Transcriptomic profiling revealed immune-related signaling pathways in response to experimental infection of Leishmania donovani in two desert lizards from Northwest China

Little is known about the immune response of lizards to Leishmania parasties. In this study, we conducted the first liver transcriptome analysis of two lizards (Phrynocephalus przewalskii and Eremias multiocellata) challenged with L. donovani, endemic to the steppe desert region of northwestern China. Our results revealed that multiple biological processes and immune-related signaling pathways are closely associated with the immune response to experimental L. donovani infection in the two lizards, and that both lizards show similar changes to mammals in terms of immunity to Leishmania. However, the interspecific divergence of the two lizards leads to different transcriptomic changes. In particular, in contrast to P. przewalskii, the challenged E. mutltiocellata was characterized by the induction of down-regulation of most DEGs. These findings will contribute to the scarce resources on lizard immunity and provide a reference for further research on immune mechanisms in reptiles.

Spatio-temporal characteristics and driving mechanism of land degradation sensitivity in Northwest China

Northwest China has been experiencing severe land degradation for a long time due to various natural and social elements. Evaluating and analyzing the process of occurrence and driving mechanism of land degradation sensitivity in this area is crucial for enhancing the local ecological environment. In this study, 18 social and environmental elements were used to construct a land degradation sensitivity index (LDSI) evaluation system in the area from vegetation, climate, management, soil, and geomorphology five factors. The spatio-temporal characteristics of LDSI in Northwest China from 2000 to 2020 were evaluated on the basis of analyzing the developmental changes of each factor. Correlation analysis and multiscale geographical weighting regression (MGWR) were used to reveal the driving mechanism of land degradation sensitivity. The results indicated a high level of land degradation sensitivity in Northwest China, with >66 % of the area (190.96 × 104 km2) in the critical sensitive class from 2000 to 2020. But the land degradation sensitivity decreased in 18.52 % of the area (53.58 × 104 km2) from 2000 to 2020, the overall trend was weakening. The spatial distribution mainly showed stronger sensitivity in the northwest and weaker sensitivity in the southeast. By exploring the driving mechanism of land degradation sensitivity, it was found that vegetation and climate showed a strong correlation, with a correlation coefficient >0.8. Drought resistance played a strong role in the dynamic process of land degradation. The basic dynamic elements showed some spatial variability in land degradation in different regions. This study is of significance for land degradation prevention and sustainable development in Northwest China.

Quantifying the drought sensitivity of grassland under different climate zones in Northwest China

Grassland is essential for maintaining the stability and functionality of terrestrial ecosystems. Although previous research has explored how grassland responds to drought, the drought sensitivity of grassland (DSG) across climate zones and aridity gradients remains uncertain. In this study, we conducted a comprehensive investigation spanning 1982 to 2015 in Northwest China. To assess the time-cumulative effect (TCE) and the time-lag effect (TLE) of drought on grassland, we employed Spearman rank correlation analysis, utilizing long-term datasets of the normalized difference vegetation index (NDVI) and the standardized precipitation evapotranspiration index (SPEI). This analysis allowed us to quantify the DSG in the region and further examine its variations across climate zones and aridity gradient. Our results revealed that 81.2 % and 99.7 % of the grassland in Northwest China was influenced by the TCE and TLE of drought, respectively, with 38.2 % and 60.9 % of these effects being statistically significant (p < 0.05). The mean accumulated and lagged timescales of drought on grassland were 7.89 and 9.41 months, respectively. Remarkably, the highest DSG was observed in the semi-arid zone (0.58), followed by the arid (0.54), sub-humid (0.51), and humid (0.44) zones. Furthermore, we identified significant nonlinear variation patterns of DSG along the aridity gradient, characterized by several discernible trend breaks. These findings contribute to our understanding of the impacts of drought on vegetation, particularly in ecologically fragile regions.

Genetic Structure and Population History of the Zaisan Toad-Headed Agama (Phrynocephalus melanurus) Inferred from Mitochondrial DNA

The agamid lizard Phrynocephalus melanurus is restricted to Northwest China (Dzungar Basin) and the adjacent Eastern Kazakhstan (Zaisan and Alakol basins). To elucidate the phylogeography of P. melanurus, we obtained the mitochondrial DNA COI segments of 175 sampled lizards from 44 localities across the whole distribution. Phylogenetic analyses revealed two main Clades comprising five geographically structured lineages (I, IIa, IIb1, IIb2, and IIb3) that fit an isolation-by-distance (IBD) model. The divergence from the most recent common ancestor was dated to ~1.87 million years ago (Ma). Demographic analyses demonstrated lineage-specific response to past climate change: stable population for Clade I, Subclade IIb1; past population expansion for IIb3 since 0.18 Ma, respectively. Bayesian phylogeographic diffusion analyses detected initial spreading at the Saur Mount vicinity, approximately 1.8 Ma. Historical species distribution model (SDM) projected expansion of the suitable habitat in the last interglacial and shift and contraction in the last glacial maximum and Holocene epochs. The SDM predicted a drastic reduction in suitable area throughout the range as a response to future climate change. Our findings suggest that the evolution of P. melanurus followed a parapatric divergence with subsequent dispersal and adaptation to cold and dry environments during the Quaternary. Overall, this work improves our understanding of the lineage diversification and population dynamics of P. melanurus, providing further insights into the evolutionary processes that occurred in Northwest China and adjacent Eastern Kazakhstan.

Spatiotemporal variations and its driving factors of NDVI in Northwest China during 2000-2021

Northwest China (WTL) is an essential ecological barrier zone of China, an important node of the "Silk Road Economic Belt," and a crucial bearing area for China's execution of the "One Road and One Belt" and "Going Global" strategies. However, its ecology is exceedingly fragile and particularly vulnerable to climate change and human interference. This study explored the spatiotemporal evolution characteristics of vegetation in WTL using NDVI data and investigated its drive mechanisms by geodetector, partial correlation analysis, and residual trend analysis methods. As well as forecasting the trend for vegetation changes. The findings demonstrated that (1) the change in NDVI manifested an overall improvement trend and the distribution in space of NDVI rose from the center to the periphery. 57.07% of the area had a sparse cover of vegetation (NDVI between 0 and 0.2). In addition, about 49% of regions had deterioration tendencies, which were mainly aggregated in HX, QCXDB, QCXDN, and the eastern of QCXQN and QCXXB. (2) The NDVI's shifting trend was unsustainability, and the region of uncertain future accounted for 57.45% of the total, with apparent unsustainability features. (3) The key parameters influencing NDVI spatial distribution were Pre (precipitation), vegetation type, land use type, and soil type. The interaction between two factors enhanced the influence of any single element, which appeared as bivariate and nonlinear enhancements. (4) Both climate variations and human activities have been recognized as key variables affecting NDVI growth. NDVI variance in 73.02% of areas was influenced by the combined effects of climate variations and human activities. However, human activities were the most influential element in NDVI growth, with the relative contributions of 80.28% (19.72% of which was caused by climate variations). These results can be conducive to deepening insights into the local vegetation status, identifying the mechanisms driving vegetation change, and providing scientific recommendations for WTL's ecosystem restoration measures based on actual situations.

Overwintering covered with soil or avoiding burial of wine grapes under cold stress: Chinese wine industry's past and future, challenges and opportunities

In northwest China, where winter is extremely cold and the grapevine is vulnerable to freezing damage, the application of soil covering has promoted the vigorous development of the local grape and wine industries. However, in recent years, the negative effects of burying soil for cold protection on the environment have gradually emerged. In some viticultural regions, the phenomenon of "summer forest, winter desert" has appeared. Therefore, it is urgent for the Chinese grape industry to find a better solution to overwinter safely and environmentally friendly. This review summarizes the advantages and disadvantages of widely used solutions to overwinter such as covering vines with soil, breeding of cold-resistant grapes, cold-resistant cultivation model, physical and chemical covering materials, and protected grape facilities were reviewed. Future overwintering measures were proposed which avoid burial and grape overwintering research directions. It also provides a theoretical foundation and technical support to improve grape yield and quality in northwest China.

Vegetation drought risk assessment based on the multi-weight methods in Northwest China

Vegetation makes an outstanding contribution to the stability of ecosystems and to a certain extent reflects the state of the terrestrial ecosystem. Drought conditions greatly affect the growth and development process of vegetation due to its remarkable stochasticity and complexity. Due to the complex coupling mechanism between vegetation and drought, the research on vegetation drought risk is still limited. In this work, we focus on Northwest China and use the improved vegetation health index (VHI) and other multi-source data. We selected indicator factors based on both hazard and vulnerability, and adopt three weight determination methods, namely entropy method, critic method, and coefficient of variation method, to construct the corresponding index model, and also to establish a vegetation drought risk assessment model to quantitatively evaluate the drought risk of vegetation in northwest China. Results show that the percentage of each drought category remarkably changed during the period encompassing 1981-2020, and the vegetation drought shows deterioration in more areas of northwest China. The vegetation drought risks derived from the three weight determination methods were generally consistent, but differed for a particular vegetation type. The overall spatial distribution pattern of vegetation drought risk in Northwest China is higher in the west and lower in the east, and the vegetation in southern Qinghai and northwestern Xinjiang presents higher drought risk. This study may be used as a tool to provide quantitative basis for vegetation protection and vegetation drought management.

