[Clinical analysis of 102 cases of labor induction in the third trimester on twin pregnancy]

Objective: To investigate the clinical characteristics of induced labor in twin pregnancy and the related factors of induced labor failure. Methods: The clinical data of twin pregnant women who underwent induced labor in Peking University Third Hospital from January 2016 to December 2022 were retrospectively analyzed. According to whether they had labor or not after induction, pregnant women were divided into the success group (pregnant women who had labor after induction, 72 cases) and the failure group (pregnant women who did not have labor after induction, 30 cases). Logistic regression was used to analyze the related factors of induction failure in twin pregnant women. Results: The parity and cervical Bishop score in the failure group were significantly lower than those in the success group, while the proportion of dichorionic diamniotic twins, assisted reproductive technology pregnancy and cervical Bishop score <6, postpartum hospital stay and total hospital stay in the failure group were significantly higher than those in the success group (all P<0.05). The proportion of induced labor by artificial rupture of membranes ± oxytocin intravenous infusion in the success group was 72.2% (52/72), which was significantly higher than that in the failure group (46.7%, 14/30; P=0.030). There were no significant differences between the two groups in the gestational age at delivery, the incidence of severe postpartum hemorrhage and blood transfusion, the amount of postpartum hemorrhage, the neonatal weight of two fetuses, the incidence of neonatal asphyxia, and the proportion of neonates admitted to the neonatal intensive care unit (all P>0.05). There were no severe perineal laceration and hysterectomy in all pregnant women. Multivariate logistic regression analysis showed that primipara (OR=3.064, 95%CI: 1.112-8.443; P=0.030) and cervical Bishop score <6 (OR=5.208, 95%CI: 2.008-13.508; P=0.001) were the independent risk factors for induction failure in twin pregnancy. Conclusions: Elective induction of labor in twin pregnancy is safe and feasible. It is helpful to improve the success rate of induction of labor by strictly grasping the timing and indications of termination of pregnancy, choosing the appropriate method of induction according to the condition of the cervix, and actively promoting cervical ripening.

Supramolecular Integration of Multifunctional Nanomaterial by Mannose-Decorated Azocalixarene with Ginsenoside Rb1 for Synergistic Therapy of Rheumatoid Arthritis

The complexity and progressive nature of diseases require the exploitation of multifunctional materials. However, introducing a function inevitably increases the complexity of materials, which complicates preparation and decreases reproducibility. Herein, we report a supramolecular integration of multifunctional nanomaterials based on mannose-modified azocalix[4]arene (ManAC4A) and ginsenoside Rb1 (Rb1), which showed advances of simplicity and reproducibility. ManAC4A possesses reactive oxygen species (ROS) scavenging capacity and hypoxia-responsiveness, together with macrophage-targeting and induction functionality. Collectively, the Rb1@ManAC4A assembly simply prepared by two components is integrated with multifunction, including triple targeting (ELVIS targeting, macrophage-targeting, and hypoxia-targeted release) and triple therapy (ROS scavenging, macrophage polarization, and the anti-inflammatory effect of Rb1). The spontaneous assembly and recognition of ManAC4A, with its precise structure and molecular weight, facilitated the simple and straightforward preparation of Rb1@ManAC4A, leading to excellent batch consistency. Progress in simplicity and reproducibility, as directed by this research, will catalyze the clinical translation of multifunctional materials.

Changes in depressive symptoms before and after the first stroke: A longitudinal study from China Family Panel Study (CFPS)

OBJECTIVES

The study sought to examine the impact of longitudinal changes in depressive symptoms in middle-aged adults before and after their first stroke, and the impact of different ages.

METHODS

The study monitored middle-aged patients with a first stroke in the China Family Panel Study (CFPS) survey from 2016 to 2020. This study examined longitudinal changes in depressive symptoms in middle-aged adults and their controls before and after stroke using multilevel models, and also explored factors influencing middle-aged adults at the time of their respective stroke and depressive symptoms using conditional regression models and stepwise regression models, respectively. A chi-square test was used to determine whether long-term changes in depressive symptoms in patients before and after stroke could be attributed to changes in a single depressive symptom.

RESULTS

The study identified 582 first-time stroke patients and 5522 controls from a population of 17,588 participants. Middle-aged populations may have an increased risk of depressive symptoms after a first stroke compared to older populations. First-time stroke victims showed increased severity of depressive symptoms in both the two years before and the two years after stroke when depressive symptoms were assessed. Differences in the presentation of a single depressive symptom were most pronounced in sleep-related symptoms.

CONCLUSIONS

The link between first stroke and changes in the trajectory of increased depressive symptoms is complex and bidirectional. Age is an important factor influencing changes in depressive symptoms, some attention should be paid to the middle-aged population. Special attention should also be paid to sleep-related symptoms in the long-term care of patients.

[Association between maternal plasma one-carbon biomarkers during pregnancy and fetal growth in twin pregnancies]

Objective: To characterize the relationship between the levels of plasma methyl donor and related metabolites (including choline, betaine, methionine, dimethylglycine and homocysteine) and fetal growth in twin pregnancies. Methods: A hospital-based cohort study was used to collect clinical data of 92 pregnant women with twin pregnancies and their fetuses who were admitted to Peking University Third Hospital from March 2017 to January 2018. Fasting blood was collected from the pregnant women with twin pregnancies (median gestational age: 18.9 weeks). The levels of methyl donors and related metabolites in plasma were quantitatively analyzed by high-performance liquid chromatography combined with mass spectrometry. The generalized estimation equation was used to analyze the relationship between maternal plasma methyl donors and related metabolites levels and neonatal outcomes of twins, and the generalized additive mixed model was used to analyze the relationship between maternal plasma methyl donors and related metabolites levels and fetal growth ultrasound indicators. Results: (1) General clinical data: of the 92 women with twin pregnancies, 66 cases (72%) were dichorionic diamniotic (DCDA) twin pregnancies, and 26 cases (28%) were monochorionic diamniotic (MCDA) twin pregnancies. The comparison of the levels of five plasma methyl donors and related metabolites in twin pregnancies with different basic characteristics showed that the median levels of plasma choline and betaine in pregnant women ≥35 years old were higher than those in pregnant women <35 years old, and the differences were statistically significant (all P<0.05). (2) Correlation between plasma methyl donor and related metabolites levels and neonatal growth indicators: after adjusting for confounding factors, plasma homocysteine level in pregnant women with twins was significantly negatively correlated with neonatal birth weight (β=-47.9, 95%CI:-94.3- -1.6; P=0.043). Elevated methionine level was significantly associated with decreased risks of small for gestational age infants (SGA; OR=0.5, 95%CI: 0.3-0.9; P=0.021) and low birth weight infants (OR=0.6, 95%CI: 0.4-0.9; P=0.020). Increased homocysteine level was associated with increased risks of SGA (OR=1.5, 95%CI: 1.0-2.2; P=0.029) and inconsistent growth in twin fetuses (OR=1.9, 95%CI: 1.0-3.7; P=0.049). (3) Correlation between the levels of plasma methyl donors and related metabolites and intrauterine growth indicators of twins pregnancies: for every 1 standard deviation increase in plasma choline level in pregnant women with twin pregnancies, fetal head circumference, abdominal circumference, femoral length and estimated fetal weight in the second trimester increased by 1.9 mm, 2.6 mm, 0.5 mm and 20.1 g, respectively, and biparietal diameter, abdominal circumference and estimated fetal weight increased by 0.7 mm, 3.0 mm and 38.4 g in the third trimester, respectively, and the differences were statistically significant (all P<0.05). (4) Relationship between plasma methyl donor and related metabolites levels in pregnant women with different chorionicity and neonatal birth weight and length: the negative correlation between plasma homocysteine level and neonatal birth weight was mainly found in DCDA twin pregnancy (β=-65.9, 95%CI:-110.6- -21.1; P=0.004). The levels of choline, betaine and dimethylglycine in plasma of MCDA twin pregnancy were significantly correlated with the birth weight and length of newborns (all P<0.05). Conclusion: Homocysteine level is associated with low birth weight in twins, methionine is associated with decreased risk of SGA, and choline is associated with fetal growth in the second and third trimesters of pregnancy.

[Clinical and genetic analysis of tyrosine hydroxylase deficiency of six cases]

The clinical and molecular genetic data of 6 patients with genetically confirmed tyrosine hydroxylase deficiency(THD) diagnosed in Department of Neurology, Qilu Hospital of Shandong University from March 2017 to February 2022 were retrospectively collected and analyzed. The 6 patients were from 5 families. Among them, 5 patients had persistent or paroxysmal abnormal walking posture, 4 patients had dystonia of head and face, including spasm of perioral and oculopharyngeal muscles, hyperactivity, and binocular upvision, 4 patients showed obvious morning light and evening heavy phenomenon, 2 patients had postural tremor of limbs, 2 patients had psychomotor retardation from childhood, 1 patient only had limb and cervical muscle weakness, 1 patient had epileptic seizures. Of the 6 patients, only 1 was adult-onset, and the rest were child-onset. Four patients had good response to low-dose dopa preparation, 2 patients from the same family had poor response to dopamine treatment, requiring extremely low dose initiation and multi-frequency titration treatment. However, the long-term treatment effect was poor with obvious abnormalities. Gene testing of 5 families revealed 8 mutations in the TH gene, with c.698G>A (p.R233H) being the hot spot mutation site. The clinical manifestations of THD are complex. Besides paroxysmal or persistent dystonia, it can also be accompanied by eye movement crisis, muscle weakness, epilepsy, and delayed mental and motor development. Most patients respond well to low-dose dopamine preparations, but a small number of patients require titration treatment with extremely low-dose dopamine preparations, and the long-term effect is not satisfactory.

