Gastrointestinal bleeding risk factors in type A aortic dissection post-aortic arch replacement.

Background: Gastrointestinal bleeding (GIB) is a notable complication in patients diagnosed with aortic dissection (AD). We evaluated the outcomes and identified the risk factors associated with GIB in patients with AD. Methods: A retrospective case-control study was conducted on patients diagnosed with type A aortic dissection (TAAD) who underwent total aortic arch replacement (TAAR) at our institution from July 2021 to July 2023. Comprehensive clinical data, laboratory findings, and imaging results were meticulously gathered and analyzed to identify potential risk factors linked to GIB in this patient cohort. Results: Of the 198 AD patients who underwent TAAR, 38 (19.2%) developed postoperative GIB (GIB group), with a median interval of 7 days between surgery and bleeding onset. The GIB group exhibited significantly higher mortality (26.3% vs. 3.1%, P<0.001), prolonged intensive care unit (ICU) stay {15 [interquartile range (IQR), 8-25] vs. 7 (IQR, 5-12) days, P<0.001}, and extended duration of ventilation [168 (IQR, 120-372) vs. 71 (IQR, 34-148) hours, P<0.001] compared to the control group (n=160, 80.8%). Logistic regression analysis identified age >54 years [odds ratio (OR): 3.529], intraoperative red blood cell (RBC) transfusion >600 mL (OR: 3.865), and concomitant celiac trunk and superior mesenteric artery (SMA) hypoperfusion (OR: 15.974) as independent risk factors for GIB in AD patients. Conclusions: GIB subsequent to TAAR in AD patients is linked to adverse prognosis. Factors such as advanced age, extensive intraoperative transfusion, and gastrointestinal (GI) perfusion abnormalities may heighten the risk of GIB in this patient population.

Sentiment analysis of online reviews of energy-saving products based on transfer learning and LBBA model.

With the exacerbation of global climate change and the growing environmental awareness among the general public, the concept of green consumption has gained significant attention across various sectors of society. As a representative example of green consumer products, energy-saving products play a crucial role in the timely realization of dual carbon goals. However, an analysis of online comments regarding energy-saving products reveals that the majority of these products still exhibit shortcomings in terms of efficacy, noise level, cost-effectiveness, and particularly, energy-saving appliances. This study focuses on the user-generated online comments data from the Taobao e-commerce platform for Grade 1 energy-saving refrigerators. By employing text mining techniques, the study aims to extract the essential information and sentiments expressed in the comments, in order to explore the consumption characteristics of Grade 1 energy-saving refrigerators. Moreover, the LBBA (LDA-Bert-BiLSTM-Attention) model is utilized to investigate the consumer topics of interest and emotional features. Initially, the LDA model is adopted to identify the attributes and weights of consumer concerns. Subsequently, the Bert model is pre-trained with the online comment data, and combined with the BiLSTM algorithm and Attention mechanism to predict sentiment categories. Finally, a transfer learning approach is utilized to determine the sentiment inclination of user-generated online comments and to identify the primary driving factors behind each sentiment category. This research employs sentiment analysis on online comments data regarding energy-saving products to uncover consumer sentiment attributes and emotional characteristics. It provides decision-makers with a comprehensive and systematic understanding of public consumption intentions, offering decision support for the efficient operation and management of the energy-saving product market.

Enhancement of antitumor response of staphylococcal enterotoxin C2 mutant 2M-118 by promoting cell-mediated antitumor immunity.

