Research on duck egg recognition algorithm based on improved YOLOv4

1. The following study addressed the problem of small duck eggs as challenging to detect and identify for pick up in complex free-range duck farm environments. It introduces improvements to the YOLOv4 convolutional neural network target detection algorithm, based on the working conditions of egg-picking robots.2. Specifically, one scale of anchor boxes was removed from the prediction network, and a duck egg labelling dataset was established to make the improved algorithm YOLOv4-ours better match the working state of egg-picking robots and enhance detection performance.3. Through multiple comparative experiments, the YOLOv4-ours object detection algorithm exhibited superior overall performance, achieving a precision of 98.85%, recall of 96.67%, and an average precision of 98.60% and F1 score increased to 97%. Compared to the original YOLOv4 model, these improvements represented increases of 1.89%, 3.41%, 1.32%, and 1.04%, respectively. Furthermore, detection time was reduced from 0.26 seconds per image to 0.20 seconds.4. The enhanced model accurately detected duck eggs in free-range duck housing, effectively meeting the real-time egg identification and picking requirements.

Construction of 2D/1D Cu7S4 nanosheets/Mn0.3Cd0.7S nanorods heterojunction for highly efficient photocatalytic hydrogen evolution

Developing cost-effective cocatalyst-modified photocatalytic systems with boosted carrier separation and rapid surface catalytic reaction is an ideal strategy for effectively converting solar energy into desired fuels. Herein, a series of Cu7S4/Mn0.3Cd0.7S hierarchical heterostructures are designed and fabricated to achieve efficient and robust photocatalytic H2 evolution by coupling one-dimensional (1D) Mn0.3Cd0.7S nanorods with two-dimensional (2D) Cu7S4 nanosheets through a facile sonochemical strategy. Benefiting from dimensionality and cocatalyst effects, the constructed 2D/1D Cu7S4/Mn0.3Cd0.7S heterojunction photocatalyst containing 1.5 wt% Cu7S4 displays excellent photostability and superior photocatalytic H2 evolution rate up to 914.3 μmol h-1, which is 4.43 and 2.22-folds increment relative to bare Mn0.3Cd0.7S and the 3 wt% Pt/Mn0.3Cd0.7S, respectively. The various characterization results reveal that the utilization of semimetallic Cu7S4 nanosheets as the cocatalyst to form a Schottky heterojunction can promote the light-harvesting capability, suppress charge carrier recombination, and provide sufficient reaction sites for hydrogen generation, thereby resulting in the dramatically improved photocatalytic performance. This work clarifies the role of Cu7S4 nanosheets as the robust and cost-effective cocatalyst in the photocatalytic reaction and opens a new horizon for designing other Cu7S4-based cocatalyst/semiconductor Schottky heterostructures for efficient solar-to-fuel conversion.

Biochemical characterization and key catalytic residue identification of a novel alpha-agarase with CBM2 domain

Agarooligosaccharides have great potential in food industry because of their various bio-activities, while the limited availability and diversity of α-agarases hinder agarooligosaccharides' broader application. To overcome this limitation, a computer-assisted method was used to screen and identify novel agarases. Firstly, one novel α-agarase, AgaB, with an N-terminal CBM2 domain (the first report of this domain in agarases), was discovered. Purified agarases only exhibited activity against agarose, with optimum activity at 40℃ and pH 8.0. Analysis of hydrolysis products indicated that AgaB is an endo-type α-agarase, producing agarotetraose and agarohexaose. Secondly, AgaB truncated CBM2 showed increased Km values, suggesting that CBM2 aids in substrate binding. Thirdly, E468 and D333 are possibly catalytic amino acids, which was supported by molecular docking results and mutants. Biochemical characterization of first reported CBM2-containing agarase and catalytic mechanism study lay the foundation for the exploration and development of α-agarases in the future.

Mutation of TRPML1 Channel and Pathogenesis of Neurodegeneration in Haimeria

Neurodegenerative diseases, a group of debilitating disorders, have garnered increasing attention due to their escalating prevalence, particularly among aging populations. Alzheimer's disease (AD) reigns as a prominent exemplar within this category, distinguished by its relentless progression of cognitive impairment and the accumulation of aberrant protein aggregates within the intricate landscape of the brain. While the intricate pathogenesis of neurodegenerative diseases has been the subject of extensive investigation, recent scientific inquiry has unveiled a novel player in this complex scenario-transient receptor potential mucolipin 1 (TRPML1) channels. This comprehensive review embarks on an exploration of the intricate interplay between TRPML1 channels and neurodegenerative diseases, with an explicit spotlight on Alzheimer's disease. It immerses itself in the intricate molecular mechanisms governing TRPML1 channel functionality and elucidates their profound implications for the well-being of neurons. Furthermore, the review ventures into the realm of therapeutic potential, pondering the possibilities and challenges associated with targeting TRPML1 channels as a promising avenue for the amelioration of neurodegenerative disorders. As we traverse this multifaceted terrain of neurodegeneration and the enigmatic role of TRPML1 channels, we embark on a journey that not only broadens our understanding of the intricate machinery governing neuronal health but also holds promise for the development of innovative therapeutic interventions in the relentless battle against neurodegenerative diseases.

Underlying Mechanisms and Tunability of the Anomalous Hall Effect in NiCo2 O4 Films with Robust Perpendicular Magnetic Anisotropy

Their high tunability of electronic and magnetic properties makes transition-metal oxides (TMOs) highly intriguing for fundamental studies and promising for a wide range of applications. TMOs with strong ferrimagnetism provide new platforms for tailoring the anomalous Hall effect (AHE) beyond conventional concepts based on ferromagnets, and particularly TMOs with perpendicular magnetic anisotropy (PMA) are of prime importance for today's spintronics. This study reports on transport phenomena and magnetic characteristics of the ferrimagnetic TMO NiCo2 O4 (NCO) exhibiting PMA. The entire electrical and magnetic properties of NCO films are strongly correlated with their conductivities governed by the cation valence states. The AHE exhibits an unusual sign reversal resulting from a competition between intrinsic and extrinsic mechanisms depending on the conductivity, which can be tuned by the synthesis conditions independent of the film thickness. Importantly, skew-scattering is identified as an AHE contribution for the first time in the low-conductivity regime. Application wise, the robust PMA without thickness limitation constitutes a major advantage compared to conventional PMA materials utilized in today's spintronics. The great potential for applications is exemplified by two proposed novel device designs consisting only of NCO films that open a new route for future spintronics, such as ferrimagnetic high-density memories.