[Clinical characteristics and analysis of risk factors for heart injuries in 55 patients with lightning injury on plateau in Tibet Autonomous Region]

Objective: To explore the clinical characteristics and treatment outcomes of patients with lightning injury on plateau in Tibet Autonomous Region, and to analyze the risk factors for heart injuries in these patients. Methods: A retrospective case series study was conducted. From January 2008 to July 2023, 55 patients with lightning injury who met the inclusion criteria were admitted to the General Hospital of PLA Tibet Military Area Command. The gender, age, ethnicity, time of injury, location of injury (average altitude), activity at the time of injury, the occurrence of thermal burns on the body surface, the occurrence of complication, the occurrence of combined injury, underlying disease or physiological process before injury, length of hospital stay, treatment outcome, and effective rate of treatment were recorded. The patients were divided into juvenile group (11 cases), young group (28 cases), middle-aged group (14 cases), and elderly group (2 cases) according to age bracket, then the gender and ethnicity distribution of patients in the 4 groups were compared. According to the occurrence of heart injuries at admission, the patients were divided into heart injury group (44 cases) and non-heart injury group (11 cases), then the gender, age, ethnicity, average altitude of location of injury, length of hospital stay, the occurrence of complication, the occurrence of combined injury, site of thermal burns on the body surface, and area of thermal burns on the body surface in patients were compared between the two groups. Data were statistically analyzed with Mann-Whitney U test, chi-square test, or Fisher's exact probability test. The multivariate logistic regression analysis was conducted to screen the independent risk factors for heart injury in patients with lightning injury. Results: Among the 55 patients aged 10-68 years, 39 were male and 16 were female, including 47 Tibetans and 8 Hans. There were no statistically significant differences in gender or ethnicity distribution of patients among the 4 groups with different age brackets (P>0.05). Lightning injuries occurred from May to September, which mostly occurred in June and July. The incidence of lightning injury was higher in Chengguan District of Lhasa City (average altitude of 3 650 m) and Baqing County of Naqu City (average altitude of 4 500 m), being 20.0% (11/55) and 16.4% (9/55), respectively. A total of 96.4% (53/55) of the patients were engaged in outdoor activities when injured, such as grazing, digging Cordyceps, and harvesting highland barley. Among the 55 patients, 46 (83.6%) cases had thermal burns on the body surface, with burn area mainly being not more than 10% total body surface area and burn depth mainly being deep partial-thickness. Fifty-two (94.5%) patients had complications, with heart injury being the most common complication (44 cases, 80.0%). Twenty-two (40.0%) patients had 11 combined injuries, and traumatic brain injury was the most common combined injury. Seventeen (30.9%) patients had 11 underlying diseases or physiological processes before injury. The length of hospital stay of patients was 9 (5, 17) d. Among the 55 patients, 14 cases were cured and discharged, 40 cases were improved, and 1 case died, with effective rate of treatment of 98.2%. Compared with those in non-heart injury group, the proportion of complication occurrence (χ2=12.28), the proportion of trunk burns (χ2=5.15), and the average altitude of location of injury (Z=-2.38) of patients in heart injury group were increased significantly (P<0.05), while there were no significant changes in the other indicators (P>0.05). Multivariate logistic regression analysis showed that the average altitude at the location of injury was the independent risk factor for heart injury in patients with lightning injury (with odds ratio of 3.28, 95% confidence interval of 1.35-7.99, P<0.05). Conclusions: Lightning injuries on plateau in Tibet Autonomous Region mainly occur from May to September, with an average altitude of 4 500 m at the location of injury. Patients with lightning injury are injured when participating outdoor activities, and the affected patients are mainly mainly young male Tibetans. Most of the injuries are mild burns. Lightning injuries are complex and have many complications, with heart injury being the most common one. The average altitude at the location of injury is the independent risk factor for heart injury in patients with lightning injury.

[Treatment of patent ductus arteriosus in very preterm infants in China]

Objective: To describe the current status and trends in the treatment of patent ductus arteriosus (PDA) among very preterm infants (VPI) admitted to the neonatal intensive care units (NICU) of the Chinese Neonatal Network (CHNN) from 2019 to 2021, and to compare the differences in PDA treatment among these units. Methods: This was a cross-sectional study based on the CHNN VPI cohort, all of 22 525 VPI (gestational age<32 weeks) admitted to 79 tertiary NICU within 3 days of age from 2019 to 2021 were included. The overall PDA treatment rates were calculated, as well as the rates of infants with different gestational ages (≤26, 27-28, 29-31 weeks), and pharmacological and surgical treatments were described. PDA was defined as those diagnosed by echocardiography during hospitalization. The PDA treatment rate was defined as the number of VPI who had received medication treatment and (or) surgical ligation of PDA divided by the number of all VPI. Logistic regression was used to investigate the changes in PDA treatment rates over the 3 years and the differences between gestational age groups. A multivariate Logistic regression model was constructed to compute the standardized ratio (SR) of PDA treatment across different units, to compare the rates after adjusting for population characteristics. Results: A total of 22 525 VPI were included in the study, with a gestational age of 30.0 (28.6, 31.0) weeks and birth weight of 1 310 (1 100, 1 540) g; 56.0% (12 615) of them were male. PDA was diagnosed by echocardiography in 49.7% (11 186/22 525) of all VPI, and the overall PDA treatment rate was 16.8% (3 795/22 525). Of 3 762 VPI who received medication treatment, the main first-line medication used was ibuprofen (93.4% (3 515/3 762)) and the postnatal day of first medication treatment was 6 (4, 10) days of age; 59.3% (2 231/3 762) of the VPI had been weaned from invasive respiratory support during the first medication treatment, and 82.2% (3 092/3 762) of the infants received only one course of medication treatment. A total of 143 VPI underwent surgery, which was conducted on 32 (22, 46) days of age. Over the 3 years from 2019 to 2021, there was no significant change in the PDA treatment rate in these VPI (P=0.650). The PDA treatment rate decreased with increasing gestational age (P<0.001). The PDA treatment rates for VPI with gestational age ≤26, 27-28, and 29-31 weeks were 39.6% (688/1 737), 25.9% (1 319/5 098), and 11.4% (1 788/15 690), respectively. There were 61 units having a total number of VPI≥100 cases, and their rates of PDA treatment were 0 (0/116)-47.4% (376/793). After adjusting for population characteristics, the range of standardized ratios for PDA treatment in the 61 units was 0 (95%CI 0-0.3) to 3.4 (95%CI 3.1-3.8). Conclusions: From 2019 to 2021, compared to the peers in developed countries, VPI in CHNN NICU had a different PDA treatment rate; specifically, the VPI with small birth gestational age had a lower treatment rate, while the VPI with large birth gestational age had a higher rate. There are significant differences in PDA treatment rates among different units.

[Association between internet use and healthy lifestyles in urban adults in Hangzhou, China]

Objective: To explore the association between internet use and healthy lifestyles in urban adults. Methods: From May to August, 2022, a face-to-face questionnaire survey was conducted in residents aged 18-64 years selected in the urban area of Hangzhou by integrated cluster stratified random sampling and Kish grid method. The information about internet use included the internet use time in the past 7 days and 12 kinds of internet use contents. Using factor analysis and K-means clustering, three types of internet use were summarized, i.e. general type, video game type and working/learning type. Healthy lifestyles were defined as active physical activity, healthy diet habit, non-smoking, non-drinking, healthy weight, and healthy waist circumference. The correlations between internet use and healthy lifestyles were evaluated by using binary logistic regression and multinomial logistic regression analyses. Results: A total of 1 624 participants were included. After adjusting for potential confounding factors, the longer internet use time group (≥8.5 h/d) was less likely to have healthy weight (OR=0.59, 95%CI:0.41-0.85) and 5-6 healthy lifestyles (OR=0.55, 95%CI: 0.32-0.96) compared with those with shorter internet use time group (<2.5 h/d). For different types of internet use, it was found that compared with working/learning type group, the general type group was less likely to have healthy diet habits (OR=0.63, 95%CI: 0.46-0.86), non-drinking (OR=0.68, 95%CI: 0.47-0.99), healthy waist circumference (OR=0.59, 95%CI: 0.42-0.84) and 5-6 healthy lifestyles (OR=0.40, 95%CI: 0.23-0.69), the video game type group was less likely to have active physical activity (OR=0.73, 95%CI: 0.55-0.97) and healthy diet habits (OR=0.79, 95%CI: 0.62-0.99). Conclusion: Too long internet use (≥8.5 h/d), general type and video game type of internet use were associated with unhealthy lifestyles.

A versatile control program for positioning and shooting targets in laser-plasma experiments

We introduce a LabVIEW-based control program that significantly improves the efficiency and flexibility in positioning and shooting solid targets in laser-plasma experiments. The hardware driven by this program incorporates a target positioning subsystem and an imaging subsystem, which enables us to install up to 400 targets for one experimental campaign and precisely adjust them in six freedom degrees. The overall architecture and the working modes of the control program are demonstrated in detail. In addition, we characterized the distributions of target positions of every target holder and simultaneously saved the target images, resulting in a large dataset that can be used to train machine learning models and develop image recognition algorithms. This versatile control system has become an indispensable platform when preparing and conducting laser-plasma experiments.

[Clinical efficacy of Xuanju compound capsule combined with urofollitropin in the treatment of patients with idiopathic oligoasthenozoospermia]

OBJECTIVE

To evaluate the therapeutic effects of Xuanju compound capsule combined with urofollitropin (uFSH) in the treatment of idiopathic oligoasthenozoospermia.

