Comparison of Short-term and Three-year Oncological Outcomes Between Robotic and Laparoscopic Gastrectomy for Gastric Cancer: A Large Multicenter Cohort Study.

OBJECTIVE: To compare the short-term and long-term outcomes between robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for gastric cancer. BACKGROUND: The clinical outcomes of RG over LG have not yet been effectively demonstrated. METHODS: This retrospective cohort study included 3599 patients with gastric cancer who underwent radical gastrectomy at eight high-volume hospitals in China from January 2015 to June 2019. Propensity score matching was performed between patients who received RG and LG. The primary end point was 3-year disease-free survival (DFS). RESULTS: After 1:1 propensity score matching, 1034 pairs of patients were enrolled in a balanced cohort for further analysis. The 3-year DFS in the RG and LG was 83.7% and 83.1% ( P =0.745), respectively, and the 3-year overall survival was 85.2% and 84.4%, respectively ( P =0.647). During 3 years of follow-up, 154 patients in the RG and LG groups relapsed (cumulative incidence of recurrence: 15.0% vs 15.0%, P =0.988). There was no significant difference in the recurrence sites between the 2 groups (all P >0.05). Sensitivity analysis showed that RG had comparable 3-year DFS (77.4% vs 76.7%, P =0.745) and overall survival (79.7% vs 78.4%, P =0.577) to LG in patients with advanced (pathologic T2-4a) disease, and the recurrence pattern within 3 years was also similar between the 2 groups (all P >0.05). RG had less intraoperative blood loss, lower conversion rate, and shorter hospital stays than LG (all P >0.05). CONCLUSIONS: For resectable gastric cancer, including advanced cases, RG is a safe approach with comparable 3-year oncological outcomes to LG when performed by experienced surgeons.

Long-term oncological outcomes of robotic versus laparoscopic gastrectomy for gastric cancer: multicentre cohort study.

BACKGROUND: The aim of this multicentre cohort study was to compare the long-term oncological outcomes of robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for patients with gastric cancer. METHODS: Patients with gastric cancer who underwent radical gastrectomy by robotic or laparoscopic approaches from 1 March 2010 to 31 December 2018 at 10 high-volume centres in China were selected from institutional databases. Patients receiving RG were matched 1 : 1 by propensity score with patients undergoing LG. The primary outcome was 3-year disease-free survival. Secondary outcomes were overall survival and disease recurrence. RESULTS: Some 2055 patients who underwent RG and 4309 patients who had LG were included. The propensity score-matched cohort comprised 2026 RGs and 2026 LGs. Median follow-up was 41 (i.q.r. 39-58) months for the RG group and 39 (38-56) months for the LG group. The 3-year disease-free survival rates were 80.8% in the RG group and 79.5% in the LG group (log rank P = 0.240; HR 0.92, 95% c.i. 0.80 to 1.06; P = 0.242). Three-year OS rates were 83.9 and 81.8% respectively (log rank P = 0.068; HR 0.87, 0.75 to 1.01; P = 0.068) and the cumulative incidence of recurrence over 3 years was 19.3% versus 20.8% (HR 0.95, 0.88 to 1.03; P = 0.219), with no difference between groups. CONCLUSION: RG and LG in patients with gastric cancer are associated with comparable disease-free and overall survival.

Disposable Plastic Waste and Associated Antioxidants and Plasticizers Generated by Online Food Delivery Services in China: National Mass Inventories and Environmental Release.