Large-Area Synthesis of Ferromagnetic Fe5- x GeTe2 /Graphene van der Waals Heterostructures with Curie Temperature above Room Temperature

Van der Waals (vdW) heterostructures combining layered ferromagnets and other 2D crystals are promising building blocks for the realization of ultracompact devices with integrated magnetic, electronic, and optical functionalities. Their implementation in various technologies depends strongly on the development of a bottom-up scalable synthesis approach allowing for realizing highly uniform heterostructures with well-defined interfaces between different 2D-layered materials. It is also required that each material component of the heterostructure remains functional, which ideally includes ferromagnetic order above room temperature for 2D ferromagnets. Here, it is demonstrated that the large-area growth of Fe5- x GeTe2 /graphene heterostructures is achieved by vdW epitaxy of Fe5- x GeTe2 on epitaxial graphene. Structural characterization confirms the realization of a continuous vdW heterostructure film with a sharp interface between Fe5- x GeTe2 and graphene. Magnetic and transport studies reveal that the ferromagnetic order persists well above 300 K with a perpendicular magnetic anisotropy. In addition, epitaxial graphene on SiC(0001) continues to exhibit a high electronic quality. These results represent an important advance beyond nonscalable flake exfoliation and stacking methods, thus marking a crucial step toward the implementation of ferromagnetic 2D materials in practical applications.

Exercise preconditioning attenuates cerebral ischemia-induced neuronal apoptosis, Th17/Treg imbalance, and inflammation in rats by inhibiting the JAK2/STAT3 pathway

BACKGROUND

Exercise preconditioning (EP) is essential for preventing ischemic stroke. Recent studies have shown that EP exerts neuroprotective effects in the cerebral ischemia-reperfusion injury model. Nonetheless, there have been few reports on the relationship between EP and the Th17/Treg balance. Moreover, it is unclear whether the JAK2/STAT3 pathway is responsible for the neuroprotective effect of EP. Therefore, we aimed to explore the impact of EP, other than the anti-inflammatory and antiapoptotic functions, on the Th17/Treg balance via the JAK2/STAT3 pathway in a middle cerebral artery occlusion (MCAO)-induced model.

RESULTS

Fifty rats were randomly allocated into five groups, including the sham group (n = 10), EP+sham group (n = 10), MCAO group (n = 10), EP+MCAO group (n = 10), and EP+MCAO+JAK2/STAT3 pathway agonist (coumermycin A1, CA1) group (n = 10). The results indicated that EP alleviated neurological deficits, reduced infarct volume, and ameliorated neuronal apoptosis induced by MCAO. Additionally, the MCAO-induced Th17/Treg imbalance could be rectified by EP. The decreased levels of IL-10 and Foxp3 and increased IL-17 and RORα in the MCAO group were reversed by EP treatment. Regarding inflammation, EP reduced the concentrations of IL-6 and IL-17 and elevated those of IL-10 and TGF-β. The neuroprotective effects of EP were accompanied by decreased phosphorylation of JAK2 and STAT3. Furthermore, CA1 pretreatment diminished all the beneficial effects of EP partially.

CONCLUSION

Our findings suggest that EP contributes to attenuating neuronal apoptosis, Th17/Treg imbalance, and inflammation induced by MCAO via inhibiting the JAK2/STAT3 pathway, indicating its therapeutic potential in ischemic stroke.

Changing patterns of the East Asian monsoon drive shifts in migration and abundance of a globally important rice pest

Numerous insects including pests and beneficial species undertake windborne migrations over hundreds of kilometers. In East Asia, climate-induced changes in large-scale atmospheric circulation systems are affecting wind-fields and precipitation zones and these, in turn, are changing migration patterns. We examined the consequences in a serious rice pest, the brown planthopper (BPH, Nilaparvata lugens) in East China. BPH cannot overwinter in temperate East Asia, and infestations there are initiated by several waves of windborne spring or summer migrants originating from tropical areas in Indochina. The East Asian summer monsoon, characterized by abundant rainfall and southerly winds, is of critical importance for these northward movements. We analyzed a 42-year dataset of meteorological parameters and catches of BPH from a standardized network of 341 light-traps in South and East China. We show that south of the Yangtze River during summer, southwesterly winds have weakened and rainfall increased, while the summer precipitation has decreased further north on the Jianghuai Plain. Together, these changes have resulted in shorter migratory journeys for BPH leaving South China. As a result, pest outbreaks of BPH in the key rice-growing area of the Lower Yangtze River Valley (LYRV) have declined since 2001. We show that these changes to the East Asian summer monsoon weather parameters are driven by shifts in the position and intensity of the Western Pacific subtropical high (WPSH) system that have occurred during the last 20 years. As a result, the relationship between WPSH intensity and BPH immigration that was previously used to predict the size of the immigration to the LYRV has now broken down. Our results demonstrate that migration patterns of a serious rice pest have shifted in response to the climate-induced changes in precipitation and wind pattern, with significant consequences for the population management of migratory pests.

Observation of Asymmetric Oxidation Catalysis with B20 Chiral Crystals

Heterogeneous processes for enantiomeric processes based on inorganic crystals have been a topic of resurgent interest. However, it remains a challenge to answer the question of what the driving forces for the emergence of homochirality in nature and chemical reactions are. Here, we propose one possible driver of enantioselectivity, namely orbital angular momentum (OAM) polarization. Enantioselective recognition of 3,4-dihydroxyphenylalanine (DOPA) was achieved by using B20 group PdGa crystals. Orbital textures of PdGa enantiomers suggest large OAM polarization for the bands near the Fermi level and carrying opposite signs. A positive or a negative magnetization in the [111] direction is expected depending on the handedness of PdGa crystal. This leads to the difference in adsorption energy between PdGa chiral crystals and DOPA molecules, depending on the pairing ability between the O 2p (DOPA) and Pd 4d orbital (PdGa). These results provide a new route to achieving enantioselectivity with pure inorganic crystals and may hold an answer to the origin of chirality in nature.

