The association between the vaginal microenvironment and fecundability: a register-based cohort study among Chinese women

OBJECTIVE

To evaluate the association between the vaginal microenvironment and fecundability among women.

DESIGN

Register-based nationwide cohort study.

SETTING

Chinese National Free Pre-conception Check-up Project from 2015 to 2018.

POPULATION

Our study included a total of 3 388 554 eligible women who were attempting to become pregnant.

METHOD

We assessed the vaginal microenvironment at baseline by considering four indices: vaginal pH, clue cell examination, whiff test and vaginal cleanliness grading. If any of these indicators was abnormal, the vaginal microenvironment was defined as poor. Propensity score matching was used to control for potential confounders and reduce bias. Logistic models were used to estimate the fecundability odds ratios (FORs) after adjustment for covariates.

MAIN OUTCOME MEASURES

Achievement of a pregnancy within 1 year.

RESULTS

Of the total study population, 379 718 women (11.2%) had a poor vaginal microenvironment and their pregnancy rate after 1 year was significantly lower than the group with a normal microenvironment (71.8% versus 76.1%, P < 0.001). After adjusting for potential confounders, the women with a poor vaginal microenvironment were associated with a 9% reduction in fecundability compared with the normal microenvironment group (FOR 0.91, 95% CI 0.90-0.92). The adverse effects of a poor vaginal microenvironment were stronger among multipara (FOR 0.89, 95% CI 0.87-0.90) or women with irregular menstruation (FOR 0.86, 95% CI 0.84-0.89).

CONCLUSION

There was a negative association between a poor vaginal microenvironment and the fecundability of women. These findings highlight the significance of assessing the vaginal microenvironment during pre-pregnancy health examinations.

TWEETABLE ABSTRACT

Women with a poor vaginal microenvironment were associated with a reduction in fecundability.

Nitrification characteristics of long-term idle aerobic activated sludge during domestication

Nitrite accumulation usually occurred when domesticating the idle aerobic activated sludge. A sequencing batch reactor (SBR) was used to investigate whether the short-cut nitrification sludge could be cultivated using the idle sludge as inoculated sludge. The results showed that the nitrification process consisted of three stages. In the first stage, the activity of ammonia-oxidizing bacteria (AOB) and nitrite-oxidizing bacteria (NOB) were very low with almost no nitrification performance. In the second stage, the activity of AOB started to recover with the effluent NH₄⁺-N gradually decreased to 0.29 mg L^-1, while NOB was alternately inhibited by free ammonia (FA), free nitrous acid (FNA), and nitrite. The effluent NO_x^--N was mainly NO₂^--N with an average nitrite accumulation ratio of 74.00%. In the third stage, the nitrification altered from short-cut nitrification to complete nitrification, and the nitrification kinetics of AOB and NOB were both well-fitted to the Monod equation (R² > 0.92). The variations of effluent pH and ORP between cycles could indicate the recovery stage of the nitrifying ability. Through monitoring the curves of effluent pH and ORP, when the domestication process is between the pH peak and ORP plateau, the short-cut nitrification sludge could be cultivated. This study revealed the mechanism of nitrite accumulation during the domestication of long-term idle aerobic activated sludge, and established a control strategy to accelerate the domestication.

[Analysis of bone mineral density and its influencing factors in 211 patients with chronic hepatitis B treated with long-term entecavir monotherapy]

