First comprehensive assessment of dietary chlorinated paraffins intake and exposure risk for the rural population of the Tibetan Plateau, China.

Knowledge regarding the occurrence of short-chain and medium-chain chlorinated paraffins (SCCPs and MCCPs) in foodstuffs and their dietary exposure risks for rural Tibetan residents remains largely unknown. Herein, we collected main foodstuffs (including highland barley, vegetables, Tibetan butter, mutton, and yak beef) across the rural Tibetan Plateau and characterized the CP profiles and concentrations. The highest SCCPs concentrations were detected in Tibetan butter (geometric mean (GM): 240.6 ng/g wet weight (ww)), followed by vegetables (59.4 ng/g ww), mutton (51.4 ng/g ww), highland barley (46.3 ng/g ww), and yak beef (31.7 ng/g ww). For MCCPs, the highest concentrations were also detected in Tibetan butter (319.5 ng/g ww), followed by mutton (181.9 ng/g ww), vegetables (127.0 ng/g ww), yak beef (71.2 ng/g ww), and highland barley (30.3 ng/g ww). The predominant congener profiles of SCCPs were C13Cl7-8 in mutton and yak beef, C10Cl7-8 in Tibetan butter, and C10-11Cl6-7 in highland barley and vegetables. The predominant congener profiles of MCCPs were C14Cl7-9 in all sample types. Combined with our previous results of free-range chicken eggs, the median estimated daily intakes (EDIs) of SCCPs and MCCPs via diet for Tibetan rural adults and children was estimated to be 728.8 and 1853.9 ng/kg bw/day and 2565.6 and 5952.8 ng/kg bw/day, respectively. In the worst scenario, MCCPs might induce potential health risks for rural Tibetan population. To our knowledge, this is the first systematic dietary exposure research of SCCPs and MCCPs in the remote rural areas.

Phantom study of a self-shielded X-ray bone age assessment instrument against scattered radiation in children.

Hand-wrist radiography is the most common and accurate method for evaluating children's bone age. To reduce the scattered radiation of radiosensitive organs in bone age assessment, we designed a small X-ray instrument with radioprotection function by adding metal enclosure for X-ray shielding. We used a phantom operator to compare the scattered radiation doses received by sensitive organs under three different protection scenarios (proposed instrument, radiation personal protective equipment, no protection). The proposed instrument showed greater reduction in the mean dose of a single exposure compared with radiation personal protective equipment especially on the left side which was proximal to the X-ray machine (≥80.0% in eye and thyroid, ≥99.9% in breast and gonad). The proposed instrument provides a new pathway towards more convenient and efficient radioprotection.

Remarkable Contamination of Short- and Medium-Chain Chlorinated Paraffins in Free-Range Chicken Eggs from Rural Tibetan Plateau.

Rapid social-economic development introduces modern lifestyles into rural areas, not only bringing numerous modern products but also new pollutants, such as chlorinated paraffins (CPs). The rural Tibetan Plateau has limited industrial activities and is a unique place to investigate this issue. Herein we collected 90 free-range chicken egg pool samples across the rural Tibetan Plateau to evaluate the pollution status of CPs. Meanwhile, CPs in related soils, free-range chicken eggs from Jiangxi, and farmed eggs from markets were also analyzed. The median concentrations of SCCPs (159 ng g-1 wet weight (ww)) and MCCPs (1390 ng g-1 ww) in Tibetan free-range chicken eggs were comparable to those from Jiangxi (259 and 938 ng g-1 ww) and significantly higher than those in farmed eggs (22.0 and 81.7 ng g-1 ww). In the rural Tibetan Plateau, the median EDI of CPs via egg consumption by adults and children were estimated to be 81.6 and 220.2 ng kg-1 bw day-1 for SCCPs and 483.4 and 1291 ng kg-1 bw day-1 for MCCPs, respectively. MCCPs might pose potential health risks for both adults and children in the worst scenario. Our study demonstrates that new pollutants should not be ignored and need further attention in remote rural areas.

Dietary carotenoids intake and sex differences in relation to chronic kidney disease a cross-sectional assessment in the NHANES study.

