Protective behaviors against COVID-19 and their association with psychological factors in China and South Korea during the Omicron wave: a comparative study

OBJECTIVES

We aimed to explore the level of protective behaviors against COVID-19 and its association with psychological factors in China and South Korea during the Omicron wave.

STUDY DESIGN

Cross-sectional study.

METHODS

We conducted a population-based cross-sectional survey from March 15 to 30, 2023 in China and South Korea. Demographic characteristics, health status, protective behaviors, and psychological factors (including perceived risks, efficacy belief, attribution of disease, fear of COVID-19, trust and evaluation, fatalism, resilience, and pandemic fatigue) were investigated. After adjusting for sociodemographic and health-related factors, multivariable regression models were constructed to explore the psychological influencing factors of protective behavior.

RESULTS

A total of 3000 participants from China and 1000 participants from Korea were included in the final analysis. The mean performance score for protective behaviors among all respondents was 2.885 in China and 3.139 in Korea, with scores ranging from 1 to 4. In China, performance scores were higher in those who were female, aged 30-39, employed, married, living in urban areas, having the highest income level, having the best subjective health status, and having a history of chronic disease (P-value <0.05). In Korea, performance scores were higher for individuals who were female, over 50 years old, educated to high school or below, unemployed, married, had a history of chronic disease, and had never been infected with SARS-CoV-2 (P-value <0.05). In the multivariable regression model, perceived severity (β = 0.067), attribution of disease (β = 0.121), fear of COVID-19 (β = 0.128), trust and evaluation (β = 0.097), psychological resilience (β = 0.068), and efficacy belief (β = 0.216) were positively associated with the performance scores, pandemic fatigue (β = -0.089) was negatively associated with performance scores in China (P-value <0.05). However, in Korea, perceived susceptibility (β = 0.075), fear of COVID-19 (β = 0.107), and efficacy belief (β = 0.357) were positively associated with protective behaviors (P-value <0.05), trust and evaluation (β = -0.078) and pandemic fatigue (β = -0.063) were negatively associated with performance scores (P-value <0.05).

CONCLUSIONS

Populations in both China and Korea demonstrated great compliance with protective behaviors during the Omicron wave. Because of the sociocultural, economic, and political differences, there were differences in the association between psychological factors and protective behaviors in the two countries. This study, from the perspective of psychological factors in different cultural contexts, would provide references for increasing adherence to protective guidelines in future outbreaks of emerging infectious diseases.

Influence of Crosslink Density on Electrical Performance and Rheological Properties of Crosslinked Polyethylene

To investigate the influence of the crosslinked polyethylene (XLPE) structure on electrical performance, various analytical methods were employed to study polyethylene structures with different degrees of crosslinking. Dynamic rheological analysis was conducted to determine material shear viscosity, dynamic viscosity, storage modulus (G'), loss modulus (G″), and other rheological parameters. Additionally, the electrical performance of the material was analyzed by studying the phenomenon of space charge accumulation under direct current voltage. The results indicate that with an increasing mass fraction of the crosslinking agent, the crosslink density of crosslinked polyethylene initially increases and then decreases. When the dicumyl peroxide (DCP) content exceeds 1.0 wt.%, there is an accumulation of like-polarity space charges. The best rheological processing performance of crosslinked polyethylene is observed when the DCP content is in the range of 1.0-1.5 wt.%.

Global burden of sleep disturbances among older adults and the disparities by geographical regions and pandemic periods

Sleep disturbances are highly prevalent during the COVID-19 pandemic, especially among older adults. We aimed to evaluate sleep heath during COVID-19 pandemic and assess the differences among geographical regions and pandemic periods. We searched three databases (PubMed, Embase, Web of Science) to find articles up to March 12, 2023. We included observational studies that reported the prevalence of sleep disturbances among adults aged 60 years or older in any setting. Two researchers independently reviewed the literature and retrieved the data. We used Der Simonian-Laird random effects meta-analyses to pool the data, followed by subgroup analysis, sensitivity analysis, and meta-regression. A total of 64 studies with 181,224 older adults during the pandemic were included. The prevalence of poor sleep quality, short sleep duration, long sleep duration, and insomnia symptoms were 47.12% (95% CI: 25.97%, 68.27%), 40.81% (95% CI: 18.49%, 63.12%), 31.61% (95% CI: 24.83%, 38.38%), and 21.15% (95% CI: 15.30%, 27.00%), respectively. The prevalence of sleep problems reported by self-constructed items was 26.97% (95% CI: 20.73%, 33.22%). When compared to America (64.13%), Europe (20.23%) and the Western Pacific (21.31%) showed a lower prevalence of sleep problems (all P < 0.0001). The prevalence of worsened sleep problems was 27.88% (95% CI: 11.94%, 43.82%). Compared to 2020 (15.14%), it increased to 47.42% in 2021 (P < 0.05). Eight studies on sleep disturbances among 672 older COVID-19 patients were included. The prevalence of sleep problems and insomnia symptoms among older COVID-19 patients were 41.58% (95% CI: 21.97%, 61.20%) and 41.56% (95% CI: 28.11%, 58.02%), respectively. A significant burden related to poor sleep has been observed among older adults worldwide over the past three years, with variations across different regions and time periods. It is important to make more efforts in prevention and intervention to identify the risk factors, treatment, and rehabilitation of sleep disturbances for healthy aging.

Clinical characteristics, outcomes and risk factors for mortality in hospitalized diabetes and chronic kidney disease patients after COVID-19 infection following widespread vaccination

BACKGROUND

COVID-19 poses a significant threat to patients with comorbidities, such as diabetes and chronic kidney disease (CKD). China experienced a nationwide COVID-19 endemic from December 2022 to January 2023, which is the first occurrence of such an outbreak following China's widespread administration of COVID-19 vaccinations.

METHODS

A total of 338 patients with diabetes and CKD combined with COVID-19 infection between December 7, 2022 and January 31, 2023 were included in this study. The end follow-up date was February 10, 2023. Univariate analysis and multivariate Cox analysis were used to analyze risk factors for death.

RESULTS

During the 50-day median follow-up period, 90 patients in the study cohort died, for a mortality rate of 26.63%. The median age of the study cohort was 74 years, with a male predominance of 74%. During hospitalization, 21% of patients had incident AKI, 17% of patients experienced stroke, and 40% of patients experienced respiratory failure. Cox proportional hazard regression showed that older age, a diagnosis of severe or critically severe COVID-19 infection, incident AKI and respiratory failure, higher level of average values of fasting glucose during hospitalization, UA, and total bilirubin were independent risk factors for death in our multivariate model.

CONCLUSIONS

These findings highlight the critical importance of identifying and managing comorbid risk factors for COVID-19, especially among the elderly, in order to optimize clinical outcomes, even after COVID-19 vaccination.

Association of temperature and precipitation with malaria incidence in 57 countries and territories from 2000 to 2019: A worldwide observational study

Background

The transmission of malaria is known to be affected by climatic factors. However, existing studies on the impact of temperature and precipitation on malaria incidence offer no clear-cut conclusions, and there is a lack of research on a global scale. We aimed to estimate the association of temperature and precipitation with malaria incidence globally from 2000 to 2019.

Methods

We used meteorological data from the National Centers for Environmental Information and malaria incidence data from the Global Burden of Disease Study 2019 to calculate effect sizes through quasi-Poisson generalised linear models while controlling for confounders.

Results

231.4 million malaria cases occurred worldwide in 2019. National annual average temperature and precipitation were associated with malaria incidence, with an increase in the age-standardised incidence rate (ASIR) of 2.01% (95% confidence interval (CI) = 2.00, 2.02) and 6.04% (95% CI = 6.00, 6.09) following one unit increase of national annual average temperature and precipitation. In subgroup analysis, we found that malaria incidence in Asian countries was most affected by temperature, while the incidence in African countries was most affected by precipitation (P < 0.05). Stratified by age, children under five were most affected by both temperature and precipitation (P < 0.05). We additionally found that the impact of the national annual average temperature on malaria incidence increased over time (P < 0.05).

Conclusions

We advocate for a comprehensive approach to malaria prevention, focussed on addressing the impact of climate factors through international collaboration, adaptive measures, and targeted interventions for vulnerable populations.

Effect of shenfu injection in patients with septic shock: A systemic review and meta-analysis for randomized clinical trials

ETHNOPHARMACOLOGICAL RELEVANCE

Shenfu injection (SFI) is a well-known Chinese herbal medicine widely used in the treatment of septic shock in China.

AIM OF THE STUDY

To explore the clinical safety and effectiveness of combined application of Shenfu injection in the treatment of septic shock on the basis of routine western medical treatment.

MATERIALS AND METHODS

Randomized controlled trials published before February 28, 2022 in patients with septic shock were searched in the Chinese Biomedical Literature Service System (SinoMed), Embase, PubMed, Cochrane Library, WOS, Scopus. Stata 15.0 and R 4.2.2 were used to meta-analyze sequential organ failure assessment (SOFA) score, case fatality rate, mean arterial pressure (MAP), arterial lactate (Lac). Adverse effects were analyzed by description.

RESULTS

A total of 904 articles were searched and 56 RCTs were included, with a total of 4279 participants. Among them, there were 2148 cases in the SFI group and 2131 cases in the control group. The meta-analysis showed that, comparing with routine western medical therapy, the combined use of SFI could effectively reduce 24 h SOFA (MD = -0.79, 95%CI: (-1.12) - (-0.46)), 72 h SOFA (MD = -1.53, 95%CI: (-1.89) - (-1.17)) and 7 d SOFA (MD = -1.55; 95%CI: (-2.86) - (-0.24)). Besides, combined use of SFI could reduce 14 d case fatality rate (RR = 0.16, 95% CI: 0.07-0.37) and 28 d case fatality rate (RR = 0.82, 95% CI: 0.71-0.95). While SFI group showed almost the same effect in 7 d case fatality rate as control (RR: 0.76; 95% CI: 0.42-1.37; P = 0.37). SFI could increase 6 h MAP (MD = 6.40, 95% CI: 3.43-9.37) and 24 h MAP (MD = 4.79, 95% CI: 1.62-7.95). Additionally, SFI could decrease 6 h Lac (MD = -0.90, 95% CI: (-1.34) - (-0.45)), 24 h Lac (MD = -0.80, 95% CI: (-1.20) - (-0.40)), 48 h Lac (MD = -0.67, 95% CI: (-1.05) - (-0.29)).

