Metabolic disparities between obese and non-obese patients with polycystic ovary syndrome: implications for endometrial receptivity indicators

OBJECTIVE

To investigate the differences in the metabolic indicators and sex hormones between obese and non-obese patients with polycystic ovary syndrome (PCOS), and their impacts on endometrial receptivity (ER).

METHODS

We selected 255 individuals with PCOS, and categorized them into the obese groups, including the OP group (obese patients with PCOS) and the ON group (obese patients without PCOS), and selected 64 individuals who were categorized in the non-obese groups, namely, the control groups, which comprise the NP group (non-obese patients with PCOS) and the NN group(non-obese patients without PCOS). The one-way analysis of variance (ANOVA) and Mann-Whitney U tests were used to compare the metabolic indicators, and sex hormone-associated and ER-associated indicators between the groups. The correlation between the aforementioned clinical markers and ER was analyzed using the Pearson's correlation coefficient.

RESULTS

(1) In comparison with the NP group, the OP group exhibited higher levels (p < .01) of free androgen index (FAI), anti-müllerian hormone (AMH), fasting insulin (FINS), insulin level within 60 min, 120 min, and 180 min-60minINS, 120minINS, and 180minINS, respectively, fasting blood glucose (FBG), blood glucose level within two hours (2hGlu), homeostatic model assessment for insulin resistance (HOMA-IR), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), waist-to-hip ratio (WHR), waist circumference, hip circumference, the ratio of the maximum blood flow velocity of the uterine artery during systole to the blood flow velocity of the uterine artery at the end of diastole (uterine artery S/D), and blood flow resistance index (RI) of the uterine artery. In comparison with the NP group, the OP group exhibited lower levels (p < .01) of sex hormone binding globulin (SHBG), dehydroepiandrosterone (DHEA), high molecular weight adiponectin (HMWA), and high-density lipoprotein cholesterol (HDL-C). (2) In the PCOS group, RI was significantly positively correlated with FAI, FINS, 120minINS, HOMA-IR, and WHR (p < .01), and significantly negatively correlated with SHBG, HDL-C, and HMWA (p < .01); uterine artery S/D was significantly positively correlated with FAI, FINS, 2hGlu, HOMA-IR, LDL-C, and WHR (p < .01), significantly positively correlated with 120minINS and FBG (p < .05), and significantly negatively correlated with SHBG and HMWA (p < .01).

CONCLUSION

(1) The OP group exhibited obvious metabolic disorders and poor ER, which was manifested as low levels of SHBG and HMWA, and high levels of FAI, HOMA-IR, WHR, uterine artery S/D, and RI. (2) In patients with PCOS, there was a substantial correlation between ER-associated indicators RI and uterine artery S/D and FAI, FINS, 120minINS, HOMA-IR, WHR, SHBG, and HMWA.

pH-Responsive and Actively Targeted Metal-Organic Framework Structures for Multimodal Antitumor Therapy and Inhibition of Tumor Invasion and Metastasis

Multimodal treatment is an important tool to overcome tumor drug resistance. The reactive oxygen species (ROS) generated by photodynamic therapy (PDT) can directly play a killing role on tumor cells, which has the advantages of repeatable treatment and no drug resistance. However, its therapeutic oxygen consumption and destruction of tumor microvessels lead to hypoxia in tumor tissues, and hypoxia leads to overexpression of the receptor tyrosine kinase (c-MET) and vascular endothelial growth factor receptor (VEGFR). Overexpression of these two receptors leads to increased tumor invasiveness and metastasis. The molecularly targeted drug cabozantinib (CAB) has multiple targets, including anti-c-MET and VEGFR, to inhibit the development of hepatocellular carcinoma (HCC). In this study, our team designed a pH-sensitive nanoparticle CAB/Ce6@ZIF-8@PEG-FA (CCZP) loaded with CAB and Ce6, which exerted a multimodal therapeutic effect of PDT and molecularly targeted therapy by laser irradiation, and the PDT-induced overexpression of MET and VEGFR could also be inhibited by the target of CAB, thus reducing the invasive tumor cells metastasis. In summary, CCZP gives full play to the advantages of both drugs, exerting multimodal treatment while reducing HCC invasion and metastasis, providing a safe, potential approach to clinical treatment.

[Analysis of the prognosis and survival of patients with acute-on-chronic liver failure]

Objective: To explore the influencing factors and the impact of artificial liver treatment on the prognosis and survival of patients with acute-on-chronic liver failure (ACLF). Methods: Clinical data from 201 cases with ACLF from January 2016 to December 2019 was retrospectively analyzed. The survival rate was calculated by the Kaplan-Meier method, the log-rank test of univariate analysis, and the multivariate analysis of the stepwise Cox regression forward method. Results: The median survival time of patients was 6 months, and the survival rates at 6, 9, and 12 months were 51.2%, 38.3%, and 29.9%, respectively. In univariate analysis, age, presence or absence of hypertension and upper gastrointestinal bleeding, treatment method, model for end-stage liver disease (MELD) score, and cholinesterase were associated with prognosis (P < 0.05). Multivariate regression analysis results showed that MELD score was the main factor affecting the 1-year prognosis of ACLF patients (P = 0.002). Artificial liver treatment was beneficial for the 1-year prognosis of ACLF patients aged < 50 years or with a MELD score of ≥20 (P < 0.05 ). The relative risk ratio (RR) of mortality was 2.55 times higher in patients with advanced age (≥50 years old) than that of younger patients (P < 0.001). Regression analysis was performed using age as a stratification factor, and upper gastrointestinal bleeding was related to the prognosis of younger patients, while choline esterase was related to the prognosis of advanced age. Regression analysis after stratified MELD score showed that age and hypertension were related to the prognosis of patients with MELD score < 20, and treatment method and age were related to the prognosis of patients with MELD score≥20. Conclusion: Artificial liver treatment is beneficial for the 1-year prognosis of ACLF patients. Age, MELD score, hypertension, and upper gastrointestinal bleeding are independent risk factors affecting the prognosis of ACLF patients.

[Efficacy evaluation of 0.05% cyclosporine A and 0.1% tacrolimus eye drops in the treatment of severe dry eye associated with chronic graft-versus-host disease]

Objective: To evaluate the effectiveness and safety of 0.05% cyclosporine A and 0.1% tacrolimus eye drops in treating severe dry eye associated with chronic graft-versus-host disease (cGVHD). Methods: This non-randomized concurrent control trial enrolled 83 eyes from 83 patients with cGVHD-associated severe dry eye. The treatment had two phases. During the initial shock treatment period (0-3 months), 44 patients received 0.05% cyclosporine A eye drops (4 times/day; group A) and 39 patients received 0.1% tacrolimus eye drops (twice/day; group B) alongside basic treatment. In the maintenance treatment period (3-6 months), both groups used 0.05% cyclosporine A eye drops (twice/day) and sodium hyaluronate. Examinations were conducted at 1, 3, and 6 months after treatment initiation, assessing the Ocular Surface Disease Index (OSDI), corneal fluorescein staining (CFS) score, and fluorescein tear break-up time (BUT) for efficacy. visual acuity and intraocular pressure (IOP) were evaluated for safety, and patients' post-medication irritation symptoms were recorded. Results: The study included 52 males and 31 females, aged (28.57±15.67) years. After 1 month of treatment, the CFS score in group A significantly decreased from 10.0 (6.0, 14.0) to 5.0 (3.0, 8.5) (P<0.001). in group B, the CFS score also significantly decreased from 10.0 (6.0, 15.0) to 6.0 (2.0, 10.0), and the BUT increased from 2.0 (1.0, 2.0) s to 2.0 (1.8, 3.3) s (P<0.001). No significant OSDI decrease was observed in either group. No significant differences were found in OSDI, CFS score, and BUT between the two groups. After 3 months, group A showed significant improvement in OSDI, CFS score, and BUT (P<0.05), while group B only demonstrated significant CFS score decrease (P<0.05). OSDI was significantly lower in group A than group B (P<0.05). No significant differences were noted in CFS score and BUT between groups. After 6 months, OSDI, CFS score, and BUT were 18.9 (9.3, 34.2), 7.0 (3.0, 8.5), and 2.0 (1.0, 3.0) s in group A, and 10.9 (3.6, 35.4), 5.5 (2.8, 10.0), and 2.0 (1.0, 10.0) s in group B. In both groups, CFS scores significantly decreased and BUT increased (P<0.05). Visual acuity improved significantly in group A at 1, 3, and 6 months (P<0.05), while no significant changes were seen in group B. Irritation symptoms were transient and self-resolving in both groups. Conclusions: Both 0.05% cyclosporine A and 0.1% tacrolimus eye drops, when combined with local glucocorticoids, exhibited significant anti-inflammatory effects, effectively and safely treating severe dry eye in cGVHD patients. Although the onset of 0.05% cyclosporine A was slower than 0.1% tacrolimus, it offered more stable long-term effects and better symptom improvement.

[Review on the progress of tobacco epidemic monitoring methods]

Tobacco use is a major preventable contributor to premature death and disease globally. Tobacco epidemic monitoring plays a vital role in tobacco control, considered an essential component of tobacco control in the WHO Framework Convention on Tobacco Control and MPOWER package of tobacco control. In this paper, we reviewed the methods of tobacco monitoring worldwide, mainly including face-to-face surveys, telephone interviews, online questionnaire surveys, data sharing, model estimation, smoking cessation support, and the combination of multiple methods. Meanwhile, we analyzed the strengths and weaknesses of those monitoring methods. Tobacco monitoring methods vary in countries and regions. The review might provide a reference for tobacco epidemic monitoring in China.

scRNA-seq reveals that origin recognition complex subunit 6 regulates mouse spermatogonial cell proliferation and apoptosis via activation of Wnt/β-catenin signaling

ABSTRACT

The regulation of spermatogonial proliferation and apoptosis is of great significance for maintaining spermatogenesis. The single-cell RNA sequencing (scRNA-seq) analysis of the testis was performed to identify genes upregulated in spermatogonia. Using scRNA-seq analysis, we identified the spermatogonia upregulated gene origin recognition complex subunit 6 (Orc6), which is involved in DNA replication and cell cycle regulation; its protein expression in the human and mouse testis was detected by western blot and immunofluorescence. To explore the potential function of Orc6 in spermatogonia, the C18-4 cell line was transfected with control or Orc6 siRNA. Subsequently, 5-ethynyl-2-deoxyuridine (EdU) and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assays, flow cytometry, and western blot were used to evaluate its effects on proliferation and apoptosis. It was revealed that ORC6 could promote proliferation and inhibit apoptosis of C18-4 cells. Bulk RNA sequencing and bioinformatics analysis indicated that Orc6 was involved in the activation of wingless/integrated (Wnt)/ β-catenin signaling. Western blot revealed that the expression of β-catenin protein and its phosphorylation (Ser675) were significantly decreased when silencing the expression of ORC6. Our findings indicated that Orc6 was upregulated in spermatogonia, whereby it regulated proliferation and apoptosis by activating Wnt/β-catenin signaling.

