Decreased Intracellular to Total Body Water Ratio and Depressive Symptoms in Patients with Maintenance Hemodialysis

Objective

Depression is a common psychiatric disorder and related to poor outcomes in patients undergoing maintenance hemodialysis (MHD). Previous studies have reported some associations between sarcopenia and depressive symptoms. Recently, intracellular water (ICW) and total body water (TBW) have been found to reflect muscle function and muscle mass. ICW/TBW ratio is a marker of sarcopenia that is simple to assess. However, the relationship between ICW/TBW ratio and depression has not been explored in MHD patients.

Methods

In our cross-sectional and multi-center study, 3300 adult MHD patients were included from June 1, 2021, to August 30, 2021. Depressive symptoms were evaluated using the Beck Depression Inventory-II (BDI-II). TBW and ICW were measured by Body Composition Monitor (BCM). Multivariable logistic regression, stratified analyses, and interactive analyses were conducted to assess the relationship between ICW/TBW ratio and depression.

Results

About 16.5% of the 3300 MHD patients were found to have depressive symptoms. The prevalence of depression increased with decreasing quartiles of ICW/TBW ratios, and decreased ICW/TBW ratio was independently associated with depression after adjusting for potential confounders. Patients in Quartile 1 of ICW/TBW ratios were more likely to have depressive symptoms (odds ratio 1.55, 95% confidence interval 1.07-2.22; p=0.002) than those in Quartile 4. History of diabetes and education status had interactive roles in the relationship between depression and ICW/TBW ratios (p < 0.05). The association of ICW/TBW ratios and depression existed in patients of both genders and different education levels, but only in non-diabetic patients.

Conclusion

In MHD patients, the decreased ratio of ICW/TBW was independently related to high depression rates.

Low Lean Tissue Index and Muscle Strength Combined with High Fat Tissue Index Are Associated with Cardiovascular Disease-Related Hospitalisation in Patients on Haemodialysis

INTRODUCTION

The combined clinical impact of muscle mass, muscle function, and adipose mass on hospitalisation events, especially those that have exact causes, such as cardiovascular diseases (CVDs), had been rarely studied in patients on haemodialysis (HD). This study aimed to determine the influence of lean tissue index (LTI), fat tissue index (FTI), and hand grip strength (HGS) on the risk of CVD-related hospitalisation in patients undergoing chronic HD.

METHODS

This multi-centre observational study enrolled a total of 2,041 clinically stable patients aged >18 years and who had undergone HD for at least 3 months at 17 HD units in 2019. The follow-up period was up to 2 years. LTI and FTI were assessed using a body composition monitoring machine, and HGS was measured by a CAMRY® dynamometer. Cox regression models were fit to estimate the associations of body composition and HGS with CVD-related hospitalisation risk.

RESULTS

During a mean follow-up of 22.6 months, CVD-related hospitalisation occurred in 492 patients. Compared with the non-CVD group, patients with CVD-related hospitalisation were older; had lower diastolic blood pressure; were more likely to have a history of diabetes; had worse activity status scores and lower levels of LTI, HGS, serum uric acid, and serum creatinine; and had higher FTI levels, body mass index, and extracellular water/intracellular water ratio. In the Cox regression models, low LTI and high FTI were independently associated with CVD-related hospitalisation in both men and women. In men, low HGS was an independent risk factor for CVD-related hospitalisation. When patients were further stratified into four distinct groups according to the sex-specific median values of LTI and FTI, the combination of low LTI and high FTI was an independent risk factor for CVD-related hospitalization (hazard ratio [HR] = 1.79 in men, 95% confidence interval 1.26-2.55; HR = 2.48 in women, 95% confidence interval 1.66-3.71; reference: high LTI/low FTI group).

CONCLUSIONS

Among patients on chronic HD, low LTI, and high FTI were associated with CVD-related hospitalisation in men and women, whereas HGS was an independent risk factor for CVD-related hospitalisation in men but not in women. Combining low LTI and high FTI increased the association with hospitalisation risk and was an independent predictor of CVD-related hospitalisation.

Decreased intracellular water is associated with sarcopenic obesity in chronic haemodialysis patients

OBJECTIVE

To explore the association between intracellular water (ICW) and sarcopenic obesity in patients undergoing chronic haemodialysis (HD).

METHODS

A multicentre, cross-sectional study of 3354 adult chronic HD patients was conducted in 20 haemodialysis centres from June 1, 2021, to August 30, 2021. The diagnosis of sarcopenic obesity was made according to the revised Asian Working Group's definition of sarcopenia combined with obesity per the body fat percentage definition. Body composition was evaluated by a body composition monitor using bioimpedance spectroscopy. Multiple logistic regression models, stratified analyses, interactive analyses, and receiver-operating characteristic analyses were conducted.

RESULTS

A total of 752 patients were diagnosed with sarcopenic obesity among 3354 participants. The patients were grouped by sex-specific ICW median levels, and the prevalence of sarcopenic obesity was significantly higher in the low ICW group than in the high ICW group (41.3%vs 3.0%). Decreased ICW was significantly associated with sarcopenic obesity. The association remained statistically significant even after adjusting for dialysis vintage, age, body mass index, biochemical indicators, and various medical histories. The odds ratios of the low ICW group were much higher than those of the high ICW group in both males and females (P for trend < 0.001). The association was stable across subgroups, and the interaction analysis showed that age, body mass index and history of diabetes had interactive roles in the association between ICW and sarcopenic obesity (P for interaction < 0.05). Furthermore, the ICW cut-off values for identifying sarcopenic obesity were 19.1 kg and 14.5 kg for males and females, respectively.

