Glutathione Induces Keap1 S-Glutathionylation and Mitigates Oscillating Glucose-Induced β-Cell Dysfunction by Activating Nrf2

Glutathione (GSH), a robust endogenous antioxidant, actively participates in the modulation of the redox status of cysteine residues in proteins. Previous studies have indicated that GSH can prevent β-cell failure and prediabetes caused by chronic oscillating glucose (OsG) administration. However, the precise mechanism underlying the protective effect is not well understood. Our current research reveals that GSH is capable of reversing the reduction in Nrf2 levels, as well as downstream genes Grx1 and HO-1, in the islet β-cells of rats induced by chronic OsG. In vitro experiments have further demonstrated that GSH can prevent β-cell dedifferentiation, apoptosis, and impaired insulin secretion caused by OsG. Additionally, GSH facilitates the translocation of Nrf2 into the nucleus, resulting in an upregulation of Nrf2-targeted genes such as GCLC, Grx1, HO-1, and NQO1. Notably, when the Nrf2 inhibitor ML385 is employed, the effects of GSH on OsG-treated β-cells are abrogated. Moreover, GSH enhances the S-glutathionylation of Keap1 at Cys273 and Cys288, but not Cys151, in OsG-treated β-cells, leading to the dissociation of Nrf2 from Keap1 and facilitating Nrf2 nuclear translocation. In conclusion, the protective role of GSH against OsG-induced β-cell failure can be partially attributed to its capacity to enhance Keap1 S-glutathionylation, thereby activating the Nrf2 signaling pathway. These findings provide novel insights into the prevention and treatment of β-cell failure in the context of prediabetes/diabetes, highlighting the potential of GSH.

Synergistic evolution of water-energy-food system resilience and efficiency in urban agglomerations

With increasing internal and external risks to the WEF system, a single emphasis on efficiency or a lopsided pursuit of resilience can lead to difficulties in adapting to complex changes and resource redundancy. Revealing the synergistic evolutionary characteristics between efficiency and resilience of the WEF system is an effective method to deal with systemic internal and external risks. However, the current study of the WEF system lacks a synergistic perspective on resilience and efficiency. Thus, taking Chengdu-Chongqing Economic Circle (CCEC) as the research object and its geospatial boundary as the system boundary, this paper adopted the entropy-topsis model to evaluate the WEF resilience, and applied the super-efficient SBM model to measure the WEF efficiency accurately, which fully considered the non-expected outputs in the process of resource utilization. Then, applying the development coordination degree model, the synergistic relationship between the two was measured. The results indicated that: the average value of WEF resilience in CCEC increased from 0.414 to 0.485 and showed spatial characteristics of west＞east＞central. The WEF efficiency interval was 0.79-0.93, and cities with average WEF efficiency reaching the effective production frontier accounted for only 37.5%. The clustered distribution of the synergy levels intensified. The number of cities with primary, medium, more advanced, and advanced levels was 6, 6, 1, and 3, respectively, with primary and medium synergy levels dominating. The findings suggest that cities should strengthen regional exchanges and formulate targeted measures based on their own situations. In addition, CCEC should possess a comprehensive understanding of the interdependencies and conflicts that arise between resilience and efficiency throughout the decision-making procedure.

A new method for vascular age estimation based on relative risk difference in vascular aging

OBJECTIVE

The current models of estimating vascular age (VA) primarily rely on the regression label expressed with chronological age (CA), which does not account individual differences in vascular aging (IDVA) that are difficult to describe by CA. This may lead to inaccuracies in assessing the risk of cardiovascular disease based on VA. To address this limitation, this work aims to develop a new method for estimating VA by considering IDVA. This method will provide a more accurate assessment of cardiovascular disease risk.

METHODS

Relative risk difference in vascular aging (RRDVA) is proposed to replace IDVA, which is represented as the numerical difference between individual predicted age (PA) and the corresponding mean PA of healthy population. RRDVA and CA are regard as the influence factors to acquire VA. In order to acquire PA of all samples, this work takes CA as the dependent variable, and mines the two most representative indicators from arteriosclerosis data as the independent variables, to establish a regression model for obtaining PA.

RESULTS

The proposed VA based on RRDVA is significantly correlated with 27 indirect indicators for vascular aging evaluation. Moreover, VA is better than CA by comparing the correlation coefficients between VA, CA and 27 indirect indicators, and RRDVA greater than zero presents a higher risk of disease.

CONCLUSION

The proposed VA overcomes the limitation of CA in characterizing IDVA, which may help young groups with high disease risk to promote healthy behaviors.

Clamparene: Synthesis, Structure, and Its Application in Spontaneous Formation of 3D Porous Crystals

Macrocyclic arenes have emerged as pivotal scaffolds in supramolecular chemistry. Despite their significant contributions to molecular recognition and diverse applications, challenges persist in the development of macrocyclic arene-based crystalline materials, particularly in achieving porosity and addressing limitations in adsorption efficiency resulting from the small cavity sizes of existing macrocyclic arenes. In this study, we present the design and synthesis of a novel macrocyclic arene, clamparene (CLP), featuring a rigid backbone, easy synthesis, and a sizable cavity. CLP self-assembles into one-dimensional sub-nanotubes that further organize into a three-dimensional porous framework in the solid state. The crystalline solid of CLP exhibits potential as a porous crystalline adsorbent for various benzene-based contaminants with rapid adsorption kinetics, large uptake amounts, and good recyclability.

Extreme drought impacts have been underestimated in grasslands and shrublands globally

Climate change is increasing the frequency and severity of short-term (~1 y) drought events-the most common duration of drought-globally. Yet the impact of this intensification of drought on ecosystem functioning remains poorly resolved. This is due in part to the widely disparate approaches ecologists have employed to study drought, variation in the severity and duration of drought studied, and differences among ecosystems in vegetation, edaphic and climatic attributes that can mediate drought impacts. To overcome these problems and better identify the factors that modulate drought responses, we used a coordinated distributed experiment to quantify the impact of short-term drought on grassland and shrubland ecosystems. With a standardized approach, we imposed ~a single year of drought at 100 sites on six continents. Here we show that loss of a foundational ecosystem function-aboveground net primary production (ANPP)-was 60% greater at sites that experienced statistically extreme drought (1-in-100-y event) vs. those sites where drought was nominal (historically more common) in magnitude (35% vs. 21%, respectively). This reduction in a key carbon cycle process with a single year of extreme drought greatly exceeds previously reported losses for grasslands and shrublands. Our global experiment also revealed high variability in drought response but that relative reductions in ANPP were greater in drier ecosystems and those with fewer plant species. Overall, our results demonstrate with unprecedented rigor that the global impacts of projected increases in drought severity have been significantly underestimated and that drier and less diverse sites are likely to be most vulnerable to extreme drought.

Nitrogen and water addition alters species diversity and interspecific relationship in a desert grassland

Water and nitrogen (N) often affect plant species diversity and interspecific relationship among plant populations in global terrestrial ecosystems. However, the effects of water and N addition on plant diversity and interspecific relationship remain poorly understood. In the study, we designed a three-year field experiment in a desert grassland to assess the effect of increased water (natural +50 %) and N addition (10 g·N·m-2·a-1) on plant diversity and interspecific relationship. Our results showed that the alpha diversity was significantly changed under increased water (W), N addition (N), and water plus N addition (WN). The species richness was decreased significantly on year scales (10 %-27 %), whereas the Pielou index first increased and then decreased over three years and was significantly affected by the interaction between increased water and N addition. The total and pairwise beta diversity were significantly increased by N addition, the community was mainly caused by the turnover component after N addition, especially in 2019 and 2020 (16.6 % and 9 %, respectively). There were significant negative associations among overall populations and dominant populations under N addition, especially Stipa bungeana and Gypsophila davurica, Gypsophila davurica and Oxytropis acemose, Artemisia dalai-lamae, and Haplophyllum dauricum. Our findings suggested that plant community structure and composition changes may be due to competition for resources among dominant populations and the turnover component under increased water and N addition, which should be considered in ecosystem management.

