Disparities in overall survival by varying duration of disability in activities of daily living in older people: A population-based cohort from Chinese Longitudinal Healthy Longevity Survey (CLHLS).

OBJECTIVES: To investigate the association between duration of disability in activity of daily living (ADL) and overall survival in older individuals. DESIGN: A prospective cohort study. SETTING: Community-based data from Chinese Longitudinal Healthy Longevity Survey. PARTICIPANTS: In total, 13,560 participants without ADL disability and 2772 participants with ADL disability at baseline were included. MEASUREMENTS: ADL disability was assessed using Katz index scale, which included six essential ADLs: dressing, bathing, transferring, toileting, continence, and eating. Dependence of each item was scored on a scale of 1, the maximum total score was 6. At baseline, duration of ADL disability was defined as the maximum duration among the six items. The study outcome was overall survival. Accelerated failure time models were constructed to investigate the association between duration of ADL disability and overall survival. Subgroup analyses by sex, age, and multimorbidites, as well as sensitive analyses were conducted. RESULTS: During 81,868.7 person-years follow-up, 11,092 deaths were recorded. Overall, ADL disability was associated with lower overall survival compared to non-ADL disability. With duration of ADL disability extending, the overall survival strikingly dropped in the first 12 months, reaching its lowest point with adjusted time ratio (TR) at 0.66 (95%CI: 0.61-0.72, p < 0.001), then moderately grew until the 60th month, finally stayed constant thereafter. Participants with ADL scores of 1-3 had higher survival compared to those with scores of 4-6, and both groups followed a similar trend of varied survival to the whole cohort. Moreover, subgroup analyses and sensitivity analyses showed the robustness of these findings. CONCLUSIONS: Our findings first address a golden time window for the older individuals with ADL disability. More attention should be given to them, especially in the first 12 months since diagnosis, to reduce mortality and extend the lifespan.

Respiration in light of evergreen and deciduous woody species and its links to the leaf economic spectrum.

Leaf respiration in the light (Rlight) is crucial for understanding the net CO2 exchange of individual plants and entire ecosystems. However, Rlight is poorly quantified and rarely discussed in the context of the leaf economic spectrum (LES), especially among woody species differing in plant functional types (PFTs) (e.g., evergreen vs. deciduous species). To address this gap in our knowledge, Rlight, respiration in the dark (Rdark), light-saturated photosynthetic rates (Asat), leaf dry mass per unit area (LMA), leaf nitrogen (N) and phosphorus (P) concentrations, and maximum carboxylation (Vcmax) and electron transport rates (Jmax) of 54 representative subtropical woody evergreen and deciduous species were measured. With the exception of LMA, the parameters quantified in this study were significantly higher in deciduous species than in evergreen species. The degree of light inhibition did not significantly differ between evergreen (52%) and deciduous (50%) species. Rlight was significantly correlated with LES traits such as Asat, Rdark, LMA, N and P. The Rlight vs. Rdark and N relationships shared common slopes between evergreen and deciduous species, but significantly differed in their y-intercepts, in which the rates of Rlight were slower or faster for any given Rdark or N in deciduous species, respectively. A model for Rlight based on three traits (i.e., Rdark, LMA and P) had an explanatory power of 84.9%. These results show that there is a link between Rlight and the LES, and highlight that PFTs is an important factor in affecting Rlight and the relationships of Rlight with Rdark and N. Thus, this study provides information that can improve the next generation of terrestrial biosphere models (TBMs).

Comparative study of different sewage sludge incineration treatments based on environmental and economic life cycle assessment.

Incineration is one of the most widely used treatments in the field of sewage sludge disposal. However, the choice of sewage sludge incineration process is still controversial. In this study, the comparative life cycle assessment of sewage sludge incineration processes, including the mono-incineration, co-incineration in coal-fired power plants and co-incineration in municipal solid waste (MSW) incineration plants, was carried out from the perspective of environment, carbon footprint and economy. The environmental assessment results show that terrestrial ecotoxicity, freshwater ecotoxicity, marine ecotoxicity, human carcinogenic toxicity and human non-carcinogenic toxicity are the most significant environmental impacts. And the environmental performance of co-incineration in coal-fired power plants is the best. Moreover, the environmental impact is most sensitive to the dehydrant, electricity and fly ash chelating agent. Co-incineration in MSW incineration plants has the lowest carbon emissions, with only 70.50% and 82% of the carbon emissions from mono-incineration and co-incineration in coal-fired power plants, respectively. Furthermore, sewage sludge mono-incineration has the highest disposal costs because of the higher depreciation and solid waste disposal costs. The comprehensive evaluation results reveal that the optimization should focus on the selection of dehydrant and fly ash chelating agent, as well as the improvement of the equipment efficiency.

