Gut microbiota and cognitive performance: A bidirectional two-sample Mendelian randomization

PURPOSE

Previous studies have suggested a potential association between gut microbiota and neurological and psychiatric disorders. However, the causal relationship between gut microbiota and cognitive performance remains uncertain.

METHODS

A two-sample Mendelian randomization (MR) study used SNPs linked to gut microbiota (n = 18,340) and cognitive performance (n = 257,841) from recent GWAS data. Inverse-variance weighted (IVW), MR Egger, weighted median, simple mode, and weighted mode were employed. Heterogeneity was assessed via Cochran's Q test for IVW. Results were shown with funnel plots. Outliers were detected through leave-one-out method. MR-PRESSO and MR-Egger intercept tests were conducted to address horizontal pleiotropy influence.

LIMITATIONS

Limited to European populations, generic level, and potential confounding factors.

RESULTS

IVW analysis revealed detrimental effects on cognitive perfmance associated with the presence of genus Blautia (P = 0.013, 0.966[0.940-0.993]), Catenibacterium (P = 0.035, 0.977[0.956-0.998]), Oxalobacter (P = 0.043, 0.979[0.960-0.999]). Roseburia (P < 0.001, 0.935[0.906-0.965]), in particular, remained strongly negatively associated with cognitive performance after Bonferroni correction. Conversely, families including Bacteroidaceae (P = 0.043, 1.040[1.001-1.081]), Rikenellaceae (P = 0.047, 1.026[1.000-1.053]), along with genera including Paraprevotella (P = 0.044, 1.020[1.001-1.039]), Ruminococcus torques group (P = 0.016, 1.062[1.011-1.115]), Bacteroides (P = 0.043, 1.040[1.001-1.081]), Dialister (P = 0.027, 1.039[1.004-1.074]), Paraprevotella (P = 0.044, 1.020[1.001-1.039]) and Ruminococcaceae UCG003 (P = 0.007, 1.040[1.011-1.070]) had a protective effect on cognitive performance.

CONCLUSIONS

Our results suggest that interventions targeting specific gut microbiota may offer a promising avenue for improving cognitive function in diseased populations. The practical application of these findings has the potential to enhance cognitive performance, thereby improving overall quality of life.

The Spatial Niche and Influencing Factors of Desert Rodents

Resource partitioning may allow species coexistence. Sand dunes in the typical steppe of Alxa Desert Inner Mongolia, China, consisting of desert, shrub, and grass habitats, provide an appropriate system for studies of spatial niche partitioning among small mammals. In this study, the spatial niche characteristics of four rodents, Orientallactaga sibirica, Meriones meridianus, Dipus sagitta, and Phodopus roborovskii, and their responses to environmental changes in the Alxa Desert were studied from 2017 to 2021. Using the capture-mark-recapture method, we tested if desert rodents with different biological characteristics and life history strategies under heterogeneous environmental conditions allocate resources in spatial niches to achieve sympatric coexistence. We investigated the influence of environmental factors on the spatial niche breadth of rodents using random forest and redundancy analyses. We observed that the spatial niche overlap between O. sibirica and other rodents is extremely low (overlap index ≤ 0.14). P. roborovskii had the smallest spatial niche breadth. Spatial niche overlap was observed in two distinct species pairs, M. meridianus and D. sagitta, and P. roborovskii and D. sagitta. The Pielou evenness index of rodent communities is closely related to the spatial distribution of rodents, and the concealment of habitats is a key factor affecting the spatial occupation of rodents.

[Longdan Xiegan Decoction and its interpretation from the perspective of meridians]

By systematically examing through Longdan Xiegan Decoction in medical books of the past dynasties, it was found that the Longdan Xiegan Decoction recorded in Lan Shi Mi Cang mainly targeted men's genital odor at frist. After Xue Ji's addition and subtraction, the scope of the prescription was gradually generalized and expanded, and confusion its name, composition and source of the prescription appeared, which was particularly prominent in Jingyue Quanshu and Yifang Jijie.Doctors used to interpret this prescription from the perspective of viscera. In order to better understand the main treatment rules of Longdan Xiegan Decoction, it is necessary to change the perspective and reinterpreted it from the perspective of meridians.Attributing the symptoms of the perineum to Liver Meridian of Foot-Jueyin,hypochondriac pain, deafness and other symptoms to the Gallbladder Meridian of Foot-Shaoyang, and adding or subtracting herbs according to the specific conditions, is not only conducive to a comprehensive and in-depth understanding of the prescription to achieve accurate clinical syndrome differentiation and medication, but also prompts modern researchers to rethink the important role of meridian theory in the formation and development of the theoretical system of traditional Chinese medicine.

Risk factors prediction of 6-month mortality after noncardiac surgery of older patients in China: a multicentre retrospective cohort study

BACKGROUND

Identifying the risk factors associated with perioperative mortality is crucial, particularly in older patients. Predicting 6-month mortality risk in older patients based on large datasets can assist patients and surgeons in perioperative clinical decision-making. This study aimed to develop a risk prediction model of mortality within 6 months after noncardiac surgery using the clinical data from 11 894 older patients in China.

MATERIALS AND METHODS

A multicentre, retrospective cohort study was conducted in 20 tertiary hospitals. The authors retrospectively included 11 894 patients (aged ≥65 years) who underwent noncardiac surgery between April 2020 and April 2022. The least absolute shrinkage and selection operator model based on linear regression was used to analyse and select risk factors, and various machine learning methods were used to build predictive models of 6-month mortality.

RESULTS

The authors predicted 12 preoperative risk factors associated with 6-month mortality in older patients after noncardiac surgery. Including laboratory-associated risk factors such as mononuclear cell ratio and total blood cholesterol level, etc. Also including medical history associated risk factors such as stroke, history of chronic diseases, etc. By using a random forest model, the authors constructed a predictive model with a satisfactory accuracy (area under the receiver operating characteristic curve=0.97).

CONCLUSION

The authors identified 12 preoperative risk factors associated with 6-month mortality in noncardiac surgery older patients. These preoperative risk factors may provide evidence for a comprehensive preoperative anaesthesia assessment as well as necessary information for clinical decision-making by anaesthesiologists.

Differences in Contents and Formation Methods of Clinical Questions in Chinese and Korean Clinical Practice Guidelines of Acupuncture-Moxibustion: Scoping Review

OBJECTIVE

To analyze the differences in the needs of users and the value orientation of clinical practice guidelines (CPGs) by comparing the contents and formation methods of clinical questions in Chinese and Korean CPGs of acupuncture-moxibustion (Acup-Mox).

METHODS

The full text of CPGs was systematically searched from the official websites of Chinese and Korean traditional medicine societies and Acup-Mox associations, with the topic "Acup-Mox for treating diseases" and the retrieval time up to September 28, 2022. Two researchers screened the CPGs independently, and extracted the guidelines' topics, content, quantity and formation methods of clinical questions. The quantitative data were collected by counting the frequency, and the qualitative data were classified and described by thematic analysis.

RESULTS

A total of 29 guidelines were included in this study, including 20 Chinese guidelines (305 questions) and 9 Korean guidelines (223 questions). The differences lie in the aspects of content and diversity, and formation method. As for content and diversity, Chinese guidelines focused mainly on the questions related to treatment such as the operation of specific intervention (86, 28.2%), efficacy of intervention (78, 25.6%), and also involving questions in diagnosis, prevention, and prognosis. While the clinical questions in Korean guidelines were concentrated to efficacy of intervention (218, 97.8%). As for formation method, in Chinese guidelines, questions were usually collected directly from clinicians, and then determined and optimized by experts. In Korean guidelines, frequently used clinical Acup-Mox interventions would be screened first. Then the expert group would set up corresponding intervention control measures so as to form clinical questions related to treatment efficacy.

CONCLUSIONS

The differences reflect the different needs of clinical practitioners, and the different aims or concepts in developing Acup-Mox guidelines between China and South Korea. Chinese guidelines emphasized promoting operation protocols and techniques of Acup-Mox for practical use, while Korean guidelines emphasized promoting the frequently used clinical intervention therapies. It is speculated that the guidelines from these two countries would play different roles in guiding clinical operation and supporting medical decision. In terms of formation methods of clinical questions, it is suggested to attach importance to optimizing process in formatting clinical questions to improve the clinical applicability of CPGs of Acup-Mox.

