Effects of non-invasive brain stimulation (NIBS) for executive function on subjects with ADHD: a protocol for a systematic review and meta-analysis

INTRODUCTION

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder with a high risk of multiple mental health and social difficulties. Executive function domains are associated with distinct ADHD symptom burdens. Non-invasive brain stimulation (NIBS) mainly includes repetitive transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), which is a promising technique, but its impact on the executive function of ADHD is uncertain. Therefore, the aim of this systematic review and meta-analysis is to derive solid and updated estimates on the effect of NIBS on executive function in children/adults with ADHD.

METHODS AND ANALYSIS

A systematic search will be performed through EMBASE, MEDLINE, PsycINFO and Web of Science databases from inception until 22 August 2022. Handsearching of grey literature and the reference lists of selected articles will also be conducted. Empirical studies assessing the effect of NIBS (TMS or tDCS) on executive function in children or adults with ADHD will be included. Two investigators will independently perform literature identification, data extraction and risk of bias assessment. Relevant data will be pooled by a fixed-effects or random-effects model according to I² statistic. Sensitivity analysis will be performed to test the robustness of the pooled estimates. Subgroup analyses will be conducted to investigate the potential heterogeneity. This protocol will generate a systematic review and meta-analysis that comprehensively synthesises the evidence on the NIBS treatment of executive function deficit of ADHD.Ethics approval is not required as this is a protocol for a systematic review of published literature. The results will be submitted to a peer-reviewed journal or a conference.

PROSPERO REGISTRATION NUMBER

CRD42022356476.

Prognosis of direct pregnancy in untreated atypical endometrial hyperplasia: a case report

BACKGROUND

An increasing number of atypical endometrial hyperplasia (AEH) or endometrial cancer (EC) patients with fertility requirements choose conservative management, such as oral high-dose progesterone. Most of them use assisted reproductive technology (ART) to become pregnant after experiencing remission. However, the outcome of pregnancy is not ideal, probably because of long-term drug application in large doses or invasive uterine cavity treatment.

CASE REPORT

We presented a case of AEH who underwent direct pregnancy with good results without any treatment for her pathological endometrium. We described her endometrial histological results pre-and post-pregnancy in detail, hitherto absent from reports on this topic.

CONCLUSIONS

Patients with a strong desire to bear children at the time of an AEH diagnosis could consider taking 1-2 years to try a pregnancy before treating their AEH.

Transient dystonia correlates with parkinsonism after 1-methyl-4-phenyl-1,2,3,6- tetrahydropyridine in nonhuman primates

Unilateral internal carotid artery 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) infusion in non-human primates produces transient contralateral hemi-dystonia followed by stable contralateral hemi-parkinsonism; the relationship between dystonia and parkinsonism remains unclear. We hypothesized that transient dystonia severity following MPTP correlates with parkinsonism severity. In male Macaca nemestrina (n = 3) and M. fascicularis (n = 17) we administered unilateral intra-carotid MPTP, then correlated validated blinded ratings of transient peak dystonia and delayed parkinsonism. We also correlated dystonia severity with post-mortem measures of residual striatal dopamine and nigral neuron counts obtained a mean 53 ± 15 days following MPTP, after resolution of dystonia but during stable parkinsonism. Median latency to dystonia onset was 1 day, and peak severity 2.5 days after MPTP; total dystonia duration was 13.5 days. Parkinsonism peaked a median of 19.5 days after MPTP, remaining nearly constant thereafter. Peak dystonia severity highly correlated with parkinsonism severity (r[18] = 0.82, p < 0.001). Residual cell counts in lesioned nigra correlated linearly with peak dystonia scores (r[18] = -0.68, p=<0.001). Dystonia was not observed in monkeys without striatal dopamine depletion (n = 2); dystonia severity correlated with striatal dopamine depletion when residual nigral cell loss was less than 50% ([11] r = -0.83, p < 0.001) but spanned a broad range with near complete striatal dopamine depletion, when nigral cell loss was greater than 50%. Our data indicate that residual striatal dopamine may not reflect dystonia severity. We speculate on mechanisms of transient dystonia followed by parkinsonism that may be studied using this particular NHP MPTP model to better understand relationships of transient dystonia to nigrostriatal injury and parkinsonism.

Neuro- and hepato-toxicity of polystyrene nanoplastics and polybrominated diphenyl ethers on early life stages of zebrafish

Nanoplastics (NPs) are good carriers of persistent organic pollutants (POPs) such as polybrominated diphenyl ethers (PBDEs) and can modify their bioavailability and toxicity to aquatic organisms. This study highlights the single and combined toxic effects of polystyrene nanoplastics (PS-NPs) and 2,2 ',4,4 '-tetrabromodiphenyl ether (BDE-47, one of the major PBDE congeners) on zebrafish embryos after an exposure of up to 120 hpf. Our results showed that PS-NPs and BDE-47 formed larger particle aggregates during co-exposure, which attached to the surface of the yolk membrane and even changed its structure, and these particles also bioaccumulated in the intestine of zebrafish larvae, compared with the PS-NPs single exposure. Further, the co-exposure significantly increased mortality, accelerated voluntary movements, enhanced hatching rate, and decreased heart rate. Hepatoxicity analyses revealed that the mixture exposure induced a darker/browner liver colour, atrophied liver and greater hepatotoxicity in zebrafish larvae. In addition to increased ROS accumulation, the reduced expression of the antioxidant gpx1a gene and increased expression of cyp1a1 were found after co-treatment. Moreover, ache and chrn7α genes associated with neurocentral development, were significantly downregulated, mainly in the co-exposure group. In conclusion, simultaneous exposure to PS-NPs and BDE-47 exacerbated oxidative stress, developmental impacts, hepatotoxicity, and neurodevelopmental toxicity in zebrafish larvae. Therefore, neurotoxic effects of complex chemical interactions between PS-NPs and persistent organic pollutants in freshwater environments should be paid more attention.