CONCLUSIONS

Shenfu injection combined with RWT showed better therapeutic effect than RWT. SFI plus RWT can improve clinical prognosis of patients with septic shock.

Assessing acceptability of the fourth dose against COVID-19 among Chinese adults: A population-based survey

Coronavirus disease 2019 (COVID-19) has wreaked havoc across the globe for approximately three years. Vaccination is a key factor to ending this pandemic, but its protective effect diminishes over time. A second booster dose at the right time is needed. To explore the willingness to receive the fourth dose of the COVID-19 vaccine and its influencing factors, we commenced a national, cross-sectional and anonymous survey in mainland China among people aged 18 and above from October 24 to November 7, 2022. A total of 3,224 respondents were eventually included. The acceptance rate of the fourth dose was 81.1% (95% CI: 79.8-82.5%), while it was 72.6% (95% CI: 71.1-74.2%) for a heterologous booster. Confidence in current domestic situation and the effectiveness of previous vaccinations, and uncertainty about extra protection were the main reasons for vaccine hesitancy. Perceived benefit (aOR = 1.29, 95% CI: 1.159-1.40) and cues to action (aOR = 1.73, 95% CI: 1.60-1.88) were positively associated with the vaccine acceptance, whereas perceived barriers (aOR = 0.78, 95% CI: 0.72-0.84) and self-efficacy (aOR = 0.79, 95% CI: 0.71-0.89) were both negatively associated with it. Additionally, sex, age, COVID-19 vaccination history, time for social media, and satisfaction with the government's response to COVID-19 were also factors affecting vaccination intention. Factors influencing the intention of heterologous booster were similar to the above results. It is of profound theoretical and practical significance to clarify the population's willingness to vaccinate in advance and explore the relevant influencing factors for the subsequent development and promotion of the fourth-dose vaccination strategies.

Pandemic Fatigue and Vaccine Hesitancy among People Who Have Recovered from COVID-19 Infection in the Post-Pandemic Era: Cross-Sectional Study in China

At present, the COVID-19 pandemic is still ongoing globally and the virus is constantly mutating. The herd immunity barrier established by past infections or vaccinations is gradually weakening and reinfections are occurring. To evaluate the pandemic fatigue and vaccine hesitancy among people who have recovered from COVID-19 in the post-pandemic era, we conducted an anonymous cross-sectional survey study in China from 4 July to 11 August 2023, nearly 6 months after the last large-scale nationwide infection. Basic sociodemographic characteristics, health-related factors (smoking, drinking, and chronic disease history), COVID-19 vaccination history, and self-reported long COVID were obtained as potential covariates. A series of logistic regression models were performed to examine the association between pandemic fatigue and vaccine hesitancy toward the next dose of COVID-19 vaccines via crude relative risks (cORs) and adjusted relative risks (aORs) with 95% CIs. According to our results, of the 2942 participants, 1242 (42.2%) were hesitant (unwilling or not sure) to receive the next dose of COVID-19 vaccines. The average score on the Pandemic Fatigue Scale was 21.67 ± 8.86, in which the scores of all items in the vaccine-hesitant group were significantly higher than those in the vaccine-accepting group. Additionally, the higher the pandemic fatigue level among people who have recovered from COVID-19, the more likely they were to be hesitant to receive the next dose of the COVID-19 vaccines (moderate: aOR = 2.94, 95% CI: 2.46-3.53; high: aOR = 6.88, 95% CI: 5.49-8.64). Overall, more than 40% of the recovered participants were unwilling or uncertain about the next vaccine dose, with varying degrees of pandemic fatigue. Pandemic fatigue is a potentially relevant factor for vaccine hesitancy and may hinder the translation of vaccination intention into behavior. Considering the ongoing reinfection situation, implementing a health education plan to reduce pandemic fatigue and prioritizing vaccination issues for people who have recovered from COVID-19 may be key to promoting the reduction of the COVID-19 disease burden and ensuring the health and well-being of the population.

RAP80 Phase Separation at DNA Double-Strand Break Promotes BRCA1 Recruitment and Tumor Radio-Resistance

PURPOSE/OBJECTIVE(S)

RAP80 has been characterized as a component of the BRCA1-A complex and is responsible for the recruitment of BRCA1 to DNA double-strand breaks (DSBs). However, we and others found that the recruitment of RAP80 and BRCA1 are not absolutely temporally synchronized, indicating that other mechanisms, apart from physical interaction, may be implicated. Recently, we and other groups have reported that liquid-liquid phase separation (LLPS) is a pivotal mechanism underlying DNA repair factors condensation at DSBs and their function. In this study, we aim to disclose whether RAP80 undergoes LLPS at DSBs and whether it is required for BRCA1 recruitment.

MATERIALS/METHODS

To verify RAP80 is an LLPS protein and its function in DNA damage response (DDR): (1) candidate-mEGFP fusion protein formed condensates in cells and showed fluorescence recovery after photobleaching (FRAP); (2) candidate protein was expressed in Escherichia coli and purified with GST; (3) intrinsically disordered region (IDR) of RAP80 were predicted and tested in cell and in vitro; (4) lentivirus were used to construct RAP80-Knock out (KO) and RAP80 re-expression cell lines; (5) length gradient K63 poly-ubiquitin chains were chemically synthesized and incubated with RAP80 protein in vitro; (6) BRCA1 and RAP80 location were determined through immunofluorescence; (7) RAP80 protein expression in tissue was determined by IHC staining.

RESULTS

Thin layer scanning and 3D reconstruction of the RAP80-mEGFP-expressing cells under a fluorescence microscope showed that RAP80-mEGFP formed spherical condensates with fast FRAP. Observation of purified proteins revealed that GST-RAP80-mEGFP protein formed liquid-like droplets, presenting as a FRAP and the fusion event among adjacent droplets. PEG-8000 and Ficol-400 strengthened the formation of GST-RAP80-mEGFP droplets in vitro. Later, we used a previously developed optoIDR tool to verify that IDR1 (1-254aa) is critical for RAP80 LLPS. To investigate whether the interaction between RAP80 and K63 poly-ubiquitin chains could enhance the condensation of RAP80, we chemically synthesized K63 ubiquitin chains and incubated them with purified GST-RAP80-mCherry proteins. The results showed that supplementation of ubiquitin multipolymer (poly-ubiquitin) significantly induced the LLPS of RAP80, and the ability of RAP80 condensates formation potency was positively correlated with the length of the ubiquitin chain. Consistent with their LLPS capacity, RAP80-WT-mEGFP, RAP80-(IDR1+AIR)-mEGFP groups showed prominent BRCA1 foci, while RAP80-IDR1-mEGFP and RAP80-(SIM+UIM)-mEGFP groups showed delayed BRCA1 recruitment. In rectal cancer tissues, positive staining of the RAP80 protein was mainly observed in the nucleus of cancer cells and high RAP80 expression was correlated with a shorter overall survival time.

CONCLUSION

RAP80 undergoes LLPS to form liquid-like condensates at DSB sites, which is important for BRCA1 recruitment and enhances tumor radio-resistance.

Prevalence and incidence of stroke among people with HIV

OBJECTIVE

We aimed to obtain more precise estimates of stroke to address the wide variation of stroke burden among people with HIV (PWH) in different clinical settings.

DESIGN

Systematic review and meta-analysis.

METHODS

We systematically searched PubMed, EMBASE, and Web of Science for original articles reporting the prevalence and incidence of stroke among PWH up to November 23, 2022. Der Simonian-Laird random effects were used to obtain pooled estimates and 95% confidence intervals (CIs).

RESULTS

We included 17 observational studies covering 1 749 003 PWH on estimation of prevalence, and 17 cohort studies covering 249 606 PWH on estimation of incidence. The pooled prevalence of stroke was 1.30% (95% CI: 1.01%, 1.59%) for PWH aged at least 15 years, and 3.98% (95% CI: 2.45%, 5.51%) for PWH aged at least 50 years. The pooled incidence of stroke was 17.86 per 10 000 person-years (95% CI: 15.96, 19.76), meanwhile, the pooled incidence of ischemic stroke (31.50 per 10 000 person-years; 95% CI: 11.11, 51.89) was higher than hemorrhagic stroke (4.43 per 10 000 person-years; 95% CI: 1.95, 6.91) among PWH aged at least 15 years.

CONCLUSION

The prevalence of stroke was nearly one per hundred among PWH aged ≥15 years, and reached four per hundred for those aged ≥50 years. The occurrence of stroke is common during HIV progression, particularly ischemic stroke. Therefore, more efforts should be made on implementing policies, strategies, and programs aimed at identifying the risk factors, improving treatment, and facilitating rehabilitation for stroke to reduce the disease burden among PWH.

Incidence and mortality trends of neglected tropical diseases and malaria in China and ASEAN countries from 1990 to 2019 and its association with the socio-demographic index

BACKGROUND

People in China and the countries in the Association of Southeast Asian Nations (ASEAN) are affected by neglected tropical diseases and malaria (NTDM). In this study, we aimed to assess the current status and trends of NTDM burden from 1990 to 2019 in China and ASEAN countries, and also explore the association of NTDM burden with socio-demographic index (SDI).

METHODS

The data from the Global Burden of Diseases Study 2019 (GBD 2019) results were used. Absolute incidence and death number, and age-standardized incidence and mortality rate (ASIR and ASMR) of NTDM in China and ASEAN were extracted. The estimated annual percentage change (EAPC) and join-point regression in the rates quantified the trends. Nonlinear regression (second order polynomial) was used to explore the association between SDI and ASRs.

RESULTS

The ASIR of NTDM increased in China, Philippines, Singapore and Brunei, at a speed of an average 4.15% (95% CI 3.83-4.47%), 2.15% (1.68-2.63%), 1.03% (0.63-1.43%), and 0.88% (0.60-1.17%) per year. Uptrends of ASIR of NTDM in recent years were found in China (2014-2017, APC = 10.4%), Laos (2005-2013, APC = 3.9%), Malaysia (2010-2015, APC = 4.3%), Philippines (2015-2019, APC = 4.2%), Thailand (2015-2019, APC = 2.4%), and Vietnam (2014-2017, APC = 3.2%, all P < 0.05). Children < 5 had relatively low incidences but unexpectedly high mortality rates of NTDM in most ASEAN countries. Both incidence and mortality rates of NTDM were higher in older people. ASIR and ASMR of NTDM had a U-shaped association with SDI.

