, smoking status and asthma control, COPD [OR = 2.189, 95% CI (1.673, 2.863)] and coronary heart disease [OR = 1.387, 95% CI (1.032, 1.864)] were associated with higher annual incidence, while allergic rhinitis [OR = 0.692, 95% CI (0.588, 0.815)] was associated with lower annual incidence, of H-AX. In terms of frequency, allergic rhinitis [OR = 1.630, 95% CI (1.214, 2.187)], COPD [OR = 1.472, 95% CI (1.021, 2.122)] and anxiety [OR = 2.609, 95% CI (1.051, 6.477)] showed statistically significant correlation with frequent H-AX. Conclusions COPD and coronary heart disease were associated with higher annual incidence, while allergic rhinitis was associated with lower annual incidence of H-AX. Allergic rhinitis, COPD and anxiety were associated with frequent H-AX. Comorbidities may have an important role in the risk and frequency of annual hospitalisations due to asthma exacerbation. The goal of asthma control should rely on a multi-disciplinary treatment protocol.

Background Obstructive sleep apnea (OSA) is the most prevalent sleep disturbance that affects approximately 936 million people worldwide and leads to extensively increased incidence of cardiovascular disease, metabolic syndrome, neurological disorders, and traffic accidents. Severe OSA patients suffer a significantly higher risk of complications and worse comorbidity outcomes. Notwithstanding, with inadequate access to contact diagnosis based on polysomnography (PSG), numerous patients with severe sleep apnea have not been diagnosed, especially during the pandemic. Moreover, how the T cell immunity is impaired in OSA remains largely unknown. Methods We primarily investigated the T cell receptor (TCR) repertoires of 50 patients with severe OSA, 23 patients with mild-to-moderate OSA, 23 patients without OSA, and 157 healthy individuals, from their peripheral blood. Firstly, we compared the clinical characteristics, blood cell counts, the ratio of neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), and CD4+/CD8+T cell count between groups. Then, we compared the diversity, clonotypes, unique VJ alleles in patients with different disease severity. Furthermore, by identifying a series of disease-associated amino acid sequences, we employed a repeated hold-out machine learning strategy to explore the optimal algorithm for calculating the TCR repertoire characteristic Index (OSA-TCI). We further confirmed its relation with clinical features by linear regression analysis. Moreover, in followup of severe OSA patients who accepted adherent non-invasive ventilation, we assessed the changes of TCR repertoires, OSA-TCI, ESS, NLR, PLR, and CD4+/CD8+T after therapy. Results We found an unexpected increase in diversity and clonotypes in the TCR repertoire of OSA patients. Furthermore, we successfully developed a novel indicator termed OSA-TCI to summarize the unique repertoire alteration, which provided 90% of sensitivity and 87% of specificity in distinguishing severe OSA. In rationalization, OSA-TCI was found correlated to AHI, BMI, hemoglobin, N1, N2 percentage of sleep, snoring, smoking and lowest oxygen saturation, but only independently related to AHI (R = 0.603) and smoking (R = 0.22). Finally, we observed OSA-TCI in the eight severe patients decreased significantly after home noninvasive ventilation for three months during follow-up, consistently in line with the TCR repertoire improvement. In contrast, NLR, PLR, and the ratio of CD4+/CD8+T cell count were found useless to diagnose and therapeutic surveillance of severe OSA. Conclusions Our study is the first to unveil the TCR repertoire alteration in OSA, indicates possible insidious autoimmune mechanisms underlying OSA, and suggests that TCR repertoires serve as a convenient peripheral blood biomarker for OSA assessment without long-time contact and facility/instrument occupation. It may shed light on future diagnostic, immunological, pathophysiological, and prognostic research on OSA.

