Obesity and activity patterns before and during COVID-19 lockdown among youths in China

This study aim to assess changes in obesity and activity patterns among youths in China during the COVID-19 lockdown. We used the COVID-19 Impact on lifestyle change survey (COINLICS), a national retrospective survey distributed via social media platforms in early May 2020 where more than 10 000 youth participants in China have voluntarily reported their basic sociodemographic information, weight status, and routine lifestyles in the months before and during COVID-19 lockdown. The extended IOTF and WHO standards were used to define overweight and obesity of the participants. We used paired t-tests or χ² tests and non-parametric methods to evaluate the significance of differences in weight-related outcomes and lifestyles across education levels, between sexes, and before and during COVID-19 lockdown. The mean body mass index of all participating youths has significantly increased (21.8-22.6) and in all education subgroups during COVID-19 lockdown. Increases also occurred in the prevalence of overweight/obesity (21.3%-25.1%, P < .001) and obesity (10.5% to 12.9%, P < .001) in overall youths, especially in high school and undergraduate students. Their activity patterns had also significantly changed, including the decreased frequency of engaging in active transport, moderate-/vigorous-intensity housework, leisure-time moderate-/vigorous-intensity physical activity, and leisure-time walking, and the increased sedentary, sleeping, and screen time. Our findings would inform policy-makers and clinical practitioners of these changes in time, for better policy making and clinical practice. School administrators should also be informed of these changes, so in-class and/or extracurricular physical activity programs could be designed to counteract them.

A new high-pressure aerosol shock tube for the study of liquid fuels with low vapor pressures

A new shock-tube facility for studying gas-phase and condensed-phase mixtures has been developed for the investigation of various hydrocarbon species at the Qatar campus of Texas A&M University. At present, the facility is intended for studying combustion behaviors of long-chain hydrocarbon molecules and mixtures thereof under realistic engine conditions. Equipped with an aerosol generation and entrainment apparatus, the facility also possesses an enlarged driver section and double-diaphragm interface between the driver and driven sections. The driver section diameter is 19.37 cm with a configurable length of 1 m-6 m. Additionally, the stainless-steel driven section has an inner surface with a mirror finish and internal diameter of 15.24 cm. The driven section is also configurable in length up to approximately 5.2 m. As with most modern shock tubes, this shock tube is equipped for use with current methods of shock velocity detection, optical diagnostics, and other diagnostic techniques. In addition to the study of aerosolized liquids (fuels and non-fuels) related to combustion chemistry, reaction kinetics, evaporation studies, and particle-fluid interactions, among others, the facility is capable of investigating traditional gas-phase mixtures like those previously undertaken in a similar facility in the Petersen Group Laboratory at Texas A&M University. The operating limits of the title facility include temperatures and pressures up to 4000 K and 100 atm, respectively. The design and characterization of a novel aerosol introduction method is also presented, which yielded measured aerosol loading uniformities of 92%-97%. Finally, ignition delay time measurements of stoichiometric mixtures of decane in air are presented, which show excellent agreement with those recently recorded in heated shock tubes.

Three-dimension oxygen gradient induced low energy input for grey water treatment in an oxygen-based membrane biofilm reactor

Grey water (GW) containing high levels of linear alkylbenzene sulfonates (LAS) can be a threat to human health and organisms in the environment if not treated properly. Although aerobic treatment could achieve high organics removal efficiency, conventional aeration can lead to serious foaming and energy waste. Here, we systematically evaluated an oxygen based membrane biofilm reactor (O₂-MBfR) for its capacity to simultaneously remove organics and nitrogen from GW. The dissolved oxygen (DO) concentration inside the reactor was maintained at 0.4 mg/L by gradually controlling the lumen air pressure. Results showed that the O₂-MBfR achieved high removal efficiency of total chemical oxygen demand (TCOD), total linear alkylbenzene sulfonates (LAS) and total nitrogen (TN) of 89.7%, 99.1% and 78.1%, respectively, with a hydraulic retention time (HRT) of 7.5 h. Lower HRT (7.0 h) led to the accumulation of LAS in the biofilm, which caused cell lysis and damaged the O₂-MBfR system, leading to a discernible and continuous decline of the reactor performance. The O₂-MBfR design completely eliminated foaming formation and the three-dimension oxygen gradient design led to low air pressure inside the membrane fiber, which enabled the high removal efficiency for both organics and nitrogen with low energy input and GW treatment cost, providing the fundamental knowledge for practical application of O₂-MBfR in wastewater treatment.

