Effects of warming on seed germination of woody species in temperate secondary forests

Seed germination, a critical stage of the plant life cycle providing a link between seeds and seedlings, is commonly temperature-dependent. The global average surface temperature is expected to rise, but little is known about the responses of seed germination of woody plants in temperate forests to warming. In the present study, dried seeds of 23 common woody species in temperate secondary forests were incubated at three temperature sequences without cold stratification and after experiencing cold stratification. We calculated five seed germination indices and the comprehensive membership function value that summarized the above indicators. Compared to the control, +2 and +4 °C treatments without cold stratification shortened germination time by 14% and 16% and increased the germination index by 17% and 26%, respectively. For stratified seeds, +4 °C treatment increased germination percentage by 49%, and +4 and +2 °C treatments increased duration of germination and the germination index, and shortened mean germination time by 69%, 458%, 29% and 68%, 110%, 12%, respectively. The germination of Fraxinus rhynchophylla and Larix kaempferi were most sensitive to warming without and with cold stratification, respectively. Seed germination of shrubs was the least sensitive to warming among functional types. These findings indicate warming (especially extreme warming) will enhance the seedling recruitment of temperate woody species, primarily via shortening the germination time, particularly for seeds that have undergone cold stratification. In addition, shrubs might narrow their distribution range.

The global burden of schizophrenia and the impact of urbanization during 1990-2019: An analysis of the global burden of disease study 2019

BACKGROUND AND HYPOTHESIS

The burden of schizophrenia is increasing. Assessing the global distribution of schizophrenia and understanding the association between urbanization factors and schizophrenia are crucial.

STUDY DESIGN

We conducted a two-stage analysis utilizing public data from GBD (global burden of disease) 2019 and the World Bank. First, the distribution of schizophrenia burden at the global, regional, and national levels as well as temporal trends was analyzed. Then, four composite indicators of urbanization (including demographic, spatial, economic, and eco-environment urbanization) were constructed from ten basic indicators. Panel data models were used to explore the relationship between urbanization indicators and the burden of schizophrenia.

RESULTS

In 2019, there were 23.6 million people with schizophrenia, an increase of 65.85% from 1990, and the country with the largest ASDR (age-standardized disability adjusted life years rate) was the United States of America, followed by Australia, and New Zealand. Globally, the ASDR of schizophrenia rose with the sociodemographic index (SDI). In addition, six basic urbanization indicators including urban population proportion, employment in industry/services proportion, urban population density, the population proportion in the largest city, GDP, and PM_2.5 concentration were positively associated with ASDR of schizophrenia, with the largest coefficients being urban population density. Overall, demographic, spatial, economic, and eco-environment urbanization all had positive effects on schizophrenia, and the estimated coefficients indicated that demographic urbanization was the most significant influence.

CONCLUSIONS

This study provided a comprehensive description of the global burden of schizophrenia and explored urbanization as a factor contributing to the variation in the burden of schizophrenia, and highlighted policy priorities for schizophrenia prevention in the context of urbanization.

Dung treated by high-temperature composting is an optimal bedding material for suckling calves according to analyses of microbial composition, growth performance, health status, and behavior

Bedding materials are important for suckling buffalo calves. Treated dung has been used as a bedding material for dairy cows but the lack of an appropriate safety assessment limits its application. In this study, we evaluated the feasibility of treated dung (TD) as a bedding material for suckling calves by comparing TD with rice husk (RH) and rice straw (RS) bedding materials. The TD was prepared through high-temperature composting by Bacillus subtilis. Thirty-three newborn suckling buffalo calves (Bubalus bubalis, 40.06 ± 5.79 kg) were randomly divided into 3 bedding material groups (TD, RH, and RS) and bedded with 1 of the 3 bedding materials for 60 d. We compared cost, moisture content, bacterial counts, and microbial composition of the 3 bedding materials, and investigated growth performance, health status, behavior, rumen fermentation, and blood parameters of bedded calves. The results showed that TD contained the fewest gram-negative bacteria and coliforms on d 1 and 30 and the lowest relative abundance of Staphylococcus throughout the experiment. The RH and TD bedding materials had the lowest cost. Calves in the TD and RS groups showed a higher dry matter intake, and final body weight and average daily gain in the TD and RS groups tended to be higher than in the RH group. Calves in the TD and RS groups had a lower disease incidence (diarrhea and fever), fewer antibiotic treatments, and lower fecal score than calves in the RH group. Higher contents of IgG, IgA, and IgM were observed in calves of the TD and RS groups than in calves of the RH group on d 10, indicating higher immune ability in TD and RS groups. Furthermore, TD bedding increased the butyric acid content in the calf's rumen, whereas RS bedding increased the acetate content, which might be attributed to the longer time and higher frequency of eating bedding material in the RS group. Considering all of the above indicators, we concluded that TD is the optimal bedding material for calves based on economics, bacterial count, microbial diversity, growth performance, and health status. Our findings provide a valuable reference for bedding material choice and calf farming.

Sunshine duration and risks of schizophrenia hospitalizations in main urban area: Do built environments modify the association?

