Safeguarding China's long-term sustainability against systemic disruptors.

China's long-term sustainability faces socioeconomic and environmental uncertainties. We identify five key systemic risk drivers, called disruptors, which could push China into a polycrisis: pandemic disease, ageing and shrinking population, deglobalization, climate change, and biodiversity loss. Using an integrated simulation model, we quantify the effects of these disruptors on the country's long-term sustainability framed by 17 Sustainable Development Goals (SDGs). Here we show that ageing and shrinking population, and climate change would be the two most influential disruptors on China's long-term sustainability. The compound effects of all disruptors could result in up to 2.1 and 7.0 points decline in the China's SDG score by 2030 and 2050, compared to the baseline with no disruptors and no additional sustainability policies. However, an integrated policy portfolio involving investment in education, healthcare, energy transition, water-use efficiency, ecological conservation and restoration could promote resilience against the compound effects and significantly improve China's long-term sustainability.

Exclusion of livestock decouples the relationship between plant production and diversity, species richness on complex topography in typical steppe in the Loess Plateau, China.

Grazing is widely used in more than one-forth of global terrestrial ecosystems, with three quarters are distributed on complex topography. Grazing and topography have both resulted in degradation of approximately 49 % of natural grasslands. However, research on the interaction between topography and livestock exclusion on grassland characteristics is scarce. This study was carried out on a typical steppe to explore the effect of topography and enclosure year on vegetation characteristics. Aboveground biomass, and species richness were examined for three different enclosure years (0, 3, and 6 years), on four slopes (0°, 15°, 30°, and 45° slope), and three aspects (flat, shady and sunny). The results indicated that: The aboveground biomass on the 0° slope had a greater value after 6 years of the enclosure. Aboveground biomass increased with the increasing enclosure year, while it decreased with increasing slope except enclosure for 0 year on shady slope. Aboveground biomass on the shady slopes was greater than on the sunny slopes. Species richness of community and perennial plants increased with increasing slope and enclosure year. The annual plants richness inversely correlated with slope and enclosure year. All plant diversity indexes increased with increasing enclosure year. Margalef and Shannon-wiener indexes decreased with increasing slope, while Simpson and Pielou indexes increased. This paper demonstrates that aspect, slope and enclosure affect aboveground biomass by affecting other vegetation characteristics. In conclusion, grassland production can be improved with moderate livestock exclusion under different topography.

Biomass-Derived Carbon Materials for Electrochemical Energy Storage.

The environmental impact from the waste disposal has been widely concerned around the world. The conversion of wastes to useful resources is important for the sustainable society. As a typical family of wastes, biomass materials basically composed of collagen, protein and lignin are considered as useful resources for recycle and reuse. In recent years, the development of carbon material derived from biomasses, such as plants, crops, animals and their application in electrochemical energy storage have attracted extensive attention. Through the selection of the appropriate biomass, the optimization of the activation method and the control of the pyrolysis temperatures, carbon materials with desired features, such as high-specific surface area, variable porous framework, and controllable heteroatom-doping have been fabricated. Herein, this review summarized the preparation methods, morphologies, heteroatoms doping in the plant/animal-derived carbonaceous materials, and their application as electrode materials for secondary batteries and supercapacitors, and as electrode support for lithium-sulfur batteries. The challenges and prospects for the controllable synthesis and large-scale application of biomass-derived carbonaceous materials have also been outlooked.

Factors affecting wearable ECG device adoption by general practitioners for atrial fibrillation screening: cross-sectional study.