China's online food delivery (OFD) services consume enormous amounts of disposable plastics. Here, we investigated and modeled the national mass inventories and environmental release of plastics and chemical additives in the plastic. The extra-tree regression identified six key descriptors in determining OFD sales in Chinese cities. Approximately 847 kt of OFD plastic waste was generated in 2021 (per capita 1.10 kg/yr in the megacities and 0.39 kg/yr in other cities). Various additives were extensively detected, with geomean concentrations of 140.96, 4.76, and 0.25 µg/g for ∑8antioxidants, ∑21phthalates, and bisphenol A (BPA), respectively. The estimated mass inventory of these additives in the OFD plastics was 164.7 t, of which 51.1 t was released into the atmosphere via incineration plants and 51.0 t was landfilled. The incineration also released 8.07 t of polycyclic aromatic hydrocarbons and 39.1 kt of particulate matter into the atmosphere. Takeout food may increase the dietary intake of phthalates and BPA by 30% to 50% and raise concerns about considerable exposure to antioxidant transformation products. This study provides profound environmental implications for plastic waste in the Chinese OFD industry. We call for a sustainable circular economy action plan for waste disposal, but mitigating the hazardous substance content and their emissions is urgent.

NDC1 promotes hepatocellular carcinoma tumorigenesis by targeting BCAP31 to activate PI3K/AKT signaling.

Hepatocellular carcinoma (HCC) is among the world's worst malignancies. Nuclear division cycle 1 (NDC1) is an essential membrane-integral nucleoporin, found in this study to be significantly increased in primary HCC. A multivariate analysis revealed that higher NDC1 expression was linked to worse outcome in HCC patients. Mouse xenograft tumors overexpressing NDC1 grew rapidly, and HCC cells overexpressing NDC1 showed enhanced proliferation, invasion, and migration in vitro. In contrast, knocking down NDC1 had the opposite effects in vitro. Furthermore, co-immunoprecipitation and liquid chromatograph mass spectrometer analyses revealed that NDC1 activated PI3K/AKT signaling by interacting with BCAP31. In summary, NDC1 and BCAP31 cooperate to promote the PI3K/AKT pathway, which is essential for HCC carcinogenesis. This suggests that NDC1 is predictive of prognosis in HCC.

Contribution of small airway inflammation to the development of COPD.

BACKGROUND: Little attention has been paid to the pathophysiological changes in the natural history of chronic obstructive pulmonary disease (COPD). The destructions of the small airways were visualized on thoracic micro-computed tomography scan. We investigated whether small airway inflammation (SAI) was the risk for the development of COPD. METHODS: A total of 1062 patients were enrolled and analyzed in the study. The partitioned airway inflammation was determined by exhaled nitric oxide (NO) of FnNO, FeNO50, FeNO200, and calculated CaNOdual. Both FeNO200 and CaNOdual were compared to detect the promising predictor for peripheral airway/alveolar inflammation in COPD. The correlation between exhaled NO and white cell classification was evaluated to determine the inflammation type during the development of COPD. RESULTS: Exhaled NO levels (FnNO, FeNO50, FeNO200, and CaNOdual) were the highest in the COPD group compared with all other groups. Furthermore, compared with controls, exhaled NO levels (FeNO50, FeNO200, and CaNOdual) were also significantly higher in the emphysema, chronic bronchitis, and smoking groups. FeNO200 was found to be a promising predictor for peripheral airway/alveolar inflammation (area under the curve [AUC] of the receiver operating characteristic [ROC] curve, area under the curve [AUC] = 0.841) compared with CaNOdual (AUC ROC = 0.707) in COPD. FeNO200 was the main risk factor (adjusted odds ratio, 2.191; 95% CI, 1.797-2.671; p = 0.002) for the development of COPD. The blood eosinophil and basophil levels were correlated with FeNO50 and FeNO200. CONCLUSION: The complete airway inflammations were shown in COPD, whereas SAI was the main risk factor for the development of COPD, which might relate to eosinophil and basophil levels.

Robotic Gastrectomy Versus Laparoscopic Gastrectomy for Gastric Cancer: A Multicenter Cohort Study of 5402 Patients in China.

