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Abstract Background Based on CSS 2019 data, this article analyzes the impact of Basic Medical Insurance for Urban and Rural Residents (BMIUR) on perceived social equity of residents. Method Using the CSS data of 2019, this article analyzes the influence of BMIUR on the perception of social equity of residents, on the basis of 2SLS model and mediating effect model. Results We find that BMIUR has a significantly positive impact on the perception of social equity. That is to say, BMIUR can improve residents’ evaluation of social equity and further promote the level of social equity, which makes residents more happiness. The conclusion remains valid after using robustness test and propensity score matching to conduct counterfactual reasoning. The discussion of mechanism indicates that the influence of BMIUR is mediated by enhancing social capital, improving satisfaction of income distribution and reducing self-paid medical expenses. This study also finds that the influence of BMIUR is more obvious in the low-income, low-skilled and mid-west groups. Conclusion The reform of the medical security system should be regarded as a foothold for improving people’s well-being and promoting social equity; Expanding people’s social capital through multiple channels and improving income distribution mechanisms; Strengthen vocational skills training, especially to provide more public services and social security for low-income groups, low-skilled groups, and groups in the western region of China, in order to improve the welfare and policy effectiveness of China's social security reform.

Abstract To analyze the current status of "pseudo" unplanned endotracheal extubation in ICU patients in China's tertiary hospitals and to provide a reference for improving the quality of medical care. Through the National Nursing Quality Data Platform, unplanned endotracheal extubation data reported by ICUs in China's tertiary hospitals from 2019 to 2022 were analyzed. The situation of reported hospitals, causes, and the current status of "pseudo" unplanned endotracheal extubation in ICU patients was analyzed. The indicator of unplanned endotracheal extubation in ICUs of China’s tertiary hospitals is mainly from first-class tertiary hospitals (74.9%), most of which are self-extractions by patients (74.6%). The proportion of "pseudo" unplanned endotracheal extubation is 45.1%. "Pseudo" unplanned endotracheal extubation is common in the ICUs of China's tertiary hospitals. As such, management blind spots deserve attention from managers and clinical staff.

In the field of remote sensing, change detection is a crucial study area. Deep learning has made significant strides in the study of remote sensing image change detection during the past few years. Deep learning techniques still have some drawbacks. The global context cannot be modeled by convolutional neural networks due to the receptive field's restrictions. When extracting visual characteristics, the neural network does not concentrate more on the change region, which results in poor distinction between change and no-change regions. To address these problems, we propose networks with large receptive fields (LRFs) and difference image enhancement. First, we design the LRF strategy. It employs a long kernel shape in one spatial dimension for obtaining a long range of relations. Keeping a narrow kernel size in the other spatial dimension can extract local context information while avoiding interference from irrelevant regions. To focus on the changing features, we design the image difference enhancement (IDE) method, which decreases the distance between invariant features and enlarges the distance between changing features. In addition, we design the cross-channel interaction (CNI) strategy, which models the relationship between feature map channels and extracts feature representations through local CNI. On the CDD, WHU-CD, and LEVIR-CD public datasets, we conducted comprehensive experiments. According to the experimental results, our proposed LRDE-Net performs better than other state-of-the-art change detection techniques, and the change regions are more precisely identified. It can better cope with seasonal changes, light intensity, and other pseudochange disturbances.

Abstract Background The transformation from the quantity of labor supply to the quality of labor supply is an important measure to improve the self-development of migrant workers. Method Based on the 2018 China Floating Population Dynamic Monitoring Survey data, this paper uses the 2SLS model based on instrumental variable estimation to analyze the impact of urban and rural integrated medical insurance on the quality of migrant workers' labor supply. Results The study found that: First, urban and rural integrated medical insurance can significantly improve the quality of labor supply for migrant workers. Even with different instrumental variables and the use of propensity score matching for counterfactual inferences, the findings remain robust. Second, the impact of urban–rural integrated medical insurance on the quality of labor supply for migrant workers has nonlinear characteristics. At the low quantile, the impact of urban–rural integrated medical insurance on the quality of labor supply for migrant workers showed a downward trend, but with the increase of the quantile, the impact of urban and rural integrated medical insurance continued to increase, showing a U-shaped trend. Conclusion Urban–rural integrated medical insurance can not only directly reduce the labor time of migrant workers and ease the labor burden of migrant workers, but also indirectly improve the quality of labor supply for migrant workers through the intermediary role of promoting the availability of public services such as family contracted doctor services and health education.

The Chinese central government has instituted a series of macro-economic tightening and easing policy measures on the real estate industry to stabilize the housing market in recent decades. However, our understanding of these policies and their impact on real estate firms is limited. This paper constructs an index of government policies on the real estate industry by collecting national housing policies in China from 2007 to 2019. We use this index to quantify the impact of government policies on real estate enterprises’ performance, based on data from 103 real estate enterprises listed on the Chinese A-share market. Two important conclusions are drawn from the panel data regression. First, tightened real estate policies significantly lower real estate enterprises’ profitability (ROA and ROE), while increase their liquidity risk. Second, the heterogeneity analysis shows that the tightened real estate policies yield downward impact more mildly on state-owned real estate enterprises than non-state-owned enterprises.

Malignant transformation of epidermoid cysts is a rare complication. Most of the previously reported cases have involved postoperative malignant transformations. We present a case of malignant transformation of a nonpostoperative epidermoid tumor into squamous cell carcinoma (SCC) that occurred in a 61-year-old Chinese woman. The patient’s initial cranial MRI scan showed an epidermoid cyst with marginal enhancement in the pre-pontine cistern, and the lesion gradually enlarged after 10 months. A craniotomy was performed using to remove part of the tumor via the right retrosigmoid approach, and postoperative pathology confirmed that the transformation of the epidermoid cyst was malignant. Our case study suggests that the possibility of malignant transformation of epidermoid cyst should not be ignored on the basis of enhanced imaging features, regardless of whether they are nodular, annular, or patchy, as is the case for inflammation. Strict follow-up is required for early detection of malignant transformation to prompt correspondingly early clinical treatment.

PurposeQuality of life refers to the degree of well-being a person feels. The development of a hemophilia-targeting quality of life scale is important for hemophiliacs and their treating physicians.MethodsTextual analysis. First, a review of studies on quality of life, hemophilia and related quality of life scales was conducted; Subsequently, two rounds of systematic searches of the Springer database were conducted to filter the literature on universal quality of life scale studies and hemophilia-targeting quality of life scale studies by title and abstract, and then textual analysis was performed.ResultsThe former included 77,456 articles, 26,117 chapters and 7,086 related bibliographies, while the latter initially retrieved 211 entries articles, 118 chapters and 43 related bibliographies. Through filtering, the former contains 22 documents, yielding 1,431 valid word stems, and the latter contains 9 documents, yielding 1,541 valid word stems.ConclusionWhile universal quality of life scales mostly fit into the broad framework of WHOQOL- BREF, the development of hemophilia-targeting quality of life scales inclines towards pains that patients suffer and technology advances in pharmaceutical. The current hemophilia QOL scales are mainly based on the HR-QoL, others mainly based on the HR-QoL as the master version. At the same time, the popularization of existing hemophilia quality of life scales in developing countries like China is not high, and the development of hemophilia quality of life scales is insufficient.