Epidemiological characteristics of seasonal influenza under implementation of zero-COVID-19 strategy in China.

OBJECTIVE: Respiratory viral diseases have posed a persistent threat to public health due to their high transmissibility. Influenza virus and SARS-Cov-2 are both respiratory viruses that have caused global pandemics. A zero-COVID-19 strategy is a public health policy imposed to stop community transmission of COVID-19 as soon as it is detected. In this study, we aim to examine the epidemiological characteristics of seasonal influenza in the past five years before and after the emergence of COVID-19 in China and observe the possible impact of the strategy on influenza. METHODS: Data from two data sources were retrospectively analyzed. A comparison on influenza incidence rate between Hubei and Zhejiang provinces was conducted based on data from the Chinese Center for Disease Control and Prevention (CDC). Then a descriptive and comparative analysis on seasonal influenza based on data from Zhongnan Hospital of Wuhan University and Hangzhou Ninth People`s Hospital before and after the outbreak of SARS-CoV-2 was conducted. RESULTS: From 2010-2017, both provinces experienced relatively low influenza activity until the 1st week of 2018, when they reached peak incidence rates of 78.16/100000PY, 34.05/100000PY respectively. Since then, influenza showed an obvious seasonality in Hubei and Zhejiang until the onset of COVID-19. During 2020 and 2021, there was a dramatic decline in influenza activity compared to 2018 and 2019. However, influenza activity seemed to rebound at the beginning of 2022 and surged in summer, with positive rates of 20.52% and 31.53% in Zhongnan Hospital of Wuhan University and Hangzhou Ninth People`s Hospital respectively as of the time writing this article. CONCLUSIONS: Our results reinforce the hypothesis that zero-COVID-19 strategy may impact the epidemiological pattern of influenza. Under the complex pandemic situation, implementation of NPIs could be a beneficial strategy containing not only COVID-19 but also influenza.

Spatial and nonlinear effects of new-type urbanization and technological innovation on industrial carbon dioxide emission in the Yangtze River Delta.

The purpose of this paper is to quantify the level of new-type urbanization and unravel the spatial and nonlinear effects of new-type urbanization and technological innovation on industrial carbon emissions. Although the impact of traditional urbanization levels on carbon emissions has been widely studied, there is still a huge room for optimization, and the impact of new-type urbanization on carbon emissions has not yet been clarified. Selecting 37 cities in the Yangtze River Delta as a research sample, this paper measures the new-type urbanization based on an evaluation system we build. Consequently, we assess the spatial and nonlinear effects of new-type urbanization and technological innovation on carbon emissions by the spatial Durbin model and non-parameter addictive model, respectively. The results indicate that the new-type urbanization and low-carbon city pilot policy have significant spatial spillover effects on reducing carbon dioxide emissions, while the economic growth plays a positive role in increasing carbon emission. As for nonlinear effects, there is a significant inverted "N"-shaped relationship between the level of new-type urbanization and carbon dioxide emissions, while the nexus between technological innovation and carbon emissions is an inverted "U"-shaped relationship. This paper provides a new perspective for confirming the mechanism of the new-type urbanization on carbon emissions. Meanwhile, these findings are of significance for the relevant authorities in China to develop appropriate policy in carbon dioxide emission reduction.

Development and assessment of diabetic nephropathy prediction model using hub genes identified by weighted correlation network analysis.