Corrigendum: Deep sequencing of plasma exosomal microRNA level in psoriasis vulgaris patients

[This corrects the article DOI: 10.3389/fmed.2022.895564.].

In silico analysis of serum miRNA profiles in seronegative and seropositive rheumatoid arthritis patients by small RNA sequencing

Rheumatoid arthritis (RA) is a refractory autoimmune disease, affecting about 1% of the world's population. RA is divided into seronegative RA and seropositive RA. However, biomarkers for discriminating between seronegative and seropositive RA have not been reported. In this study, we profiled serum miRNAs in seronegative RA patients (N-RA), seropositive RA patients (P-RA) and healthy controls (HC) by small RNA sequencing. Results indicated that compared with HC group, there were one up-regulated and four downregulated miRNAs in N-RA group (fold change ≥ 2 and P value < 0.05); compared with P-RA group, there were two up-regulated and four downregulated miRNAs in N-RA group; compared with HC group, there were three up-regulated and four downregulated miRNAs in P-RA group. Among them, the level of hsa-miR-362-5p in N-RA group was up-regulated compared with that in HC group and P-RA group, and the level of hsa-miR-6855-5p and hsa-miR-187-3p in P-RA group was upregulated compared with that in N-RA group and HC group. Validation by qPCR confirmed that serum hsa-miR-362-5p level was elevated in N-RA group. Subsequently, by analyzing the target genes using RNAhybrid, PITA, Miranda and TargetScan and functions of differential miRNAs utilizing Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG), we found that the target genes and molecular pathways regulated by miRNAs in seronegative RA and seropositive RA were roughly the same, and miRNAs in these two diseases may participate in the occurrence and development of diseases by regulating the immune system. In conclusion, this study revealed the profiles of serum miRNAs in seronegative and seropositive RA patients for the first time, providing potential biomarkers and targets for the diagnosis and treatment of seronegative and seropositive RA.

Targeting the renin angiotensin system for respiratory diseases

Renin-angiotensin system (RAS) plays an indispensable role in regulating blood pressure through its effects on fluid and electrolyte balance. As an aside, cumulative evidence from experimental to clinical studies supports the notion that dysregulation of RAS contributes to the pro-inflammatory, pro-oxidative, and pro-fibrotic processes that occur in pulmonary diseases like asthma, chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and acute lung injury (ALI). Pharmacological intervention of the various RAS components can be a novel therapeutic strategy for the treatment of these respiratory diseases. In this chapter, we first give a recent update on the RAS, and then compile, review, and analyse recent reports on targeting RAS components as treatments for respiratory diseases. Inhibition of the pro-inflammatory renin, angiotensin-converting enzyme (ACE), angiotensin (Ang) II, and Ang II type 1 receptor (AT1R) axis, and activation of the protective ACE2, AT2R, Ang (1-7), and Mas receptor axis have demonstrated varying degrees of efficacies in experimental respiratory disease models or in human trials. The newly identified alamandine/Mas-related G-protein-coupled receptor member D pathway has shown some therapeutic promise as well. However, our understanding of the RAS ligand-and-receptor interactions is still inconclusive, and the modes of action and signaling cascade mediating the newly identified RAS receptors remain to be better characterized. Clinical data are obviously lacking behind the promising pre-clinical findings of certain well-established molecules targeting at different pathways of the RAS in respiratory diseases. Translational human studies should be the focus for RAS drug development in lung diseases in the next decade.

The effect of grazing and reclamation on rodent community stability in the Alxa desert

Ecosystem stability has been of increasing interest in the past several decades as it helps predict the consequences of anthropogenic disturbances on ecosystems. A wild rodent community under reclamation and different grazing disturbances in the Alxa Desert was investigated using live trapping from 2006 to 2011. We studied the rodent community composition, community diversity, and variability of different life history strategies. These results showed that reclamation reduced rodent community stability by increasing temporal variability of community, reducing rodent community resistance as shown by decreasing dominance of KSS strategists, and increased the resistance variability of the rodent community by increasing the variability of abundance and richness for KSS strategists. Grazing reduced rodent community resilience by reducing the dominance of rRF strategists, and increased the resilience variability of the rodent community by increasing the variability of abundance and richness for rRF strategists. Those results may answer the three ecological questions about how ecosystems respond to disturbances from a diversity perspective. The ecosystems with intermediate disturbance are more stable, in other words, with higher resistance and resilience. The increase of KSS strategists means the increase of resistance of the community. The increase of rRF strategists means the increase of community resilience.

[Retrospective analysis of short-term curative effect of total laparoscopic loop ileostomy reversal after radical resection of rectal cancer]

Objective: To investigate the safety, feasibility and short-term efficacy of total laparoscopic loop ileostomy reversal in patients after resection of rectal cancer. Methods: The clinical data of 20 patients who underwent total laparoscopic loop ileoscopic loop ileostomy after radical resection of rectal cancer at Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, or Beijing Chaoyang District Sanhuan Cancer Hospital from October 2019 to June 2020 were collected and retrospectively analyzed. Results: All patients had successfully underwent total laparoscopic ileostomy reversal without conversion to open surgery or discontinued operation. No perioperative related death cases were found. In the whole group, the median operation time was 97 (60-145) minutes and the median intraoperative blood loss was 20 (10-100) milliliters. The median Visual Analogue Scale (VAS) score was 1.9 (1-5) one day after the operation. Nobody needed to use additional analgesic drugs. The median time to grand activities was 25 (16-42) hours, the median time to flatus was 44 (19-51) hours, and the median hospitalization after operation was 6.9 (5-9) days. No patients underwent operation related complications such as operative incision infection, abdominal and pelvic infection, intestinal obstruction, anastomotic leakage, bleeding and so on. Conclusions: Total laparoscopic loop ileostomy reversal appears to be safe, feasible and with promising efficacy for selected patients.

[Effect and safety of endobronchial placement of vaseline gauze in the treatment of patients with bronchial fistula]

Objective: To investigate the application of vaseline gauze to occlude the bronchial fistulas and its clinical effectiveness and safety in this retrospective study. Methods: This study retrospectively reviewed the clinical records of 14 patients with bronchial fistulas at Department of Respiratory and Critical Care Medicine, Shanghai Dongfang Hospital affiliated to Tongji University between June 2019 and June 2022. Seven of the 14 patients were female, and the age ranged from 16 to 74 years. We retrieved all the clinical records of all the enrolled patients during the 6 to 12 months follow-up after the operation, including the information for removal of chest drainage pipe, the failure of endobronchial blockage using vaseline gauze, as well as the complications (migration of the vaseline gauze, obstructive pneumonia, pulmonary atelectasis, et. al.) after the operation. Results: Of the 14 patients, 3 patients had fistula located in main or lobar bronchi; 10 patients had fistula located in distal airways; and 1 patient had fistula located both in main bronchi and distal airways. Ten patients were complicated with pneumonia or pleural cavity infections; Five were complicated with pneumothorax or hydropneumothorax. All of the 14 patients achieved successful airway occlusion after the placement of vaseline gauze in the responsible bronchial airways or stumps for the fistulas. Eleven of the 14 patients successfully removed the drainage tube for the residual cavity, 3 of the 14 patients successfully removed the vaseline gauze for the fistula which was healing during the follow up of 6-12 months. No one of the patients had severe complications or treatment failure. Conclusion: Bronchial placement of vaseline gauze might be a feasible and effective technique for treatment of bronchial fistulas.

Discussion on Collection of Clinical Questions in International Clinical Practice Guidelines of Acupuncture-Moxibustion

The clinical questions of acupuncture-moxibustion (Acup-Mox) guidelines are complicated, including not only the curative effect of Acup-Mox intervention measures, but also the operational elements of Acup-Mox. This paper aimed to put forward the idea and process of collecting clinical questions in developing international acupuncture clinical practice guidelines. The experience was collected and the idea of collecting clinical questions of Acup-Mox was formed through expert consultation and discussion in combination with expert opinions. Based on the characteristics of Acup-Mox discipline. This paper put forward the thinking of collecting elements of clinical questions following the intervention-population-outcome-control (I-P-O-C) inquiry process, according to the discipline of Acup-Mox. It was emphasized that in the process of collecting clinical questions, "treatable population" and "alleviable outcome indicators" for a specific Acup-Mox intervention with certain therapeutic effect should be focused on, so as to highlight the pertinence of clinical questions of Acup-Mox guidelines in terms of population and outcome elements.