BACKGROUND: Staphylococcal enterotoxin C2 (SEC2) is used as an immunotherapeutic drug in China. However, SEC2 are limited due to its immunosuppressive and toxic effects. A SEC2 2M-118 (H118A/T20L/G22E) mutant generated by site-directed mutagenesis was studied to elucidate the underlying antitumor mechanism. METHODS: The effects of 2M-118 on mouse fibrosarcoma (Meth-A) cells and cytokine responses were tested in vitro using a transwell assay and ELISA, respectively. 2M-118 effect on immune function in tumor-bearing mice was tested. Cytokine levels and antitumor responses were measured using ELISA and flow cytometry, respectively. TUNEL staining and immunohistochemistry were employed to detect the tumor apoptosis and CD4+ and CD8+ tumor infiltrating lymphocytes (TILs) in tumor tissue. RESULTS: 2M-118 demonstrated the growth inhibition on tumor cells, increase of cytokines production (IL-2, IFN-γ, and TNF-α) and splenocyte proliferation in vitro. 2M-118 effectively inhibited tumor development and increased lymphocytes and cytokines in a tumor-bearing mouse model. Additionally, 2M-118 regulated the tumormicroenvironment by reducing the number of myeloid-derived suppressor cells (MDSCs), increasing the number of TILs, and inducing tumorcell apoptosis. CONCLUSION: 2M-118 promotes immune function and enhances antitumor response. This indicates that 2M-118 could potentially be developed as a novel anti-tumor drug with-highefficiencyandlowtoxicity.

Crown Ether Electrolyte Induced Li2O2 Amorphization for Low Polarization and Long Lifespan Li-O2 Batteries.

Lithium-oxygen batteries possess an extremely high theoretical energy density, rendering them a prime candidate for next-generation secondary batteries. However, they still face multiple problems such as huge charge polarization and poor life, which lay a significant gap between laboratory research and commercial applications. In this work, we adopt 15-crown-5 ether (C15) as solvent to regulate the generation of discharge products in lithium-oxygen batteries. The coronal structure endows C15 with strong affinity to Li+, firmly stabilizes the intermediate LiO2 and discharge product Li2O2. Thus, the crystalline Li2O2 is amorphized into easily decomposable amorphous products. The lithium-oxygen batteries assembled with 0.5 M C15 electrolyte show an increased discharge capacity from 4.0 mAh cm-2 to 5.7 mAh cm-2 and a low charge overpotential of 0.88 V during the whole lifespan at 0.05 mA cm-2. The batteries with 1 M C15 electrolyte can cycle stably for 140 cycles. Furthermore, the amorphous characteristic of Li2O2 product is preserved when matched with redox mediators such as LiI, with the charge polarization further decreasing to 0.74 V over a cycle life of 190 cycles. This provides new possibilities for electrolyte design to promote Li2O2 amorphization and reduce charge overpotential in lithium-oxygen batteries.

Electrolyte Design for Lithium-Ion Batteries for Extreme Temperature Applications.

With increasing energy storage demands across various applications, reliable batteries capable of performing in harsh environments, such as extreme temperatures, are crucial. However, current lithium-ion batteries (LIBs) exhibit limitations in both low and high-temperature performance, restricting their use in critical fields like defense, military, and aerospace. These challenges stem from the narrow operational temperature range and safety concerns of existing electrolyte systems. To enable LIBs to function effectively under extreme temperatures, the optimization and design of novel electrolytes are essential. Given the urgency for LIBs operating in extreme temperatures and the notable progress in this research field, a comprehensive and timely review is imperative. This article presents an overview of challenges associated with extreme temperature applications and strategies used to design electrolytes with enhanced performance. Additionally, the significance of understanding underlying electrolyte behavior mechanisms and the role of different electrolyte components in determining battery performance are emphasized. Last, future research directions and perspectives on electrolyte design for LIBs under extreme temperatures are discussed. Overall, this article offers valuable insights into the development of electrolytes for LIBs capable of reliable operation in extreme conditions.

Climate co-benefits of VOC control policies in China based on a cross-scale approach.