Variations and its driven factors of anthropogenic nitrogen loads in the Yangtze River Economic Belt during 2000-2019

Since the millennium, China has economically taken off with rapid urbanization, and anthropogenic nitrogen emission intensity has undergone remarkable changes. To better understand the impact of urbanization on anthropogenic nitrogen, this study calculated the spatio-temporal heterogeneity of anthropogenic nitrogen in the Yangtze River Economic Belt (YREB) since 2000, based on the estimation, using obstacle analysis to quantify the driving of industry and agriculture on N growth and using the gray model to analyze the impact of urbanization on N changes. Additionally, using the environmental pressure model to predict the future N load. The results indicated N load in the YREB increased rapidly from 21.4 Tg in 2001 to a peak of 24.5 Tg in 2012 and then decreased to 22.2 Tg in 2019. Although N flux gradually increased from the west to the east of the YREB, the growth rate had an opposite trend with a negative growth in the eastern region. Hotspots are mainly concentrated in urban agglomerations, which contributed to ~ 60% N load of the YREB, and the YREB contributed to ~ 90% N load of the Yangtze River Basin. Obstacle degree scores indicated wastewater was a major industrial driver of N growth before 2010, and then became waste gas; increased mechanization and fertilizer control effectively reduced nitrogen emissions during agricultural development. The gray analysis of urbanization indicated urban population, industry, and services had the strongest correlation with N load changes. Scenario simulations suggest N loads of the YREB remain at a high level by 2030; however, there are still opportunities to effectively control N growth through high technological innovation and reducing the proportion of industry under an enormous population. This research contributes to a better understanding of the impact of urbanization on anthropogenic nitrogen and helps developing countries to precisely control nitrogen hotspots and sources.

Polyaspartic acid enhances the Cd phytoextraction efficiency of Bidens pilosa by remolding the rhizospheric environment and reprogramming plant metabolism

The green soil chelator polyaspartic acid (PASP) can enhance heavy metal phytoextraction efficiency, but the potential mechanisms are not clearly understood from the whole soil-plant system. In this study, we explored the effects and potential mechanisms of PASP addition in soils on plant growth and cadmium (Cd) uptake in the Cd hyperaccumulator Bidens pilosa by analysing variations in chemical elements, rhizospheric microbial community, and plant metabolomics. The results showed that PASP significantly promoted the biomass yield and Cd concentration in B. pilosa, leading to an increase in the total accumulated Cd by 46.4% and 76.4% in shoots and 124.7% and 197.3% in roots under 3 and 6 mg kg^-1 PASP addition, respectively. The improved soil-available nutrients and enriched plant growth-promoting rhizobacteria (e.g., Sphingopyxis, Sphingomonas, Cupriavidus, Achromobacter, Nocardioides, and Rhizobium) were probably responsible for the enhanced plant growth after PASP addition. The increase in Cd uptake by plants could be due to the improved rhizosphere-available Cd, which was directly activated by PASP and affected by the induced rhizobacteria involved in immobilizing/mobilizing Cd (e.g., Sphingomonas, Cupriavidus, Achromobacter, and Rhizobium). Notably, PASP and/or these potassium (K)-solubilizing rhizobacteria (i.e., Sphingomonas, Cupriavidus, and Rhizobium) highly activated rhizosphere-available K to enhance plant growth and Cd uptake in B. pilosa. Plant physiological and metabolomic results indicated that multiple processes involving antioxidant enzymes, amino acids, organic acids, and lipids contributed to Cd detoxification in B. pilosa. This study provides novel insights into understanding how soil chelators drive heavy metal transfer in soil-plant systems.

[Clinical manifestations of 1 015 cases of herpes simplex virus keratitis]

Objective: To explore the demographic distribution, clinical signs, and clinical types of herpes simplex virus keratitis (HSK). Methods: Retrospective case series. The data of 1 015 cases of HSK (1 054 eyes) diagnosed in Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University from January 2010 to June 2019 were collected. The patients included 613 males and 402 females, and the age was 47.43±16.79 years. Information of the patients such as age, sex, the season of onset, eye laterality, and clinical signs was assessed. Slit-lamp microscopy and corneal fluorescein staining were used to locate the anatomical position of lesions. HSK was classified into epithelial type, neurotrophic type, stromal type, endothelial type, and mixed type. The distribution data was compared by the Chi-square test or Fisher's exact test. Results: There were 41 children (≤14 years old; 4.04%), 338 youth (15-44 years old; 33.30%), 374 middle-aged (45-59 years old; 36.85%), and 262 elderly (≥60 years old; 25.81%) patients. The type was epithelial in 246 cases (24.24%), neurotrophic in 27 cases (2.66%), stromal in 372 cases (36.65%), endothelial in 274 cases (26.99%), and mixed in 96 cases (9.46%). There was statistically significant difference in clinical typing among the different age groups (χ²=30.197, P=0.003). Epithelial HSK was found in 141 males (57.32%) and 105 females (42.68%), neurotrophic HSK in 16 males (59.26%) and 11 females (40.74%), stromal HSK in 226 males (60.75%) and 146 females (39.25%), endothelial HSK in 171 males (62.41%) and 103 females (37.59%), and mixed HSK in 59 males (61.46%) and 37 females (38.54%). There was no statistically significant difference in clinical classification of keratitis between genders (χ²=1.519, P=0.823). Among the cases of mixed type, there were 21 cases of epithelial-stromal type (21.88%), 30 cases of epithelial-endothelial type (31.25%), 37 cases of stromal-endothelial type (38.54%), 1 case of epithelial-neurotrophic type (1.04%), and 7 cases of neurotrophic-stromal type (7.29%). Conclusions: HSK occurs mainly in middle-aged and young adults, but rarely in children. The proportion of males is higher than that of females. The proportion of stromal HSK is highest, and 9.46% of patients present mixed HSK.