BACKGROUND

Although studies have explored the relationship between sunshine duration and schizophrenia, the evidence was ambiguous. Different built environments may alter the effect of sunlight on schizophrenia, thus the purpose of this study was to investigate the effects of built environments on the sunshine duration-schizophrenia association.

MATERIALS AND METHODS

Daily schizophrenia hospitalizations data during 2017-2020 in Hefei's main urban area, China, and corresponding meteorological factors as well as ambient pollutants were collected. The impact of sunshine duration on schizophrenia admissions in urban areas was investigated using a generalized additive model combined with a distributed lagged nonlinear model. Additionally, the various modifying effects of different Building Density, Building Height, Normalized Vegetation Index, and Nighttime Light were also explored between sunshine duration and schizophrenia.

RESULTS

We observed that inadequate sunshine duration (<5.3 h) was associated with an increase in schizophrenia hospital admissions, with a maximum relative risk of 1.382 (95 % confidence interval (CI): 1.069-1.786) at 2.9 h. In turn, adequate sunshine duration reduced the risk of schizophrenia hospitalizations. Subgroup analyses indicated females and old patients were particularly vulnerable. In the case of insufficient sunshine duration, significant positive effects were noticed on schizophrenia risk at High-Building Density and High-Nighttime Light. Higher NDVI as well as Building Height were found to be associated with lower risks of schizophrenia.

CONCLUSIONS

Given that sunshine duration in various built environments might lead to distinct effects on schizophrenia hospitalizations. Our findings assist in identifying vulnerable populations that reside in particular areas, thus suggesting policymakers provide advice to mitigate the onset of schizophrenia by allocating healthcare resources rationally and avoiding adverse exposures to vulnerable populations timely.

[Challenges and countermeasures in the development of artificial intelligence research in ophthalmology]

The advent of artificial intelligence (AI) technology has led to revolutionary advancements in the diagnosis and treatment of ophthalmic diseases, introducing a novel AI-assisted diagnostic approach for ophthalmology that is rich in imaging diagnostic technologies. However, as clinical applications continue to evolve, AI research in ophthalmology faces challenges such as the lack of standardized datasets and innovative algorithm models, insufficient cross-modal information fusion, and limited clinical interpretability. In response to the growing demand for AI research in ophthalmology, it is essential to establish ophthalmic data standards and sharing platforms, innovate core algorithms, and develop clinical logic interpretable models for the screening, diagnosis, and prediction of eye diseases. Additionally, the deep integration of cutting-edge technologies such as 5G, virtual reality, and surgical robots would advance the development of ophthalmic intelligent medicine into a new phase.

Pembrolizumab monotherapy versus chemotherapy in platinum-pretreated, recurrent or metastatic nasopharyngeal cancer (KEYNOTE-122): an open-label, randomized, phase III trial

BACKGROUND

Pembrolizumab previously demonstrated robust antitumor activity and manageable safety in a phase Ib study of patients with heavily pretreated, programmed death ligand 1 (PD-L1)-positive, recurrent or metastatic nasopharyngeal carcinoma (NPC). The phase III KEYNOTE-122 study was conducted to further evaluate pembrolizumab versus chemotherapy in patients with platinum-pretreated, recurrent and/or metastatic NPC. Final analysis results are presented.

PATIENTS AND METHODS

KEYNOTE-122 was an open-label, randomized study conducted at 29 sites, globally. Participants with platinum-pretreated recurrent and/or metastatic NPC were randomly assigned (1 : 1) to pembrolizumab or chemotherapy with capecitabine, gemcitabine, or docetaxel. Randomization was stratified by liver metastasis (present versus absent). The primary endpoint was overall survival (OS), analyzed in the intention-to-treat population using the stratified log-rank test (superiority threshold, one-sided P = 0.0187). Safety was assessed in the as-treated population.

RESULTS

Between 5 May 2016 and 28 May 2018, 233 participants were randomly assigned to treatment (pembrolizumab, n = 117; chemotherapy, n = 116); Most participants (86.7%) received study treatment in the second-line or later setting. Median time from randomization to data cut-off (30 November 2020) was 45.1 months (interquartile range, 39.0-48.8 months). Median OS was 17.2 months [95% confidence interval (CI) 11.7-22.9 months] with pembrolizumab and 15.3 months (95% CI 10.9-18.1 months) with chemotherapy [hazard ratio, 0.90 (95% CI 0.67-1.19; P = 0.2262)]. Grade 3-5 treatment-related adverse events occurred in 12 of 116 participants (10.3%) with pembrolizumab and 49 of 112 participants (43.8%) with chemotherapy. Three treatment-related deaths occurred: 1 participant (0.9%) with pembrolizumab (pneumonitis) and 2 (1.8%) with chemotherapy (pneumonia, intracranial hemorrhage).

CONCLUSION

Pembrolizumab did not significantly improve OS compared with chemotherapy in participants with platinum-pretreated recurrent and/or metastatic NPC but did have manageable safety and a lower incidence of treatment-related adverse events.

