Exploring ways to improve China's ecological well-being amidst air pollution challenges using mixed methods.

Ecological well-being performance (EWP), a novel concept in sustainable development research, diverges from traditional ecological efficiency in terms of perspectives, core content, and driving factors. However, research on EWP remains insufficiently comprehensive, particularly the corresponding theoretical and methodological investigations into driving pathways. To address this gap, this study develops an "economy-environment-health" framework, incorporating air pollution and associated health losses into the evaluation system, and employs a two-stage Super-NSBM and Window DEA model for reevaluating EWP. The study further investigates the primary pathways of EWP, focusing on environmental regulations, technological innovation, and structural adjustments through both quantitative and qualitative methods. Quantitative spatial econometric analysis reveals that factors such as market-driven environmental regulations, green invention patents, and industrial and energy consumption structures significantly enhance EWP. While examining the "net effects" contributions of individual variables using spatial econometric models, the fsQCA method is employed to identify four effective driving paths for EWP from a configurational perspective. These paths are 1) technological innovation and structural adjustment under environmental regulations with public participation; 2) a combination of environmental regulation, technological innovation, and structural adjustment; 3) structural adjustment with minimal influence from environmental regulations and technological innovation; and 4) structural adjustment directed by market-incentive environmental regulations.

Consolidation radiographic morphology can be an indicator of the pathological basis and prognosis of partially solid nodules.

BACKGROUND: Part-solid nodules (PSNs) have gradually shifted to defining special clinical subtypes. Commonly, the solid portions of PSNs show various radiological morphologies, of which the corresponding pathological basis and prognosis are unclear. We conducted a radiological-pathological evaluation to determine the histopathologic basis of different consolidation radiographic morphologies related to prognosis. MATERIALS AND METHODS: A cohort of 275 patients with a surgical pathological diagnosis of lung adenocarcinoma were enrolled. Preoperative computed tomography (CT) images of the PSNs were recorded and assessed. A panel of 103 patients with complete pathological specimens was selected to examine the radiological-pathological associations, and follow-up was performed to identify the prognosis. RESULTS: Of the 275 patients, punctate consolidation was observed radiologically in 43/275 (15.7%), stripe consolidation in 68/275 (24.7%), and irregular consolidation in 164/275 (59.6%) patients. The radiological morphology of the solid components was significantly associated with the histopathological subtypes (P < 0.001). Visual punctate solid components on CT correlated with tertiary lymphoid structures, stripe solid components on CT correlated with fibrotic scar, and irregular solid components on CT correlated with invasion. PSNs with regular consolidation had a better prognosis than those with irregular consolidation. CONCLUSION: Radiological morphology of solid components in PSNs can indicate the pathological basis and is valuable for prognosis. In particular, irregular solid components in PSNs usually indicate serious invasive growth, which should be taken with caution during assessment.

Tertiary lymphoid structures in lung adenocarcinoma: characteristics and related factors.

OBJECTIVE: Tertiary lymphoid structures (TLSs) are found in a variety of malignancies and affect the growth of tumors, but few studies have addressed their role in lung adenocarcinoma (LAC). We aimed to evaluate clinical features associated with TLSs in patients with LAC. METHODS AND MATERIALS: A collection of resected pulmonary nodules in patients with LAC was retrospectively analyzed. TLSs were quantified by their number per square millimeter tumor area (density) and by the degree of lymphocyte aggregation (maturity) in each case. The correlation between TLS density and maturity and clinical features was calculated. RESULTS: A total of 243 patients were selected, of whom 219 exhibited TLSs. The occurrence of TLSs was correlated with computed tomography (CT) features as follows: pure ground-glass nodules (pGGNs) (n = 43) was associated with a lower occurrence rate than part-solid nodules (PSNs) (n = 112) and solid nodules (SNs) were (n = 88) (p = 0.037). TLS density was correlated with age and CT features. Poisson regression showed higher TLS density in PSNs and SNs than in pGGNs (incidence rate ratio [IRR]: 3.137; 95% confidence interval [CI]: 1.35-7.27; p = 0.008 and IRR: 2.44; 95% CI: 1.02-5.85; p = 0.046, respectively). In addition, TLS density was higher in patients aged under 60 years than in those aged over 60 years (IRR: 0.605; 95% CI: 0.4-0.92; p = 0.018). The maturity of TLSs was higher in patients with higher tumor stages (p = 0.026). CONCLUSIONS: We demonstrated distinct profiles of TLSs in early LAC and their correlations with CT features, age, and tumor stages, which could help understand tumor progression and management.

How does the turnover intention of village clinic doctors change after China's new health care system reform? A comparison based on three surveys in a province in eastern China.

Objectives: This study aims to analyze the changes in village clinic doctors' turnover intention following the new health care system reform (NHCSR). Methods: All the data were obtained from three surveys conducted in 2012, 2015, and 2018 in a province in eastern China. Descriptive analysis and analysis of variance (ANOVA) were used to analyze the changes in village clinic doctors' turnover intention. Results: The mean scores of village clinic doctors' turnover intention were 2.87 ± 1.07, 2.76 ± 1.12, and 2.99 ± 1.14 in 2012, 2015, and 2018, respectively, with a significant difference (F = 3.60, P = 0.03). During the 3 years, the turnover intention scores of village clinic doctors who were male, aged 40 years and below, secondary technical school graduates, had the qualifications to practice as village clinic doctors, and were under village-township integrated management first decreased and then increased. The turnover intention scores of village clinic doctors with medical practitioner qualifications increased; however, the scores, decreased for those without village-township integrated management. Conclusion: The turnover intention of village clinic doctors has increased, and the possible reasons for this phenomenon include changes in the demographic characteristics of village clinic doctors and policy factors. The government should pay more attention to the problems that village clinic doctors consider of urgent concern, such as the treatment of income and pension insurance, and provide greater career development and training opportunities for village clinic doctors to maintain their motivation and stability.

