[Epidemiological investigation of iron deficiency among preschool children in 10 provinces, autonomous regions, or municipalities in China]

Objective: To understand the current status of anemia, iron deficiency, and iron-deficiency anemia among preschool children in China. Methods: A cross-sectional study was conducted with a multi-stage stratified sampling method to select 150 streets or townships from 10 Chinese provinces, autonomous regions, or municipalities (East: Jiangsu, Zhejiang, Shandong, and Hainan; Central: Henan; West: Chongqing, Shaanxi, Guizhou, and Xinjiang; Northeast: Liaoning). From May 2022 to April 2023, a total of 21 470 children, including community-based children aged 0.5 to<3.0 years receiving child health care and kindergarten-based children aged 3.0 to<7.0 years, were surveyed. They were divided into 3 age groups: infants (0.5 to<1.0 year), toddlers (1.0 to<3.0 years), and preschoolers (3.0 to<7.0 years). Basic information such as sex and date of birth of the children was collected, and peripheral blood samples were obtained for routine blood tests and serum ferritin measurement. The prevalence rates of anemia, iron deficiency, and iron-deficiency anemia were analyzed, and the prevalence rate differences were compared among different ages, sex, urban and rural areas, and regions using the chi-square test. Results: A total of 21 460 valid responses were collected, including 10 780 boys (50.2%). The number of infants, toddlers, and preschoolers were 2 645 (12.3%), 6 244 (29.1%), and 12 571 (58.6%), respectively. The hemoglobin level was (126.7±14.8) g/L, and the serum ferritin level was 32.3 (18.5, 50.1) μg/L. The overall rates of anemia, iron deficiency, and iron-deficiency anemia were 10.4% (2 230/21 460), 28.3% (6 070/21 460), and 3.9% (845/21 460), respectively. The prevalence rate of anemia was higher for boys than for girls (10.9% (1 173/10 780) vs. 9.9% (1 057/10 680), χ2=5.58, P=0.018), with statistically significant differences in the rates for infants, toddlers and preschoolers (18.0% (475/2 645), 10.6% (662/6 244), and 8.7% (1 093/12 571), respectively, χ2=201.81, P<0.01), and the rate was significantly higher for children in rural than that in urban area (11.8% (1 516/12 883) vs. 8.3% (714/8 577), χ2=65.54, P<0.01), with statistically significant differences in the rates by region (χ2=126.60, P<0.01), with the highest rate of 15.8% (343/2 173) for children in Central region, and the lowest rate of 5.3% (108/2 053) in Northeastern region. The prevalence rates of iron deficiency were 33.8% (895/2 645), 32.2% (2 011/6 244), and 25.2% (3 164/12 571) in infants, toddlers, and preschoolers, respectively, and 30.0% (3 229/10 780) in boys vs. 26.6% (2 841/10 680) in girls, 21.7% (1 913/8 821), 40.0% (870/2 173), 27.1% (2 283/8 413), 48.9% (1 004/2 053) in Eastern, Central, Western, and Northeastern regions, respectively, and each between-group showed a significant statistical difference (χ2=147.71, 29.73, 773.02, all P<0.01). The prevalence rate of iron-deficiency anemia showed a significant statistical difference between urban and rural areas, 2.9% (251/8 577) vs. 4.6% (594/12 883) (χ2=38.62, P<0.01), while the difference in iron deficiency prevalence was not significant (χ2=0.51, P=0.476). Conclusions: There has been a notable improvement in iron deficiency and iron-deficiency anemia among preschool children in China, but the situation remains concerning. Particular attention should be paid to the prevention and control of iron deficiency and iron-deficiency anemia, especially among infants and children in the Central, Western, and Northeastern regions of China.

[The method of determination for 2, 3-Butanedione in the air of workplace by high performance liquid chromatography with derivatization]

Objective: To establish a method for the determination of 2, 3-Butanedione (BUT) in the air of workplace, which including the process of collection by absorption in phosphoric acid aqueous solution and the process of analysis and detection by high performance liquid chromatography with derivatization. Methods: In October 2022, a porous glass plate absorption tube containing 10 ml of 0.01% phosphoric acid solution was used to collect BUT in the air of the workplace at a flow rate of 0.2 L/min. The absorption solution was derived by 2, 4-dinitrophenylhydrazine for 75 min and separated on a SB-C18 column (250 mm×4.6 mm, 5 μm) . At the column temperature of 30 ℃, the mixture of acetonitrile-water (V∶V, 1∶1) was eluted at the flow rate of 1.0 ml/min. It was detected by UV detector (λ=365 nm) , qualitatived by retention time and quantitatived by external standard. Results: It showed that BUT in phosphoric acid aqueous solution could be stored for at least 7 d at 4 ℃. There was a linear relationship within the determination range of 0.05-6.00 μg/ml, the linear regression equation was y=89.610x+0.133, r=0.9999. The sampling absorption efficiencies were 98.33%-100.00%, the detection limit of the method was 0.005 μg/ml, the minimum detection concentration was 0.016 mg/m(3) (based on V(0)=3.0 L) . The recovery rates were 95.96%-102.44%, the intra batch precision were 4.36%-7.78%, and the inter batch precision were 4.96%-6.06%. Conclusion: The method has the advantages of simple operation, high sensitivity and good accuracy. It can prevent the loss and degradation of BUT. It can be used for the determination of BUT in the air of workplace.

