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Abstract The rail profile milling process allows considerable thickness to be removed in a single pass. However, the residual waviness formation law after milling and its subsequent effect on rail performance remains uncertain. In this paper, the wavelength and wave height of the residual waviness are identified as the key characteristics. The relationship between milling speed and residual waviness is determined, and a numerical model of the residual waviness formed on the surface after milling is established based on the commonly used three milling speeds of 300, 600, and 1000 m/h, and its accuracy is verified using the parameters of the residual waviness detected by the milling experiments. A three-dimensional finite element analysis model of wheel-rail contact was employed to analyze the contact stresses and low fatigue cycles at a wheel load of 11.5 tons with no residual waviness on the rail profile surface and with three types of residual waviness, respectively. The results show that the residual waviness changes the wheel-rail contact position and the morphology of the contact area, reduces the maximum contact stress and increases the strain fatigue cycles. The application of elevated milling speeds reduces the wheel-rail contact stresses after milling, thereby increasing the low fatigue cycles.

Abstract Objectives Middle-aged and older adults smoking for years are afflicted by smoking-related diseases and functional limitations; however, little is known about the effect of smoking on nonfatal conditions in middle and later life. This study aims to investigate the impact of smoking on both total life expectancy (TLE) and disability-free life expectancy (DFLE) and the variations in such effects by educational level in China. Methods Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), 2011–2018, with a total sample of 16,859 individuals aged 45 years or older involved in the final analysis. The Activities of Daily Living (ADL) scale was used to measure disability, and the population-based multistate life table method was used to estimate the differences in TLE and DFLE by smoking status and educational attainment. Results At baseline, 28.9% of participants were current smokers, 8.5% were former smokers, and 62.6% never smoked. Approximately 5.6% were identified with ADL disability. Both current smokers and former smokers experienced lower TLE and DFLE than never smokers, and such differences were particularly prominent among men. Intriguingly, former smokers manifested a lower DFLE for both sexes and a lower TLE among women, though a longer TLE among men, compared with current smokers. Similar differences in TLE and DFLE by smoking status were observed for groups with different levels of education. Conclusion Never smokers live longer and healthier than current smokers and persons who quit smoking. Smoking was associated with greater reductions in TLE and DFLE among men. However, educational attainment might not moderate the adverse effect of smoking on both fatal and nonfatal conditions in the context of China. These findings have implications for disability prevention, aged care provision and informing policies of healthy aging for China and elsewhere.

Abstract Introduction Based on the data from the China Health and Retirement longitudinal study (CHARLS), we aimed to investigate the bidirectional relationship between depressive symptoms and functional disability. Methods Data were collected across 3 waves from 2013 to 2018. The activities of daily living (ADLs) and the instrumental activities of daily living (IADLs) scales were used to measure functional disability and the CESD-10 was used to measure depressive symptoms. Cross-lagged models were performed to examine cross effect between depressive symptoms and functional disability across three waves. Results Data on 10,092(mean [SD] age, 61.98[8.44] years; 3764 females [37.30%]) and 10,180 participants (mean [SD] age, 62.01[8.46] years; 3788 females [37.21%]) in IADL sample and ADL sample were included in the analyses. For IADL disability, the cross-lagged model shows a bidirectional association across three waves; the multivariable GEE model revealed that changes in CESD-10 score across waves were associated with worse IADL disability (β ranges: 0.08–0.10) and vice versa, worsen of IADL disability ascending developing of CESD-10 score (β ranges: 0.09–0.10). For ADL disability, the cross-lagged model shows a bidirectional association across three waves; the multivariable GEE model revealed that changes of CESD-10 score across waves were associated with worse IADL disability (β ranges: 0.08–0.10) and vice versa, worsen of IADL disability ascending developing of CESD-10 score (β ranges: 0.09–0.10). Discussion Study findings underscore a significant bidirectional between depressive symptoms and functional disability in older adults. Thus, simultaneous intervention should be taken to manage the mutual development of functional disability and depression.

Objective In well-trapped hydrothermal geothermal reservoirs, the research on injecting CO2 into reservoirs simultaneously with recharge water is carried out, which has both economic and environmental benefits for carbon sequestration. Methods A 3D reservoir model was established to study the CO2 breakthrough time and the migration of CO2-rich brine in a reservoir under different well spacings, formation inclination angles, sieve tube positions and exploitation and reinjection rates. Results The results show that (1) when the exploitation and reinjection rate is 20 kg/s and the well spacing is 1 200 m within 20 years of operation, there is no CO2 breakthrough. (2) In inclined formations, when the recharge well is located downstream of the production well, as the formation inclination angle increases, the CO2 breakthrough time increases, and the migration distance of carbonated water increases along the downdip direction of the formation. (3) Considering the impact of the screen position on the breakthrough time and CO2 mass fraction in the production well after breakthrough, it is beneficial to ensure the safety and effectiveness of CO2 geological storage when the recharge well sieve tube is located 30 m above the reservoir and the production well sieve is located 30 m below the reservoir. (4) The exploitation and reinjection rates have greater impacts on the CO2 breakthrough time. When the exploitation and reinjection rate is 12 kg/s, there is no CO2 breakthrough. When the exploitation and reinjection rate increases to 28 kg/s, the breakthrough time decreases to 11.8 years. Conclusion Therefore, in practical engineering applications, the CO2 breakthrough time can be delayed, and the safety of CO2 geological storage can be improved through the study of operating parameters and the inherent characteristics of the formation.

Aim This review aims to summarize the epidemiology, etiology, pathogenesis, clinical manifestations, and current diagnostic and therapeutic approaches for mucormycosis. The goal is to improve understanding of mucormycosis and promote early diagnosis and treatment to reduce mortality.Methods A comprehensive literature review was conducted, focusing on recent studies and data on mucormycosis. The review includes an analysis of the disease’s epidemiology, etiology, and pathogenesis, as well as current diagnostic techniques and therapeutic strategies.Results Mucormycosis is increasingly prevalent due to the growing immunocompromised population, the COVID-19 pandemic, and advances in detection methods. The pathogenesis is closely associated with the host immune status, serum-free iron levels, and the virulence of Mucorales. However, the absence of typical clinical manifestations complicates diagnosis, leading to missed or delayed diagnoses and higher mortality.Conclusion An enhanced understanding of the epidemiology, pathogenesis, and clinical presentation of mucormycosis, along with the adoption of improved diagnostic and therapeutic approaches, is essential for reducing mortality rates associated with this opportunistic fungal infection. Early diagnosis and prompt treatment are critical to improving patient outcomes.