[Effects of Nitrogen and Phosphorus Addition on Soil Nutrient Content and Stoichiometry in Desert Grassland]

In order to discuss the response of soil nutrient content, stoichiometric ratio, and dynamic nutrient balance to the addition of multiple restrictive nutrients, the correlation between available nutrients and total nutrients in soil, as well as the indication of soil total and available stoichiometric characteristics, were studied in a desert grassland subjected to 4 years of nutrient addition treatments. The Ningxia desert grassland was used as the research object to carry out nitrogen (N) and phosphorus (P) addition experiments. The experiment included four treatments:control (CK), N addition[10 g·(m²·a)^-1], P addition[10 g·(m²·a)^-1], and NP co-addition (10 g·(m²·a)^-1 N+10 g·(m²·a)^-1 P). The results showed that:① in the fourth year of nutrient addition, soil total nitrogen (TN) content was significantly increased. The N:P ratio was significantly increased by N addition, and soil organic carbon (SOC) content was significantly increased by P addition and NP co-addition. In the third and fourth years of nutrient addition, the soil available N:P ratio (AN:AP) was significantly increased by N addition; N addition and NP co-addition significantly increased the content of ammonium nitrogen (NH₄⁺-N) and nitrate nitrogen (NO₃^--N) but significantly reduced the soil available C:N ratio. P addition and NP co-addition significantly increased total phosphorus (TP) and soil available phosphorus (AP), whereas it significantly reduced the soil total and available C:P and N:P ratios. ② The interaction between N addition and P addition had a combined effect on NH₄⁺-N, AP, available C:N, and AN:AP ratio of desert grassland. ③ The soil C:N ratio was relatively stable in desert grassland, soil N:P ratio was mainly limited by soil TP content, and the soil available C:P and AN:AP ratios were mainly limited by soil AP content. ④ There were cumulative effects of N and P additions on soil N, SOC, and inorganic nitrogen. N limitation in desert grassland was alleviated by N addition, whereas it was aggravated by P addition and NP co-addition. The variation coefficients of soil available stoichiometric characteristics were higher than that of soil total stoichiometric characteristics. Soil available stoichiometry was more sensitive to N and P addition than soil total stoichiometry in desert grassland, which could better reflect the effects of N and P addition on soil ecological stoichiometry and as a rapid indicator of soil nutrient status in desert grassland.

Responses of soil seed banks to drought on a global scale

The global increase in drought frequency and intensity in large areas has potentially important effects on soil seed banks (SSBs). However, a systematic evaluation of the impact of drought on SSBs at a global scale has not yet been well understood. We evaluated the effects of drought on SSBs and identified the association key drivers in the current meta-analysis. The overall effects of drought on soil seed density and richness were weak negative and positive, respectively. Drought significantly increased soil seed density by 11.94 % in forest ecosystem, whereas soil seed richness were significantly increased in vascular plants (7.39 %). Linear mixed-effect results showed that soil seed density and richness significantly reduced as increasing drought intensity. In addition, geography (altitude) has significance in controlling the lnRR of soil seed density by altering climate (mean annual precipitation, drought) and soil properties (pH, soil organic carbon, and clay content) in the structural equation model, whereas soil seed richness was controlled by geography (altitude, and latitude) via climate (mean annual precipitation). In summary, the results suggested the size of SSBs response to drought and its relationship with drought intensity in terrestrial ecosystems, it may shed light on ecosystem restoration, succession, and management using SSBs when estimating the future drought.

The local coupling and telecoupling of urbanization and ecological environment quality based on multisource remote sensing data

Coordinating the relationship between urbanization and ecological environment quality (EEQ) is crucial to achieving sustainable development. With the development of globalization, the pattern of remote interaction between urbanization and EEQ has gradually increased. However, the current study on the coupling of urbanization and EEQ lacks a remote perspective, and the remote sensing ecological index (RSEI) model has not yet considered the environmental pollution caused by population agglomeration. For these reasons, this study proposes the remote sensing ecological environment index (RSEEI) model and measures the local coupling and telecoupling coordination degree (LTCCD) of urbanization and EEQ in China from 2000 to 2020. According to the results, the rate of change of EEQ in China was -0.00011a^-1. RSEEI widens the gap between the east and west of EEQ, differentiated by the Heihe-Tengchong Line. China's urbanization is growing at a 0.0008a^-1 rate, with a spatially driven radiation potential with Beijing, Shanghai, Hong Kong, and Macao as the core. LTCCD follows an increasing trend from inland to coastal and west to east. Over 70% of provinces experienced a shift in adjacent LTCCD levels, and 14 provinces moved from disorder to coordination after 2010. The telecoupling strengthens the correlation between urbanization and EEQ among regions compared with traditional coupling. In addition, the eastern coastal areas, the northern and central-south inland areas, and the northwest face different coordination problems.

A dynamic view of environmental regulation influence mechanism on manufacturing agglomeration-a case study of the Yangtze River Delta city cluster

Rapid development and agglomeration of manufacturing industries in China inevitably lead to serious environmental pollution problems. The government restrains development of manufacturing industries through environmental regulation policies, but this may affect manufacturing industries agglomeration. Therefore, studying the impact of environmental regulation (ER) on manufacturing agglomeration (MA) is a critical prerequisite for the sustainability of China's manufacturing industry. Based on the panel data of 41 cities in Yangtze River Delta (YRD) region of China from 2003 to 2017, this paper explores the threshold effect of ER on MA using a panel threshold model and analyzes the heterogeneity impact of ER on MA in different regions and analyzes the dynamic mechanism and contribution of each influencing factor on MA using a panel vector autoregressive model. The results show that (1) there is a double threshold effect of ER on MA, showing an inverted "U"-shaped effect of rising and then falling; there are threshold effects of ER on MA based on foreign direct investment (FDI) and economic development level (EDL). The effect of ER on MA has the threshold effect under different FDI and EDL level, in which the effect based on FDI shows an inverted "U" shape relationship of rising and then falling; the effect based on EDL shows a growing trend. (2) There are 29 cities in YRD region in the "weak regulation" or "strong regulation" stage, both of which are not conducive to MA. (3) ER has a facilitating effect on MA, but with the extension of forecast period, this facilitating effect turns into an inhibiting effect. MA is mainly influenced by itself and transportation conditions (TC). Our study can provide some insights for improving the ecological environment and promoting the development of manufacturing clusters in YRD region.

His-Purkinje conduction system pacing and atrioventricular node ablation in treatment of persistent atrial fibrillation refractory to multiple ablation procedures: A case report

In patients with symptomatic atrial fibrillation refractory to optimal medical therapy, atrioventricular node ablation followed by permanent pacemaker implantation is an effective treatment option. A 66-year-old woman with symptomatic persistent atrial fibrillation refractory to multiple ablation procedures was referred to our institution. After optimal drug therapy, the patient still had obvious symptoms. Sequential His-Purkinje conduction system pacing and atrioventricular node ablation were performed. Left bundle branch pacing was used as a backup pacing method if thresholds of His bundle pacing were too high or loss of His bundle capture occurred in the follow-up. At the 6-month follow-up, the European Heart Rhythm Association classification for AF was improved, the score of the Atrial Fibrillation Effect on Quality of Life was enhanced, and the 6-Minute Walk Test was ameliorated. The present case was subjected to His-Purkinje conduction system pacing in combination with atrioventricular node ablation as treatment for a symptomatic persistent atrial fibrillation refractory to multiple ablation procedures, and this procedure alleviated symptoms and improved the quality of life in a short-term follow-up.

