Remote Ischemic Postconditioning-Mediated Neuroprotection against Stroke by Promoting Ketone Body-Induced Ferroptosis Inhibition

Neuronal death resulting from ischemic stroke is the primary cause of adult mortality and disability, and effective neuroprotective agents for poststroke intervention are still lacking. Remote ischemic postconditioning (RIPostC) has demonstrated significant protective effects against ischemia in various organs; however, the specific mechanisms are not fully understood. This study investigated the potential neuroprotective mechanisms of RIPostC in the context of ischemic stroke. Using a rat model of middle cerebral artery occlusion, we found that RIPostC mitigated neurological damage, improved movement in the open-field test, and protected against neuronal apoptosis. In terms of energy metabolism, RIPostC enhanced ATP levels, suppressed lactate content, and increased the production of ketone bodies (KBs). In the ferroptosis assay, RIPostC protected against lipoperoxidation, reversed the reduction of glutathione peroxidase 4 (GPX4), and mitigated the excessive expression of long-chain acyl-CoA synthetase family member 4 (ACSL4). In oxygen-glucose deprivation/reoxygenation-treated HT22 cells, KBs maintained GPX4 levels, suppressed ACSL4 expression, and preserved the mitochondrial cristae number. However, the effect of KBs on the expression of GPX4, ACSL4, and the number of mitochondrial cristae was blocked by erastin. Moreover, both RIPostC and KBs reduced total iron and ferrous ion content by repressing iron transporters both in vitro and in vivo. In conclusion, KBs-induced mitigation of ferroptosis could represent a new therapeutic mechanism for RIPostC in treating stroke.

[The precision medicine for the treatment of acute respiratory distress syndrome is based on identification of phenotypes]

The acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome characterized by distinct etiologies and complicated pathobiological mechanism. It is difficult to discriminate patients with unique biological features or individual response to specific therapy by traditional definition and subgrouping. Unfortunately, there are few clinical evidences supporting effective drug therapy to ARDS. The sub-phenotype or endotype of ARDS is related to potential mechanism of the syndrome, and is critical to personalized treatment of ARDS. An appropriate sub-phenotype of ARDS may be defined by data-driven assessment of the available data including clinical features, biological biomarkers and respiratory parameters of the patients. Latent class analysis or machine learning has potential to establish new sub-phenotype of ARDS stably, which is helpful to guide precision medicine approach.

Measurements of All-Particle Energy Spectrum and Mean Logarithmic Mass of Cosmic Rays from 0.3 to 30 PeV with LHAASO-KM2A

We present the measurements of all-particle energy spectrum and mean logarithmic mass of cosmic rays in the energy range of 0.3-30 PeV using data collected from LHAASO-KM2A between September 2021 and December 2022, which is based on a nearly composition-independent energy reconstruction method, achieving unprecedented accuracy. Our analysis reveals the position of the knee at 3.67±0.05±0.15  PeV. Below the knee, the spectral index is found to be -2.7413±0.0004±0.0050, while above the knee, it is -3.128±0.005±0.027, with the sharpness of the transition measured with a statistical error of 2%. The mean logarithmic mass of cosmic rays is almost heavier than helium in the whole measured energy range. It decreases from 1.7 at 0.3 PeV to 1.3 at 3 PeV, representing a 24% decline following a power law with an index of -0.1200±0.0003±0.0341. This is equivalent to an increase in abundance of light components. Above the knee, the mean logarithmic mass exhibits a power law trend towards heavier components, which is reversal to the behavior observed in the all-particle energy spectrum. Additionally, the knee position and the change in power-law index are approximately the same. These findings suggest that the knee observed in the all-particle spectrum corresponds to the knee of the light component, rather than the medium-heavy components.

Measurement of Ultra-High-Energy Diffuse Gamma-Ray Emission of the Galactic Plane from 10 TeV to 1 PeV with LHAASO-KM2A

The diffuse Galactic γ-ray emission, mainly produced via interactions between cosmic rays and the interstellar medium and/or radiation field, is a very important probe of the distribution, propagation, and interaction of cosmic rays in the Milky Way. In this Letter, we report the measurements of diffuse γ rays from the Galactic plane between 10 TeV and 1 PeV energies, with the square kilometer array of the Large High Altitude Air Shower Observatory (LHAASO). Diffuse emissions from the inner (15°10  TeV). The energy spectrum in the inner Galaxy regions can be described by a power-law function with an index of -2.99±0.04, which is different from the curved spectrum as expected from hadronic interactions between locally measured cosmic rays and the line-of-sight integrated gas content. Furthermore, the measured flux is higher by a factor of ∼3 than the prediction. A similar spectrum with an index of -2.99±0.07 is found in the outer Galaxy region, and the absolute flux for 10≲E≲60  TeV is again higher than the prediction for hadronic cosmic ray interactions. The latitude distributions of the diffuse emission are consistent with the gas distribution, while the longitude distributions show clear deviation from the gas distribution. The LHAASO measurements imply that either additional emission sources exist or cosmic ray intensities have spatial variations.

Causal Association Between Tea Consumption and Gout: A Mendelian Randomization Study

OBJECTIVE

Evidence from prospective studies on the consumption of tea and risk of gout is conflicting and limited. We aimed to investigate the potential causal effects of tea intake on gout using Mendelian randomization (MR).

METHODS

Genome-wide association studies in UK Biobank included 349 376 individuals and successfully discovered single-nucleotide polymorphisms linked to consumption of one cup of tea per day. Summary statistics from the Chronic Kidney Disease Genetics consortium included 13 179 cases and 750 634 controls for gout. Two-sample MR analyses were used to evaluate the relationship between tea consumption and gout risk. The inverse-variance weighted (IVW) method was used for primary analysis, and sensitivity analyses were also conducted to validate the potential causal effect.

RESULTS

In this study, the genetically predicted increase in tea consumption per cup was associated with a lower risk of gout in the IVW method (OR: 0.90; 95% CI: 0.82-0.98). Similar results were found in weighted median methods (OR: 0.88; 95% CI: 0.78-1.00), while no significant associations were found in MR-Egger (OR: 0.89; 95% CI: 0.71-1.11), weighted mode (OR: 0.80; 95% CI: 0.65-0.99), and simple mode (OR: 1.01; 95% CI: 0.75-1.36). In addition, no evidence of pleiotropy was detected by MR-Egger regression (P=0.95) or MR-PRESSO analysis (P=0.07).

CONCLUSION

This study provides evidence for the daily consumption of an extra cup of tea to reduce the risk of gout.

[Trend of hypertension death and its impact on life expectancy in 6 northwestern provinces of China, 2013-2021]

Objective: To analyze the mortality trend of hypertension in Xinjiang Uygur Autonomous Region, Qinghai Province, Shaanxi Province, Gansu Province, Ningxia Hui Autonomous Region and Inner Mongolia Autonomous Region (6 provinces) in northwestern China, from 2013 to 2021, and evaluate the influence of hypertension on people's life expectancy. Methods: Based on national death surveillance data and demographic data in the 6 provinces from 2013 to 2021, the mortality rate, standardized mortality rate, life expectancy, cause eliminated life expectancy (CELE), potential gains in life expectancy (PGLEs) and life loss rate of hypertension were calculated. Software Joinpoint was used to analyze the mortality trends and calculate average annual percentage change (AAPC) and annual percentage change (APC) in hypertension deaths. Results: From 2013 to 2021, the overall standardized mortality rate of hypertension in the 6 provinces showed a downward trend (AAPC=-1.82%, P=0.050). The mortality rate in rural area was always higher than that in urban area, and showed an increasing trend after 2016 (APC=4.74%, P=0.003), and the mortality rate in men was always higher than that in women. The incidence trend of deaths of different types of hypertension were different, and the deaths caused by hypertensive heart disease accounted for the highest proportion (72.69%). In 2021, the life expectancy of the population in the 6 provinces increased by 1.01 years, the CELE increased by 0.93 years, the PGLEs decreased by 0.08 years, and the life loss rate decreased by 0.11% compared with 2013. Conclusions: The overall standardized mortality rate of hypertension showed a decreasing trend in the 6 northwestern provinces from 2013 to 2021, but it showed an increasing trend in rural area after 2016. Prevention of hypertension should be further strengthened in rural area, men and elderly population.