[Application value of D-dimer in preoperative diagnosis of low toxic infectious nonunion]

OBJECTIVE

To evaluate the value of D-dimer and common hematological indexes in the preoperative diagnosis of low toxicity infectious bone nonunion.

METHODS

Total of 116 cases of bone nonunion from June 2015 to January 2020 were analyzed retrospectively, including 91 males and 25 females;the age ranged from 18 to 65 years old with an average of(45.3±11.2) years old. According to the diagnostic criteria, 116 cases were divided into low toxicity infectious bone nonunion group(31 cases) and aseptic bone nonunion group(85 cases). D-dimer, total leukocyte count, C-reactive protein and erythrocyte sedimentation rate(ESR) were measured at admission, and the differences between two groups were compared. The diagnostic accuracy, sensitivity and specificity were analyzed through the subject working characteristic curve and the area under the curve.

RESULTS

All patients were followed up for 12 to 24 months with an average of (11.5±4.3) months. D-dimer, total leukocyte count, C-reactive protein and ESR in low toxicity infectious bone nonunion group were higher than those in aseptic bone nonunion group(P<0.05);compared with other hematological indexes, the area under the curve of D-dimer was the highest, which is 0.826, and the best cut-off value of D-dimer was 1.57 g/L. The sensitivity and specificity of preoperative diagnosis of low toxicity infectious bone nonunion were 78.3% and 84.2%.

CONCLUSION

The preoperative diagnostic value of D-dimer in low toxicity infectious bone nonunion is better than other inflammatory indexes. The combination of D-dimer and other inflammatory indexes is conducive to the early diagnosis of low toxicity infectious bone nonunion and the evaluation of the condition.

Endoscopic nasobiliary drainage-based saline-injection ultrasound: an imaging technique for remnant stone detection after retrograde cholangiopancreatography

Background

The purpose of this retrospective study aimed to assess the accuracy of detection of remnant common bile duct (CBD) stones by injecting saline through endoscopic nasobiliary drainage (ENBD) tubes under transabdominal ultrasound (US) guidance.

Method

Stone extraction and ENBD are regularly achieved through endoscopic retrograde cholangiopancreatography (ERCP) in patients with CBD stones. At 1–3  days thereafter, routine US studies were performed and repeated, using ENBD tubal saline injections (20–100  mL).

Results

A total of 302 patients underwent standard ERCP stone extractions in conjunction with occlusion cholangiograms, routine US testing, and ENBD-based saline-injection US exams. By occlusion cholangiogram, remnant stones were suspected in 31 (10.3%) patients in total of 302, and 26 (83.8%) were verified as true positives (sensitivity, 50.9%; specificity, 98.0%). Routine US studies proved suspicious in 13 (4.3%) patients in total of 302, and 12 (92.3%) were verified as true positives (sensitivity, 23.5%; specificity, 99.6%). Using ENBD-based saline-injection US, suspected stones were identified in 50 (16.6%) patients in total of 302, and 46 (92%) were verified as true positives (sensitivity, 90.1%; specificity, 98.4%). The sensitivity of ENBD-based saline-injection US significantly surpassed that of occlusion cholangiogram (p < 0.001) and routine US (p < 0.001).

Conclusion

Detection of remnant CBD stones via ENBD-based saline-injection US is a valid, inexpensive, and repeatable means of patient screening that is non-invasive, radiation-free, and dynamically informative. This may help improve the accuracy of detecting remnant CBD stones after ERCP.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-022-02394-8.

Deep Sequencing of Plasma Exosomal microRNA Level in Psoriasis Vulgaris Patients

Psoriasis is a chronic skin disease affecting 1% to 3% of the world population. Psoriasis vulgaris (PV) is the most common form of psoriasis. PV patients suffer from inflamed, pruritic and painful lesions for years (even a lifetime). However, conventional drugs for PV are costly. Considering the need for long-term treatment of PV, it is urgent to discover novel biomarkers and therapeutic targets. Plasma exosomal miRNAs have been identified as the reliable biomarkers and therapy targets of human diseases. Here, we described the levels of serum exosomal miRNAs in PV patients and analyzed the functional features of differently expressed miRNAs and their potential target genes for the first time. We identified 1182 miRNAs including 336 novel miRNAs and 246 differently expressed miRNAs in serum exosomes of healthy people and PV patients. Furthermore, the functional analysis found differently expressed miRNA-regulated target genes enriched for specific GO terms including primary metabolic process, cellular metabolic process, metabolic process, organic substance metabolic process, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway containing cellular processes, human diseases, metabolic pathways, metabolism and organismal systems. In addition, we found that some predicted target genes of differentially expressed miRNAs, such as CREB1, RUNX2, EGFR, are both involved in inflammatory response and metabolism. In summary, our study identifies many candidate miRNAs involved in PV, which could provide potential biomarkers for diagnosis of PV and targets for clinical therapies against PV.

[Interpretation of China national standard Nomenclature and Location of Meridian Points (GB/T 12346-2021)]

To cooperate with the popularization and application of the China national standard Nomenclature and Location of Meridian Points (GB/T 12346 -2021), this study introduced the differences between the 2021 version and the 2006 version, and explained the principles of the revision and the changes in the standard name, terminology, definition and the expression of meridian points' body regions. In addition, the revision of the specific contents, including the adjustment of "bone proportional cun" of several meridian points and the revision basis of location of some meridian points were explained.

AKT serine/threonine kinase 2-mediated phosphorylation of fascin threonine 403 regulates esophageal cancer progression

Fascin is the main actin-bundling protein in filopodia and is highly expressed in metastatic tumor cells. The overexpression of Fascin has been associated with poor clinical prognosis and metastatic progression. Post-translational modifications of Fascin, such as phosphorylation, can affect the proliferation and invasion of tumor cells by regulating the actin-bundling activity of Fascin. However, the phosphorylation sites of Fascin and their corresponding kinases require further exploration. In the current study, we identified novel phosphorylation of Fascin Threonine 403 (Fascin-T403) mediated by AKT serine/threonine kinase 2 (AKT2), which was studied using mass spectrometry data from esophageal cancer tissues (iProX database: IPX0002501000). A molecular dynamics simulation revealed that Fascin-Threonine 403 phosphorylation (Fascin-T403D) had a distinct spatial structure and correlation of amino acid residues, which was different from that of the wild type (Fascin-WT). Low-speed centrifugation assay results showed that Fascin-T403D affected actin cross-linking. To investigate whether Fascin-T403D affected the function of esophageal cancer cells, either Fascin-WT or Fascin-T403D were rescued in Fascin-knockout or siRNA cell lines. We observed that Fascin-T403D could suppress the biological behavior of esophageal cancer cells, including filopodia formation, cell proliferation, and migration. Co-immunoprecipitation (Co-IP) and Duolink in situ proximity ligation assay (PLA) were performed to measure the interaction between Fascin and AKT2. Using in vitro and in vivo kinase assays, we confirmed that AKT2, but not AKT1 or AKT3, is an upstream kinase of Fascin Threonine 403. Taken together, the AKT2-catalyzed phosphorylation of Fascin Threonine 403 suppressed esophageal cancer cell behavior, actin-bundling activity, and filopodia formation.

[Analysis and thought on reaching the consensus during the development of acupuncture and moxibustion clinical practice guidelines in China]

Based on the 28 Chinese clinical practice guidelines of acupuncture and moxibustion, this study summarized and analyzed the contents related to reaching consensus during the development process. The results indicated that all the 28 guidelines reported they have used consensus in the "recommendations" section, and provided details on consensus personnel, consensus methods, consensus process and consensus materials. However, it was found that the reporting of consensus was in need of further improvement. The limitations included unclear definition and responsibilities of "expert group", obscure concept between "consensus meeting" and "expert discussion", non-rigorous process of reaching consensus when generating recommendations and lacking of detailed reporting of the consensus reaching process. As such, we suggested that future researchers should conduct researches to further standardized the consensus process when developing acupuncture and moxibustion clinical practice guidelines, so as to improve the quality and clinical applicability of guidelines．.

