Predictors and Variation in Steroid Injection Use for Carpal Tunnel Syndrome from a Multicenter Quality Collaborative

BACKGROUND

Steroid injections are commonly used as first-line treatment for carpal tunnel syndrome (CTS); however, research has shown that their benefit is generally short term, and many patients go on to receive carpal tunnel release (CTR). The purpose of this study was to determine the variation in steroid injection use by hand surgeons.

METHODS

The authors analyzed data from a nine-center hand surgery quality collaborative. Data from 1586 patients (2381 hands) were included if they underwent elective CTR at one of the sites. Mixed effects logistic regression models were used to examine the association of receipt of steroid injection and association of receipt of more than one steroid injection among patient-level covariates.

RESULTS

Steroid injection use significantly varied by practice, ranging from 12% to 53% of patients. The odds of receiving a steroid injection were 1.4 times higher for women ( P < 0.01), 1.6 times higher for patients with chronic pain syndrome ( P < 0.01), 0.5 times lower for patients with moderate electromyography (EMG) classification, and 0.4 times lower for patients with severe EMG classification (both P < 0.01). Patients with high scores on the Six-Item CTS Scale ( P = 0.02) and patients with moderate ( P = 0.04) or severe EMG ( P = 0.05) classification had lower odds of receiving multiple steroid injections. Complete symptomatic improvement after steroid injection was significantly reported by patients with a high Six-Item CTS Scale score ( P = 0.03) and patients with severe EMG classification ( P = 0.02).

CONCLUSIONS

The authors found wide patient-level and practice-level variation in the use of steroid injections before CTR. These findings underscore the need for improved data and standard practice guidelines regarding which patients benefit from steroid injection.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, III.

[Research progress on the application of specially lense related to myopia prevention and control]

In order to decelerate the growth of myopia in children and adolescents and reduce the risks of associated eye complications, extensive research has been conducted on preventive measures, including optical, behavioral, and pharmaceutical interventions. Spectacle lenses, due to their safety, convenience, and high patient compliance, stand out as the most common method for correcting refractive errors compared to other interventions. As far as we know, various forms of spectacle lenses are currently used in clinical practice, including bifocal lenses, progressive multifocal lenses, peripheral defocus lenses, defocus incorporated multiple segments (DIMS) lenses, highly aspherical lenslets, diffusion optics technology lenses, and violet light transmission (VL) glasses. However, a systematic and comprehensive overview of myopia-controlling spectacle lenses is still lacking. Therefore, this article summarizes the latest research progress on the myopia prevention and control technology of spectacle lenses at home and abroad, providing theoretical support for the myopia prevention and control effect of different spectacle lens technologies, promoting the application of related technologies in clinical work, and offering new ideas for myopia prevention and control.

Post-Bariatric Panniculectomy: Postoperative Complications by Weight Loss Surgery Type

BACKGROUND

Over 250,000 patients undergo bariatric surgery each year in the United States. Approximately 21% will undergo subsequent body contouring after massive weight loss. Patients with prior bariatric surgery are at a greater risk for complications relative to the general population. However, it is unknown if bariatric surgery type is associated with differential complication risk after panniculectomy.

METHODS

A retrospective chart review of post-bariatric who underwent abdominal panniculectomy at a single large quaternary care center was performed. Postoperative complications were graded according to the Clavien-Dindo classification. Descriptive statistics, multivariable logistic regression, and power calculations were performed.

RESULTS

In total, 216 patients were included. Restrictive bariatric surgery accounted for 48.6% while 51.3% had a history of malabsorptive bariatric surgery. The overall rate of complications was 34.3% (restrictive: 36.2%; malabsorptive: 32.8%, p=0.66). Wound complications were observed in 25.5% (n=55) of patients. Systemic complications occurred in 11.1% of patients overall, with statistically similar rates between restrictive and malabsorptive groups. After adjusting for both patient and operative factors, no significant difference in total complications (OR=1.15, 95% CI: 0.47 to 2.85, p=0.76), systemic complications (OR=0.26, 95% CI: 0.05 to 1.28, p=0.10), or wound complications (OR=2.31, 95% CI: 0.83 to 6.41, p=0.11) was observed.

CONCLUSIONS

Complications following panniculectomy in bariatric surgery patients is high and predominantly related to wound healing. No significant difference between type of bariatric surgery and complication risk was found.

Cimifugin Relieves Histamine-Independent Itch in Atopic Dermatitis via Targeting the CQ Receptor MrgprA3

Background: We previously found that cimifugin has a potent antiallergic inflammatory effect in atopic dermatitis (AD). However, whether cimifugin has an antipruritic effect in AD was unknown. Methods: Mouse scratching behavior tests were performed to verify the proposed antipruritic effect of cimifugin on DNFB- or FITC-mediated AD. Chloroquine (CQ)- and compound 48/80-evoked acute itch models were employed to clarify the effect of cimifugin on histamine-dependent or -independent itch. Intracellular calcium changes were assessed in a primary culture of mouse dorsal root ganglia (DRG) in response to pruritogen exposure with or without cimifugin treatment, including CQ, histamine, allyl-isothiocyanate (AITC), and capsaicin. Molecular docking and microscale thermophoresis (MST) assays were performed to predict and verify the binding ability and modes between cimifugin and the CQ receptor MrgprA3, respectively. Results: We found that cimifugin attenuates itch behaviors effectively in FITC-induced AD. Notably, cimifugin significantly alleviated acute itching behaviors induced by CQ but not compound 48/80 in vivo. Moreover, cimifugin remarkably inhibited CQ-evoked calcium influx in DRG cells but had no obvious effect on histamine-induced calcium influx. Nevertheless, cimifugin did not interfere with either AITC-stimulated TRPA1 activation- or capsaicin-stimulated TRPV1 activation-mediated calcium influx in DRG cells. Molecular docking predicted that CQ and cimifugin might share similar binding abilities and binding modes with MrgprA3. MST assay confirmed cimifugin directly targeting MrgprA3. Conclusion: The present study demonstrates that cimifugin has a potent antipruritic effect in AD with a histamine-independent mechanism via targeting the CQ receptor MrgprA3. Thus, cimifugin is a promising candidate antipruritic agent for AD.

Surgical treatment of nasopharyngeal cancer - a consensus recommendation from two Chinese associations

BACKGROUND

Surgical treatment is playing an increasingly important role in the management of nasopharyngeal carcinoma (NPC). This consensus focuses on the indications for optimal surgery, and surgical methods in the whole process of treatment for NPC to provide a useful reference to assist these difficult clinical decisions.

METHODOLOGY

A thorough review of available literature on NPC and surgery was conducted by the Association for the prevention and treatment of nasopharyngeal carcinoma in China, international exchange and promotion Association for medicine and healthcare, and the Committee on nasopharyngeal cancer of Guangdong provincial anticancer association. A set of questions and a preliminary draft guideline was circulated to a panel of 1096 experienced specialists on this disease for voting on controversial areas and comments. A refined second proposal, based on a summary of the initial voting and different opinions expressed, was recirculated to the experts in two authoritative medical science and technology academic groups in the prevention and treatment of NPC in China for review and reconsideration.

RESULTS

The initial round of questions showed variations in clinical practice even among similar specialists, reflecting the lack of high-quality supporting data and resulting difficulties in formulating clinical decisions. Through exchange of comments and iterative revisions, recommendations with high-to-moderate agreement were formulated on general treatment strategies and details of surgery, including indications and surgical approaches.

CONCLUSION

By standardizing the surgical indications and practice, we hope not only to improve the surgical outcomes, but also to highlight the key directions of future clinical research in the surgical management of NPC.

Impact of consensus guideline publication on the timing of elective pediatric umbilical hernia repair

BACKGROUND

The American Academy of Pediatrics published consensus guidelines advising observation of asymptomatic umbilical hernias until age 4 or 5, given unnecessary risks of early intervention and substantial practice variation. Yet, the impact of guidelines on early repair (age <4) or if certain groups remain at risk for avoidable intervention is unclear.