Farmers' participation into the recovery of waste agricultural plastic film: An application of the Theory of Planned Behavior

This study aims to address the lack of relevant researches in the field of waste recycling using the Theory of Planned Behavior (TPB). A village-scale social survey was conducted to investigate the degree of farmers' participation in a waste plastic film program, i.e. Old for New in northwest China. The program required farmers to recycle plastic film residues in exchange for new films. Survey results showed that 67.5% of farmers accepted the program, yet only 14.5% of them actually participated. Logistic regression analysis was used to analyze questionnaire data and identify the factors that significantly affected farmers' recycling behavior. Principal component and weight analysis further showed that farmers' participation was mainly influenced by their attitudes (p < 0.01), with a relative weight (RW) of 46.3%. Yet, subjective norms (p < 0.1) and perceived behavior control (p < 0.1) had less effect on the degree of participation, and their RWs were 4.2% and 4.1% only, respectively. Moreover, the RW of plastic film usage characteristics and household characteristics reached up to 13.2% and 6.4%, respectively. Interestingly, environmental awareness (β = 0.083) and compulsory environmental education (β = 0.130) as surface factors strongly affected the farmers' adoption and response, with the RW of 25.7%. As such, the extended TPB model was established to analyze the participation behavior of farmers for stronger explanatory power. This study highlighted a promising strategy based on TPB for waste plastic film recycling and similar environmental management practices.

Occurrence and sources of microplastics in dust of the Ebinur lake Basin, northwest China

Currently, there is a lack of studies on microplastic pollution in mountain terrains and foothills areas in Northwest China and Central Asia. Here, we collected monthly dusts samples for one year and we studied the distribution, pollution levels, and sources of microplastics in atmospheric dust fall in the Ebinur Lake Basin in Northwest China. Results showed that the average content of dust microplastic on construction land was 28.61 ± 1.13 mg/kg, followed by farmland (20.25 ± 1.56 mg/kg), forest (19.52 ± 1.06 mg/kg), and deserts (8.08 ± 0.56 mg/kg). Regarding different land use types, atmospheric dust reduction dominated on farmland (58.64%), followed by urban area (26.65%), forest (9.76%), and desert (4.95%). Regarding the shape of microplastics, the order of occurrence in dust was film (46.85%) > fiber (35.15%) > foam(12.35%) > fragment (5.65%). In this study, four colors of microplastics were found in dust, and white accounted for the largest proportion (52.15%), followed by transparent (18.65%), black (19.45%), and green (9.75%). The main components of film microplastics in atmospheric dustfall in the Ebinur Lake Basin were PE and PP, and their sources were mainly plastic products in daily life, plastic industrial packaging materials from urban enterprises, broken plastic woven bags, and PET mostly from fabric fragment emissions. The abundance of microplastics in dust was correlated with atmospheric dust pH, EC, and total salt content. The contents of seven heavy metals (Cu, Ni, Cd, Pb, Cr, Mn, and Co) adsorbed by microplastics were also correlated with pH, EC, and total salt content. Our results represent a reference for microplastics pollution prevention in mountain terrains and foothills areas in northwest China and Central Asia.

Helicobacter pylori infection increases the risk of thyroid nodules in adults of Northwest China

Background

Thyroid nodules (TNs) are very common in the adults of Northwest China. The role of Helicobacter pylori (H. pylori) infection in TNs is poorly investigated and even with controversial conclusions. Our study aimed at highlighting the relationship between H. pylori infection and the risk of TNs.

Methods

9,042 individuals were enrolled with thyroid ultrasonography and 14C-urea breath test (14C-UBT). Baseline characteristics and relevant covariates were obtained, including basic and laboratory indicators. After applying the exclusion criteria, 8,839 patients were included and divided into 2 groups: a cross-sectional study of single follow-up (n=8,711) and a retrospective cohort study of multiple follow-ups for 5 years (n=139).

Results

The prevalence of H. pylori infection and TNs was 39.58% and 47.94% in the adults of Northwest China, respectively. The prevalence of TNs was significantly higher among H. pylori-positive individuals than those without infection (52.55% vs. 44.92%, p<0.01). The result of binary logistic regression revealed that the crude odds ratio (OR) was 1.624 (95% CI 1.242~2.123) in Model 1 without adjustment compared to H. pylori-negative group, and was also positive in Model 2, 3, and 4 (Model 2: OR=1.731, 95% CI 1.294~2.316; Model 3: OR=2.287, 95% CI 1.633~3.205; Model 4: OR=2.016, 95% CI 1.390~2.922) after the adjustment. The data of 5-year follow-up showed that the annual incidence of TNs was significantly higher in individuals with persistent H. pylori infection than non-infected counterparts (all p<0.05).

Conclusions

H. pylori is an independent risk factor for TNs in the adults of Northwest China.

Investigating the rationale for low-carbon production techniques in agriculture for climate change mitigation and fostering sustainable development via achieving lowcarbon targets

In China, agricultural activities are a major source of greenhouse gas emissions, ranking second only to another significant source. This presents a significant obstacle to reducing emissions and jeopardizes both the availability of food and the sustainable growth of agriculture. It is primarily the farmers who utilize cultivated land and are thus accountable for the initiation of these emissions. Farmers' role is significant in adopting green and low-carbon (LC) agricultural production practices, and their actions are directly tied to the achievement of the dual goals of carbon reduction. Understanding their motivations for engaging in LC production and the factors that influence their willingness to do so is important for both theory and practice. In this study, data was collected from 260 questionnaires in 13 counties across five major cities in Shaanxi Province. The purpose was to identify factors that impact farmers' motivation and willingness to engage in LC agriculture using linear regression analysis. A structural equation model was constructed to better understand the underlying mechanisms that influence farmers' actions towards LC farming practices. The study's findings indicate that (1) farmers' behavior towards LC production practices is notably impacted by internal motivation based on joy and internal motivation based on responsibility (IMR); (2) IMR has the most pronounced effect on farmers' adoption of LC production practices; (3) the internal motivation based on joy, IMR, behavior attitude, subjective norm, and perceived behavior control are related to each other; and (4) the multi-group analysis of the data indicates that the impact of internal motivation based on joy and IMR on adopting sustainable farming practices may vary among different groups. It is essential to support farmers who have strong intrinsic motivation to engage in sustainable agriculture. Additionally, policymakers must promote positive attitudes towards sustainable farming to achieve the desired environmental (LC) objectives.

New Fossil Evidence Suggests That Angiosperms Flourished in the Middle Jurassic

Angiosperms are a group of plants with the highest rate of evolution, the largest number of species, the widest distribution and the strongest adaptability. Needless to say, angiosperms are the most important group for the humans. The studies on the origin, evolution and systematics of angiosperms have been the major challenges in plant sciences. However, the origin and early history of angiosperms remains poorly understood and controversial among paleobotanists. Some paleobotanists insist that there were no angiosperms in the pre-Cretaceous age. However, this conclusion is facing increasing challenges from fossil evidence, especially Early Jurassic Nanjinganthus, which is based on over two hundred specimens of fossil flowers. Studying more fossil plants is the only reliable way to elucidate the origin and early evolution of angiosperms. Here, we document a new species of angiosperms, Qingganninginfructus formosa gen. et sp. nov, and provide the first detailed three-dimensional morphology of Qingganninginfructus gen. nov from the Middle Jurassic of Northwest China. A Micro-CT examination shows that the best-preserved fossil infructescence has eleven samaroid fruits, each with a single basal ovule. Since these fossils are distinct in morphology and organization from all organs of known gymnosperms and angiosperms (the latter are defined by their enclosed ovules), we interpret Qingganninginfructus as a new genus of angiosperms including a new species, Q. formosa gen. et sp. nov., and an unspecified species from the Middle Jurassic of Northwest China. The discovery of this new genus of angiosperms from the Middle Jurassic, in addition to the existing records, undermines the "no angiosperms until the Cretaceous" stereotype and updates the perspective on the origin and early history of angiosperms.

Utilization of dental care service and associated factors among pre-school children in northwest China over the past decade

OBJECTIVE

The purpose of this study was to analyze the factors influencing the utilization of oral health care among 5 years old children.

METHODS

We conducted two observational cross-sectional studies. The studies were conducted in 2005 and 2015 and included 5-year-old children who underwent dental examination by trained dentists and the caregivers of the children were requested to answer the questionnaire. Multi-level stratified sampling method was used. Chi-square tests were used to analyze the utilization of dental care and other socio-economic variables. Logistic regression models were employed to explore the primary factors influencing the use of dental care among pre-school children.

RESULTS

In 2005, a total of 399 and in 2015, 492 child-caregiver pairs were included. The majority of the caregivers in both surveys were females, comprising 68.2% and 74.8% of the caregivers in 2005 and 2015, respectively. 75.2% and 87.0% (p < 0.05) of the respondents had an education level of lesser than 9 years. The prevalence of caries was higher in 2015 (63.2%) (p < 0.05) than in 2005 (53.4%). In 2005 and 2015, the utilization of dental care services was 20.8% and 20.0%, respectively. A statistically significant association was observed between caries and dental care use in 5-year-olds over the past decade. After adjusting for confounders, dental service usage among children in urban areas was 1.62 times higher than that of rural areas in 2005 (95% CI 0.069-0.571), and the self-assessment of caregivers regarding their child's oral health significantly improved oral health use in 2015.

CONCLUSION

The utilization of dental care services over the past decade is insufficient among pre-school children in northwest China. Hence, with the decreasing gap about economic and health service resources, policymakers should place greater emphasis on raising awareness among caregivers about the oral health status of their children.