CONCLUSIONS

The burden of NTDM in China and ASEAN countries was still huge and affects vulnerable and impoverished populations' livelihoods, including children under the age of 5 and people aged 60 and older. Facing with the large burden and complex situation of NTDM in China and ASEAN countries, regional cooperating strategies are needed to reduce the burden of NTDM, so as to achieve the goal of elimination in the world.

Association between inequalities in human resources for health and all cause and cause specific mortality in 172 countries and territories, 1990-2019: observational study

OBJECTIVE

To explore inequalities in human resources for health (HRH) in relation to all cause and cause specific mortality globally in 1990-2019.

DESIGN

Observational study.

SETTING

172 countries and territories.

DATA SOURCES

Databases of the Global Burden of Disease Study 2019, United Nations Statistics, and Our World in Data.

MAIN OUTCOME MEASURES

The main outcome was age standardized all cause mortality per 100 000 population in relation to HRH density per 10 000 population, and secondary outcome was age standardized cause specific mortality. The Lorenz curve and the concentration index (CCI) were used to assess trends and inequalities in HRH.

RESULTS

Globally, the total HRH density per 10 000 population increased, from 56.0 in 1990 to 142.5 in 2019, whereas age standardized all cause mortality per 100 000 population decreased, from 995.5 in 1990 to 743.8 in 2019. The Lorenz curve lay below the equality line and CCI was 0.43 (P<0.05), indicating that the health workforce was more concentrated among countries and territories ranked high on the human development index. The CCI for HRH was stable, at about 0.42-0.43 between 1990 and 2001 and continued to decline (narrowed inequality), from 0.43 in 2001 to 0.38 in 2019 (P<0.001). In the multivariable generalized estimating equation model, a negative association was found between total HRH level and all cause mortality, with the highest levels of HRH as reference (low: incidence risk ratio 1.15, 95% confidence interval 1.00 to 1.32; middle: 1.14, 1.01 to 1.29; high: 1.18, 1.08 to 1.28). A negative association between total HRH density and mortality rate was more pronounced for some types of cause specific mortality, including neglected tropical diseases and malaria, enteric infections, maternal and neonatal disorders, and diabetes and kidney diseases. The risk of death was more likely to be higher in people from countries and territories with a lower density of doctors, dentistry staff, pharmaceutical staff, aides and emergency medical workers, optometrists, psychologists, personal care workers, physiotherapists, and radiographers.

CONCLUSIONS

Inequalities in HRH have been decreasing over the past 30 years globally but persist. All cause mortality and most types of cause specific mortality were relatively higher in countries and territories with a limited health workforce, especially for several specific HRH types among priority diseases. The findings highlight the importance of strengthening political commitment to develop equity oriented health workforce policies, expanding health financing, and implementing targeted measures to reduce deaths related to inadequate HRH to achieve universal health coverage by 2030.

Cost-Effectiveness Analysis of COVID-19 Inactivated Vaccines in Reducing the Economic Burden of Ischaemic Stroke after SARS-CoV-2 Infection

Due to significant economic burden and disability from ischaemic stroke and the relationship between ischaemic stroke and SARS-CoV-2 infection, we aimed to explore the cost-effectiveness of the two-dose inactivated COVID-19 vaccination program in reducing the economic burden of ischaemic stroke after SARS-CoV-2 infection. We constructed a decision-analytic Markov model to compare the two-dose inactivated COVID-19 vaccination strategy to the no vaccination strategy using cohort simulation. We calculated incremental cost-effectiveness ratios (ICERs) to evaluate the cost-effectiveness and used number of the ischaemic stroke cases after SARS-CoV-2 infection and quality-adjusted life-years (QALYs) to assess effects. Both one-way deterministic sensitivity analysis and probabilistic sensitivity analysis were performed to assess the robustness of the results. We found that the two-dose inactivated vaccination strategy reduced ischaemic stroke cases after SARS-CoV-2 infection by 80.89% (127/157) with a USD 1.09 million as vaccination program cost, saved USD 3675.69 million as direct health care costs and gained 26.56 million QALYs compared with no vaccination strategy among 100,000 COVID-19 patients (ICER < 0 per QALY gained). ICERs remained robust in sensitivity analysis. The proportion of older patients and the proportion of two-dose inactivated vaccination among older people were the critical factors that affected ICER. This study suggests the importance of COVID-19 vaccination is not only in preventing the spread of infectious diseases, but also in considering its long-term value in reducing the economic burden of non-communicable diseases such as ischaemic stroke after SARS-CoV-2 infection.

Associations among socioeconomic status, multimorbidity of non-communicable diseases, and the risk of household catastrophic health expenditure in China: a population-based cohort study

BACKGROUND

Multimorbidity of non-communicable diseases (NCDs) is increasingly prevalent among older adults around the world, leading a higher risk of household catastrophic health expenditure (CHE). As current powerful evidence was insufficient, we aimed to estimate the association between multimorbidity of NCDs and the risk of CHE in China.

METHODS

We designed a cohort study using data investigated in 2011-2018 from the China Health and Retirement Longitudinal Study, which is a nationally-representative study covering 150 counties of 28 provinces in China. We used mean ± standard deviation (SD) and frequencies and percentages to describe baseline characteristics. Person χ2 test was employed to compare the differences of baseline characteristics between households with and without multimorbidity. Lorenz curve and concentration index were used to measure the socioeconomic inequalities of CHE incidence. Cox proportional hazards models were applied to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the association between multimorbidity and CHE.

RESULTS

Among 17,708 participants, 17,182 individuals were included for the descriptive analysis of the prevalence of multimorbidity in 2011, and 13,299 individuals (8029 households) met inclusion criteria and were included in the final analysis with a median of 83 (interquartile range: 25-84) person-months of follow-up. 45.1% (7752/17,182) individuals and 56.9% (4571/8029) households had multimorbidity at baseline. Participants with higher family economic level (aOR = 0.91, 95% CI: 0.86-0.97) had lower multimorbidity prevalence than those with lowest family economic level. 82.1% of participants with multimorbidity did not make use of outpatient care. The CHE incidence was more concentrated among participants with higher socioeconomic status (SES) with a concentration index of 0.059. The risk of CHE was 19% (aHR = 1.19, 95% CI: 1.16-1.22) higher for each additional NCD.

CONCLUSIONS

Approximately half of middle-aged and older adults in China had multimorbidity, causing a 19% higher risk of CHE for each additional NCD. Early interventions for preventing multimorbidity among people with low SES could be intensified to protect older adults from financial hardship. In addition, concerted efforts are needed to increase patients' rational healthcare utilization and strengthen current medical security for people with high SES to reduce economic disparities in CHE.

COVID-19 Vaccination Coverage among 42,565 Adults Amid the Spread of Omicron Variant in Beijing, China

Vaccines against coronavirus disease 2019 (COVID-19) have been in use for over two years, but studies that reflect real-world vaccination coverage and demographic determinants are lacking. Using a multistage stratified random cluster sampling method, we planned to directly explore vaccination coverage and the demographic determinants of different doses of COVID-19 vaccines in Beijing, especially in older populations. All 348 community health service centers in 16 districts were involved. We performed multivariable logistic regression analyses to identify demographic determinants of different coverage rates via adjusted odds ratios (aORs) and 95% CIs. Of the 42,565 eligible participants, the total vaccination coverage rates for ≥1 dose, ≥2 doses, ≥3 doses, and 4 doses were 93.3%, 91.6%, 84.9%, and 13.0%, respectively, but decreased to 88.1%, 85.1%, 76.2%, and 3.8% in the older population. Among all participants, younger (aOR = 1.77, 95% CI: 1.60–1.95), male (aOR = 1.15, 95% CI: 1.06–1.23), and better-educated residents (high school and technical secondary school aOR = 1.58, 95% CI: 1.43–1.74; bachelor’s degree aOR = 1.53, 95% CI: 1.37–1.70) were more likely to be fully vaccinated. People who lived in rural areas (aOR = 1.45, 95% CI: 1.31–1.60) and held the new rural cooperative health insurance (aOR = 1.37, 95% CI: 1.20–1.57) established a higher rate of full vaccination coverage. No history of chronic disease was positively associated with a higher coverage rate (aOR = 1.81, 95% CI: 1.66–1.97). Occupation also affected vaccination coverage. Demographic factors influencing the rate of vaccination with at least one or three doses were consistent with the results above. Results remained robust in a sensitivity analysis. Given the highly transmissible variants and declining antibody titers, accelerating the promotion of booster vaccination coverage, especially in high-risk groups such as the elderly, is a top priority. For all vaccine-preventable diseases, rapidly clarifying vaccine-hesitant populations, clearing barriers, and establishing a better immune barrier can effectively safeguard people’s lives and property and coordinate economic development with epidemic prevention and control.

Trends in Online Search Activity and the Correlation with Daily New Cases of Monkeypox among 102 Countries or Territories

Research assessing the trend in online search activity on monkeypox (mpox) and the correlation with the mpox epidemic at the global and national level is scarce. The trend of online search activity and the time-lag correlations between it and daily new mpox cases were estimated by using segmented interrupted time-series analysis and Spearman correlation coefficient (rs), respectively. We found that after the declaration of a Public Health Emergency of International Concern (PHEIC), the proportion of countries or territories with increasing changes in online search activity was lowest in Africa (8.16%, 4/49), and a downward trend in online search activity was highest in North America (8/31, 25.81%). The time-lag effect of global online search activity on daily new cases was significant (rs = 0.24). There were eight countries or territories with significant time-lag effect; the top three countries or territories were Brazil (rs = 0.46), United States (rs = 0.24), and Canada (rs = 0.24). Interest behavior in mpox was insufficient, even after the declaration of PHEIC, especially in Africa and North America. Online search activity could be used as an early indicator of the outbreak of mpox at the global level and in epidemic countries.