Diabetic nephropathy (DN) is one microvascular complication of diabetes. About 30% of diabetic patients can develop DN, which is closely related to the high incidence and mortality of heart diseases, and then develop end-stage renal diseases. Therefore, early detection and screening of high-risk patients with DN is important. Herein, we explored the differences of serum transcriptomics between DN and non-DN in type II diabetes mellitus (T2DM) patients. We obtained 110 target genes using weighted correlation network analysis. Gene Ontology enrichment analysis indicates these target genes are mainly related to membrane adhesion, alpha-amino acid biosynthesis, metabolism, and binding, terminus, inhibitory synapse, clathrinid-sculpted vesicle, kinase activity, hormone binding, receptor activity, and transporter activity. Kyoto Encyclopedia of Genes and Genomes analysis indicates the process of DN in diabetic patients can involve synaptic vesicle cycle, cysteine and methionine metabolism, N-Glycan biosynthesis, osteoclast differentiation, and cAMP signaling pathway. Next, we detected the expression levels of hub genes in a retrospective cohort. Then, we developed a risk score tool included in the prediction model for early DN in T2DM patients. The prediction model was well applied into clinical practice, as confirmed by internal validation and several other methods. A novel DN risk model with relatively high prediction accuracy was established based on clinical characteristics and hub genes of serum detection. The estimated risk score can help clinicians develop individualized intervention programs for DN in T2DM. External validation data are required before individualized intervention measures.

The fern economics spectrum is unaffected by the environment.

The plant economics spectrum describes the trade-off between plant resource acquisition and storage, and sheds light on plant responses to environmental changes. However, the data used to construct the plant economics spectrum comes mainly from seed plants, thereby neglecting vascular non-seed plant lineages such as the ferns. To address this omission, we evaluated whether a fern economics spectrum exists using leaf and root traits of 23 fern species living under three subtropical forest conditions differing in light intensity and nutrient gradients. The fern leaf and root traits were found to be highly correlated and formed a plant economics spectrum. Specific leaf mass and root tissue density were found to be on one side of the spectrum (conservative strategy), whereas photosynthesis rate, specific root area, and specific root length were on the other side of the spectrum (acquisitive strategy). Ferns had higher photosynthesis and respiration rates, and photosynthetic nitrogen-use efficiency under high light conditions and higher specific root area and lower root tissue density in high nutrient environments. However, environmental changes did not significantly affect their resource acquisition strategies. Thus, the plant economics spectrum can be broadened to include ferns, which expands its phylogenetic and ecological implications and utility.

Medical costs and hospital utilization for hemophilia A and B urban inpatients in China: a national cross-sectional study.

BACKGROUND: Hemophilia care in mainland China has been greatly improved since the establishment of the Hemophilia Treatment Center Collaborative Network of China (HTCCNC), and most of drugs for hemophilia have been covered by basic medical insurance schemes. This study assesses whether medical costs and hospital utilization disparities exist between hemophilia A and hemophilia B urban inpatients in China and, second, whether the prescription of coagulation factor concentrates for hemophilia A and hemophilia B inpatients was optimal, from the third payer perspective. METHODS: We conducted a retrospective nationwide analysis based on a 5% random sample from claims data of China Urban Employees' Basic Medical Insurance (UEBMI) and Urban Residents' Basic Medical Insurance (URBMI) schemes from 2010 to 2016. Univariate analysis and multiple regression analysis based on a generalized linear model were conducted. RESULT: A total of 487 urban inpatients who had hemophilia were identified, including 407 inpatients with hemophilia A and 80 inpatients with hemophilia B. Total medical cost for hemophilia B inpatients was significantly higher than for hemophilia A inpatients (USD 2912.81 versus USD 1225.60, P < 0.05), and hemophilia B inpatients had a significantly longer length of hospital stay than hemophilia A inpatients (9.00 versus 7.00, P < 0.05). Total medical costs were mostly allocated to coagulation factor products (76.86-86.68%), with coagulation factor cost of hemophilia B significantly higher than hemophilia A (P < 0.05). Both hemophilia cohorts utilized greatest amount of plasma-derived Factor VIII, followed by recombinant Factor VIII and prothrombin complex concentrates. CONCLUSIONS: Patients with hemophilia B experienced significantly higher inpatient cost, coagulation factor cost and longer length of hospital stay than patients with hemophilia A. Our findings revealed the suboptimal use of coagulation factor concentrate drugs and a higher drug cost burden incurred by hemophilia B than hemophilia A inpatients. Our results call for efforts to strengthen drug regulatory management for hemophilia and to optimize medical insurance schemes according to hemophilia types.