Spatiotemporal variation of irrigation water requirements for grain crops under climate change in Northwest China

Clarifying the spatiotemporal variation of crop irrigation water requirement (IWR) under the background of climate change is an essential basis for water resource management, determining the irrigation quota and adjusting the planting structure. Using 61 years of climate data from 205 stations in Northwest China, this study investigated the spatiotemporal variations of climatic factors and IWR during the growth period of five main grain crops (spring wheat, winter wheat, spring maize, summer maize, and rice) and explored the dominant climatic driving factors of IWR variation. Results showed that (1) the IWR of grain crops showed distinct differences. Rice was the highest water consumption crop (mean of 753.78 mm), and summer maize was the lowest (mean of 452.90 mm). (2) The variation trends and average values of IWR of different grain crops have spatial heterogeneity across Northwest China. For most crops, high values and increasing trends of IWR were mainly located in eastern Xinjiang, western Gansu, and western Inner Mongolia. (3) T_max (maximum temperature), T_min (minimum temperature), and P_eff (effective precipitation) showed an increasing trend during the growth period of each grain crop, while U₁₀ (wind speed at 10 m height), SD (solar radiation), and RH (relative humidity) presented decreasing trends. (4) SD, T_max, and U₁₀ promoted the increase of grain crops' IWR, while P_eff and RH inhibited it. The impacts of climatic factors on the grain crop IWR differed among different regions. P_eff was the most influential factor to the IWR of all grain crops in most areas. Therefore, under the premise of a significant increase in T and uncertain precipitation mode in the future, it is urgent to take effective water-saving measures according to the irrigation needs of the region. To cope with the adverse impact of climate change on the sustainable development of agriculture in the northwest dry area, to ensure regional and national food security.

Clinicopathological characteristics and prognostic analysis of PIK3CA mutation in breast cancer patients in Northwest China

PURPOSE

Multiple studies on PIK3CA mutations in breast cancer (BC) had been performed, which showed the controversial results among different countries and races even those from the same country. The present study aimed to explore the PIK3CA gene mutation status in BC patients in Northwest China and reveal the relationship between PIK3CA mutations and clinicopathological features along with prognosis.

MATERIALS AND METHODS

1002 BC patients from Northwest China were recruited in this study, genomic DNA was extracted from formalin-fixed paraffin-embedded (FFPE) tumor tissues, and hotspot mutations in the exon 9 and 20 of PIK3CA gene were detected by ARMS-PCR.

RESULTS

PIK3CA mutations were found in 31.2% (313/1002) of BC patients, among them 66.1% were mutations in exon 20% and 32.6% were mutations in exon 9. H1047R was the most common mutation type, accounting for 56.5% of the total mutated samples. Significant correlations were observed between PIK3CA mutation status and age (P = 0.035), histopathologic types (P = 0.004), pathological grade (P = 0.013), ER positivity (P < 0.001), PR positivity (P < 0.001), molecular subtypes (P = 0.004) and family history (P = 0.007). Cox multivariate analysis showed that patients with mutations in exon 9 or 20 had shorter DFS and OS than wild-type patients. Those with exon 9 mutations subgroup had the worst prognosis. Interestingly, patients with H1047L mutation had the best prognosis than others.

CONCLUSION

PIK3CA mutations could be used as an indicator of clinical outcome or targeted therapy for multiple breast cancer subgroups in Northwest China.

Spatiotemporal pattern of reference crop evapotranspiration and its response to meteorological factors in Northwest China over years 2000-2019

Agricultural irrigation water in Northwest China accounts for more than 80% of total local water consumption, which is 1.23 times that of China. However, Northwest China is the most water-scarce place in China. Water scarcity in restricts crop growth and production. Reference crop evapotranspiration (ET₀) is important for agricultural water management. Understanding the reason for ET₀ change is helpful to provide a basis for rational planning of agricultural irrigation systems to conserve water. This study investigated the temporal and spatial variation characteristics of ET₀ at 181 meteorological stations in Northwest China from 2000 to 2019. And the sensitive factors and dominant factors affecting ET₀ change were quantitatively identified based on sensitivity analysis and contribution rate evaluation. Results showed that (1) a significant increase in maximum and minimum temperature (T_max and T_min), a significant decrease in sunshine duration (SD) and relative humidity (RH), and a slight increase in wind speed at 10 m height (U₁₀) were observed. (2) Annual ET₀ had an insignificant increasing trend. Spring and autumn ET₀ contributed greatly to the growth of annual ET₀, especially in March, May, September, October, and November. ET₀ in HH (Yellow River Basin area) had decreased at annual scale, while other subregions were the opposite trend. Significant differences in monthly and seasonal changes in the spatial distribution of ET₀. (3) U₁₀ was the dominating contribution factor related to annual ET₀ variability, followed by T_min, RH, T_max, and SD. In seasonal time scale, T_min, SD, U₁₀, and RH were the most dominant factors in spring, summer, autumn, and winter respectively. (4) Spatial distribution for contribution rates of various meteorological factors showed significant diversity among various subregions. The positive contribution of U₁₀ was the major cause of the increase in ET₀ in semi-arid grassland area (BGH), the southwest of "Qice line" (QCXXN), and the southeast of "Qice line" (QCXDN); the significant increase in T_min contributed most in Qaidam Basin (CDM), Hexi inland river basin (HX), the northeast of "Qice line" (QCXDB), and the northwest of "Qice line" (QCXXB), while the contribution of decreasing SD offsets the positive effects of other factors, leading to the decrease in ET₀ in HH. Our work illustrates that water management measures should be different at different spatial and temporal scales. The effect of U₁₀ can be offset by covering, to reduce evaporation and maintain water in BGH, QCXXN, and QCXDN. And high-temperature resistant varieties are planted to adapt to temperature growth in CDM, HX, QCXDB, and QCXXB. Agricultural water management strategies should be formulated and selected according to local conditions.

Family functioning and health-related quality of life of inpatients with coronary heart disease: a cross-sectional study in Lanzhou city, China

Background

A key outcome in coronary heart disease (CHD) is Health Related Quality of Life (HRQoL), and family functioning is important in the management of CHD. But few studies have examined both together, and little is known about them among inpatients with CHD in less developed areas of China. Therefore, this study aimed to assess the HRQoL and family functioning status of inpatients with CHD in Lanzhou from Northwest China, and identify the factors that affect their HRQoL.

Methods

A cross‑sectional study was conducted in 224 CHD inpatients at one major hospital. Sociodemographic data and disease information of CHD inpatients were collected by face-to-face using a structured questionnaire and data were also obtained from patient medical records. HRQoL was measured using the Sickness Impact Profile (SIP). Family functioning was measured using the family APGAR index. Multiple binary logistic regression analysis (MBLRA) was used to explore potential risk factors associated with HRQoL, and Pearson’s correlations were used to assess the relationship between family functioning and HRQoL.

Results

The overall, physical and psychosocial SIP scores were 25.03 ± 8.52, 18.61 ± 9.90 and 28.08 ± 9.64, respectively. The total family APGAR score was 6.11 ± 2.45. MBLRA found older age, poorer cardiac function and more severe disease were associated with poorer HRQoL, while better family functioning, higher monthly income, and urban living were associated with better HRQoL. Family functioning was weakly to moderately correlated with total and psychosocial HRQoL.

Conclusions

Older and less affluent inpatients with lower educational level, less family support and more severe CHD have poorest quality of life, and health care providers should consider interventions to support them.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-022-02844-x.

Occurrence of macroplastic debris in the long-term plastic film-mulched agricultural soil: A case study of Northwest China

Widespread presence of plastic mulch has led to macroplastic (MaP) pollution. While this issue is widely explored in aquatic ecosystems, MaP pollution on land has been neglected. In 2019, we conducted a large-scale survey of MaPs in Northwest China in 0-30 cm soil with long-term mulching. Samples of MaP debris were collected from 67 sites across Gansu, east Qinghai, and north Shannxi Provinces. All visible MaP pieces for each site were separated and weighed. The mass of each MaP piece was calibrated by size measured in digital images. The MaP mass averaged 47.2 kg ha^-1, and the number of MaPs averaged 266.2 pieces ha^-1. The mass and number of MaPs varied from site to site. The mean size of MaPs was 19.5 cm² piece^-1 or 28.0 mg piece^-1. More importantly, the number of small MaP pieces (<5 and 5-20 cm² piece^-1) accounted for 76.7% of the total number of MaPs detected, and small-sized plastic debris (<10 and 10-25 mg piece^-1) were detected in 70.1% of the sampling sites. The percentage of small fragments increased before 15-year of mulching and then declined. However, the amount of medium-large debris (20-50 and >50 cm² piece^-1) showed a trend opposite to that of small fragments. The percentage of MaPs was greater in the small size group than in the medium-large size group. The arid to semi-arid area exhibited higher MaP contamination compared with the semi-arid to the semi-humid area. These observations indicate that plastic debris residing in soil tend to be fragmented, making plastic film recovery more challenging and causing severe soil pollution. Further studies are required to regulate plastic mulch methods and explore the degradation process.

Spatiotemporal variation in soil degradation and economic damage caused by wind erosion in Northwest China

Wind erosion causes significant dust emissions in northwest China, resulting in large amounts of soil organic matter and nutrient losses. It has a significant impact on air quality, climate change, vegetation growth, and economic growth at the regional scale. In this work, the Weather Research Forecasting with Chemistry atmospheric chemical transport model was used to simulate the temporal and spatial processes of dust emissions in northwest China from 1980 to 2015. The temporal and spatial variation characteristics of the loss of soil organic matter and nutrients (total nitrogen and total phosphorus) due to dust emissions, and the economic damage from wind erosion, were simulated and calculated. Spatial patterns of soil organic matter and nutrient losses are consistent with dust emission rates across the research region. The average annual dust emissions were approximately 65.17 million tons, with losses of soil organic matter, total nitrogen, and total phosphorus resulting from dust emissions of 531,494 tons, 30,754 tons, and 37,095 tons, respectively. In addition, the average annual economic loss caused by wind erosion was 309.25 million yuan in northwest China during the entire study period. This research is valuable for understanding the role of wind erosion on the carbon and nutrient cycles and the mechanism of soil degradation in northwest China and estimating the economic impacts of wind erosion.