Global Epidemiological Features of Human Monkeypox Cases and Their Associations With Social-Economic Level and International Travel Arrivals: A Systematic Review and Ecological Study

Objectives: We aimed to evaluate global epidemiological features of human monkeypox (mpox) cases and their associations with social-economic level and international travel arrivals. Methods: We estimated the pooled value by random-effects models. Then, we conducted an ecological study to evaluate the relationship of confirmed cases with social-economic indices and international travel arrivals using correlation analyses. Results: The average age (2022: 35.52, 95% CI [28.09, 42.94] vs. before 2022: 18.38, 95% CI [14.74, 22.02]) and comorbidity rate (2022: 15.7%, 95% CI [8.9%, 22.4%] vs. before 2022: 14.9%, 95% CI [8.5%, 21.3%]) of mpox cases in the 2022 human mpox outbreak were significantly higher than those of cases before 2022. During the 2022 mpox outbreak, the proportion of men who have sex with men (MSM) was high (79.8%, 95% CI [65.5%, 94.2%]). The number of confirmed mpox cases in 2022 significantly correlated with high social-economic levels and international travel arrivals (all p < 0.05). Conclusion: Our findings highlighted the importance of early surveillance and timely detection in high-risk populations, including older people, MSM, and travelers, which is crucial to curb the wide transmission of mpox.

Trends of SARS-CoV-2 Infection Among Couriers in Risky Business After the Optimization of Prevention and Control Measures — China, December 2022 to January 2023

Introduction

On December 7, 2022, China implemented "Ten New Measures" to optimize prevention and control measures for coronavirus disease 2019 (COVID-19). The purpose of this study was to evaluate the national and regional trends of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among couriers in China from December 2022 to January 2023.

Methods

Data from the National Sentinel Community-based Surveillance in China was utilized, including participants from 31 provincial-level administrative divisions and Xinjiang Production and Construction Corps. Participants were tested for SARS-CoV-2 infection twice a week from December 16, 2022 to January 12, 2023. Infection was defined as a positive result for SARS-CoV-2 nucleic acid or antigen. The daily average newly positive rate of SARS-CoV-2 infection and the estimated daily percentage change (EDPC) were calculated.

Results

In this cohort, 8 rounds of data were collected. The daily average newly positive rate of SARS-CoV-2 infection decreased from 4.99% in Round 1 to 0.41% in Round 8, with an EDPC of -33.0%. Similar trends of the positive rate were also observed in the eastern (EDPC: -27.7%), central (EDPC: -38.0%) and western regions (EDPC: -25.5%). Couriers and community population showed a similar temporal trend, with the peak daily average newly positive rate of couriers being higher than that of community population. After Round 2, the daily average newly positive rate of couriers decreased sharply, becoming lower than that of community population in the same period.

Conclusions

The peak of SARS-CoV-2 infection among couriers in China has passed. As couriers are a key population for SARS-CoV-2 infection, they should be monitored continuously.

Trends of SARS-CoV-2 Infection in Rural Area in Sentinel Community-Based Surveillance — China, December 2022 to January 2023

Introduction

In late 2022, a rapid transmission of Omicron variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred throughout China. The purpose of this study was to provide the latest data and evaluate trends of SARS-CoV-2 infection in rural China among the community population.

Methods

Data on SARS-CoV-2 infection among approximately 90,000 participants in rural China were collected by the National Sentinel Community-Based Surveillance (NSCS) system. Participants were tested for SARS-CoV-2 infection (defined as positive for SARS-CoV-2 nucleic acid or antigen) twice weekly from December 16, 2022 to January 12, 2023. The daily average of newly positive rate and its estimated daily percentage change were calculated to describe the national and regional trends of SARS-CoV-2 infection in rural China.

Results

In rural China, the daily average new positive rate of SARS-CoV-2 infection peaked at 4.79% between December 20-22, 2022 and then decreased to 0.57% between January 10-12, 2023, with an average decrease of 29.95% per round. The peak of new SARS-CoV-2 infection was slightly earlier and lower in North China (5.28% between December 20-22, 2022) than in South China (5.63% between December 23-26, 2022), and then converged from December 30, 2022 to January 2, 2023. The peak of 6.09% occurred between December 20-22, 2022 in eastern China, while the peak of 5.99% occurred later, between December 27-29, 2022, in central China.

Conclusions

Overall, the epidemic wave in rural China peaked between December 20-22, 2022, and passed quickly following the optimization of prevention and control measures. Currently, SARS-CoV-2 infection in community populations in rural China is sporadic.

Association between public attention and monkeypox epidemic: A global lag-correlation analysis

The human monkeypox has become a public health problem globally. Google Trends Index (GTI) is an indicator of public attention, being potential for infectious disease outbreak surveillance. In this study, we used lag-correlation analysis to evaluate the spearman correlation coefficients between public attention and monkeypox epidemic by -36 to +36 days-lag in top 20 countries with most cumulated cases until September 30, 2022, the meta-analyses were performed to pool the coefficients of countries among all lags. We also constructed vector autoregression model and Granger-causality test to probe the significance of GTI in monkeypox forecasting. The strongest spearman correlation was found at lag +13 day (r = 0.53, 95% confidence interval: 0.371-0.703, p < 0.05). Meta-analysis showed significantly positive correlation when the lag was from -12 to +36 day, which was most notable on the third posterior day (lag +3 day). The pooled spearman correlation coefficients were all above 0.200 when the lag ranged from +1 to +20 day, and the causality of GTI for daily case was significant in worldwide and multiple countries. The findings suggested a robust association between 13-days-priority GTI and daily cases worldwide. This work introduced a potential monitor indicator on the early warning and surveillance of monkeypox outbreak.

Trends of SARS-CoV-2 Infection in Sentinel Community-Based Surveillance After the Optimization of Prevention and Control Measures — China, December 2022–January 2023

Introduction

On December 7, 2022, China implemented the "Ten New Measures" to optimize its prevention and control measures for coronavirus disease 2019 (COVID-19). To provide the latest data after the optimization, we evaluated trends of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among the community population in China.

Methods

We utilized data from the National Sentinel Community-Based Surveillance (NSCS) system in China to assess trends of SARS-CoV-2 infection. NSCS is a national community-based surveillance cohort with 0.42 million participants from all 31 provincial-level administrative divisions (PLADs) and Xinjiang Production and Construction Corps (XPCC). Participants were tested for infection twice a week (a total of eight rounds) from December 16, 2022 to January 12, 2023. SARS-CoV-2 infection was defined as testing positive for SARS-CoV-2 nucleic acid or antigen. We calculated the daily average of newly positive rates of SARS-CoV-2 infection.

Results

In this national cohort, the daily average newly positive rate of SARS-CoV-2 infection decreased from 4.13% in Round 1 (December 16-19, 2022) to 0.69% in Round 8 (January 10-12, 2023). The epidemic peak occurred in Round 2 (December 20-22, 2022). Similar trends were observed in urban areas (decreasing from 4.65% to 0.73%), rural areas (decreasing from 2.83% to 0.57%), the eastern region (decreasing from 4.18% to 0.67%), the central region (decreasing from 5.43% to 0.61%), and the western region (decreasing from 3.01% to 0.77%).

Conclusions

NSCS data showed that the peak of SARS-CoV-2 infection in China had passed. SARS-CoV-2 infection in community populations in China is currently at a low epidemic level.

Trends and disparities in 44 national notifiable infectious diseases in China: An analysis of national surveillance data from 2010 to 2019

Research assessing the changing epidemiology of infectious diseases in China after the implementation of new healthcare reform in 2009 was scarce. We aimed to get the latest trends and disparities of national notifiable infectious diseases by age, sex, province, and season in China from 2010 to 2019. The number of incident cases and deaths, incidence rate, and mortality of 44 national notifiable infectious diseases by sex, age groups, and provincial regions from 2010 to 2019 were extracted from the China Information System for Disease Control and Prevention and official reports and divided into six kinds of infectious diseases by transmission routes and three classes (A-C) in this descriptive study. Estimated annual percentage changes (EAPCs) were calculated to quantify the temporal trends of incidence and mortality rate. We calculated the concentration index to measure economic-related inequality. Segmented interrupted time-series analysis was used to estimate the impact of the COVID-19 pandemic on the epidemic of notifiable infectious diseases. The trend of incidence rate on six kinds of infectious diseases by transmission routes was stable, while only mortality of sexual, blood-borne, and mother-to-child-borne infectious diseases increased from 0.6466 per 100 000 population in 2010 to 1.5499 per 100 000 population in 2019 by 8.76% per year (95% confidence interval [CI]: 6.88-10.68). There was a decreasing trend of incidence rate on Class-A infectious diseases (EAPC = -16.30%; 95% CI: -27.93 to -2.79) and Class-B infectious diseases (EAPC = -1.05%; 95% CI: -1.56 to -0.54), while an increasing trend on Class-C infectious diseases (EAPC = 6.22%; 95% CI: 2.13-10.48). For mortality, there was a decreasing trend on Class-C infectious diseases (EAPC = -14.76%; 95% CI: -23.46 to -5.07), and an increasing trend on Class-B infectious diseases (EAPC = 4.56%; 95% CI: 2.44-6.72). In 2019, the infectious diseases with the highest incidence rate and mortality were respiratory diseases (340.95 per 100 000 population), and sexual, blood-borne, and mother-to-child-borne infectious diseases (1.5459 per 100 000 population), respectively. The greatest increasing trend of incidence rate was observed in seasonal influenza, from 4.83 per 100 000 population in 2010 to 253.36 per 100 000 population in 2019 by 45.16% per year (95% CI: 29.81-62.33), especially among females and children aged 0-4 years old. The top disease with the highest mortality was still AIDs, which had the highest average yearly mortality in 24 provinces from 2010 to 2019, and its incidence rate (EAPC = 14.99%; 95% CI: 8.75-21.59) and mortality (EAPC = 9.65; 95%CI: 7.71-11.63) both increased from 2010 to 2019, especially among people aged 44-59 years old and 60 or older. Male incidence rate and mortality were higher than females each year from 2010 to 2018 on 29 and 10 infectious diseases, respectively. Additionally, sex differences in the incidence and mortality of AIDS were becoming larger. The curve lay above the equality line, with the negative value of the concentration index, which indicated that economic-related health disparities exist in the distribution of incidence rate and mortality of respiratory diseases (incidence rate: the concentration index = -0.063, p < 0.0001; mortality: the concentration index = -0.131, p < 0.001), sexual, blood-borne, and mother-to-child-borne infectious diseases (incidence rate: the concentration index = -0.039, p = 0.0192; mortality: the concentration index = -0.207, p < 0.0001), and the inequality disadvantageous to the poor (pro-rich). Respiratory diseases (Dec-Jan), intestinal diseases (May-Jul), zoonotic infectious diseases (Mar-Jul), and vector-borne infectious diseases (Sep-Oct) had distinct seasonal epidemic patterns. In addition, segmented interrupted time-series analyses showed that, after adjusting for potential seasonality, autocorrelation, GDP per capita, number of primary medical institutions, and other factors, there was no significant impact of COVID-19 epidemic on the monthly incidence rate of six kinds of infectious diseases by transmission routes from 2018 to 2020 (all p > 0.05). The incidence rates of six kinds of infectious diseases were stable in the past decade, and incidence rates of Class-A and Class-B infectious diseases were decreasing because of comprehensive prevention and control measures and a strengthened health system after the implementation of the new healthcare reform in China since 2009. However, age, gender, regional, and economic disparities were still observed. Concerted efforts are needed to reduce the impact of seasonal influenza (especially among children aged 0-4 years old) and the mortality of AIDs (especially among people aged 44-59 years old and 60 or older). More attention should be paid to the disparities in the burden of infectious diseases.