Introduction: Atrial fibrillation (AF) is a challenging cardiovascular disease worldwide. Wearable electrocardiograph devices (WEDs) have great potential to improve the detection rate of AF in primary care. However, the factors that influence general practitioners' (GPs) perception and acceptance of WEDs are not well understood. To identify factors that influence the intention of GPs to utilize WEDs in a clinical setting to screen patients for AF. Method: The research hypotheses and questionnaire items were designed and developed based on the unified theory of acceptance and technology (UTAUT) framework. We used stratified sampling and obtained the data through an online survey. Structural equation modeling was used to analyze the collected data.Results: A total of 1,004 valid questionnaires from GPs across Sichuan province in China were collected. Three factors increased GPs' intention to utilize WEDs to screen patients for AF, including performance expectancy (ß = 0.121, p = 0.004), social influence (ß = 0.356, p < 0.001), and price perception (ß = 0.587, p < 0.001). Perception risk (ß = -0.059, p < 0.001) decreased usage intention, while effort expectancy (ß = -0.079, p = 0.155) and facilitating conditions (ß = -0.014, p = 0.868) did not affect usage intention. Gender (ß = -0.022, p = 0.179), age (ß = 0.006, p = 0.699), education level (ß = -0.22, p = 0.184) and training (ß = 0.007, p = 0.69) were not significantly correlated with usage intention, and these four factors had no moderating effect on the path coefficients. Discussion: GPs' intention to utilize WEDs is affected by performance expectancy, price perception, perception risk and social influence. Researcher should improve the usability and perception of WEDs for screening and carry out studies to provide high-quality evidence for the security and efficacy of wearable devices.

Exogenous fibrolytic enzymes promoted energy and nitrogen utilization and decreased CH4 emission per unit dry matter intake of tan sheep grazed a typical steppe by enhancing nutrient digestibility on China loess plateau.

Exogenous fibrolytic enzyme (EFE) products in ruminant nutrition may be an important alternative to meet the increased demands for animal products in the future with reduced environmental impacts. This study aimed to evaluate the dose-response of EFE supplementation on the nutrient digestibility, nitrogen and energy utilization, and methane (CH4) emissions of Tan sheep grazed in summer and winter. A total of 20 Tan wether sheep with an initial body weight of 23.17 ±â€…0.24 kg were used in a randomized complete block design and categorized into two groups. Animals fed orally with 1 g of EFE (10,000 U/g) mixed with 30 mL of water using a drencher constituted the EFE group. For experimental accuracy, the control (CON) group was orally administered with 30 mL of normal saline daily before grazing. The following results were obtained: EFE in the diet increased dry matter intake (DMI) (P < 0.05), average daily gain (ADG) (P < 0.05), and digestibility (P < 0.05) compared with CON in summer and winter. DMI increased but ADG and digestibility decreased in winter compared with those in summer. Sheep fed with the EFE diet increased the concentrations of rumen ammonia nitrogen (P < 0.05) and total volatile fatty acids (P > 0.05), but reduced pH (P > 0.05), compared with CON in summer and winter. EFE increased nitrogen (N) intake, digestible N, retained N, and retained N/digestible N (P < 0.05) but reduced fecal N/N intake, urinary N/N intake, and excretion N/N intake in summer and winter (P < 0.05), compared with CON. Retained N/N intake was reduced and excretion N/N intake increased in winter relative to those in summer. In winter, gross energy (GE), manure E/GE, CH4 emissions, CH4/DMI, and CH4/GE increased but digestion energy and metabolic energy decreased compared with those in summer. Sheep fed with the EFE diet had a greater GE intake than those fed with the CON diet (P < 0.05) but had lesser CH4/DMI and CH4E/GE (P < 0.05) than those fed with the CON diet in both summer and winter. In conclusion, EFE supplementation increased DMI, apparent digestibility, and N deposition rate. These effects were beneficial for animal production. The CH4 emission per unit DMI of grazing Tan sheep was lesser and conducive for augmenting the environmental benefits.

Globally, the supply­demand relationship between grassland and livestock is mainly mediated by the optimization of pasture management. The interaction between grassland and livestock is one of the fundamental drivers of grassland occurrence and development. Natural grassland yields and quality are affected by precipitation, heat, and grazing, and their dynamics vary seasonally with distinct peaks and troughs. The use of exogenous fibrolytic enzymes during troughs can improve the growth performance, digestion, and metabolism of grazing sheep. The exogenous fibrolytic enzyme supplement used in this research may aid in improving the health and overall productivity of grazing sheep.

Effects of grazing and precipitation addition induced by functional groups on the relationship between aboveground biomass and species richness of a typical steppe.