Dectin1 contributes to hypertensive vascular injury by promoting macrophage infiltration through activating the Syk/NF-κB pathway

Vascular injury is an early manifestation leading to end-organ damage in hypertension pathogenesis, which involves a macrophage-associated immune response. Dendritic cell-associated C-type lectin-1 (Dectin1) is a pivotal player in regulating inflammation-mediated cardiovascular disease. However, its role in hypertension-induced vascular damage and the underlying mechanisms remain unclear. We hypothesized that Dectin1 might accelerate angiotensin II (Ang II)- or deoxycorticosterone acetate-salt (DOCA-salt)-induced vascular injury through proinflammatory actions in macrophages. Macrophage Dectin1 was upregulated in mouse aortic tissues stimulated with Ang II. In the peripheral blood, Ang II also increased CD11b+F4/80+ macrophages in mice. In our constructed Dectin1 knockout mice, Dectin1 deletion protected against Ang II-induced EB extravasation and aortic wall thickness. Deficiency of Dectin1 or its pharmacological inhibition considerably improved fibrosis and inflammation responses, accompanied by a reduction in M1 macrophage polarization as well as proinflammatory cytokines and chemokines induced by Ang II or DOCA-salt. Through the bone marrow (BM) transplantation assay, these effects were verified in the wild type mice reconstituted with Dectin1-deficient BM cells. Mechanistically, Ang II promoted Dectin1 homodimerization, thereby triggering the spleen tyrosine kinase/nuclear factor kappa B pro-inflammatory cascade to induce the expression of inflammatory factors and chemokines in vivo and in vitro. In conclusion, Dectin1 has an essential role in the pathogenic procedure of Ang II-stimulated or DOCA-salt-induced vascular damage in mice and represents a promising therapeutic target for cardiovascular diseases.

Automatic interpretation and clinical evaluation for fundus fluorescein angiography images of diabetic retinopathy patients by deep learning

BACKGROUND/AIMS

Fundus fluorescein angiography (FFA) is an important technique to evaluate diabetic retinopathy (DR) and other retinal diseases. The interpretation of FFA images is complex and time-consuming, and the ability of diagnosis is uneven among different ophthalmologists. The aim of the study is to develop a clinically usable multilevel classification deep learning model for FFA images, including prediagnosis assessment and lesion classification.

METHODS

A total of 15 599 FFA images of 1558 eyes from 845 patients diagnosed with DR were collected and annotated. Three convolutional neural network (CNN) models were trained to generate the label of image quality, location, laterality of eye, phase and five lesions. Performance of the models was evaluated by accuracy, F-1 score, the area under the curve and human-machine comparison. The images with false positive and false negative results were analysed in detail.

RESULTS

Compared with LeNet-5 and VGG16, ResNet18 got the best result, achieving an accuracy of 80.79%-93.34% for prediagnosis assessment and an accuracy of 63.67%-88.88% for lesion detection. The human-machine comparison showed that the CNN had similar accuracy with junior ophthalmologists. The false positive and false negative analysis indicated a direction of improvement.

CONCLUSION

This is the first study to do automated standardised labelling on FFA images. Our model is able to be applied in clinical practice, and will make great contributions to the development of intelligent diagnosis of FFA images.

Automated classification of multiple ophthalmic diseases using ultrasound images by deep learning

BACKGROUND

Ultrasound imaging is suitable for detecting and diagnosing ophthalmic abnormalities. However, a shortage of experienced sonographers and ophthalmologists remains a problem. This study aims to develop a multibranch transformer network (MBT-Net) for the automated classification of multiple ophthalmic diseases using B-mode ultrasound images.

METHODS

Ultrasound images with six clinically confirmed categories, including normal, retinal detachment, vitreous haemorrhage, intraocular tumour, posterior scleral staphyloma and other abnormalities, were used to develop and evaluate the MBT-Net. Images were derived from five different ultrasonic devices operated by different sonographers and divided into training set, validation set, internal testing set and temporal external testing set. Two senior ophthalmologists and two junior ophthalmologists were recruited to compare the model's performance.

RESULTS

A total of 10 184 ultrasound images were collected. The MBT-Net got an accuracy of 87.80% (95% CI 86.26% to 89.18%) in the internal testing set, which was significantly higher than junior ophthalmologists (95% CI 67.37% to 79.16%; both p<0.05) and lower than senior ophthalmologists (95% CI 89.45% to 92.61%; both p<0.05). The micro-average area under the curve of the six-category classification was 0.98. With reference to comprehensive clinical diagnosis, the measurements of agreement were almost perfect in the MBT-Net (kappa=0.85, p<0.05). There was no significant difference in the accuracy of the MBT-Net across five ultrasonic devices (p=0.27). The MBT-Net got an accuracy of 82.21% (95% CI 78.45% to 85.44%) in the temporal external testing set.

CONCLUSIONS

The MBT-Net showed high accuracy for screening and diagnosing multiple ophthalmic diseases using only ultrasound images across mutioperators and mutidevices.