Purpose: Variant interpretation, guided by American College of Medical Genetics and Genomics guidelines, can inform clinical decision-making. However, interpretations may change over time for a variety of reasons. Periodic reanalysis of previous variant interpretations is important to ensure that reported genetic findings remain accurate according to current knowledge. Methods: We performed automated filtering by comparing ClinVar variants available in August 2020 with those from August 2021 to screen for potential reanalysis candidates from 3 projects. These variants were subsequently interpreted based on the American College of Medical Genetics and Genomics/Association for Molecular Pathology variant interpretation guideline or ClinGen revised gene-specific guidelines if applicable. Results: Our method annotated 241 unique variants requiring reanalysis, from 3 projects containing 3,832,210 previously interpreted variants, including those filtered automatically. Among these 241 variants, 43 variants changed interpretation, including 55.81% (N = 24) with upgraded and 44.19% (N = 19) with downgraded classifications. An efficiency study showed that our strategy increased the reanalysis efficiency and saved reviewing time. Conclusion: We demonstrated an effective high-throughput method, initiating from external data updates, to achieve variant reanalysis in a clinical laboratory. This filtering method reduced the number of variants that need to be reanalyzed, screened potential variants, and saved time and cost for clinical laboratories.

Stem canker and black scurf of potatoes, caused by Rhizoctonia solani, are economically important diseases. Although the field application of sodium silicate has been shown to improve potato’s resistance against R. solani, the underlying mechanism remains unclear. In this study, we examined this resistance using transcriptomic analysis. Potato stems inoculated with R. solani were treated with sodium silicate, while a control group received no sodium silicate treatment. The plants were grown under natural environmental conditions at the farm of Inner Mongolia Agricultural University. Potato stems were sampled 4, 8, and 12 days after treatment. Total RNA was extracted using the TRIzol reagent and transformed into cDNA. The cDNA was sequenced, the reads were aligned, and the expression levels of genes were quantified and compared between the treated and control groups. A total of 1491 genes were identified as differentially expressed genes (DEGs). Furthermore, these DEGs were found to be involved in hydrolase activity, plant–pathogen interactions, hormone signal transduction, and the phenylpropanoid biosynthesis pathway. To confirm the up- and down-regulation of DEGs, quantitative real-time polymerase chain reaction (qRT-PCR) was performed on randomly selected genes. The results showed that the application of sodium silicate induces a complex defense network in potato plants involving physical barriers, innate immunity, phytohormone signaling, and various phenylpropanoid compounds to combat R. solani infection. This study provides valuable insights into the molecular mechanisms underlying sodium-silicate-induced resistance and its potential for reducing stem canker and black scurf in potato crops.

The Wearable Robotic Limb (WRL) is a type of robotic arm worn on the human body, aiming to enhance the wearer’s operational capabilities. However, proposing additional methods to control and perceive the WRL when human limbs are heavily occupied with primary tasks presents a challenge. Existing interactive methods, such as voice, gaze, and electromyography (EMG), have limitations in control precision and convenience. To address this, we have developed an interactive device that utilizes the mouth and tongue. This device is lightweight and compact, allowing wearers to achieve continuous motion and contact force control of the WRL. By using a tongue controller and mouth gas pressure sensor, wearers can control the WRL while also receiving sensitive contact feedback through changes in mouth pressure. To facilitate bidirectional interaction between the wearer and the WRL, we have devised an algorithm that divides WRL control into motion and force-position hybrid modes. In order to evaluate the performance of the device, we conducted an experiment with ten participants tasked with completing a pin-hole assembly task with the assistance of the WRL system. The results show that the device enables continuous control of the position and contact force of the WRL, with users perceiving feedback through mouth airflow resistance. However, the experiment also revealed some shortcomings of the device, including user fatigue and its impact on breathing. After experimental investigation, it was observed that fatigue levels can decrease with training. Experimental studies have revealed that fatigue levels can decrease with training. Furthermore, the limitations of the device have shown potential for improvement through structural enhancements. Overall, our mouth and tongue interactive device shows promising potential in controlling the WRL during tasks where human limbs are occupied.

Abstract Background With the prolongation of the life expectancy of the Chinese population and the intensification of the aging process of the population, the mental health problems of the elderly have become increasingly prominent. This study aims to explore whether self-employment can promote and how to promote the mental health of the elderly. Method Based on the 2018 China Longitudinal Aging Social Survey (CLASS) data, this paper uses OLS model and KHB method to verify the impact of self-employment on the mental health of the younger elderly and its mechanism. Results The results indicate that self-employment can significantly reduce the depression tendency of the younger elderly and promote their mental health. Heterogeneity analysis shows that self-employment has a more significant positive impact on the mental health of the younger elderly who are self-rated healthy, free of chronic diseases and low-level medical service utilization. The mechanism shows that self-employment can indirectly improve the mental health of the younger elderly through income growth effect and self-worth realization effect, in which the self-worth realization effect is greater than the economic effect. It illustrates that with the development of China’s economy, the elderly are pursuing more intrinsic values brought by self-employment than economic benefits. Conclusion In view of the above research results, it is suggested to encourage the elderly to actively participate in social activities, provide policy support for the younger elderly to engage in self-employment, increase government support as well as health guarantee level, and improve the subjective initiative of the elderly to participate in self-employment, so that the society can truly realize the healthy aging of “being useful and productive for the elderly”.

The existing literature contends that high housing prices are a negative factor inhibiting population mobility and urban innovation. This paper explores the interaction effect among population mobility, housing prices and urban innovation. Based on panel data from the Yangtze River Delta region from 2010 to 2019, we establish a simultaneous equation model (SEMs) to test the relationship between population mobility, housing prices, and urban innovation vitality. The empirical results show that (1) population mobility and housing prices are positively correlated; (2) urban innovation vitality has a significant and positive effect on housing prices; (3) population mobility and urban innovation vitality are also positively correlated.

Wearable electronics are advancing towards miniaturization and flexibility. However, traditional energy supply methods have largely hindered their development. An effective solution to this problem is to convert human mechanical energy into electricity to power wearable electronic devices. Therefore, it is greatly attractive to design flexible, foldable and even stretchable energy harvesting devices. Herein, we use the electrospinning and kirigami approach to develop a type of highly stretchable kirigami-patterned nanofiber-based triboelectric nanogenerator (K-TENG). Due to its innovative structural design, the K-TENG can achieve a tensile strain of 220%, independent of the tensile properties of the material itself. When a person swings their arms, the K-TENG fixed to the clothing can convert mechanical energy from human movement into electrical energy. The produced electricity can directly drive 50 LED lights and a digital watch, or be stored in a lithium battery to charge the smartwatch and smartphone, respectively. This study employs a new method to fabricate a stretchable triboelectric nanogenerator and demonstrates its promising applications in wearable power technology.