An Estimation of the Effect of Green Financial Policies and Constraints on Agriculture Investment: Evidences of Sustainable Development Achievement in Northwest China

Farming' community actively participating as micro-actors in green finance schemes is critical for regional planning and development. On the basis of the extent to which financial progress and sustainable development are coordinated, in a difference-in-differences approach, this article employed 2350 small investigations to estimate the influence of green-finance strategies on peasants' agriculture investment and developed a mediation effect method. It investigates the role of peasant managerial variability in mediating the influence of financial constraints. The results indicate that the introduction of a financial restriction variable reduces the positive impacts of green-finance regulations on peasants' agricultural investment. Moreover, peasants who participate in non-agricultural management exercises are more inclined to take advantage of green financing regulations and are affected via financial restrictions in mediate means. The building of a green-finance sector in remote regions should accomplish unique positioning and rapid growth.

Short-term effects of main air pollutants exposure on LOS and costs of CVD hospital admissions from 30,959 cases among suburban farmers in Pingliang, Northwest China

BACKGROUND

Although cardiovascular disease (CVD) has been the major contributor to global mortality and disability especially in undeveloped and developing countries/areas with severer air pollutions, studies are quite limited and evidence is insufficient of short-term main air pollutants exposure on health burden of CVD hospital admissions in those regions particularly through direct costs.

METHOD

Based on an analysis of 30,959 CVD hospital admissions among suburban farmers from 2018 to 2019 through multiple linear regression (MLR), our study evaluated the impact of main air pollutants (PM_2.5, PM₁₀, SO₂, CO, NO₂ and O₃) exposure on number of cases, length of stay (LOS) and costs of CVD hospital admissions in Pingliang, China.

RESULTS

Concentration of SO₂ and O₃ rising from a low level was found to lower the costs, LOS and daily cases of CVD hospital admissions and PM_2.5, PM₁₀, CO and NO₂ were found to aggravate the burden. Besides, the NO₂ could put more economic stress on those CVD patients in Pingliang (China) which implies that some improvements could be done on public medical insurance policy and benefit local suburban farmers by strengthening the supports on specific drugs and therapies.

CONCLUSIONS

More efforts should be made to lower the concentration of air pollution by coordinated control managements even in a low-level scenario. Concentration levels and interactions between main air pollutants may play an important role in air pollution-induced CVD health burden. Future research is needed to explore more evidence in different areas, especially with low-level SO₂ effects.

Effects of Industrial Structure Adjustment on Pollutants Discharged to the Aquatic Environment in Northwest China

Northwest China is located along China’s Belt and Road Initiative routes and represents the frontier and core region for China’s construction and development of the Silk Road Economic Belt. In recent years, the conflict between economic development and environmental pollution has become increasingly intense in this region, with the latter mainly caused by disorderly industrialization brought about by rapid urbanization processes. Inappropriate industrial structure is the primary reason for environmental degradation in Northwest China, which has limited precipitation and available water. Due to its fragile aquatic environment and unsustainable use of water resources, the pollution and degradation of the aquatic environment has become a bottleneck that severely restricts the sustainable development of China’s northwest region. In the present study, five provinces or autonomous regions in Northwest China were selected as the study objects. Based on the vector autoregressive (VAR) model, quantitative research methods, such as impulse response function and variance decomposition analysis, were applied to quantify the dynamics between industrial structure adjustment and changes in industrial pollutant discharges to the aquatic environment, so that the impact of industrial structure adjustment on pollutants discharged to the aquatic environment could be quantified and characterized. Therefore, the present study has both theoretical and practical significance. The conclusions are as follows: (1) In general, industrial structure in most provinces in Northwest China imposes a positive effect over the discharge of pollutants to the aquatic environment. Adjusting industrial structure and reducing the proportion of secondary industry present can to some extent promote reductions in the discharge of pollutants to the aquatic environment. However, such beneficial effects may vary among different provinces. (2) Specifically, for Gansu, province industrial structure adjustment could help reduce the discharge of pollutants to the aquatic environment effectively during the early stages, but this positive effect gradually weakens and disappears during the later stages. In Qinghai province, industrial structure adjustment could not help reduce the discharge of pollutants to the aquatic environment effectively during the early stages, but a positive effect gradually increases and continues to function later. The performance in Shaanxi and Xinjiang provinces was quite similar, with industrial structure adjustment helping to effectively reduce the discharge of pollutants to the aquatic environment over a long period of time. This positive effect can play a more sustained and stable role. For Ningxia province, industrial structure adjustment can not only help significantly reduce the discharge of pollutants to the aquatic environment but also displays a significant positive effect. (3) Given the specific conditions and characteristics of the region under study, relevant policies for industrial structure adjustment should be formulated and implemented.

Effects and contributions of meteorological drought on agricultural drought under different climatic zones and vegetation types in Northwest China

Meteorological drought is one of the driving forces behind agricultural drought. The response of agricultural drought to meteorological drought remains poorly understood under different climatic zones and vegetation types in Northwest China (NWC). Furthermore, the contribution of climate factors and human activities to agricultural drought in NWC remains unclear. We combined the Standardized Precipitation Evapotranspiration Index (SPEI) and the satellite Vegetation Condition Index (VCI) to characterize meteorological and agricultural drought, respectively. Based on the trend analysis, Spearman's correlation coefficient and residual trend analysis, we studied the variation characteristics and response relationships of meteorological and agricultural drought under different climatic zones and vegetation types in NWC from 2000 to 2019 and evaluated the contributions of climate factors (SPEI and precipitation) and human activities on the agricultural drought. The results showed that under different climatic zones and vegetation types, the SPEI and VCI all showed an upward trend in NWC, indicating that meteorological and agricultural drought slowed down. It was further pointed out that the climate was humidified and the soil moisture increased in NWC. Meteorological drought has a definite effect on agricultural drought, and the effect varied non-linearly along the drought gradient with the strongest responses in the semiarid ecosystems. Drought resistance of different climatic zones and vegetation types was different, caused by the specific sensitivity and uniqueness of local arid environment. Among them, grasslands dominated the regional SPEI-VCI changes in NWC. The combined effects of climatic factors (SPEI and precipitation) and human activities promoted the variation of agricultural drought in NWC. Climatic factors were the main drivers of agricultural drought change in grasslands, with the contribution rate reaching 76.71%. However, human activities all contributed significantly to agricultural drought than climatic factors, especially in the Loess Plateau, Junggar Basin and northern Tianshan Mountains, where the positive contribution of human activities exceeded 80%. Thus, the SPEI and VCI can effectively reveal the change law of meteorological drought and agricultural drought in NWC. This study provides a theoretical basis for drought disaster relationship assessment.

Effect of long-term saline mulched drip irrigation on soil-groundwater environment in arid Northwest China

Water shortage and soil salinization are the two main factors that are limiting the sustainability of agriculture in arid and semi-arid areas. The mulched drip irrigation (MDI) with brackish groundwater is widely used in the arid areas of Northwest China. In this study, field experiments were carried out to study the effect of long-term MDI with brackish groundwater on the soil and groundwater environment. It was found that the groundwater level decreased in the Peacock river watershed steadily from 2008 to 2019, resulted from escalating groundwater exploitation due to the expanding agricultural irrigation area and increasing irrigation water demand. The decline of groundwater level reduced the evaporation of phreatic surface (ET_g) and groundwater recharge from MDI (R_g). The ET_g and R_g would be very small, where ET_g tended to be zero and R_g would decrease to a constant value, while the water table depth was larger than 3 m. In addition, MDI had little effect on the soil moisture content (SMC) during the MDI period while the groundwater level was shallow (less than 1.9 m), and it increased SMC gradually as the cycle of irrigations increased while the groundwater level was deep (greater than 4.2 m). MDI reduced the concentration of soluble salt ions (Na⁺, K⁺ and Cl^-) and increased the concentration of Ca²⁺ and SO₄^2- in the soil. The accumulation of Ca²⁺ and SO₄^2- in bare soil was more serious than that in the mulched land. The SMC, soil ions concentrations, soil salinity and the total dissolved solids of groundwater decreased significantly with the decrease of the groundwater level, and the salinization degree of the soil and groundwater tended to be weak in the field experimental site. However, groundwater level dropped too much caused by increasing agricultural irrigation would be harmful to the sustainable ecological environment.

Age-specific prevalence and genotype distribution of human papillomavirus in women from Northwest China

BACKGROUND

Human papillomavirus (HPV) is the leading cause of cervical cancer with more than 200 genotypes. Different genotypes have different potentials in causing premalignant lesions and cervical cancers. In this study, we investigated the age-specific prevalence and genotype distribution of HPV genotypes in Northwest China.

MATERIALS AND METHODS

We recruited 145,918 unvaccinated women from Northwest China for population-based HPV DNA screening test during June 2015 to December 2020. And a lab-based test was performed for each volunteer by flow fluorescent technology to identify the genotypes of HPV.

RESULTS

The overall infection rate of HPV was 22.97%. With the participants divided into 12 groups according to age, a bimodal curve of infection rate was obtained. And the two peaks appeared in the younger than 20 group and 61-65 group, respectively. The five most common HPV genotypes included HPV 16, 58, 52, 53 and 61 in all participants, which were in descending order of frequency. Among women younger than 25 years old, HPV 6 and 11 were more common and even higher than some genotypes mentioned above. Among women older than 65 years old, HPV 18 and 66 were more common than or as high as the six most common genotypes in all populations. Additionally, the distribution of single and multiple infections in each age group was also different.

CONCLUSION

The baseline prevalence and genotype distribution of HPV in Northwest China was uncovered for the first time. Age was related to the epidemiology of different HPV genotypes. All the results would be of great significance for future healthcare services.