Type 2 diabetes mellitus (T2DM) is a widespread metabolic condition with a high global morbidity and mortality rate that affects the whole body. Their primary consequences are mostly caused by the macrovascular and microvascular bed degradation brought on by metabolic, hemodynamic, and inflammatory variables. However, research in recent years has expanded the target organ in T2DM to include the lung. Inflammatory lung diseases also impose a severe financial burden on global healthcare. T2DM has long been recognized as a significant comorbidity that influences the course of various respiratory disorders and their disease progress. The pathogenesis of the glycemic metabolic problem and endothelial microangiopathy of the respiratory disorders have garnered more attention lately, indicating that the two ailments have a shared history. This review aims to outline the connection between T2DM related endothelial cell dysfunction and concomitant respiratory diseases, including Coronavirus disease 2019 (COVID-19), asthma, chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF).

Multiple neuroendocrine tumors (M-NETs) are rare in the rectum and there is no consensus on their characteristics and treatments. Here, we report 15 cases of rectal M-NETs and review the previous literature. We discuss the clinical characteristics, endoscopic features and pathological features of rectal M-NETs, aiming to analyze the treatments and follow-up strategies in combination with these characteristics. We retrospectively reviewed and analyzed the data of 15 patients with rectal M-NETs who were diagnosed and treated at Beijing Friendship Hospital, Capital Medical University. Their clinical data, endoscopic findings, pathological features and treatments were analyzed. Follow-up evaluations and literature review were performed. In all, 14 male (93.3%) and 1 female (6.7%) were recruited. The average age at diagnosis was 55.7 years. The clinical manifestations include asymptomatic in 9 patients (60.0%), defecation habits changes in 2 patients (13.3%), anal distension in 2 patients (13.3%), and abdominal distension in 2 patient (13.3%). The largest tumor diameter ≤10mm was found in 13 patients (86.7%) and >10mm in 2 patients (13.3%). All of the lesions originated from the mucous or submucosa layer. WHO grades were all NET G1. The number of tumors diagnosed by pathology in 13 patients was consistent with that observed by endoscopy, while more lesions were observed by pathology than endoscopy in two patients. Lymph node metastasis occurred in 1 patient (6.7%), and vascular or lymphatic invasion occurred in 9 patients (60.0%). Among the 13 patients with the largest tumor diameter being ≤10mm, lymphovascular invasion occurred in 8 patients (61.5%). And among the 2 patients with the largest tumor diameter of >10mm, lymphovascular invasion occurred in 1 patient (50.0%). 14 patients underwent endoscopic resection and 1 underwent surgical excision. Postoperative follow-up was achieved in 13 patients and no recurrence or metastasis was found. The true number of rectal M-NETs may be more than seen under endoscopy. Rectal M-NETs is associated with a high risk of metastasis; therefore, treatment and surveillance strategies should be more radical than single lesion.

Over the last decade, Nitrogen Oxide (NOx) emissions have garnered significantly greater attention due to the worldwide emphasis on sustainable development strategies. In response to the issues of dynamic measurement delay and low measurement accuracy in the NOx sensors of heavy-duty diesel vehicles, a novel Multilayer Perceptron (MLP)–Random Forest Regression (RFR) fusion algorithm was proposed and explored in this research. The algorithm could help perform post-correction processing on the measurement results of diesel vehicle NOx sensors, thereby improving the reliability of the measurement results. The results show that the measurement errors of the On-board Nitrogen oxide Sensors (OBNS) were reduced significantly after the MLP-RFR fusion algorithm was corrected. Within the concentration range of 0–90 ppm, the absolute measurement error of the sensor was reduced to ±4 ppm, representing a decrease of 73.3%. Within the 91–1000 ppm concentration range, the relative measurement error was optimised from 35% to 17%, providing a reliable solution to improve the accuracy of the OBNS. The findings of this research make a substantial contribution towards enhancing the efficacy of the remote monitoring of emissions from heavy-duty diesel vehicles.