A tera-electron volt afterglow from a narrow jet in an extremely bright gamma-ray burst

Some gamma-ray bursts (GRBs) have a tera-electron volt (TeV) afterglow, but the early onset of this has not been observed. We report observations with the Large High Altitude Air Shower Observatory of the bright GRB 221009A, which serendipitously occurred within the instrument field of view. More than 64,000 photons >0.2 TeV were detected within the first 3000 seconds. The TeV flux began several minutes after the GRB trigger, then rose to a peak about 10 seconds later. This was followed by a decay phase, which became more rapid ~650 seconds after the peak. We interpret the emission using a model of a relativistic jet with half-opening angle ~0.8°. This is consistent with the core of a structured jet and could explain the high isotropic energy of this GRB.

Protein-Scaffolded DNA Nanostructures for Imaging of Apurinic/Apyrimidinic Endonuclease 1 Activity in Live Cells

Nucleic acids are valuable tools for intracellular biomarker detection and gene regulation. Here we propose a new type of protein (avidin)-scaffolded DNA nanostructure (ADN) for imaging the activity of apurinic/apyrimidinic endonuclease 1 (APE1) in live cells. ADN is designed by assembling an avidin-displayed abasic site containing DNA strands labeled with a fluorophore or a quencher via a complementary linker strand. ADN is nonemissive due to the close proximity of fluorophores and quenchers. APE1-mediated cleavage separates the fluorophores from the quenchers, delivering activated fluorescence. In vitro assays show that ADN is responsive to APE1 with high sensitivity and high specificity. ADN can efficiently enter the cells, and its capability to visualize and detect intracellular APE1 activities is demonstrated in drug-treated cells and different cell lines. The modular and easy preparation of our nanostructures would afford a valuable platform for imaging and detecting APE1 activities in live cells.

Crosstalk between PML and p53 in response to TGF-β1: A new mechanism of cardiac fibroblast activation

Cardiac fibrosis is a common pathological cardiac remodeling in a variety of heart diseases, characterized by the activation of cardiac fibroblasts. Our previous study uncovered that promyelocytic leukemia protein (PML)-associated SUMO processes is a new regulator of cardiac hypertrophy and heart failure. The present study aimed to explore the role of PML in cardiac fibroblasts activation. Here we found that PML is significantly upregulated in cardiac fibrotic tissue and activated cardiac fibroblasts treated with transforming growth factor-β1 (TGF-β1). Gain- and loss-of-function experiments showed that PML impacted cardiac fibroblasts activation after TGF-β1 treatment. Further study demonstrated that p53 acts as the transcriptional regulator of PML, and participated in TGF-β1 induced the increase of PML expression and PML nuclear bodies (PML-NBs) formation. Knockdown or pharmacological inhibition of p53 produced inhibitory effects on the activation of cardiac fibroblasts. We further found that PML also may stabilize p53 through inhibiting its ubiquitin-mediated proteasomal degradation in cardiac fibroblasts. Collectively, this study suggests that PML crosstalk with p53 regulates cardiac fibroblasts activation, which provides a novel therapeutic strategy for cardiac fibrosis.

Constraints on Heavy Decaying Dark Matter from 570 Days of LHAASO Observations

The kilometer square array (KM2A) of the large high altitude air shower observatory (LHAASO) aims at surveying the northern γ-ray sky at energies above 10 TeV with unprecedented sensitivity. γ-ray observations have long been one of the most powerful tools for dark matter searches, as, e.g., high-energy γ rays could be produced by the decays of heavy dark matter particles. In this Letter, we present the first dark matter analysis with LHAASO-KM2A, using the first 340 days of data from 1/2-KM2A and 230 days of data from 3/4-KM2A. Several regions of interest are used to search for a signal and account for the residual cosmic-ray background after γ/hadron separation. We find no excess of dark matter signals, and thus place some of the strongest γ-ray constraints on the lifetime of heavy dark matter particles with mass between 10^{5} and 10^{9}  GeV. Our results with LHAASO are robust, and have important implications for dark matter interpretations of the diffuse astrophysical high-energy neutrino emission.

[Progress in research of determinants of healthy life expectancy]

Objective: To analyze the influencing factors of healthy life expectancy (HLE). Methods: Seven Chinese and English databases were used for the retrieval of related literatures published by May 7, 2022 to identify influencing factors of HLE, including diseases and injuries and their risk factors. Based on the ecological model of health determinants, this study classifies the risk factors of diseases and injuries into five levels: personal characteristics, individual behavior and lifestyle, social network, living and working conditions, and macroscopic socio-economic, cultural and environmental conditions. Contents of research area, HLE indicators, research population, influencing factors, data sources and results were extracted. The frequencies of reported documents of different HLE indicators and influencing factors of different dimensions were visualized by using evidence map, and the empirical studies of four authoritative English medical journals and Chinese core medical journals were further compared and described. Results: A total of 90 studies were selected, in which 26 were conducted in China (28.9%). Fifty-three studies are about diseases and injuries in the first dimension, and all of them have studied non-communicable diseases, accounting for the highest proportion (58.9%). There were 77 studies about the analysis on the determinants of health at five levels by an ecological model, all the studies reported multi-level results. Among them, 53 studies reported personal characteristics (58.9%), 47 studies reported individual behavior and lifestyle (52.2%), 10 studies reported social networks (11.1%), 35 studies reported living and working environment (38.9%), 8 studies reported social economy, culture status and environment condition (8.9%). The literatures about HLE published by 4 authoritative English medical journals and 21 Chinese core medical journals in recent three years were selected. Non-communicable diseases and personal characteristics were the top two most commonly studied factors of HLE, and 11 (52.3%) and 12 (57.1%) studies reported these two kinds of factors respectively. The most important factor contributing to the global disability-adjusted life years of non-communicable diseases was individual behavior and lifestyle, which was the most changeable factor. Conclusions: In recent three years, studies involving influencing factors of HLE were mainly non-communicable diseases and personal characteristics. In the future, individual behavior, lifestyle and working environment should be strengthened.

[Cone-beam CT analysis of vertical control of mandible and changes of temporomandibular joint in adult patients with skeletal class Ⅱ malocclusion with high angle]

Objective: To investigate the shape and position changes of temporomandibular joint (TMJ) in adult skeletal class Ⅱ malocclusion with high angle patients after vertical mandibular control, and the correlation between vertical mandibular changes and condylar position changes. Methods: Twenty adult skeletal class Ⅱ malocclusion with high angle patients [6 males and 14 females, aged (21.4±2.4) years] who underwent extraction treatment and active vertical control in the Department of Orthodontics, Lanzhou University Stomatological Hospital from October 2017 to November 2020 were selected. Cone-beam CT data of the patient before and after treatment were imported into Invivo Dental 5.0 software for three-dimensional reconstruction and correction, and the vertical index of mandible in reconstructed lateral cephalogram (mandibular plane angle, posterior anterior height ratio, mandibular true rotation angle) were measured. Incisal angle and variables of condyle shape, position and articular fossa shape were measured. Paired t test was performed on the results before and after treatment, and the correlation between mandibular vertical changes and condylar position changes was determined by Pearson correlation coefficient calculation. Results: After treatment, the overbite and overjet were within normal range, and the vertical height of the molars was controlled. Compared with the measurement before treatment, mandibular plane angle and mandibular true rotation angle were decreased by 2.05°±1.22° (t=7.60, P<0.001) and 1.42°±1.92° (t=3.54, P=0.002), respectively. The posterior anterior height ratio was increased by (1.89±3.32)% (t=2.56, P=0.019). After treatment, the mediolateral diameter of condyle, the anteroposterior diameter of condyle, the maximum cross-sectional area of condyle, the height of condyle head, the width of articular fossa, the depth of articular fossa and the articular nodular angle were increased by (0.55±0.76) mm (t=-2.73, P=0.015), (0.27±3.51) mm (t=-3.23, P=0.006), (6.01±7.36) mm² (t=-2.80, P=0.013), (0.33±0.72) mm (t=-2.14, P=0.046), (0.56±0.93) mm (t=-2.37, P=0.032), 0.33 (0.14, 0.51) mm (Z=-2.76, P=0.006) and 1.50°±2.40° (t=-2.44, P=0.028), respectively. The internal condylar space and the external condylar space were decreased by (0.33±0.49) mm (t=2.31, P=0.035) and (0.20±0.23) mm (t=3.58, P=0.003), respectively. Before orthodontic treatment, 6 patients were with anterior displacement of the condyle, 7 patients with central position of the condyle, and 7 patients with posterior displacement of the condyle. After correction, patients who were with central position of the condyle have not changed much. The posterior displaced condyle in 2 patients and anterior displaced condyle in 3 patients became in central position after treatment. The joint space index was closer to the central position in 3 patients with anterior displacement and 3 patients with posterior displacement. The position of condyle in 1 patient with posterior displacement and 1 patient with anterior displacement remained basically unchanged. There was a significant negative correlation between the change of the posterior-anterior height ratio and the change of the internal condylar space in patients (r=-0.52, P=0.019), and a low correlation with the contral condylar space and the external condylar space(r=-0.48, P=0.031; r=-0.47, P=0.035). Conclusions: Skeletal class Ⅱ malocclusion with high angle adult patients achieved normal overbite and overjet and remodeling of condyle and articular fossa occurred after orthodontic treatmnet and vertical control. There was a certain negative correlation between the change of posterior-anterior height ratio and the change of condylar position.