Objective: To investigate the changes of bone mineral density and its related influencing factors in chronic hepatitis B patients treated with long-term entecavir monotherapy. Methods: 211 cases with chronic hepatitis B treated with entecavir monotherapy in the Department of Infectious Diseases of Henan Provincial People's Hospital from June 2018 to September 2019 were retrospectively collected. Age, gender, body mass index, number of years of medication use, presence or absence of liver cirrhosis and current bone mineral density level (using dual-energy X-ray detection, taking lumbar L1 ~ 4 and left femur as observation region) and other related data were collected. 211 cases general situation was descriptively analyzed by case-control study design. Two independent sample t-tests were used to compare the differences in serum calcium, phosphorus, and renal function levels in patients with different medication durations. Univariate logistic regression was used to screen the influencing factors of bone mineral density level. Significant variables of univariate analysis were included in multivariate logistic regression to obtain the independent influencing factors leading to the decrease of bone mineral density level. The test level was set as α = 0.05. Results: The average age of 211 cases with chronic hepatitis B was (42.36 ± 11.10) years. The average medication time use was (2.52 ± 1.94) years. The body mass index (23.95 ± 3.11), and male-to-female ratio was 2.25/1. The incidence of liver cirrhosis was 35.5%. The incidence of low bone mass in the two observation sites (lumbar spine L1~4 and left femur) was 24.6% and 29.4%, respectively. There were statistically significant differences in serum calcium, phosphorus and renal function levels among patients with different entecavir treatment duration (≥3 years and < 3 years) (P < 0.05). Univariate analysis result showed that the influencing factors of BMD were age, the number of years of medication use, gender, liver cirrhosis (L1~4 of the lumbar spine region) and age, the number of years of medication, and gender (left femoral region). The variables that entered the two models after the multivariate analysis were age (L1~4 region of lumbar spine: OR = 2.225, left femur OR = 1.660), gender (L1~4 region of lumbar spine: OR = 3.048, left femur OR = 2.496), number of years of medication use (L1~4 region of lumbar spine: OR = 1.387, left femur OR = 1.276). Conclusion: Age, gender, and the number of years of medication use are independent factors that influence the bone mineral density of patients with chronic hepatitis B treated with long-term entecavir. Low bone mass risk at the two observation sites is 2.225 and 1.66 times the normal level for every 10 years of age increase. Compared with men, the risk of low bone mass at the two observation sites is 3.048 and 2.496 times for women, and for every additional year of medication use, the risk of low bone mass at the two observation sites is 1.387 and 1.276 times the normal level. Female patients with older age and prolonged medication use are at high risk of developing bone mineral density reduction.

Enhanced denitrification of secondary effluent using composite solid carbon source based on agricultural wastes and synthetic polymers

Solid-phase denitrification is a promising approach to enhance nitrate removal. In this work, polybutylene succinate (PBS) and peanut shell (PS) (with crosslinked polyvinyl alcohol-sodium alginate (PVA-SA) as carrier) were used to prepare a composite solid carbon source (3P) to denitrify the secondary effluent. The results showed that for carbon release performance, 3P had not only a large release of organics, like PS, but also the excellent sustainability of PBS. Among the short chain fatty acids released by PBS, PS, PVA-SA and 3P, the percentages of acetic acid were 59.42%, 72.54%, 72.29% and 92.11%, respectively. When 3P was used as external carbon source, denitrification performance could be enhanced with effluent dissolved organic carbon lower than 20 mg/L. The prepared 3P could improve denitrification, from both microbial and kinetic aspects. The relative abundance of Gammaproteobacteria increased from 39.32% to 43.58%, and the half saturation constant of the fitting Monod equation was 21.28 mg/L. The prepared 3P is an ideal carbon source for secondary effluent denitrification. Using multiple crosslinking methods to produce carrier is an effective way to show the properties of each material.

[Impacts of incomplete revascularization following off-pump coronary artery bypass grafting on perioperative outcomes in octogenarians]

Objective: To assess the impacts of incomplete revascularization following off-pump coronary artery bypass grafting (OPCABG) on perioperative outcomes in octogenarians. Methods: A retrospective analysis of 242 octogenarian patients with coronary artery disease (CAD) hospitalized in Beijing Anzhen Hospital from June 2008 to July 2016 was performed. These patients were divided into the complete revascularization group (n=181) and the incomplete revascularization group (n=61) depending on whether they underwent complete revascularization. The impacts of incomplete revascularization following OPCABG on perioperative outcomes were summarized and compared between the two groups. Results: Among the 242 patients over 80 years who received OPCABG, there were 198 males (81.8%). Compared to the complete revascularization group, those in the incomplete revascularization group were older [(83.2±1.5) vs (81.5±1.1) years old, P=0.03], with more carotid stenosis (44.3% vs 25.4%, P=0.01), more involved in the diagonal and circumflex branch of coronary artery (49.2% vs 17.1%, P=0.01; 83.6% vs 70.2%, P=0.03), shorter operative time [(4.1±1.7) h vs (4.7±1.2) h, P=0.03), longer preoperative [(7.1±2.3) d vs (5.2±2.0) d, P=0.01] and total hospitalization time [(16.3±6.8) d vs (12.5±4.2) d, P=0.01], however, the differences of the in-hospital mortality and incidence of other perioperative complications were not statistically significant between the two groups (all P>0.05). Conclusion: Compared with complete revascularization, incomplete revascularization following OPCABG in CAD patients over 80 years old does not increase the perioperative mortality and the incidence of other complications, and it reduces the operative time. However, it increases the time of preoperative and total hospital stay.