Based on the 20-year high-resolution precipitation data from TRMM and GPM radar products, diurnal features over complex terrains along the Yangtze River (YR) are investigated. Using the Fast Fourier Transform (FFT) method, the first (diurnal) and second (semi-diurnal) harmonic amplitude and phase of precipitation amount (PA), precipitation frequency (PF), and intensity (PI) are analyzed. The diurnal amplitudes of PA and PF have a decreasing trend from the west to the east with the decreasing altitude of large-scale terrain, while the semi-diurnal amplitudes of PA and PI depict the bimodal precipitation cycle over highlands. For the eastward propagation of PA, PF is capable of depicting the propagation from the upper to the middle reaches of YR, while PI shows the eastward propagation from the middle to the lower reaches of YR during nighttime and presents sensitivity to highlands and lowlands. According to the contribution of different-sized precipitation systems to PI over the highlands and lowlands, the small (2) ones contribute the least while the large ones (>6000 km2) contribute the most, but the medium ones (200–6000 km2) show a slightly larger contribution over the highlands than over the lowlands. The propagation of each scaled precipitation system along the YR is further analyzed. We found that small precipitation systems mainly happen in the afternoon without obvious propagation. Medium ones peak 2–4 h later than the small ones, with two eastward propagation directions at night from the middle reaches of YR to the east. The large ones are mainly located in lowlands at night, with two propagation routes in the morning over the middle and lower reaches of YR. Such a relay of the propagation of the medium and large precipitation systems explains the eastward movement of PI along the YR, which merits future dynamic studies.

Abstract Background The severity of COVID-19 associates with the clinical decision making and the prognosis of COVID-19 patients, therefore, early identification of patients who are likely to develop severe or critical COVID-19 is critical in clinical practice. The aim of this study was to screen severity-associated markers and construct an assessment model for predicting the severity of COVID-19. Methods 172 confirmed COVID-19 patients were enrolled from two designated hospitals in Hangzhou, China. Ordinal logistic regression was used to screen severity-associated markers. Least Absolute Shrinkage and Selection Operator (LASSO) regression was performed for further feature selection. Assessment models were constructed using logistic regression, ridge regression, support vector machine and random forest. The area under the receiver operator characteristic curve (AUROC) was used to evaluate the performance of different models. Internal validation was performed by using bootstrap with 500 re-sampling in the training set, and external validation was performed in the validation set for the four models, respectively. Results Age, comorbidity, fever, and 18 laboratory markers were associated with the severity of COVID-19 (all P values

Abstract Background The 12-week, multicentre, observational INITIAL study (NCT02143739) assessed asthma severity in newly diagnosed Chinese patients. Methods Post hoc analysis of medication combinations prescribed per routine clinical practice at baseline, and the impact on control levels evaluated using 2012 vs 2018 Global Initiative for Asthma (GINA) criteria. Results In total, 4491 patients were included in the analysis. At baseline, intermittent, mild, moderate and severe asthma was reported in 3.9, 12.0, 22.6 and 61.6% of patients, respectively. Most patients (90.2%) were prescribed inhaled corticosteroid/long-acting β2 agonist (ICS/LABA). ICS/LABA plus ≥1 additional medication(s) was prescribed to 66.7% of patients, with leukotriene receptor antagonist (LTRA, 54.7%) being the most common additional medication. Distribution of ICS/LABA vs ICS/LABA+LTRA was comparable in patients with intermittent (3.2% vs 3.0%), mild (11.5% vs 9.7%), moderate (21.2% vs 19.9%) and severe asthma (64.1% vs 67.4%). Control levels among patients using ICS/LABA+LTRA vs ICS/LABA were comparable using GINA 2012 and lower using GINA 2018 criteria. The proportion of patients using ICS/LABA+LTRA vs ICS/LABA with intermittent, mild, moderate and severe asthma controlled at Week 12 (using GINA 2012) were 78.1% vs 80.0, 86.5% vs 85.8, 78.5% vs 71.3, and 59.6% vs 61.8%, respectively. Using GINA 2018 criteria proportions were 86.8% vs 95.9, 86.1% vs 93.2, 82.1% vs 85.3, and 71.9% vs 77.6%, respectively. Conclusions Asthma control was not improved by adding LTRA to ICS/LABA and may have been unnecessary for some newly diagnosed patients. These findings were irrespective of the GINA criteria (2012 vs 2018) used and baseline severity.