Millions of excess cases and thousands of excess deaths of malaria occurred globally in 2020 during the COVID-19 pandemic

Background

The COVID-19 pandemic disrupted malaria-related health care services, leading to an excess burden of malaria. However, there is a lack of research on the indirect global impact of the COVID-19 pandemic on malaria. We aimed to assess the excess burden of malaria due to the COVID-19 pandemic in malaria-endemic countries in 2020.

Methods

Based on data from the World Health Organization Global Observatory, we used estimated annual percentage changes (EAPCs) from 2000 to 2019 (model A) and from 2015 to 2019 (model B) to predict the malaria burden in 2020. We calculated the ratios between reported and predicted malaria incidence (incidence rate ratio (IRR)) and mortality rates (mortality rate ratio (MRR)).

Results

In 2020, African countries suffered the most from malaria, with the largest number of malaria cases (64.7 million) and deaths (151 thousand) observed in Nigeria. Most countries showed a decrease in malaria incidence and mortality rates from 2000 to 2019, with the strongest decline in incidence rates in Bhutan (EAPC = -35.7%, 95% CI = -38.7 to -32.5%) and mortality rates Ecuador (EAPC = -40.6%, 95% confidence interval (CI) = -46.6 to -33.8%). During the COVID-19 pandemic in 2020, there was a total of 18 million excess malaria cases and 83 291 excess deaths per model A, and 7.4 million excess cases and 33 528 excess deaths per model B globally. Malaria incidence rates increased excessively in over 50% of the malaria-endemic countries, with the greatest increase in Costa Rica (IRR = 35.6) per model A and Bhutan (IRR = 15.6) per model B. Mortality rates had increased excessively in around 70% of the malaria-endemic countries, with the greatest increase in Ecuador in both model A (MRR = 580) and model B (MRR = 58).

Conclusions

The emergence of the COVID-19 pandemic indirectly caused an increase in the prevalence of malaria and thwarted progress in malaria control. Global efforts to control the pandemic's impact should be balanced with malaria control to ensure that the goal for global malaria elimination is achieved on time.

Acceptance of the COVID-19 vaccine booster dose and associated factors among the elderly in China based on the health belief model (HBM): A national cross-sectional study

Background

The reluctance of individuals to obtain solid vaccine-induced immunity represents a fundamental challenge to containing the spread of SARS-CoV-2, including its highly mutated variants. We aimed to assess vaccination acceptance and associated factors for the COVID-19 vaccine booster dose among elderly people (≥60 years old) in China, providing a theoretical and practical reference for universal vaccination policy.

Methods

A national anonymous survey was conducted in mainland China from May 25 to June 8, 2022, using a stratified random sampling method. Individuals 60 years of age and above were the target population. A chi-squared test and Cochran-Armitage test for trend were used to compare and examine vaccine acceptance rates by characteristics. Via a backward stepwise method, multivariable logistic regression models were established to assess factors associated with booster dose acceptance. Two-sided P < 0.05 was considered statistically significant.

Results

Of 3,321 eligible participants, 82.8% (95% CI: 81.5-84.1%) were willing to receive COVID-19 vaccine booster shots. Concerns about contraindications (38.3%), vaccine safety (32.0%), and limited movement (28.0%) were the main reasons for vaccine hesitancy. Nearly one-third still believed that the booster dose was unnecessary after receiving the initial vaccination. Older adults with a low level of perceived barriers (aOR = 1.86, 95% CI, 1.03-3.38), a high level of perceived benefit (aOR = 2.31, 95% CI, 1.38-3.87), and higher cues to action (moderate, aOR = 2.22, 95% CI, 1.39-3.56; high, aOR = 5.46, 95% CI: 3.44-8.67) were more likely to accept the booster dose. Other major factors affecting the booster dose acceptance rate were occupation, time spent on social media, vaccination history, and a high knowledge score for COVID-19 and vaccines. In addition, for those over 70 years of age, rising awareness of susceptibility could be a better gateway for improving their willingness to get vaccinated.

Conclusions

A total of 82.8% of recruited older adults were willing to receive the booster dose. Acceptance behaviors were closely related to occupation, time spent on social media, vaccination history, knowledge factors, perception of barriers, and benefit, as well as action cues. Targeted public health measures are a priority for improving the vaccination coverage of valid immunity among the elderly population, not only to prevent infection and poor prognosis caused by emerging variants but also to reduce the huge disease and economic burden caused by the long-term sequelae after SARS-CoV-2 infection.

Neighborhood social cohesion is associated with the willingness toward the booster dose of COVID-19 vaccines among the Chinese older population

Neighborhood social cohesion is a prominent psychosocial factor during the pandemic, and trust in neighbors is critical for implementing health prevention-related behaviors with public health messages. We planned to specifically explore the association between neighborhood social cohesion and vaccine acceptability among older adults (≥60 years) in China. Using a random stratified sampling method, an anonymous cross-sectional online survey was conducted in mainland China via a professional scientific data platform from May 25 to June 8, 2022. A revised Social Cohesion Scale was applied to evaluate the level of neighborhood social cohesion. Of the 3,321 recruited respondents aged 60 and above, 82.8% (95% CI: 81.5-84.1) reported their willingness to be vaccinated. With all significant covariates adjusted, older adults with moderate (aOR = 1.77, 95% CI: 1.04-3.04) and high level of social cohesion (aOR = 2.21, 95% CI: 1.29-3.77) were more likely to receive the booster dose. Our findings remained robust in a series of models after controlling for different covariates. Uncertainty about contraindications (38.3%), underestimation of their vulnerability (33.1%), and concerns about vaccine safety (32.0%) were the three main reasons for vaccine hesitancy. Therefore, building a harmonious community environment, strengthening neighborhood communication and exchange, and making good use of peer education among neighbors may become a breakthrough to promote herd immunity, especially for vulnerable older adults with limited social networks.

Incidence and Mortality Trends of Upper Respiratory Infections in China and Other Asian Countries from 1990 to 2019

Respiratory infections remain a major public health problem, affecting people of all age groups, but there is still a lack of studies analyzing the burden of upper respiratory infections (URIs) in Asian countries. We used the data from the Global Burden of Diseases Study 2019 results to assess the current status and trends of URI burden from 1990 to 2019 in Asian countries. We found that Thailand had the highest age-standardized incidence rate (ASIR) of URI both in 1990 (354,857.14 per 100,000) and in 2019 (344,287.93 per 100,000); and the highest age-standardized mortality rate (ASMR) was in China in 1990 (2.377 per 100,000), and in Uzbekistan in 2019 (0.418 per 100,000). From 1990 to 2019, ASIRs of URI slightly increased in several countries, with the speediest in Pakistan (estimated annual percentage change [EAPC] = 0.404%, 95% CI, 0.322% to 0.486%); and Kuwait and Singapore had uptrends of ASMRs, at a speed of an average 3.332% (95% CI, 2.605% to 4.065%) and 3.160% (95% CI, 1.971% to 4.362%) per year, respectively. The age structure of URI was similar at national, Asian and Global levels. Children under the age of five had the highest incidence rate, and the elderly had the highest mortality rate of URI. Asian countries with a Socio-demographic Index between 0.5 and 0.7 had relatively lower ASIRs but higher ASMRs of URIs. The declined rate of URI ASMR in Asian countries was more pronounced in higher baseline (ASMR in 1990) countries. Our findings suggest that there was a huge burden of URI cases in Asia that affected vulnerable and impoverished people's livelihoods. Continuous and high-quality surveillance data across Asian countries are needed to improve the estimation of the disease burden attributable to URIs, and the best public health interventions are needed to curb this burden.

Knowledge and vaccination acceptance toward the human monkeypox among men who have sex with men in China

Background

MSM individuals are at high risk of monkeypox infection, and judicious use of vaccines can control the outbreak. Therefore, we conducted a national cross-sectional survey to assess the vaccination willingness, associated factors, and related knowledges of monkeypox among MSM individuals in China.

Methods

This anonymous cross-sectional study was conducted in China from July 1 to July 3, 2022, and electronic questionnaires were sent online to MSM individuals of specific institutions. Men, aged 18 or older, who had anal sex in the past year were recruited. Multivariable logistic regression models and univariable logistic regression models were performed in different groups of participants, including all eligible respondents, people with or without self-reported HIV infection, and people who had sex with at least one male sexual partner in last month.

Results

A total of 2,618 male respondents, including 2,134 homosexuals and 484 bisexuals, were enrolled in our final analysis. Most of the respondents had a certain understanding of the source of infection, transmission route, and preventive measures, but lacked knowledge of the susceptible population, clinical manifestations, vaccination, and treatment. In total, 90.2% of all respondents were willing to receive the vaccines against monkeypox. Among people with self-reported HIV infection, the vaccination acceptance rate was 91.7%, while it was 89.7% in the rest. The main influencing factors were knowledge about monkeypox (moderate: aOR = 1.47, 95% CI: 1.04-2.08; high: aOR = 2.03, 95% CI: 1.23-3.34), knowledge about prevention measures (moderate: aOR = 3.52, 95% CI: 2.51-4.94; high: aOR = 5.32, 95% CI: 2.98-9.47), concerns about their susceptibility to monkeypox infection (aOR = 4.37, 95% CI: 3.29-5.80), and possible contact with people and animals in epidemic areas (aOR = 0.42, 95% CI: 0.25-0.70). For self-reported HIV-infected individuals, education (bachelor degree: aOR = 0.40, 95% CI: 0.18-0.89) and poor condom use (sometimes: aOR = 2.18, 95% CI: 1.06-4.47) may also affect the vaccination.

