Efficacy, safety, and immunogenicity of an Escherichia coli-produced nine-valent human papillomavirus vaccine: a multicentre, double-blind, randomised, controlled, phase 3 trial.

Ticagrelor with aspirin dual antiplatelet therapy combined with intravenous thrombolysis in patients with ischaemic stroke in China (TAPIS): a multicentre, double-blind, randomised controlled trial.

In-depth analysis of the spatial and temporal evolution of eco-efficiency and the structural characteristics of its spatial correlation network can provide a scientific basis for promoting the synergistic and high-quality development of the region. Based on the super-efficiency SBM model with non-expected outputs, the eco-efficiency of 30 provinces (excluding data from the Tibet Autonomous Region, Hong Kong, Macao, and Taiwan) in China is measured and quantified in terms of spatial and temporal evolution from 2013 to 2022. With the assistance of the modified gravitational model and the social network analysis method, the spatial correlation network correlation characteristics of the eco-efficiency in the provinces are analyzed. The study found that: ① The overall level of China's eco-efficiency has risen in the past ten years, showing a positive development trend, but the development of eco-efficiency among provinces was unbalanced, with obvious spatial differences, showing a spatial pattern of "low-high-low" from the north to the south. The hyper-variable density was the main source of the differences in eco-efficiency. ② There was an obvious spatial correlation of ecological efficiency among provinces and regions, which was manifested in a complex spatial network structure, but this correlation was relatively weak. ③ Shanghai, Beijing, Jiangsu, and Guangdong provinces and cities were located in the core of the eco-efficiency network, assuming the role of central actors and playing the role of "bridge," while the central and western provinces were at the periphery of the network. ④ There were obvious correlation and spillover effects among different segments in the eco-efficiency network, but the composition of the segments varied significantly, and the interactions among the segments in 2022 were mainly characterized by "net benefit" and "net spillover." In conclusion, the results of this study can provide a scientific basis for the construction of the network of regional synergistic high-quality development and inter-provincial eco-efficiency and provide practical support for the development of global eco-optimization and differentiation strategies.

ABSTRACT Railway architecture often embodies the innovation and globalisation processes characteristic of industrialisation. In China, many early examples of railway architecture demonstrate these processes, as seen in the stations of Imperial Railways of North China (IRNC, later known as Peking-Mukden Railway). Built between 1881 and 1912 combining Chinese, British and other countries’ actants, this line brought to Beijing new building solutions, techniques and typologies. This article adopts an archaeological approach to analyse the physical and documentary evidence of 11 station sites. Using field recording and architectural analyses, it defines the original designs of these constructions and explains them within their cultural context. It is concluded that the railway architecture of IRNC in Beijing reflects the influence of the European engineers who came to China to work in the development of its early railway network, as well as the country's timid process of globalisation and modernisation at the end of the imperial era.

Urban railway corridors—including abandoned, redesigned, and in-use lines—can support biodiversity and ecological connectivity in fragmented cities, yet their ecological dynamics and roles in Nature-based Solutions (NbS) remain poorly understood. Addressing this requires a context-sensitive approach that differentiates corridor types and compares their ecological functions. This study compares vegetation dynamics along railway corridors in two cities with contrasting socio-ecological contexts—Perth (Western Australia) and Beijing (China)—using a typology-based comparative approach. The results show that: (1) vegetation dynamics differ fundamentally between the two cities, with Perth characterized by vertically structured vegetation dominated by native tree layers and non-native disturbance-tolerant annual groundcover, while Beijing supports more continuous vegetation with widespread natural regeneration of native species; and (2) these differences correspond to distinct suggested NbS strategies. For Perth, NbS should combine phenology-aware management (wet versus dry seasons) with disturbance-based zoning and staged native planting strategies. In contrast, Beijing corridors are characterized by more uniform disturbance patterns but differentiated corridor typologies, indicating NbS structured around corridor-type management with a stronger emphasis on the support of native groundcover establishment and allowing for self-sustaining regeneration. These findings highlight how different contexts shape vegetation dynamics and provide comparative ecological insights for developing context-specific NbS for urban railway corridors.