Antimicrobial high molecular weight pectin polysaccharides production from diverse citrus peels using a novel PL10 family pectate lyase

The discovery of environmentally friendly enzymes that can convert inexpensive and abundant citrus peel pectin into high value-added product is a potential avenue for the citrus peel application. In this study, a novel PL10-family pectate lyase (pelA) was characterized from marine bacterium Echinicola pacifica. PelA was a Ca²⁺ dependent pectate lyase whose activity was highest at pH 8 and 40 °C. It was capable of degrading polygalacturonic acid (PGA) and citrus peel pectin (CPP), but not apple peel pectin. Notably, PelA hydrolyzed PGA to high molecular weight polysaccharide (average molecular weight 111.4 kDa). Moreover, PelA was also able to degrade CPP from nine distinct citrus species into polysaccharides (average molecular weight ranging from 84.7 to 539.2 kDa) that showed antimicrobial activity against Staphylococcus epidermidis (88.8 %), Bacillus subtilis (99.8 %), Staphylococcus aureus (92.1 %), Escherichia coli (100.0 %) and Klebsiella pneumoniae (86.4 %). Considering the high market value of pectin in the food industry, PelA's capacity to convert citrus pectin into high molecular weight polysaccharides lays a foundation for its applications.

Efficacy and safety of Tuina (Chinese Therapeutic Massage) for knee osteoarthritis: A randomized, controlled, and crossover design clinical trial

Background

Knee osteoarthritis (KOA) is a highly prevalent joint disease among the middle-aged and elderly population that can lead to pain, functional impairment, decreased quality of life, and a large number of medical expenses. Physical therapy is one of the main treatment methods for KOA. In China, Tuina has been widely used in the treatment of KOA, but up to now, there is no high-quality medical evidence to support its effectiveness and safety. The purpose of this study was to objectively evaluate the efficacy and safety of Tuina in the treatment of KOA.

Methods

A crossover design clinical trial was performed on 96 patients. The test group and the control group in the trial were allocated randomly in a ratio of 1:1. The test group received Tuina treatment for 4 weeks first and then received health education intervention for another 4 weeks. The control group received health education intervention for 4 weeks first and then received Tuina treatment for another 4 weeks. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) total score was chosen as the primary outcome. The WOMAC pain score, WOMAC stiffness, WOMAC daily activity score, and visual analog scale (VAS) score were the secondary outcomes. Adverse events during the intervention were collected in both groups.

Results

Compared with the baseline, the WOMAC total score, WOMAC pain score, WOMAC stiffness, WOMAC daily activity, and VAS score of patients in both groups were improved significantly at weeks 4 and 8 (p < 0.001). All patients who received Tuina treatment were significantly superior to those who received health education intervention in the WOMAC total score (194.96, 95% CI = 164.94–224.97, P < 0.001), WOMAC pain score (45.96, 95% CI = 35.82–56.09, P < 0.001), WOMAC stiffness (31.42, 95% CI = 26.37–36.46, P < 0.001), WOMAC daily activity (117.58, 95% CI = 97.56–137.61, P < 0.001), and VAS score (1.07, 95% CI = 0.83–1.32, P < 0.001). Both groups had no serious adverse events during the treatment.

Conclusion

This trial demonstrated that Tuina can reduce joint pain in patients with KOA and improve the physical functions of the knee joint effectively and safely.

Clinical trial registration

This trial was registered in the Chinese Clinical Trial Registry (No. ChiCTR-TTRCC-13003157). http://www.chictr.org.cn/showproj.aspx?proj=6402.

Formation and Evolution of Micro/Nano Periodic Ripples on 2205 Stainless Steel Machined by Femtosecond Laser

The preparation of micro/nano periodic surface structures using femtosecond laser machining technology has been the academic frontier and hotspot in recent years. The formation and evolution of micro/nano periodic ripples were investigated on 2205 stainless steel machined by femtosecond laser. Using single spot irradiation with fixed laser fluences and various pulse numbers, typical ripples, including nano HSFLs (‖), nano LSFLs (⟂), nano HSFLs (⟂) and micro grooves (‖), were generated one after another in one test. The morphologies of the ripples were analyzed, and the underlying mechanisms were discussed. It was found that the nano holes/pits presented at all stages could have played a key role in the formation and evolution of micro/nano periodic ripples. A new kind of microstructure, named the pea pod-like structure here, was discovered, and it was suggested that the formation and evolution of the micro/nano periodic ripples could be well explained by the pea pod-like structure model.

Exercise attenuates mitochondrial autophagy and neuronal degeneration in MPTP induced Parkinson's disease by regulating inflammatory pathway

Parkinson's disease (PD) is a chronic neuronal loss of dopamine and drugs used for its management has several limitations. The present report determines the effect of exercise on mitochondrial autophagy against PD. Parkinson's disease was induced by 15 doses of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP; 30 mg/kg, i.p.) for 3 weeks, on five consecutive days in a week. Exposure of exercise was provided for 40 min for a period of 2 weeks after PD confirmation. Assessment of behaviour was performed to evaluate the effect of exercise on motor function and cognitive function in PD rats. Levels of reactive oxygen species (ROS) and inflammatory cytokines were assessed in PD rats using enzyme linked immunosorbent assay (ELISA). Expression of myocyte-specific enhancer factor 2D (MEF2D) and NADH dehydrogenase 6 (ND6) was estimated in PD rats. Exposure to exercise ameliorates the altered motor function and cognitive function in PD rats. There was a reduction in ROS and cytokine levels in the brain tissue of the exercise group compared to the negative control group. Exercise ameliorates the altered expression of apoptotic proteins and mRNA expression of MEF2D and ND6 in the brain tissue of MPTP induced PD rats. In conclusion, data of study reveal that exercise protects the mitochondrial autophagy in PD rats by reducing inflammatory cytokines and oxidative stress.

Research for correlation between heart rate variability parameters and bone mineral density in patients of type 2 diabetes mellitus

PURPOSE

The relationship of CAN and BMD, fracture risk is still unclear in T2DM. The aim of the present study is to investigate the correlation between heart rate variability (HRV) and BMD in T2DM.

METHODS

The study included 276 patients with T2DM aged ≥ 50 years, and Cardiovascular Autonomic Reflex Tests (CARTs) were applied to divide patients into two groups: CAN ( ±). 24 h Ambulatory ECG was assessed for HRV, BMD was measured by dual-energy X-ray bone densitometry, and FRAX scores were calculated for 10-year hip fracture risk (HF¹) and major osteoporotic fracture risk (MOF). Adjusted regression analysis was performed to investigate influence factors for BMD and fracture risk. ROC curve was used to analyze the optimal cut-off point of LF/HF for screening osteoporosis.

