App-based self-guided mindfulness training for adults with epilepsy: a six-week single-arm feasibility study.

Beyond school resources: Unraveling the urban–rural academic achievement gap in Mainland China

Field-adaptable RAA-CRISPR/LbCas12a assay for specific detection of Karenia brevis in natural seawater.

Yi-Shen-Hua-Shi granules ameliorate renal injury via PPARγ-Klotho-mediated metabolic restoration and immune regulation in adenine-induced chronic kidney disease.

Aim: Community-acquired bacterial pneumonia (CABP) remains a major cause of morbidity and mortality worldwide, particularly among elderly and susceptible populations. Escalating antimicrobial resistance among prevalent CABP pathogens in China, combined with safety limitations of existing regimens, underscores the urgent need for novel therapeutic strategies. Lefamulin (LEF) and omadacycline (OMA), recently approved in mainland China, offer promising alternatives, but direct comparative evidence is lacking. This study aims to indirectly compare the clinical efficacy and safety outcomes of LEF versus OMA in the treatment of CABP and to explore subgroup differences in high-risk populations. Materials & methods: A systematic literature review was conducted across PubMed, Embase, the Cochrane Library and ClinicalTrials.gov from inception through March 2024, limited to English-language studies, to identify phase III randomized controlled trials evaluating LEF or OMA in adults with CABP. The Bucher method was used for the indirect comparison, with effect estimates reported as risk ratios (RRs) and 95% CIs. Similarities in trial design and populations supported the transitivity assumption. Primary end points were early clinical response (ECR), investigator-assessed clinical response (IACR) at test of cure (TOC) and treatment-emergent adverse events leading to death. Subgroup analyses were further stratified by patient age (elderly patients), presence of comorbidities and causative pathogens. Results: Three randomized controlled trials involving 2063 patients were included in this study. LEF and OMA demonstrated comparable efficacy in terms of ECR (RR: 1.01, 95% CI: 0.93-1.09) and in terms of IACR at TOC (RR: 0.95, 95% CI: 0.88-1.02). The relative risk of treatment-emergent adverse events leading to death in the LEF group compared with the OMA group was 0.67 (95% CI: 0.15-3.02), with no statistically significant difference observed. In subgroup analysis, LEF demonstrated statistically significant superiority over OMA in treating patients with Haemophilus influenzae infections (RR: 1.28, 95% CI: 1.03-1.60). No other subgroups reached statistical significance. LEF showed a numerical trend toward favoring in multiple subgroups, including the elderly, patients with comorbidities, and those infected with specific pathogens, particularly in the ECR analysis. Meanwhile, OMA demonstrated potential numerical advantages in a few subgroups defined by comorbidities or specific pathogens for IACR at TOC. Conclusions: Both LEF and OMA have been shown to be effective and safe in treating CABP. LEF demonstrated significant benefit in Haemophilus influenzae infections and consistently favorable trends in high-risk or specific infected subgroups. OMA also shows favorable trends in certain patient groups. These findings highlight the need to further accumulate additional clinical data or real-world evidence to support future comparative research. The introduction of novel antibiotics, such as LEF and OMA, represents an important step toward addressing the pressing challenge of antimicrobial resistance and improving outcomes for patients with CABP in China.

Factors contributing to the success of carbapenem-resistant Klebsiella pneumoniae (CRKP) of sequence type 11 (ST11) remain poorly understood. All GenBank-available K. pneumoniae genome sequences were retrieved. Isolates from mainland China carrying blaKPC and exhibiting high-quality assembly were selected for determining ST, virulence factors, antimicrobial resistance genes, plasmid types, and outer membrane porins (OmpK35 and OmpK36). Cloning experiments were performed for complementing porin deficiencies. In vitro growth assays under carbapenem selection pressure and carbon utilization assays were conducted. The structure alteration of OmpK36 with a two-amino-acid Gly-Asp insertion (OmpK36GD) was modeled. ST11 accounted for 87.22% (8930/10 238) of all blaKPC-carrying CRKP Chinese strains. The majority (96.13%, 8584/8930) of ST11 CRKP strains had a truncated OmpK35 (OmpK35-del), with a 17%-amino-acid remnant, and OmpK36GD. Only 6.42% (84/1308) of non-ST11 CRKP possessed such alterations. The GD insertion obstructs the outermost channel and compromises OmpK36 function. ST11 CRKP with OmpK35-del and OmpK36GD exhibited higher minimum inhibitory concentrations to carbapenems, which was reduced by complementing wild-type of OmpK35 and/or OmpK36. Strains possessing OmpK35-del and OmpK36GD had better growth under low concentration (2 or 4 mg/L) meropenem. Unlike truncations of OmpK36, OmpK36GD does not interfere with utilizing carbon sources. OmpK35 deficiency and OmpK36 structure alteration, combined with KPC-2 carbapenemase production, contribute to the high-level carbapenem resistance observed in ST11 CRKP strains. OmpK36GD represents an optimal model for OmpK36 deficiencies due to its minimal fitness cost. With the porin deficiencies, ST11 CRKP strains demonstrate enhanced growth and proliferation under carbapenem selection pressure, likely promoting their prevalence.