OBJECTIVE: A large-scale multicenter retrospective cohort study was conducted to compare the short- and long-term outcomes of robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for gastric cancer. SUMMARY OF BACKGROUND DATA: RG is being increasingly used worldwide, but data from large-scale multicenter studies on the short- and long-term oncologic outcomes of RG versus LG are limited. The potential benefits of RG compared with LG for gastric cancer remain controversial. METHODS: Data from eligible patients who underwent RG or LG for gastric cancer of 11 experienced surgeons from 7 centers in China between March 2010 and October 2019 were collected. The RG group was matched 1:1 with the LG group by using propensity score matching. The primary outcome was postoperative complications. RESULTS: After propensity score matching, a well-balanced cohort of 3552 patients was included for further analysis. The occurrence of overall complications (12.6% vs 15.2%, P = 0.023) was lower in the RG group than in the LG group. RG was associated with less blood loss (126.8 vs 142.5 mL, P < 0.001) and more retrieved lymph nodes in total (32.5 vs 30.7, P < 0.001) and in suprapancreatic areas (13.3 vs 11.6, P < 0.001).The long-term oncological outcomes were comparable between the two groups. CONCLUSIONS: The results of this multicenter study demonstrate that RG is a safe and effective treatment for gastric cancer when performed by experienced surgeons, although longer operation time and higher costs are still concerns about RG. This study provides evidence suggesting that RG may represent an alternative surgical treatment to LG.

Comparison of the efficacy and safety of rivaroxaban and low-molecular-weight heparin in Chinese lung cancer patients with nonhigh-risk pulmonary embolism.

BACKGROUND: Data that guide selection of differing anticoagulant regimens for specific cancer-associated venous thromboembolism (VTE) are lacking. We aimed to compare the efficacy and safety of rivaroxaban and low-molecular-weight heparin (LMWH) against nonhigh-risk pulmonary embolism (PE) in Chinese lung cancer patients. METHODS: Four hundred forty-six Chinese lung cancer patients with nonhigh-risk PE who initiated treatment with rivaroxaban or LMWH were identified from Zhongshan Hospital database from 2016 to 2020. The primary outcomes were the composite event of VTE recurrence or major bleeding, and all-cause mortality. The secondary outcomes were VTE recurrence, major bleeding and clinically relevant non-major bleeding (CRNMB). Propensity score matching was used to balance baseline covariates. We conducted sensitivity analysis by stabilized inverse probability of treatment weighting and competing risk analysis by a Fine and Gray subdistribution hazard model. RESULTS: In propensity score-matched cohorts, rivaroxaban was similar to LMWH in the risks of the composite outcome (hazard ratio (HR), 0.73; 95% confidence interval (CI), 0.45-1.21; P = 0.22), VTE recurrence (HR, 0.69; 95% CI, 0.36-1.34; P = 0.28), major bleeding (HR, 0.79; 95% CI, 0.37-1.68; P = 0.54) and CRNMB (HR, 1.13; 95% CI, 0.62-2.09; P = 0.69). All-cause mortality was significantly lower in rivaroxaban group than LMWH group (HR, 0.52; 95% CI, 0.36-0.75; P < 0.001). The primary and secondary outcomes favored rivaroxaban over LMWH in all the subgroups expect for central PE and intermediate-risk PE. The sensitivity analysis yielded similar results, and competing risk analysis was in accordance with the primary findings. CONCLUSIONS: Rivaroxaban might be a promising alternative to LMWH as initial treatment for nonhigh-risk PE in lung cancer patients.

Regulator of G protein signaling protein 6 alleviates acute lung injury by inhibiting inflammation and promoting cell self-renewal in mice.