CONCLUSION

Decreased ICW was an independent risk factor for sarcopenic obesity in chronic HD patients. The measurement of ICW by bioimpedance spectroscopy might be a non-invasive and valid means for identifying the risk of future sarcopenic obesity in HD patients.

Low intracellular water and incident cognitive impairment in chronic hemodialysis patients

OBJECTIVE

To explore the effect of intracellular water (ICW) evaluated by the bioelectrical Impedance Spectroscopy (BIS) on the risk of incident cognitive impairment (CI) in chronic hemodialysis (HD) patients.

METHODS

Three thousand three hundred eighty-five patients were recruited and monitored prospectively for up to 3 years (the median follow-up time, 2 years) in this observational cohort study. Mini-Mental State Examination score (MMSE) was used to assess the global cognitive function. ICW was measured by body composition monitor based on BIS. Multiple Cox regression models, stratified analyses, and interactive analyses were conducted.

RESULTS

During the follow-up period, 1256 patients (37.1%) experienced incident CI. The incidence of CI was increased with decreasing quartiles of ICW (27.4%, 32.2%, 38.9%, and 50.1% for the fourth, third, second, and first quartiles, respectively). Decreased ICW was significantly associated with incident CI. The association remained statistically significant even after adjusting for age, sex, education, albumin, C-reactive protein, residual renal function and various medical histories. The hazard ratios were 1.38 (1.17-1.64) and 1.28 (1.08-1.52) for ICW quartile 1 and quartile 2, respectively (reference, quartile 4). The association stably existed across subgroups, and the residual renal function had an interactive role in the association between ICW and incident CI (p = 0.014).

CONCLUSION

Low baseline ICW was an independent risk factor for CI in chronic HD patients. Our finding highlights the necessity of using BIS to measure body composition when assessing the risk of CI in HD patients.

Introducing an Experimental Approach to Predict Spot Scanning Time Parameters for a Superconducting Cyclotron Proton Therapy Machine

PURPOSE/OBJECTIVE(S)

Proton pencil beam scanning (PBS) delivery sequence varies a lot among institutions due to the differences in vendors, machine types, and beamline configurations, which impacts PBS interplay effects and treatment delivery time estimation. This study aims to develop an independent experimental approach to predict the spot scanning time parameters for a clinical superconducting cyclotron proton therapy machine.

MATERIALS/METHODS

This independent experimental approach employed an open-air parallel-plate detector with a temporal resolution of 0.05ms. A series of spot, energy, and dose rate patterns were designed and delivered, including (1) Spot switching time (SSWT) under different spot spacing for IEC-X, IEC-Y directions and diagonal direction (traveling in both X and Y direction) for three energy layers (110, 170 and 230 MeV); The Wilcoxon test is used to validate the prediction of SSWT along the diagonal direction. (2) Energy layer switching time (ELST) with different descending energy gaps for a fixed initial energy and different initial energies for a fixed descending energy gap. (3) Dose rate (MU/min) are measured for different minimum-MU-per-energy-layer (MMPEL), which are compared with the previous publication.

RESULTS

A SSWT jump at 10mm (can be customized) spot spacing is observed because of triggering the machine's "raster mode" threshold. Discontinuous two variable piecewise linear functions were used to fit the SSWT in X/Y for spot spacing and energy. SSWT in X/Y is increasing as spot spacing and energy increase. SSWT in the diagonal direction is determined by the time either in the x-direction or y-direction, whichever takes longer (see Table 1 for one example of validations). ELST is linear depending on descending energy gap. The dose rate dependence on MMPEL is confirmed with previous publications of a similar type of machine.

CONCLUSION

The study provided the first independent quantitative experimental modeling of the beam delivery time parameters without any information from vendors. Such machine-specific delivery sequence models could pave the foundation of precise interplay effect evaluation for clinical decision-making.

Pencil Beam Scanning Proton Stereotactic Body Radiation Therapy (SBRT): A Robust Single Institution Experience

PURPOSE/OBJECTIVE(S)

To describe the feasibility of treating a complex and diverse group of patients using pencil beam scanning (PBS) proton stereotactic body radiation therapy (SBRT: 5 or fewer fractions, with a fraction size of at least 5 Gy).

MATERIALS/METHODS

Our center treats on average 105-120 PBS proton treatments daily, of which 9.5% of treatment courses are proton SBRT. Statistics of disease sites, treatment planning parameters (target volume, prescriptions, number of fields, SFO vs. MFO), and treatment efficiencies (scheduled time slots, actual treatment time) are presented for 305 consecutive SBRT patients receiving 1507 fractions in the past three years. Thermoplastic masks or Vacuum-lock bags are used to immobilize SBRT patients and index the patients' treatment position. Imaging guidance of orthogonal kV images and volumetric cone-beam CT is routinely used for patient setup.