Improved evaluation method of the soil wind erosion intensity based on the cloud-AHP model under the stress of global climate change

Under the stress of global climate change, soil wind erosion has become a major environmental issue in the Three-River Source Region (TRSR) of China. However, few large-scale studies have been conducted on soil wind erosion owing to the lack of investigational data or complex parameters. Moreover, the uncertainty and randomness in the weight determination process cannot be avoided using the traditional method. Thus, a cloud-analytic hierarchy process (cloud-AHP) model was proposed to construct a wind erosion intensity index model for the TRSR based on seven typical land surface parameters. The following results were obtained. (1) The cloud-AHP model can better eliminate the randomness and uncertainty in the weight determination process. (2) The proposed evaluation method of wind erosion intensity has better applicability in the TRSR with overall accuracy of 93%. (3) The overall wind erosion intensity in this region is moderate. The wind erosion intensity was the largest in the Yangtze River (0.55, moderate erosion) and smallest in the source region of the Lancang River (0.50, mild erosion). (4) Significant differences are observed in the influences of various vegetation types on wind erosion intensity. Bare land exhibits the highest wind erosion intensity, whereas a coniferous forest exhibits the smallest. Moreover, grassland is a key control zone of soil and water conservation because it has the largest spatial heterogeneity of internal erosion intensity. These results can provide data and technical support for preventing and controlling soil erosion and protecting the environment in the region.

Revealing the mechanisms for potassium ferrate affecting methane production from anaerobic digestion of waste activated sludge

This study investigated the issue of potassium ferrate (PF) affecting anaerobic methane generation from sludge by a set of experimental and model analyses. Experimental results indicated that the methane production was significantly promoted from 164.7 to 204.1 mL/g VSS (volatile suspended solids) with PF dosage enhanced from 0 to 0.05 g/g TSS (total suspended solids). Further enhancement of PF dosage reduced methane production, which even decreased to 135.4 mL/g VSS when PF dosage increased to 0.1 g/g TSS. Model-based analysis showed that except for methane production potential, the methane production rate was also promoted by PF treatment, which was sufficiently enhanced from 8.80 to 11.88 mL/g VSS/d when PF dosage was 0.05 g/g TSS. Mechanism studies indicated that PF not only promoted sludge disintegration, but also enhanced the proportion of biodegradable organics in sludge liquor, and the digestion potential of the non-biodegradable humus and lignocellulose were promoted.

The role of Stim1 in the progression of lupus nephritis in mice

OBJECTIVE

To investigate the expression of Stim1 in the kidneys of mice with lupus, and the effect of Stim1 on the progression of renal interstitial fibrosis.

METHODS

Mice (MRL/lpr) with spontaneous lupus nephritis (LN) and normal control mice (C57/BL) were selected. Immunohistochemistry and Masson staining were used to determine the degree of renal interstitial fibrosis in kidney tissues. The expression of Stim1 and fibronectin in tissues was measured by qRT-PCR, western blotting, and immunohistochemistry. Urine protein, blood urea nitrogen, and serum creatinine levels in the mice were analyzed, and Spearman analysis was conducted to determine the correlation with Stim1 expression levels. Mouse renal tubular epithelial cells (mRTECs) were chosen as the experimental objects. After various treatments, the cells were divided into the blank control group, lipopolysaccharide (LPS) treatment group, LPS+siRNA-NC group and LPS+siRNA-Stim1 group. Western blotting and immunofluorescence were used to measure epithelial-mesenchymal transition (EMT)-related protein levels.

RESULTS

There was significant interstitial fibrosis in the kidneys of LN mice. Compared with that in normal mice, the expression of Stim1 in the kidney tissues of LN mice was significantly increased, and Stim1 expression was positively correlated with fibronectin, urine protein, blood urea nitrogen and serum creatinine levels. LPS induced the expression of Stim1, fibronectin, and α-SMA in mRTECs and decreased the protein level of E-CA, while silencing Stim1 effectively alleviated the effects of LPS.

CONCLUSION

Stim1 is significantly increased in the kidneys of lupus mice, and it is possible to promote EMT in renal tubular epithelial cells and renal interstitial fibrosis by elevating fibronectin, which ultimately contributes to renal damage.