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a disease with high mortality and morbidity. Regulator of G protein signaling protein 6 (RGS6), identified as a tumor suppressor gene, has received increasing attention owing to its close relationship with oxidative stress and inflammation. However, the association between ARDS and RGS6 has not been reported. METHODS: Congruously regulated G protein-coupled receptor (GPCR)-related genes and differentially expressed genes (DEGs) in an acute lung injury (ALI) model were identified, and functional enrichment analysis was conducted. In an in vivo study, the effects of RGS6 knockout were studied in a mouse model of ALI induced by lipopolysaccharide (LPS). HE staining, ELISA, and immunohistochemistry were used to evaluate pathological changes and the degree of inflammation. In vitro, qRT‒PCR, immunofluorescence staining, and western blotting were used to determine the dynamic changes in RGS6 expression in cells. The RGS6 overexpression plasmid was constructed for transfection. qRT‒PCR was used to assess proinflammatory factors transcription. Western blotting and flow cytometry were used to evaluate apoptosis and reactive oxygen species (ROS) production. Organoid culture was used to assess the stemness and self-renewal capacity of alveolar epithelial type II cells (AEC2s). RESULTS: A total of 110 congruously regulated genes (61 congruously upregulated and 49 congruously downregulated genes) were identified among GPCR-related genes and DEGs in the ALI model. RGS6 was downregulated in vivo and in vitro in the ALI model. RGS6 was expressed in the cytoplasm and accumulated in the nucleus after LPS stimulation. Compared with the control group, we found higher mortality, more pronounced body weight changes, more serious pulmonary edema and pathological damage, and more neutrophil infiltration in the RGS6 knockout group upon LPS stimulation in vivo. Moreover, AEC2s loss was significantly increased upon RGS6 knockout. Organoid culture assays showed slower alveolar organoid formation, fewer alveolar organoids, and impaired development of new structures after passaging upon RGS6 knockout. In addition, RGS6 overexpression decreased ROS production as well as proinflammatory factor transcription in macrophages and decreased apoptosis in epithelial cells. CONCLUSIONS: RGS6 plays a protective role in ALI not only in early inflammatory responses but also in endogenous lung stem cell regeneration.

Particle size-resolved emission characteristics of complex polycyclic aromatic hydrocarbon (PAH) mixtures from various combustion sources.

Combustion of domestic solid fuels is a significant source of polycyclic aromatic hydrocarbons (PAHs). Some oxygenated PAHs (o-PAHs) and PAHs with molecular weight of 302 (MW302 PAHs) are more toxic than the traditional 16 priority PAHs, whereas their emissions were much less elucidated. This study characterized the size-dependent emissions of parent PAHs (p-PAHs), o-PAHs, and MW302 PAHs from various combustion sources. The estimated emission factors (eEFs) from biomass burning sources were highest for most of the PAHs (391-8928 µg/kg), much higher than that of anthracite coal combustion (43.0-145 µg/kg), both which were operated in an indoor stove. Cigarette smoking had a high eEF of o-PAHs (240 ng/g). MW302 PAHs were not found in the emissions of smoking, cooking, and vehicular exhausts. Particle-size distributions of PAHs were compound- and source-dependent, and the tendency to associate with smaller particles was observed especially in biomass burning and cigarette smoking sources. Furthermore, the inter-source differences in PAH eEFs were associated with their dominance in fine particles. PAH composition profiles also varied with the particle size, showing increasing contributions of large-molecule PAHs with decreasing sizes in most cases. The size distributions of p-PAHs are much more significantly dependent on their n-octanol/air partition coefficients and vapor pressures than those of o-PAHs, suggesting differences in mechanisms governing their distributions. Several molecular diagnostic ratios (MDRs), including two based on MW302 PAHs, specific to these combustion scenarios were identified. However, the MDRs within some sources are also strongly size-dependent, providing a new explanation for the uncertainty in their application for source identification of PAHs. This work also highlights the necessity for understanding the size-resolved atmospheric behaviors and fate of PAHs after their emission.

Improved optical camera communication systems using a freeform lens.