RESULTS

SBRT patients are grouped based on the target locations: pelvis (31%), liver (17%), thoracic (13%), spine (8%), abdominal (8%), brain (7%), non-spine bone (7%), ocular (6%), and head and neck (2%). Only 112 patients (37%) were receiving their 1st RT course, whereas 113 (37%) had one prior in-field RT course, and 80 (26%) had multiple prior in-field RT courses. The median [IQR] target volume was 65.4 [29.3, 168] cc (range: 0.3-2475 cc). 72% of cases were planned with SFO and 28% with MFO. On average, 3.76 fields (range: 2 to 12) were planned for each treatment. 44% of the treatments were planned with three or fewer fields, and 10% received more than five fields, most of which involved repainting for moving targets. Over 97% of treatments were delivered in 5 fractions, with ∼3% delivered in 3 fractions. The median [IQR] prescription per treatment was 8 [7, 10] Gy (range: 5-18 Gy per treatment). 85% (84%) of the SBRT treatments were scheduled (delivered) in a 45-minute or shorter slot, and 6% (7%) of treatments were scheduled (delivered) in over a one-hour slot, most commonly for multiple isocenter treatments. 93% of treatments were delivered within 15 minutes of the planned treatment time or shorter. Deep-inspiration breath-hold (DIBH) was applied to 45% of liver SBRT cases, with the remaining 55% planned on 4D CT with (14%) or without (86%) abdominal compression. DIBH was applied in 13% of lung SBRT cases. The application of other motion mitigation approaches, such as volumetric repainting, was determined by the target motion amplitude and whether the patient could tolerate DIBH.

CONCLUSION

In the most diverse and largest proton SBRT experience delivered in the world over the past 3 years, over 300 patients were treated, demonstrating the feasibility and efficiency of delivering proton SBRT in a very busy center. The planning and treatment parameter statistics reported serve as a helpful reference for the proton community.

Prospective Evaluation of Patient-Reported Outcomes of Invisible Ink Tattoos for the Delivery of External Beam Radiation Therapy: The PREFER Trial

PURPOSE/OBJECTIVE(S)

Invisible ink tattoos allow for setup accuracy while avoiding the cosmetic permanence of visible ink tattoos. The goal of this trial was to evaluate patient-reported preference for the use of invisible ink tattoos in a radiation oncology clinic.

MATERIALS/METHODS

In an IRB-approved, prospective, feasibility trial, patients at a single institution receiving pencil beam scanning proton therapy to the thorax, abdomen, or pelvis underwent invisible ink tattoo-based treatment setup. Patient preference surveys comparing visible and invisible ink tattoos were completed prior to simulation (17 questions), immediately following simulation (5 questions), and at the end of treatment (18 questions), with preference scored on a 5-point Likert scale from strongly disagree to strongly agree, and cosmesis scored on a 4-point Likert scale of excellent-good-fair-poor. Differences in distributions were examined using Wilcoxon rank-sum tests, Fisher's exact tests, or chi-square tests, where statistical significance was considered at p<0.05.

RESULTS

Of 107 patients screened, 102 were enrolled and 94 completed all surveys. Mean age was 55.0 years, and 58.5% were female. Most patients were white (79.1%) and non-Hispanic (92.6%). Patients most commonly had breast (34.0%), prostate (16.0%), and lung (9.6%) cancer. An average of 5 (range 3-8) invisible ink tattoos were placed per patient. Overall, 75.5% of patients reported that they would prefer to receive invisible tattoos vs. visible tattoos, and 88.3% rated the overall cosmetic outcome of invisible ink tattoo marks as excellent or good. Compared to males, females were more willing to travel farther from their home in order to avoid receiving visible tattoos (45.4% vs. 23.1%, p = 0.035) and would pay additional money to avoid receiving visible tattoos (34.5% vs. 5.1%, p = 0.002). Patients who had previously received any tattoo (cosmetic or visible RT tattoos) were more satisfied with the appearance of their invisible ink tattoos compared to those who had never previously received tattoos (82.9% vs. 61.5%, p = 0.022). Patients receiving definitive intent RT were more satisfied with the appearance of the tattoos compared to those receiving palliative intent RT (67.1% vs. 38.9%, p = 0.011). Patients with at least a college education were less satisfied with the appearance of tattoos compared to those without a college education (67.0% vs. 95.0% p = 0.018).

CONCLUSION

These findings demonstrate stronger avoidance of visible tattoos and patient preference for invisible tattoos. The standard incorporation of invisible ink tattoos for patient setup should be strongly considered.

A Dosimetric Assessment of Sexual Organ Sparing Proton Radiotherapy in Female Pelvic Cancer Patients

PURPOSE/OBJECTIVE(S)

Optimizing treatment techniques for female patients undergoing curative treatment for pelvic cancers requires incorporating the goals of maximizing cure while maintaining quality of life. Optimizing treatment to maintain sexual quality of life has received little attention in female patients despite the presence of and toxicity risks to functional anatomic organs and their associated neurovasculature, including the bulboclitoris, vagina, and ovaries. Recent dosimetric data without employing sexual organ sparing suggest that mean VMAT dose to the bulboclitoris in low rectal cancer is around 3300 cGy, and in anal cancer, mean dose is around 2000 cGy to the external genitalia and 4500-5000 cGy to the bulboclitoris, all of which would be expected to result in clinically significant toxicity. Therefore, investigation of the avoidance of these important organs is needed and we hypothesize that proton techniques may achieve greater sparing than photon techniques.

MATERIALS/METHODS

In this study, we dosimetrically compare proton- vs. photon-based techniques in sparing functional sexual organs. The cohort consisted of four consecutive female pelvic cancer cases that had received 5000 cGy or greater. All cases were re-planned with VMAT and protons while optimizing dose to functional sexual organs and maintaining target coverage. Sexual organ structures assessed include the genitalia, vagina, ovaries, bulboclitoris and internal pudendal arteries. Given the small number of patients included in this demonstration study, statistical tests were not performed.