Introduction Mild cognitive impairment (MCI) is an intermediate phase between normal cognitive ageing and dementia and poses a serious threat to public health worldwide; however, it might be reversible, representing the best opportunity for secondary prevention against serious cognitive impairment. As a non-pharmacological intervention for those patients, interventions that combine physical exercise and cognitive training, whether delivered simultaneously or sequentially, may have superior effects on various cognitive domains, including global cognition, memory, executive function and attention. The supportive evidence remains incomplete. This study aims to assess the effectiveness of a combined exercise and cognitive intervention in Chinese older adults with mild cognitive impairment (COGITO), empowered by digital therapy and guided by the Health Action Process Model and the Theory of Planned Behaviour (HAPA-TPB theory) in a home-based setting.Methods and analysis This study is a randomised controlled, assessor-blinded multi-centre study. Four parallel groups will include a total of 160 patients, receiving either a combined exercise and cognitive intervention, an isolated exercise intervention, an isolated cognitive intervention or only health education. These interventions will be conducted at least twice a week for 50 min each session, over 3 months. All interventions will be delivered at home and remotely monitored through RehabApp and Mini-programme, along with an arm-worn heart rate telemetry device. Specifically, supervisors will receive participants’ real-time training diaries, heart rates or other online monitoring data and then provide weekly telephone calls and monthly home visits to encourage participants to complete their tasks and address any difficulties based on their training information. Eligible participants are community-dwelling patients with no regular exercise habit and diagnosed with MCI. The primary outcome is cognitive function assessed by the Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog) and Community Screening Instrument for Dementia (CSI-D), with baseline and three follow-up assessments. Secondary outcomes include quality of life, physical fitness, sleep quality, intrinsic capacity, frailty, social support, adherence, cost-effectiveness and cost-benefit.Ethics and dissemination The study was approved by the Institutional Review Board of Peking University. Research findings will be presented to stakeholders and published in peer-reviewed journals and at provincial, national and international conferences.Trial registration number ChiCTR2300073900.

Background This study took Beijing as an example to estimate the incidence and regional inequalities of catastrophic health expenditures (CHEs) in a megacity of China.Methods This study used data from the Health Services Survey Beijing (HSSB) 2018. Logistic regressions were used to investigate the risk factors for experiencing CHE, and concentration curves, the concentration index and its decomposition method based on probit models were used to estimate the inequalities in CHE.Results CHE occurred in 25.51% of the households of the outer suburb villages, 6.78% of the households of the innercity area communities, 17.10% of the households of the villages of the inner-city areas, and 11.91% of the households of the communities of the outer suburbs. In areas in the outer suburbs, households with private insurance coverage were associated with a lowered risk of CHE, and lower educational attainment and lower occupational class were related to an increasing risk of CHE. This study also discovered pro-rich financing disparities in CHE in Beijing, with the outer suburbs having the highest levels of CHE disparity. When it comes to the observed contributions of disparities in CHE, a significant portion of them is connected to the sorts of occupations, educational levels, and residential status.Conclusion The impoverishment brought on by medical expenses and CHE must still be taken into account in the postpoverty elimination era. The megacity of China was discovered to have significant regional differences in the incidence of pro-rich financing inequity in CHE. Disparities in socioeconomic status (SES), one of the controllable variables, may be a key area to address to lower the risk and minimize CHE inequality in megacities towards the path to universal health coverage (UHC). Additionally, it is important to consider the financial protection impact of inclusive supplementary medical insurance on lowering the likelihood of CHE in the periphery areas.

BackgroundThe existing literature reveals several significant knowledge gaps that hinder health care providers in formulating exercise prescriptions for cognitive health. ObjectiveThis study endeavors to elucidate the relationship between the level of physical activity and cognitive function in older adults in China. Moreover, it seeks to explore the associations between distinct exercise behaviors—such as exercise types, the purpose motivating engagement in exercise, the accessibility of exercise fields, and the inclination toward exercise—and cognitive function. MethodsUsing data from the China Longitudinal Aging Social Survey (CLASS conducted in 2016, cognitive function was meticulously assessed through the modified Chinese version of the Mini-Mental State Examination, encompassing measures of orientation, memory, and calculation. Using self-report structured questionnaires, a myriad of information about physical activity during leisure time, exercise engagement, exercise intensity, primary exercise types, reasons for exercise participation, availability of sports facilities, and exercise willingness was diligently gathered. Robust ordinary least squares regression models were then used to compute coefficients along with 95% CIs. ResultsA discernible inverted U-shaped trend in cognitive scores emerged as the level of physical activity surpassed the threshold of 500 metabolic equivalents of task (MET) minutes per week. Notably, individuals with a physical activity level between 500 and 999 MET minutes per week exhibited a coefficient of 0.31 (95% CI 0.09 to 0.54), those with a physical activity level between 1000 and 1499 MET minutes per week displayed a coefficient of 0.75 (95% CI 0.52 to 0.97), and those with a physical activity level above 1500 MET minutes per week demonstrated a coefficient of 0.45 (95% CI 0.23 to 0.68). Older individuals engaging in exercise at specific MET levels showcased superior cognitive function compared to their inactive counterparts. Furthermore, individuals driven by exercise motivations aimed at enhancing physical fitness and health, as well as those using sports facilities or public spaces for exercise, exhibited notably higher cognitive function scores. ConclusionsThe findings underscore the potential of exercise as a targeted intervention for the prevention and treatment of dementia or cognitive decline associated with aging in older individuals. Leveraging these insights to formulate informed exercise recommendations holds promise in addressing a significant public health challenge linked to aging populations.

The aim of this study was to investigate the effects of dietary protein inclusion level on growth, protein absorption pathway and liver metabolism-related pathway in triploid crucian carp (Carassius carassius triploid). Six experimental diets with different protein levels (26%, 29%, 32%, 35%, 38%, 41%) were formulated. A total of 540 fish with an initial weight of 11.79 ± 0.09 g were randomly assigned to 18 cages and six treatments with three replicates of 30 fish each for 8 weeks feeding. The results showed that the specific growth rate (SGR) and feed efficiency (FE) of triploid crucian carp were highly positively correlated with protein content (p < 0.05). The broken-line regression analysis showed that the optimal dietary inclusion level was determined to be 39% considering SGR of triploid crucian carp. In addition, genes related to protein absorption were influenced by the protein inclusion level of dietary. The mRNA expressions of pept1, lat2, cdx2, jak2 and sp1 exhibited similar change tendency and promoted to highest expression at 41% groups, 32% followed. Furthermore, the expressions of hepatic metabolism genes tor, s6k1, igf1, ampd1 and adsl reached peak at 38% dietary protein inclusion level, while 4e-bp2 gene showed the highest expression levels at 41% dietary protein inclusion level. Finally, igf1 expression in liver and cdx2 in intestine showed high pearson coefficients with dietary protein level suggesting their expressions were significant positively regulated by dietary protein level. In conclusion, this study evidenced the influence of dietary protein level on growth, protein absorption pathway, TOR and IGF pathways of hepatic metabolism related in triploid crucian carp. 39% dietary protein inclusion level would be optimum level of triploid crucian carp dietary, which will lead to a better growth and high feed efficiency of triploid crucian carp.

Abstract MicroRNA (miRNA) delivery by extracellular vesicles (EVs) has recently inspired tremendous developments in cancer treatments. However, hybridization between miRNA and its target mRNA is still difficult to be imaged in vivo to assess the therapeutic effects in time. Herein we design a nano-scale fluorescent “off–on” complex encapsulated by small extracellular vesicles (sEVs) for real-time visualization and evaluation of gene therapy efficiency in human gastric cancer cells and murine xenograft tumor models. The complex is formed by π–π stacking between graphene quantum dots (GQDs) and tumor suppressor miR-193a-3p conjugated fluorescent tag whose signals remain off when binding to GQDs. Loaded into sEVs using tunable sonication techniques, the GQDs/Cy5-miR particles enter the tumor cells and promote miR-193a-3p escape from endosomes. The miR-193a-3p in GQDs/Cy5-miR is unleashed to pair the specific target oncogene cyclin D1 (CCND1), therefore turning on the fluorescence of miRNA tags. We find out that GQDs/Cy5-miR@sEVs can activate the “turn-on” fluorescent signal and exhibit the longest retention time in vivo, which suggests a minimized degradation of miR-193a-3p in dynamic processes of miRNA-mRNA binding. More importantly, GQDs/Cy5-miR@sEVs significantly promote cancer apoptosis in vitro and in vivo via the enhanced cellular uptake. Our study demonstrates that GQDs/Cy5-miR@sEVs represent an efficient and refined theranostic platform for gene therapy in cancers. Graphical Abstract