[Research progress in radiomics based on CT and MRI images for prediction of microvascular invasion in hepatocellular carcinoma]

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. Microvascular invasion (MVI) is considered the major risk factor for postoperative recurrence and metastasis in HCC. The diagnosis of MVI relies on the postoperative pathological assessment of the tumor tissues. Seeking non-invasive methods and biomarkers for evaluation of MVI before surgery has important clinical implications for guiding surgical treatment and improving patients' survival. Recent studies have reported the applications of radiomics technique in prediction of MVI in HCC and showed promising results. Herein we summarized the research progress in CT- or MRI-based radiomics models for prediction of MVI in HCC to provide helpful thinking for further research in this field.

[Expert consensus on measurement and clinical application of serum HBV RNA in patients with chronic HBV infection]

Since the discovery of circulating hepatitis B virus (HBV) RNA in the peripheral blood of patients with chronic hepatitis B in 1996, a growing number of studies have focused on clarifying the biological characteristics and clinical application value of serum HBV RNA. This consensus mainly summarizes the research progress of serum HBV RNA existing profiles, quantitative detection methods, and current clinical applications. In order to better apply this indicator for the clinical management of patients with chronic HBV infection, recommendations on quantitative detection target regions, detection results, and clinical applications are put forward.

Exploring Lorentz Invariance Violation from Ultrahigh-Energy γ Rays Observed by LHAASO

Recently, the LHAASO Collaboration published the detection of 12 ultrahigh-energy γ-ray sources above 100 TeV, with the highest energy photon reaching 1.4 PeV. The first detection of PeV γ rays from astrophysical sources may provide a very sensitive probe of the effect of the Lorentz invariance violation (LIV), which results in decay of high-energy γ rays in the superluminal scenario and hence a sharp cutoff of the energy spectrum. Two highest energy sources are studied in this work. No signature of the existence of the LIV is found in their energy spectra, and the lower limits on the LIV energy scale are derived. Our results show that the first-order LIV energy scale should be higher than about 10^{5} times the Planck scale M_{Pl} and that the second-order LIV scale is >10^{-3}M_{Pl}. Both limits improve by at least one order of magnitude the previous results.

[Clinical application of serum Golgi protein 73 in patients with chronic liver diseases]

Golgi protein 73 (GP73) is a transmembrane protein on the Golgi apparatus and can be cut and released into the blood. In recent years, an increasing number of clinical studies have shown that the elevated serum GP73 level is closely related to liver diseases. And thus GP73 is expected to be used as a new serum marker for assessing progress of chronic liver diseases. Herein, the clinical application of serum GP73 in chronic hepatitis, liver fibrosis, liver cirrhosis and hepatocellular carcinoma with different etiologies was reviewed based on available literatures; and a research outlook in this field is made.

[Mortality trend of chronic respiratory diseases in China, 1990-2019]

Objective: To analyze mortality and its trend of chronic respiratory diseases (CRD) in China from 1990 to 2019. Methods: Based on the provincial results of China from the 2019 Global Burden of Disease (GBD) study, the average annual percent change (AAPC) of standardized mortality rates of different CRDs were analyzed by using Joinpoint 4.8.0.1, and the age-standardized mortality rate of CRD was calculated by using the GBD 2019 world standard population. Based on the comparative risk assessment theory of GBD, the attributable deaths due to 12 CRD risk factors were estimated, including smoking, indoor air pollution, occupational gas exposure, particulates and smog exposure, environmental particulate pollution, low temperature, passive smoking, ozone pollution, occupational exposure to silica, occupational asthma, high body mass index, high temperature and occupational exposure to asbestos. Results: From 1990 to 2019, the number of deaths and standardized mortality of chronic obstructive pulmonary disease (COPD) showed a downward trend (P<0.001). The number of COPD deaths decreased from 1 244 000 (912 000 - 1 395 000) in 1990 to 1 037 000 (889 000 - 1 266 000) in 2019. AAPC=-0.9% (95%CI: -1.5% - -0.3%), P<0.001; The standardized mortality rate decreased from 217.9/100 000 (163.3/100 000 - 242.0/100 000) in 1990 to 65.2/100 000 (55.5/100 000 - 80.1/100 000) in 2019. AAPC= -4.2% (95%CI:-5.2% - -3.2%), P<0.001. The number of deaths from asthma decreased from 40 000 (30 000 - 58 000) in 1990 to 25 000 (20 000 - 31 000) in 2019. AAPC=-2.0% (95%CI: -2.6% - -1.4%), P<0.001; The standardized mortality rate of asthma decreased from 6.4/100 000 (4.7/100 000 - 9.5/100 000) in 1990 to 1.5/100 000 (1.2/100 000 - 1.9/100 000) in 2019. AAPC=-5.1% (95%CI: -5.8% - -4.4%), P<0.001. The number of pneumoconiosis deaths decreased from 11 000 (8 000 - 14 000) in 1990 to 10 000 (8 000 - 14 000) in 2019, AAPC=-0.2%(95%CI:-0.4% - 0.1%), P=0.200; The standardized mortality rate of pneumoconiosis decreased from 1.4/100 000 (1.0/100 000 - 1.7/100 000) in 1990 to 0.5/100 000 (0.4/100 000 - 0.7/100 000) in 2019. AAPC=-3.1% (95%CI: -3.4% - -2.8%), P<0.001. The number of deaths from pulmonary interstitial diseases and pulmonary sarcoidosis increased from 3 000 (3 000 - 6 000) in 1990 to 8 000 (6 000 - 10 000) in 2019, AAPC=3.5% (95%CI: 2.7% - 4.2%), P<0.001; The corresponding standardized mortality rate changed little from 1990 to 2019, and AAPC was not statistically significant.The age-standardized mortality rates of different CRDs were higher in men than those in women. In 1990 and 2019, the mortality rates of COPD, asthma, pneumoconiosis and interstitial pulmonary disease and pulmonary sarcoidosis increased with age. In 2019, the population attributable fractions (PAFs) for smoking, environmental particulate pollution, occupational gas exposure, particulate and smog exposure, low temperature exposure and passive smoking were 71.1% (68.0% - 74.3%), 24.7% (20.1% - 30.0%), 19.3% (13.0% - 25.4%), 15.7% (13.6% - 18.3%) and 8.8% (4.5% - 13.1%) respectively in men, and the PAFs for environmental particulate pollution, smoking, low temperature exposure, occupational gas exposure, particulate and smog exposure, and passive smoking were 24.1% (19.6% - 29.3%), 21.9% (18.7% - 25.2%), 16.4% (14.0% - 19.2%), 15.6% (10.2% - 21.1%) and 14.7% (7.9% - 21.3%) respectively in women. Conclusions: During 1990-2019, the overall death level of CRD decreased significantly in China, but it is still at high level in the world. Active prevention and control measures should be taken to reduce the death level caused by CRD.

Structural characterization of a water-soluble polysaccharide from Angelica dahurica and its antitumor activity in H22 tumor-bearing mice

A novel Angelica dahurica polysaccharide (ADP) with Mw of 6.09 × 10³ Da was isolated. The contents of total sugar and uronic acid in ADP were 91.04% and 12.69%. The structure characteristics indicated that ADP was an acidic polysaccharide consisting of rhamnose, arabinose, galactose, glucose, mannose, glucuronic acid and galacturonic acid (0.09: 0.61: 1.88: 1: 0.14: 0.63: 0.03). Moreover, there were →3)-Manp-(1→, →4, 6)-Galp-(1→, →4)-Galp-(1→, →3)-Glcp-(1→, →5)-Araf-(1→, →2)-Galp-(1→ in ADP with relative molar ratios of 0.32:0.57:0.29:0.95:0.71:0.26. In vivo experiments suggested that ADP significantly inhibited the tumor growth of mice, increased the activities of spleen lymphocytes and natural killer (NK) cells, improved the cytokine level (IL-2 and TNF-α) and the proportions of lymphocyte subsets in the peripheral blood. The tumor cell progression was arrested in the G₁ phase, and the apoptosis rate of tumor cells were 7.54% and 19.32% at the dose of 100 and 200 mg/kg, which was consistent with the results of pathological observation. In summary, the study might provide a theoretical basis for the application on functional foods containing Angelica dahurica polysaccharides.