Identification of the rhizospheric microbe and metabolites that led by the continuous cropping of ramie (Boehmeria nivea L. Gaud)

Continuous cropping lowers the production and quality of ramie (Boehmeria nivea L. Gaud). This study aimed to reveal the metagenomic and metabolomic changes between the healthy- and obstacle-plant after a long period of continuous cropping. After 10 years of continuous cropping, ramie planted in some portions of the land exhibited weak growth and low yield (Obstacle-group), whereas, ramie planted in the other portion of the land grew healthy (Health-group). We collected rhizosphere soil and root samples from which measurements of soil chemical and plant physiochemical properties were taken. All samples were subjected to non-targeted gas chromatograph-mass spectrometer (GS/MS) metabolome analysis. Further, metagenomics was performed to analyze the functional genes in rhizospheric soil organisms. Based on the findings, ramie in Obstacle-group were characterized by shorter plant height, smaller stem diameter, and lower fiber production than that in Health-group. Besides, the Obstacle-group showed a lower relative abundance of Rhizobiaceae, Lysobacter antibioticus, and Bradyrhizobium japonicum, but a higher relative abundance of Azospirillum lipoferum and A. brasilense compared to the Health-group. Metabolomic analysis results implicated cysteinylglycine (Cys-Gly), uracil, malonate, and glycerol as the key differential metabolites between the Health- and Obstacle-group. Notably, this work revealed that bacteria such as Rhizobia potentially synthesize IAA and are likely to reduce the biotic stress of ramie. L. antibioticus also exerts a positive effect on plants in the fight against biotic stress and is mediated by metabolites including orthophosphate, uracil, and Cys-Gly, which may serve as markers for disease risk. These bacterial effects can play a key role in plant resistance to biotic stress via metabolic and methionine metabolism pathways.

Transcriptional responses of toxigenic and atoxigenic isolates of Aspergillus flavus to oxidative stress in aflatoxin-conducive and non-conducive media

Aflatoxin production by isolates of Aspergillus flavus varies, ranging from highly toxigenic to completely atoxigenic. Several mechanisms have been identified which regulate aflatoxin production including medium carbon source and oxidative stress. In recent studies, aflatoxin production has been implicated in partially ameliorating oxidative stress in A. flavus. To better understand the role of aflatoxin production in oxidative stress responses, a selection of toxigenic and atoxigenic isolates of A. flavus with moderate to high oxidative stress tolerance were exposed to increasing concentrations of H2O2 in both aflatoxin-conducive and non-conducive media. Mycelial mats were collected for global transcriptome sequencing followed by differential expression, functional prediction, and weighted co-expression analyses. Oxidative stress and medium carbon source had a significant effect on the expression of several secondary metabolite gene clusters including those for aflatoxin, aflatrem, aflavarin, cyclopiazonic acid, and kojic acid. Atoxigenic biological control isolates showed less differential expression under stress than other atoxigenic isolates suggesting expression profiles may be useful in screening. Increasing stress also resulted in regulation of SakA/Hog1 and MpkA MAP kinase signalling pathways pointing to their potential roles in regulating oxidative stress responses. Their expression was also influenced by medium carbon source. These results suggest that aflatoxin production along with that of other mycotoxins may occur as part of a concerted coping mechanism for oxidative stress and its effects in the environment. This mechanism is also regulated by availability of simple sugars and glycolytic compounds for their biosynthesis.

Blackwater biomethane recovery using a thermophilic upflow anaerobic sludge blanket reactor: Impacts of effluent recirculation on reactor performance

Thermophilic anaerobic digestion is a promising process for high-solid blackwater (BW) treatment due to improved hydrolysis rates, high methanogenesis efficiency, and pathogen removal, when compared with mesophilic treatment. In the present work, the effects of effluent recirculation (i.e., mixing) on thermophilic blackwater treatment were studied. A laboratory-scale thermophilic upflow anaerobic sludge blanket reactor was operated with and without effluent recirculation. The methanogenesis efficiency of the BW treatment increased from 45.0 ± 2.9% when effluent recirculation was applied to 56.7 ± 5.5% without effluent recirculation. Without effluent recirculation, the COD accumulation in the bioreactor was reduced from 17.2 to 3.8% and the effluent volatile fatty acids (VFA) concentration was reduced from 0.64 ± 0.18 to 0.15 ± 0.10 g/L. Further, both acetoclastic and hydrogenotrophic methanogenic activity increased from 101.3 ± 10.8 and 93.9 ± 6.1 to 120.4 ± 9.4 and 118.2 ± 13.2 mg CH₄-COD/(gVSS⋅d), respectively, after effluent recirculation was discontinued. The predominant methanogens changed from Methanothermobacter (67%) with effluent recirculation to Methanosarcina (62%) without effluent recirculation. As compared to the effluent recirculation conditions, the enhanced biomethane recovery and treatment performance without effluent recirculation can be attributed to the close proximity of bacteria and archaea groups and the reduced VFA accumulation. Predicted functional gene comparison showed higher prevalence of function for intermediate metabolite transportation (transporters, ATP-binding cassette (ABC) transporters, and two-component system) after discontinuing effluent circulation, which contributed to improved syntrophic propionate oxidation and syntrophic acetate oxidization and enhanced hydrogenotrophic methanogenesis.