RESULTS

Baseline data showed significant differences in the duration of T2DM, insulin resistance index (HOMA-IR), 25-hydroxyvitamin D[25(OH)D], femoral neck BMD, hip BMD, lumbar BMD, HF¹, and MOF between the CAN ( +) and CAN (-) groups. The proportion of patients with osteoporosis increased as the degree of CAN lesion increased. Correlation analysis showed that LF/HF was significantly correlated with BMD, especially with hip (r = - 0.534, p < 0.001). Regression analysis showed that LF/HF was a risk factor for reduced BMD and increased fracture risk. The optimal cut-point value for LF/HF to predict osteoporosis by ROC curve analysis was 3.17.

CONCLUSIONS

CAN is associated with reduced BMD and increased fracture risk in patients with T2DM, and LF/HF may have the potential to be a predictor of diabetic osteoporosis and have some clinical value in early diagnosis of diabetic osteoporosis and non-traumatic fractures in T2DM.

Analysis of reporting quality of clinical practice guidelines/consensuses on metastatic colorectal cancer based on the RIGHT checklist

OBJECTIVE

The current study aimed to assess the reporting quality of the clinical practice guidelines/consensuses on metastatic colorectal cancer based on the Reporting Items for Practice Guidelines in HealThcare (RIGHT) checklist.

METHODS

We searched China National Knowledge Infrastructure, VIP database, Wanfang Data, Chinese Biological Literature Service System, PubMed, Web of Science, ScienceDirect, Elsevier clinicalkey, BMJ Database, EMBASE, Cochrane Library, World Health Organization Network and other websites. We collected clinical practice guidelines/consensuses on metastatic colorectal cancer with published between 1 January 2017 and 1 April 2021 after release of the RIGHT checklist. Two reviewers extracted the basic information independently and conducted a RIGHT evaluation.

RESULTS

Eighteen guidelines/consensuses were included, 10 from China and 8 from other countries. The average reporting rate was 74.1%±11.2%. Thirteen items had 100% reporting rate, and the reporting rate for items No. 16 (11.1%), 17 (16.7%) and 18b (22.2%) was low. Basic information had the highest reporting rate (100%), whereas review and quality assurance had the lowest (13.9%). The average reporting rate of guidelines/consensuses published in other countries was higher than in China [p=0.005; odds ration (OR) 1.17, 95% confidence interval (CI) 1.07-1.28]. The average reporting rate of the guidelines was higher than that of the consensus statements (p<0.001; OR 1.20, 95% CI 1.10-1.31). The reporting rates of guidelines/consensuses focused on whole body (79.0%±12.7%) were higher than local organ (69.2%±7.3%) metastases (p=0.005; OR 1.14, 95% CI 1.04-1.25).

CONCLUSIONS

The quality of reporting using the RIGHT checklist varied among the guidelines/consensuses on metastatic colorectal cancer. Low-quality items were external review and quality assurance. Developers of guidelines/consensuses should aim to improve the reporting quality in the future.

The Mobile Phone Addiction and Depression Among High School Students: The Roles of Cyberbullying Victimization, Perpetration, and Gender

Objective

To examine the relation between mobile phone addiction and high school students' depression, and its inner mechanism-the sequential mediating roles of the cyberbullying victimization and the cyberbullying perpetration in this relationship.

Methods

1297 high school students were recruited to complete the Smartphone Addiction Scale, European Cyberbullying Intervention Project Questionnaire and the Center for Epidemiological Studies Depression Scale.

Results

(1) Mobile phone addiction was positively correlated with and high school students' depression; (2) cyberbullying victimization and the cyberbullying perpetration significantly mediated the relation between mobile phone addiction and high school students' depression, which contained tow mediating paths-the independent mediating effects of cyberbullying victimization and the sequential mediating effect of cyberbullying victimization and the cyberbullying perpetration; (3) there are gender differences in the sequential mediation model, and boys who are victims of cyberbullying are more likely to develop into cyberbullying perpetrators than girls.

Conclusion

The results of this study indicate that depression among high school students with mobile phone addiction can be eliminated through the development of cyberbullying victimization and the cyberbullying perpetration.

Extracellular vesicles derived from bone marrow mesenchymal stem cells alleviate neuroinflammation after diabetic intracerebral hemorrhage via the miR-183-5p/PDCD4/NLRP3 pathway

OBJECTIVES

Intracerebral hemorrhage (ICH) induced by diabetes results in further brain injury and nerve cell death. Bone marrow mesenchymal stem cell (BMSC) transplantation contributes to attenuating neurological deficits after ICH. This study investigated the mechanism of extracellular vesicles (EVs) derived from BMSCs in reducing neuroinflammation after diabetic ICH.

METHODS

BMSC-EVs were isolated and identified. The rat model of db/db-ICH was established and the model rats were administered with EVs. miR-183-5p expression in brain tissues of db/db-ICH rats was detected. The brain injury of db/db-ICH rats was evaluated by measuring neurobehavioral score, brain water content and inflammatory factors. BV2 cells were cultured in vitro to establish high-glucose (HG)-Hemin-BV2 cell model. The levels of reactive oxygen species (ROS) and inflammatory factors in BV2 cells were measured, and BV2 cell viability and apoptosis were assessed. The targeting relationship between miR-183-5p and PDCD4 was predicted and verified. The activation of PDCD4/NLRP3 pathway in rat brain tissues and BV2 cells was detected.

RESULTS

miR-183-5p expression was reduced in db/db-ICH rats brain tissues. BMSC-EVs ameliorated cranial nerve function, decreased brain water content and repressed inflammatory response by carrying miR-183-5p. BMSC-EVs mitigated HG-Hemin-BV2 cell injury, reduced ROS level and suppressed inflammatory response. miR-183-5p targeted PDCD4. PDCD4 promoted BV2 cell inflammation by activating the NLRP3 pathway. BMSC-EVs inhibited HG-Hemin-BV2 cell inflammation through the miR-183-5p/PDCD4/NLRP3 pathway, and inhibition of miR-183-5p reversed the protective effect of EVs.

CONCLUSION

BMSC-EVs carried miR-183-5p into db/db-ICH rat brain tissues and repressed the NLRP3 pathway by targeting PDCD4, thus alleviating neuroinflammation after diabetic ICH.

