Projection of Mortality Burden Attributable to Nonoptimum Temperature with High Spatial Resolution in China.

The updated climate models provide projections at a fine scale, allowing us to estimate health risks due to future warming after accounting for spatial heterogeneity. Here, we utilized an ensemble of high-resolution (25 km) climate simulations and nationwide mortality data from 306 Chinese cities to estimate death anomalies attributable to future warming. Historical estimation (1986-2014) reveals that about 15.5% [95% empirical confidence interval (eCI):13.1%, 17.6%] of deaths are attributable to nonoptimal temperature, of which heat and cold corresponded to attributable fractions of 4.1% (eCI:2.4%, 5.5%) and 11.4% (eCI:10.7%, 12.1%), respectively. Under three climate scenarios (SSP126, SSP245, and SSP585), the national average temperature was projected to increase by 1.45, 2.57, and 4.98 °C by the 2090s, respectively. The corresponding mortality fractions attributable to heat would be 6.5% (eCI:5.2%, 7.7%), 7.9% (eCI:6.3%, 9.4%), and 11.4% (eCI:9.2%, 13.3%). More than half of the attributable deaths due to future warming would occur in north China and cardiovascular mortality would increase more drastically than respiratory mortality. Our study shows that the increased heat-attributable mortality burden would outweigh the decreased cold-attributable burden even under a moderate climate change scenario across China. The results are helpful for national or local policymakers to better address the challenges of future warming.

Global supply chains amplify economic costs of future extreme heat risk.

Evidence shows a continuing increase in the frequency and severity of global heatwaves1,2, raising concerns about the future impacts of climate change and the associated socioeconomic costs3,4. Here we develop a disaster footprint analytical framework by integrating climate, epidemiological and hybrid input-output and computable general equilibrium global trade models to estimate the midcentury socioeconomic impacts of heat stress. We consider health costs related to heat exposure, the value of heat-induced labour productivity loss and indirect losses due to economic disruptions cascading through supply chains. Here we show that the global annual incremental gross domestic product loss increases exponentially from 0.03 ± 0.01 (SSP 245)-0.05 ± 0.03 (SSP 585) percentage points during 2030-2040 to 0.05 ± 0.01-0.15 ± 0.04 percentage points during 2050-2060. By 2060, the expected global economic losses reach a total of 0.6-4.6% with losses attributed to health loss (37-45%), labour productivity loss (18-37%) and indirect loss (12-43%) under different shared socioeconomic pathways. Small- and medium-sized developing countries suffer disproportionately from higher health loss in South-Central Africa (2.1 to 4.0 times above global average) and labour productivity loss in West Africa and Southeast Asia (2.0-3.3 times above global average). The supply-chain disruption effects are much more widespread with strong hit to those manufacturing-heavy countries such as China and the USA, leading to soaring economic losses of 2.7 ± 0.7% and 1.8 ± 0.5%, respectively.

China's carbon-neutral policies will reduce short-term PM2.5-associated excess incidence of cardiovascular diseases.

China's carbon-neutral target could have benefits for ambient fine particulate matter (PM2.5)-associated mortality. Although previous studies have researched such benefits, the potential impact on cardiovascular disease incidence burden is yet to be investigated thoroughly. Here, we first estimate the association between short-term PM2.5 exposure and the incidence of stroke and coronary heart disease (CHD) via a case-crossover study before projecting future changes in short-term PM2.5-associated excess incidence across China from 2025 to 2060 under three different emission scenarios. We find that, compared to the 2015-2020 baseline, average PM2.5 concentrations nationwide in 2060 under SSP119 (an approximation of a carbon-neutral scenario) are projected to decrease by 81.07%. The short-term PM2.5-related excess incidence of stroke and CHD is projected to be reduced to 3,352 cases (95% confidence interval: 939, 5,738)-compared with 34,485 cases under a medium-emissions scenario (SSP245)-and is expected to be accompanied by a 95% reduction in the related economic burden. China's carbon-neutral policies are likely to bring health benefits for cardiovascular disease by reducing short-term PM2.5-related incidence burden.

