IMPORTANCE The aging of the population is associated with an increasing burden of fractures worldwide. However, the epidemiological features of fractures in mainland China are not well known. OBJECTIVE To assess the prevalence of and factors associated with osteoporosis, clinical fractures, and vertebral fractures in an adult population 40 years or older in mainland China. DESIGN, SETTING. AND PARTICIPANTS This cross-sectional study, the China Osteoporosis Prevalence Study, was conducted from December 2017 to August 2018. A random sample of individuals aged 20 years or older who represented urban and rural areas of China were enrolled, with a 99% participation rate. MAIN OUTCOMES AND MEASURES Weighted prevalence of osteoporosis, clinical fracture, and vertebral fracture by age, sex, and urban vs rural residence as determined by x-ray absorptiometry, questionnaire, and radiography. RESULTS A total of 20 416 participants were included in this study; 20 164 (98.8%; 11 443 women [56.7%]; mean [SD] age, 53 [13] years) had a qualified x-ray absorptiometry image and completed the questionnaire, and 8423 of 8800 (95.7%) had a qualified spine radiograph. The prevalence of osteoporosis among those aged 40 years or older was 5.0% (95% CI, 4.2%-5.8%) among men and 20.6% (95% CI, 19.3%-22.0%) among women. The prevalence of vertebral fracture was 10.5% (95% CI, 9.0%-12.0%) among men and 9.7% (95% CI, 8.2%-11.1%) among women. The prevalence of clinical fracture in the past 5 years was 4.1% (95% CI, 3.3%-4.9%) among men and 4.2% (95% CI, 3.6%-4.7%) among women. Among men and women, 0.3% (95% CI, 0.0%-0.7%) and 1.4% (95% CI, 0.8%-2.0%), respectively, with osteoporosis diagnosed on the basis of bone mineral density or with fracture were receiving antiosteoporosis treatment to prevent fracture. CONCLUSIONS AND RELEVANCEIn this cross-sectional study of an adult population in mainland China, the prevalence of osteoporosis and vertebral fracture were high and the prevalence of vertebral fracture and clinical fracture was similarly high in men and women. These findings suggest that current guidelines for screening and treatment of fractures among patients in China should focus equally on men and women and should emphasize the prevention of vertebral fractures.

Game-based learning supported by mobile intelligence technology has promoted the renewal of teaching and learning models. Herein, a model of Question-Observation-Doing-Explanation (QODE) based on smart phones was constructed and applied to science learning during school disruption in COVID-19 pandemic. In this study, from the theoretical perspective of cognitive-affective theory of learning with media, Bandura’s motivation theory and community of inquiry model, self-report measure was used to verify the effect of students’ scientific self-efficacy and cognitive anxiety on science engagement. A total of 357 valid questionnaires were used for structural equation model research. The results indicated that two types of scientific self-efficacy, as indicated by scientific learning ability and scientific learning behavior, were negatively associated with cognitive anxiety. In addition, cognitive anxiety was also negatively correlated to four types of science engagement, as indicated by cognitive engagement, emotional engagement, behavioral engagement, and social engagement through smartphone interactions. These findings provide further evidence for game-based learning promoted by smart phones, contributing to a deeper understanding of the associations between scientific self-efficacy, cognitive anxiety, and science engagement. This study points out that the QODE model is suitable for implementing smart mobile devices to students’ science learning.

Background40–50% of colorectal cancer (CRC) patients develop metastatic disease; the presence of metastasis hinders the effective treatment of cancer through surgery, chemotherapy and radiotherapy, which makes 5-year survival rate extremely low; therefore, studying CRC metastasis is crucial for disease therapy. In the present study, we investigated the role of rhomboid domain containing 1 (RHBDD1) in tumor metastasis of CRC.MethodsThe expression of RHBDD1 was analyzed in 539 colorectal tumor tissues for its correlation with lymphatic metastasis and distal metastasis. Transwell assay in vitro and pleural metastasis analysis in vivo were performed to determine the functions of RHBDD1 during CRC cells metastasis. RNA-seq analysis, TOP/FOP flash reporter assay, western blot and transwell assay were performed to investigate the underlying mechanism for the function of RHBDD1 on Wnt signaling pathway. Bioinformatics analysis was conducted to investigate epithelial-mesenchymal transition (EMT) and stemness in HCT-116 cells. Tissue microarray analysis, Q-PCR and western blot were performed to determine the correlation of RHBDD1 and Zinc Finger E-Box Binding Homeobox 1 (ZEB1).ResultsIn this study, we found that RHBDD1 expression was positively correlated with lymphatic metastasis and distal metastasis in 539 colorectal tumor tissues. RHBDD1 expression can promote CRC cells metastasis in vitro and in vivo. RNA-Seq analysis showed that the Wnt signaling pathway played a key role in this metastatic regulation. RHBDD1 mainly regulated ser552 and ser675 phosphorylation of β-catenin to activate the Wnt signaling pathway. Rescuing ser552 and ser675 phosphorylation of β-catenin resulted in the recovery of signaling pathway activity, migration, and invasion in CRC cells. RHBDD1 promoted EMT and a stem-like phenotype of CRC cells. RHBDD1 regulated the Wnt/β-catenin target gene ZEB1, a potent EMT activator, at the RNA and protein levels. Clinically, RHBDD1 expression was positively correlated with ZEB1 at the protein level in 71 colon tumor tissues.ConclusionsOur findings therefore indicated that RHBDD1 can promote CRC metastasis through the Wnt signaling pathway and ZEB1. RHBDD1 may become a new therapeutic target or clinical biomarker for metastatic CRC.Electronic supplementary materialThe online version of this article (10.1186/s13046-018-0687-5) contains supplementary material, which is available to authorized users.

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This paper contributes to a geographically-informed preliminary assessment of the diverse and uneven immediate impacts of the Covid-19 pandemic, and outlines an agenda for geographical studies of its longer term effects. Intrigued by the apparent tendency of an inverse relationship between a country's health security capacities and Covid-19 mortalities, the paper explores the significance of a range of geographically situated contextual factors in the realms of the economy, governance and culture as mediators of the public health impacts of Covid-19, and questions how these realms may also be reshaped by this viral pandemic. The paper concludes with reflections on the path dependency and state centrality of pandemic response, and the potential postpandemic reconfiguration of state-market-society relationships.