Matching actions to needs: shifting policy responses to the changing health needs of Chinese children and adolescents.

China is home to the second largest population of children and adolescents in the world. Yet demographic shifts mean that the government must manage the challenge of fewer children with the needs of an ageing population, while considering the delicate tension between economic growth and environmental sustainability. We mapped the health problems and risks of contemporary school-aged children and adolescents in China against current national health policies. We involved multidisciplinary experts, including young people, with the aim of identifying actionable strategies and specific recommendations to promote child and adolescent health and wellbeing. Notwithstanding major improvements in their health over the past few decades, contemporary Chinese children and adolescents face distinct social challenges, including high academic pressures and youth unemployment, and new health concerns including obesity, mental health issues, and sexually transmitted infections. Inequality by gender, geography, and ethnicity remains a feature of health risks and outcomes. We identified a mismatch between current health determinants, risks and outcomes, and government policies. To promote the health of children and adolescents in China, we recommend a set of strategies that target government-led initiatives across the health, education, and community sectors, which aim to build supportive and responsive families, safe communities, and engaging and respectful learning environments. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

A 20-year shift in China's sewage sludge heavy metals and its feasibility of nutrient recovery in land use.

Recycling resources from wastewater is even more important for developing a more sustainable society. Disposing sewage sludge, which accumulates most pollutants and resources in sewage, is the main challenge in wastewater pollution control and resource utilization. Heavy metals (HMs) are the greatest constraint limiting the application of sewage sludge to land as a sustainable use of this material. We conducted a meta-analysis of the concentrations of HMs in Chinese sewage sludge by combining data from studies published from 2000 to 2019 (N = 8477). Over this period, the reported concentrations of HMs in sewage sludge declined in three stages (a fluctuating stage, a slight decrease stage, and a rapid and stable decrease stage). The results revealed that economic development and environmental policy implementation were the main factors mitigating HM pollution in sewage sludge in China. Moreover, if environmental regulations were strengthened and HM pollution-mitigation strategies were made consistent, such that the proportion of sewage sludge applied to land in China could be increased from 18.6% to 48.0% (the proportion applied to land in the United States), the ecosystem services analysis showed that huge ecological-economic benefits could be realized (3.1 billion Chinese Yuan) and the use of fertilizers could be substantially reduced (the use of nitrogen fertilizers by 8.5% and the use of phosphate fertilizers by 18.1%). This review shows that China should formulate a unified policy and interdepartmental committee for sustainable application of sewage sludge to land and wastewater resource recycling management.

The occurrence characteristics, removal efficiency, and risk assessment of polycyclic aromatic hydrocarbons in sewage sludges from across China.

Sewage sludge is considered to be an important sink for polycyclic aromatic hydrocarbons (PAHs) in wastewater treatment plants and the potential risks from sludge contaminated with PAHs during land application has attracted attention. To identify the priority PAHs for control and enhance their removal from sludge, the occurrence characteristics, removal efficiency, and risk assessment of PAHs in sewage sludges from across China were analyzed. Data collection was from 2001 to 2023. Results showed that 16 PAHs were widely detected in Chinese sewage sludge with total amounts (∑16PAHs) between 0.06 and 34.93 mg kg dw-1. Fossil fuel, coal, and biomass combustion are main anthropogenic sources of PAHs in China. In general, phenanthrene (PHE), anthracene (ANT), fluorescein (FL), chrysene (CHR), pyrene (PYR), and benzo[b]fluoranthene (BbF) are regarded as the main components and PAHs with 3-5 rings dominate (84.01%-91.53%) sewage sludge in China. Although aerobic composting and anaerobic treatment significantly improve ∑16PAHs removal, sludge stabilization treatment only reduced the risk by a small amount, especially for high-molecular-weight (HMW) PAHs. The benzo[a]anthracene (BaA), benzo[a]pyrene (BaP), and dibenzo[a,h]anthracene (DahA) are proposed as the priority control contaminants for sewage sludge in China because they have consistently high-risk quotient (RQ) values of 2.42-7.47, 1.28-3.16, 1.06-1.83 before and after sludge stabilization, respectively. More attention should be paid to BaA, BbF, benzo[k]fluoranthene (BkF), BaP, DahA, and indeno[1,2,3-cd]pyrene (IcdP) in Beijing; ANT, BaA, and BaP in Shanghai; and BaA and BaP in Guanghzou. Although the toxic equivalent quotient (TEQ) for PAHs met the limit concentration requirements of the national standard, the potential health risks due to long-term exposure to HMW PAHs cannot be ignored because the incremental lifetime cancer risk (ILCR) was consistently in the risk threshold range (>1 × 10-6). Some suggestions on enhanced treatment approaches and land use standards are proposed to further alleviate the risk from HMW PAHs.