Factors associated with depression in residents in the post-epidemic era

OBJECTIVE

To explore the factors associated with depression in residents in the post-epidemic era of COVID-19.

METHODS

A multi-stage stratified random sampling method was used to conduct a questionnaire survey among community residents through self-designed questionnaires and self-rating depression scale (SDS). Multivariate logistic regression analysis was performed on the influencing factors of depressive symptoms.

RESULTS

A total of 1993 residues completed the survey of depression status. The incidence of depressive symptoms was 27.04%. The multivariate logistic regression analysis showed that female (odds ratio (OR): 6.239, 95% confidence interval (CI): 2.743-10.698), body mass index (BMI) > 24 (OR: 2.684, 95% CI: 1.059-3.759) and drinking (OR: 1.730, 95% CI: 1.480-3.153) were the risk factors for developing depressive symptoms. Married (OR: 0.417, 95% CI: 0.240-0.652), monthly income (3001-5000 yuan, OR: 0.624, 95% CI: 0.280-0.756; >5000 yuan, OR: 0.348, 95% CI: 0.117-0.625), ordinary residents (OR: 0.722, 95% CI: 0.248-0.924) and urban residents (OR: 0.655, 95% CI: 0.394-0.829) were the protective factors of depressive symptoms.

CONCLUSIONS

Under the post-epidemic era of COVID-19, depressive symptoms are still common among community residents in China. Gender, BMI, drinking, marriage, monthly income and nature of personnel and residential area are associated with the incidence of depressive symptoms.

[A retrospective controlled study on the treatment effect of distraction osteogenesis and maxillomandibular advancement for severe obstructive sleep apnea hypopnea syndrome patients]

Objective: To compare the treatment effect of distraction osteogenesis (DO) and maxillomandibular advancement (MMA) for severe obstructive sleep apnea hypopnea syndrome (OSAHS) patients and to guide clinical decisions about treatment of OSAHS. Methods: Thirty-seven OSAHS patients which accepted maxillomandibular advancement (MMA) or distraction osteogenesis (DO) in Stomatological Hospital of the Department of Maxillofacial Trauma and Orthognathic Surgery, School of Stomatology, The Forth Military Medical University from June 2017 to June 2019 were collected. Their preoperative and postoperative data of cephalometry, polysomnography (PSG), Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale (ESS) scores were collected and analyzed. With propensity score matching method, the treatment effect of MMA and DO was analyzed and compared. Results: According to the statistics of MMA group, only AHI was correlated with operative successful rate and cure rate. With the increase of AHI, the treatment effect of MMA on OSAHS patients gradually decreased. The cut-off point of AHI as a predictor of MMA treatment failure was 78.2 n/h. All the matched cases were severe OSAHS patients. Statistical analysis showed that the mandibular elongation of DO patients[(24.00±4.39) mm] was significantly more than that of MMA group [(11.20±1.37) mm] (t=-6.11, P<0.001), the improvement of PSG index [including lowest oxygen saturation (LSpO₂), longest apnea (LA) and longest hypopnea (LH)] in DO group [LSpO₂=(93.40±1.82)%; LA=(18.28±8.32) s; LH=(61.84±32.94) s] was significantly higher than that in the MMA group [LSpO₂=(86.00±4.06)%, LA=(64.08±21.78) s, LH=(172.40±30.70) s](t=-3.72, P=0.005; t=4.39, P=0.003; t=5.49, P=0.004). The PSQI and the ESS scores of DO group (PSQI=4.20±0.83; ESS=3.40±1.52) were also significantly better than that of MMA group (PSQI=8.80±2.39, ESS=9.40±2.88)(t=4.07, P=0.001; t=4.12, P=0.002). Conclusions: For severe OSAHS patients, the objective and subjective indicators of DO treatment group showed a better therapeutic effect than that of MMA.

Efficacy and safety of intracoronary pro-urokinase injection during percutaneous coronary intervention in treating ST elevation myocardial infarction patients: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

Intracoronary injection of pro-urokinase (Pro-UK) during percutaneous coronary intervention (PCI) seems to be a promising treatment in improving myocardial perfusion. In this systematic review and meta-analysis, we aimed at investigating the efficacy and safety of intracoronary Pro-UK injection during PCI in ST elevation myocardial infarction (STEMI) patients.