Volatile organic compounds (VOC) contributing to smog formation, have been an important indicator of atmospheric governance during China's "14th Five-Year Plan". VOC would be possibly incorporated into the scope of environmental protection tax, but previous studies have seldom explored impacts of VOC control policies at national and regional levels. Here, we design a national uniform VOC control policy, as well as two regionally differentiated policies based on regional disparities in PM2.5 concentrations and energy intensity by using a cross-scale dynamic computable general equilibrium (CGE) model. Our analysis is to assess the impacts of these policies on VOC, CO2, sulfur dioxide (SO2), nitrogen oxides (NOX), and PM2.5 emissions, air quality and environmental equity, and to estimate health benefits, policy costs and net benefits. We find that national and regionally differentiated VOC control policies generally lead to VOC emission reductions and generate co-benefits on emission reductions in CO2, SO2, NOX and PM2.5 at national and provincial levels. However, regional emission leakage exists due to differences in the provincial costs of VOC mitigation. The regionally differentiated VOC pricing policies are found to be more effective to enhance environmental equity than the uniform policy. In particular, the regionally differentiated VOC control policy based on provincial energy efficiency is found to be superior to other policies in terms of improve air quality. Furthermore, the human health benefits associated with VOC pricing policies would partially offset policy costs at both the national and regional levels. Our results suggest that policymakers would pay attention to developing regions with low energy efficiency which have the great emission reduction potential. Advanced producing technology and further end-of-pipe control measures to reduce non-combustion PM2.5 emissions are needed. VOC policy designed based on provincial energy efficiency provides great insights for environmental policy making to accomplish 2035 goal of building a Beautiful China.

Long-Lifespan Lithium Metal Batteries Enabled by a Hybrid Artificial Solid Electrolyte Interface Layer.

Lithium metal batteries based on metallic Li anodes have been recognized as competitive substitutes for current energy storage technologies due to their exceptional advantage in energy density. Nevertheless, their practical applications are greatly hindered by the safety concerns caused by lithium dendrites. Herein, we fabricate an artificial solid electrolyte interface (SEI) via a simple replacement reaction for the lithium anode (designated as LNA-Li) and demonstrate its effectiveness in suppressing the formation of lithium dendrites. The SEI is composed of LiF and nano-Ag. The former can facilitate the horizontal deposition of Li, while the latter can guide the uniform and dense lithium deposition. Benefiting from the synergetic effect of LiF and Ag, the LNA-Li anode exhibits excellent stability during long-term cycling. For example, the LNA-Li//LNA-Li symmetric cell can cycle stably for 1300 and 600 h at the current densities of 1 and 10 mA cm-2, respectively. Impressively, when matching with LiFePO4, the full cells can steadily cycle for 1000 times without obvious capacity attenuation. In addition, the modified LNA-Li anode coupled with the NCM cathode also exhibits good cycling performance.

FeOCl Nanoparticle-Embedded Mesocellular Carbon Foam as a Cathode Material with Improve d Electrochemical Performance for Chloride-Ion Batteries.

Chloride-ion batteries (CIBs) have been regarded as a promising alternative battery technology to lithium-ion batteries because of their abundant resources, high theoretical volumetric energy density, and high safety. However, the research on chloride-ion batteries is still in its infancy. Exploring appropriate cathode materials with desirable electrochemical performance is in high demand for CIBs. Herein, the FeOCl nanocrystal embedded in a mesocellular carbon foam (MCF) has been prepared and developed as a high-performance cathode material for CIBs. The MCF with uniform and large mesocells (15.7-31.2 nm) interconnected through uniform windows (15.2-21.5 nm) can provide high-speed pathways for electron and chloride-ion transport and accommodate the strain caused by the volume change of FeOCl during cycling. As a result, the optimized FeOCl@MCF cathode exhibits the highest discharge capacity of 235 mAh g-1 (94% of the theoretical capacity) among those of the previously reported metal (oxy)chloride cathodes for CIBs. A reversible capacity of 140 mAh g-1 after 100 cycles is retained. In contrast, only 18 mAh g-1 was kept for the FeOCl cathode.

Early and midterm results of valve-sparing aortic root reconstruction with a bovine pericardium patch for patients with acute type a aortic dissection.