Abstract Background Luminal breast cancer (BC) is the predominant subtype of breast cancer with a sustained risk of late recurrence and death. Understanding the molecular mechanisms for the oncogenesis of luminal BC would improve the prognosis for this large subset of patients. SPDEF was reported to be dysregulated in breast cancers. However, the biological functions and underlying molecular mechanism of SPDEF in luminal BC remains largely unknown. The aim of the present study was to elucidate the potential roles of SPDEF underlying subtype-specific functions in BC, especially in luminal subtypes. Methods The expressions and clinicopathological characteristics of SPDEF in luminal BC patients were evaluated bioinformatically. In vitro and in vivo assays were performed to investigate the oncogenic function and stemness maintenance of SPDEF in luminal BC. Chromatin immunoprecipitation (ChIP) and dual luciferase reporter assays were conducted to determine the transcription regulation of GALNT7 by SPDEF. GALNT7 levels in serum from luminal BC patients were further detected by enzyme-linked immunosorbent assay (ELISA). Results SPDEF is markedly upregulated in luminal BC and positively associated with tumor progression and poor prognosis. Furthermore, we confirmed that SPDEF enhanced the proliferation, migration, invasion and stemness of luminal BC cells in vitro as well the tumorigenicity in vivo. Mechanistically, we demonstrated the stimulative effect of SPDEF on the progression and stemness of luminal BC, which is mediated by its directly transcriptional target GALNT7. Clinically, we verified that the GALNT7 can be used as a noninvasive diagnostic marker. Noteworthy, the combined detection of serum GALNT7 and traditional tumor markers can enhance diagnostic accuracy thus is of vital importance in the early diagnosis of luminal BC. Conclusions Our study reveals a novel mechanism by which SPDEF transcriptionally activates GALNT7 via directly binding to its promoter to promote cell proliferation, motility and stemness, and led to luminal BC tumorigenesis and poor prognosis.

In this study, Gastrodia elata was treated with compound enzyme, and Lactiplantibacillus plantarum STDA6 was used as fermentation agent to prepare fermented G. elata oral liquid. Orthogonal experiment was used to optimize the preparation process of lactic acid bacteria fermented G. elata oral liquid. The results showed that the optimal process conditions for enzymatic hydrolysis of G. elata were carried out after mixing pectinase, cellulase, tannins and α-amylase, and the optimal process conditions for enzymatic hydrolysis of complex enzymatic hydrolysis were: the ratio of material to liquid (g:mL) was 1:11, the amount of enzyme was 0.4%, the pH value was 4.0, the enzymatic hydrolysis temperature was 50 ℃, the enzymatic hydrolysis time was 180 min. The optimum technological conditions of lactic acid bacteria fermenting G. elata oral liquid were as follows: inoculation amount with 1×105 CFU/mL, fermentation time for 12 h, fermentation temperature at 37 ℃, sucrose addition with 10%. The average number of L. plantarum STDA6 in G. elata oral liquid fermented by lactic acid bacteria was 2×108 CFU/mL, pH value was 3.5, the total number of bacteria was less than 10 CFU/mL and coliform, mold, yeast, Staphylococcus aureus, Salmonella were not been detected, which complied with the relevant requirements of GB/T 31326-2014 ‘Botanical Beverage’.

Non-communicable diseases (NCDs) are currently a major global health challenge and one of the core issues of concern to the World Health Organization (WHO). As populations′ aging, middle- and low-income countries face a double burden of communicable diseases and NCDs, with a serious pressure on health systems of the countries. In this paper, we summarize the role of and challenges to the WHO in promoting global control of NCDs, and make recommendations for the development of global NCD prevention and control strategies.

The oral cavity is the second most microbially rich region of the human body, and many studies have shown that there is a strong association between microorganisms and oral health. Some pathogenic bacteria produce biofilms and harmful metabolites in the mouth that may cause oral problems such as oral malodor, periodontitis, and dental caries. Altering the oral microbiota by using probiotics may alleviate oral health problems. Thus, using multi-function screening, we aimed to identify probiotics that can significantly improve oral health. The main parameters were the inhibition of pathogenic bacteria growth, inhibition of biofilm formation, reduction in the production of indole, H2S, and NH3 metabolites that cause halitosis, increase in the production of H2O2 to combat harmful bacteria, and co-aggregation with pathogens to prevent their adhesion and colonization in the oral cavity. Tolerance to cholic acid and choline was also assessed. Bifidobacterium animalis ZK-77, Lactobacillus salivarius ZK-88, and Streptococcus salivarius ZK-102 had antibacterial activity and inhibited biofilm production to prevent caries. They also improved the oral malodor parameter, H2S, NH3, and indole production. The selected probiotics (especially L. salivarius ZK-88) alleviated the inflammation in the oral cavity of rats with periodontitis. The analysis of the gingival crevicular fluid microbiome after probiotic intervention showed that B. animalis ZK-77 likely helped to restore the oral microbiota and maintain the oral microecology. Next, we determined the best prebiotics for each candidate probiotic in order to obtain a formulation with improved effects. We then verified that a probiotics/prebiotic combination (B. animalis ZK-77, L. salivarius ZK-88, and fructooligosaccharides) significantly improved halitosis and teeth color in cats. Using whole-genome sequencing and acute toxicity mouse experiments involving the two probiotics, we found that neither probiotic had virulence genes and they had no significant effects on the growth or development of mice, indicating their safety. Taking the results together, B. animalis ZK-77 and L. salivarius ZK-88 can improve oral health, as verified by in vivo and in vitro experiments. This study provides a reference for clinical research and also provides new evidence for the oral health benefits of probiotics.

Background Family environments can shape children’s personalities and social networks, rendering distinguishing adverse childhood experiences (ACEs) from family and society essential, but related evidence remains limited.Aims This cross-sectional study aimed to investigate the correlations between intrafamilial and social ACEs, their associations with depressive symptoms and cognitive impairment and the (education-moderated) mediating role of social ACEs.Methods Data for this cross-sectional study were from the China Health and Retirement Longitudinal Study. Nine intrafamilial (0, 1, 2, 3, and 4 or more) and three social (0, 1, and 2 or more) ACEs were identified. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale. Global cognition, including episodic memory and mental intactness, was calculated as z scores. Binary and ordered logistic regressions, generalised linear models with Gaussian family and identity link, and mediation analysis were used.Results 13 435 participants aged 59.0 (51.0–66.0) were included. Compared with participants with no intrafamilial ACEs, those with 1, 2, 3, and 4 or more intrafamilial ACEs tended to develop more social ACEs, with odds ratios (ORs) of 1.55 (95% confidence interval (CI): 1.36 to 1.76), 2.36 (95% CI: 2.08 to 2.68), 3.46 (95% CI: 3.02 to 3.96) and 6.10 (95% CI: 5.30 to 7.02), respectively. Both intrafamilial and social ACEs were associated with depressive symptoms (OR >3 for four or more intrafamilial ACEs and two or more social ACEs) and global cognition (β=−0.26 for four or more intrafamilial ACEs and β=−0.29 for two or more social ACEs). Social ACEs mediated the associations of intrafamilial ACEs with depressive symptoms and global cognition by 12.3% and 13.1%, respectively. Furthermore, as education levels increased, the impact of intrafamilial ACEs on depressive symptoms was increasingly mediated through social ACEs, while the mediating role of social ACEs between intrafamilial ACEs and cognitive impairment gradually diminished.Conclusions Improving children’s social environments and elevating general education can prevent later-life depressive symptoms and cognitive impairment attributed to ACEs in China.