Comparison of agricultural wastes and synthetic macromolecules as solid carbon source in treating low carbon nitrogen wastewater

This paper investigated the feasibility of using agricultural wastes and synthetic macromolecules as solid carbon sources and studied the effects of improvement of denitrification by the selected agricultural wastes. The carbon release capacity and denitrification performance of corncob (CC), peanut shell (PS), obsolescent rice (OR) and polycaprolactone (PCL), poly butylene succinate (PBS), polyvinyl alcohol sodium alginate (PVA-SA) were systematically analyzed. The results showed that for each carbon source, the first-order kinetic equation was basically followed during the carbon release process. PVA-SA, CC and PS had higher carbon release capacity with accumulative dissolved organic carbon (DOC) of 16.22-20.63 mg·g^-1 and chemical oxygen demand (COD) of 100.86-134.10 mg·g^-1. Correspondingly, they showed excellent denitrification performance with almost no residual NO₃^--N, and the denitrification process well followed the Monod equation. PCL, PBS and OR had lower carbon release capacity with accumulative DOC of 2.06-3.14 mg·g^-1 and COD of 13.29-24.13 mg·g^-1, respectively. Nevertheless, these materials can also improve the denitrification performance, with the residual NO₃^--N in the range of 6.02-6.36 mg·L^-1, and the effluent DOC was in the range of 10-15 mg·L^-1. Synthetic polymers are more suitable for nitrogen removal in groundwater treatment, while agricultural wastes are ideal carbon sources for secondary effluent treatment.

[A survey on therapy strategies for rheumatoid arthritis in Chinese rheumatologists]

To investigate how Chinese rheumatologists treated patients with rheumatoid arthritis (RA). We performed a survey on the choices of first-line and second-line anti-RA therapies, prescription of methotrexate and glucocorticoids, assessment of disease activity and frequencies of follow-up at the Asia Pacific League of Associations for Rheumatology meeting 2016 in Shanghai. The majority (85.1%) of rheumatologists preferred methotrexate as first-line treatment. As alternative agents, 71.0% rheumatologists chose leflunomide or sulfasalazine. If methotrexate was not tolerable, only 8.6% rheumatologists would switch to parenteral administration. After failure of responding to methotrexate, 62.0% rheumatologists recommended to change or combine other conventional synthetic disease modifying anti-rheumatic drugs (DMARDs). Etanercept was the most popular biological option in 65.2% rheumatologists. Almost all (97.3%) rheumatologists prescribed methotrexate at an initial dose of 7.5 to 15 mg/week and 73.8% rheumatologists at a maximum of 10 to 15 mg/week. There were 49.3% rheumatologists prescribing oral glucocorticoids at first-line therapy. Surprisingly, 42.6% rheumatologists never or rarely assessed disease activity in daily work. For patients having achieved remission, 74.2% rheumatologists would follow up them every 1 to 3 months. This study suggests that most Chinese rheumatologists treat RA patients consistent with international guidelines, while the maximum dose of methotrexate, glucocorticoid as first-line treatment, assessment of disease activity and follow-up frequency are locally modified.

