Investigation of FRMPD4 variants associated with X-linked epilepsy

BACKGROUND

The etiology of unexplained epilepsy in most patients remains unclear. Variants of FRMPD4 are suggested to be associated with neurodevelopmental disorders. Therefore, we screened for disease-causing FRMPD4 variants in patients with epilepsy.

METHODS

Trios-based whole-exome sequencing was conducted on a cohort of 85 patients with unexplained epilepsy, their parents, and extended family members. Additional cases with FRMPD4 variants were identified from the China Epilepsy Gene Matching Platform V.1.0. The frequency of variants was analyzed, and their subregional effects were predicted using in silico tools. The genotype-phenotype correlation of the newly defined causative genes and protein stability were analyzed using I-Mutant V.3.0 and Grantham scores.

RESULTS

Two novel missense variants of FRMPD4 were identified in two families. Using the gene matching platform, we identified three additional novel missense variants. These variants presented at low or no allele frequencies in the gnomAD database. All the variants were located outside the three FRMPD4 main domains (WW, PDZ, and FERM). In silico analyses revealed that the variants were damaging and were predicted to be the least stable. All patients eventually became seizure-free. Eight of the 21 patients with FRMPD4 variants had epilepsy, of which five (63%) had missense variants located outside the domains, two had deletions involving exon 2, and one had a frameshift variant located outside the domains. Patients with epilepsy caused by missense variants were often free of intellectual disabilities (4/5), whereas patients with epilepsy caused by truncated variants had intellectual disabilities and structural brain abnormalities (3/3).

CONCLUSIONS

The FRMPD4 gene is potentially associated with epilepsy. The genotype-phenotype correlation of FRMPD4 variants indicated that differences in variant types and locations of FRMPD4 may explain their phenotypic variation.

Blood Group Antigen A Carriers Exhibit an Extended Progression-Free Survival with no more Immune-Related Adverse Events

Extensive investigations have been conducted regarding the potential correlation between blood type and the immune system, as well as cancer risk in the Southern Chinese population. However, the prognostic value of the blood group and its genetic determinants in the context of immune checkpoint inhibitor (ICI) treatment remains unclear. Therefore, the associations between the ABO blood group and its single nucleotide polymorphisms (SNPs) were examined in relation to ICI treatment outcomes in 370 eligible patients with cancer. This approach allowed us to derive the blood group from the SNPs responsible for blood group determination. In the discovery cohort (N = 168), antigen A carriers (blood types A and AB) exhibited an extended progression-free survival (PFS; hazard ratio (HR) = 0.58, 95% confidence interval (CI) = 0.34-0.98). The association results from the SNP-derived blood were consistent with those from the measured blood group. In the validation cohort (N = 202), Cox regression analysis revealed that the antigen A carriers (rs507666 AA+GA genotype carriers) experienced significantly extended PFS compared with the non-antigen A carriers (HR = 0.61, 95% CI = 0.40-0.93). Therefore, a longer PFS was observed in antigen A carriers (P value = 0.003, HR = 0.60, 95% CI = 0.44-0.84). Furthermore, haplotype 2 carriers (rs507666 GA and rs659104 GG) demonstrated both extended PFS and improved overall survival. Notably, the presence of antigen A was not associated with the occurrence of overall immune-related adverse events (irAEs) or organ-specific toxicity. In summary, our findings revealed that antigen A carriers did not experience a higher incidence of irAEs while exhibiting better immunotherapy efficacy.

Yield stress Measurement of municipal sludge: A comprehensive evaluation of testing methods and concentration effects using a rotational rheometer

Accurate prediction and measurement of yield stress are crucial for optimizing sludge treatment and disposal. However, the differences and applicability of various methods for measuring yield stress are subjects of ongoing debate. Meanwhile, literature on measuring sludge yield stress is limited to low solid concentrations (TS <10%), understanding and studying the yield stress of medium to high solid concentration sludge is crucial due to increasingly stringent standards for sludge treatment and disposal. So, this study employed a rotational rheometer to measure sludge yield stress across a wide range of TS (4-50%) using steady shear, dynamic oscillatory shear, and transient shear. The study derived significant conclusions by comparing and summarizing the applicability and limitations of each testing method: Dynamic oscillatory shear methods, including G'-σ curve method, γ-σ curve method, and G**γc method can measure sludge yield stress ranging from 4% to 40% TS, while other methods are restricted to low or limited solid concentrations; The G' = G″ method, utilizing the intersection of G' and G″ curves, consistently yields the highest value for yield stress when 4%≤ TS ≤ 12%; The rotational rheometer cannot measure sludge yield stress when the solid concentration exceeds 40% TS; The relationship between sludge yield stress and solid concentration is stronger as a power-law for TS ≤ 25%, transitioning to linear for higher concentrations (28%≤ TS <40%). This study systematically explores the applicability and limitations of various measurement methods for characterizing sludge yield stress across a wide range of solid concentrations, providing valuable guidance for scientific measurement and highlighting challenging research issues.

Effects of meteorological factors on influenza transmissibility by virus type/subtype

BACKGROUND

Quantitative evidence on the impact of meteorological factors on influenza transmissibility across different virus types/subtypes is scarce, and no previous studies have reported the effect of hourly temperature variability (HTV) on influenza transmissibility. Herein, we explored the associations between meteorological factors and influenza transmissibility according to the influenza type and subtype in Guangzhou, a subtropical city in China.

METHODS

We collected influenza surveillance and meteorological data of Guangzhou between October 2010 and December 2019. Influenza transmissibility was measured using the instantaneous effective reproductive number (Rt). A gamma regression with a log link combined with a distributed lag non-linear model was used to assess the associations of daily meteorological factors with Rt by influenza types/subtypes.

RESULTS

The exposure-response relationship between ambient temperature and Rt was non-linear, with elevated transmissibility at low and high temperatures. Influenza transmissibility increased as HTV increased when HTV < around 4.5 °C. A non-linear association was observed between absolute humidity and Rt, with increased transmissibility at low absolute humidity and at around 19 g/m3. Relative humidity had a U-shaped association with influenza transmissibility. The associations between meteorological factors and influenza transmissibility varied according to the influenza type and subtype: elevated transmissibility was observed at high ambient temperatures for influenza A(H3N2), but not for influenza A(H1N1)pdm09; transmissibility of influenza A(H1N1)pdm09 increased as HTV increased when HTV < around 4.5 °C, but the transmissibility decreased with HTV when HTV < 2.5 °C and 3.0 °C for influenza A(H3N2) and B, respectively; positive association of Rt with absolute humidity was witnessed for influenza A(H3N2) even when absolute humidity was larger than 19 g/m3, which was different from that for influenza A(H1N1)pdm09 and influenza B.

CONCLUSIONS

Temperature variability has an impact on influenza transmissibility. Ambient temperature, temperature variability, and humidity influence the transmissibility of different influenza types/subtypes discrepantly. Our findings have important implications for improving preparedness for influenza epidemics, especially under climate change conditions.

Superantigen-fused T cell engagers for tumor antigen-mediated robust T cell activation and tumor cell killing

Inadequate T cell activation has severely limited the success of T cell engager (TCE) therapy, especially in solid tumors. Enhancing T cell activity while maintaining the tumor specificity of TCEs is the key to improving their clinical efficacy. However, currently, there needs to be more effective strategies in clinical practice. Here, we design novel superantigen-fused TCEs that display robust tumor antigen-mediated T cell activation effects. These innovative drugs are not only armed with the powerful T cell activation ability of superantigens but also retain the dependence of TCEs on tumor antigens, realizing the ingenious combination of the advantages of two existing drugs. Superantigen-fused TCEs have been preliminarily proven to have good (>30-fold more potent) and specific (>25-fold more potent) antitumor activity in vitro and in vivo. Surprisingly, they can also induce the activation of T cell chemotaxis signals, which may promote T cell infiltration and further provide an additional guarantee for improving TCE efficacy in solid tumors. Overall, this proof-of-concept provides a potential strategy for improving the clinical efficacy of TCEs.

De novo GABRA1 variants in childhood epilepsies and the molecular subregional effects

Background

The GABRA1 gene, encoding the GABRAR subunit α1, plays vital roles in inhibitory neurons. Previously, the GABRA1 gene has been identified to be associated with developmental and epileptic encephalopathy (DEE) and idiopathic generalized epilepsy (IGE). This study aims to explore the phenotypic spectrum of GABRA1 and molecular subregional effect analysis.

Methods

Trios-based whole-exome sequencing was performed in patients with epilepsy. Previously reported GABRA1 mutations were systematically reviewed to analyze the molecular subregional effects.