The impact of hazes on schizophrenia admissions and the synergistic effect with the combined atmospheric oxidation capacity in Hefei, China

OBJECTIVES

Currently, most epidemiological studies on haze focus on respiratory diseases, cardiovascular diseases, etc. However, the relationship between haze and mental health has not been adequately explored. The purpose of this study was to investigate the influence of hazes on schizophrenia admissions and to further explore the potential interaction effect with the combined atmospheric oxidative indices (O_x and O_x^wt).

METHODS

We collected 5328 cases during the cold season from 2013 to 2015 in Hefei, China. By integrating the Poisson Generalized Linear Models with the Distributed Lag Non-linear Models, the association between haze and schizophrenia admissions was evaluated. The interaction between hazes and two combined oxidation indexes was tested by stratifying hazes and O_x, and O_x^wt.

RESULTS

Haze was found to be significantly linked to an increased risk of hospitalization for schizophrenia, and a 9-day lag effect on schizophrenia (lag 3-lag 11), with the largest effect on lag 6 (RR = 1.080, 95% confidence interval (CI): 1.046-1.116). Males, females, and <40 y (people under 40 years old) were sensitive to hazes. Furthermore, in the stratified analysis, we found synergies between two combined oxidation indexes and hazes. The interaction relative risk (IRR) and relative excess risk due to interaction (RERI) between O_x and hazes were 1.170 (95% CI: 1.071-1.277) and 0.149 (95% CI: 0.045-0.253), respectively. For O_x^wt, the IRR and RERI were 1.179 (95% CI: 1.087-1.281) and 0.159 (95% CI: 0.056-0.263), respectively. It is noteworthy that this synergistic effect was significant in males and <40 y when examining the various subgroups in the interaction analysis.

CONCLUSIONS

Our findings suggest that exposure to haze significantly increases the risk of hospitalization for schizophrenia. More significant public health benefits can be obtained by prioritizing haze periods with high combined atmospheric oxidation capacity.

[A retrospective comparative study between robotic thyroidectomy through transoral vestibular approach and bilateral breast-axillary approach]

Objective: To compare the surgical outcome of robotic thyroidectomy through transoral approach and the bilateral breast-axillary approach. Methods: Retrospective analysis was made on the clinical data of patients who performed transoral robotic thyroidectomy (TORT group) or bilateral breast-axillary approach (BABA group) in the Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army from July 2020 to May 2022. Both groups received lobectomy with lymph node dissection of the central region. A total of 100 cases were included in the study, including 48 cases in the TORT group and 52 cases in the BABA group. The propensity score matching method was used for 1∶1 matching of patients between the 2 groups, with a match tolerance of 0.03. There were 31 patients in each group successfully matched. In the TORT group, there were 5 males and 26 females, aged (33.2±7.9) years (range: 21 to 53 years). While there were 4 males and 27 females in the BABA group, aged (34.6±9.2) years (range: 19 to 58 years). The t test, Mann-Whitney U test, χ² test or Fisher exact test were used to compare the clinical efficacy between the two groups. Results: All the patients successfully completed robotic thyroid surgery without conversion to open surgery. Compared with BABA group, the TORT group had longer operation time ((211.3±57.2) minutes vs. (126.2±37.8) minutes, t=6.915, P<0.01), shorter drainage tube retention time ((5.4±1.0) days vs. (6.4±1.2) days, t=-3.544, P=0.001), shorter total hospital stay ((6.6±1.2) days vs. (7.4±1.3) days, t=-2.353, P=0.022), and higher cosmetic score (9.46±0.25 vs. 9.27±0.26, t=2.925, P=0.005). There was no significant difference between the two groups in the number of lymph nodes dissection, metastasis in the central compartment, and the incidence of postoperative complications (all P>0.05). Conclusions: Compared with the bilateral breast-axillary approach, the transoral vestibular approach of robotic thyroidectomy is also safe and effective. It shows similar surgical results to the bilateral breast-axillary approach in strictly selected patients, but the postoperative recovery speed is much faster, and the hospital stay is shorter. Transoral robotic thyroidectomy is a more recommended surgical method for patients with high aesthetic demand.

[Effect of hemoperfusion on protein energy wasting and long-term prognosis in patients on maintenance hemodialysis]