[Surgical selection and metastatic warning of splenic lymph node dissection in advanced gastric cancer radical surgery: a prospective, single-center, randomized controlled trial]

Objective: To investigate the surgical options for splenic lymph node dissection in patients with advanced gastric cancer undergoing radical total gastrectomy, and to evaluate the sentinel effect of No. 4s lymph node on splenic lymph node metastasis. Methods: A prospective, single-center, randomized and controlled study was carried out (Trial registration, No.NCT02980861). Enrollment criteria: (1) >18 years old and <65 years old; (2) gastric adenocarcinoma locating in the proximal or corpus; (3) preoperative clinical staging as cT2-4aN0-3M0; (4) D2 radical total gastrectomy feasible judged before operation; (5) physical ability score 0 to 1; (6) I to III of ASA classification. Pregnant or lactating women, patients with severe mental illness or previous history of upper abdominal surgery, those suffered from other malignant tumors in the past 5 years, or heart and lung system diseases judged to affect surgery before operation, those receiving preoperative chemotherapy, radiotherapy or targeted therapies, and distant metastases being found during surgery were excluded. According to above criteria, 222 patients at The First Medical Center of Chinese PLA General Hospital from December 2016 to December 2017 were enrolled prospectively and were randomly divided into the laparoscopic splenic hilar lymph node dissection group (laparoscopic group, n=114) and the open splenic hilar lymph node dissection group (open group, n=108). The result of rapid frozen immunohistochemistry of harvested No.4s lymph nodes was used to evaluate the sensitivity and specificity of sentinel effect on splenic hilar lymph node metastasis. The surgical parameters, postoperative recovery parameters, and complication rates were compared between the two groups. Results: There were 80 males and 34 females in the lapascopic group with a mean age of (56.1±10.2) years, and 69 males and 39 females in the open group with a mean age of (58.4±10.9) years. There were no significant differences in baseline data between the two groups (all P>0.05). Total blood loss was less in the laparoscopic group [(96.3±82.4) ml vs. (116.6±101.9) ml, t=1.124, P<0.001], and the amount of bleeding from the splenic hilar lymph nodes dissected was also less than that in the open group [(25.3±17.8) ml vs. (59.5±36.4) ml, t=1.172, P<0.001]. However, the operation time, the time of splenic hilar lymph node, the number of lymph node dissected and number of splenic hilar lymph node dissected were not significantly different between the two groups (all P>0.05). As compared to the open group, the laparoscopic group had shorter time to the first flatus [(1.3±1.2) days vs. (1.6±1.5) days, t=1.665, P=0.021], shorter time to fluid diet [(4.6±1.4) days vs. (4.9 ± 1.6) days, t=1.436, P=0.007], shorter time to remove nasogastric tube [(3.9±2.6) days vs. (4.3±2.4) days, t=0.687, P<0.001] and shorter hospital stay [(10.3±6.6) days vs. (12.1±7.2) days, t=0.697, P<0.001]. Complication rate was 14.0% (16/114) and (12.0%) ((1)3/108) in the laparoscopic group and the open group, respectively, without significant difference (χ(2)=6.723, P=0.331). The sensitivity of the No. 4s lymph node for the prediction of splenic hilar lymph node metastasis reached 89.5%, and the specificity reached 99.6%. Conclusions: Laparoscopic technique is safe and feasible in the treatment of splenic hilar lymph node dissection in advanced gastric cancer. The No.4s lymph node examination has good sentinel effect on predicting the metastasis of splenic hilar lymph nodes.

[Establishment of patient derived xenograft model of high-grade mucinous carcinoma peritonei accompanied with signet ring cells and identification of biological characteristics]