BACKGROUND AND AIMS: Current evidence on the relationship between dietary carotenoids intake (DCI) and chronic kidney disease (CKD) are limited. Moreover, whether there is an association between DCI and prevalence of CKD and how this association might be impacted by sex is not clear. METHODS AND RESULTS: Overall, 4507 women and 4396 men were included for analysis. The study used data from the National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey carried out in the USA. The exposure factor for this analysis was DCI. The outcome was CKD, defined as eGFR < 60mL/min/1.73 m2. Multivariate logistic regression was used to analyzed the associations of DCI and prevalence of CKD both in men and women. There was a significant inverse association between higher DCI and prevalence of CKD only among females. Per LgDCI unit increment, the multivariable adjusted odd ratio (OR) (95% confidence interval) for prevalence of CKD was 0.72 (0.58, 0.90) in females and 0.95 (0.77, 1.18) in males. When compared with the lowest quartile, the ORs of the highest quartile of DCI for prevalence of CKD were 0.59 (0.40, 0.87) in females and 0.87 (0.60, 1.26) in males. The associations remained similar in the subgroup analyses. CONCLUSIONS: The findings suggest that a higher intake of dietary carotenoids is associated with a lower prevalence of CKD in women, but not in men.

Facile and Cost-Effective Fabrication of Highly Sensitive, Fast-Response Flexible Humidity Sensors Enabled by Laser-Induced Graphene.

The need to simplify fabrication processes and reduce costs for high-performance humidity sensors is increasingly vital, especially in fields such as healthcare and agriculture. This study introduces a simple and cost-effective approach using laser-induced graphene (LIG) on a polyimide film to create highly sensitive and fast-response flexible humidity sensors. The LIG acts as the electrode, while the porous polyimide between the interdigital LIG electrodes serves as the humidity sensing material, showing changes in electrical conductivity based on the humidity levels. The LIG humidity sensor, an ionic-conduction type, exhibits remarkable sensitivity, with a 28,231-fold increase in current as relative humidity changes from 26.1 to 90.2%. It also boasts of ultrashort response/recovery times (less than 0.5/7 s), providing significant advantages in detecting rapid and subtle humidity variations compared to a commercially available MEMS humidity sensor. We successfully demonstrated the LIG humidity sensor's capabilities in ultrafast breathing monitoring (≈174 times per minute), moisture detection of grains, and detection of sudden water pipe leakage. Due to its straightforward and cost-effective fabrication process, the LIG humidity sensor holds immense practical value for affordable, widespread use across various applications.

[Health Benefit Assessment of Coal-to-electricity Policy on PM2.5 Pollution in Beijing-Tianjin-Hebei Region].

To accurately assess the health benefits of the coal-to-electricity policy during the heating period in the Beijing-Tianjin-Hebei(BTH) Region, the premature deaths caused by PM2.5 before and after the implementation of the coal-to-electricity policy during the heating period in each district and county of the BTH Region were estimated, and the corresponding health loss values were calculated using the willingness to pay method. The results showed that the implementation of the coal-to-electricity policy in the BTH Region brought 1745 cases(95% CI:1443-1907) of health benefits and 2.38 billion yuan(95% CI:1.45-3.06) in economic benefits. In Beijing, Tianjin, and Hebei there were 495 cases(95% CI:436-554), 296 cases(95% CI:238-354), and 954 cases(95% CI:693-1076) of health benefits, respectively. The economic benefits were 0.35 billion yuan(95% CI:0.30-0.39), 0.33 billion yuan(95% CI:0.27-0.40), and 1.70 billion yuan(95% CI:0.88-2.28), respectively, accounting for 0.01%, 0.02%, and 0.04% of GDP in each region. The number of premature deaths due to COPD, LC, ALRI, IHD, and STROKE decreased by 187 cases(95% CI:165-224), 318 cases(95% CI:178-458), 193 cases(95% CI:115-204), 506 cases(95% CI:232-780), and 542 cases(95% CI:463-621), respectively. Areas with relatively high environmental PM2.5 concentrations and concentrated population-intensive pollution emissions can achieve significant health and economic benefits.

Low-Cost Preparation of High-Performance Na-B-H-S Electrolyte for All-Solid-State Sodium-Ion Batteries.