Results

De novo GABRA1 mutations were identified in six unrelated patients with heterogeneous epilepsy, including three missense mutations (p.His83Asn, p.Val207Phe, and p.Arg214Cys) and one frameshift mutation (p.Thr453Hisfs*47). The two missense mutations, p.His83Asn and p.Val207Phe, were predicted to decrease the protein stability but no hydrogen bond alteration, with which the two patients also presented with mild genetic epilepsy with febrile seizures plus and achieved seizure-free status by monotherapy. The missense variant p.Arg214Cys was predicted to decrease protein stability and destroy hydrogen bonds with surrounding residues, which was recurrently identified in three cases with severe DEE. The frameshift variant p.Thr453Hisfs*47 was located in the last fifth residue of the C-terminus and caused an extension of 47 amino acids, with which the patients presented with moderated epilepsy with generalized tonic-clonic seizures alone (GTCA) but achieved seizure-free status by four drugs. The four variants were not presented in gnomAD and were evaluated as "pathogenic/likely pathogenic" according to ACMG criteria. Analysis of all reported cases indicated that patients with mutations in the N-terminal extracellular region presented a significantly higher percentage of FS and DEE, and the patients with variants in the transmembrane region presented earlier seizure onset ages.

Significance

This study suggested that GABRA1 variants were potentially associated with a spectrum of epilepsies, including EFS+, DEE, and GTCA. Phenotypic severity may be associated with the damaging effect of variants. The molecular subregional effects help in understanding the underlying mechanism of phenotypic variation.

Enhancing data reliability in quantitative characterization of moisture distribution in sludge using DSC: Impact of sample attributes and test parameters

Exploring moisture distribution, especially bound water content, is vital for studying and applying sludge dewatering. The differential scanning calorimetry (DSC) method has been extensively utilized for the quantitative characterization of moisture distribution in sludge. However, this method has certain limitations, such as low reproducibility of results, leading to controversial parameter values in different papers and hindering result comparison. In this study, we investigated the influence of key sample attributes on measuring sludge bound water using the DSC method.The findings demonstrated that the moisture content and mass of sludge samples substantially influenced the reproducibility and stability of DSC test results. To ensure data reliability, the moisture content of the sludge sample should be minimized and kept below 84%, with the mass not exceeding 10 mg. Compared to the influence of sludge moisture content and sample mass, the heating rate (1⁓5 °C/min) minimally affected DSC test results. This study offers a comprehensive insight into how sample attributes and test parameters affect the quantitative characterization of bound water in sludge using the DSC method. Furthermore, practical strategies are presented to enhance the method's applicability in sludge bound water characterization.

[Clinical outcomes of endovascular therapy in acute stroke patients with anterior circulation tandem occlusions due to atherosclerosis and dissection]

Objective: To compare the clinical outcomes of endovascular therapy in acute stroke patients with anterior circulation tandem occlusions caused by atherosclerosis or dissection. Methods: A retrospective cohort study. A total of 98 patients with anterior circulation tandem lesions undergoing endovascular therapy in the Wuhan NO.1 Hospital (March 2016 to March 2022) were analyzed. Median age was 64(55,71) years old, and 82.7% (81/98 cases) were males. According to the lesion etiology, the patients were divided into atherosclerosis and dissection groups. The differences in clinical outcomes between the two groups were investigated, including favorable 90-day functional outcome (modified Rankin Scale score of 0-2), successful reperfusion (modified Thrombolysis in Cerebrovascular Infarction score of 2b-3), symptomatic intracranial hemorrhage, stroke-associated pneumonia, 90-day all-cause mortality, and average hospitalization days. Logistic regression analysis was used to adjust for potential confounders affecting functional outcomes in both groups, and to determine odds ratios and 95% confidence intervals. Results: Seventy-one patients were grouped into the atherosclerotic cause and 27 into the dissection cause cohorts. The rate of favorable 90-day functional outcome was 43.7% (31/71 cases) in the atherosclerosis group versus 55.6% (15/27 cases) in the dissection group (adjusted odds ratio=1.339; 95% confidence interval, 0.374-4.798; P=0.654). No significant differences were found in other clinical outcomes between the two groups (all P>0.05). Conclusion: The clinical prognosis of patients with tandem lesions caused by atherosclerotic stenosis or artery dissection was similar after endovascular therapy. Future studies are still needed to verify our results.

LNAPL migration processes based on time-lapse electrical resistivity tomography

Contamination from light non-aqueous phase liquids (LNAPLs) and their derivatives, arising from exploration, production, and transportation, has become a prevalent pollution source. This poses direct threats to human health. However, conventional investigative methods face limitations when applied to studying the extent and migration process of LNAPL contamination, as well as the redistribution of LNAPL during groundwater level fluctuations. Conventional methods lack the ability to rapidly, efficiently, and in real-time acquire information about contaminated areas. Therefore, this study utilizes time-lapse electrical resistivity tomography to investigate the migration mechanism of LNAPL under unsaturated conditions, constant groundwater levels, and groundwater level reductions. A relationship between resistivity and water and oil contents was established and used for inverse calculation of LNAPL content via resistivity inversion. Time-lapse electrical resistivity tomography revealed LNAPL migration in a "concave" shape across three conditions. Groundwater presence notably slowed migration, hindering downward movement and leading to a floating oil band. A robust mathematical model was established to derive the relationship between resistivity and water and oil contents. Finally, LNAPL distribution under unsaturated conditions was inversely obtained from resistivity data, showing highest content at the top leak point, obstructed area, and bottom of soil column. Consequently, time-lapse electrical resistivity tomography demonstrates a notable capacity to characterize the LNAPL migration process. This technique constitutes an effective geophysical method for monitoring and describing the characteristics of LNAPL migration. Its significance lies in enhancing our understanding of remediation for LNAPL-induced groundwater and land contamination.

Hepatitis D virus dual-infection among Chinese hepatitis B patient related to hepatitis B surface antigen, hepatitis B virus DNA and age

BACKGROUND

The screening practices for hepatitis D virus (HDV) are diverse and non-standardized worldwide, and the exact prevalence of HDV is uncertain.

AIM

To estimate HDV prevalence and investigate viral marker quantity trends in patients with hepatitis D.

METHODS

We collected 5594 serum samples from patients with hepatitis B in Jilin Province, China (3293 males and 2301 females, age range of 2 to 89 years). We then conducted tests for hepatitis B surface antigen (HBsAg), hepatitis B Virus (HBV) DNA, anti-hepatitis D antigen (HDAg), and HDV RNA.

RESULTS

We found that the prevalence of anti-HDAg and HDV RNA among hepatitis B patient were 3.6% (3.2-4.2%) and 1.2% (0.9-1.5%), respectively, 87.69% of hepatitis D patients were 51-70 years old. HDV infection screening positive rate of patients with HBV DNA levels below 2000 IU/mL (2.0%) was higher than those above 2000 IU/mL (0.2%). Among anti-HDAg positive patients, the HDV RNA positive rate was positively correlated with the HBsAg level and anti-HDAg level. There was a weak correlation between HBsAg and anti-HDAg levels among hepatitis D patients.

CONCLUSION

Our study highlights the importance of considering multiple factors when assessing the severity of HDV infection, comprehensive evaluation of patients' clinical and laboratory parameters is necessary for proper diagnosis and treatment.

Improving the tumor selectivity of T cell engagers by logic-gated dual tumor-targeting

Targeting single tumor antigens makes it difficult to provide sufficient tumor selectivity for T cell engagers (TCEs), leading to undesirable toxicity and even treatment failure, which is particularly serious in solid tumors. Here, we designed novel trispecific TCEs (TriTCEs) to improve the tumor selectivity of TCEs by logic-gated dual tumor-targeting. TriTCE can effectively redirect and activate T cells to kill tumor cells (~18 pM EC₅₀) by inducing the aggregation of dual tumor antigens, which was ~70- or 750- fold more effective than the single tumor-targeted isotype controls, respectively. Further in vivo experiments indicated that TriTCE has the ability to accumulate in tumor tissue and can induce circulating T cells to infiltrate into tumor sites. Hence, TriTCE showed a stronger tumor growth inhibition ability and significantly prolonged the survival time of the mice. Finally, we revealed that this concept of logic-gated dual tumor-targeted TriTCE can be applied to target different tumor antigens. Cumulatively, we reported novel dual tumor-targeted TriTCEs that can mediate a robust T cell response by simultaneous recognition of dual tumor antigens at the same cell surface. TriTCEs allow better selective T cell activity on tumor cells, resulting in safer TCE treatment.

