Abstract. The quantification of ammonia (NH3) emissions is essential to the more accurate quantification of atmospheric nitrogen deposition, improved air quality and the assessment of ammonia-related agricultural policy and climate mitigation strategies. The quantity, geographic distribution and historical trends of these emissions remain largely uncertain. In this paper, a new Chinese agricultural fertilizer NH3 (CAF_NH3) emissions inventory has been compiled that exhibits the following improvements: (1) a 1  ×  1 km gridded map on the county level was developed for 2008; (2) a combined bottom-up and top-down method was used for the local correction of emission factors (EFs) and parameters; (3) the temporal patterns of historical time trends for 1978–2008 were estimated and the uncertainties were quantified for the inventories; and (4) a sensitivity test was performed in which a province-level disaggregated map was compared with CAF_NH3 emissions for 2008. The total CAF_NH3 emissions for 2008 were 8.4 TgNH3 yr−1 (a 6.6–9.8 Tg interquartile range). From 1978 to 2008, annual NH3 emissions fluctuated with three peaks (1987, 1996 and 2005), and total emissions increased from 3.2 to 8.4 Tg at an annual rate of 3.0 %. During the study period, the contribution of livestock manure spreading increased from 37.0 to 45.5 % because of changing fertilization practices and the rapid increase in egg, milk, and meat consumption. The average contribution of synthetic fertilizer, which has a positive effect on crop yields, was approximately 38.3 % (minimum: 33.4 %; maximum: 42.7 %). With rapid urbanization causing a decline in the rural population, the contribution of the rural excrement sector varied widely between 20.3 % and 8.5 %. The average contributions of cake fertilizer and straw returning were approximately 3.8 and 4.5 %, respectively, thus small and stable. Collectively, the CAF_NH3 emissions reflect the nation's agricultural policy to a certain extent. An effective approach to decreasing PM2.5 concentrations in China would be to simultaneously decrease NOx, SO2, and NH3 emissions.

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Aims To investigate practice patterns in exit‐site care and identify the risk factors for exit‐site infection. Design A quantitative cross‐sectional design. Methods Data were collected in 12 peritoneal dialysis (PD) centres in 2018. Daily exit‐site care practice patterns and exit‐site status of patients receiving PD were assessed through interviews and questionnaires. Results/findings Most of the 1,204 patients adhered with the protocols about main aspects of exit‐site care, such as cleansing agents selection, frequency of cleansing, catheter fixation, and following the catheter protective measures. However, their adherence levels on hand hygiene, mask wearing, observing exit site, examining secretion, and communicating with PD staff were rather low. Eighty‐four patients' exit sites were evaluated as problematic exit site (PES). And 186 patients had catheter‐related infection (CRI) history. After multivariable logistic regression analysis, diabetes (OR = 1.631), traction bleeding history (OR = 2.697), antibiotic agents use (OR = 2.460), compliance on mask wearing (OR = 0.794), and observing exit site (OR = 0.806) were influencing factors of CRI history. Traction bleeding history (OR = 2.436), CRI history (OR = 10.280), and effective communication (OR = 0.808) with PD staff were influencing factors for PES. Conclusions The adherence levels on different aspects of exit‐site care were varied in patients having PD. Their self‐care behaviours did correlate with the exit‐site status. Impact The adherence level of patients’ exit‐site care practice needs attention of medical staff. Further studies about the optimal procedure in exit‐site care were warranted.

Reactive gaseous nitrogen (Ngr) emissions significantly affect Earth's climate system. Disagreement exists, however, over Ngr contributions to short-versus long-term climate forcing, from local to global scales and among different gaseous forms, including NH 3 , NO x , and N 2 O. Here, we provide a comprehensive inventory of Ngr from China's croplands based on a new bottom-up, mass flow-based approach integrated with fine-resolution agricultural activity data and nitrogen emission factors. We demonstrate that China's croplands emit about 8.87 Tg N to the atmosphere in 2014. Across different prefectures, Ngr emission per capita conforms to a "Kuznets curve," that is, first increases then decreases, along the gradient of increasing urbanization. Ngr emission per gross domestic productivity (GDP) decreases exponentially with increasing urbanization or per capita GDP. Furthermore, climate change impact analyses suggest that the global-scale warming effect of China's cropland N 2 O emissions dominate over local cooling effects ascribed to its NH 3 and NO x emissions. Plain Language Summary Reactive gaseous nitrogen, sourced to the world's highest fertilizer application rates in China, imparts local cooling effects on short time scales. The effects are ultimately counterbalanced by nitrous oxide emissions over the long term, leading to substantial warming effects on the global climate system. We base our conclusion on the first-ever high-resolution assessment of reactive nitrogen emissions to the atmosphere from China's croplands. Owing to limited high-resolution reactive gaseous nitrogen emissions data, hitherto, large uncertainties have existed in the detailing the role of China's cropland reactive gaseous nitrogen emissions on climate forcing. This paucity of information poses a challenge for informing China's agricultural sustainability policies with regard to maintaining/increasing agricultural yields while reduces reactive gaseous nitrogen emissions and their warming potential. Our analyses provide essential information for further sustainable N management and the interactions between agriculture and climate change. We provide policy-relevant information for mitigation targets, including the 2°C limit goal set by the 2015 Paris Agreement of the United Nations Framework Convention on Climate Change, enabling progress related to multiple United Nations Sustainable Development Goals.