[Application of entropy weight TOPSIS comprehensive method in the evaluation of students' physical health level]

Objective: To comprehensively evaluate the physical health level of students of different school-age segments in four regions of Anhui province using the entropy weight approximation ideal solution ranking method (TOPSIS), and to provide a scientific method and basis for conducting school health work evaluation. Methods: Using the physical fitness survey data of four regions in Anhui province, the entropy weight method was used to draw the weights of various indicators for different school-age segments of men and women. Then, the TOPSIS method was used to evaluate the school-age segments of men and women in the four regions. Finally, the physical health level of students in four regions was classified according to the results of entropy weight TOPSIS and the rank sum ratio method. Results: A total of 10 127 students were included in this study, with an average age of (11.85±3.82) years, including 5 050 males (49.8%) and 5 072 urban students (50.1%). The results of the entropy weight method showed that the weight of body mass index of boys was similar to that of girls in each school-age segment. According to the TOPSIS and rank sum ratio analysis, the physical health level of students in the four regions of Anhui province was different. The physical health score of Suzhou was 0.617 4 points, which was classified as the best grade. The scores of Hefei and Wuhu were 0.556 3 and 0.411 2, which were classified as middle. Jiju City scored 0.381 9 points, which was classified as poor. Conclusion: TOPSIS combined with rank sum ratio can reflect the level of students' physical health, which can be applied to the evaluation of students' physical health and provide a basis for monitoring students' physical health.

[Characteristics of serum bile acids among healthy children in Zhejiang province]

Objective: To characterize the serum bile acid profiles of healthy children in Zhejiang Province. Methods: A cross-sectional study was conducted on 245 healthy children who underwent imaging and laboratory biochemical tests during routine physical examinations at the Children's Hospital of Zhejiang University School of Medicine from January 2020 to July 2022. Overnight fasting venous blood samples were collected, and the concentrations of 18 individual bile acids in the serum were accurately quantitated using tandem mass spectrometry. The concentration difference of bile acid were compared between different genders and to explore the correlation between age and bile acid levels. Used the Mann-Whitney U test for intergroup comparison and Spearman test to correlation analysis. Results: A total of 245 health children with a age of 10 (8, 12) years including 125 boys and 120 girls. There were no significant differences in levels of total bile acids, primary and secondary bile acids, free and conjugated bile acids between the two gender groups (all P>0.05). The serum concentrations of ursodeoxycholic acid and glycoursodeoxycholic acid in girls were significantly higher than those in boys (199.0 (66.9, 276.5) vs. 154.7 (49.3, 205.0) nmol/L, 274.0 (64.8, 308.0) vs. 181.0 (43.8, 209.3) nmol/L, Z=2.06, 2.71, both P<0.05). The serum taurolithocholic acid in both boys and girls were positively correlated with age (r=0.31, 0.32, both P<0.05). The serum chenodeoxycholic acid and glycochenodeoxycholic acid in the boys group were positively correlated with age (r=0.20, 0.23, both P<0.05), whereas the serum tauroursodeoxycholic acid in the girls group was negatively correlated with age (r=-0.27, P<0.05), and the serum cholic acid was positively correlated with age (r=0.34, P<0.05). Conclusions: The total bile acid levels are relatively stable in healthy children in Zhejiang province. However, individual bile acids showed gender differences and were correlated with age.

Fish-TViT: A novel fish species classification method in multi water areas based on transfer learning and vision transformer

The classification of fish species has important practical significance for both the aquaculture industry and ordinary people. However, existing methods for classifying marine and freshwater fishes have poor feature extraction ability and do not meet actual needs. To address this issue, we propose a novel method for multi-water fish classification (Fish-TViT) based on transfer learning and visual transformers. Fish-TViT uses a label smoothing loss function to solve the problem of overfitting and overconfidence of the classifier. We also employ Gradient-weighted Category Activation Mapping (Grad-CAM) technology to visualize and understand the features of the model and the areas on which the decision depends, which guides the optimization of the model architecture. We first crop and clean fish images, and then use data augmentation to expand the number of training datasets. A pre-trained visual transformer model is used to extract enhanced features of fish images, which are subsequently cropped into a series of flat patches. Finally, a multi-layer perceptron is used to predict fish species. Experimental results show that Fish-TViT achieves high classification accuracy on both low-resolution marine fish data (94.33%) and high-resolution freshwater fish data (98.34%). Compared with traditional convolutional neural networks, Fish-TViT has better performance.

Characterization of welding fume and airborne heavy metals in electronic manufacturing workshops in Hangzhou, China: implication for occupational population exposure

Occupational exposure to contaminants created by electronic manufacturing process is not well characterized. The aim of this study was to carry out risk assessments of exposure to welding fume and airborne heavy metals (HMs) in electronic manufacturing workshops. Seventy-six air samples were collected from five sites in Hangzhou, China. In welding workshops, the most abundant contaminant found was welding fume, followed by Fe, Mn, Zn, Cu, Pb, Cd, and Cr. The concentration of Mn was positively correlated with Fe (r = 0.906). When compared with non-welding workshops, the Fe content in the air of welding workshops increased significantly (P < 0.05), while the Cu content decreased significantly (P < 0.05). Singapore semi-quantitative health risk assessment model and the United States Environmental Protection Agency (US EPA) inhalation risk assessment model were applied to assess the occupational exposure. In welding workshops, the levels of 8-h time weighted average (8 h-TWA) calculated for welding fume (range 0.288 ~ 6.281 mg/m³), Mn (range Nd ~ 0.829 mg/m³), and Fe (range 0.027 ~ 2.234 mg/m³) partly exceeded the permissible limits. While, in non-welding workshops, the average of 8 h-TWA for Cu (0.411 mg/m³) was higher than the limit. The risk rates (RR) assessed for Pb (2.4 vs 1.7), Mn (2.0 vs 1.4), and Fe (1.4 vs 1.0) were higher in welding workshops than that in non-welding workshops, but Cu (1.0 vs 2.2) were lower. The mean excess lifetime cancer risks (ELCR) in welding (5.59E - 06 per 1000 people) and non-welding (1.88E - 06 per 1000 people) workshops were acceptable. The mean non-cancer risk (HQ) estimated for Mn was greater than 10 in both welding (HQ = 164) and non-welding (HQ = 11.1) workshops. These results indicate that there was a risk of occupational exposure implication in the electronic manufacturing workshops. Reducing contaminant exposure through engineering controls and management strategies, such as efficient ventilation and reducing exposure hours, is thus suggested.