Objective: To explore the effect of hemoperfusion (HP) combined with hemodialysis (HD) (HD+HP) on protein energy wasting (PEW) and long-term prognosis in patients on maintenance HD (MHD). Methods: A prospective multicenter cohort study was conducted. Adult MHD patients who completed PEW assessment and underwent regular dialysis between July 2015 and July 2021 at 23 hemodialysis centers in Guizhou Province were selected. Demographic characteristics, physical indicators, laboratory indicators, 3-day diet diary and HP treatment data of the subjects were collected. The patients were divided into different groups according to the presence or absence of HP, the frequency of HP treatment and the type of cartridge, and then relevant indicators were compared. Multivariate logistic regression model and Cox proportional regression model were used to analyze the influence of HP treatment on PEW risk in MHD patients. Meanwhile, Kaplan-Meier method was used to plot the survival curve. Results: A total of 4 623 MHD patients (2 789 males and 1 834 females) aged (53.7±15.9) years were included in the study, with a median dialysis age of 64.3 (44.3, 92.3) months. There were 3 429 (74.2%) MHD patients treated with HD+HP, and 1 194 patients (25.8%) were not treated with HP. According to the 2008 diagnostic criteria of the International Society for Renal Nutrition and Metabolism (ISRNM), the incidence of PEW was 26.0% (1 204/4 623). Multivariate logistic regression analysis showed that female (OR=2.48, 95%CI: 1.55-3.95, P<0.001), diabetes (OR=1.75, 95%CI: 1.08-2.83, P=0.024) and high-sensitivity C-reactive protein (hs-CRP) (OR=1.02, 95%CI: 1.01-1.03, P=0.003) were risk factors for PEW, while treatment with HD+HP (OR=0.51, 95%CI: 0.31-0.87, P=0.012) and elevated triglyceride levels (OR=0.62, 95%CI: 0.48-0.80, P<0.001) were protective factors. Cox hazard ratio regression showed that among different HP treatment frequencies and cartridge types, 2 times/month (HR=0.40, 95%CI: 0.17-0.95, P=0.037), 3 times/month (HR=0.44, 95%CI: 0.23-0.85, P=0.014), 4 times/month (HR=0.54, 95%CI: 0.34-0.85, P=0.008), HA130 (HR=0.57, 95%CI: 0.36-0.89, P=0.014) and HA230 (HR=0.30, 95%CI: 0.15-0.63, P=0.001) had protective effects on the occurrence of PEW in MHD patients. The all-cause mortality rate was 11.3% (521/4 623) at 33 (24, 48) months of follow-up. Kaplan-Meier analysis showed that patients undergoing 4 times/month HP treatment (χ²=36.78, P<0.001) and using HA230 (χ²=9.46, P=0.002) had the highest survival rate. Conclusion: Treatment with HD+HP is a protective factor for PEW in patients with MHD, and 4 times/month HP treatment or HA230 significantly reduces the risk of PEW and all-cause mortality in patients with MHD.

[Excerpt from the 2022 American Association for the Study of Liver Diseases clinical practice guideline: management of primary sclerosing cholangitis and cholangiocarcinoma]

What are the new contents of the guideline since 2010?A.Patients with primary and non-primary sclerosing cholangitis (PSC) are included in these guidelines for the diagnosis and management of cholangiocarcinoma.B.Define "related stricture" as any biliary or hepatic duct stricture accompanied by the signs or symptoms of obstructive cholestasis and/or bacterial cholangitis.C.Patients who have had an inconclusive report from MRI and cholangiopancreatography should be reexamined by high-quality MRI/cholangiopancreatography for diagnostic purposes. Endoscopic retrograde cholangiopancreatography should be avoided for the diagnosis of PSC.D. Patients with PSC and unknown inflammatory bowel disease (IBD) should undergo diagnostic colonoscopic histological sampling, with follow-up examination every five years until IBD is detected.E. PSC patients with IBD should begin colon cancer monitoring at 15 years of age.F. Individual incidence rates should be interpreted with caution when using the new clinical risk tool for PSC for risk stratification.G. All patients with PSC should be considered for clinical trials; however, if ursodeoxycholic acid (13-23 mg/kg/day) is well tolerated and after 12 months of treatment, alkaline phosphatase (γ- Glutamyltransferase in children) and/or symptoms are significantly improved, it can be considered to continue to be used.H. Endoscopic retrograde cholangiopancreatography with cholangiocytology brushing and fluorescence in situ hybridization analysis should be performed on all patients suspected of having hilar or distal cholangiocarcinoma.I.Patients with PSC and recurrent cholangitis are now included in the new unified network organ sharing policy for the end-stage liver disease model standard.J. Liver transplantation is recommended after neoadjuvant therapy for patients with unresectable hilar cholangiocarcinoma with diameter < 3 cm or combined with PSC and no intrahepatic (extrahepatic) metastases.

[Association of lean tissue index with arteriovenous fistula dysfunction in maintenance hemodialysis patients]

The clinical data of maintenance hemodialysis (MHD) patients from twenty hemodialysis centers in Guizhou province from June to September 2020 were collected by cross-sectional study. The patients were divided into AFD group and non-AFD group according to whether AFD had occurred. LTI was measured by body composition monitor. The results showed that the incidence of AFD in 2 781 MHD patients was 30.0% (835/2 781). Median LTI level was 15.2 (13.2, 17.5) kg/m². The LTI level in the AFD group was higher than that in the non-AFD group (P < 0.05). According to the tertiles of LTI, low LTI group (LTI ≤ 13.9 kg/m²) had the highest incidence of AFD (35.5%, 334/940), and the high LTI group had the lowest incidence of AFD (26.3%, 241/916), and the difference among the three groups was statistically significant (χ²=20.182,P < 0.001). Multivariate logistic regression analysis showed that low LTI group as the reference, the risk of AFD in moderate LTI group (13.9 kg/m² < LTI ≤ 16.6 kg/m²) and high LTI group were associated with the 20.0% (OR=0.800, 95% CI 0.650-0.986, P=0.036) and 22.8% (OR=0.772, 95% CI 0.616-0.966, P=0.024) decrease, respectively. These results suggest that low LTI level is independently associated with an increased risk of AFD in MHD patients.