Thermodynamic analysis and performance evaluation of a solar-assisted high temperature heat pump system with lubricants

Multi-mode spatial accessibility to vaccination services and its impact on influenza-related hospitalisations among older adults.

To investigate the species of sandflies and the prevalence of Leishmania infections in sandflies from selected areas of northern and northwestern China, so as to provide insights into identification of leishmaniasis vectors and assessment of epidemiological trends of leishmaniasis in China. Sandfly samples were collected from Mentougou District of Beijing Municipality, Xiangning County in Linfen City of Shanxi Province, Ejin Banner in Alxa League of Inner Mongolia Autonomous Region, and Payzawat County of Karamay District of Karamay City, Gaochang District of Turpan City in Xinjiang Uygur Autonomous Region from July 2023 to July 2024. Approximately 100 intact female sandfly samples were randomly selected from each site and the species of sandflies was identified according to morphological characteristics and molecular assays. Female sandflies originating from the same habitat were grouped into pools of 10 individuals. Leishmania infection was detected using polymerase chain reaction (PCR) assay targeting the internal transcribed spacer 1 (ITS-1) gene, and the prevalence of Leishmania infection was calculated in sandflies from different sampling sites using the minimum infection rate (MIR) method. In addition, positive amplicons were sequenced and subjected to phylogenetic analysis. A total of 6 155 sandflies were collected from different environments at sampling sites across the six aforementioned regions from July 2023 to July 2024. Phlebotomus chinensis (96.00%) was the dominant sandfly species in Mentougou District, Beijing Municipality, with a small proportion of Ph. sergenti (4.00%), and only Ph. chinensis was found in Xiangning County, Linfen City, Shanxi Province. Ph. wui was the only sandfly species detected in Ejin Banner, Alxa League, Inner Mongolia Autonomous Region, and Payzawat County, Kashgar City, Xinjiang Uygur Autonomous Region, and Ph. caucasicus (97.70%) was the dominant sandfly species in Karamay District, Karamay City, Xinjiang Uygur Autonomous Region, with a small proportion of Ph. wui (2.30%), while Ph. alexandri was the only species in Gaochang District, Turpan City, Xinjiang Uygur Autonomous Region. A total of 40, 60, 34, 18, 18, and 22 pools of sandfly samples were tested from Mentougou District in Beijing Municipality, Xiangning County in Linfen City of Shanxi Province, Ejin Banner in Alxa League of Inner Mongolia Autonomous Region, Payzawat County in Kashgar City, Karamay District in Karamay City, and Gaochang District in Turpan City of Xinjiang Uygur Autonomous Region, respectively. L. infantum was detected in Ph. chinensis samples from Mentougou District in Beijing Municipality, and Xiangning County of Linfen City in Shanxi Province, with MIR of 0.25% to 1.00%, and L. donovani was detected in Ph. wui from Ejin Banner in Alxa League of Inner Mongolia Autonomous Region, and Payzawat County in Kashgar City of Xinjiang Uygur Autonomous Region, with MIR of 0.56% to 0.88%; however, no Leishmania infection was detected in Ph. caucasicus from Karamay District in Karamay City or Ph. alexandri from Gaochang District in Turpan City of Xinjiang Uygur Autonomous Region. Phylogenetic analysis showed that the Leishmania ITS-1 gene sequences obtained from Mentougou District in Beijing Municipality and Xiangning County in Linfen City of Shanxi Province were clustered into the same clade with the reference sequences of L. infantum ITS-1 gene, while the Leishmania ITS-1 gene sequences obtained from Ejin Banner in Alxa League of Inner Mongolia Autonomous Region and Payzawat County in Kashgar City of Xinjiang Uygur Autonomous Region were clustered into the same clade with the reference sequences of L. donovani ITS-1 gene. There are variations in sandfly species in selected areas of northern and northwestern China, and variations in the species of Leishmania infecting sandflies. Improved surveillance of sandfly vectors and targeted control strategies with adaptations to geographical features and leishmaniasis vectors are recommended.