Decoupling of water resources utilization and coordinated economic development in China's Hexi Corridor based on ecological water resource footprint

The rapid growth of population and economy leads to a further increase in demand for water resources. The contradiction between supply and demand of water resources has become the main bottleneck restricting sustainable development of a regional social economy. Accurate measurement of regional water usage and the harmonious balance between water consumption (WC) and economic growth (EG) are the premise of regional high-quality development. Based on this premise, this paper studied the arid oasis region, Hexi Corridor, as the research object; utilized the theory of ecological footprint to calculate the ecological footprint (EFW) and ecological carrying capacity (ECCW) of water resources from 2005 to 2019; and quantitatively analyzed the water utilization situation in Hexi Corridor in the past 15 years. Then, combining with the coordinated development decoupling evaluation model, the connection between WC and EG was evaluated. The main results of this study were as follows: (1) During the study period, EFW has shown a fluctuating downward trend, decreasing from 1.745 in 2015 to 1.588 hm²/person in 2019. The average annual EFW per capita of 10,000 yuan of GDP decreased by 10.18%, which showed that the water resources utilization efficiency was gradually increasing. However, there was still a large water deficit. The average water ecological pressure index was 16.55; water resources were under great pressure. (2) From 2005 to 2019, the relationship between WC and EG experienced stages of strong decoupling-weak decoupling-weak negative decoupling-strong decoupling in Hexi Corridor, and the coordination between the two was gradually strengthened. (3) The decoupling status of the Hexi Corridor cities was gradually optimized. Zhangye was the best and in a stable decoupling state, followed by Wuwei and Jiuquan. The number of decoupling years accounted for 85.7% and 78.6% of the evaluation period, respectively. The cities with poor decoupling status were Jiayuguan and Jinchang, and the number of decoupling years accounted for 71.4% and 57.1%, respectively. This study provides some highlights for the formulation of arid oasis regional water strategy.

Vascular age acquired from the pulse signal: A new index to screen early vascular aging

BACKGROUND

Chronological age (CA) has been adopted as an important independent risk factor in cardiovascular risk assessment. However, different individuals with same CA may have distinct actual vascular aging due to various lifestyles. Therefore, it is difficult to fully describe the difference of actual vascular aging by CA.

OBJECTIVE

This study proposes a new index vascular age (VA) to avoid the limitations of CA.

METHOD

In this work, VA refers to the sum of CA and lifestyle impact (Age_LI). Firstly, we take the pulse signal features and CA as independent variables and dependent variable respectively, and adopt cross validation to train Support Vector Regression model. Then we acquire the predicted chronological age (PA) of all subjects with the model. Secondly, we obtain the function model between CA and PA, and calculate the expectation of PA (ePA) for each subject. Simultaneously, we take the difference between PA and ePA as the estimated value of Age_LI to further calculate VA. Finally, in order to evaluate the effectiveness of VA, we compare the correlations between CA, PA, VA and 8 objective indices such as augmentation index, pulse transit time, diastolic augmentation index, etc. RESULTS: In general, VA and PA are closer to these 8 objective indices than CA. Moreover, VA is also superior to PA in vascular aging evaluation.

CONCLUSION

The VA suggested in this study emphasizes the difference of vascular aging in same CA group, which can better reflect the actual vascular aging than CA and PA.

Accuracy and modification of the STOP ‐bang questionnaire for screening patients with obstructive sleep apnea in China

Despite the high sensitivity of the STOP-Bang questionnaire [snoring, tiredness, observed apneas, high blood pressure, body mass index, age, neck size, gender] questionnaire (SBQ), which is widely used to screen individuals at high risk of obstructive sleep apnea (OSA), few studies have evaluated the discrimination related to sex in the SBQ. Therefore, our study aimed to assess whether SBQ performance is gender-related and modified by changing body mass index (BMI) and neck circumference (NC) cut-off values. A total of 470 patients attended the sleep centres. They were divided into moderate-to-severe OSA and non-moderate-to-severe OSA groups based on the apnea-hypopnea index (AHI) and the results of the SBQ screening. The predictive performance of the SBQ screening instrument was evaluated by 2 × 2 contingency tables and discriminatory ability, which was estimated from the area under the curve (AUC) obtained from receiver operating characteristic curve. Our results suggest that when screening for moderate-to-severe OSA, the original SBQ has higher sensitivity and lower specificity for men; however, women have higher specificity and lower sensitivity. The SBQ achieved the maximum AUC of 0.783 for men and 0.634 for women when the BMI cut-off value was established at 30 kg/m² and the NC cut-off value was established at 38 cm in men, and the BMI cut-off value was established at 25 kg/m² and the NC cut-off value at 36 cm in women. Balancing the optimal sensitivity and specificity, the cut-off value of the optimal modified SBQ total scores for men was determined to be ≥4 and ≥3 for women.

Enhancing the MEP Coordination Process with BIM Technology and Management Strategies

Building Information Modeling (BIM) has been increasingly used in coordinating the different mechanical, electrical, and plumbing (MEP) services in the construction industries. As the construction industries are slowly adapting to BIM, the use of 2D software may become obsolete in the future as MEP services are technically more complicated to coordinate, due to respective services’ codes of practice to follow and limit ceiling height. The 3D MEP designs are easy to visualize before installing the respective MEP services on the construction site to prevent delay in the construction process. The aid of current advanced technology has brought BIM to the next level to reduce manual work through automation. Combining both innovative technology and suitable management methods not only improves the workflow in design coordination, but also decreases conflict on the construction site and lowers labor costs. Therefore, this paper tries to explore possible advance technology in BIM and management strategies that could help MEP services to increase productivity, accuracy, and efficiency with a lower cost of finalizing the design of the building. This will assist the contractors to complete construction works before the targeted schedule and meet the client’s expectations.

Glutathione prevents high glucose-induced pancreatic fibrosis by suppressing pancreatic stellate cell activation via the ROS/TGFβ/SMAD pathway

The activation of pancreatic stellate cells (PSCs) is the key mechanism of pancreatic fibrosis, which can lead to β-cell failure. Oxidative stress is an important risk factor for PSC activation. There is no direct evidence proving if administration of glutathione can inhibit fibrosis and β-cell failure. To explore the role of glutathione in pancreatic fibrosis and β-cell failure induced by hyperglycaemia, we established a rat model of pancreatic fibrosis and β-cell failure. The model was founded through long-term oscillating glucose (LOsG) intake and the setup of a sham group and a glutathione intervention group. In vitro, rat PSCs were treated with low glucose, high glucose, or high glucose plus glutathione to explore the mechanism of high glucose-induced PSC activation and the downstream effects of glutathione. Compared with sham rats, LOsG-treated rats had higher reactive oxygen species (ROS) levels in peripheral leukocytes and pancreatic tissue while TGFβ signalling was upregulated. In addition, as the number of PSCs and pancreatic fibrosis increased, β-cell function was significantly impaired. Glutathione evidently inhibited the upregulation of TGFβ signalling and several unfavourable outcomes caused by LOsG. In vitro treatment of high glucose for 72 h resulted in higher ROS accumulation and potentiated TGFβ pathway activation in PSCs. PSCs showed myofibroblast phenotype transformation with upregulation of α-SMA expression and increased cell proliferation and migration. Treatment with either glutathione or TGFβ pathway inhibitors alleviated these changes. Together, our findings suggest that glutathione can inhibit PSC activation-induced pancreatic fibrosis via blocking ROS/TGFβ/SMAD signalling in vivo and in vitro.

Discovery of a Highly Selective β2-Adrenoceptor Agonist with a 2-Amino-2-phenylethanol Scaffold as an Oral Antiasthmatic Agent

Asthma patients in resource-poor countries cannot obtain adequate basic asthma medications because most asthma medications are supplied as inhalants. An alternative approach is to create oral antiasthmatic drugs with high β₂/β₁-selectivity, which should reduce treatment costs. In this study, we designed a cohort of compounds 1 using 2-(4-amino-3-chloro-5-(trifluoromethyl)phenyl)-2-(tert-butylamino)ethan-1-ol hydrogen chloride (1a) as the lead compound with an aim to expand the library of compounds possessing the 2-amino-2-phenylethanol scaffold. Structure-activity relationship studies on these compounds revealed that compounds created showed remarkable β₂ selectivity compared to isoproterenol and gave additional insights on the rational design of β₂-adrenoceptor agonists. Moreover, 1a was found as the best candidate compound showing the greatest potential for drug development. Cell-based assays showed that 1a was about 10 times more selective than salbutamol toward the β₂-adrenoceptor. Moreover, 1a exhibited good oral bioavailability and low acute oral toxicity. These data reveal 1a as an oral antiasthmatic agent.