Several studies have explored the influence of grazing or precipitation addition (PA), two important components of human activities and global climate change on the structure and function of communities. However, the response of communities to a combination of grazing and PA remains largely unexplored. We investigated the impact of grazing and PA on the relationship between aboveground biomass (AGB) and species richness (SR) of communities in three-year field experiments conducted in a typical steppe in the Loess Plateau, using a split-plot design with grazing as the main-plot factor and PA as the split-plot factor. AGB and SR have response threshold value to PA, which was decreased by grazing for AGB, but increased for SR. This indicates that implementing grazing management strategies is conducive to strengthening the protection of biodiversity in arid and semi-arid grasslands. Grazing promoted the AGB-SR coupling of the community by increasing the SR of medium drought tolerance (MD), low drought tolerance, and grazing tolerant functional groups. Grazing also accelerated the AGB-SR decoupling of the community by changing the AGB of high drought tolerance, MD, high grazing tolerance, and medium grazing tolerance functional groups. PA mediated changes in MD and SR of both drought and grazing tolerant functional groups and AGB of low grazing tolerance promoted the coupling of AGB-SR of the community. The Two-dimension functional groups classification method reflects the changes of AGB and SR in communities more reasonable than the division of single-factor functional groups.

Letter to the Editor: clinical utility of urine DNA for noninvasive detection and minimal residual disease monitoring in urothelial carcinoma.

Current methods for the early detection and minimal residual disease (MRD) monitoring of urothelial carcinoma (UC) are invasive and/or possess suboptimal sensitivity. We developed an efficient workflow named urine tumor DNA multidimensional bioinformatic predictor (utLIFE). Using UC-specific mutations and large copy number variations, the utLIFE-UC model was developed on a bladder cancer cohort (n = 150) and validated in The Cancer Genome Atlas (TCGA) bladder cancer cohort (n = 674) and an upper tract urothelial carcinoma (UTUC) cohort (n = 22). The utLIFE-UC model could discriminate 92.8% of UCs with 96.0% specificity and was robustly validated in the BLCA_TCGA and UTUC cohorts. Furthermore, compared to cytology, utLIFE-UC improved the sensitivity of bladder cancer detection (p < 0.01). In the MRD cohort, utLIFE-UC could distinguish 100% of patients with residual disease, showing superior sensitivity compared to cytology (p < 0.01) and fluorescence in situ hybridization (FISH, p < 0.05). This study shows that utLIFE-UC can be used to detect UC with high sensitivity and specificity in patients with early-stage cancer or MRD. The utLIFE-UC is a cost-effective, rapid, high-throughput, noninvasive, and promising approach that may reduce the burden of cystoscopy and blind surgery.

Development of a performance measurement system for general practitioners' office in China's primary healthcare.

BACKGROUND: General practitioners are the main providers of primary care services. To better strengthen the important role of general practitioners in primary healthcare services, China is promoting the general practitioners' office system. There is a lack of well-accepted methods to measure the performance of general practitioner offices in China. We thus aim to develop a systematic and operable performance measurement system for evaluating the general practitioner's office. METHODS: We establish an index pool of the performance measurement system of general practitioners' offices by a cross-sectional study and the literature research method and adopt the focus group method to establish the preliminary system. The Delphi method is then used to conduct three rounds of consultation to modify indices, which aims to form the final indicator system. We determine the weight of each index by the analytic hierarchy process method, which together with the final indicator system constitutes the final performance measurement system. Finally, we select three offices from three different cities in Sichuan Province, China, as case offices to conduct the case study, aiming to assess its credibility. RESULTS: Our results show that the first office scored 958.5 points, the second scored 768.1 points, and the third scored 947.7 points, which corresponds to the reality of these three offices, meaning that the performance measurement system is effective and manoeuvrable. CONCLUSIONS: Our study provides support for standardizing the functions of China's general practitioner's office, improving the health service quality of generalists, and providing a theoretical basis for the standardization of the general practitioner's office.

Identification and Functional Analysis of Key Autophosphorylation Residues of Arabidopsis Senescence Associated Receptor-like Kinase.