METHODS

From June 2022 to June 2023, patients with idiopathic oligoastheospermia were enrolled in this study, and divided into trail group (Xuanju compound capsule combined with urofollitropin tablets, n=53) and control group (urofollitropin tablets, n=61) according to the difference in treatment. Treatment methods: Xuanju compound capsule, 3 pills, three times a day; Urofollitropin, 75IU, one times three day. The curses of treatments for control group and trail group is 12 weeks. In order to evaluate the therapeutic effects of control group and trial group, semen volume, sperm concentration, progressive sperm ratio (PR), peripheral serum sex hormone, liver functions were analyzed before and after treatment for two times.

RESULTS

Compared with the baseline, the semen volume and liver function were not significantly changed after the treatment in control group and trial group. However, sperm concentration, PR, testosterone (T) levels, follicle stimulating hormone (FSH) levels, and luteinizing hormone (LH) levels were significantly unregulated after the treatment in control group and trial group. More importantly, compared to control group, sperm concentration, PR, T leves, FSH levels, LH levels, and T/E2 ratio of trial group were further enhanced after the treatment, which were statistically significant (P < 0.05).

CONCLUSIONS

Xuanju compound capsule combined with urofollitropin tablets could significantly improve the semen quality, up-regulate the testosterone levels and T/E2 ratio in patients with idiopathic oligoasthenozoospermia.

[Outcome analysis of pregnancy termination and expectant treatment in pregnant women with suspected invasive placenta accreta spectrum disorders in the second trimester]

Objective: To investigate the maternal and fetal outcomes of expectant treatment and early termination of pregnancy in pregnant women with suspected invasive placenta accreta spectrum disorders (PAS) in the second trimester. Methods: A retrospective cohort study was performed on 51 pregnant women with suspected invasive PAS (ultrasound score ≥10) evaluated by ultrasound with gestational age <26 weeks and confirmed as invasive PAS by intraoperative findings or postoperative pathology in Peking University Third Hospital from January 2015 to January 2022. According to the informed choice of pregnant women and their families, they were divided into expectant treatment group (37 cases) and mid-term termination group (14 cases). The general clinical data and outcome indexes of the two groups were analyzed by χ² test, Mann-Whitney U rank sum test, logistic regression and linear regression. Results: (1) General clinical data: among 51 pregnant women who were assessed as suspected invasive PAS by ultrasonography in the second trimester, invasive PAS was finally diagnosed by intraoperative findings and postoperative pathology, among which 46 cases (90%) were placenta percreta and 5 cases (10%) were placenta increta. (2) Outcome indicators: univariate analysis showed that there were no statistically significant differences in the intraoperative blood loss (median: 2 200 vs 2 150 ml), the proportion of blood loss >1 500 ml [73% (27/37) vs 9/14], the hysterectomy rate [62% (23/37) vs 8/14], the rate of intensive care unit (ICU) admission [78% (29/37) vs 9/14] between the expectant treatment group and the mid-term termination group (all P>0.05). Multivariate analysis showed that the rate of intraoperative blood loss >1 500 ml (aOR=0.481, 95%CI: 0.017-13.958; P=0.670), hysterectomy (aOR=0.264, 95%CI: 0.011-6.569, P=0.417) and ICU admission (aOR=1.327, 95%CI: 0.048-36.882, P=0.867) between the two groups showed no statistical differences. (3) Outcome analysis: all 37 cases in the expectant treatment group had live births and no early neonatal death. Five pregnant women (14%, 5/37) in the expectant treatment group underwent emergency cesarean section in the course of expectant treatment. In the mid-term termination group, all pregnancies were terminated by operation, including 9 cases of hysterectomy and 5 cases of placental hysterectomy. There was 1 fetal survival (gestational age of termination: 27⁺⁴ weeks) and 13 fetal death in the mid-term termination group. Conclusions: Pregnant women who are diagnosed as suspected invasive PAS, especially those with placenta percreta, have the risk of uterine rupture and emergency surgery in the course of expectant treatment. However, early termination of pregnancy does not reduce the risk of intraoperative blood loss and hysterectomy.

Association between internal migration experience and depressive symptoms: analysis of PSID data

BACKGROUND

Depression is on the rise globally. Additionally, the United States has a high level of population mobility. The main aim of this study was to provide a reference for improving the mental health of internal migrants by investigating the relationship between internal migration experience and depressive symptoms.

METHODS

We analysed data from the Panel Study of Income Dynamics (PSID). We included PSID data from the 2005 to 2019 waves in which all respondents were asked about their internal migration experience and depressive symptoms. This study included 15,023 participants. T tests, chi-square tests, multiple logistic regression methods were performed and fixed effects model.

RESULTS

In the sample, the prevalence of depressive symptoms was 4.42%. The risk of depression in internal migrants was 1.259 times (OR = 1.259, 95% CI = (1.025-1.547, p < 0.05) that of nonmigrants. Internal migration experience was significantly positively associated with female depressive episodes (OR = 1.312, 95% CI = 1.010-1.704, p < 0.05) and increased risk of becoming depressed at a young age (OR = 1.304, 95% CI = 1.010-1.684, p < 0.05). The association between internal migration experience and depressive symptoms was more significant for participants who might move (OR = 1.459, 95% CI = 1.094-1.947, p < 0.05). In addition, different internal migratory causes are associated with depressive symptoms to varying degrees.

CONCLUSIONS

Our findings highlight the need for greater policy attention to mental health inequalities between Internal migrants and those who never move away from their hometown in the United States. Our study provides a foundation for further research.

Triple targeting host-guest drug delivery system based on lactose-modified azocalix[4]arene for tumor ablation

Host-guest drug delivery systems (HGDDSs) have been studied in an effort to modify the characteristics of therapeutic agents through noncovalent interactions, reduce toxic side effects and improve therapeutic effects. However, it is still an important task to continuously improve the targeting ability of HGDDSs, which is conducive to the development of precision medicine. Herein, we utilize the lactose-modified azocalix[4]arene (LacAC4A) as a triple targeting drug carrier customized for antitumor purposes. LacAC4A integrates three targeting features, passive targeting through the enhancing permeability and retention effect, active targeting by the interactions of lactose and the asialoglycoprotein receptors on the surface of tumor cells, and stimuli-responsive targeting via the reduction of the azo group under a hypoxia microenvironment. After loading doxorubicin (DOX) in LacAC4A, the supramolecular nanoformulation DOX@LacAC4A clearly showed the effective suppression of tumor growth through in vivo experiments. LacAC4A can achieve effective targeting, rapid release, and improve drug bioavailability. This design principle will provide a new material for drug delivery systems.

Population total and unbound pharmacokinetics and pharmacodynamics of ciprofol and M4 in subjects with various renal functions

AIMS

The aim of this study was to develop a population pharmacokinetic (PK) model to simultaneously describe both total and unbound concentrations of ciprofol and its major glucuronide metabolite, M4, and to link it to the population pharmacodynamics (PD) model in subjects with various renal functions.

METHODS

A total of 401 and 459 pairs of total and unbound plasma concentrations of ciprofol and M4, respectively, as well as 2190 bispectral index (BIS) data from 24 Chinese subjects with various renal functions were available. Covariates that may potentially contribute to the PK and PD variability of ciprofol were screened using a stepwise procedure. The optimal ciprofol induction dosing regimen was determined by model-based simulations.

RESULTS

The PK of unbound ciprofol could best be described by a three-compartment model, while a two-compartment model could adequately describe unbound M4 PK. The concentrations of total and unbound ciprofol and M4 were linked using a linear protein binding model. The relationship between plasma concentrations of ciprofol and BIS data was best described by an inhibitory sigmoidal E_max model with a two-compartment biophase distribution compartment. Hemoglobin was the identified covariate determining the central compartment clearance of ciprofol; uric acid was a covariate affecting the central compartment clearance of M4 and protein binding rate, k_B . The included covariates had no effect on the PD of ciprofol. Simulation results indicated that the label-recommended dose regimen was adequate for anaesthesia induction.

CONCLUSIONS

The developed model fully characterized the population PK and PD profiles of ciprofol. No dose adjustment is required in patients with mild and moderate renal impairment.

Effects of breviscapine on cerebral ischemia-reperfusion injury and intestinal flora imbalance by regulating the TLR4/MyD88/NF-κB signaling pathway in rats

ETHNOPHARMACOLOGICAL RELEVANCE

The plant Erigeron breviscapus (Vant.) Hand.-Mazz.,a Chinese herbal medicine with multiple pharmacological effects and clinical applications, has been traditionally used in the treatment of paralysis caused by stroke and joint pain from rheumatism by the Yi minority people of Southwest China for generations.However, its mechanism involves many factors and has not been fully clarified.

AIM OF THE STUDY

Taking intestinal flora as the target, the protective effect of extract(breviscapine) of E. breviscapus on cerebral ischemia and its possible mechanism were discussed from the perspective of brain inflammatory pathway and intestinal CYP3A4, which depends on intestinal flora.

MATERIALS AND METHODS

In this study, we first verified the binding ability between major active ingredient of Erigeron breviscapus and the core target TLR4 protein by molecular docking using Vina software.We established a rat model of cerebral ischemia-reperfusion injury in vivo.The neurological function of rats was scored by Bederson score table, the cerebral infarction volume was detected by TTC staining, and the serum NSE level was detected by ELASA. 16S rRNA sequencing was used to detect the intestinal flora of rats in each group.The expression levels of cerebral TLR4/MyD88/NF-κB and CYP3A4 mRNA and protein in different intestinal segments were detected by qRT-PCR and Western blot.

RESULTS

Compared with the model group, the neurological injury score, infarct volume and serum NSE concentration of breviscapine low, medium and high dose groups and nimodipine groups decreased significantly. Meanwhile, breviscapine could significantly reduce the expression level of the TLR4/MyD88/NF-κB in brain tissue and CYP3A4 in different intestinal segments of rats with cerebral ischemia-reperfusion injury. In addition, breviscapine also significantly ameliorated intestinal flora dysbiosis of rats with cerebral ischemia-reperfusion injury.