Short-term origin-destination (OD) demand prediction is critical in managing the multimodal transportation system. The joint short-term OD demand prediction for multimodal systems faces three challenges: (1) data availability: real-time OD demand is not available for prediction; (2) sparsity and high-dimensionality of OD demand: the OD demand is spatiotemporal sparse and usually high dimension; (3) impact of different transportation modes: the future OD demand for one mode is affected by others, and extensive studies primarily focus on a single transportation mode, overlooking the influence between different modes. To tackle these challenges, we propose a multitask learning and Partial-Differential-based model to predict the short-term Multimodal Transport Systems OD demand (PD-MTSOD), which includes (1) an OD demand learner to estimate real-time OD demand, (2) data aggregation with hypergraph attention to capture spatiotemporal features, and (3) OD demand decomposition into self-generated increment, other-modes-generated increment, and real-time OD demand, and use partial-differential-based methods to model intermodal correlations. Extensive tests on Beijing and New York city's multimodal systems show that PD-MTSOD surpasses baseline models. In addition, we prove the benefits of joint considering multiple transportation and explore the correlations of different transportation modes. This paper offers a reliable method for understanding multimodal transportation systems.

Vista view within the historic urban context is an important and vulnerable form of the visual landscape. Focussing on the changing image of vista views in the Old City of Beijing, this study was conducted in two parts: the historical reconstruction of initial views and the status assessment of current views. In the first part, we reconstruct the viewing points and objects of Ming and Qing Beijing through on-site surveys and historical material materials, derive viewing corridors and corresponding vista spaces through spatial modelling and GIS-based analysis, and formulate a quantitative classification framework according to viewing distances and angles. In the second part, we establish an evaluation framework for current views in terms of view components based on the principles of authenticity and integrity, filter existing views through integrity assessment, and analyse their authenticity in terms of position, character, and atmosphere. For the reconstruction results, 25 initial viewing points, 58 viewing objects, and 374 viewing corridors are identified; the quantities and spatial distribution characteristics of 7 types of initial images are obtained. For the assessment findings, 132 views have vanished due to the disappearance of 4 viewing points and 18 viewing objects; the existing 242 views generally have good authenticity, and the most intact and authentic types are ‘Tiao’, ‘Xi’, and ‘Kan’. This study provides a reference for the renewal and conservation of historical and traditional settlements.

To enhance the technical support of soil environmental quality monitoring services for territorial spatial planning and the sustainable development of ecological civilization in the Beijing Municipal Administrative Center， this study systematically investigated the changes in heavy metal contamination status and sources in the soils of Tongzhou District over the past two decades. Using inverse distance weighted （IDW） spatial interpolation， the geo-accumulation index， the single-factor pollution index， and the Nemerow comprehensive pollution index， this study conducted a sectional evaluation of the spatial distribution and accumulation characteristics of eight heavy metal elements （As， Cd， Cr， Cu， Hg， Ni， Pb， and Zn） in the soils of Tongzhou District from 2005 to 2023. Correlation analysis， principal component analysis （PCA）， and the positive matrix factorization （PMF） model were employed to identify the principal components and source contributions of heavy metals. The results showed that the concentrations of Cr， Cu， Ni， Pb， and Zn exhibited minimal variation across the four selected years （2005， 2011， 2018， and 2023）， while the median values of Cd， Hg， and Zn exceeded the background values of Beijing. The concentrations of Cd and Hg in top soil were significantly higher than those in deeper layers， with the proportion of Cd enriched sites showing a decreasing trend over the years， whereas Hg exhibited strong spatial heterogeneity. From 2005 to 2011， Cd， Hg， Cu， and Pb were highly enriched in areas with intense industrial activities， incineration sources， and traffic emissions. In 2018， high concentrations of Cd， Zn， Cu， and Pb were primarily distributed in the central and eastern agricultural lands of the study area. Compared to that in 2005， the enrichment extent of Cd， Hg， Cu， Pb， and Zn in 2023 was significantly reduced. In 2005， As， Cr， Cu， Ni， Pb， and Zn mainly originated from natural/agricultural mixed sources， while in 2011， these elements were primarily derived from natural， traffic， and agricultural mixed sources. Cd was mainly associated with industrial sources in both 2005 and 2011. In 2018 and 2023， As， Cr， Cu， Ni， and Pb were predominantly attributed to natural， traffic， and agricultural mixed sources， whereas Cd and Zn were mainly from industrial sources. Hg in soil across all four years was primarily derived from atmospheric deposition. Key factors influencing variations in source contributions included land development intensity， agricultural fertilization rates， traffic emissions， the scale of industrial pollution enterprises， energy combustion emissions， and overall atmospheric pollution levels.