All-solid-state sodium-ion batteries have the potential to improve safety and mitigate the cost bottlenecks of the current lithium-ion battery system if a high-performance electrolyte with cost advantages can be easily synthesized. In this study, a one-step dehydrogenation-assisted strategy to synthesize the novel thio-borohydride (Na-B-H-S) electrolyte is proposed, in which both raw material cost and preparation temperature are significantly reduced. By using sodium borohydride (NaBH4 ) instead of B as a starting material, B atoms can be readily released from NaBH4 with much less energy and thus became more available to generate thio-borohydride. The synthesized Na-B-H-S (NaBH4 /Na-B-S) electrolyte exhibits excellent compatibility with current cathode materials, including FeF3 (1.0-4.5 V), Na3 V2 (PO4 )3 (2.0-4.0 V), and S (1.2-2.8 V). This novel Na-B-H-S electrolyte will take a place in mainstream electrolytes because of its advantages in preparation, cost, and compatibility with various cathode materials.

Rapid assessment of malnutrition based on GLIM diagnosis in Crohn's disease.

Background and aims: Malnutrition is strongly linked to adverse outcomes in patients with Crohn's disease (CD). In this study, our objective was to validate the Global Leadership Initiative on Malnutrition (GLIM) criteria and develop a fast and accurate diagnostic approach for identifying malnutrition in CD patients. Methods: This study assessed 177 CD patients from four general hospitals. The efficacy of the GLIM criteria for the diagnosis of CD malnutrition was compared. By analyzing the independent factors, a nomogram model was derived and internally validated to predict the diagnosis of malnutrition in patients with CD. Model performance was assessed using discrimination and calibration, decision curves, and net benefit analyses. Results: Compared with the SGA criteria, the GLIM criteria was consistent in sensitivity (88.89%) and specificity (78.43%) [AUC = 0.84; 95% Confidence Interval (CI): 0.77-0.89]. The Harvey-Bradshaw index(HBI) score (OR: 1.58; 95% CI: 1.15-2.18), body mass index (OR: 0.41; 95% CI: 0.27-0.64), and mid-upper arm circumference (OR: 0.68; 95% CI: 0.47-0.9) were independent factors associated with malnutrition. The nomogram was developed based on these indicators showing good discrimination in malnutrition diagnosis (AUC = 0.953; 95% CI: 0.922-0.984), with agreement after calibration curve and decision curve analysis. Conclusion: The GLIM criteria are appropriate for diagnosing malnutrition in CD patients. The HBI score may be used to diagnose malnutrition in patients with CD and become a possible selection for the GLIM etiologic criteria of inflammation. The HBM nomogram could be a simple, rapid, and efficient method for diagnosing malnutrition in CD patients.

Construction of Negative Electrostatic Pore Environments in a Scalable, Stable and Low-Cost Metal-organic Framework for One-Step Ethylene Purification from Ternary Mixtures.

One-step separation of C2 H4 from ternary C2 mixtures by physisorbents remains a challenge to combine excellent separation performance with high stability, low cost, and easy scalability for industrial applications. Herein, we report a strategy of constructing negative electrostatic pore environments in a stable, low-cost, and easily scaled-up aluminum MOF (MOF-303) for efficient one-step C2 H2 /C2 H6 /C2 H4 separation. This material exhibits not only record high C2 H2 and C2 H6 uptakes, but also top-tier C2 H2 /C2 H4 and C2 H6 /C2 H4 selectivities at ambient conditions. Theoretical calculations combined with in situ infrared spectroscopy indicate that multiple N/O sites on pore channels can build a negative electro-environment to provide stronger interactions with C2 H2 and C2 H6 over C2 H4 . Breakthrough experiments confirm its exceptional separation performance for ternary mixtures, affording one of the highest C2 H4 productivity of 1.35 mmol g-1 . This material is highly stable and can be easily synthesized at kilogram-scale from cheap raw materials using a water-based green synthesis. The benchmark combination of excellent separation properties with high stability and low cost in scalable MOF-303 has unlocked its great potential in this challenging industrial separation.

A Dataset on the Dynamic Monitoring of Health and Family Planning of China's Internal Migrants: A Multi-Wave Large-Scale, National Cross-Sectional Survey from 2009 to 2018.