The Arctic plays a crucial role in the intricate workings of the global climate system. With the rapid development of information technology, satellite remote sensing technology has emerged as the main method for sea ice surface temperature (IST) observation. To obtain Arctic IST, we used the FengYun-3D Microwave Radiation Imager (FY-3D/MWRI) brightness temperature (Tb) data for IST inversion using multiple linear regressions. Measured data on IST parameters in the Arctic are difficult to obtain. We used the Moderate-Resolution Imaging Spectroradiometer (MODIS) MYD29 IST data as the baseline to obtain the coefficients for the MWRI IST inversion function. The relation between MWRI Tb data and MODIS MYD29 IST product was established and the microwave IST inversion equation was obtained for the months of January to December 2019. Based on the R2 results and the IST inversion results, we compared and analyzed the MWRI IST data from the months of January to April, November, and December with the Operation IceBridge KT19 IR Surface Temperature data and the Northern High Latitude Level 3 Sea and Sea Ice Surface Temperature (NHL L3 SST/IST). We found that compared MWRI IST with NHL L3 IST, the correlation coefficients (Corr) > 0.72, mean bias ranged from −1.82 °C to −0.67 °C, and the standard deviation (Std) ranged from 3.61 °C to 4.54 °C; comparing MWRI IST with KT19 IST, the Corr was 0.69, the bias was 0.51 °C, and the Std was 4.34 °C. The obtained error conforms to the precision requirement. From these results, we conclude that the FY-3D/MWRI Tb data are suitable for IST retrieval in the Arctic using multiple linear regressions.

Abstract Objective Unequal utilization of medical services will have a significant impact on the consumption of resources entitled through health insurance claims of patients. With the proposal of the goal of Healthy China, it is essential to achieve the equity of medical service utilization of patients with rare diseases to further promote social equity and justice. To analyze the consumption of medical resources of rare disease patients, so as to explore how different medical insurance types impact patients’ medical resources consumption. This study pioneeringly used medical data from Peking Union Medical College Hospital. By analyzing the consumption data, this paper fills the research gap of existing studies on the analysis of medical service utilization inequality based on the perspective of insurance participation by examining the effects of different types of insurance coverage on medical resource consumption of hemophiliacs. At the same time, rare disease patients as a minority group have long been neglected in the analysis of medical resource consumption, and this paper fills the research gap of medical service utilization of this group to a certain extent by taking hemophiliacs as the object of analysis. Methods Based on the medical data of hemophilia patients in Peking Union Medical College Hospital from 2010 to 2020, we analyze the consumption of medical resources of the patients, and use a multiple regression model to explore how different medical insurance types impact patients’ medical resources consumption. Results The study has three main findings. Firstly, the disparity in medical expenditure among different hemophilia patients is quite obvious, and the drug expense accounts for a large proportion of the total cost. Secondly, the ratio of reimbursement is generally low, and there is a wide difference in the amount of reimbursement for different types of medical insurance. Thirdly, the resource consumption of patients with different medical insurance types differs a lot. Conclusion In order to improve the current medical insurance system and mechanism for providing orphan drugs, we put forward the following suggestions. First of all, the medical security system should expand its coverage to eliminate the medical expenditure gap between different hemophilia patients, therefore better promoting equity under the same insurance type. At the same time, the reimbursement level of medical expenses for patients with rare diseases should be appropriately improved, so as to reduce the financial burden of patients with rare diseases, and promote the realization of economic equity. In addition, society should pay special attention to the disadvantaged groups, reduce the differences between various medical insurance, and improve the level of health and equity of the whole society.

Abstract Background Due to its high expression capability, recombination of Escherichia coli and pET vector has become the bioengineering preferred expression system. Because β-lactamases mediate bacterial antimicrobial resistance, these enzymes have a substantial clinical impact. Using the E. coli expression system, several kinds of β-lactamases have been produced. However, previous studies have been focused on characterizing target β-lactamases, and the effects of cultivation and induction conditions on the expression efficiency of target enzymes were not addressed. Results Using pET-28a as the cloning vector and E. coli BL21(DE3) as the expression host, this study originally elucidated the effects of IPTG concentration, culture temperature, induction time, and restriction sites on recombinant β-lactamase expression. Moreover, the effects of the target protein length and the 6 × His-tag fusion position on enzyme purification were also explored, and consequently, this study yielded several important findings. (i) Only the signal peptide–detached recombinant β-lactamase could exist in a soluble form. (ii) Low-temperature induction was beneficial for soluble β-lactamase expression. (iii) The closer to the rbs the selected restriction site was, the more difficult it was to express soluble β-lactamase. (iv) The short-chain recombinant protein and the protein with His-tag fused at its C-terminus showed high affinity to the Ni2+ column. Conclusions Based on our findings, researchers can easily design an effective program for the high production of soluble recombinant β-lactamases to facilitate other related studies.

Abstract Background At present, there is no specific research on the factors affecting the success rate of urethroplasty in patients with DSD. The purpose of this study is to explore the factors affecting the success of urethroplasty in DSD patients, and to provide some reference for the surgical treatment of DSD patients undergoing urethroplasty. Method We reviewed patients with DSD who underwent urethroplasty from January 2016 to December 2019 retrospectively. Patients were divided into four groups: the successful group, the urethrocutaneous fistula group, the urethral diverticulum group, and the urethral stricture group. Risk factors were determined from the following data included the DSD classification, the age of first operation, length of urethral defect, degree of hypospadias, cryptorchidism, micropenis, gonad type, hormone therapy before operation, transposition of penis and scrotum, surgical strategy, urethral covering material, and postoperative catheter removal time. We explored the difference of each factor between four groups through the comparative study of single factor and multifactor logistic regression analysis of related factors. Result 122 cases were enrolled in this group (n = 122), 12 cases were lost to follow-up. Median follow-up was 28 months (12–55 months).We found the success rate of operation decreased with longer urethral defect (B = − 0.473, P = 0.005). The success rate of operation was higher in staged operation and TPIT (TPIT = Transverse Preputial Island Tube operation)-related operation than primary operation (B = 1.238, P = 0.006) and TPIT-nonrelated operation (B = 2.293, P = 0.001). Although there was a significant difference between the age of the first operation and the occurrence of urethrocutaneous fistula (P = 0.006 0.05). The incidence of urethrocutaneous fistula was lower in TPIT-related operation than in TPIT-nonrelated operation (B = − 2.507, P = 0.000). The incidence of postoperative urethral diverticulum was lower in staged operation than in primary operation (B = − 1.737, P = 0.015). Conclusion For patients with disorder of sex development undergoing urethroplasty, the length of urethral defect is an independent risk factor affecting both the success rate of operation and the urethrocutaneous fistula. The age of the first operation has a statistically significant effect on the occurrence of postoperative urethrocutaneous fistula, but it is not an independent factor. Urethrocutaneous fistula is less found in TPIT-related operation in the study. Staged operation is an independent protective factor for postoperative urethral diverticulum compared with one-stage operation but isn’t related to urethrocutaneous fistula.

Ginseng residue is a by-product stemming from the commercial extraction of ginsenosides. To assess the disparities between ginseng residue and ginseng tablet, we employed the ultra-high-performance liquid chromatography–quadrupole time-of-flight/mass spectrometry (UPLC-Q-TOF/MS) technique for sample analysis. The analyses revealed the presence of 39 compounds in both ginseng residue and ginseng tablets. Subsequently, the contents of total ginsenosides and total ginseng polysaccharides in the ginseng residue and ginseng tablet were determined. The results indicate that while only a small fraction of ginsenosides remained in the ginseng residue, a significant amount of polysaccharides was retained. Furthermore, our evaluation encompassed the antioxidant activities of both ginseng residue and ginseng tablets. Notably, ginseng residue exhibited robust antioxidant effects, thereby showcasing its potential for recycling as a functional food raw material.