Transcriptional responses of toxigenic and atoxigenic isolates of Aspergillus flavus to oxidative stress in aflatoxin-conducive and non-conducive media

Aflatoxin production by isolates of Aspergillus flavus varies, ranging from highly toxigenic to completely atoxigenic. Several mechanisms have been identified which regulate aflatoxin production including medium carbon source and oxidative stress. In recent studies, aflatoxin production has been implicated in partially ameliorating oxidative stress in A. flavus. To better understand the role of aflatoxin production in oxidative stress responses, a selection of toxigenic and atoxigenic isolates of A. flavus with moderate to high oxidative stress tolerance were exposed to increasing concentrations of H2O2 in both aflatoxin-conducive and non-conducive media. Mycelial mats were collected for global transcriptome sequencing followed by differential expression, functional prediction, and weighted co-expression analyses. Oxidative stress and medium carbon source had a significant effect on the expression of several secondary metabolite gene clusters including those for aflatoxin, aflatrem, aflavarin, cyclopiazonic acid, and kojic acid. Atoxigenic biological control isolates showed less differential expression under stress than other atoxigenic isolates suggesting expression profiles may be useful in screening. Increasing stress also resulted in regulation of SakA/Hog1 and MpkA MAP kinase signalling pathways pointing to their potential roles in regulating oxidative stress responses. Their expression was also influenced by medium carbon source. These results suggest that aflatoxin production along with that of other mycotoxins may occur as part of a concerted coping mechanism for oxidative stress and its effects in the environment. This mechanism is also regulated by availability of simple sugars and glycolytic compounds for their biosynthesis.

Treatment of grey water (GW) with high linear alkylbenzene sulfonates (LAS) content and carbon/nitrogen (C/N) ratio in an oxygen-based membrane biofilm reactor (O2-MBfR)

Grey water (GW) containing high levels of linear alkylbenzene sulfonates (LAS) can be a threat to the human health and organisms in the environment if not treated properly. Although aerobic treatment may achieve high GW treatment efficacy, conventional aeration can lead to serious foaming. Here, we firstly and systematically evaluated an oxygen-based membrane biofilm reactor (O₂-MBfR) for its capacity to simultaneous remove organics and nitrogen from greywater with high LAS levels and carbon/nitrogen (C/N) ratios. After a five-day startup period, multifarious microorganisms formed multifunctional biofilms and the MBfR achieved high removal rates of chemical oxygen demand (COD), LAS, and total nitrogen (TN) of 88.4%, 95.6%, and 80%, respectively, with a hydraulic retention time of 7.86 h. Higher organics loading (5.53 g TCOD/m²-day) caused cell lysis and damaged the O₂-MBfR system, leading to a discernible and continuous decline of the reactor performance. The O₂-MBfR design completely eliminated foaming formation. LAS -biodegrading-rich genus containing Clostridium, Parvibaculum, Dechloromonas, Desulfovibrio, Mycobacterium, Pseudomonas, and Zoogloea enable the nearly complete removal of LAS even under high C/N conditions. Results demonstrated that the O₂-MBfR technology is feasible for treating GW containing high LAS and C/N ratio, while remaining free of foaming formation, and at a low cost due to high O₂ utilization rates.

Spatial-temporal shifts of ecological vulnerability of Karst Mountain ecosystem-impacts of global change and anthropogenic interference

Under the background of global climate change, the natural environment of the southwest karst mountain region is undergoing profound changes. Considering the differences in the relative importance of each index in the vulnerability evaluation system in different periods, this study presents the dynamic weight determination method and then establishes the dynamic weight table of the ecological vulnerability evaluation index in the southwest karst mountain region. At the same time, net primary productivity (NPP) is introduced to help determine the ecological vulnerability classification threshold in different periods, and then the spatial-temporal change pattern and driving mechanism of ecological vulnerability in the past 15 years are analyzed. Results show the following: (1) Dynamic weight determination method has good application in the study of ecological vulnerability in long-term series, and the threshold of vulnerability classification based on NPP can ensure the comparability of ecological vulnerability evaluation results in different periods; (2) From 2000 to 2015, the southwest karst mountain region generally belonged to the moderate vulnerability category, and a decreasing trend is observed from the Sichuan-Yunnan-Guizhou border area to its surrounding region in a spatial distribution pattern; (3) In the past 15 years, the ecological vulnerability of the southwest karst mountain region increased first and then decreased; (4) The spatial-temporal change pattern of ecological vulnerability in the southwest karst mountain region is significantly affected by GDP of different industries, precipitation, soil erosion, rocky desertification. These results would be in particular useful for planning the conservation strategies or assessments of the conservation priorities. In addition, the method employed could provide a technical support and references for the ecological assessment and restoration of other similar karst mountain ecosystem zones in China or worldwide.