Assessment and validation of three spot urine assay methods for the estimation of 24-hour urinary sodium excretion in Chinese Tibetan adults living in the mountains.

Twenty-four-hour urine collection is the gold standard method for the evaluation of salt intake, but it is often impractical in large-scale investigations, especially in resource-poor areas. Methods for the estimation of 24-hour urinary sodium excretion (USE) using a spot urine sample have been established, but have not been validated in Chinese Tibetans. Therefore, the authors aimed to evaluate the Kawasaki, Tanaka, and the International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT) formulas for the prediction of 24-hour USE in Chinese Tibetan adults. The authors analyzed the bias, correlation, agreements between estimated values and measured values, and the relative and absolute differences and misclassification at the individual level for the three methods in 323 Tibetan participants from the Ganzi Tibetan Autonomous Prefecture of Sichuan Province, China. The mean biases between the measured values and the estimated 24-hour USE using the Kawasaki, Tanaka, and INTERSALT methods were 5.4 mmol/day (95% confidence interval [CI]: 0.8-10.1 mmol/day), -40.8 mmol/day (95% CI: -44.6 to -36.9 mmol/day), and -57.1 mmol/day (95% CI: -61.9 to -52.4 mmol/day), respectively. The Pearson correlation coefficients for the relationships between the measured values and the estimated 24-hour USE were 0.43 (Kawasaki), 0.38 (Tanaka), and 0.27 (INTERSALT), respectively (all p < .01). The intraclass correlation coefficients showed similar patterns to the correlation data: 0.47 for Kawasaki, 0.40 for Tanaka, and 0.27 for INTERSALT (all p < .01). The upper and lower limits of agreement between the measured values and the estimated 24-hour USE were -92.6 and 81.8 mmol/day for the Kawasaki method, -28.5 and 110.0 mmol/day for the Tanaka method, and -28.4 and 142.7 mmol/day for the INTERSALT method. Compared with the other two methods, the percentage of individuals that were misclassified by using the Kawasaki method was 48.2%, while those for the Tanaka and INTERSAL methods was 72.1% and 75.5%, respectively. However, when an individual's salt intake was higher than 12.8 g/day, the misclassification rates of the Kawasaki, Tanaka, and INTERSALT methods were 20%, 90%, and 97.5%, respectively. Thus, the authors found that the Kawasaki equation may have performed better than the other equations at Chinese Tibetan population level assessment, but none of these equations are suitable for use or perform well at the individual level. A more accurate method of using a spot urine sample to evaluate individual 24-hour USE for Tibetans is needed.

An equity evaluation in stroke inpatients in regard to medical costs in China: a nationwide study.

BACKGROUND: Stroke has always been a severe disease and imposed heavy financial burden on the health system. Equity in patients in regard to healthcare utilization and medical costs are recognized as a significant factor influencing medical quality and health system responsiveness. The aim of this study is to understand the equity in stroke patients concerning medical costs and healthcare utilization, as well as identify potential factors contributing to geographic variation in stroke patients' healthcare utilization and costs. METHODS: Covering 31 provinces in mainland China, our main data were a 5% random sample of stroke claims from Urban Employees Basic Medical Insurance (UEBMI) and Urban Residents Basic Medical Insurance (URBMI) from 2013 to 2016. The Theil index was employed to evaluate the equity in stroke patients in regard to healthcare utilization and medical costs, and the random-effect panel model was used to explore the impact of province-level factors (health resource factors, enabling factors, and economic factors) on medical costs and health care utilization. RESULTS: Stroke patients' healthcare utilization and medical costs showed significant differences both within and between regions. The UEBMI scheme had an overall lower Theil index value than the URBMI scheme. The intra-region Theil index value was higher than the inter-region Theil index, with the Theil index highest within eastern China, China's richest and most developed region. Health resource factors and enabling factors (represented by reimbursement rate and education attainment years) were identified significantly associated with medical costs (P < 0.05), but have no impact on average length of stay. CONCLUSIONS: China's fragmented urban health insurance schemes require further reform to ensure better equity in healthcare utilization and medical costs for stroke patients. Improving education attainment, offering equal access to healthcare, allocating health resources reasonably and balancing health services prices in different regions also count.

