Defect-Mediated Formation of Oriented Phase Domains in a Lithium-Ion Insertion Electrode.

The performance and robustness of electrodes are closely related to transformation-induced nanoscale structural heterogeneity during (de)lithiation. As a result, it is critical to understand at atomic scale the origin of such structural heterogeneity and ultimately control the transformation microstructure, which remains a formidable task. Here, by performing in situ studies on a model intercalation electrode material, anatase TiO2, we reveal that defects─both preexisting and as-formed during lithiation─can mediate the local anisotropic volume expansion direction, resulting in the formation of multiple differently oriented phase domains and eventually a network structure within the lithiated matrix. Our results indicate that such a mechanism operated by defects, if properly harnessed, could not only improve lithium transport kinetics but also facilitate strain accommodation and mitigate chemomechanical degradation. These findings provide insights into the connection of defects to the robustness and rate performance of electrodes, which help guide the development of advanced lithium-ion batteries via defect engineering.

Incidence of and risk factors for preoperative deep vein thrombosis in elderly patients with end-stage osteoarthritis following total knee arthroplasty: a retrospective cohort study.

BACKGROUND: Deep vein thrombosis (DVT) is a common and serious risk in elderly patients with knee osteoarthritis (OA), making preoperative detection crucial. Despite this, identifying OA patients at high risk for preoperative DVT and appropriately targeting them for venous ultrasound screening remains a challenge. There is limited research-based evidence on the risk factors for preoperative DVT in elderly patients with end-stage OA. We examined the incidence of and risk factors for preoperative DVT in elderly patients with end-stage OA scheduled for total knee arthroplasty. METHODS: We retrospectively analyzed the demographic data (age, sex, body mass index, current smoking, alcohol consumption, walking status, and Barthel index score), medical history, and laboratory test indices of 1411 patients with end-stage OA aged ≥ 60 years scheduled for total knee arthroplasty from January 2015 to December 2018. Risk factors for preoperative DVT were evaluated by univariate and multivariate logistic analyses. Receiver operating characteristic analysis was performed to determine optimal cut-off values. RESULTS: The incidence of preoperative DVT was 4.5% (63 of 1411 patients). Seven independent risk factors were correlated with preoperative DVT in the multivariate logistic regression: age (odds ratio [OR], 1.073; P = 0.002), D-dimer concentration (OR, 1.173; P = 0.003), hyperlipidemia (OR, 2.038; P = 0.045), atrial fibrillation (OR, 4.004; P = 0.033), chronic renal failure (OR, 6.732; P = 0.008), chronic obstructive pulmonary disease (COPD) (OR, 8.721; P = 0.001), and walking status (wheelchair) (OR, 2.697; P = 0.002). The optimal cut-off values for predicting preoperative DVT were 0.585 µg/mL for the D-dimer concentration (area under the curve [AUC], 0.769; P < 0.001) and 72.5 years for age (AUC, 0.668; P < 0.001). CONCLUSION: Among elderly patients with end-stage OA, venous ultrasonography to rule out DVT risk should be prioritized in those with a high D-dimer concentration (> 0.585 µg/mL), high age (> 72.5 years), hyperlipidemia, atrial fibrillation, chronic renal failure, COPD, and walking status (wheelchair).

Neonatal heart tissue-derived EVs alleviate adult ischemic cardiac injury via regulating the function of macrophages and cardiac regeneration in murine models.

Previous studies confirmed the regenerative capacity of the mammalian neonatal heart. We recently found that adult heart tissue-derived EVs can protect the heart from myocardial ischemia-reperfusion (I/R). However, the role of EVs from neonatal heart tissue in cardiac healing post-ischemia remains unclear. In the present study, we revealed that intramyocardial administration of neonatal cardiac tissue-derived EVs (ncEVs) alleviated cardiac inflammation, mitigated reperfusion injury, and improved cardiac function in murine I/R models. In vitro, ncEVs inhibited M1 polarization of macrophages induced by LPS while up-regulated their phagocytic function via the miR-133a-3p-Ash1l signaling pathway. Moreover, the administration of ncEVs contributed to cardiac angiogenesis and improved cardiac function in murine myocardial infarction models. Collectively, these results suggested that neonatal heart-derived EVs can regulate the function of macrophages and contribute to cardiac regeneration and function recovery in murine cardiac ischemic models. Therefore, the derivatives in neonatal heart tissue-derived EVs might serve as a potential therapeutic strategy in ischemic diseases.