Hypertension management in elderly with severe intracerebral hemorrhage

Objective

To explore the effect of individualized blood pressure (BP)‐lowering treatment on the outcomes of elderly patients with severe intracerebral hemorrhage (ICH).

Methods

We performed an exploratory analysis of Controlling Hypertension After Severe Cerebrovascular Event (CHASE) trial, which was a multicenter, randomized, controlled clinical trial. Patients with severe ischemic or hemorrhagic stroke (defined as GCS ≤ 12 or NIHSS ≥ 11) were randomized into individualized versus standard BP‐lowering treatment in CHASE trial. In this exploratory analysis, patients with severe ICH were included. The primary outcome was the percentage of patients with 90‐day functional independence defined as modified Rankin Scale (mRS) ≤2.

Results

We included 242 patients with severe ICH in the present analysis, consisting of 142 patients aged <65 years and 100 patients aged ≥65 years. There were significant differences between patients aged ≥65 years and <65 years in the proportion of functional independence (47.9% vs. 15.0%, P < 0.001) and good outcome (73.9% vs. 50.0%, P < 0.001) at day 90. In patients aged ≥65 years, the adjusted individualized BP‐lowering treatment had an unequivocal effect on the functional independence at day 90 (21.6% vs. 8.2%, odds ratio [OR]: 4.309, 95% confidence interval [CI]: 1.040‐17.859, P = 0.044) and improved the neurological deficits at discharge (∆ NIHSS ≥ 4: 64.7% vs. 34.7%, OR: 4.300, 95% CI: 1.599‐11.563, P = 0.004).

Interpretation

Compared with the younger counterparts, the elderly patients (≥65 years) with acute severe ICH might benefit more from individualized BP‐lowering treatment.

Unraveling the World’s Longest Non-stop Migration: The Indian Ocean Crossing of the Globe Skimmer Dragonfly

Insect migration redistributes enormous quantities of biomass, nutrients and species globally. A subset of insect migrants perform extreme long-distance journeys, requiring specialized morphological, physiological and behavioral adaptations. The migratory globe skimmer dragonfly (Pantala flavescens) is hypothesized to migrate from India across the Indian Ocean to East Africa in the autumn, with a subsequent generation thought to return to India from East Africa the following spring. Using an energetic flight model and wind trajectory analysis, we evaluate the dynamics of this proposed transoceanic migration, which is considered to be the longest regular non-stop migratory flight when accounting for body size. The energetic flight model suggests that a mixed strategy of gliding and active flapping would allow a globe skimmer to stay airborne for up to 230–286 h, assuming that the metabolic rate of gliding flight is close to that of resting. If engaged in continuous active flapping flight only, the flight time is severely reduced to ∼4 h. Relying only on self-powered flight (combining active flapping and gliding), a globe skimmer could cross the Indian Ocean, but the migration would have to occur where the ocean crossing is shortest, at an exceptionally fast gliding speed and with little headwind. Consequently, we deem this scenario unlikely and suggest that wind assistance is essential for the crossing. The wind trajectory analysis reveals intra- and inter-seasonal differences in availability of favorable tailwinds, with only 15.2% of simulated migration trajectories successfully reaching land in autumn but 40.9% in spring, taking on average 127 and 55 h respectively. Thus, there is a pronounced requirement on dragonflies to be able to select favorable winds, especially in autumn. In conclusion, a multi-generational, migratory circuit of the Indian Ocean by the globe skimmer is shown to be achievable, provided that advanced adaptations in physiological endurance, behavior and wind selection ability are present. Given that migration over the Indian Ocean would be heavily dependent on the assistance of favorable winds, occurring during a relatively narrow time window, the proposed flyway is potentially susceptible to disruption, if wind system patterns were to be affected by climatic change.

miR-221 Exerts Neuroprotective Effects in Ischemic Stroke by Inhibiting the Proinflammatory Response

BACKGROUND

Ischemic stroke is clearly affected by microRNAs (miRNAs) due to dysfunction of their regulatory networks. Our clinical data confirmed decreased miR-221 levels in plasma collected from patients with acute ischemia compared with plasma from healthy controls. Therefore, we further aimed to demonstrate the regulatory mechanisms by which miR-221 exerts its neuroprotective effects in acute ischemic brain injury.

METHODS

Middle cerebral artery occlusion (MCAO) was used to establish focal cerebral ischemia in adult male C57BL/6 mice. A miR-221 mimic or a negative mimic control was injected by intracerebroventricular administration 24 h prior to MCAO. After 48 h, cerebral infarction volume and neurological scores were calculated, and to determine the extent of neuroprotection by miR-221, neurobehavioral tests were performed. Quantitative real-time PCR, ELISA, and flow cytometry were also performed to identify the expression of inflammation-related cytokines and chemokines as well as infiltration/activation of various immune cells in the brain.

RESULTS

The results showed that MCAO mice treated with a miR-221 mimic exhibited significantly decreased cerebral infarction volume and increased amelioration of behavioral deficits. Moreover, the expression of proinflammatory cytokines (TNF-α, MCP-1, VCAM-1, and IL-6) and chemokines (CCL2 and CCL3) was significantly decreased in the miR-221 mimic-treated group. In addition, the flow cytometry data showed that macrophage infiltration and microglial activation were blocked by miR-221 treatment.

CONCLUSION

our results indicate that miR-221 could decrease brain damage in the setting of acute ischemic stroke by inhibiting the proinflammatory response, which furthered our understanding of the molecular basis of miR-221 and provided a new potential therapeutic target for the treatment of ischemic stroke .

Blood pressure variability and outcome in acute severe stroke: A post hoc analysis of CHASE-A randomized controlled trial

The influence of blood pressure variability (BPV) on outcomes in patients with severe stroke is still largely unsettled. Using the data of CHASE trial, the authors calculated the BPV during the acute phase and subacute phase of severe stroke, respectively. The primary outcome was to investigate the relationship between BPV and 90‐day modified Rankin scale (mRS) ≥ 3. The BPV was assessed by eight measurements including standard deviation (SD), mean, maximum, minimum, coefficient of variation (CV), successive variation (SV), functional successive variation (FSV), and average real variability (ARV). Then, the SD of SBP was divided into quintiles and compared the quintile using logistic regression in three models. The acute phase included 442 patients, and the subacute phase included 390 patients. After adjustment, six measurements of BPV during the subacute phase rather than acute phase were strongly correlated with outcomes including minimum (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.69‐0.99, p = .037), SD (OR: 1.10, 95% CI: 1.03‐1.17, p = .007), CV (OR: 1.12, 95% CI: 1.03‐1.23, p = .012), ARV (OR: 1.13, 95% CI: 1.05‐1.20, p < .001), SV (OR: 1.09, 95% CI: 1.04‐1.15, p = .001), and FSV (OR: 1.12, 95% CI: 1.05‐1.19, p = .001). In the logistic regression, the highest fifth of SD of SBP predicted poor outcome in all three models. In conclusion, the increased BPV was strongly correlated with poor outcomes in the subacute phase of severe stroke, and the magnitude of association was progressively increased when the SD of BP was above 12.