CONCLUSIONS

Breviscapine can protect rats from cerebral ischemia-reperfusion injury by regulating intestinal flora, inhibiting brain TLR4/MyD88/NF-κB inflammatory pathway and intestinal CYP3A4 expression.

[Analysis on the household secondary attack rates of the SARS-CoV-2 Delta variant and the associated factors]

Objective: To evaluate the household secondary attack rates of the SARS-CoV-2 Delta variant and the associated factors. Methods: A COVID-19 outbreak caused by the Delta variant occurred in Nanjing in July 2021. A total of 235 cases with current addresses in Nanjing were reported from 171 households. The subjects in this study were selected from household close contact(s) of infected cases. The information on household index cases and their contacts were collected, and the household secondary attack rate (HSAR) and the risk factors were analyzed by the multi-factor logistic regression model. Results: A total of 234 cases of household close contacts and 64 household secondary cases were reported from 103 households, and the HSAR was 27.4% (64/234, 95%CI:22.0% to 33.4%). The proportions of household size for 2 to 3, 4 to 5, and 6 to 9 were 64.1% (66), 26.2% (27) and 9.7% (10), respectively. A total of 35 cases of household cluster outbreaks were reported (35/103, 34.0%). The number of the first case in the household (FCH) was 103 and males accounted for 27.2% (28 cases), with the median age (Q₁, Q₃) of 49 (9, 56). The number of household close contacts was 234 and males accounted for 59.0% (138 cases), with the median age (Q₁, Q₃) of 42 (20, 55) and the median exposure period (Q₁, Q₃) of 3 (1, 3) days. The multi-factor logistic regression model showed that the higher HSAR was observed in the FCH with the features of airport staff (OR=2.913, 95%CI:1.469-5.774), detection from home quarantine screening (OR=6.795, 95%CI:1.761-26.219) and detection from mass screening (OR=4.239, 95%CI:1.098-16.368). Meanwhile, higher HSAR was observed in cases with longer household exposure (OR=1.221, 95%CI:1.040-1.432), non-vaccination (OR=2.963, 95%CI:1.288-6.813) and incomplete vaccinations (OR=2.842, 95%CI:0.925-8.731). Conclusion: The generation interval of the Delta variant is shortened, and the ability of transmission within the household is enhanced. In the outbreak in Nanjing, the associated factors of HSAR are occupation, detection route, vaccination and exposure period.

[Longitudinal correlation between cell phone use and sleep quality in college students]

Objective: To investigate the current situation of cell phone use and sleep quality among college students, establish a sleep quality trajectory model and explore the influence of cell phone use on the sleep quality trajectory. Methods: Based on data from the College Student Behavior and Health Cohort Study 2019-2020, a latent class growth modeling was used to establish a sleep quality trajectory model among college students. The baseline influencing factors of sleep quality trajectories among college students were analyzed by χ² test, and the effects of cell phone use on sleep quality trajectories were analyzed by binary logistic regression. Results: A total of 1 092 college students were included in the analysis. The detection rates of cell phone use and poor sleep quality were 24.5% and 13.3%. Latent class growth model identified two groups of sleep quality trend trajactories: an improved sleep quality group (86.0%) and a decreased sleep quality group (14.0%). The result of binary logistic regression showed that the cell phone use was a risk factor of sleep quality trajectories. Conclusion: The cell phone use during college period could increase the risk of poor sleep quality. Targeted intervention measures about cell phone use should be adopted to improve the sleep quality among college students.

Matrix stiffness in regulation of tumor angiogenesis

Angiogenesis is one of the most common malignant features of solid tumors such as liver cancer, pancreatic cancer, and gastrointestinal tumors, which is the basis of tumor growth, invasion, and metastasis. It is also an important target of anti-tumor therapy. Tumor angiogenesis is usually triggered by biochemical, hypoxic, and biomechanical factors in the microenvironment. The regulation of biochemical signals and hypoxic microenvironment in tumor angiogenesis have been widely documented, but the role of biomechanical signals in tumor angiogenesis has gradually begun to be uncovered in recent years. The vasculature system is naturally sensitive to mechanical stimuli. Recent studies have highlighted the important regulatory effects of biomechanical stimuli, such as matrix stiffness, fluid shear stress, and vascular lumen pressure, on the phenotype and functions of tumor blood vessels. In this paper, we summarize the new progress and internal mechanisms of matrix stiffness-mediated effects on tumor angiogenesis.

SLC25A25-AS1 over-expression could be predicted the dismal prognosis and was related to the immune microenvironment in prostate cancer

It has been established that long-chain coding RNA (lncRNA) SLC25A25-AS1 is associated with cancer progression. However, the roles and mechanisms of SLC25A25-AS1 in prostate cancer (PC) have not been reported in the literature. The present study explored the relationship between SLC25A25-AS1 expression and PC progression via comprehensive analysis. The pan-cancer expression of SLC25A25-AS1 was identified using data from The Cancer Genome Atlas (TCGA) database and tissue specimens from our hospital. The expression levels of SLC25A25-AS1 in various subgroups based on the clinical features were identified. The prognostic value of SLC25A25-AS1 and SLC25A25-AS1 co-expressed lncRNAs in PC patients was assessed by survival analysis and ROC analysis, and prognosis-related risk models of SLC25A25-AS1 were constructed. The relationship between SLC25A25-AS1 and the PC immune microenvironment was investigated using correlation analysis. SLC25A25-AS1 expression in PC was significantly increased and correlated with the T stage, clinical stage, Gleason score (GS), and dismal prognosis. SLC25A25-AS1 overexpression exhibited good performance in evaluating the prognosis of PC patients. The area under the curves (AUCs) of the 1-, 3-, and 5-year overall survival (OS) for SLC25A25-AS1 was 1, 0.876, and 0.749. Moreover, the AUCs for the 1-, 3-, and 5-year progress free interval (PFI) for SLC25A25-AS1 were 0.731, 0.701, and 0.718. SLC25A25-AS1 overexpression correlated with the infiltration of CD8 T cells, interstitial dendritic cells (IDC), macrophages and other cells. AC020558.2, ZNF32-AS2, AP4B1-AS1, AL355488.1, AC109460.3, SNHG1, C3orf35, LMNTD2-AS1, and AL365330.1 were significantly associated with SLC25A25-AS1 expression, and short OS and PFI in PC patients. The risk models of the SLC25A25-AS1-related lncRNAs were associated with a dismal prognosis in PC. Overall, SLC25A25-AS1 expression was increased in PC and related to the prognosis and PC immune microenvironment. The risk model of SLC25A25-AS1 have huge prospect for application as prognostic tools in PC.

[Clinical risk factors of cesarean scar pregnancies]

Objective: To explore the risk factors related to cesarean scar pregnancies (CSP). Methods: Among the patients during July 2016 to June 2021 in Peking University Third Hospital, 596 cases of CSP patients were included as study group, and 1 192 cases of intrauterine pregnancy(IUP) women with history of cesarean section(s) were chosen as control group through stratified sampling according to the civil year of previous cesarean section matched with CSP group. The correlation between the general situation of patients, the history of gravidity and parity, the history of surgeries in uterine cavity and the previous cesarean section and the occurrence of CSP was explored through multivariate logistic regression analysis. Results: The current age of 596 CSP patients was (34.6±4.4) years, and that of 1 192 IUP patients was (35.6±3.6) years (P<0.001). Multivariate logistic regression analysis showed that the following factors may increase the risk of CSP: age<35 years old (OR=2.306, 95%CI: 1.774-2.998), history of medical abortion (OR=1.629, 95%CI 1.102-2.407), pregnancy interval<2 years from the last cesarean section (OR=2.147, 95%CI: 1.237-3.726), pregnancy interval ≥8 years from the last cesarean section (OR=1.474, 95%CI: 1.110-1.957), history of surgeries in uterine cavity before the last cesarean section (OR=2.558, 95%CI: 1.809-3.615), history of surgeries in uterine cavity after the last cesarean section (OR=8.020, 95%CI: 5.966-10.781), previous cesarean delivery ≥2 times (OR=14.051, 95%CI: 9.699-20.356) and history of previous cesarean sections before labor (OR=2.683, 95%CI: 1.930-3.731)(all P<0.05). Conclusions: The occurrence of CSP is related to the age of patients, the history of medical abortion, pregnancy interval, the history of surgeries in uterine cavity and the previous cesarean section, among which previous cesarean delivery ≥2 times and history of surgeries in uterine cavity after the last cesarean section are the strongly associated risk factors.

Bisabolane-type sesquiterpenoids with potential anti-inflammatory and anti-HIV activities from the stems and leaves of Morinda citrifolia

The phytochemical study on the stems and leaves of Morinda citrifolia L. resulted in the isolation of a new naturally occurring bisabolane-type sesquiterpenoid, morincitrinoid A (1), together with five known analogues (2-6). The chemical structure of 1 was elucidated by comprehensive spectral analyses. The known compounds 2-6 were identified by comparing their spectral data with those reported in the literature, which were isolated from M. citrifolia for the first time. In addition, the anti-inflammatory and anti-HIV activities of compounds 1-6 were evaluated in vitro. Compounds 1-6 displayed significant inhibitory activities on NO (nitric oxide) production induced by lipopolysaccharide in mouse macrophage RAW 264.7 cells with IC₅₀ values ranging from 0.98 ± 0.07 to 6.32 ± 0.11 μM, which was comparable to hydrocortisone. Meanwhile, compounds 1-6 showed remarkable anti-HIV-1 reverse transcriptase (RT) effects with the EC₅₀ values ranging from 0.16 to 6.29 μM.