Pancreatic draining lymph nodes (PLNs) serve as a pathogenic hub contributing to the development of type 1 diabetes

Type 1 diabetes (T1D) is a chronic, progressive autoinflammatory disorder resulting from the breakdown of self-tolerance and unrestrained β cell-reactive immune response. Activation of immune cells is initiated in islet and amplified in lymphoid tissues, especially those pancreatic draining lymph nodes (PLNs). The knowledge of PLNs as the hub of aberrant immune response is continuously being replenished and renewed. Here we provide a PLN-centered view of T1D pathogenesis and emphasize that PLNs integrate signal inputs from the pancreas, gut, viral infection or peripheral circulation, undergo immune remodeling within the local microenvironment and export effector cell components into pancreas to affect T1D progression. In accordance, we suggest that T1D intervention can be implemented by three major ways: cutting off the signal inputs into PLNs (reduce inflammatory β cell damage, enhance gut integrity and control pathogenic viral infections), modulating the immune activation status of PLNs and blocking the outputs of PLNs towards pancreatic islets. Given the dynamic and complex nature of T1D etiology, the corresponding intervention strategy is thus required to be comprehensive to ensure optimal therapeutic efficacy.

[Effect of health management service for hypertension patients under framework of Basic Public Health Service Project: a regression discontinuity design]

Objective: To evaluate the effect of health management service on hypertension patients (HMSFHP) under the framework of the Basic Public Health Service Project by using regression discontinuity design. Methods: The participants were enrolled from an observational cohort survey in 2015 and followed up was conducted in 2019. The participants with SBP 130-150 mmHg and/or DBP 80-100 mmHg in the baseline survey of the cohort in 2015 were included in the present study. Additionally, we obtained the dates of participants receiving HMSFHP and their blood pressure data from follow-up records, physical examination records and telephone interview. The participants were divided into intervention group and control group based on the cutoff points, i.e. SBP ≥140 mmHg and/or DBP ≥90 mmHg. The local linear regression model were used to estimate the effect of HMSFHP on reducing blood pressure of the participants. Results: After adjusting for age, sex and time length of receiving HMSFHP, the results of the model including participants with 80-100 mmHg for DBP in 2015 indicated that, for the participants who received HMSFHP, the DBP decreased by 6.66 mmHg from 2015 to 2019. For the participants with SBP 130-150 mmHg in 2015, the reduction estimate of the model was -6.17 mmHg, the difference was not significant (P=0.178), suggesting that receiving HMSFHP did not cause change in SBP for the participants who received HMSFHP. Conclusion: Receiving HMSFHP had effect to reduce DBP, and HMSFHP had a positive effect on the control of blood pressure in patients with hypertension.

A new dimeric (-)-5-methylmellein from cultures of the basidiomycete Inonotus sinensis

(-)-5-Methylmellein (1) and its new dimer (2) were isolated from cultures of the basidiomycete Inonotus sinensis. Their structures were elucidated on the basis of extensive spectroscopic methods including UV, IR, HR-EI-MS, 1D NMR and 2D NMR. The structure of Compound 2 was determined by single-crystal X-ray crystallographic analysis. Compound 2 was tested for the cytotoxicities against five human cancer cell lines.

Pyroptosis and its role in cancer

Programmed cell death (PCD) is mediated by specific genes that encode signals. It can balance cell survival and death. Pyroptosis is a type of inflammatory, caspase-dependent PCD mediated by gasdermin proteins, which function in pore formation, cell expansion, and plasma membrane rupture, followed by the release of intracellular contents. Pyroptosis is mediated by caspase-1/3/4/5/11 and is primarily divided into the classical pathway, which is dependent on caspase-1, and the non-classical pathway, which is dependent on caspase-4/5/11. Inflammasomes play a vital role in these processes. The various components of the pyroptosis pathway are related to the occurrence, invasion, and metastasis of tumors. Research on pyroptosis has revealed new options for tumor treatment. This article summarizes the recent research progress on the molecular mechanism of pyroptosis, the relationship between the various components of the pyroptosis pathway and cancer, and the applications and prospects of pyroptosis in anticancer therapy.

[Potential short-term effects of tobacco control scheme under various application scenarios of tobacco control measures across the globe: a Meta-analysis]

Objective: based on summarizing the simulation and prediction of tobacco control measures across the globe and sorting out the various scenarios of tobacco control measures, the potential short-term effects of seven tobacco control measures in different scenarios were systematically analyzed. Methods: Until April 2022, PubMed, Embase, EconLit, PsychINFO, and CINAHL databases were used to retrieve literature about tobacco control measures simulation and prediction models across the globe. Inclusion and exclusion criteria were strictly followed. Meta-analysis for the potential short-term effects of seven tobacco control measures in different scenarios was performed using the R software. Results: A total of 22 papers covering 16 countries were selected. Five studies were conducted in the United States, three in Mexico, and two in Italy. There were all papers with the measures to tax increases, smoke-free air laws, and mass media campaigns, 21 papers with youth access restrictions, 20 with marketing restrictions, and 19 with cessation treatment programs and health warnings. The tax increases had diverse influences on the price elasticity of different age groups. The price elasticity in the age group 15-17 years was the highest, which was 0.044 (95%CI: 0.038-0.051). The potential short-term effects of smoke-free air laws in workplaces were higher than in restaurants and other indoor public places. The effects of youth access restrictions were greater in the age group <16 years than in the age group 16-17. The stronger the implementation of other measures, the greater the potential short-term effects. A comparison of seven tobacco control measures showed that the cessation treatment programs increase in cessation rate was the highest, 0.404 (95%CI: 0.357-0.456). The reduction in smoking rate and reduction in initiation rate of youth access restrictions strongly enforced and publicized was the highest in the age group <16 years, 0.292 (95%CI: 0.269-0.315), and 0.292 (95%CI: 0.270-0.316). Conclusions: The potential short-term effects of seven tobacco control measures in different scenarios were evaluated more accurately and objectively through Meta-analysis. In the short term, cessation treatment programs will substantially increase smoking cessation rates, and strong youth access enforcement will sharply reduce smoking and initiation rates among adolescents under 16. These results also offer strong data-related support for the simulation and prediction of tobacco control measures in China and other countries.

Effect of LSD1 on osteogenic differentiation of human periodontal ligament stem cells in periodontitis

OBJECTIVE

Periodontitis is a chronic inflammation of periodontal tissues. This study is expected to assess the effect of LSD1 on the osteogenic differentiation of hPDLSCs in periodontitis.

METHODS

hPDLSCs were separated, cultivated, and identified, and then treated by LPS to induce inflammatory microenvironment and subjected to osteogenic differentiation. Subsequently, LSD1 expression was determined, and then silenced to assess its effect on hPDLSCs. Next, the binding relation between LSD1 and miR-590-3p was analyzed. miR-590-3p expression was detected and then overexpressed to evaluate its role in hPDLSCs in periodontitis. Afterward, the relation between LSD1 and OSX was analyzed. H3K4me2 level and OSX transcription were measured, and the role of H3K4me2 was determined. Additionally, the role of OSX in hPDLSCs was verified.

RESULTS

LSD1 was poorly expressed after osteogenic differentiation of hPDLSCs while it was rescued upon LPS induction. The osteogenic differentiation of hPDLSC in periodontitis was strengthened upon LSD1 downregulation. Besides, miR-590-3p targeted LSD1 transcription, and LSD1 inhibited OSX transcription via H3K4me2 demethylation. miR-590-3p overexpression improved osteogenic differentiation of hPDLSCs in periodontitis. But this improvement was annulled by OSX inhibition.

CONCLUSION

miR-590-3p targeted LSD1 transcription and upregulated H3K4me2 methylation to promote OSX transcription, thereby encouraging osteogenic differentiation of hPDLSCs in periodontitis.

[Correlation of muscle strength with cognitive function and medial temporal lobe atrophy in patients with mild to moderate Alzheimer's disease]

Objective: To analyze the correlation of muscle strength with cognitive function and medial temporal lobe atrophy (MTA) in patients with mild to moderate Alzheimer's disease (AD). Methods: General information, sarcopenia-related indicators, neuropsychological tests and MTA score were collected in 80 confirmed AD patients (41 mild and 39 moderate patients) and 43 normal controls (NC) from the Memory Disorders Clinic of Department Of Neurology in the Second Affiliated Hospital of Soochow University between January and December 2021. Appendicular skeletal muscle mass index (ASMI), grip strength and 5-times sit-to-stand time and 6-m gait speed were used for assessing muscle mass, muscle strength and physical function, respectively. Cognitive function was assessed by Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment scale (MoCA), Memory and Executive Screening Scale (MES), Digit Symbol Substitution Test (DSST), Digital Span Test (DST) and Verbal Fluency Task (VFT), respectively. DST included Forward Digit Span Test (FDST) and Backward Digit Span Test (BDST). All the subjects underwent 3.0T coronal three-dimensional gradient echo sequence MRI. MTA scale was performed to evaluate the degree of medial temporal lobe atrophy. The differences in the sarcopenia-related indicators, cognitive score and MTA score were analyzed among the three groups, and the partial correlation analysis was performed between the inter-groups. Results: Eighty AD patients (24 males and 56 females) were included, aged (72±7) years old, with 41 mild and 39 moderate patients. Meanwhile, 43 NC included 19 males and 24 females, with a mean age of (70±6) years old. The disease duration in moderate AD patients was longer than that of mild AD patients [34.0 (25.0, 43.5) months vs 24.0 (11.0, 34.0) months, P<0.001]. The differences of sarcopenia-related indicators and MTA score among the three groups were statistically significant (all P<0.001), including 5-times sit-to-stand time [(13.6±1.8) s vs (11.5±1.7) s vs (10.3±1.9) s, P<0.001] and MTA score [2.0 (2.0, 3.0) vs 1.0 (1.0, 2.0) vs 0 (0, 0), P<0.001]. In neuropsychological tests, compared to the NC group, MMSE, MoCA, MES and VFT scores in mild and moderate AD groups were lower (all P<0.001); meanwhile, compared to the mild AD group, the moderate group had lower MMSE, MoCA, MES, DSST and VFT scores (all P<0.001). In sarcopenia-related indicators, muscle strength in particular was correlated with widespread cognitive functioning domains and MTA score in AD patients. Grip strength was positively correlated with MMSE, MoCA , MES, FDST (r=0.387, 0.418, 0.522 and 0.484, respectively, all P<0.001), DSST (r=0.327, P=0.006) and VFT score (r=0.354, P=0.003), and negatively correlated with MTA score (r=-0.631, P<0.001). 5-times sit-to-stand time was negatively correlated with MMSE, MoCA, MES, DSST, FDST, VFT score (r=-0.583, -0.587, -0.814, -0.591, -0.552 and -0.485, respectively, all P<0.001), and BDST (r=-0.355, P=0.003) strongly positively correlated with MTA score (r=0.836, P<0.001). ASMI was positively correlated with MMSE, MoCA, MES, DSST, FDST score (r=0.257, 0.238, 0.428, 0.282 and 0.364, respectively, all P<0.05), and negatively correlated with MTA score (r=-0.377, P=0.001). 6-m gait speed was positively correlated with MMSE, MoCA, MES, DSST, FDST score (r=0.419, 0.486, 0.699, 0.559 and 0.500, respectively, all P<0.001), BDST and VFT score (r=0.384、0.377, respectively, both P=0.001), and strongly negatively correlated with MTA score (r=-0.803, P<0.001). Conclusions: Patients with mild to moderate AD have widespread cognitive impairment. Muscle mass, muscle strength and physical function are all significantly impaired. Compared to muscle mass and physical function, decreased muscle strength is significantly associated with widespread cognitive decline and increased degree of medial temporal lobe atrophy.

