我国公共卫生科技创新的现状与挑战

近年来,我国公共卫生领域科技创新紧密结合国家重大战略需求,形成了具有我国特色的优势学科领域,建设了若干高水平的科技创新平台和研究基地,并取得系列重大成果。但与发达国家和我国现代公共卫生体系及能力建设目标相比,特别是结合新时期健康中国建设战略需求和重大公共卫生挑战,我国在公共卫生关键科技问题的发展水平上仍存在短板,同时公共卫生科技创新也面临着某些体制机制因素的制约。本文提出了未来我国公共卫生科技创新的重点方向,并聚焦体制机制提出加强公共卫生科技创新的对策建议。

Message from Deputy Editor-in-Chief Liming Li—On the Launch of the China CDC Weekly

As the Founding Director-General of China CDC and the Deputy Editor-in-Chief,I would like to express my heartfelt congratulations for the China CDC Weekly.Public health in China has been keeping pace with the development and construction of New China through its world-renowned accomplishments.In its 70 years of experience,China has established a public health system for epidemic and disease prevention with the following aspects.

Association of physical activity with risk of chronic kidney disease in China:A population-based cohort study

Background:Information on the association between physical activity(PA)and the risk of chronic kidney disease(CKD)is limited.We aimed to explore the associations of total,domain-specific,and intensity-specific PA with CKD and its subtypes in China.Methods:The study included 475,376 adults from the China Kadoorie Biobank aged 30-79 years during 2004-2008 at baseline.An interviewer-administered questionnaire was used to collect the information about PA,which was quantified as metabolic equivalent of task hours per day(MET-h/day)and categorized into 4 groups based on quartiles.Cox regression was used to analyze the association between PA and CKD risk.Results:During a median follow-up of 12.1 years,5415 incident CKD cases were documented,including 1159 incident diabetic kidney disease(DKD)cases and 362 incident hypertensive nephropathy(HTN)cases.Total PA was inversely associated with CKD risk,with an adjusted hazard ratio(HR,95%confidence interval(95%CI))of 0.83(0.75-0.92)for incident CKD in the highest quartile of total PA as compared with participants in the lowest quartile.Similar results were observed for risk of DKD and HTN,and the corresponding HRs(95%CIs)were 0.75(0.58-0.97)for DKD risk and 0.56(0.37-0.85)for HTN risk.Increased nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA were significantly associated with a decreased risk of CKD,with HRs(95%CIs)of 0.80(0.73-0.88),0.85(0.77-0.94),and 0.85(0.76-0.95)in the highest quartile,respectively.Conclusion:PA,including nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA,was inversely associated with the risk of CKD,including DKD,HTN,and other CKD,and such associations were dose dependent.

A Railway Fastener Inspection Method Based on Abnormal Sample Generation

Regular fastener detection is necessary to ensure the safety of railways.However,the number of abnormal fasteners is significantly lower than the number of normal fasteners in real railways.Existing supervised inspectionmethods have insufficient detection ability in cases of imbalanced samples.To solve this problem,we propose an approach based on deep convolutional neural networks(DCNNs),which consists of three stages:fastener localization,abnormal fastener sample generation based on saliency detection,and fastener state inspection.First,a lightweight YOLOv5s is designed to achieve fast and precise localization of fastener regions.Then,the foreground clip region of a fastener image is extracted by the designed fastener saliency detection network(F-SDNet),combined with data augmentation to generate a large number of abnormal fastener samples and balance the number of abnormal and normal samples.Finally,a fastener inspection model called Fastener ResNet-8 is constructed by being trained with the augmented fastener dataset.Results show the effectiveness of our proposed method in solving the problem of sample imbalance in fastener detection.Qualitative and quantitative comparisons show that the proposed F-SDNet outperforms other state-of-the-art methods in clip region extraction,reaching MAE and max F-measure of 0.0215 and 0.9635,respectively.In addition,the FPS of the fastener state inspection model reached 86.2,and the average accuracy reached 98.7%on 614 augmented fastener test sets and 99.9%on 7505 real fastener datasets.