Unveiling electron transfer and radical transformation pathways in coupled electrocatalysis and persulfate oxidation reactions for complex pollutant removal.

The degradation of multiple organic pollutants in wastewater via advanced oxidation processes might involve different radicals, of which the types and concentrations vary upon interacting with different pollutants. In this study, electrochemical activation of peroxymonosulfate (E/PMS) using advanced activated carbon cloth (ACC) as electrode was applied for simultaneous degradation of mixed pollutants, e.g., metronidazole (MNZ) and p-chloroaniline (PCA). 92.5 % of MNZ and 91.4 % of PCA can be degraded at the cathode and anode at a low current density and PMS concentration, respectively. The rate constants for the simultaneous removal of MNZ and PCA in the E/PMS/MNZ(PCA) system were 118 times and 6 times higher than those in the sole PMS system, and 2.5 times and 1.6 times higher than those in the E/Na2SO4/MNZ(PCA) system, respectively. Different electrochemical characteristics, EPR spectra and radical quenching tests verified that the degradation of MNZ and PCA in the optimal system proceeded primarily through non-radical-dominated oxidation, involving electron transfer and 1O2 effect. The system also exhibited low energy consumption (0.215 kWh/m-3·order-1), broad operational pH range, excellent removal efficiency for water matrix, and low by-products toxicity, indicating its strong potential for practical applications. The ACC, with its super stable, low cost, and electrochemical activity, make it as a promising materials applicable in the E/PMS system for degradation of multiple pollutants. The study further elucidated the mechanism of pollutant interaction with electrode materials in terms of radical and non-radical transformation, providing fundamental insight into the application of this system for treatment of complex wastewater.

Influence of the Pre-pregnancy Diabetes Mellitus Management Model Based on the Internet of Things Technology Combined With the Paradigmatic Diagnosis and Treatment Management Model on the Pregnancy Outcome.

Context: Pre-gestational diabetes mellitus is a significant health concern associated with an increased rate of health complications in newborns and mothers. Effectively strengthening the management of pregnancy, controlling mothers' blood-sugar levels, and ensuring the safety of mothers and children are factors that needs attention. Objective: The study intended to explore the effects on pregnancy outcomes of a new integrated management model of pre-pregnancy diabetes that uses the Internet of Things technology, combined with typical diagnosis and treatment, to improve maternal and fetal outcomes. Design: The research team conducted a prospective cohort study. Setting: The study took place in the Department of Obstetrics at Shanghai Sixth People's Hospital in Shanghai, China. Participants: Participants were 173 pregnant women at the hospital who had received a diagnosis of gestational diabetes mellitus between January 2020 and December 2022. Interventions: The research team divided participants into two groups: (1) the joint management group, the intervention group, with 87 participants, and (2) the traditional management group, the control group, with 86 participants. Both groups received standardized treatment and nutritional intervention, and the joint management group also received treatment under the new management mode, the Internet of Things. Outcome Measures: The research team examined: (1) blood-glucose compliance-fasting blood glucose and 2 h postprandial blood glucose; (2) comparison of treatment compliance between the groups; (3) pregnancy outcomes, (4) newborn outcomes, (5) patient satisfaction; and (6) lipid metabolism, including triglycerides (TG), high-density lipoproteins (HDL), total cholesterol (TCH) free fatty acid (FFA). Results: Compared to the traditional management group, the joint management group's: (1) fasting blood glucose and 2 h postprandial blood glucose were significantly lower than those of traditional management group (P < .0001); (2) treatment compliance was significantly higher (P < .05); (3) incidences of cesarean sections (P = .0069) and fetal distress (P = .0145) were significantly lower, (4) incidences of macrosomia and neonatal hypoglycemia were significantly lower (P < .05); (5) patient satisfaction rate was significantly higher (P = .0023) and (6) TG (P < .0001), LDL (P < .0001), and FFA (P = .0011) were significantly lower and HDL (P < .0001) was significantly higher. Conclusions: The management mode that combined the Internet of Things platform with standardized diagnosis and treatment of pregnant women with gestational diabetes mellitus had good compliance and high patient satisfaction and could reduce maternal and infant complications; it's worthy of clinical promotion.

Progress of researches on the mechanisms of acupuncture intervention underlying improvement of ischemic stroke by regulating microRNAs. / 针刺调控微小RNAæ²»ç–—ç¼ºè¡€æ€§è„‘å’ä¸­æœºåˆ¶çš„ç ”ç©¶è¿›å±•.