Exceptional terrestrial warmth around 4200-2800 years ago in Northwest China

One of the Holocene abrupt events around 4200 years ago, lasting for ∼ 200 years, is thought to have caused cultural disruptions, yet terrestrial climatic status right after the cold/dry event remains poorly defined and is often presumed that a generally cool condition prevailed during the Bronze Age (∼ 4000-2200 years ago). Here we report an alkenone-based summer temperature record over the past ∼ 12,000 years, in addition to two updated alkenone records, from Northwest China, providing new insights into the climatic status right after the event. Our results indicate that exceptional terrestrial warmth, up to ∼ 6 °C, occurred around 4200-2800 years ago during the Bronze Age, superimposed on the long-term Holocene cooling trend. The exceptional warmth in Northwest China, together with other climate anomalies elsewhere, suggests an unusual large-scale climatic reorganization at 4200-2800 years ago when solar activity remained high, with important implications to the climate background for cultural developments during the Bronze Age.

Climate change drives NDVI variations at multiple spatiotemporal levels rather than human disturbance in Northwest China

Changes in land management and climate alter vegetation dynamics; however, the factors driving vegetation changes remain elusive at multiple spatiotemporal levels. Here, we assess the drivers of changes in greenness from 2000 to 2015 in Northwest China (NW China). We used multiple stepwise linear regression (MSLR), redundancy analysis (RDA), and 12 other models to quantify the impacts of precipitation and temperature metrics, gross domestic product (GDP), population, and grazing intensity on the normalized difference vegetation index (NDVI) at three administrative levels (county, town, and village), four temporal levels (yearly, May, July, and September), two vegetation types (woodland and grassland), and at annual precipitation gradients of <200, 200-400, and >400 mm. The results suggest that NW China underwent vegetation greening from 2000 to 2015. Precipitation and temperature were the most influential factors contributing to the NDVI change. Population was the main determinant of NDVI under the precipitation gradient of <200 mm, and the effect of GDP on NDVI was moderate. On the temporal scale, annual precipitation, precipitation before the previous year, and precipitation in the current year determined the NDVI in May, July, and September, respectively, for both woodland and grassland. At multiple scales, climate change was the primary driver of vegetation change in NW China, rather than human disturbance. These findings expand our understanding on drivers of NDVI at multiple levels over a long period. Measures to manage decreasing vegetation coverage may be more effective and could be implemented sooner based on predicted climate change in drylands worldwide.

Frailty is associated with 90-day unplanned readmissions and death in patients with heart failure: A longitudinal study in China

BACKGROUND

Frailty has been reported to be significantly associated with adverse health outcomes in people with heart failure (HF).

OBJECTIVES

To explore the potential effects of frailty on unplanned readmissions and death in people with HF patients aged 18 years or older.

METHODS

342 HF patients aged 18 years or older from the heart centers of two different tertiary care hospitals located in northwest of China were enrolled between July and December 2020. Frailty was assessed by the Tilburg Frailty Indicator. The patients were followed for unplanned readmissions, and all-cause mortality at 30, 60, as well as 90 days after discharge. Multivariate cox regression models were used to analyze the effects of frailty on 90-day unplanned readmission and death in the patients with HF.

RESULTS

Frailty prevalence was 54.7% among 342 HF patients, with a mean age of 64.65 ± 11.90 years. It was found that compared to non-frailty HF patients, the frailty HF patients were older and displayed higher systolic blood pressure, longer duration of HF, more severe cognitive function, and more comorbidities (P < 0.05). On the contrary, the patients in the frail group had a higher incidence of unplanned readmission (73.1% vs. 26.9%, χ2 = 18.87, P < 0.01) and death (100% vs. 0%, χ2 = 6.94, P < 0.01) than those in the non-frail group. Multivariate cox regression analysis showed that frailty could serve as an independent risk factor for 90-day unplanned readmission (HR = 1.469, 95% CI 1.318-1.637, P < 0.01) and 90-day death (HR=2.270, 95% CI 1.091-4.726, P < 0.01) in the patients with HF.

CONCLUSION

Frailty can act as an independent predictor of unplanned readmission and death 90-day after discharge in HF patients aged 18 years or older.

An exceptionally well-preserved herbaceous eudicot from the Early Cretaceous (late Aptian-early Albian) of Northwest China

A fossil eudicot, Gansufructus saligna gen. et sp. nov., is reported from the Early Cretaceous (late Aptian-early Albian) of the Gansu Province, Northwest China, based on numerous well-preserved axes with attached leaves and infructescences. The leaves are alternate, short petiolate and linear-lanceolate with low rank pinnate to reticulate venation. The infructescences are loose panicles bearing fruits in different stages of maturity, each containing four partly free carpels borne in a whorled arrangement. Each carpel has three to five seeds borne along its ventral margin. The nature of the leaves and axes indicates a terrestrial, herbaceous habit. In general organization, Gansufructus is closely similar to the fruit-bearing axes of Sinocarpus decussatus from the Early Cretaceous Jehol Biota, as well as other more or less contemporaneous angiosperms from the Far East, which together provide evidence of diverse eudicot angiosperms of low stature colonizing areas close to environments of deposition.

Long-term observations of the chemical composition, fluxes and sources of atmospheric wet deposition at an urban site in Xi'an, Northwest China

Atmospheric wet deposition (AWD) is closely related to air quality, and excessive deposition poses risks to ecological systems and human health. Seasonal and interannual variations in acidity, electric conductivity (EC), ionic composition, fluxes, sources, and atmospheric transport of AWD were analyzed at an urban site in Xi'an from 2016 to 2019. The annual volume-weighted mean (VWM) pH and EC values were 6.8 and 40.6 μS cm^-1, respectively. NO₃^- (47%) was the most dominant anion, while Ca²⁺ (34%) was the most dominant cation. The analysis of fractional acidity (FA) and neutralization factors (NFs) showed that 96% of the acidity was neutralized by alkaline constituents, especially Ca²⁺ and NH₄⁺. The annual AWD flux of total ions was 125.9 kg ha^-1 year^-1, and NO₃^-, NO₂^-, SO₄^2- and NH₄⁺ fluxes accounted for approximately 70%, indicating considerable sulfur (9.1 kg ha^-1 year^-1) and nitrogen (22.0 kg ha^-1 year^-1) deposition. Under dilution by precipitation, the EC and major ion concentrations were lower, while the pH and fluxes were higher, in summer and autumn, and the opposite results were observed in spring and winter. The source apportionment via by positive matrix factorization (PMF) revealed that the six sources of major ions were confirmed as follows: vehicular emissions (38.1%), agriculture (22.3%), fossil fuel combustion (13.8%), crust (12.9%), marine (9.6%), and biomass burning (3.3%). And on the basis of back trajectory analysis, the air masses of precipitation were primarily from the northwest in spring and winter, from the southeast in summer, and from various directions in autumn, and they transported different natural and anthropogenic pollutants along their paths, thereby affecting the chemical composition and fluxes of AWD.

Apolipoprotein E Gene Polymorphism and Coronary Artery Disease Risk Among Patients in Northwest China

Purpose

The association between apolipoprotein E (ApoE) gene polymorphisms and the risk of coronary artery disease (CAD) among different populations has been assessed in numerous previous studies, but the results remain inconclusive. The present study aimed to determine the role of ApoE genotypes in CAD risk and the interrelationships between lipid profiles and ApoE alleles and genotypes among the population of northwest China.

Patients and Methods

This study was performed on 308 patients with CAD and 308 control participants. ApoE gene polymorphism was analysed using the polymerase chain reaction and hybridization.

Results

The findings indicated that the frequencies of ε3/ε4 genotype and ε4 allele frequency were significantly higher in patients with CAD than in the control participants. ε2 carriers had significantly lower total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) levels than did ε3 or ε4 carriers among the control participants. However, our study found no significant differences in plasma lipoprotein levels between ɛ2, ɛ3 and ɛ4 carriers in patients with CAD. Moreover, ε4 carriers had significantly higher ApoB, ApoB/ApoA-I levels and significantly lower ApoE levels in both patients with CAD and control participants. ε4 allele presence was associated with a nearly two-fold higher CAD risk. After adjusting for other established risk factors, ε4 allele was an independent risk factor for CAD. After stratified by age (≤ 60 years and >60 years), ε4 allele was indicated to increase the CAD risk 3.3-fold in elderly patients with CAD, but not in young patients with CAD. After stratified by sex, ε4 allele was not a risk factor in females and males patients with CAD.

Conclusion

This study provides evidence that the ε4 allele, drinking, smoking, hypertension, and TG and ApoE levels are independent risk factor for CAD among patients in northwest China.

The effect of water stress on net primary productivity in northwest China

Net primary productivity (NPP) has been widely used as the indicator of vegetation function and exhibits large spatial and temporal variations caused by numerous factors. Northwest China (NWC) is one of the driest regions in China, and water supply is the key determinant of NPP here. However, studies on the effects of water stress on NPP in NWC at the regional scale are still relatively lacking. Thus, in this study, based on a set of Moderate-Resolution Imaging Spectroradiometer (MODIS) NPP and evapotranspiration (ET) datasets, we quantified the response of NPP to water stress, which is indicated by crop water stress index (CWSI). Regional average of annual NPP in NWC showed an increasing trend during the study period, at a rate of 0.84 g C m-2 yr-1. At the province level, the NPP increase rates increased in the order of Ningxia (7.7%), Shaanxi (6.5%), Gansu (4.5%), Qinghai (3.8%), and Xinjiang (1.7%). NPP was negatively correlated with CWSI (p<0.05) in 73% of areas, indicating the key role of water stress in constraining NPP over this arid region. The effect of water stress on NPP changes with elevation. Water stress has the strongest negative impact on NPP in areas with elevations around 2000 m. In elevations above 5000 m, NPP is not limited by water stress, mostly positively correlated with CWSI. Our findings further clarify the importance of water stress in dryland ecosystems, while highlighting that elevation gradients can significantly affect the correlation between NPP and water stress.