This data article presents data from the China Migrants Dynamic Survey (CMDS), a multi-wave, large-scale national cross-sectional survey of China's internal migrants from 2009 to 2018. The CMDS is an annual questionnaire survey conducted by the former National Health and Family Planning Commission (NHFPC) of the People's Republic of China. The respondents included in this survey are internal migrants over 15 years old. The sample was drawn from the China Migrant Population Information System, using multi-stage stratified sampling method and the probability proportional-to-size (PPS) cluster sampling strategy. Between 2009 and 2018, there were 1,527,650 internal migrants from 23 provinces, 5 autonomous regions and 4 municipalities participated in the surveys. The survey tools were a series of self-designed questionnaires with high inheritance and consistency designed and implemented by the NHFPC. The questionnaires mainly contain basic information of the respondents and their family members, migration status, healthcare or health behaviors, public health service utilization, social insurance, social integration, and family planning. The dataset is currently the most widely used survey data on China's internal migrants, offering information on migration patterns, healthcare and health behaviors, use of public health services, access to social security, social integration, and family planning, which are valuable for health planning, health decision-making, and health equity research.

Evaluation and Comparison of Real-World Databases for Conducting Research in Patients With Colorectal Cancer.

PURPOSE: Evaluating whether patient populations in clinico-genomic oncology databases are comparable with whom in other databases without genomic component is important. METHODS: Four databases were compared for colorectal cancer (CRC) cases and stage IV CRC cases: American Association for Cancer Research Project Genomics Evidence Neoplasia Information Exchange Biopharma Collaborative (GENIE-BPC), The Cancer Genome Atlas (TCGA), SEER-Medicare, and MarketScan Commercial and Medicare Supplemental claims databases. These databases were also compared with the SEER registry database which serves as national benchmarks. Demographics, clinical characteristics, and overall survival were compared in patients with newly diagnosed CRC and patients with stage IV CRC across databases. Treatment patterns were further compared in patients with stage IV CRC. RESULTS: A total of 65,976 patients with CRC and 13,985 patients with stage IV CRC were identified. GENIE-BPC had the youngest patient population (mean age [years]: CRC, 54.1; stage IV CRC, 52.7). SEER-Medicare had the oldest patient population (CRC, 77.7; stage IV CRC, 77.3). Most patients were male and of White race across databases. GENIE-BPC had the highest proportion of patients with stage IV CRC (48.4% v other databases 13.8%-25.4%) and patients receiving treatments (95.7% v 37.6%-59.1%). Infusional fluorouracil, leucovorin, and oxaliplatin with or without bevacizumab was the most common regimen across databases accounting for 47.3%-78.5% of patients receiving first line of therapy. The median survival from diagnosis was 36, 94, 44 months (CRC) and 23, 36, 15 months (stage IV CRC) for patients in GENIE-BPC after left truncation, TCGA, and SEER-Medicare databases, respectively. CONCLUSION: Compared with other databases, GENIE-BPC had the youngest patients with CRC with the most advanced disease and the largest proportion of patients receiving treatment. Investigators should consider adjustments when extrapolating results from clinico-genomic databases to the general CRC population.

The impact of green taxes on green innovation of enterprises: a quasi-natural experiment based on the levy of environmental protection taxes.

Green innovation is a strategic choice for Chinese enterprises to achieve in balancing economic performance and environmental benefits. Environmental protection tax (EPT) is the first green tax in China. How to fully leverage the institutional dividends of environmental tax reform to achieve green innovation in enterprises is of great significance for the high-quality development of China's current economy. This study takes the levy of environmental protection taxes as the quasi-natural experiment and uses DID, DDD, PSM-DID and so on to verify the impact of EPT on green innovation. The results show that EPT can improve green innovation through the path of legitimacy pressure and legitimacy management. Notably, the effects are more obvious in enterprises with non-state-owned, low-financing constraints and located in the eastern region. Furthermore, green innovations under the push of environmental protection tax can improve long-term performance, while it has a negative effect on short-term performance. The levy of EPT has the dual dividend effect of economy and environment. Moreover, this study explores the source of the legitimacy pressure and the strategic response of enterprises and provides guidance for government's precise implementation of policies to optimize the role of EPT in green innovation.

Occurrence and risk assessment of organophosphate esters in global aquatic products.