Shaping global health promotion:a comprehensive analysis of the 10 Global Conferences on Health Promotion Conferences(1986-2021)

Objective This study analyzed how the 10 Global Conferences on Health Promotion have played a significant role in shaping and promoting a worldwide consensus and actions on health promotion,effectively addressing diverse health challenges that evolved over different periods.Methods The textual analysis method was used in this study and text encoding was conducted to systematically examine the declarations and reports presented by the 10 Global Conferences on Health Promotion held during 1986-2021.We summarized the themes and key achievements,and key vocabulary in the conference declarations was extracted and analyzed to construct the global health promotion consensus and actions.Results The fundamental principles of the conferences are to foster consensus and initiate actions in the realm of health promotion on a global scale.The primary purpose and goal are to promote health from regional to global.Significantly,our findings highlight a transition in the primary actors driving health promotion.It underscores a shift in health promotion from being driven primarily by organizations like the World Health Organization,governments,and international bodies,to a more inclusive approach involving non-governmental organizations and the general public.This development implies that health promotion has evolved into a collective global endeavor,demanding the proactive involvement of various stakeholders,and forging new alliances in public health.Meanwhile,the coronavirus disease 2019(COVID-19)pandemic has further shaped the landscape of health promotion,underscoring the need for intensified focus on areas including disease prevention,health education,and the integration of digital health technologies,and emphasizing the importance of a multidimensional,responsive approach in public health initiatives.Conclusions Sustained collaboration and innovative strategies are pivotal to advancing health promotion globally.Countries,together with public and private entities,should intensify cooperation.Multisectoral collaboration among partners such as healthcare,education,social security,and the industry is vital for health promotion and achieving global health goals.

Implementation of Clinical Diagnostic Criteria and Universal Symptom Survey Contributed to Lower Magnitude and Faster Resolution of the COVID-19 Epidemic in Wuhan

自新型冠状病毒肺炎(coronavirus disease 2019, COVID-19)疫情发生以来,中国大多数的病例集中在武汉市。虽然早期病例数和死亡人数迅速增加,但通过采取多种防控措施,疫情得以快速遏制。纵观全球,疫情已蔓延至全球六大洲的187个国家,确诊病例数已超过300万,这一数字仍在快速增长。在此特殊背景下,有必要对我国疫情防控措施开展科学的、定量的评估,为全球疫情防控提供决策依据。为此,本研究评估了临床诊断标准实施和全城症状排查对武汉市疫情控制的贡献。考虑COVID-19的传播机理、隔离措施等,建立SEIR+Q传播动力学模型。基于武汉市截至2020年2月14日官方公布的每日确诊病例数和未确诊的临床诊断病例数进行建模,并预测2月14日以后的疫情态势。基于实际疫情数据,与模型预测趋势相比较,评价防控措施效果。结果显示,若维持2月14日以前防控措施不变,那么预测将于3月25日和4月29日,每日新增病例数分别降至100例和10例以下,将于5月31日首次现零。而事实上,截至3月6日,武汉市每日新增病例数降至100例以下,截至3月11日降至10例以下,3月18日首次实现零增长,较之模型预测结果分别提前了19 d、49 d和74 d。截至3月30日,实际累计病例数为50 006例,比模型预测值减少19 951例。有效再生数[effective reproductive number, R(t)]分析显示,2月6-10日的第一次全城症状排查后,R(t)显现出下降趋势,2月12-14日的临床诊断标准实施和2月17-19日的第二次全城症状排查后,R(t)显现出较大的降幅,与实际情况较为一致。综上所述,武汉市临床诊断标准的实施和全城症状排查等综合防控措施成效显著,可为世界各国的疫情防控决策提供科学依据。

A Detection Method of Bolts on Axlebox Cover Based on Cascade Deep Convolutional Neural Network