RESULTS

MRI was required to appropriately delineate soft tissue. In all cases, dosimetric sparing of sexual organs was improved with proton therapy without compromising target coverage. Mean doses were marginally decreased for structures within the PTV, while structures such as the bulboclitoris were spared substantially. Mean dose to the external genitalia was low with sparing using both VMAT (Median [IQR] (cGy): 852 [811, 1090]) and Proton techniques (Median [IQR] (cGy): 39.4 [11.9, 78.5]). Similarly, mean dose with sparing to the external genitalia was lower than would be expected without sparing, using both VMAT and Proton techniques (Median (IQR) Dmean (cGy) VMAT 3100 [2890, 3580] vs. Proton 1530 [1100, 2090]), with protons demonstrating greater sparing. In one case of a sacral chordoma, ovaries were substantially spared to below ablative thresholds (Dmean (cGy) VMAT 3598.8 and 3548.0 vs Proton 34.1 and 103.3).

CONCLUSION

Magnetic resonance imaging at simulation combined with proton radiotherapy for female sexual organ sparing may provide a technically feasible route to more equitable sexual outcomes for female patients. These results will guide future studies to optimize proton treatment techniques for female sexual organ sparing for future trials.

Expression Profiles of Long Non-Coding RNAs in the Articular Cartilage of Rats Exposed to T-2 Toxin

T-2 toxin could induce bone damage. But there is no specific mechanism about the long non-coding RNAs (lncRNAs) involved in T-2 toxin-induced articular cartilage injury. In this study, 24 SD rats were randomly divided into a control group and a T-2 group, which were administered 4% absolute ethanol and 100 ng/g · bw/day of T-2 toxin, respectively. After treatment for 4 weeks, safranin O/fast green staining identified the pathological changes in the articular cartilage of rats, and immunofluorescence verified the autophagy level increase in the T-2 group. Total RNA was isolated, and high-throughput sequencing was performed. A total of 620 differentially expressed lncRNAs (DE-lncRNAs) were identified, and 326 target genes were predicted. Enrichment analyses showed that the target genes of DE-lncRNAs were enriched in the autophagy-related biological processes and pathways. According to the autophagy database, a total of 23 autophagy-related genes were identified, and five hub genes (Foxo3, Foxo1, Stk11, Hdac4, and Rela) were screened using the Maximal Clique Centrality algorithm. The Human Protein Atlas database indicated that Rela and Hdac4 proteins were highly expressed in the bone marrow tissue, while Foxo3, Foxo1, and Stk11 proteins were reduced. According to Enrichr, etoposide and diatrizoic acid were identified as the key drugs. The real-time quantitative PCR results were consistent with the RNA sequencing (RNA-Seq) results. These results suggested that autophagy was involved in the rat articular cartilage lesions induced by T-2 toxin. The lncRNAs of NONRATG014223.2, NONRATG012484.2, NONRATG021591.2, NONRATG024691.2, and NONRATG002808.2, and their target genes of Foxo3, Foxo1, Stk11, Hdac4, and Rela, respectively, were the key regulator factors of autophagy.

Pan-cancer analysis of G6PD carcinogenesis in human tumors

Glucose-6-phosphate dehydrogenase (G6PD) is involved in the catalytic pentose phosphate pathway (PPP), which is closely related to energy metabolism. G6PD plays a crucial role in many types of cancer, but the specific molecular mechanisms of G6PD in cancer remain unclear. Therefore, we investigated the potential oncogenic role of G6PD in various tumors based on The Cancer Genome Atlas (TCGA), the cBioPortal datasets, the University of California Santa Cruz (UCSC) Xena browser, and the UALCAN-based online tool. G6PD was highly expressed in several cancer tissues (hepatocellular carcinoma, glioma, and breast cancer) compared with normal tissues and was significantly associated with poor prognosis of hepatocellular carcinoma, clear cell renal cell carcinoma, and breast cancer. Promoter methylation levels of G6PD were lower in Bladder Urothelial Carcinoma (BLCA) (P = 2.77e-02), breast invasive carcinoma (BRCA) (P = 1.62e-12), kidney renal clear cell carcinoma (KIRC) (P = 4.23e-02), kidney renal papillary cell carcinoma (KIRP) (P = 2.64e-03), liver hepatocellular carcinoma (LIHC) (P = 1.76e-02), stomach adenocarcinoma (STAD) (P = 3.50e-02), testicular germ cell tumors (TGCT) (P = 1.62e-12), higher in prostate adenocarcinoma (PRAD) (P = 1.81e-09), and uterine corpus endometrial carcinoma (UCEC) (P = 2.96e-04) compared with corresponding normal tissue samples. G6PD expression was positively correlated with the infiltration level of immune cells in most tumors, suggesting that G6PD may be involved in tumor immune infiltration. In addition, the functional mechanism of G6PD also involves 'Carbon metabolism', 'Glycolysis/Gluconeogenesis', 'Pentose phosphate pathway', and 'Central carbon pathway metabolism in cancer signaling pathway'. This pan-cancer study provides a relatively broad understanding of the oncogenic role of G6PD in various tumors and presents a theoretical basis for the development of G6PD inhibitors as therapeutic drugs for multiple cancers.