Traumatic fractures in China from 2012 to 2014: a National Survey of 512,187 individuals

The China National Fracture Study has been conducted to provide a national dataset of traumatic fractures across China. A national representative sample of 512,187 individuals was selected. The population-weighted incidence rates, distribution, injury mechanisms, and risk factors for traumatic fractures were identified for various groups of individuals.

INTRODUCTION

The China National Fracture Study (CNFS) has been conducted to provide a comprehensive and up-to-date national dataset of traumatic fractures across China. This study aims to report the national incidences and distributions of traumatic fractures that occurred in 2012, 2013, and 2014 and to analyze the risk factors.

METHODS

A national representative sample of individuals was selected from 24 rural counties and 24 urban cities of 8 provinces using stratified random sampling and the probability proportional to size (PPS) methodology. Participants were interviewed to identify whether they sustained traumatic fractures of the trunk and/or four extremities that had occurred in 2012, 2013, and 2014. The main risk factors associated with traumatic fractures were analyzed by multiple logistic regression models.

RESULTS

A total of 512,187 individuals, including 259,649 males and 252,538 females, participated in the CNFS. The population-weighted incidence rates of traumatic fractures in China were calculated to be 2.5 (95% CI, 2.2-2.8) per 1000 population in 2012, 2.8 (95% CI, 2.5-3.3) in 2013, and 3.2% (95% CI, 2.8-3.6) in 2014. The population-weighted incidence rates of fragility fractures among participants aged 65 years and older were calculated to be 27.4 (95% CI, 21.4-33.4) per 1000 population in 2012, 36.0 (95% CI, 28.6-43.5) in 2013, and 42.4 (95% CI, 34.9-49.9) in 2014. The most common cause of fracture was low-energy injuries, followed by traffic accidents. For all age groups, sleeping less than 7 h was a risk factor for traumatic fractures. Alcohol consumption and previous fracture history were identified as risk factors for adults aged 15 years and over. Cigarette smoking was found to be a risk factor for males aged 15-64 years old. For individuals aged 15-64 years old, underweight incurred a risk effect for males and overweight for females. Alcohol consumption, sleeping less than 7 h per day, living in the central and eastern regions, a body mass index less of than 18.5, and having a previous fracture history were identified as strong risk factors for fragility fractures.

CONCLUSION

The national incidence, distribution, and injury mechanisms for traumatic fractures were revealed in the CNFS. Risk factors were identified for various groups of individuals.

Discovery of Pyrido[2,3-b]indole Derivatives with Gram-Negative Activity Targeting Both DNA Gyrase and Topoisomerase IV

The rise of multidrug resistant (MDR) Gram-negative (GN) pathogens and the decline of available antibiotics that can effectively treat these severe infections are a major threat to modern medicine. Developing novel antibiotics against MDR GN pathogens is particularly difficult as compounds have to permeate the GN double membrane, which has very different physicochemical properties, and have to circumvent a plethora of resistance mechanisms such as multiple efflux pumps and target modifications. The bacterial type II topoisomerases DNA gyrase (GyrA₂B₂) and Topoisomerase IV (ParC₂E₂) are highly conserved targets across all bacterial species and validated in the clinic by the fluoroquinolones. Dual inhibitors targeting the ATPase domains (GyrB/ParE) of type II topoisomerases can overcome target-based fluoroquinolone resistance. However, few ATPase inhibitors are active against GN pathogens. In this study, we demonstrated a successful strategy to convert a 2-carboxamide substituted azaindole chemical scaffold with only Gram-positive (GP) activity into a novel series with also potent activity against a range of MDR GN pathogens. By systematically fine-tuning the many physicochemical properties, we identified lead compounds such as 17r with a balanced profile showing potent GN activity, high aqueous solubility, and desirable PK features. Moreover, we showed the bactericidal efficacy of 17r using a neutropenic mouse thigh infection model.

Controlling Hypertension After Severe Cerebrovascular Event (CHASE): A randomized, multicenter, controlled study

BACKGROUND

The optimal blood pressure lowering target in the acute phase of severe stroke is uncertain. Our aim was to compare the efficacy and safety of individualized blood pressure lowering with standard blood pressure lowering in severe stroke.

METHODS

Five-hundred consecutive patients with acute severe stroke and elevated BP were recruited from 26 Chinese hospitals. Eligible patients were randomized into an individualized blood pressure lowering group (with 10-15% reduction in systolic blood pressure from admission level or standard blood pressure lowering group (with a target SBP of <200 mm Hg in acute ischemic stroke and <180 mm Hg in intracerebral hemorrhage). The primary outcome was the proportion of patients with a poor functional outcome at day 90 of enrolment.

RESULTS

Of 483 participants included in the analysis, 242 received individualized blood pressure lowering treatment and 241 received standard treatment. The primary outcome event was observed in 71.1% of the participants in the individualized treatment group and in 73.4% of the standard treatment group (odds ratio with individualized treatment for primary outcome, 0.75; 95% confidence interval, 0.47 to 1.19; p = 0.222). The rates of serious adverse events in the two groups were similar (27.7% vs. 28.2%).

CONCLUSIONS

In patients with acute severe stoke, individualized blood pressure lowering treatment did not significantly reduce the rate of three-month death or dependence.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT02982655. Registered in 5 December 2016, https://clinicaltrials.gov/ct2/show/NCT02982655.

Education intervention for older adults with osteoporosis: a systematic review

BACKGROUND

Various education interventions were developed for preventing or managing OP, but the effects of those interventions on older adults were inconclusive.

PURPOSE

This study evaluated the effectiveness of educational interventions in preventing osteoporosis in older adults. A literature search was performed in MEDLINE (PubMed), Cochrane Library, and CBM (China BioMed Database) from the initial date of each database to Oct 2016.