METHODS

This retrospective study used data from children's hospitals participating in the Pediatric Health Information System database. Children aged 17 years and younger who underwent umbilical hernia repair from July 2017 to August 2022 were eligible for inclusion. Children with recurrent hernias, an emergency, or urgent presentation were excluded. An interrupted time series using segmented multivariable logistic regression estimated the association of guideline publication in November 2019 with the odds of guideline-adherent repair (age ≥4) after adjusting for sociodemographic characteristics and hospital-level random effects.

RESULTS

16,544 children underwent repair, of which 3,115 (18.8%) were children <4 years old. After adjustment, guideline publication was associated with an immediate increase in guideline-adherent repairs (odds ratio = 1.25 95% confidence interval = 1.05-1.49). The interrupted time series found that each month after publication was associated with a 2% increase in the odds of guideline-adherent repair (odds ratio = 1.02, 95% confidence interval = 1.01-1.03). Children with public insurance were nearly 20% less likely to receive guideline-adherent repair than privately insured children (odds ratio = 0.82, 95% confidence interval = 0.74-0.91). Children in the Midwest had lower odds of guideline-adherent repair (Midwest versus Northeast: odds ratio = 0.45. 95% confidence interval = 0.24-0.84).

CONCLUSION

Guideline publication was associated with greater odds of guideline-adherent repair, yet public insurance coverage and Midwest location remain significant predictors of early repair against recommendations.

A Generalized Deep Learning Method for Synthetic CT Generation

PURPOSE/OBJECTIVE(S)

The application of deep learning to generate synthetic CT (sCT) has been widely studied in radiotherapy. Existing methods generally involve data from two different image modalities, such as CBCT-CT or MRI-CT, the quality of sCT is adversely affected by source image quality. We propose a unique method of synthesizing MRI and CBCT into sCT based on single-modal CT for training, and call it SmGAN.

MATERIALS/METHODS

We used planning CT of a group of 35 head and neck cases to as training data. We then applied two different spatial transformations to the planning CT image to produce the transformed CT1 and CT2. And We used a random style enhancement technique (Shuffle Remap) to modify the image distribution of CT1 which we termed CT1+E. CT1+E was used to simulate the patient's "image of the day" while CT2 to simulate the "planning image". After feeding both CT1+E and CT2 into the generator, we obtained the sCT predicted by the generator. The generator was trained using the Mean Absolute Error (MAE) loss between sCT and CT1. In the actual clinical process, we use the patient's CBCT or MRI instead of CT1+E and the patient's planning CT instead of CT2 as the input of the generator. After processing, we get an sCT that can maintain the spatial position of the image taken on the day, while presenting features similar to the planning CT. The evaluation data we have includes 10 pairs of MRI-Def_CT and 10 pairs of CBCT-Def_CT Head and Neck patients. Def_CT is obtained from the planning CT based on the spatial position deformation of MRI and CBCT. To evaluate the accuracy of sCT based on MRI and CBCT with Def CT, we use a range of metrics, including Hounsfield Unit (HU) difference, peak signal-to-noise ratio (PSNR), structural similarity (SSIM) and gamma pass rate. All results will be benchmarks against the advanced method RegGAN for comparison.

RESULTS

Compared to RegGAN, the results of SmGAN were significantly better. The mean absolute errors within the body were (44.7±216.2 HU vs. 36.7±131.4 HU) and (64.9±123.7 HU vs. 58.2±152.8 HU) for the CBCT-SCT and MRI-SCT, respectively (Table 1). In addition, experimental results show that SmGAN also outperforms RegGAN in dose calculation accuracy. For example, under the 10% threshold, SmGAN's gamma pass rate of 1mm and 1% is 0.926±0.02, compared with gamma rate of 0.896±0.02 for RegGAN.

CONCLUSION

We proposed a generalized deep learning model for synthetic CT generation, based on CBCT or MRI images. The proposed algorithm achieved high accuracy of dosimetric metrics, as well as excellent IMRT QA verification results. Compared to other existing synthetic CT generation methods, the proposed SmGAN required a single-modal image for training, which is considered as a major breakthrough in the industry, and is expected to have wide spread of clinical applications.

Association of Screen Time with Anxiety and Depressive Symptoms in College Students During COVID-19 Outbreak in Shanghai: Mediation Role of Sleep Quality

The study aimed to investigate the associations between different types of screen time (ST) and anxiety and depressive symptoms in college students during the Coronavirus disease 2019 (COVID-19) outbreak in Shanghai, China; the potential mediation role of sleep quality was also examined. A total of 1,550 college students completed an online survey in May 2022. ST, Self-rating Anxiety Scale (SAS) score, Self-rating Depression Scale (SDS) score, Pittsburgh Sleep Quality Index (PSQI) score, and physical activity were self-reported. Multiple linear regression and mediation analysis were conducted. The results showed that more time spent in TV/movie viewing (>2 h/day) and recreational reading (>1 h/day) was associated with higher levels of anxiety, while more time spent in online social media (>2 h/day) was associated with a higher level of depressive symptoms. In contrast, time spent in online social media (1-2 h/day) was associated with a lower level of anxiety. Meanwhile, recreational reading (2-3 h/day) had a significant indirect effect on anxiety and depressive symptoms through sleep quality. During the COVID-19 outbreak, the associations of ST with anxiety and depressive symptoms varied by the type of screen viewing in college students. The associations of slightly excessive time spent on recreational reading with higher levels of anxiety and depressive symptoms were partially mediated by sleep quality.

Dual-Conductive and Stiffness-Morphing Microneedle Patch Enables Continuous In Planta Monitoring of Electrophysiological Signal and Ion Fluctuation

The use of conductive microneedles presents a promising solution for achieving high-fidelity electrophysiological recordings with minimal impact on the interfaced tissue. However, a conventional metal-based microneedle suffers from high electrochemical impedance and mechanical mismatch. In this paper, we report a dual-conductive (i.e., both ionic and electronic conductive) and stiffness-morphing microneedle patch (DSMNP) for high-fidelity electrophysiological recordings with reduced tissue damage. The polymeric network of the DSMNP facilitates electrolyte absorption and therefore allows the transition of stiffness from 6.82 to 0.5139 N m-1. Furthermore, the nanoporous conductive polymer increases the specific electrochemical surface area after tissue penetration, resulting in an ultralow specific impedance of 893.13 Ω mm2 at 100 Hz. DSMNPs detect variation potential and action potential in real time and cation fluctuations in plants in response to environmental stimuli. After swelling, DSMNPs mechanically "lock" into biological tissues and prevent motion artifact by providing a stable interface. These results demonstrate the potential of DSMNPs for various applications in the field of plant physiology research and smart agriculture.

Autonomic modulation, spontaneous baroreflex sensitivity and fatigue in young men after COVID-19

Impaired autonomic modulation and baroreflex sensitivity (BRS) have been reported during and after COVID-19. Both impairments are associated with negative cardiovascular outcomes. If these impairments were to exist undetected in young men after COVID-19, they could lead to negative cardiovascular outcomes. Fatigue is associated with autonomic dysfunction during and after COVID-19. It is unclear if fatigue can be used as an indicator of impaired autonomic modulation and BRS after COVID-19. This study aims to compare parasympathetic modulation, sympathetic modulation, and BRS between young men who had COVID-19 versus controls and to determine if fatigue is associated with impaired autonomic modulation and BRS. Parasympathetic modulation as the high-frequency power of R-R intervals (lnHFR-R), sympathetic modulation as the low-frequency power of systolic blood pressure variability (LFSBP), and BRS as the -index were measured by power spectral density analysis. These variables were compared between 20 young men who had COVID-19 and 24 controls. Independent t-tests and Mann-Whitney U tests indicated no significant difference between the COVID-19 and the control group in: lnHFR-R, P=0.20; LFSBP, P=0.11, and -index, P=0.20. Fatigue was not associated with impaired autonomic modulation or BRS. There is no difference in autonomic modulations or BRS between young men who had COVID-19 compared to controls. Fatigue did not seem to be associated with impaired autonomic modulation or impaired BRS in young men after COVID-19. Findings suggest that young men might not be at increased cardiovascular risk from COVID-19-related dysautonomia and impaired BRS.