Background: This study aimed to examine the association between exposure to the 1976 Great Tangshan Earthquake (GTE) in adolescence and later-life depressive symptoms and to investigate the potential mechanisms underlying this association. Methods: Data were from the 2015 China Health and Retirement Longitudinal Study (CHARLS). The 10-item short form of the Center for Epidemiologic Studies Depression scale (CESD-10) was chosen to measure depressive symptoms. We used the difference-in-difference (DID) method, binary logistic regression models, and multilevel logistic regression models to explore the association of earthquake exposure during adolescence with later-life depressive symptoms. Additionally, multilevel mediation analysis with structural equation modeling (MMSEM) was conducted to investigate potential mechanisms. Results: We identified that adolescent exposure to earthquakes was related to a lower risk of depressive symptoms in later life (OR = 0.90, P = 0.019; OR = 0.48, P = 0.031; OR = 0.47, P = 0.034, respectively). However, this significant association was observed only in females (OR = 0.83, P = 0.028; OR = 0.46, P = 0.053; OR = 0.42, P = 0.037, respectively). Moreover, social activity participation played a mediating role in the association between exposure to earthquakes in adolescence and later-life depressive symptoms. Conclusions: We observed a lower risk of depressive symptoms in later life in survivors of earthquake exposure during adolescence. Further, we found the mediating role of social participation in the association between earthquake exposure in adolescence and later-life depressive symptoms, which gives support for the posttraumatic growth (PTG) theory. Our findings imply that, in order to lower the risk of depression in later life following exposure to a natural disaster in adolescence, it is necessary to take into account the buffering effect of social participation.

Background: China's send-down movement in the 1960s and 1970s, as a natural experiment, provides a unique opportunity to investigate the relationship between peers' dissemination of health literacy, community health workers, and infectious disease control in areas with weak health systems and inadequate human resources. To address the lack of studies on the health effects of the send-down movement, this study examined the associations between prenatal exposure to the send-down movement and infectious diseases in China. Methods: We analyzed 188,253 adults born in 1956–1977 with rural hukou who participated in the Second National Sample Survey on Disability in 2006 across 734 counties of China. Difference-in-difference models were used to detect the effect of the send-down movement on infectious diseases. Infectious diseases were ascertained by using the combination of self- or family members’ reports and on-site medical diagnosis of disabilities attributed to infectious disease by experienced specialists. The density of the relocated urban sent-down youth or “sent-down youths” (SDYs) in each county defined the intensity variable of the send-down movement. Results: Individuals in SDY-receiving areas with increased intensity of prenatal exposure to the send-down movement had a decreased probability of infectious diseases (β = −0.0362, 95% CI: 0.0591, −0.0133) after controlling for a set of regional and cohort characteristics. This association was stronger in counties with more prevalent infectious diseases prior to the send-down movement (β = −0.0466, 95% CI: 0.0884, −0.0048) than in those with less prevalence (β = −0.0265, 95% CI: 0.0429, −0.010). No substantial differences were found across sex-specific groups or by strictness of send-down movement implementation. On average, prenatal exposure to the send-down movement corresponded to a decrease in the probability of infectious diseases in rural areas by 19.70%. Conclusions: For areas with weak health systems, strengthening community health workers and promoting health literacy may be two key points to address the burden of infectious diseases. Increasing education and primary health care through peer-to-peer dissemination may contribute to the reduction of infectious disease prevalence.

Abstract Objectives To evaluate the association between oral health behavior and multiple chronic diseases among middle-aged and older adults. Methods We obtained data of the Beijing Health Service Survey and used multivariate logistic models to estimate the association between oral hygiene behavior and the risk of chronic diseases. Results The risk of any chronic diseases (OR = 1.27, 95% CI: 1.18–1.37), cardiovascular diseases (CVD, OR = 1.30, 95% CI: 1.21–1.39), and endocrine or nutritional metabolic disorders (OR = 1.11, 95% CI: 1.01–1.22) was higher in those who with poor oral health behavior. There was no significant correlation between oral health behavior and the risk of diseases of the musculoskeletal, respiratory, digestive, and genitourinary systems. Conclusions Poor oral hygiene practices were associated with higher risk of chronic diseases, CVD and diabetes mellitus (DM) among middle-aged and older adults. These findings motivate further studies to evaluate whether improved oral health behavior may prevent the incidence of chronic diseases.

Background: Our study aimed to investigate the association between multimorbidity and the cognitive decline related functional limitations. Methods: Data were obtained from the 2011–2018 China Health and Retirement Longitudinal Study, and generalized estimating equation models were used for estimation. A Chinese multimorbidity-weighted index (CMWI) was used to quantify the cumulative disease burden of multimorbidity. A margin plot was used to show the probability of functional limitations by global cognitive function and CMWI. Then, subgroup analysis was performed by demographic factors, the severity of functionally impaired ADL/IADL, and the trajectories of cognitive function. Results: Multimorbidity was demonstrated to be associated cognitive decline related functional limitations over 8 years, with the coefficient of the interaction of cognitive function −0.001 (−0.001, −0.001). This moderating effect was only significant in the relationship between cognitive function and ≥2-item impaired ADL/IADL (coefficient = −0.008, 95% CI: 0.009, −0.007) but was not significant in the relationship between cognitive function and 1-item impaired ADL/IADL. The accelerated role of multimorbidity associated with more severe function limitations than the relatively mild limitations attributed to cognitive decline, and the role of multimorbidity was stronger in individuals with continuously high function of cognitive trajectories and gradually declining cognitive function than in those with low level of cognitive trajectories. Conclusions: Effectively managing multimorbidity is important for preventing cognitive decline. Preventing the onset and progression of multimorbidity may be one potential strategy for early prevention and intervention to reverse or postpone cognitive decline and its further dementia risk.

Abstract Background The acupoint selections impact the effects of acupuncture, and preliminary evidence showed potential connection between pain threshold (PT) and acupuncture response. This study examined whether acupuncture at acupoints with lower PT versus higher PT would yield different effects in patients with knee osteoarthritis (KOA). Methods In this multicenter randomized clinical trial, patients were randomly assigned (1:1:1) to receive acupuncture at acupoints with lower PT (LPT group), acupuncture at acupoints with higher PT (HPT group), and no acupuncture (waiting-list group). PT was measured with electronic von Frey detector. The primary outcome was the change in WOMAC total score from baseline to 16 weeks, and the secondary outcomes were SF-12 score, and active knee range of motion (ROM). Intention-to-treat analysis was conducted with linear mixed-effect model. Results Among 666 randomized patients, 625 (93.84%) completed the study. From baseline to 16 weeks, patients in the LPT group versus HPT group had similar effects in reducing WOMAC total score (adjusted mean difference (MD) 2.21, 95% confidence interval (CI) −2.51 to 6.92, P = 0.36), while a greater reduction in WOMAC total score was observed in LPT group (−9.77, 95% CI −14.47 to −5.07, P