MATERIALS AND METHODS

A comprehensive literature searched on PubMed, Embase, Cochrane, Ovid-MEDLINE, Ovid-Embase, Ovid-Cochrane Databases and ClinicalTrials.gov from inception until June 1, 2022, in English only. The primary outcome was myocardial perfusion, including thrombolysis in myocardial infarction (TIMI) grades, corrected TIMI frame count (CTFC), TIMI myocardial perfusion grades (TMPG). The secondary outcomes were ST-segment resolution (STR), major adverse cardiovascular events (MACE), myocardial marker, cardiac function and hemorrhagic complications.

RESULTS

We identified 5 studies (all RCTs) involving 761 participants. Under PCI procedure, compared with placebo, intracoronary Pro-UK injection may improve myocardial perfusion, including increasing the TIMI grades [odd ratio (OR) 0.46; 95% confidence interval (CI) 0.28-0.75; p = 0.002; I2 = 0%] , CTFC (OR -3.47; 95% CI [-5.60, -1.33]; p = 0.001; I2 = 0%) and TMPG (OR 0.17; 95% CI [0.06-0.44]; p = 0.0003; I2 = 0%), increase the rate of STR (OR 2.25; 95% CI [1.56-3.26]; p < 0.0001; I2 = 0%), reduce the incidence of MACE (OR 0.51; 95% CI [0.33-0.81]; p = 0.004; I2 = 0%) and reduce myocardial infarct size (CK, standardized mean difference [SMD] -0.45; 95% [CI] [-0.62, -0.28]; p < 0.00001; I2 = 10%. CK-MB, [SMD] -0.43; 95% CI [-0.68, -0.18]; p = 0.0007; I2 = 60%. cTnI, [SMD] -0.31; 95% CI [-0.46, -0.17]; p < 0.0001; I2 = 0%). Moreover, the treatment may improve the cardiac functions (LVFE, pooled mean difference [MD] 1.23; 95% CI [0.66-1.79]; p < 0.0001; I2 = 24%. LVEDd, pooled MD -0.13; 95% CI [-0.17, -0.09]; p < 0.00001; I2 = 0%). But there is no statistically significant difference between the Pro-UK group and placebo in the occurrence of hemorrhagic complications (OR 1.19; 95% CI [0.75-1.87]; p = 0.46; I2 = 0%).

CONCLUSIONS

Intracoronary Pro-UK injection during PCI in STEMI patients is an effective and safe treatment to perform. The treatment may improve myocardial perfusion and rate of STR, as well as decreasing the incidence of MACE and myocardial infarct size. Importantly, the treatment may improve the cardiac functions and life quality. In the future, more multi-centered and massive sample studies are required.

Tracing phosphorus cycle in global watershed using phosphate oxygen isotopes

The Phosphorus (P) cycle is a crucial biochemical process in the earth system. However, an extensive increase of P input into watersheds destroyed the ecosystem. To explore the effects of internal P loading and external P input in global watersheds, we reviewed the research progress and synthesized the isotope data of experimental results from literatures. An integrated result of the observational and experimental studies revealed that both internal P and external P largely contribute to watershed P loadings in watersheds. Internal P can be released to the overlying water during sediment resuspension process and change of redox conditions near the sediment-water interface. Growing fertilizer application on farmlands to meet food demand with population rise and diet improvement contributed to an huge increase of external P input to watersheds. Therefore, water quality cannot be improved by only reducing internal P or external P loadings. In addition, we found that phosphate oxygen isotope technology is an effectively way to trace the P biogeochemical cycle in watersheds. To better predict the dynamic of P in watersheds, future research integrating oxygen isotope fractionation mechanisms and phosphate oxygen isotope technology would be more effective.

Toxic effects of polystyrene nanoplastics and polybrominated diphenyl ethers to zebrafish (Danio rerio)

Nanoplastics (NPs) are good carriers of persistent organic pollutants (POPs) such as polybrominated diphenyl ethers (PBDEs), and can alter their bioavailability and toxic impacts to aquatic organisms. This study highlights the single and combined toxic effects of polystyrene nanoplastics (PS-NPs) and 2,2',4,4'-tetrabromodiphenyl ether (BDE-47, one of the dominant congeners of PBDEs) on zebrafish embryos after an exposure duration of up to 120 hpf. Results showed that PS-NPs and BDE-47 co-exposure exacerbated the morphological deformities in terms of pericardial edema, yolk sac edema and curved tail in zebrafish larvae. Compared to BDE-47 single exposure, the combined exposure caused lower survival rates, shorter body lengths, and accelerated spontaneous movements. Further, PS-NPs were quickly aggregated on the surface of the embryonic chorions covered almost the entire membrane at 12 and 48 hpf, and concentration dependent accumulation was also found in the brain, mouth, trunk, gills, heart, liver and gastrointestinal tract at the larval stages. During the recovery period (7 days), PS-NPs were released from all the organs, with the highest elimination from the gastrointestinal tract. Histopathological examination revealed that co-exposure caused greater damage to retinal structures, muscle fibers and cartilage tissues. Responses of hypothalamic-pituitary-thyroid axis (CRH, TSHβ, NIS, TTR, Dio2, TG, TRα and TRβ) and reproduction (Esr2 and Vtg1) related genes were also investigated, and results showed that the co-exposure induced more significant upregulated expressions of TSHβ, TG, Doi 2, and TRβ, compared to BDE-47 single exposure. In conclusion, co-exposure to NPs and BDE-47 exacerbated developmental and thyroid toxicity in zebrafish, generally elucidating the toxicological effects mediated by complex chemical interactions between NPs with POPs in the freshwater environment.