Organophosphate esters (OPEs), as an important class of new pollutants, have been pervasively detected in global aquatic products, arousing widespread public concern due to their potential bioaccumulative behavior and consequent risks. With the continuous improvement of living standards of citizens, there have been constant increment of the proportion of aquatic products in diets of people. The levels of OPEs exposed to residents may also be rising due to the augmented consumption of aquatic products, posing potential hazards on human health, especially for people in coastal areas. The present study integrated the concentrations, profiles, bioaccumulation, and trophic transfer of OPEs in global aquatic products, including Mollusca, Crustacea, and fish, evaluated health risks of OPEs through aquatic products in daily diets by Mont Carol Simulation (MCS), and found Asia has been the most polluted area in terms of the concentration of OPEs in aquatic products, and would have been increasingly polluted. Among all studied OPEs, chlorinated OPEs generally showed accumulation predominance. It is worth noting that some OPEs were found bioaccumulated and/or biomagnified in aquatic ecosystems. Though MCS revealed relative low exposure risks of residents, sensitive and special groups such as children, adolescents, and fishermen may face more serious health risks than the average residents. Finally, knowledge gaps and recommendations for future research are discussed encouraging more long-term and systematic global monitoring, comprehensive studies of novel OPEs and OPEs metabolites, and more toxicological studies to completely evaluate the potential risks of OPEs.

Disease burden of prostate cancer from 2014 to 2019 in the United States: estimation from the Global Burden of Disease Study 2019 and Medical Expenditure Panel Survey.

OBJECTIVES: The aim of this study was to evaluate the disease burden of prostate cancer (PC) and assess key influencing factors associated with the disease expenditures of PC in the United States. METHODS: The total deaths, incidence, prevalence, and disability-adjusted life-years of PC were obtained from the Global Burden of Disease Study 2019. The Medical Expenditure Panel Survey was used to estimate healthcare expenditures and productivity loss and to investigate patterns of payment and use of healthcare resources in the United States. A multivariable logistic regression model was conducted to identify key factors influencing expenditures. RESULTS: For patients aged 50 and older, the burden for all age groups showed a modest increase over the 6-year period. Annual medical expenditures were estimated to range from US$24.8 billion to US$39.2 billion from 2014 to 2019. The annual loss in productivity for patients was approximately US$1,200. The top 3 major components of medical costs were hospital inpatient stays, prescription medicines, and office-based visits. Medicare was the largest source of payments for survivors. In terms of drug consumption, genitourinary tract agents (57.0%) and antineoplastics (18.6%) were the main therapeutic drugs. High medical expenditures were positively associated with age (p=0.005), having private health insurance (p=0.016), more comorbidities, not currently smoking (p=0.001), and patient self-perception of fair/poor health status (p<0.001). CONCLUSIONS: From 2014 to 2019, the national real-world data of PC revealed that the disease burden in the United States continued to increase, which was partly related to patient characteristics.

Assessment of the Role of Artificial Intelligence in the Association Between Time of Day and Colonoscopy Quality.

Importance: Time of day was associated with a decline in adenoma detection during colonoscopy. Artificial intelligence (AI) systems are effective in improving the adenoma detection rate (ADR), but the performance of AI during different times of the day remains unknown. Objective: To validate whether the assistance of an AI system could overcome the time-related decline in ADR during colonoscopy. Design, Setting, and Participants: This cohort study is a secondary analysis of 2 prospective randomized controlled trials (RCT) from Renmin Hospital of Wuhan University. Consecutive patients undergoing colonoscopy were randomly assigned to either the AI-assisted group or unassisted group from June 18, 2019, to September 6, 2019, and July 1, 2020, to October 15, 2020. The ADR of early and late colonoscopy sessions per half day were compared before and after the intervention of the AI system. Data were analyzed from March to June 2022. Exposure: Conventional colonoscopy or AI-assisted colonoscopy. Main Outcomes and Measures: Adenoma detection rate. Results: A total of 1780 patients (mean [SD] age, 48.61 [13.35] years, 837 [47.02%] women) were enrolled. A total of 1041 procedures (58.48%) were performed in early sessions, with 357 randomized into the unassisted group (34.29%) and 684 into the AI group (65.71%). A total of 739 procedures (41.52%) were performed in late sessions, with 263 randomized into the unassisted group (35.59%) and 476 into the AI group (64.41%). In the unassisted group, the ADR in early sessions was significantly higher compared with that of late sessions (13.73% vs 5.70%; P = .005; OR, 2.42; 95% CI, 1.31-4.47). After the intervention of the AI system, as expected, no statistically significant difference was found (22.95% vs 22.06%, P = .78; OR, 0.96; 95% CI; 0.71-1.29). Furthermore, the AI systems showed better assistance ability on ADR in late sessions compared with early sessions (odds ratio, 3.81; 95% CI, 2.10-6.91 vs 1.60; 95% CI, 1.10-2.34). Conclusions and Relevance: In this cohort study, AI systems showed higher assistance ability in late sessions per half day, which suggests the potential to maintain high quality and homogeneity of colonoscopies and further improve endoscopist performance in large screening programs and centers with high workloads.