Abstract Background There was little evidence concerning the association of community socioeconomic status (SES) and the cross-level interaction between community- and individual-level SES with depressive symptoms in China. This study aimed to investigate the association of community-level SES with depressive symptoms among Chinese middle-aged and older people and to examine whether individual-level SES moderates this relationship. Methods Using data from the China Health and Retirement Longitudinal 2011–2018 Study, the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) short form was used to measure depressive symptoms in 35,546 Chinese individuals aged 45 years and older. Community SES was calculated as a sum of z scores of the average years of schooling and household income per capita, which were derived by aggregating the individual measures to the community level. Two-level hierarchical linear regression was used. Results Community SES was negatively related to CES-D-10 scores (coef=-0.438). A 1-SD increase in individual SES was associated with lower CES-D-10 scores (coef=-0.490). The cross-level interaction on individual- and community-level SES was significantly associated with depressive symptoms, indicating that with the increase of individual-level SES, the effect of community-level SES on depression decreases. Stratified analyses observed robust associations of community SES with CES-D scores between urban and rural residents. Conclusions This study showed that individuals who live in lower-SES communities had more severe depressive symptoms, particularly individuals with low SES. Additional attention should be given to the community socioeconomic context of middle-aged and older adults with lower SES, which may be helpful to reduce SES inequalities in depressive symptoms in China.

Abstract Background Although numerous studies focused on the relationship between area socioeconomic status (SES) and health, only a few of them investigated how community-level SES was linked to late-life cognitive function as well as the potential pathways underlying this association, and very few of them focused on the context of China. This study examined how community-level SES was linked to cognitive function and the potential pathways underlying this association among middle-aged and older adults in China. Methods Data was drawn from the waves 1–4 of China Health and Retirement Longitudinal Study. We measured cognitive function with the components of the Telephone Interview of Cognitive Status battery. Community-level SES was derived from a sum of z scores of the percentage of the illiterate and the per-capita net income status within communities. We adopted two-level hierarchical linear regression models to explore the associations between community-level SES and cognitive function. A multilevel mediation analysis with structural equation modeling was undertaken to disaggregate the direct and indirect pathways of the associations. Results Higher community-level SES was associated with better cognitive function (β = 0.562, 95% CI = 0.390, 0.734), and this significant association was only present in rural participants, not in urban participants. Furthermore, we discovered the mediating effects of outdoor exercise facilities within communities (β = 0.023, 95% CI = 0.000, 0.056) and individual-level SES (β = 0.108, 95% CI = 0.057, 0.156) to explain the relationship between community SES and cognitive function. Conclusions These findings highlight the importance of community environmental interventions in maintaining individuals’ cognitive health in China, especially for older adults. Our results provided solid empirical evidence for reducing mental health inequalities in China, and suggested that developing an aging-friendly environment and properly distributing community resources are important to improve cognitive function of older adults.

IntroductionThe COVID-19 pandemic outbreak have caused increased levels of emotional and behavioral problems, particularly among people with pre-existing mental health conditions. Young individuals with autism spectrum disorders (ASD) and developmental delay (DD) are particularly at risk due to their vulnerability. The purpose of this study was to look into the different effects of the COVID-19 pandemic on 1–6-year-old children with ASD and DD.MethodsParents and guardians of children with ASD completed an online survey that included questions about their children’s socio-demographics characteristics, the effects of the COVID-19 outbreak on their health, and what they needed in order to deal with the conditions of the pandemic.ResultsThis study compared 4,138 children with ASD to 711 children with DD. Children with ASD had a higher risk of having more emotional and behavioral problems than children with DD (OR 1.38, 95% CI 1.12–1.70). Compared to parent-oriented rehabilitation at home, discontinuing rehabilitation had a higher likelihood of negative emotional and behavioral change (OR 1.67, 95% CI 1.41–1.98). Having teachers’ online support had a higher likelihood of negative emotional and behavioral change for ASD children (OR 1.26, 95% CI 1.03–1.54).ConclusionsThis article provided evidence that children with developmental disabilities, particularly ASD, were at risk for a variety of challenges to their emotional functioning during the COVID-19 period, and that online support was not an ideal way for children with ASD to receive effective educational intervention in China.

AimsUrbanization plays an important role in individuals' health. However, it is difficult to isolate healthy migrant effect between urbanization and health. This study examined the effects of urbanization on depressive symptoms and its possible pathways among Chinese middle-aged and older adults independent of the influence of health-selective migration.MethodsUsing the baseline survey of the China Health and Retirement Longitudinal Study, this study compared the depressive symptoms among three groups (urbanized rural residents, rural non-migrants and urban non-migrants). The 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) short form was used to measure depressive symptoms. Logistic regression models and Structural Equation Model (SEM) were applied to examine the association between urbanization and depressive symptoms and the corresponding potential mechanisms.ResultsOur final sample contained 11,156 respondents with an average age of 58.91 (SD = 9.48), with 5,142 males (46.09%) and 6,014 females (53.91%). Compared with urbanized rural residents, rural residents were more likely to have depressive symptoms (OR = 1.19, 95% CI = 1.07, 1.32), and urban residents were associated with a decreased risk of depressive symptoms (OR = 0.81, 95% CI: 0.70, 0.94). A large proportion of the association between urbanization and depressive symptoms were mainly mediated by social participation, income and living conditions.ConclusionsPlanned urbanization had an independent impact on decreased depressive symptoms. Improvements in social participation, income and living conditions are the main drivers behind this relationship. Additionally, urbanization compensates for the negative impact of depressive symptoms from disadvantaged early life conditions, but it cannot eliminate the gap between urbanized rural people and urban non-migrants.

Background: Preclinical studies often provide the evidence base for clinical studies. However, the design and reporting of preclinical trial results are inadequate, resulting in poor reproducibility and clinical translatability. We aimed to systematically evaluate the methodology and reporting quality of animal studies of acupuncture for cancer pain. Methods: About 7 databases were searched for animal research articles on acupuncture for cancer pain from the beginning of the database to January 31, 2022. ARRIVE guidelines, STRICTA, and SYRCLE risk of bias tools were used to assess the reporting quality and risk of bias of the selected studies. Results: A total of 18 studies were evaluated. Of the 22 items on the SYRCLE tool, only 6 items had a positive reporting rate of more than 50%. Of the 39 items in the ARRIVE guidelines, 14 were rated excellent, and the least frequently reported checklist items were 7. Out of the 17 STRICTA checklist items analyzed, 10 were considered appropriately reported in more than 80% of the studies, while 4 were correctly reported in less than 20%. Conclusions: Some crucial points in the design, implementation, and reporting of the experiments included in the study were not well developed, which could significantly affect the clarity, reproducibility, and translatability of the experiments. There is a need to fully implement scientific tool guidelines for future experimental studies in order to improve the quality of preclinical studies and facilitate effective translation of their results to the clinic.

Slow transit constipation is an intractable constipation with unknown aetiology and uncertain pathogenesis. The gut microbiota maintains a symbiotic relationship with the host and has an impact on host metabolism. Previous studies have reported that some gut microbes have the ability to produce 5-hydroxytryptamine (5-HT), an important neurotransmitter. However, there are scarce data exploiting the effects of gut microbiota-derived 5-HT in constipation-related disease. We genetically engineered the probiotic Escherichia coli Nissle 1917 (EcN-5-HT) for synthesizing 5-HT in situ. The ability of EcN-5-HT to secrete 5-HT in vitro and in vivo was confirmed. Then, we examined the effects of EcN-5-HT on intestinal motility in a loperamide-induced constipation mouse model. After two weeks of EcN-5-HT oral gavage, the constipation-related symptoms were relieved and gastrointestinal motility were enhanced. Meanwhile, administration of EcN-5-HT alleviated the constipation related depressive-like behaviors. We also observed improved microbiota composition during EcN-5-HT treatment. This work suggests that gut microbiota-derived 5-HT might promise a potential therapeutic strategy for constipation and related behavioral disorders.