[Role of NF-κB p65 and related cytokines in rats with liver function injury induced by dibutyl phthalate and benzo (a) pyrene]

Objective: To explore the role of nuclear factor-κB (NF-κB) p65 and related cytokines in rats with liver function injury induced by dibutyl phthalate (DBP) and benzo (a) pyrene (BaP) , in order to provide support for enriching the mechanism of liver injury induced by DBP and BaP. Methods: In September to December of 2019, a total number of 160 specific pathogen free Sprague Dawley rats were numbered in order of sex and body weight, then using the statistical table of random numbers, they were randomly divided into eight groups and each group consists of twenty animals (10 male and 10 female rats) , including blank control group, vehicle control group (given corn oil) , DBP 50 mg/kg (DBP(50)) group, DBP 250 mg/kg (DBP(250)) group, BaP 1 mg/kg (BaP(1)) group, BaP 5 mg/kg (BaP(5)) group, DBP 50 mg/kg plus BaP 1 mg/kg (DBP(50)+BaP(1)) group and DBP 250 mg/kg plus BaP 5 mg/kg (DBP(250)+BaP(5)) group, then DBP and BaP were administered to rats as a homogenous mixture in corn oil by gavage. After exposure for 90 days, liver was separated to test the mRNA and protein expression levels of NF-κB p65 by Real-time fluorescence quantitative polymerase chain reaction and Western blotting. Then serum of rats was collected to detect the levels of CXCL-13, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) by Enzyme-Linked Immunosorbent Assay, and the levels of alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , albumin (ALB) and total protein (TP) were detected by Reitman-Frankel assay. Results: The protein expression of NF-κB p65 in BaP(1) group was not statistically significant, but the mRNA and protein expression levels of NF-κB p65 in the liver tissues of rats in other exposure group were higher than those in the blank control group (P<0.05) , and the expression levels of NF-κB p65 increased more obvious in the DBP and BaP co-exposed groups than those in the low and high dose groups that single-exposed to DBP and BaP (P<0.05) . The serum levels of CXCL-13 and IL-6 of rats in other group were obviously higher than those of the blank control group except for the BaP(1) group, and the increase was more obvious in the high-dose group that co-exposed to DBP and BaP (P<0.05) . While the level of TNF-α in each exposure group was higher than those in the blank control group and the levels of TNF-α in the DBP and BaP co-exposed groups were strongly augmented compared to those in the low and high dose groups that single-exposed to DBP and BaP (P<0.05) . What's more, compared with the blank control group, the level of ALT in each exposure group was increased significantly. Except for the BaP(1) group, the levels of AST in other exposed groups were increased (P<0.05) , and the levels of ALT and AST in the DBP and BaP co-exposed groups were significantly elevated in comparison to the low and high dose groups that single-exposed to DBP and BaP (P<0.05) . On the contrary, the level of ALB in each exposure group was significantly lower than that in the blank control group, especially decreased significantly in the DBP and BaP co-exposed group (P<0.05) . The level of TP decreased only in the high-dose group that single and co-exposed to DBP and BaP, and the decrease was more significant in the DBP and BaP co-exposed group (P<0.05) . When DBP exposed alone, Pearson correlation analysis showed that NF-κB p65 protein expression level was positively correlated with IL-6, TNF-α and ALT (r=0.762, 0.951, and 0.924, P<0.05) . After BaP exposed alone, the NF-κB p65 protein expression level was positively correlated with TNF-α and ALT (r=0.911 and 0.910, P<0.05) . When DBP and BaP exposed together, NF-κB p65 protein expression level was positively correlated with CXCL-13, IL-6, TNF-α, ALT and AST (r=0.711, 0.764, 0.955, 0.903 and 0.827, P<0.05) . In addition, Pearson correlation analysis showed a positive correlation between TNF-α and ALT (r=0.833 and 0.894, P<0.05) when DBP or BaP exposed alone. Furthermore, when DBP and BaP exposed together, CXCL-13, IL-6 and TNF-α were positively correlated with ALT (r= 0.871, 0.925 and 0.942, P<0.05) , and also positively correlated with AST (r=0.910, 0.892 and 0.890, P<0.05) . Conclusion: Single and co-exposed to DBP and BaP may regulate the abnormal secretion of related cytokines by upregulating the expression level of NF-κB p65 in rat liver tissue, thus leading to hepatocyte injury in rats, and the damage effect may be enhanced when DBP and BaP are exposed together.

[Analysis on factors associated with the place of death among individuals with cardiovascular diseases in China, 2018]

Objective: To understand the distribution patterns of the place of death (PoD) among individuals with cardiovascular disease (CVD) in the provinces of China in 2018. Relationships between CVD deaths in healthcare/medical institutions and individual demographics, social-economic status (SES), the underlying cause of death, and local cultural factors were also explored. Methods: Using data from the National Cause-of-death Reporting System, we examined potential, influential factors of CVD deaths in healthcare/medical institutions through multilevel logistic regression. Results: In 2018, there were 853 832 CVD deaths in disease surveillance points in the country, with 661 625 (77.49%) home deaths and 156 441 (18.32%) occurring in healthcare and medical institutions. Factors including sex, age, nationality, marital status, education level, occupation, the underlying cause of death, criterion for diagnosis, and urban/rural residency, were significantly influential on CVD deaths in healthcare/medical institutions. Meanwhile, spatial variations were shown at factors the subnational level, with 45.39% related to factors at the individual level. Conclusion: Home was the dominant place for CVD deaths in the country, with substantial spatial variations in PoD between provinces. The probability of dying in healthcare/medical settings was comparatively higher among CVD patients with superior socioeconomic status and who lived in urban areas. Adequate information should be collected and included in further studies on exploring influential factors of PoD. Since both social factors, individual preferences, and acute and chronic CVD deaths are critical, it is necessary to enhance treatment capacity. A booming approach incorporating home/hospice care with on-site medical services might also improve the quality of end-of-life care among CVD patients in China.

[Analysis on all-cause mortality rate and life expectancy in China, 2005-2018]

Objective: To understand the geographical variations and temporal trends of all-cause mortality rate and life expectancy in China at national and subnational levels during 2005-2018. Methods: Using data from National Cause-of-death Reporting System, China National Maternal and Child Health Surveillance System, Under-reporting Surveys, and related social determinants covariates, we estimated all-cause mortality rate and life expectancy at national and subnational levels in China during 2005-2018. We depicted the geographical variations and temporal trends between provinces on mortality rate and life expectancy. We then decomposed changes in national and subnational deaths into three explanatory components: change due to age-specific mortality rate, change due to the population structure by age, and change due to growth of the total population. Results: In 2018, it was estimated that there were 10 482 297 total deaths (95%CI: 9 723 233-11 466 875 deaths) in China, with 6 113 926 men (95%CI: 5 773 158-6 572 407 men) and 4 368 241 women (95%CI: 3 950 075-4 894 468 women). The all-cause mortality rate was 755.54 per 100 000 (95%CI: 701.49 per 100 000-825.78 per 100 000), with 861.78 per 100 000 (95%CI: 813.75 per 100 000-926.40 per 100 000) in men and 642.73 per 100 000 (95%CI: 581.20 per 100 000-720.15 per 100 000) in women, while age-standardized all-cause mortality rate was 652.27 per 100 000 (95%CI: 599.22 per 100 000-721.71 per 100 000), with 806.38 per 100 000 (95%CI: 755.10 per 100 000-874.31 per 100 000) in men and 503.37 per 100 000 (95%CI: 450.50 per 100 000-572.01 per 100 000) in women. In 2018, it was estimated that the life expectancy in the whole country was 77.15 years old (95%CI: 75.92-78.11 years old), with 74.81 (95%CI: 73.57-75.76) in men and 79.87 (95%CI: 78.61-80.91) in women. Developed areas as Shanghai, Beijing, Jiangsu, and Zhejiang owned comparatively higher life expectancy, while undeveloped areas like Tibet, Guizhou, Xinjiang, and Qinghai showed lower levels. During 2005-2018, there was a 29.87% increase in total deaths at the national level, with 27.74% in men and 31.29% in women. Changes due to age-specific mortality rate, the population structure by age, and the growth of the total population constituted -35.74%, 7.34%, and 58.28% of the total increase, respectively. Conclusions: From 2005 to 2018, the all-cause mortality rate increased while the age-standardized mortality rate decreased substantially among Chinese residents. Change due to population structure by age was the dominant driver. An upward trend of life expectancy was observed in all provinces, with marked differences between the provinces.