Post-marketing surveillance of adverse events following enterovirus type 71 inactivated vaccine in China, 2016-2023.

To investigate the effectiveness of structured emergency drills in enhancing core disaster nursing competencies and preparedness among emergency department nurses, this multicenter prospective cohort study enrolled 178 nurses from four tertiary-level Class A hospitals (the top-tier ones in mainland China) in a city between January and December 2024 and quarterly structured practical emergency drills were implemented as an intervention. Meanwhile, Standardized assessment tools were administered at baseline and at the end of each quarter. Results showed that both the total score for core disaster nursing competencies and the total disaster preparedness score rose significantly in respective, from 122.8 ± 14.2 at baseline to 179.2 ± 12.6 in the fourth quarter (P < 0.001), and from 80.4 ± 10.8 to 118.9 ± 9.7 (P < 0.001). Multivariate regression analysis revealed that professional title (β=0.214, P=0.008), disaster training experience (β=0.186, P=0.016), and years of service (β=0.172, P=0.025) significantly influenced core competency improvement. Conclusions could be drawn as the structured practical emergency drills significantly enhance core disaster nursing competencies and preparedness among emergency department nurses, establishing an effective disaster response training model.

Objective This systematic review and meta-analysis aimed to determine the pooled prevalence of anxiety among women with polycystic ovary syndrome (PCOS) in mainland China and explore the potential contributors related to anxiety prevalence among PCOS. Methods We searched PubMed, EMBASE, Web of Science, CNKI, WanFang, and VIP databases from inception to January 2025. Pooled prevalence estimates were calculated using random-effects models, with subgroup analyses stratified by region, age, BMI, assessment tools, and diagnostic criteria. Heterogeneity was assessed by I 2 statistics and meta-regression. Results Thirty-five studies (8,655 participants) met inclusion criteria. The pooled anxiety prevalence was 32% (95% CI: 26–38%), with substantial heterogeneity ( I 2 = 97.8%, p < 0.001). Subgroup analyses revealed higher prevalence in younger women (<26 years: 39% vs. ≥26 years: 25%), West China (36% vs. East/Central China: 28%), and studies using GAD-7 (41% vs. SAS: 31%). Diagnostic criteria influenced estimates (Rotterdam: 31% vs. PRCHIS: 27%). Meta-regression identified no significant moderators. Sensitivity analyses confirmed robustness, and publication bias was nonsignificant. Conclusion Anxiety affects nearly one-third of Chinese women with PCOS, with prevalence shaped by age, region, and assessment methodologies. Despite alignment with global trends, regional disparities underscore the need for culturally adapted mental health interventions. Clinicians should prioritize anxiety screening in PCOS management, particularly for younger women and underserved populations.

Cigarette smoking is a global epidemic, and is particularly pronounced in China, the world's largest manufacturer and consumer of cigarettes. Price-based approaches are effective for tobacco control, but can falter in settings with weak policy enforcement. Changing social norms around cigarette smoking may reduce smoking through the exertion of anti-smoking social influence even in the absence of strong regulatory conditions. However, evidence of the social norms-smoking relationship over time at a population level in China is severely lacking. We fit Bayesian latent growth curve models to understand how smoking-related descriptive norms (perceptions of others' smoking), injunctive norms (perceptions of others' approval of smoking), and cigarette smoking unfold over time. We used longitudinal data from adults who smoke in four cities over nine years (N = 5,400 observations), provided by the International Tobacco Control Policy Evaluation Project in Mainland China. Self-reported smoking status was defined as smoking ≥100 cigarettes in one's lifetime and currently smoking at least one cigarette per week. Higher pro-smoking descriptive and injunctive norms were associated with increases in cigarette smoking over time, even after controlling for known confounders such as addiction level, exposure to household smoking, and exposure to pro-smoking media. Higher pro-smoking descriptive norms were associated with both higher initial level of cigarette smoking and slower rates of smoking reduction over time. Social norms impact smoking over time among middle-aged people who smoke in China. Tobacco control efforts should support anti-smoking descriptive norms through group-based interventions and creating social networks of those who do not smoke.