Objective: To establish the patient derived xenograft (PDX) model of pseudomyxoma peritonei (PMP), and identify the key characteristics of tumor biology of this model, in order to provide a reliable model for studying the pathological mechanisms and new therapeutic strategies of PMP. Methods: PMP tumor tissue was obtained from surgery and cut into pieces after washing. Then tumor pieces were implanted subcutaneously in BAL B/c-nu mice for 6 stable passages. In the 7th passage, tumor tissue was implanted orthotopically into abdomen. Subcutaneous tumor and orthotopic tumor were then homogenized to make tumor cell suspension, implanted into abdomen of 10 BAL B/c-nu mice through midline laparotomy, 100 μl for each. The key experimental parameters including body weight changes in the observation period, experimental peritoneal cancer index (ePCI) score at the autopsy, histopathological and immunohistochemical characteristics, and gene expression profiles by high-throughput whole-genome exon sequencing were detected and recorded. Results: The successful rate of established orthotopic PDX model of human PMP was 100% (10/10). The animals showed smooth body weight increases after tumor inoculation until day 27, then the body weight began to decrease steadily. Widespread tumor dissemination of PMP tumor through the whole abdomen was found by autopsy, including the diaphragm, liver, spleen, stomach, kidney, parietal peritoneum, bowel and mesenterium. Gelatinous ascites was also observed in abdominopelvic cavity. The ePCI score ranged from 5 to 9, with a 8 of median ePCI. Histopathological studies showed peritoneal mucinous carcinomatosis accompanied with signet ring cells (PMCA-S), obvious tumor cell atypia and parenchymal invasion.Immunohistochemistry showed the expressions of MUC1, MUC2, MUC5AC, CEA, CA199, CK20, CDX-2 and Ki-67 were positive, MUC6, CK7 and p53 were negative. Whole-exome sequencing identified that the most significant genetic alteration is the exon10 missense mutation c. 1621A>C of KIT gene, the mutation abundance was 89.7%. Conclusion: PDX model of PMCA-S is successfully established, which displays the characters of high-degree malignancy, high proliferation and strong aggressiveness.

Exposure to sodium salicylate disrupts VGLUT3 expression in cochlear inner hair cells and contributes to tinnitus

To examine whether exposure to sodium salicylate disrupts expression of vesicular glutamate transporter 3 (VGLUT3) and whether the alteration in expression corresponds to increased risk for tinnitus. Rats were treated with saline (control) or sodium salicylate (treated) Rats were examined for tinnitus by monitoring gap-pre-pulse inhibition of the acoustic startle reflex (GPIAS). Auditory brainstem response (ABR) was applied to evaluate hearing function after treatment. Rats were sacrificed after injection to obtain the cochlea, cochlear nucleus (CN), and inferior colliculus (IC) for examination of VGLUT3 expression. No significant differences in hearing thresholds between groups were identified (p>0.05). Tinnitus in sodium salicylate-treated rats was confirmed by GPIAS. VGLUT3 encoded by solute carrier family 17 members 8 (SLC17a8) expression was significantly increased in inner hair cells (IHCs) of the cochlea in treated animals, compared with controls (p<0.01). No significant differences in VGLUT3 expression between groups were found for the cochlear nucleus (CN) or IC (p>0.05). Exposure to sodium salicylate may disrupt SLC17a8 expression in IHCs, leading to alterations that correspond to tinnitus in rats. However, the CN and IC are unaffected by exposure to sodium salicylate, suggesting that enhancement of VGLUT3 expression in IHCs may contribute to the pathogenesis of tinnitus.

Linear polarization grating combining a circular polarization grating with a special cycloidal diffractive quarter waveplate

We introduce and demonstrate a switchable novel linear polarization grating (LPG) consisting of a circular polarization grating (CPG) and a special cycloidal diffractive quarter waveplate (CQWP). The CQWP is developed that marvelously matches the polarization-state of beams passing through the CPG. Such an LPG is so polarization-sensitive that it can split an incident linear polarized beam into two proportionally controllable left- or right-handed circularly polarized lights. We establish rigorous simulation model based on finite element method to investigate near-field polarization-state distribution of CPGs. Furthermore, LPGs are demonstrated and the diffraction properties are obtained with simulation and Jones Matrix analysis. The combination of CPGs and CQWPs is achieved with polymerizable liquid crystal. The experimental results of deflection angle and polarization selectivity of LPGs are consistent with those of simulation.