[Influences of using different spatial weight matrices in analyzing spatial autocorrelation of cardiovascular diseases mortality in China]

Objective: To explore the potential influences and applicability of different spatial weight matrices used in analyzing spatial autocorrelation of cardiovascular disease (CVD) mortality in China. Methods: Using data from the National Cause-of-death Reporting System, we used adjacency-based Rook and Queen contiguity and distance-based K nearest neighbors/distance threshold. We then conducted global and local spatial autocorrelation analysis of CVD mortality at the county level in China, 2018. Results: All four categories and 26 types of spatial weight matrices had detected significant global and local spatial autocorrelation of CVD mortality in China. Global Moran's I statistics reached its peak when using first-order Rook (0.406), first-order Queen (0.406), K nearest neighbors including five spatial units (0.409), and distance threshold with 100 kilometers (0.358). Meanwhile, apparent local spatial autocorrelation was found in CVD mortality. Substantial disparities were observed when detecting "High-High clusters", "Low-Low clusters", "High-Low clusters" and "Low-High clusters" of CVD mortality spatial distribution by using different weight matrices. Conclusions: Using different spatial weight matrices in analyzing the spatial autocorrelation of CVD mortality, we could understand the spatial distribution characteristics of CVD mortality in-depth at the county level in China. In this way, adequate supports could also be provided on CVD premature death control and rational medical resource allocation regionally.

Peta-electron volt gamma-ray emission from the Crab Nebula

The Crab Nebula is a bright source of gamma rays powered by the Crab Pulsar's rotational energy through the formation and termination of a relativistic electron-positron wind. We report the detection of gamma rays from this source with energies from 5 × 10^-4 to 1.1 peta-electron volts with a spectrum showing gradual steepening over three energy decades. The ultrahigh-energy photons imply the presence of a peta-electron volt electron accelerator (a pevatron) in the nebula, with an acceleration rate exceeding 15% of the theoretical limit. We constrain the pevatron's size between 0.025 and 0.1 parsecs and the magnetic field to ≈110 microgauss. The production rate of peta-electron volt electrons, 2.5 × 10³⁶ ergs per second, constitutes 0.5% of the pulsar spin-down luminosity, although we cannot exclude a contribution of peta-electron volt protons to the production of the highest-energy gamma rays.

Extended Very-High-Energy Gamma-Ray Emission Surrounding PSR J0622+3749 Observed by LHAASO-KM2A

We report the discovery of an extended very-high-energy (VHE) gamma-ray source around the location of the middle-aged (207.8 kyr) pulsar PSR J0622+3749 with the Large High-Altitude Air Shower Observatory (LHAASO). The source is detected with a significance of 8.2σ for E>25  TeV assuming a Gaussian template. The best-fit location is (right ascension, declination) =(95.47°±0.11°,37.92°±0.09°), and the extension is 0.40°±0.07°. The energy spectrum can be described by a power-law spectrum with an index of -2.92±0.17_{stat}±0.02_{sys}. No clear extended multiwavelength counterpart of the LHAASO source has been found from the radio to sub-TeV bands. The LHAASO observations are consistent with the scenario that VHE electrons escaped from the pulsar, diffused in the interstellar medium, and scattered the interstellar radiation field. If interpreted as the pulsar halo scenario, the diffusion coefficient, inferred for electrons with median energies of ∼160  TeV, is consistent with those obtained from the extended halos around Geminga and Monogem and much smaller than that derived from cosmic ray secondaries. The LHAASO discovery of this source thus likely enriches the class of so-called pulsar halos and confirms that high-energy particles generally diffuse very slowly in the disturbed medium around pulsars.

Ultrahigh-energy photons up to 1.4 petaelectronvolts from 12 γ-ray Galactic sources

The extension of the cosmic-ray spectrum beyond 1 petaelectronvolt (PeV; 10¹⁵ electronvolts) indicates the existence of the so-called PeVatrons-cosmic-ray factories that accelerate particles to PeV energies. We need to locate and identify such objects to find the origin of Galactic cosmic rays¹. The principal signature of both electron and proton PeVatrons is ultrahigh-energy (exceeding 100 TeV) γ radiation. Evidence of the presence of a proton PeVatron has been found in the Galactic Centre, according to the detection of a hard-spectrum radiation extending to 0.04 PeV (ref. ²). Although γ-rays with energies slightly higher than 0.1 PeV have been reported from a few objects in the Galactic plane^3-6, unbiased identification and in-depth exploration of PeVatrons requires detection of γ-rays with energies well above 0.1 PeV. Here we report the detection of more than 530 photons at energies above 100 teraelectronvolts and up to 1.4 PeV from 12 ultrahigh-energy γ-ray sources with a statistical significance greater than seven standard deviations. Despite having several potential counterparts in their proximity, including pulsar wind nebulae, supernova remnants and star-forming regions, the PeVatrons responsible for the ultrahigh-energy γ-rays have not yet been firmly localized and identified (except for the Crab Nebula), leaving open the origin of these extreme accelerators.

[Clinical outcomes and influence factors of 435 singleton pregnancies with short cervix]

Objective: To investigate the clinical outcomes of different treatment options on singleton short cervix and its influence factors. Methods: Totally 435 cases of singleton pregnancies who were diagnosed with short cervix (≤25 mm) between 12 to 33⁺⁶ gestational weeks in Peking University First Hospital from January 2018 to December 2018 were enrolled, including 21 cases with cervical length <10 mm, 414 cases with cervical length between 10 to 25 mm. The onset time was <24 gestational weeks in 106 cases, while 104 cases were at 24-29⁺⁶ gestational weeks and 225 cases of ≥30 gestational weeks. Gestational outcomes including delivery before 37 weeks, delivery before 34 weeks, neonatal birth weight (NBW) and adverse neonatal outcome (ANO) were compared among three treatment groups: rest group, progesterone group and cerclage group. Influence factors were also investigated. Results: (1) The incidence of short cervix in pregnancy was 7.07% (435/6 155), while 106 cases were at <24 gestational weeks (1.72%, 106/6 155), 104 cases (1.69%, 104/6 155) at 24-29⁺⁶ gestational weeks and 225 cases (3.66%, 225/6 155) at ≥30 gestational weeks. (2) In the group of cervical length <10 mm, rate of delivery before 37 and 34 weeks were 62% (13/21) and 57% (12/21) respectively. One case of progesterone treatment underwent miscarriage. Compared with rest group (n=8), delivery weeks [28.5 (25.0-40.0) vs 37.0 (28.0-40.0), P=0.020] and NBW [1 245 g (630-3 830 g) vs 2 648 g (1 560-3 830 g), P=0.028] were higher in cerclage group (n=9), while ANO was not statistically different (P>0.05). (3) In the group of cervical length ≥10 mm before 24 gestational weeks, the delivery weeks, incidence of delivery before 34 weeks, adjusted incidence of delivery before 37 weeks, NBW and ANO were not statistically different (P>0.05) among rest group (n=36), progesterone group (n=26) and cerclage group (n=34). In vitro fertilization (OR=11.97, 95%CI: 1.88-76.44, P=0.009), infection (OR=46.03, 95%CI: 5.12-413.58, P=0.001), sludge on sonography (OR=9.87, 95%CI: 1.69-57.60, P=0.011) and history of short cervix (OR=7.24, 95%CI: 1.04-50.24, P=0.045) were independent risk factors of preterm birth. (4) In the group of cervical length ≥10 mm and gestational weeks between 24-29⁺⁶, the delivery weeks, incidence of delivery before 37 weeks, incidence of delivery before 34 weeks, NBW and ANO were not statistically different (P>0.05) among rest group (n=52), progesterone group (n=34) and cerclage group (n=9). Infection was an independent risk factor of preterm birth (OR=56.40, 95%CI: 4.67-680.61, P=0.002). (5) Outcomes of 223 cases were relatively good in the group of cervical length ≥10 mm beyond 30 gestational weeks. The incidence of delivery before 34 weeks was 6.3% (14/223). The delivery weeks, incidence of delivery before 37 and 34 weeks, NBW and ANO were not statistically different (P>0.05) among 3 groups. Infection (OR=10.91, 95%CI: 2.21-53.96, P=0.003) and history of preterm birth (OR=8.63, 95%CI: 1.25-59.65, P=0.029) were independent risk factors of preterm birth. Conclusions: Short cervix is a common complication of pregnancy. Cervical cerclage is related with better outcome for patients with cervical length <10 mm. Neither progesterone nor cervical cerclage improves pregnancy outcome for >10 mm cervical length patients comparing with rest. Infection, sludge, in vitro fertilization, history of short cervix and history of preterm birth are independent risk factors of preterm birth in short cervix pregnancies.