[Smoking relapse rate and influencing factors in smokers aged 15 years and above in China]

Objective: To describe the relapse status of smokers aged ≥15 years in China, and investigate the main factors influencing their relapse behavior. Methods: The data of this study cames from the 2018 China Adult Tobacco Survey, covering 400 committees or villages in 200 districts or counties in 31 provinces (autonomous regions and municipalities) of China. The relevant data of smoking and relapsing in residents aged ≥15 years were collected by face-to-face interview. Software SAS 9.4 was used to clean and analyze the data, and logistic regression model was used to analyze the influencing factors for relapse rate. Results: A total of 19 376 questionnaires were completed, with a response rate of 91.50%. In 2018, 66.05% of smokers aged ≥15 years in China had smoking relapse, in whom 66.59% were males and 55.79% were females. In all age groups, the age group 15-24 years had the highest smoking relapse rate (82.63%). Multivariate analysis showed that the younger age 15-24 years (OR=4.618,95%CI:1.981-10.763), e-cigarette use (OR=9.782,95%CI:3.139-30.490), and tobacco advertising, promotion and sponsorship in the past 30 days (OR=1.710,95%CI:1.291-2.265) were associated with higher smoking relapse rate. Compared with people who were allowed smoking at home or those without smoking limit, the smoking relapse rate in people who were not allowed to smoke at home (OR=0.562, 95%CI: 0.439-0.719) or those with smoking limit (OR=0.487, 95%CI: 0.366-0.647) was lower. Conclusion: The smoking relapse rate in Chinese smokers is high, especially in young people. It is suggested to conduct targeted intervention based on the results of this study to reduce the smoking relapse rate and help achieve the smoking control goal in Healthy China 2030.

The interferon regulatory factors, a double-edged sword, in the pathogenesis of type 1 diabetes

Type 1 diabetes (T1D) is an autoimmune disease resulted from the unrestrained inflammatory attack towards the insulin-producing islet β cells. Although the exact etiology underlying T1D remains elusive, viral infections, especially those specific strains of enterovirus, are acknowledged as a critical environmental cue involved in the early phase of disease initiation. Viral infections could either directly impede β cell function, or elicit pathological autoinflammatory reactions for β cell killing. Autoimmune responses are bolstered by a massive body of virus-derived exogenous pathogen-associated molecular patterns (PAMPs) and the presence of β cell-derived damage-associated molecular patterns (DAMPs). In particular, the nucleic acid components and the downstream nucleic acid sensing pathways serve as the major effector mechanism. The endogenous retroviral RNA, mitochondrial DNA (mtDNA) and genomic fragments generated by stressed or dying β cells induce host responses reminiscent of viral infection, a phenomenon termed as viral mimicry during the early stage of T1D development. Given that the interferon regulatory factors (IRFs) are considered as hub transcription factors to modulate immune responses relevant to viral infection, we thus sought to summarize the critical role of IRFs in T1D pathogenesis. We discuss with focus for the impact of IRFs on the sensitivity of β cells to cytokine stimulation, the vulnerability of β cells to viral infection/mimicry, and the intensity of immune response. Together, targeting certain IRF members, alone or together with other therapeutics, could be a promising strategy against T1D.

Lymphotoxins Serve as a Novel Orchestrator in T1D Pathogenesis

Type 1 diabetes (T1D) stems from pancreatic β cell destruction by islet reactive immune cells. Similar as other autoimmune disorders, there is no curative remedy for T1D thus far. Chronic insulitis is the hallmark of T1D, which creates a local inflammatory microenvironment that impairs β cell function and ultimately leads to β cell death. Immune regulation shows promise in T1D treatment by providing a time window for β cell recovery. However, due to the complex nature of T1D pathogenesis, the therapeutic effect of immune regulation is often short-lasting and unsatisfying in monotherapies. Lymphotoxins (LTs) were first identified in 1960s as the lymphocyte-producing cytokine that can kill other cell types. As a biological cousin of tumor necrosis factor alpha (TNFα), LTs play unique roles in T1D development. Herein in this review, we summarized the advancements of LTs in T1D pathogenesis. We particularly highlighted their effect on the formation of peri-islet tertiary lymphoid organs (TLOs), and discussed their synergistic effect with other cytokines on β cell toxicity and autoimmune progression. Given the complex and dynamic crosstalk between immune cells and β cells in T1D setting, blockade of lymphotoxin signaling applied to the existing therapies could be an efficient approach to delay or even reverse the established T1D.

[Spectral CT multi-parameter imaging in preoperatively evaluation the status of lymphovascular and perineural invasion of gastric cancer]

Objective: To explore the application value of spectral CT multi-parameter imaging in preoperative assessment the status of lymphovascular invasion (LVI) and perineural invasion (PNI) in patients with gastric cancer. Methods: A total of 62 patients who underwent energy spectral CT and with pathology confirmed gastric cancer in Lanzhou Uiversity Second Hospital from September 2020 to September 2021 were retrospectively collected, which including 46 males and 16 females, aged from 36 to 71 (57.5±9.1) years. According to the presence or absence of LVI/PNI in postoperative pathological results, they were divided into the positive group (42 cases) and the negative group (20 cases). The CT values of 40 keV and 70 keV (CT_{40 keV}, CT_{70 keV}), iodine concentration (IC), normalized iodine concentration (NIC) were measured in the arterial phase, the venous phase, and the delay phase, and the spectral curve slope of 40 keV to 70 keV (K_(40-70)) and the combined parameters (the arterial phase: AP~all, the venous phase: VP~all, the delay phase: DP~all) were calculated. Spectral parameters between the positive and negative groups were compared, and the receiver operating characteristic curve (ROC) with the area under the curve (AUC), sensitivity, specificity, and optimal threshold were calculated for evaluating the diagnostic performance of each parameter. Results: The CT_{40 keV}, CT_{70 keV}, K_(40-70), IC, and NIC in the arterial phase and the venous phase and the CT_{70 keV} and NIC in the delay phase of the LVI/PNI-positive group were all higher than those of the negative group [the representative parameters: the arterial phase NIC 0.14±0.04 vs 0.12±0.04, the venous phase NIC 0.5(0.5, 0.6) vs 0.4(0.4, 0.5), the delay phase NIC 0.6±0.1 vs 0.5±0.1, all P<0.05]. ROC curve analysis showed that the diagnostic efficacy of the parameters of the venous phase is better than that of the arterial phase and the delay phase, and the diagnostic efficiency of the combined parameters is better than that of the individual parameters. The AUC value, sensitivity, and specificity of the most optimal parameter VP~all of the venous phase were 0.931(95%CI:0.872-0.990), 80.95%, and 95.00%, respectively. Conclusions: In the preoperative evaluation the status of the LVI and PNI in gastric cancer, the diagnostic efficacy in the venous phase parameters is better than that in the arterial phase and delay phase, and the diagnostic efficacy of combined parameters is better than that of individual parameters.

[Quit intention and smoking cessation behavior of current smokers aged 15 years and above in China, 2018]

Objective: To describe the current situation on quit intention and quit attempts among current smokers aged 15 years and above in China and explore the main factors affecting their smoking cessation behaviors. Methods: The subjects were people aged 15 years and above in China. A stratified multi-phased randomized cluster sampling method was used. The survey covered 200 districts/counties in 31 provinces (autonomous regions and municipalities directly under the central government), including 19 376 people under investigation. The data were weighted with SAS 9.4 for complex sampling analysis, and the frequency and weighted component ratio were used for description. The influencing factors were studied using the Rao Scott χ² test and unconditional multivariate logistic regression. Results: Among current smokers, 6.63% reported that they planned to quit smoking in the next month, 5.44% for men and 8.49% for women. 17.96% of the current smokers made quit attempts in the past 12 months, with 17.80% men and 22.15% women. People who smoke occasionally (OR=3.42, 95%CI: 2.09-5.59) made quit attempts in the past (OR=4.91, 95%CI: 0.33-0.52) and knew that smoking would lead to three diseases (OR=2.24, 95%CI: 1.48-3.40) had higher quit intention. People who occasionally smoke (OR=1.68, 95%CI: 1.20-2.34) received smoking cessation suggestions from medical staff (OR=1.96, 95%CI: 1.62-2.37), were a ware of that smoking causes three diseases (OR=1.63, 95%CI: 1.32-2.02) and had smoking prohibition regulations in indoor areas of their homes, had a higher rate of quit attempts. Conclusion: Providing effective smoking cessation intervention services and creating a supportive tobacco control environment are significant in promoting smoking cessation behavior.

[Development and challenges of tobacco epidemic surveillance in China]

Tobacco use is the leading preventable risk factor causing the global burden of disease and one of China's most significant public health issues. Continuous and dynamic tobacco monitoring can provide critical index data for developing tobacco control strategies and measures and evaluating the impact of tobacco control. The WHO has incorporated monitoring programs into the crucial content of tobacco control and put forward relevant compliance requirements in the Framework Convention on Tobacco Control (FCTC). The Chinese government has actively promoted tobacco control significantly since the entry into force of the FCTC in China and continuously strengthened tobacco monitoring. In 2021, China's tobacco monitoring was honored to have reached the highest level required by the WHO. This study introduces the sampling design of tobacco surveys, monitoring content, the definition of key indicators and data weighting based on a complex sampling design, analyzing the challenges facing in the current setting, and provides a reference for the understanding and utilization of the data, the comparison of the results, and the future development of tobacco monitoring. The surveys involved in this study will focus on the specialized epidemiological surveys of tobacco for adults and adolescents carried out nationwide.