Inflammation/Coagulopathy/Immunology Responsive Index Predicts Poor COVID-19 Prognosis

In the early stage of coronavirus disease 2019 (COVID-19), most cases are identified as mild or moderate illnesses. Approximately 20% of hospitalised patients become severe or critical at the middle or late stage of the disease. The predictors and risk factors for prognosis in those with mild or moderate disease remain to be determined. Of 694 patients with COVID-19, 231 patients with mild or moderate disease, who were hospitalised at 10 hospitals in Wenzhou and nearby counties in China, were enrolled in this retrospective study from 17 January to 20 March 2020. The outcomes of these patients included progression from mild/moderate illness to severe or critical conditions. Among the 231 patients, 49 (21.2%) had a poor prognosis in the hospital. Multivariate logistic regression analysis showed that higher inflammation/coagulopathy/immunology responsive index (ICIRI=[c-reactive protein × fibrinogen × D-dimer]/CD8 T cell count) on admission (OR=345.151, 95% CI=23.014−5176.318) was associated with increased odds ratios for poor prognosis. The area under the receiver operating characteristic curve for ICIRI predicting severe and critical condition progression was 0.65 (95% CI=0.519−0.782) and 0.80 (95% CI=0.647−0.954), with cut-off values of 870.83 and 535.44, respectively. Conversely, age, sex, comorbidity, neutrophil/lymphocyte ratio, CD8 T cell count, and c-reactive protein, fibrinogen, and D-dimer levels alone at admission were not good predictors of poor prognosis in patients with mild or moderate COVID-19. At admission, a novel index, ICIRI, tends to be the most promising predictor of COVID-19 progression from mild or moderate illness to severe or critical conditions.

Role of extracellular polymeric substances in the immobilization of hexavalent chromium by Shewanella putrefaciens CN32 unsaturated biofilms

Microbial remediation provides a promising avenue for the management and restoration of heavy metal-contaminated soils. Microorganisms in soils usually exist within unsaturated biofilms, however, their response to heavy metals is still limited compared to saturated biofilms. This work investigated the Cr(VI) immobilization by Shewanella putrefaciens CN32 unsaturated biofilms, and explored the underlying mechanisms of Cr(VI) complexation. Results reveal a dose-dependent toxicity of Cr(VI) to the growth of the unsaturated biofilms. During the early growth stage, the Cr(VI) addition stimulated more extracellular polymeric substances (EPS) production. In the meantime, the EPS were demonstrated to be the primary components for Cr(VI) immobilization, which accounted for more than 60% of the total adsorbed Cr(VI). The Fourier transform infrared spectra and X-ray photoelectron spectra corroborated that the binding sites for immobilizing Cr(VI) were hydroxyl, carboxyl, phosphoryl and amino functional groups of the proteins and polysaccharides in EPS. However, for the starved unsaturated biofilms, EPS were depleted and the EPS-bound Cr(VI) were released, which caused approximately 60% of the adsorbed Cr(VI) onto cell components and further aggravated the Cr(VI) stress to cells. This work extends our understanding about the Cr(VI) immobilization by unsaturated biofilms, and provides useful information for remediation of heavy metal-contaminated soils.

Levosimendan protects from sepsis-inducing cardiac dysfunction by suppressing inflammation, oxidative stress and regulating cardiac mitophagy via the PINK-1-Parkin pathway in mice

Background

Sepsis is a leading cause of death in China, the mortality rate of which is elevated when cardiac dysfunction is induced. Levosimendan is used for the treatment of decompensated cardiac failure. In this study, we sought to investigate the role of levosimendan in the inflammation, oxidative stress, and mitophagic response of the septic heart.

Methods

A lipopolysaccharide (LPS)-induced septic myocardial dysfunction mouse model was established. To study the relationship between levosimendan and inflammation, oxidative stress, and mitophagy response, mice were pretreated with mdivi-1 (an inhibitor of mitophagy) prior to LPS administration. Levosimendan was given (24 µg/kg) via intraperitoneal injection 3 h after LPS had been administered. At 6 h after LPS injection, echocardiographic analysis, enzyme-linked immunosorbent assay (ELISA), oxidative stress index, myocardial pathological changes, transmission electron microscopy (TEM), immunofluorescence, and western blot were used to investigate the protective effects of levosimendan against LPS-induced myocardial dysfunction.

Results

In the sepsis model, levosimendan markedly ameliorated myocardial dysfunction, decreased the release of myocardial enzymes and inflammatory cytokines, improved oxidative stress index and myocardial pathological changes, reduced mitochondrial division, and activated mitophagy. To confirm whether the protection of levosimendan was mediated by mitophagy, a mitophagy inhibitor-mdivi-1 was used in this study. It significantly impaired the protective effects of levosimendan. In addition, our studies further confirmed the protection of levosimendan against LPS-induced myocardial injury and the mechanisms involving PINK-1-Parkin mediated mitophagy signaling.

Conclusions

Levosimendan was able to rescue the LPS-induced cardiac dysfunction mice, supporting its mechanism of action by suppressing inflammation, oxidative stress, and directly targeting the PINK-1-Parkin pathway.

Arabidopsis Glutathione-S-Transferases GSTF11 and GSTU20 Function in Aliphatic Glucosinolate Biosynthesis

Glutathione (GSH) conjugation with intermediates is required for the biosynthesis of glucosinolate (GSL) by serving as a sulfur supply. Glutathione-S-transferases (GSTs) primarily work on GSH conjugation, suggesting their involvement in GSL metabolism. Although several GSTs, including GSTF11 and GSTU20, have been recently postulated to act in GSL biosynthesis, molecular evidence is lacking. Here, we demonstrated that GSTF11 and GSTU20 play non-redundant, although partially overlapping, roles in aliphatic GSL biosynthesis. In addition, GSTU20 plays a more important role than GSTF11, which is manifested by the greater loss of aliphatic GSLs associated with GSTU20 mutant and a greater number of differentially expressed genes in GSTU20 mutant compared to GSTF11 mutant. Moreover, a double mutation leads to a greater aggregate loss of aliphatic GSLs, suggesting that GSTU20 and GSTF11 may function in GSL biosynthesis in a dosage-dependent manner. Together, our results provide direct evidence that GSTU20 and GSTF11 are critically involved in aliphatic GSL biosynthesis, filling the knowledge gap that has been speculated in recent decades.

MR Imaging Differences in the Circle of Willis between Healthy Children and Adults

BACKGROUND AND PURPOSE

Asymmetries in the circle of Willis have been associated with several conditions, including migraines and stroke, but they may also be age-dependent. This study examined the impact of age and age-dependent changes in cerebral perfusion on circle of Willis anatomy in healthy children and adults.

MATERIALS AND METHODS

We performed an observational, cross-sectional study of bright and black-blood imaging of the proximal cerebral vasculature using TOF-MRA and T2 sampling perfection with application-optimized contrasts by using different flip angle evolution (T2-SPACE) imaging at the level of the circle of Willis in 23 healthy children and 43 healthy adults (4-74 years of age). We compared arterial diameters measured manually and cerebral perfusion via pseudocontinuous arterial spin-labeling between children and adults.

RESULTS

We found that the summed cross-sectional area of the circle of Willis is larger in children than in adults, though the effect size was smaller with T2-SPACE-based measurements than with TOF-MRA. The circle of Willis is also more symmetric in children, and nonvisualized segments occur more frequently in adults than in children. Moreover, the size and symmetry of the circle of Willis correlate with cerebral perfusion.