Prediction of photosynthetic light-response curves using traits of the leaf economics spectrum for 75 woody species: effects of leaf habit and sun-shade dichotomy.

PREMISE: Photosynthetic light-response (PLR) curves for leaves are important components of models related to carbon fixation in forest ecosystems, linking the Mitscherlich equation and Michaelis-Menten equation to traits of the leaf economics spectrum (LES). However, models do not consider changes in leaf habits (i.e., evergreen and deciduous) and within-canopy shading variation in these PLR curves. METHODS: Here, we measured the PLR curves in sun and shade leaves of 44 evergreen and 31 deciduous species to examine the relationships between variables of the Mitscherlich equation and Michaelis-Menten equation, leaf nitrogen (N) and phosphorus (P) content, and leaf mass per area (LMA). RESULTS: Small changes were caused by different leaf habits and shade variations in relationships linking variables of the two equations to leaf N and P content and LMA. Values of the scaling exponents for PLR curve parameters did not differ regardless of canopy position and leaf habit (P > 0.05). The PLR curves in species with different leaf habits (i.e., evergreen and deciduous) at different canopy positions could be predicted using the general allometric relations between leaf traits and PLR parameters in the two equations. For photosynthetic photon flux densities from 0 to 2000 µmol m-2 s-1 , approximately 71% (Mitscherlich equation) and 70% (Michaelis-Menten equation) of the net assimilation rates could be predicted. CONCLUSIONS: These findings indicate that leaf net assimilation rates can be predicted through the large available data for LES traits. Incorporation of values for these traits available in the LES databases into ecosystem models of forest productivity and carbon fixation warrants further investigation.

Health care utilization for patients with stroke: a 3-year cross-sectional study of China's two urban health insurance schemes across four cities.

BACKGROUND: Stroke is a devastating disease and a major cause of death and disability in China. While existing studies focused mainly on differences in stroke patients' health care utilization by insurance type, this study assesses whether health utilization and medical costs differed by insurance type across four cities in China. METHODS: A 5% random sample from the 2014-2016 China Urban Employees' Basic Medical Insurance (UEBMI) and Urban Residents' Basic Medical Insurance (URBMI) claims data were collected across four cities, Beijing, Shanghai, Tianjin, and Chongqing. Descriptive statistics and ordinary least squares regression were employed to analyze the data. RESULTS: We found that differences in healthcare utilization and inpatient and outpatient medical expenses varied more by city-specific insurance type than they did between the UEBMI and URBMI schemes. For example, the median UEBMI medical outpatient costs in Beijing (RMB500.2) were significantly higher than UEBMI patients in Shanghai (RMB260.8), Tianjin (RMB240.8), and Chongqing (RMB293.0), and Beijing URBMI patients had significantly higher outpatient medical costs (RMB356.9) than URBMI patients in Shanghai (RMB233.4) and Chongqing (RMB211.0), which were significantly higher than Tianjin (RMB156.2). Patients in Chongqing had 66.4% (95% CI: - 0.672, - 0.649) fewer outpatient visits, 13.0% (95% CI: - 0.144, - 0.115) fewer inpatient visits, and 34.2% (95% CI: - 0.366, - 0.318) shorter length of stay than patients in Beijing. The divergence of average length of stay and out-of-pocket (OOP) expenses by insurance type was also greater between cities than the UEMBI-URBMI mean difference. CONCLUSIONS: Significant city-specific differences in stroke patients' healthcare utilization and medical costs reflected inequalities in health care access. The fragmented social health insurance schemes in China should be consolidated to provide patients in different cities equal financial protection and benefit packages and to improve the equity of stroke patient access to health care.

Genomic resources in plant breeding for sustainable agriculture.