Recent Advances of Biochar-Based Electrochemical Sensors and Biosensors

In the context of accelerating the global realization of carbon peaking and carbon neutralization, biochar produced from biomass feedstock via a pyrolysis process has been more and more focused on by people from various fields. Biochar is a carbon-rich material with good properties that could be used as a carrier, a catalyst, and an absorbent. Such properties have made biochar a good candidate as a base material in the fabrication of electrochemical sensors or biosensors, like carbon nanotube and graphene. However, the study of the applications of biochar in electrochemical sensing technology is just beginning; there are still many challenges to be conquered. In order to better carry out this research, we reviewed almost all of the recent papers published in the past 5 years on biochar-based electrochemical sensors and biosensors. This review is different from the previously published review papers, in which the types of biomass feedstock, the preparation methods, and the characteristics of biochar were mainly discussed. First, the role of biochar in the fabrication of electrochemical sensors and biosensors is summarized. Then, the analytes determined by means of biochar-based electrochemical sensors and biosensors are discussed. Finally, the perspectives and challenges in applying biochar in electrochemical sensors and biosensors are provided.

[Diffuse midline gliomas with H3K27 alteration in children: a clinicopathological analysis of forty-one cases]

Objective: To investigate the clinicopathological features of pediatric diffuse midline glioma with H3K27 alteration and to analyze their relationship with prognosis. Methods: Forty-one cases of childhood diffuse midline glioma with H3K27 alteration were collected at Children's Hospital of Fudan University (39 cases) and Xi'an Children's Hospital (2 cases), from July 2016 to July 2020. The clinical manifestations, imaging data, histopathology, immunohistochemical phenotype and molecular genetics features, tumor size, site and histological grading were evaluated. Results: Among the 41 cases, 21 were males and 20 females, the age of onset was 3-14 years, the average and median age was 7.6 years and 7.0 years, respectively. The tumor sites were brain stem (n=36) and other locations (n=5). The clinical manifestations were dizziness, gait disturbance, and limb weakness, etc. The MRI features were variable. The histology varied from low-grade to high-grade glioma with neuron differentiation. Immunohistochemistry showed that the tumor cells expressed H3K27M, GFAP, and Olig2. Genetic study showed that 76% (16/21) of tumors had H3F3A gene mutation, mostly accompanied by TP53 (62%, 13/21) missense mutation; five tumors (24%, 5/21) had HIST1H3B gene mutation, accompanied by missense mutations in ACVR1 and PI3K pathway-related gene PIK3CA (4/5) and PIK3R1 (1/5) mutations. The prognosis was dismal with only one alive and others died. The average and median overall survival time was 7 months and 4 months, respectively. Cox multivariate regression analysis showed that age, tumor location, radiologically maximum tumor diameter, histologic grading, and surgical methods were not significantly associated with overall survival rate (P>0.05). Conclusions: Pediatric diffuse midline gliomas with H3K27 alteration have unique clinicopathological and genetic characteristics. The prognosis is poor. The tumor location and histopathologic grading are not related to prognosis. New specific drugs and comprehensive treatment are needed to improve the prognosis.

An integrated approach to quantify ecological and human health risks of soil heavy metal contamination around coal mining area

Soil heavy metals harm ecological biodiversity and human health, and quantifying the risks more accurately is still obscure. In this study, a network environ analysis was applied to quantify risks between ecological communities based on control allocation and human health risk models to calculate human health exposure risks from soil heavy metals around Greenside coal mining in South Africa. Ecological and human health risks were apportioned using PMF model. Results showed assessed heavy metals (mean) exceeded local background content with a cumulative of moderately polluted using pollution load index (PLI). Total initial risk (R_i), the risk to biological organisms from direct soil exposure, was 0.656 to vegetation and 1.093 to soil microorganisms. Risk enters the food web via vegetation and harms the whole system. Integrated risks (initial, direct, and indirect) to vegetation, herbivores, soil microorganisms, and carnivores were 0.656, 0.125, 1.750, and 0.081, respectively, revealing that soil microorganisms are the most risk receptors. Total Hazard Index (HI_T) was <1 for adults (0.574) whereas >1 for children (4.690), signifying severe non-cancer effects to children. Total cancer risk (TCR) to children and adults surpassed the unacceptable limit (1.00E-04). Comparatively, Cr is a high-risk metal accounted for 63.24% (adults) and 65.88% (children) of the HI_T and 92.98% (adults) and 91.31% (children) of the TCR. Four sources were apportioned. Contributions to R_i (soil microorganisms and vegetation) from F3 (industrial), F4 (atmospheric), F2 (coal mining), and F1 (natural) were 42.20%, 24.56%, 23.55%, and 9.68%, respectively. The non-cancer risk from F3 (37.67% to adults and 38.40% to children) was dominant, and TCR to children from the sources except F1 surpassed the unacceptable limit. An integrated approach of risk quantification is helpful in managing risks and reducing high-risk pollution sources to better protect the environment and human health.