Multidimensional evaluation of teaching strategies for pharmacology based on a comprehensive analysis involving 21,269 students

Background: Given the limitations of traditional pharmacology pedagogical method, diverse novel teaching methods have been widely explored. In this study, we performed a network meta-analysis (NMA) to evaluate the effects of different strategies in pharmacology education.

Methods: Literature databases were searched from their inception to November 2022, and the studies were screened according to predefined inclusion and exclusion criteria to extract important information. Outcomes, including theoretical test scores, experimental test scores, subjective test scores, satisfaction scores, and the proportion of satisfaction, were analyzed using R software (version 3.6.1) and STATA (version 15). The NMA was conducted with a random-effects model under the Bayesian framework to calculate odds ratios (ORs) or mean differences (MDs) with associated 95% credible intervals (95% CIs). Surface under the cumulative ranking curve (SUCRA) probability values were calculated to rank the teaching methods examined.

Results: A total of 150 studies involving 21,269 students were included. This NMA systematically evaluated 24 teaching strategies, such as problem-based learning (PBL), team-based learning (TBL), case-based learning (CBL) and flipped classrooms (FC), etc., The results of the NMA showed that, PBL combined with CBL was most likely to improve students’ theoretical and subjective test scores (SUCRA = 75.49 and 98.19%, respectively), TBL was most likely to improve the experimental test score (SUCRA = 92.38%) and the satisfaction score (SUCRA = 88.37%), while FC had the highest probability of being the best option for improving the proportion of satisfaction (SUCRA = 84.45%).

Conclusion: The current evidence indicates that TBL, PBL combined with CBL, and FC might be optimal strategies for pharmacology education since they have a more beneficial effect on students.

Epidemiological characteristics of imported acute infectious diseases in Guangzhou, China, 2005-2019

BACKGROUND

The global spread of infectious diseases is currently a prominent threat to public health, with the accelerating pace of globalization and frequent international personnel intercourse. The present study examined the epidemiological characteristics of overseas imported cases of acute infectious diseases in Guangzhou, China.

METHODS

We retrospectively investigated the distribution of diseases, demographic characteristics, and temporal and spatial variations of imported cases of acute infectious diseases in Guangzhou based on the surveillance data of notifiable infectious diseases from 2005 to 2019, provided by Guangzhou center for Disease Control and Prevention. The Cochran-Armitage trend test was applied to examine the trend in the number of imported cases over time.

RESULTS

A total of 1,025 overseas imported cases of acute infectious diseases were identified during the study period. The top three diseases were dengue (67.12%), malaria (12.39%), and influenza A (H1N1) pdm09 (4.10%). Imported cases were predominantly males, with a sex ratio of 2.6: 1 and 75.22% of the cases were those aged 20-49 years. Businessmen, workers, students and unemployed persons accounted for a large proportion of the cases (68.49%) and many of the cases came from Southeast Asia (59.02%). The number of imported cases of acute infectious diseases increased during the study period and hit 318 in 2019. A clear seasonal pattern was observed in the number of imported cases with a peak period between June and November. Imported cases were reported in all of the 11 districts in Guangzhou and the central districts were more seriously affected compared with other districts.

CONCLUSIONS

The burden of dengue imported from overseas was substantial and increasing in Guangzhou, China, with the peak period from June to November. Dengue was the most common imported disease. Most imported cases were males aged 20-49 years and businessmen. Further efforts, such as strengthening surveillance of imported cases, paying close attention to the epidemics in hotspots, and improving the ability to detect the imported cases from overseas, are warranted to control infectious diseases especially in the center of the city with a higher population density highly affected by imported cases.

Fermentation of rose residue by Lactiplantibacillus plantarum B7 and Bacillus subtilis natto promotes polyphenol content and beneficial bioactivity

The present study evaluated the effect of fermentation with Lactiplantibacillus plantarum B7 and Bacillus subtilis natto on phenolic compound levels and enzyme activity, as well as antioxidant capacity of the rose residue. Results showed that the polyphenol content of rose residue was significantly increased from 16.37 ± 1.51 mg/100 mL to 41.02 ± 1.68 mg/100 mL by fermentation at 37 °C and 2.0% (v/v) inoculum size for 40 h. The flavone, soluble dietary, and protein contents were also enhanced by almost 1-fold, 3-fold, and 1-fold, respectively. Fifteen phenolic compounds were quantified in the fermented broth, among which the concentration of gallic acid, quercetin, and p-coumaric acid increased by 5-fold, 4-fold, and almost 8-fold, respectively. Chlorogenic acid was a new phenolic compound produced during fermentation. Moreover, the fermented rose residue presented higher superoxide dismutase, α-amylase, and protease activity. ABTS^•+, hydroxylradical, and DPPH^• scavenging activity increased by 60.93%, 57.70%, and 37.00%, respectively. This provides an effective means of transforming rose residue into a highly bioactive value-added substance.

Lasers and Intense Pulsed Light for the Treatment of Pathological Scars: A Network Meta-Analysis

BACKGROUND

Laser and intense pulsed light (IPL) therapies have shown promising effects on pathological scars, but the comparative effectiveness of laser and IPL therapies has not yet been studied.

OBJECTIVES

The aim of this study was to compare and rank the efficacy of laser and IPL therapies to determine the most effective treatment method for pathological scars.

METHODS

Relevant studies published up to February 2022 were identified by searching PubMed, Web of Science, Cochrane Library, CNKI, and Wanfang databases. We defined Vancouver Scar Scale score as the primary outcome. Both frequentist and Bayesian approaches were used to perform a network meta-analysis.

RESULTS

We included 25 trials with a total of 1688 participants. The rankings based on the surface under the cumulative ranking curve for the Vancouver Scar Scale score based on the Bayesian approach suggested IPL + CO2 (96.43%) > pulsed dye laser (PDL) + 1064-nm Nd:YAG (yttrium aluminum garnet) laser (86.21%) > PDL + CO2 (82.15%) > CO2 (58.97%) > 1064-nm Nd:YAG (57.03%) > PDL (52%) > 532-nm Nd:YAG (33.28%) > Er:YAG + IPL (28.38%) > Er:YAG (26.56%) > IPL (15.03%) > control (13.97%). The ranking results based on the frequentist approach were basically consistent with those based on the Bayesian approach.

CONCLUSIONS

The results of the network meta-analysis showed that the combination of IPL and CO2 laser has the highest probability of being the most effective intervention. However, our conclusions must be interpreted with caution due to the relatively few evaluation indicators included in our study. Future well-designed randomized controlled trials with large sample sizes are required to confirm our conclusions.

LEVEL OF EVIDENCE: 4

Montreal cognitive assessment (MoCA) is highly correlated with 1-year mortality in hip fracture patients

Prevalence of cognitive impairment in hip fractures was 86.5%. MoCA is an independent risk factor of mortality. MoCA score of < 15 is correlated with 11.71 times increased risk of mortality. Early attention and caution should be given to these patients for appropriate intervention to decrease mortality rates.

INTRODUCTION

Hip fractures rank amongst the top 10 causes of disability and current mortality of hip fractures is high. Objectives were to determine 1) prevalence of cognitive impairment, 2) whether Montreal Cognitive Assessment (MoCA) score was an independent risk factor associated with mortality, 3) MoCA cut-off that result in high risk of mortality.

METHODS

This was a cohort study between July 2019 to June 2020. Inclusion criteria were 1) hip fracture, 2) >  = 65 years old, and 3) low-energy trauma. Patients undergo assessment for cognitive impairment with MoCA. Prevalence was assessed, MoCA cut-off point, and accuracy of statistical model was evaluated. Logistic regression modelling was used to assess association between mortality and MoCA.

RESULTS

There were 260 patients recruited. Two hundred twenty-five patients had MoCA score < 22 signifying cognitive impairment, and 202 patients had MoCA score of < 19. 46 hip fracture patients died at 1-year follow-up. 45 of these patients had MoCA score < 19, and 1 patient had a MoCA > 22. Results showed statistical significance and good model effect (at least 0.8) with MoCA cut-off points between < 15 and < 19 (p < 0.05). After controlling confounding factors, statistical significance still existed in MoCA cut-off point at < 15 (odds ratio (95% CI) = 11.71 (1.14, 120.71); p = 0.04).

CONCLUSION

Prevalence of cognitive impairment in hip fractures was 86.5%. MoCA is an independent risk factor of mortality in hip fracture patients. MoCA score of < 15 is correlated with 11.71 times increased risk of mortality at 1-year after a hip fracture. AUC with MoCA score < 15 was 0.948. Early attention and caution should be given to these patients for appropriate intervention to decrease mortality rates.