[Analysis of exposure to tobacco advertisement and promotion among Chinese adults aged 15 years and above, 2010 and 2018]

Objective: To investigate the exposure to tobacco advertisements and promotions among Chinese adults aged 15 and above, identify the publicity channels and forms of tobacco advertising and promotion in 2010 and 2018, and implicate further tobacco control measures in China. Methods: A multistage, stratified, randomized cluster sampling design was used in 2010 and 2018 China Adult Tobacco Survey, with national representativeness. 13 354 and 19 376 permanent residents were selected in the 2010 and 2018 surveys. SAS 9.4 software was applied for data analysis, and all the data were weighted based on a complex sampling design. Rao Scott χ2 test was used for group comparison of a single factor. Results: In 2010 and 2018, 19.61% and 18.14% of the survey respondents did see tobacco advertising and promotion. From 2010 to 2018, there was no significant change in the situation of tobacco advertisements and promotions. Among those who had gone to a cigarette shop, the proportion of seeing tobacco advertisements increased from 29.28% in 2010 to 43.28% in 2018. Among those who had seen tobacco advertisements on TV, the rate fell from 50.93% in 2010 to 28.58% in 2018. Among those who had gone to movie theaters, the proportion of seeing tobacco advertisements increased from 2.17% in 2010 to 9.89% in 2018. Among those who had used the Internet, the proportion of seeing tobacco advertisements online rose from 19.20% in 2010 to 42.30% in 2018. In terms of tobacco promotion, the percentages of people who had seen tobacco promotions, cigarette price discounts, cigarette discount coupons, gifts, and other preferential activities in various places in the past 30 days were 4.99% vs. 9.30%, 0.78% vs. 4.09%, 0.04% vs. 0.33% and 0.98% vs. 3.33% in 2010 and 2018, respectively (P<0.001). Conclusions: Tobacco advertising and promotion are still prevalent in China, with no significant change in 2010 and 2018. Tobacco advertising and promotion have been with the constant changes and development of media platforms. It is necessary to improve the implementation of relevant policies, comprehensively ban tobacco advertisements and promotions, and strengthen the supervision of ads and promotions.

[Secondhand smoke exposure and its influencing factors among Chinese people aged 15 years and above in 2010 and 2018]

Objective: To investigate secondhand smoke (SHS) exposure among non-current smokers aged 15 and over and its influencing factors in China in 2010 and 2018. Methods: The 2010 and 2018 China Adult Tobacco Surveys used multistage stratified cluster random sampling methods to obtain national representative samples across 31 provinces (autonomous regions and municipalities) in China. This study selected non-current smokers aged 15 and over as the research subjects to describe the general demographic characteristics, perceptions of SHS hazards, attitudes towards smoking bans in indoor areas in public places, and SHS exposure and the smoking restriction regulations in different places. The Rao-Scott χ2 test was used to compare the rates, and the unconditional logistic regression was used to analyze the influencing factors of SHS exposure. All the subjects in the analysis were weighted based on a complex sampling design. Results: Among non-current smokers aged 15 and over, from 2010 to 2018, the percentage of indoor smokers had decreased from 84.7% to 71.9%. The rates of people who saw smoking in various places declined with a statistically significant difference (P<0.001). The exposure to SHS for females, people aged 45-64, teachers, medical staff, workers in enterprises, businesses, waiters, and people who live in rural and central areas declined. The differences were statistically significant (P<0.05). In 2018, the percentage of SHS exposure for those who reported a comprehensive smoking ban in households or allowed smoking in certain areas was lower than for those who reported allowed or without a smoking ban. Among those aged 25-44, SHS exposure for those who reported complete smoking prohibition in workplaces was lower than those who reported allowed or without smoking prohibition (OR=0.65, 95%CI: 0.49-0.87). The proportion of SHS exposure for those who believe that smoking should not be allowed in indoor areas of 0-5 public places is higher than that smoking should not be allowed in the indoor spaces of 8 public places (OR=2.13, 95%CI: 1.35-3.36). Among people aged 45-64, the proportions of SHS exposure for teachers (OR=0.37, 95%CI: 0.17-0.78) and medical staff (OR=0.35, 95%CI: 0.16-0.76) and staff working in agriculture, forestry, animal husbandry, fishery, and water conservancy were lower than governmental staff (OR=0.49, 95%CI: 0.29-0.84). Conclusions: Data from the decreased exposure of Chinese non-current smokers aged 15 and over to SHS suggests the initial achievement through constructing a smoke-free environment, but continued efforts are needed. It is necessary to actively advocate for smoke-free families, strengthen publicity and education on the hazards of tobacco and SHS, and improve the skills of non-smokers in rejecting SHS exposure.

Thyrotoxicosis after a massive levothyroxine ingestion: A case report

BACKGROUND

The literature on thyrotoxicosis caused by excessive ingestion of exogenous thyroid hormone is limited, and most cases reported have involved pediatric clinical studies.

CASE SUMMARY

A 21-year-old woman initially presented with palpitation and chest tightness after an overdose of levothyroxine (10 mg). The patient transiently lost consciousness and developed atrial fibrillation during hospitalization. We used propylthiouracil to decrease the peripheral conversion of T4 to T3 and inhibit the synthesis of endogenous thyroxine, propranolol to control heart rate, hydrocortisone to correct severe thyrotoxicosis, and hemoperfusion to increase levothyroxine clearance. The patient recovered and was discharged.

CONCLUSION

For patients with thyrotoxicosis after taking excess levothyroxine, it is critical to monitor vital signs and initiate effective treatment.

[Third ventricle width measured by transcranial ultrasound and its diagnostic value in patients with Alzheimer's disease]

Objective: To explore the diagnostic value of third ventricle width (TVW) measured by transcranial ultrasound (TCS) in the clinical diagnosis of Alzheimer's disease (AD) by analyzing and comparing the image characteristics of TVW in AD patients and healthy controls, and its correlation with cranial magnetic resonance medial temporal lobe atrophy (MTA) visual score and neuropsychological characteristics. Methods: TCS examination, MTA score and neuropsychological tests were performed in 39 confirmed AD and 41 normal controls from the Second Affiliated Hospital of Soochow University between January and July 2021. The correlation of TVW with MTA score and neuropsychological characteristics was analyzed and compared between the two groups. Results: A total of thirty-nine AD patients were enrolled, with 28 males and 11 females, aged (73±9) years, including 18 mild, 20 moderate, and 1 severe AD patient. Meanwhile, 41 healthy controls were also included, with 24 males and 17 females, aged (69±6) years old. TVW in AD patients was significantly wider than that in normal controls [0.76(0.66, 0.87) cm vs 0.50(0.44, 0.56) cm, P<0.001]. In neuropsychological tests, compared with normal controls, AD patients showed impaired performances in several cognitive functions, and there were statistically significant differences in delayed memory [0(0, 0) vs 4.0(4.0, 5.0), P<0.001], naming [2.0(1.0, 3.0) vs 3.0(2.0, 3.0), P<0.001], executive function [2.0(2.0, 3.0) vs 3.0(2.5, 3.0), P<0.001], language [0.0(0.0, 2.0) vs 3.0(2.0, 3.0), P<0.001] and other aspects between AD patients and normal controls (all P<0.05). TVW was negatively correlated with immediate memory (r=-0.339, P=0.035), delayed recall (r=-0.523, P<0.001), attention and computing power (r=-0.409, P=0.045), visual space and executive function (r=-0.333, P=0.039), but positively correlated with the atrophy of the medial temporal lobe (r= 0.552, P<0.001). Conclusions: TCS can be used to measure TVW in AD patients. When combined with MTA score and neuropsychological tests, it can provide a reliable objective basis for the clinical diagnosis of AD.

LncRNA B4GALT1-AS1 promotes non-small cell lung cancer cell growth via increasing ZEB1 level by sponging miR-144-3p

Background

Long noncoding RNAs (lncRNAs) are emerging as key players in the development and progression of cancer. Several malignancies involve dysregulated long noncoding ribonucleic acids (lncRNAs) in non-small cell lung cancer cell growth and their aggressive phenotypes. LncRNA B4GALT1-AS1 is important in the advancement of various malignancies, although its contribution to non-small cell lung cancer (NSCLC) remains unexplored.

Methods

LncRNA B4GALT1-AS1 in NSCLC tissues was detected and further validated in a cohort of non-small cell lung cancer tissues. The effects of lncRNA B4GALT1-AS1 on proliferation were determined by in vitro experiments. The B4GALT1-AS1-miR-144-3p-ZEB1 axis was assessed by dual-luciferase reporter and RNA immunoprecipitation (RIP) assays. Furthermore, the mechanism of B4GALT1-AS1 was investigated using loss-of-function assays in vitro.

Results

We showed significant upregulation of B4GALT1-AS1 in cell lines and tissues of NSCLC. B4GALT1-AS1 knockdown impeded the in vitro proliferation-related characteristics of the NSCLC cells. The demonstration of the binding capacity of B4GALT1-AS1 and miR-144-3p was predicted by bioinformatics and luciferase reporter activity assay. The B4GALT1-AS1 and miR-144-3p interaction was shown by using rescue experiments. NSCLC has a positive association with its target, zinc finger e-box binding homeobox 1 (ZEB1).

Conclusions

In summary, the progression of NSCLC was facilitated by lncRNA B4GALT1-AS1 via interaction with miR-144-3p and positive regulation of ZEB1 expression.

The tale of TILs in breast cancer: A report from The International Immuno-Oncology Biomarker Working Group

The advent of immune-checkpoint inhibitors (ICI) in modern oncology has significantly improved survival in several cancer settings. A subgroup of women with breast cancer (BC) has immunogenic infiltration of lymphocytes with expression of programmed death-ligand 1 (PD-L1). These patients may potentially benefit from ICI targeting the programmed death 1 (PD-1)/PD-L1 signaling axis. The use of tumor-infiltrating lymphocytes (TILs) as predictive and prognostic biomarkers has been under intense examination. Emerging data suggest that TILs are associated with response to both cytotoxic treatments and immunotherapy, particularly for patients with triple-negative BC. In this review from The International Immuno-Oncology Biomarker Working Group, we discuss (a) the biological understanding of TILs, (b) their analytical and clinical validity and efforts toward the clinical utility in BC, and (c) the current status of PD-L1 and TIL testing across different continents, including experiences from low-to-middle-income countries, incorporating also the view of a patient advocate. This information will help set the stage for future approaches to optimize the understanding and clinical utilization of TIL analysis in patients with BC.

[Evaluation on the quality of 236 National Demonstration Areas for comprehensive prevention and control of chronic diseases betweem 2017 and 2019]

Objective: To evaluate the quality of the National Demonstration Area for Comprehensive Prevention and Control of NCDs (referred to as "the Demonstration Area"). Methods: Based on the evaluation scores of the Demonstration Area field survey from 2017 to 2019, we counted the scores of each indicator, comparing the scores among indicators and regions. x±s was used to describe the scores. The 95%CI of the score was used to test the statistical difference among regions. Each score was converted into a hundred-mark system to compare the scores among indicators. Results: Of 236 Demonstration Areas, the total score was 83.5. The scores of the first-level indicator listed from high to low appeared as Integrating System of NCD Prevention and Control (92.8), Policy Perfection (90.3), Building Supportive Environment for NCD Prevention and Control (88.4), Implementation of Health Education and Health Promotion (87.4), Whole-course Management of NCDs (78.1), Innovation and Guidance (76.5), Surveillance and Evaluation (75.1). Total scores were higher in the east (259.2±18.8) comparing to the middle (243.2±15.2) or the west (245.4±19.7) regions. Conclusions: Substantial variations on the quality in the Demonstration Area existed across different regions in China. These disparities are important to the government when developing health policies and allocating resources. Whole-course Management of NCDs, Surveillance and Evaluation, and Innovation and Guidance in the Demonstration Area also needs to be improved.

