STUDY QUESTION What is the current status of assisted reproductive technology (ART) service availability, efficacy and safety in mainland China? SUMMARY ANSWER In this first national report on ART status in mainland China, data on treatment numbers, outcomes and complications in 2016 are provided and analyzed, respectively. WHAT IS KNOWN ALREADY National ART Service Provision Surveys are conducted in mainland China regularly. Data were analyzed, and this manuscript was written by team members from the National Center for Women and Children’s Health, China CDC and the Department of Women and Children Health, National Health Commission of the People’s Republic of China. STUDY DESIGN, SIZE AND DURATION A cross-sectional nationwide survey was completed in 2018, in which data regarding ART treatments, performed from 1st January to 31st December2016 in 445 ART clinics located in 31 provinces of mainland China, were collected. PARTICIPANTS/MATERIALS, SETTING AND METHODS There were in total 451 licensed ART clinics (including artificial insemination clinics) in mainland China in 2016, of which 445 submitted service data. A total of 906 840 cycles were provided by 323 in vitro fertilization (IVF) clinics, involving 375 770 conventional IVF cycles, 154 948 intracytoplasmic sperm injection (ICSI) cycles, 367 146 frozen embryo transfer (FET) thawing cycles and 8976 preimplantation genetic diagnosis (PGD) treatment cycles. A total of 161 376 artificial (i.e. intrauterine) insemination (AI) cycles were reported by 443 clinics, with 126 872 cycles using the husband’s semen (AIH) and 34 504 using donor semen (AID). MAIN RESULTS AND THE ROLE OF CHANCE In total, 98.7% of the licensed clinics, contributing to 100% of the ART services (including AID and AIH cycles), were included in this report. (Six clinics provided institutional information only and were excluded.) There were 906 840 in vitro fertilization cycles performed in mainland China with a population of over 1.3 billion inhabitants, with cycles per million inhabitants (C/M) increasing from 360 in 2013 to 657 in 2016, nationwide (range among provinces: 45–3676). After treatment with conventional IVF, the clinical pregnancy rate (PR) per oocyte retrieval cycle was 23.2%, the delivery rate (DR) per oocyte retrieval cycle was 18.7% and the proportion of twin delivery among the total deliveries was 27.9%. For ICSI cycles, the PR, DR and TDR were 20.5%, 16.7% and 27.2%, respectively. For FET per thawing cycles, the PR, DR and TDR were 48.2%, 37.6% and 24.2%. For PGD per diagnosis cycles, the PR, DR and TDR were 38.1%, 29.7% and 4.2%. For AIH cycles, the PR and DR were 13.3% and 10.5%; for AID cycles, the PR and DR were 24.3% and 21.1%, respectively. The total number of live infants born in mainland China in 2016, was 18.46 million, and the number of infants born through ART conducted in 2016 was 311 309, which accounted for 1.69% of the total. The reported rate of birth defects was about 87/10 000. The incidence of moderate to severe ovarian hyper-stimulation syndrome (OHSS) was 11.5 per 1000 oocyte retrieval cycles, and other complications were much more rare. LIMITATIONS AND REASONS FOR CAUTION This report is based on the summary data of ART services provided. The success rates were not calculated by age stratification. A low rate of birth defects was reported, which might be confounded by variations in birth follow-up methods, statistical timing and record taking. WIDER IMPLICATIONS OF THE FINDINGS ART service availability has improved significantly in recent years in mainland China. Because China is a vast country, significant imbalances in ART service provision do exist; however, the main efficacy and safety indicators were close to those of western countries. TRIAL REGISTRATION NUMBER N/A STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the National Key R&D Program of China (2016YFC1000307–2). There are no competing interests.