Associations of Physical Activity with Alzheimer’s Disease Pathologies and Cognition: The CABLE Study

Background: The associations of physical activity with Alzheimer’s disease (AD) pathologies remain controversial. Objective: To quantitatively assess the association between the frequency of physical activity with cerebrospinal fluid (CSF) biomarkers in AD and further explore the mechanism by which AD pathologies regulate the correlation between physical activity and cognition. Methods: A total of 918 participants without dementia from Chinese Alzheimer’s Biomarker and Lifestyle (CABLE) were examined in this population-based cross-sectional study. Multiple linear models were used to evaluate the associations of physical activity with CSF biomarkers and cognition. Moreover, mediation analyses were conducted to investigate the potential relationships between physical activity, AD pathologies, and cognitive function. Results: Regular physical activity was positively associated with CSF Aβ 42 (p <  0.001) and Aβ 42/40 (p <  0.001), while it was negatively associated with p-tau/Aβ 42 (p <  0.001) and t-tau/Aβ 42 (p <  0.001). Of all participants, regular physical activity was associated with increased cognitive function (p <  0.001). The interaction effect indicated that age moderated the association between physical activity frequency and CSF Aβ 42 (p = 0.014) and p-tau/Aβ 42 (p = 0.041). The impact of physical activity on cognition was mediated in part by amyloid pathologies, accounting for 4.87% to 21.56% of the total effect (p <  0.05). Conclusion: This study showed the beneficial impact of physical activity on AD pathologies and cognition in participants without dementia.

Complete Chloroplast Genome Sequence of Triosteum sinuatum, Insights into Comparative Chloroplast Genomics, Divergence Time Estimation and Phylogenetic Relationships among Dipsacales

Triosteum himalayanum, Triosteum pinnatifidum (Triosteum L., Caprifoliaceae, Dipsacales) are widely distributed in China while Triosteum sinuatum mainly occurrs in northeast China. Few reports have been determined on the genus Triosteum. In the present research, we sequenced 2 chloroplast genomes of Triosteum and analyzed 18 chloroplast genomes, trying to explore the sequence variations and phylogeny of genus Triosteum in the order Dipsacales. The chloroplast genomes of the genus Triosteum ranged from 154,579 bp to 157,178 bp, consisting of 132 genes (86 protein-coding genes, 38 transfer RNA genes, and 8 ribosomal RNA genes). Comparative analyses and phylogenetic analysis supported the division of Dipsacales into two clades, Adoxaceae and six other families. Among the six families, a clade of Valerianaceae+Dipsacaceae was recovered as a sister to a clade of Morinaceae+Linnaeaceae. A closer relationship of T. himalayanum and T. pinnatifidum among three species was revealed. Our research supported that Loniceraferdinandi and Triosteum was closely related. Zabelia had a closer relationship with Linnaea borealis and Dipelta than Morinaceae. The divergence between T. sinuatum and two other species in Triosteum was dated to 13.4 mya.

[Analysis on epidemiological characteristics of dengue fever and E gene evolution of dengue virus in Guangzhou, 2020]

Objective: To assess the incidence of dengue fever and E gene evolution of dengue virus in Guangzhou in 2020 and understand the local epidemiological characteristics of dengue fever and spreading of dengue virus. Methods: The information of dengue fever cases in Guangzhou in 2020 was collected from Notifiable Infectious Disease System of Chinese Center for Disease Control and Prevention Information System. Serum samples from the cases were detected by real-time PCR. The E gene was sequenced and analyzed. Maximum likelihood phylogenetic trees were constructed using software MEGA 5.05. The statistical analysis was conducted using software SPSS 20.0. Results: A total of 33 dengue fever cases were reported in Guangzhou in 2020, including 31 (93.94%) imported cases and 2 (6.06%) local cases. Compared with the data during 2016 to 2019, the number of cases, overall incidence and local incidence all decreased with statistically significant differences (all P<0.05). The imported cases from Southeast Asia constituted 90.32% (28/31) of imported cases. The E gene sequences and the phylogenetic trees of imported and local cases demonstrated close relationship with the virus sequences from Southeast Asian, and they were less homologous with the sequences of dengue virus isolated in Guangzhou in previous years. Conclusions: The incidence of dengue in Guangzhou in 2020 was significantly affected by the imported cases, especially those from Southeast Asian countries. The study result demonstrated that dengue fever was not endemic in Guangzhou and it was caused by imported ones.

Transmission and containment of the SARS-CoV-2 Delta variant of concern in Guangzhou, China: A population-based study

BACKGROUND

The first community transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant of concern (VOC) in Guangzhou, China occurred between May and June 2021. Herein, we describe the epidemiological characteristics of this outbreak and evaluate the implemented containment measures against this outbreak.

METHODOLOGY/PRINCIPAL FINDINGS

Guangzhou Center for Disease Control and Prevention provided the data on SARS-CoV-2 infections reported between 21 May and 24 June 2021. We estimated the incubation period distribution by fitting a gamma distribution to the data, while the serial interval distribution was estimated by fitting a normal distribution. The instantaneous effective reproductive number (Rt) was estimated to reflect the transmissibility of SARS-CoV-2. Clinical severity was compared for cases with different vaccination statuses using an ordinal regression model after controlling for age. Of the reported local cases, 7/153 (4.6%) were asymptomatic. The median incubation period was 6.02 (95% confidence interval [CI]: 5.42-6.71) days and the means of serial intervals decreased from 5.19 (95% CI: 4.29-6.11) to 3.78 (95% CI: 2.74-4.81) days. The incubation period increased with age (P<0.001). A hierarchical prevention and control strategy against COVID-19 was implemented in Guangzhou, with Rt decreasing from 6.83 (95% credible interval [CrI]: 3.98-10.44) for the 7-day time window ending on 27 May 2021 to below 1 for the time window ending on 8 June and thereafter. Individuals with partial or full vaccination schedules with BBIBP-CorV or CoronaVac accounted for 15.3% of the COVID-19 cases. Clinical symptoms were milder in partially or fully vaccinated cases than in unvaccinated cases (odds ratio [OR] = 0.26 [95% CI: 0.07-0.94]).

CONCLUSIONS/SIGNIFICANCE

The hierarchical prevention and control strategy against COVID-19 in Guangzhou was timely and effective. Authorised inactivated vaccines are likely to contribute to reducing the probability of developing severe disease. Our findings have important implications for the containment of COVID-19.

[Epidemiological characteristics of three local epidemics of COVID-19 in Guangzhou]

Objective: To understand the epidemiological characteristics of three local COVID-19 epidemics in Guangzhou and provide reference for optimizing strategies and measures of COVID-19 prevention and control. Methods: The data of local COVID-19 cases in Guangzhou reported as of June 18, 2021 were collected from National Notifiable Disease Report System of China. The software Excel 2019 and SPSS 22.0 were applied for data cleaning and statistical analysis. Results: A total of 726 COVID-19 cases were reported in the three local epidemics in Guangzhou. In the epidemic associated with the outbreak of COVID-19 in Hubei province, 366 cases were reported. Most cases were female (51.6%, 189/366), aged 18-65 years (81.4%, 298/366), jobless/unemployed (32.2%, 118/366) and retired persons (20.2%,74/366). The initial symptoms of most cases were fever (71.6%, 250/349) and cough (60.7%, 212/349). In the epidemic associated with the imported COVID-19 cases from Africa, 207 cases were reported. Most cases were aged 18-40 years (72.9%, 151/207), male (69.6%, 144/207), and engaged in commercial services (62.3%,129/207). The initial symptoms of most cases were no obvious discomfort (55.6%, 15/27) and cough (37.0%, 10/27). In the epidemic associated with Delta variant of SARS-CoV-2, 153 cases were reported, in which women accounted for 58.8% (90/153), most cases were over 41 years old (64.7%,99/153), and retired persons accounted for the highest proportion (32.0%,49/153). The initial symptoms of most cases were cough (32.9%, 48/146) and no obvious discomfort (28.1%, 41/146). The household secondary attack rates of the three local epidemics were 11.2%, 5.7% and 11.5%, respectively. The median (P₂₅, P₇₅) of incubation periods were 6.5 (4.0,10.8) d, 4.0 (2.5, 6.0) d and 4.0 (3.0,5.0) d. The serial intervals median (P₂₅, P₇₅) were 4.0 (3.0, 8.0) d, 4.0 (2.5, 6.0) d and 3.0 (2.0,5.0) d. There were significant differences in gender, age, occupation, initial symptoms, household secondary attack rate and incubation period among the three local COVID-19 epidemics (all P<0.05). In the proportion of the case finding way, passive detection in patient treatment were mainly 44.3%(162/366) in the epidemic associated with the outbreak of COVID-19 in Hubei province,but active community case screening [58.5% (121/207) and 27.5% (24/153)] and close contact management in imported case were mostly [33.3% (69/207) and 67.3% (103/153)] in the epidemic associated with the imported COVID-19 cases from Africa and with Delta variant of SARS-CoV-2, respectively. Conclusions: Due to the different sources of infection, strain types and prevention and control strategies, the epidemiological characteristics of the three local COVID-19 epidemics in Guangzhou differed in demographics, clinical symptoms, transmission routes and case finding, which suggested that it is necessary to improve the key population and common symptom monitoring in the routine prevention and control of COVID-19 to prevent the reemerge of the epidemic.