[Analysis on disease burden of stroke in China and the regions with different sociodemographic index from 1990 to 2017]

Objective: To examine the trend of stroke disease burden and its main risk-attributable factors in China and regions with different Socio-Demographic Index (SDI) from 1990 to 2017. Methods: With 2017 Global Burden of Disease (GBD) data, years lived with disability (YLDs), years of life lost (YLLs) and disability-adjusted of life years (DALYs) were applied to describe the disease burden and major risk factors of stroke in China and different SDI regions from 1990 to 2017, and to analyze the changing trend of the disease burden and major risk factors of stroke. Results: From 1990 to 2017, the YLD crude rate, YLL crude rate and DALY crude rate for stroke in China showed an increasing trend and the rate of change was 126.5%, 14.6%, and 24.4%, respectively. In 2017, the YLD crude rate, YLL crude rate and DALY crude rate for stroke in China were 502.6 per 100 000, 2 633.1 per 100 000 and 3 135.7 per 100 000, respectively. Among them, the YLD crude rate, YLL crude rate, and DALY crude rate of stroke were the highest in the ≥70 age group, which were 2 617.2 per 100 000, 16 789.4 per 100 000 and 19 406.6 per 100 000, respectively. The YLD crude rate in male was 475.5 per 100 000, which was slightly lower than that of female (530.9 per 100 000), while the DALY crude rate and YLL crude rate for stroke were 3 657.1 per 100 000 and 3 181.7 per 100 000, respectively, which were significantly higher than that of female (2 591.8 per 100 000 and 2 060.9 per 100 000). Compared with regions with different SDI, the age standardized YLD rate, the age standardized YLL rate, the age standardized DALY rate in China were all at a high level. Among them, the age-standardized YLD rate increased from 286.2 per 100 000 to 374.5 per 100 000, with a rate of change of 30.9%; the age-standardized YLL rate decreased from 3 215.6 per 100 000 to 1 967.8 per 100 000, with a rate of change of -38.8%; the age-standardized DALY rate increased from 3 501.8 per 100 000 to 2 342.3 per 100 000, with a rate of change of -33.1%. The top five risk factors for stroke in China were hypertension, excessive sodium intake, insufficient fruit intake, insufficient cereal intake, and smoking in 1990 and 2017. High Body-Mass Index and Alcohol Use's rankings rose from the 9th and 10th in 1990 to the 6th and 7th in 2017, respectively. Conclusion: The burden of stroke disease in China is at a high level, and hypertension is the primary risk factor.

[Evaluation of the effectiveness of treatment of 16 patients with tongue microcystic lymphatic malformation using bipolar coagulation forceps combined with 1% lauromacrogol foam sclerotherapy]

PURPOSE

To investigate the clinical efficacy and safety of bipolar coagulation forceps combined with 1% lauromacrogol foam sclerotherapy in the treatment of microcystic lymphatic malformation of tongue.

METHODS

The clinical data of 16 patients with microcystic lymphatic malformation of the tongue admitted to the Department of Stomatology of Foshan First People's Hospital from April 2017 to April 2020 were retrospectively analyzed, including 7 males and 9 females, aging from 15 months to 21 years. The average age of patients was 8.32±1.21 years. The efficacy and complications of the patients were evaluated.

RESULTS

All 16 patients were followed up for 6 to 12 months. The clinical response was evaluated as eleven patients (68.75%) for grade Ⅳ, three (18.75%) for grade Ⅲ, two (12.5%) for grade Ⅱ, and the effective rate was 87.5%. Necrosis of tongue mucosa and muscle occurred in 1 patient.

CONCLUSIONS

Bipolar coagulation forceps combined with 1% lauromacrogol foam sclerotherapy is a minimally invasive, safe and effective treatment for tongue microcystic lymphatic malformation.

[Association between physical activity and risk of stroke among adults aged 40 years and above: a prospective cohort study]

Objective: To examine the effect of physical activity (PA) on the incident risk of stroke among adults aged 40 years and above. Methods: The baseline data including PA and demographic characteristics were obtained from the Adult Chronic Disease Surveillance with population representativeness in Ningbo in 2015. The follow-up data of interested health outcomes from 2015 to 2019 were retrieved from a population-based Integrated Noncommunicable Disease Collaborative Management System in Ningbo. The two databases were matched to form a queue. PA was divided into three levels of low-intensity, moderate-intensity, and vigorous-intensity according to the metabolic equivalents (METs) spent per week. Cox regression model was used to calculate the hazard ratio (HR) and 95% confidence interval. Results: A total of 3 353 subjects were included at baseline survey in 2015. Until Dec 31, 2019, there had been 31 stroke events had occurred since then, with accumulative incidence rate of 242/100 000, and an average follow-up time of (50.28±2.54) months. When adjusted for gender, age, education level, smoking status, alcohol consumption, BMI and hypertension, multivariate Cox regression analysis showed that greater PA was associated with a 37.9% reduction of incidence of stroke (HR=0.621,95%CI:0.393-0.983). Compared with those who had low-intensity PA, those who were with vigorous-intensity. PA appeared associated with a 63.1% decrease in the incidence of stroke (HR=0.369, 95%CI: 0.139-0.976). However, there was no statistical significance with moderate-intensity PA (HR=0.712,95%CI:0.323-1.569), noticed. Conclusions: Greater PA is likely to reduce the incidence of stroke. Our findings indicated that people should be encouraged to increase the PA level and developing a healthy supportive environment in the community.

Smoothing process of conformal vibration polishing for mid-spatial frequency errors: characteristics research and guiding prediction

By combining the conformal polishing method with short stroke vibration, a novel, to the best of our knowledge, conformal vibration polishing (CVP) method is proposed. The CVP method is expected to be an efficient means of optical processing by its high material removal rate and smoothing characteristics of mid-spatial frequency (MSF) errors. A quantitative time-domain smoothing model and a convergence factor (${\rm CF}_C$) are presented based on the research of smoothing characteristics. The motion mechanism, material removal ability, solution, and expansion of the smoothing model are demonstrated theoretically and experimentally. The experimental results exhibited good agreement with the theoretical predictions for the proposed method. The research provides a certain theoretical foundation for parameter selection and process optimization of the CVP method.

[Application of healthy big data in prevention and control of chronic diseases]

With the continuous development of informatization, big data has been increasingly used in the prevention and control of chronic diseases, which has a significant and considerable influence on public health. This paper briefly introduces the definition, characteristics and classification of big data and healthy big data, focusing on the analysis methods and their applications in tertiary prevention, as well as the challenges in technology, data management, sharing and quality, ethics and privacy, with the aim of providing more research approaches for healthy big data application in chronic disease prevention and control.

[Dragon-tiger fighting needling therapy in treatment of painful diabetic peripheral neuropathy: a randomized controlled trial]

OBJECTIVE

To compare the clinical therapeutic effect on painful diabetic peripheral neuropathy (PDPN) between dragon-tiger fighting needling and pregabalin capsules.

METHODS

A total of 60 patients with PDPN were randomized into an observation group and a control group, 30 cases in each one. On the base of treatment with routine anti-hyperglycaemic measures and nutritional neurotherapy, the dragon-tiger fighting needling was exerted at Sanyinjiao (SP 6), Zusanli (ST 36), Yinlingquan (SP 9) and Xuehai (SP 10) in the observation group, once daily. Pregabalin capsules were prescribed for oral administration in the control group, 75 mg, twice a day. The treatment for 2 weeks was as one course and 2 courses of treatment were required in total. The score of visual analogue scale (VAS), the score of MOS item short form health survey (SF-36) and nerve conduction velocity before and after treatment were compared between the two groups. The clinical therapeutic effect was evaluated in the two groups.

RESULTS

After treatment, VAS score was reduced as compared with before treatment in the two groups (P<0.05). The reducing range of VAS score in the observation group was larger than the control group (P<0.05). After treatment, the sensory nerve conduction velocity (SNCV) and motor nerve conduction velocity (MNCV) of median nerve and posterior tibial nerve were all improved as compared with before treatment in the two groups (P<0.05). SNCV and MNCV in the observation group were higher than the control group (P<0.05). After treatment, the score of each item in SF-36 was increased as compared with before treatment in the two groups (P<0.05) and the score of each item in SF-36 in the observation group was higher than the control group (P<0.05). The total effective rate was 86.7% (26/30) in the observation group, better than 60.0% (18/30) in the control group (P<0.05).

CONCLUSION

The dragon-tiger fighting needling therapy relieves painful symptoms, improves the quality of life and increases nerve conduction velocity in the patients with diabetic peripheral neuropathy, and the therapeutic effect is better than oral administration of pregabalin capsules.

Correlation between Negative Rapid Influenza Diagnostic Test and Severe Disease in Hospitalized Adults with Laboratory-Confirmed Influenza Virus Infection

False-negative rapid influenza diagnostic test (RIDT) results could mislead physicians to exclude an influenza diagnosis. We sought to evaluate the association between negative RIDT and intensive care unit (ICU) admission. We reviewed data from hospitalized adults with laboratory-confirmed influenza virus infections in a tertiary referral hospital in Taiwan from July 2009 to February 2011. The diagnosis was documented by real-time PCR or virus culture. Of 134 hospitalized adults infected with influenza virus, 38 (28%) were admitted to the ICU. Compared with RIDT-positive patients, the percentage of ICU admission was significantly higher among RIDT-negative patients (46% versus 13%, P < 0.001). The RIDT-negative patients had higher percentages of lower respiratory symptoms and more chest radiograph infiltrates. The time interval between the RIDT and antiviral treatment was longer in RIDT-negative than RIDT-positive patients (1.94 days versus 0.03 days, P < 0.001). Among patients presenting with mild illness, only a negative RIDT and delayed antiviral treatment were associated with ICU admission after adjusting for potential confounding factors. To conclude, patients with a negative RIDT were more likely to have severe disease and a delay in initiating antiviral treatment. Our findings should help improve treatment outcomes of hospitalized patients with influenza infection.