Portable fluid circuit device containing printed silicone microvessels as a training aid for arterial microanastomosis

Anastomosis of the microvessels requires high-level skills and extensive basic training. This study was performed to introduce and evaluate an inexpensive laboratory device as a training aid. Micro-tubes of 0.8 mm inner diameter and 0.5/0.8 mm wall thickness mimicking human vein/artery were printed from a silicon-containing hydrogel using three-dimensional printing technology. The hydrogel components are optimized to render the printed tubes biomechanical features resembling the blood vessels of a living organism. These artificial vessels were connected to a pump for fluid flow, simulating the blood circulation. Forty medical interns were assigned to two equal groups. The 20 interns in group A practiced anastomosis using the training aid for a total of 10 hours over 5 days. The 20 interns in group B practiced anastomosis using the traditional gum pieces and silicone tubes. Then, all interns performed anastomosis on rat carotid arteries, and their performance was scored by a team of five experienced maxillofacial surgeons. The average success score and time required for anastomosis were compared between the two groups. The mean success score of group A was significantly higher than that of group B (0.83 ± 0.12 vs 0.64 ± 0.10, P < 0.001). The mean anastomosis time of group A was significantly shorter than that of group B (10.2 ± 1.1 vs 17.2 ± 1.4 minutes, P < 0.001). This training device for vessel microanastomosis is an inexpensive, practical, and effective tool for use in laboratories and also reduces the use of animals.

[Efficacy of a recombinant bovine basic fibroblast growth factor gel for the treatment of moderate dry eye: a multicenter randomized double-blind parallel controlled clinical trial]

Objective: To compare the clinical efficacy of a recombinant bovine basic fibroblast growth factor (rb-bFGF) gel and a gel matrix in the treatment of moderate dry eye. Methods: It was a prospective random double-blind controlled study. One hundred patients diagnosed as moderate dry eye in Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Beijing Tongren Hospital, Capital Medical University, Eye & ENT Hospital of Fudan University and Zhongshan Ophthalmic Center from August 2015 to April 2019 were divided into two groups: experimental group and control group. Two groups of patients were allocated to receive either a rb-bFGF gel or a gel matrix 4 times per day for 4 weeks. Subjective symptoms, break-up time of the tear film (BUT), Schirmer Ⅰ test (SⅠt) and corneal fluorescein sodium staining were assessed at baseline, 2 and 4 weeks after treatment. Bulbar impression cytology was evaluated at baseline and 4 weeks after treatment. Irritation of the rb-bFGF gel and the gel matrix was estimated after treatment. T test, Wilcoxon signed-rank test or Mann-Whitney U test was used for quantitative data, and Chi-square test was used for enumerative data. Results: Eighty-four subjects were included for statistical analyses after the exclusion of 16 subjects who were lost for followup, with an age of 43±14 years. There were 42 cases in the experimental group and the control group, respectively. There was no statistically significant difference between the two groups in demographic baseline characteristics before treatment (P>0.05). The total score of subjective symptoms was 7.17±3.60 and 5.95±3.25 at 2 and 4 weeks after therapy in the experimental group, which were lower than 9.48±3.88 before treatment (t=6.226, 6.563; both P<0.05); in the control group, it was 7.01±3.25 and 6.32±3.85 at 2 and 4 weeks after treatment, with a significant reduction in comparison with that before treatment (9.15±3.58; t=4.693, 4.726; both P<0.05). The median (lower quartile, upper quartile) BUT was 4.00 (2.40, 5.00) s and 4.64 (3.00, 5.00) s at 2 and 4 weeks after therapy in the experimental group, which were longer than 3.72 (2.00, 4.39) s before treatment (Z=-2.485, -3.152; both P<0.05). The BUT was 4.41 (2.79, 5.12) s at 2 weeks after therapy in the control group, which was of no statistical difference compared with 3.89 (2.09, 4.25) s before treatment (Z=-1.953, P>0.05). The BUT was 5.21 (3.00, 5.02) s at 4 weeks after therapy in the control group, which was longer than that before treatment (Z=-2.485, P<0.05). The SⅠt score was 7.31 (3.75, 10.00) mm and 8.50 (4.00, 11.00) mm at 2 and 4 weeks after therapy in the experimental group, which were significantly higher than 6.69 (2.00, 8.13) mm before treatment (Z=-2.031, -2.236; both P<0.05); in the control group, it was 6.82 (2.00, 8.25) mm and 6.86 (3.00, 9.25) mm at 2 and 4 weeks after therapy, which were not significantly increased compared with 6.50 (2.00, 7.75) mm before treatment (Z=-0.179, -1.161; both P>0.05). The corneal fluorescein sodium staining points were 5.00 (2.00, 5.00) and 3.71 (0.00, 5.00) at 2 and 4 weeks after therapy in the experimental group, which were significantly lower than 7.10 (5.00, 7.00) before treatment (t=-2.895, -4.639; both P<0.05); those in the control group were 5.52 (0.00, 7.00) and 6.19 (0.75, 6.25) at 2 and 4 weeks after treatment, with a significant reduction in comparison with 8.90 (5.00, 10.50) before treatment (t=-2.776, -1.991; both P<0.05). The differences in the average total score of subjective symptoms, BUT, SIt, and corneal fluorescein sodium staining points between both groups were not statistically significant at each time point. The impression cytology grade was decreased from 1.72 (1.00, 2.00) before treatment to 0.94 (0.00, 2.00) at 4 weeks after therapy in the experimental group (Z=-2.803, P<0.05). The staining grade of conjunctival imprinted cells in the control group was 1.42 (1.00, 2.00) at 4 weeks, which showed no statistical significance compared with 1.56 (1.00, 2.00) before treatment (Z=1.195, P>0.05). The impression cytology grade was significantly reduced in the experimental group compared with the control group at 4 weeks after treatment (Z=-3.308, P<0.05). The number of goblet cells was 10.90 (5.00, 20.00) at 4 weeks after therapy in the experimental group, which was significantly higher than 6.30 (5.00, 8.00) before treatment (Z=-2.383, P<0.05); in the control group, it was 8.36 (4.00, 12.00) at 4 weeks after treatment, with no significant increase in comparison with that before treatment [7.55 (5.00, 11.00)] (Z=-0.095, P>0.05). The number of goblet cells was not significantly increased in the experimental group compared with the control group at 4 weeks after treatment (Z=-1.162, P>0.05). Most patients indicated that the drug was non-irritating, and no patient had intolerable irritation affecting daily lives at 4 weeks after therapy; there was no difference between the two groups (Z=-0.290, P>0.05). Conclusions: Both the rb-bFGF gel and the gel matrix can effectively improve the symptoms and signs of moderate dry eye. However, compared with the gel matrix, the rb-bFGF gel shows obvious advantages in promoting conjunctival epithelial cell repair and increasing the number of goblet cells. (Chin J Ophthalmol, 2021, 57: 930-938).