DATA EXTRACTION

Two investigators independently extracted essential data from qualified studies concerning the settings, population, interventions, follow-ups, and outcomes of interest, namely effects of bone mineral density tests, changes in behavior, knowledge increase, self-efficacy, medication adherence (calcium and vitamin D), and quality of life, respectively.

DATA SYNTHESIS

A total of 17 studies met the inclusion criteria and therefore were included in the current study. The overall quality of the included studies was moderate. We were unable to carry out a meta-analysis due to the heterogeneity of these studies. We fond that compared with control groups, patients' knowledge of osteoporosis increased significantly (p < .05) through all five interventions, which included PowerPoint presentations and discussion, class-based educational programs, osteoporosis self-management courses, revised health belief model and classes, computerized support programs and brush-up courses.

LIMITATION

Studies included in the present study were all conducted in Western countries and only descriptive methods were applied in synthesis due to heterogeneity in interventions and outcomes.

CONCLUSION

Education interventions were effective in preventing osteoporosis in older adults. Future research should focus on approaching this issue quantitatively (i.e., through meta-analysis).

Immunogenicity and safety of an accelerated hepatitis E vaccination schedule in healthy adults: a randomized, controlled, open-label, phase IV trial

OBJECTIVES

This study aimed to evaluate the immunogenicity and safety of a hepatitis E (HE) vaccine using an accelerated vaccination schedule (vaccine doses at 0, 7 and 21 days).

METHODS

A total of 126 participants aged ≥18 years were randomly assigned to receive the hepatitis E virus vaccine in either the accelerated group (0, 7 and 21 days) or the routine group (0, 1 and 6 months). Serology samples were obtained at 0, 21, 28 and 51 days, and 7 months in the accelerated group, or 0, 1, 2 and 7 months in the routine group after the first vaccine injection. Adverse events (AEs) reported during the whole study were analysed.

RESULTS

A total of 126 participants were randomized, 63 for each group. Sixty-two participants in the accelerated group and 63 in the routine group received at least one dose of vaccine; 57 and 63 participants received all three doses and were included in per-protocol set, respectively. In the per-protocol population, at 1 month after the last dose (accelerated group at 51 days versus routine group at 7 months), the seropositive rates were both 100% (57/57 and 63/63, respectively), and the geometric mean concentrations (GMCs) were 8.51 WHO units/mL (95% CI 6.73-10.76) in the accelerated group and 9.67 WHO units/mL (95% CI 7.67-12.20) in the routine group. The ratio of the accelerated group GMC to the routine group GMC was 0.88 (95% CI 0.61-2.17, lower limit of 95% CI > 0.5), indicating that the accelerated vaccination schedule was non-inferior to the routine one. The overall incidence rates of solicited AEs in the accelerated and routine groups were 32.26% (20/62) and 30.16% (19/63), respectively (p 0.800). Most AEs were moderate.

CONCLUSIONS

An accelerated schedule is safe and provides protective antibodies in a shorter time compared with the routine schedule. The accelerated schedule should be recommended to adults who are travelling on short notice to an HE-endemic area or during an HE outbreak (Clinical Trial Registration. NCT03168412).

Combination therapy with parathyroid hormone analogs and antiresorptive agents for osteoporosis: a systematic review and meta-analysis of randomized controlled trials

Combination therapy with parathyroid hormone (PTH) analogs and antiresorptive agents may be more effective than monotherapy for the treatment of osteoporosis. This study aimed to estimate the effectiveness and safety of this combination therapy for osteoporosis. MEDLINE, EMBASE, and Cochrane Library were searched from inception to May 1, 2018, including randomized controlled trials (RCTs) with a duration of at least 6 months on adults with osteoporosis treated with combination therapy versus monotherapy. Outcomes included fractures, bone mineral density (BMD) changes, and adverse events. A meta-analysis was performed using a random-effect model, to estimate risk ratios (RRs) for fractures, and mean differences (MDs) for BMD changes. A total of 19 RCTs and 2177 patients were included. Compared with monotherapy, combination therapy had an advantage of 36% (RR, 0.64; 95% confidence interval (CI), 0.42-0.98) regarding fracture risk reduction. It also appears to improve lumbar spine BMD by 4.06% (95%CI = 2.60-5.53) and total hip BMD by 1.89% (95%CI = 1.25-2.53). No RCT reported an increased risk of serious adverse events. Among patients with osteoporosis, combination therapy was superior to monotherapy regarding improvement of the lumbar spine and total hip BMD, without risk of serious adverse events. Combination therapy also had an advantage over monotherapy on fracture risk reduction. However, owing to the limited sample size, additional larger studies are required to confirm this benefit.

Boosting the photocatalytic hydrogen evolution activity of g-C3N4 nanosheets by Cu2(OH)2CO3-modification and dye-sensitization

The positive synergetic effects among g-C₃N₄, Cu₂(OH)₂CO₃ and fluorescein dramatically boost the H₂-evolution activity over a fluorescein-sensitized Cu₂(OH)₂CO₃/g-C₃N₄ photocatalyst.

Multichannel continuous-wave fiber cavity ringdown gas sensing utilizing frequency-shifted interferometry

We present a multichannel continuous-wave (CW) fiber cavity ringdown (FCRD) gas sensing method based on frequency-shifted interferometry (FSI). This scheme detects gas concentration by measuring the intensity decay rates of continuous light from different ringdown cavities in the spatial domain, unlike conventional FCRD techniques, which measure the decay rates of pulse light in the time domain. This method shares one CW light source, one slow detector, and one slow data collector. In order to illustrate the theory, acetylene gas concentration measurement in a two-channel FSI-FCRD system was experimentally conducted in the range of 0%-1%. A linear relation was established between concentration and absorption loss, which is proportional to the intensity decay rate, and the measurement resolutions of 3.871%/dB and 3.658%/dB were achieved, respectively. The results reveal that the proposed system has the advantages of low cost, high sensitivity, high precision, and good stability in multichannel gas detection.

Resting-State Functional MRI: Everything That Nonexperts Have Always Wanted to Know

Resting-state fMRI was first described by Biswal et al in 1995 and has since then been widely used in both healthy subjects and patients with various neurologic, neurosurgical, and psychiatric disorders. As opposed to paradigm- or task-based functional MR imaging, resting-state fMRI does not require subjects to perform any specific task. The low-frequency oscillations of the resting-state fMRI signal have been shown to relate to the spontaneous neural activity. There are many ways to analyze resting-state fMRI data. In this review article, we will briefly describe a few of these and highlight the advantages and limitations of each. This description is to facilitate the adoption and use of resting-state fMRI in the clinical setting, helping neuroradiologists become familiar with these techniques and applying them for the care of patients with neurologic and psychiatric diseases.