Selenomethionine Antagonized microRNAs Involved in Apoptosis of Rat Articular Cartilage Induced by T-2 Toxin

T-2 toxin and selenium deficiency are considered important etiologies of Kashin-Beck disease (KBD), although the exact mechanism is still unclear. To identify differentially expressed microRNAs (DE-miRNAs) in the articular cartilage of rats exposed to T-2 toxin and selenomethionine (SeMet) supplementation, thirty-six 4-week-old Sprague Dawley rats were divided into a control group (gavaged with 4% anhydrous ethanol), a T-2 group (gavaged with 100 ng/g·bw/day T-2 toxin), and a T-2 + SeMet group (gavaged with 100 ng/g·bw/day T-2 toxin and 0.5 mg/kg·bw/day SeMet), respectively. Toluidine blue staining was performed to detect the pathological changes of articular cartilage. Three rats per group were randomly selected for high-throughput sequencing of articular cartilage. Target genes of DE-miRNAs were predicted using miRanda and RNAhybrid databases, and the Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway were enriched. The network map of miRNA-target genes was constructed using Cytoscape software. The expression profiles of miRNAs associated with KBD were obtained from the Gene Expression Omnibus database. Additionally, the DE-miRNAs were selected for real-time quantitative PCR (RT-qPCR) verification. Toluidine blue staining demonstrated that T-2 toxin damaged articular cartilage and SeMet effectively alleviated articular cartilage lesions. A total of 50 DE-miRNAs (28 upregulated and 22 downregulated) in the T-2 group vs. the control group, 18 DE-miRNAs (6 upregulated and 12 downregulated) in the T-2 + SeMet group vs. the control group, and 25 DE-miRNAs (5 upregulated and 20 downregulated) in the T-2 + SeMet group vs. the T-2 group were identified. Enrichment analysis showed the target genes of DE-miRNAs were associated with apoptosis, and in the MAPK and TGF-β signaling pathways in the T-2 group vs. the control group. However, the pathway of apoptosis was not significant in the T-2 + SeMet group vs. the control group. These results indicated that T-2 toxin induced apoptosis, whereas SeMet supplementation antagonized apoptosis. Apoptosis and autophagy occurred simultaneously in the T-2 + SeMet group vs. T-2 group, and autophagy may inhibit apoptosis to protect cartilage. Compared with the GSE186593 dataset, the evidence of miR-133a-3p involved in apoptosis was more abundant. The results of RT-qPCR validation were consistent with RNA sequencing results. Our findings suggested that apoptosis was involved in articular cartilage lesions induced by T-2 toxin, whereas SeMet supplementation antagonized apoptosis, and that miR-133a-3p most probably played a central role in the apoptosis process.

A Dual Organic Solvent Zn-Ion Electrolyte Enables Highly Stable Zn Metal Batteries

Aqueous zinc (Zn) batteries have been regarded as an alternative to lithium-ion batteries due to their high abundance, low cost, and higher intrinsic safety. However, the low Zn plating/stripping reversibility, Zn dendrite growth, and continuous water consumption have hindered the practical application of aqueous Zn anodes. Herein, a hydrous organic Zn-ion electrolyte based on a dual organic solvent, namely hydrated Zn(BF₄)₂ zinc salt dissolved in dimethyl carbonate (DMC) and vinyl carbonate (EC) solvents [denoted as Zn(BF₄)₂/DMC/EC], can address these problems, which not only inhibits the side reactions but also promotes uniform Zn plating/stripping through the formation of a stable solid state interface layer and Zn²⁺-EC/2DMC pairs. This electrolyte enables the Zn electrode to stably undergo >700 cycles at a rate of 1 mA cm^-2 with a Coulombic efficiency of 99.71%. Moreover, the full cell paired with V₂O₅ also demonstrates excellent cycling stability without capacity decay at 1 A g^-1 after 1600 cycles.

[Status and associated factors of pre-exposure prophylaxis use among men who have sex with men in 24 cities in China]

Objective: To understand the cognition and medication use of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in China and its associated factors. Method: From August 25 to September 5, 2021, 2 447 MSM were recruited in 24 cities to complete the online questionnaire through a male social interaction platform, Blued 7.5 software. The survey contents included demographic information of the respondents, PrEP awareness and usage, and risk behaviors. Descriptive analysis and multi-level logistic regression were performed for data analysis. SPSS 24.0 and SAS 9.4 software were used for statistical analysis. Results: Among the 2 447 respondents of MSM, 1 712 (69.96%) had heard of PrEP, 437 (17.86%) ever used PrEP, 274 (11.20%) were on PrEP, and 163 (6.66%) had discontinued PrEP; among the 437 cases (whoever used PrEP), more than 61.88% (388/627) adopted emtricitabine/tenofovir disoproxil fumarate regimen, and most of them adopted on-demand regimen. The average PrEP dosage reported in the past year is 1.12 tabletsper person per week. PrEP purchase was primarily via an online channel, and the most concerned factor was the PrEP effectiveness on HIV prevention. The most common reasons for discontinuing PrEP, reported by 163 cases, were the lack of HIV risk perception, the use of a condom to prevent HIV, and the economic burden of PrEP use. The logistic regression analysis showed that PrEP use among MSM in 24 cities was statistically associated with age, monthly income, ever having unprotected anal sex in the past year, used sexual drugs and sexually transmitted disease (STD) diagnosis in the past year. Compared with MSM aged 18-24, the proportion of MSM was relatively lower among those aged 25-44, who discontinued the PrEP (aOR=0.54,95%CI:0.34-0.87) or never used PrEP (aOR=0.62,95%CI:0.44-0.87). The proportion of unprotected anal sex among MSM currently on PrEP use was higher than those who have stopped PrEP and never used PrEP (all P<0.05). Those MSM group, with monthly income higher than 5 000 Yuan, used sexual drugs and STD diagnosis in the past year were more likely to have a higher rate for PrEP usage (all P<0.05). Conclusions: Currently, pre-exposure prophylaxis in the MSM group is primarily obtained via the online channel and adopted in an on-demand mode. Although the PrEP users have reached a certain proportion, it is still necessary to strengthen health education on the PrEP effects and side effects of MSM and to improve the awareness and use rate, especially for young MSM group, which can be combined with the advantages of the internet targeting its needs and use barriers.