MicroRNAs play an important role in the occurrence and development of ischemic stroke (IS). A lot of researches have shown that acupuncture intervention can improve IS-induced neural dysfunction by regulating miRNA. In the present paper, we summarized the current progress of researches on the mechanisms of acupuncture underlying improvement of IS via regulation of miRNA from 1) promoting angiogenesis and increasing cerebral blood flow, 2) inhibiting inflammatory response, 3) maintaining blood-brain barrier homeostasis and relieving brain edema, 4) regulating programmed cell death, 5) promoting neuron regeneration, and 6) improving synaptic plasticity. These miRNA -related mechanisms may provide a reference for the follow-up research .

Tracking the Helicobacter pylori Epidemic in Adults and Children in China.

BACKGROUND: The Helicobacter pylori epidemic in China accounts for up to a third of gastric cancers worldwide. We aim to monitor the temporal and spatial dynamics of H. pylori infection in both adults and children across China. MATERIALS AND METHODS: We developed a surveillance system consisting of a data collection component that harnessed survey reports in natural populations and an analysis component that accounted for the differences in survey time and location, population age structure, and H. pylori detection method. System outputs were estimates of the prevalence of H. pylori in adults and children (aged ≤ 14 years) presented at three hierarchical levels (regional, provincial, and prefectural). RESULTS: The overall prevalence of H. pylori infection declined sharply in adults (63.3%, 52.5%, 43.4%, and 38.7%) and less sharply in children (23.1%, 26.1%, 16.0%, and 15.7%) in 1983-1999, 2000-2009, 2010-2014, and 2015-2019, respectively. The changes were asynchronous across regions, with the most marked declines in the Northwest, the Hong Kong-Macao-Taiwan region, and the East. We estimated that 457.6 million adults and 44.5 million children have been infected with H. pylori, with cross-province disparities in prevalence ranging from 24.3% to 69.3% among adults and 2.9% to 46.3% among children. In general, the risk level of gastric cancer increased as the prevalence of H. pylori increased. The correlation was statistically significant for both adult men (Spearman coefficient of correlation: 0.393, p = 0.0146) and women (0.470, p = 0.0029). CONCLUSIONS: The tracking system would be important for the continuous and stratified tracking of the Helicobacter pylori epidemic across China and can be used to furnish an evidence base for the formulation of tailored prevention strategies.

CHIR99021 and Brdu Are Critical in Chicken iPSC Reprogramming via Small-Molecule Screening.

Background/Objectives: Induced pluripotent stem cells (iPSCs) reprogrammed from somatic cells into cells with most of the ESC (embryonic stem cell) characteristics show promise toward solving ethical problems currently facing stem cell research and eventually yield clinical grade pluripotent stem cells for therapies and regenerative medicine. In recent years, an increasing body of research suggests that the chemical induction of pluripotency (CIP) method can yield iPSCs in vitro, yet its application in avian species remains unreported. Methods: Herein, we successfully obtained stably growing chicken embryonic fibroblasts (CEFs) using the tissue block adherence method and employed 12 small-molecule compounds to induce chicken iPSC formation. Results: The final optimized iPSC induction system was bFGF (10 ng/mL), CHIR99021 (3 µM), RepSox (5 µM), DZNep (0.05 µM), BrdU (10 µM), BMP4 (10 ng/mL), vitamin C (50 µg/mL), EPZ-5676 (5 µM), and VPA (0.1 mM). Optimization of the induction system revealed that the highest number of clones was induced with 8 × 104 cells per well and at 1.5 times the original concentration. Upon characterization, these clones exhibited iPSC characteristics, leading to the development of a stable compound combination for iPSC generation in chickens. Concurrently, employing a deletion strategy to investigate the functionality of small-molecule compounds during induction, we identified CHIR99021 and BrdU as critical factors for inducing chicken iPSC formation. Conclusions: In conclusion, this study provides a reference method for utilizing small-molecule combinations in avian species to reprogram cells and establish a network of cell fate determination mechanisms.

Design of a long-lived Mo2C-MoO2@GC-N electrocatalyst by the ambient DC arc plasma for the hydrogen evolution reaction.