[Status of fungal sepsis among preterm infants in 25 neonatal intensive care units of tertiary hospitals in China]

Objective: To analyze the prevalence and the risk factors of fungal sepsis in 25 neonatal intensive care units (NICU) among preterm infants in China, and to provide a basis for preventive strategies of fungal sepsis. Methods: This was a second-analysis of the data from the "reduction of infection in neonatal intensive care units using the evidence-based practice for improving quality" study. The current status of fungal sepsis of the 24 731 preterm infants with the gestational age of <34⁺⁰ weeks, who were admitted to 25 participating NICU within 7 days of birth between May 2015 and April 2018 were retrospectively analyzed. These preterm infants were divided into the fungal sepsis group and the without fungal sepsis group according to whether they developed fungal sepsis to analyze the incidences and the microbiology of fungal sepsis. Chi-square test was used to compare the incidences of fungal sepsis in preterm infants with different gestational ages and birth weights and in different NICU. Multivariate Logistic regression analysis was used to study the outcomes of preterm infants with fungal sepsis, which were further compared with those of preterm infants without fungal sepsis. The 144 preterm infants in the fungal sepsis group were matched with 288 preterm infants in the non-fungal sepsis group by propensity score-matched method. Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of fungal sepsis. Results: In all, 166 (0.7%) of the 24 731 preterm infants developed fungal sepsis, with the gestational age of (29.7±2.0) weeks and the birth weight of (1 300±293) g. The incidence of fungal sepsis increased with decreasing gestational age and birth weight (both P<0.001). The preterm infants with gestational age of <32 weeks accounted for 87.3% (145/166). The incidence of fungal sepsis was 1.0% (117/11 438) in very preterm infants and 2.0% (28/1 401) in extremely preterm infants, and was 1.3% (103/8 060) in very low birth weight infants and 1.7% (21/1 211) in extremely low birth weight infants, respectively. There was no fungal sepsis in 3 NICU, and the incidences in the other 22 NICU ranged from 0.7% (10/1 397) to 2.9% (21/724), with significant statistical difference (P<0.001). The pathogens were mainly Candida (150/166, 90.4%), including 59 cases of Candida albicans and 91 cases of non-Candida albicans, of which Candida parapsilosis was the most common (41 cases). Fungal sepsis was independently associated with increased risk of moderate to severe bronchopulmonary dysplasia (BPD) (adjusted OR 1.52, 95%CI 1.04-2.22, P=0.030) and severe retinopathy of prematurity (ROP) (adjusted OR 2.55, 95%CI 1.12-5.80, P=0.025). Previous broad spectrum antibiotics exposure (adjusted OR=2.50, 95%CI 1.50-4.17, P<0.001), prolonged use of central line (adjusted OR=1.05, 95%CI 1.03-1.08, P<0.001) and previous total parenteral nutrition (TPN) duration (adjusted OR=1.04, 95%CI 1.02-1.06, P<0.001) were all independently associated with increasing risk of fungal sepsis. Conclusions: Candida albicans and Candida parapsilosis are the main pathogens of fungal sepsis among preterm infants in Chinese NICU. Preterm infants with fungal sepsis are at increased risk of moderate to severe BPD and severe ROP. Previous broad spectrum antibiotics exposure, prolonged use of central line and prolonged duration of TPN will increase the risk of fungal sepsis. Ongoing initiatives are needed to reduce fungal sepsis based on these risk factors.

Short-term exposure to air pollution is an emerging but neglected risk factor for schizophrenia: A systematic review and meta-analysis

OBJECTIVE

This meta-analysis aimed to explore the association between short-term exposure to air pollution and schizophrenia (SCZ)1, and investigate the susceptible population and the lag characteristics of different pollutants.

METHODS

A systematic review and meta-analysis was conducted by searching PubMed, Cochrane, Web of Sciences, and CNKI for relevant literature published up to 28 Feb 2022. Meta-analysis was performed separately to investigate the association of ambient particulates (diameter ≤ 2.5 μm (PM2.5)2, 2.5 μm < diameter < 10 μm (PMC)3, ≤10μm (PM10)4) and gaseous pollutants (nitrogen dioxide (NO2)5, sulfur dioxide (SO2)6, carbon monoxide (CO)7) with SCZ. Relative risk (RR)8 per 10 μg/m3 increase in air pollutants concentration was used as the effect estimate. Subgroup analyses were conducted by age, gender, country, median pollutant concentration, and median temperature.