[Safety and efficacy of the early administration of levosimendan in patients with acute non-ST-segment elevation myocardial infarction and elevated NT-proBNP levels: An Early Management Strategy of Acute Heart Failure (EMS-AHF)]

Objectives: To investigated the safety and efficacy of treating patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) and elevated levels of N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) with levosimendan within 24 hours of first medical contact (FMC). Methods: This multicenter, open-label, block-randomized controlled trial (NCT03189901) investigated the safety and efficacy of levosimendan as an early management strategy of acute heart failure (EMS-AHF) for patients with NSTEMI and high NT-proBNP levels. This study included 255 patients with NSTEMI and elevated NT-proBNP levels, including 142 males and 113 females with a median age of 65 (58-70) years, and were admitted in the emergency or outpatient departments at 14 medical centers in China between October 2017 and October 2021. The patients were randomly divided into a levosimendan group (n=129) and a control group (n=126). The primary outcome measure was NT-proBNP levels on day 3 of treatment and changes in the NT-proBNP levels from baseline on day 5 after randomization. The secondary outcome measures included the proportion of patients with more than 30% reduction in NT-proBNP levels from baseline, major adverse cardiovascular events (MACE) during hospitalization and at 6 months after hospitalization, safety during the treatment, and health economics indices. The measurement data parameters between groups were compared using the t-test or the non-parametric test. The count data parameters were compared between groups using the χ² test. Results: On day 3, the NT-proBNP levels in the levosimendan group were lower than the control group but were statistically insignificant [866 (455, 1 960) vs. 1 118 (459, 2 417) ng/L, Z=-1.25,P=0.21]. However, on day 5, changes in the NT-proBNP levels from baseline in the levosimendan group were significantly higher than the control group [67.6% (33.8%,82.5%)vs.54.8% (7.3%,77.9%), Z=-2.14, P=0.03]. There were no significant differences in the proportion of patients with more than 30% reduction in the NT-proBNP levels on day 5 between the levosimendan and the control groups [77.5% (100/129) vs. 69.0% (87/126), χ²=2.34, P=0.13]. Furthermore, incidences of MACE did not show any significant differences between the two groups during hospitalization [4.7% (6/129) vs. 7.1% (9/126), χ²=0.72, P=0.40] and at 6 months [14.7% (19/129) vs. 12.7% (16/126), χ²=0.22, P=0.64]. Four cardiac deaths were reported in the control group during hospitalization [0 (0/129) vs. 3.2% (4/126), P=0.06]. However, 6-month survival rates were comparable between the two groups (log-rank test, P=0.18). Moreover, adverse events or serious adverse events such as shock, ventricular fibrillation, and ventricular tachycardia were not reported in both the groups during levosimendan treatment (days 0-1). The total cost of hospitalization [34 591.00(15 527.46,59 324.80) vs. 37 144.65(16 066.90,63 919.00)yuan, Z=-0.26, P=0.80] and the total length of hospitalization [9 (8, 12) vs. 10 (7, 13) days, Z=0.72, P=0.72] were lower for patients in the levosimendan group compared to those in the control group, but did not show statistically significant differences. Conclusions: Early administration of levosimendan reduced NT-proBNP levels in NSTEMI patients with elevated NT-proBNP and did not increase the total cost and length of hospitalization, but did not significantly improve MACE during hospitalization or at 6 months.

Technology Roadmap for Flexible Sensors

Humans rely increasingly on sensors to address grand challenges and to improve quality of life in the era of digitalization and big data. For ubiquitous sensing, flexible sensors are developed to overcome the limitations of conventional rigid counterparts. Despite rapid advancement in bench-side research over the last decade, the market adoption of flexible sensors remains limited. To ease and to expedite their deployment, here, we identify bottlenecks hindering the maturation of flexible sensors and propose promising solutions. We first analyze challenges in achieving satisfactory sensing performance for real-world applications and then summarize issues in compatible sensor-biology interfaces, followed by brief discussions on powering and connecting sensor networks. Issues en route to commercialization and for sustainable growth of the sector are also analyzed, highlighting environmental concerns and emphasizing nontechnical issues such as business, regulatory, and ethical considerations. Additionally, we look at future intelligent flexible sensors. In proposing a comprehensive roadmap, we hope to steer research efforts towards common goals and to guide coordinated development strategies from disparate communities. Through such collaborative efforts, scientific breakthroughs can be made sooner and capitalized for the betterment of humanity.

[Research progress on the role of adipose-derived stem cell exosomes in skin scar formation]

The adipose-derived stem cell exosomes are subcellular structures of adipose stem cells. They are nano-sized membrane vesicles that can transport various cell components and act on target cells by paracrine, and they play an important role in the exchanges of substance and information between cells. Scar healing is the commonest way of healing after skin tissue injury. Pathological scar can not only cause movement dysfunction, but also lead to deformity, which affects the appearance of patients and brings life and mental pressure to the patients. In recent years, many researches have shown that the adipose-derived stem cell exosomes contain a variety of bioactive molecules, which play an important role in reducing scar formation and scar-free wound healing, by affecting the proliferation and migration of fibroblasts and the composition of extracellular matrix. This article reviewed the recent literature on the roles and mechanisms of adipose-derived stem cell exosomes in scar formation, and prospected the future application and development of adipose-derived stem cell exosomes in scar treatment.

Compound Muscle Action Potential Amplitude as a Predictor of Functional and Patient-Reported Outcomes in Ulnar Neuropathy at the Elbow

BACKGROUND

Ulnar neuropathy at the elbow (UNE) is a debilitating upper extremity condition that often leaves patients with residual symptoms even after surgical treatment. The role of electrodiagnostic studies (EDX) in guiding the treatment of UNE is not well established, and conventional electrodiagnostic parameters may not reflect the severity of disease. Compound muscle action potential (CMAP) amplitude is a parameter that corresponds with axonal injury and motor symptoms and may more accurately predict the severity of neurologic injury.

METHODS

This prospective multi-center study recruited 78 patients in the Surgery of the Ulnar Nerve (SUN) project. Patients underwent electrodiagnostic testing, clinical assessment of motor and sensory function, and completed patient-reported outcome (PRO) questionnaires, including the Michigan Hand Questionnaire (MHQ), Disability of the Arm, Shoulder and Hand (DASH) questionnaire, and Carpal Tunnel Questionnaire (CTQ). Correlations were measured among each of the electrodiagnostic parameters and outcomes and predictive models for each outcome were subsequently developed.

RESULTS

Of all the electrodiagnostic parameters measured, only CMAP amplitude was predictive of scores on the MHQ, DASH, CTQ function scale, and motor impairment in grip and pinch strength. None of the parameters were predictive of scores on the CTQ symptom scale or sensory impairments as measured with 2-point discrimination or Semmes-Weinstein monofilament testing.

CONCLUSIONS

CMAP amplitude, but not other conventional electrodiagnostic parameters, is predictive of functional outcomes in UNE. This electrodiagnostic measurement can alert the clinician to severe cases of UNE and inform surgical decision-making.

Electrodiagnostic Predictors of Outcomes After In Situ Decompression of the Ulnar Nerve

PURPOSE

Patients with severe ulnar neuropathy at the elbow frequently experience suboptimal surgical outcomes. Clinical symptoms alone may not accurately represent the severity of underlying nerve injury, calling for objective assessment tools, such as electrodiagnostic studies. The goal of our study was to determine whether specific electrodiagnostic parameters can be used to predict the outcomes after in situ decompression of the ulnar nerve.

METHODS

This prospective study enrolled consecutive patients aged ≥18 years diagnosed with ulnar neuropathy at the elbow. Patients completed a baseline battery of motor, sensory, functional, and electrodiagnostic tests before undergoing in situ decompression of the ulnar nerve. They were reassessed at 6 weeks, 3 months, 6 months, and 12 months after surgery. Forty-two patients completed at least 2 follow-up assessments and were included in the study.

RESULTS

When controlling for other electrodiagnostic measurements and demographic factors, none of the electrodiagnostic parameters were predictive of outcomes at 12 months after surgery. Patients with decreased compound muscle action potential amplitudes demonstrated slower trends of recovery in grip strength, pinch strength, and overall scores on the Michigan Hand Outcomes Questionnaire as well as its function, work, and activities of daily living subscales, Disabilities of the Arm, Shoulder, and Hand questionnaire, and the Carpal Tunnel Questionnaire. Decreased motor nerve conduction velocity was predictive of slower recovery of 2-point discrimination and pinch strength.