Footprints of total coliforms, faecal coliforms and E. coli in a wastewater treatment plant and the probabilistic assessment and reduction of E. coli infection risks.

Wastewater contains various pathogenic microorganisms, and the disease of workers caused by exposure to wastewater at the wastewater treatment plants (WWTPs) is a growing concern. The footprints of total coliforms (TC), faecal coliforms (FC) and Escherichia coli (E. coli) in a conventional activated sludge WWTP during 12 consecutive months were clarified. It was found that TC, FC and E.coli in influent were significantly removed (log 4.71, log 4.43 and log 4.62, respectively) by WWTP with sand filtration playing a key role, and excess sludge was a major potential pathway for them flowing to the environment. Through quantitative microbial risk assessment (QMRA), hand-to-mouth ingestion of untreated wastewater and wastewater in secondary/efficient sedimentation tanks, as well as accidental ingestion of sludge in dewatering workshop presented the highest infection risks of pathogenic E.coli in the WWTP, considerably exceeded the U.S. EPA benchmark (≤1 × 10-4 pppy). PPE application and E.coli concentration reduction in wastewater or sludge were recommended to reduce the infection risks at these stages. Further, partial ozonation and dissolved ozone flotation thickening were investigated able to reduce the infection risks at the stages of secondary and tertiary treatment of wastewater or sludge treatment by 90- 98 %. The findings of this study would assist in selecting appropriate processes for the further sanitation of WWTPs.

Life cycle assessment of greenhouse gas emissions of typical sewage sludge incineration treatment route based on two case studies in China.

The rapidly increasing amount of municipal sewage sludge generated in China necessitates a thorough examination and evaluation of available treatment options. In recent years, thermal-drying and incineration technology has gained popularity, however, it may lead to significant greenhouse gas (GHG) emissions. Nevertheless, the differences in boundary conditions and technological characteristic across various cases may affect emission levels significantly. Therefore, this study utilizes a life cycle assessment to estimate the GHG emissions associated with two typical sludge incineration routes in China: direct thermal-drying combined with coal co-incineration incinerator in Case 1 and indirect thermal-drying and self-sustain combustion in Case 2. The entire treatment processes, containing different functional units, were comprehensively investigated. The results demonstrate that Case 1 and Case 2 produce 1133.33 and 350.89 kg CO2-eq/tDS (sludge dry solid) of GHG emissions, respectively. In Case 1, coal co-incineration produces 828.63 kg CO2-eq/tDS of GHG emissions, accounting for 73.1% of the total GHG emissions. Moreover, the exhaust gas treatment is a significant GHG emission source, accounting for 9.2% and 16.9% of the total GHG emissions in Case 1 and Case 2, respectively. Additionally, the sludge thickening and dewatering unit in Case 2 produces 213.75 kg CO2-eq/tDS of GHG emissions, accounting for 60.9% of the total GHG emissions. Analysis of energy flow and heat balance characteristics indicate that the indirect heat transfer method used in thermal-drying leads to significant heat loss, which limits heat recovery potential and hinders GHG emission reduction. This study proposed a scenario case based on Case 2, addressing the issues with the improvement of heat transfer process and reduction of electricity consumption, potentially reducing GHG emissions by 8.8%. Additionally, applying an exhaust gas heat recovery system could further offset up to 22.8% of the total GHG emission.

Habitat quality assessment of wintering migratory birds in Poyang Lake National Nature Reserve based on InVEST model.