A238 BILE ACID COMPOSITION AND DIETARY FAT: IMPLICATIONS FOR CROHN’S DISEASE IN A COHORT OF HEALTHY FIRST-DEGREE RELATIVES

Background

Crohn’s disease (CD) is a chronic relapsing inflammatory disease of the gastrointestinal tract. The etiology of CD may arise from complex interactions including host genetics, diet, and the intestinal microbiome. Increased consumption of saturated fats, characteristic of the Western diet, is a known risk factor for CD. Dietary fat (DF) is absorbed by the host through the release of primary bile acids (PBAs) and bio-transformed by the microbiome into secondary bile acids (SBAs). Altogether, bile acids (BAs) can act as signaling molecules involved in host immune regulation and potentially in CD onset.

Purpose

To investigate the relationship between CD risk, BAs, and DF, and evaluate the predictive performance of CD onset of these factors by developing machine learning models.

Method

We used samples healthy first-degree relatives (FDRs) recruited as part of the Crohn’s Colitis Canada- Genes, Environment, Microbial (GEM) project. Those who developed CD (n=87) were matched 1:4 by age, sex, follow-up time, and geographic location with control FDRs remaining healthy (n=347).

Serum, urine, and stool BA were measured using ultrahigh Performance Liquid Chromatography-Tandem Mass Spectroscopy. DF types were derived from food frequency questionnaire data. We used conditional logistic regressions to identify associations between CD onset, BAs (n=93), and DFs (n=9). We further explored the relationships of significant CD-related BAs and DF via Generalized Estimation Equations. Finally, we used a tree-based machine-learning algorithm (XGBoost) with 5-fold cross-validation to assess the prediction performance of CD onset using BA from all sources as well as DF. Two-sided p<0.05 was considered significant.

Result(s)

In total, 10 of 93 BAs, and two of nine DFs were significantly associated with increased odds of CD onset (p<0.05). Additionally, five BAs were significantly associated with DF (p<0.05). Serum-derived BAs had the best predictive performance for CD, with a mean AUC of 0.70 [95% CI: 0.63;0.76], followed by stool derived BAs with a mean AUC= 0.65 [0.55;0.75], and followed by urine derived Bas with a mean AUC= 0.57 [0.48;0.66]. Lastly DF was not a predictive marker of CD onset with a mean AUC= 0.50 [0.41;0.60].

Conclusion(s)

This study suggests that BAs are associated with the pathogenesis of CD and the effects may be influenced by DF. Serum-derived BAs may be able to better predict the risk of CD than other stool or urine derived BA, while DF is not directly implicated in CD risk.

Submitted on behalf of the CCC-GEM consortium.

Funding

Crohn’s and Colitis Canada Genetics Environment Microbial (CCC-GEM) III

The Leona M. and Harry B. Helmsley Charitable Trust

Kenneth Croitoru is the recipient of the Canada Research Chair in Inflammatory Bowel Diseases

The International Organization for the Study of Inflammatory Bowel Diseases (IOIBD)

Jingcheng Shao is the recipient of a Data Science Institute Summer Undergraduate Data Science award

Disclosure of Interest

None Declared

Deep learning-based image analysis of eyelid morphology in thyroid-associated ophthalmopathy

Background

We aimed to propose a deep learning-based approach to automatically measure eyelid morphology in patients with thyroid-associated ophthalmopathy (TAO).

Methods

This prospective study consecutively included 74 eyes of patients with TAO and 74 eyes of healthy volunteers visiting the ophthalmology department in a tertiary hospital. Patients diagnosed as TAO and healthy volunteers who were age- and gender-matched met the eligibility criteria for recruitment. Facial images were taken under the same light conditions. Comprehensive eyelid morphological parameters, such as palpebral fissure (PF) length, margin reflex distance (MRD), eyelid retraction distance, eyelid length, scleral area, and mid-pupil lid distance (MPLD), were automatically calculated using our deep learning-based analysis system. MRD1 and 2 were manually measured. Bland-Altman plots and intraclass correlation coefficients (ICCs) were performed to assess the agreement between automatic and manual measurements of MRDs. The asymmetry of the eyelid contour was analyzed using the temporal: nasal ratio of the MPLD. All eyelid features were compared between TAO eyes and control eyes using the independent samples t-test.

Results

A strong agreement between automatic and manual measurement was indicated. Biases of MRDs in TAO eyes and control eyes ranged from -0.01 mm [95% limits of agreement (LoA): -0.64 to 0.63 mm] to 0.09 mm (LoA: -0.46 to 0.63 mm). ICCs ranged from 0.932 to 0.980 (P<0.001). Eyelid features were significantly different in TAO eyes and control eyes, including MRD1 (4.82±1.59 vs. 2.99±0.81 mm; P<0.001), MRD2 (5.89±1.16 vs. 5.47±0.73 mm; P=0.009), upper eyelid length (UEL) (27.73±4.49 vs. 25.42±4.35 mm; P=0.002), lower eyelid length (LEL) (31.51±4.59 vs. 26.34±4.72 mm; P<0.001), and total scleral area (SA_TOTAL) (96.14±34.38 vs. 56.91±14.97 mm²; P<0.001). The MPLDs at all angles showed significant differences in the 2 groups of eyes (P=0.008 at temporal 180°; P<0.001 at other angles). The greatest temporal-nasal asymmetry appeared at 75° apart from the midline in TAO eyes.