CONCLUSIONS

Compound muscle action potential amplitude, but not other conventional electrodiagnostic parameters, was predictive of functional outcomes after in situ decompression of the ulnar nerve. This parameter should play a role in determining the timing and prognosis of treatment for ulnar neuropathy at the elbow.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic II.

Accumulation of potentially toxic elements in Chinese tea (Camellia sinensis): Towards source apportionment and health risk assessment

Tea (Camellia sinensis) is a popular beverage that is consumed globally. However, a better understanding of potentially toxic elements (PTEs) content in tea leaves and infusion is necessary to minimize risk on human health. Therefore, 249 tea samples (grown in different areas) covering six types of tea were collected in China to investigate the PTEs contents, identify their potential source and assess the health risk associated with drinking tea. PTE contents in tea leaves across six tea types were ND-0.900 (Cd), 0.005-2.133 (As), ND-5.679 (Pb), ND-13.86 (Cr), 1.601-22.93 (Ni), ND-2.048 (Se), 0.109-622.4 (F), 13.02-269.9 (Rb), 1.845-50.88 (Sr), and 2.796-53.23 (Ba) mg/kg. The result of tea infusion showed that 14.3 %-44.1 % (green tea), 14.5 %-46.7 % (black tea), 10.5 %-25.3 % (dark tea), 13.6 %-34.2 % (oolong tea), 16.9 %-40.7 % (yellow tea), and 19.9 %-35.1 % (white tea) of F were released. All tea types, except green tea, exhibited comparatively low leachability of Cd, As, Pb and Cr in tea infusion. The source apportionment revealed that PTEs in tea leaves mainly originated from soil parental materials, while industrial activities, fertilizer application, and manufacturing processes may contribute to exogenous Se, Cd, As, and Cr accumulation. Health risk assessment indicated that F in tea infusion dominated the health risk. Humans may be exposed to a higher health risk by drinking green tea compared to that of other tea types. Nevertheless, the long-term tea consumption is less likely to contribute to pronounced non-carcinogenic and carcinogenic risks. This study confirmed that tea consumption is an important and direct pathway of PTEs uptake in humans. The health risk associated with drinking tea should be of concern.

Sex-specific metabolic risk factors and their trajectories towards the non-alcoholic fatty liver disease incidence

PURPOSE

Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease. This study examined sex-specific associations between NAFLD and metabolic factors and investigated the trajectory of risk factors.

METHODS

We retrospectively investigated 16,140 individuals from Beijing Health Management Cohort. Univariate and multivariate time-dependent Cox regression analyses were performed to identify independent risk factors for new-onset NAFLD. The trajectory of risk factors was investigated using the latent growth curve model and growth mixture model.

RESULTS

Over a median follow-up of 3.15 years, 2,450 (15.18%) participants developed NAFLD. The risk factors for NAFLD in men were increased body mass index (BMI); waist circumference (WC); triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), haemoglobin (Hb), and serum uric acid (SUA) levels; and platelet (PLT) count and decreased serum creatinine-to-body weight (sCr/bw) and high-density lipoprotein cholesterol (HDL-C) levels. In women, the risk factors were increased BMI, WC, and fasting plasma glucose (FPG), TG, LDL-C, SUA, white blood cell (WBC), and PLT and decreased sCr/bw and HDL-C levels. In addition, BMI, LDL-C, sCr/bw and PLT changing trajectories were associated with NAFLD in men; BMI, WC, TG, LDL-C, SUA and sCr/bw trends was associated with NAFLD risk in women.

CONCLUSIONS

Development of NAFLD is associated with BMI, LDL-C, sCr/bw and PLT changing trajectories in men; BMI, WC, TG, LDL-C, SUA and sCr/bw trends are associated an increased risk of NAFLD in women. Deterioration of metabolic risk factors status can be a predictor of NAFLD many years before its occurrence.

The combined impacts of selenium and phosphorus on the fate of arsenic in rice seedlings (Oryza sativa L.)

Although the single role of selenium (Se) or phosphorus (P) in regulating the As contamination of rice plants has been reported in some studies, the combined impacts of Se and P on the fate of As and the underlying mechanisms are poorly understood. To address this knowledge gap, the uptake, translocation, and biotransformation of As mediated by Se were investigated in rice (Oryza sativa L.) seedlings hydroponically cultured with P-normal and P-deficient conditions. The results showed Se addition stimulated the uptake of arsenite and arsenate by 15.6% and 30.7%, respectively in P-normal condition, and such effect was more profound in P-deficient condition with the value of 43.8% and 70.8%. However, regardless of Se addition, P-deficiency elevated the As uptake by 47.0%-92.1% for arsenate but had no obvious effects for arsenite. Accompanying with the As transfer factor_Shoot/Root reduced by 74.5%-80.2% and 71.1%-85.7%, Se addition decreased the shoot As content by 65.8%-69.7% and 59.6%-73.1%, respectively, in the arsenite- and arsenate-treated rice plants. Relative to the corresponding treatments of P-normal condition, P-deficiency reduced the As transfer factor_Shoot/Root by 38.9%-52.5% and thus decreasing the shoot As content by 35.2%-42.5% in the arsenite-treated plants; while the opposite impacts were observed in the arsenate-treated plants, in which the shoot As content was increased by 22.4%-83.7%. The analysis results of As species showed As(III) was dominant in both shoots (68.9%-75.1%) and roots (94.9%-97.2%), and neither Se addition nor P-deficiency had obvious impacts on the interconversion between As(III) and As(V). Our results demonstrate the regulating roles of Se in As accumulation mainly depend on P regimes and the specific rice tissues, but the effects of P-deficiency on the fate of As were influenced by the form of As added to the culture.

Selenite and selenate showed contrasting impacts on the fate of arsenic in rice (Oryza sativa L.) regardless of the formation of iron plaque

The different effects of selenite and selenate on the fate of As and the function of iron plaque in the interaction between Se and As are poorly understood. Rice seedlings (Oryza sativa L.) were selected as experimental plants in this study, the hydroponic experiments were conducted to investigate the possible regulatory roles of selenite and selenate on the uptake, translocation, and transformation of arsenite or arsenate accompanied by iron plaque. In arsenite- and arsenate-treated rice, the Fe30 treatments stimulated root uptake by 12.4-39.8% and 18.6-37.0%, respectively, but inhibited the movement of As from iron plaque to the roots, resulting in the absorption of a considerable amount of As on iron plaque. Regardless of the iron plaque formation, selenite (selenate) significantly increased (decreased) the root uptake of arsenite and arsenate by 28.1-53.0% and 40.0%-61.7%, respectively (45.6-56.3% and 42.5-47.7%, respectively). Interestingly, the supply of selenite significantly reduced root-to-shoot As translocation by 71.9-77.3% and 66.2-67.7%, respectively, in arsenite- and arsenate-treated rice seedlings; however, a significant increase (90.5-122.9%) was induced by selenate was found only in the arsenate-treated plants. Furthermore, the translocation of As from iron plaque to the roots was significantly increased (decreased) by selenite (selenate). As and Fe in iron plaque were significantly positively correlated in all As-treated rice plants, and this correlation was more profound than that in the shoots and roots. However, neither Fe treatments nor inorganic Se addition affected the interconversion between As(III) and As(V) obviously; and As(III) was the dominant species in both shoots (68.3-84.9%) and roots (90.7-98.2%). Our results indicate selenite and selenate are effective in reducing the As accumulation in an opposite way, and the presence of iron plaque had no obvious impact on the interaction between Se and As in rice plants.

Screen-based sedentary behaviors but not total sedentary time are associated with anxiety among college students

Objective

The purpose of the study was to investigate the associations of device-measured total sedentary time and screen-based sedentary time with anxiety in college students.

Methods

Three hundred and twenty-one college students (mean age = 19.72 ± 1.18, 55.8% females) were recruited from Shanghai, China. Total sedentary time was objectively measured using accelerometry, while screen-based sedentary time was self-reported. Anxiety symptom was evaluated using the Self-Rating Anxiety Scale. Linear regression modeling was used to assess the associations of total sedentary time and screen-based sedentary time with anxiety symptom.