CONCLUSIONS

Our results demonstrate that the circle of Willis is different in size and symmetry in healthy children compared with adults, likely associated with developmental changes in cerebral perfusion. Further work is needed to understand why asymmetric vasculature develops in some but not all adults.

Nexus between green logistic operations and triple bottom line: evidence from infrastructure-led Chinese outward foreign direct investment in Belt and Road host countries

The Belt and Road initiative (BRI) mainly relies on the traditional and underdeveloped logistical trade routes including the terrestrial and oceanic Silk Road. The poor logistic infrastructure across the BRI region not only restricts trade potential and economic progress but also creates several social and environmental challenges. Therefore, this study investigates the relationship between green logistic operations, economic, environmental, and social indicators of countries along with the BRI. This study provides three key findings using feasible generalized least squares (FGLS) and system generalized method of moments (Sys-GMM) estimation techniques. First, Chinese outward foreign direct investment significantly improves the quality and quantity of green logistic operations in terms of transport infrastructure, customs services, cost, time, tracking, and reliability of international shipments. Second, a higher quality of transport-related infrastructure, customs clearance efficiency, and competency of logistics services significantly mitigate the level of carbon emissions due to the energy conservation in the supply chain process. Moreover, the application of renewable energy resources significantly improves the quality of logistics operations. These results indicate that higher quality of green logistic operations provides efficient infrastructure and greater information sharing among supply chain partners that increase trade volume, growth opportunities, and environmental sustainability. Third, a higher institutional quality helps to mitigate social concerns through improvement in the efficiency of logistic operations. Although BRI regional estimates show significant variations, the overall results imply that BRI participating countries should integrate with ongoing investment projects to promote the quality and quantity of green logistic infrastructure and ensuring environmental stewardship.

Inflammation/coagulopathy/fibrinolysis: Dynamic indicators of COVID-19 progression in patients with moderate COVID-19 in Wenzhou, China

Background

The majority of the coronavirus disease 2019 (COVID-19) non-survivors meet the criteria for disseminated intravascular coagulation (DIC). Although timely monitoring of clotting hemorrhagic development during the natural course of COVID-19 is critical for understanding pathogenesis, diagnosis, and treatment of the disease, however, limited data are available on the dynamic processes of inflammation/coagulopathy/fibrinolysis (ICF).

Methods

We monitored the dynamic progression of ICF in patients with moderate COVID-19. Out of 694 COVID-19 inpatients from 10 hospitals in Wenzhou, China, we selected 293 adult patients without comorbidities. These patients were divided into different daily cohorts according to the COVID-19 onset-time. Furthermore, data of 223 COVID-19 patients with comorbidities and 22 critical cases were analyzed. Retrospective data were extracted from electronic medical records.

Results

The virus-induced damages to pre-hospitalization patients triggered two ICF fluctuations during the 14-day course of the disease. C-reactive protein (CRP), fibrinogen, and D-dimer levels increased and peaked at day 5 (D) 5 and D9 during the 1st and 2nd fluctuations, respectively. The ICF activities were higher during the 2nd fluctuation. Although 12-day medication returned high CRP concentrations to normal and blocked fibrinogen increase, the D-dimer levels remained high on days 17 ± 2 and 23 ± 2 days of the COVID-19 course. Notably, although the oxygenation index, prothrombin time and activated partial thromboplastin time were within the normal range in critical COVID-19 patients at administration, 86% of these patients had a D-dimer level > 500 μg/L.

Conclusion

COVID-19 is linked with chronic DIC, which could be responsible for the progression of the disease. Understanding and monitoring ICF progression during COVID-19 can help clinicians in identifying the stage of the disease quickly and accurately and administering suitable treatment.

N-salicyloyl tryptamine derivatives as potential therapeutic agents for Alzheimer's disease with neuroprotective effects

Alzheimer's disease (AD) has become a serious threat to the developed nations with burgeoning patients and annual costs on health care system in modern society. Neuroinflammation, as one of the specific biochemical factors in the progress of neurodegeneration diseases, performs a crucial role in the pathogenesis and development of AD. Therefore, it is of great significance to develop effective anti-neuroinflammatory strategies for the treatment of AD. N-salicyloyl tryptamine derivatives were previously reported and demonstrated that possessed great potential anti-neuroinflammatory effects and favorable blood-brain barrier (BBB) permeation. Herein, a series of novel N-salicyloyl tryptamine derivatives were synthesized and their anti-AD potential was evaluated both in vitro and in vivo. Among them, L7 performed well anti-neuroinflammatory effects and excellent neuroprotective effects, as well as little toxicity. To lucubrate its potential for the treatment of AD, behavior tests including morris water maze (MWM), eight-arm radial maze, open field test and novel object recognition (NOR) test were carried out and the results showed that L7 could remarkably improve Aβ-induced cognitive impairment. Moreover, the mechanism of action of L7 on improving Aβ-induced AD was preliminarily investigated, and the results uncovered that the neuroprotective effects of L7 was might exerte via intervening Aβ-induced pyroptosis through NLRP3-caspase-1-GSDMD axis and ameliorating neuronal apoptosis by mitochondrial apoptosis pathway. Besides, the distribution of Aβ plaques in brain tissues were detected by immunohistochemical (IHC) assay and the results indicated that L7 could significantly attenuate the deposition of Aβ plaques in the brain.

NF-kB decoy oligodeoxynucleotide preserves disc height in a rabbit anular-puncture model and reduces pain induction in a rat xenograft-radiculopathy model

While it is known that the degenerated intervertebral disc (IVD) is one of the primary reasons for low-back pain and subsequent need for medical care, there are currently no established effective methods for direct treatment. Nuclear factor-κB (NF-κB) is a transcription factor that regulates various genes' expression, among which are inflammatory cytokines, in many tissues including the IVD. NF-κB decoy is an oligodeoxynucleotide containing the NF-κB binding site that entraps NF-κB subunits, resulting in suppression of NF-κB activity. In the present preclinical study, NF-κB decoy was injected into degenerated IVDs using the rabbit anular-puncture model. In terms of distribution, NF-κB decoy persisted in the IVDs up to at least 4 weeks after injection. The remaining amount of NF-κB decoy indicated that it fit a double-exponential-decay equation. Investigation of puncture-caused degeneration of IVDs showed that NF-κB decoy injection recovered, dose-dependently, the reduced disc height that was associated with reparative cell cloning and morphological changes, as assessed through histology. Gene expression, by quantitative real-time polymerase chain reaction (qRT-PCR), showed that NF-κB decoy attenuated inflammatory gene expression, such as that of interleukin-1 and tumor necrosis factor-α, in rabbit degenerated IVDs. NF-κB decoy also reduced the pain response as seen using the "pain sensor" nude rat xenograft-radiculopathy model. This is the first report demonstrating that NF-κB decoy suppresses the inflammatory response in degenerated IVDs and restores IVD disc height loss. Therefore, the intradiscal injection of NF-κB decoy may have the potential as an effective therapeutic strategy for discogenic pain associated with degenerated IVDs.

Sodium butyrate relieves lung ischemia-reperfusion injury by inhibiting NF-κB and JAK2/STAT3 signaling pathways

OBJECTIVE

Ischemia-reperfusion (IR) is the main cause of acute lung injury (ALI) in clinical lung transplantation, extracorporeal circulation, lung sleeve resection, trauma and cardiopulmonary resuscitation. The inflammatory response and oxidative stress following IR are factors that cause and aggravate its secondary damage. The purpose of this study was to investigate the efficacy and mechanism of sodium butyrate (NaB) on lung ischemia-reperfusion injury (LIRI).

MATERIALS AND METHODS

We used male C57BL/6 mice to construct the LIRI model and administered the mice with NaB. By examining the expression of inflammatory factors and oxidative stress-related molecules in mouse lung tissue, we investigated the effects of NaB on inflammation and oxidative stress in lung tissue after IR. In addition, the changes in the activity of the NF-κB and JAK2/STAT3 signaling pathways were also examined to determine the mechanism of NaB.