Abstract The Lightning Mapping Imager (LMI) onboard Fengyun‐4A (FY‐4A) is the first Chinese lightning detection sensor in geostationary orbit. This study presents the lightning characteristics observed by the FY‐4A LMI in its first year, and then observations from the Lightning Imaging Sensor (LIS) onboard the International Space Station (ISS) are used to validate the performance of the LMI sensor. LMI lightning events are defined by the pixel's luminosity exceeding the threshold radiance. During the first year of operation, LMI events revealed a reasonable geographical distribution. The diurnal cycles of LMI event/background/threshold radiance are in general agreement with the later afternoon peaks in previous findings. However, the LMI events that occurred around the LIS flash time and in the LMI observation field‐of‐view show a slightly delayed peak at around 1900 LST. This peak can be shifted closer to LIS's results after removing LMI events with event radiance lower than 300 μJsr−1m−2μm−1, suggesting that a larger threshold radiance value is needed to qualify some of these LMI events. Finally, LIS lightning groups were matched with LMI lightning events using different temporal and spatial collocation criteria. The detection efficiency is defined by the fraction of LIS groups detected by LMI to assess LMI's performance. The LMI detection efficiency relative to LIS was found to be regionally dependent and lower in the daytime than at nighttime. These results contribute to applications of LMI lightning observations in storm research and provide suggestions for further algorithm improvement.

The lung is constantly exposed to environmental particulates such as aeroallergens, pollutants, or microorganisms and is protected by a poised immune response. Innate lymphoid cells (ILCs) are a population of immune cells found in a variety of tissue sites, particularly barrier surfaces such as the lung and the intestine. ILCs play a crucial role in the innate immune system, and they are involved in the maintenance of mucosal homeostasis, inflammation regulation, tissue remodeling, and pathogen clearance. In recent years, group 3 innate lymphoid cells (ILC3s) have emerged as key mediators of mucosal protection and repair during infection, mainly through IL-17 and IL-22 production. Although research on ILC3s has become focused on the intestinal immunity, the biology and function of pulmonary ILC3s in the pathogenesis of respiratory infections and in the development of chronic pulmonary inflammatory diseases remain elusive. In this review, we will mainly discuss how pulmonary ILC3s act on protection against pathogen challenge and pulmonary inflammation, as well as the underlying mechanisms.

Introduction: Workplace violence (WPV) against healthcare providers has severe consequences and is underreported worldwide. The aim of this study was to present the features, causes, and outcomes of serious WPV against healthcare providers in China.Method: We searched for serious WPV events reported online and analyzed information about time, location, people, methods, motivations, and outcomes related to the incident.Result: Serious WPV reported online in China (n = 379) were mainly physical (97%) and often involved the use of weapons (34.5%). Doctors were victims in most instances (81.1%). Serious WPV mostly happened in cities (90.2%), teaching hospitals (87.4%), and tertiary hospitals (67.9%) and frequently in Emergency Department (ED), Obstetrics and Gynecology Department (OB-GYN), and pediatric departments; it was most prevalent in the months of June, May, and February. Rates of serious WPV increased dramatically in 2014 and decreased after 2015, with death (12.8%), severe injury (6%), and hospitalization (24.2%) being the major outcomes. A law protecting healthcare providers implemented in 2015 may have helped curb the violence.Conclusion: Serious WPV in China may stem from poor patient–doctor relationships, overly stressed health providers in highly demanding hospitals, poorly educated/informed patients, insufficient legal protection, and poor communication. Furthering knowledge about WPV and working toward curtailing its presence in healthcare settings are crucial to increasing the safety and well-being of healthcare workers.