A crucial challenge in hydrogen production through electrolysis is developing inexpensive, earth-abundant, and highly efficient Pt-free electrocatalysts for the hydrogen evolution reaction (HER). Molybdenum carbide is ideal for this application because of its special electrical structure, low cost, and advantageous characteristics. Herein, the long-lived electrocatalysts for HER have been synthesized via the direct current (DC) arc discharge plasma method under ambient air conditions, and the relationship between the properties of materials and catalytic characteristics has been established. The samples differed in the ratio of molybdenum, graphite, and melamine. The sample with the highest proportion of melamine in the initial mixture has Mo2C-MoO2 heterointerfaces, which demonstrates the highest and most stable electrocatalytic activity with the overpotential of 148 mV at 10 mA·cm-2 and Tafel slope of 63 mV·dec-1 in alkaline electrolyte. Meanwhile, the electrodes demonstrated long-lived electrochemical durability for two weeks and investigated the features of forming a stable system for HER.

New species of Eupolyphaga Chopard, 1929 and Pseudoeupolyphaga Qiu & Che, 2024 (Blattodea, Corydioidea, Corydiinae), with notes on their female genitalia.

Two new species of Eupolyphaga (E.bicolor Han, Che & Wang, sp. nov. and E.nigra Han, Che & Wang, sp. nov.) and six new species of Pseudoeupolyphaga (P.flava Han, Che & Wang, sp. nov., P.deficiens Han, Che & Wang, sp. nov., P.magna Han, Che & Wang, sp. nov., P.longiseta Han, Che & Wang, sp. nov., P.latizona Han, Che & Wang, sp. nov., and P.baimaensis Han, Che & Wang, sp. nov.) are described and illustrated. The female external genitalia and spermathecae of these two genera are reported and the role of these characters in species delimitation is discussed.

A prospective randomized controlled study of multi-intravenous infusion of umbilical cord mesenchymal stem cells in patients with heart failure and reduced ejection fraction (PRIME-HFrEF) trial: Rationale and design.

Background and objective: The use of mesenchymal stem cells for heart failure treatment has gained increasing interest. However, most studies have relied on a single injection approach, with no research yet confirming the effects of multiple administrations. The present trial aims to investigate the safety and efficacy of multi-intravenous infusion of umbilical cord-mesenchymal stem cells (UC-MSCs) in patients with heart failure and reduced ejection fraction (HFrEF). Methods: The PRIME-HFrEF trial is a single-center, prospective, randomized, triple-blinded, placebo-controlled trial of multi-intravenous infusion of UC-MSCs in HFrEF patients. A total of 40 patients meeting the inclusion criteria for HFrEF were enrolled and randomized 1:1 to the MSC group or the placebo group. Patients enrolled will receive intravenous injections of either UC-MSCs or placebo every 6 weeks for three times. Both groups will be followed up for 12 months. The primary safety endpoint is the incidence of serious adverse events. The primary efficacy endpoint is a change in left ventricular ejection fraction (LVEF) measured by left ventricular opacification (LVO) with contrast echocardiography and magnetic resonance imaging (MRI) at 12 months. The secondary endpoints include a composite of the incidence of death and re-hospitalization caused by heart failure at the 12th month, serum NT-proBNP, growth stimulation expressed gene 2 (ST2), and a change of right ventricular structure and function. Conclusions: The PRIME-HFrEF study is designed to shed new light on multiple UC-MSC administration regimens for heart failure treatment.

Review of Emamectin Benzoate Poisoning.

Emamectin Benzoate, a potent pesticide extensively used in agriculture, has raised concerns due to its potential for severe poisoning. While its safety in mammals is attributed to limited blood-brain barrier penetration and reduced affinity for specific channels, Emamectin Benzoate Poisoning can unexpectedly manifest with severe symptoms. Predominantly resulting from intentional ingestion, clinical presentations involve central nervous system depression, respiratory distress, gastrointestinal symptoms, and sore throat. Formulation solvents enhance toxicity, leading to corrosive injuries and metabolic imbalances. Skin contact induces irritation. Diagnosis relies on clinical evaluation, lacking specific laboratory data. Treatment lacks a designated antidote; hence, decontamination and cautious symptomatic management play pivotal roles. Severe cases require vigilant monitoring, with intensive care unit admission calling for altered consciousness and respiratory distress.

Artificial intelligence for geoscience: Progress, challenges, and perspectives.