Reversible protein phosphorylation mediated by protein kinases and phosphatases plays important roles in the regulation of leaf senescence. We previously reported that the senescence-associated leucine-rich repeat receptor-like kinase AtSARK autophosphorylates on both serine/threonine and tyrosine residues and functions as a positive regulator of Arabidopsis leaf senescence; the senescence-suppressed protein phosphatase SSPP interacts with and dephosphorylates the cytoplasmic domain of AtSARK, thereby negatively regulating leaf senescence. Here, 27 autophosphorylation residues of AtSARK were revealed by mass spectrometry analysis, and six of them, including two Ser, two Thr, and two Tyr residues, were further found to be important for the biological functions of AtSARK. All site-directed mutations of these six residues that resulted in decreased autophosphorylation level of AtSARK could significantly inhibit AtSARK-induced leaf senescence. In addition, mutations mimicking the dephosphorylation form of Ser384 (S384A) or the phosphorylation form of Tyr413 (Y413E) substantially reduced the interaction between AtSARK and SSPP. All results suggest that autophosphorylation of AtSARK is essential for its functions in promoting leaf senescence. The possible roles of S384 and Y413 residues in fine-tuning the interaction between AtSARK and SSPP are discussed herein.

Recent Advances in Self-Assembly and Application of Para-Aramids.

Poly(p-phenylene terephthalamide) (PPTA) is one kind of lyotropic liquid crystal polymer. Kevlar fibers performed from PPTA are widely used in many fields due to their superior mechanical properties resulting from their highly oriented macromolecular structure. However, the "infusible and insoluble" characteristic of PPTA gives rise to its poor processability, which limits its scope of application. The strong interactions and orientation characteristic of aromatic amide segments make PPTA attractive in the field of self-assembly. Chemical derivation has proved an effective way to modify the molecular structure of PPTA to improve its solubility and amphiphilicity, which resulted in different liquid crystal behaviors or supramolecular aggregates, but the modification of PPTA is usually complex and difficult. Alternatively, higher-order all-PPTA structures have also been realized through the controllable hierarchical self-assembly of PPTA from the polymerization process to the formation of macroscopic products. This review briefly summarizes the self-assembly methods of PPTA-based materials in recent years, and focuses on the polymerization-induced PPTA nanofibers which can be further fabricated into different macroscopic architectures when other self-assembly methods are combined. This monomer-started hierarchical self-assembly strategy evokes the feasible processing of PPTA, and enriches the diversity of product, which is expected to be expanded to other liquid crystal polymers.

Multimodal Treatment Combining Salvage Surgery-Assisted Chemotherapy and Checkpoints Blockade Immunotherapy Achieves Complete Remission on a Recurrent Penile Cancer Patient: A Case Report.

Penile squamous cell carcinoma (pSCC) is a rare disease in developed countries. pSCC causes a severe health problem and social burden in developing countries. We reported a 49-year-old male recurrent pSCC patient with medium PD-L1 expression and low TMB. The patient obtained complete response after multimodal therapy (MMT). The clinical manifestation is a recurrence in the right groin with nearly ruptured pSCC. He had partial resection of penile cancer plus bilateral groin lymph node dissection and pelvic lymph node dissection during the first operation. Pathology of the recurrent tumor showed fibrous tissue with cancer infiltration and necrosis. We used MMT, including resection of palliative right inguinal metastases, four cycles of paclitaxel+bleomycin+cisplatin, and continuous sintilimab to treat the patient. The patient had a complete response (CR) after four cycles of therapy and sustained CR for 18 months with continuous sintilimab, showing a good tolerance and acceptable toxicity. This is the first case presenting a complete response in a relapsed pSCC patient. These results suggest that MMT is worth exploring.

Comparison of Three Interfacial Conductive Networks Formed in Carbon Black-Filled PA6/PBT Blends.

Interfacial localization of carbon fillers in cocontinuous-structured polymer blends is well-known as a high-efficiency strategy for conductive network formation. However, a comparison with interfacial localization of carbon fillers in sea-island-structured polymer blends is lacking. Here, three types of highly efficient conductive networks formed on the basis of interfacial localization of carbon black (CB) in polyamide 6 (PA6)/poly(butylene terephthalate) (PBT) blends with different blend compositions (80/20, 50/50 and 20/80 vol/vol) were investigated and compared in terms of electrical resistivity, morphology as well as rheological and mechanical properties. The order of the electrical percolation threshold of CB in the three blends is 50/50 < 20/80 < 80/20, which can be attributed to different network structures. The rheological percolation thresholds are close to the electrical ones, confirming the formation of CB networks. The formation mechanisms for the three types of CB network structures are analyzed. All the three types of PA6/PBT-6 vol% CB composites showed improved tensile strength compared with PA6/PBT blends, being in favor for practical applications.