<b><i>Introduction:</i></b> Telemedicine (TM) has shown to provide potential benefits on clinical outcomes in patients with chronic kidney disease but limited evidences published in the peritoneal dialysis (PD) population. This study aimed to explore the long-term effects of TM on the mortality and technique failure. <b><i>Methods:</i></b> The Peritoneal Dialysis Telemedicine-assisted Platform Cohort Study (PDTAP Study) was conducted prospectively in 27 hospitals in China since 2016. Patient and practice data were collected through the doctor-end of the TM app (Manburs) for all participants. TM including self-monitoring records, on-line education materials, and real-time physician-patient contact was only performed for the patient-end users of the Manburs. The primary outcome was all-cause mortality. The secondary outcomes were cause-specific mortality and all-cause and cause-specific permanent transfer to hemodialysis. <b><i>Results:</i></b> A total of 7,539 PD patients were enrolled between June 2016 and April 2019, with follow-up till December 2020. Patients were divided into two cohorts: TM group (39.1%) and non-TM group (60.9%). A propensity score was used to create 2,160 matched pairs in which the baseline covariates were well-balanced. There were significantly lower risks of all-cause mortality (HR 0.59 [0.51, 0.67], <i>p</i> &#x3c; 0.001), CVD mortality (HR 0.59 [0.49, 0.70], <i>p</i> &#x3c; 0.001), all-cause transfer to hemodialysis (0.57 [0.48, 0.67], <i>p</i> &#x3c; 0.001), transfer to hemodialysis from PD-related infection (0.67 [0.51, 0.88], <i>p</i> = 0.003), severe fluid overload (0.40 [0.30, 0.55], <i>p</i> &#x3c; 0.001), inadequate solute clearance (0.49 [0.26, 0.92], <i>p</i> = 0.026), and catheter-related noninfectious complications (0.41 [0.17, 0.97], <i>p</i> = 0.041) in the TM group compared with the non-TM group. <b><i>Conclusion:</i></b> This study indicated real-world associations between TM usage and reduction in patient survival and technique survival through a multicenter prospective cohort.

In the present study, differentially expressed microRNAs (miRNAs) in peritoneal exosomes that were isolated from 10 patients with epithelial ovarian cancer (EOC) with metastasis in the abdominal cavity and 10 participants without cancer (NC) were identified. These differentially expressed miRNAs that were revealed by next-generation sequencing were categorized by Gene Ontology enrichment and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis of their target genes. Notably, two miRNAs that were associated with EOC-miR-149-3p and miR-222-5p-were identified. There were significant differences in expression of miR-149-3p and miR-222-5p between EOC and NC samples, and the effect of the expression level of the two miRNAs on the patient survival was identified using publicly available data from The Cancer Genome Atlas. There is an association between these two miRNAs and EOC, that was further verified by reverse transcription-quantitative polymerase chain reaction in peritoneal exosomes from 10 patients with EOC and NC participants. These results indicated that miR-149-3p and miR-222-5p might be novel biomarkers for evaluating the prognosis of patients with EOC and that these two miRNAs might have potential therapeutic values.

Objectives: The primary objective of the Peritoneal Dialysis Telemedicine-assisted Platform Cohort (PDTAP) Study is to explore potential predictors and their effects on patient survival, technique survival, and the occurrence of infectious and noninfectious complications. Design: The PDTAP study is a national-level cohort study in China. A newly developed PD telemedicine application provided a unique and convenient way to collect multicenter, structured data across units. Setting: The PDTAP study was underway in 27 hospitals from 14 provinces located at 7 geographical regions (northwest, northeast, north, central, southwest, southeast, and south) in China. Participants: Our study aims to enroll at least 7000 adult patients with end-stage renal disease receiving PD. Methods: Approval has been obtained through the ethics committees of all hospitals. All participants signed the informed consent form after the center had received ethics board approval in accordance with the Declaration of Helsinki. Main outcome measures: Patient survival, technique survival, hospitalization, and the occurrence of infectious and noninfectious complications. Conclusions: The PDTAP study aims to explore potential predictors and their effects on patient survival, technique survival, and infectious and noninfectious complications using a newly developed PD telemedicine system to collect multicenter, structured data in real-world practice. Substantial and transformable findings in relation to PD practices were expected. This study also developed a national-level infrastructure for further collaboration and ancillary investigation.

Background: The prevalence of diabetes mellitus (DM) among patients with chronic kidney disease (CKD) has been increasing in recent years in China. This study aimed to evaluate the association between DM and health-related quality of life (HRQOL) in patients with CKD. Methods: In our study, participants with CKD stage 1 to 4 from 39 centers in China were screened and enrolled. The Kidney Disease Quality of Life (KDQOL™-36) questionnaire was used to assess HRQOL. Participants were divided into a diabetic group and a non-diabetic group. Demographic data, clinical data, and HRQOL scores were compared between the two groups. Multivariable robust regression was used to analyze the factors related to HRQOL in CKD patients. Results: A population of 2742 CKD patients was included in this study. CKD patients with DM were older and had lower education level, longer treatment periods and a higher prevalence of cardiovascular disease than CKD patients without DM (P < 0.05). HRQOL scores in the "symptoms and problems", "effects of kidney disease", and "SF-12 physical function" dimensions were significantly lower in the diabetic group than the non-diabetic group (86.88 ± 13.76 vs. 90.59 ± 10.75, 84.78 ± 14.86 vs. 87.28 ± 12.45, and 41.40 ± 9.77 vs. 45.40 ± 8.82, respectively, all P < 0.05). DM was negatively correlated with the symptoms and problems (regression coefficient for log transformed [175-score] = 0.010) and the SF-12 physical function dimension (regression coefficient = − 2.18) (all P < 0.05). Conclusion: HRQOL of diabetic patients with CKD was worse than that of non-diabetic patients with CKD. DM was an independent and negative factor affecting HRQOL in patients with CKD.