Conclusions

Our proposed system allowed automatic, comprehensive, and objective measurement of eyelid morphology by only using facial images, which has potential application prospects in TAO. Future work with a large sample of patients that contains different TAO subsets is warranted.

Fabrication of THz corrugated wakefield structure and its high power test

We present overall process for developing terahertz (THz) corrugated structure and its beam-based measurement results. 0.2-THz corrugated structures were fabricated by die stamping method as the first step demonstration towards GW THz radiation source and GV/m THz wakefield accelerator. 150-[Formula: see text]m thick disks were produced from an OFHC (C10100) foil by stamping. Two types of disks were stacked alternately to form 46 mm structure with [Formula: see text] 170 corrugations. Custom assembly was designed to provide diffusion bonding with a high precision alignment of disks. The compliance of the fabricated structure have been verified through beam-based wakefield measurement at Argonne Wakefield Accelerator Facility. Both measured longitudinal and transverse wakefield showed good agreement with simulated wakefields. Measured peak gradients, 9.4 MV/m/nC for a long single bunch and 35.4 MV/m/nC for a four bunch trains, showed good agreement with the simulation.

Porphyromonas gingivalis Evades Immune Clearance by Regulating Lysosome Efflux

Porphyromonas gingivalis, a major periodontal pathogen, invades autophagosomes of cells, including gingival epithelial cells, endothelial cells, gingival fibroblasts, macrophages, and dendritic cells, to escape antimicrobial autophagy and lysosome fusion. However, it is not known how P. gingivalis resists autophagic immunity, survives within cells, and induces inflammation. Thus, we investigated whether P. gingivalis could escape antimicrobial autophagy by promoting lysosome efflux to block autophagic maturation, leading to intracellular survival, and whether the growth of P. gingivalis within cells results in cellular oxidative stress, causing mitochondrial damage and inflammatory responses. P. gingivalis invaded human immortalized oral epithelial cells in vitro and mouse oral epithelial cells of gingival tissues in vivo. The production of reactive oxygen species (ROS) increased upon bacterial invasion, as well as mitochondrial dysfunction-related parameters with downregulated mitochondrial membrane potential and intracellular adenosine triphosphate (ATP), upregulated mitochondrial membrane permeability, intracellular Ca²⁺ influx, mitochondrial DNA expression, and extracellular ATP. Lysosome excretion was elevated, the number of intracellular lysosomes was diminished, and lysosomal-associated membrane protein 2 was downregulated. Expression of autophagy-related proteins, microtubule-associated protein light chain 3, sequestosome-1, the NLRP3 inflammasome, and interleukin-1β increased with P. gingivalis infection. P. gingivalis may survive in vivo by promoting lysosome efflux, blocking autophagosome-lysosome fusion, and destroying autophagic flux. As a result, ROS and damaged mitochondria accumulated and activated the NLRP3 inflammasome, which recruited the adaptor protein ASC and caspase 1, leading to the production of proinflammatory factor interleukin-1β and inflammation.

Association between serum copper/zinc ratio and lung cancer: A systematic review with meta-analysis

BACKGROUND

Numerous studies have investigated the relationship between serum copper/zinc ratio and lung cancer. However, the results are inconsistent. Therefore, we evaluated the association between copper/zinc ratio and lung cancer.

MATERIALS AND METHODS

Observational studies reporting serum copper/zinc ratio in lung cancer patients and controls were identified from PubMed, Web of Science, EMBASE, CNKI and Wanfang databases online before December 2021. Summary standard mean difference (SMD) and the corresponding 95 % confidence interval (95 % CI) were applied to compare the serum serum copper/zinc ratio between lung cancer patients and controls using a random-effects model.

RESULTS

Thirty-nine articles including 3598 lung cancer patients, 1402 benign lung diseases, and 3314 healthy controls were included in this study. The pooled results showed that the lung cancer patients had significantly higher serum copper/zinc ratio than healthy controls [SMD (95 % CI): 1.62 (1.31, 1.93)] and patients with benign lung diseases [SMD (95 % CI): 0.60 (0.36, 0.84)]. The results were robust according to sensitivity analysis. Meanwhile, consistent results were obtained both in European populations and Asian populations. Moreover, serum copper/zinc ratio was significant higher in patients with advanced stage of lung cancer than that in patients with early stage of lung cancer.

CONCLUSION

The results showed that elevated serum copper/zinc ratio might be associated with increased risk of lung cancer.

Precisely Tuning the Pore-Wall Surface Composition of Bioceramic Scaffolds Facilitates Angiogenesis and Orbital Bone Defect Repair