Changes in dietary patterns among youths in China during COVID-19 epidemic: The COVID-19 impact on lifestyle change survey (COINLICS)

Limited studies have focused on how COVID-19 outbreak and thereby lockdown have affected the youth's diet patterns. This study aimed to assess changes in diet patterns among youths in China under the COVID-19 lockdown, based on the COVID-19 Impact on Lifestyle Change Survey (COINLICS), a nationwide retrospective survey distributed via social media platforms during 9-12 May 2020 where 10,082 youth participants in China have voluntarily reported their basic sociodemographic information and routine diet patterns in the months before and after COVID-19 lockdown. We used paired t-tests or χ² tests to evaluate the significance of differences in consumption patterns of 12 major food groups and beverages across educational levels, between sexes, and before and after COVID-19 lockdown. During the COVID-19 lockdown, significant decreases were observed in the frequency of intake of rice, meat, poultry, fresh vegetables, fresh fruit, soybean products, and dairy products, with significant sex differences (females consuming more rice, fresh vegetables and fruit and less meat, poultry, soybean and dairy products than males). Significant increases were observed in the frequency of consumption of wheat products, other staple foods, and preserved vegetables, with males consuming these foods more frequently than females. Graduate students consumed most foods more frequently except rice and other staple foods and preserved vegetables. The frequency of sugar-sweetened beverage consumption had decreased while frequency of tea drinking had increased. The participating youths' diet patterns had significantly changed during the COVID-19 lockdown, with heterogeneities observed to different extents between sexes and across educational levels. Our findings would inform policy-makers and health professionals of these changes in time for better policy making and public health practice.

Autophagy-related protein EI24 delays the development of pulmonary fibrosis by promoting autophagy

Etoposide-induced protein 2.4 (EI24) is an autophagy-associated protein and acts as a tumor suppressor. However, its role in tissue fibrosis remains unknown. Herein, a downregulation of EI24 levels in the lungs from mouse pulmonary fibrosis (PF) model and lung epithelial cells was observed in response to bleomycin (BLM) or transforming growth factor-β1 (TGF-β1). Then, the role of EI24 in PF was investigated through the upregulation of EI24 in vitro and in vivo. EI24 inhibited epithelial-mesenchymal transition (EMT) process and extracellular matrix (ECM) production in EI24-overexpressing cells after stimulation with BLM or TGF-β1. The overexpression of EI24 at 14 days after the establishment of the PF model through tail vein injection delayed the progression of PF. Moreover, the administration of EI24-overexpressing plasmid promoted the autophagy level in the lungs of the PF mouse model. In addition, the inhibition of autophagy by 3-methyladenine limited the role of EI24 in these processes. Thus, the current data indicated that EI24 attenuates PF through inhibition of EMT process and ECM production by promoting autophagy.

Epidemiology of Hand, Foot, and Mouth Disease Before and After the Introduction of Enterovirus 71 Vaccines in Chengdu, China, 2009-2018

BACKGROUND

Hand, foot, and mouth disease (HFMD) has posed a serious threat to children's health. Three inactivated monovalent enterovirus 71 (EV71) vaccines are proved to be highly efficacious in phase III clinical trials and are now available in China.

METHODS

We analyzed the citywide surveillance data on HFMD cases in Chengdu during 2009-2018, and estimated cumulative first-dose EV71 vaccination coverage among children eligible to EV71 vaccination after August 2016 in Chengdu. Time series susceptible-infected-recovered model was developed to analyze basic reproduction number and herd immunity threshold of HFMD. Overall and serotype-specific HFMD incidences and severity risks were compared before and after the EV71 vaccination.

RESULTS

Among 3 laboratory-identified serotype categories, i.e. EV71, coxsackievirus A16 (CV-A16), and other enteroviruses, the major serotype attributed to HFMD has been changing across years. The cumulative first-dose EV71 vaccination coverage rate was estimated as 60.8% during the study period in Chengdu. By contrast, herd immunity threshold for EV71-related HFMD was 94.0%. After introduction of EV71 vaccines, the overall incidence of HFMD increased 60.8%, mainly driven by 173.7% and 11.8% increased in HFMD caused by other enteroviruses and CV-A16, respectively, which offset a significant reduction in the incidence of HFMD caused by EV71. The overall case-severity risk decreased from 1.4% to 0.3%, with significantly declined presented in all serotype categories.

CONCLUSIONS

The incidence and severity of EV71-related HFMD decreased following implementation of EV71 vaccination. Developing multivalent vaccines and strengthening laboratory-based surveillance could further decline burden of HFMD.