Dysfunction of EAAT3 Aggravates LPS-Induced Post-Operative Cognitive Dysfunction

Numerous results have revealed an association between inhibited function of excitatory amino acid transporter 3 (EAAT3) and several neurodegenerative diseases. This was also corroborated by our previous studies which showed that the EAAT3 function was intimately linked to learning and memory. With this premise, we examined the role of EAAT3 in post-operative cognitive dysfunction (POCD) and explored the potential benefit of riluzole in countering POCD in the present study. We first established a recombinant adeno-associated-viral (rAAV)-mediated shRNA to knockdown SLC1A1/EAAT3 expression in the hippocampus of adult male mice. The mice then received an intracerebroventricular microinjection of 2 μg lipopolysaccharide (LPS) to construct the POCD model. In addition, for old male mice, 4 mg/kg of riluzole was intraperitoneally injected for three consecutive days, with the last injection administered 2 h before the LPS microinjection. Cognitive function was assessed using the Morris water maze 24 h following the LPS microinjection. Animal behavioral tests, as well as pathological and biochemical assays, were performed to clarify the role of EAAT3 function in POCD and evaluate the effect of activating the EAAT3 function by riluzole. In the present study, we established a mouse model with hippocampal SLC1A1/EAAT3 knockdown and found that hippocampal SLC1A1/EAAT3 knockdown aggravated LPS-induced learning and memory deficits in adult male mice. Meanwhile, LPS significantly inhibited the expression of EAAT3 membrane protein and the phosphorylation level of GluA1 protein in the hippocampus of adult male mice. Moreover, riluzole pretreatment significantly increased the expression of hippocampal EAAT3 membrane protein and also ameliorated LPS-induced cognitive impairment in elderly male mice. Taken together, our results demonstrated that the dysfunction of EAAT3 is an important risk factor for POCD susceptibility and therefore, it may become a promising target for POCD treatment.

Submersed macrophyte restoration with artificial light-emitting diodes: A mesocosm experiment

Urban lakes are important natural assets but are exposed to multiple stressors from human activities. Submersed macrophytes, a key plant group that helps to maintain clear-water conditions in lakes, tend to be scarce in urban lakes, particularly when they are eutrophic or hypertrophic, and their loss is linked, in part, to impaired underwater light climate. We tested if enhancing the underwater light conditions using light-emitting diodes (LEDs) could restore submersed macrophytes in urban lakes. Twelve mesocosms (1000 L each) were each planted with tape grass (Vallisneria natans) and monitored over three months (22 August-7 November), using a control and three artificial light intensity treatments (10, 50, and 100 µmol m-2 s-1). Compared with the control, the high light treatment (100 µmol m-2 s-1) had higher leaf number, maximum leaf length, and average leaf length (3.9, 5.8, and 2.8 times, respectively). Shoot number, leaf number, leaf dry mass, root dry mass, and photosynthetic photon flux density in the high-light treatment were significantly greater than the control, but root length and phytoplankton chlorophyll a were not related to plant growth variables and were low in all treatments. Periphyton chlorophyll a increased significantly with the plant growth variables (i.e., shoot number, leaf number, and maximum leaf length) and was high in the light treatments but did not hamper the growth of the macrophytes. These results indicate that LED light supplementation enables the growth of V. natans under eutrophic conditions, at least in the absence of fish as in our experiment, and that the method may have potential as a restoration method in urban lakes. Lake-scale studies are needed, however, to fully evaluate LED light supplementation under natural conditions where other stressors (e.g., fish grazing) may need to be controlled for successful restoration of urban lakes.

[Investigation and analysis on the current situation of clinical practice guidelines for acupuncture and moxibustion at home and abroad]

To provide directional suggestions for the establishment of international clinical practice guidelines for acupuncture and moxibustion by investigating the current situation of clinical practice guidelines for acupuncture and moxibustion at home and abroad. The clinical practice guidelines were obtained by questionnaire survey, database retrieval and experts consulting. The guidelines were read carefully, and the content was analyzed. A total of 27 acupuncture-moxibustion clinical practice guidelines were retrieved, of which most of the guidelines came from China. The definition and scope of "acupuncture and moxibustion "vary according to different guidelines; and the focus of the content and the method of establishing the guidelines are quite different, so it is very necessary to unify the formulation methods of acupuncture-moxibustion clinical practice guidelines. Chinese clinical practice guidelines for acupuncture and moxibustion were characterized by taking the ancient literature as the evidence. Excavating the value of ancient literature and clinical experience of acupuncture-moxibustion experts are the key points and difficulties in the developing of clinical practice guidelines of acupuncture and moxibustion in the future.

[Analysis on development necessity and key points for Technical Specification of Acupuncture- Moxibustion: General Rules of Drafting of international industry organization standard]

This paper analyzes the development necessity of a series of international technical specification of acupuncture-moxibustion from three aspects, the development status of global Technical Specification of Acupuncture-Moxibustion, providing technical support for acupuncture-moxibustion legislation and assisting standardized acupuncture-moxibustion research. The necessity of giving priority to the development of WFAS's Technical Specification of Acupuncture-Moxibustion: General Rules of Drafting (General Rules for short) in the series of standards is discussed from filling the field gap and following the international practice. The key points should be paid attention to in the development process of General Rules are summarized，such as improving practicality based on international perspective, enhancing authority by following international rules, improving international applicability by forming a professional team and ensuring high quality and objective neutrality of the General Rules.

[Consideration on existing problems in development of clinical practice guidelines for acupuncture and moxibustion in China]

To sort out the existing problems within the published 35 evidence-based acupuncture-moxibustion clinical practice guidelines (group standards) in Chinese: the development methods and the development process are not clear and strict enough; the evidence evaluation system fails to fully reflect the characteristics of acupuncture and moxibustion. Therefore, Norms for Formulation and Evaluation of the Guidelines on Clinical Practice of Acupuncture-Moxibustion, should require the guideline developers to consider the characteristics of acupuncture discipline, evaluate modern literature evidence comprehensively, and integrate ancient literature and medical experts' experience, to form proper recommendations for clinical practice. Specific requirements should be made simultaneously in the development process to make it clearer and stricter.

Study on the effectiveness and safety of Xingpi Yanger granule combined with Saccharomyces boulardii for rotavirus enteritis in children: A protocol for systematic review and meta-analysis

BACKGROUND

To systematically evaluate the effectiveness and safety of traditional Chinese medicine preparation XPYEG combined with SBI and SBI alone in the treatment of REC, and to provide the reference in drugs for the clinical treatment of children with rotavirus enteritis.

METHODS

Retrieving the English databases: PubMed, Cochrane Library and Embase; Chinese databases: CNKI, CBM and WANFANG Data. Retrieving a randomized controlled trial of XPYEG and SBI in the treatment of REC. The retrieval time is from the above database until September 2020. The retrieval strategy of combining free words and subject words is adopted, and the references included in the literature are searched manually in accordance with the literature studied in this paper and not included in the above database. Two researchers screen the literature according to the literature inclusion and exclusion criteria, extract valid data and evaluate the quality of the literature, and cross-check it. Using the RevMan 5.3 software to conduct the meta-analysis on the main outcome and secondary outcome indicators of the included literature, while assessing the evidence quality of included study.

RESULTS

The effectiveness and safety of XPYEG and SBI in the treatment of REC are presented through the main and secondary outcome indicators.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/3QSZG.

CONCLUSION

This study will conclude whether the combination of XPYEG and SBI is more effective than SBI alone in the treatment of REC, and whether the medication increases the risk of adverse reactions compared with single medication.

ETHICS AND DISSEMINATION

This study does not involve the specific patients, and all research data comes from publicly available professional literature, so an ethics committee is not required to conduct an ethical review and approval of the study.