Orbital bone damage (OBD) may result in severe post-traumatic enophthalmos, craniomaxillofacial deformities, vision loss, and intracranial infections. However, it is still a challenge to fabricate advanced biomaterials that can match the individual anatomical structure and enhance OBD repair in situ. Herein, we aimed to develop a selective surface modification strategy on bioceramic scaffolds and evaluated the effects of inorganic or organic functional coating on angiogenesis and osteogenesis, ectopically and orthotopically in OBD models. It was shown that the low thermal bioactive glass (BG) modification or layer-by-layer assembly of a biomimetic hydrogel (Biogel) could readily integrate into the pore wall of the bioceramic scaffolds. The BG and Biogel modification showed appreciable enhancement in the initial compressive strength (∼30-75%) or structural stability in vivo, respectively. BG modification could enhance by nearly 2-fold the vessel ingrowth, and the osteogenic capacity was also accelerated, accompanied with a mild scaffold biodegradation after 3 months. Meanwhile, the Biogel-modified scaffolds showed enhanced osteogenic differentiation and mineralization through calcium and phosphorus retention. The potential mechanism of the enhanced bone repair was elucidated via vascular and osteogenic cell responses in vitro, and the cell tests indicated that the Biogel and BG functional layers were both beneficial for in vitro osteoblastic differentiation and mineralization on bioceramics. Totally, these findings demonstrated that the bioactive ions or biomolecules could significantly improve the angiogenic and osteogenic capabilities of conventional bioceramics, and the integration of inorganic or organic functional coating in the pore wall is a highly flexible material toolbox that can be tailored directly to improve orbital bone defect repair.

[Meta-analysis on the contents of trace elements in workers with occupational exposure to lead]

Objective: To quantitatively evaluate the content differences of trace elements in workers with occupational exposure to lead. Methods: In January 2021, relevant literatures on the contents of trace elements in workers with occupational exposure to lead published from 1990 to 2020 were searched through CNKI, Wanfang, VIP, PubMed, web of science and Embase. Screened and extracted the literatures, and evaluated the quality of the included literatures with Newcastle Ottawa Scale. Meta analysis was performed with Review Manager 5.3 software, and standardized mean difference (SMD) and its 95% confidence interval were used as effect indicators. Results: A total of 20 literatures were included, and the quality scores were 5-7. The results of Meta-analysis showed that compared with the control group, the contents of blood zinc (SMD=-1.01, 95%CI: -1.53, -0.49) , hair zinc (SMD=-0.17, 95%CI: -0.33, -0.01) , hair copper (SMD=-0.50, 95%CI: -1.01, 0) , hair iron (SMD=-3.91, 95%CI: -5.80, -2.03) and hair manganese (SMD=-1.09, 95%CI: -2.02, -0.15) in occupational lead exposure group were significantly lower (P<0.05) . Compared with the control group, the content of cobalt in hair of occupational lead exposure group (SMD=1.41, 95%CI: 0.72, 2.10) was higher, and the difference was statistically significant (P<0.05) . There was no significant difference in the contents of blood chromium, blood copper, blood iron, blood manganese, blood selenium and hair nickel between the two groups (P>0.05) . Conclusion: Workers with occupational exposure to lead have abnormal trace elements.

The relationship between serum 25-hydroxyvitamin-D level and sweat function in patients with type 2 diabetes mellitus

AIMS

The objective of this study is to explore the relationship between serum 25-hydroxyvitamin-D(25-(OH)₂D₃) level and sweat function in patients with type 2 diabetes mellitus (T2DM).

METHODS

A cross-sectional study of 1021 patients with T2DM who underwent 25-(OH)₂D₃ level detections and sweat function tests was carried out. These individuals were divided into deficient groups (n = 154 cases), insufficient groups (n = 593 cases) and sufficient groups (n = 274 cases). Spearman correlation analysis and multivariate stepwise linear regression analysis were implemented to determine the association of 25-(OH)2D3 level and sweat function.

RESULTS

The total presence of sweating dysfunction was 38.59%. Patients with a lower level of serum 25-(OH)₂D₃ had more severe sweat secretion impairment (P < 0.05). As the decrease of serum 25-(OH)₂D₃ level, the presence of sweating dysfunction increased (P < 0.05). 25-(OH)₂D₃ level was positively correlated with sweat function parameters, age and duration of T2DM were negatively correlated with sweat function parameter (P < 0.05). Multivariate stepwise linear regression analysis explored a significant association between serum 25-(OH)₂D₃ level with sweat function (P < 0.05).

CONCLUSIONS

Serum 25-(OH)₂D₃ level was positively correlated with sweat function in patients with T2DM.

[Determination of methyl isobutyl ketone in urine by headspace coupled with gas chromatography-mass spectrometry]

Objective: To establish a method for the determination of methyl isobutyl ketone (MIBK) in urine samples by headspace-gas chromatography-mass spectrometry. Methods: Automatic headspace sampling technique was adopted to optimize the headspace conditions (headspace bottle heating temperature and equilibration time) and gas chromatographic conditions. A total of 5 ml samples were taken and added with 3.0 g ammonium sulfate into a 20 ml headspace bottle. After heated at 60 ℃ for 30 mins, gas from the upper part of headspace bottle was injected into gas chromatography with an injection volume of 100 μl. The target was separated by HP-5MS UI (30 m×0.25 mm×0.25 μm) capillary column and then detected by mass spectrometry detector. The retention time and external standard method were used for qualitative and quantitative analysis of MIBK in samples, respectively. Results: The standard curve of MIBK showed significant linearity between 20.0-1 000.0 μg/L. The standard curve was y=62.9x-652.5, and the correlation coefficient r=0.9998. The detection limit of MIBK was 5.0 μg/L and the quantification limit of MIBK was 16.0 μg/L. The average recovery rate was 95.3%~100.2% at three spiked concentrations of low (50.0 μg/L) , medium (200.0 μg/L) and high (500.0 μg/L) . The intra-day and inter-day precisions were 1.7%~3.8% (n=6) and 1.2%~4.0% (n=6) respectively. This method was stable for the determination of MIBK, and the urine could be kept 14 d at -20 ℃ without significantly loss. Conclusion: This method is proved to be simple, practical and highly sensitive. It can satisfy the request for the determination of urine samples of workers exposed to MIBK.