This paper proposes a cascade deep convolutional neural network to address the loosening detection problem of bolts on axlebox covers.Firstly,an SSD network based on ResNet50 and CBAM module by improving bolt image features is proposed for locating bolts on axlebox covers.And then,theA2-PFN is proposed according to the slender features of the marker lines for extracting more accurate marker lines regions of the bolts.Finally,a rectangular approximationmethod is proposed to regularize themarker line regions asaway tocalculate the angle of themarker line and plot all the angle values into an angle table,according to which the criteria of the angle table can determine whether the bolt with the marker line is in danger of loosening.Meanwhile,our improved algorithm is compared with the pre-improved algorithmin the object localization stage.The results show that our proposed method has a significant improvement in both detection accuracy and detection speed,where ourmAP(IoU=0.75)reaches 0.77 and fps reaches 16.6.And in the saliency detection stage,after qualitative comparison and quantitative comparison,our method significantly outperforms other state-of-the-art methods,where our MAE reaches 0.092,F-measure reaches 0.948 and AUC reaches 0.943.Ultimately,according to the angle table,out of 676 bolt samples,a total of 60 bolts are loose,69 bolts are at risk of loosening,and 547 bolts are tightened.

Prevalence of anemia of varying severity, geographic variations, and association with metabolic factors among women of reproductive age in China: a nationwide, population-based study

To investigate the epidemiological characteristics of anemia of varying severity among women of reproductive age,we conducted a nationwide,cross-sectional study between January 1,2019 and December 31,2019,including 4184547 nonpregnant women aged 18–49 years from all 31 provinces in the mainland of China.Anemia was defined as having hemoglobin concentration<120.0 g/L and categorized as mild,moderate,and severe.Multivariate logistic models with cluster effect were used to explore the association of anemia and metabolic risk factors.The standardized prevalence of anemia and moderate and worse anemia among women of reproductive age in China was 15.8%(95%CI 15.1%–16.6%)and 6.6%(6.3%–7.0%),respectively.The prevalence of anemia and the proportion of moderate and worse anemia significantly increased with age.We also observed great geographic variations in the prevalence of anemia,with a high likelihood in south,central,and northwest China.Moderate and/or severe anemia was positively associated with overweight and obesity,diabetes,and impaired kidney function.In conclusion,anemia remains a significant challenge for women of reproductive age in China.Geographic variations and metabolic risk factors should be considered in the comprehensive and targeting strategy for anemia reduction.

A Regularized Newton Method with Correction for Unconstrained Convex Optimization

In this paper, we present a regularized Newton method (M-RNM) with correction for minimizing a convex function whose Hessian matrices may be singular. At every iteration, not only a RNM step is computed but also two correction steps are computed. We show that if the objective function is LC2, then the method posses globally convergent. Numerical results show that the new algorithm performs very well.

Rapid and effective treatment of traumatic spinal cord injury using stem cell derived exosomes

Traumatic spinal cord injury is a fatal acute event without effective clinical therapies.Following the trauma,immediate neural protection and microenvironment mitigation are vitally important for nerve tissue repair,where stem cell-based therapies could be eclipsed by the deficiency of cells due to the hostile microenvironment as well as the transport and preservation processes.Effective emergency strategies are required to be convenient,biocompatible,and stable.Herein,we assess an emergency cell-free treatment using mesenchymal stem cell-derived exosomes,which have proven capable of comprehensive mitigation of the inhibitory lesion microenvironment.The clinically validated fibrin glue is utilized to encapsulate the exosomes and in-situ gelates in transected rat spinal cords to provide a substrate for exosome delivery as well as nerve tissue growth.The emergency treatment alleviates the inflammatory and oxidative microenvironment,inducing effective nerve tissue repair and functional recovery.The therapy presents a promising strategy for effective emergency treatment of central nervous system trauma。

Genetic and healthy lifestyle factors in relation to the incidence and prognosis of severe liver disease in the Chinese population