[Analysis on international demand investigation for technical specification of acupuncture- moxibustionthe and its general rules of drafting]

The electronic questionnaire was adopted to survey the international demand on Technical Specification of Acupuncture-Moxibustion: General Rules of Drafting (General Rules for short) to explore the potential problems during the application and provide the evidence for the development of international standard of General Rules. A total of 102 valid questionnaires were collected from 18 countries and regions. The priority of the demand for international standard on the technical specification of acupuncture-moxibustion is filiform needle, moxibustion, electroacupuncture, cupping, auricular acupuncture, scalp acupuncture and scraping. One hundred experts (98.04%) at home and abroad believe the necessity of the international standard development of General Rules. The awareness rate of the existing national standard of General Rules is 71.57% and the foreign experts think that its expression may be "unclear" and the domestic experts think it may be "lack of practicability". The domestic experts hope to highlight the commonness in the scope of the international standard of General Rules and the foreign experts hope to retain more individuality. Regarding the specific questions during the technique manipulations of acupuncture-moxibustion, there are the big differences in "relevant terminology" "preoperative preparation" and "adverse reaction and contraindications" at home and abroad. In order to improve the international compatibility and applicability, it is necessary to give full consideration to the needs of different countries in the development of international standard of General Rules and balance as far as possible between refining "common problems" and satisfying "individual needs".

[Application of portable electroencephalograph in patients with epilepsy and establishment of medical platform]

Objective: To provide a portable electroencephalograph that can facilitate long-term monitoring of epilepsy patients outside the hospital, and establish a medical platform for epilepsy data monitoring and treatment. Methods: From June 2018 to October 2019, twenty-nine patients from Huashan Hospital (superior hospital) and Jing'an District Central Hospital (subordinate hospital) of Fudan University were enrolled in the study. Among them, twenty-eight cases were diagnosed with epilepsy and 1 case was epileptic seizure. Electroencephalogram (EEG) was collected by portable electroencephalograph once a week and followed up for three months. The seizure frequency, seizure form, medication type, EEG lead number and positive rate were recorded. Patients' medical records and EEG data were uploaded to the cloud database to build a medical alliance platform. Doctors of different levels of hospitals couldobtain diagnosis and achieve resource sharing based on the platform. The data was statistically analyzed using SPSS 18.0. Results: The EEG data collected by the portable electroencephalograph hadfewer artifacts, complete sleep cycle, and could record the interictaldischarges. Twenty-nine patientsunderwent a total of 148 EEG monitoring during the three-month follow-up. Eighty-five cases of epileptic discharges were detected, and the EEG positive rate was 57.4%. The positive rate of EEG in patients with generalized seizures (84.9%) was higher than that in patients with focal seizures (42.1%) (P<0.01); the positive rate of EEG in patients with 2-3 antiepileptic drugs and patients with frequent seizures within three months were also higher (P<0.05). Doctors in the superior hospital in the platform make diagnosis and treatment suggestions according to the above data. Elevenseizure-free patients and four patients with fewer seizures and discharges were diverted to the community hospital for follow-up. Fourteen patients with poor seizure control and/or continuous epileptic discharges were diverted to the superior hospitalto adjust the medication. Doctors of subordinate hospital acquired the diagnosis and treatment suggestions through the platform, and then strengthened the daily care and follow-up. Conclusion: Combined with a portable electroencephalograph, the current study establishs a medical platform for patients with epilepsy to achieve long-term monitoring and rational use of medical resources.

[Objective, approach and symbolic achievement of the standardization on extraordinary points]

Through sorting out the development of meridian points and the standardization of extraordinary points in dynasties, two objectives are discovered in the standardization of extraordinary points starting from the Tang Dynasty. The points with extraordinary effect are selected points and transferred to meridian points and the commonly-used key points are selected and developed to be standardized acupoints. Hence, 3 approaches are summarized. Approach No.1: a large number of "meridian-outside" points that are the potential supplementation but not included yet in meridian points are supplemented to meridian points. Approach No.2: based on the specified requirement, the key points are selected from the acupoints with determined locations and names, which is developed to be the standard of acupoints. Approach No.3: the acupoints with extraordinary effect are selected from the "meridian-outside" points and these points are collected for the formulation of the standard of extraordinary points. The latter two approaches provide for the development direction of teaching and standardization in the future.

[Evolution of the concept of extra ordinary point and standardization of related terms]

Through an analysis of the historical development of the concept of extra ordinary point, it is found that the terms of "Qi point" "extra ordinary point" "Loujing point" "extra meridian point" and "Bie point" used in the ancient medical books in the Yuan, Ming, and Qing Dynasties actually expressed two different concepts of "extra ordinary points with the magical effects" and "extra points other than the meridian points". The standardized term for the former concept should be "extra ordinary point" (Qi point for short), and the standardized term for the latter concept should be "extra meridian point", which is also called "Loujing point" and "Bie point". Since these two different concepts are not clarified in modern acupuncture textbooks, especially the misreading of "Jing Wai", no consensus has been reached on the definition of "extra ordinary point" and "extra meridian point", and the standardized terms have not been decided, which changed from "extra ordinary point" to "Qi point" and "extra point" and recently returned to "extra ordinary point". These confusions in textbooks have a direct impact on the determination of the related acupuncture terms used in national and international standards.

Replacing soybean meal with flax seed meal: effects on nutrient digestibility, rumen microbial protein synthesis and growth performance in sheep

Flax seed meal (FSM) is rich in various nutrients, especially CP and energy, and can be used as animal protein feed. In animal husbandry production, it is a long-term goal to replace soybean meal (SBM) in animal feed with other plant protein feed. However, studies on the effects of replacing SBM with FSM in fattening sheep are limited. The aim of this experiment was to study the effects of replacing a portion of SBM with FSM on nutrient digestibility, rumen microbial protein synthesis and growth performance in sheep. Thirty-six Dorper × Small Thin-Tailed crossbred rams (BW = 40.4 ± 1.73 kg, mean ± SD) were randomly assigned into four groups. The dietary treatments (forage/concentrate, 45 : 55) were isocaloric according to the nutrient requirements of rams. Soybean meal was replaced with FSM at different levels (DM basis): (1) 18% SBM (18SBM), (2) 12% SBM and 6% FSM (6FSM), (3) 6% SBM and 12% FSM (12FSM) and (4) 18% FSM (18FSM). The rams were fed in individual pens for 60 days, with the first 10 days for adaptation to diets, and then the digestibility of nutrients was determined. There was no significant difference in DM intake, but quadratic (P < 0.001) effects on the average daily gain and feed efficiency were detected, with the highest values in the 6FSM and 12FSM groups. For DM and NDF digestibility, quadratic effects were observed with the higher values in the 6FSM and 12FSM groups, but the digestibility of CP linearly decreased with the increase in FSM in the diet (P = 0.043). There was a quadratic (P < 0.001) effect of FSM inclusion rate on the estimated microbial CP yield. However, the values of intestinally absorbable dietary protein decreased linearly (P < 0.001). For the supply of metabolisable protein, both the linear (P = 0.001) and quadratic (P = 0.044) effects were observed with the lowest value in the 18FSM group. Overall, the results indicated that SBM can be effectively replaced by FSM in the diets of fattening sheep and the optimal proportion was 12.0% under the conditions of this experiment.

[Monitoring Method of Total Particulate Matter in Ultra-low-emission and High-humidity Exhaust Gas from Stationary Sources and an Actual Test in a Gas Power Plant]

With the implementation of ultra-low-emission transformation in coal-fired power plants and other related industries in China, the concentrations of filterable particulate matter (FPM) and gaseous pollutants in exhaust gas from stationary sources have reduced significantly, while the emission of condensable particulate matter (CPM) remains a concern. In this study, the monitoring methods of FPM and CPM at a relatively low FPM concentration in exhaust gas from stationary sources in China and abroad were comprehensively analyzed. On the basis of existing research and experimental exploration, the monitoring methods of FPM and CPM were further studied. A direct condensation sampling and monitoring method for total particulate matter (TPM) in ultra-low-emission and high-humidity exhaust gas from stationary sources, which is suitable for the actual situation in China, was developed and established before being used to measure TPM in exhaust gas from a gas power plant in Beijing. The results showed that the emission concentration of TPM in the exhaust gas from the gas power plant was between 1.98 mg·m^-3 and 3.77 mg·m^-3 (average of 2.81 mg·m^-3), whereas the average emission concentration of FPM was only 0.10 mg·m^-3. The emission type of particulate matter in exhaust gas from the gas power plant was mainly CPM, which accounted for 93.8% to 99.2% of the TPM (average of 97.0%). The proportion of FPM to TPM ranged from 0.7% to 6.2% (average of 3.0%). The emission concentration of filterable CPM was slightly higher than that of FPM.