[Studies of the norm of Karitane Parenting Confidence Scale(KPCS)among parents of infants in urban areas of China]

Objective: To establish the norm of the Chinese version of Karitane Parenting Confidence Scale (KPCS) in urban areas of China. Methods: From August to December 2017, the parents of 2 216 children (<36 months old) were selected from 15 cities (Beijing, Lianyungang, Hangzhou, Chengdu, Xi'an, Guangzhou, Changsha, Jinan, Guiyang, Ningbo, Dalian, Qinhuangdao, Maanshan, Chongqing and Wuhan) in 14 provinces by stratified random sampling. The general demographic characteristics and parents' parenting confidence were collected by a self-made questionnaire and KPCS Chinese version. The percentile norm was established. P₃, P₁₀ and P₂₅ were used as the criteria to define the degree of lack of parenting confidence. Results: The age of mothers was (30.67±4.29). The age of the father was (32.50±4.99) years old. There were 726 (32.76%), 759 (34.25%) and 731 (32.99%) infants in 6-12, 12-23 and 24-35 months old groups. The total scores of P₅₀, P₂₅, P₁₀ and P₃ of KPCS (Chinese version) of infant parents in urban areas in China were 41, 38, 33, and 29 respectively. When the scores of parents were 34-37, 30-33, and ≤ 29, they were judged as mild, moderate, and severe lack of parenting confidence. There was no significant difference in the Chinese version of KPCS between parents of different age groups and parents of different gender (χ²=3.53, P=0.171; χ²=1.41, P=0.236). Each factor score≤P₃ is defined as the boundary score, and the corresponding boundary scores of "parenting" "support" and "competence" were 13, 9, and 5 respectively. Conclusion: The Chinese version of KPCS can be used to assess the parenting confidence of infants in urban areas of China. It can used as one of the bases for scientific and objective evaluation of the parenting status of families.

Review of Detection and Quantification of Rabies Virus Antibodies

Rabies is an almost invariably fatal disease. According to the World Health Organization (WHO), rabies virus neutralizing antibody (RVNA) titers of ≥0.5 IU/mL are considered adequate for rabies protection. Therefore, detection and quantification of RABV antibodies are important. Many methods have been developed for detecting RABV antibodies. In the present study, we reviewed several methods of detecting RABV antibodies in human and animal samples and evaluated and compared their performance. Of 34 methods, 5 demonstrated unsatisfactory sensitivity or specificity. The others exhibited sensitivity and specificity of ≥75%. The correlation coefficient for five of eight methods was >0.8. The Bland-Altman mean bias of five of five methods was <±2.0. The kappa values of 25 of 28 methods were higher than 0.4, demonstrating at least moderate agreement. Analysis of the performance of these methods emphasized that any new technology should be considered carefully and objectively before being used as an appropriate and applicable alternative.

Associations between gut microbiota and thyroidal function status in Chinese patients with Graves' disease

OBJECTIVE

The imbalance of gut microbiota has been linked to manifold endocrine diseases, but the association with Graves' disease (GD) is still unclear. The purpose of this study was to investigate the correlation between human gut microbiota and clinical characteristics and thyroidal functional status of GD.

METHODS

14 healthy volunteers (CG) and 15 patients with primary GD (HG) were recruited as subjects. 16SrDNA high-throughput sequencing was performed on IlluminaMiSeq platform to analyze the characteristics of gut microbiota in patients with GD. Among them, the thyroid function of 13 patients basically recovered after treatment with anti-thyroid drugs (oral administration of Methimazole for 3-5 months). The fecal samples of patients after treatment (TG) were sequenced again, to further explore and investigate the potential relationship between dysbacteriosis and GD.

RESULTS

In terms of alpha diversity index, the observed OTUs, Simpson and Shannon indices of gut microbiota in patients with GD were significantly lower than those in healthy volunteers (P < 0.05).The difference of bacteria species was mainly reflected in the genus level, in which the relative abundance of Lactobacillus, Veillonella and Streptococcus increased significantly in GD. After the improvement of thyroid function, a significant reduction at the genus level were Blautia, Corynebacter, Ruminococcus and Streptococcus, while Phascolarctobacterium increased significantly (P < 0.05). According to Spearman correlation analysis, the correlation between the level of thyrotropin receptor antibody (TRAb) and the relative abundance of Lactobacillus and Ruminococcus was positive, while Synergistetes and Phascolarctobacterium showed a negative correlation with TRAb. Besides, there were highly significant negative correlation between Synergistetes and clinical variables of TRAb, TPOAb and TGAb (P < 0.05, R <  - 0.6).

CONCLUSIONS

This study revealed that functional status and TRAb level in GD were associated with composition and biological function in the gut microbiota, with Synergistetes and Phascolarctobacterium protecting the thyroid probably, while Ruminococcus and Lactobacillus may be novel biomarkers of GD.