Mixed reality technology can give humans an intuitive visual experience, and combined with the multi-source information of the human body, it can provide a comfortable human–robot interaction experience. This paper applies a mixed reality device (Hololens2) to provide interactive communication between the wearer and the wearable robotic limb (supernumerary robotic limb, SRL). Hololens2 can obtain human body information, including eye gaze, hand gestures, voice input, etc. It can also provide feedback information to the wearer through augmented reality and audio output, which is the communication bridge needed in human–robot interaction. Implementing a wearable robotic arm integrated with HoloLens2 is proposed to augment the wearer’s capabilities. Taking two typical practical tasks of cable installation and electrical connector soldering in aircraft manufacturing as examples, the task models and interaction scheme are designed. Finally, human augmentation is evaluated in terms of task completion time statistics.

Abstract Background Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes. DR involves a state of systemic inflammation, and chronic inflammation can promote microvascular and macrovascular diseases in diabetic patients and accelerate disease progression. Ultrawide-field FFA (UWFA) systems are increasingly being used to examine a wider retina. The aim of this study was to explore the correlation between the different manifestations of retinopathy under UWFA and the systemic indicators of white blood cells in patients with diabetic retinopathy. Methods This retrospective study included the hospitalized DR patients in the Department of Ophthalmology and Endocrinology of the Affiliated Hospital 2 of Nantong University between January 2016 and March 2019. This study examined the correlations between the UWFA examination results and glycated hemoglobin (HbA1c), routine blood tests,and the neutrophil-to-lymphocyte ratio of patients with clinically diagnosed DR during hospitalization. Results A total of 115 patients with DR (53 females and 62 males) were included (199 eyes: 102 right eyes and 97 left eyes). UWFA revealed that most eyes (77.4%) had grade 4 microvascular leakage, 52.8% had grade 0 capillary non-perfusion area, 59.3% had grade 0 neovascularization, and 92.0% had grade 0 fibrous proliferative membranes. Microvascular leakage was correlated with the NLR (r = 0.186, P = 0.027). Capillary non-perfusion area was correlated with the monocyte ratio (r = 0.144, P = 0.042) and the eosinophil ratio (r = 0.123, P = 0.044). Neovascularization was correlated to the monocyte ratio (r = 0.324, P = 0.018). Finally, the fibrous proliferative membrane was correlated to the monocyte ratio (r = 0.418, P = 0.002). Only the eosinophil ratio was independently associated with proliferative DR (odds ratio = 1.25, 95% confidence interval: 1.04–1.51, P = 0.018). Conclusion The results of UWFA imaging in patients with DR are correlated with white blood cell population indexes. The eosinophil ratio was independently associated with proliferative DR.

ObjectiveTo analyze the impact of the contract of family doctors in community-level in Beijing on residents’ medical expenses, so as to explore the efficacy of family physician contract service to facilitate the hierarchical treatment system. This study pioneeringly used the panel data of medical records and medical insurance settlement details provided by a community hospital in Beijing. By analyzing the correlation between family doctors and medical expenses, the study provided empirical support for the advancement of family doctor contracting in China.MethodsUsing the panel data of medical records and medical insurance settlement details of 5,851 residents in a community hospital in Beijing from January 2018 to May 2021 for a total of 41 months, mixed-effects model and random-effects model were used for analysis.ResultsThe contract of family doctor has significantly increased residents’ medical expenses. The types of medical insurance and whether patients with chronic diseases have a significant impact on residents’ medical expenses.ConclusionFamily doctor contracting increases the probability of residents seeing a doctor in community hospitals. Community family doctor contracting services should be vigorously promoted, especially for special groups such as chronic disease patients and the elderly. The increase in the contracting rate of family doctors will become an important starting point for promoting hierarchical medical system and increasing the primary treatment at the community-level.

Sea ice motion (SIM) has significant implications for sea–air interactions, thermohaline circulation, and the development of the Arctic passage. This research proposes an improved SIM retrieval method from Fengyun-3D’s (FY-3D) microwave radiometer imager’s (MWRI) brightness temperature (Tb) data based on the modified classical maximum cross-correlation (MCC) method and the multisource data merging method. This study utilized buoy data to establish the search area range, applied distinct thresholds across various Arctic regions, and merged the buoy data, reanalysis wind data, and SIM retrieved from FY-3D/MWRI Tb data. In 2019, for the final Arctic SIM results retrieved from the MWRI 89 GHz and 36.5 GHz Tb data, the root-mean-square error (RMSE) and the mean average error (MAE) in the east–west direction were 2.07 cm/s and 1.38 cm/s and those in the north–south direction were 1.96 cm/s and 1.15 cm/s, compared to the ice-tethered profiler (ITP) data. Compared with the daily average data of the National Snow and Ice Data Center (NSIDC), the RMSE and MAE of the SIM results obtained in this study were 0.74 cm/s and 0.93 cm/s in the east–west direction, and 0.56 cm/s and 0.72 cm/s in the north–south direction, respectively. The monthly average of the SIM retrieved from the MWRI Tb data in this research also showed a good agreement with the monthly average of the NSIDC SIM product. The comparison showed that the MWRI Tb data could be used to retrieve the Arctic SIM, and the Arctic SIM retrieval method presented in this paper was accurate and general.

Using L-band microwave radiative transfer theory to retrieve ice and snow parameters is one of the focuses of Arctic research. At present, due to limitations of frequency and substrates, few operational microwave radiative transfer models can be used to simulate L-band brightness temperature (TB) in Arctic sea ice. The snow microwave radiative transfer (SMRT) model, developed with the support of the European Space Agency in 2018, has been used to simulate high-frequency TB in polar regions and has obtained good results, but no studies have shown whether it can be used appropriately in the L-band. Therefore, in this study, we systematically evaluate the ability of the SMRT model to simulate L-band TB in the Arctic sea ice and snow environment, and we show that the results are significantly optimized by improving the simulation method. In this paper, we first consider the thermal insulation effect of snow by adding the thermodynamic equation, then use a reasonable salinity profile formula for multi-layer model simulation to solve the problem of excessive L-band penetration in the SMRT single-layer model, and finally add ice lead correction to resolve the large influence it has on the results. The improved SMRT model is evaluated using Operation IceBridge (OIB) data from 2012 to 2015 and compared with the snow-corrected classical L-band radiative transfer model for Arctic sea ice proposed in 2010 (KA2010). The results show that the SMRT model has better simulation results, and the correlation coefficient (R) between SMRT-simulated TB and Soil Moisture and Ocean Salinity (SMOS) satellite TB is 0.65, and the RMSE is 3.11 K. Finally, the SMRT model with the improved simulation method is applied to the whole Arctic from November 2014 to April 2015, and the simulated R is 0.63, and the RMSE is 5.22 K. The results show that the SMRT multi-layer model is feasible for simulating L-band TB in the Arctic sea ice and snow environment, which provides a basis for the retrieval of Arctic parameters.

Black ginseng is a new type of processed ginseng that is traditionally used in herbal medicine in East Asian countries. It is prepared from fresh, white, or red ginseng by undergoing a process of steaming and drying several times. However, the chemical differentiation of black ginseng with different processing levels is not well understood. The aim of this study was to propose a new method for discriminating and quantifying black ginseng. Six ginsenosides from black ginseng were accurately quantified, and based on this, the black ginseng samples were divided into incomplete and complete black ginseng. Ultrahigh-performance liquid chromatography–quadrupole-time of flight/mass spectrometry (UPLC-Q-TOF/MS) combined with a multivariate statistical analysis strategy was then employed to differentiate the two groups. A total of 141 ions were selected as analytical markers of black ginseng, with 45 of these markers being annotated by matching precise m/z and MS/MS data from prior studies.