Bi-needle technique versus transforaminal endoscopic spine system technique for percutaneous endoscopic lumbar discectomy in treating intervertebral disc calcification: a propensity score matched cohort analysis

OBJECTIVE

The aim of this study was to evaluate the clinical results of a Bi-needle technique and conventional transforaminal endoscopic spine system (TESSYS) technique for percutaneous endoscopic lumbar discectomy (PELD) in treating patients with intervertebral disc calcification (IDC).

BACKGROUND

PELD has gained acceptance for treating patients with IDC. The Bi-needle technique was designed to improve the efficiency and safety of PELD.

METHOD

Bi-needle and TESSYS group within each cohort were balanced using 1:1 propensity score matching. Finally, 32 patients with IDC treated by Bi-needle technique from December 2015 to September 2017 were enrolled and 25 patients treated by TESSYS technique from the same spine surgery center between January 2013 and October 2017 were enrolled as controls.

RESULTS

Propensity score matching generated 22 Bi-needle and 22 TESSYS patients. There were no significant differences in visual analog scale and lumbar Japanese Orthopaedic Association scores between Bi-needle and TESSYS group. Operative time and rate of complications in the Bi-needle was significantly better than the TESSYS group (p < 0.01).

CONCLUSIONS

Both surgical methods achieved good clinical outcomes. However, compared with the TESSSY technique, operative time of the Bi-needle technique is shorter, and rate of complications is lower.

Is selective nerve root block necessary for learning percutaneous endoscopic lumbar discectomy: a comparative study using a cumulative summation test for learning curve

PURPOSE

The aim of this study was to investigate the effect of lumbar spine selective nerve root block (SNRB) experience on the learning efficiency of percutaneous endoscopic lumbar discectomy (PELD) for junior trainees.

METHODS

A total of 480 patients undergoing single-level PELD performed by eight junior trainees were included. The trainees were divided into two groups based on whether they had previous SNRB experience (group A, yes; group B, no). Surgical proficiency was defined as total operation time less than 65 minutes and cumulative radiation exposure time no more than 40 seconds. The learning curve was analyzed by cumulative summation (CUSUM) test. Clinical evaluations included Macnab classification, visual analog scale (VAS)-low back score, VAS-leg score, and Oswestry Disability Index (ODI). Follow-up information at 12 months was also obtained.

RESULTS

Integral number of cases before achieving an acceptable surgical level in group A (47.75 ± 2.50 cases) was significantly smaller than that in group B (56.50 ± 1.29 cases, p < 0.05), along with less accumulated failure (18.75 ± 0.96 cases vs. 25.50 ± 1.75 cases, p < 0.05). The two groups were comparable in clinical outcomes. Forty-seven cases of complications were observed, with 17 in group A and 30 in group B (p < 0.05).

CONCLUSION

Previous experience of SNRB improved the performance of PELD with shorter operation time and less radiation exposure. SNRB practice may reduce the complication rate without a significant effect on the recurrence of symptoms and reoperation.

Combination of liver graft sonographic grading and point shear wave elastography to reduce early allograft dysfunction after liver transplantation

OBJECTIVE

To analyze the performance of a liver graft sonographic grading system and point shear wave elastography (PSWE) in predicting early allograft dysfunction (EAD) after liver transplantation (LT).

METHODS

Successive brain-dead donors and liver recipients in our hospital from March 2017 to May 2018 were retrospectively recruited. All donors underwent PSWE examination, abdominal ultrasonography, and sonographic grading (grade 0 to grade 5). Donors with ≥ 10 valid PSWE examinations and a failure rate of < 60% were included. For all recipients, abdominal ultrasonography and blood tests for biologic parameters were performed preoperatively and daily postoperatively to screen for EAD. The recipients and their grafts were classified into EAD and non-EAD groups. Statistical analyses were performed to analyze the correlations among liver stiffness (LS), liver graft sonographic grading, and EAD.

RESULTS

Thirty-two donors and 32 corresponding liver recipients were enrolled (15 cases in the EAD group; 17 in the non-EAD group). There were no grade 0, 1, or 2 cases in the two groups. For prediction of EAD in recipients after LT, the AUC for PSWE was 0.929 and the AUC for combination of PSWE and sonographic grading system was 0.935.

CONCLUSIONS

Combination of PSWE and sonographic grading system can predict postoperative EAD in LT recipients with high sensitivity. Abnormal results may suggest a need for liver biopsy preoperatively, thus avoiding unnecessary surgical preparation for liver procurement.

KEY POINTS

• Combination of PSWE with new sonographic grading system is useful for preoperative evaluation of liver grafts from brain-dead donors. • EAD is as a criterion for evaluating the diagnostic value of PSWE and sonographic grading system. • Combination of PSWE and sonographic grading system can predict postoperative EAD in LT recipients with high sensitivity.

Application of Zero-profile Spacer in the Treatment of Three-level Cervical Spondylotic Myelopathy: 5-year Follow-up Results

STUDY DESIGN

A retrospective study.

OBJECTIVE

To assess the long-term results of zero-profile spacer for 3-level anterior cervical discectomy and fusion (ACDF).

SUMMARY OF BACKGROUND DATA

Although widely used, there are still controversies about the long-term results of zero-profile spacer, especially in multilevel cases.

METHODS

Cases received 3-level ACDF for cervical spondylotic myelopathy (CSM) using either zero-profile spacer (n = 27) (ZP Group), or plate and cages (n = 34) (PC Group), and with 5-year follow-up were reviewed. Neurological function and life quality were assessed by modified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI), and Short-Form 36 (SF-36) score. Disc height, cervical lordosis, fusion rate, and surgical complications were observed.

RESULTS

Neurological recovery and life quality improvement were similar in both groups. Disc height and cervical lordosis (C2-7 Cobb angle) were well restored after operations, but lost in both groups during follow-up. Loss of correction (LOC) in disc height was larger in ZP Group (11.38% vs 5.71%, P < 0.05) at 5-year follow-up. LOC of cervical lordosis in ZP group constantly grew from 11.28% to 48.13% during 5-year follow-up, significantly higher than that in the PC group (from 7.43% to 14.01%) (P < 0.05). The rate of postoperative dysphagia was no statistical difference between the two groups, and symptoms were all disappeared within 1 year. There were 10 levels of adjacent segment degeneration (1 in ZP Group, and 10 in PC Group, P = 0.02). Cage subsidence (11 of 81 levels, 13.58%) and screw migration (2 of 81 levels, 2.47%) were only observed in the ZP Group. The migrated screws in one case were surgically removed. Fusion was achieved in all cases.

CONCLUSIONS

In long-term follow-up of 3-level ACDF for CSM, zero-profile spacer has the similar clinical results, but loss of correction of disc height and cervical alignment were significantly higher, compared with anterior plate and cages.

LEVEL OF EVIDENCE

3.

Thoracic de-kyphosis for revision surgery of a failure case of endoscopic discectomy: a case report and literature review

BACKGROUND

Indications and clinical outcomes of percutaneous endoscopic thoracic discectomy(PETD) in treating thoracic disc herniation is rarely reported and still controversial. We reported an unsatisfied recovery of thoracic disc herniation with PETD, treated by a second posterior thoracic laminectomy and Ponte osteotomy.

CASE DESCRIPTION

A male presented with lower extremity weakness and stagger caused by T3/4 intervertebral disc herniation. The upper thoracic curve was in excessive kyphosis with T2-5 Cobb angle of 34.3 degrees. The preoperative ODI score was 34 and Roelzs's JOA score was 14. Percutaneous transforaminal endoscopic thoracic discectomy (PETD) from a posterior lateral approach was performed. At five-month follow-up, his thoracic back pain and staggering gait did not improve. The postoperative T2-5 Cobb angle was 32.1 degrees, the ODI score was 24 and Roelzs's JOA score was 14. A second posterior thoracic decompression this time with fixation was performed, but no disc herniation was detected. A Ponte osteotomy was performed to correct the kyphosis. One month after the second surgery, muscle strength of the lower limbs was improving with the T2-5 Cobb angle decreased to 19.4 degrees, the ODI score decreased to 10 and Roelzs's JOA score increase to 16. Six month later, the ODI score decreased to 0 and Roelzs's JOA score improved to 18. In review of the literature, PETD doesn't guarantee the patient a satisfactory neurological recovery for kyphotic thoracic disc herniation. Posterior decompression with Ponte osteotomy may be beneficial to release the tension and decompression of the spinal cord tension.