Association between fluoride exposure and blood pressure in children and adolescents aged 6 to19 years in the United States: NHANES, 2013-2016

To examine the association between fluoride exposure and childhood blood pressure (BP), we used data involving 3260 subjects participating in the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2016. Both plasma and water fluoride concentrations were measured using the ion-specific electrode. Outcome variables were systolic blood pressure (SBP) and diastolic blood pressure (DBP). For a 1-mg/L increase in water fluoride concentration, the participants' SBP decreased by 0.473 mm Hg (95% CI: -0.860, -0.087). Specifically, inverse associations were found between water fluoride and SBP in girls (β= -0.423, 95% CI: -0.886, -0.021), adolescents (β= -0.623, 95% CI: -0.975, -0.272), and non-Hispanic whites (β= -0.694, 95% CI: -1.237, -0.151). Also, every 1-μmol/L increase in plasma fluoride concentration was associated with a 1.183 mm Hg decrease in SBP among other races (95% CI: -2.258, -0.108). This study suggested that fluoride exposure may affect childhood blood pressure.

Analysis of regional differences and spatial spillover effects of agricultural carbon emissions in China

In order to realize "double carbon" target in agriculture and high-quality development of the rural economy in China, it is crucial to study the regional differences and spatial spillover effects of agricultural carbon emissions (ACE). This paper measures ACE using panel data of 31 Chinese provinces from 2005 to 2020, examines the spatio-temporal evolution characteristics，the convergence of agricultural carbon emissions, compares and analyzes regional differences, and investigates the spatial correlation and spatial spillover effects. The study found that: (1) Total agricultural carbon emissions over the research period exhibit a rising and then reducing trend, the spatial distribution of total agricultural carbon emissions is described as high in east-central and low in west. The gap of agricultural carbon emissions is gradually declining in the east, and will eventually reach their respective steady-state levels in the west and northeast. (2) There is a strong spatial interprovincial link of ACE, which has a beneficial knock-on effect on the convergence of adjacent provinces. (3) Agricultural industrial structure, urbanization level, the size of the agricultural labor force, and the intensity of the agricultural machinery input all directly affect ACE in this province and indirectly affect ACE in adjacent provinces, with the exception of the negligible coefficient of economic development level on ACE. Hence, pertinent policy suggestions are put out to serve as a guide for reducing ACE.

Physical activity domains and patterns with risk of depressive symptoms: A cross-sectional study in China

BACKGROUND

The health benefits of domain-specific physical activity (PA) on depressive symptoms were inconclusive. Few studies explored PA patterns and depressive symptoms. This study aimed to investigate the associations of PA domains and patterns with depressive symptoms.

METHODS

We conducted a cross-sectional study in China with 5047 adults. Latent class analysis was applied to identify the PA patterns and logistic regression analysis was used to calculate odds ratios (ORs) and 95 % confidence intervals (CIs).

RESULTS

The ORs (95 % CIs) for the active versus inactive groups were 0.79 (0.69-0.91) for leisure-time PA, 0.57 (0.49-0.65) for transport PA, 0.95 (0.82-1.09) for household PA, and 1.38 (1.18-1.62) for occupational PA. We found non-linear associations between leisure-time PA, transport PA and depressive symptoms, with the lowest risk at 11 METs-h/week of leisure-time PA (equal to 147 min/week moderate PA or 88 min/week vigorous PA) and 23 METs-h/week of transport PA. There was a marginal inverse association with household PA for men while not for women. We identified four PA patterns and found a lower risk of depressive symptoms associated with "low occupational PA pattern" versus "moderate PA level pattern" (0.45 (0.38-0.52)).

LIMITATIONS

Given the cross-sectional design, causality cannot be inferred.

CONCLUSIONS

Our study supported an inverse association of leisure-time PA and transport PA with depressive symptoms and a positive association of occupational PA. The observed inconsistent association of household PA among men and women, and the finding that "low occupational PA pattern" was associated with a lower risk of depressive symptoms warrant further investigation.

Generation characteristics and spreading risk of VOCs released from a biological fermentation pharmaceutical factory