Community-Level Practice Checklists for Health Protection During Cold Spells in China.

Communities play a crucial role in protecting the health of vulnerable populations such as the elderly, low-income groups, and high-risk individuals during cold spells. However, current strategies for responding to cold spells primarily consist of programmatic policies that lack practicality, specificity, and detailed implementation guidelines for community workers. Therefore, this study aims to identify and analyze the challenges faced by communities in responding to cold spells, review international experiences, and develop a set of practical checklists for community-level health protection. These checklists will assist community workers and volunteers in effectively preparing for, responding to, and recovering from cold spells.

Bilateral Blurry Vision After a Liver Transplant.

A 31-year-old woman presented for evaluation of bilateral blurry vision over the past month. She experienced fulminant hepatic failure 3 months ago and underwent a liver transplant 2 weeks later. Postoperative pathological results showed hepatolenticular degeneration. What would you do next?

Spatiotemporal trends of hemorrhagic fever with renal syndrome (HFRS) in China under climate variation.

Hemorrhagic fever with renal syndrome (HFRS) is a zoonotic disease caused by the rodent-transmitted orthohantaviruses (HVs), with China possessing the most cases globally. The virus hosts in China are Apodemus agrarius and Rattus norvegicus, and the disease spread is strongly influenced by global climate dynamics. To assess and predict the spatiotemporal trends of HFRS from 2005 to 2098, we collected historical HFRS data in mainland China (2005-2020), historical and projected climate and population data (2005-2098), and spatial variables including biotic, environmental, topographical, and socioeconomic. Spatiotemporal predictions and mapping were conducted under 27 scenarios incorporating multiple integrated representative concentration pathway models and population scenarios. We identify the type of magistral HVs host species as the best spatial division, including four region categories. Seven extreme climate indices associated with temperature and precipitation have been pinpointed as key factors affecting the trends of HFRS. Our predictions indicate that annual HFRS cases will increase significantly in 62 of 356 cities in mainland China. Rattus regions are predicted to be the most active, surpassing Apodemus and Mixed regions. Eighty cities are identified as at severe risk level for HFRS, each with over 50 reported cases annually, including 22 new cities primarily located in East China and Rattus regions after 2020, while 6 others develop new risk. Our results suggest that the risk of HFRS will remain high through the end of this century, with Rattus norvegicus being the most active host, and that extreme climate indices are significant risk factors. Our findings can inform evidence-based policymaking regarding future risk of HFRS.

The influence of humid heat on morbidity of megacity Shanghai in China.

BACKGROUND: Increased attention has been paid to humid-heat extremes as they are projected to increase in both frequency and intensity. However, it remains unclear how compound extremes of heat and humidity affects morbidity when the climate is projected to continue warming in the future, in particular for a megacity with a large population. METHODS: We chose the Wet-Bulb Globe Temperature (WBGT) index as the metric to characterize the humid-heat exposure. The historical associations between daily outpatient visits and daily mean WBGT was established using a Distributed Lag Non-linear Model (DLNM) during the warm season (June to September) from 2013 to 2015 in Shanghai, a prominent megacity of China. Future morbidity burden related to the combined effect of high temperature and humidity were projected under four greenhouse gases (GHGs) emission scenarios (SSP126, SSP245, SSP370 and SSP585). RESULTS: The humid-heat weather was significantly associated with a higher risk of outpatient visits in Shanghai than the high-temperature conditions. Relative to the baseline period (2010-2019), the morbidity burden due to humid-heat weather was projected to increase 4.4 % (95 % confidence interval (CI): 1.1 %-10.1 %) even under the strict emission control scenario (SSP126) by 2100. Under the high-GHGs emission scenario (SSP585), this burden was projected to be 25.4 % (95 % CI: 15.8 %-38.4 %), which is 10.1 % (95 % CI: 6.5 %-15.8 %) more than that due to high-temperature weather. Our results also indicate that humid-hot nights could cause large morbidity risks under high-GHGs emission scenarios particularly in heat-sensible diseases such as the respiratory and cardiovascular disease by the end of this century. CONCLUSIONS: Humid heat exposures significantly increased the all-cause morbidity risk in the megacity Shanghai, especially in humid-hot nights. Our findings suggest that the combined effect of elevated temperature and humidity is projected to have more substantial impact on health compared to high temperature alone in a warming climate.