Climate change during the last 40 years has had a serious impact on agriculture and threatens global food and nutritional security. From over half a million plant species, cereals and legumes are the most important for food and nutritional security. Although systematic plant breeding has a relatively short history, conventional breeding coupled with advances in technology and crop management strategies has increased crop yields by 56 % globally between 1965-85, referred to as the Green Revolution. Nevertheless, increased demand for food, feed, fiber, and fuel necessitates the need to break existing yield barriers in many crop plants. In the first decade of the 21st century we witnessed rapid discovery, transformative technological development and declining costs of genomics technologies. In the second decade, the field turned towards making sense of the vast amount of genomic information and subsequently moved towards accurately predicting gene-to-phenotype associations and tailoring plants for climate resilience and global food security. In this review we focus on genomic resources, genome and germplasm sequencing, sequencing-based trait mapping, and genomics-assisted breeding approaches aimed at developing biotic stress resistant, abiotic stress tolerant and high nutrition varieties in six major cereals (rice, maize, wheat, barley, sorghum and pearl millet), and six major legumes (soybean, groundnut, cowpea, common bean, chickpea and pigeonpea). We further provide a perspective and way forward to use genomic breeding approaches including marker-assisted selection, marker-assisted backcrossing, haplotype based breeding and genomic prediction approaches coupled with machine learning and artificial intelligence, to speed breeding approaches. The overall goal is to accelerate genetic gains and deliver climate resilient and high nutrition crop varieties for sustainable agriculture.

Maternal and paternal histories differentially influence risks for diabetes, insulin secretion and insulin resistance in a Chinese population.

AIMS/INTRODUCTION: To investigate the differential effects of maternal versus paternal history of diabetes on the risks for diabetes and prediabetes, as well as on insulin secretion and resistance in Chinese individuals. MATERIALS AND METHODS: From the 2007 to 2008 China National Diabetes and Metabolism Disorders Study, 39,244 participants were included and divided into four categories: negative parental history, paternal history only (PH), maternal history only (MH), and both paternal and maternal history. RESULTS: The age- and sex-standardized prevalence rates of diabetes in the negative parental history, PH, MH, and both paternal and maternal history groups were 8.59, 12.56, 15.86 and 29.81%, respectively. The prevalence rates of impaired glucose metabolism were 24.13, 25.41, 31.13 and 50.80%, with the prevalence in the MH group being significantly higher than that in the PH group. Compared with that in the FH0 group, the risks of diabetes in the PH, MH, and both paternal and maternal history groups were 2.01-, 2.67- and 6.37-fold greater, and the risks of impaired glucose metabolism were 1.28-, 1.65- and 3.45-fold greater. In addition, MH had a significantly greater impact on impaired glucose metabolism than PH (PMHvsPH  = 0.0292). Regression analyses suggested MH was associated with homeostatic model assessment for ß-cell function (ß[SE] = -0.0910[0.0334], P = 0.0065), insulinogenic index (-0.1866[0.0550], P = 0.0007), homeostatic model assessment for insulin resistance (0.0662[0.0227], P = 0.0036) and Matsuda Index [-0.0716(0.0203), P = 0.0004]. PH was specifically associated with homeostatic model assessment for insulin resistance (0.1343[0.0267], P < 0.0001) and Matsuda Index (-0.1566[0.0243], P < 0.0001), but the effects were stronger than those of MH (PMHvsPH  = 0.0431, 0.0054). CONCLUSIONS: MH and PH differentially influence the risks for diabetes, insulin secretion, and insulin resistance in the Chinese population, suggesting they participate in the pathogenesis of diabetes through different mechanisms.

Internet-based patient- primary care physician-cardiologist integrated management model of hypertension in China: study protocol for a multicentre randomised controlled trial.