Pharmaceutical factories produce a large amount of volatile organic compounds (VOCs), which may pose a potential health threat to the environment, workers, and nearby residents. Sampling points were set up in the tylosin biological fermentation workshop (FW) and sewage treatment station (STS) of a pharmaceutical factory in a central city in northern China to collect VOCs and study their generation characteristics and diffusion. The results indicated that with the increase in fermentation time, VOC production decreased gradually, and the decline was rapid. The main VOCs produced by the FW are oxygen-containing organics and nitrogen-containing organics including 1-heptyladehyde (8.86 × 10² mg m^-3), 1-methyl-2-pyrrolidone (6.36 × 10² mg m^-3) and benzene (5.85 × 10² mg m^-3). The STS mainly produces nitrogen-containing organics and oxygen-containing organics including 1-methyl-2-pyrrolidone (3.38 × 10³ mg m^-3), diethyl amine (9.60 × 10² mg m^-3) and methyl ethyl ketone (2.98 × 10² mg m^-3). VOCs produced by biopharmaceutical factories can diffuse for a long distance in the atmosphere. The highest concentration of chlorinated organic compounds can spread to 11.43 kilometers in the horizontal direction and 3 kilometers in the vertical direction. Acetaldehyde, butyraldehyde, diethylamine, butyl acetate and methyl ethyl ketone are odorous gases detected in the FW and STS, respectively. Benzene, carbon tetrachloride and acetaldehyde are the main carcinogenic VOCs produced in the fermentation process of tylosin. The research elucidated production characteristics, diffusion and health risks of VOCs in the FW, which provided a reference for the control of VOCs.

Chronological and Replicative Aging of CD51+/PDGFR-α+ Pulp Stromal Cells

As a crucial source of mesenchymal stromal cells, CD51⁺/PDGFR-α⁺ human dental pulp stromal cells (hDPSCs) are promising seeding cells for regenerative medicine. Cellular senescence hinders the translational application of hDPSCs. However, it remains unclear whether chronological and replicative senescence results in distinct outcomes for hDPSCs. To investigate the influence of senescence on DPSCs, we used transgenic lineage tracking, immunofluorescence, flow cytometry, and various molecular experiments to depict the dynamic pattern of hDPSCs in mice and humans during chronological and replicative senescence. The data demonstrated that CD51⁺/PDGFR-α⁺ cells were decreased in chronological senescence. Impaired self-renewal and higher ossificatory differentiation were observed in chronologically senescent hDPSCs. Regarding replicative senescence, a decreased CD51⁺ but upregulated PDGFR-α⁺ population was observed in culture. Furthermore, weakened self-renewal and osteogenic differentiation were observed in replicatively senescent hDPSCs. In summary, CD51⁺/PDGFR-α⁺ hDPSCs decrease in chronologically aged pulp, with self-renewal that is impaired without impaired osteogenic differentiation. However, replicative senescence has a different impact: self-renewal and ossific differentiation are impaired and CD51 expression is reduced, but PDGFR-α expression remains. These findings demonstrate the different outcomes of chronological and replicative senescence in CD51⁺/PDGFR-α⁺ hDPSCs. Furthermore, we revealed that impaired self-renewal is the core dysfunction for both types of cellular aging and that osteogenic differentiation capability differs between them. This study provides insights into the influence of chronological and replicative senescence on the characteristics and capabilities of hDPSCs. These advances provide fundamental knowledge to alleviate cellular aging of CD51⁺/PDGFR-α⁺ hDPSCs and promote their translational applications.

CircRNA_06354 might promote early-onset preeclampsia in humans via hsa-miR-92a-3p/vascular endothelial growth factor-A

BACKGROUND

Early-onset preeclampsia (EOPE) is a serious pregnancy disorder with multisystem complications. Recently, circRNA was reported to participate in the progression of EOPE. However, the role and mechanism of circRNA_06354 in the pathophysiological development of EOPE remain unclear.

METHODS

Blood samples from patients with EOPE and healthy pregnant controls (CTRL) were analyzed by RNA-seq. functions and mechanisms of circRNA_06354 in EOPE were investigated by a series of experiments. An EOPE rat model was constructed to detect the expression levels of circRNA_06354.

RESULTS

The level of circRNA_06354 was altered in EOPE and CTRL individuals, as well as EOPE and CTRL rats. CircRNA_06354 had a sensitivity of 88.9% and a specificity of 100% in predicting EOPE. Subcellular localization indicated that circRNA_06354 was primarily detected in the cytoplasm of HTR8-/SV-neo cells and the cytotrophoblast of EOPE placentas. In addition, circRNA_06354 transcription was markedly higher than that of its linear counterpart. RNA pull-down assays implied that hsa-miR-92a-3p might sponge circRNA_06354. Vascular endothelial growth factor-A (VEGF-A) levels were found to be increased in EOPE patients. Moreover, overexpression of circRNA_06354 suppressed the migration, invasion and tube formation of trophoblastic cells invading spiral arteries or the endometrium.

CONCLUSION

CircRNA_06354 inhibits trophoblastic cell invasion, migration and tube formation toward the endometrium in the initiation of EOPE. The circRNA_06354/hsa-miR-92a-3p/VEGF-A axis might be a therapeutic target in the prevention and treatment of EOPE.

Integrated 16S rDNA sequencing and metabolomics to explore the intestinal changes in children and rats with dental fluorosis

Dental fluorosis (DF) is a widely prevalent disease caused by excessive fluoride with limited awareness of its underlying pathogenesis. Here, a pilot population study was conducted to explore the pathogenesis of DF from the perspective of intestinal microbiome changes, and verified it in animal experiments combining intestinal microbiome and metabolomics. A total of 23 children were recruited in 2017 in China and divided into DF (n = 9) and control (n = 14) groups (DFG and CG, respectively). The SD rat model was established by drinking water containing sodium fluoride (NaF). Gut microbiome profiles of children and rats were analyzed by16S rDNA V3-V4 sequencing, and the intestinal metabolomics analysis of rats was performed by LC-MS methods. The 16 S rDNA sequencing revealed that the gut microbiome composition was significantly perturbed in children in DFG compared to that in CG. Acidobacteria and Thermi were specifically observed in DFG and CG, respectively. Besides, 15 fecal microbiotas were significantly altered at the genus level in DFG. Furthermore, only the expression of annotated genes for pentose and glucuronate interconversion pathway was significant lower in DFG than that in CG (P = 0.04). Notably, in NaF-treated rats, we also observed the changes of some key components of pentose and glucuronate interconversion pathway at the level of microorganisms and metabolites. Our findings suggested that the occurrence of DF is closely related to the alteration of intestinal microorganisms and metabolites annotated in the pentose and glucuronate interconversion pathway.