Tenecteplase versus standard medical treatment for basilar artery occlusion within 24 h (TRACE-5): a multicentre, prospective, randomised, open-label, blinded-endpoint, superiority, phase 3 trial.

The Katian (Late Ordovician) represents a critical phase of the Great Ordovician Biodiversification Event (GOBE), and was marked by the diversification and pronounced provincialism of brachiopods across the tropical and temporal Proto-Tethys. Taxonomic revisions of brachiopod assemblages from Mongolia and Russia remain challenging because of restricted accessibility to historical fossil sites. However, modern analytical techniques offer promising avenues to extract new data from limited material. Here, we re-examine the rhynchonellide brachiopod Salairella latecostellata—a morphologically distinctive taxon with atrypide-like outline—from the Bayankhongor region of central Mongolia. Serial grinding of two topotypes reveals their internal morphology, facilitating a systematic revision of the genus. Salairella had a restricted distribution to what is now the Altai Mountains, Siberia, and Mongolia. This contrasts with the coeval shallow water Altaethyrella Fauna, which dominated the regions of modern China and Kazakhstan during the Katian. This palaeobiogeographical disparity infers a latitudinal gradient-driven brachiopod endemism within the Katian Proto-Tethys. The Altai Mountains region then emerges as an evolutionary hotspot and transitional zone for rhynchonellide brachiopods preceding the Late Ordovician Mass Extinction (LOME). Yuchen Zhang* [yuchenzhang@nigpas.ac.cn], State Key Laboratory of Palaeobiology and Petroleum Stratigraphy, Nanjing Institute of Geology and Palaeontology, Chinese Academy of Sciences, 39 East Beijing Road, Nanjing 210008, China; and Key Laboratory of Deep-time Geography and Environment Reconstruction and Applications of Ministry of Natural Resources, Chengdu University of Technology, Chengdu 610059, China; Tatiana A. Shcherbanenko [Shcherbanenkota@ipgg.sbras.ru], Trofimuk Institute of Petroleum Geology and Geophysics, Siberian Branch, Russian Academy of Sciences, Novosibirsk, 630090 Russia; Murun Bat-Orgil [murunb@mas.ac.mn], Institute of Paleontology, Mongolian Academy of Sciences, Ulaanbaatar 15160, Mongolia; Ya. Ariunchimeg [ariunyarinpil@gmail.com], Institute of Paleontology, Mongolian Academy of Sciences, Ulaanbaatar 15160, Mongolia.