RESULTS

The expression levels of the inflammatory factors (IL-1β, IL-6 and TNF-α) in lung tissue of mice after IR were significantly increased, while NaB reduced the expression of inflammatory factors. In addition, the oxidative stress level of mouse lung tissue after IR increased significantly, showing the decrease of antioxidant molecules SOD1/2, catalase (CAT), and Peroxiredoxin 1 (Prdx1), while the intake of NaB increased the antioxidant level of mouse lung tissue. The activities of NF-κB and JAK2/STAT3 signaling pathways were significantly increased in lung tissue after IR, whereas NaB inhibited the activity of NF-κB and JAK2/STAT3 signaling pathways.

CONCLUSIONS

NaB relieves LIRI by inhibiting NF-κB and JAK2/STAT3 signaling pathways to reduce inflammation and oxidative stress levels in lung tissue of mice after IR.

Age cohorts stratified according to age-distributions of COVID-19 morbidity statistics identify uniquely age-dependent CD3+CD8+ T-cell lymphocytopenia in COVID-19 patients without comorbidities on admission

If age boundaries are arbitrarily or roughly defined, age-related analyses can result in questionable findings. Here, we aimed to delineate the uniquely age-dependent immune features of coronavirus disease 2019 (COVID-19) in a retrospective study of 447 patients, stratified according to age distributions of COVID-19 morbidity statistics into well-defined age-cohorts (2–25y, 26–38y, 39–57y, 58–68y, and 69–79y). Age-dependent susceptibilities and severities of the disease were observed in COVID-19 patients. A comparison of the lymphocyte counts among the five age-groups indicated that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection led to age-dependent lymphopenia. Among the lymphocyte subsets, the CD8⁺ T cell count alone was significantly and age-dependently decreased (520, 385, 320, 172, and 139 n/μl in the five age-groups, respectively). In contrast, the CD4⁺ T cell, B cell, and natural killer cell counts did not differ among age-cohorts. Age and CD8⁺ T cell counts (r=‒0.435, p<0.0001) were negatively correlated in COVID-19 patients. Moreover, SARS-CoV-2 infection age-dependently increased the plasma C-reactive protein concentrations (2.0, 5.0, 9.0, 11.6, and 36.1 mg/L in the five age-groups, respectively). These findings can be used to elucidate the role of CD8⁺ T cells in age-related pathogenesis and to help develop therapeutic strategies for COVID-19.

Angiotensin II-mediated improvement of renal mitochondrial function via the AMPK/PGC-1α/NRF-2 pathway is superior to norepinephrine in a rat model of septic shock associated with acute renal injury

Background

This study sought to compare the therapeutic effects of angiotensin II (ANG II) and norepinephrine (NE) on cecal ligation and puncture (CLP)-induced septic acute kidney injury (AKI) in rats.

Methods

Sepsis shock was induced in anesthesia Sprague-Dawley male rats by CLP model for 24 hours. A total of 40 rats were divided into five groups, including control group, sham group, CLP group, CLP + ANG II group, and CLP + NE group. CLP + ANG II and CLP + NE group were administration of ANG II or NE after sepsis shock respectively, maintaining the MAP at 75–85 mmHg. CLP group was administration of saline for contrast. At 0, 18, 24 hours measured the renal blood grades and resistant index (RI) by ultrasound equipment. At 6, 12, 18 and 24 hours collected 0.5 mL blood sample for creatinine and lactic acid examination. Rats were observed for 24 hours after CLP procedure and then sacrificed for subsequent examination, rat serum were used to determine the levels of inflammatory response factors, kidney tissues were used to examine the oxidative stress factors and mitochondrial related proteins.” We added the sentence as following: “The AMPK, PGC-1α and NRF-2 expression in renal cortex was significantly increased in the CLP + ANG II group.

Results

Compared to the vehicle treatment, both ANG II and NE administration restored the decrease in the mean arterial pressure (MAP) and alleviated mitochondrial impairments in CLP rats. However, only ANG II alleviated CLP-induced abnormalities in serum creatinine and lactic acid concentrations, renal blood flow, the renal resistant index, renal histopathology, the production of proinflammatory cytokines, and oxidative stress markers in rats. ANG II was also found to be superior to NE in reversing the CLP-induced suppression of mitochondrial biogenesis-related protein expression in the kidneys of rats.

Conclusions

ANG II was better than NE in alleviating CLP-induced septic AKI in rats.

Sex- and age-specific clinical and immunological features of coronavirus disease 2019

To simultaneously determine clinical and immunological responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in young and old females and males, 681 coronavirus disease 2019 (COVID-19) patients and 369 normal controls (NCs) were analyzed based on age and sex classifications using multiple linear regression analysis. Compared to the age-matched NCs, both young and old male and female non-comorbid COVID-19 patients had lower lymphocyte counts and alanine aminotransferase (ALT) concentration, and only young male and female patients had lower neutrophil counts. Compared to young patients, both old males and females had significantly higher plasma ALT and AST concentrations. Compared to young and old females, age-matched males had higher plasma ALT and AST concentrations, but only young males had higher C-reactive protein (CRP) concentration. Compared to females, old males, but not young males, showed higher incidence of critical illness. Compared to young patients, old females had more leukocyte and neutrophil counts above the normal upper limit and B cell count below the normal lower limit (NLL), while old males had more lymphocyte and natural killer (NK) cell counts below the NLL. No sex or age associations with B cell and NK cell counts were observed. However, there were age-dependent decreases in CD8+ T-cell counts in both male and female COVID-19 patients. Age was negatively associated with CD8+ T cell counts but positively associated with neutrophil count, CRP, ALT, and AST concentrations, and sex (females) was negatively associated with neutrophil count, CRP, ALT, and AST concentrations. The present study suggests that SARS-CoV-2 infection mainly induced 1) beneficial sex (female)-related differences regarding reduced COVID-19 disease severity and negative associations with inflammatory responses and liver damage, and 2) harmful age-related differences relating to negative associations with CD8+ T cell count and positive associations with inflammatory responses and liver damage. Thus, sex and age are biological variables that should be considered in the prevention and treatment of COVID-19.

The role of technology innovation and people's connectivity in testing environmental Kuznets curve and pollution heaven hypotheses across the Belt and Road host countries: new evidence from Method of Moments Quantile Regression

The Belt and Road Initiative (BRI) is closely linked to the ecological sustainability of the infrastructure ventures that intrinsically include the aspects of climate change and pollution. Though there exists literature on the environmental Kuznets curve (EKC) and pollution haven hypothesis (PHH), very few explore the scope in the light of Belt and Road host countries (B&RCs). Therefore, the study examines the income-induced EKC and Chinese outward foreign direct investment (FDI)-based PHH in the multivariate framework of people's connectivity and technology innovation in B&RCs from 2003 to 2018. The outcome of the study reveals that the observed relationship is quantile-dependent, which may disclose misleading results in previous studies using traditional methodologies that address the averages. Utilizing the novel "Method of Moments Quantile Regression (MMQR)" of Machado and Silva (J Econom 213:145-173, 2019), the findings confirm an inverted U-shape association between economic growth and CO₂ emissions only at lower to medium emission countries, thus validating the EKC hypothesis. The Chinese outward FDI flows increase carbon emissions at medium to high emission countries, thereby confirming PHH. The findings also indicate that people's connectivity contributes to increasing emissions while innovation mitigates carbon emissions at lower to medium polluted countries. Moreover, the outcomes of Granger causality confirm one-way causality between economic growth and CO₂ emissions, between FDI and CO₂ emissions, between people's connectivity and CO₂ emissions, and between innovation and CO₂ emissions. The results offer valuable insight for legislators to counteract CO₂ emissions in B&RCs through innovation-led energy conservation in infrastructure projects while adopting green and sustainable financing mechanisms to materialize mega construction projects under the BRI.