Candida tropicalis is a leading cause of invasive candidiasis in the Asia-Pacific region with reported crude mortality rates exceeding 50%. The rising prevalence of azole-resistant strains presents a significant clinical challenge. We analyzed 1,016 C. tropicalis clinical isolates collected over nine years from 27 hospitals across North India. Fluconazole resistance was detected in 5.1% (n = 52) of isolates, with cross-resistance observed to voriconazole in 55.7% and itraconazole in 44.2% of isolates. Multilocus sequence typing (MLST) analysis of global 1,630 isolates including 208 Indian and whole-genome sequencing of 716 global isolates (139 Indian) confirmed the clonal emergence and persistence of azole-resistant MLST clade 4 strains in Indian hospitals. Phylogenomic analyses identified that Indian azole-resistant lineage was closely related to azole-resistant isolates from mainland China and Taiwan. The underlying mechanism of resistance involved hotspot mutations (Y132F) in the ERG11 gene along with its duplication, overexpression, and twofold high ergosterol content. Comparative transcriptomics of two clinical isolates exhibiting >512 fold difference in fluconazole susceptibility identified upregulation of virulence-associated genes, ALS7 gene (eightfold), SAP7 and SAP9 (1.6- and 2-fold, respectively) in azole-resistant isolate. Furthermore, azole-resistant isolates showed robust biofilm-associated metabolic activity (twofold), reduced β-glucan exposure, and greater survival in both neutrophil and macrophage killing assays. Notably, azole-resistant lineage exhibits several traits associated with adhesion and immune evasion that could possibly enable its spread in healthcare settings and signals the beginning of a greater spread of this clone. The urgent need for continuous genomic surveillance and antifungal stewardship is warranted to mitigate the spread of multidrug-resistant C. tropicalis.IMPORTANCEInvasive fungal infections affect 6.5 million people annually and are associated with high mortality rates. Despite being the leading cause of invasive yeast infections in the Asia-Pacific, this is the first comprehensive study of Candida tropicalis from India documenting the emergence of azole-resistant clonal lineage (clade 4) in several hospitals in India. Azole resistance is driven by mutations, gene duplication, and overexpression of its target gene ERG11. The Indian azole-resistant isolates showed high genetic relatedness with those from China. Also, resistant isolate showed overexpression of virulence-related genes and robust biofilm formation. Notably, reduced β-glucan exposure in fluconazole-resistant isolates may contribute to their decreased susceptibility to the innate immune system. Importantly, this study provides evidence for the emergence of azole-resistant C. tropicalis lineage in India, which exhibits several traits associated with adhesion and immune evasion that could possibly enable its spread in healthcare settings leading to a public health concern.

Dementia is a group of neurological disorders affecting millions worldwide, placing substantial strain on healthcare systems. Although diet has been identified as a modifiable risk factor for cognitive health in aging, there is limited research on how dietary patterns affect cognitive outcomes in ethnic Chinese populations. Chinese populations, primarily in Mainland China, Hong Kong, Macao, Taiwan, and Singapore, have distinct genetic profiles and diverse dietary traditions. These genetic and cultural dietary factors may interact in specific ways to influence cognitive health. This systematic review and meta-analysis critically evaluated the evidence on the dietary factors and cognitive health in the ethnic Chinese population. A systematic search of PubMed, Web of Science, Scopus, and CNKI were conducted according to the PRISMA criteria. Two reviewers independently extracted data using a standardized data extraction template. Information collected included study characteristics, participant demographics, dietary exposures or patterns, cognitive outcomes, and key findings. Study quality was assessed using the National Institutes of Health criteria for observational studies. Extracted data, including reported odds ratios (ORs) and corresponding 95% CIs, were summarized and used for subsequent analyses. Meta-analyses were performed using random-effects models to pool ORs with corresponding 95% CIs. Between-study heterogeneity was assessed using τ2 and I2 statistics, with I2 values >50% indicating substantial heterogeneity. Statistical significance was set at P < .05. Evidence from observational studies suggests that dietary patterns rich in vegetables, fruits, fish, and plant-based foods are associated with a lower risk of cognitive decline in ethnic Chinese adults, potentially influenced by unique genetic variations, traditional dietary practices, and cultural factors. Adherence to the Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegenerative Delay(MIND) diets, as well as higher consumption of mushrooms and tea, was linked to better cognitive health, whereas diets high in red meat and low in fish and legumes were associated with increased risk. Meta-analysis showed a protective association for plant-based diets (OR: 0.78; 95% CI: 0.69-0.87). PROSPERO NO. CRD42024575522.