Poyang Lake National Nature Reserve (PLNNR) is an important resting place for wintering migratory birds on the East Asian-Australasian Flyway (EAAF). In recent years, due to human activities and climate change, the area of wetlands has shown a downward trend, and the number and habitat of wintering migratory birds have been threatened. It is urgent to evaluate the habitat quality of wintering migratory birds in PLNNR. Therefore, the InVEST model and landscape index were used to evaluate the habitat quality of wintering migratory birds, and the grey correlation theory was used to reveal the response of typical wintering migratory bird population to habitat quality. The results showed that the habitat quality of the PLNNR was still at a high level, but showed a downward trend, with the average index of habitat quality decreasing from 0.872 to 0.817. The area of the highest quality habitat decreased by 3394.92 hm2, the area of the lowest, low, and medium quality habitats increased by 3112.11 hm2, and the area of the high quality habitat remained stable. The lowest, low, and medium quality habitat expanded from the middle to the south of the PLNNR mainly because of the expansion of construction land and cultivated land. The area with deterioration in habitat quality was 10,477.53 hm2, mainly concentrated in the center and south of the PLNNR. The area with restoration in habitat quality was 6148.26 hm2, mainly concentrated in the Bang Lake and Dacha Lake. The area with no change in habitat quality remained stable. The fragmentation degree and shape complexity of highest and high quality habitats increased, dominance degree and connectivity decreased, and the landscape pattern of habitat quality showed a downward trend. Typical wintering migratory birds have a strong correlation with highest, high, and low habitat quality, and there is a downward trend with the deterioration of habitat quality. Finally, this paper puts forward constructive suggestions on the degradation of habitat quality caused by land-use change.

Fate and health risk assessment of heavy metals in Brassica chinensis L. (pak-choi) and soil amended by sludge-based biochar.

Biochar is widely used in agriculture to efficiently solve the problem of sludge. In this study, sludge-based biochar (referred to as BC1, BC2, and BC3) was prepared by mixing sludge with FeCl3, Na2SiO3, and Ca (H2PO4)2, respectively. Then, it was mixed with fresh soil to plant Brassica chinensis L. The analysis of the effects of the three biochar types showed that all of them were beneficial to the growth of Brassica chinensis L. We added the biochar to the soil and found that the concentration of heavy metals did not exceed the recommended threshold. Additionally, the aboveground part of Brassica chinensis L. met the standard requirement for food safety (GB 2761-2017). Notably, BC3 stood out with the best effect on the growth of Brassica chinensis L. and resulted in the improvement of the physical and chemical properties of soil such as ammonium nitrogen, available phosphorus, and available potassium (BC3 was followed by BC2 and BC1). BC3 could efficiently inhibit the migration of heavy metals, thereby reducing the overall heavy metal pollution level and ameliorating the soil nutrients. BC3 could increase the organic carbon by 258.92%, available phosphorus by 234.45%, and available potassium by 37.12% compared with the CK group. The THQ and TTHQ estimates of Brassica chinensis L. were lower than one, indicating that the health risk of heavy metal intake was not prominent. Additionally, the application of the proposed biochar could reduce the form of F1 (acid extracted state) and increase the form of F4 (residue state) in soil. Overall, we conclude that the application of the proposed biochar can promote the root absorption of heavy metals and inhibit the migration of heavy metals.

Life-cycle assessment of two sewage sludge-to-energy systems based on different sewage sludge characteristics: Energy balance and greenhouse gas-emission footprint analysis.

Anaerobic digestion and incineration are widely used sewage sludge (SS) treatment and disposal approaches to recovering energy from SS, but it is difficult to select a suitable technical process from the various technologies. In this study, life-cycle assessments were adopted to compare the energy- and greenhouse gas- (GHG) emission footprints of two sludge-to-energy systems. One system uses a combination of AD with incineration (the AI system), whereas the other was simplified by direct incineration (the DI system). Comparison between three SS feedstocks (VS/TS: 57.61 -73.1 ds.%) revealed that the AI system consistently outperformed the DI system. The results of sensitivity analyses showed that the energy and GHG emission performances were mainly affected by VS content of the SS, AD conversion efficiency, and the energy consumption of sludge drying. Furthermore, the energy and GHG emission credit of the two systems increased remarkably with the increase in the VS content of the SS. For the high-organic-content sludge (VS/TS: 55%-80%), the energy and GHG emission credit of the AI system increase with the increase of AD conversion efficiency. However, for the low organic content sludge (VS/TS: 30%-55%), it has the opposite effect. In terms of energy efficiency and GHG performance, the AI system is a good choice for the treatment of high-organic-content sludge (VS/TS>55%), but DI shows superiority over AI when dealing with low organic content sludge (VS/TS<55%).