Chinese Patent Medicine Liuweiwuling Tablet had Potent Inhibitory Effects on Both Wild-Type and Entecavir-Resistant Hepatitis B Virus (HBV) in vitro and Effectively Suppressed HBV Replication in Mouse Model

Liuweiwuling Tablet (LWWL) is a licensed Chinese patent medicine (approval number: Z20060238) included in the national health insurance for anti-inflammation of chronic HBV infection, whereas its anti-HBV effect remains clarification. The study aimed to clarify its antiviral effect and related mechanisms. HepG2.2.15 cells (wild-type HBV-replicating cells) and HepG2. A64 cells (entecavir-resistant HBV-replicating cells) were used for in vitro test. Hydrodynamic injection-mediated HBV-replicating mouse model was used for in vivo test. Active compounds and related mechanisms for antiviral effect of LWWL were analyzed using network pharmacology and transcriptomics. The inhibition rates of LWWL (0.8 mg/ml) on HBV DNA, HBsAg, and pgRNA were 57.06, 38.55, and 62.49% in HepG2.2.15 cells, and 51.57, 17.57, and 53.88% in HepG2. A64 cells, respectively. LWWL (2 g kg^-1 d^-1 for 4 weeks)-treated mice had 1.16 log₁₀ IU/mL decrease of serum HBV DNA, and more than 50% decrease of serum HBsAg/HBeAg and hepatic HBsAg/HBcAg. Compared to tenofovir control, LWWL was less effective in suppressing HBV DNA but more effective in suppressing HBV antigens. Thirteen differentially-expressed genes were found in relation to HBV-host interaction and some of them were enriched in interferon (IFN)-β pathway in LWWL-treated HepG2.2.15 cells. CD3⁺CD4⁺ T-cell frequency and serum IFN-γ were significantly increased in LWWL-treated mice compared to LWWL-untreated mice. Among 26 compounds with potential anti-HBV effects that were predicted by network pharmacology, four compounds (quercetin, luteolin, wogonin, and kaempferol) were experimentally confirmed to have antiviral potency. In conclusion, LWWL had potent inhibitory effect on both wild-type and entecavir-resistant HBV, which might be associated with increasing IFN-β and IFN-γ production.

[Research Progress on Metabolite Identification of Synthetic Cannabinoid New Psychoactive Substances]

Abstract

Synthetic cannabinoids are currently a class of new psychoactive substances with the largest variety and most abused. Metabolite identification research can provide basic data for monitoring synthetic cannabinoids abuse, which is the current research hotspot. The main trend of structural modification of synthetic cannabinoid is to replace the fluorine atom on pentyl indole or indazole cyclopentyl with hydrogen atom, which greatly improves the biological activity of the compound. The main metabolic reactions include hydroxylation, fluoropentyl oxidative, ester hydrolyze, amide hydrolysis. Liquid chromatography-high resolution mass spectrometry has become the preferred choice for the structural identification of metabolites. This review mainly summarizes research on metabolism software prediction and human hepatocyte model, human liver microsomes model, rat in vivo model, zebrafish model and fungus C. elegans model in metabolite identification based on the structure and classification of synthetic cannabinoids.

Effectiveness of inactivated SARS-CoV-2 vaccines against the Delta variant infection in Guangzhou: a test-negative case-control real-world study

The effectiveness of inactivated SARS-CoV-2 vaccines against the Delta variant, which has been associated with greater transmissibility and virulence, remains unclear. We conducted a test-negative case–control study to explore the vaccine effectiveness (VE) in real-world settings. We recruited participants aged 18–59 years who consisted of SARS-CoV-2 test-positive cases (n = 74) and test-negative controls (n = 292) during the outbreak of the Delta variant in May 2021 in Guangzhou city, China. Vaccination status was compared to estimate The VE of SARS-CoV-2 inactivated vaccines. A single dose of inactivated SARS-CoV-2 vaccine yielded the VE of only 13.8%. After adjusting for age and sex, the overall VE for two-dose vaccination was 59.0% (95% confidence interval: 16.0% to 81.6%) against coronavirus disease 2019 (COVID-19) and 70.2% (95% confidence interval: 29.6–89.3%) against moderate COVID-19 and 100% against severe COVID-19 which might be overestimated due to the small sample size. The VE of two-dose vaccination against COVID-19 reached 72.5% among participants aged 40–59 years, and was higher in females than in males against COVID-19 and moderate diseases. While single dose vaccination was not sufficiently protective, the two-dose dosing scheme of the inactivated vaccines was effective against the Delta variant infection in real-world settings, with the estimated efficacy exceeding the World Health Organization minimal threshold of 50%.

Effect of Physician-Pharmacist Participation in the Management of Ambulatory Cancer Pain Through a Digital Health Platform: Randomized Controlled Trial

Background

Self-management of ambulatory cancer pain is full of challenges. Motivated by the need for better pain management, we developed a WeChat-supported platform, Medication Housekeeper (MediHK), to enhance communication, optimize outcomes, and promote self-management in the home setting.

Objective

We conducted a randomized controlled trial to assess whether the joint physician-pharmacist team through MediHK would provide better self-management of ambulatory patients with cancer pain.

Methods

Patients were randomly assigned to either an intervention group or control group. During the 4-week study period, the pharmacist would send 24-hour pain diaries daily, adverse drug reaction (ADR) forms every 3 days, and the Brief Pain Inventory form every 15 days to patients in the intervention group via MediHK. If a patient needed a change in drug/dosage or treatment of an ADR after the comprehensive review, the pharmacist would propose pharmacological interventions to the attending physician, who was then responsible for prescribing or adjusting pain medications. If no adjustments were needed, the pharmacist provided appropriate targeted education based on knowledge deficits. Patients in the control group received conventional care and did not receive reminders to fill out the forms. However, if the control group patients filled out a form via MediHK, the pain management team would review and respond in the same way as for the intervention group. The primary outcomes included pain intensity and pain interference in daily life. Secondary outcomes included patient-reported outcome measures, medication adherence, ADRs, and rehospitalization rates.

Results

A total of 100 patients were included, with 51 (51%) in the intervention group and 49 (49%) in the control group. The worst pain scores, least pain scores, and average pain scores in the intervention group and the control group were statistically different, with median values of 4 (IQR 3-7) vs 7 (IQR 6-8; P=.001), 1 (IQR 0-2) vs 2 (IQR 1-3; P=.02), and 2 (IQR 2-4) vs 4 (IQR 3-5; P=.001), respectively, at the end of the study. The pain interference on patients' general activity, mood, relationships with others, and interests was reduced, but the difference was not statistically significant compared with the control group (Ps=.10-.76). The medication adherence rate increased from 43% to 63% in the intervention group, compared with an increase of 33% to 51% in the control group (P<.001). The overall number of ADRs increased at 4 weeks, and more ADRs were monitored in the intervention group (P=.003). Rehospitalization rates were similar between the 2 groups.

Conclusions

The joint physician-pharmacist team operating through MediHK improved pain management. This study supports the feasibility of integrating the internet into the self-management of cancer pain.