Iatrogenic acid-induced gingival recession during crown cementation: A case report

Accidental contact of various chemicals in dentistry may cause damage to the gingiva. A male patient presented for a full mouth rehabilitation with ceramic crowns. The patient underwent the steps of ceramic crown preparation uneventfully. At the time of crown delivery, cotton rolls were placed in several vestibular areas for isolation. They were regularly changed during different steps of etching and cementation process, which included the use of Multilink Primer B (Ivoclar Vivadent™). On removal of the cotton roll in the area of upper right canine, the gingival tissues appeared blanched and grayish white. The cotton roll was found to have absorbed some etching material in it. As the patient was asymptomatic, he was dismissed. Two weeks later, the patient presented with inflammation and gingival recession in the same area. Initially, he was treated palliatively, and subsequently, he received a connective tissue graft on the upper right canine. This case report showed that acid etching material used during the prosthodontic cementation may have caused a gingival recession, which was successfully treated with tunnel flap and connective tissue graft. Optimal isolation of the operative field should be performed to avoid this problem.

Backstepping-based adaptive control of a quadrotor UAV with guaranteed tracking performance

In this paper, a backstepping based indirect adaptive control design and an alternative direct adaptive control scheme, both with guaranteed transient and steady-state tracking performances, are proposed for trajectory tracking of a quadrotor unmanned aerial vehicle (UAV). Backstepping techniques, combined with a prescribed performance function based error transformation, are employed in both designs to achieve the bounded transient and steady-state tracking errors of the strict-feedback position system which comprises both lateral position and altitude dynamics. The effects of parametric inertia and drag uncertainties on attitude regulation are compensated using a least squares based parameter identification algorithm in the indirect adaptive control design, and using a constructive Lyapunov analysis approach in the direct adaptive control scheme. The stability of the closed-loop system for both designs is proven via Lyapunov analysis. Simulation and experimental test results are provided to verify the effectiveness of the proposed control designs.

Impact of Prior Ischemic Stroke on Outcomes in Patients With Heart Failure - A Propensity-Matched Study

BACKGROUND

Whether ischemic stroke per se, rather than older age or additional comorbidities, accounts for the adverse prognosis of heart failure (HF) is uncertain. The present study examineed the intrinsic association of ischemic stroke with outcomes in a propensity-matched cohort.Methods and Results:Of 1,351 patients hospitalized with HF, 388 (28.7%) had prior ischemic stroke. Using propensity score for prior ischemic stroke, estimated for each patient, a matched cohort of 379 pairs of HF patients with and without prior ischemic stroke, balanced on 32 baseline characteristics was assembled. At 30 days, prior ischemic stroke was associated with significantly higher risks of the combined endpoint of all-cause death or readmission (hazard ratio [HR]: 1.91; 95% confidence interval [CI]: 1.38 to 2.65; P<0.001), all-cause death (HR: 2.08; 95% CI: 1.28 to 3.38; P=0.003), all-cause readmission (HR: 2.67; 95% CI: 1.78 to 4.01; P<0.001), and HF readmission (HR: 2.11; 95% CI: 1.19 to 3.72; P=0.010). Prior ischemic stroke was associated with a significantly higher risk of all 4 outcomes at both 6 months and 1 year.

CONCLUSIONS

Prior ischemic stroke was a potent and persistent risk predictor of death and readmission among patients with HF after accounting for clinical characteristics.

1105 A Randomized Controlled Trial of a Psychological Intervention for Decreasing Bedtime Procrastination: The BED-PRO Study

Introduction

Bedtime Procrastination (BP) is defined as the behavior of going to bed later than intended, without having external reasons for doing so. Previous studies have shown that BP has a negative effect on sleep and health, and there is a need to develop interventions to decrease BP. This study (BED-PRO) is an ongoing study evaluating a behavioral intervention to reduce BP.

Methods

Fifteen participants who scored higher than 33 on the Bedtime Procrastination Scale were randomized to either the treatment (TRT, n=6) or control group (CTRL, n=9). Treatment consisted of four face-to-face individual sessions. All participants completed self-report questionnaires on Bedtime Procrastination Scale (BPS), Epworth Sleepiness Scale (ESS), Positive Affect and Negative Affect Schedule (K-PANAS-R) and completed the 7-day sleep diary. Data was analyzed using two-way mixed Measures Analysis of Variance (ANOVA).

Results

Mean age of the participants was 21.78 (±1.8) years and 80% (n=12) were females. Group by time interactions from repeated measures analyses revealed significant post intervention improvements in the TRT group compared to the CTRL group on all bedtime procrastination duration and scores, sleep efficiency, refreshment after waking, daytime sleepiness and negative affect of K-PANAS-R. Specifically, bedtime procrastination duration in the TRT group measured by sleep diaries decreased significantly from 75.30 (±58.57) min to 14.83 (±7.83) min, while the CTRL group did not change from 57.60 (±32.01) to 54.36 (±40.82) min (p=0.019). In addition, the TRT group reported significant improvements in bedtime procrastination scores from 36.00 (±4.05) to 22.50 (±6.72).

Conclusion

Based on results, the behavioral intervention used in this study looks promising in improving bedtime procrastination and sleep.

Support

This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea(NRF-2018S1A5A8026807)

A novel nomogram to predict all-cause readmission or death risk in Chinese elderly patients with heart failure

Aims

Elderly patients with heart failure (HF) are associated with frequent all‐cause readmission or death. The present study sought to develop an accurate and easy‐to‐use model to predict all‐cause readmission or death risk in Chinese elderly patients with HF.

Methods and results

This was a prospective cohort study in patients with HF aged 65 or older. Demographic, co‐morbidity, laboratory, and medication data were collected. A Cox regression model was used to identify factors for the prediction of readmission or death at 30 days and 1 year. A nomogram was developed with bootstrap validation. Of the included 854 patients, the cumulative all‐cause readmission and mortality rates were 10.5% and 11.6% at 30 days and 34.9% and 19.7% at 1 year, respectively. The independent risk factors associated with both 30 day and 1 year readmission or death were older age, stroke, diastolic blood pressure < 60 mmHg, body mass index ≤ 18.5 kg/m², lower estimated glomerular filtration rate, and BNP > 400 pg/mL (all P < 0.05). Anaemia, abnormal neutrophils, and admission without angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers were the specific independent risk factors of 30 day all‐cause readmission or death (all P < 0.05), whereas serum sodium ≤ 140 mmol/L and admission without beta‐blockers were the specific independent risk factors of 1 year all‐cause readmission or death (all P < 0.05). The C‐index of the 30 day and 1 year diagnosis prediction model was 0.778 [95% confidence interval (CI) 0.693–0.862] and 0.738 (95% CI 0.640–0.836), respectively.

Conclusions

We developed accurate and easy‐to‐use nomograms to predict all‐cause readmission or death in Chinese elderly patients with HF. The nomograms will assist in reducing the all‐cause readmission and mortality rates.

[Research on the characteristics of the formation and inheritance of Lei's medicine in Quzhou from the perspective of regional medicine]

Lei's medicine is the main school of traditional Chinese medicine in Quzhou, Zhejiang Province. It originated from Xin'an medical school. It has been passed on for more than 200 years, but it is still lack of in-depth study. From the perspective of regional medicine, combined with the regional characteristics of Quzhou, absorbing the research results of local social history and environmental history, starting with the historical materials such as Lei's medical works, local chronicles literature and so on, the school characteristics are summarized as: the formation of "treatment in accordance with three types of disease causes" , the academic inheritance of "inheriting the past and integrating the present" , the inheritance mode of "multiple integration" , the cultural connotation of "combining medicine with Confucianism" , and the school characteristics of "integration and innovation" . The purpose of this paper is to provide reference for the research of academic schools and the inheritance of traditional Chinese medicine.