Optical camera communication (OCC) systems, which utilize image sensors embedded in commercial-off-the-shelf devices to detect time and spatial variations in light intensity for enabling data communications, have stirred up researchers' interest. Compared to a direct OCC system whose maximum data rate is strongly determined by the LED source size, a reflected OCC system can break that limitation since the camera captures the light rays reflecting off an observation plane (e.g., a wall) instead of those light rays directly emanated from the light source. However, the low signal-to-noise ratio caused by the non-uniform irradiance distribution produced by LED luminaire on the observation plane in current reflected OCC systems cannot be avoided, hence low complexity and accurate demodulation are hard to achieve. In this paper, we present a FreeOCC system, which employs a dedicatedly tailored freeform lens to precisely control the propagation of modulated light. A desired uniform rectangular illumination is produced on the observation plane by the freeform lens, yielding a uniform grayscale distribution within the received frame captured by the camera in the proposed FreeOCC system. Then, the received signal can be easily demodulated with high accuracy by a simple thresholding scheme. A prototype of the FreeOCC system demonstrates the high performance of the proposed system, and two pulse amplitude modulation schemes (4-order and 8-order) are performed. By using the freeform lens, the packet reception rate is increased by 35% and 32%, respectively; the bit error rate is decreased by 72% and 59%, respectively, at a transmission frequency of 5 kHz. The results clearly show that the FreeOCC system outperforms the common reflected OCC system.

Characterization of airborne particles and cytotoxicity to a human lung cancer cell line in Guangzhou, China.

Air pollution by airborne particles is a serious health problem worldwide. The present study was aimed at investigating the concentrations and composition of total suspended particles (TSPs) and PM2.5 at various industrial/commercial sites of Guangzhou, a megacity of Southern China. Major and trace elements, ions and carbonaceous fraction were determined and main components were calculated. In addition, in order to assess the potential toxic on the respiratory system of these PM, cytotoxicity of size-fractionated particles (PM10-5.6, PM5.6-3.3, PM3.3-1.1, PM1.1-0.43) for a human lung cancer cell line (A549) was also investigated. Correlations between PM constituents and toxicity were assessed. Median levels of TSPs and PM2.5 in industrial/commercial sites were 206 and 57.7 µg/m3, respectively. Nickel, Cu, Mo, Mn, Pb, and Ti were the most abundant metals in TSPs and PM2.5. Industrial activities and coal combustion were the most important sources of carbonaceous particles in the zone. MTT assays showed that PM10-5.6 and PM1.1-0.43 had the highest and the lowest cytotoxicity to A549 cell lines, respectively. Inhalable particles around the manufacturing of metal facilities and formal waste treatment plants showed a high cytotoxicity to A549 cell lines. In general terms, no significant correlations were found between main components of PM and toxicity. However, W showed a significant correlation with cell viability.

Legacy and Currently Used Organic Contaminants in Human Hair and Hand Wipes of Female E-Waste Dismantling Workers and Workplace Dust in South China.

Legacy organic contaminants, such as polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs), and several currently used organic contaminants, such as novel brominated retardants (NBFRs), organophosphate flame retardants (OPFRs), and Dechlorane Plus (DPs), were measured in the segmented hair and hand wipes of e-waste dismantling workers and in the dust from their workplace in an e-waste recycling site in South China to assess the accumulation and sources of organic contaminants in the hair shaft. The median concentrations of DPs, PBDEs, NBFRs, PCBs and OPFRs in hair samples were 23.5, 154, 156, 349, and 371 ng/g, respectively. A linear increase in organic contaminant concentrations was found along the hair shaft, with significant differences among each segment, while the age-related patterns were similar among the 7 hair segments. A linear relationship was found between the accumulation rates and the log KOW, indicating that the accumulation rates of organic contaminants along the hair shaft decreased with increasing log KOW values. Enantiomer fraction (EF) values of PCB-132 in distal segments were close to those in dust and air, while EFs in proximal segments were close to those in serum. The contributions of PCBs from external sources to hair increased with the distance from the scalp of hair segments, from 67.8% in 0-3 cm segments to 95.9% in 18-21 cm segments.

In vitro oral and inhalation bioaccessibility of hydrophobic organic contaminants (HOCs) in airborne particles and influence of relevant parameters.