Objectives: We evaluated the feasibility, effectiveness, and safety of valve-sparing aortic root reconstruction with a bovine pericardium patch for patients with acute type A aortic dissection (ATAAD). Methods: From January 2016 to January 2021, 895 consecutive patients with ATAAD received surgical treatment at our hospital. After applying our exclusion criteria, 508 patients were included in this research. Based on the attending surgeon's judgment and preference, 192 patients underwent our novel surgical novel surgical technique of valve-sparing aortic root reconstruction (repair group [RG]) and 316 patients underwent the Bentall procedure (Bentall group [BG]). Results: In the RG, the early mortality rate was 4.2% (8/192). In the BG, the early mortality rate was 5.1% (16/316). There were no significant differences between groups. The incidence of postoperative renal failure in the BG was significantly higher than that in the RG. The mean follow-up time was 2.93 years (standard deviation, ±1.38 years). There were no significant differences between groups regarding ATAAD-related mortality and reoperation. In the RG, the rate of freedom from aortic root reoperation at 5 years was 98.2%, and the grade of aortic regurgitation 6 months later was significant less than that before surgery, and it did not worsen during later follow-up. Conclusions: Valve-sparing aortic root reconstruction with a bovine pericardium patch can be successfully performed for selected patients with ATAAD and is associated with low in-hospital and late mortality rates and low root reoperation rates during early and midterm follow-up.

Evolution of the Knowledge Mapping of Climate Change Communication Research: Basic Status, Research Hotspots, and Prospects.

Climate change communication is a crucial strategy for addressing the major challenges of climate change, and the knowledge mapping analysis and overview of it helps to clarify research progress. Based on CiteSpace, 428 pieces of domestic and foreign literature are collected to clarify the basic status of climate change communication research and summarize research hotspots and prospects. The study found that: (1) The earliest traceable English literature on climate change communication appeared in 2000. The number of articles published has risen steadily since 2008, reaching its first peak in 2015. (2) In contrast, research into Chinese climate change communication began late and progressed slowly. The Chinese literature on climate change communication first appeared in 2009. Although domestic research generally continues to pay attention to this phenomenon, there is still room for development compared with international research. (3) The research hotspots for climate change communication are obtained through keyword co-occurrence analysis. Public perceptions of climate change are strongly influenced by political ideology. Since climate change has political attributes, people from different political parties or groups form their views on climate change through identity protection. (4) The research content on climate change communication can be summarized into the following six aspects: the development of climate change communication research; differences in public perceptions of climate change; factors influencing climate change communication; key elements of the climate change communication process; the important role of the media in climate change communication; and effective strategies for climate change communication. Finally, the shortcomings of this study are summarized and future research prospects on climate change communication are put forward from the perspectives of research methods, research contexts, and research paradigms.

Knowledge domain and research progress in green consumption: a phase upgrade study.

Green consumption (GC), as one of the important initiatives to achieve the goal of carbon peaking and carbon neutrality, has attracted widespread attention from scholars in environmental and economic fields. This article reviews the literature on GC, asking two main questions: how can GC research be analyzed from macro, meso, and micro perspectives? How have the research topics in the field of GC evolved in international and Chinese academia? This study makes a visual analysis of knowledge domain based on the literature of Web of Science Core Collection and China National Knowledge Infrastructure, so as to reveal hot topics, stage division, and research trend of GC research. The results revealed the following: GC research is in a period of rapid growth, and it is mainly distributed in developed countries dominated by the USA and in developing countries dominated by China. There is a trend of interdisciplinary research on GC, such as ecology, psychology, health, systematics, politics, and economics, which indicates that GC research has become increasingly inseparable from human survival and health, psychological acceptance, and social development. For the international academia, GC research pays more attention to the transformation of consumer psychology, while the Chinese academia is more concerned with the regulation of consumer behavior and the activation of green emotions. Considering the focus and characteristics of GC supervision, this study proposes GC 3.0 with a consumer-oriented and emphasizing green emotions and proposes future application scenarios from four aspects: government supervision, social self-regulation, enterprise demonstration, and personal self-monitoring.

Double-Faced Bond Coupling to Induce an Ultrastable Lithium/Li6PS5Cl Interface for High-Performance All-Solid-State Batteries.