CONCLUSIONS

Thoracic disc herniation with kyphosis angle >20 degrees (T2-5), percutaneous endoscopic thoracic discectomy is not likely to get good neurologic results. Posterior laminectomy with ponte osteotomy might be beneficial for these patients to induce dorsal drifting of the spinal cord from anterior herniation.

Carbon emissions embodied in the global supply chain: Intermediate and final trade imbalances

By differentiating intermediate trade from final trade, this paper combines typical statistics for the world economy in 2012 to explore the transfer of embodied carbon emissions via the global supply chain and the related trade imbalance. The emission transfer embodied in interregional trade is in magnitude around 40% of global direct carbon emissions. The global intermediate trade volume of embodied carbon emissions is estimated to be 2.3 times as much as the final trade volume. While Mainland China obtains a considerable economic trade surplus, its carbon trade deficit is about twice the carbon trade surplus of the United States. Mainland China's final trade deficit is around 1.2 times as much as its intermediate trade deficit of embodied carbon emissions. EU27, the United States, ASEAN and Japan serve as the major contributors to China's intermediate and final trade deficits. For the United States, its intermediate carbon trade surplus is almost equal to its final trade surplus. The United States gains a carbon surplus with most of its trading partners in both intermediate and final trades. A future scenario analysis in terms of carbon emission projection is conducted. While the direct and embodied carbon emissions of the United States and Japan are estimated to change slightly from 2012 to 2040, India's carbon emissions are projected to experience a twofold increase during the period. In the long term, though with ups and downs, the economic globalization will be inevitably moving forward, leading to a highly sliced-up global supply chain and increasingly delicate regional specialization as well as frequent intermediate trade between regions. It is suggested that nations and regions should follow this trend and adapt themselves to the global value chain by carefully assessing their roles in intermediate and final trades in terms of both currency and embodied carbon emissions.

[AGREE-based evaluation and content analysis of evidence-based clinical practice guidelines for acupuncture-moxibustion]

OBJECTIVE

To carry out the methodological quality evaluation and content analysis of the evidence-based clinical practice guidelines for acupuncture-moxibustion in China, and to provide reference for the development and updating of future guidelines.

METHODS

With Appraisal of Guidelines for Research and EvaluationⅡ(AGREEⅡ), 20 evidence-based clinical practice guidelines for acupuncture and moxibustion in China were evaluated from six aspects: scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability and editorial independence. In addition, the contents of 20 guidelines were systematically analyzed, and the characteristics of guidelines were summarized from the aspects of disease selection, operation technology type and safety.

RESULTS

The scores of six domains were scope and purpose (91.1%), stakeholder involvement (68.5%), rigour of development (68.6%), clarity of presentation (90.3%), applicability (34.5%) and editorial independence (16.7%). The recommendations of the 20 acupuncture guidelines covered common clinical problems such as diagnosis, treatment and precautions, which were in line with the clinical characteristics of acupuncture and moxibustion in terms of content structure.

CONCLUSION

The methodology of the evidence-based clinical practice guidelines for acupuncture and moxibustion in China conformed to the requirements of AGREEⅡ on the quality evaluation, and the overall quality was moderate, but the aspects of applicability and editorial independence were still needed to be improved. The contents of recommendations in 20 guidelines were specific and clear, in line with the characteristics of acupuncture and moxibustion, presenting clinical reference value. In the future, in the process of guideline development, the method of developing acupuncture and moxibustion guidelines should be constantly improved to improve the quality of the guidelines; in the meantime, more attention should be paid to the generalization and clinical applicability evaluation.

Cervical nerve root variant: report of two cases under the cervical endoscopy and review of clinical literature

Background: We know of five cases of cervical nerve root variants that have been reported, all of which were found during posterior cervical surgery. We reported two cases of cervical nerve root variants. One had two anomalous branches of the C7 root, is the other had a C5, C6 nerve root communication branch. Case description: A 62-year-old female presented with neck and right upper extremity pain, accompanied by hypaesthesia in her right forearm for 4 months. Preoperative X-ray film, magnetic resonance imaging (MRI) and computed tomography (CT) scan demonstrated C6-7 uncovertebral joint hyperplasia and foraminal stenosis. She underwent posterior cervical endoscopic foraminoplasty. The right C7 nerve root was observed to have two anomalous branches originated from a proximal trunk. After the surgery, the symptoms resolved. A 54-year-old female presented with radiating pain and numbness in her right arm and hand for 4 months. Preoperative MRI showed a C5/6 intervertebral disc herniation. She had hypaesthesia in radial side of her right arm and 1st-3rd fingers. Posterior cervical endoscopic foraminalplasty was performed for the patient. After decompression of the bony wall of the posterior nerve root canal, a 2-mm thick communicating nerve was observed emerging from the dura with the C6 nerve root and exiting to the caudal level. After the surgery, the symptoms resolved immediately. Conclusions: Cervical nerve root variant may be more apparent on edoscopic approaches to the cervical foraminae than at open surgery.

Improved Damage Characteristics Identification Method of Concrete CT Images Based on Region Convolutional Neural Network

The detection of internal damage characteristics of concrete is an important aspect of damage evolution mechanism in concrete meso-structure. In this paper, the improved Faster R-CNN is used to detect the porosity and cracks in concrete CT images. Based on the Faster R-CNN, ResNet-101 and ResNet-50 are used as the main framework. Feature pyramid network (FPN) and ROI Align are introduced to improve the performance of the model. FPN can generate high quality feature maps. ROI Align solves the region mismatch caused by the quantization operation. Experiments show that the detection accuracy of ResNet-101[Formula: see text]+[Formula: see text]FPN[Formula: see text]+[Formula: see text]ROI Align reaches 87.08%, which is 4.74 higher than that of ResNet-101. The detection accuracy of ResNet-50 [Formula: see text]+[Formula: see text] FPN [Formula: see text]+[Formula: see text] ROI Align reached 81.36%, which is 3.12% points higher than ResNet-50. These two improved algorithms are slower than the original algorithm for the detection time of a single picture. An effective method is provided to analyze concrete meso-damage evolution through the research.

Novel findings from determination of common expressed plasma exosomal microRNAs in patients with psoriatic arthritis, psoriasis vulgaris, rheumatoid arthritis, and gouty arthritis

BACKGROUND

Circulating exosomal microRNAs modulate not only cancer cell metabolism but also the immune response, and therefore plasma exosomal microRNAs might have the potential to be the biomarkers for a number of immune disorders.

OBJECTIVE

This study was conducted to identify the common mechanisms among psoriatic arthritis (PsA), psoriasis vulgaris (PV), rheumatoid arthritis (RA), and gouty arthritis (GA). The common expressed plasma exosomal microRNAs in these diseases were determined.

METHODS

The expression of microRNAs derived from plasma exosome of patients with PsA (n=30), PV (n=15), RA (n=15), GA (n=15), and healthy controls (n=15) was evaluated via sequencing. Function analysis of common expressed microRNAs was conducted by the Gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) enrichment analyses. Coexpression analysis was conducted to identify novel and significant genes and proteins by using the Search Tool for the Retrieval of Interacting Genes (STRING). A systematic literature review was conducted to uncover the role of the common microRNAs in the pathogenesis of PsA, PV, RA, and GA.

RESULTS

A total of 36 common expressed microRNAs were detected in patients with PsA, PV, RA, and GA. The most significantly enriched biological processes, cellular components, and molecular functions were "homophilic cell adhesion via plasma membrane adhesion molecules," "CCR4-NOT complex," and "calcium ion binding," respectively. "Antigen processing and presentation" was the most significantly enriched pathway. A total of 91 validated coexpressed gene pairs were identified and 16 common expressed microRNAs and 85 potential target genes were screened based on Cytoscape. Of 36 common expressed microRNAs, 5 microRNAs, including hsa-miR-151a-3p, hsa-miR-199a-5p, hsa-miR-370-3p, hsa-miR-589-5p, and hsa-miR-769-5p, were considered to be connected with the common pathogenesis of PsA, PV, RA, and GA. Systemic review revealed that the roles of these 5 microRNAs are related to immune disorder and bone injury, which matches the conclusion from GO and KEGG analyses.