Conclusions

There was still a lack of knowledge about the human monkeypox among MSM individuals in China. The vaccination acceptance rate of this high-risk population was high, and it was closely related to the knowledge factors, fear of infection, and possible contact with people or animals in affected areas. Targeted publicity and education of the high-risk groups, vaccination pre-arranged planning should be formulated to cope with the further development of this infectious disease.

[Exploration on teaching reform of cancer epidemiology course]

This study aims to explore optimized teaching mode of cancer epidemiology for undergraduates, and provide scientific ideas and basis for improving teaching quality. Non-randomized concurrent control study was used. Undergraduates, enrolled in 2018, from the department of preventive medicine in A and B medical universities were selected as research objects. Traditional teaching mode was used for cancer epidemiology course in A medical university, and innovative teaching mode named "one core, four dimensions" was adopted in B medical university. After the course, questionnaire method was used to investigate self-cognition of students, teaching satisfaction and class preparation time of teachers in B Medical University. The post-class test method was used to compare the students' grades of cancer epidemiology in the two universities. The results indicated that among the 58 students of B medical university, 94.83% (55/58) students were familiar with common types of epidemiological studies and 86.21% (50/58) mastered the evaluation indicators of screening research. Among the nine teaching faculties from B medical university, seven reported that the new teaching plan helped students to learn frontier knowledge of cancer epidemiology, and eight reported the new teaching model was conducive to the interaction between teachers and students. The text score of students in B medical university was 50.34±4.90, significantly higher than that in A medical university (46.21±4.91, t=5.20, P<0.001). The optimized teaching mode of cancer epidemiology is highly praised by students and teachers, which has the potential to improve students' grasp of cancer epidemiology, the ability to combine theory with practice, and the teaching effect of cancer epidemiology.

MSX1 Drives Tooth Morphogenesis Through Controlling Wnt Signaling Activity

Tooth agenesis is a common structural birth defect in humans that results from failure of morphogenesis during early tooth development. The homeobox transcription factor Msx1 and the canonical Wnt signaling pathway are essential for "bud to cap" morphogenesis and are causal factors for tooth agenesis. Our recent study suggested that Msx1 regulates Wnt signaling during early tooth development by suppressing the expression of Dkk2 and Sfrp2 in the tooth bud mesenchyme, and it demonstrated partial rescue of Msx1-deficient molar teeth by a combination of DKK inhibition and genetic inactivation of SFRPs. In this study, we found that Sostdc1/Wise, another secreted Wnt antagonist, is involved in regulating the odontogenic pathway downstream of Msx1. Whereas Sostdc1 expression in the developing tooth germ was not increased in Msx1-/- embryos, genetic inactivation of Sostdc1 rescued maxillary molar, but not mandibular molar, morphogenesis in Msx1-/- mice with full penetrance. Since the Msx1-/-;Sostdc1-/- embryos exhibited ectopic Dkk2 expression in the developing dental mesenchyme, similar to Msx1-/- embryos, we generated and analyzed tooth development in Msx1-/-;Dkk2-/- double and Msx1-/-;Dkk2-/-;Sostdc1-/- triple mutant mice. The Msx1-/-;Dkk2-/- double mutants showed rescued maxillary molar morphogenesis at high penetrance, with a small percentage also exhibiting mandibular molars that transitioned to the cap stage. Furthermore, tooth development was rescued in the maxillary and mandibular molars, with full penetrance, in the Msx1-/-;Dkk2-/-;Sostdc1-/- mice. Together, these data reveal 1) that a key role of Msx1 in driving tooth development through the bud-to-cap transition is to control the expression of Dkk2 and 2) that modulation of Wnt signaling activity by Dkk2 and Sostdc1 plays a crucial role in the Msx1-dependent odontogenic pathway during early tooth morphogenesis.

The association between social media use and hesitancy toward COVID-19 vaccine booster shots in China: a web-based cross-sectional survey

COVID-19 vaccine booster shots are necessary to provide durable immunity and stronger protection against the emerging SARS-CoV-2 variants. As a major platform for access to information, social media plays an important role in disseminating health information. This study aimed to evaluate hesitancy toward COVID-19 vaccine booster shots in China, assess its association with social media use, and provide information to manage social media. We conducted a cross-sectional study across all 31 provinces in mainland China from November 12, 2021, to November 17, 2021. In total, 3,119 of 3,242 participants completed the questionnaire (response rate = 96.2%). COVID-19 vaccine booster shot hesitancy rate in China was 6.5% (95% CI: 5.6-7.3). Unemployment (adjusted odds ratio [aOR] 2.428, 95% CI: 1.590-3.670), low monthly income (aOR 2.854,95% CI: 1.561-5.281), low scores of knowledge (aOR 0.917, 95% CI: 0.869-0.968) and low level of cues to action (aOR 0.773, 95% CI: 0.689-0.869) were associated with vaccine hesitancy. Compared with public social media, lower vaccine hesitancy was associated with high perceived importance of social media (aOR 0.252, 95% CI: 0.146-0.445) and official social media use (aOR 0.671, 95% CI: 0.467-0.954), while higher vaccine hesitancy was associated with traditional media use (aOR 3.718, 95% CI: 1.282-10.273). More efforts are needed to regulate the content of social media and filtering out misinformation. The role of official social media in disseminating health information should be enhanced.

Association Between Risk Perception and Acceptance for a Booster Dose of COVID-19 Vaccine to Children Among Child Caregivers in China

Background

At present, the widespread variants and the weakened immunity provided by vaccines over time have further emphasized the importance of vaccination, boosters, and prevention efforts against COVID-19. Here, this study intends to investigate the acceptability of a booster dose of COVID-19 vaccine among child caregivers, aiming to explore the association between risk perception and child vaccine acceptance.

Methods

This anonymous, national, cross-sectional survey was conducted for one week from November 12, 2021 in mainland China. The risk perception among child caregivers was assessed based on the Health Belief Model (HBM) and the individuals was equally divided into three levels according to the total preset scores of each perception dimension. Pearson χ² test was used to compare the differences among participants stratified by sociodemographic characteristics, health status, knowledge factors and risk perception. Univariate and multivariate logistic regression models were performed to explore the associations between risk perception and the acceptance of a booster dose of COVID-19 vaccine.

Results

A total of 88.46% of 1,724 participants were willing to accept the booster dose of the COVID-19 vaccine for their children. People who lived in central China (91.93%), had a high school or polytechnic school level education (93.98%), and had a history of COVID-19 vaccination (88.80%) were more likely to accept a booster dose of the COVID-19 vaccine for their children. The complicated vaccination process (24.5%) and uncertainty about the safety (16.5%) and efficacy (21.3%) of vaccines were the three main reasons for vaccine hesitancy among child caregivers. The acceptance of the booster dose of the COVID-19 vaccine was closely related to a higher level of perceived susceptibility (moderate: aOR = 1.56, 95% CI: 1.07–2.29, P = 0.022; high: aOR = 1.75, 95% CI: 1.06–2.89, P = 0.029) and high perceived benefit (high: aOR = 7.22, 95% CI: 2.63–19.79, P < 0.001). The results were stable in the sensitivity analysis.

Conclusions

88.46% of child caregivers were willing to have a booster dose of COVID-19 vaccine to children, and the acceptance was closely associated with a higher level of perceived susceptibility and perceived benefit. The complicated vaccination process, uncertainty about the safety and effectiveness of COVID-19 vaccines were the main reasons for their hesitancy. Therefore, targeted public health measures to increase perceived susceptibility and benefit are still needed to meet the requirements of higher-level immunization coverage.

Acceptance of a Third Dose of COVID-19 Vaccine and Associated Factors in China Based on Health Belief Model: A National Cross-Sectional Study

COVID-19 infections are returning to many countries because of the emergence of variants or declining antibody levels provided by vaccines. An additional dose of vaccination is recommended to be a considerable supplementary intervention. We aim to explore public acceptance of the third dose of the COVID-19 vaccine and related influencing factors in China. This nationwide cross-sectional study was conducted in the general population among 31 provinces in November, 2021. We collected information on basic characteristics, vaccination knowledge and attitudes, and vaccine-related health beliefs of the participants. Univariable and multivariable logistic regression models were used to assess factors associated with the acceptance of a third COVID-19 vaccine. A total of 93.7% (95% CI: 92.9–94.6%) of 3119 Chinese residents were willing to receive a third dose of the COVID-19 vaccine. Individuals with low level of perceived susceptibility, perceived benefit, cues to action cues, and high level of perceived barriers, old age, low educational level, low monthly household income, and low knowledge score on COVID-19 were less likely to have the acceptance of a third dose of COVID-19 (all p < 0.05). In the multivariable logistic regression model, acceptance of the third dose of COVID-19 vaccine was mainly related to previous vaccination history [Sinopharm BBIP (aOR = 6.55, 95% CI 3.30–12.98), Sinovac (aOR = 5.22, 95% CI:2.72–10.02), Convidecia (aOR = 5.80, 95% CI: 2.04–16.48)], high level of perceived susceptibility (aOR = 2.48, 95% CI: 1.48–4.31) and high level of action cues (aOR = 23.66, 95% CI: 9.97–56.23). Overall, residents in China showed a high willingness to accept the third dose of COVID-19 vaccines, which can help vaccine manufacturers in China to manage the vaccine production and distribution for the huge domestic and international vaccine demand. Relevant institutions could increase people’s willingness to booster shots by increasing initial COVID-19 vaccination rates, public’s perception of COVID-19 susceptibility and cues to action through various strategies and channels. Meanwhile, it also has certain reference significance for other countries to formulate vaccine promotion strategies.

The aquaculture supply chain in the time of covid-19 pandemic: Vulnerability, resilience, solutions and priorities at the global scale

The COVID-19 global pandemic has had severe, unpredictable and synchronous impacts on all levels of perishable food supply chains (PFSC), across multiple sectors and spatial scales. Aquaculture plays a vital and rapidly expanding role in food security, in some cases overtaking wild caught fisheries in the production of high-quality animal protein in this PFSC. We performed a rapid global assessment to evaluate the effects of the COVID-19 pandemic and related emerging control measures on the aquaculture supply chain. Socio-economic effects of the pandemic were analysed by surveying the perceptions of stakeholders, who were asked to describe potential supply-side disruption, vulnerabilities and resilience patterns along the production pipeline with four main supply chain components: a) hatchery, b) production/processing, c) distribution/logistics and d) market. We also assessed different farming strategies, comparing land- vs. sea-based systems; extensive vs. intensive methods; and with and without integrated multi-trophic aquaculture, IMTA. In addition to evaluating levels and sources of economic distress, interviewees were asked to identify mitigation solutions adopted at local / internal (i.e., farm-site) scales, and to express their preference on national / external scale mitigation measures among a set of a priori options. Survey responses identified the potential causes of disruption, ripple effects, sources of food insecurity, and socio-economic conflicts. They also pointed to various levels of mitigation strategies. The collated evidence represents a first baseline useful to address future disaster-driven responses, to reinforce the resilience of the sector and to facilitate the design reconstruction plans and mitigation measures, such as financial aid strategies.