[Current status and projection of non-communicable diseases in 126 countries participating in the Belt and Road initiative]

Objective: To compare the indicators of non-communicable diseases (NCD) and predict the achieving time of United Nations (UN) Sustainable Development Goals (SDG) in 125 countries participating in the Belt and Road (B&R) initiative and China. Methods: Using the open access data of Global Burden of Disease study, we first got the premature mortality rates of four main chronic diseases (cardiovascular disease, cancer, diabetes and chronic respiratory diseases) and suicide mortality rate in the 126 countries from1990 to 2017. We transformed the value of each indicator into a scale of 0-100 in percentile for each country and applied geometric mean to calculate total NCD score for comparison among 126 countries. We then examined the association of NCD scores with socio-demographic index (SDI) values. Finally, we used annualized rates of change during 1990-2015 to predict achieving time of the UN goal by 2030 for each indicator of chronic diseases premature mortality rate and suicide mortality rates in each B&R country. Results: The integral median of total NCD score in the 126 countries in 2017 was 82.7. The score of China was 87.6, ranking 33(rd). The top three countries were Kuwait (98.1), Peru (97.5) and Italy (96.0). The last three countries were Papua New Guinea (28.9), Vanuatu (54.7) and Ukraine (58.0). The total NCD score showed positive correlation with SDI values (r=0.33) mainly due to chronic disease indicator (r=0.45). Fifteen countries will achieve the SDG goal of chronic disease premature mortality in or before 2030, but China will achieve it in 2038. Fifteen countries are expected to achieve the goal of suicide mortality, and China will acheive the goal ahead of schedule in 2024. Conclusions: The NCD rates varied widely among the countries along B&R. It is a challenge to achieve the SDG goal of chronic disease premature mortality rate by 2030 for China. In order to achieve the SDG goals by 2030, we should strengthen multilateral cooperation and complement each other's advantages, and reduce NCD mortality of people and improve people's health in countries along B&R.

Silencing LncRNA LINC01305 inhibits epithelial mesenchymal transition in lung cancer cells by regulating TNXB-mediated PI3K/Akt signaling pathway

The aim of this study was to investigate whether LINC01305 can regulate TNXB-mediated phosphatidilinositol 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway and therefore affect epithelial mesenchymal transition in lung cancer cells. Quantitative real-time polymerase chain reaction (qRT-PCR) was conducted to detect LINC01305 level in 52 non-small cell lung cancer (NSCLC) tissues and paracancerous normal lung tissues, and the relationship between LINC01305 expression and clinical pathological parameters of these subjects was analyzed. After LINC01305 was knocked down in PC9 cell and overexpressed in A549 cells, qRT-PCR was used to verify the transfection efficiency, and nuclear fractionation technique, cell counting kit-8 (CCK-8), plate cloning assay and Transwell test were used to detect the effect of LINC01305 on cell viability. LINC01305 had an obviously higher expression in NSCLC tissues, and the expression in lung cancer patients with tumor size >3 cm was higher than those with tumor ≤3 cm. LINC01305 expression in tumor tissues in T3-T4 stage was obviously higher than those in T1-T2 stage, and the overall survival rate of lung cancer patients with high expression of LINC01305 was lower than those with low expression. Moreover, clinical analysis revealed that LINC01305 level was related to tumor size, TNM stage and lymph node metastasis of patients with lung cancer, but not related to age or gender. Silencing LINC01305 can inhibit the epithelial mesenchymal transition-induced transformation of lung cancer cells through regulating TNXB-mediated PI3K/Akt signaling pathway, which in turn affects the progression of lung cancer.

[Trends of burden on ischemic heart disease and epidemiological transition of related risk factors in China, 1990-2017]

Objective: To examine the trend of burden on ischemic heart disease (IHD) and epidemiological transition on related risk factors among the Chinese population from 1990 to 2017. Methods: Based on open access data from the Global Burden of Disease (GBD) 2017 Study, we used years of life lost (YLD), years lived with disability (YLL), and disability-adjusted of life years (DALY) to describe the changes of IHD burden stratified by different sex and age groups from 1990 to 2017. We applied population-attributable faction (PAF) to analyze the burden attributable to risk factors and epidemiological transition. Results: In 2017, rates on YLD, YLL, and DALY for IHD were 74.2/100 000, 2 459.6/100 000, and 2 523.1/100 000, respectively. DALY rate and YLL rate for IHD in males were invariably higher than those in females except for YLD rate in females. 24 modifiable risk factors were causally associated with IHD. The top five risk factors that influencing DALYs, PAF, and DALY rate in 2017 appeared as: high blood pressure (16.429 million person years, 54.6%, 1 163.1/100 000), high LDL cholesterol (13 941 million person years, 46.3%, 987.0/100 000), diet high in sodium (10.900 million person years, 36.2%, 771.1/100 000), smoking (8.647 million person years, 28.7%, 612.2/100 000), and low-nut diet (7.452 million person years, 24.8%, 527.6/100 000). DALY rate for IHD showed an increase of 90.9%, from 1 116.4/100 000 in 1990 to 2 131.0/100 000 in 2017. Compared with 1990, the YLD rate experienced an evident increase in those aged 15-49 and over 70, in 2017. Annual average growth rate of YLD rate was higher in the ≥70 age group, between 2007 and 2017 (0.4%) than that between 1990 and 2007 (0.2%). The annual average increasing rates of both YLL and DALY were much lower from 2007 to 2017 (0.6%, 0.6%) than those from 1990 to 2007 (1.3%, 1.2%). From 1990 to 2017, DALYs attributed to meaty food (929.7%), beverages with high sugar content (822.7%), and high body-mass index (327.3%) experienced the highest increase. The largest increase in PAF occurred for beverages with high sugar content (400.0%). DALY rates increased for the 8 risk factors whereas decreased on the 7 risk factors, in consecutive rankings between 2007 and 2017. Conclusions: Despite the fact that burden on IHD-caused premature death had been reducing, related disabilities remain challenging with IHD the leading cause of burden, particularly in the ≥70 year-olds. Higher IHD burden from premature death was seen in males but disability appeared higher in females. It is significantly important to strengthen programs on prevention and control for hypertension including reducing modifiable risk factors such as smoking, unreasonable diet habits.

[Current status of the clinical practice and analysis on the ratioanl prescription of antiarrhythmic drugs in Chinese patients with atrial fibrillation: Results from the Chinese Atrial Fibrillation Registry (CAFR) trial]

Objective: To explore the practice patterns and the related factors of oral antiarrhythmic drug (AAD) treatment in Chinese patients with atrial fibrillation (AF), and to evaluate the compliance of AAD application to atrial fibrillation management guidelines. Methods: From August 2011 to August 2016, medical records from 18 014 patients with AF were analyzed based on data from the Chinese Atrial Fibrillation Registry trial. Patients were divided into AAD group (7 788 cases, 43.23%) and non-AAD group (10 226 cases, 56.77%) according to whether AAD was used at baseline or at the time of first use during follow-up. Amiodarone (4 129 cases, 53.02%) and propafenone (3 211 cases, 41.23%) were the mostly prescribed AAD and subgroup analysis was performed accordingly. Medical records were analyzed by random forest regression to evaluate the use of AAD and related factors in patients with AF, and the rationality of AAD was analyzed according to the guidelines for the management of atrial fibrillation. Result: A total of 18 014 patients were included in this study, of which 60.48% (10 895/18 014) were male patients, 22.65% (4 081/18 014) were elderly patients(≥75 years old), there were 7 788 patients (43.23%) in AAD group, and 10 226 patients(56.77%) in non-AAD group. Compared with the non-AAD group, the elderly patients (≥75 years old, 13.74%(1 070/7 788) vs. 29.44%(3 011/10 226)), persistent AF (28.95% (2 250/7 788) 45.80% (4 683/10 226)), heart failure(8.29% (646/7 788) vs. 21.95% (2 245/10 226)), stroke and (or) TIA(12.15% (946/7 788) vs. 19.95% (2 040/10 226)), renal dysfunction(16.36%(1 274/7 788) vs. 29.37% (3 003/10 226)), and high thromboembolism risk(60.17% (4 748/7 788) vs. 76.40% (7 813/10 226)) were less prevalent in the AAD subgroup (P<0.001). Multivariate analysis showed that patients in tertiary hospitals (OR=3.72, 95%CI 3.17-4.37) were more likely to use AAD, elderly patients (≥75 years old, OR=0.47, 95%CI 0.39-0.55), persistent atrial fibrillation (OR=0.66, 95%CI 0.60-0.72), and patients with heart failure (OR=0.54, 95%CI 0.47-0.63), stroke and (or) TIA (OR=0.77, 95%CI 0.68-0.87), renal dysfunction (OR=0.75, 95%CI 0.59-0.95) and high thromboembolism risk(OR=0.7, 95%CI 0.58-0.84) were more likely not to use AAD(P<0.05). In the AAD group, amiodarone and propafenone were the most commonly used AAD, accounting for 53.02% (4 129/7 788) and 41.23% (3 211/7 788), respectively. Multivariate analysis showed that patients with persistent atrial fibrillation (OR=4.57, 95%CI 3.94-5.29) and coronary heart disease (OR=4.14, 95%CI 3.03-5.64), heart failure (OR=2.07, 95%CI 1.48-2.89), non-ischemic cardiomyopathy (OR=4.84, 95%CI 2.41-9.73) were more likely to use amiodarone, and those with normal left ventricular ejection fraction (OR=0.31, 95%CI 0.15-0.65) and low thromboembolism risk (OR=0.78, 95%CI 0.63-0.97) were more likely to use propafenone (P<0.001). The overall incidence of AAD treatment, which was not indicated by the guidelines was 6.5% (480/7 340); 5.1% (212/4 129) in the amiodarone group and 8.3% (268/3 211) in the propafenone group, respectively. Compared with the rational AAD use group, the proportion of irrational drug use was higher in the elderly (≥75 years old) (20.4% (98/480) vs. 12.9% (887/6 860)), patients of high thromboembolism risk (77.1% (379/480) vs. 59.0% (4 047/6 860)), and in non-tertiary hospitals (7.1% (34/480) vs. 3.3% (299/6 860)), but lower in men(50.8% (244/480) vs. 64.5% (4 427/6 860)), P<0.001. Conclusions: The patients with paroxysmal atrial fibrillation, who were treated with AAD, were mostly patients with fewer complications, and the patients who were treated with amiodarone were mostly patients with persistent atrial fibrillation, patients were more likely to complicate with organic heart disease. The incidence of AAD that do not comply with the guidelines was low, and it was more common in non-tertiary hospitals and the elder patients with high thromboembolism risk.

Dimensional Changes of Lumbar Intervertebral Foramen in Direct Anterior Approach-Specific Hyperextension Supine Position

Objective

To investigate the changes in the lumbar intervertebral foramen (LIVF) dimensions from neutral supine to direct anterior approach (DAA)‐specific hyperextension supine position through a standardized three‐dimensional (3D) reconstruction computerized tomography (CT) method.

Methods

A total of 35 healthy volunteers (18 men and 17 women) were included in this retrospective study. The mean age of enrolled subjects was 28.9 ± 5.0 years. In September 2018, all the individuals underwent a 3D CT scan of the lumbar spine in neutral and 30° hyperextension supine positions, which mimicked the patient’s position in DAA total hip arthroplasty (THA). The dimensions of the LIVF, including foraminal area, height, and width, were measured on 3D reconstructed CT models at all lumbar foraminal levels. Foraminal area was defined as the area bounded by the adjacent superior and inferior vertebral pedicles, the posterosuperior boundary of the inferior vertebral body, the surface of the intervertebral disc posteriorly, the posteroinferior boundary of the superior vertebral body, and the surface of the ligamentum flavum anteriorly. Foraminal height was defined as the longest distance between the border of the superior and the inferior pedicle. Foraminal width was defined as the shortest distance between the posteroinferior edge of the superior vertebrae and the opposing boundary. Subgroup analysis and multiple linear regression were used to evaluate the relationship between percentage changes of the LIVF dimensions and side, sex, and age.