The bioaccessibility of environmental contaminants has been assessed widely using in vitro simulation; however, the physiological parameters used vary greatly. In this study, we assessed the influence of various physiological parameters and food material on the oral or inhalation bioaccessibility of PM2.5-bound hydrophobic organic contaminants (HOCs), including halogenated flame retardants (HFRs), organophosphorus flame retardants (OPFRs), and polycyclic aromatic hydrocarbons (PAHs). The results showed that physiologically based pepsin and pancreatin have a small influence on the HOC liberation from particles. The bioaccessibility increased dramatically when the bile salt concentrations exceeding the critical micelle concentration, and application of porcine bile salts probably lead to underestimated bioaccessibility. Protein and carbohydrates significantly increased the bioaccessibility of most HOCs, while a significant bioaccessibility reduction was caused by green tea. The bioaccessibility of most HOCs was not promoted by liquor under normal physiological condition, but was significantly promoted under fast condition. Long residence time of PM2.5 in the lung (15 days) would result in higher mobilization of PAHs into the lung fluid than short time (one day). However, the inverse time-dependence for OPFRs suggests degradation in the lung fluid. A mechanism of hydrolysis of organophosphorus ester is hypothesized, and the half lives ranged from 17 to 90 days.

Semivolatile Organic Compounds (SOCs) in Fine Particulate Matter (PM2.5) during Clear, Fog, and Haze Episodes in Winter in Beijing, China.

Few efforts have been made to elucidate the influence of weather conditions on the fate of semivolatile organic compounds (SOCs). Here, daily fine particulate matter (PM2.5) during clear, haze, and fog episodes collected in the winter in Beijing, China was analyzed for polycyclic aromatic hydrocarbons (PAHs), brominated flame retardants (BFRs), and organophosphate flame retardants (OPFRs). The total concentrations of PAHs, OPFRs, and BFRs had medians of 45.1 ng/m3 and 1347 and 46.7 pg/m3, respectively. The temporal pattern for PAH concentrations was largely dependent on coal combustion for residential heating. OPFR compositions that change during colder period were related to enhanced indoor emissions due to heating. The mean concentrations of SOCs during haze and fog days were 2-10 times higher than those during clear days. We found that BFRs with lower octanol and air partition coefficients tended to increase during haze and fog episodes, be removed from PM2.5 during clear episodes, or both. For PAHs and OPFRs, pollutants that are more recalcitrant to degradation were prone to accumulate during haze and fog days. The potential source contribution function (PSCF) model indicated that southern and eastern cities were major source regions of SOCs at this site.

Organophosphorus esters (OPEs) in PM2.5 in urban and e-waste recycling regions in southern China: concentrations, sources, and emissions.

Organophosphate esters (OPEs) are novel ubiquitous contaminants that are attracting growing concern, but their emissions into the environment are still poorly understood. In this study, 12 OPEs were measured in fine particulate matter (PM2.5) at 20 industrial sites in an urban region and four e-waste recycling facilities in a rural region in southern China. There was no significant difference in the concentrations of ∑OPEs between the urban region (519-62,747 pg/m3, median = 2854 pg/m3) and the rural e-waste region (775-13,823 pg/m3, 3321 pg/m3). High OPE concentrations in urban PM2.5 were generally associated with the electrical, electronic, plastic, and chemical industries. There were no significant correlations between most OPEs in these two regions, suggesting different emission mechanisms. The average emissions of ∑OPEs estimated using a simplified dispersion model were 73.0 kg/yr from the urban industrial point sources and 33.2 kg/yr from the e-waste recycling facilities. The estimated emission inventory from industrial activities in the whole city (3228-4452 kg/yr) was approximately 30-fold higher than that from the e-waste recycling (133 kg/yr) facilities because urban region has a much larger industrial scale. To the best of our knowledge, this is the first effort to model the emissions of OPEs from industrial and e-waste recycling activities to the atmosphere.

Brominated flame retardant (BFRs) and Dechlorane Plus (DP) in paired human serum and segmented hair.