Results

Accelerometer-assessed total sedentary time was not associated with anxiety symptom. Prolonged sedentary time on TV and movie viewing (>2 h on weekdays) and social media using (>2 h on weekdays and weekend) were associated with a higher level of anxiety. However, time on video gaming and recreational reading was not associated with anxiety symptom.

Conclusion

The findings indicated that screen-based sedentary behaviors but not total sedentary time were associated with anxiety symptom among college students. The associations of screen-based sedentary behaviors with anxiety symptom varied by the types of screen time.

[A retrospective controlled study on the treatment effect of distraction osteogenesis and maxillomandibular advancement for severe obstructive sleep apnea hypopnea syndrome patients]

Objective: To compare the treatment effect of distraction osteogenesis (DO) and maxillomandibular advancement (MMA) for severe obstructive sleep apnea hypopnea syndrome (OSAHS) patients and to guide clinical decisions about treatment of OSAHS. Methods: Thirty-seven OSAHS patients which accepted maxillomandibular advancement (MMA) or distraction osteogenesis (DO) in Stomatological Hospital of the Department of Maxillofacial Trauma and Orthognathic Surgery, School of Stomatology, The Forth Military Medical University from June 2017 to June 2019 were collected. Their preoperative and postoperative data of cephalometry, polysomnography (PSG), Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale (ESS) scores were collected and analyzed. With propensity score matching method, the treatment effect of MMA and DO was analyzed and compared. Results: According to the statistics of MMA group, only AHI was correlated with operative successful rate and cure rate. With the increase of AHI, the treatment effect of MMA on OSAHS patients gradually decreased. The cut-off point of AHI as a predictor of MMA treatment failure was 78.2 n/h. All the matched cases were severe OSAHS patients. Statistical analysis showed that the mandibular elongation of DO patients[(24.00±4.39) mm] was significantly more than that of MMA group [(11.20±1.37) mm] (t=-6.11, P<0.001), the improvement of PSG index [including lowest oxygen saturation (LSpO₂), longest apnea (LA) and longest hypopnea (LH)] in DO group [LSpO₂=(93.40±1.82)%; LA=(18.28±8.32) s; LH=(61.84±32.94) s] was significantly higher than that in the MMA group [LSpO₂=(86.00±4.06)%, LA=(64.08±21.78) s, LH=(172.40±30.70) s](t=-3.72, P=0.005; t=4.39, P=0.003; t=5.49, P=0.004). The PSQI and the ESS scores of DO group (PSQI=4.20±0.83; ESS=3.40±1.52) were also significantly better than that of MMA group (PSQI=8.80±2.39, ESS=9.40±2.88)(t=4.07, P=0.001; t=4.12, P=0.002). Conclusions: For severe OSAHS patients, the objective and subjective indicators of DO treatment group showed a better therapeutic effect than that of MMA.

Association Between Daytime vs Overnight Digit Replantation and Surgical Outcomes

IMPORTANCE

Recent evidence suggests that select delayed replantation may not adversely affect digit survival; however, whether surgical timing (overnight or daytime) is associated with digit replantation outcomes is unknown.

OBJECTIVE

To assess whether digit survival, complication rate, and duration of surgery are associated with time of replantation.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective case series study included all replantations performed at a single tertiary referral academic center between January 1, 2000, and August 1, 2021. Data were analyzed between October 2, 2021, and January 1, 2022. Four daytime surgery intervals were selected based on literature review. Daytime replantations started within the intervals whereas overnight replantations began outside the intervals. For each case, the procedure difficulty score and the attending surgeon expertise score were calculated. Logistic and linear regressions adjusting for confounders including procedure difficulty score and expertise score were used to assess surgical timing and outcomes. Participants were adults (aged ≥18 years) undergoing digit replantations between January 2000 and August 2021 with at least 1-month follow-up. Replantation was defined as the reattachment of a completely amputated digit that necessitated anastomosis of both artery and vein.

EXPOSURES

Daytime or overnight digit replantation.

MAIN OUTCOMES AND MEASURES

Viable replanted digit at 1-month follow-up, number of complications, and duration of surgery.

RESULTS

A total of 98 patients (mean [SD] age, 39.5 [15.3] years; 136 [93%] men) and 147 digits met inclusion criteria. Overall success rate was 55%. Between 4 pm and 7 am, overnight replantations were associated with 0.4 fewer complications (β, -0.4; 95% CI, -0.8 to -0.1) and 90.7 minutes shorter operative time (β, -90.7; 95% CI, -173.6 to -7.7). A 1-point increase in surgeon expertise score was associated with 1.7 times increased odds of replantation success for all intervals (adjusted odds ratio, 1.7; 95% CI, 1.2 to 2.4; P = .002). There were no differences in digit survival by surgical time.

CONCLUSIONS AND RELEVANCE

In this case series study of digit replantations, time of operation was not associated with replantation success. Overnight replantation was associated with fewer complications and shorter duration of surgery compared with daytime surgery. Results of this study suggest that overnight replantations may be performed with outcomes comparable to daytime replantations at a tertiary care academic center.

[Prognosis of adenoid cystic carcinoma of head and neck and risk factors for lung metastasis]

Objective: To analyze the prognosis and risk factors of lung metastasis of patients with adenoid cystic carcinoma(ACC) of head and neck. Methods: A retrospective study was conducted. The data of 157 patients with ACC of head and neck treated in Beijing Tongren Hospital, Capital Medical University from January 2014 to October 2020 were collected, including 72 males and 85 females, with onset age between 14 and 72 years old. According to whether lung metastasis occurred, the patients were divided into lung metastasis group (88 cases) and non-pulmonary metastasis group (69 cases). Kaplan-Meier method was used to calculate the overall survival rate and progression-free survival rate using SPSS 26.0 software. Log-rank test was used to evaluate statistically relevant clinicopathological factors. Cox proportional risk model was used in multivariate analysis for the factors affecting the lung metastasis-free survival using R Studio 1.2.5042. Results: The 3-year and 5-year overall survival rates were 91.5% and 85.2%, respectively. The 3-year and 5-year progression-free survival rates were 57.7% and 34.3%, respectively. Univariate analysis showed that primary site, histological grade, high-grade transformation, Ki-67, T stage, and lymph node status were the risk factors for lung metastasis (χ²=11.78, 10.41, 4.06, 4.71, 5.37, 16.20, respectively, all P<0.05). Multivariate analysis showed independent risk factors for lung metastasis, including submandibular gland and sublingual gland (HR=3.53, 95%CI: 1.19-10.46, P<0.05), T3-4 stage (HR=3.09, 95%CI: 1.54-6.23, P<0.05), and Grade Ⅱ-Ⅲ grade (HR=2.47, 95%CI: 1.26-4.86,P<0.05). Conclusion: Distant metastasis, mainly pulmonary metastasis, affects the long-term prognosis of patients with ACC significantly. Primary site, T stage and histopathological grade can be used as the predictors for the risk of lung metastasis.

Bilirubin oxidation end product B prevents CoCl2-induced primary cortical neuron apoptosis by promoting cell survival Akt/mTOR/p70S6K signaling pathway

Bilirubin oxidation end products (BOXes) are associated with the late-developing neurological deficits after subarachnoid hemorrhage (SAH) possibly by direct constricting the cerebral arteries, but their specific impacts on neurons especially in the state of hypoxia, a prominent feature during the late stage of SAH, remain unclear. Here, we explored the effects of BOXes on the primary cortical neurons subjected to CoCl₂-induced hypoxia by evaluating the morphological and apoptotic changes of neurons. The present study showed that Z-BOX B but not Z-BOX A greatly alleviated CoCl₂-induced neuronal cell deterioration and apoptosis. Immunocytochemical staining assay showed Z-BOX B significantly increased neurite length, the numbers of both secondary and tertiary branches, and the protein level of Synaptophysin. Caspase 3/7 apoptosis assay and DAPI staining showed that Z-BOX B markedly reduced primary cortical neurons apoptosis. The expression of cleaved Caspase-3 was suppressed by Z-BOX B treatment, while the expression of Bcl-xL was upregulated. To further discover the mechanism of the neuroprotective effect observed in Z-BOX B, we found Z-BOX B increased the expression of p-mTOR, p-Akt, and p-p70S6K. In general, our results implicated Z-BOX B may prevent CoCl₂-induced primary cortical neurons apoptosis by activating sAkt/mTOR/p70S6K signaling pathway. Hence, the present data may provide new insights into the pathophysiological mechanism of delayed neurological dysfunction after SAH and novel targets for treating SAH.