[A prospective multi-center clinical investigation of HIV-negative pulmonary cryptococcosis in China]

Objective: To investigate the current status of the diagnosis and treatment of pulmonary cryptococcosis in respiratory medicine and improve the understanding of the clinical characteristics of HIV-negative pulmonary cryptococcosis in China. Methods: A prospective multi-center open cohort study was designed to screen for pulmonary cryptococcosis in the general wards and intensive care units of the Department of Respiratory Diseases in 22 hospitals. The HIV-negative patients with positive cryptococcal etiological diagnosis based on smear culture, antigen detection and histopathology were enrolled in the study. The clinical data of enrolled patients were collected and analyzed. Results: A total of 457 cases of pulmonary cryptococcosis were enrolled, among which 3.28% (15/457) were disseminated infections. The case fatality rate was 0.88% (4/457). The majority of the cases were diagnosed by histopathological examinations (74.40%, 340/457) and cryptococcus antigen detection (37.64%, 172/457). Patients with pulmonary cryptococcosis accounted for 2.04‰ (457/223 748) of the total hospitalized patients in the Department of Respiratory Diseases during the same period, and the ratio was the highest in south and east China. Meanwhile, 70.24% (321/457) of the patients had no underlying diseases, while 87.75% (401/457) were found to have immunocompetent status. Cough and expectoration were the most common clinical symptoms in patients with pulmonary cryptococcosis. However, 25.16% (115/457) of the patients had no clinical symptom or physical signs. In terms of imaging features on pulmonary CT, multiple pulmonary lesions were more common than isolated lesions, and there were more subpleural lesions than perihilar or medial lesions. Morphologically, most of the lesions were middle-sized nodules (1-5 cm) or small-sized nodules (3 mm to 1 cm). The sensitivity of serum cryptococcus antigen test was 71.99% (203/282). Moreover, antigen-positive patients differed from antigen-negative patients in terms of basic immune status, clinical symptoms, imaging features and infection types. Meanwhile, immunocompromised patients differed from immunocompetent patients in terms of clinical symptoms, physical signs, infection-related inflammation indicator levels, imaging features, serum cryptococcus antigen positive rate and prognosis. Conclusions: The majority of cases of HIV-negative pulmonary cryptococcosis in China had no underlying disease or immunocompromised status, and the overrall prognosis was favorable. However, early diagnosis of HIV-negative pulmonary cryptococcosis remains challenging due to the complicated manifestations of the disease.

Clinical application of short peptide enteral nutrition preparations in patients with chronic hepatitis B and renal failure

BACKGROUND

In recent years, the incidence of diseases has been at a relatively high level. Patients often have liver failure as the main clinical manifestation and secondary renal failure. The resulting malnutrition symptoms will affect the prognosis of patients. At present, the nutritional status of patients with chronic viral hepatitis combined with renal failure has received extensive attention in the medical field, and the choice of nutritional preparations for nutritional therapy has become a hot topic of current research.

AIM

To explore the clinical application of short peptide enteral nutrition preparations in patients with chronic hepatitis B and renal failure.

METHODS

A retrospective study was performed on 89 patients with moderate chronic hepatitis B combined with renal failure who were treated at our hospital from November 2015 to February 2020. According to the choice of nutritional preparations, the patients were divided into a control group (42 cases) and an observation group (47 cases). Patients in both groups were given reasonable bed rest time and diet control during the treatment period; the control group was supplemented with ordinary enteral nutrition preparations, and the observation group was given short peptide enteral nutrition preparations. The course of treatment was 4 wk for both groups. Liver and kidney function indexes of the two groups of patients were recorded and compared before and after treatment. The incidence of gastrointestinal adverse reactions in the two groups of patients was compared.

RESULTS

After the course of treatment, the liver function indexes (TP, Alb, PA, FBG, TB, ALT, and AST) and renal function indexes (Scr, BUN, and UREA) of the two groups of patients were significantly improved compared with the values before treatment (P < 0.05), and the improvement of the observation group was significantly better than that of the control group (P < 0.05). The incidence of adverse reactions such as nausea, vomiting, diarrhea, abdominal distension, and abdominal cramps in the observation group (12.77%) was significantly lower than that in the control group (33.33%; P < 0.05).

CONCLUSION

Short peptide enteral nutrition preparations have the characteristic of being easily absorbed by the epithelial cells of the gastrointestinal tract, which can significantly improve the tolerance of the patient's gastrointestinal tract. In addition, short peptide enteral nutrition preparations can greatly improve the liver and kidney function of the patients and help maintain their nutrition, thus having positive significance for the prognosis of patients.

A novel polysaccharide from Castanea mollissima Blume: Preparation, characteristics and antitumor activities in vitro and in vivo

A new water-soluble polysaccharide, CMP90, with a molecular weight of 23.9 kDa was isolated from Castanea mollissima Blume and the preliminary structural characteristics and antitumor effects of CMP90 in vitro and in vivo were investigated in the research. CMP90 consists of arabinose, galactose, glucose, xylose and mannose (molar ratio: 0.08:0.11:5.14:0.12:0.08) with α- and β-anomeric units. The results of in vitro experiments indicated that CMP90 exhibited a significant inhibitory effect on the proliferation of HL-60 cells with typical apoptotic characteristics by inducing cell cycle arrested at G1/M phase. Additionally, the results in vivo suggested CMP90 was able to inhibit the growth of S180 solid tumors via protecting immune organs, improving the levels of serum cytokines (TNF-α, IL-2 and IFN-γ), enhancing the activities of immune cells (macrophages, lymphocytes and NK cells) and inducing cell apoptosis or death. Taken together, these combined data clearly indicated that CMP90 may be used as a potential candidate agent for cancer therapy.

[Analysis of sugammadex for antagonistic neuromuscular block in patients with radical resection of lung cancer under thoracoscope]

Objective: To investigate the efficacy and safety of sugammadex for antagonistic neuromuscular block in patients with radical resection of lung cancer under thoracoscope. Methods: One hundred patients undergoing radical resection of lung cancer under thoracoscope in Affiliated Cancer Hospital of Zhengzhou University from March to September in 2019, were randomly divided into control group (group C) and sugammadex group (group S). All patients were anaesthetized (induced and maintained) with intravenous target-controlled infusion of propofol and remifentanil, and intermittent intravenous injection of the neuromuscular block of rocuronium. During the operation, the bispectral index (BIS) was used to monitor the depth of anesthesia, and the neuromuscular block was assessed with TOF. Single-lung mechanical ventilation and double-lumen endotracheal intubation were carried out, and patient-controlled analgesia after operation were enforced. Patients in group C received neostigmine (2 mg) combined with atropine (0.5-1.0 mg) after thoracic closure, while patients in group S received sugammadex (2 mg/kg) at TOF count (≥2) after thoracic closure, and then double-lumen endotracheal tubes were extubated according to extubation indications. At these time points: T(0) (immediate before anesthesia induction), T(1) (immediate before tracheal intubation), T(2) (immediately after thoracic closure), T(3) (1 h after operation), T(4) (6 h after operation), T(5) (24 h after operation), T(6)(48 h after operation), the heart rate(HR) and mean arterial pressure (MAP) were recorded, QT interval (V3 ECG) were measured and calculated, indicators of liver function [alanine transaminase (ALT), aspartate transaminase(AST)], renal function [blood urea nitrogen (BUN), creatinine (Cre)] and clotting function [thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen (FIB)] were detected. The duration of operation, postoperative conditions within 48 hours after operation(the time of tracheal tube extubation, respiratory suppression/dysfunction, allergy, nausea and vomiting, itching of skin, abnormal sensation), pathological types and the postoperative hospital stay were recorded. Results: There were no significant differences of the age, sex ratio, body mass index (BMI), American Society of Anesthesiologists (ASA) grading ratio, duration of operation, pathological types and the postoperative hospital stay, HR, MAP and QT interval between two groups (all P>0.05). There were no remarkable differences of the levels of serum histamine, ALT, AST, BUN, Cre, TT, PT, APTT and FIB before and after administration of neuromuscular blockade antagonists (neostigmine or Sugammadex) in the same group patients (all P>0.05), also no significant differences between group C and group S at the same time points (all P>0.05). Average time of tracheal tube extubation in group S [(3.7±1.3) min] was sharply shorter than that in group C [(14.5±4.4) min, t=2.266, P<0.05)]. There were no patients with allergy, skin itching, sensory abnormality in these two groups. There were no significant difference of the incidence of postoperative nausea and vomiting between these two groups. There were 5 patients with respiratory depression in group C and no respiratory depression patient in group S, the difference was statistically significant between these two groups (χ(2)=5.263, P<0.05). Conclusion: Sugammadex is effective for antagonizing the neuromuscular blockade of rocuronium in patients with radical resection of lung cancer under thoracoscope, and can shorten the time of tracheal tube extubation after surgery.