Trial Registration

Chinese Clinical Trial Registry ChiCTR1900023075; https://www.chictr.org.cn/showproj.aspx?proj=36901

Soluble Expression of Fc-Fused T Cell Receptors Allows Yielding Novel Bispecific T Cell Engagers

The specific recognition of T cell receptors (TCR) and peptides presented by human leukocyte antigens (pHLAs) is the core step for T cell triggering to execute anti-tumor activity. However, TCR assembly and soluble expression are challenging, which precludes the broad use of TCR in tumor therapy. Herein, we used heterodimeric Fc to assist in the correct assembly of TCRs to achieve the stable and soluble expression of several TCRs in mammalian cells, and the soluble TCRs enable us to yield novel bispecific T cell engagers (TCR/aCD3) through pairing them with an anti-CD3 antibody. The NY-ESO-1/LAGE-1 targeted TCR/aCD3 (NY-TCR/aCD3) that we generated can redirect naïve T cells to specific lysis antigen-positive tumor cells, but the potency of the NY-TCR/aCD3 was disappointing. Furthermore, we found that the activation of T cells by NY-TCR/aCD3 was mild and unabiding, and the activity of NY-TCR/aCD3 could be significantly improved when we replaced naïve T cells with pre-activated T cells. Therefore, we employed the robust T cell activation ability of staphylococcal enterotoxin C2 (SEC2) to optimize the activity of NY-TCR/aCD3. Moreover, we found that the secretions of SEC2-activated T cells can promote HLA-I expression and thus increase target levels, which may further contribute to improving the activity of NY-TCR/aCD3. Our study described novel strategies for soluble TCR expression, and the optimization of the generation and potency of TCR/aCD3 provided a representative for us to fully exploit TCRs for the precision targeting of cancers.

Influencing factors of end-of-dose failure in patients with cancer pain after oral oxycodone sustained-release tablets: a retrospective, case-control study

OBJECTIVE

Comparing the characteristics of end-of-dose failure patients and non-end-of-dose failure patients in the Chinese population and exploring the factors that may affect the occurrence of end-of-dose failure in cancer pain patients.

METHODS

The outpatient with cancer pain from 2016 to 2019 were collected through hospital information system, and patients were included who met the following criteria: patients with the average numerical rating scale  ≥4 points within 3 days after taking the oxycodone sustained-release preparation, titrated to an effective therapeutic dose suitable for patients, had at least two clinical visits information of the patient with a minimum of ≥3 days between visits, the average numerical rating scale of the next visit after the treatment of occasional pain is ≥4, and were divided into end-of-dose failure group and non-end-of-dose failure group.

RESULTS

Age (P < 0.05, odds ratio 0.933), diagnosis of nasopharyngeal carcinoma (P < 0.05, odds ratio 0.009), pain site is the head and neck (P < 0.05, odds ratio 0.005) and the abdomen (P < 0.01, odds ratio 0.021), and the metastatic site is the liver (P < 0.05, odds ratio 0.001) are related to the occurrence of end-of-dose failure.

CONCLUSIONS

Younger patients are more likely to develop end-of-dose failure. Patients diagnosed with nasopharyngeal cancer, with pain in the head and neck and abdomen, and with liver metastases have a lower incidence of end-of-dose failure.

[Spatial autocorrelation of dengue cases and molecular biological characteristics of envelope gene of dengue virus in Guangzhou, 2019]

Objective: Analyze epidemiological situation of dengue fever,and survey impacts of four serotypes dengue viruses in Guangzhou, 2019. Methods: Information of patients was collected in Notifiable Infectious Disease Report System (NIDRS). Spatial autocorrelation of dengue cases was evaluated using ArcGIS version 10.2. Serum samples were tested by real-time PCR. Virus strains were isolated from positive sera. Then E gene was sequenced. Phylogenetic trees were including PhyMLsoftwarev 3.1. Results: A total of 1 655 dengue cases, consisted of 1 382 local cases and 273 imported cases, was confirmed in 2019. The incidence was 11.10 per 100 000 dengue cases were autocorrelated in Guangzhou. There were 18 high-high clusters. Most of the imported dengue cases were imported from Southeast Asian countries (86.08%,235/273) and African countries (2.56%,7/273). Of 749 serum samples detected by real-time PCR, the positive rate was 93.06% (697/749). Four hundred and sixty-four dengue virus strains had been isolated in 2019. Compared with data from the genotype tree of the former years, no genotype shift was discovered. Serotype 1 was still predominant. Serotype 2 was the significant strain in Baiyun district and Liwan district. Conclusions: Dengue fever was spreading all over Guangzhou in 2019. The suburban areas, which played a more critical role in causing the spread and outbreak of dengue fever, should be given more prominence. Inspection at ports should be enforced to prevent importing cases from African countries and Southeast Asian countries. The risk of serotype 2 cannot be overlooked. Four serotypes dengue viruses prevailed simultaneously in Guangzhou, which warns us to take precaution of severe dengue outbreaks.

Characterization and Engineering of Pseudomonas chlororaphis LX24 with High Production of 2-Hydroxyphenazine

The take-all disease of wheat is one of the most serious diseases in the field of food security in the world. There is no effective biological pesticide to prevent the take-all disease of wheat. 2-Hydroxyphenazine (2-OH-PHZ) was reported to possess a better inhibitory effect on the take-all disease of wheat than phenazine-1-carboxylic acid, which was registered as "Shenqinmycin" in China in 2011. The aim of this study was to construct a 2-OH-PHZ high-producing strain by strain screening, genome sequencing, genetic engineering, and fermentation optimization. First, the metabolites of the previously screened new phenazine-producing Pseudomonas sp. strain were identified, and the taxonomic status of the new Pseudomonas sp. strain was confirmed through 16S rRNA and matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS). Then, the new Pseudomonas sp. strain was named Pseudomonas chlororaphis subsp. aurantiaca LX24, which is a new subspecies of P. chlororaphis that can synthesize 2-OH-PHZ. Next, the draft genome of strain LX24 was determined, and clusters of orthologous group (COG) analysis, KEGG analysis, and gene ontology (GO) analysis of strain LX24 were performed. Furthermore, the production of 2-OH-PHZ increased to 351.7 from 158.6 mg/L by deletion of the phenazine synthesis negative regulatory genes rpeA and rsmE in strain LX24. Finally, the 2-OH-PHZ production of strain LX24 reached 677.1 mg/L after fermentation optimization, which is the highest production through microbial fermentation reported to date. This work provides a reference for the efficient production of other pesticides and antibiotics.

Damage control strategies in gallbladder-preserving cholecystolithotomy: from incision to channel establishment to non-invasive procedure

Damage control strategies for cholecystolithotomy are summarized as incision–suture technique, puncture and channel establishment method, and physiological duct-directed approach. Cultural influence, medical assessment, complications, recurrences, and further direction for cholecystolithotomy are involved.

[Clinical application of single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation]

Objective: To examine the clinical application value of single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation in the treatment of early breast cancer. Methods: From February 2014 to July 2019, the clinic-pathological data of 34 early breast cancer patients received single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation at Department of General Surgery, Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed and followed up. All the patients were female, with an age of 46(11) years (M(Q_R)) (range: 26 to 64 years). The radical cure degree of operation, cosmetic effect after operation were evaluated. The satisfaction to operation and personal quality of life after operation was accessed by BREAST-Q scale. Results: All surgical procedures were successfully completed. The operation time was (313.4±11.7) minutes (range: 200 to 485 minutes). The blooding-liquid was (33.8±3.3) ml (range: 10 to 100 ml). There were 5 cases (14.7%) of nipple areola necrosis after operation, of which 1 patient received taking the prosthesis out because of prosthesis exposure. There was no capsular contracture or postoperative bleeding case. The follow-up time was 35(17) months (range: 12 to 77 months), and there was one case suffering local recurrence and metastasis, and another suffering metastasis. The scores of postoperative breast satisfaction, psychosocial status, chest wall status and sexual health were 78.32±2.57 (range: 55 to 100), 89.12±2.30 (range: 82 to 100), 91.47±1.33 (range: 43 to 100), and 78.50±2.68 (range: 39 to 100). Conclusion: Single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation in the treatment of early breast cancer can achieve provided curative and cosmetic effect on patients with breast cancer, with good patients' postoperative quality of life and satisfaction.

Supplementation with Yucca schidigera improves antioxidant capability and immune function and decreases fecal score of dairy calves before weaning

Yucca schidigera (YS) is a species of plant rich in antimicrobials, antioxidants, and immunomodulators. It has been used as feed additive to improve animal performance and decrease methane emissions in cattle. However, few studies have evaluated YS in dairy calves. In this study, we evaluated the effects of YS on the growth performance, antioxidant capacity, and immune function in dairy calves before weaning. We randomly assigned 40 newborn female Holstein calves (4 d old; 40 ± 5 kg of body weight) to 1 of 4 treatments (n = 10 per treatment), which were fed 0, 3, 6, or 9 g/d of YS powder. The YS allowance was mixed into milk or milk replacer and fed twice daily. Dry matter intake (both liquid and starter feed) and fecal score were recorded daily, and body weight, withers height, body length, and heart girth were measured at 4, 14, 28, 42, and 60 d of age. Blood was sampled from the jugular vein at 14, 42, and 60 d of age after the afternoon feeding for analysis of serum antioxidant capacity and immune function. Feeding YS did not affect dry matter intake, but decreased the feed-to-gain ratio with a quadratic dose effect. Over the whole study period, the average daily gain tended to linearly increase with the increasing YS doses, and it was 6.8% higher in diets supplemented with 9 g/d of YS than in the basal control diet without YS. The YS supplementation linearly decreased fecal score in a dose-dependent manner, and the frequency of diarrhea was significantly decreased as the YS supplementation increased throughout the whole study period. The YS supplementation also linearly decreased maleic dialdehyde concentration in the serum compared with the control group. The activity of catalase tended to linearly and quadratically increase, and that of glutathione peroxidase increased linearly with the increased YS supplementation. Serum concentrations of IgA and IgG increased linearly with the increased YS supplementation, and that of IgG tended to increase quadratically. To the best of our knowledge, this is the first study that demonstrated that feeding YS to young calves could improve growth, feed efficiency, and immunity, and decrease fecal score and diarrhea. The results of this study indicated that feeding YS at 9 g/d may be recommended to benefit dairy calves before weaning.