Effects of lncRNA ANRIL on proliferation and apoptosis of oral squamous cell carcinoma cells by regulating TGF-β/Smad pathway

OBJECTIVE

To investigate the role of the long non-coding ribonucleic acid (lncRNA) antisense non-coding RNA in the INK4 locus (ANRIL) in the proliferation and apoptosis of the oral squamous cell carcinoma (OSCC) cells by regulating the transforming growth factor-beta (TGF-β)/Smad pathway.

PATIENTS AND METHODS

Human OSCC cells were cultured, and then transfected with small interfering (si)-ANRIL to inhibit the lncRNA ANRIL and ANRIL-OE to overexpress the lncRNA ANRIL. Next, the flow cytometry was carried out to detect the apoptosis rate, the proliferation was determined via methyl thiazolyl tetrazolium (MTT) assay, and the changes in the protein level were detected through Western blotting (WB).

RESULTS

The lncRNA ANRIL was highly expressed in the tissues and serum of patients. The proliferation ability of the cells transfected with si-ANRIL was significantly reduced, while that of the cells transfected with ANRIL-OE was overtly increased. The apoptosis rate was (9.21±5.22)%, (22.3±1.34)%, and (13.21±6.22)% in lncRNA ANRIL-OE group, si-ANRIL group and control group, respectively. The protein expression level of the apoptotic protein active caspase-3 was lowered after the treatment with ANRIL-OE, and the key molecules of the TGF-β/Smad pathway were notably down-regulated after inhibiting ANRIL with si-ANRIL.

CONCLUSIONS

The lncRNA ANRIL regulates the TGF-β/Smad signaling pathway to promote the proliferation and suppress the apoptosis of OSCC cells.

Nursing Staff Time and Care Quality in Long-Term Care Facilities: A Systematic Review

BACKGROUND AND OBJECTIVES

In long-term care (LTC) facilities, nursing staff are important contributors to resident care and well-being. Despite this, the relationships between nursing staff coverage, care hours, and quality of resident care in LTC facilities are not well understood and have implications for policy-makers. This systematic review summarizes current evidence on the relationship between nursing staff coverage, care hours, and quality of resident care in LTC facilities.

RESEARCH DESIGN AND METHODS

A structured literature search was conducted using four bibliographic databases and gray literature sources. Abstracts were screened by two independent reviewers using Covidence software. Data from the included studies were summarized using a pretested extraction form. The studies were critically appraised, and their results were synthesized narratively.

RESULTS

The systematic searched yielded 15,842 citations, of which 54 studies (all observational) were included for synthesis. Most studies (n = 53, 98%) investigated the effect of nursing staff time on resident care. Eleven studies addressed minimum care hours and quality of care. One study examined the association between different nursing staff coverage models and resident outcomes. Overall, the quality of the included studies was poor.

DISCUSSION AND IMPLICATIONS

Because the evidence was inconsistent and of low quality, there is uncertainty about the direction and magnitude of the association between nursing staff time and type of coverage on quality of care. More rigorously designed studies are needed to test the effects of different cutoffs of care hours and different nursing coverage models on the quality of resident care in LTC facilities.

Determining the contributions of climate change and human activities to the vegetation NPP dynamics in the Qinghai-Tibet Plateau, China, from 2000 to 2015

Reflecting on the change in the global biodiversity pattern, the Tibetan Plateau, considered to be a "natural laboratory" for analyzing environmental change in China and around the world, has suffered profound changes in the vegetation ecosystem. This study introduces the gravity center model and geographical detectors to examine and discuss the spatial-temporal change pattern and the driving mechanism behind vegetation net primary production (NPP) in the Qinghai-Tibet Plateau from the year 2000 to 2015 while also quantitatively classifying the relative roles incorporated in the NPP change process. The study found that (1) from 2000 to 2015, the annual average NPP of the Tibetan Plateau demonstrated a declining trend from southeast to northwest. (2) The gravity center of vegetation NPP on the Qinghai-Tibet Plateau seems to have shifted eastward in the past 16 years, indicating that the level of vegetation NPP in the east depicts a greater increment and growth rate than the west. (3) In the arid regions, temperature and rainfall appear as the dominant factors for vegetation NPP, while slope and aspect parameters have constantly assumed dominancy for the same in the tropical rainforest-monsoon ecological zone in southeastern Tibet. (4) The structure of vegetation NPP exhibits an interaction between human and natural factors, which enhances the influence of single factors. (5) Considering the global ecological change and related human activities, certain differences are observed in the dominant and interaction factors for different study periods and ecological subregions in the Qinghai-Tibet Plateau. The research results could prove conclusive for vegetation ecological protection in the Qinghai-Tibet plateau.