RESULTS

We identified 17 articles mainly conducted in Asia, of which 13 were included in the meta-analysis. Increased risk of SCZ was associated with short-term exposure to PM2.5 (RR: 1.0050, 95 % confidence interval (CI)9: 1.0017, 1.0083), PMC (1.0117, 1.0023, 1.0211), PM10 (1.0047, 1.0025, 1.0070), NO2 (1.0275, 1.0132, 1.0420), and SO2 (1.0288, 1.0146, 1.0432) exposure. Subgroup analyses showed that females may be more susceptible to SO2 and NO2, and the young seem to be more sensitive to PM2.5 and PM10. Gaseous pollutants presented the immediate risk, and particulates showed the delayed risk.

CONCLUSIONS

The present meta-analysis suggests that short-term exposure to PM2.5, PMC, PM10, SO2, and NO2 exposure may be associated with an elevated risk of SCZ.

[Meta-analysis of the interventional effects of music therapy on pain and anxiety of burn patients in wound dressing change]

Objective: To evaluate the interventional effects of music therapy on pain and anxiety of burn patients in wound dressing change. Methods: The meta-analysis method was adopted. Databases including China National Knowledge Internet, Wanfang Database, and VIP database were retrieved with the search terms in Chinese version of ", , /, /", and PubMed, Embase, and Cochrane Library were retrieved with the search terms in English version of "music, burn, dressing change/wound dressing, pain/ache/sore" to obtain the publicly published randomized controlled trials on the application of music therapy for wound dressing change in burn patients from the establishment of each database to May 2021. The outcome indexes included pain score/percentage and anxiety score after dressing change. Rev Man 5.4 and Stata 14.0 statistical software were used to conduct a meta-analysis of eligible studies. Results: A total of 520 burn patients from 7 studies were included, including 260 patients in music therapy group who received music therapy and 260 patients in routine dressing change group who received routine dressing change. The bias risk of all the 7 included studies was uncertain. Compared with those in routine dressing change group, the pain percentages (relative risk=0.06, 95% confidence interval=0.01-0.41, P<0.01) and pain scores after dressing change (standardized mean difference (SMD)=-0.91, 95% confidence interval=-1.61--0.22, P<0.05) of patients in music therapy group were significantly lower. Subgroup analysis showed that music type and timing of intervention might be the source of heterogeneity in pain scores after dressing change. The anxiety scores of patients in music therapy group were significantly lower than those in routine dressing change group (SMD=-0.64, 95% confidence interval=-1.09--0.19, P<0.01). There was no publication bias in pain or anxiety scores after dressing change. Conclusions: Music therapy can relieve the pain and anxiety of burn patients during dressing change.

Quality and efficiency of a standardized e-handover system for pediatric nursing: A prospective interventional study

AIM

This study examined the effect on pediatric nursing handover quality and efficiency when a standardized e-handover system was implemented.

BACKGROUND

Handover quality is an important aspect of nursing quality management; however, handover quality among nursing staff is poor.

METHODS

A prospective interventional study was carried out in a general pediatrics ward from December 2019 to November 2020. The tools included a standardized e-handover system. The intervention strategies included workflow remodeling and employee training on oral handover using the standardized e-handover system.

RESULTS

The omission frequency of critical handover elements decreased from 47.32% to 2.94% (p < .01), among which the omission frequencies of nine out of 16 key elements significantly decreased. Integrity also showed improvement. Specifically, the integrity of five types of critical information was significantly improved, including vital signs, signs and symptoms, laboratory test results, radiologic examination results, and treatment regimen (2.00 vs. 5.00, p < .01; 3.00 vs. 5.00, p < .01; 3.00 vs. 5.00, p < .01; 5.00 vs. 5.00, p = .009; 3.00 vs. 4.00, p < .01, respectively). Information accuracy was 100%. Workflow and efficiency significantly improved, communication duration with patient/family during work hours significantly increased (24.00 vs. 56.00, p < .01), and prehandover preparation duration significantly decreased (32.00 vs. 2.50, p < .01). Nurse handover satisfaction showed improvement (56.88 ± 15.08 vs. 74.31 ± 9.22, p < .01).

CONCLUSION

The standardized e-handover system effectively improved nurse handover quality, optimized workflow, increased work efficiency, and promoted teamwork.

IMPLICATIONS FOR NURSING MANAGEMENT

Standardized e-handover systems have great potential for ensuring the safety of pediatric patients and improving the quality of handover.

Association between sequential extreme precipitation-heatwaves events and hospitalizations for schizophrenia: The damage amplification effects of sequential extremes

OBJECTIVES

In the context of frequent global extreme weather events, there are few studies on the effects of sequential extreme precipitation (EP) and heatwaves (HW) events on schizophrenia. We aimed to quantify the effects of the events on hospitalizations for schizophrenia and compare them with EP and HW alone to explore the amplification effect of successive extremes on health loss.

METHODS

A time-series Poisson regression model combined with a distributed lag non-linear model was applied to estimate the association between sequential EP and HW events (EP-HW) and schizophrenia hospitalizations. The effects of EP-HW with different intervals and intensities on the admission of schizophrenia were compared. In addition, we calculated the mean attributable fraction (AF) and attributable numbers (AN) per exposure of extreme events to reflect the amplification effect of sequential extreme events on health hazards compared with individual extreme events.