Abstract Background For liver cancer patients, the occurrence of postoperative complications increases the difficulty of perioperative nursing, prolongs the hospitalization time of patients, and leads to large increases in hospitalization costs. The ability to identify influencing factors and to predict the risk of complications in patients with liver cancer after surgery could assist doctors to make better clinical decisions. Objective The aim of the study was to develop a postoperative complication risk prediction model based on machine learning algorithms, which utilizes variables obtained before or during the liver cancer surgery, to predict when complications present with clinical symptoms and the ways of reducing the risk of complications. Methods The study subjects were liver cancer patients who had undergone liver resection. There were 175 individuals, and 13 variables were recorded. 70% of the data were used for the training set, and 30% for the test set. The performance of five machine learning models, logistic regression, decision trees-C5.0, decision trees-CART, support vector machines, and random forests, for predicting postoperative complication risk in liver resection patients were compared. The significant influencing factors were selected by combining results of multiple methods, based on which the prediction model of postoperative complications risk was created. The results were analyzed to give suggestions of how to reduce the risk of complications. Results Random Forest gave the best performance from the decision curves analysis. The decision tree-C5.0 algorithm had the best performance of the five machine learning algorithms if ACC and AUC were used as evaluation indicators, producing an area under the receiver operating characteristic curve value of 0.91 (95% CI 0.77–1), with an accuracy of 92.45% (95% CI 85–100%), the sensitivity of 87.5%, and specificity of 94.59%. The duration of operation, patient’s BMI, and length of incision were significant influencing factors of postoperative complication risk in liver resection patients. Conclusions To reduce the risk of complications, it appears to be important that the patient's BMI should be above 22.96 before the operation, and the duration of the operation should be minimized.

Abstract Objectives Postoperative complications increase the workload of nursing staff as well as the financial and mental distress suffered by patients. The objective of this study is to identify clinical factors associated with postoperative complications after liver cancer resection surgery. Methods Data from liver cancer resections occurring between January 1st, 2019 to December 31st, 2019 was collected from the Department of Liver Surgery in West China Hospital of Sichuan University. The Kruskal–Wallis test and logistic regression were used to perform single-factor analysis. Stepwise logistic regression was used for multivariate analysis. Models were established using R 4.0.2 software. Results Based on data collected from 593 cases, the single-factor analysis determined that there were statistically significant differences in BMI, incision type, incision length, duration, incision range, and bleeding between cases that experienced complications within 30 days after surgery and those did not. Stepwise logistic regression models based on Kruskal–Wallis test and single-factor logistic regression determined that BMI, incision length, and duration were the primary factors causing complications after liver resection. The adjust OR of overweight patients and patients with obesity (stage 1) compared to low weight patients were 0.12 (95% CI:0.02–0.72) with p = 0.043 and 0.18 (95% CI:0.03–1.00) with p = 0.04, respectively. An increase of 1 cm in incision length increased the relative risk by 13%, while an increase of 10 min in surgical duration increased the relative risk by 15%. Conclusions The risk of postoperative complications after liver resection can be significantly reduced by controlling factors such as bleeding, incision length, and duration of the surgery.

Chinese urban spatial expansion leads to inefficient use of land resources. This study uses the data of 289 cities from 2007 to 2018 and uses panel data models to test the driving mechanism of urban expansion. The study derives three conclusions. First, there is a significant positive correlation between urban power hierarchy and urban spatial expansion. If the urban administrative power hierarchy is high, then the urban built-up area increases more. Second, there is a significant positive correlation between the scale of hidden debt and the expansion of urban space. The increase of the urban investment bonds’ scale will promote the expansion of urban built-up areas. Third, there is a significant positive correlation between the quantity of bond issuers and urban spatial expansion. First published online 04 January 2023

To date, multiple graphene@MXene hybrids have been reported via various synthesis approaches, but almost all the graphene@MXene hybrids inevitably used the reduced graphene oxide that prepared by chemical oxidation/reduction method, which generally involved the complex and dangerous operation procedure, and the highly toxic chemical reagent. How to prepare graphene@MXene hybrid through a simple, safe and eco-friendly synthetic route is highly desired. Compared with traditional synthesis technology, ultrasound synthesis strategy displays the merits of simplicity, low cost and environment protection. Herein, MXene (Ti3C2Tx) nanoflakes coupled with graphene nanosheets (graphene@MXene) were prepared in N-methylpyrrolidone (NMP) by simple ultrasound-assisted liquid-phase exfoliation method for the first time. Besides, the effect of types of solvent with different viscocity, sonication temperature and sonication duration time on the property of graphene@MXene hybrids were systematacially investigated. It is found the liquid-phase exfoliated graphene owned excellent electron transfer ability and the MXene (Ti3C2Tx) nanoflakes possessed outstanding adsorption property, the as-synthesized graphene@MXene hybrid exhibited significant signal synergistic enhancement effect toward the oxidation of hazardous veterinary drug residue compound (chlorpromazine) and food additives (rhodamine B). Based on this, a novel and sensitive electrochemical sensor was fabricated, the linear detection ranges were 5 nM to 0.5 μM for chlorpromazine with sensitivity of 1090 µA μM−1 cm−2, and 10 nM to 2.5 μM for rhodamine B with sensitivity of 440 and 102.14 µA μM−1 cm−2. Besides, the detection limits were evaluated to be as low as 1.25 nM and 2.45 nM for chlorpromazine and rhodamine B, respectively.

Abstract Background Due to lack of proven therapies, we evaluated the effect of CBP on Influenza-Associated Neurological Disease in children. Methods A single-center, retrospective, cohort study was conducted in Luoyang, Henan province, China from January 2018 to January 2020. Children ( 0.05). The inflammatory factors (CRP, PCT and IL-6) of 30 cases were tested at admission and after 3 days of admission. In the CBP group, there was a significant decrease in IL-6 levels at 3 days of admission (p = 0.003) and a decrease in CRP and PCT levels, but no significant difference (p > 0.05). In the non-CBP group, there were no significant difference on levels of CRP, PCT and IL-6 at admission and 3-day of admission (p > 0.05). The 28-day mortality was significantly lower in the CBP group compared with the non-CBP group (11.11% vs. 50%, p = 0.034). Conclusions CBP definitely reduces IL-6 levels significantly. We did find that the survival rate of patients in the CBP group was improved. But we don’t know if there is a relationship between the reduction of IL-6 levels and the survival rate. Trial registration: http://www.chictr.org.cn/index.aspx (ChiCTR2000031754).

Selective occlusion of tumor vasculature has proven to be an effective strategy for cancer therapy. Among vascular coagulation agents, the extracellular domain of coagulation-inducing protein tissue factor, truncated tissue factor (tTF), is the most widely used. Since the truncated protein exhibits no coagulation activity and is rapidly cleared in the circulation, free tTF cannot be used for cancer treatment on its own but must be combined with other moieties. We here developed a novel, tumor-specific tTF delivery system through coupling tTF with the DNA aptamer, AS1411, which selectively binds to nucleolin receptors overexpressing on the surface of tumor vascular endothelial cells and is specifically cytotoxic to target cells. Systemic administration of the tTF-AS1411 conjugates into tumor-bearing animals induced intravascular thrombosis solely in tumors, thus reducing tumor blood supply and inducing tumor necrosis without apparent side effects. This conjugate represents a uniquely attractive candidate for the clinical translation of vessel occlusion agent for cancer therapy.