Sulfide-type solid electrolytes (SSEs) are supposed to be preferential candidates for all-solid-state Li metal batteries (ASSLMBs) due to their satisfactory Li+ conductivity and preferable mechanical stiffness. Nonetheless, the poor stability between the Li anode and SSEs and uncontrolled Li dendrite growth severely restrict their commercial application. Herein, an amphiphilic LixSiOy-enriched solid electrolyte interphase (SEI) as a "Janus" layer was first introduced at the Li/SSEs interface, and it exhibited bond coupling reactivity with both the Li anode and SSEs by forming Li-S, Li-O-Si, and Si-S covalent bonds, which is called the pincer effect. In addition to the physical isolation of Li and SSEs to prevent side reactions between them, LixSiOy with high ionic conductivity offers abundant and evenly distributed transport channels for fast Li+ migration. As evidenced by in situ microscopy, the high-strength anodic interface constructed by the pincer effect and in situ decomposition mentioned above is free from mechanical damage during the Li plating/stripping. As a result, the symmetric cells exert an outstanding cycling performance for over 2000 h at 0.2 mA cm-2 and even 500 h at 0.5 mA cm-2 without evident resistance growth. The artificial SEI layer with the pincer effect and its effective application in interfacial stabilization put forward a new perspective for the commercialization of ASSLMBs.

MSCs-Derived Extracellular Vesicles Carrying miR-212-5p Alleviate Myocardial Infarction-Induced Cardiac Fibrosis via NLRC5/VEGF/TGF-ß1/SMAD Axis.

The purpose of the present study was to define the role of mesenchymal stem cell (MSC)-derived extracellular vesicles (EVs) in the progression of myocardial infarction (MI)-induced cardiac fibrosis. An in vitro cell model of hypoxia-induced cardiac fibrosis was constructed in cardiac fibroblasts (CFs). miR-212-5p was poorly expressed in clinical pathological samples and animal models of cardiac fibrosis caused by MI, while miR-212-5p expression was enriched in EVs released from MSCs. EVs from MSCs were isolated, evaluated, and co-cultured with CFs. Dual-luciferase reporter gene assay revealed that miR-212-5p negatively targeted NLRC5 progression of cardiac fibrosis. Following loss- and gain-function assay, EVs expressing miR-212-5p protected against cardiac fibrosis evidenced by reduced levels of α-SMA, Collagen I, TGF-ß1, and IL-1ß. In vivo experiments further confirmed the above research results. Collectively, EVs from MSCs expressing miR-212-5p may attenuate MI by suppressing the NLRC5/VEGF/TGF-ß1/SMAD axis.

Public psychological distance and spatial distribution characteristics during the COVID-19 pandemic: a Chinese context.

The COVID-19 pandemic is a public health emergency, which continues to have a significant impact on the functioning of society and the public's daily life. From the perspective of psychological distance (PD), this study used descriptive, differential, and spatial autocorrelation analysis methods to explore the cognitive distance, emotional distance, expected distance and behavioral distance of the Chinese public in relation to the COVID-19 pandemic. An analysis of 4042 valid sample data found that: (1) The event emotional distance and subject emotional distance were both furthest from the event and subject psychological distance dimensions, and anger about the event was the strongest. (2) The government was the most appealing subject in the process of pandemic prevention and control, but at the same time, the public's sense of closeness to the government was also lower than that of the other three subjects, e.g., medical institutions. (3) Different pandemic regions showed significant differences in PD. Mean scores of PD in each risk region were as follows: High-risk regions > medium-risk regions > low-risk regions. (4) From a global perspective, no spatial autocorrelation was found in PD. However, from a local perspective, high-value regions (provinces with distant PD) are mainly concentrated in the southern regions (Guizhou, Guangxi, Hainan, Jiangxi), and low-value regions (provinces with close PD) are mainly concentrated in North China (Shanxi, Hebei, Beijing). Combined with the relevant conclusions, this paper put forward policy recommendations.

Knowledge mapping analysis of international research on environmental communication using bibliometrics.