In this study we report on a doorstepping intervention which produced a 12.5%, statistically significant,increase in the recycling capture rate. More importantly, we investigate why doorstepping caused theincrease, through focus groups, structured interviews and questionnaires. By analyzing the findings withrespect to a pragmatic set of eleven clusters of determinants of behaviour change, we find that socialnorms and emotion were important, with prompts as a more minor determinant. We can now planfurther doorstepping knowing an emphasis on these is useful. Knowledge, skills, belief of consequences,belief of capability, action planning, role clarification, feedback, and motivation were determinant clusters found not to be important in this case.\ud \ud Recycling behaviour change interventions often do not generally produce transferable learning becausethey are usually presented as case studies and not broken down into key elements. Our analytica lapproach of breaking down a poorly defined activity - doorstepping - into elements which influencedifferent clusters of determinants, and then exploring their separate impacts, allows some predictiveplanning and optimization for other interventions. The specific context here was residential food wasterecycling in apartment blocks of communities in Shanghai, China

We reported that the multiple PDZ protein 1 (MUPP1) is an osmotic response protein in kidney cells. This up-regulation was found to be necessary for the maintenance of tight epithelial properties in these cells. We investigated whether an interaction with one or more members of the claudin family is responsible for this observation. In response to hypertonicity, the up-regulation of claudin-4 (Cldn4) expression, and not other claudins, was initially identified in inner medullary collecting duct (IMCD3) cells by gene array and further verified by quantitative PCR and Western blotting. In kidney tissues, Cldn4 expression was substantial in the papilla and absent in the cortex. Furthermore, Cldn4 expression significantly increased in the papilla of mice after 36 h of thirsting. Cldn4 immunofluorescence in hypertonically stressed cells revealed colocalization with MUPP1 at the tight junctions. Interaction between Cldn4 and MUPP1 was also demonstrated by coimmunoprecipitation of both proteins from IMCD3 cells chronically adapted to hypertonicity. In IMCD3 cells stably silenced for MUPP1 expression under hypertonic conditions, a significant decrement in Cldn4 expression was observed that was restored after inhibition of lysosome activity. Immunofluorescence detection identified that in these MUPP1-silenced cells Cldn4 was mistargeted to the lysosomes. Functionally, silencing Cldn4 expression in IMCD3 cells resulted in a decrease in the transepithelial resistance to the same degree as observed when MUPP1 expression was silenced, suggesting that MUPP1 contributes to the maintenance of a tight epithelium in the medulla of the kidney under hypertonic stress by correctly localizing Cldn4 to the tight junctions.osmotic stress response ͉ kidney cells ͉ inner medulla

Background The epidemic of COVID-19 presents a special threat to elderly adults. However, information on kidney damage in elderly patients with COVID-19 is limited. Acute kidney injury (AKI) is common in hospitalized adults and associated with a poor prognosis. We sought to explore the association between AKI and mortality in elderly patients with COVID-19. Methods We conducted a retrospective, observational cohort study in a large tertiary-care university hospital in Wuhan, China. All consecutive inpatients elderly than 65 years with COVID-19 were enrolled in this cohort. Demographic data, laboratory values, comorbidities, treatments, and clinical outcomes were all collected. Data were compared between patients with AKI and without AKI. The association between AKI and mortality was analyzed. Results Of 1764 in-hospital patients, 882 elderly cases were included in this cohort. The median age was 71 years (interquartile range [IQR]: 68-77), 440 (49.9%) were man. The most presented comorbidity was cardiovascular diseases (58.2%), followed by diabetes (31.4%). Of 882 elderly patients, 115 (13%) developed AKI and 128 (14.5%) died. Patients with AKI had higher mortality than those without AKI (68 [59.1%] vs 60 [7.8%]; P < 0.001). Multivariable Cox regression analysis showed that increasing odds of in-hospital mortality associated with higher interleukin-6 on admission, myocardial injury and AKI. Conclusion AKI is not an uncommon complication in elderly patients with COVID-19 but is associated with high risk of death. Physicians should aware the risk of AKI in elderly patients with COVID-19.