Random terpolymer based on thiophene-thiazolothiazole unit enabling efficient non-fullerene organic solar cells

Developing a high-performance donor polymer is critical for achieving efficient non-fullerene organic solar cells (OSCs). Currently, most high-efficiency OSCs are based on a donor polymer named PM6, unfortunately, whose performance is highly sensitive to its molecular weight and thus has significant batch-to-batch variations. Here we report a donor polymer (named PM1) based on a random ternary polymerization strategy that enables highly efficient non-fullerene OSCs with efficiencies reaching 17.6%. Importantly, the PM1 polymer exhibits excellent batch-to-batch reproducibility. By including 20% of a weak electron-withdrawing thiophene-thiazolothiazole (TTz) into the PM6 polymer backbone, the resulting polymer (PM1) can maintain the positive effects (such as downshifted energy level and reduced miscibility) while minimize the negative ones (including reduced temperature-dependent aggregation property). With higher performance and greater synthesis reproducibility, the PM1 polymer has the promise to become the work-horse material for the non-fullerene OSC community.

[Effect of salvianolic acid B on high-glucose induced renal tubular epithelial-mesenchymal transition in rats and its mechanism]

The aim of this paper was to observe the effect of salvianolic acid B(Sal B) on high-glucose induced renal tubular epithelial-mesenchymal transition(EMT) in rats, and to explore its possible mechanisms of prevention and treatment of diabetic nephropathy. The rat renal tubular epithelial NRK-52 E cells were cultured in vitro. The cells were divided into control group, high glucose group, high glucose+10 μmol·L~(-1)Sal B group(Sal B), the above 3 groups were set at 6, 12, 24 and 48 h for dynamic observation; high glucose+Sal B different concentration(1, 5, 10 μmol·L~(-1)) groups, high glucose+5.0 μmol·L~(-1) pioglitazone group, high glucose+10 μmol·L~(-1)Sal B+5 μmol·L~(-1)GW9662 group. The protein expression levels of PPARγ, PTEN, α-SMA, E-cadherin and PI3 K/Akt signaling molecules were determined by Western blot. The mRNA expression of PPARγ and PTEN were detected by Real-time PCR. The viabi-lity of NRK52 E cells was determined by MTT assay. The results showed that as compared with control group, the mRNA and protein expression levels of PPARγ and PTEN in high glucose group gradually reduced, the protein expression levels of α-SMA and p-Akt~((Thr308))gradually increased, and the protein expression of E-cadherin gradually reduced(P&lt;0.05). As compared with high glucose group, when increases in Sal B doses, the mRNA and protein expression levels of PPARγ, PTEN in high glucose + different concentrations of Sal B groups gradually increased, the protein expression levels of α-SMA and p-Akt~((Thr308)) gradually reduced, and the protein expression of E-cadherin gradually increased(P&lt;0.05), however, the effect of 1 μmol·L~(-1)concentration of Sal B on the expression of PPARγ mRNA and protein and PTEN mRNA was not significantly different. As compared with high glucose group, the mRNA and protein expression levels of PPARγ mRNA(except 6 h) and protein(except 6 h), PTEN mRNA(except 6 h) and protein(except 6, 12 h) kept increasing, the protein expression levels of α-SMA and p-Akt~((Thr308))(except 6 h) continued to reduce, the protein expression of E-cadherin kept increasing in high glucose+10 μmol·L~(-1) Sal B dynamic observation group(P&lt;0.05). As compared with high glucose group, Sal B and the pioglitazone(PIO) can greatly enhance the expression of PPARγ, PTEN at mRNA and protein levels, enhance the expression of E-cadherin at protein levels, and reduce the expression of α-SMA, p-Akt~((Thr308))protein level(P&lt;0.05), there was no significant difference between the two groups. However, the expression levels of PPARγ and PTEN mRNA and protein, E-cadherin, α-SMA and p-Akt(Thr308) protein in the Sal B+GW9662 control group were not statistically significant compared with the high glucose group. The effect of Sal B was blocked by the PPARγ antagonist GW9662. It can be concluded that Sal B can suppress the NRK52 E cells induced by high-glucose EMT. The mechanism may be related to the activation of PPARγ with Sal B, and the up-regulation of PTEN expression, and thereby inhibiting the fibrosis effect of PI3 K/Akt signaling pathway.

Stillbirths in China: a nationwide survey

Objective

To estimate a stillbirth rate at 24 or more gestational weeks in 2015–2016 and to explore potentially preventable causes in China.

Design

A multi‐centre cross‐sectional study.

Setting

Ninety‐six hospitals distributed in 24 (of 34) provinces in China.

Population

A total of 75 132 births at 24 completed weeks of gestation or more.