Gastric cancer cell-derived extracellular vesicles disrupt endothelial integrity and promote metastasis

The endothelium is the critical barrier that controls transendothelial communications. Blood vessels in cancer tissue are poorly developed and highly permeable. However, it is poorly understood how circulating cancer cells released through these "leaky" vessels break the intact vasculature of remote organs to metastasize. We investigated the roles of cancer cell-derived extracellular vesicles (CEVs) in regulating cancer metastasis by analyzing samples from gastric cancer patients, performing in vitro experiments, and studying mouse models. We made several novel observations. First, the rate of metastasis was closely associated with plasma levels of CEVs in patients with gastric cancer. Second, cultured endothelial cells endocytosed CEVs, resulting in cytoskeletal rearrangement, low expression of the junction proteins cadherin and CD31, and forming large intercellular gaps to allow the transendothelial migration of cancer cells. The dynamin inhibitor Dynasore prevented these CEV-induced changes of endothelial cells by blocking CEVs endocytosis. Third, CEVs disrupted the endothelial barrier of cancer-bearing mice to promote cancer metastasis. Finally, lactadherin promoted the clearance of circulating CEVs to reduce metastasis. These results demonstrate the essential role of CEVs in promoting the metastasis of gastric cancer.

[Analysis of China's influenza vaccine application policy based on the macro model of the health system]

This article uses the analysis framework of the macro model of the health system to analyze the influenza vaccine policy documents issued by the state and governments at all levels from three perspectives: structure, process and results, and provides a scientific basis for improving the application strategy of influenza vaccine. It is suggested that on the basis of continuing to strengthen publicity, mobilization and organizational guarantee, measures to promote the application of influenza vaccine in China by exploring multi-channel financing mechanisms, combining the experience of new crown vaccination to improve the convenience of influenza vaccination, and scientifically setting vaccination rate targets, improve preparedness for an influenza pandemic.

[Clinical features of vaginal trial delivery in twin pregnancy and factors related with failure]

Objective: To investigate the case characteristics and factors related with failure of vaginal trial delivery in twin pregnancy. Methods: A retrospective analysis was performed on the clinical data of patients with twin pregnancy who underwent vaginal trial delivery in Peking University Third Hospital from January 2016 to June 2021. There were 109 cases in the successful group (vaginal delivery of both fetuses) and 28 cases in the failed group (cesarean delivery of one or all fetuses), the differences between the two groups were compared and the related factors of vaginal trial failure in twin pregnancy were analyzed. Results: There was no significant difference in age between the two groups[(32.4±3.8) years vs (31.3±3.3) years, P=0.163].The proportion of conception through assisted reproductive technology and induced labor in the successful group was significantly lower than that in the failed group(36.7% vs 60.7%, P<0.05;35.8% vs 60.7%, P<0.05). The average gestational age [(35.5±1.9) weeks vs (36.7±2.1) weeks, P<0.05], the body weight of the first fetus[ (2 328.4±431.9) g vs (2 585.7±443.9) g, P<0.05], the body weight of the second fetus [(2 286.2±434.8) g vs (2 531.8±574.8) g, P<0.05] and the sum of the body weight of the two fetuses[(4 614.6±801.9) g vs (5 117.5±916.1) g, P<0.05] in the successful group were significantly lower than those of the failure group. Multivariate analysis showed that assisted fertility technique (OR=2.878, 95%CI:1.167-7.099) and the sum of the body weight of the two fetus ≥4 735g (OR=4.304, 95%CI:1.659-11.165) were independent risk factors for vaginal trial failure of twin pregnancy. Conclusions: Vaginal trial delivery in twin pregnancy is relatively safe. Vaginal delivery should be carefully selected for patients with twin pregnancy who concepted through assisted reproductive technology and the sum of the body weight of the two fetus ≥4 735g.

Synthesis, Renal Clearance, and Photothermal Therapy Based on the Self-Assembly of a Nanomedicine Consisting of Quaterrylene Bisimide and Glycocluster Conjugates

Renal-clearable nanomedicines are considered the next generation of nanomedicines, and show potential application for future clinical translations. However, it is important to determine whether self-assembly can form large aggregates that accrue in tumors and then tailor the size of these assemblies to be excreted renally. In this paper, a renal-clearable nanomedicine based on quanterrylene bisimide-mannose conjugates (QDI-Man) was developed. QDI-Man showed a high renal clearance efficiency of 80.31 ± 2.85% in mice. We confirmed that the self-assembly of QDI-Man exhibited a dynamic adjustment process through the renal filtration thresholds, that is, "aggregation → self-regulating the aggregate size through the renal filtration thresholds → reaggregating into aggregates". Benefiting from the modification of mannose-based glycoclusters, QDI-Man showed selective photothermal therapy because of the mannose receptors overexpressed in breast cancer cells, and showed good photothermal therapy in mice. This paper developed a dynamic adjustment theory for effective renal clearance based on organic self-assembly.

[Ocular biometry of infants and young children with congenital cataract]

Objective: To understand the developmental characteristics of early ocular biological parameters in patients with congenital cataract. Methods: Retrospective case series study. The ocular biometry data such as the axial length, corneal curvature, anterior chamber depth and central corneal thickness of 169 patients under 3 years old who were diagnosed with congenital cataract in Eye Hospital of Wenzhou Medical University (Hangzhou Branch) from June 2016 to June 2020 were reviewed, and they were analyzed by 3 age groups. There were 87, 41, and 41 patients in three age groups, 1 to 6 months, 7 to 12 months, and 13 to 36 months, respectively; 108 patients with bilateral affected eyes and 61 patients with unilateral affected eyes were included; 84 patients with partial opacity lens and 85 patients with total opacity lens were included. The right eyes of the patients with bilateral congenital cataract were selected for analysis. Statistical analysis of ocular biological parameters between groups was performed using the independent samples t-test and paired samples t-test. Statistical analysis of the relationship between age in months and biological parameters was performed using the Pearson's correlation test. Results: The axial length at the age of 1 to 6 months in the affected eyes of patients with bilateral cataract was (17.59±1.19) mm, it was shorter than the affected eyes of patients with unilateral cataract [(18.18±1.34) mm], and the axial length in the affected eyes of patients with unilateral cataract were shorter than the healthy eyes [(19.01±0.93) mm]. At the age of 7 to 12 months, the axial length in the affected eyes of patients with unilateral cataract [(19.89±0.74) mm] was shorter than the healthy eyes [(20.48±0.43) mm]. The differences were statistically significant (t=-2.06, -5.62, -3.47, all P<0.05). The axial length in the affected eyes with partial opacity at the age of 1 to 6 months was shorter than those with total opacity [(17.43±1.14) mm vs. (18.06±1.29) mm; t=-2.38, P=0.020]. The difference in axial length (affected eyes vs. healthy eyes) was significantly correlated with the age in months in partial cataract (r=0.53, P=0.001). The corneal curvature in the affected eyes of patients with unilateral cataract was flatter than the healthy eyes at the age of 7 to 12 months [(42.41±1.82) D vs. (43.19±1.96) D; t=-2.29, P=0.038], but was steeper at the age of 13 to 36 months [(43.36±2.32) D vs. (42.55±1.88) D; t=2.17, P=0.043]. The anterior chamber depth in the affected eyes of patients with unilateral cataract was less than the healthy eyes at the age of 1 to 6 months [(2.44±0.37) mm vs. (2.58±0.33) mm; t=-2.08, P=0.048].The central corneal thickness in the affected eyes of patients with unilateral cataract was thicker than the healthy eyes both at the age of 1 to 6 months and 7 to 12 months [(555.26±46.95) μm vs. (541.85±40.78) μm, (542.93±27.63) μm vs. (530.93±30.36) μm; t=3.82, 2.26; P=0.001, 0.040]. Conclusions: Congenital cataracts maybe affect the early development of axial length, corneal curvature, anterior chamber depth and central corneal thickness. The degree of lens opacity maybe affecte the early axial length development. The axial length in eyes with partial opacity can be shorter than those with total opacity before the age of 6 months, and thereafter gradually outnumbered the latter.

Chitinophaga hostae sp. nov., isolated from the rhizosphere soil of Hosta plantaginea

A Gram-negative, rod-shaped aerobic bacterium designated as strain 2R12T was isolated from the rhizosphere soil of Hosta plantaginea. Phylogenetic analyses based on the 16S rRNA gene revealed that strain 2R12T should be assigned to the genus Chitinophaga with the highest sequence similarity to Chitinophaga arvensicola DSM 3695T (99.1 %) and Chitinophaga ginsengisegetis DSM 18108T (98.6 %). The major fatty acids of strain 2R12T (>10 %) were iso-C15 : 0, C16 :1 ω5c and iso-C17 : 0 3-OH. The major polar lipids were phosphatidylethanolamine, two unidentified aminolipids and five unidentified lipids. The predominant respiratory quinone was MK-7. The genomic DNA G+C content was 46.1 mol%. The average nucleotide identity values of strain 2R12T with C. arvensicola DSM 3695T and C. ginsengisegetis DSM 18108T were 77.9 and 78.8 %, respectively, while in silico DNA–DNA hybridization values for strain 2R12T with these strains were 22.8 and 23.3 %, respectively. Based on comparative analysis of phylogenetic, phylogenomic, phenotypic and chemotaxonomic characteristics, strain 2R12T represents a novel species in the genus Chitinophaga , for which the name Chitinophaga hostae sp. nov. is proposed. The type strain is 2R12T (=ACCC 61757T=JCM 34719T).