Assessment of water pollution in the Tibetan Plateau with contributions from agricultural and economic sectors: a case study of Lhasa River Basin.

The freshwater environment of watersheds in the Tibetan Plateau is bound with the safety of the Asian Water Tower. In this study, nitrogen (N) and phosphorus (P) loads delivered to freshwater and the associated gray water footprint (GWF) in the agriculture, tourism, domestic life, and industrial sectors were estimated to assess the seasonal and annual characteristics of the water pollution levels (WPLs) in the Lhasa River Basin from 2006 to 2018, and WPL calculations were compared with actual water quality measurements from 2017 to 2018. We found that more than 90% of the GWF came from anthropogenic sources. From the perspective of the whole basin, domestic life was the largest contributor to both N-related GWFs (52%) and P-related GWFs (50%), followed by agriculture for N-related GWFs (32%) and tourism industry for P-related GWFs (30%). The N emissions into the freshwater environment exceeded the maximum assimilation capacity of the watersheds in individual years at both seasonal and annual scales, while P emissions were completely within the pollution assimilative capacity. Besides, we found the serious N pollution near irrigation areas at the seasonal scale (WPL = 2.7 and TN = 1.11 mg/L). The prosperity of tourism has led to a tenfold increase in N-related GWFs and a fivefold increase in P-related GWFs for the tourism industry near the Lhasa city. The strict top-down unified management for ecological environmental protection in plateaus may be an effective method.

Association between parental socioeconomic status and offspring overweight/obesity from the China Family Panel Studies: a longitudinal survey.

OBJECTIVE: To examine the association between parental socioeconomic status (SES) and the risk of offspring overweight/obesity and the changes of the association that occur as children grow older. DESIGN: We used data from the nationally representative longitudinal survey of the China Family Panel Studies of 2010 and its three follow-up waves in 2012, 2014 and 2016. PARTICIPANTS: A total of 6724 children aged 0-15 years old were included. PRIMARY AND SECONDARY OUTCOME MEASURES: Average household income and paternal and maternal education levels were used as SES indicators. Logistic regression model for panel data was used to examine the associations between SES indicators and child overweight/obesity. A restricted cubic spline linear regression model was used to estimate body mass index (BMI) trajectories with child growth across parental SES levels. RESULTS: Compared with the lowest education level (primary school or less), the ORs for fathers who had completed junior high school, senior high school and junior college or higher were 0.85 (95% CI 0.75 to 0.97), 0.77 (95% CI 0.64 to 0.92) and 0.72 (95% CI 0.55 to 0.93), respectively. The corresponding ORs for mothers were 0.76 (95% CI 0.67 to 0.86), 0.59 (95% CI 0.47 to 0.72) and 0.45 (95% CI 0.34 to 0.60), respectively. A negative association between parental education and offspring overweight/obesity was observed in the first 10 years but not in children 11-15 years old. BMI differences across parental education levels emerged from birth and widened before 6-7 years old, but decreased before adolescence. High average household income was related to a low risk of offspring overweight/obesity but not when parental education level was adjusted for. CONCLUSION: High parental education levels were associated with a low risk of offspring overweight/obesity, especially before adolescence. Effective approaches need to be adopted in early childhood to reduce socioeconomic differences in overweight/obesity.

Towards Comprehensive National Surveillance for Adolescent Health in China: Priority Indicators and Current Data Gaps.