Vehicle emission is a major source of urban ultrafine particles (UFPs), yet measurement and emission control for UFP lags significantly behind that of other pollutants. The China VI emission standard, one of the strictest globally, introduced the nation’s first particle number (PN) limits. This study focused on real-world PN emissions in the capital city Beijing, which adopted China VI ahead of the national schedule in 2019. Based on long-term particle number size distribution measurements and online UFP composition analysis, a pronounced decline in emission rates of vehicle-attributed PN from 2019 to 2023 was found, resulting in decreases of ~70% for atmospheric PN3–30 nm, ~48% for PN30–100 nm, and ~42% for PN>100 nm. These reductions substantially outpace those observed for PM2.5 and NO2. Early implementation of China VI, coupled with rapid electric vehicle adoption, are the primary drivers behind Beijing’s more pronounced PN mitigation (−44%) compared with nationwide (−33%). These findings highlight the effectiveness of more stringent vehicle emission standards and electric vehicle strategies in reducing atmospheric UFPs, shedding light on future vehicle emission regulations.

Based on a structural equation model, this study aims to verify the relationships between experiential marketing of the Anta brand and brand attitude, purchase intention, and recommendation intention. A stratified sampling method was employed to select three cities—Beijing, Changsha City in Hunan Province, and Guiyang City in Guizhou Province—where 500 adult consumers with recent Anta purchase experience were surveyed through on-site questionnaires. Data analysis was conducted using SPSS 26.0 and AMOS 21.0, supported by literature review and mathematical statistics. The results indicate that sensory experience, action experience, cognitive experience, and affective experience within experiential marketing have significant positive effects on brand attitude, whereas relational experience shows no significant impact on brand attitude. All dimensions of experiential marketing positively influence purchase intention. Brand attitude significantly and positively affects purchase intention. Brand attitude does not significantly influence recommendation intention. Purchase intention has a significant positive effect on recommendation intention.

The North China Plain, a major grain production base in China, is facing the chronic threat of climate-change-induced delays in winter wheat sowing, with late sowing constraining yields by shortening the pre-winter growth period, and soil moisture at sowing potentially serving as a key factor to alleviate late-sowing losses. However, previous studies have mostly independently analyzed the effects of sowing time or water stress, and there is still a lack of systematic quantitative evaluation on how the interaction effects between the two determine long-term yield potential and risk. To fill this gap, this study aims to quantify, in the context of long-term climate change, the independent and interactive effects of different sowing dates and baseline soil moisture on the growth, yield, and production risk of winter wheat in the North China Plain, and to propose regionally adaptive management strategies. We selected three representative stations—Beijing (BJ), Wuqiao (WQ), and Zhengzhou (ZZ)—and, using long-term meteorological data (1981–2025) and field trial data, undertook local calibration and validation of the APSIM-Wheat model. Based on the validated model, we simulated 20 management scenarios comprising four sowing dates and five baseline soil moisture levels to examine the responses of phenology, aboveground dry matter, and yield, and further defined yield-reduction risk probability and expected yield loss indicators to assess long-term production risk. The results show that the APSIM-Wheat model can reliably simulate the winter wheat growing period (RMSE 4.6 days), yield (RMSE 727.1 kg ha−1), and soil moisture dynamics for the North China Plain. Long-term trend analysis indicates that cumulative rainfall and the number of rainy days within the conventional sowing window have risen at all three sites. Delayed sowing leads to substantial yield reductions; specifically, compared with S1, the S4 treatment yields about 6.9%, 16.2%, and 16.0% less at BJ, WQ, and ZZ, respectively. Moreover, increasing the baseline soil moisture can effectively compensate for the losses caused by late sowing, although the effect is regionally heterogeneous. In BJ and WQ, raising the baseline moisture to a high level (P85) continues to promote biomass accumulation, whereas in ZZ this promotion diminishes as growth progresses. The risk assessment indicates that increasing baseline moisture can notably reduce the probability of yield loss; for example, in BJ under S4, elevating the baseline moisture from P45 to P85 can reduce risk from 93.2% to 0%. However, in ZZ, even the optimal management (S1P85) still carries a 22.7% risk of yield reduction, and under late sowing (S4P85) the risk reaches 68.2%, suggesting that moisture management alone cannot fully overcome late-sowing constraints in this region. Optimizing baseline soil moisture management is an effective adaptive strategy to mitigate late-sowing losses in winter wheat across the North China Plain, but the optimal approach must be region-specific: for BJ and WQ, irrigation should raise baseline moisture to high levels (P75-P85); for ZZ, the key lies in ensuring baseline moisture crosses a critical threshold (P65) and should be coupled with cultivar selection and fertilizer management to stabilize yields. The study thus provides a scientific basis for regionally differentiated adaptation of winter wheat in the North China Plain to address climate change and achieve stable production gains.