Drought monitoring in arid and semi-arid region based on multi-satellite datasets in northwest, China

Drought is a complex natural disaster affected by multiple climate factors and underlying surface. In recent years, drought monitoring indices of remote sensing have been widely applied to monitor drought in a certain region or global. However, some remote sensing drought monitoring indices do not consider the drought-causing factors enough to reflect the comprehensive drought situation of a region fully. In this paper, a new remote sensing drought monitoring index, called Remote Sensing Drought Evaluation Index (RSDEI), was constructed by combining Vegetation Condition Index (VCI), Temperature Condition Index (TCI), Precipitation Condition Index (PCI), and Soil Moisture Condition Index (SMCI) using the spatial principal component analysis (SPCA) method. The reasonableness of RSDEI was test and verified using Net Primary Productivity (NPP), Standardized Precipitation Evapotranspiration Index (SPEI), and unit area crop yield. The RSDEI was also applied to the drought condition monitoring of the northwest arid and semi-arid region from 2001 to 2019.The result demonstrated that the results showed that the RSDEI had a high correlation coefficient with SPEI-12 (R=0.85, p<0.01). It is concluded that the correlation coefficient between RSDEI and NPP is 0.74 at 95% confidence level, which indicates that RSDEI and NPP have a strong correlation. Then, the correlation between RSDEI and crop yield per unit area is 0.89. The results of RSDEI showed that the drought in northwest China started in May and lasted in September from 2001 to 2019. The lowest value of RSDEI appeared in May, which inflected the significant difference of drought level in different month in northwest China. The result of CV (coefficient of variation) showed that the drought variation in the study area had a stable low fluctuation condition as a whole, in the northwest and northeast of study area, which indicated that the changes of drought were different in the past 19 years. The Hurst exponent analysis showed that the area with the positive evolution of Hurst index (0.5<H<1) is 1,845,046.669 km²,which accounts for 75.9% of the total area, while the area with reverse evolution characteristics (H<0.5) accounts for 24.1% of the total area. The result obtained above reflected that the drought changes in most regions are better than that in the past 19 years. The trend gradually changes from drought to humid.

Whole-Exome Sequencing in a Cohort of High Myopia Patients in Northwest China

High myopia (HM) is one of the leading causes of visual impairment worldwide. In order to expand the myopia gene spectrum in the Chinese population, we investigated genetic mutations in a cohort of 27 families with HM from Northwest China by using whole-exome sequencing (WES). Genetic variations were filtered using bioinformatics tools and cosegregation analysis. A total of 201 candidate mutations were detected, and 139 were cosegregated with the disease in the families. Multistep analysis revealed four missense variants in four unrelated families, including c.904C>T (p.R302C) in CSMD1, c.860G>A (p.R287H) in PARP8, c.G848A (p.G283D) in ADAMTSL1, and c.686A>G (p.H229R) in FNDC3B. These mutations were rare or absent in the Exome Aggregation Consortium (ExAC), 1000 Genomes Project, and Genome Aggregation Database (gnomAD), indicating that they are new candidate disease-causing genes. Our findings not only expand the myopia gene spectrum but also provide reference information for further genetic study of heritable HM.

Association between maternal iron supplementation and newborn birth weight: a quantile regression analysis

Objective

Our study aimed to explore the association between maternal iron supplementation and newborn birth weight (BW) in Shaanxi Province using quantile regression (QR).

Method

The data used in this study were derived from a large cross-sectional survey of a population in Shaanxi Province, Northwest China. A total of 28,209 women and their infants were selected using a stratified multistage random sampling method. The effect of iron supplementation on the newborn BW was assessed by a multiple linear regression model and QR.

Results

A total of 5.15% of the women took iron supplements during pregnancy. Multiple linear regression showed that the iron supplementation during pregnancy had positive effects on the BW, with an average increase of 43.07 g (β = 43.07, t = 3.55, and p < 0.001). The QR showed that the iron supplementation during pregnancy was associated with an increased newborn BW from very low to higher percentiles (quantiles: 0 ~ 0.40), with the β ranging from 136.51 to 43.86. As the percentiles of the BW increased, the neonatal BW gain gradually declined in the iron supplementation group compared with the group that did not receive iron supplementation (quantiles: 0 ~ 0.40, with the β ranging from 136.51 to 43.86). Iron supplementation was more effective among women who suffered from anemia during pregnancy (β = 45.84, t = 2.05, and p = 0.04; quantiles: 0 ~ 0.15, 0.30, 0.80, with β ranging from 150.00 to 39.29) than it was in any other group (β = 38.18, t = 2.62, and p = 0.009; quantiles: 0 ~ 0.15, with β ranging from 133.33 to 28.32).

Conclusions

Iron supplementation during pregnancy is associated with an increased newborn BW, and the effect was more obvious in the newborns with the lower BW and newborns whose mothers suffered from anemia during pregnancy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13052-021-01084-7.

Time series of atmospheric Δ14CO2 recorded in tree rings from Northwest China (1957-2015)

Radiocarbon (¹⁴C) is a unique and important tool for understanding carbon cycle in the nature, and its use can be significantly enhanced where reliable historical atmospheric Δ¹⁴CO₂ records can be established. In China, continuous atmospheric Δ¹⁴CO₂ records since the 1950s are scarce, a period when dramatic variations of Δ¹⁴CO₂ occurred caused by intensive human activities. In this research, Δ¹⁴C of Qinghai spruce tree rings collected from Huangzhong (HZ) (36.27°N, 101.67°E, 2982 m amsl) were measured by Accelerator Mass Spectrometry, and a Δ¹⁴CO₂ time series from 1957 to 2015 was reconstructed. The results show that HZ Δ¹⁴C was generally higher than the contemporaneous average level in the mid-high latitudes of the Northern Hemisphere. The peak value of HZ Δ¹⁴C occurred in 1964 (as bomb peak) was higher than that of other tree ring records in East Asia at a similar latitude, likely due to the impact of the atmosphere nuclear tests at Semipalatinsk (Kazakhstan). The record shows no obvious disturbance of Lop Nor nuclear weapons tests (in Northwest China) during 1964-1980, except for 1971. A local Suess effect began to appear since 2001, and the estimated atmospheric fossil fuel-derived CO₂ (CO_2ff) concentration increased from 3.5 ppm to 8.8 ppm from 2006 to 2015. This is associated with the implementation of the "Western Development" strategy in China. HZ Δ¹⁴C records document background Δ¹⁴C data, useful for regional carbon cycle research and atmospheric CO_2ff quantification in the region. These data also provide baseline values for assessment environmental safety connected with nuclear power plants in China.

Increased association between climate change and vegetation index variation promotes the coupling of dominant factors and vegetation growth

Vegetation productivity dynamics are closely related to climate change, and water availability determines vegetation growth in water-limited ecosystems. Nevertheless, how changes in the interactions between climatic factors and vegetation activity variation regulate the relationship between their trends remains unclear. The Normalized Difference Vegetation Index (NDVI) is an effective proxy of vegetation growth. First, we investigated the NDVI trends, and the results revealed a vegetation activity with weaker greening and greater spatial heterogeneity after an obvious land-cover breakpoint in 1999 compared with that before 1999 in northwest China. Notably, the Loess Plateau greatly led the greenness trends, but the Tibet Plateau showed mean browning after 1999, which implied that the coupling of climate change and vegetation trends varied with spatio-temporal changes. Subsequently, using the Geographical Detector Method (GDM), we quantified and compared the association between climate change and the interannual variability of NDVI in the two stages. Vegetation productivity variation is more closely related to changes in climatic factors after 1999 compared with that before 1999. Precipitation (PPT) and vapor pressure deficit (VPD) are the primary constraints to vegetation growth in both stages. Patterns in NDVI trend increases are consistent with those of increased PPT and decreased VPD and vice versa after 1999. However, the same patterns were not observed before 1999 because of the weak association between climate change and NDVI variation. This implicated a great significance of the association between climate change and changes in vegetation activity for the prediction of potential carbon sequestration due to the shift of dominant factors and their trends under future climate change.

Energy-water security challenge: Impact of energy production on water sustainable developments in Northwest China in 2017 and 2030

Energy consumption has gradually become an important factor affecting the sustainable use of regional water resources, especially in areas with abundant energy but scarce water. In this research, the water consumption for energy production in arid Northwest China (NWC) in 2017 and 2030 was evaluated, and the virtual water (VW) transfer embodied in the energy trade was also calculated based on a large amount of data collected from multiple sources. The results showed that the energy-related water consumption in NWC in 2017 was 2.6 billion m³, accounting for approximately 3.4% of the total regional water consumption and 61.8% of the total regional industrial water consumption. This value is projected to reach 8.6 billion m³ in 2030 under a normal water consumption scenario (BAU scenario), and 5.4 and 3.6 billion m³ under a regular water-saving scenario (RWS scenario) and enhanced water-saving scenario (EWS scenario), respectively. In 2017, except for Qinghai and Gansu, the other province in the study area was a VW exporter and the total VW output volume was 710.3 million m³, accounting for 26.9% of the total water consumption for energy production, this ratio will reach approximately 60% in 2030 due to the expansion of energy industry. In addition, based on our research, the available water in four provinces cannot meet the future energy requirements under EWS scenario owing to the water shortage, however, different energy development strategies need to be selected faced with the different types of water shortage condition. This study also proposed some countermeasures to ensure the coordinated development of regional water and energy.