Template-Sacrificing Synthesis of Well-Defined Asymmetrically Coordinated Single-Atom Catalysts for Highly Efficient CO2 Electrocatalytic Reduction

Although various single-atom catalysts have been designed, atomically engineering their coordination environment remains a great challenge. Herein, a one-pot template-sacrificing pyrolysis approach is developed to synthesize well-defined Ni-N₄-O catalytic sites on highly porous graphitic carbon for electrocatalytic CO₂ reduction to CO with high Faradaic efficiency (maximum of 97.2%) in a wide potential window (-0.56 to -1.06 V vs RHE) and with high stability. In-depth experimental and theoretical studies reveal that the axial Ni-O coordination introduces asymmetry to the catalytic center, leading to lower Gibbs free energy for the rate-limiting step, strengthened binding with *COOH, and a weaker association with *CO. The present results demonstrate the successful atomic-level coordination environment engineering of high-surface-area porous graphitic carbon-supported Ni single-atom catalysts (SACs), and the demonstrated method can be applied to synthesize an array of SACs (metal-N₄-O) for various catalysis applications.

Uptake and translocation mechanisms of different forms of organic selenium in rice (Oryza sativa L.)

Selenium (Se) is an essential trace element for human and animal health, and toward an understanding of the uptake and translocation of Se in plants is important from the perspective of Se biofortification. In this study, we conducted hydroponic experiments to investigate the mechanisms of organic Se [selenomethionine (SeMet) and selenomethionine-oxide (SeOMet)] uptake, translocation, and the interactions between SeMet and SeOMet in rice. We also investigated differences in the dynamics of organic and inorganic Se uptake by rice roots. Concentration-dependent kinetic results revealed that SeMet uptake during a 1 h exposure was 3.19-16.0 times higher than that of three other Se chemical forms, with uptake capacity (V_max ) values ordered as follows: SeMet>SeOMet>selenite>selenate. Furthermore, time-dependent kinetic analysis revealed that SeMet uptake by roots and content in shoots were initially clearly higher than those of SeOMet, although the differences gradually diminished with prolonged exposure time; while no significant difference was found in the transfer factor of Se from rice roots to shoots between SeMet and SeOMet. Root uptake of SeOMet was significantly inhibited by carbonyl cyanide 3-chlorophenylhydrazone (CCCP) (30.4%), AgNO₃ (41.8%), and tetraethylammonium chloride (TEACl) (45.6%), indicating that SeOMet uptake is a metabolically active process, and that it could be mediated via aquaporins and K⁺ channels. Contrarily, SeMet uptake was insensitive to CCCP, although markedly inhibited by AgNO₃ (93.1%), indicating that rice absorbs SeMet primarily via aquaporins. Furthermore, Se uptake and translocation in rice treated simultaneously with both SeMet and SeOMet were considerably lower than those in rice treated with SeMet treatment alone and notably lower than the theoretical quantity, indicating interactions between SeMet and SeOMet. Our findings provide important insights into the mechanisms underlying the uptake and translocation of organic Se within plants.

Comparative responses of cadmium accumulation and subcellular distribution in wheat and rice supplied with selenite or selenate

Cadmium (Cd) contamination of crop plants has aroused a worldwide concern because of the threats posed to human health through accumulation in the food chains. Selenium (Se) can alleviate the Cd-induced phytotoxicity, but the relevant underlying mechanisms are not fully understood. Therefore, with wheat (Triticum aestivum L.) and rice (Oryza sativa L.) chosen as the target plants in this study, the effects of selenite or selenate on Cd accumulation and subcellular distribution were investigated through greenhouse hydroponic experiments; and simultaneously, the effects of pre-Se treatment with selenite or selenate on Cd accumulation and root-to-shoot translocation in the studied plants were also included. Results showed the addition of Se slightly changed the Cd content in plant roots in a time-dependent manner; however, with the obvious decreasing trend on the Cd transfer factor (TF), its content in plant shoots was significantly reduced by selenite or selenate in a plant species-dependent manner. At 48 h of exposure, the supplementation of selenite and selenate significantly decreased the Cd content by 40.4% and 38.0% in wheat shoots, and by 72.2% and 40.9% in rice shoots, respectively. Additionally, the order of Cd proportion distributed to the different subcellular fractions of plant tissues was as follows: cell wall > soluble cytosol > organelle, irrespective of the Se treatments or the plant species. However, selenate increased the Cd percentage in soluble cytosol of wheat shoots, while selenite increased that percentage in the cell wall of rice shoots; and the Cd proportion in soluble cytosol of the studied plant roots was significantly enhanced owing to selenite or selenate addition. Moreover, similar to the co-application, the pre-Se treatment with inorganic Se also reduced the Cd accumulation and translocation both in wheat and rice. Our results proved that the inorganic Se could decline the Cd accumulation and translocation in the crop plants, although selenite was found more effective than selenate regarding such effects.

MicroRNA-198 inhibits metastasis of thyroid cancer by targeting H3F3A

OBJECTIVE

This study was designed to investigate the role of microRNA-198 in thyroid cancer (TCa) progression.

PATIENTS AND METHODS

Quantitative real-time polymerase chain reaction (qRT-PCR) was carried out to examine microRNA-198 and H3F3A levels in tumor tissue specimens and paracancerous ones collected from 50 patients with TCa, and the interplay between microRNA-198 or H3F3A and some clinical indicators or prognosis of TCa patients was analyzed as well. MicroRNA-198 and H3F3A overexpression models were constructed using lentivirus in TCa cell lines TPC-1 and BHP2-7, and the impacts of microRNA-198 on TCa cell functions were evaluated by using cell counting kit-8 (CCK-8), plate clone formation, and transwell assays. Finally, recovery investigations were conducted to explore the underlying mechanisms as well as the interaction between microRNA-198 and H3F3A.

RESULTS

QRT-PCR indicated that in tumor tissues of TCa patients, microRNA-198 showed a remarkably lower expression than in adjacent normal tissue samples. Compared with patients with high expression of microRNA-198, those with microRNA-198 low expression had more advanced tumor stage, larger tumor size, higher lymph node metastasis rate, and lower overall survival rate. Meanwhile, the results of research on H3F3A were just opposite to the above observations on microRNA-198. In in vitro cell experiments, overexpression of microRNA-198 significantly weakened the proliferation and migration ability of thyroid tumor cells. Besides, Luciferase reporter gene experiment revealed that H3F3A was a specific target gene for microRNA-198. Moreover, qRT-PCR indicated that H3F3A and microRNA-198 were negatively correlated in thyroid carcinoma tissues. In addition, compared with NC group, overexpression of H3F3A markedly enhanced the migration and proliferative capacity of TCa cells. Lastly, recovery experiment revealed a mutual regulation between microRNA-198 and H3F3A, the two of which may together participate in the malignant progression of TCa.

CONCLUSIONS

MicroRNA-198 is remarkably reduced in TCa and inhibits malignant progression of TCa by regulating H3F3A. Meanwhile, microRNA-198 is remarkably associated with pathological stage, tumor size, lymph node metastasis, and poor prognosis of TCa.

[Expert consensus on the treatment of oral and maxillofacial space infections]

Oral and maxillofacial space infections (OMSI) are common diseases of the facial region involving fascial spaces. Recently, OMSI shows trends of multi drug-resistance, severe symptoms, and increased mortality. OMSI treatment principles need to be updated to improve the cure rate. Based on the clinical experiences of Chinese experts and with the incorporation of international counterparts' expertise, the principles of preoperative checklist, interpretation of examination results, empirical medication principles, surgical treatment principles, postoperative drainage principles, prevention strategies of wisdom teeth pericoronitis-related OMSI, blood glucose management, physiotherapy principles, Ludwig's angina treatment and perioperative care were systematically summarized and an expert consensus on the diagnosis and treatment of OMSI was reached. The consensus aims to provide criteria for the diagnosis and treatment of OMSI in China so as to improve the level of OMSI treatment.