ObjectiveAirway inflammation in asthma involves not only the central airways but extends to peripheral airways. Lung deposition may be key for an appropriate treatment of asthma. We compared the clinical effects of extrafine hydrofluoroalkane (HFA)-beclomethasone-formoterol (BDP-F) versus equipotent doses of nonextrafine combination of an inhaled corticosteroid and a long acting β2-agonist (ICS-LABA) in asthma.MethodsWe identified eligible studies by a comprehensive literature search of PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). Data analysis was performed with the Review Manager 5.3.5 software (Cochrane IMS, 2014).ResultsA total of 2326 patients with asthma from ten published randomized controlled trials (RCTs) were enrolled for analysis. Change from baseline in morning pre-dose peak expiratory flow (PEF), evening pre-dose PEF and forced expiratory volume in one second (FEV1) were detected no significant differences between extrafine HFA-BDP-F and nonextrafine ICS-LABAs (p = 0.23, p = 0.99 and p = 0.23, respectively). Extrafine HFA-BDP-F did not show any greater benefit in forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75%), the parameter concerning peripheral airways (MD 0.03L/s, p = 0.65; n = 877). There were no substantial differences between interventions in fractional exhaled nitric oxide (FeNO) levels or in its alveolar fraction. The overall analysis showed no significant benefit of extrafine HFA-BDP-F over nonextrafine ICS-LABA in improving Asthma Control Test (ACT) score (p = 0.30) or decreasing the number of puffs of rescue medication use (p = 0.16). Extrafine HFA-BDP-F did not lead to less exacerbations than nonextrafine ICS-LABA (RR 0.61, 95% CI: 0.31 to 1.20; I2 = 0; p = 0.15).ConclusionEnrolled RCTs of extrafine HFA-BDP-F have demonstrated no significant advantages over the equivalent combination of nonextrafine ICS-LABA in improving pulmonary function concerning central airways or peripheral airways, improving asthma symptom control or reducing exacerbation rate.

BackgroundThe paradigm shift in hepatitis C virus (HCV) treatment options in the last five years has raised the prospect of eliminating the disease as a global health threat. This will require a step-change in the number being treated with the new direct-acting antivirals (DAAs). Given constrained budgets and competing priorities, policy makers need information on how to scale-up access to HCV treatment. To inform such decisions, we examined the cost effectiveness of screening and treatment interventions in Yunnan, China.Methods and findingsWe simulated the HCV epidemic using a previously published model of HCV transmission and disease progression, calibrated to Yunnan data, and implemented a range of treatment and screening interventions from 2019. We incorporated treatment, diagnosis, and medical costs (expressed in 2019 US Dollars, USD) to estimate the lifetime benefits and costs of interventions. Using this model, we asked: is introducing DAAs cost effective from a healthcare sector perspective; what is the optimal combination of screening interventions; and what is the societal return on investment of intervention? The incremental cost-effectiveness ratio (ICER) of switching to DAAs with a median cost of 7,400 USD (50,000 Chinese Yuan) per course is 500 USD/disability adjusted life year (DALY) averted; at a threshold of 50% of Yunnan gross domestic product (2,600 USD), switching to DAAs is cost effective 94% of the time. At this threshold, the optimal, cost-effective intervention comprises screening people who inject drugs, those in HIV care, men who have sex with men, and ensuring access to DAAs for all those newly diagnosed with HCV. For each USD invested in this intervention, there is an additional 0·80 USD (95% credible interval: 0·17-1·91) returned through reduced costs of disease or increased productivity. Returns on investment are lower (and potentially negative) if a sufficiently long-term horizon, encompassing the full stream of future benefits, is not adopted. The study had two key limitations: costing data were not always specific to Yunnan province but were taken from China-level studies; and modelled interventions may require more operational research to ensure they can be effectively and efficiently rolled-out to the entire province.ConclusionsIntroducing DAAs is cost effective, the optimal package of screening measures is focussed on higher risk groups, and there are likely to be positive returns from investing in such HCV interventions. Our analysis shows that targeted investment in HCV interventions will have net benefits to society; these benefits will only increase as DAA costs fall.

The power system is affected by different levels of transient shock caused by different switching angle when AC filter switching on. The shock causes frequent action and aging of lightning arrester. In this article, the causes of frequent action of lightning arrester in Nuozhadu DC project are analyzed by means of power systems computer aided design simulation. The overvoltage, current, and energy of AC filter switching on are also analyzed. The critical angle of the arrester action of AC filters is discussed. The results show that AC filter switching on can affect this group and other groups. When the closing phase angle reaches 12°, the arrester in this group lightnings. When the closing phase angle reaches 18, the arresters in other groups lightning. Finally, the influence of the three phases and the impact which varies with power are also discussed.