Application of SARIMA model in forecasting and analyzing inpatient cases of acute mountain sickness

BACKGROUND

Acute Mountain Sickness (AMS) is typically triggered by hypoxia under high altitude conditions. Currently, rule of time among AMS inpatients was not clear. Thus, this study aimed to analyze the time distribution of AMS inpatients in the past ten years and construct a prediction model of AMS hospitalized cases.

METHODS

We retrospectively collected medical records of AMS inpatients admitted to the military hospitals from January 2009 to December 2018 and analyzed the time series characteristics. Seasonal Auto-Regressive Integrated Moving Average (SARIMA) was established through training data to finally forecast in the test data set.

RESULTS

A total of 22 663 inpatients were included in this study and recorded monthly, with predominant peak annually, early spring (March) and mid-to-late summer (July to August), respectively. Using the training data from January 2009 to December 2017, the model SARIMA (1, 1, 1) (1, 0, 1) 12 was employed to predict the test data from January 2018 to December 2018. In 2018, the total predicted value after adjustment was 9.24%, less than the actual value.

CONCLUSION

AMS inpatients have obvious periodicity and seasonality. The SARIMA model has good fitting ability and high short-term prediction accuracy. It can help explore the characteristics of AMS disease and provide decision-making basis for allocation of relevant medical resources for AMS inpatients.

Impact of Lymphocyte Subsets of Grafts on the Outcome of Haploidentical Peripheral Blood Stem Cell Transplantation

The contribution of lymphocyte subset composition of the graft on the outcomes following haploidentical peripheral blood stem cell transplantation (haploPBSCT) is not fully elucidated. We retrospectively analyzed 314 patients with hematological malignancies who underwent haploPBSCT from 2016 to 2020 in our center. We obtained a cutoff value of CD3+ T cell dose (2.96 × 10⁸/kg) that separated the risk of II-IV acute graft-versus-host disease (aGvHD) and divided patients into the low CD3+ T cell dose group (CD3+ low) and the high CD3+ T cell dose (CD3+ high) group. Significantly higher incidences of I-IV aGvHD, II-IV aGvHD, and III-IV aGvHD were identified in the CD3+ high group (50.8%, 19.8%, and 8.1% in the high group, 23.1%, 6.0%, and 0.9% in the low group, P < 0.0001, P = 0.002, and P = 0.02, respectively). We found that CD4+ T cell and its naïve and memory subpopulations of grafts had a significant impact on aGvHD (P = 0.005, P = 0.018, and P = 0.044). Besides, we found an inferior reconstitution of natural killer (NK) cells in the CD3+ high group than in the low group within the first-year posttransplant (239 cells/μL vs 338 cells/μL, P = 0.0003). No differences in engraftment, chronic GvHD (cGvHD), relapse rate, transplant-related mortality (TRM), and overall survival (OS) were identified between the two groups. In conclusion, our study found that a high CD3+ T cell dose led to a high risk of aGvHD and inferior reconstitution of NK cells in the haploPBSCT setting. In the future, carefully manipulating the composition of lymphocyte subsets of grafts might reduce the risk of aGvHD and improve the transplant outcome.

Rubbing Salt in the Wound: Molecular Evolutionary Analysis of Pain-Related Genes Reveals the Pain Adaptation of Cetaceans in Seawater

Pain, usually caused by a strong or disruptive stimulus, is an unpleasant sensation that serves as a warning to organisms. To adapt to extreme environments, some terrestrial animals have evolved to be inherently insensitive to pain. Cetaceans are known as supposedly indifferent to pain from soft tissue injury representatives of marine mammals. However, the molecular mechanisms that explain how cetaceans are adapted to pain in response to seawater environment remain unclear. Here, we performed a molecular evolutionary analysis of pain-related genes in selected representatives of cetaceans. ASIC4 gene was identified to be pseudogenized in all odontocetes (toothed whales) except from Physeter macrocephalus (sperm whales), and relaxed selection of this gene was detected in toothed whales with pseudogenized ASIC4. In addition, positive selection was detected in pain perception (i.e., ASIC3, ANO1, CCK, and SCN9A) and analgesia (i.e., ASIC3, ANO1, CCK, and SCN9A) genes among the examined cetaceans. In this study, potential convergent amino acid substitutions within predicted proteins were found among the examined cetaceans and other terrestrial mammals, inhabiting extreme environments (e.g., V441I of TRPV1 in cetaceans and naked mole rats). Moreover, specific amino acid substitutions within predicted sequences of several proteins were found in the studied representatives of cetaceans (e.g., F56L and D163A of ASIC3, E88G of GRK2, and F159L of OPRD1). Most of the substitutions were located within important functional domains of proteins, affecting their protein functions. The above evidence suggests that cetaceans might have undergone adaptive molecular evolution in pain-related genes through different evolutionary patterns to adapt to pain, resulting in greater sensitivity to pain and more effective analgesia. This study could have implications for diagnosis and treatment of human pain.