Evaluation of the diagnostic performance of the creatinine-based Chronic Kidney Disease Epidemiology Collaboration equation in people with diabetes: A systematic review

AIMS

GFR estimated with the creatinine-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI_Cr ) equation is used to screen for diabetic kidney disease and assess its severity. We systematically reviewed the process and outcome of evaluating CKD-EPI_Cr in estimating point GFR or GFR decline over time in adults with type 1 or type 2 diabetes.

METHODS

In this systematic review, MEDLINE, Embase and Cochrane Central Register of Controlled Trials were searched up to August 2019. Observational studies comparing CKD-EPI_Cr with measured GFR (mGFR) in adults with diabetes were included. Studies on people with kidney transplant, non-diabetes related kidney disease, pregnancy, potential kidney donors, and those with critical or other systematic illnesses were excluded. Two independent reviewers extracted data from published papers and disagreements were resolved by consensus. Risk-of-bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. (PROSPERO registration number: CRD42018108776).

RESULTS

From the 2820 records identified, 29 studies (14 704 participants) were included. All studies were at risk of bias. Bias (eight different forms) ranged from -26 to 35 ml min^-1  1.73 m^-2 ; precision (five different forms) ranged between 9 and 63 ml min^-1  1.73 m^-2 ; accuracy (five different forms) ranged between 16% and 96%; the correlation coefficient between CKD-EPI_Cr and mGFR (four different forms) ranged between 0.38 and 0.86; and the reduced major axis regression slope ranged between 0.8 and 1.8.

CONCLUSIONS

Qualitative synthesis of data suggested CKD-EPI_Cr was inaccurate in estimating point GFR or GFR decline over time. Furthermore, a lack of consistency in the methods and processes of evaluating the diagnostic performance of CKD-EPI_Cr limits reliable quantitative assessment. The equation needs to be improved in adults with diabetes.

[Correlation between thyroid function and glucolipid metabolism in type 1 diabetic adults]

To assess the correlation between thyroid function and glucolipid metabolism in type 1 diabetic adults. A retrospective analysis was conducted in 230 type 1 diabetic adults who were hospitalized in the Department of Endocrinology of Shandong Provincial Hospital Affiliated to Shandong University from January 2008 to January 2020. It showed that thyroid stimulating hormone(TSH) was significantly positively correlated with total cholesterol (TC) (r=0.239), triglycerides (TG) (r=0.166) and low-density lipoprotein cholesterol (LDL-C) (r=0.249), respectively (all P<0.05). Free triiodothyronine (FT₃) was significantly negatively correlated with fasting plasma glucose (FPG) (r=-0.272), glycated hemoglobin (HbA1c) (r=-0.240), TC (r=-0.197) and LDL-C (r=-0.220), respectively (all P<0.05). Free thyroxine (FT₄) was negatively correlated with TC (r=-0.171) and LDL-C (r=-0.170), respectively (all P<0.05). TC was an independent predictor of TSH, FT₃ and FT₄, FT₃ and FT₄ were independent predictors of HbA1c. TSH was an independent predictor of TC, TG and LDL-C. Thyroid function is closely related to glucolipid metabolism in type 1 diabetic adults.

[Occurrence and related factors of preterm birth in Guangxi Zhuang Autonomous Region during 2017-2019]

Objective: To investigate the incidence of preterm birth in Guangxi Zhuang Autonomous Region and explore the related factors and their combined effects. Methods: The study subjects were women giving birth to live babies at the monitoring points of critical maternal hospital monitoring system in Guangxi Zhuang Autonomous Region from January 1, 2017 to December 31, 2019. The data of general characteristics (age and marital status), pregnancies (parity, number of previous cesarean delivery, the number of prenatal check and number of fetuses in this pregnancy) and disease conditions (placenta previa, placental abruption, hypertension, diabetes, anemia, and heart disease) were collected, and the incidence of preterm birth were calculated according to the definition of preterm birth set by WHO and China, respectively. Logistic regression model was used to explore the factors associated with premature birth and their combined effects. Results: According to definitions of WHO and China, the cumulative incidence of preterm birth in Guangxi from 2017 to 2019 was 7.45% (16 819/225 727) and 7.34% (16 559/225 727), respectively. Advanced age [≤34 years old as reference, OR (95%CI) of 35-39 and ≥40 years old were 1.36 (1.30-1.42) and 1.61 (1.50-1.74), respectively], unmarried (including divorced or widowed) [OR (95%CI): 1.28 (1.17-1.40)], primiparae [OR (95%CI): 1.34 (1.29-1.40)], previous cesarean section [no previous cesarean section as reference, OR (95%CI) of 1 and ≥2 times of previous cesarean section were 1.30 (1.24-1.36) and 1.85 (1.65-2.08), respectively], antenatal examination<8 [OR (95%CI): 2.72 (2.62-2.81)], multiple pregnancies [OR (95%CI): 15.00 (14.01-16.06)], placenta previa [OR (95%CI): 6.90 (6.35-7.50)], placental abruption [OR (95%CI): 8.18 (7.36-9.10)], gestational hypertension [OR (95%CI): 2.29 (2.17-2.42)], gestational diabetes mellitus [OR (95%CI): 1.43 (1.37-1.49)], anemia [OR (95%CI): 1.10 (1.07-1.14)], and heart diseases [OR (95%CI): 2.98(2.43-3.65)] were all positively correlated with preterm birth. The risk of preterm birth in pregnant women exposed to 1, 2, 3, 4, 5, 6 and ≥7 preterm birth related factors was 1.51, 2.29, 4.49, 9.69, 20.87, 46.88 and 192.11 times that of non-exposed women, respectively (all P values<0.001). Conclusion: Preterm birth is associated with maternal general characteristics, pregnancy and disease status, and the combined effect of preterm birth related factors significantly increases the risk of preterm birth.

[Clinical study of yiqi huoxue recipe in the treatment of liver fibrosis of chronic viral hepatitis]

Objective: To clarify the clinical efficacy of Yiqi Huoxue recipe in the treatment of liver fibrosis of chronic viral hepatitis. Methods: An open, positive-drug, parallel-controlled study method was applied. A total of 207 cases of liver fibrosis with chronic hepatitis B and C diagnosed with liver biopsy and transient elastography were selected. According to the principle of syndrome differentiation in traditional Chinese medicine, self-made Yiqi Huoxue recipe (n = 127) and Fuzheng Huayu capsule (n = 80) were used for the treatment course of 24-48 weeks. Change score of TCM symptom, liver biochemistry, liver stiffness measurement (LSM), and noninvasive liver fibrosis index [aspartate transaminase to platelet ratio index (APRI), and fibrosis-4 score (FIB-4)] were compared between the two groups to evaluate the therapeutic effect of Yiqi Huoxue recipe on liver fibrosis. Results: Yiqi Huoxue recipe group and Fuzheng Huayu capsule group baseline LSM, APRI and FIB-4 was compared, and there was no statistically significant difference between them (P > 0.05). Yiqi Huoxue recipe and Fuzheng Huayu capsule received patients had improved symptom scores to a certain extent. Hepatic facies, discomfort over liver area, and soreness and weakness of waist and knees (P < 0.05) was significantly improved in Yiqi Huoxue recipe than Fuzheng Huayu capsule. Liver biochemical indicators (ALT, AST, GGT, ALP) had gradually relapsed with the extension of treatment duration and the normalization rate between the two groups after 24 to 48 weeks had reached 100% vs. 100%, 100% vs. 93.8%, 96.8% vs. 92.3% and 87.5% vs. 81.8%. After 12 weeks of treatment, APRI values ​​of both groups had significantly reduced, and after 48 weeks of treatment, LSM values of both groups had significantly improved. Moreover, Yiqi Huoxue recipe FIB-4 score was significantly improved after 48 weeks of treatment, and the difference was statistically significant compared to Fuzheng Huayu capsule group (P < 0.05). After treatment, LSM, APRI, and FIB-4 total effectiveness in the two groups were 80.0% vs. 63.6%, P = 0.046; 68.4% vs. 52.0%, P = 0.052; 68.4% vs. 62.0%, P = 0.437, respectively. LSM total effectiveness was significantly higher in Yiqi Huoxue recipe treated group than Fuzheng Huayu capsule group. Conclusion: Traditional Chinese medicine Yiqi Huoxue decoction can be used as an optimal treatment for liver fibrosis of chronic viral hepatitis.