Results

The LIVF dimensions varied significantly between the two positions at all levels (P < 0.05). From neutral to hyperextension supine position, the foraminal area reduced by 20.1% at lumbar 1–2 (L_1–2), 22.6% at L_2–3, 19.9% at L_3–4, 18.1% at L_4–5, and 12.0% at lumbar 5–sacral 1 (L₅–S₁) level, respectively; the foraminal height reduced by 9.5% at L_1–2, 10.5% at L_2–3, 9.5% at L_3–4, 9.6% at L_4–5, and 6.1% at L₅–S₁ level, respectively; the foraminal width reduced by 12.8% at L_1–2, 14.5% at L_2–3, 13.0% at L_3–4, 10.4% at L_4–5, and 8.4% at L₅–S₁ level, respectively. The changes in LIVF dimensions were biggest at L_2–3 level and smallest at L₅–S₁ level. Subgroup analysis showed that there were no significant differences in the percentage changes of LIVF dimensions between the sexes and sides (P > 0.05). Multiple linear analysis showed that the percentage changes of LIVF dimensions were not related to side, sex, and age (P > 0.05).

Conclusion

The dimensions of the LIVF showed significant decrease at all levels in the DAA‐specific hyperextension supine position compared with the neutral supine position, and the percentage changes of LIVF dimensions were not influenced by side, sex, and age.

Three-point Method to Guide the Tibial Resection and Component Placing in Total Knee Arthroplasty

Objective

To introduce a three‐point method combining the midpoint of the posterior cruciate ligament (PCL), the midsulcus of the tibial spines, and the midpoint of the anterior cruciate ligament (ACL) to determine appropriate tibial resection and component placing during TKA and to compare this method with Insall's 1/3 method.

Methods

A consecutive series of 128 knees that underwent TKA from January 2015 to August 2018 were analyzed. In one group (64 knees), the medial 1/3 of tibial tubercle (the Insall's traditional method) was used for tibial component alignment. In the other group (64 knees), the three‐point line connecting the midpoint of the PCL, the midpoint of the tibial spines, and the midpoint of the ACL was used for tibial component alignment. Both groups used the anterior tibial tendon as the distal reference for tibial resection. The coronal alignment error of the tibial component was determined by the angle between the line parallel to the tibial component platform and the tibial mechanical axis measured on postoperative radiograph. The axial rotation error of the femoral or tibial component was the intersection angle between the transepicondylar axis (TEA) and a line tangent to the posterior edge of the femoral or tibial component measured on CT. The coronal and axial alignment errors were compared between the two groups.

Results

The average coronal alignment error of the tibial component in the three‐point method group was 0.2° ± 1.4° versus − 0.9° ± 1.8°in the Insall's 1/3 method group (P < 0.001), and the mean absolute value in the three‐point method group reduced by 37.3% compared to Insall's traditional method group. The average axial rotation error of the femoral component was 0.2° ± 1.2° in the three‐point method group versus − 1.1° ± 1.7° in the Insall's 1/3 method group (P < 0.001), and the mean absolute value in three‐point method group decreased by 43.9% compared to Insall's traditional method group. The average axial rotation error of the tibial component was 0.4° ± 1.4° versus − 1.4° ± 1.8° in the Insall's 1/3 method group (P < 0.001), and the mean absolute value in the three‐point method group reduced by 35.5% compared to the Insall's traditional method group. The rates of rotation outliers were significantly lower in the three‐point method group (P < 0.05).

Conclusion

The line connecting the midpoint of the PCL, the midsulcus of the tibial spines, and the midpoint of the ACL could be used as the reference for the tibial resection and component placing. This method appears to be more accurate than Insall's 1/3 method. The results of this study provide a candidate method for component orientation with little error.

The path to a better biomarker: application of a risk management framework for the implementation of PD-L1 and TILs as immuno-oncology biomarkers in breast cancer clinical trials and daily practice

Immune checkpoint inhibitor therapies targeting PD-1/PD-L1 are now the standard of care in oncology across several hematologic and solid tumor types, including triple negative breast cancer (TNBC). Patients with metastatic or locally advanced TNBC with PD-L1 expression on immune cells occupying ≥1% of tumor area demonstrated survival benefit with the addition of atezolizumab to nab-paclitaxel. However, concerns regarding variability between immunohistochemical PD-L1 assay performance and inter-reader reproducibility have been raised. High tumor-infiltrating lymphocytes (TILs) have also been associated with response to PD-1/PD-L1 inhibitors in patients with breast cancer (BC). TILs can be easily assessed on hematoxylin and eosin-stained slides and have shown reliable inter-reader reproducibility. As an established prognostic factor in early stage TNBC, TILs are soon anticipated to be reported in daily practice in many pathology laboratories worldwide. Because TILs and PD-L1 are parts of an immunological spectrum in BC, we propose the systematic implementation of combined PD-L1 and TIL analyses as a more comprehensive immuno-oncological biomarker for patient selection for PD-1/PD-L1 inhibition-based therapy in patients with BC. Although practical and regulatory considerations differ by jurisdiction, the pathology community has the responsibility to patients to implement assays that lead to optimal patient selection. We propose herewith a risk-management framework that may help mitigate the risks of suboptimal patient selection for immuno-therapeutic approaches in clinical trials and daily practice based on combined TILs/PD-L1 assessment in BC. © 2020 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

[Morphological changes of the central sulcus in children with complete growth hormone deficiency: a 3.0 T MRI study]

Objective: To analyze morphological changes in central sulcus of the cerebral cortex in children with complete growth hormone deficiency (CGHD). Methods: Patients attending the Shandong Provincial Hospital who were diagnosed with CGHD or idiopathic short stature were recruited from January 2015 to January 2019. Thirty children with CGHD (18 males and 12 females, 5 to 14 years old) and 30 children with idiopathic short stature (22 males and 8 females, 5 to 14 years old) were included. Measurements of the central sulcus, including the average width, maximum depth, average depth, top length, bottom length and depth position-based profiles (DPP), were obtained using Brain VISA software. The significant differences between groups were statistically analyzed. Results: The average width of bilateral central sulci in children with CGHD (left: (2.26±0.41) mm; right: (2.19±0.34) mm) were significantly higher than those in children with idiopathic short stature (left: (2.10±0.27) mm; right: (2.02±0.18) mm) (P<0.05) ; The maximum depth of the left central sulcus ((19.67±1.29) mm) and the average depth of the right central sulcus ((14.18±1.41) mm) were significantly lower than those in children with idiopathic short stature (left maximum depth: (20.69±1.43) mm; right average depth: (14.92±1.21) mm) (P<0.05) . Children with CGHD had significantly lower DPP at the middle part of the left central sulcus (sites: 46-54) and the inferior part of the right central sulcus(sites: 91-98). Conclusion: There are significant morphological changes of the central sulcus in children with CGHD, which may represent the structural basis of their relatively slower development in motor, cognitive and linguistic functional performance.

[An interlaboratory comparison study on the detection of RUNX1-RUNX1T1 fusion transcript levels and WT1 transcript levels]

Objective: To investigate the current status and real performance of the detection of RUNX1-RUNX1T1 fusion transcript levels and WT1 transcript levels in China through interlaboratory comparison. Methods: Peking University People's Hospital (PKUPH) prepared the samples for comparison. That is, the fresh RUNX1-RUNX1T1 positive (+) bone morrow nucleated cells were serially diluted with RUNX1-RUNX1T1 negative (-) nucleated cells from different patients. Totally 23 sets with 14 different samples per set were prepared. TRIzol reagent was added in each tube and thoroughly mixed with cells for homogenization. Each laboratory simultaneously tested RUNX1-RUNX1T1 and WT1 transcript levels of one set of samples by real-time quantitative PCR method. All transcript levels were reported as the percentage of RUNX1-RUNX1T1 or WT1 transcript copies/ABL copies. Spearman correlation coefficient between the reported transcript levels of each participated laboratory and those of PKUPH was calculated. Results: ①RUNX1-RUNX1T1 comparison: 9 samples were (+) and 5 were (-) , the false negative and positive rates of the 20 participated laboratories were 0 (0/180) and 5% (5/100) , respectively. The reported transcript levels of all 9 positive samples were different among laboratories. The median reported transcript levels of 9 positive samples were from 0.060% to 176.7%, which covered 3.5-log. The ratios of each sample's highest to the lowest reported transcript levels were from 5.5 to 12.3 (one result which obviously deviated from other laboratories' results was not included) , 85% (17/20) of the laboratories had correlation coefficient ≥0.98. ②WT1 comparison: The median reported transcript levels of all 14 samples were from 0.17% to 67.6%, which covered 2.6-log. The ratios of each sample's highest to the lowest reported transcript levels were from 5.3-13.7, 62% (13/21) of the laboratories had correlation coefficient ≥0.98. ③ The relative relationship of the reported RUNX1-RUNX1T1 transcript levels between the participants and PKUPH was not always consistent with that of WT1 transcript levels. Both RUNX1-RUNX1T1 and WT1 transcript levels from 2 and 7 laboratories were individually lower than and higher than those of PKUPH, whereas for the rest 11 laboratories, one transcript level was higher than and the other was lower than that of PKUPH. Conclusion: The reported RUNX1-RUNX1T1 and WT1 transcript levels were different among laboratories for the same sample. Most of the participated laboratories reported highly consistent result with that of PKUPH. The relationship between laboratories of the different transcript levels may not be the same.