Virtual water output intensifies the water scarcity in Northwest China: Current situation, problem analysis and countermeasures

With 80% water resources in the south and 65% arable land in the north, China is facing a rigorous challenge due to the spatial mismatch between water distribution and food & energy production to make a balanced development of economy and ecosystem. In the past decades, the northwest has played a prominent role in maintaining national food and energy security. However, the lack of water resources in this region poses a great threat to sustainable development. Based on this, this study quantitatively analyzed the evolution trend of water footprint (WF) of major crops and energy products in Northwest China from 2000 to 2015 and revealed the virtual water (VW) transfer pattern with commodity trade and its water resource stress caused by the virtual water output. The results show that, although the improvement of technology has greatly reduced the WF per unit production, the northwest region is still a net VW output area, whose net VW output associated with food and energy trade is increasing sharply from 287.2 × 10⁸ m³ (2000) to 328.5 × 10⁸ m³ (2015) with a growth rate of 14.4%, seriously aggravating the local water resource pressure. To ensure the water, food and energy safety of the northwest, we proposed countermeasures and suggestions on technological development and strategic planning, including water-saving technology promotion, industrial and agricultural structure optimization, and the coordinated management of physical and virtual water. The above findings provide a scientific reference to ensure the sustainable development of Northwest China.

Ecological dynamics of terrestrial and freshwater ecosystems across three mid-Phanerozoic mass extinctions from northwest China

The Earth has been beset by many crises during its history, and yet comparing the ecological impacts of these mass extinctions has been difficult. Key questions concern the kinds of species that go extinct and survive, how communities rebuild in the post-extinction recovery phase, and especially how the scaling of events affects these processes. Here, we explore ecological impacts of terrestrial and freshwater ecosystems in three mass extinctions through the mid-Phanerozoic, a span of 121 million years (295–174 Ma). This critical duration encompasses the largest mass extinction of all time, the Permian–Triassic (P–Tr) and is flanked by two smaller crises, the Guadalupian–Lopingian (G–L) and Triassic–Jurassic (T–J) mass extinctions. Palaeocommunity dynamics modelling of 14 terrestrial and freshwater communities through a long sedimentary succession from the lower Permian to the lower Jurassic in northern Xinjiang, northwest China, shows that the P–Tr mass extinction differed from the other two in two ways: (i) ecological recovery from this extinction was prolonged and the three post-extinction communities in the Early Triassic showed low stability and highly variable and unpredictable responses to perturbation primarily following the huge losses of species, guilds and trophic space; and (ii) the G–L and T–J extinctions were each preceded by low-stability communities, but post-extinction recovery was rapid. Our results confirm the uniqueness of the P–Tr mass extinction and shed light on the trophic structure and ecological dynamics of terrestrial and freshwater ecosystems across the three mid-Phanerozoic extinctions, and how complex communities respond to environmental stress and how communities recovered after the crisis. Comparisons with the coeval communities from the Karoo Basin, South Africa show that geographically and compositionally different communities of terrestrial ecosystems were affected in much the same way by the P–Tr extinction.

Individual Disaster Preparedness in Drought-and-Flood-Prone Villages in Northwest China: Impact of Place, Out-Migration and Community

Rural communities are generally more vulnerable to natural hazards when compared to urban communities. Moreover, rural communities are diverse and unique in their place, population, agricultural production and culture, which make it challenging for different rural settings to prepare for disasters. There is a little comparison made about the individual disaster preparedness among rural communities with different geographic landforms. In this study, we examined the individual disaster preparedness of rural residents in three drought-and-flood-prone villages with different landforms (plains, loess plateau and mountains) via a cross-sectional self-report structured questionnaire survey conducted in Northwest China. We also adopted an ecological framework to examine the determinants of villagers’ individual disaster preparedness across different dimensions: place, individual sociodemographic factors, family socioeconomic status, hazard adaptations, community and neighbourhood influences. We found that place was a significant factor for disaster preparedness when controlling individual sociodemographic and family socioeconomic factors. The level of preparedness in the plains was higher than both mountains and plateau. Moreover, the villagers who had out-migrated to work reported a higher level of disaster preparedness than did local villagers. In addition, the community and neighbourhood played an important role in determining individual disaster preparedness. This research highlights the needs for tailored community-based disaster risk reduction programs to improve villagers’ knowledge and skills of disaster preparedness.

Profiling multiple heavy metal contamination and bacterial communities surrounding an iron tailing pond in Northwest China

Northwest China is abundant in iron ore reserves and has become one of the important iron ore mining bases in China. However, the contamination and microbial community structure of iron tailing ponds in Northwest China have not been extensively investigated. In the present study, we characterized the main physicochemical properties, the multiple heavy metal contamination, and the bacterial community structure of the soils surrounding an iron tailing pond in Linze County, Zhangye city, Gansu Province. The tailing-associated soils were barren, exhibiting alkaline pH and low organic matter (OM), total nitrogen (TN) and total potassium (TK) compared with the control areas. There was considerable multiple heavy metal pollution in the iron tailing pond, mainly including lead (Pb), manganese (Mn), arsenic (As), cadmium (Cd), zinc (Zn), iron (Fe) and copper (Cu). Among the 303 identified core operational taxonomic units (OTUs), Actinobacteria, Proteobacteria and Deinococcus-Thermus were predominant at the phylum level, and Blastococcus, Arthrobacter, Marmoricola, Kocuria, Truepera, and Sphingomonadaceae were prevalent at a finer taxonomic level. The bacterial richness and diversity of the tailing samples were significantly lower than those of the reference samples. RDA, VPA and Spearman correlation analyses showed that the soil pH, CEC, OM, TP, TK, Cd, Pb, Ni, Zn, As and Mn had significant effects on the bacterial community composition and distribution. This work profiles the basic features of the soil physicochemical properties, the multiple heavy metal contamination and the bacterial community structure in an iron tailing pond in Northwest China, thereby providing a foundation for the future ecological remediation of the iron tailing environment in the area.

Dietary profile and phenolics consumption in university students from the Ningxia Hui Autonomous Region of China

Background

Polyphenol intake assessment is a first step for evaluating relationships between polyphenols and health-related outcomes. Ningxia Hui Autonomous Region is one of the minority areas in China, which is primarily consists of arid, dry desert.

Objectives

This study was to make assessment about phenolics intake by university students from Ningxia of China.

Methods

This study employed data from a cross-sectional survey conducted from February to June 2018 in Ningxia Hui Autonomous Region of Northwest China. A total of 413 undergraduate students (143 boys, 270 girls), mean age 20.6 years, participated in the study. Food-frequency consumption and anthropometric measurements were included in the survey. According to phenol-explorer website, the amount of different classes of phenolic compounds were established. Statistics analyses were conducted with IBM SPSS 20.0.

Results

Profile of the student subjects showed low weight (19.1%), overweight (6.8%) and obesity (0.5%). The mean value about phenolics intake was 1378 mg/day. The main polyphenols consumed were flavonoids (58.7% of total polyphenols), followed by phenolic acids (38.1%). Vegetables, fruits and cereals products were the most consumed foods, while infusions and sugar products were lower. Fruit was the main food sources of total polyphenols, especially apple (22.95%), orange juice (19.03%) and apple juice (3.93%).

Conclusions

This is the first study on the polyphenol intake of university students in Ningxia of China. The present results will be benefit for further investigation on the role of polyphenol intake against disease occurrence for this adults group.

Concentrations of polycyclic aromatic hydrocarbons in street dust from bus stops in Qingyang city: Estimates of lifetime cancer risk and sources of exposure for daily commuters in Northwest China

Lifetime cancer risk and exposure of daily commuters to polycyclic aromatic hydrocarbons (PAHs) in cities of Northwest China were determined from a study of street dust samples obtained from bus stops in Qingyang city. The sum of 16 priority PAHs (Σ16 PAHs) concentrations in the dust samples ranged from 0.8 to 18.3 mg kg^-1 (mean 3.0 mg kg^-1) and the distribution of individual, carcinogenic, combustion specific, low (2-3 rings) and high molecular weight (4-6 rings) PAHs was determined. The benzo[a]pyrene toxic equivalents of Σ16 PAHs ranged from 0.01 to 12.2 mg kg^-1 (mean 0.8 mg kg^-1). Incremental lifetime cancer risk from exposure to PAHs in dust at bus stops in Qingyang city was estimated at 1.9 × 10^-6 for adults and 3.5 × 10^-6 for children (confidence limit ≥ 95%). Emission source analysis of PAHs in bus stop dust showed that they were mainly derived from residential coal, oil and biomass combustion, e.g. from boilers, traffic vehicles, and Kang heaters. Higher concentrations of PAHs were obtained at bus stops near transport hubs, commercial districts, and administrative institutions.

Estimating potential evapotranspiration based on self-optimizing nearest neighbor algorithms: a case study in arid-semiarid environments, Northwest of China

Changes in potential evapotranspiration will affect the surface ecology and environment of the land. Accurate and quick estimation of potential evapotranspiration will help to analyze environmental change. In this study, in combination with the canonical correlation analysis (CCA) and k-nearest neighbor algorithm (k-NN), a new method for calculating potential evapotranspiration (CCA-k-NN) based on self-optimizing nearest neighbor algorithm was proposed, in which less meteorological data were used for estimation. By analyzing the basic principles of CCA and k-NN and according to the requirement of estimating ET₀, the CCA-k-NN method was constructed, and its basic principles and key steps were described. In this method, CCA algorithm was used to find the most relevant meteorological data for potential evapotranspiration, and the dimensionality of meteorological data for subsequent estimation of ET₀ was reduced. Then, k-NN algorithm was used to estimate ET₀. The Northwest of China was chosen as the research area to evaluate the applicability of this method. The 148 data stations in the region were divided into training datasets, testing datasets, and validation datasets. ET₀ was estimated on three datasets using the proposed method, and the estimation accuracy of the CCA-k-NN method was evaluated with FAO-56 Penman-Monteith as a reference. The results show that the CCA-k-NN method maintains a high correlation with FAO-56 Penman-Monteith (correlation coefficient is greater than 0.9) and has a good estimation accuracy. RMSE and MAE are both less than 1 mm day^-1, and the overall performance of NSCE is greater than 0.5, all of which reach the level of "applicable" and above. At the same time, the CCA-k-NN method has low time complexity O(n). Comparison of the results of the CCA-k-NN method with those of other empirical models showed that the CCA-k-NN method is more accurate and can be employed successfully in estimating ET₀.