Methods

COX Proportional Hazard Models were performed to examine risk factors for antepartum and intrapartum stillbirths. Population attributable risk percentage was calculated for major risk factors. Correspondence analysis was used to explore region‐specific risk factors for stillbirths.

Main outcome measures

Stillbirth rate and risk factors for stillbirth.

Results

A total of 75 132 births including 949 stillbirths were used for the final analysis, giving a weighted stillbirth rate of 13.2 per 1000 births (95% CI 7.9–18.5). Small for gestational age (SGA) and pre‐eclampsia/eclampsia increased antepartum stillbirths by 26.2% and 11.7%, respectively. Fetal anomalies increased antepartum and intrapartum stillbirths by 17.9% and 7.4%, respectively. Overall, 31.4% of all stillbirths were potentially preventable. Advanced maternal age, pre‐pregnant obesity, chronic hypertension and diabetes mellitus were important risk factors in East China; low education and SGA were major risk factors in Northwest, Southwest, Northeast and South China; and pre‐eclampsia/eclampsia and intrapartum complications were significant risk factors in Central China.

Conclusions

The prevalence of stillbirth was 13.2 per 1000 births in China in 2015–2016. Nearly one‐third of all stillbirths may be preventable. Strategies based on regional characteristics should be considered to reduce further the burden of stillbirths in China.

Tweetable abstract

The stillbirth rate was 13.2 per 1000 births in China in 2015–2016 and nearly one‐third of all stillbirths may be preventable.

The stillbirth rate was 13.2 per 1000 births in China in 2015–2016 and nearly one‐third of all stillbirths may be preventable.

Key syntrophic partnerships identified in a granular activated carbon amended UASB treating municipal sewage under low temperature conditions

Two laboratory-scale up-flow anaerobic sludge blankets (UASB) reactors, one with and one without granular activated carbon (GAC), were operated for municipal sewage treatment at low temperatures (16.5 ± 2.0 °C). During the 120-day operation, the GAC-amended reactor significantly enhanced COD removal (from 62% to 75%, P < 0.05) and methane production (from 87 to 218 mg CH₄-COD/reactor/d) than the non-GAC reactor. Bacterial communities were significantly different between the two reactors (P < 0.05). Geobacter, a key indicator for direct interspecies electron transfer (DIET), had the highest differential score (LEfSe analysis), showing significantly higher abundances in the GAC-amended reactor (3.7-8.8%) than the non-GAC reactor (0.9-4.0%). GAC also enriched syntrophic bacteria, Syntrophomonas, Syntrophus and sulfate reducing bacteria. Methanobacterium dominated the archaeal community in the GAC-amended reactor sludge (35.7%) and GAC-biofilm (75.3%), and was less abundant in the non-GAC reactor (9.9%). It indicates that GAC enriched microbial syntrophic partners with potential electro-activities in the anaerobic digestion process.

[Clinical efficacy of cyberknife in patients with primary large hepatocellular carcinoma over 70 years old]

Objective: To analyze the clinical efficacy and safety of cyberknife in the treatment of patients with primary large hepatocellular carcinoma over 70 years old. Methods: A total of 82 patients (58 males and 24 females) with large hepatocellular carcinoma aged over 70 years (70 to 85 years, (75±4) years) with a median tumor diameter of 6.7 cm (5.0~10.0 cm) were retrospectively collected. All patients were diagnosed by pathology or radiography in the Cancer Radiotherapy Center of the Fifth Medical Center of the PLA General Hospital from March 2014 to December 2018, and treated with cyberknife stereotactic radiotherapy. Progression free survival rate (PFS), local control rate (LC), overall survival rate (OS) and adverse reactions were observed at 1, 2 and 3 years. Kaplan-Meier was used for survival analysis, and Cox regression model was used to analyze survival-related factors. Results: All 82 patients successfully completed radiation therapy with a median survival time of 20 months, a median PFS of 10 months, an objective response rate of 64.63% (53/82), and a disease control rate of 85.37% (70/82). After treatment, the PFS at 1, 2, and 3 years were 39.0% (32/82), 22.1% (18/82), and 17.1% (14/82), respectively; the LC at 1, 2, and 3 years were 95.1% (78/82), 92.3% (76/82), and 92.3% (76/82), respectively; and the OS at 1, 2, and 3 years were 68.3% (56/82), 48.8% (40/82) and 31.7% (26/82), respectively. Nine patients suffered from radiation-induced liver disease (RILD), and there were no deaths due to RILD. Cox regression analysis showed that alpha-fetoprotein (AFP) was an independent risk factor for OS (HR=2.304, 95%CI 1.118-4.747;P<0.05). Conclusion: Cyberknife treatment for patients with primary large hepatocellular cancer over 70 years old has higher LC and OS, better curative effect, and less treatment-related adverse reactions.