Radiographic features and prognosis of early- and late-onset non-small cell lung cancer immune checkpoint inhibitor-related pneumonitis.

BACKGROUND: Immunotherapy is becoming a standard of care for non-small cell lung cancer (NSCLC). Checkpoint inhibitor-associated pneumonia (CIP) is a rare and potentially life-threatening event that can occur at any time during tumor immunotherapy. However, there may be differences in the radiological patterns and prognosis of CIP during different periods. This study aimed to investigate the radiographic features and prognosis of early- and late-onset immune-related pneumonitis. METHODS: We retrospectively analyzed the clinical data of 677 NSCLC patients receiving immunotherapy to identify 32 patients with CIP, analyzed the clinical and radiographic data, and summarized the radiological features and prognosis of early- and late-onset CIP. RESULTS: CIP had an incidence of 4.7%, a median onset time of 10 weeks, and a mortality of 28.1%. Among these, CIP included 14 early-onset cases, where grade ≥ 3 CIP accounted for 92.9%, main radiographic pattern was organizing pneumonia (OP)-like pattern, and mortality was 50.0%. We also identified 18 late-onset CIPs, where grade ≥ 3 CIP accounted for 50.0%, main radiographic pattern was nonspecific interstitial pneumonia (NSIP)-like pattern, and mortality was 11.1%. The overall survival rate of the early-onset group was significantly lower than that of the late-onset group (P < 0.05). CONCLUSION: Early-onset CIP cases were higher in the Common Terminology Criteria for Adverse Events (CTCAE v5.0) grade and mainly presented with an OP-like radiographic pattern; whereas, late-onset CIP cases were lower in CTCAE grade and mainly presented with an NSIP-like radiographic pattern. Finally, the prognosis of the early-onset CIP group was poorer than that of the late-onset CIP group. We believe that this study will be helpful for clinicians for making early diagnosis and deciding treatment modalities for patients with CIP.

Independent risk factors for lymph node metastasis in 2623 patients with Non-Small cell lung cancer.

PURPOSE: this study attempts to identify the independent risk factors that can predict lymph node metastasis for the patients with non-small cell lung cancer (NSCLC), and guide doctor adoption of individualized treatment for such patients. MATERIALS AND METHODS: This study was approved by the Hospital's Ethics Committee and all patients had signed informed consent forms. We retrospectively reviewed NSCLC patients who had undergone surgical resection from December 2008 to December 2013.The statistical significance of evaluation variables and lymph node metastasis was determined with Pearson's Chi-square test. The risk factors of lymph node metastasis were determined through univariate and multivariate logistic regression analysis. And for the age and tumor diameter factors, optimal cutoff points were determined with a receiver operating characteristic analysis. RESULTS: In the present study, a total of 2623 patients were included in the study, and 779 patients with lymph node metastasis. Three independent risk factors were identified: age, tumor diameter and Ki-67 index. We found that <65 years of age (Adjusted-OR:1.921), ≥2.85 cm of tumor diameter (Adjusted-OR:3.141), and 5%~25% in Ki-67 group (Adjusted-OR:2.137),≥25% (Adjusted-OR:3.341) were significant. Also we found that 307 patients with lymph node metastasis and the lymph node metastasis rate was 51.0%, when the age<65 years, Ki-67 index≥25%, and the tumor diameter≥2.85 cm. On the contrary, there were only 2 patients with lymph node metastasis, and the rate of lymph node metastasis was 5.1%. CONCLUSION: Identifying three independent risk factors that predict lymph node metastasis in non-small cell patients, Among NSCLC patients in whom all three predictors were identified, and over a half of the patients showed lymph node metastasis.

A Bacteriochlorin-Based Metal-Organic Framework Nanosheet Superoxide Radical Generator for Photoacoustic Imaging-Guided Highly Efficient Photodynamic Therapy.

Hypoxic tumor microenvironment is the bottleneck of the conventional photodynamic therapy (PDT) and significantly weakens the overall therapeutic efficiency. Herein, versatile metal-organic framework (MOF) nanosheets (DBBC-UiO) comprised of bacteriochlorin ligand and Hf6(µ3-O)4(µ3-OH)4 clusters to address this tricky issue are designed. The resulting DBBC-UiO enables numerous superoxide anion radical (O2 -•) generation via a type I mechanism with a 750 nm NIR-laser irradiation, part of which transforms to high toxic hydroxyl radical (OH•) and oxygen (O2) through superoxide dismutase (SOD)-mediated catalytic reactions under severe hypoxic microenvironment (2% O2), and the partial recycled O2 enhances O2 -• generation. Owing to the synergistic radicals, it realizes advanced antitumor performance with 91% cell mortality against cancer cells in vitro, and highly efficient hypoxic solid tumor ablation in vivo. It also accomplishes photoacoustic imaging (PAI) for cancer diagnosis. This DBBC-UiO, taking advantage of superb penetration depth of the 750 nm laser and distinct antihypoxia activities, offers new opportunities for PDT against clinically hypoxic cancer.