Effectiveness and safety of SARS-CoV-2 vaccine in real-world studies: a systematic review and meta-analysis

BACKGROUND

To date, coronavirus disease 2019 (COVID-19) becomes increasingly fierce due to the emergence of variants. Rapid herd immunity through vaccination is needed to block the mutation and prevent the emergence of variants that can completely escape the immune surveillance. We aimed to systematically evaluate the effectiveness and safety of COVID-19 vaccines in the real world and to establish a reliable evidence-based basis for the actual protective effect of the COVID-19 vaccines, especially in the ensuing waves of infections dominated by variants.

METHODS

We searched PubMed, Embase and Web of Science from inception to July 22, 2021. Observational studies that examined the effectiveness and safety of SARS-CoV-2 vaccines among people vaccinated were included. Random-effects or fixed-effects models were used to estimate the pooled vaccine effectiveness (VE) and incidence rate of adverse events after vaccination, and their 95% confidence intervals (CI).

RESULTS

A total of 58 studies (32 studies for vaccine effectiveness and 26 studies for vaccine safety) were included. A single dose of vaccines was 41% (95% CI: 28-54%) effective at preventing SARS-CoV-2 infections, 52% (31-73%) for symptomatic COVID-19, 66% (50-81%) for hospitalization, 45% (42-49%) for Intensive Care Unit (ICU) admissions, and 53% (15-91%) for COVID-19-related death; and two doses were 85% (81-89%) effective at preventing SARS-CoV-2 infections, 97% (97-98%) for symptomatic COVID-19, 93% (89-96%) for hospitalization, 96% (93-98%) for ICU admissions, and 95% (92-98%) effective for COVID-19-related death, respectively. The pooled VE was 85% (80-91%) for the prevention of Alpha variant of SARS-CoV-2 infections, 75% (71-79%) for the Beta variant, 54% (35-74%) for the Gamma variant, and 74% (62-85%) for the Delta variant. The overall pooled incidence rate was 1.5% (1.4-1.6%) for adverse events, 0.4 (0.2-0.5) per 10 000 for severe adverse events, and 0.1 (0.1-0.2) per 10 000 for death after vaccination.

CONCLUSIONS

SARS-CoV-2 vaccines have reassuring safety and could effectively reduce the death, severe cases, symptomatic cases, and infections resulting from SARS-CoV-2 across the world. In the context of global pandemic and the continuous emergence of SARS-CoV-2 variants, accelerating vaccination and improving vaccination coverage is still the most important and urgent matter, and it is also the final means to end the pandemic.

[Causal relationship between physical exercise and risk of ischemic stroke recurrence based on the potential outcome theory]

OBJECTIVE

To explore the causal relationship between physical exercise and ischemic stroke recurrence using a multiple imputation approach based on the potential outcomes framework.

METHODS

We collected data from 636 patients who were diagnosed with first-ever ischemic stroke between July, 2010 and December, 2018 at West China Hospital, Sichuan University.All the patients had motor ability and were followed up at least for 1 year.According to the intensity of physical exercise, the patients were divided into low-level physical exercise (LPE) group (n=244) and moderate-to high-intensity exercise (MHPE) group (n=392).With both the result and the time of recurrence as the potential outcomes, a multiple imputation method was used to impute the missing values based on a predictive matrix.Based on the imputed datasets, a causal inference model was built to estimate the average causal effect of physical exercise on the risk of stroke recurrence.

RESULTS

Among the enrolled patients, 148 experienced recurrent stroke with a median recurrence time of 24.0 months and a cumulative recurrence rate of 23.3%during follow-up.As there were no outliers and the marginal distributions of the potential outcomes were basically consistent, both the Strip plots and Kenel density plots indicated that the imputed values could have been plausible measurements if they had not been missing.The average causal effect (ACE) of physical exercise on stroke recurrence was 0.578 (95%CI: 0.186-0.970, P=0.012).

CONCLUSION

There is a causal relationship between physical exercise and the risk of ischemic stroke recurrence, indicating the value of moderate or high-level exercise after stroke in reducing the risk of stroke recurrence.

[Analysis of low-dose computed tomography compliance and related factors among high-risk population of lung cancer in three provinces participating in the cancer screening program in urban China]

Objective: To analyze the compliance and related factors of low-dose computed tomography (LDCT) screening among the high-risk population of lung cancer in three provinces participating in the cancer early diagnosis and early treatment program in urban areas of China. Methods: From October 2017 to October 2018, 17 983 people aged between 40 and 74 years old at high risk of lung cancer were recruited from Zhejiang, Anhui and Liaoning provinces. The basic demographic characteristics, living habits, history of the disease and family history of cancer were collected by using a cancer risk assessment questionnaire, and the data of participants examined by LDCT were obtained from the hospitals participating in the program. The screening compliance was quantified by the screening participation rate, and it was calculated as the proportion of participants completing LDCT scan among high-risk population. The related factors of LDCT screening compliance were analyzed by using a multivariate logistic regression model. Results: The age of 17 983 participants was (56.52±8.22) years old. Males accounted for 51.9% (N=9 332), and 69.5% (N=12 495) had ever smoked, including former smokers and current smokers. A total of 6 269 participants were screened by LDCT, and the screening participation rate was 34.86%. The results of multivariate logistic regression analysis showed that the age group of 50 to 69 years old, female, passive smokers, alcohol consumption, family history of lung cancer and history of chronic respiratory diseases were more likely to be screened by LDCT, while the compliance of LDCT screening in current smokers was low. Conclusions: The LDCT screening compliance of the high-risk population of lung cancer in urban areas of China still needs to be improved. Age, sex, smoking, drinking, family history of lung cancer and history of chronic respiratory disease are associated with screening compliance.

Narrative review on potential role of gut microbiota in certain substance addiction

As a neuropsychiatric disorder, substance addiction represents a major public health issue with high prevalence and mortality in many countries. Recently, gut microbiota has been certified to play a part in substance addiction through various mechanisms. Hence, we mainly focused on three substance including alcohol, cocaine and methamphetamine in this review, and summarized their relationships with gut microbiota, respectively. Besides, we also concluded the possible treatments for substance addiction from the perspective of applying gut microbiota. This review aims to build a bridge between substance addiction and gut microbiota according to existing evidences, so as to excavate the possible bi-directional function of microbiota-gut-brain axis in substance addiction for developing therapeutic strategies in the future.

Totally endoscopic sublay (TES) repair for lateral abdominal wall hernias: technique and first results

BACKGROUND

The optimal surgical treatment for lateral hernias of the abdominal wall remains unclear. The presented prospective study assesses for the first time in detail the clinical value of a totally endoscopic sublay (TES) technique for the repair of these hernias.

METHODS

Twenty-four consecutive patients with a lateral abdominal wall hernia underwent TES repair. This technique is naturally combined with a transversus abdominis release maneuver to create a sufficient retromuscular/preperitoneal space that can accommodate, if necessary, a giant prosthetic mesh.

RESULTS

The operations were successful in all but one patient who required open conversion because of dense intestinal adhesion. The mean defect width was 6.7 ± 3.9 cm. The mean defect area was 78.0 ± 102.4 cm² (range 4-500 cm²). The mean mesh size used was 330.2 ± 165.4 cm² (range 108-900 cm²). The mean operative time was 170.2 ± 73.8 min (range, 60-360 min). The mean visual analog scale score for pain at rest on the first day was 2.5 (range 1-4). The average postoperative stay was 3.4 days (range 2-7 days). No serious complications (Dindo-Clavien Grade 2-4) were seen within a mean follow-up period of 13.3 months.

CONCLUSIONS

A totally endoscopic technique (TES) for the treatment of lateral hernias is described. The technique revealed to be reliable, safe and cost-effective. The first results are promising, but larger studies with longer follow-up periods are recommended to determine the real clinical value.

Retroperitoneal totally endoscopic prosthetic repair of primary lumbar hernia

PURPOSE

A primary lumbar hernia is a rare entity that requires surgical management, but the preferred technique has not been established. We herein describe a standardized and reproducible retroperitoneal totally endoscopic prosthetic (TEP) repair technique for primary lumbar hernias.

METHODS

Ten adult patients with primary lumbar hernias underwent retroperitoneal TEP repair from February 2019 to July 2020. A sufficient retroperitoneal space was established to accommodate a non-coated polypropylene mesh to reinforce the weakened flank area, and hernia content reduction and defect closure were then performed. The patients' clinical data were prospectively collected and analyzed.

RESULTS

Nine patients had a primary superior lumbar hernia and one patient had a primary diffuse lumbar hernia. All operations were successfully performed without serious intraoperative complications. The mean defect area was 6.4 ± 2.8 cm² (range 4-12 cm²), and the mean mesh area was 144.6 cm² (range 130-180 cm²). The average operative time (skin to skin) was 49.0 ± 5.7 min (range 40-60 min), and intraoperative bleeding was minimal. The mean visual analog pain scale score at rest on the first postoperative day was 2.2 (range 2-3). The average length of postoperative stay was 1.5 days (range 1-2 days). No serious postoperative complications occurred. No recurrence, chronic pain, or mesh infection occurred during a mean follow-up period of 7.5 months.

CONCLUSIONS

The retroperitoneal TEP repair for primary lumbar hernias is safe, efficient, and reproducible. Anti-adhesive coated meshes and fixation tackers are not required, making this a cost-effective procedure that is worthy of recommendation.

Long noncoding RNA SNHG14 promotes breast cancer cell proliferation and invasion via sponging miR-193a-3p

OBJECTIVE

Breast cancer (BC) is one of the most ordinary fatal cancers. Recent studies have identified the vital role of long noncoding RNAs (lncRNAs) in the development and progression of BC. In this research, lncRNA SNHG14 was studied to identify how it functioned in the development and metastasis of BC.