Background:Severe liver disease(SLD),including cirrhosis and liver cancer,constitutes a major disease burden in China.We aimed to examine the association of genetic and healthy lifestyle factors with the incidence and prognosis of SLD.Methods:The study population included 504,009 participants from the prospective China Kadoorie Biobank aged 30-79 years.The individuals were from 10 diverse areas in China without a history of cancer or liver disease at baseline.Cox regression was used to estimate adjusted hazard ratios(HRs)for incident SLD and death after SLD diagnosis associated with healthy lifestyle factors(smoking,alcohol,physical activity,and central adiposity).Additionally,the contribution of genetic risk for hepatitis B virus(HBV,assessed by genetic variants in major histocompatibility complex,class II,DP/DQ[HLA-DP/DQ]genes)was also estimated.Results:Compared with those with 0-1 healthy lifestyle factor,participants with 2,3,and 4 factors had 12%(HR 0.88[95%confidence interval[CI]0.85,0.92]),26%(HR 0.74[95%CI:0.69,0.79]),and 44%(HR 0.56[95%CI:0.48,0.65])lower risks of SLD,respectively.Inverse associations were observed among participants with both low and high genetic risks(HR per 1-point increase 0.83[95%CI:0.74,0.94]and 0.91[95%CI:0.82,1.02],respectively;P_(interaction)=0.51),although with a non-significant trend among those with a high genetic risk.Inverse associations were also observed between healthy lifestyle factors and liver biomarkers regardless of the genetic risk.Despite the limited power,healthy lifestyle factors were associated with a lower risk of death after incident SLD among participants with a low genetic risk(HR 0.59[95%CI:0.37,0.96]).Conclusions:Lifestyle modification may be beneficial in terms of lowering the risk of SLD regardless of the genetic risk.Moreover,it is also important for improving the prognosis of SLD in individuals with a low genetic risk.Future studies are warranted to examine the impact of healthy lifestyles on SLD prognosis,particularly among individuals with a high genetic risk.

Long-term prognosis and prognostic determinants of patients with first attack of mild and moderate ischemia at Beijing community hospitals

A total of 710 patients with first-ever ischemic stroke were consecutively recruited between January 2003 and December 2004 from five community hospitals/stations in five districts of Beijing, China. As of December 31, 2008, a total of 2 477 person-years were followed-up. During the five-year follow-ups, 117 adverse events occurred, including all-cause death and acute cardiovascular events （recurrent stroke, acute myocardial infarction, and sudden death）. The five-year cumulative mortality rate was 2.18/100 person-years （54 cases）, with 3.88/100 person-years （96 cases） of acute cardiovascular events and 3.02/100 person-years （75 cases） of recurrent stroke. Multiple factor analyses using the Cox proportional hazards ratio models showed that age, diabetes, and dependence of activities of daily living were independent predictors for death, acute cardiovascular disease events, or recurrent stroke. The results demonstrated that recurrent stroke was a major vascular disease that affected the prognosis of mild or moderate stroke patients. Secondary prevention of stroke patients should include active management of vascular risk factors and rehabilitation.

A De-Noising Method for Track State Detection Signal Based on the Statistical Characteristic of Noise

Based on the statistical characteristics analysis of random noise power and autocorrelation function, this paper proposes a de-noising method for track state detection signal by using Empirical Mode Decomposition (EMD). This method is used to noise reduction refactoring for the first Intrinsic Mode Function (IMF) component in accordance with the “random sort-accumulation-average-refactoring' order. Signal autocorrelation function characteristics are used to determine the cut-off point of the dominant mode. This method was applied to test signals and the actual inertial unit signals;the experimental results show that the method can effectively remove the noise and better meet the precision requirement.

Recent progress in understanding the role of genes in the pathogenesis of cutaneous squamous cell carcinoma

Cutaneous squamous cell carcinoma(cSCC)is the second most common skin tumor in humans.Ultraviolet(UV)radiation is an important environmental risk factor for cSCC;other risk factors include human papilloma virus(HPV)infection,chronic inflammation,and chronic wounds.A large proportion of patients present with an aggressive form of cSCC at the time of diagnosis,which is often accompanied by regional lymph node involvement and distant metastases.The long-term prognosis for these highly metastatic diseases is extremely poor,with a 10-year survival rate of less than 10%.Therefore,clarifying the pathogenesis of this tumor is of great significance and may contribute to the identification of novel biomarkers and development of new therapeutic strategies.In this review,we focus on the recent progress in genes related to the development of this tumor,intending to aid future investigations into the genetic alterations related to cSCC.