Hepatitis B virus (HBV) infection is a public health threat worldwide, and there is no direct treatment yet available. In the event of infection, patients may present liver cirrhosis and cancer, which threaten the patients’ health globally, especially in the Asia-Pacific region and China. In 2019, Chinese hepatopathologists updated the 2015 Guidelines for the Prevention and Treatment of Chronic Hepatitis B as the clinical reference. The other versions formulated by the American Association for the Study of Liver Diseases (2018 AASLD guidelines) (AASLD, 2018), European Association for the Study of the Liver (2017 EASL guidelines) (EASL, 2017), and Asian-Pacific Association for the Study of the Liver (2015 APASL guidelines) (APASL, 2015) also provide clinical guidance. However, there are still some issues that need to be addressed. In the present study, the following aspects will be introduced successively: (1) Who should be treated in the general population according to the guidelines; (2) Treatment of specific populations infected with HBV; (3) Controversial issues in clinical practice; (4) Perspective.

The transformation from the retrospective to the prospective payment system is significant to improve the quality of public healthcare (QPH). This article used the quasi-natural experiment of the global budget payment reform of government (GBPRG) in Chengdu, adopted the difference in difference (DID) method to estimate the effect of the GBPRG on the QPH, and concluded that GBPRG has a significant positive impact on the healthcare outcome and has a significant effect on improving the QPH. Policy implications drawn from the results show that the government should continue to explore compound healthcare insurance payment method (HIPM), improve the governance capabilities of the government, reduce transaction costs, improve healthcare insurance reimbursement policies, adjust the proportion of healthcare insurance reimbursements, continuously optimize the allocation of healthcare resources, establish an incentive mechanism to improve the QPH, and realize the pareto optimal choice of healthcare resource allocation.

Entrepreneurship is an important way to provide solutions for social employment problems. Using data from the 2016 China Labor Force Dynamic Survey (CLDS), we explore the influence of farming experience on urban residents’ entrepreneurial decisions at the theoretical and empirical levels. A Probit model with instrumental variables method was used to analyze the influence of farming experience on urban residents’ entrepreneurial decisions, while a mediating effect model was used to test its channels of action. The results show that: (1) farming experience can contribute to the entrepreneurial decision of urban residents relative to those without experience in farming. To overcome possible endogeneity issues, an Eprobit model based on the estimation of instrumental variables was used for testing. (2) Heterogeneity tests based on age, city type, and physical capital found that this effect was more significant in urban residents with non-capital cities, middle-aged groups, and high-material capital. (3) Farming experience indirectly drives entrepreneurial decisions through the mediating role of promoting positive personality traits, such as “optimism” and “mutual aid consciousness.” Therefore, the farming experience has a positive effect on urban residents’ entrepreneurial decisions and helps to understand the deeper influence of micro-individual characteristics on entrepreneurial decisions in the urbanization process.

BackgroundIn China, different classification of hospitals (COH) provide treatment for patients with different degrees of illness. COH play an important role in Chinese medical outcomes, but there is a lack of quantitative description of how much impact the results have. The objective of this study is to examine the correlation between COH on medical outcomes with the hope of providing insights into appropriate care and resource allocation.MethodsFrom the perspective of the COH framework, using the Urban Employee Basic Medical Insurance (UEBMI) data of Chengdu City from 2011 to 2015, with a sample size of 512,658 hospitalized patients, this study used the nested multinomial logit model (NMNL) to estimate the impact of COH on the medical outcomes.ResultsThe patients were mainly elderly, with an average age of 66.28 years old. The average length of stay was 9.61 days. The female and male gender were split evenly. A high level of hospitals is positively and significantly associated with the death and transfer rates (p < 0.001), which may be related to more severe illness among patients in high COH.ConclusionThe COH made a difference in the medical outcomes significantly. COH should be reasonably selected according to disease types to achieve the optimal medical outcome. So, China should promote the construction of a tiered delivery system.

Abstract Background Since 2015, all pilot cities of public hospital reform in China have allowed the zero-markup drug policy and implemented the policy of Separating of Hospital Revenue from Drug Sales (SHRDS). The objective of this study is to evaluate whether SHRDS policy reduces the burden on patients, and to identify the mechanism through which SHRDS policy affects healthcare expenditure. Methods In this study, we use large sample data of urban employee’s healthcare insurance in Chengdu, and adopt the difference in difference model (DID) to estimate the impact of the SHRDS policy on total healthcare expenditures and drug expenditure of patients, and to provide empirical evidence for deepening medical and health system reform in China. Results After the SHRDS policy’s implementation, the total healthcare expenditure kept growing, but the growth rate slowed down between 2014 to 2015. The total healthcare expenditure of patients decreased by only 0.6%, the actual reimbursement expenditure of patients decreased by 4.1%, the reimbursement ratio decreased by 2.6%. and the drugs expenditure dropped by 14.4%. However, the examinations expenditure increased by 18.2%, material expenditure increased significantly by 38.5%, and nursing expenditure increased by 12.7%. Conclusions After implementing the SHRDS policy, the significant reduction in drug expenditure led to more physicians inducing patients’ healthcare service needs, and the increased social healthcare burden was partially transferred to the patients’ personal economic burden through the decline in the reimbursement ratio. The SHRDS policy is not an effective way to control healthcare expenditure.

As the collateral for the issuance of urban investment bonds (UIBs), land leasing revenue is the fund that is used to repay the debt with large-scale land hoarding and increasing land price due to China’s rapid urbanization. This paper employs the fixed effect model and panel data from 2006 to 2015 to analyze the influence of land hoarding and price on debt scale and risk of local governments. Results reveal that both land hoarding scale and land price exhibit a positive influence on the UIBs’ scale and risk. However, regional differences are evident. In the Eastern region, the correlation between land asset and UIBs can be testified. First published online 19 November 2020

Sea ice type classification is of great significance for the exploration of waterways, fisheries, and offshore operations in the Arctic. However, to date, there is no multiple remote sensing method to detect sea ice type in the Arctic. This study develops a multiple sea ice type algorithm using the HaiYang-2B Scatterometer (HY-2B SCA). First, the parameters most applicable to classify sea ice type are selected through feature extraction, and a stacking model is established for the first time, which integrates decision tree and image segmentation algorithms. Finally, multiple sea ice types are classified in the Arctic, comprising Nilas, Young Ice, First Year Ice, Old Ice, and Fast Ice. Comparing the results with the Ocean and Sea Ice Satellite Application Facility (OSI-SAF) Sea Ice Type dataset (SIT) indicates that the sea ice type classified by HY-2B SCA (Stacking-HY2B) is similar to OSI-SAF SIT with regard to the changing trends in extent of sea ice. We use the Copernicus Marine Environment Monitoring Service (CMEMS) high-resolution sea ice type data and EM-Bird ice thickness data to validate the result, and accuracies of 87% and 88% are obtained, respectively. This indicates that the algorithm in this work is comparable with the performance of OSI-SAF dataset, while providing information of multiple sea ice types.