Brominated flame retardants (BFRs) and Dechlorane Plus (DP) were measured in both human hair and paired serum samples from a cohort of university students in South China. Segmental analysis was conducted to explore gender difference and the relationships between the hair and serum. The concentrations of total PBDEs in the hair and serum samples were in a range of 0.28-34.1ng/g dry weight (dw) and 0.16-156ng/g lipid weight (lw), respectively. Concentrations of ∑DPs (sum of the syn-DP and anti-DP isomers) in all hair samples ranged from nd-5.45ng/g dry weight. Concentrations of most PBDEs and decabromodiphenylethane (DBDPE) in distal segments (5-10cm from the scalp) were higher than those in the proximal segments (0-5cm from the scalp) (t-test, p < 0.05), which could be due to the longer exposure time of distal segments. The proximal segments exhibited a unique congener profile, more close to that in the serum rather than the distal segments of hair. An obvious gender difference was found in the levels of ∑PBDEs using integrated hair samples, while the difference disappeared when considering alone the proximal segments of hair (0-5cm from scalp) for both genders. This paper provides supplement to the current knowledge on sources of BFRs and DPs in hair and declares the importance of segmental analysis.

Cause-specific mortality for 240 causes in China during 1990-2013: a systematic subnational analysis for the Global Burden of Disease Study 2013.

BACKGROUND: China has experienced a remarkable epidemiological and demographic transition during the past three decades. Far less is known about this transition at the subnational level. Timely and accurate assessment of the provincial burden of disease is needed for evidence-based priority setting at the local level in China. METHODS: Following the methods of the Global Burden of Disease Study 2013 (GBD 2013), we have systematically analysed all available demographic and epidemiological data sources for China at the provincial level. We developed methods to aggregate county-level surveillance data to inform provincial-level analysis, and we used local data to develop specific garbage code redistribution procedures for China. We assessed levels of and trends in all-cause mortality, causes of death, and years of life lost (YLL) in all 33 province-level administrative units in mainland China, all of which we refer to as provinces, for the years between 1990 and 2013. FINDINGS: All provinces in mainland China have made substantial strides to improve life expectancy at birth between 1990 and 2013. Increases ranged from 4.0 years in Hebei province to 14.2 years in Tibet. Improvements in female life expectancy exceeded those in male life expectancy in all provinces except Shanghai, Macao, and Hong Kong. We saw significant heterogeneity among provinces in life expectancy at birth and probability of death at ages 0-14, 15-49, and 50-74 years. Such heterogeneity is also present in cause of death structures between sexes and provinces. From 1990 to 2013, leading causes of YLLs changed substantially. In 1990, 16 of 33 provinces had lower respiratory infections or preterm birth complications as the leading causes of YLLs. 15 provinces had cerebrovascular disease and two (Hong Kong and Macao) had ischaemic heart disease. By 2013, 27 provinces had cerebrovascular disease as the leading cause, five had ischaemic heart disease, and one had lung cancer (Hong Kong). Road injuries have become a top ten cause of death in all provinces in mainland China. The most common non-communicable diseases, including ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and cancers (liver, stomach, and lung), contributed much more to YLLs in 2013 compared with 1990. INTERPRETATION: Rapid transitions are occurring across China, but the leading health problems and the challenges imposed on the health system by epidemiological and demographic change differ between groups of Chinese provinces. Localised health policies need to be implemented to tackle the diverse challenges faced by local health-care systems. FUNDING: China National Science & Technology Pillar Program 2013 (2013BAI04B02) and Bill & Melinda Gates Foundation.

Dichloro-diphenyl-trichloroethanes (DDTs) in human hair and serum in rural and urban areas in South China.