INTRODUCTION: The control rate of hypertension is low in China, especially in rural, western and minority areas. This is related to poor medical skills among physicians in primary care institutions and low levels of trust among patients. However, primary healthcare institutions are the main battleground for the prevention and treatment of hypertension. It is worth exploring how to most effectively integrate patients, primary care physicians and cardiologists in tertiary hospitals, to build a long-term mechanism for the prevention and treatment of hypertension. In this study, we aim to evaluate the clinical effectiveness and conduct a health economic evaluation of an internet-based patient-primary care physician-cardiologist integrated management model of hypertension in areas of China with different socioeconomic levels. METHODS AND ANALYSIS: This is a 12-month, multicentre, randomised controlled trial involving patients with hypertension in urban communities and rural areas of Sichuan Province, China. Each primary healthcare institution will cooperate with their tertiary hospital through the Red Shine Chronic Disease Management System (RSCDMS). Patients will be randomly assigned 1:1 to two groups: (1) a traditional care group; (2) an intervention group in which primary care physicians and cardiologists can share patient data and manage patients together through the RSCDMS. Patients can upload their blood pressure (BP) values and communicate with physicians using the system. The primary outcome is the change in systolic BP over a 12-month period. Secondary outcomes are changes in diastolic BP, BP control rate, values of 24-hour ambulatory BP monitoring, difference in cost-effectiveness between the groups, patient satisfaction, medication adherence and home BP monitoring compliance. All data will be recorded and stored in the RSCDMS and analysed using IBM SPSS V.26.0. ETHICS AND DISSEMINATION: This study has been approved by the Biomedical Research Ethics Committee of the West China Hospital of Sichuan University in Sichuan, China (No. 2020-148). Written informed consent will be obtained from all participants. The results of this study will be disseminated to the public through academic conferences and peer-reviewed journals. TRIAL REGISTRATION NUMBER: ChiCTR2000030677.

The Leaf Economics Spectrum Constrains Phenotypic Plasticity Across a Light Gradient.

The leaf economics spectrum (LES) characterizes multivariate correlations that confine the global diversity of leaf functional traits onto a single axis of variation. Although LES is well established for traits of sun leaves, it is unclear how well LES characterizes the diversity of traits for shade leaves. Here, we evaluate LES using the sun and shade leaves of 75 woody species sampled at the extremes of a within-canopy light gradient in a subtropical forest. Shading significantly decreased the mean values of LMA and the rates of photosynthesis and dark respiration, but had no discernable effect on nitrogen and phosphorus content. Sun and shade leaves manifested the same relationships among N mass, P mass, A mass, and R mass (i.e., the slopes of log-log scaling relations of LES traits did not differ between sun and shade leaves). However, the difference between the normalization constants of shade and sun leaves was correlated with functional trait plasticity. Although the generality of this finding should be evaluated further using larger datasets comprising more phylogenetically diverse taxa and biomes, these findings support a unified LES across shade as well as sun leaves.

Cost-effectiveness analysis of different hypertension management strategies in a community setting.

Self-management schemes and mobile apps can be used for the management of hypertension in the community, but the most appropriate patient population is unknown. To explore whether the Chinese Health Literacy Scale (CHLSH) can be used to screen for appropriate patients with hypertension for self-management and to evaluate the clinical effectiveness and health economic evaluation of three hypertension management schemes. This was a prospective study performed from March 2017 to July 2017 in consecutive patients with primary hypertension and of 50-80 years of age from the Jinyang community, Wuhou District, Chengdu. The CHLSH was completed and the patients were classified into the high (n = 283) and low (n = 315) health literacy groups. The patients were randomly divided into the self-management, traditional management, and mobile app management groups. The high-health literacy group was selected to construct the cost-effectiveness decision tree model. Blood pressure control rate and the quality-adjusted life years (QALYs) were determined. At the end of follow-up, the success rate of self-management was 83.4%. The costs for 6 months of treatment for each patient with hypertension in the self-management, traditional management, and mobile app groups were 1266, 1751, and 1856 yuan, respectively. The costs required for obtaining 1 QALY when managing for 6 months were: 30,869 yuan for self-management; 48,628 yuan for traditional management; and 43,199 yuan for the mobile app. The CHLSH can be used as a tool for screening patients with hypertension for self-management. The cost-effectiveness of self-management was optimal.

Association of metabolic syndrome with atherogenic index of plasma in an urban Chinese population: A 15-year prospective study.