Biological denitrification using polycaprolactone-peanut shell as slow-release carbon source treating drainage of municipal WWTP

The development of slow-release carbon source is an effective way to reduce the total nitrogen (TN) in low carbon to nitrogen ratio wastewater. In this study, a novel solid slow-release carbon source (PPP) was prepared using polycaprolactone (PCL) and peanut shell (PS) as carbon sources with polyvinyl alcohol-sodium alginate (PVA-SA) as hybrid scaffolds. The carbon release properties of PPP and each carbon source materials were compared. The performances of nitrogen removal and microbial community structure using PPP as external carbon source were investigated. The results showed that PPP had the best slow-release performance, and its release process followed the first-order release equation. The ratio of acetic acid, propionic acid and butyric acid in released organic matter was stable at (75.73 ± 4.62)%:(17.22 ± 4.53)%:(7.06 ± 1.02)%. When using PPP as an external carbon source for denitrification, the relative abundance of Gammaproteobacteria increased from 39.32% to 46.66%, while the Shannon index decreased from 8.59 to 8.29. The utilization efficiency of PPP was determined by the ratio of the organic matter releasing rate to the released organic matter consumption rate. By optimizing the PPP dosage, both high nitrogen removal efficiency and low residual organic matter could be achieved.

Bone mass density and bone metabolism marker are associated with progression of carotid and cardiac calcified plaque in Chinese elderly population

Osteoporosis and cardiovascular diseases often coexist in the same elderly individuals. Does this suggest some potential correlation between the two diseases? Low bone mass and change of bone biomarker are associated with a higher risk of carotid and cardiac calcification plaques.

INTRODUCTION

Bone mineral density (BMD) and bone metabolism marker may contribute to the progression of carotid and cardiac arterial calcifications. The aim of this study was to investigate whether low bone mass and the change of bone biomarker are associated with the prevalence of calcified atherosclerotic plaque in elderly Chinese.

METHODS

We conducted a five-year prospective study. BMD was measured by dual-energy X-ray absorptiometry scanning. Carotid and cardiac computed tomography angiography (CTA) was conducted using a 64-multidetector row scanner to assess carotid and cardiac arterial plaque at baseline and during follow-up.

RESULTS

Of 1571 community residents over 60 years of age, 184 (11.7%) subjects developed carotid calcified plaque, 510 (32.5%) subjects developed cardiac calcified plaque and 97 (6.2%) subjects developed co-existence calcified plaques in carotid and cardiac arteries. After adjustment for age and all relevant confounders, Q1, Q2 quartile of BMD, and osteoprotegerin (OPG), osteocalcin (OC), and C-terminal cross-linked telopeptide of type I collagen (CTX) were associated with increased risk of calcified plaques.

CONCLUSION

This study suggested that lower BMD and change of bone metabolism biomarker were associated with a higher risk of carotid and cardiac calcified plaque development.

Two-dimensional symmetrical radial sub-aperture coherence and the local precision defect elimination method for high-precision beam steering

Sub-aperture coherence (SAC) is a classical phase control method for high-precision beam steering using liquid crystal optical phased arrays (LCOPA). On this basis, radial sub-aperture coherence (RSAC) and symmetrical radial sub-aperture coherence (SRSAC) were proposed, which guarantee the stability of steering angles when the beam aperture and incident position fluctuate. In this article, the pre-existing one-dimensional SRSAC was firstly extended to a more universal 2D phase generation algorithm. Meanwhile, for the intractable problem of local precision defects caused by the basic two-dimensional variable period grating (2D-VPG) algorithm, we tracked their locations accurately and designed a targeted elimination method carefully. So these remarkable error peaks could be thoroughly removed by using 2D-SRSAC optimized by the local precision defect elimination method. Since then, all the excellent performance of 1D-SRSAC can be perfectly transplanted to 2D, which makes the non-mechanical beam steering technology using LCOPA more mature and competitive in the applications required ultra-high precision.

Three-dimensional printing of metals for biomedical applications

Three-dimensional (3D) printing technology has received great attention in the past decades in both academia and industry because of its advantages such as customized fabrication, low manufacturing cost, unprecedented capability for complex geometry, and short fabrication period. 3D printing of metals with controllable structures represents a state-of-the-art technology that enables the development of metallic implants for biomedical applications. This review discusses currently existing 3D printing techniques and their applications in developing metallic medical implants and devices. Perspective about the current challenges and future directions for development of this technology is also presented.