Emerging environmental health issues in low-and middle-income countries

Emerging epidemiological evidence has demonstrated that ambient air pollution,such as particulate matter(PM),is associated with increased cardio-respiratory mortality and morbidity.1'2 Air pollution has been recognized as the single biggest environmental risk factor for attributable burden of noncommunicable diseases(NCDs),3 which has provided strong rationale for actions reducing population exposure to air pollutants in particular countries or regions even on a global scale.The air quality in high-income countries has substantially improved over the past decades,while it has generally deteriorated in most low-and middle-income countries(LMICs;determined by the World Bank and based on gross national income per capita),under the settings of global urbanization and economic development.4 In addition,there has been rapid growth in prevalence of NCDs worldwide due to ageing and lifestyle changes,and NCDs are now the most common causes of death and disability globally.5 Thus,to synthesize and provide up-to-date evidence on health impact of air pollution,World Health Organization(WHO)has released the latest edition of global air quality guidelines-WHO Global Air Quality Guidelines(hereafter referred to as uAQGs(2021on September 22,2021,6 which has significant implications to future actions on air pollution control and disease management under the context of climate change and global health promotion.

A De-Noising Method for Track State Detection Signal Based on EMD

In the track irregularity detection, the acceleration signals of the inertial measurement unit (IMU) output which with low frequency components and noise, this paper studied a de-noising algorithm. Based on the criterion of consecutive mean square error, a de-noising method for IMU acceleration signals based on empirical mode decomposition (EMD) was proposed. This method can divide the intrinsic mode functions (IMFs) derived from EMD into signal dominant modes and noise dominant modes, then the modes reflecting the important structures of a signal were combined together to form partially reconstructed de-noised signal. Simulations were conducted for simulated signals and a real IMU acceleration signals using this method. Experimental results indicate that this method can efficiently and adaptively remove noise, and this method can better meet the precision requirement.

Ideal cardiovascular health and mortality:pooled results of three prospective cohorts in Chinese adults

Background: Evidence on the relations of the American Heart Association’s ideal cardiovascular health (ICH) with mortality in Asians is sparse, and the interaction between behavioral and medical metrics remained unclear. We aimed to fill the gaps. Methods: A total of 198,164 participants without cancer and cardiovascular disease (CVD) were included from the China Kadoorie Biobank study (2004-2018), Dongfeng-Tongji cohort (2008-2018), and Kailuan study (2006-2019). Four behaviors (i.e., smoking, physical activity, diet, body mass index) and three medical factors (i.e., blood pressure, blood glucose, and blood lipid) were classified into poor, intermediate, and ideal levels (0, 1, and 2 points), which constituted 8-point behavioral, 6-point medical, and 14-point ICH scores. Results of Cox regression from three cohorts were pooled using random-effects models of meta-analysis. Results: During about 2 million person-years, 20,176 deaths were recorded. After controlling for demographic characteristics and alcohol drinking, hazard ratios (95% confidence intervals) comparing ICH scores of 10-14 vs. 0-6 were 0.52 (0.41-0.67), 0.44 (0.37-0.53), 0.54 (0.45-0.66), and 0.86 (0.64-1.14) for all-cause, CVD, respiratory, and cancer mortality. A higher behavioral or medical score was independently associated with lower all-cause and CVD mortality among the total population and populations with different levels of behavioral or medical health equally, and no interaction was observed. Conclusions: ICH was associated with lower all-cause, CVD, and respiratory mortality among Chinese adults. Both behavioral and medical health should be improved to prevent premature deaths.