A novel bio-washing eluent obtained from fermentation of fruit wastes for removal of soil Pb: efficiency, mechanism, and risk assessment.

Agricultural wastes are inexpensive materials for soil remediation. However, the direct water extracts from these wastes showed low efficiency for Pb removal, thus limiting their application. In this study, citrus pericarp (CP) and pineapple peel (PP), as the common agricultural wastes, were inoculated with lactic acid bacteria to produce fermentation liquors (FCP and FPP) for improving Pb removal efficiency. Results showed that the Pb removal rates by FCP and FPP reached 37.3 and 43.6%, and increased by almost 50.0% than those by CP and PP. The ecological risk of Pb reduced by 83.0-88.2% after five times continuous washing with FCP and FPP, and the Pb concentrations conformed to soil remediation standard of China. Moreover, soil organic carbon 1.5 times increased in the washed soils, while total potassium improved by 40.7-68.0%. The mechanisms of Pb removal by these wastes involved in adsorption-desorption of Pb2+, complexation with organic ligands, and co-precipitation of Pb complexes. The increase of low molecular organic acids during the fermentation promoted dissolution of Pb and provided more hydroxyl, carboxyl, and amine groups to interact with Pb2+, thus improving its removal rate. Therefore, fermentation liquid from fruit wastes is a novel, effective, and ecofriendly bio-washing eluent for Pb removal from contaminated soils.

Avelumab Maintenance Treatment After First-line Chemotherapy in Advanced Urothelial Carcinoma-A Cost-Effectiveness Analysis.

BACKGROUND: Recently, a clinical trial (NCT02603432) showed that avelumab maintenance treatment, post first-line chemotherapy, can significantly prolong the overall survival of patients with advanced urothelial carcinoma (UC), however, the treatment was very expensive. This study aimed to determine the cost-effectiveness of avelumab maintenance therapy in advanced or metastatic UC from the US taxpayer perspective. METHODS: Based on the data of the JAVELIN Bladder 100 clinical trial (NCT02603432), a Markov multi-state model was constructed to investigate the costs and clinical outcomes of avelumab maintenance after platinum-based chemotherapy versus best supportive care (BSC) for advanced or metastatic UC. Parameters of the model came from the 2020 Average Sales Price Drug Pricing Files and published literature. The main outputs were costs, life years (LYs), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Robustness was tested by deterministic and probabilistic sensitivity analyses. The analysis was stratified to include both the overall population and a subset of programmed death-ligand 1 (PD-L1)-positive patients. RESULTS: Avelumab maintenance therapy was estimated to generate an additional 0.26 QALYs (1.46 vs. 1.20 QALYs) and costs $183,271 ($278,323 vs. $95,052) more compared to BSC alone in the overall population, yielding an ICER of $699,065/QALY. For the PD-L1-positive population, avelumab produced a 0.42 increase in QALYs (1.74 vs. 1.32 QALYs) and raised costs to $223,238 ($320,355 vs. $97,117), resulting in an ICER of $521,850/QALY for this population. Both ICERs were above the willingness-to-pay (WTP) threshold of $200,000/QALY. Sensitivity analyses manifested that the model was robust. CONCLUSION: From the perspective of the US taxpayer, avelumab maintenance therapy is considered cost-ineffective for patients with advanced or metastatic UC at a WTP threshold of $200,000/QALY in the overall population as well as in PD-L1-positive population.

Quantifying interconnectedness and centrality ranking among financial institutions with TVP-VAR framework.