New progress in the mechanism of microenvironment-driven chemoradiotherapy resistance in digestive system tumors

Tumor microenvironment (TME) is the cornerstone of the survival of tumor cells. It generally presents unique physical and chemical characteristics such as hypoxia, immunosuppression, metabolic reprogramming, and matrix stiffening, which not only offer suitable soil to support tumorigenesis and progression, but also resist the effects of radiotherapy and chemotherapy. Here, we summarize new progress in the mechanism of hypoxia, immunosuppression, metabolic reprogramming, and matrix stiffness-driven chemoradiotherapy resistance in digestive system tumors, and discuss the new intervention strategy against matrix stiffness-driven chemoradiotherapy resistance, which underlines the contribution of physical and chemical characteristics of tumor microenvironment in drug resistance.

[The short-term and long-term prognostic analysis in patients with chronic total occlusion acute non-ST segment elevation myocardial infarction]

Objectives: To investigate the clinical impacts of chronic total occlusion (CTO) in acute non-ST segment elevation myocardial infarction (NSTEMI) patients underwent primary percutaneous coronary intervention (PCI). Methods: A total of 2 271 acute NSTEMI patients underwent primary PCI from China Acute Myocardial Infarction Registry were enrolled in this study and divided into the CTO group and the non-CTO group according to the angiography. The primary endpoint was in-hospital mortality and mortality during a 2-year follow-up. The secondary endpoint was major adverse cardiovascular events (MACE) including revascularization, death, re-myocardial infarction, heart failure readmission, stroke and major bleeding. Results: Thirteen-point four percent of the total acute NSTEMI patients had concurrent CTO. In-hospital mortality (3.6% vs. 1.4%, P<0.01) and 2-year mortality (9.0% vs. 5.1%, P<0.01) were significantly higher in the CTO group than those in the non-CTO group, respectively. Multiple regression analyses showed that chronic obstructive pulmonary disease (HR 7.28, 95%CI 1.50-35.35, P=0.01) was an independent risk factor of in-hospital mortality, and advanced age (HR 1.04, 95%CI 1.01-1.07, P<0.01), and low levels of ejection fraction (HR 0.95, 95%CI 0.93-0.98, P<0.01) were independent risk factors of 2-year mortality. CTO (HR1.67, 95%CI 1.10-2.54, P=0.02) was an independent risk factor of revascularization, but not a risk factor of mortality. Conclusions: Although acute NSTEMI patients concurrent with CTO had higher mortality, CTO was only an independent risk factor of revascularization, but not of mortality. Advanced age and low levels of ejection fraction were independent risk factors of long-term death among acute NSTEMI patients.

[The effect of occupational stress on anxiety of nursing staff in a third-grade general hospital and mediating effect of job burnout]

Objective: To explore the mediating effect of job burnout of nursing staff in clinical departments on occupational stress and anxiety, and to provide scientific basis for the formulation of intervention measures to relieve anxiety. Methods: From November 2020 to January 2021, a cross-sectional survey was conducted to investigate the basic situation, occupational stress, job burnout and anxiety of 653 nursing staff in a third class A general hospital in Hebei Province. Spearman rank correlation was used to analyze the relationship between occupational stress, job burnout and anxiety, stepwise regression and mediating effect model were used to verify the mediating effect of job burnout on the relationship between occupational stress and anxiety. Results: 551 valid questionnaires were collected with effective recovery of 84.38%. The incidence of high occupational stress was 68.06% (375/551) , the incidence of job burnout was 63.70% (351/551) [high, moderate and moderate were 11.07% (61/551) and 52.63% (290/551) respectively], and the incidence of anxiety was 55.72% (307/551) [mild, moderate and severe were 38.11% (210/551) , 8.53% (47/551) and 9.08% (50/551) respectively]. Occupational stress was positively correlated with job burnout and anxiety (r=0.545, 0.479) , and job burnout was positively correlated with anxiety (r=0.542, P<0.05) . The mediating effect analysis showed that occupational stress had a statistically significant effect on anxiety (c=0.509, P<0.001) , and the mediating effect of job burnout on the relationship between occupational stress and anxiety accounted for 44.99% of the total effect. Conclusion: The anxiety level of the nursing staff in this third-class A general hospital was relatively high. Job burnout has a mediating effect between occupational stress and anxiety, and anxiety of nursing staff can be alleviated by reducing occupational stress or job burnout.

Response of salinity gradient power generation to inflow mode and temperature difference by reverse electrodialysis

Sustainable utilization has been becoming the core idea of concentrated seawater disposal, which makes the harvest of salinity gradient power based on reverse electrodialysis (RED) become one of the important ways. As the important factors affecting RED performance, different flow orientations along the membrane and solution temperature have been studied in the previous researches. However, there are still some details that need to be clarified. In this study, the inflow mode was further detailed investigated. The results showed that after eliminating the interference of bubbles in the counter-current, the co-current was still better than the counter-current; when the solution of HCC (high concentration compartment) and LCC (low concentration compartment) was circulated for 3 h, the concentration of concentrated seawater discharge liquid was reduced by 6.93%, which was conducive to reducing the negative impact on the marine ecological environment. Meanwhile, the response of salinity gradient power generation to temperature difference was that high temperature had a positive effect on power density, and the order was both the HCC and LCC (0.44 W m^-2) > LCC (0.42 W m^-2) > HCC (0.39 W m^-2). Although the RED performance was more sensitive to the temperature rise of LCC, the positive temperature difference between HCC and LCC is a more practical advantage because the temperature of concentrated seawater in HCC is usually high. These new observations could provide supports for the industrial development of RED in generating electricity economically and reducing the negative environmental impact of concentrated seawater.

The dietary inflammatory index and metabolic health of population-based Chinese elderly

BACKGROUND AND OBJECTIVES

This study evaluated the relationship between dietary inflammatory index (DII) and metabolic health in the Chinese elderly.

METHODS AND STUDY DESIGN

A total of 6,730 participants from the "Community-based Cardiovascular and Health Promotion Study" (CoCHPS) cohort were included in this study. The DII scores were acquired using a validated 125-item food-frequency questionnaire (FFQ) (ranged -5.84 to 3.90). The correlation of DII with metabolic health indexes was evaluated with logistic regression and multivariable cox regression using SPSS and R software.

RESULTS

Compared with low DII scores, subjects in the highest DII score quartiles had higher odds of metabolic dysfunction (OR=1.36, 95% CI: 1.07-1.68, p trend=0.023). In the subgroup analyses, the effect of a pro-inflammatory diet on metabolic dysfunction was particularly evident among people with hyperglycaemia (HR=1.58, 95% CI: 1.35-2.14), hypertension (HR=1.48, 95% CI: 1.07-2.09), dyslipidemia (HR=1.45, 95% CI: 1.24-1.87), abdominal obesity (HR=2.16, 95% CI: 1.57-2.96), and ≥60 years old (HR=1.32, 95% CI: 1.04-1.56) or who were women (HR=1.35, 95% CI: 1.08-1.67).

CONCLUSIONS

DII score was associated with metabolic health. Further studies are needed to deepen our understanding of dietary parameters and different populations.

Anthraquinones with potential antiproliferative activities from the fruits of Morinda citrifolia

The phytochemical investigation on the fruits of Morinda citrifolia led to the isolation and characterization of a new anthraquinone, moricitrifone (1), along with seven known anthraquinones (2-8). The chemical structure of 1 was elucidated by extensive spectral analyses. The known compounds (2-8) were identified by comparing their spectral data with those reported in the literature. The antiproliferative activities of all isolated anthraquinones (1-8) against five human cancer cell lines: HL-60, SMMC-7721, A-549, MCF-7 and SW480 were evaluated in vitro. Compounds 1-8 exhibited remarkable antiproliferative activities with IC₅₀ values ranging from 0.26 ± 0.05 to 16.58 ± 0.18 μM, which were comparable to those of doxorubicin.

[Twelve-week of sofosbuvir/velpatasvir therapeutic regimen for chronic hepatitis C patients in northwest region of China: a real-world multicenter clinical study]

Objective: To study the real-world outcome of China FDA-approved Sofosbuvir (SOF)/Velpatasvir (VEL) in Northwest China. Methods: In this multicenter, prospective, real-world cohort study, we recruited patients from 10 sites from Northwest China, who were chronically infected with HCV GTs 1-6 from 06/2018 to 09/2019. Patients received SOF (400mg)/VEL (100mg) for 12 weeks, and with ribavirin 900-1200 mg for GT3 cirrhosis and for any genotype decompensated cirrhosis. The primary endpoint was sustained virological response at 12-weeks post-treatment (SVR12) and safety. The secondary endpoint was the change of liver function after the achievement of SVR12. Results: Totally, 143 patients were enrolled in the study, four patients were lost to follow-up and one died during the follow-up, 138 patients were included in per-protocol analysis. Of the 138 patients, the mean age 53 years, 53.6% male, 94.2% Han nationality, 53.6% liver cirrhosis, 10.1% HBsAg(+), 6.5% renal dysfunction, 5.1% treatment-experienced, and 16.7% patients received ribavirin treatment. The genotype distribution was as follows: 35.5% GT1, 42.8% GT2, 15.9% GT3, and 5.8% un-typed. The SVR12 rate was 96.5% (138/143, 95%CI: 93.5%-99.6%) for intention-to-treat analysis, and in per-protocol analysis, all 138 patients obtained SVR12 (100%). Compared with baseline, the serum total bilirubin, ALT and AFP levels decreased (all P < 0.05), as well as increased ALB and platelet count (all P < 0.001) at post-treatment 12-weeks. Overall adverse events (AEs) rate is 29.0%, and the most common AEs were anemia (14.5%) and fatigue (8.0%). Severe side effects (edema and fatigue) occurred in 2 patients, one of whom needed a short-term interruption of treatment due to fatigue. Conclusion: In this real-world cohort study, 12-week SOF/VEL regimen with or without ribavirin achieved high SVR12 rates (96.5%-100% overall) with excellent safety profile among patients with HCV GT1/2/3 infection including patients with GT3 and cirrhosis, and led to improvement of liver function.