iTRAQ-based quantitative proteomics analysis reveals inhibitory mechanismsof the antimicrobial peptide MDAP-2 against Salmonella gallinarum

MDAP-2 is a new AMP with high inhibitory activity on Salmonella gallinarum, which may be developed as an antimicrobial agent in the agricultural industry and food preservation. To investigate the underlying the action mechanism of MDAP-2 on Salmonella gallinarum, impacts of MDAP-2 on the growth curve and bacterial morphology of Salmonella gallinarum were studied. iTRAQ-based proteomics analysis was also performed on proteins extracted from treated and untreated Salmonella gallinarum cells. The differentially expressed proteins were then analyzed using the KEGG and GO databases. Finally, the function of some differentially expressed proteins was verified. The results showed that 150 proteins (41 up-regulated and 109 down-regulated) were found differentially expressed (fold > 1.8, p⟨0.05). The results indi- cate that MDAP-2 kills Salmonella gallinarum mainly through two mechanisms: (i) direct inhibi- tion of cell wall/ membrane/ envelope biogenesis, energy production/ conversion, carbohydrate transport/ metabolism, and DNA transcription/ translation through regulation of special protein levels; (ii) indirect effects on the same pathway through the accumulation of Reactive oxygen species (O2 ▪-, H2O2 and OH▪-).

Growth retardation-responsive analysis of mRNAs and long noncoding RNAs in the liver tissue of Leiqiong cattle

As an important type of non-coding RNA molecule, long non-coding RNAs (lncRNAs) have varied roles in many biological processes, and have been studied extensively over the past few years. However, little is known about lncRNA-mediated regulation during cattle growth and development. Therefore, in the present study, RNA sequencing was used to determine the expression level of mRNAs and lncRNAs in the liver of adult Leiqiong cattle under the condition of growth retardation and normal growth. We totally detected 1,124 and 24 differentially expressed mRNAs and lncRNAs, respectively. The differentially expressed mRNAs were mainly associated with growth factor binding, protein K63-linked ubiquitination and cellular protein metabolic process; additionally, they were significantly enriched in the growth and development related pathways, including PPAR signaling pathway, vitamin B6 metabolism, glyoxylate and dicarboxylate metabolism. Combined analysis showed that the co-located differentially expressed lncRNA Lnc_002583 might positively influence the expression of the corresponding genes IFI44 and IFI44L, exerting co-regulative effects on Leiqiong cattle growth and development. Thus, we made the hypothesis that Lnc_002583, IFI44 and IFI44L might function synergistically to regulate the growth of Leiqiong cattle. This study provides a catalog of Leiqiong cattle liver mRNAs and lncRNAs, and will contribute to a better understanding of the molecular mechanism underlying growth regulataion.

Altered exosomal miR-181d and miR-30a related to the pathogenesis of CVB3 induced myocarditis by targeting SOCS3

OBJECTIVE

MicroRNAs are a group of gene expression regulators and some of which have been confirmed to be associated with acute viral myocarditis (VM). This study aims to find new biomarkers for VM diagnosis and explore the roles of miRNAs during the pathogenesis of VM.

PATIENTS AND METHODS

23 patients with acute myocarditis and 12 controls were included in this research. The expression of 10 candidate miRNAs in the serum exosome was examined by qRT-PCR. The direct targets were predicted using bioinformatics tools and then confirmed by dual luciferase assay and immunoblotting. Levels IL-6 of cell culture supernatants were determined by enzyme-linked immunosorbent assay. Six weeks old male mice were injected intraperitoneally with Coxsackievirus B3 (CVB3) and then treated by miRNA inhibitors through tail vein injection.

RESULTS

Five miRNAs were found to have disturbed expression in the exosome and may have the potential to be used as biomarker for VM diagnosis. Meanwhile, the expression of miR-30a and -181d was also altered in the cells after CVB3 infection. We identified SOCS3 as a direct target of miR-30a and -181d. Furthermore, during CVB3 infection, up-regulated miR-30a and -181d are related to enhanced IL-6 level via modulating SOCS3 expression. miRNA inhibitors injection increased mice survival rate after CVB3 infection.

CONCLUSIONS

miR-30a and -181d contribute to the over-activated inflammatory response to viral infection of the heart during coxsackievirus infection.

Novel homozygous nonsense mutations in LHCGR lead to empty follicle syndrome and 46, XY disorder of sex development

Empty follicle syndrome (EFS) is a disorder associated with female infertility and presents as a complete failure to retrieve oocytes during ART cycles despite normal follicle development and careful aspiration. To date, only two EFS cases have been reported with homozygous missense mutations in the luteinizing hormone/chorionic gonadotropin receptor (LHCGR) gene, and both cases showed normal estradiol (E2) production during ovulation induction. The molecular genetic mechanisms of EFS remain unknown. Herein, we report two novel homozygous inactivating LHCGR mutations, c.736 C>T (p.Q246*) and c.846dupT (p.R283*), in two female EFS patients from unrelated consanguineous families. The probands had impaired E2 production during the ART process, which differs from previously reported EFS cases. The inactivating mutations not only led to EFS in the two female probands, but also resulted in 46, XY disorder of sex development (46, XY DSD) in their male siblings. As far as we know, this is the first report of LHCGR mutations leading to both EFS and 46, XY DSD within the same pedigree. Our findings provide researchers and clinicians with a better understanding of phenotype-genotype correlations between EFS and 46, XY DSD and the LHCGR gene.

An ensemble method for multi-type Gram-negative bacterial secreted protein prediction by integrating different PSSM-based features

In Gram-negative bacteria, a wide range of proteins are secreted by highly specialized secretion systems. These secreted proteins play essential roles in the response of bacteria to their environment and also in several physiological processes such as adhesion, pathogenicity, adaptation and survival. Therefore, identifying secreted proteins in Gram-negative bacteria may assist in understanding the secretion mechanism and development of new antimicrobial strategies. Considering that a single-feature model is less likely to comprehensively cover this information, three kinds of feature models were used in this paper to represent protein samples by composition analysis, correlation analysis and smoothing encoding method on position-specific scoring matrix profiles. A support vector machine-based ensemble method with these hybrid features was developed to predict multi-type Gram-negative bacterial secreted proteins. Finally, our method achieves overall accuracies of 97.09% and 96.51% using an independent dataset test and jackknife test on a public test dataset, which are 3.49% and 2.32% higher, respectively, than results obtained by other methods. These results show the effectiveness and stability of the proposed ensemble method. It is anticipated that our method will provide useful information for further research on bacterial secreted proteins and secreted systems.

Structural optimization and additional targets identification of antisense oligonucleotide G3139 encapsulated in a neutral cytidinyl-lipid combined with a cationic lipid in vitro and in vivo

Antisense oligonucleotides (ASOs) usually contain a fully phosphorothioate (PS) backbone, which possibly interact with many genes and proteins under intracellular conditions. G3139 is an ASO that targets Bcl-2 mRNA and induces cell apoptosis. Here, we report a kind of cytidinyl-lipid combined with a cationic lipid (DNCA/CLD, molar ration, 28:3, named mix), which may interact with oligonucleotides via H-bond formation, pi-stacking and electrostatic interaction, accompanied by low zeta potentials. The IC₅₀ value of G3139 delivered by mix-lipid reduced from above 20 μM to 0.158 μM for MCF-7/ADR, and exhibited stronger antiproliferation upon other cancer cell lines. In addition, PS modification in the 3'-half of G3139 (especially at positions 13-16) enhanced serum stability, target specificity and anticancer activity. Also, a locked nucleic acid (LNA) gapmer G3139 (LNA-G3139) showed superior antiproliferation (78.5%) and Bcl-2 mRNA suppression effects (85.5%) at 200 nM, mainly due to its high complementary RNA affinity. More apoptosis-associated targets were identified, and a lower level of non-specific protein binding (HSA) revealed that both antisense and aptamer mechanisms might simultaneously exist. A combination of a new delivery system and chemical modifications, such as in LNA-G3139, may have potential clinical application prospects in the future.