ABSTRACT Based on a sample of Chinese A‐share listed enterprises from 2012 to 2021, this study examines the effects and mechanisms of regional digitalization on corporate greenwashing. The findings indicate that regional digitalization initially exacerbates corporate greenwashing, but in the long run, it inhibits this behavior. The results from the mechanism analysis reveal that regional digitalization exacerbates corporate greenwashing by reducing information disclosure quality. Furthermore, our empirical results reveal heterogeneity in the impact of digitalization on greenwashing among different types of enterprises. The effect is significant for firms with non‐tech background CEOs, non‐tech firms, digital transformation firms, and firms within the Yangtze River Economic Belt and low firm level of corporate digitalization, likely because these firms are more inclined to use digitalization for image‐building or face stronger external pressures. Besides, the moderating roles of financing cost and cross‐listing status are tested. The study reveals that higher equity financing costs help reduce greenwashing. However, digitalization tends to amplify greenwashing behavior when equity financing costs are high. In contrast, debt financing costs show no significant impact on greenwashing. For cross‐listing, firms listed in both Mainland China and Hong Kong are generally less prone to greenwashing due to stricter disclosure requirements, but digitalization amplifies their potential for greenwashing behavior under dual regulatory systems that require compliance with both markets. This research contributes to understanding how digitalization can mitigate greenwashing and promote genuine environmental responsibility in the corporate sector.

Canine visceral leishmaniasis (CVL), also known as kala-azar, is a significant vector-borne and largely zoonotic disease caused by Leishmania spp. The disease is naturally transmitted by sandflies as vectors and affects dogs and wild dogs in many countries worldwide. A literature review and meta-analysis were conducted to estimate the prevalence of CVL in Mainland China from 2013 to 2023. A total of 17 publications on CVL investigation in Mainland China were screened from the Chinese National Knowledge Infrastructure, Wan Fang Database, Chinese Science and Technology Periodical Database (VIP), Medline database via PubMed interface, and ScienceDirect. The study utilized a random-effect model to determine the pooled prevalence of CVL. The analyzed data were selected, and the estimated prevalence of CVL in Mainland China was 21.3% (95% confidence interval [CI]: 14.0-29.6). The prevalence of CVL in Northwestern China (39.4%, 95% CI: 33.9-45.0) was significantly higher than in other regions. The main cases of CVL are located mainly in Northwest and Southwest China. In nonendemic areas, the infection occurred in samples collected, but the prevalence was lower, only 3.5% (95% CI: 1.7-5.7). Conversely, it was much higher in endemic areas (33.0%, 95% CI: 23.66-443.1). Additionally, we presented potential factors, such as detection methods, age, and sex. Our data showed that CVL infection still exists in some parts of China.

BackgroundPediatric palliative care in Mainland China is still developing. Biological, psychological, and social factors may change during the course of illness and after the child's death.ObjectivesThis study examines pediatric end-of-life decision-making in Mainland China across biological, psychological, and social dimensions.MethodsThis study examined illness narratives using a case-based qualitative approach. The analysis included twelve pediatric end-of-life decision-making cases involving children from neonates to 18years of age.ResultsThe findings indicate that diagnosis- and treatment-related decisions were primarily shaped by the child's biological condition. As time passed, parents' emotions played a larger role in decisions about continuing or stopping treatment and about fulfilling the child's wishes. Social considerations were evident in relation to financial costs, travel burden, and access to care. Following death, bereavement experiences and funeral customs further shaped decision-making, alongside constraints related to limited services and staff shortages.ConclusionsThe findings show that biological, psychological, and social factors changed over the course of illness and bereavement. This suggests a need for better decision support and follow-up bereavement care within pediatric palliative care services in Mainland China.