[Efficacy of early interdisciplinary palliative care based on WARM model in non-small-cell lung cancer]

Objective: To assess the therapeutic effect of the early interdisciplinary palliative care based on WARM model (whole, assessment, revaluation, management) on the quality of life, psychological state, pain and nutritional status in patients with non-small-cell lung cancer (NSCLC). Methods: A total of 60 patients from Chongqing University Cancer Hospital with newly diagnosed advanced NSCLC from Oct 15, 2019 to Jun 12, 2020 were enrolled. According to the method of random number table, the patients were divided into two groups: standard oncologic care group (SC, n=30) and early palliative care group (EPC, n=30). SC group only received standard oncological care, while EPC group received standard oncological care and additional comprehensive treatment from a MDT consisted of medical oncologists, palliative care nurses, dietitians and psychologists. The quality of life [functional assessment of cancer therapy-lung (FACT-L) scale], psychological state [hospital anxiety and depression scale (HADS) and patient health questionnaire-9 (PHQ-9)], nutritional status [patient-generated subjective global assessment (PG-SGA)], and cancer pain status [numerical rating scale (NRS)] were observed and compared between the two groups before and after the 6 months treatment, respectively. Results: A total of 45 patients completed 6 months treatment, including 24 males and 21 females, aged 38-82 (60.5±1.7), with 23 patients in the EPC group and 22 patients in the SC group. Patients assigned to EPC group had a better quality of life than those assigned to SC group [FACT-L scale: (122.3±1.6) vs (111.8±2.1), P<0.001]. Fewer patients had anxiety and depressive symptoms in the EPC group than those in the SC group [HADS anxiety subscale: (1.1±0.3) vs (2.9±0.4), P<0.001; HADS depression subscale: (0.7±0.3) vs (3.6±0.4), P<0.001]. The PHQ-9 results showed that 100.0% (23/23) patients were free of depression in the EPC group, while 45.5% (10/22) patients were free of depression in SC group (P<0.001). Furthermore, patients in the EPC group had a better nutritional status [moderate malnutrition: 60.9% (14/23); no malnutrition: 39.1% (9/23)] than those in the SC group [severe malnutrition: 40.9% (9/22); moderate malnutrition: 50.0% (11/22); no malnutrition: 9.1% (2/22)] (P<0.001). There was no significant difference in NRS score between EPC group and SC group (P=0.140). Conclusion: Early interdisciplinary palliative care based on WARM model can improve the quality of life, psychological state and nutritional status in NSCLC patients.

[Effects of SGLT2i on 24-hour ambulatory blood pressure in patients with type 2 diabetes complicating hypertension: a meta-analysis]

Objective: To analyze the effects of different types of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on 24-hour ambulatory blood pressure in patients with type 2 diabetes mellitus and hypertension. Method: In this meta-analysis, we searched for randomized controlled trials on the effect of SGLT2i on 24-hour ambulatory blood pressure in patients with type 2 diabetes and hypertension. Three databases, namely PubMed, Web of Science and Cochrane Library, were searched. The search was organized on the concept of 3 conceptual groups: the first group contained terms used to describe SGLT2i, the second group contained terms related to blood pressure, and the third group contained terms used to describe randomized controlled trials. The search time was from the establishment of the database to December 2020. The inclusion and exclusion criteria were formulated in accordance with the requirements of the Cochrane systematic review. According to whether the heterogeneity of the study was significant or not, a random effect model or a fixed effect model were used to conduct the analysis on the impact of different types of SGLT2i on 24-hour ambulatory blood pressure and day and night blood pressure in patients with type 2 diabetes and hypertension. Further subgroup analysis was performed to define potential factors, which might lead to clinical heterogeneity. Results: Seven clinical trials were finally included. The result of the meta-analysis showed that compared with placebo group, SGLT2i could reduce the 24-hour dynamic systolic blood pressure of patients with type 2 diabetes and hypertension by 4.36 mmHg (1 mmHg=0.133 kPa). Reduction was 4.59, 3.74, 5.06, and 3.64 mmHg by canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin respectively; SGLT2i could reduce the 24-hour dynamic diastolic blood pressure of patients with type 2 diabetes and hypertension by 2.20 mmHg, and the reduction was 2.30, 1.22, 2.00, and 2.69 mmHg by canagliflozin, dapagliflozin, empagliflozin and ertugliflozin respectively. SGLT2i could reduce the daytime systolic blood pressure of patients with type 2 diabetes and hypertension by 5.25 mmHg, and reduction was 5.38, 4.87, 6.00, and 4.37 mmHg by canagliflozin, dapagliflozin, empagliflozin and ertugliflozin, respectively. Simultaneously, SGLT2i could reduce the diastolic blood pressure of patients with type 2 diabetes and hypertension by 2.62 mmHg, and the reduction was 2.56, 2.47, and 2.80 mmHg by canagliflozin, empagliflozin and ertugliflozin, respectively. SGLT2i could reduce the nighttime systolic blood pressure of patients with type 2 diabetes and hypertension by 3.62 mmHg, and the reduction was 2.09, 2.06, 3.92, and 2.45 mmHg by canagliflozin, dapagliflozin, empagliflozin and ertugliflozin, respectively. At the same time, SGLT2i could reduce the nighttime diastolic blood pressure of patients with type 2 diabetes and hypertension by 1.60 and 1.51 mmHg, the reduction was 1.53 and 2.58 mmHg by canagliflozin, empagliflozin and ertugliflozin, respectively. Conclusion: SGLT2i can reduce 24-hour ambulatory blood pressure in patients with type 2 diabetes and hypertension.