Multiscale research on spatial supply-demand mismatches and synergic strategies of multifunctional cultivated land.

Multifunctional cultivated land has both sides of supply and demand, and their matches are very important to boost the high-quality development of agriculture and rural areas. The supply-demand match index and GIS spatial analysis were employed to explore the supply-demand mismatches and synergic strategies of multifunctional cultivated land. Taking the Wuhan Metropolitan Area (WMA), China as an example, we obtained the following results: (1) There were obvious supply-demand mismatches of multifunctional cultivated land in the production function, ecological function, and landscape culture function. The spatial distribution of supply-demand mismatches of the three different functions of cultivated land is different. The supply of cultivated land production function is less than the demand, while the supply of landscape culture function is greater than the demand. The supply matches the demand of cultivated land in the ecological function. (2) The supply-demand mismatches of multifunctional cultivated land have scale effects. From the 1 km × 1 km grid scale to the township, county (district), and prefecture-level city scales, the proportion of deficit regions of production function and ecological function decreases with increasing scale. In contrast, the deficit regions of landscape culture function are always concentrated in the center of the WMA. It is considered that we should improve the supply of cultivated land in the production function, protect ecological function and enhance the demand of landscape culture function. Moreover, the management of multifunctional cultivated land needs to strengthen the multiscale spatial linkage and differential strategies of the supply side and demand side.

Macroscopic-Scale Preparation of Aramid Nanofiber Aerogel by Modified Freezing-Drying Method.

Aerogel has been widely known as a low-density and highly porous material and is closely connected with the complex processing methods, such as freeze-drying or supercritical drying. In this work, using the polymerization-induced aramid nanofiber (PANF) as a building block, we put forward a modified freezing-drying method for the high-efficiency preparation of all-para-aromatic-amide aerogels. In the preparation process, PANF hydrogel is first frozen at -18 °C and then dried at 20-150 °C for the formation of PANF aerogel. The PANF framework formed during the freezing process is crucial for the formation of the PANF aerogel. Moreover, the space-occupying effect of ice crystals is also helpful for the formation of the macroscopic pore structure in the aerogel. Aerogels with large size or well-controlled shape could be successfully obtained by this method. Through the variation of PANF concentration in the hydrogel and drying temperature, aerogels with different densities (20-185 mg/cm3) could be achieved, and the lowest density is reached at 150 °C, with the PANF concentration of 0.7%. The low-density PANF aerogels show high specific compressive strengths and low thermal conductivities, which are comparable to those resulting from the freeze-drying or supercritical drying method. Furthermore, the shrinkage phenomenon in the drying process could be skillfully utilized for the preparation of PANF aerogel-coated objects. The PANF aerogels could be applied as a thermal insulating material or shock absorption material in practical applications.

Construction of Aramid Engineering Materials via Polymerization-Induced para-Aramid Nanofiber Hydrogel.

The processing of poly(p-phenylene terephthalamide) (PPTA) has long been a great challenge. This work reports a simple "monomers-nanofibers-macroscopic product" (MNM) hierarchical self-assembly approach to build 3D all-PPTA engineering materials. This approach mainly includes the preparation of polymerization-induced aramid nanofibers (PANFs) from monomers and the fabrication of all-PPTA materials from PANF hydrogel. Various 3D architectures, including simple solid bulks and sophisticated honeycombs (HCs), are obtained after the dehydration and shrinking of the PANF hydrogel. The tensile strength and compressive yield strength of PANF bulk are more than 62 and 90 MPa, respectively, which are comparable to typical engineering plastics. The compressive strength of PANF HC with a density of 360 kg m-3 is more than 24 MPa. The thermal stability of PANF bulk and PANF HC are as good as that of Kevlar fiber and almost no decomposition occurred before 500 °C in a nitrogen atmosphere. Furthermore, the MNM process is performed under mild conditions, without high temperature, high pressure, or corrosive solvent. The MNM process is a novel strategy for the processing of all aromatic polyamide materials with complex structures and high performances and would be another development since the breakthrough of liquid crystal spinning technology of PPTA.

A rare case of severe right heart failure due to pulmonary artery lymphomatoid granulomatosis.