Ultrahigh-strength and ductile superlattice alloys with nanoscale disordered interfaces

Alloys that have high strengths at high temperatures are crucial for a variety of important industries including aerospace. Alloys with ordered superlattice structures are attractive for this purpose but generally suffer from poor ductility and rapid grain coarsening. We discovered that nanoscale disordered interfaces can effectively overcome these problems. Interfacial disordering is driven by multielement cosegregation that creates a distinctive nanolayer between adjacent micrometer-scale superlattice grains. This nanolayer acts as a sustainable ductilizing source, which prevents brittle intergranular fractures by enhancing dislocation mobilities. Our superlattice materials have ultrahigh strengths of 1.6 gigapascals with tensile ductilities of 25% at ambient temperature. Simultaneously, we achieved negligible grain coarsening with exceptional softening resistance at elevated temperatures. Designing similar nanolayers may open a pathway for further optimization of alloy properties.

The effectiveness of early start of Grade III response to dengue in Guangzhou, China: A population-based interrupted time-series study

In 2019, dengue incidences increased dramatically in many countries. However, the prospective growth in dengue incidence did not occur in Guangzhou, China. We examined the effectiveness of early start of Grade III response to dengue in Guangzhou. We extracted the data on daily number of dengue cases during 2017–2019 in Guangzhou and weekly data for Foshan and Zhongshan from the China National Notifiable Disease Reporting System, while the data on weekly number of positive ovitraps for adult and larval Aedes albopictus were obtained from Guangzhou Center for Disease Control and Prevention. We estimated the number of dengue cases prevented by bringing forward the starting time of Grade III response from September in 2017–2018 to August in 2019 in Guangzhou using a quasi-Poisson regression model and applied the Baron and Kenny’s approach to explore whether mosquito vector density was a mediator of the protective benefit. In Guangzhou, early start of Grade III response was associated with a decline in dengue incidence (relative risk [RR]: 0.54, 95% confidence interval [CI]: 0.43–0.70), with 987 (95% CI: 521–1,593) cases averted in 2019. The rate of positive ovitraps also significantly declined (RR: 0.64, 95% CI: 0.53–0.77). Moreover, both mosquito vector density and early start of Grade III response was significantly associated with dengue incidence after adjustment for each other. By comparing with the incidence in Foshan and Zhongshan where the Grade III response has not been taken, benefits from the response starting in August were confirmed but not if starting from September. Early start of Grade III response has effectively mitigated the dengue burden in Guangzhou, China, which might be partially through reducing the mosquito vector density. Our findings have important public health implications for development and implementation of dengue control interventions for Guangzhou and other locations with dengue epidemics.

There is a lack of data on comparing the observed dengue incidences under the real-world scenarios that interventions commenced at different times. In 2019, WHO scaled up the response to dengue due to the escalation of outbreaks occurring in many countries. In the same year, local government in Guangzhou started the Grade III response to dengue one month ahead in August. It is uncertain the degree to which the early intervention mitigated dengue burden. Our study examined the effectiveness of early start of Grade III response in Guangzhou using a quasi-Poisson regression model by comparing the dengue incidence with early start of Grade III response and that under the counterfactual scenario that the Grade III response began in September as in 2017 and 2018. We estimated that 987 dengue cases were averted due to the early start of Grade III response, which were equivalent to 71.4% of the total number of local dengue cases in 2019. Early start of Grade III response reduced the dengue burden, which might be partially through controlling the mosquito vector density. Dengue intervention strategies applied in Guangzhou could provide experience on how to effectively prevent and control dengue for other locations with dengue epidemics.

Aspirin protects human coronary artery endothelial cells by inducing autophagy

Although the use of aspirin has substantially reduced the risks of cardiovascular events and death, its potential mechanisms have not been fully elucidated. In a previous study, we found that aspirin triggers cellular autophagy. In the present study, we aimed to determine the protective effects of aspirin on human coronary artery endothelial cells (HCAECs) and explore its underlying mechanisms. HCAECs were treated with oxidized low-density lipoprotein (ox-LDL), angiotensin II (Ang-II), or high glucose (HG) with or without aspirin stimulation. The expression levels of endothelial nitric oxide (NO) synthase (eNOS), p-eNOS, LC3, p62, phosphor-nuclear factor kappa B (p-NF-κB), p-p38 mitogen-activated protein kinase (p-p38 MAPK), and Beclin-1 were detected via immunoblotting analysis. Concentrations of soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) were measured via ELISA. NO levels were determined using the Griess reagent. Autophagic flux was tracked by tandem mRFP-GFP-tagged LC3. Results showed that aspirin increased eNOS level and reduced injury to the endothelial cells (ECs) caused by ox-LDL, Ang-II, and HG treatment in a dose-dependent manner. Aspirin also increased the LC3II/LC3I ratio, decreased p62 expression, and enhanced autophagic flux (autophagosome and autolysosome puncta) in the HCAECs. p-NF-κB and p-p38 mitogen-activated protein kinase inhibition, sVCAM-1 and sICAM-1 secretion, and eNOS activity promotion by aspirin treatment were found to be dependent on Beclin-1. These results suggested that aspirin can protect ECs from ox-LDL-, Ang-II-, and HG-induced injury by activating autophagy in a Beclin-1-dependent manner.

Trends and seasonality in cause-specific mortality among children under 15 years in Guangzhou, China, 2008-2018

BACKGROUND

This study analyzed the trends and seasonality in mortality among children aged 0-14 years in Guangzhou, China during 2008-2018. Understanding the epidemiology of this public health problem can guide policy development for children mortality prevention.

METHODS

A population-based epidemiological retrospective study was conducted. Seven thousand two hundred sixty-five individual data of children mortality were obtained from the Guangzhou Center for Disease Control and Prevention (CDC). The Poisson regression was used to quantify the annual average reduction rate and the difference in mortality rate between sex and age groups. Incidence ratio with 95% confidence interval (CI) was estimated to determine the temperaol variations in mortality by month, season, school term, day of the week and between holidays and other days.

RESULTS

Between 2008 and 2018, the children mortality rate in Guangzhou decreased from 54.0 to 34.3 per 100,000 children, with an annual reduction rate of 4.6% (95% CI: 1.1%-8.1%), especially the under-5 mortality rate decreased by 8.3% (95% CI: 4.8%-11.6%) per year. Decline trends varied by causes of death, even with an upward trend for the mortality of asphyxia and neurological diseases. The risk of death among males children was 1.33 times (95% CI: 1.20-1.47) of that of females. The distribution of causes of death differed by age group. Maternal and perinatal, congenital and pneumonia were the top three causes of death in infants and cancer accounted for 17% of deaths in children aged 1-14 years. Moreover, the injury-related mortality showed significant temporal variations with higher risk during the weekend. And there was a summer peak for drowning and a winter peak for asphyxia.

CONCLUSIONS

Guangzhou has made considerable progress in reducing mortality over the last decade. The findings of characteristics of children mortality would provide important information for the development and implementation of integrated interventions targeted specific age groups and causes of death.

Role of the initial degree of anaemia and treatment model in the prognosis of gastric cancer patients treated by chemotherapy: a retrospective analysis

Background

Anaemia is highly prevalent in gastric cancer (GC) patients. The role of initial haemoglobin levels in predicting the prognosis of GC patients treated by chemotherapy has not been well determined. Our present study aims to evaluate the relationship between the degree of anaemia and the overall survival (OS) and progression-free survival (PFS) of patients with GC.

Methods

Our retrospective study enrolled 598 patients who were treated with chemotherapy when the recurrent or metastatic GCs were unsuitable for surgical resection. Univariate and multivariate analyses were performed to identify risk factors that had the potential to affect patient prognosis. Additionally, the relationship between clinicopathological characteristics, including treatment method, and degree of cancer-related reduction in haemoglobin was further analysed.