This paper explores the evolution of geoscientific inquiry, tracing the progression from traditional physics-based models to modern data-driven approaches facilitated by significant advancements in artificial intelligence (AI) and data collection techniques. Traditional models, which are grounded in physical and numerical frameworks, provide robust explanations by explicitly reconstructing underlying physical processes. However, their limitations in comprehensively capturing Earth's complexities and uncertainties pose challenges in optimization and real-world applicability. In contrast, contemporary data-driven models, particularly those utilizing machine learning (ML) and deep learning (DL), leverage extensive geoscience data to glean insights without requiring exhaustive theoretical knowledge. ML techniques have shown promise in addressing Earth science-related questions. Nevertheless, challenges such as data scarcity, computational demands, data privacy concerns, and the "black-box" nature of AI models hinder their seamless integration into geoscience. The integration of physics-based and data-driven methodologies into hybrid models presents an alternative paradigm. These models, which incorporate domain knowledge to guide AI methodologies, demonstrate enhanced efficiency and performance with reduced training data requirements. This review provides a comprehensive overview of geoscientific research paradigms, emphasizing untapped opportunities at the intersection of advanced AI techniques and geoscience. It examines major methodologies, showcases advances in large-scale models, and discusses the challenges and prospects that will shape the future landscape of AI in geoscience. The paper outlines a dynamic field ripe with possibilities, poised to unlock new understandings of Earth's complexities and further advance geoscience exploration.

Small molecule CCR4 antagonists in cutaneous T-cell lymphoma.

Mycosis fungoides (MF) and Sézary syndrome (SS) are two most common types of cutaneous T-cell lymphoma (CTCL). Despite advances in understanding the pathogenesis of MF and SS, effective treatments remain limited. CC chemokine receptor 4 (CCR4) is highly expressed on CTCL cells and serves as a great therapeutic target. Mogamulizumab, an FDA-approved anti-CCR4 antibody, has shown efficacy in treating MF/SS; however, its side effects have raised concerns, underscoring the need for more effective and less toxic CCR4-targeted therapies. While small molecule CCR4 antagonists have been studied in other diseases involving CCR4+ Th2 cells and regulatory T-cells, but their effects in CTCL have not been previously explored. This study assessed the effects of two small molecule CCR4 antagonists, C021 (Class I) and AZD2098 (Class II), in MF derived cell line (MJ) and SS derived cell line (HuT 78) in vitro and in vivo. As results, both C021 and AZD2098 inhibited chemotactic responses to CCL17 and CCL22 in MJ and HuT 78 cells. However, only C021 downregulated CCR4 expression, inhibited cell proliferation, induced cell apoptosis and cell cycle arrest, and decreased colony formation in MJ and HuT 78 cells in vitro. Furthermore, only C021 inhibited tumor growth in CTCL xenograft mice in vivo. These findings suggest that Class I CCR4 antagonists such as C021 exerts more potent anti-tumor effects on CTCL cells in vitro and in vivo compared to Class II CCR4 antagonists like AZD2098, highlighting its potential for clinical application.

Contactless ultrasound droplet manipulation system for mixing chemical reagents.

Green chemistry has been a rising topic in environmental sustainability, with a focus on the waste and consumption reduction of chemical and biomedical industries. Traditional chemical handling processes require tools that contact chemical reagents to produce vast amounts of residues and disposals. This study presents a contactless chemical mixing system that integrates acoustic droplet ejection and levitation techniques. First, the acoustic droplet ejection system creates a droplet in mid-air from a designated liquid reservoir by focusing acoustic energy at the liquid-air junction. The droplet levitation system captures and transports the droplet along a predetermined path by shifting the focal points of the acoustic standing waves. This facilitates contactless mixing of chemicals in a defined ratio. Notably, this study employs piezoelectric discs in an acoustic droplet ejection system to eject droplets from liquids. The relationship between the duration of the driving bursts and height and size of ejected droplets was also investigated. The proposed acoustic standing wave levitation system captures droplets with weights between 2.8 and 5.2 mg. To assess the reliability of the proposed system, 25 droplets were sequentially generated and transported to the mixing well without failure. The root mean square error between the collected and expected liquid weights was only 0.098 mg. The proposed system offers a promising solution for reducing waste and promoting environmentally friendly practices in chemical and biomedical laboratories.

BiOBr/FeMoO4 composite achieves oxygen vacancy concentration adjustment to promote persulfate activation degradation of organic pollutants in saline water.