BackgroundTo describe the status quo and trends in the global burden of all cancers caused by secondhand smoke during 1990–2019.MethodsData on cancer associated with secondhand smoke were extracted from the Global Heath Data Exchange. Cancer burden was measured by cancer-related deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs).ResultsIn 2019, age-standardized rates of death, DALYs and YLLs among the cancer population globally caused by secondhand smoke were 1.60, 38.54 and 37.77, respectively. The proportions of these in the total cancer burden for all risk factors combined decreased slightly from 1990 to 2003 and then increased from 2004 to 2019. In 2019, >50% of the cancer burden was concentrated in men aged 55–75 years and women aged 50–70 years. Between 1990 and 2019, there was an increase in age-standardized rates of death, DALYs, YLDs and YLLs among those aged ≥70 years. The age-standardized YLDs rate attributable to secondhand smoke was higher among women; it decreased in men but increased in women, causing a wider gap between the sexes. A greater cancer burden was mainly seen in North America in 1990 and Europe in 2019. Reductions in the annual rate change of cancer burden were found mainly in North America and Oceania, while increases were found in Africa and Asia. In 2019, high–middle- and middle-SDI countries had higher age-standardized rates of deaths, DALYs, YLDs and YLLs than the global level. During 1990 and 2019, the largest decline in cancer burden was seen in high-SDI countries, while middle- or low-SDI countries experienced increases in all age-standardized rates.ConclusionsCancer burden attributable to secondhand smoke is concerning given the increasing health loss and differences in distribution of cancer burden worldwide. Further studies are needed to investigate the causes of disparities in cancer burden attributable to secondhand smoke and to improve understanding of the contribution of secondhand smoke to the burden of different types of cancer.

The nucleon-pair shell model (NPSM) within the framework of a broken symmetry basis is studied. The results demonstrate the validity of such a scheme, which in turn leads to a significant reduction in the dimensionality of the multi-pair configuration space. Specifically, in the case of an axially-deformed basis, the results yield a satisfactory description of the low-lying spectrum, even without the need for applying the projection procedure. In the case of a triaxially-deformed basis, the result of variation after angular momentum projection suggest a potential for using the NPSM to find exact solutions in a semi-magic system.

Background: Increasing evidence regards the role of ambient particles on morbidity and mortality caused by cardiovascular diseases (CVDs). However, there was no evidence about the association between ambient particles and CVD-associated disability. This study used large national representative data to investigate the relationship between long-term exposure to an aerodynamic diameter less than or equal to 2.5 µm (PM2.5) and CVD-associated disability among Chinese adults aged 45 years old and above and estimated the burden of CVD-associated disability attributed to PM2.5. Methods: Using data from the Second National Sample Survey on Disability, this study used a combination of self-reports or family members’ reports and on-site medical diagnosis by experienced specialists to ascertain CVD-associated disability in 852,742 adults aged 45 years old and above. Logistic regression models and spline regression models were used to examine the association between PM2.5 long-term exposure and CVD-associated disability, and the population attributable risk was calculated to assess the burden of CVD-associated disability contributed to PM2.5. Results: Every increase of 10 μg/m3 in PM2.5 was associated with an 8% (OR = 1.08, 95% CI: 1.05, 1.10) increase the odds of CVD-associated disability. Stratified analyses by demographic factors suggested that this association was robust. There were 1.05 (0.74,1.35) million -3.53 (3.29,3.75) million CVD-associated disabilities attributed to high PM2.5 concentration exposure (≥35 µg/m3) among middle-aged and older adults in 2006. A reduction in PM2.5 concentrations to 35 µg/m3 corresponded to a decrease of 13.59% (9.55%, 17.46%)–23.98% (17.17%, 30.25%) in CVD-associated disability by age group, respectively, and this magnitude increased in areas with a high prevalence of CVD-related disability. Conclusions: This study suggests that reducing PM2.5 concentrations may contribute to preventing CVD-associated disability and decreasing air pollution-related medical expenditures and rehabilitation fees.

BackgroundBreast cancer (BC) is the leading cause of cancer−related mortality in females and the most common malignancy with high morbidity worldwide. It is imperative to develop new biomarkers and therapeutic targets for early diagnosis and effective treatment in BC.MethodsWe revealed the oncogene function of cadherin 1 (CDH1) via bioinformatic analysis in BC. Moreover, miRNA database was utilized to predict miRNAs upstream of CDH1. Expression of CDH1-related miRNAs in BC and their values in BC stemness and prognosis were analyzed through TCGA‐BRCA datasets. In addition, Gene Ontology (GO) and Gene Set Enrichment Analysis (GSEA) were performed to explore the potential functions and signaling pathways of CDH1 in combination with CDH1-related miRNAs in BC progression. Finally, the differential expressions of soluble E-cadherin (sE-cad), which is formed by the secretion of CDH1-encoded E-cadherin into serum, analyzed by enzyme-linked immunosorbent assay (ELISA). Reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) was used to detect the expression level of CDH1-related miRNAs in serum samples.ResultsThe mRNA and protein expressions of CDH1 were elevated in BC tissues compared with normal counterparts. Moreover, CDH1 overexpression was positively correlated with BC stage, metastatic, stemness characteristics, and poor prognosis among patients. In predictive analysis, miR-340, miR-185, and miR-20a target CDH1 and are highly expressed in BC. miR-20a overexpression alone was strongly associated with high stemness characteristics and poor prognosis of BC. Additionally, GO, KEGG, and hallmark effect gene set analysis demonstrated that CDH1 in combination with overexpression of miR-340, miR-185, or miR-20a participated in multiple biological processes and underly signaling pathways involving in tumorigenesis and development of BC. Finally, we provide experimental evidence that the combined determination of serum sE-cad and miR-20a in BC has highly diagnostic efficiency.ConclusionsThis study provides evidence for CDH1 as an oncogene in BC and suggests that miR-20a may regulate the stemness characteristics of BC to exert a pro-oncogenic effect by regulating CDH1. Moreover, sE-cad and miR-20a in serum can both be used as valid noninvasive markers for BC diagnosis.

ObjectiveOtitis media is a recognized cause of significant hearing loss, particularly in developing countries. This study aimed to investigate the relationship between otitis media and hearing loss in Chinese adults aged 18 years and older.MethodsThe survey was based on WHO Ear and Hearing Disorders Survey Protocol and 36,783 adults at the ages between 18 years and above were selected in this study. Trained local examiners performed pure tone audiometry to screen people with hearing loss, and those who were screened positively for hearing loss were referred to audiologists to make final diagnosis. All participants underwent clinical ENT check-up and otoscopic examination by doctors trained in ENT. Each participant was assigned a single middle ear diagnosis. Diagnoses were assigned as per the WHO classification of ear and hearing disorders.ResultsLogistic regressions showed that higher prevalence of hearing loss was found in participants with otitis media, with an unadjusted odds ratio of 5.67 (95%CI: 4.66, 6.90). The next two models (Model 2–3) had slight impact on ORs. The interaction of residency and otitis media was statistically significant (OR = 1.70, 95%CI = 1.15, 2.53); otitis media patients in rural areas had higher risk of hearing loss. However, this interaction became not significant in 65 years old and above participants.ConclusionsOtitis media was associated with the risk of hearing loss. Compared with urban patients with otitis media, rural patients have the higher risk of hearing loss. Action to reduce the risk of hearing loss in otitis media will require attention to rural-urban disparities.