[Epidemiological investigation on an imported cutaneous anthrax case in Shanghai]

Objective: To discuss the challenges and problems of the prevention and control of emerging infectious diseases in Shanghai as a megacities. Methods: An imported case of cutaneous anthrax occurred in Shanghai on May 30, 2019. Shanghai Municipal Center for Disease Control & Prevention conducted an epidemiological investigation and treatment of the cases; after this case, the data of patients with cutaneous anthrax were collected, and an epidemiological study was conducted. Meanwhile, the wound and blood samples of the patient were collected for laboratory testing. Results: Of the seven wound samples of the patient, 6 were positive for the Bacillus anthracis nucleic acid test, and the double serological test results showed a 4-fold increase in the titer of anthrax antibodies. Shanghai CDC conducted an epidemiological investigation of the confirmed cases and observed its contacts. After treatment, the patients recovered, and no other issues appeared among the 19 contacts. Conclusions: Shanghai must strengthen the training of clinicians on emerging infectious diseases to achieve early detection, diagnosis, and treatment of imported infectious diseases and reduce the incidence, spread, and death of the diseases. At the same time, multi-department joint prevention and control are needed to prevent and control secondary cases.

Long non-coding RNA UCA1 mediates proliferation and metastasis of laryngeal squamous cell carcinoma cells via regulating miR-185-5p/HOXA13 axis

OBJECTIVE

LncRNA urothelial cancer associated 1 (UCA1) is involved in the development of laryngeal squamous cell carcinoma (LSCC), however, its specific mechanism is not fully clear.

PATIENTS AND METHODS

Quantitative reverse transcription-PCR (RT-qPCR) was conducted to determine the expressions of lncRNA-UCA1, miR-185-5p and homeobox A13 (HOXA13) in LSCC tissues and cell lines. Cell Counting Kit-8 assay, colony formation assay, wound healing assay, Transwell and flow cytometry, DIANA-LncBase V2, as well as Starbase, Targetscan, and Dual-Luciferase reporter gene system were conducted to detect and confirm the crosstalk networks among lncRNA-UCA1, miR-185-5p, and HOXA13.

RESULTS

The levels of UCA1 and HOXA13 were significantly higher and the expression of miR-185-5p was reduced in LSCC tissues and cell lines. Moreover, miR-185-5p was predicted as a target gene for lncRNA UCA1, while HOXA13 was the target gene for miR-185-5p. UCA1 siRNA inhibited the proliferation and invasion of LSCC cells, moreover, the proliferation and invasion of LSCC cells were suppressed by miR-185-5p mimics but were enhanced by miR-185-5p inhibitor. UCA1 siRNA and overexpressed HOXA13 reversed the promotive effects of miR-185-5p inhibitor and inhibitory effects of miR-185-5p mimics on cell proliferation and metastasis, respectively.

CONCLUSIONS

The current findings reveal the important role of lncRNA UCA1/miR-185-5p/HOXA13 regulatory network in LSCC cells, and potentially provide new insights into the pathogenesis of LSCC.

Cross-genera amplification and identification of Colpodella sp. with Cryptosporidium primers in fecal samples of zoo felids from northeast China

The protozoans include many intracellular human pathogens. Accurate detection of these pathogens is necessary to treat the diseases. In clinical epidemiology, molecular identification of protozoan is considered a more reliable and rapid method for identification than microscopy. Among these protozoans, Cryptosporidium considered being one of the important water-borne zoonotic pathogens and a major cause of a diarrheal disease named cryptosporidiosis in humans, domestic animals, and wild animals. This study was aimed to identify Cryptosporidium in zoo felids (N= 56) belonging to different zoo of China, but accidentlly Colpodella was encountered in the zoo felids sample and phylogenetic data confirmed this unexpected amplification from fecal samples using two-step nested-PCR. Phylogenetic analysis revealed the fact about the specific primers used previously by many researchers and cross-genera amplification. We came to know that genetically sequenced amplicon gives more accurate identification of species. This study suggests more investigation on Colpodella which has been neglected previously but gains the attention of researchers after identified from humans and animals and has been known to correlate with neurological symptoms in patients.