This study characterizes the relationship between extratropical precipitation systems to changes in upper troposphere and lower stratosphere (UTLS) temperature and tropopause height within different environments. Precipitation features (PFs) observed by the Global Precipitation Measurement (GPM) satellite are collocated with GPS radio occultation (RO) temperature profiles from 2014 to 2017 and classified as non-deep stratospheric intrusion (non-DSI; related to convective instability) or deep stratospheric intrusion (DSI; related to strong dynamic effects on the tropopause). Non-DSI PFs introduce warming (up to 1 K) in the upper troposphere, transitioning to strong cooling (up to −3.5 K) around the lapse rate tropopause (LRT), and back to warming (up to 2.5 K, particularly over the ocean) in the lower stratosphere. UTLS temperature anomalies for DSI events are driven predominantly by large scale dynamics, with major cooling (up to −6 K) observed from the mid-troposphere to the LRT, which transitions to strong warming (up to 4 K) in the lower stratosphere. Small and deep non-DSI PFs typically result in a lower LRT (up to 0.4 km), whereas large but weaker PFs lead to a higher LRT with similar magnitudes. DSI events are associated with larger LRT height decreases, with anomalies of almost −2 km near the deepest PFs. These results suggest intricate relationships between precipitation systems and the UTLS temperature structure. Importantly, non-DSI PF temperature anomalies show patterns similar to tropical convection, which provides unification of previous tropical research with extratropical barotropic convective impacts to UTLS temperatures.

Abstract Background Chemoattractant receptor-homologous molecule expressed on Th2 cells (CRTH2) antagonists are novel agents for asthma but with controversial efficacies in clinical trials. Therefore, we conducted a meta-analysis to determine the roles of CRTH2 antagonists in asthma. Methods We searched in major databases for RCTs comparing CRTH2 antagonists with placebo in asthma. Fixed- or random-effects model was performed to calculate mean differences (MD), risk ratio (RR) or risk difference (RD) and 95% confidence interval (CI). Results A total of 14 trails with 4671 participants were included in our final analysis. Instead of add-on treatment of CRTH2 antagonists to corticosteroids, CRTH2 antagonist monotherapy significantly improved pre-bronchodilator FEV1 (MD = 0.09, 95% CI 0.04 to 0.15, P = 0.0005), FEV1% predicted (MD = 3.65, 95% CI 1.15 to 6.14, P = 0.004), and AQLQ (MD = 0.25, 95% CI 0.09 to 0.41, P = 0.002), and reduced asthma exacerbations (RR = 0.45, 95% CI 0.23 to 0.85, P = 0.01). Rescue use of SABA was significantly decreased in both CRTH2 antagonist monotherapy (MD = − 0.04, 95% CI -0.05 to − 0.03, P

Since early March 2014, the NASA/JAXA Global Precipitation Measurement Core- Observatory (GPM-CO) satellite has allowed analysis of precipitation systems around the globe, thanks to the capabilities of the GPM Microwave Imager (GMI) and Dual-Frequency Precipitation Radar (DPR). In this work, we demonstrate how GPM-CO measurements obtained from 4 years of observations over the Mediterranean area can be used as an extremely effective tool to study the main climatological characteristics of the most intense Mediterranean storm structures. DPR and GMI-based Precipitation Features (PFs) parameters are used as proxies of the vertical structure and microphysical properties of these events, and their statistical distribution is analyzed to identify extremes. The analysis of annual, seasonal and geographical distribution of the identified deep convective systems highlights substantial differences in their diurnal cycle and in the distribution between land-sea and summer-winter. There is a general shift of the convective systems from the south (mostly over the sea) in the cold season, to the north (mostly over land) in the warm season. The analysis shows also that the inferred convective intensity is not always related to heavy precipitation. Known DPR and GMI-based criteria were adopted to identify overshooting top events and potential hailstorms, identify extreme deep convection signatures, like those observed for tropical and subtropical systems, and the most intense occur mostly over the sea. Although the analysis is limited to four years, the results show that the GPM-CO offers unprecedented measurements to identify and characterize extreme weather events in the Mediterranean region, with unique potentials for future long-term climatology and interannual variability analysis.