Background: Smartphones are becoming increasingly indispensable in everyday life for most undergraduates in China, and this has been associated with problematic use or addiction. The aim of the current study was to investigate the prevalence of smartphone addiction and the associated factors in male and female undergraduates. Methods: This cross-sectional study was conducted in 2016 and included 1441 undergraduate students at Wannan Medical College, China. The Smartphone Addiction Scale short version (SAS-SV) was used to assess smartphone addiction among the students, using accepted cut-offs. Participants' demographic, smartphone usage, and psycho-behavioral data were collected. Multivariate logistic regression models were used to seek associations between smartphone addiction and independent variables among the males and females, separately. Results: The prevalence of smartphone addiction among participants was 29.8% (30.3% in males and 29.3% in females). Factors associated with smartphone addiction in male students were use of game apps, anxiety, and poor sleep quality. Significant factors for female undergraduates were use of multimedia applications, use of social networking services, depression, anxiety, and poor sleep quality. Conclusions: Smartphone addiction was common among the medical college students investigated. This study identified associations between smartphone usage, psycho-behavioral factors, and smartphone addiction, and the associations differed between males and females. These results suggest the need for interventions to reduce smartphone addiction among undergraduate students.

We show that sex steroids protect the adult murine skeleton through a mechanism that is distinct from that used to preserve the mass and function of reproductive organs. The classical genotropic actions of sex steroid receptors are dispensable for their bone protective effects, but essential for their effects on reproductive tissues. A synthetic ligand (4-estren-3alpha,17beta-diol) that reproduces the nongenotropic effects of sex steroids, without affecting classical transcription, increases bone mass and strength in ovariectomized females above the level of the estrogen-replete state and is at least as effective as dihydrotestosterone in orchidectomized males, without affecting reproductive organs. Such ligands merit investigation as potential therapeutic alternatives to hormone replacement for osteoporosis in both women and men [corrected].

During the past decades in China, the traditional state monopoly has experienced difficulties in meeting the huge demand for new infrastructure and improvement in service levels, engendering the growth of different forms and degrees of private sector involvement. Since the 1990s, China has started experimenting with the public-private partnership (PPP) delivery method in the water supply sector. However, many problems stemming from unsuccessful risk management have been encountered in PPP applications that have eventually led to project failure. This paper aims to identify and evaluate typical risks associated with PPP projects in the Chinese water supply sector. A literature review, a Delphi survey, and face-to-face interviews were used to achieve these objectives. Finally, a register of 16 critical risk factors (CRFs) of water PPP projects in China was established. The findings revealed that completion risk, inflation, and price change risk have a higher impact on Chinese water PPP projects, whereas government corruption, an imperfect law and supervision system, and a change in market demand have a lower impact on the water supply sector. The findings can help project stakeholders to improve the efficiency of privatization in public utility service and provide private investors with a better understanding while they participate in the enormous Chinese water market through the PPP mode.

Background Hypertension in children and adolescents is on the rise worldwide, especially in China. The prevalence of hypertension is related to many factors, such as obesity. In the era of smart phones, it is important to study the negative health effects of mobile phones on blood pressure. The purpose of this study was to investigate the prevalence of hypertension and its association with smartphone addiction among junior school students in China. Methods A school-based cross-sectional study was conducted, including total 2639 junior school students (1218 boys and 1421 girls), aged 12–15 years old (13.18 ± 0.93 years), enrolled in the study by random cluster sampling. Height, weight, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured following standard protocols, and the body mass index (BMI) was calculated. Overweight/obesity and hypertension were defined according to sex- and age-specific Chinese children reference data. The Smartphone Addiction Scale short version (SAS-SV) and the Pittsburgh Sleep Quality Index (PSQI) were used to assess smartphone addiction and sleep quality among the students, respectively. Multivariate logistic regression models were used to seek associations between smartphone addiction and hypertension. Results The prevalence of hypertension and smartphone addiction among participants were 16.2% (13.1% for females and 18.9% for males) and 22.8% (22.3% for females and 23.2% for males), respectively. Obesity (OR = 4.028, 95% CI: 2.829–5.735), poor sleep quality (OR = 4.243, 95% CI: 2.429–7.411), smartphone addiction (OR = 2.205, 95% CI: 1.273–3.820) were significantly and independently associated with hypertension. Conclusions Among the junior school students surveyed in China, the prevalence of hypertension was high, which was related to obesity, poor sleep quality and smartphone addiction. These results suggested that smartphone addiction may be a new risk factor for high blood pressure in adolescents.