Feeding artery: a valuable feature for differentiation of regenerative nodule, dysplastic nodules and small hepatocellular carcinoma in CEUS LI-RADS.

OBJECTIVE: To investigate whether the feeding artery (FA) feature can aid in discriminating small hepatocellular carcinoma (HCC) using the contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) from precancerous lesions. METHODS: Between June 2017 and May 2021, a total of 347 patients with 351 precancerous liver lesions or small HCCs who underwent CEUS were enrolled. Two independent radiologists assigned LI-RADS categories to all lesions and assessed the presence of the FA feature, which was used as an ancillary feature to either upgrade or downgrade the LI-RADS category. The diagnostic performance of CEUS LI-RADS, both with and without the FA feature, was evaluated based on accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: The FA feature was found to be more prevalent in HCC (85.54%, p < 0.001) than in regenerative nodules (RNs, 29.73%), low-grade dysplastic nodules (LGDNs, 33.33%), and high-grade dysplastic nodules (HGDNs, 55.26%). Furthermore, the presence of arterial phase hyperenhancement (APHE), washout (WO), and FA in liver nodules was associated with a higher expression of GPC-3 and Ki-67 compared to the group without these features (p < 0.001). After adjusting, the sensitivity and accuracy of LR-5 for HCC improved from 68.67% (95%CI: 62.46%, 74.30%) to 77.51% (95%CI: 71.72%, 82.44%) and from 69.23% (95%CI: 64.11%, 74.02%) to 73.79% (95%CI: 68.86%, 78.31%), respectively. CONCLUSION: The FA feature is a valuable feature for distinguishing small HCC and precancerous lesions and could be added as a possible ancillary feature in CEUS LI-RADS which was backed up by biomarkers. CLINICAL RELEVANCE STATEMENT: The presence of a feeding artery is a valuable imaging feature in the differentiation of HCC and precancerous lesions. Incorporating this characteristic in the CEUS LI-RADS can enhance the diagnostic ability. KEY POINTS: • Feeding artery is more frequent in HCC than in regenerative nodules, low-grade dysplastic nodules, and high-grade dysplastic nodules. • Feeding artery feature is a valuable ancillary feature for CEUS LI-RADS to differentiate regenerative nodules, low-grade dysplastic nodules, high-grade dysplastic nodules, and HCC. • The existence of feeding artery, arterial phase hyperenhancement, and washout is associated with more GPC-3 positive expression and higher Ki-67 expression than the group without these features.

The uneven impacts of climate change on China's labor productivity and economy.

Climate change is considered to increase economic costs by worsening heat-related labor productivity loss. While extensive global and national research has been conducted on this topic, few studies have analyzed subnational and individual economic impacts, potentially weakening local governments' motivation to tackle climate change. Figuring out the most affected regions and labors could help climate policymakers to identify priority regions and sectors to allocate adaptation resources efficiently, and enhance stakeholder engagement. This study adopted a provincial Computable General Equilibrium model by distinguishing different labors and regions in modelling work to address the aforementioned gap. The study estimated economic costs at different level under three climate change scenarios (lower (SSP126), middle (SSP245), and higher (SSP585) warming scenario). Low-income regions located in southwest part of China (such as Guangxi and Guizhou), would experience the largest economic loss, 3.4-7.1 times higher than high-income in China by 2100 under SSP245 scenario. Additionally, wages for labors highly sensitive to heat in these regions are expected to rise, for example, by an 8.3% rise in Guangxi, driven by the rising demand for these labors. Conversely, others would experience a significant wage decrease, especially those with less sensitivity (e.g., managers). Therefore, we recommended that national financial supports be allocated more to these most affected regions and that government encourage managers provide assistance to workers vulnerable to heat.