Carbonyl compounds play a pivotal role in the formation of secondary pollutants such as O3 and SOA, significantly impacting air quality and human health. This study extended the observation period compared to previous research, providing a long-term perspective on carbonyl compound variations and their environmental implications. Atmospheric observations were conducted at Beijing (BJ) and Xianghe (XH) during the summer and winter months of 2018, 2019, and 2023 to study the sources and impacts of carbonyl compounds in typical urban areas and peri‑urban areas. Notably, concentrations in the summer of 2023 increased compared to 2018 and 2019. The predominant carbonyl compounds-formaldehyde, acetaldehyde, and acetone-accounted for over 60 % of the total. The mean values of OFP in BJ ranged from 18.55 to 58.61 µg/m3, lower than those in XH (29.82 to 65.48 µg/m3), with formaldehyde and acetaldehyde contributing over 80 % of the total. SOAP exhibited a similar pattern, with values in XH (69.21 to 508.55 µg/m3) significantly exceeding those in BJ (34.47 to 159.78 µg/m3). The PMF model highlighted vehicle exhaust, secondary pollution, and biomass combustion as major sources of carbonyl compounds, emphasizing differences in source contributions between the two regions. This study's comparative analysis over different years and locations provides new insights into the dynamic changes in carbonyl compounds and their environmental importance. These results not only reinforce the importance of carbonyl compounds regulation but also offer a valuable reference for evaluating and refining emission control strategies during this period.

Causes of Owls Admission to the Wildlife Rescue Centre in Beijing (China) from 2006–2022