PATIENTS AND METHODS

SNHG14 expression of tissues was detected by Real Time-quantitative Polymerase Chain Reaction (RT-qPCR) in 50 paired patients with BC. And cell proliferation assay, colony formation assay, and transwell assay were enrolled to observe the biological behavior changes of BC cells through gain or loss of SNHG14. In addition, luciferase assays and RNA immunoprecipitation assay (RIP) were performed to discover the potential targets of SNHG14 in BC cells.

RESULTS

SNHG14 expression level of BC samples was higher than that of adjacent ones. Besides, cell growth ability and cell invaded ability of BC cells were inhibited after SNHG14 was silenced, while cell growth ability and cell invaded ability of BC cells were promoted after SNHG14 was overexpressed. In addition, miR-193a-3p was upregulated after silence of SNHG14 in BC cells, while miR-193a-3p was downregulated after overexpression of SNHG14 in BC cells. Furthermore, luciferase assays and RNA immunoprecipitation assay (RIP) showed that miR-193a-3p was a direct target of SNHG14 in BC.

CONCLUSIONS

Our study uncovers a new oncogene in BC and suggests that SNHG14 could enhance BC cell proliferation and invasion via sponging miR-193a-3p, which provided a novel therapeutic target for BC patients.

Genome-wide Analyses Identify a Novel Risk Locus for Nonsyndromic Cleft Palate

The 3 major subphenotypes observed in patients with nonsyndromic orofacial clefts (NSOFCs) are nonsyndromic cleft lip only (NSCLO), nonsyndromic cleft lip with palate (NSCLP), and nonsyndromic cleft palate only (NSCPO). However, the genetic architecture underlying NSCPO is largely unknown. Here we performed a 2-stage genome-wide association study (GWAS) on NSCPO and replication analyses of selected variants in other NSOFCs from the Chinese Han population. We identified a novel locus (15q24.3) and a known locus (1q32.2) where variants in or near the gene reached genome-wide significance (2.80 × 10^-13 < P < 1.72 × 10^-08) in a test for association with NSCPO in a case-control design. Although a variant from 15q24.3 was found to be significantly associated with both NSCPO and NSCLP, the direction of estimated effects on risk were opposite. Our functional annotation of the risk alleles within 15q24.3 coupled with previously established roles of the candidate genes within identified risk loci in periderm development, embryonic patterning, and/or regulation of cellular processes supports their involvement in palate development and the pathogenesis of cleft palate. Our study advances the understanding of the genetic basis of NSOFCs and provides novel insights into the pathogenesis of NSCPO.

Long noncoding RNA SNHG14 promotes breast cancer cell proliferation and invasion via sponging miR-193a-3p

Since this article has been suspected of research misconduct and the corresponding authors did not respond to our request to prove originality of data and figures, "Long noncoding RNA SNHG14 promotes breast cancer cell proliferation and invasion via sponging miR-193a-3p, by S.-D. Xie, C. Qin, L.-D. Jin, Q.-C. Wang, J. Shen, J.-C. Zhou, Y.-X. Chen, A.-H. Huang, W.-H. Zhao, L.-B. Wang, published in Eur Rev Med Pharmacol Sci 2019; 23 (6): 2461-2468. DOI: 10.26355/eurrev_201903_17393. PMID: 30964172" has been withdrawn. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/17393.

Beneficial role of acetylcholine in chlorophyll metabolism and photosynthetic gas exchange in Nicotiana benthamiana seedlings under salinity stress

Acetylcholine (ACh) is believed to improve plant growth. However, regulation at biochemical and molecular levels is largely unknown. The present study investigated the impact of exogenously applied ACh (10 µm) on growth and chlorophyll metabolism in hydroponically grown Nicotiana benthamiana under salt stress (150 mm NaCl). Salinity reduced root hydraulic conductivity while ACh-treated seedlings exhibited a significant increase, resulting in increased relative water content. Salinity induced a reduction in chlorophyll biosynthetic intermediates, such as protoporphyrin-IX, Mg-photoporphyrin-IX and protochlorophyllide, which were significantly ameliorated in the presence of ACh. This influence of ACh on chlorophyll synthesis was confirmed by up-regulation of HEMA1, CHLH, CAO and POR genes. Gas exchange parameters, i.e. stomatal conductance, internal CO2 concentration and transpiration rate, increased with ACh, thereby alleviating the salinity effects on photosynthesis. In addition, the salinity-induced enhancement of lipid peroxidation declined after ACh treatment through modulation of the activity of the assayed antioxidant enzymes (superoxide dismutase and peroxidase). Importantly, ACh significantly reduced the uptake of Na and increased uptake of K, resulting in a decline in the Na/K ratio. Results of the present study indicate that ACh can be effective in ameliorating NaCl-induced osmotic stress, altering chlorophyll metabolism and thus photosynthesis by maintaining ion homeostasis, hydraulic conductivity and water balance.

Single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac high ligation using an ordinary taper needle: a novel technique for pediatric inguinal hernia

PURPOSE

Laparoscopic high ligation of the internal inguinal ring is an alternative procedure for treatment of pediatric inguinal hernia (PIH), with a major trend toward increasing use of extracorporeal knotting and decreasing use of working ports. We have utilized this laparoscopic technique to treat the entire spectrum of PIH (including incarcerated cases) for more than 17 years, and the technique continues to evolve and improve. We herein report our latest modification of this minimally invasive technique, namely single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac high ligation using an ordinary taper needle, and evaluate its safety and efficacy.

METHODS

From July 2016 to July 2019, 790 children with indirect PIH were treated by laparoscopic surgery. All patients underwent high ligation surgery with a modified single-site laparoscopic technique mainly performed by extracorporeal suturing with an ordinary closed-eye taper needle (1/2 arc 11 × 34). The clinical data were retrospectively analyzed.

RESULTS

All surgeries were successful without serious complications. A contralateral patent processus vaginalis (CPPV) was found intraoperatively and subsequently repaired in 190 patients (25.4%). The mean operative time was 15 min (8-25 min) for 557 unilateral hernias and 21 min (14-36 min) for 233 bilateral hernias. The mean postoperative stay was 20 h. Minor complications occurred in five patients (0.63%) and were managed properly, with no major impact on the final outcomes. No recurrence was noted in the patients who were followed up for 6-42 months. No obvious scar was present postoperatively.

CONCLUSION

Modified SLPEC of hernia sac high ligation using an ordinary taper needle for repair of indirect PIH is a safe, reliable, and minimally invasive procedure with satisfactory outcome, with no special device being needed. It is easy to learn and perform and is worthy of popularization in the clinical setting.

Heme oxygenase-1 regulates autophagy through carbon-oxygen to alleviate deoxynivalenol-induced hepatic damage

Deoxynivalenol (DON) cannot be totally removed due to its stable chemical characteristics and chronic exposure to low doses of DON causes significant toxic effects in humans and animals. However, the potential hazard of such low-dose exposure in target organs still remains not completely understood, especially in liver, which is mainly responsible for detoxification of DON. In the present study, we demonstrated for the first time that estimated human daily DON exposure (25 μg/kg bw) for 30 and 90 days caused low-grade inflammatory infiltration around hepatic centrilobular veins, elevated systemic IL-1β, IL-6 and TNF-α and impaired liver function evidenced by increased serum ALT activity. At the molecular level, expressions of autophagy-related proteins as well as Cleaved Caspase-3 and Cleaved Caspase-7 were upregulated during DON exposure, which indicated the activation of autophagy and apoptosis. Importantly, AAV-mediated liver-specific overexpression of HO-1 reversed DON-induced liver damages, upregulated autophagy and attenuated apoptosis in liver, while AAV-mediated HO-1 silence aggravated DON-induced liver damages, inhibited autophagy and increased apoptosis. Furthermore, in vitro experiments demonstrated that lentivirus-mediated HO-1 overexpression in Hepa 1-6 cells prolonged the duration of autophagy and delayed the onset of apoptosis. HO-1 silence in Hepa 1-6 cells inhibited activation of autophagy and accelerated occurrence of apoptosis, and these could be recovered by CO pre-treatment. Therefore, we suppose that HO-1 might be a potential research target to protect human and animal from liver injuries induced by low dose of DON exposure.

Requirement of Hyaluronan Synthase-2 in Craniofacial and Palate Development

Cleft palate is a common major birth defect resulting from disruption of palatal shelf growth, elevation, or fusion during fetal palatogenesis. Whereas the molecular mechanism controlling palatal shelf elevation is not well understood, a prevailing hypothesis is that region-specific accumulation of hyaluronan, a predominant extracellular glycosaminoglycan in developing palatal mesenchyme, plays a major role in palatal shelf elevation. However, direct genetic evidence for a requirement of hyaluronan in palate development is still lacking. In this study, we show that Has2, 1 of 3 hyaluronan synthases in mammals, plays a major role in hyaluronan synthesis in the neural crest-derived craniofacial mesenchyme during palatogenesis in mice. We analyzed developmental defects caused by tissue-specific inactivation of Has2 throughout the cranial neural crest lineage or specifically in developing palatal or mandibular mesenchyme, respectively, using Wnt1-Cre, Osr2-Cre, and Hand2-Cre transgenic mice. Inactivation of Has2 either throughout the neural crest lineage or specifically in the developing palatal mesenchyme caused reduced palatal shelf size and increased palatal mesenchyme cell density prior to the time of normal palatal shelf elevation. Whereas both Has2f/f;Wnt1-Cre and Has2f/f;Osr2-Cre mutant mice exhibit cleft palate at complete penetrance, the Has2f/f; Wnt1-Cre fetuses showed dramatically reduced mandible size and complete failure of palatal shelf elevation, whereas Has2f/f;Osr2-Cre fetuses had normal mandibles and delayed palatal shelf elevation. All Has2f/f;Hand2-Cre pups showed reduced mandible size and about 50% of them had cleft palate with disruption of palatal shelf elevation. Results from explant culture assays indicate that disruption of palatal shelf elevation in Has2f/f;Hand2-Cre mutant fetuses resulted from physical obstruction by the malformed mandible and tongue. Together, these data indicate that hyaluronan plays a crucial intrinsic role in palatal shelf expansion and timely reorientation to the horizontal position above the tongue as well as an important role in mandibular morphogenesis that secondarily affects palatal shelf elevation.