Financial risk is spread and amplified through the interconnectedness among financial institutions. We apply a time-varying parameter vector autoregression model to analyze the dynamic spillover effects in the Chinese financial system. We find that the 2017 house price control policies have significantly increased the risk of China's financial system. Before 2017, with the prosperity of the real estate market, the interconnectedness of the Chinese financial system continued to decline, while after 2017, with the slowdown of house price growth and the downturn of the real estate market, the interconnectedness turned to increase. For different sectors, the trends and the magnitudes of the spillover effects are diverse, and any sector can contribute to systemic risk in a dynamic way. Finally, we rank 20 systemically important financial institutions according to two centrality measures. The stable institution ranking provides less noisy information for regulators to formulate a policy and intervene in the market effectively.

Efficacy, safety, and cost-effectiveness of triple therapy in preventing relapse in rheumatoid arthritis: A randomized controlled trial (ESCoRT study).

BACKGROUND: Biological agents, such as tumor necrosis factor inhibitors (TNFi), have been widely used in rheumatoid arthritis (RA) patients and greatly improved goal achievement. The aim of this study was to investigate whether conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) combination was better in reducing relapse than methotrexate (MTX) monotherapy, and more cost-effective than continuing TNFi plus MTX in RA patients who achieved low disease activity (LDA) with TNFi and MTX therapy. METHODS: RA patients who failed to csDMARDs received an induction therapy of MTX plus TNFi for maximally 12 weeks. Those achieving LDA in 12 weeks were randomly assigned at a 1:1:1 ratio into three groups: (A) adding hydroxychloroquine and sulfasalazine for the first 12 weeks and then discontinuing TNFi for the following 48 weeks; (B) maintaining TNFi and MTX for 60 weeks; and (C) maintaining TNFi and MTX for the first 12 weeks and then discontinuing TNFi for the following 48 weeks. The primary outcome was relapse. RESULTS: A total of 117 patients were enrolled for induction therapy and 67 patients who achieved LDA within 12 weeks were randomized, with 24, 21, and 22 patients in groups A, B, and C, respectively. The relapse rates of groups A and B during the entire 60 weeks were comparable [10/22 (45.5%) vs. 7/20 (35.0%), χ2 = 0.475, P = 0.491], however, significantly lower than that of group C [10/22 (45.5%) vs. 17/20 (85.0%), χ2 = 5.517, P = 0.019; 7/20 (35.0%) vs. 17/20 (85.0%), χ2 = 11.035, P = 0.004, respectively]. Taking RMB 100,000 Yuan as the threshold of willingness to pay, compared to MTX monotherapy (group C), both TNFi maintenance and triple csDMARDs therapies were cost-effective, but triple csDMARDs therapy was better. CONCLUSION: For RA patients who have achieved LDA with TNFi and MTX, csDMARDs triple therapy was a cost-effective option in favor of reducing relapse. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02320630.

Assessment of Suitable Reference Genes for qRT-PCR Normalization in Eocanthecona furcellata (Wolff).

Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) is a widely used tool for measuring gene expression; however, its accuracy relies on normalizing the data to one or more stable reference genes. Eocanthecona furcellata (Wolff) is a polyphagous predatory natural enemy insect that preferentially feeds on more than 40 types of agricultural and forestry pests, such as those belonging to the orders Lepidoptera, Coleoptera, and Hymenoptera. However, to our knowledge, the selection of stable reference genes has not been reported in detail thus far. In this study, nine E. furcellata candidate reference genes (ß-1-TUB, RPL4, RPL32, RPS17, RPS25, SDHA, GAPDH2, EF2, and UBQ) were selected based on transcriptome sequencing results. The expression of these genes in various samples was examined at different developmental stages, in the tissues of male and female adults, and after temperature and starvation treatments. Five algorithms were used, including ΔCt, geNorm, NormFinder, BestKeeper, and RefFinder, to evaluate reference gene expression stability. The results revealed that the most stable reference genes were RPL32 and RPS25 at different developmental stages; RPS17, RPL4, and EF2 for female adult tissue samples; RPS17 and RPL32 for male adult tissue samples; RPS17 and RPL32 for various temperature treatments of nymphs; RPS17 and RPS25 for nymph samples under starvation stress; and RPS17 and RPL32 for all samples. Overall, we obtained a stable expression of reference genes under different conditions in E. furcellata, which provides a basis for future molecular studies on this organism.