PURPOSE: The purpose of the study was to propose a health indicator system responsive to current Chinese adolescent health needs and identify data gaps in current information systems. METHODS: We identified 186 keywords for adolescent health gathered from three sources: contributors to the burden of disease captured in the Global Burden of Diseases 2015, together with independent literature and expert desk reviews; major health-related policies released by the State Council of China; and global strategies issued by UN agencies over the past five years. All keywords were synthesized into indicators and ranked with core indicators identified through panel discussions and literature review. A further systematic review was conducted to identify data sources for each indicator. RESULTS: We identified 100 indicators which we categorized into five dimensions: health outcomes including adolescent mortality and morbidity; health knowledge, skills and risk behaviors including smoking, physical activity; demographic and socioeconomic status including education or employment; responsiveness of the health service system including the provision of health education at school; and the physical and social environments including safe drinking water, secondhand smoke exposure, injuries, and bullying. In total, 72 indicators had nationally representative data, including 22 out of 24 core indicators (91.7%), 27 out of 33 potential core indicators (81.8%), and 23 out of 43 general indicators (53.5%). A large proportion of these indicators rely solely on data from school or household surveys. CONCLUSIONS: The proposed health indicator system has the potential to rapidly identify shifting priorities for adolescent health in China but will require greater investment in primary data collection in neglected areas.

Finite Element Assessment of the Screw and Cement Technique in Total Knee Arthroplasty.

BACKGROUND: The screw and cement technique is a convenient method used to rebuild medial tibial plateau defects in primary total knee arthroplasty (TKA). The objective of this study was to perform a finite element assessment to determine the effect of different numbers of screws on the stability of TKA and to determine whether differences exist between two different insertion angles. METHOD: Six tibial finite element models with defects filled with screws and cement and one model with defects filled only with cement were generated. Contact stresses on the surface of cancellous bone in different areas were calculated. RESULTS: Compared to the cement-only technique, the stress on the border of cancellous bone and bone cement decreased by 10% using the screw and cement technique. For bone defects with a 12% defect area and a 12-mm defect depth, the use of 1 screw achieved the greatest stability; for those with a 15% defect area and a 20-mm defect depth, 2 screws achieved the greatest stability. CONCLUSIONS: (1) The screw and cement technique is superior to the bone cement-only technique. For tibial defects in which the defect area comprises a large percentage but the depth is less than 5 mm, the screw and cement technique is recommended. (2) Vertical screws can achieve better stability than oblique screws. (3) Screws should be used in moderation for different defects; more is not always better.

National and Subnational Trends in Mortality and Causes of Death in Chinese Children and Adolescents Aged 5-19 Years From 1953 to 2016.

PURPOSE: We aimed to analyze the recent trends of mortality and rankings of causes of death in Chinese children and adolescents from 1953 to 2016. METHODS: Data on mortality and causes of death in Chinese children and adolescents aged 5-19 years were extracted from the China Health Statistics Yearbook and the Global Burden of Disease Study from 1953 to 2016. Mortality variations were analyzed by year, age, sex, province, and causes of death. RESULTS: The mortality of Chinese children and adolescents aged 5-19 years declined steadily from 1953 (366.03/100,000) to 2016 (27.21), with the largest reduction in adolescents aged 15-19 years and the smallest reduction in those aged 10-14 years. Large subnational disparities for all-cause mortality existed in national 31 provinces with higher mortality in western regions compared with eastern regions, but with narrowing disparities between 1981 and 2010. Injuries dominated the causes of death compared with noncommunicable diseases and communicable, maternal and neonatal, and nutritional diseases from 1990 (58.13/100,000 vs. 32.10 and 14.31) to 2016 (22.65 vs. 13.00 and 2.93). In 2016, the leading three causes of death were road injuries (8.30/100,000), drowning (7.25), and leukemia (2.60). Drowning was the leading cause of death for 5- to 14-year-olds, but road injuries have been the leading cause for 15- to 19-year-olds of both sexes since 2010. CONCLUSIONS: Although mortality in Chinese adolescents now stands at just 7% of rates in the 1950s, there is a need to address continuing inequalities across sex, economic status, and region.

Reducing Anemia Among School-Aged Children in China by Eliminating the Geographic Disparity and Ameliorating Stunting: Evidence From a National Survey.