ABSTRACT Background Higher-order thinking skills are crucial for students to adapt to the rapidly changing global landscape. Governments, including China, emphasize fostering these skills, with critical thinking as a key component. However, reliable assessment instruments, especially in disciplines like science, are challenging to develop. Existing methods, such as multiple-choice and open-ended questions, have limitations, leading to the exploration of hybrid-format assessments that combine both for a more comprehensive evaluation. Purpose This study aims to develop and validate a hybrid-format critical thinking assessment instrument tailored for senior high school students in mainland China. The instrument integrates both generic multiple-choice items (GMCI) and open-ended science questions (OESQ) to assess students’ critical thinking skills. Sample This study involved 216 senior high school students from two schools in eastern China, selected for their representative academic performance and demographic profiles. Design and methods The study developed the generic and science-specific critical thinking assessment instrument (GSCTAI), incorporating GMCI and OESQ. The instrument was validated using a Rasch model, assessing overall reliability, unidimensionality, item-person interaction, goodness-of-fit, and differential item functioning. It was used to assess students’ overall critical thinking level and performance across various dimensions. Results The GSCTAI demonstrated good performance in unidimensionality, item-person interaction, goodness-of-fit, and differential item functioning. Students exhibited moderate overall critical thinking skills, with significant weaknesses identified in diagnostic evaluation skills. Notable polarization was observed in self-regulation and analytical comparison abilities. Conclusion The GSCTAI is a reliable and valid assessment instrument. The results highlight key dimensions of critical thinking that need improvement, namely diagnostic evaluation skills, self-regulation skills, and analytical comparison skills.

ABSTRACT Although technology-enhanced approaches have been widely used to support students’ self-regulated learning (SRL), limited research has explored how prior knowledge influences SRL performance and behavioural patterns. This study investigated differences in learning outcomes and SRL behaviours between high-performing (HG) and low-performing (LG) university students in Mainland China using Vocab+, a mobile app embedded with a self-regulation support scheme. Twenty students participated, with data collected through pre- and post-tests and in-app log data. Quantitative analysis and lag sequential analysis were conducted. Results revealed that LG students demonstrated greater improvement in English vocabulary learning over 2 weeks, narrowing the performance gap with HG students. While both groups displayed similar SRL strategies, LG students showed a higher frequency of goal adjustment during the forethought phase. In the performance phase, LG students focused more on time monitoring than task completion, whereas HG students balanced both. In the reflection phase, LG students primarily evaluated their own progress, while HG students tended to compare their performance with peers. These findings suggest that the embedded SRL support in Vocab+ can mitigate the impact of prior knowledge and promote effective self-regulation, particularly among lower-performing learners in mobile-assisted language learning environments.

The COVID-19 pandemic has profoundly reshaped everyday life, with long-term effects across multiple domains. While much existing scholarship has emphasised the negative consequences of the crisis, this article highlights its unexpected potentials by examining how single gay men in mainland China used Blued, the country’s largest gay dating app, during lockdown. Grounded in domestication theory, we used in-depth interviews to explore how users appropriated these platforms under conditions of restricted mobility, and how such practices generated new understandings of digital intimacy and sexuality. Our findings reveal that dating apps, typically associated with casual hook-ups, were re-domesticated into three distinct functions during the pandemic: as a “sexual laboratory” for experimenting with desire; as an “emotional space” for coping with isolation and as a “community support network” for mutual help. These context-specific practices not only enrich the study of gay social media use but also prompt a broader reconsideration of how technology mediates sexual and affective life under conditions of crisis. Taken together, these findings suggest that inclusive pandemic preparedness must account for how everyday platforms can become informal infrastructures of care, information, and connection when mobility is restricted and offline services are disrupted.

Critical windows and joint effects of prenatal heat and relative humidity exposure on stillbirth: A prospective longitudinal cohort study.

Introduction The rapid integration of Artificial Intelligence (AI) into sports communication presents a fundamental tension between technological efficiency and humanistic values. Methods To understand the mechanisms of audience adoption, this study applies the media affordance framework to investigate the factors shaping audience acceptance of AI in sports. A comprehensive questionnaire survey was conducted and collected 526 valid responses from sports viewers across mainland China. Results Multiple linear regression analysis reveals that content credibility and cross-scenario adaptability are the most two significant positive predictors of audience acceptance. Conversely, the perceived ethical risks of technology act as a powerful inhibitor. Further analysis uncovers significant group differences: younger, “digital native” audiences and students exhibit greater skepticism, whereas mid-career professionals and sports industry insiders demonstrate higher levels of acceptance. Discussion All the above content collectively suggest that audience acceptance is a complex negotiation between the perceived utility of AI and its ethical implications. On this basis, this study extends the application of media affordance theory and provides an empirical basis for a multi-stakeholder collaborative framework to foster human-AI synergy in the evolving sports media landscape.