Results

Our results revealed that patients with HB_ini level ≤ 80 g/L had a trend toward a shortened median OS and PFS (p = 0.009 and p = 0.049, respectively). Interestingly, we also found that HB_dec ≥ 30 g/L was associated with a significantly shortened median OS and PFS (p = 0.039 and p = 0.001, respectively). Multivariate analysis showed that HB_ini levels ≤80 g/L could be used as an independent prognostic factor for recurrent and metastatic GC. More importantly, HB_dec ≥ 30 g/L and treatment response were also significantly associated with OS and PFS. Furthermore, the degree of haemoglobin decrease was associated with chemotherapy including platinum and the number of chemotherapy cycles.

Conclusion

Our study concludes that the initial degree of anaemia and a decrease in haemoglobin of ≥30 g/L can serve as biomarkers to predict prognosis in recurrent or metastatic GC patients, while chemotherapy treatment rather than red blood cell (RBC) transfusion can improve their prognosis. Additionally, platinum should not be recommended for treating severely anaemic GC patients.

[Epidemiological characteristics of a case infected with avian influenza A (H5N6) virus associated with exposure to aerosol]

Objective: To investigate the epidemiological and clinical characteristics of a case infected with avian influenza A (H5N6) virus associated with exposure to aerosol and provide evidence for the prevention and control of human infection with avian influenza virus. Methods: Epidemiological investigation was conducted to identify the history of exposure, infection route, and disease progression. Real-time fluorescent quantitative RT-PCR was used to test the samples collected from the case, close contacts, environment and poultry market. Results: The case had no history of exposure to live poultry and poultry market. But before the onset the case had a history of exposure to the live poultry placed in a car with doors and windows closed. The samples collected from the case's lower respiratory tract and the remaining frozen chicken meat were all influenza A (H5N6) virus positive. Conclusions: The source of infection was the live poultry, and the infection route might be the exposure to aerosol in a car with doors and windows closed, where the poultry were temporarily stored. It is necessary to promote centralized poultry slaughtering, cold chain distribution and fresh poultry sale, as well as strengthen health education and establish the concept of consuming fresh poultry.

Formation of new lymphatic vessels in glioma: An immunohistochemical analysis

We investigated the distribution and formation of new lymphatic vessels in gliomas. Specimens from seven glioma cases were analyzed by immunohistochemical staining for CD34, lymphatic endothelial hyaluronic acid receptor 1 (LYVE‐1), prospero‐related homeobox 1 (Prox1), nestin, and hypoxia‐inducible factor 1α (HIF‐1α). Three types of vessels were observed in glioma specimens: LYVE‐1⁺ lymphatic vessels, CD34⁺ blood vessels, and LYVE‐1⁺/CD34⁺ blood vessels. Prox1⁺/LYVE‐1⁺ cells were distributed in some lymphatic vessels as well as among vascular endothelial cells and glioma cells. Nestin⁺ cells were scattered throughout the gliomas, and some lymphatic cells also expressed nestin. HIF‐1α⁺ Prox1⁺ cells were widely distributed within the glioma specimens. The present immunohistochemical analysis revealed upregulation of Prox1 and HIF‐1α in some glioma tissues as well as the differentiation of nestin⁺ tumor stem cells into LYVE‐1⁺ lymphatic vessels.

Developing Student Evidence-Based Practice Questionnaire (S-EBPQ) for undergraduate nursing students: Reliability and validity of a Chinese adaptation

RATIONALE, AIMS, AND OBJECTIVES

The assessment of evaluating undergraduate nursing students' evidence-based practice engagement is an important issue, yet few tools have been developed specifically in Mainland China. The purpose of this study was to adapt the Student Evidence-based Practice Questionnaire (S-EBPQ) to Mainland China's cultural context and to evaluate the psychometric properties of the newly adapted Chinese S-EBPQ.

METHODS

Cross-cultural adaptation, including translation of the original S-EBPQ into Mandarin Chinese language, was performed according to published guidelines. A pilot study was conducted in Mainland China with 25 Chinese undergraduate nursing students. A subsequent validation study was conducted with 400 undergraduate nursing students from Mainland China. Construct validity was assessed by exploratory factor analysis (n = 190) and confirmatory factor analysis (n = 210). Reliability was determined using internal consistency and test-retest reliability.

RESULTS

The split-half coefficient for the overall Chinese S-EBPQ was 0.858. A content validity index of 0.986 was achieved. Principal component analysis resulted in a 4-factor structure explaining 68.285% of the total variance. The comparative fit index was 0.927, and the root mean squared error of approximation was 0.072 from the confirmatory factor analysis. Known-group validity was supported by the significant differences according to various characteristics of participants. Internal consistency was high for the Chinese S-EBPQ reaching a Cronbach α value of 0.934. Test-retest reliability was 0.821.

CONCLUSION

The newly cross-culturally adapted S-EBPQ possesses adequate validity, test-retest reliability, and internal consistency and therefore may be utilized in nursing education to assess EBP of undergraduate nursing students in Mainland China.

[Cd Balance Analysis of a Typical Rice Paddy System in Central Hunan]

By conducting field positioning experiments, we studied the development trend of Cd pollution in a typical paddy system. The samples of atmospheric deposition and irrigation water were collected monthly from November 2015 to November 2018 during which fertilizer, soil, and rice samples were also collected. The Cd concentration in the samples was monitored and analyzed to conduct research on the balance between Cd inputs and outputs in a typical paddy system in Hunan Province. The results suggest that through irrigation water, atmospheric deposition and fertilizer, the average annual input of Cd in the paddy field system is 8.735 g·(hm²·a)^-1, of which atmospheric deposition, the major source, accounts for 69.15%-82.04% of the total input, with an average of 76.61%. This is followed by irrigation water and fertilizer, respectively, accounting for 12.62%-23.66% and 5.34%-7.19%, with an average of 16.94% and 6.45%, respectively. Through surface runoff, soil infiltration and the rice harvest of the aboveground portion, the annual average output of Cd contained in the paddy system is 7.093 g·(hm²·a)^-1. Rice harvest accounts for 85.27%-95.02% of the total output, with an average of 89.69%; surface runoff accounted for 4.57%-13.96% of the total output, with an average of 9.41%; and soil infiltration accounted for 0.41%-1.51% of the total output, with an average of 0.90%. The study indicates that Cd contained in paddy systems in Central Hunan exhibits a net input, and the soil Cd pollution is increasing as a result. Straw returning and straw removal have an important impact on the soil Cd balance, and straw removal can slow the trend of soil Cd pollution accumulation.

Effect of meteorological factors on scarlet fever incidence in Guangzhou City, Southern China, 2006-2017

OBJECTIVE

To explore the relationship between meteorological factors and scarlet fever incidence from 2006 to 2017 in Guangzhou, the largest subtropical city of Southern China, and assist public health prevention and control measures.

METHODS

Data for weekly scarlet fever incidence and meteorological variables from 2006 to 2017 in Guangzhou were collected from the National Notifiable Disease Report System (NNDRS) and the Guangzhou Meteorological Bureau (GZMB). Distributed lag nonlinear models (DLNMs) were conducted to estimate the effect of meteorological factors on weekly scarlet fever incidence in Guangzhou.

RESULTS

We observed nonlinear effects of temperature, relative humidity, and wind velocity. The risk was the highest when the weekly mean temperature was 31 °C during lag week 14, yielding a relative risk (RR) of 1.48 (95% CI: 1.01-2.17). When relative humidity was 43.5% during lag week 0, the RR was 1.49 (95% CI: 1.04-2.12); the highest RR (1.55, 95% CI: 1.20-1.99) was reached when relative humidity was 93.5% during lag week 20. When wind velocity was 4.4 m/s during lag week 13, the RR was highest at 3.41 (95% CI: 1.57-7.44). Positive correlations were observed among weekly temperature ranges and atmospheric pressure with scarlet fever incidence, while a negative correlation was detected with aggregate rainfall. The cumulative extreme effect of meteorological variables on scarlet fever incidence was statistically significant, except for the high effect of wind velocity.

CONCLUSION

Weekly mean temperature, relative humidity, and wind velocity had double-trough effects on scarlet fever incidence; high weekly temperature range, high atmospheric pressure, and low aggregate rainfall were risk factors for scarlet fever morbidity. Our findings provided preliminary, but fundamental, information that may be useful for a better understanding of epidemic trends of scarlet fever and for developing an early warning system. Laboratory surveillance for scarlet fever should be strengthened in the future.