Background: The aim of this study was to assess the geographic disparity in anemia and whether stunting was associated with anemia in different geographic groups among school-aged children in China. Methods: 71,129 Han children aged 7, 9, 12, and 14 years old were extracted from the 2014 cycle of Chinese National Surveys on Children Constitution and Health. Anemia, anemia severity, and stunting were defined according to WHO definitions. Binary logistic regression models were used to estimate the association between anemia and stunting in different geographic groups. Results: The prevalence of anemia was significantly higher in girls (10.8%) than boys (7.0%). The highest anemia prevalence was in Group VII (lower class/rural, 12.0%). A moderate/severe prevalence of anemia was concentrated in Group VII and Group VIII (western/lower class/rural) for both sexes. The prevalence of anemia was higher in stunting boys than non-stunting boys in Group IV (lower class/city, χ2 = 12.78, P = 0.002) and Group VII (χ2 = 6.21, P = 0.018), while for girls, it was higher in stunting girls than their non-stunting peers only in Group II (upper class/large city, χ2 = 4.57, P = 0.046). Logistic regression showed that the stunting children have 30% higher risk of anemia than non-stunting children after adjustment for age, sex and school (OR = 1.30, 95% CI: 1.05-1.60). Conclusion: A significant geographic disparity and an association between anemia and stunting among specific groups of school-aged children in China was demonstrated. Consequently, eliminating the geographic disparity and ameliorating stunting might contribute to the improvement of Chinese children's anemia. Specific guidelines and interventions are needed, especially for adolescent girls and the groups with serious anemia burden.

Ethnicity, socioeconomic status and the nutritional status of Chinese children and adolescents: Findings from three consecutive national surveys between 2005 and 2014.

BACKGROUND: Economic development has brought rapid shifts in the food environment of Chinese children and adolescents. OBJECTIVES: To assess the changes in childhood nutritional status across ethnic groups and economic status from 2005 to 2014. METHODS: 664 094 Chinese Han and 224 151 ethnic minority children and adolescents aged 7 to 18 years were assessed in three national cross-sectional surveys (2005, 2010 and 2014). Gross domestic product (GDP) per capita of each ethnic group was categorized into four strata of socioeconomic status. To assess ethnic disparities at each time point, we used logistic regression to estimate the prevalence odds ratios (OR) for thinness, overweight and obesity in the 24 ethnic minority groups vs Han Chinese. RESULTS: Children in the two upper economic strata (over about US$4000 GDP per capita) had a high prevalence of overweight and obesity, while those in the two lower economic strata (below US$4000 GDP per capita) had a high prevalence of thinness. From 2005 to 2014, the prevalence of thinness decreased from 18.6% to 13.1% in Han children, and from 20.4% to 17.1% in ethnic minority students. At the same time, the prevalence of overweight and obesity increased from 10.4% to 17.7% in Han children, and from 4.3% to 9.2% in ethnic minority students, respectively. CONCLUSIONS: A rapid nutritional transition has occurred from 2005 to 2014 with shifts from thinness to overweight and obesity in both Han and ethnic minority children and adolescents, reflecting local GDP per capita.

Preoperative vascular heterogeneity and aggressiveness assessment of pituitary macroadenoma based on dynamic contrast-enhanced MRI texture analysis.