The investigation about the mechanism of crystal plane regulation on the generation of oxygen vacancies remains a challenge. In this paper, BiOBr/FeMoO4 composites were synthesized by precise control of crystal plane growth, and it exhibited the enhanced concentration of oxygen vacancies due to lower formation energy of oxygen vacancies. The composite performs higher photo-Fenton-like ability for degrading oxytetracycline hydrochloride (OTC). Structural analyses and theoretical calculations reveal that crystal plane regulation induces significant changes in oxygen vacancy concentration. The BiOBr/FeMoO4/peroxydisulphate (PDS) /light system, which dominated by the non-radical pathway, degraded 96.8 % ± 1.0 % of OTC within 30 min. The activation mechanism of the system and the degradation pathway of OTC were elucidated. The intermediates in the degradation process of OTC were evaluated using liquid chromatograph-mass spectrometer (LC-MS), toxicity evaluation software tool (T.E.S.T) and soybean germination experiments. This work offers novel insights into the pivotal role of crystal plane directional regulation in the quantitative generation of oxygen vacancies.

Ion-Sieving Separator Functionalized by Natural Mineral Coating toward Ultrastable Zn Metal Anodes.

Aqueous zinc-ion batteries (AZIBs) exhibit promising prospects in becoming large-scale energy storage systems due to environmental friendliness, high security, and low cost. However, the growth of Zn dendrites and side reactions remain heady obstacles for the practical application of AZIBs. To solve these challenges, a functionalized Janus separator is successfully constructed by coating halloysite nanotubes (HNTs) on glass fiber (GF). Impressively, the different electronegativity on the inner and outer surfaces of HNTs endows the HNT-GF separator with ion-sieving property, leading to a significantly high transference number of Zn2+ (tZn2+ = 0.71). Meanwhile, the HNT-GF separator works as an interfacial ion comb to regular Zn2+ flux and realizes multisite progressive nucleation, bringing decreased nucleation overpotential and uniform Zn2+ deposition. Consequently, the HNT-GF separator enables the Zn anode to display an ultralong plating/stripping life of 3000 h and high rate tolerance with a stable long cycle life even under a density of 50 mA cm-2. Moreover, the Zn∥HNT-GF∥MnO2 full cell represents an ultrastable cycling stability with a high capacity retention of 93.4% even after 1000 cycles at a current density of 2 A g-1. This work provides a convenient method for the separator modification of AZIBs.

VADIS: A Visual Analytics Pipeline for Dynamic Document Representation and Information-Seeking.

In the biomedical domain, visualizing the document embeddings of an extensive corpus has been widely used in informationseeking tasks. However, three key challenges with existing visualizations make it difficult for clinicians to find information efficiently. First, the document embeddings used in these visualizations are generated statically by pretrained language models, which cannot adapt to the user's evolving interest. Second, existing document visualization techniques cannot effectively display how the documents are relevant to users' interest, making it difficult for users to identify the most pertinent information. Third, existing embedding generation and visualization processes suffer from a lack of interpretability, making it difficult to understand, trust and use the result for decision-making. In this paper, we present a novel visual analytics pipeline for user-driven document representation and iterative information seeking (VADIS). VADIS introduces a prompt-based attention model (PAM) that generates dynamic document embedding and document relevance adjusted to the user's query. To effectively visualize these two pieces of information, we design a new document map that leverages a circular grid layout to display documents based on both their relevance to the query and the semantic similarity. Additionally, to improve the interpretability, we introduce a corpus-level attention visualization method to improve the user's understanding of the model focus and to enable the users to identify potential oversight. This visualization, in turn, empowers users to refine, update and introduce new queries, thereby facilitating a dynamic and iterative information-seeking experience. We evaluated VADIS quantitatively and qualitatively on a real-world dataset of biomedical research papers to demonstrate its effectiveness.

Spatial consistency of co-exposure to air and surface water pollution and cancer in China.

Humans can be exposed to multiple pollutants in the air and surface water. These environments are non-static, trans-boundary and correlated, creating a complex network, and significant challenges for research on environmental hazards, especially in real-world cancer research. This article reports on a large study (377 million people in 30 provinces of China) that evaluated the combined impact of air and surface water pollution on cancer. We formulate a spatial evaluation system and a common grading scale for co-pollution measurement, and validate assumptions that air and surface water environments are spatially connected and that cancers of different types tend to cluster in areas where these environments are poorer. We observe "dose-response" relationships in both the number of affected cancer types and the cancer incidence with an increase in degree of co-pollution. We estimate that 62,847 (7.4%) new cases of cancer registered in China in 2016 were attributable to air and surface water pollution, and the majority (69.7%) of these excess cases occurred in areas with the highest level of co-pollution. The findings clearly show that the environment cannot be considered as a set of separate entities. They also support the development of policies for cooperative environmental governance and disease prevention.