Environmental communication (EC) is of great significance to the practice of environmental protection by human society, as it involves disseminating ecological and environmental information, communicating environmental risks, and increasing environmental awareness among the audience. In this study, knowledge mapping analysis was used to systematically review research in the field of EC. A scientometric analysis (1900-2020) was carried out on 2219 journal articles obtained from the Web of Science database to explore the basic characteristics, research hotspots, and research frontiers of EC research. The results revealed that: (1) Research on EC received widespread attention since the beginning of the 21st century, and 2010 was an important turning point in the study of EC. EC research shows the trend of interdisciplinary development. (2) Well-known universities in western countries and from around the world constitute the main body of current EC research. However, there is still a lack of international cooperation in the field of EC research. (3) Climate change, as a complex scientific issue, is not only a global environmental issue, but also the most concerned and hot issue in the field of EC. It has a strong political attribute and has become a major issue that cannot be ignored in politics. (4) According to the timeline analysis of research hotspots, EC research was innovatively divided into an initial stage, a development stage, and a rising stage. Combined the keyword bursts result with the research hotspots analysis, the research frontier of EC was divided into four periods. Finally, the shortcomings of this study are summarized and directions for future research of EC are proposed by considering the following four aspects: research perspective, research content, research paradigm and method, and research context.

Suppressing Redox Shuttle with MXene-Modified Separators for Li-O2 Batteries.

Redox mediators (RMs) have been developed as efficient approaches to lower the charge polarization of Li-O2 batteries. However, the shuttle effect resulting from their soluble nature severely damages the battery performance, causing failure of the RM and anode corrosion. In this work, a chemical binding strategy based on a MXene-modified separator with a 3D porous hierarchical structure design was developed to suppress the I3- shutting in LiI-involved Li-O2 battery. As corroborated by experimental characterizations and theoretical calculations, the abundant -OH terminal groups on the MXene surface functioned as effective binding sites for suppressing the migration of I3-, while the 3D porous structure ensured the fast transfer of lithium ions. As a result, the Li-O2 battery with the MXene-modified separator showed no sign of redox shuttling compared with its counterparts in the full discharge/charge tests. In the meantime, the MXene-modified separator based-cell exhibited a stable cycle life up to 100 cycles, which is 3 times longer than the control samples. We believe that this work could provide insights into the development of separator modification for Li-O2 batteries with RMs.

Silencing CircHIPK3 Sponges miR-93-5p to Inhibit the Activation of Rac1/PI3K/AKT Pathway and Improves Myocardial Infarction-Induced Cardiac Dysfunction.

The ceRNA network involving circular RNAs (circRNAs) is essential in the cardiovascular system. We investigated the underlying ceRNA network involving circHIPK3 in myocardial infarction (MI). After an MI model was established, cardiac function was verified, and myocardial tissue damage in mice with MI was evaluated. A hypoxia model of cardiomyocytes was used to simulate MI in vivo, and the expression of and targeting relationships among circHIPK3, miR-93-5p, and Rac1 were verified. The apoptosis of cardiomyocyte was identified. Gain- and loss-of-functions were performed to verify the ceRNA mechanism. The MI-modeled mice showed cardiac dysfunction and enlarged infarct size. CircHIPK3 was highly expressed in mouse and cell models of MI. Silencing circHIPK3 reduced infarct size, myocardial collagen deposition, and myocardial apoptosis rate and improved cardiac function. CircHIPK3 sponged miR-93-5p, and miR-93-5p targeted Rac1. Overexpression of miR-93-5p inhibited MI-induced cardiomyocyte injury and eliminated the harmful effect of circHIPK3. CircHIPK3 acted as ceRNA to absorb miR-93-5p, thus promoting the activation of the Rac1/PI3K/AKT pathway. We highlighted that silencing circHIPK3 can upregulate miR-93-5p and then inhibit the activation of Rac1/PI3K/Akt pathway, which can improve MI-induced cardiac dysfunction.

FeNi-LDH Intercalation for Suppressing the Self-Discharge of the VB2-Air Battery.