Lymphomatoid granulomatosis is a rare, vascular-centric, and vessel-destroying lymphoproliferative disease that hardly involves the pulmonary arteries. Herein, we report a case with severe right heart failure and pulmonary arterial stenosis caused by pulmonary artery lymphomatoid granulomatosis. This case was diagnosed by percutaneous transluminal pulmonary artery biopsy and was effectively treated with stent implantation and steroid administration.

Understanding the marginal distributions and correlations of link travel speeds in road networks.

Link travel speeds in road networks are essential data for a variety of research problems in logistics, transportation, and traffic management. Real-world link travel speeds are stochastic, and highly dependent on speeds in previous time periods and neighboring road links. To understand how link travel speeds vary over space and time, we uncover their distributions, their space- and/or time-dependent correlations, as well as partial correlations, based on link travel speed datasets from an urban road network and a freeway network. We find that more than 90% (57%) of travel speeds are normally distributed in the urban road (freeway) network, and that correlations generally decrease with increased distance in time and space. We also investigate if and how different types of road links affect marginal distributions and correlations. The results show that different road link types produce quite similar marginal distributions and correlations. Finally, we study marginal distributions and correlations in a freeway network. Except that the marginal distribution and time correlation are different from the urban road network, others are similar.

From Monomers to a Lasagna-like Aerogel Monolith: An Assembling Strategy for Aramid Nanofibers.

The manipulation of nanobuilding blocks into a 3D macroscopic monolith with ordered hierarchical structures has been much desired for broad and large-scale practical applications of nanoarchitectures. In this paper, we demonstrate a fully bottom-up strategy for the preparation of aramid aerogel monoliths. The process starts from the synthesis of poly(p-phenylene terephthalamide) (PPTA) through the polycondensation of p-phenylenediamine and terephthaloyl chloride, with the assistance of a nonreactive dispersing agent (polyethylene glycol dimethyl ether), which helps the dispersal of the as-synthesized PPTA in an aqueous medium for the formation of p-aramid nanofibers (ANF). Then the vacuum-assisted self-assembly (Vas) technique is skillfully connected with the ice-templated directional solidification (I) technique, and the combined VasI method successfully tailors the self-assembly of ANF to transform the 1D nanofibers into a 3D aerogel monolith with a specific long-range aligned, lasagna-like, multilaminated internal structure. The study of the aerogel microstructure revealed the dependence of the lamina orientation on the direction of the freezing front of ice crystals. This direction should be parallel to the deposition plane of the Vas process if a long-range aligned lamellar structure is desired. The anisotropy of the multilaminated aerogel was proven by the different results in the radial and axial directions in the compression and thermal conductivity tests. As a kind of organic aerogel, the ANF monolith has typical low density, high porosity, and low thermal conductivity. Additionally, the ANF monolith exhibits high compressive stress and excellent thermal stability. Considering its high performance and facile preparation process, potential applications of the ANF aerogel monolith can be expected.

Effects of Diisocyanate Structure and Disulfide Chain Extender on Hard Segmental Packing and Self-Healing Property of Polyurea Elastomers.

Four linear polyurea elastomers synthesized from two different diisocyanates, two different chain extenders and a common aliphatic amine-terminated polyether were used as models to investigate the effects of both diisocyanate structure and aromatic disulfide chain extender on hard segmental packing and self-healing ability. Both direct investigation on hard segments and indirect investigation on chain mobility and soft segmental dynamics were carried out to compare the levels of hard segmental packing, leading to agreed conclusions that correlated well with the self-healing abilities of the polyureas. Both diisocyanate structure and disulfide bonds had significant effects on hard segmental packing and self-healing property. Diisocyanate structure had more pronounced effect than disulfide bonds. Bulky alicyclic isophorone diisocyanate (IPDI) resulted in looser hard segmental packing than linear aliphatic hexamethylene diisocyanate (HDI), whereas a disulfide chain extender also promoted self-healing ability through loosening of hard segmental packing compared to its C-C counterpart. The polyurea synthesized from IPDI and the disulfide chain extender exhibited the best self-healing ability among the four polyureas because it had the highest chain mobility ascribed to the loosest hard segmental packing. Therefore, a combination of bulky alicyclic diisocyanate and disulfide chain extender is recommended for the design of self-healing polyurea elastomers.