PURPOSE: To assess the vascular heterogeneity and aggressiveness of pituitary macroadenomas (PM) using texture analysis based on Dynamic Contrast-Enhanced MRI (DCE-MRI). METHOD: Fifty patients with pathologically confirmed PM, including 32 patients with aggressive PM (aggressive group) and 18 patients with non-aggressive PM (non-aggressive group), were included in this study. The preoperative DCE-MRI and clinical data were collected from all patients. The features based on Ktrans, Ve, and Kep were generated using Omni-Kinetics software. Independent-samples t-test and Mann-Whitney U test were used for comparison between two groups. Logistic regression analysis was used to determine the optimal model for distinguishing aggressive and non-aggressive PM. RESULTS: Six features related to tumor morphology, 24 features in Ktrans, 20 features in Ve, and 3 features in Kep were significantly different between the aggressive and non-aggressive groups. Volume count, gray-level non-uniformity in Ktrans, voxel value sum in Ve and run-length non-uniformity in Kep (AUC = 0.816, 0.903, 0.785, 0.813) were considered the best feature for tumor diagnosis. After modeling, the diagnosis efficiency of mean model and total model was desirable (AUC = 0.859 and 0.957), and the diagnostic efficiency of morphological, Ktrans, Ve and Kep features model was improved (AUC = 0.845, 0.951, 0.847, 0.804). CONCLUSIONS: Texture analysis based on DCE-MRI elucidates the vascular heterogeneity and aggressiveness of pituitary adenoma. The total model could be used as a new noninvasive method for predicting the aggressiveness of pituitary macroadenoma.

Study on landscape ecological risk assessment of Hooded Crane breeding and overwintering habitat.

Xinqing Wetland and Shengjin Lake Wetland are the main habitats of Hooded Crane in China. However, in recent years, the irrational land use situation of occupied wetlands has occurred frequently, resulting in the destruction of the breeding of the Hooded Crane population and the destruction of the wintering habitat. The paper takes Xinqing Wetland and Shengjin Lake Wetland as the research area, and uses landscape ecology and geostatistics as the theoretical basis to reveal the changes of land landscape in the study area, and analyze the main breeding and wintering habitat types of Hooded Crane. The landscape ecological risk assessment model is constructed by the landscape pattern index method, and the ecological risk in the study area is divided into five levels: extremely low ecological risk, low ecological risk, medium ecological risk, high ecological risk and extremely high ecological risk. The landscape ecological risk of the study area is analyzed from the aspects of single landscape type, spatial distribution characteristics and time series changes. Overall, from 1986 to 2018, the landscape ecological risks of Xinqing Wetland and Shengjin Lake Wetland all showed an upward trend, both from the low ecological risk level in 1986 to the middle ecological risk level in 2018. The ecological risk value of Xinqing Wetland increased from 0.3777 in 1986 to 0.5882 in 2018; the ecological risk value of Shengjin Lake wetland landscape increased from 0.2706 in 1986 to 0.5709 in 2018. The growth rate of the Shengjin Lake wetland is higher than that of the Xinqing Wetland. In order to better protect the ecological environment of the wetland and protect the habitat of the Hooded Crane, this paper will propose corresponding suggestions and countermeasures.

Association between retinal arterial narrowing and left ventricular diastolic dysfunction in masked hypertensives.

Morphological change in retinal vessel diameters has been reported to be associated with negative cardiovascular outcomes, but its association with left ventricular diastolic dysfunction (LVDD) is not clear. This study aimed to examine the association between echocardiographic markers of LVDD and retinal vascular diameters, in untreated masked hypertension (MH). In this observational study, 105 MH patients without other cardiovascular risks were included (mean age 48.4 ± 5.7, female 72.4%). All individuals underwent extensive clinical and laboratory investigations, including echocardiography, ambulatory blood pressure monitoring, and retinal vascular diameters measured by optical coherence tomography. In the group, LVDD was diagnosed in 36 participants evaluated by left ventricular volume index, E/A and E/e' ratio. Compared to non-LVDD, LVDD subjects displayed narrower retinal arteriolar diameter (139.1 ± 33.8 vs 165.1 ± 29.1; adjusted P = .007) and wider retinal venular diameter (237.9 ± 42.2 vs 214.9 ± 44.8; adjusted P = .045). Significant and independent associations were demonstrated for retinal arteriolar narrowing and E/A ratio (adjusted ß = 0.744, P = .031) and for retinal arteriolar diameter and E/e' ratio (adjusted ß = -0.158, P = .001) after controlling for age, gender, body mass index, ambulatory systolic blood pressure, low-density lipoprotein cholesterol, and retinal venular diameter. In untreated MH subjects, retinal arteriolar diameter, a marker of microvascular damage, was independently associated with echocardiographic markers of diastolic dysfunction. These findings might underscore the hypothesis that microvascular disease could contribute to cardiac remodeling.