[Color stability of computer aided design and computer aided manufacture composite ceramic/resin cements after accelerated ageing]

Objective: To investigate the color stability of computer aided design and computer aided manufacture (CAD/CAM) composite ceramic/resin cements after accelerated ageing. Methods: Twelve groups (ten samples each group) were used as experimental groups, which were composed of CAD/CAM composite ceramic of three kinds of thickness (0.50, 0.75, 1.00 mm) (Lava Ultimate) associated with resin cements (Variolink N) of four colors (A1, A3, T, BL1). Another three groups of CAD/CAM composite ceramic/resin cements of three different kinds of thickness (0.50, 0.75, 1.00 mm) were used as control groups (ten samples each group). All samples were put into the xenon lamp ageing instrument to implement accelerated ageing. Spectrophotometers were used to measure the lightness (L(*)), red green color value (a(*)) and blue yellow color value (b(*)) of all samples before and after accelerated ageing process, and the changes of color variation (ΔE) was calculated. The effect of composite ceramic thickness and resin cement color on the changes of color variation (ΔE) before and after the ageing of CAD/CAM composite ceramic/resin cement and whether there was an interaction between them were tested by two-way ANOVA. Results: Before and after accelerated ageing, the ΔE of CAD/CAM composite ceramic/resin cements were <3.3. Two-way ANOVA showed that the thickness of CAD/CAM composite ceramics had an effect on ΔE (F=27.025, P<0.001), and the color of resin cement also had an effect on ΔE (F=15.606, P<0.001), but there was no interaction between them (F=0.534, P=0.829). Conclusions: The thickness of CAD/CAM composite ceramics and the color of resin cements could both affect the color stability of composite ceramic/resin cements combination. However, the resulted color change is within the clinically acceptable range.

[Interpretation for the group standards in technical specification of management for field survey in large population-based cohort study]

Large population-based cohort study is an important resource for population disease prevention and control, the results of which provide scientific basis for individualized treatment and precise prevention, and it is also the key strategic content of precision medicine. The Chinese Preventive Medicine Association coordinated experienced researchers from the Chinese Academy of Medical Sciences and other professional institutes to write up the group standard entitled Technical specification of management for field investigation in large population-based cohort study (T/CPMA 001-2019). Based on the research of large population-based cohort study in China and the principle of scientific, normative, applicable, and feasible, the standard proposed six aspects of management requirements including institutional arrangement, personnel composition, equipment, materials, documents and finance, as well as the basic requirements of the on-site investigation, the requirements of each position and the overall quality control requirements, etc.. The standard aims to guide the large population-based cohorts that have been or intended to be established in China, including national cohorts, regional population cohorts, and special population cohorts, hence to improve scientific research level, accelerate scientific research output and provide localization basis for disease prevention and control in China.

Rapid discovery and identification of the anti-inflammatory constituents in Zhi-Shi-Zhi-Zi-Chi-Tang

The anti-inflammatory active ingredients of Zhi-Shi-Zhi-Zi-Chi-Tang (ZSZZCT), a traditional Chinese medicine formula, were predicted and identified using an approach based on activity index, LC-MS, semi-preparative LC and NMR. Firstly, the whole extract of ZSZZCT was analyzed using liquid chromatography-quadrupole time of flight-mass spectrometry (LC-Q-TOF-MS) and liquid chromatography - ion trap mass spectrometry (LC-IT-MS), 79 constituents were detected and 39 constituents were identified unambiguously or tentatively. Subsequently, the whole extract of the formula was separated into multiple components and the activity index method was used to calculate index values of the 79 constituents by integrating the chemical and pharmacological information of multiple components. Four polymethoxyl flavones were predicted as the major active constituents according to the activity index values. Furthermore, three polymethoxyl flavones were prepared using the strategy with semi-preparative LC guided by LC-MS, and their anti-inflammatory activities were validated. The results show that three polymethoxyl flavones with higher positive index values, i.e., 3, 5, 6, 7, 8, 3', 4'-heptamethoxyflavone, 3-hydroxynobiletein and tangeretin had significant anti-inflammatory effects. In conclusion, the predicted results indicated that the activity index method is feasible for the accurate prediction of active constituents in TCM formulae.

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

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

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

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

[Effects of insufficient physical activity on motality and life expectancy in adult aged 25 and above among Chinese population]

Objective: To analyze the attribution of mortality and impact on life expectancy caused by insufficient physical activity in different gender and areas in adults aged ≥25 years among Chinese people. Methods: Data from the programs related to Chinese death surveillence, risk factors of chronic survey, health outcomes of physical activity as well as relative risk (RR) on Global Burden of Disease (GBD) study were used. Population attributable fraction (PAF) of different health outcomes attributable to deaths that caused physical activity and the influence of life expectancy in adults aged ≥25 years in Chinese people were calculated. Results: The overall PAF for all cause of death due to physical activity in adults aged ≥25 years was 4.24%, with 4.86% in females and 3.82% in males. The health outcomes of inadequate physical activity would include breast cancer, colorectal cancer, ischemic heart disease, ischemic stroke and diabetes with relative PAFs as 9.04%, 13.96%, 14.96%, 17.80% and 16.92%, respectively. The attribution of death on Physical activity was 388 954. The most attributed death was ischemic heart disease, followed by ischemic stroke. With the elimination of physical inactivity, the total life expectancy was expected to lose by 0.43 years, with 0.47 years in women, and 0.39 years in men. Conclusion: The increase of physical activity may benefit on health condition so to reduce the burden of chronic diseases and increase the life expectancy.

[Death and impact of life expectancy attributable to smoking in China, 2013]

Objective: To analyze the death attributable to smoking and impact of life expectancy in China in 2013. Methods: According to the characteristics of different diseases, we calculated the population attributable fractions of different diseases, death and impact of life expectancy which caused by smoking, using direct method (current smoking rate as exposure levels) and indirect method (smoking impact ratio as exposure levels), based on data from both programs of death surveillance and Chinese chronic disease risk factor surveillance of 2013. Results: In 2013, smoking caused around 1.59 million deaths which accounted for 17.38% of all deaths in China. Constituent ratio of death caused by smoking in males (23.66%) was much higher than that in females (8.30%). However, in urban areas (17.24%), it was slightly lower than that in rural areas (17.51%). Constituent ratio of death caused by smoking in the eastern regions appeared the lowest (16.81%), with western regions the highest (17.91%). In 2013, lung cancer, COPD and ischemia heart disease were the top three diseases causing deaths that related to smoking, but the top three population attributable fractions were lung cancer, COPD and nasopharyngeal carcinoma in China. In 2013, smoking caused a reduction of 2.04 years of life expectancy loss in China, with males in the western regions the highest (3.05 years). Conclusion: Smoking is still an important public health problem in China. Tobacco-control-targeted programs in the heavily involved areas could reduce the number of deaths from related diseases that caused by smoking.