The VB2-air battery is currently known for its highest theoretical specific capacity, up to 4060 mA h g-1. This together with the excellent environmental compatibility and high security endues with promising application prospects for the battery. However, the self-discharge of the anode caused by hydrogen evolution corrosion results in a severe capacity loss during discharge. In this work, we studied the FeNi-LDH intercalation for suppressing the self-discharge of the VB2-air battery. We adopt the vertical FeNi-LDH arrays to modify VB2 particles. Hydroxyl ions participating in the discharge reaction are transported along adsorbed water molecules and hydroxide host layers through a rapid hydrogen bond formation and cleavage to the VB2 surface, while the depolarizer hydrogen ions are isolated. The hydrogen evolution corrosion on the VB2 anode is effectively suppressed. As a result, the discharge specific capacity of the battery is increased by 700 mA h g-1.

Measurement of the Energy Intensity of Human Well-Being and Spatial Econometric Analysis of Its Influencing Factors.

Current energy efficiency indicators (such as energy intensity) do not properly reflect the inherent relationship between "energy-environment-health". Therefore, this study introduces the indicator of energy intensity of human well-being (EIWB) to depict the efficiency problem between energy consumption and residents' health. In this paper, panel data of 30 provinces in mainland China from 2005 to 2016 is used to calculate the EIWB of each province and analyze its spatial distribution. Moreover, the effect of influencing factors on EIWB is investigated by using the spatial Durbin model. The results show that: (1) The EIWB presents a spatial agglomeration. The provinces with high EIWB mostly cluster in the northern China. (2) Industrial structure and energy structure have positive effects on EIWB in local area through increasing energy consumption and damaging residents' health. (3) The effect of urbanization and income on local EIWB is significantly positive because it will promote energy consumption. (4) Industrial structure, health expenditure, foreign direct investment and technological progress have spatial spillover effects due to its significant impact on residents' health in neighboring areas. Based on conclusions, the corresponding policy recommendations are proposed.

Immunogenicity and safety of human papillomavirus vaccine coadministered with other vaccines in individuals aged 9-25 years: A systematic review and meta-analysis.

INTRODUCTION: Adolescents and young adults are at a high risk of developing human papillomavirus (HPV) infections, which can be prevented with the use of vaccines. Moreover, a combined immunization strategy for administration of HPV vaccines with other routine vaccines may lead to better compliance. We aim to comprehensively evaluate immunogenicity and safety in the case of concomitantly administered HPV vaccine in individuals aged 9-25 years. METHODS: Relevant studies, published up to December 27, 2018, were identified through searches of Medline/PubMed, EMBASE, Web of Knowledge. The pooled relative risk (RR) of immunogenicity and safety information pertaining to the concomitant administration of HPV vaccines with other routine vaccines in healthy participants aged 9-25 years were evaluated. RESULTS: A total of 13 papers (11,657 participants) were included in this meta-analysis. The analyses showed that, between the concomitant and nonconcomitant administration groups, the seroconversion rate for the specific antibodies against all HPV types (type 16-, 18-, 6-, 11-, 31-, 33-, 45-, 52-, and 58) were the same (the pooled RR = 1.00, 95% confidence interval (CI) of 1.00-1.00); for the bivalent HPV (2vHPV) vaccine, the risks of local adverse events showed no significant difference (the pooled RR = 1.00, 95%CI: 0.97-1.04), and the risks of systemic adverse events were almost similar (the pooled RR = 1.10, 95% CI: 1.03-1.18); for the non-bivalent HPV (4vHPV and 9vHPV) vaccines, the risks of local adverse events were slightly higher in the concomitant administration groups (the pooled RR = 1.31, 95%CI: 1.17-1.47), and the risks of systemic adverse events were higher in the concomitant administration groups (the pooled RR = 2.09, 95% CI: 1.69-2.59). CONCLUSIONS: We believe that the concomitant administration of other vaccines along with HPV vaccine is acceptable and there is no interference with the immune response to HPV vaccine. Concomitant vaccine administration has the potential to minimize the number of vaccination visits, leading to increased compliance, hence more effective disease prevention.