[Evaluation of inferior mesenteric vessel and ureter by contrast-enhanced abdominal pelvic CT and its clinical influence on laparoscopic rectal surgery]

Objective: To assess the anatomic relationship of inferior mesenteric artery (IMA)/inferior mesenteric vein (IMV) with ureter by contrast-enhanced abdominal pelvic CT, in order to provide guidance for vascular management and ureteral protection in laparoscopic rectal surgery. Methods: A retrospective cohort study was conducted. Image data of contrast-enhanced abdominal pelvic CT at Department of Medical Radiography of Peking University First Hospital in November 2018 were enrolled. Exclusion criteria: (1) previous history of abdominal or pelvic surgery; (2) scoliosis deformities; (3) missing images; (4) minors; (5) inferior mesenteric vascular disease or tumor involvement resulting in suboptimal imaging; (6) poor image quality. Finally, contrast-enhanced abdominal pelvic CT data of 249 cases were collected, including 120 males and 129 females with mean age of (60.1±13.4) years. Multi-planar reconstruction (MPR) and maximum intensity projection (MIP) were used to evaluate the anatomic relationship of IMA/IMV with ureter. IMA root location, IMA length, branch types of IMA, distance between major branches, distance between IMA/IMV and ureter at the level of root of IMA, left colic artery (LCA) root, abdominal aortic bifurcation, and sacral promontory were measured and association between IMA/IMV and ureter site was summarized. Results: The distance from IMA root to the aortic bifurcation and sacral promontory was (42.0±8.5) mm and (101.8±14.0) mm, respectively. The length of IMA was (38.5±10.7) mm. The proportion of IMA roots locating at levels of the 2nd, 3rd, and 4th lumbar vertebra was 3.2% (8/249), 79.5% (198/249), and 17.3% (43/249), respectively. The higher the level of the lumbar vertebra, the longer the IMA [length of IMA originating from the 2nd, 3rd, 4th lumbar vertebra level: (42.4±10.9) mm, (39.5±10.4) mm, (33.0±10.9) mm, respectively; F=7.48, P<0.001]. In 111 cases (44.6%), LCA arose independently from IMA (type 1), and the distance between LCA and the first branch of sigmoid artery (SA) was (15.0±7.4) mm; in 56 cases (22.5%), LCA and SA had a common trunk (type 2), with a length of (11.0±8.5) mm; in 78 cases (31.3%), LCA branched with SA at the same point (type 3); LCA was absent in 4 cases (1.6%)(type 4). The length of IMA in LCA-deficient type 4 was (54.8±18.0) mm, which was longer than (38.2±10.5) mm in LCA-presence type (type 1, type 2 and type 3) and the difference was statistically significant (t=-3.11, P=0.002). The distance between the ureter and IMA was the longest at the level of IMA root [(35.7±8.1) mm], was the shortest at the level of the aortic bifurcation [(22.4±6.4) mm], and the distance between the ureter and IMA in different planes was significantly different (F=185.70, P<0.001). The distance between the ureter and IMV was the longest at the level of the sacral promontory [(21.1±9.0) mm], was the shortest at the level of LCA root [(12.0±5.7) mm], whose difference was also statistically significant (F=87.66, P<0.001). Conclusions: CT post-processing techniques including MPR and MIP can efficiently and accurately assess the branch types of IMA and anatomical relationship between IMA/IMV and ureter, and provide insights into laparoscopic rectal surgery for surgeons. IMA/IMV and ureter depart farthest at the level of IMA root. Artery first and plane second strategy in the middle approach of laparoscopic rectal surgery is considerable and feasible.

[Surgical technique and mid-and-long curative effect analysis of primary repair of chronic Achilles tendon rupture]

Objective: To examine the surgical method and clinical outcome of primary repair of chronic Achilles tendon rupture. Methods: From March 2012 to August 2017, clinical data of 35 consecutive patients with chronic Achilles tendon rupture who were treated with primary repair by the same doctor at Department of Sports Medicine, Peking University Third Hospital were retrospectively analyzed.There were 29 males and 6 females with age of (41.0±9.3)years(range:29-65 years), the follow-up period was (45.6±17.2) months(range:17-82 months). All the patients had unilateral tendon rupture with 22 cases on the left and 13 cases on the right.The preoperative and postoperative Visual Analogue Scale(VAS), American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score(AOFAS), the Victorian Institute of Sport Assessment-Achilles(VISA-A), the Achilles tendon Total Rupture Score(ATRS)and the Tegner Activity Score of patients were collected and compared by paired-t test. Results: Among 47 patients with chronic Achilles tendon rupture, 35 patients were followed up for (45.6 ± 17.2)months(range: 17-28 months). No serious postoperative complications such as infection or nerve damage and rerupture outcomes were reported. At the last follow-up,the VAS decreased from 1.0(2.0) (M(Q(R))) preoperative to 0.0(0.8)(Z=-3.586, P=0.00), AOFAS increased from 64.3±12.5 to 97.0±5.0(t=-14.359,P<0.001), VISA-A increased from 51.3± 9.8 to 87.8±18.0(t=- 17.656, P=0.00), Tegner increased from 0.9±0.3 to 4.6±1.7(t=- 12.524, P=0.00)and ATRS increased from 40.0±3.5 to 97.9±3.9(t=-64.133,P=0.00). Twenty-eight patients (80.0%) had returned to their preinjury activity levels, and 7 patients (20.0%) no longer participate in recreational sports. According to Arner-Lindholm curative effect evaluation criteria, 32 cases(91.4%)gained the excellent results, 1 case(2.9%) of good and 2 cases(5.7%) bad, and the percentage of the cases with the excellent or good results was 94.3%. All except 2 patients with bad results could perform a single-limb heel rise painlessly. Conclusions: Primary repair is an efficient approach for chronic Achilles tendon rupture. The mid-and-long curative effect is satisfactory and stable.Compared with other surgical techniques, operation is relatively simple and economical. The primary repair is considerably safe, with few serious complications such as infection or nerve damage and reruptures.

P14.27 The significance of multicentric noncontrast-enhancing lesions distant from surgically resected glioblastoma: Case series of 3 patients

BACKGROUND

Glioblastoma is the most malignant primary brain tumor. The tumor location and multiplicity plays an important role in surgical and further treatment. The incidence of multiple lesions at the time of diagnosis was known as 1–20%, which showed a poor prognostic factor. Most researches has focused on multiple contrast-enhancing lesions, however, multicentric non-enhancing lesions distant from glioblastoma has been rarely evaluated. The authors reported the case series of the patient who showed multicentric non contrast-enhancing lesions without connection to histologically-proven glioblastoma.

MATERIAL AND METHODS

Multicentric non contrast-enhancing lesions were defined as areas of FLAIR hyperintensity and mass effect without post-contrast enhancement, separated from the histologically-proven glioblastoma in a newly diagnosed disease. Three patients who showed distant non-enhancing lesions with appearance of a multicentric low-grade glioma were included in this study. The typical enhancing lesions were surgically resected and standard chemo-radiotherapy was followed in all patients.

RESULTS

All patients were male and their age was 38, 60 and 65 years old respectively. Multicentric tumor location was as follows: Case 1, left frontal lobe with non-enhancing lesion in left parahippocampal gyrus; Case 2, left parietal with non-enhancing lesion in left anteromedial temporal lobe; Case 3, left thalamus with non-enhancing lesions in both basal frontal and right temporal lobe. Pathologically, the resected enhancing tumor revealed glioblastoma in 2 patients and diffuse midline glioma in 1. All tumors were IDH-wild type. The resected enhanced lesion showed no progression but all non-enhancing lesions developed contrast-enhancing tumors at 3, 13 and 17 months after initial treatment, with high tracer uptake on 18FDG-PET or 18FDOPA-PET. Despite multidisciplinary treatment, two patients died from disease progression at 30 and 32 months after diagnosis and one patient is still alive with overall survival of 15 months.

CONCLUSION

The appearance of multicentric non-enhancing lesions distant from a typically enhancing tumor showed an uncommon finding in glioblastoma and poor prognostic features. These lesions progress faster than expected for a low-grade glioma. These lesions should be distinguished from typical low-grade glioma and should be considered more advanced lesions than their appearances suggest.