Progresses in sustainable catalytic transformations—a critical field for utilizing new feedstocks, creating high-performance materials, and establishing eco-friendly processes—rely increasingly on carbon materials and related technologies. For this reason, the development of carbon-based catalysts, along with advancements on the sophisticated toolkit of decarbonization and carbon circularity strategies, forms a cornerstone of sustainable development for the catalysis and material science community. The importance of carbon in catalysis stems from its ability to generate diverse and flexible, multidimensional structures. Engineered into porous, zeolite-like networks, these carbons, frequently in the form of metal-free systems of lightweight hetero-doped networks, create specialized confined environments ideal for catalytic and energy applications. Sourcing these C-based materials from renewable feedstocks has finally allowed to directly connect technological innovation with sustainable carbon circularity. The development of hybrid composites—from metal nanoparticles to atomically dispersed single-atom catalysts—has further boosted the importance of C-based networks in catalysis. Today, carbon is acknowledged as an active promoter in thermal, electro-, photo-, and photo-electro-catalysis, surpassing its former identity as a passive, inert material/support. Celebrating the 10th edition of the CARBOCAT conference (CARBOCAT 10, Florence, Italy, 24th–26th June, 2024), this special issue showcases the vibrant research of its global community. The featured papers not only demonstrate the field's energy but also affirm carbon's catalytic power in pushing the frontiers of nanoscience, characterization methodologies, and industrial innovation. Showcasing diversity in carbon-based materials and their multiple applications, this ChemCatChem collection features original and review studies on nanoporous carbons (Matos, https://doi.org/10.1002/cctc.202500644), waste/biomass-derived carbons (García-López, https://doi.org/10.1002/cctc.202500189; Acocella, https://doi.org/10.1002/cctc.202500707; Kozłowski, https://doi.org/10.1002/cctc.202500143; Saladino, https://doi.org/10.1002/cctc.202402097 and https://doi.org/10.1002/cctc.202400974; Ginoble-Pandoli, https://doi.org/10.1002/cctc.202401042), carbon nanofibers (Manzoli, https://doi.org/10.1002/cctc.202500268 and Bitter, https://doi.org/10.1002/cctc.202500134), and their composites with metal nanoparticles or inorganic oxides (Soares, https://doi.org/10.1002/cctc.202500084; Hermans, https://doi.org/10.1002/cctc.202500070 Tassinari, https://doi.org/10.1002/cctc.202500931; Luengnaruemitchai, https://doi.org/10.1002/cctc.202500808 and Gupta, https://doi.org/10.1002/cctc.202401840). These materials found application in electrocatalytic, photocatalytic, and thermal processes for sustainable chemistry, including environmental remediation strategies, CO2 conversion, and biomass valorization. In light of the field's growing importance, the CARBOCAT 10 International Advisory Board (gathered in Florence, Italy) has unanimously designated Professors Fei Wei (Tsinghua University), De Chen (NTNU, Norway), Xiulian Pan (DICP, China), and Qiang Zhang (Tsinghua University) as chairpersons of the next CARBOCAT edition (CARBOCAT 11). Professor Yuefeng Liu (DICP, China) will serve as the Scientific Secretary. The conference will be held from 28th–31st May, 2026, at Tsinghua University in Beijing (China). The world-class stature of chairpersons and the host institution ensures that CARBOCAT 11 will be an event of extraordinary success like ours was. The Chairperson of Carbocat10 wishes to thank the National Interuniversity Consortium of Materials Science and Technology (INSTM), AIM Group International, and all sponsors for their generous support in the logistics and realization of a highly successful event.

IntroductionIntegrating real-world evidence (RWE) into regulatory decision-making requires validation against pivotal randomized controlled trials for the same estimand. We emulated the LEADER trial using Chinese claims data to evaluate liraglutide’s cardiovascular safety, assessing RWE-RCT concordance and examining the methodological adaptations and operational challenges encountered when emulating RCTs with claims data.Materials and methodsUsing the Beijing Municipal Medical Insurance Database (2020–2024), we emulated the LEADER protocol. We identified new users of liraglutide and, as an active comparator, new users of DPP-4 inhibitors (DPP4i). The primary outcome was 3-point Major Adverse Cardiovascular Events. Propensity score matching was employed to balance baseline characteristics. Hazard Ratios were estimated using Cox proportional hazards models. Negative control outcomes (fractures and head injuries) and E-values were employed to assess the potential for unmeasured confounding.ResultsThe final cohort included 17, 772 patients (8, 886 per group). Over a median follow-up of 35 months, the incidence of MACE was 7.0% in the liraglutide group versus 7.8% in the DPP4i group. In the primary analysis, liraglutide was associated with a trend toward reduced cardiovascular risk (HR 0.90; 95% CI: 0.81, 1.01; P = 0.063), consistent with the effect size observed in the LEADER trial (HR 0.87), though not reaching statistical significance. However, sensitivity analysis adjusting for baseline comorbidities and drug exposure demonstrated a significant benefit (HR 0.90; 95% CI: 0.80, 1.01). The negative control analysis showed no association (HR 1.02; 95% CI: 0.93, 1.12), supporting the absence of unmeasured confounding.ConclusionThis target trial emulation study validated the cardiovascular safety profile of liraglutide observed in the LEADER trial. Liraglutide demonstrated non-inferiority to DPP-4 inhibitors for the risk of MACE. While the primary analysis for superiority showed a trend toward benefit, it did not reach statistical significance. However, sensitivity analyses suggested potential benefits and supporting the robustness of the safety findings.