[Protective effects of berberine against exhaustion exercise induced myocardial injury in rats]

Objective: To investigate the effect and possible mechanism of berberine (Ber) on myocardial injury induced by exhaustion exercise (Ee). Methods: Forty healthy male SPF Sprague-Dawley rats were randomly divided into 5 groups using the random unit group design method: control group, Ee group and Ee plus Ber group (low: 50 mg·kg(-1)·d(-1), medium: 100 mg·kg(-1)·d(-1) and high dose: 150 mg·kg(-1)·d(-1), n=8 each). Ber (1.5 ml) or equal volume saline was given per gavage for 14 days. Rats assigned to Ee groups underwent Ee swimming once daily and rats in control group remain sedentary. After 14 days, echocardiographic measurements were performed and left ventricular ejection fraction (LVEF) and fractional shortening (LVFS), left ventricular diastolic diameter (LVIDd) and left ventricular systolic diameter (LVIDs) were obtained. The morphological structure of heart was detected by HE and Masson staining. Serum superoxide dismutase (SOD) and malondialdehyde (MDA) were measured by enzyme-linked immunosorbent assay. Cardiomyocytes apoptosis was detected by TUNEL method. The protein expression of myocardial hypertrophy marker protein B-type natriuretic peptide (BNP) and apoptotic marker protein (Bcl-2, Bax) in rat myocardial tissue was detected by Western blot. Results: (1) Both LVFS and LVEF were significantly lower, and LVIDs and LVIDd were significantly larger in Ee group than those in control group (all P<0.01). The LVFS and LVEF in medium dose of Ber and high-dose Ber groups were significantly higher, and the LVIDs and LVIDd were significantly smaller than those in Ee group (all P<0.01). (2) The results of HE staining showed that the myocardial cells in control group were closely arranged, regular, normal in morphology, clear in structure, and uniform in staining. The myocardial cells of rats in Ee group were disarranged, cell staining was uneven, and vacuoles appeared in the cytoplasm. The disorder of myocardial cell arrangement and unequal staining in the medium dose of Ber were attenuated than in Ee group. The Masson staining results showed that the myocardial cells in control group were closely arranged, regular, normal in shape, clear in structure, and rarely blue-stained (fibrosis). Myocardial cells in rats in Ee group showed obvious fibrosis. The myocardial cell fibrosis in rats with medium dose of Ber was significantly reduced than exercise group. (3) MDA content in myocardial tissue of rats in Ee group was significantly higher than that of control group, and MDA content in myocardial tissue of rats in medium dose of Ber group was significantly lower than in Ee group (P<0.01). The SOD activity of myocardial tissue in rats was significantly lower than that of control group, while that of rats with medium dose of Ber was significantly higher than that of rats in Ee group (P<0.01). (4) TUNEL staining results showed that only a small amount of apoptosis myocardial cells were seen in control group, and a large number of apoptosis myocardial cells were seen in rats in Ee group. However, the number of apoptotic cardiomyocytes in medium dose of Ber was significantly lower than that in Ee group. The AI of rat cardiomyocytes was significantly higher than that of control group (P<0.01), and the AI of rat cardiomyocytes in median dose of Ber group was significantly lower than in Ee group (P<0.01). (5) BNP and Bax protein expression in the myocardial tissues of rats in Ee group were significantly higher than in control group (P<0.01). BNP and Bax protein expression in the myocardial tissues in median dose of Ber group were significantly lower than that of Ee group (P<0.01). The myocardial protein expression level of Bax was significantly higher, and the myocardial protein level of Bcl-2 was significantly lower in Ee group than in control group (both P<0.01), treatment with median dose of Ber could partly reverse above changes (both P<0.01). Conclusion: Ber can attenuate exhaustion exercise induced myocardial injury and remodeling in rats, and the beneficial effects of Ber might possibly be mediated by reducing free radical release and cardiomyocytes apoptosis.

Exposure to herbicides reduces larval sensitivity to insecticides in Spodoptera litura (Lepidoptera: Noctuidae)

Herbicides and insecticides are widely used in modern agriculture. It has been reported in various studies that application of insecticides can increase tolerance of herbivorous insects to insecticides. However, limited information exists on susceptibility to insecticides when insects are exposed to herbicides. This study was conducted to investigate the potential impact of the herbicides trifluralin and 2-methyl-4-chlorophenoxyacetic acid sodium salt (MCPA-Na) on the susceptibility of the nocturnal moth Spodoptera litura to the insecticides λ-cyhalothrin, phoxim and bifenthrin. We found that larvae exposed to trifluralin or MCPA-Na became significantly less susceptible to both insecticides than non-exposed control larvae. Herbicide-treated larvae did not show altered growth under the used test conditions. However, heads of herbicide-treated larvae showed increased expression of the acetylcholinesterase genes SlAce1 and SlAce2. Moreover, the fat body and midgut of herbicide-treated larvae displayed elevated expression of detoxification genes (the carboxylesterase gene SlCarE; the glutathione S-transferase genes SlGSTe2 and SlGSTe3; the cytochrome P450 monooxygenase genes CYP6B48, CYP9A40 and CYP321B1). The CYP6B48 gene exhibited highest inducibility. In conclusion, the data of this study suggest that exposure of S. litura larvae to herbicides may stimulate detoxification mechanisms that compromise the efficacy of insecticides.

Effects of acupuncture in treating insomnia due to spleen-stomach disharmony syndrome and its influence on intestinal microbiome: Study protocol for a randomized controlled trial

BACKGROUND

Insomnia is a common complaint that is closely related to gastrointestinal symptoms, which is consistent with the traditional Chinese medicine classical theory of "stomach disharmony leading to restless sleep." Acupuncture is an effective complementary and alternative medicine therapy to improve gastrointestinal function and restore the normal sleep-wake cycle. However, studies on the effectiveness of acupuncture for insomnia due to spleen-stomach disharmony syndrome are limited to case reports and few randomized controlled trials; deeper research on its mechanism is still lacking. This randomized controlled trial aims to assess the treatment efficacy of "harmonizing stomach to tranquilize mind" acupuncture for insomnia and its influence on the intestinal microbiome.

METHODS/DESIGN

This is a randomized, single-blind, parallel-group study. Sixty eligible patients with insomnia due to spleen-stomach disharmony syndrome will be randomly divided into two groups (1:1 allocation ratio). The intervention group will use "harmonizing stomach to tranquilize mind" acupuncture, and the control group will receive sham acupuncture. Participants will receive 5 acupuncture treatment sessions per week for 4 consecutive weeks. The Pittsburgh Sleep Quality Index will be used to evaluate the clinical efficacy of acupuncture treatment by making assessments at baseline, the end of treatment and the end of the follow-up. High-throughput 16S ribosomal ribonucleic acid gene sequencing will be performed to detect changes in the intestinal microbial composition before and after treatment.

DISCUSSION

The results of this trial are expected to confirm that "harmonizing stomach to tranquilize mind" acupuncture can effectively relieve insomnia and alter the intestinal microbiome.

TRIAL REGISTRATION

Chinese Clinical Trials Registry: ChiCTR1800017092.

Mikania Micrantha Wilt Virus Alters Insect Vector's Host Preference to Enhance Its Own Spread

As an invasive weed, Mikaniamicrantha Kunth has caused serious damage to natural forest ecosystems in South China in recent years. Mikania micrantha wilt virus (MMWV), an isolate of the Gentian mosaic virus (GeMV), is transmitted by Myzuspersicae (Sulzer) in a non-persistent manner and can effectively inhibit the growth of M. micrantha. To explore the MMWV-M. micrantha-M. persicae interaction and its impact on the invasion of M. micrantha, volatile compounds (VOCs) emitted from healthy, mock-inoculated, and MMWV-infected plants were collected, and effects on host preference of the apterous and alate aphids were assessed with Y-shaped olfactometers. Gas chromatography-mass spectrometry (GC-MS) analysis indicated that MMWV infection changed the VOC profiles, rendering plants more attractive to aphids. Clip-cages were used to document the population growth rate of M.persicae fed on healthy, mock-inoculated, or MMWV-infected plants. Compared to those reared on healthy plants, the population growth of M. persicae drastically decreased on the MMWV-infected plants. Plant host choice tests based on visual and contact cues were also conducted using alate M.persicae. Interestingly, the initial attractiveness of MMWV-infected plants diminished, and more alate M. persicae moved to healthy plants. Taken together, MMWV appeared to be able to manipulate its plant host to first attract insect vectors to infected plants but then repel viruliferous vectors to promote its own dispersal. Its potential application for invasive weed management is discussed.

[Mortality attributable to inadequate intake of fruits among population aged 25 and above in China, 2013]

Objective: To assess the mortality attributable to low fruit intake among people over 25 years old in China, 2013, and its effect on life expectancy. Methods: Based on data collected from China Chronic Disease and Risk Factor Surveillance in 2013, the average fruit intake in different genders and areas were calculated. Potential impact fraction (PIF) was used to examine the impact on deaths, mortality and life expectancy. Results: The average daily fruit intake was (113.3±168.9) g among people over 25 years old, with (103.6±160.1) g for men and (122.7±176.6) g for women, in China in 2013. Fruit intake for urban residents was significantly higher than that in rural residents and higher in eastern regions than that in central or western regions. Scores that attributable to low fruit intake accounted for 15.21% of the total deaths and the population attributable fraction of inadequate intake of fruits to associated diseases was 35.00%. PIF for all the deaths in rural residents (16.50%) appeared higher than that of the urban residents (13.88%), and higher in the residents living in the eastern region (15.48%) than that in the central (16.27%) or western (13.75%) regions. Number of deaths that attributable to low fruit intake was 1.348 4 million. Deaths caused by related diseases appeared as: ischemic heart disease (472.5 thousands), hemorrhagic stroke (338.8 thousands), ischemic stroke (259.0 thousands), lung cancer (208.4 thousands), esophageal cancer (60.7 thousands), laryngeal cancer (5.4 thousands) and oral cancer (3.6 thousands). Numbers of all deaths and related diseases for urban residents were lower than that of the rural residents, with central regions (452.7 thousands) higher than that in the eastern (531.1 thousands) or western (364.6 thousands) regions. The average life expectancy loss caused by low fruit intake was 1.73 years, 1.80 years for men and 1.58 years for women, in this country. Loss of life expectancy in the rural residents was higher than that of the urban residents, and higher in central regions than that in the eastern or western regions. Conclusions: The intake of fruit was far lower than the recommended standard set for the Chinese people. Population attributable fraction was related to the associated diseases caused by inadequate intake of fruits which also made serious impact on life expectancy.

[Number of deaths that attributable to high fasting plasma glucose among population aged 25 and above and its impact on life expectancy in China, 2013]

Objective: To analyze deaths that attributable to high fasting plasma glucose and its impact on life expectancy among Chinese residents in 2013. Methods: Data from the Mortality Surveillance Programs in National Disease Surveillance Points System and the China Chronic Disease Surveillance (2013) were used. Death attributed to high fasting plasma glucose and its impact on the life expectancy of Chinese residents were estimated, based on the principle of population attributable fraction. Results: In 2013, the total number of deaths attributed to high fasting plasma glucose among aged ≥25 years old was 621 thousand, with 333 thousand males and 288 thousand females. Diseases related to the number of deaths caused by high fasting plasma glucose would include ischemic heart disease (212 thousand) as the most important one. Cerebrovascular disease appeared the 2(nd) place, with around 181 thousand cases and then followed by diabetes (145 thousand), chronic kidney disease (52 thousand) and tuberculosis (31 thousand). After removal of the effects on high blood glucose exposure, the life expectancy of Chinese residents in 2013 would have reached 76.5 years old, an average increase of 0.7 years, compared to the average life expectancy of all deaths, with men having an increase of 0.7 years and women of 0.8 years, respectively. Conclusions: High fasting plasma glucose appeared an important risk factor for mortality and life expectancy on the Chinese residents. Programs related to prevention and control of high fasting plasma glucose and related diseases should be strengthened.