RESULTS

EP-HW increased the risk of hospitalization for schizophrenia, with significant effects lasting from lag0 (RR and 95% CI: 1.150 (1.041-1.271)) to lag11 (1.046 (1.000-1.094)). Significant associations were found in the subgroups of male, female, married people, and those aged≥ 40 years old. Shorter-interval (0-3days) or higher-intensity EP-HW (both precipitation ≥ P97.5 and mean temperature ≥ P97.5) had a longer lag effect compared to EP-HW with longer intervals or lower intensity. We found that the mean AF and AN caused by each exposure to EP-HW (AF: 0.074% (0.015%-0.123%); AN: 4.284 (0.862-7.118)) were higher than those induced by each exposure to HW occurring alone (AF:0.032% (0.004%-0.058%); AN:1.845 (0.220-3.329)).

CONCLUSIONS

Sequential extreme precipitation-heatwaves events significantly increase the risk of hospitalizations for schizophrenia, with greater impact and disease burden than independently occurring extremes. The impact of consecutive extremes is supposed to be considered in local sector early warning systems for comprehensive public health decision-making.

Spontaneous Ferromagnetism Induced Topological Transition in EuB_{6}

The interplay between various symmetries and electronic bands topology is one of the core issues for topological quantum materials. Spontaneous magnetism, which leads to the breaking of time-reversal symmetry, has been proven to be a powerful approach to trigger various exotic topological phases. In this Letter, utilizing the combination of angle-resolved photoemission spectroscopy, magneto-optical Kerr effect microscopy, and first-principles calculations, we present the direct evidence on the realization of the long-sought spontaneous ferromagnetism induced topological transition in soft ferromagnetic EuB_{6}. Explicitly, we reveal the topological transition is from Z_{2}=1 topological insulator in paramagnetic state to χ=1 magnetic topological semimetal in low temperature ferromagnetic state. Our results demonstrate that the simple band structure near the Fermi level and rich topological phases make EuB_{6} an ideal platform to study the topological phase physics.

Low-density lipoprotein cholesterol levels and long-term bleeding in patients undergoing percutaneous coronary intervention: 5-year outcomes from a large cohort study

Aims

Recent research reported that lower low-density lipoprotein cholesterol (LDL-C) is associated with more in-hospital bleeding in acute coronary syndrome (ACS) patients. However, the association between lower LDL-C levels and long-term bleeding in percutaneous coronary intervention (PCI) patients remains unclear.

Methods

A total of 10724 patients treated with PCI enrolled in ourhospital from January 2013 to December 2013. The primary endpoint was the Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding at 5 years. The secondary endpoint was intracranial hemorrhage. Taking the LDL-C value of 1.8 mmol/L (70 mg/dL) or 1.4 mmol/L (55 mg/dL) as cut-off points, patients were grouped to analyse, respectively.

Results

Among 9697 PCI patients treated with dual antiplatelet therapy finally enrolled, a total of 411 BARC type 2, 3 or 5 bleedings and 42 intracranial hemorrhage were recorded during a follow-up of 5 years. With LDL-C value of 1.8 mmol/L as cut-off point, multivariate Cox regression showed that lower LDL-C level was not associated with the risk for bleeding [hazard ratio (HR): 1.166, 95% confidence interval (CI): 0.879–1.549]. The result was consistent (HR: 1.185; 95% CI: 0.713–1.968) in a 1:4 propensity-score matching cohort (n=1285). For further study, we performed subgroup analysis which showed that lower LDL-C was not associated with the risk for bleeding in ACS (HR: 1.140; 95% CI: 0.846–1.535) or non-ACS patients (HR: 1.284; 95% CI: 0.909–1.813). With LDL-C value of 1.4 mmol/L as cut-off point, Cox regression showed that lower LDL-C level was not associated with the risk for bleeding in total population, ACS or non-ACS patients (P&gt;0.05). The result was consistent in a 1:4 propensity-score matching cohort (n=760) (P&gt;0.05). As for secondary endpoint, lower LDL-C level was not associated with the risk for intracranial hemorrhage whether the LDL-C value is 1.8 or 1.4 mmol/L as the cut-off point (P&gt;0.05).

Conclusions

To the best of our knowledge, we firstly report lower LDL-C level (whether the LDL-C value is 1.8 or 1.4 mmol/L as the cut-off point) was not the independent risk factor of long-term bleeding in PCI population and ACS or non-ACS subgroup populations.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): CAMS Innovation Fund for Medical Sciences (CIFMS); Young and middle-aged talents in the XPCC Science and Technology Project

SPRSound: Open-Source SJTU Paediatric Respiratory Sound Database

It has proved that the auscultation of respiratory sound has advantage in early respiratory diagnosis. Various methods have been raised to perform automatic respiratory sound analysis to reduce subjective diagnosis and physicians' workload. However, these methods highly rely on the quality of respiratory sound database. In this work, we have developed the first open-access paediatric respiratory sound database, SPRSound. The database consists of 2,683 records and 9,089 respiratory sound events from 292 participants. Accurate label is important to achieve a good prediction for adventitious respiratory sound classification problem. A custom-made sound label annotation software (SoundAnn) has been developed to perform sound editing, sound annotation, and quality assurance evaluation. A team of 11 experienced paediatric physicians is involved in the entire process to establish golden standard reference for the dataset. To verify the robustness and accuracy of the classification model, we have investigated the effects of different feature extraction methods and machine learning classifiers on the classification performance of our dataset. As such, we have achieved a score of 75.22%, 61.57%, 56.71%, and 37.84% for the four different classification challenges at the event level and record level.