Abstract Background Although previous clinical studies suggest possible benefits of acupuncture for knee osteoarthritis (KOA), the value of acupuncture at sensitized points is uncertain. We aimed to preliminarily assess the feasibility of performing a definitive randomized controlled trial to explore the effectiveness of acupuncture for KOA with highly sensitized acupoints. Methods In this randomized, single-blind, parallel, pilot trial, 36 participants with KOA were randomly assigned to receive acupuncture at highly sensitized acupoints (high-sensitization group) or at low/non-sensitized points (low/non-sensitization group) by a computer-generated random sequence. Both groups received three treatment sessions per week for four consecutive weeks (12 sessions in total). Assessments were performed at screening and at 4, 8, 12, and 16 weeks after randomization. Primary feasibility outcomes were patient recruitment, retention rate, and adherence to group treatment. Secondary outcomes included the change of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score from baseline to 16 weeks, the change of Short Form (SF)-12 health survey score, and safety outcomes. Results Patient recruitment of 36 patients took 2 months, achieving the recruitment target. Retention rates were similar between the treatment groups, 14 (77.8%) patients in the high-sensitization group completed the 16-week follow-up and compared to 14 (77.8%) patients in low/non-sensitization group, but the result was lower than expected. All patients received at least ten treatment sessions in total. The WOMAC total score and the pain, stiffness, and physical function score in the high-sensitization group were lower or very close to those in the control group at each assessment point. Similar results were observed on quality of life. No adverse events occurred. Conclusion This trial has presented preliminary data on the feasibility of conducting a large trial to test the effectiveness of acupuncture at sensitized points in KOA patients. Trial registration ClinicalTrials.gov, NCT03008668 . Registered on 26 December 2016—retrospectively registered.

Abstract Background Improving education level was evidenced to decrease the risk of schizophrenia, but whether this strength of education role depends on gender is not. This study aimed to investigate whether there was gender difference in the association between education and schizophrenia in Chinese adults. Methods Data were obtained from the Second China National Sample Survey on Disability in 2006, including 1,909,205 participants aged 18 years or older. Schizophrenia was ascertained according to the International Statistical Classification of Diseases, Tenth Revision. Logistics regression models were fitted to examine the combined effect of gender and education on schizophrenia. Results The lifetime prevalence of schizophrenia in female groups was higher than in male groups, with 0.44% (95%CI: 0.42–0.45%) and 0.36% (95%CI: 0.35–0.37%), respectively. Compared with schizophrenia male patients, more females with schizophrenia experienced severe or extreme difficulty in understanding and communicating. However, more males with schizophrenia suffered from severe or extreme difficulty in the function of daily activities. The combined effect of education and schizophrenia was statistically significant, indicating that, as the level of education increased, schizophrenia risk of females decreased faster than the risk of males. Conclusions This study showed that additional years of education associated with lower risk of schizophrenia, and this association was stronger in females than in males. As education elevated, the risk of schizophrenia decreased more for women than for men. The findings indicate that improving education level may have an effect on reducing the gender disparities in mental health of China. Actions to prevent schizophrenia and address its gender disparities will require attention to the improving educational opportunities.

Abstract Background Zheng Qing Feng Tong Ning (ZQFTN) is a sinomenine (SIN) preparation that has been used in clinical practice. Our study aimed to assess the methodological and reporting quality of meta-analyses on the Chinese herbal formula ZQFTN for the treatment of rheumatoid arthritis (RA). Methods Systematic searches were carried out with the 5 following electronic databases from inception to July 2019: China National Knowledge Infrastructure (CNKI), Wanfang, VIP database for Chinese technical periodicals (VIP), Cochrane Library and PubMed. The quality of the methodology and reporting was measured with the assessment of multiple systematic reviews 2 (AMSTAR 2) scale, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Results Eight studies were identified. Among the 16 items of the AMSTAR 2 scale, four items were optimally reported (“Y” =100% of the items), and another four items were poorly reported (“Y” =0% of the items). Only 2 studies received a good overall score (“Y” ≥50% of the items). Regarding the PRISMA statement, the scores of 5 studies were lower than the average score (17.69), indicating that the quality of the reports was very low. In terms of the GRADE, none of the 61 results were of high quality (0.0%). Fifteen results were of medium quality (25%), 34 were of low quality (55%), and 12 were of very low quality (20%). Among the five downgrading factors, deviation risk (n = 61, 100%) was the most common downgrading factor, followed by inconsistency (n = 30, 50%), publication bias (n = 17, 28%), inaccuracy (n = 11, 18%) and indirectness (n = 0, 0%). Conclusions The methodological and reporting quality of the meta-analyses and systematic reviews in the included studies are less than optimal, and researchers should undergo additional training and follow the AMSTAR 2 scale, PRISMA statement and GRADE to design high-quality studies in the future.

Introduction: Adolescents are at high risk for negative health outcomes associated with high-risk sexual behaviors (HRSBs), and researchers have attempted to identify factors that influence such behavior so that meaningful prevention and intervention programs may be developed. Aim: To investigate the associations between CSA experience and HRSBs in Chinese youth aged 15-24 years old. Methods: Data were from the Survey of Youth Access to Reproductive Health in China, a national sample survey conducted in 2009. The following behaviors were classified as HRSBs: condom non-use during the first sexual experience, having sex with multiple partners, taking part in casual sex, engaging in commercial sex, taking part in anal sex, and condom non-use during the most recent sexual encounter. Differences in HRSBs between the sexes were examined. The χ2 test and binary logistic regression were used to estimate the association between CSA experience and HRSBs. Main Outcome Measure: The sexual behaviors of condom non-use during the first sexual experience, sexual activity with multiple partners, taking part in casual sex, engaging in commercial sex (defined as paying or receiving money/gifts in exchange for sex), taking part in anal sex, and condom non-using during the most recent sexual intercourse were classified as HRSBs. Results: 4,974 Sexually active youth were included in this study, 150 respondents (3.0%) reported CSA experience, and 3,950 (79.4%) sexually active youth had engaged in at least 1 type of HRSBs. The odds of having sex with multiple partners (odds ratio [OR] 4.31, 95% CI 3.07–6.07), casual sex (OR 3.65, 95% CI 2.55–5.24), commercial sex (OR 7.43, 95% CI 5.13–10.77), anal copulation (OR 2.54, 95% CI 1.57–4.12), or any of these HRSBs (OR 5.02, 95% CI 2.33–10.80) were significantly higher among those who had experienced CSA. There was a gender-specific difference in the associations of CSA with different types of HRSBs. Conclusion: Sexual abuse experience in childhood is highly correlated with HRSBs among Chinese youth, and the pattern of this association differs between males and females. Public knowledge and social assistance systems needs to be improved for children and youth in China. Gender-specific counter-measures may be more efficient for interventions.Ding R, Wen X, He P, et al. Association Between Childhood and Adolescent Sexual Abuse Experiences and High-Risk Sexual Behaviors Among Chinese Youth. Sex Med 2018;6:273–281. Key Words: Childhood Sexual Abuse, High-Risk Sexual Behaviors, Youth, China