Predictive value of GRACE score combined with BNP and glycosylated hemoglobin for in-hospital cardiovascular events in patients with acute coronary syndrome after percutaneous coronary intervention

Purpose

To investigate the value of Global Registry of Acute Coronary Events (GRACE) score combined with B-type natriuretic peptide (BNP) and glycosylated hemoglobin (HbA1c) in predicting in-hospital major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).

Methods

A total of consecutive 675 patients with acute coronary syndrome (ACS) admitted to our hospital from June 2019 to June 2020, and finally, 319 patients treated with the percutaneous coronary intervenion (PCI) were enrolled. Major adverse cardiovascular events (MACE) during hospitalization included cardiac death, cardiogenic shock, congestive heart failure, recurrent ischemic chest pain and malignant arrhythmia. The area under the curve (AUC) was used to evaluate the predictive value of MACE during hospitalization.

Results

Among 319 patients, during hospitalization, 26 patients (8.15%) experienced the MACE. Compared to that of non-MACE group, there were more patients with previous history of heart failure (P&lt;0.001), lower in-admission systolic and diastolic blood pressure (P all&lt;0.05), and higher heart rate, GRACE score, BNP, and HbA1c levels in the MACE group (P all&lt;0.05). Multivariate logistic regression analysis showed that history of heart failure (OR: 1.498, 95% CI: 1.144–2.249), GRACE score (OR: 1.040, 95% CI: 1.017–1.063), BNP (OR: 1.019, 95% CI: 1.012–1.026) and HbA1C (OR: 1.199, 95% CI: 1.043–1.378) were independent risk factors for MACE in patients with ACS after PCI (P all&lt;0.05). The AUC of GRACE score for predicting MACE in ACS patients after PCI was 0.758, while the AUC of BNP and HbA1C was 0.838 and 0.788, respectively. When GRACE score combined with BNP and HbA1c, the AUC was increased to 0.876, which was significantly higher than the GRACE score alone (Z=4.142, P&lt;0.001).

Conclusion

In this study, we reported for the first time, GRACE score combined with BNP and HbA1c significantly improved the predictive value of in-hospital MACE in ACS patients after PCI compared with traditional GRACE score, which can help clinicians identify high risk patients to improve their prognosis in the clinical practice.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Young and middle-aged talents in the XPCC Science and Technology Project (2020CB012); Key Science and Technology Project of Shihezi (2019ZH09) ROC Curve

[Incidence and trend of severe postpartum hemorrhage between 2016 and 2019 in China]

Objective: To investigate the incidence and trend of severe postpartum hemorrhage (sPPH) in China, and to provide basic data for the development and evaluation of sPPH prevention and control strategy. Methods: Obstetric data was extracted from annual national representative sampling surveys based on the National Clinical Improvement System. From 2016 to 2019, 2 978, 3 400, 4 576 and 4 594 maternity hospitals with sPPH cases were included for statistics. The annual incidence of sPPH was calculated according to province and type of medical institutions and generalized linear model was emplyed to identify the determinants affecting sPPH incidence. Results: In China, sPPH incidence increased from 0.62% in 2016 to 0.93% in 2018, and was 0.92% in 2019. Eighteen provinces had an inverted U-shaped trend of sPPH over time and most of them had the highest incidence in 2018; ten provinces had an upward trend of sPPH and 3 provinces had a U-shaped trend. In 2019, the top five provinces with the highest sPPH incidence were Yunnan (1.88%), Beijing (1.45%), Jiangsu (1.31%), Guizhou (1.26%), and Ningxia Hui Autonomous Region (1.22%); the top five provinces with the lowest incidence were Henan (0.55%), Jiangxi (0.60%), Inner Mongolia Autonomous Region (0.64%), Liaoning (0.64%) and Gansu (0.69%). In 2019, the sPPH incidence in different types of medical institutions were as follows: tertiary public general hospital (1.15%), tertiary public specialized hospital (1.02%), secondary public general hospital (0.81%), private hospital (0.61%) and secondary public specialized hospital (0.58%). sPPH incidence was positively associated with proportion of twin pregnancies, macrosomia, primipara, and puerpera aged ≥35 years in maternity hospitals (P<0.05). Conclusions: sPPH incidence generally showes an increasing trend from 2016 and is stable at a high level in recent two years in China. It is warranted to further strengthen the monitoring of postpartum hemorrhage, and improve the capability of hierarchical management and treatment in maternity institutions and regions, in order to reduce sPPH incidence and maternal mortality.

[Diagnosis, treatment and outcome of adnexal torsion at different gestational weeks during pregnancy]

Objective: To investigate the clinical characteristics, diagnosis, treatment and outcome of adnexal torsion at different gestational weeks during pregnancy. Methods: A retrospective analysis was conducted of the clinical data of 24 pregnancy patients with adnexal torsion, aged 21-38 (30.6±4.4) years old, who were admitted and delivered in Peking University Third Hospital from 2015 to 2019. According to the gestational age, all patients were divided into two groups:<28 weeks group (11cases) and ≥28 weeks group (13 cases), to compare the intergroup differences in clinical characteristics, treatment and outcome, and the differences of clinical data and outcome between two groups were compared. Results: The proportion of patients with twin pregnancy and assisted reproductive technology in the<28 weeks group was significantly higher than that in the ≥28 weeks group (5/11 vs 1/13, 8/11 vs 1/13, P<0.05). No significant differences between the two groups were recorded in terms of the size of the adnexal mass, the cycles of torsion and the duration from onset to operation. Compared with the≥28 weeks group, the adnexal removal rate of the<28 weeks group was lower (3/11 vs 6/13), but the difference was not statistically significant. The proportion of blood flow signals of ultrasound before operation, cases undergoing laparoscopic surgery and cases whose pathological findings were physiological cysts in the<28 weeks group were significantly higher than that in the ≥28 weeks group (8/11 vs 4/13, 8/11 vs 0, 8/11vs 4/13; P<0.05). Concerning the pregnancy outcomes, there was no difference in the mode of delivery, the delivery gestational age and the body weight of newborns between the two groups. Conclusions: The patients with adnexal torsion prior to 28 weeks(<28 weeks)of pregnancy were more likely to be conceived by assisted reproductive technologies, and the etiology was more likely to be ovarian physiological cysts. Both laparoscopy and laparotomy were safe and effective in the treatment of adnexal torsion with good outcome for mother and infant in the study.

[Comparison of the accuracy of intraocular lens power calculation formulas based on the new swept-source optical coherence tomography biometry]

Objective: To compare the accuracy of 6 intraocular lens power calculation formulas based on the new swept-source optical coherence tomography biometry and to analyze the prediction error. Methods: Retrospective case series study. Clinical data were collected from 599 patients (599 eyes) who had underwent uncomplicated phacoemulsification and the IOLMaster 700 examination at the Eye Hospital of Wenzhou Medical University between November 2018 and November 2019. Among the patients, there were 208 males and 391 females with an age of (69±10) years. According to the axial length (AL), eyes were divided into the short AL group (≤22.5 mm, n=100), the normal AL group (>22.5 mm and<25.5 mm, n=375); and the long AL group (≥25.5 mm, n=124). Eyes were also grouped based on the mean keratometry (Km) as flat (≤42.00 D, n=47), normal (>42.00 D to<46.00 D, n=461), and steep (≥46.00 D, n=91), and by anterior chamber depth (ACD) as shallow (≤2.5 mm, n=71), normal (>2.5 mm to<3.5 mm, n=436), and deep (≥3.5 mm, n=92). The median absolute errors (MedAEs) of the Barrett Universal Ⅱ, Haigis, Hoffer Q, Holladay Ⅰ, Holladay Ⅱ, and SRK/T formulas in different AL, Km, and ACD groups were compared using the Friedman test. Results: The differences in MedAE among the 6 formulas of 599 patients (599 eyes) were statistically significant (χ²=120.549, P<0.001). The MedAE of the Barrett Universal Ⅱ formula was smallest (0.35 D), followed by the SRK/T formula (0.36 D). There was no significant difference between the MedAEs of the Barrett universal Ⅱ and Haigis, SRK/T formula (all P=1.000), but there were statistically significant differences among the other formulas (all P<0.01). In different AL groups, the MedAE of each formula was statistically different (χ²=38.307, 38.779, 112.997; all P<0.01).The Barrett Universal Ⅱ formula resulted in the lowest MedAE in the short AL group (0.40 D) and the long AL group (0.31 D). The MedAE of the SRK/T in the normal AL group was lowest (0.35 D). The 6 formulas showed significant differences in MedAE values in different Km groups (χ²=12.284, 90.924, 39.387; all P<0.05).The Haigis formula achieved the lowest MedAE in the flat Km group (0.26 D) and the steep Km group (0.34 D). The Barrett UniversalⅡ formula achieved the lowest MedAE in the normal Km group (0.33 D). The differences in MedAE values of the 6 formulas in different ACD groups were statistically significant (χ²=37.389, 57.643, 52.845; all P<0.01), and the MedAE values of the Barrett Universal Ⅱ in different ACD groups were smallest (0.46, 0.33, 0.31 D). Conclusions: The Barrett Universal Ⅱ formula perform the best over the entire AL range, followed by the Haigis and SRK/T formulas. The Barrett Universal Ⅱ formula result in the lowest prediction error in the short AL group, the long AL group, and all ACD groups. The Haigis formula may be more accurate when the Km was ≤42.00 D or ≥46.00 D. (Chin J Ophthalmol, 2021, 57: 502-511).