The mutation frequencies of GJB2, GJB3, SLC26A4 and MT-RNR1 of patients with severe to profound sensorineural hearing loss in northwest China

OBJECTIVE

To expose the spectrum and frequency of GJB2, GJB3, SLC26A4 and MT-RNR1 in northwest China and to investigate the underlying causative genes in patients without common mutations.

METHODS

We analyzed the mutation screening results of GJB2, GJB3, SLC26A4 and MT-RNR1 in 398 unrelated severe-to-profound probands with bilateral, symmetrical sensorineural hearing loss. Subsequently, we selected 10 probands with a significant family history of inherited hearing loss (HL) that did not have the above four common gene mutations to perform next-generation sequencing (NGS) of 139 known deafness genes, followed by co-segregation analysis of all available family members.

RESULTS

Among the 398 patients, 69 (17.34%) had the biallelic GJB2 gene mutations, and the most common mutations were c.235delC, c.109G>A and c.299_300delAT, with allele frequencies of 12.31%, 3.38% and 3.89%, respectively. A total of 63 (15.83%) cases with biallelic SLC26A4 mutations were detected, and the most common pathogenic alleles were c.919-2A>G, c.2168A>G and c.1174A>T, with allele frequencies of 9.17%, 2.26% and 0.88%, respectively. Mitochondrial gene mutations were detected in 9 (2.26%) patients, with 5 cases of mitochondrial DNA (mtDNA) m.1555A>G mutation and 4 cases of mtDNA m.1095T>C mutation. In 10 probands with a clear family history of HL, NGS showed two novel pathogenic variants in 2 families, including c.4129C>T/c.3268C>T in LOXHD1, c.334G>A/c.2968G>T in CDH23. Sanger sequencing confirmed that these variants segregated with the HL in each family.

CONCLUSIONS

Our results showed that GJB2 and SLC26A4 were the two major HL-causing genes in northwest China. The most common mutation alleles in GJB2 were c.235delC, c.109G>A and c.299_300delAT, and those in SLC26A4 were c.919-2A>G, c.2168A>G and c.1174A>T. In addition, both genes and their loci can be used as the first selection of deafness gene screening. Additionally, for patients who did not have mutations of these common genes, NGS provided an efficient diagnosis for increasing known deafness genes.

Assessing groundwater pollution and potential remediation processes in a multi-layer aquifer system

Pumping-induced leakage across aquitards may induce a deterioration of water quality in multi-layer aquifer systems. It is critical to understand long-term trends of water quality parameters when assessing the sustainability of groundwater abstraction. Daily drinking water needs of 2.2 million people in Yinchuan region of northwest China are solely met by groundwater resources, but long-term groundwater withdrawal has created an extensive cone of depression (294 km² in area) in confined aquifer causing increased vertical recharge. In this study, a model was established and calibrated with head data, then was incorporated with field tracer tests to provide key information on the hydro-dispersive characteristics of the contaminant for assessing both the current and future state of the aquifer system. The results confirmed a close association between water quality deterioration and high downward fluxes of high chloride groundwater, most notably near the center of the cone of depression. On a temporal scale, water quality degradation remains slow, largely due to the high, pre-existing storage of good quality water. Modeling suggests that the water quality in the upper confined aquifer will lose its potability over a 25 km² and 50 km² area within 200 years under the current and intensified pumping conditions, respectively. Elevated chloride values were also detected toward the east of the cone, highlighting the impact of hydrological settings on the vertical groundwater flow. Modeling of potential aquifer remediation shows an even slower response with a further 250 years or more required for potability to be restored in affected areas. The findings can provide valuable guidance to for decision makers and support the sustainable management of aquifer exploitation.

Impact of climate change and human activities on economic values produced by ecosystem service functions of rivers in water shortage area of Northwest China

Climate change and human activities are affecting the ecological health of rivers and the economic value of its ecosystem services. Taking water quantity as the intermediate variable, we proposed a quantitative calculation method for the impact of climate change and human activities on the economic value produced by the ecosystem service functions of rivers. The framework mainly consists of three steps: firstly, we quantitatively determined the changes in the amount of water coming from rivers due to climate change and human activities; secondly, combining the theory of resource and environmental economics to calculate the economic value generated by ecological service functions of rivers; finally, we quantitatively identified and analyzed the impact of climate change and human activities on the economic value produced by the ecosystem service functions of rivers. Taking Baoji section of Weihe River (BSWR) as an example, we quantitatively analyzed and calculated the impact of climate change and human activities on the economic value produced by ecosystem service functions of rivers. The main conclusions of this paper are as follows: in recent 52 years, the economic value produced by the ecosystem service functions of rivers decreased by 3.57 billion yuan due to the climate change and human activities; the total economic value has been reduced by an average of 68 million yuan per year. This useful work can not only reveal the impact of climate change and human activities on the economic value of ecosystem services of rivers but also can provide an important basis for the reasonable management model of water resource of ecosystem of rivers watershed.

Epidemiological characteristics of spinal cord injury in Northwest China: a single hospital-based study

Background

While the cities in China in which spinal cord injury (SCI) studies have been conducted previously are at the forefront of medical care, northwest China is relatively underdeveloped economically, and the epidemiological characteristics of SCI have rarely been reported in this region.

Methods

The SCI epidemiological survey software developed was used to analyze the data of patients treated with SCI from 2014 to 2018. The sociodemographic characteristics of patients, including name, age, sex, and occupation, were recorded. The following medical record data, obtained from physical and radiographic examinations, were included in the study: data on the cause of injury, fracture location, associated injuries, and level of injury. Neurological function was evaluated using the American Spinal Injury Association (ASIA) impairment scale. In addition, the treatment and complications during hospitalization were documented.

Results

A total of 3487 patients with SCI with a mean age of 39.5 ± 11.2 years were identified in this study, and the male to female ratio was 2.57:1. The primary cause of SCI was falls (low falls 47.75%, high falls 37.31%), followed by traffic accidents (8.98%), and impact with falling objects (4.39%). Of all patients, 1786 patients (51.22%) had complications and other injuries. According to the ASIA impairment scale, the numbers of grade A, B, C, and D injuries were 747 (21.42%), 688 (19.73%), 618 (17.72%), and 1434 (41.12%), respectively. During the hospitalization period, a total of 1341 patients experienced complications, with a percentage of 38.46%. Among all complications, pulmonary infection was the most common (437, 32.59%), followed by hyponatremia (326, 24.31%), bedsores (219, 16.33%), urinary tract infection (168, 12.53%), deep venous thrombosis (157, 11.71%), and others (34, 2.53%). Notably, among 3487 patients with SCI, only 528 patients (15.14%) received long-term rehabilitation treatment.

Conclusion

The incidence of SCI in northwest China was on the rise with higher proportion in males; fall and the MCVs were the primary causes of SCI. The occupations most threatened by SCI are farmers and workers. The investigation and analysis of the epidemiological characteristics of SCI in respiratory complications are important factors leading to death after SCI, especially when the SCI occurs in the cervical spinal cord. Finally, the significance of SCI rehabilitation should be addressed.

A potent risk model for predicting new-onset acute coronary syndrome in patients with type 2 diabetes mellitus in Northwest China

AIMS

Type 2 diabetes mellitus (T2DM) is now very prevalent in China. Due to the lower rate of controlled diabetes in China compared to that in developed countries, there is a higher incidence of serious cardiovascular complications, especially acute coronary syndrome (ACS). The aim of this study was to establish a potent risk predictive model in the economically disadvantaged northwest region of China, which could predict the probability of new-onset ACS in patients with T2DM.

METHODS

Of 456 patients with T2DM admitted to the First Affiliated Hospital of Xi'an Jiaotong University from January 2018 to January 2019 and included in this study, 270 had no ACS, while 186 had newly diagnosed ACS. Overall, 32 demographic characteristics and serum biomarkers of the study patients were analysed. The least absolute shrinkage and selection operator regression was used to select variables, while the multivariate logistic regression was used to establish the predictive model that was presented using a nomogram. The area under the receiver operating characteristics curve (AUC) was used to evaluate the discriminatory capacity of the model. A calibration plot and Hosmer-Lemeshow test were used for the calibration of the predictive model, while the decision curve analysis (DCA) was used to evaluate its clinical validity.

RESULTS

After random sampling, 319 and 137 T2DM patients were included in the training and validation sets, respectively. The predictive model included age, body mass index, diabetes duration, systolic blood pressure (SBP), diastolic blood pressure (DBP), low-density lipoprotein cholesterol, serum uric acid, lipoprotein(a), hypertension history and alcohol drinking status as predictors. The AUC of the predictive model and that of the internal validation set was 0.830 [95% confidence interval (CI) 0.786-0.874] and 0.827 (95% CI 0.756-0.899), respectively. The predictive model showed very good fitting degree, and DCA demonstrated a clinically effective predictive model.

CONCLUSIONS

A potent risk predictive model was established, which is of great value for the secondary prevention of diabetes. Weight loss, lowering of SBP and blood uric acid levels and appropriate control for DBP may significantly reduce the risk of new-onset ACS in T2DM patients in Northwest China.