BackgroundThe identification of hepatitis E virus (HEV) from rabbits motivated us to assess the possibility of using rabbits as a non-human primate animal model for HEV infection and vaccine evaluation.Methodology/Principal FindingsFirst, 75 rabbits were inoculated with seven strains of genotypes 1, 3, 4, and rabbit HEV, to determine the appropriate strain, administrative route and viral dosage. Second, 15 rabbits were randomly divided into three groups and vaccinated with 0 µg (placebo), 10 µg and 20 µg of HEV candidate vaccine, HEV p179, respectively. After three doses of the vaccination, the rabbits were challenged with 3.3×105 genome equivalents of genotype 4 HEV strain H4-NJ703. The strain of genotype 1 HEV was not found to be infectious for rabbits. However, approximately 80% of the animals were infected by two rabbit HEV strains. All rabbits inoculated with a genotype 3 strain were seroconverted but did not show viremia or fecal viral shedding. Although two genotype 4 strains, H4-NJ153 and H4-NJ112, only resulted in part of rabbits infected, another strain of genotype 4, H4-NJ703, had an infection rate of 100% (five out of five) when administrated intravenously. However, only two out of fifteen rabbits showed virus excretion and seroconversion when inoculated orally with H4-NJ703 of three different dosages. In the vaccine evaluation study, rabbits vaccinated with 20 µg of the HEV p179 produced anti-HEV with titers of 1∶104–1∶105 and were completely protected from infection. Rabbits vaccinated with 10 µg produced anti-HEV with titers of 1∶103–1∶104 and were protected from hepatitis, but two out of the five rabbits showed virus shedding.Conclusions/SignificanceRabbits may be served as an alternative to the non-human primate models for HEV infection and vaccine evaluation when certain virus strains, appropriate viral dosages, and the intravenous route of inoculation are selected.

BackgroundMonitoring the treatment outcomes of tuberculosis and determining the specific factors associated with unsuccessful treatment outcome are essential to evaluate the effectiveness of tuberculosis control program. This study aimed to assess treatment outcomes and explore the factors associated with unsuccessful outcomes among new pulmonary smear positive and negative tuberculosis patients in Anqing, China.MethodsA nine-year retrospective study was conducted using data from Anqing Center for Diseases Prevention and Control. New pulmonary tuberculosis patients treated with two six-month regimens were investigated. Non-conditional logistic regression was performed to calculate odds ratios and 95% confidence intervals for factors associated with unsuccessful outcomes.ResultsAmong 22,998 registered patients (16,939 males, 6059 females), 64.54% were smear-positive patients. The treatment success rates was 95.02% for smear-positive patients and 95.00% for smear-negative patients. Characteristics associated with an higher risk of unsuccessful treatment among smear-positive patients included aged above 35 years, treatment management model of self-medication, full-course management and supervision in intensive phase, unchecked chest X-ray, cavity in chest X-ray, and miliary shadow in chest X-ray, while normal X-ray was negative factor. Unsuccessful treatment among smear-negative patients was significantly associated with age over 45 years, treatment management model of full-course management, unchecked chest X-ray, presence of miliary shadow in chest X-ray and delay over 51 days.ConclusionsTuberculosis treatment in Anqing area was successful and independent of treatment regimens. Special efforts are required for patients with unsuccessful outcomes.

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Sarcopenia is an age-associated disease characterized by loss of muscle mass and function, but the diagnostic cutoff values remain controversial. To investigate the diagnostic cutoff values and incidence of sarcopenia in a plateau population, the limb skeletal muscle mass, gait speed and grip strength of 2318 Tibetan adults were measured according to the criteria of the Asian Working Group for Sarcopenia. We found that the diagnostic reference values for sarcopenia in the high-altitude population were significantly lower than those in the plain population, and the incidences of sarcopenia in the highaltitude population over 60 years old were 17.2% in men and 36.0% in women, which were significantly higher than those in the plain population. Our study proposes reference values for the diagnosis of sarcopenia in Tibet. We suggest that the cutoff value for sarcopenia in the plateau population should be established based on altitude. Hypoxia may be an important risk factor for sarcopenia.Sarcopenia is a progressive and generalized skeletal muscle disorder involving the accelerated loss of muscle mass and function that is associated with increased adverse outcomes, including falls, functional decline, frailty, and mortality 1 . With the ageing of the population, sarcopenia has become one of the major public health problems in the world 2,3 . Since 2010, the study of sarcopenia in the field of international geriatrics has become increasingly intense, focusing on the diagnostic criteria and pathogenesis of sarcopenia. Both the European and Asian sarcopenia working groups have recommended diagnostic criteria of sarcopenia based on muscle mass, muscle strength and physical function presented by skeletal muscle mass index (SMI), handgrip strength (HS) and gait speed (GS), respectively 4,5 . Currently, the incidence of sarcopenia and the cutoff values for SMI and HS in different populations are very different. The incidence of sarcopenia is related not only to age but also to racial differences. Ethnic factors may be one of the main reasons for the differences in the incidence of sarcopenia among different populations 6-8 . The European Working Group on Sarcopenia in Older People (EWGSOP) has suggested that primary sarcopenia is mainly related to ageing and is a phenotype in the process of biological senescence. Ageing is a sequential process of genetic programming, which inevitably results in a decrease in the amount of ageing muscle, but this process is affected by the environment, lifestyle and ageing-related diseases 9 and shows significant individual differences. Therefore, ethnic and individual differences should be taken into account in determining diagnostic reference values for sarcopenia, and the best reference values should include a wide range of races and ages. Asia is the most dense and fastest ageing region in the world, and sarcopenia will have a very large impact on the Asian population 5 . The Asian Working Group for Sarcopenia (AWGS) has recommended that a large number of investigations should be carried ...