[Integration of clinical significance and statistical significance on clinical study results categorization: a Meta-epidemiology study]

Objective: Statistical significance plays an important role in the interpretation of clinical trial results. However, on the basis of obtaining statistical significance, the assessment of clinical significance is often neglected. This study attempted to propose a simple and unambiguous new classification method for study results, focusing on studies with statistical positive findings to evaluate whether the results have clinical significance. Methods: Our study subjects were the clinical studies in 2019 ACC and ESC annual meetings. Meta-epidemiology methods were used to extract the characteristic variable from each study. The primary evaluation indicators included target effect-size and observed effect-size. Based on the difference between the two indicators, the studies that had statistical significance were subdivided to identify studies with possible insufficient clinical significance; Furthermore, the theoretical threshold based on power analysis was proposed, which was used as the basis for the interpretation of study results. Results: There were 12 clinical studies included in the final analysis. All of them were published on top journals. Those studies had relative high quality on both study design and reporting. The correlation coefficient between the observed and target effect-size was 0.892. Among the 7 studies with statistical significance, two of them were classified as insufficient clinical significance. The counts was 1 (1/3) and 1 (1/4) for the studies reported in ACC and ESC respectively. Conclusions: The achievement of clinical significance is critical even in the study with positive results. This paper proposes a new classification standard that combines clinical significance with statistical significance and further suggests a method to evaluate the reliability of clinical study results in order to assist researchers in identifying potential risks caused by insufficient clinical significance, and provide some reference and help for the reasonable interpretation of clinical study results.

[The acute and long-term outcome of patients with ST segment elevation myocardial infarction concurrent with chronic total occlusion]

Objective: To evaluate the acute and long-term outcome of patients with ST segment elevation myocardial infarction (STEMI) concurrent with chronic total occlusion (CTO) undergoing primary percutaneous coronary intervention (PCI). Methods: 11 905 STEMI patients from the China Acute Myocardial Infarction Registry were enrolled in this study and divided into CTO group and non-CTO group according to the angiography results of primary PCI. 1∶3 propensity score matching was used to match the patients between the two groups. The primary endpoint was in-hospital mortality and mortality at 1-year post PCI. The secondary endpoint was major adverse cardiovascular events (MACE) including death, re-myocardial infarction, revascularization, heart failure associated readmission, stroke and major bleeding at 1-year post PCI. Results: There were 931 CTO patients (7.8%) in this cohort (male=755 (81.1%), mean age (62.2±11.4 years)). The rest 10 974 patients were STEMI without CTO (male=8 829 (80.5%),mean age (60.0±11.8) years). After propensity score matching, 896 patients were enrolled in CTO group and 2 688 in non-CTO group. In-hospital mortality was significantly higher in the CTO group than in non-CTO group (4.2% vs. 2.4%, P=0.006). The ratio of all cause death, cardiac death, and MACE at 1-year follow up was also significantly higher in the CTO group than in non-CTO group (8.5% vs. 4.4%, P<0.001, 5.3% vs. 2.6%, P=0.001, 35.1% vs. 23.3%, P<0.001, respectively). Multiple regression analysis showed that CTO (HR=1.54, 95%CI 1.06-2.22, P=0.022), advanced age (HR=1.06, 95%CI 1.04-1.08, P<0.001), and previous heart failure history (HR=4.10, 95%CI 1.90-8.83, P<0.001) were independent risk factors of 1-year mortality. Conclusions: The in-hospital and 1-year mortality increased significantly in STEMI patients concurrent with CTO. CTO, advanced age and history of heart failure are independent risk factors of 1-year death among STEMI patients.

[Evaluation of safety of two inactivated COVID-19 vaccines in a large-scale emergency use]

Objective: To evaluate the safety of two inactivated COVID-19 vaccines in a large-scale emergency use. Methods: Based on the "Vaccination Information Collection System", the incidence data of adverse reactions in the population vaccinated with the inactivated COVID-19 vaccines developed by Beijing Institute of Biological Products Co., Ltd and Wuhan Institute of Biological Products Co., Ltd, respectively, in emergency use were collected, and the relevant information were analyzed with descriptive epidemiological and statistical methods. Results: By December 1, 2020, the vaccination information of 519 543 individuals had been collected. The overall incidence rate of adverse reactions was 1.06%, the incidence rate of systemic adverse reactions was 0.69% and the incidence rate of local adverse reactions was 0.37%. The main systemic adverse reactions included fatigue, headache, fever, cough and loss of appetite with the incidence rates of 0.21%, 0.14%, 0.06%, 0.05% and 0.05%, respectively; the main local adverse reactions were injection site pain and injection site swelling with the incidence rates of 0.24% and 0.05%, respectively. Conclusion: The two inactivated COVID-19 vaccines by Beijing Institute of Biological Products Co., Ltd and Wuhan Institute of Biological Products Co., Ltd showed that in the large-scale emergency use, the incidence rate of general reactions was low and no serious adverse reactions were observed after the vaccinations, demonstrating that the vaccines have good safety.

[Chemical constituents from Morinda citrifolia and their inhibitory activities on proliferation of synoviocytes in vitro]

The chemical constituents from the stems and leaves of Morinda citrifolia were isolated and purified by column chromatography methods with silica gel, ODS, Sephadex LH-20 and preparative high performance liquid chromatography(HPLC). The structures of the isolated compounds were identified by physicochemical properties and spectroscopic analysis, as well as comparisons with the data reported in literature. 17 compounds were isolated from the 90% ethanol extract of the stems and leaves of M. citrifolia, and were identified as 9,10-dihydroxy-4, 7-megastigmadien-3-one(1), 5,12-epoxy-6,9-hydroxy-7-megastigmen-3-one(2), fukinone(3), β-eudesmol(4), sarmentol F(5), 4, 5-dihydroblumenol A(6), 3-hydroxy-β-ionone(7), aristol-8-en-1-one(8), ergosta-7-en-3β-ol(9), ergosta-7-ene-3β,5α,6β-triol(10),(22E)-5α,8α-epidioxyergosta-6,22-dien-3β-ol(11), olivil(12), 4-epi-larreatricin(13), chushizisin Ⅰ(14), rabdosia acid A(15), glycerol monolinoleate(16) and(9Z,12Z,15Z)-2,3-dihydroxypropyl octadeca-trienoate(17). All compounds were isolated from M. citrifolia for the first time. All isolated compounds were evaluated for their anti-rheumatoid arthritis activities via examining their inhibitory activities on the proliferation of synoviocytes in vitro using MTS met-hod. Compounds 1-11 showed significant anti-rheumatoid arthritis activities, displaying the inhibitory effects on the proliferation of MH7 A synovial fibroblast cell with the IC_(50) values ranging from(38.69±0.86) to(203.45±1.03) μmol·L~(-1).

[Effect of HBV infection pattern on prevalence of fatty liver disease in Jinchang cohort]

Objective: To investigate the influence of HBV infection on the prevalence of fatty liver disease in Jinchang cohort and provide theoretical evidence for the prevention and treatment of fatty liver disease. Methods: Epidemiological investigation, laboratory examination and abdominal ultrasound were conducted in the baseline population of Jinchang cohort to collect the basic data, the differences in the prevalence of fatty liver disease under different HBV infection patterns were described and compared and the influence of different HBV infection patterns on the prevalence of fatty liver disease were evaluated by using logistic regression analysis. Results: The baseline Jinchang cohort population totaled 45 605, including 27 917 males and 17 688 females. The male to female ratio was 1.6∶1. The mean age of the overall population was 46.49 years. Among the 8 common HBV infection modes in the Jinchang cohort, the prevalence of fatty liver was low in HBsAg, HBeAg and HBcAb positive, HBsAg and HBcAb positive, and HBsAg, HBeAb and HBcAb positive groups. For 4 serum markers of HBV infection, the prevalence of fatty liver disease in HBsAg and HBeAg positive groups was lower than that in HBsAg and HBeAg negative groups. Logistic regression analysis showed that being HBsAg and HBcAb positive (OR=0.61, 95%CI: 0.39-0.98) and HBsAg, HBeAg and HBcAb positive (OR=0.52, 95%CI: 0.30-0.89) could reduce the risk for fatty liver disease. Conclusion: Acute HBV infection reduces the prevalence of fatty liver disease, and the reason may be related to the disturbance of the body's fat metabolism by active HBV replication.

Carbazole alkaloids from the fruits of Clausena anisum-olens with potential PTP1B and α-glucosidase inhibitory activities

The phytochemical investigation on the fruits of Clausena anisum-olens led to the isolation of 18 carbazole alkaloids (1-18), containing three new ones, clausenanisines A-C (1-3), and three new naturally occurring carbazole alkaloids, clausenanisines D-F (4-6), as well as 12 known analogues (7-18). The chemical structures of clausenanisines A-F (1-6) were elucidated by extensive spectroscopic methods. Notably, clausenanisine A (1) was a novel carbazole alkaloid with a unique five-membered cyclic ether, while clausenanisine E (5) is an unusual carbazole alkaloid owning an unprecedented naturally occurring carbon skeleton possessing 14 carbon atoms. The known carbazole alkaloids (7-18) were identified by the comparison of their spectral data with those data reported in the literature. All known carbazole alkaloids 7-18 were isolated from C. anisum-olens for the first time. Moreover, all isolated compounds 1-18 were assessed for their protein tyrosine phosphatase 1B (PTP1B) and α-glucosidase inhibitory activities in vitro. Compounds 1-18 exhibited remarkable PTP1B inhibitory activities with IC₅₀ values in the range of 0.58 ± 0.05 to 38.48 ± 0.32 μM, meanwhile, compounds 1-18 displayed significant α-glucosidase inhibitory activities with IC₅₀ values ranging from 3.28 ± 0.16 to 192.23 ± 0.78 μM. These research results imply that the separation and identification of these carbazole alkaloids showing notable PTP1B and α-glucosidase inhibitory activities from the fruits of C. anisum-olens can be very significant for discovering and developing new PTP1B inhibitors and α-glucosidase inhibitors for the treatment of diabetes mellitus.