Ectopic expression of BrIQD35 promotes drought stress tolerance in Nicotiana benthamiana

The plant IQD gene family is responsive to a variety of stresses. In this study, we studied the structural features and functions of the gene BrIQD35 in Chinese cabbage, a member of the IQD gene family. BrIQD35 was cloned and shown to contain an IQ motif. Transient expression of BrIQD35 indicated that it was localized on the plasma membrane and was significantly upregulated under drought and salt stress in Chinese cabbage. To further identify the function of BrIQD35, it was heterologously overexpressed in Nicotiana benthamiana. Although there was no significant difference between BrIQD35-overexpressed and wild-type (WT) plants under salt stress, WT N. benthamiana showed more wilting than the BrIQD35-overexpressed plants under drought stress. Since the IQ motif has been annotated as a CaM binding site, yeast two-hybrid assays were used to explore the interaction between BrIQD35 and CaM. The results indicated that BrIQD35 interacts weakly with CaMb, but not with CaMa, suggesting that BrIQD35 may function through the Ca2+ -CaMb pathway. The findings reveal a novel gene involved in drought tolerance, which is important for plant breeding and quality improvement for Chinese cabbage.

[Bilateral anterior lenticonus: a case report]

A patient complained of ophthalmology with poor vision in both eyes for more than 30 years and aggravation for more than 2 years. The central anterior lens capsule was found to have a conical protrusion under a slit-lamp microscope after pupil dilation in both eyes. The diagnosis was bilateral cataract and congenital anterior lenticonus. Phacoemulsification cataract extraction combined with intraocular lens implantation was performed. The visual acuity in both eyes was significantly better after surgery.

High fibrinogen-to-albumin ratio with type 2 diabetes mellitus is associated with poor prognosis in patients undergoing percutaneous coronary intervention: 5-year findings from a large cohort

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): the National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences

Background

Inflammation plays a crucial role in coronary atherosclerosis progression, and growing evidence has demonstrated that the fibrinogen-to-albumin ratio index (FAR) is associated with the severity of coronary artery disease (CAD). However, the long-term risk of cardiovascular events remains indistinct in patients with different level of FAR and different glycemic metabolism status. This study was to access 5-year clinical outcomes of diabetic and non-diabetic patients who underwent percutaneous coronary intervention (PCI) with different level of FAR.

Methods

We consecutively enrolled 10,724 patients with CAD hospitalized for PCI and followed up for major adverse cardiac and cerebrovascular events (MACCE) covering all-cause mortality, non-fatal myocardial infarction, non-fatal ischemic stroke and unplanned coronary revascularization. FAR was computed using the following formula: Fibrinogen (mg/dL) / Albumin (g/L). According to the optimal cut-off value of FAR, which was determined by the surv_cutpoint function of the R package survminer via RStudio software (version 2021.09.0), patients were divided into higher level of FAR (FAR-H) and lower level of (FAR-L) subgroups, and were further categorized into for groups as FAR-H with DM and non-DM, and FAR-L with DM and non-DM.

Results

5,298 patients (58.36 ± 10.36 years, 77.7% male) were ultimately enrolled in the present study. A total of 1,099 (20.7%) MACCEs were documented during the 5-year follow-up. The optimal cut-off value of FAR was 0.0783 by the surv_cutpoint function. Compared to ones with FAR-H and DM, patients with FAR-L and non-DM, FAR-H and non-DM, FAR-L and DM had decreased risk of MACCEs [adjusted hazard ratio (HR): 0.75, 95% confidence interval (CI) 0.64-0.89, p = 0.001; HR: 0.006, 95% CI 0.66-0.93, p = 0.006; HR: 0.81, 95% CI 0.68-0.97, p = 0.019]. Notably, non-diabetic patients with lower level of FAR also had lower all-cause mortality risk than those in the FAR-H/DM group (HR: 0.41, 95% CI 0.27-0.63, p &lt; 0.001). Multivariate Cox proportional hazards regression analysis also indicated the highest risk of MACCEs in patients with FAR-H and DM than others (p for trend = 0.005). In addition, subgroup analysis revealed consistent effects on 5-year MACCE across various subgroups.

Conclusion

Diabetic patients with higher level of FAR had the worse 5-year outcomes compared with patients in other three groups. The level of FAR may help to identify high-risk individuals in this specific population.