Human hair has been employed as a biomarker for exposure to persistent organic pollutants (POPs), but information on the source of dichloro-diphenyl-trichloroethane (DDT) and its metabolites in hair is limited. The present study investigated the contamination of DDTs in human hair from a rural area and an urban area of South China and compared with those in human serum and indoor dust. The concentrations of ∑DDTs ranged from 2.30 to 489ng/g, with a median of 21.8ng/g in human hair. The ∑DDT concentrations (median=40.8ng/g) in female hair were significantly higher than those in male hair (median=20.6ng/g). There were significantly positive correlations between the concentrations of DDTs and ages in both the female and male hair, but the age-dependence for DDTs in serum was less significant. The profile of DDT analogues in female hair, differing from that in the male hair, was more similar to that in the indoor dust, suggesting a more important role of exogenous exposure in female hair. We estimated that exogenous source is responsible for approximately 11% and 20% of the burden of DDTs in the male and female hair, respectively. Adjusted multiple linear regression model showed significantly positive association between the p,p'-DDE concentrations in the paired hair and serum samples, indicating that endogenous origins are the primary sources of DDTs in the hair of the residents in the study areas. Our findings demonstrated that human hair is a reliable biomarker for body burden of DDTs and can be used in epidemiology research and retrospective assessment of DDT exposure.

Organic contaminants and heavy metals in indoor dust from e-waste recycling, rural, and urban areas in South China: Spatial characteristics and implications for human exposure.

The concentrations of several organic contaminants (OCs) and heavy metals were measured in indoor dust from e-waste recycling, rural, and urban areas in South China to illustrate the spatial characteristics of these pollutants and to further evaluate human exposure risks. The median concentrations of polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), decabromodiphenyl ethane (DBDPE), and dechlorane plus (DPs) were 38.6-3560, 2360-30,100, 665-2720, and 19.5-1860ng/g, while the median concentrations of Cd, Pb, Cu, Cr, and Zn were 2.46-40.4, 206-1380, 217- 1200, 25.3-134, and 176-212µg/g in indoor dust. The levels of all pollutants, except Zn, in dust from the e-waste recycling area were significantly higher than those from the other areas. Cd, Pb, and most OCs exhibited similar pollution patterns in the three areas, indicating that e-waste recycling activities are the major pollution source. In contrast, Cu, Cr, Zn, and penta-BDE are likely derived from household products in the rural and urban areas. The highest estimated daily intakes (EDIs) of PCBs, PBDEs, DBDPE, and DPs were 0.15-163, 3.97-1470, 1.26-169, and 0.11-134ng/kg bw/day for toddlers and adults. The highest EDIs of BDE 209 and Pb in toddlers in the e-waste recycling area were 16% and 18 times higher than the reference doses, indicating the high exposure risk of these pollutants in the e-waste recycling area.

Polychlorinated Biphenyls (PCBs) in Human Hair and Serum from E-Waste Recycling Workers in Southern China: Concentrations, Chiral Signatures, Correlations, and Source Identification.

Hair is increasingly used as a biomarker for human exposure to persistent organic pollutants (POPs). However, the internal and external sources of hair POPs remain a controversial issue. This study analyzed polychlorinated biphenyls (PCBs) in human hair and serum from electronic waste recycling workers. The median concentrations were 894 ng/g and 2868 ng/g lipid in hair and serum, respectively. The PCB concentrations in male and female serum were similar, while concentrations in male hair were significantly lower than in female hair. Significant correlations between the hair and serum PCB levels and congener profiles suggest that air is the predominant PCB source in hair and that hair and blood PCB levels are largely dependent on recent accumulation. The PCB95, 132, and 183 chiral signatures in serum were significantly nonracemic, with mean enantiomer fractions (EFs) of 0.440-0.693. Nevertheless, the hair EFs were essentially racemic (mean EFs = 0.495-0.503). Source apportionment using the Chemical Mass Balance model also indicated primary external PCB sources in human hair from the study area. Air, blood, and indoor dust are responsible for, on average, 64.2%, 27.2%, and 8.79% of the hair PCBs, respectively. This study evidenced that hair is a reliable matrix for monitoring human POP exposure.