Hip fracture patients who experience a greater fluctuation in RDW during hospital course are at heightened risk for all-cause mortality: a prospective study with 2-year follow-up

This study aims to detect whether there remains valuable prognostic information in fluctuation of red cell distribution width (RDW) in hip fracture patients. Results show that this readily available parameter may provide a more effective strategy for assessment of mortality risk, therefore providing a reference for clinical planning and decision-making.

INTRODUCTION

Prognostic values have been found in the fluctuation of some hematologic parameters. The red cell distribution width (RDW) routinely reported with all complete blood cell counts (CBC) has proven to be associated with poor outcomes in various diseases. However, whether the fluctuation in RDW is predictive of long-term mortality in hip fracture patients treated with surgery remains unknown.

METHODS

One thousand three hundred thirty hip fracture patients who underwent surgery from January 1, 2000 to November 18, 2012 were recruited in this prospective cohort study. Fluctuation in the RDW between admission and discharge was measured, and a Kaplan-Meier (KM) analysis and multivariable Cox regression model were applied to evaluate the relationship between this fluctuation and mortality. Risk factors for a larger fluctuation were detected by using Logistic regression analyses.

RESULTS

In addition to the admission RDW, a high RDW level at the time of discharge was also associated with an increased risk of death, while no significant difference was found in the postoperative RDW. Fluctuation in the RDW between admission and discharge was an independent risk predictor for 2-year mortality (HR 1.45 95%CI 1.06-2.00, p = 0.022). Factors affecting the change in the RDW between admission and discharge included both the demographic characteristics of the patients and clinical interventions.

CONCLUSION

Hip fracture patients who experience a greater fluctuation in RDW during the hospital course are at a heightened risk for 2-year all-cause mortality.

Controlling Hypertension After Severe Cerebrovascular Event (CHASE): study protocol for a randomized controlled trial

Background

No ideal blood pressure (BP) range has been scientifically determined for acute stroke, and no studies on BP management have been carried out for patients with severe stroke. This trial aims to investigate whether individualized lowering of elevated BP would improve the outcome in patients with severe stroke.

Methods/design

The CHASE trial is a multicenter, randomized, controlled study. A total of 500 adult patients with acute severe stroke will be enrolled in 18 study sites in China and randomized to individualized BP lowering (10–15% reduction from admission level) or guideline-recommended BP lowering. The primary outcome measurement is the proportion of participants with a poor outcome (modified Rankin Scale ≥ 3) at day 90 of enrollment. Secondary outcomes include disability at hospital discharge and the ability of activities of daily living at day 90 of enrollment. The relationship between intervention and the primary outcome will be analyzed using multivariate logistic regression adjusted for study site, demographics, and baseline characteristics.

Discussion

The CHASE trial will be the first study to explore the optimum BP management for acute severe stroke. This trial potentially offers a strong argument for individualized target for lowering elevated BP in patients with severe stroke.

Trial registration

ClinicalTrials.gov, NCT02982655. Registered on 30 November 2016.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2530-x) contains supplementary material, which is available to authorized users.

The association between serum uric acid level and the risk of fractures: a systematic review and meta-analysis

Controversy has arisen in regarding the association between serum uric acid (UA) and fracture risk. Therefore, we conducted a systemic review and meta-analysis by pooling estimate of five prospective studies (29,110 participants). Results showed that an increased serum UA level is associated with a lower risk of fracture. Numerous studies have demonstrated that high serum UA is a relevant risk factor for a wide variety of diseases, whereas new understanding in serum uric acid follows recent reports demonstrating a protective role of UA in health status. However, the association between serum UA and fracture remains controversial. Therefore, we conduct a systemic review and meta-analysis to determine whether elevated UA level is a protective factor for fracture among prospective studies. We searched for studies published before May 6, 2016, using PubMed, Embase, and Cochrane databases, without any language restriction. The inclusion criteria were published studies investigating the association between UA and fractures. Two authors independently screened the retrieved articles in accordance to the predefined inclusion criteria. We pooled the study-specific relative risk estimates using a random-effect model for comparison of persons whose UA levels were in the top tertile with those in the bottom tertile. Factors that may predict these associations were evaluated in subgroup analysis and meta-regression. The five included prospective studies included 29,110 participants. In random-effect models that included all five included studies, the summary hazard ratios (HRs) (top vs bottom tertiles) were 079 (95% CI, 0.69 to 0.89), without evidence of heterogeneity (P for heterogeneity = 0.458; I ² = 0%). Similar results were shown when pooling estimate of three higher-quality studies (HR 0.80 95% CI, 0.69 to 0.93). The association between UA and fracture remained in sensitivity and subgroup analyses. An increased serum UA level is shown to be associated with a lower risk of fracture, albeit additional large, high-quality prospective studies or a meta-analysis of individual data are still needed to verify the association.

Characteristics of symptoms experienced by persons with dry eye disease while driving in China

PurposeTo assess the vision-related quality of life and self-reported driving performance of patients with dry eye disease (DED).Patients and methodsThe study was performed in the eye centre of Peking University Third Hospital, China. In total, 87 dry eye patients and 42 controls were enroled, including 49 patients without any treatment (group A), 38 patients treated with artificial tears (group B) and 42 controls without DED (group C). The participants had no eye disease other than DED. Scores of a vision-related quality-of-life questionnaire (Ocular Surface Disease Index (OSDI)), a daily life-related visual function questionnaire and a questionnaire about performance during driving were collected. Data were compared among the groups and analysed.ResultsSignificant differences in all clinical characteristics and OSDI scores were found between DED patients and normal controls (P<0.05). While subjects in group A felt more uncomfortable than those in group B, the functional limitations related to dry eye were significant in all DED patients, especially for daily work and using a computer. DED was correlated with unsafe driving habits and performance, which may increase the risk of dangerous driving (P<0.01). For patients with DED, the rate of accidents and near-accidents was 10.33%, and the rate of missed targets totalled 32.17%.ConclusionsDED can lead to many inconveniences in daily life, including driving. The frequencies of unsafe driving habits and performance were increased in patients with DED.