[A screening system for anti-metastatic small-molecule compounds based on perinucleolar compartment prevalence in liver cancer cells]

Objective: To establish a screening system for anti-metastatic small-molecule compounds based on perinucleolar compartment (PNC) prevalence in liver cancer cells and to investigate its validity. Methods: Polypyrimidine tract-binding protein (PTB) monoclonal antibody was used to measure the PNC prevalence in HepG2, HepG2M, and Huh7 cells, and wound healing assay and transwell assay were used to analyze the migration and invasion abilities of hepatoma cells. HepG2M cells were used as the model for the screening of anti-metastatic small-molecule compounds, and after the treatment with the compounds A1, A4, and E696, qPCR was used to measure the expression of metastasis-related miRNAs (miR-141 and miR-200c). A one-way analysis of variance was used for comparison of data between multiple groups. Results: PTB immunofluorescence assay showed that HepG2M cells had the highest PNC prevalence, followed by Huh7 and HepG2 cells, and PNC prevalence was positively correlated with the metastasis and invasion abilities of hepatoma cells. The PNC prevalence of HepG2M cells was reduced to 22.88% ±4.61% by A1, 14.22% ± 3.05% by A4, and 26.12% ± 4.94% by E696. Wound healing assay showed that the 48-hour scratch ratio increased from 17.70% ± 3.34% to 64.50% ± 2.65%, 83.40% ± 5.10%, and 57.20% ± 3.06% (F = 171.1, P < 0.01), respectively. Transwell assay showed that the number of invasive cells was reduced from 264.33 ± 30.50 to 104.33 ± 13.50, 58.00 ± 11.00, and 111.33 ± 19.50 (F = 59.87, P < 0.01), respectively. The anti-metastatic effect of these three compounds was positively correlated with their ability to destroy PNC. A4 upregulated the expression of miR-141 and miR-200c in a dose-dependent manner, and after HepG2M cells were treated with A4 at a concentration of 5 μM, 10 μM, or 20 μM, the level of miR-141 was increased to 3.61 ± 0.78, 8.12 ± 1.15, and 18.24 ± 2.44 folds (F = 88.01, P < 0.01), respectively, and that of miR-200c was increased to 2.82 ± 0.43, 4.82 ± 0.89, and 10.74 ± 1.22 folds (F = 87.94, P < 0.01), respectively. Conclusion: The screening system for anti-metastatic small-molecule compounds based on PNC prevalence can provide an effective technical platform for research and development of anti-metastatic drugs for liver cancer.

[Interpretation for the group standards in data management for large population-based cohorts]

Precision medicine became the key strategy in development priority of science and technology in China. The large population-based cohorts become valuable resources in preventing and treating major diseases in the population, which can contribute scientific evidence for personalized treatment and precise prevention. The fundamental question of the achievements above, therefore, is how to construct a large population-based cohort in a standardized way. The Chinese Preventive Medicine Association co-ordinated experienced researchers from Peking University and other well-known institutes to write up two group standards Technical specification of data processing for large population-based cohort study (T/CPMA 001-2018) and Technical specification of data security for large population-based cohort study (T/CPMA 002-2018), on data management. The standards are drafted with principles of emphasizing their scientific, normative, feasible, and generalizable nature. In these two standards, the key principles are proposed, and technical specifications are recommended in data standardization, cleansing, quality control, data integration, data privacy protection, and database security and stability management in large cohort studies. The standards aim to guide the large population-based cohorts that have been or intended to be established in China, including national cohorts, regional population cohorts, and special population cohorts, hence, to improve domestic scientific research level and the international influence, and to support decision-making and practice of disease prevention and control.

[Effects of thermal cycling on mechanical properties of resin-ceramic composites]

Objective: To investigate the influence of thermal cycling on the mechanical properties of resin-ceramic composites. Methods: The different groups of resin-ceramic composites A (Lava Ultimate, 3M ESPE, USA), B (block HC, Shofu, Japan), C (Hyramic, Upcera, China), D (Vita Enamic, Vita, German), and the feldspar ceramic E (Mark Ⅱ, Vita, German) were included in this study. The properties of these groups (with 30 samples in each group), including flexural strength, flexural modulus and Vickers hardness were tested before and after thermal cycling (0, 10 000 and 20 000 cycles, respectively). The data were statistically analyzed. Results: Before thermal cycling, the flexural strength of groups A, B and C [(166.28±13.78) MPa, (170.21±11.36) MPa and (202.04±16.55) MPa] were higher than those of groups D and E [(137.09±8.83) MPa and (119.35±5.98) MPa], and the flexural modulus [(62.39±3.40) GPa] and Vickers hardness [(406.97±14.73) HV] of E group were higher than those of other groups (P<0.05). The flexural strength, flexural modulus and Vickers hardness of groups D and E did not change after thermal cycling (all P>0.05), while those of groups A, B and C decreased (all P<0.05). Conclusion: After thermal cycling, the mechanical properties of the A, B and C groups decreased, while those of the groups D and E were stable.

[Estimation of the impact of risk factors control on non-communicable diseases mortality, life expectancy and the labor force lost in China in 2030]

Objective: To estimate the impact of risk factors control on non-communicable diseases (NCDs) mortality, life expectancy and the numbers of labor force lost in China in 2030. Methods: We used the results of China from Global Burden of Disease Study 2013, according to the correlation between death of NCDs and exposure of risk factors and the comparative risk assessment theory, to calculate population attributable fraction (PAF) and disaggregate deaths of NCDs into parts attributable and un-attributable. We used proportional change model to project risk factors exposure and un-attributable deaths of NCDs in 2030, then to get deaths of NCDs in 2030. Simulated scenarios according to the goals of global main NCDs risk factors control proposed by WHO were constructed to calculate the impact of risk factors control on NCDs death, life expectancy and the numbers of labor force lost. Results: If the risk factors exposure changed according to the trend of 1990 to 2013, compared to the numbers (8.499 million) and mortality rate (613.5/100 000) of NCDs in 2013, the death number (12.161 million) and mortality rate (859.2/100 000) would increase by 43.1% and 40.0% respectively in 2030, among which, ischemic stroke (increasing by 103.3% for death number and 98.8% for mortality rate) and ischemic heart disease (increasing by 85.0% for death number and 81.0% for mortality rate) would increase most quickly. If the risk factors get the goals in 2030, the NCDs deaths would reduce 2 631 thousands. If only one risk factor gets the goal, blood pressure (1 484 thousands NCDs deaths reduction), smoking (717 thousands reduction) and BMI (274 thousands reduction) would be the most important factors affecting NCDs death. Blood pressure control would have greater impact on ischemic heart disease (662 thousands reduction) and hemorrhagic stroke (449 thousands reduction). Smoking control would have the greatest effect on lung cancer (251 thousands reduction) and chronic obstructive pulmonary disease (201 thousands reduction). BMI control would have the greatest impact on ischemic heart disease (86 thousands reduction) and hypertensive heart disease (45 thousands reduction). If the risk factors exposure changed according to the trend of 1990 to 2013, in 2030, the life expectancy of Chinese population would reach to 79.0 years old, compared to 2013, increasing by 3.3 years old, the labor force at the age of 15-64 years old would loss 1.932 million. If the risk factors get the goals in 2030, life expectancy would increase to 81.7 years old and the number of labor force lost would decrease to 1.467 million. Blood pressure, smoking and BMI control would have much greater impact on life expectancy (4.9, 4.0 and 3.8 years old respectively) and labor force lost (630 thousands, 496 thousands and 440 thousands respectively). Conclusion: Risk factors control would play an important role in reducing NCD death, improving life expectancy of residents and reducing loss of labor force. Among them, the control of blood pressure raising, smoking and BMI raising would have a greater contribution to the improvement of population health status.

[Effect of Benzidine Test on DNA Analysis of Bloodstain]

OBJECTIVES

To explore the effect of benzidine test and related reagents on DNA analysis of bloodstain.

METHODS

A total of 970 bloodstain filter paper samples with 1 μL venous blood were collected, and 10 of them acted as control samples. After benzidine test and related reagent processing, DNA of 960 samples was extracted by Chelex-100 and silica bead methods and then multiplex amplified by AmpFℓSTR™ Identifiler™ Plus PCR kits. The results of STR typing were compared between different groups.

RESULTS

DNA were extracted immediately after benzidine test. Totally STR loci （3.80±1.34） were detected by silica bead method, while no STR loci were obtained by Chelex-100 method. Thirteen samples （21.7%） with whole STR typing results were obtained by drying after benzidine test, and the STR locus number （12.90±1.49） which obtained by silica bead method was much higher than by Chelex-100 method （4.70±1.96） （P<0.05）. When DNA was extracted immediately after the addition of glacial acetic acid, the STR locus number was （9.40±2.09） by silica bead method, but no STR typing result was obtained by Chelex-100 method. All 15 STR loci could be obtained by only adding glacial acetic acid after drying and only adding tetramethylbenzidine alcoholization liquid or 3% hydrogen peroxide liquid.

CONCLUSIONS

Benzidine test has significant influence on DNA analysis of bloodstain. The Chelex-100 method is not suitable for the DNA extraction of bloodstain after benzidine test. Drying after benzidine test and silica bead methods can effectively enhance the STR locus number of bloodstain.