Background: The reports about valuable oligosaccharides in ginseng are quite limited. There is an urgent need to develop a practical procedure to detect and analyze ginseng oligosaccharides. Methods: The oligosaccharide extracts from ginseng were permethylated by solid-phase methylation method and then were analyzed by ultra-high-performance liquid chromatography-Q-Orbitrap/MS. The sequence, linkage, and configuration information of oligosaccharides were determined by using accurate m/z value and tandem mass information. Several standard references were used to further confirm the identification. The oligosaccharide composition in white ginseng and red ginseng was compared using a multivariate statistical analysis method. Results: The nonreducing oligosaccharide erlose among 12 oligosaccharides identified was reported for the first time in ginseng. In the comparison of the oligosaccharide extracts from white ginseng and red ginseng, a clear separation was observed in the partial least squares-discriminate analysis score plot, indicating the sugar differences in these two kinds of ginseng samples. The glycans with variable importance in the projection value large than 1.0 were considered to contribute most to the classification. The contents of oligosaccharides in red ginseng were lower than those in white ginseng, and the contents of maltose, maltotriose, maltotetraose, maltopentaose, maltohexaose, maltoheptaose, maltooctaose, maltononaose, sucrose, and erlose decreased significantly (p

BackgroundThe association between the triglyceride–glucose (TyG) index and type 2 diabetes mellitus (T2DM) in older adults has not been fully understood. This research aims to explore the association between the TyG index and the incidence of T2DM in an older Chinese population aged over 75 years.MethodsThis longitudinal analysis study was performed based on a database from a health check screening program in China. The participants were stratified based on the quintile ranges of the TyG index (Q1 to Q5 groups). T2DM was defined as fasting plasma glucose (FPG) ≥ 7.00 mmol/L and/or self-reported T2DM. The cumulative incidences of T2DM in various quintile groups were estimated by the Kaplan–Meier method. The Cox proportional hazard model was used to examine the independent impact of the TyG index on the risk of T2DM during the follow-up period. Subgroup analysis was performed by gender and BMI to further validate the credibility of the results.ResultsDuring the follow-up period, a total of 231 new-onset T2DM cases were recorded among the 2,571 individuals aged over 75 years. After adjusting confounding factors, elevated TyG index independently indicated a higher risk of T2DM (HR = 1.89; 95% CI, 1.47–2.44; p < 0.01). Higher TyG index quintile groups (Q3 to Q5) also presented with a higher risk of T2DM (hazard ratio (HR) = 1.36, 1.44, and 2.12, respectively) as compared with the lowest quintile group (Q1). Subgroup analysis showed that increased TyG index led to a higher risk of T2DM with HR = 2.35 (95% CI, 1.73–3.19), 1.90 (95% CI, 1.27–2.83), 2.95 (95% CI, 1.94–4.50), and 1.72 (95% CI, 1.25–2.35) in male subgroup, female subgroup, BMI < 24 kg/m2 subgroup, and BMI ≥ 24 kg/m2 subgroup, respectively.ConclusionsTriglyceride–glucose index independently correlated with the risk of incident T2DM in Chinese adults aged over 75 years. The TyG index might be useful in monitoring T2DM in the older populations.

Abstract Heterostructure nanoparticles (NPs), constructed by two single‐component NPs with distinct nature and multifunctional properties, have attracted intensive interest in the past few years. Among them, heterostructures made of upconversion NPs (UCNPs) and metal–organic frameworks (MOFs) can not only integrate the advantageous characteristics (e.g., porosity, structural regularity) of MOFs with unique upconverted optical features of UCNPs, but also induce cooperative properties not observed either for single component due to their special optical or electronic communications. Recently, diverse UCNP‐MOF heterostructures are designed and synthesized via different strategies and have demonstrated appealing potential for applications in biosensing and imaging, drug delivery, and photodynamic therapy (PDT). In this review, the synthesis strategies of UCNP‐MOF heterostructures are first summarized, then the authors focus mainly on discussion of their biomedical applications, particularly as PDT agents for cancer treatment. Finally, the authors briefly outlook the current challenges and future perspectives of UCNP‐MOF hybrid nanocomposites. The authors believe that this review will provide comprehensive understanding and inspirations toward recent advances of UCNP‐MOF heterostructures.

Abstract Background Different classification of hospitals (COH) have an important impact on medical expenditures in China. The objective of this study is to examine the impact of COH on medical expenditures with the hope of providing insights into appropriate care and resource allocation. Methods From the perspective of COH framework, using the Urban Employee Basic Medical Insurance (UEBMI) data of Chengdu City from 2011 to 2015, with sample size of 488,623 hospitalized patients, our study empirically analyzed the effect of COH on medical expenditure by multivariate regression modeling. Results The average medical expenditure was 5468.86 Yuan (CNY), the average expenditure of drug, diagnostic testing, medical consumables, nursing care, bed, surgery and blood expenditures were 1980.06 Yuan (CNY), 1536.27 Yuan (CNY), 500.01 Yuan (CNY), 166.23 Yuan (CNY), 221.98 Yuan (CNY), 983.18 Yuan (CNY) and 1733.21 Yuan (CNY) respectively. Patients included in the analysis were mainly elderly, with an average age of 86.65 years old. Female and male gender were split evenly. The influence of COH on total medical expenditures was significantly negative (p

Abstract Background Mastermind-like domain-containing 1 (MAMLD1) has previously been identified as a causative gene for “46,XY Disorders of Sex Development (DSD)”. Recently, there has been some controversy regarding the causative role of MAMLD1 variations in DSDs. Here we describe a clinical series and review the reported cases to evaluate the role of MAMLD1 variants in children with 46,XY DSD. Cases of 46,XY DSD harbouring MAMLD1 variants from unrelated families were recruited from the Beijing Children’s Hospital in China (N = 10) or identified through a literature search (N = 26). The clinical manifestations and genetic variants of all the patients were evaluated. Results Hypospadias was the most prevalent phenotype among our 10 cases (8 out of 10 cases) and in all the previously reported ones. Central precocious puberty and isolated micropenis were observed for the first time. Among the 10 cases, nine variants were identified, including three nonsense (p.R356X, p.Q152X, and p.Q124X) and six missense (p.P334S, p.S662R, p.A421P,p.T992I, p.P542S, and p.R927L) variants. In silico analysis showed that the variants p.P334S, p.P542S, p.S662R, and p.R927Lmight lead to drastic changes in the interaction force of the amino acid chain and the flexibility of the spatial structure, and such changes may affect protein function. Conclusion Patients with 46,XY DSD harbouring MAMLD1variants manifest a broad spectrum of phenotypes and mostly present with hypospadias. The six novel variants reported here enrich the mutation database and contribute to our understanding of the pathogenesis of 46,XY DSD.

BackgroundRecently, more patients who recovered from the novel coronavirus disease 2019 (COVID-19) may later test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) again using reverse transcription-polymerase chain reaction (RT-PCR) testing. Even though it is still controversial about the possible explanation for clinical cases of long-term viral shedding, it remains unclear whether the persistent viral shedding means re-infection or recurrence.MethodsSpecimens were collected from three COVID-19-confirmed patients, and whole-genome sequencing was performed on these clinical specimens during their first hospital admission with a high viral load of SARS-CoV-2. Laboratory tests were examined and analyzed throughout the whole course of the disease. Phylogenetic analysis was carried out for SARS-CoV-2 haplotypes.ResultsWe found haplotypes of SARS-CoV-2 co-infection in two COVID-19 patients (YW01 and YW03) with a long period of hospitalization. However, only one haplotype was observed in the other patient with chronic lymphocytic leukemia (YW02), which was verified as one kind of viral haplotype. Patients YW01 and YW02 were admitted to the hospital after being infected with COVID-19 as members of a family cluster, but they had different haplotype characteristics in the early stage of infection; YW01 and YW03 were from different infection sources; however, similar haplotypes were found together.ConclusionThese findings show that haplotype diversity of SARS-CoV-2 may result in viral adaptation for persistent shedding in multiple recurrences of COVID-19 patients, who met the discharge requirement. However, the correlation between haplotype diversity of SARS-CoV-2 virus and immune status is not absolute. It showed important implications for the clinical management strategies for COVID-19 patients with long-term hospitalization or cases of recurrence.