CONCLUSION

(1) Both immune disorder and bone metabolic dysregulation could be the shared mechanism in the development of PsA, PV, RA, and GA. (2) Immune dysfunction is involved in GA. Our study may shed new light on the diagnosis and treatment strategy of these autoimmune diseases and GA, which warrants further studies.

Learning Curve for Percutaneous Endoscopic Lumbar Diskectomy in Bi-needle Technique Using Cumulative Summation Test for Learning Curve

BACKGROUND

The purpose of this study was to determine the number of cases needed to achieve the level of competence for percutaneous endoscopic lumbar diskectomy (PELD) via the bi-needle technique using the cumulative summation test for learning curve (LC-CUSUM).

METHODS

A retrospective design was used. We included 60 patients who underwent a single-level PELD via the bi-needle technique performed by a single surgeon. The surgeon had 5 years of experience in open surgery including the transforaminal endoscopic spine system and Yeung endoscopic spine system but no experience in the bi-needle technique. Surgery success was defined as an operative time <60 minutes, and the acceptable procedure was completed within 3 times of C-arm fluoroscopies. The LC-CUSUM was used to analyze the data.

RESULTS

The average operative time for PELD via the bi-needle technique was 58.3 ± 12.4 minutes. The mean operative time was 65.7 ± 12.1 minutes in the early learning period (30 cases) and 51.0 ± 7.5 minutes in the late learning period (30 cases) (P < 0.05). On the basis of the evaluation indexes of the operative time and radioactive exposure, the LC-CUSUM signaled proficiency for the bi-needle technique at the 50th-54th operation. Seven cases of complications were observed during the whole learning process, with 6 in the early period and 1 in the late period (P < 0.05).

CONCLUSIONS

The novel bi-needle technique is safe and effective for PELD with appropriate patients, and the learning curve is acceptable. A substantial learning period (50-54 cases) is needed before a spine surgeon can master the bi-needle technique.

[Clarify some cognitive problems of standardization of acupuncture and moxibustion based on the characteristics of disciplines]

At present, there is still a underrecognition of the standardization work of acupuncture and moxibustion and the confusion of the basic theory. In order to better advance the next step, it is necessary to review the way and clarify the understanding. Based on the definition, principles and methods of standardization, combined with the practice of standardization of acupuncture and moxibustion, this paper analyzes the relationship between standardization and modernization, standardization and individualization diagnosis and treatment, modern standards and traditional classics, as well as standard development and research, it is proposed to base on the development of disciplines, objectively analyze the different needs at home and abroad, as well as scientific research and clinical practice, and clarify the true purpose of standardization of acupuncture and moxibustion. Standard cannot be simply developed on the base of the individual characteristics of acupuncture, and it is not possible to simply develop acupuncture with standardized concepts and methods. It is necessary to return to acupuncture itself and re-examine acupuncture and moxibustion from a standardized perspective, e.g.in-depth analysis and reflection on which characteristics of acupuncture need to be standardized, how to standardize. It is proposed that the scientific research should be organically combined with the development of standards, and drafting should be in compliance with the rules and the quality of the standard should be improved, so as to truly promote the development of the discipline of acupuncture.

Energy use by globalized economy: Total-consumption-based perspective via multi-region input-output accounting

Within a single integrated globalized economy featuring robust fluxes of interregional trades, the world economy is like a giant bathtub containing the world inventory of energy use. Based on different norms or ethic percepts, the energy use of the world economy is reallocated to nations and regions via global supply chain using normative accounting schemes. By combining typical statistics for world economy 2012, a new perspective is presented in this study to look into the energy use of regional economies from the side of genuine final consumers. Parallel to the final-demand-based accounting method, a total-consumption-based multi-region input-output accounting method is developed following the norm of consumption being the ultimate end and purpose of all producing activities. From a total-consumption-based perspective, the energy use of the United States economy is shown in magnitude 1.8 times that of mainland China, compared to a ratio of 88% from a territorial-based perspective. The consumer-product-related trade imbalances of major economies in terms of both currency and energy use are analyzed, with major interregional net trade flows illustrated. While the United States and mainland China are respectively revealed as the leading net exporter and net importer of currency, the energy trade deficit of the latter is in magnitude around four times the energy trade surplus of the former. The trade structures by geography and sector are respectively presented for the United States and mainland China as two distinct economies. It is found that around half of the United States' exports of energy use originate from transport and service industries, while nearly 90% of mainland China's exports of energy use come from heavy industry. The findings are supportive for nations to identify their roles in the global supply chain from the perspective of genuine final consumers and adjust the trade patterns for sustained energy use.

Generation and Characterization of Fibroblast-Specific Basigin Knockout Mice

Basigin is a well-known extracellular stimulator of fibroblasts and may confer resistance to apoptosis of fibroblasts in vitro under some pathological status, but its exact function in fibroblasts and the underlying mechanism remain poorly understood. The systematic Basigin gene knockout leads to the perinatal lethality of mice, which limits the delineation of its function in vivo. In this study, we generated a fibroblast-specific Basigin knock-out mouse model and demonstrated the successful deletion of Basigin in fibroblasts. The fibroblast-specific deletion of Basigin did not influence the growth, fertility and the general condition of the mice. No obvious differences were found in the size, morphology, and histological structure of the major organs, including heart, liver, spleen, lung and kidney, between the knockout mice and the control mice. The deletion of Basigin in fibroblasts did not induce apoptosis in the tissues of the major organs. These results provide the first evidence that the fibroblast-specific Basigin knock-out mice could be a useful tool for exploring the function of Basigin in fibroblasts in vivo.

[Present situation, challenge and strategy of acupuncture standardization in China]

On the base of the overall summarization of the development situation of acupuncture standardization, four kinds of relationships are proposed, which needs to be harmonized in the current acupuncture standardization, i.e. standardization and individualization, China acupuncture and world acupuncture, quantity and quality, as well as internal motivation and the government overall instruction. Through in-depth analysis of the problems and their causes, the solutions and measures are put forward, e.g. paying attention to the study on relevant knowledge on standardization and standard publicity, increasing the inputs on theoretic study, strategy study, methodological study as well as the applicability of standards, accelerating the construction of talent team, cultivating and attracting first-class professionals to participate in the standardization work, integrating institutions, straightening out relations as well as improving management system and operation mechanism of acupuncture standardization.

[Bioavailability of Dissolved Organic Carbon in Rivers for Typical Vegetation Types in the Permafrost Regions on the Qinghai-Tibet Plateau]

Samples collected from 12 rivers with typical vegetation types in the permafrost regions on the Qinghai-Tibetan Plateau were incubated in the laboratory, and the relationships among the vegetation types, river discharges, the compositions of dissolved organic carbon (DOC), permafrost areas, riverine DOC concentration, biodegradability of dissolved organic carbon (BDOC), and the biodegradation kinetics were examined. The results showed that the DOC concentrations of typical vegetation types in the basin, such as alpine meadow (AM), alpine swamp meadow-alpine meadow (ASM-AM), alpine meadow-alpine steppe (AM-AS), and alpine meadow-alpine steppe-bare soil (AM-AS-BL), were (5.17±0.21), (5.02±0.50), (3.55±0.25), and (2.79±0.41) mg ·L^-1, respectively. The values for the bioavailability of river DOC of different vegetation types were (23.54±2.62)%, (23.66±3.31)%, (18.17±5.26)%, and (11.72±15.56)%, respectively. Correspondingly, the riverine DOC aromaticity increased along with the vegetation cover, while the biodegradation and degradation rates decreased gradually. During the incubation, the reaction of BDOC was in accordance with the first-order kinetics equation. Furthermore, the BDOC in continuous permafrost regions of the rivers was greater than that in the non-continuous permafrost regions. The BDOC in higher discharges were lower than those with lower discharges. Taken together, the results suggested that the vegetation types were the main controlling factors for the BDOC, and BDOC was also related to the discharge and permafrost.