Near-infrared (NIR) laser-induced phototherapy through NIR agents has demonstrated the great potential for cancer therapy. However, insufficient tumor killing due to the nonuniform heat or cytotoxic singlet oxygen (1O2) distribution over tumors from phototherapy results in tumor recurrence and inferior outcomes. To achieve high tumor killing efficacy, one of the solutions is to employ the combinational treatment of phototherapy with other modalities, especially with chemotherapeutic agents. In this paper, a simple and effective multimodal therapeutic system was designed via combining chemotherapy, photothermal therapy (PTT), and photodynamic therapy (PDT) to achieve the polytherapy of malignant glioma which is one of the most aggressive tumors in the brain. IR-780 (IR780) dye-labeled tube-forming peptoids (PepIR) were synthesized and self-assembled into crystalline nanotubes (PepIR nanotubes). These PepIR nanotubes showed an excellent efficacy for PDT/PTT because the IR780 photosensitizers were effectively packed and separated from each other within crystalline nanotubes by tuning IR780 density; thus, a self-quenching of these IR780 molecules was significantly reduced. Moreover, the efficient DOX loading achieved due to the nanotube large surface area contributed to an efficient and synergistic chemotherapy against glioma cells. Given the unique properties of peptoids and peptoid nanotubes, we believe that the developed multimodal DOX-loaded PepIR nanotubes in this work offer great promises for future glioma therapy in clinic.

Objective: To investigate the anti-angiogenesis mechanisms and key targets of total saponins of Panax japonicus (TSPJ) in the treatment of rheumatoid arthritis (RA).Methods: RStudio3.6.1 software was used to obtain differentially expressed genes (DEGs) by analyzing the differences in gene expression in the synovial tissue of RA and to predict the potential targets of active compounds from TSPJ by the PharmMapper and SwissTargetPrediction databases. We evaluated the overlapping genes by intersectional analysis of DEGs and drug targets. Based on the overlapping genes, we used Cytoscape 3.7.2 software to construct a protein–protein interactions (PPI) network and applied Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis to determine the mechanisms of the treatment. Finally, the correlations with angiogenesis-related genes were explored. Collagen-induced arthritis (CIA) model was established and treated with different doses of TSPJ. The manifestations of CIA were determined by evaluation of arthritis index and histology score. Serum levels of vascular endothelial growth factor (VEGF) and the hypoxia-inducible factor 1 (HIF-1) were tested by ELISA. The mRNA levels of IL-1β and IL-17A were detected by real time-quantitative PCR.Results: Altogether, 2670 DEGs were obtained by differential analysis, and 371 drug targets were predicted for four active components (Araloside A, Chikusetsusaponin IVa, Ginsenoside Rg2, and Ginsenoside Ro). A total of 52 overlapping genes were included in the PPI network and the KEGG analysis. However, only 41 genes in the PPI network had protein interactions. The results of the KEGG enrichment analysis were all related to angiogenesis, including VEGF and HIF-1 signaling pathways. Seven genes with negative correlations and 16 genes with positive correlations were obtained by correlational analysis of DEGs in the VEGF and HIF-1 signaling pathways. SRC proto-oncogene, nonreceptor tyrosine kinase (SRC), and the signal transducer and activator of transcription 3 (STAT 3) had a higher value of degree and showed a significant correlation in the pathways; they were regarded as key targets. Compared with the model group, TSPJ significantly relieved the symptoms and decreased the expression of VEGFA, HIF-1α, IL-1β, and IL-17A in serum or spleens of CIA mice.Conclusion: In the current study, we found that antiangiogenesis is one of the effective strategies of TSPJ against RA; SRC and STAT 3 may be the key targets of TSPJ acting on the VEGF and HIF-1 signaling pathways, which will provide new insight into the treatment of RA by inhibiting inflammation and angiogenesis.

BackgroundYouth with disability contribute to a high burden of disease but are often neglected. This study aims to estimate the prevalence of disability and its association with poverty among Chinese youth aged 15-24 years.MethodsData were obtained from a nationally representative population-based cross-sectional survey in 2006 and its follow-up investigations from 2007 to 2013 in 31 provinces of mainland China. A total of 357 856 non-institutionalized youth at age of 15-24 years were investigated. Population weighted numbers and prevalence rates with 95% CI of various types and causes of disabilities for the overall youth were estimated where appropriate. Univariate and multivariate logistic regressions were used to identify the association between poverty and each type of and cause-specific disability.ResultsA weighted number of 3 633 838 youth were living with disability in China, with a prevalence rate of 19.7 per thousand Chinese youth. Youth living in poor households were 3.84 times more likely to be with disability than those living in affluent households (95% CI: 3.56-4.14). Associations were similar for most types of and cause-specific disabilities. Among youth with disability, those from poor households had less healthcare service use (OR: 0.71, 95% CI: 0.61-0.82) than those from affluent households.ConclusionA significant number of Chinese youth were living with disability, and poverty is significant associated with the disability among youth. Investment in health and disability prevention are essential to the development of youth, as well as their families and communities.

Along with the excessive use of antibiotics, the emergence and spread of multidrug-resistant bacteria has become a public health problem and a great challenge vis-à-vis the control and treatment of bacterial infections. As the natural predators of bacteria, phages have reattracted researchers’ attentions. Phage therapy is regarded as one of the most promising alternative strategies to fight pathogens in the post-antibiotic era. Recently, genetic and chemical engineering methods have been applied in phage modification. Among them, genetic engineering includes the expression of toxin proteins, modification of host recognition receptors, and interference of bacterial phage-resistant pathways. Chemical engineering, meanwhile, involves crosslinking phage coats with antibiotics, antimicrobial peptides, heavy metal ions, and photothermic matters. Those advances greatly expand the host range of phages and increase their bactericidal efficiency, which sheds light on the application of phage therapy in the control of multidrug-resistant pathogens. This review reports on engineered phages through genetic and chemical approaches. Further, we present the obstacles that this novel antimicrobial has incurred.

Hearing loss is the most common sensory impairment, but limited studies focused on the association of socioeconomic status (SES) with hearing loss among adults of working age. This paper aimed to fill this gap among Chinese adults. We obtained data from Ear and Hearing Disorder Survey conducted in four provinces of China in 2014-2015. The survey was based on WHO Ear and Hearing Disorders Survey Protocol and 25,860 adults aged 25 to 59 years were selected in this study. Trained local examiners performed pure tone audiometry to screen people with hearing loss, and those who were screened positively for hearing loss were referred to audiologists to make final diagnosis. SES was measured by occupation, education and income. Results show after adjusting for SES measures and covariates, in urban areas, compared with white-collar workers, blue-collar workers and the unemployed were more likely to have hearing loss, with an odds ratio of 1.2 (95%CI: 1.0, 1.3) and 1.2 (95%CI: 1.0, 1.4), respectively. Compared with people with education of senior high school or above, those with junior high school, primary school and illiteracy had 1.6 (95%CI: 1.4, 1.8), 2.1(95%CI: 1.7, 2.5) and 2.6 (95%CI: 1.9, 3.7) times as likely to have hearing loss, respectively. In rural areas, the unemployed had 1.5 (95%CI: 1.0, 2.3) times the risk of hearing loss compared with white-collar workers, and illiterates had 1.6 (95%CI: 1.6, 2.1) times the risk of hearing loss compared with people with education of senior high school or above, after SES variables and covariates were taken into considerations. Income was not significantly associated with hearing loss in urban and rural areas. In conclusion, SES, in the form of occupation and education, was associated with hearing loss among working-aged population, and further studies are needed to explore the mechanism of such association.