This study first analyzes how local governments’ land-leasing behaviors affect Chinese cities’ debt risk then examines the impact of officials’ promotion mechanisms on debt risk in China’s urban land bank system. The land-leasing behavior is reflected through three indicators, namely, land-leasing revenue, land-leasing scale, and land financial dependence level. Two new indicators are constructed to measure the local government’ debt risk from the perspective of debt scale and debt repayment: the debt scale risk and debt burden risk. Empirical analyses are based on the data of 281 prefecture-level cities from 2006–2015. The main findings are twofold. First, the debt scale risk is positively affected by the land-leasing revenue, and officials’ promotion pressure. The debt burden risk is positively affected by the land financial dependence and officials’ promotion pressure. Second, the officials’ promotion pressure significantly enhances the positive effect of land-leasing revenue on the debt scale risk. Local officials, who are under promotion pressure, are inclined to expand the size of urban investment bonds, which increases debt scale risk.

The Arctic region plays an important role in the global climate system. To promote the application of Medium Resolution Spectral Imager-II (MERSI-II) data in the ice surface temperature (IST) inversion, we used the thermal infrared channels (channels 24 and 25) of the MERSI-II onboard Chinese FY-3D satellite and the thermal infrared channels (channels 31 and 32) of the Earth Observing System (EOS) Moderate-Resolution Imaging Spectroradiometer (MODIS) onboard the National Aeronautical and Space Administration (NASA) Aqua satellite for data analysis. Using the Observation–Observation cross-calibration algorithm to cross-calibrate the MERSI and MODIS thermal infrared brightness temperature (Tb) data in the Arctic, channel 24 and 25 data from the FY-3D/MERSI-II on Arctic ice were evaluated. The thermal infrared Tb data of the MERSI-II were used to retrieve the IST via the split-window algorithm. In this study, the correlation coefficients of the thermal infrared channel Tb data between the MERSI and MODIS were >0.95, the mean bias was −0.5501–0.1262 K, and the standard deviation (Std) was Tb data were closer to the MODIS data, and the bias range of the 11 μm and 12 μm channels was −0.0214–0.0119 K and the Std was Tb data after calibration to retrieve the IST, the results of the MERSI and MODIS IST were more consistent. By comparing the IST retrieved from the MERSI thermal infrared calibrated Tb data with MODIS MYD29 product, the mean bias was −0.0612–0.0423 °C and the Std was Tb data after calibration is better than that before calibration for retrieving the IST. When comparing the Arctic ocean sea and ice surface temperature reprocessed data (L4 SST/IST) with the IST data retrieved from MERSI, the bias was 0.9891–2.7510 °C, and the Std was

Sea ice is an important marine phenomenon in the Arctic region, and it is of great importance to study the motion of Arctic sea ice in the present day when its melting is accelerated by global warming. This study proposes a method to retrieve the motion of sea ice based on the maximum cross-correlation (MCC) and the successive correction method (SCM). The proposed method can apply different scales of search ranges to template matching according to the location of sea ice in the Arctic area. In addition, the data assimilation method can assign different weights to different data. We used 36.5 GHz and 89 GHz brightness temperature (Tb) data from the microwave radiometer imager (MWRI) aboard the Fengyun-3D (FY-3D) satellite, for the first time in the literature, to retrieve the sea ice motion in the Beaufort Sea from January to April 2019. The retrieved sea ice motion results were in good agreement with those obtained from the motion of the buoys. Compared with the data from the buoys, the root mean-squared error (RMSE) of the sea ice motion retrieved from FY-3D/MWRI Tb data was 1.1418 cm/s in the zonal direction and 1.0481 cm/s in the meridional direction, and the mean absolute error (MAE) between them was 0.7166 cm/s in the zonal direction and 0.6777 cm/s in the meridional direction. The RMSE between the sea ice motion obtained from the National Snow and Ice Data Center (NSIDC) and the motion of the buoys was 0.9515 cm/s in the zonal direction and 0.67003 cm/s in the meridional direction, and the MAE between them was 0.6576 cm/s in the zonal direction and 0.4922 cm/s in the meridional direction. The RMSE of daily average velocity from the FY-3D/MWRI results and NSIDC data product was 2.2726 cm/s in zonal and 1.9270 cm/s in meridional, and the MAE was 1.5103 cm/s in zonal and 1.1071 cm/s in zonal. The density of the merged data was higher than that obtained from a single polarization or frequency in this paper. The results indicate that FY-3D/MWRI Tb data can retrieve the sea ice motion successfully.

Abstract Introduction Incomplete pubertal development is a common phenomenon found in patients with Klinefelter syndrome (KFS). KFS combined with central precocious puberty (CPP) rarely occurs. We herein report a rare case of KFS with CPP and review several studies to determine the possible mechanism underlying this condition. Case presentation An 8‐year, 5‐month‐old male patient was admitted to our hospital because of enlargement of the penis and small testes. Laboratory evaluation revealed high luteinizing hormone and follicle‐stimulating hormone levels, a high testosterone level, and the 48,XXYY karyotype. He was treated with triptorelin. One year later, the patient's testosterone level decreased and pubertal arrest occurred. Conclusion The literature review in this study showed that the occurrence of hypogonadism combined with CPP is not unique to patients with KFS; it has also been reported in individuals with Turner syndrome, adrenal hypoplasia congenita, and other diseases. Such individuals share common features including partial hypogonadism and a normal hypothalamic‐pituitary‐gonadal axis. CPP is considered a prelude to hypogonadism, and treatment with a gonadotropin‐releasing hormone agonist may prevent gonadal failure.

The use of immunotherapy can be limited by adverse side effects. In this study, the authors designed a nanodevice that spatiotemporally controlled activate immunomodulatory agents at the tumour site upon near-infrared light triggering, thus preventing systemic toxicity with maintained efficacy

Background. The incidence of diabetes mellitus (DM) was increasing in recent years, and it is important to screen those nondiabetic populations through health examination to detect the potential risk factors for DM. We aimed to find the predictive effect of health examination on DM. Methods. We used the public database from Rich Healthcare Group of China to evaluate the potential predictive effect of health examination in the onset of DM. The colinear regression was used for estimating the relationship between the dynamics of the health examination index and the incident year of DM. The time-dependent ROC was used to calculate the best cutoff in predicting DM in the follow-up year. The Kaplan-Meier method and Cox regression were used to evaluate the HR of related health examination. Results. A total of 211,833 participant medical records were included in our study, with 4,172 participants diagnosing as DM in the following years (among 2-7 years). All the initial health examination was significantly different in participants’ final diagnosing as DM to those without DM. We found a negative correlation between the incidence of years of DM and the average initial FPG (r=−0.1862, P5.21 mmol/L) had a 2.73-fold chance to develop as DM in follow-up (95%CI=2.65–2.81, P