Classical swine fever virus NS5A protein antagonizes innate immune response by inhibiting the NF-κB signaling

The NS5A non-structural protein of classical swine fever virus(CSFV)is a multifunctional protein involved in viral genomic replication,protein translation,assembly of infectious virus particles,and regulation of cellular signaling pathways.Previous report showed that NS5A inhibited nuclear factor kappa B(NF-κB)signaling induced by poly(I:C);however,the mechanism involved has not been elucidated.Here,we reported that NS5A directly interacted with NF-κB essential modulator(NEMO),a regulatory subunit of the IκB kinase(IKK)complex,to inhibit the NF-κB signaling pathway.Further investigations showed that the zinc finger domain of NEMO and the aa 126–250 segment of NS5A are essential for the interaction between NEMO and NS5A.Mechanistic analysis revealed that NS5A mediated the proteasomal degradation of NEMO.Ubiquitination assay showed that NS5A induced the K27-linked but not the K48-linked polyubiquitination of NEMO for proteasomal degradation.In addition,NS5A blocked the K63-linked polyubiquitination of NEMO,thus inhibiting IKK phosphorylation,IκBαdegradation,and NF-κB activation.These findings revealed a novel mechanism by which CSFV inhibits host innate immunity,which might guide the drug design against CSFV in the future.

Association between fresh fruit consumption and the risk of chronic obstructive pulmonary disease-related hospitalization and death in Chinese adults:A prospective cohort study

Background:Existing evidence suggests that fruit consumption is a significant influencing factor for chronic obstructive pulmonary disease(COPD),but this is unclear in the Chinese population.We examined the association of fresh fruit consumption with the risk of COPD-related hospitalization and death in a nationwide,population-based prospective cohort from China.Methods:Between 2004 and 2008,the China Kadoorie Biobank recruited>0.5 million adults aged 30 to 79 years from ten diverse regions across China.After excluding individuals diagnosed with major chronic diseases and prevalent COPD,the prospective analysis included 421,428 participants.Cox regression was used to calculate the hazard ratios(HRs)for the association between fresh fruit consumption and risk of COPD-related hospitalization and death,with adjustment for established and potential confounders.Results:During a mean follow-up of 10.9 years,11,292 COPD hospitalization events and deaths were documented,with an overall incidence rate of 2.47/1000 person-years.Participants who consumed fresh fruit daily had a 22%lower risk of COPD-related hospitalization and death compared with non-consumers(HR=0.78,95%confidence interval[CI]:0.71-0.87).The inverse association between fresh fruit consumption and COPD-related hospitalization and death was stronger among non-current smokers and participants with normal body mass index(BMI)(18.5 kg/m^(2)≤BMI<24.0 kg/m^(2));the corresponding HRs for daily fresh fruit consumption were 0.78(95%CI:0.68-0.89)and 0.69(95%CI:0.59-0.79)compared with their counterparts,respectively.Conclusions:High-frequency fruit consumption was associated with a lower risk of COPD in Chinese adults.Increasing fruit consumption,together with cigarette cessation and weight control,should be considered in the prevention and management of COPD.

Pregnancy Loss in Relation to the Risks of Female-Specific Cancers in a Population-Based Cohort and Mendelian Randomization Study — China, 2004–2017

Summary What is already known about this topic?Limited evidence exists regarding the relationship between pregnancy loss and female-specific cancers within the Chinese population from prospective cohort studies.What is added by this report?Terminations were associated with a 13%lower risk of endometrial cancer,whereas stillbirths were related to an 18%higher risk of cervical cancer.Rural residents with a history of pregnancy loss experienced a 19%and 38%increased risk of breast and cervical cancers,respectively,compared to their urban counterparts.Moreover,a positive graded relationship between live births and pregnancy loss on cervical cancer was observed.What are the implications for public health practice?This study has significant implications for identifying women at an increased risk for breast and genital cancers and contributes to the development of effective public health strategies for female cancer prevention.Future research on reproductive history,particularly in rural areas,should be given priority in efforts to improve female cancer screening and early detection.