BACKGROUND AND AIMS: The metabolic syndrome(Mets) is a multiplex risk factor for atheroselerotie cardiovascular disease. The aims of the study were to assess the association of the Mets with atherogenic index of plasma(AIP) and other atherogenic parameters in an urban Chinese population. METHODS AND RESULTS: The data were collected in 1992 and then again in 2007 from the same group of 582 individuals(359 men and 223 women) without Mets in 1992. During 15 years' follow-up, AIP was the lipid parameter that was most strongly associated with Mets, with an unadjusted odds ratio of 5.66 (95% CI:1.76-18.23, P = 0.004) in the univariate logistic regression analysis. Multivariate logistic regression analyses also revealed that AIP was an independent risk factor for Mets. AIP significantly predicted Mets in men, with an unadjusted odds ratio of 30.73 (95% CI: 5.62, 168.12 P = 0.012) in a univariate model. Associations remained significant after adjustment for smoking, drinking, physical exercise and components of Mets. The incidences of Mets adjusted for age according to the quartiles of AIP showed a statistical linear trend in men(P for trend = 0.007) rather than in women(P for trend = 0.529). CONCLUSIONS: AIP might be a strong and independent predictor for Mets in an urban Chinese population. The incidence of Mets increased with AIP elevated in men while not in women.

Endoscopic versus surgical drainage treatment of calcific chronic pancreatitis.

BACKGROUND: Endoscopic therapy and surgery are both conventional treatments to remove pancreatic duct stones that developed during the natural course of chronic pancreatitis. However, few studies comparing the effect and safety between surgery drainage and endoscopic drainage (plus Extracorporeal Shock Wave Lithotripsy, ESWL).The aim of this study was to compare the benefits between endoscopic and surgical drainage of the pancreatic duct for patients with calcified chronic pancreatitis. METHODS: A total of 86 patients were classified into endoscopic/ESWL (n = 40) or surgical (n = 46) treatment groups. The medical records of these patients were retrospectively analyzed. RESULTS: Pain recurrence and hospital stays were similar between the endoscopic/ESWL treatment and surgery group. However, endoscopic/ESWL treatment yielded significantly lower medical expense and less complications compared with the surgical treatment. CONCLUSIONS: In selective patients, endoscopic/ESWL treatment could achieve comparable efficacy to the surgical treatment. With lower medical expense and less complications, endoscopic/ESWL treatment would be much preferred to be the initial treatment of choice for patients with calcified chronic pancreatitis.

Safety assessment of sorafenib in Chinese patients with unresectable hepatocellular carcinoma: subgroup analysis of the GIDEON study.

BACKGROUND: This study aimed to investigate the safety of sorafenib for the treatment of unresectable hepatocellular carcinoma in Chinese patients. METHODS: A subgroup of 345 Chinese patients from the international database of the Global Investigation of therapeutic DEcisions in hepatocellular carcinoma and Of its treatment with sorafeNib (GIDEON) study was included in this analysis. Safety assessment measures were adverse events (AEs) and serious adverse events (SAEs) graded using the National Cancer Institute Common Terminology Criteria version 3.0. RESULTS: Of 331 evaluable patients, 98% started sorafenib at 800 mg/day. The median treatment duration was 22 weeks (range, 0.1-116 weeks), and median overall survival (OS) was 322 days (10.7 months). Approximately 50% of patients had at least one adverse event, and 6% had grade 3-4 adverse events. Drug-related adverse events were experienced by 29% of patients, and 3.6% had grade 3-4 drug-related adverse events. Overall, 23% of patients (n = 77) experienced serious adverse events, among which only 1 event was drug-related (0.3%). No differences in overall adverse events, serious adverse events, and deaths were observed between Child-Pugh A and Child-Pugh B patients. The most frequent drug-related adverse events were dermatological/skin (24%), hand-foot skin reaction (20%), gastrointestinal (11%), and diarrhea (11%). The majority of adverse events occurred within 30 days of beginning sorafenib. CONCLUSION: Sorafenib has satisfactory efficacy and safety in Chinese Child-Pugh A and B patients with unresectable HCC using the recommended dosage of 800 mg/day, and the safety of sorafenib is not affected by liver function. Prophylaxis for gastrointestinal adverse events may help to decrease dose interruptions or discontinuation. TRIAL REGISTRATION: ClinicalTrials.gov ; Identifier: NCT00812175. Date of registration: December 19, 2008.