Magnetic molecularly imprinted polymers for extraction of S-phenylmercapturic acid from urine samples followed by high-performance liquid chromatography

In this study, magnetic molecularly imprinted polymers (MMIPs) were prepared and used as sorbents for extraction of S-phenylmercapturic acid (S-PMA) from urine samples, followed by high-performance liquid chromatography ultraviolet-visible (HPLC-UV/Vis) analysis. The MMIPs were synthesized by the copolymerization reaction of (phenylthio) acetic acid (template molecule), methacrylic acid (functional monomers) and ethylene glycol dimethacrylate (cross-linkers). The morphology, structure property and surface groups of the prepared MMIPs were characterized by scan electron microscopy, transmission electron microscopy, infrared spectroscopy, X-ray diffraction pattern, thermogravimetric analyses, Brunauer-Emmett-Teller and vibrating sample magnetometer. The selectivity of the MMIPs was investigated in the presence of interferents. Various parameters affecting the S-PMA extraction efficiency were investigated, including MMIPs amount, pH, sample volume, desorption solvent, as well as extraction and desorption time. The obtained optimal parameters were as follows: MMIPs amount (20 mg), pH (3.0), sample volume (5 mL), desorption solvent (methanol/acetic acid [9/1, v/v]), extraction time (30 minutes) and desorption time (2 minutes). The method was validated according to the Food and Drug Administration Guidance for Industry on Bioanalytical Method Validation. The calibration curve for the analyte was linear in the concentration range of 0.030-1.0 mg/L (r = 0.9995). The LOD and LOQ of the method were 0.0080 and 0.0267 mg/L, respectively. The enrichment factor of the MMIPs was 5. The relative standard deviations of intra- and inter-day tests were in the range of 3.8-5.1% and 3.9-6.3%, respectively. The recoveries at three different concentrations of 0.10, 0.50 and 0.80 mg/L ranged between 95.2% and 98.6%. In addition, the MMIPs could be reused for at least eight times. The proposed method was successfully applied to the determination of S-PMA in urine samples. In addition, this developed method could be used as a tool in the early screening and clinical diagnosis of benzene intoxication.

[Endovascular treatment strategies for distal entry tear of Stanford type B aortic dissection]

Currently, thoracic endovascular aortic repair (TEVAR) is the first-line treatment for patients with complicated Stanford type B aortic dissections. However, TEVAR does not occlude the distal entry tear of dissections, and blood flow persists in the false lumen. Dissections might progress in some patients. Studies showed that distal entry tear increased the possibility of late aortic events during follow-up. Thus, treatment of distal entry tear is necessary in some high-risk patients after TEVAR. In this article, the current treatment strategies of distal entry tear are summarized, which include PETTICOAT, STABILISE, covered stent, fenestrated and branched stent-grafts, false lumen embolization, vascular occluder, and Knickerbocker. However, the number of the cases of most approaches is so limited that the indications and effectiveness need to be further studied. Selecting the right treatment for the right patient is of great importance.

Gamma-Ray Observation of the Cygnus Region in the 100-TeV Energy Region

We report observations of gamma-ray emissions with energies in the 100-TeV energy region from the Cygnus region in our Galaxy. Two sources are significantly detected in the directions of the Cygnus OB1 and OB2 associations. Based on their positional coincidences, we associate one with a pulsar PSR J2032+4127 and the other mainly with a pulsar wind nebula PWN G75.2+0.1, with the pulsar moving away from its original birthplace situated around the centroid of the observed gamma-ray emission. This work would stimulate further studies of particle acceleration mechanisms at these gamma-ray sources.

A Novel Automatic Morphologic Analysis of Eyelids Based on Deep Learning Methods

Purpose: To propose a deep-learning-based approach to automatically and objectively evaluate morphologic eyelid features using two-dimensional(2D) digital photographs and to assess the agreement between automatic and manual measurements.Materials and Methods: The 2D photographs of 1378 normal Asian participants (2756 eyes) were included for training, validating and testing the cornea and eyelid segmentation network. Margin reflex distance 1 (MRD1) and margin reflex distance 2 (MRD2) of 406 eyes from 203 participants were manually evaluated by 3 ophthalmologists and the photographs of 406 eyes were measured automatically for 8 morphologic eyelid features. The Spearman's correlation coefficient, intra-class correlation coefficient (ICC) and Bland-Altman analyses were used to determine the agreement between manual and automatic MRDs.Results: The dice coefficient was 0.922 and 0.974 for eyelid and cornea segmentation, respectively. A strong correlation was shown between manually and automatically measured MRD1 (r = 0.993, ICC = 0.996) and MRD2 (r = 0.950, ICC = 0.974). Bland-Altman analyses also showed excellent reliability with bias being 0.04 mmbetween automated and manual MRD1 measurements and 0.06 mm for MRD2. Automatically measured 8 features (MRD1, MRD2, palpebral fissure, medial area, lateral area, cornea area, upper and lower eyelid lengths) were found to be increased with age and peaked around the age range of 21 to 30 years.Conclusions: The proposed novel integrative analysis scheme was comparable with human performance. The approach with excellent reliability and reproductivity showed great potential for automated diagnosis and remote monitoring of eyelid-related diseases.

First Detection of sub-PeV Diffuse Gamma Rays from the Galactic Disk: Evidence for Ubiquitous Galactic Cosmic Rays beyond PeV Energies

We report, for the first time, the long-awaited detection of diffuse gamma rays with energies between 100 TeV and 1 PeV in the Galactic disk. Particularly, all gamma rays above 398 TeV are observed apart from known TeV gamma-ray sources and compatible with expectations from the hadronic emission scenario in which gamma rays originate from the decay of π^{0}'s produced through the interaction of protons with the interstellar medium in the Galaxy. This is strong evidence that cosmic rays are accelerated beyond PeV energies in our Galaxy and spread over the Galactic disk.

Facile Preparation of Activated Carbon from Peanut Shell for Determination of Bisphenol A in Human Urine by High-Performance Liquid Chromatography

Herein, a facile and low-cost method for the preparation of activated carbon from peanut shell was developed for the first time for the fast extraction and determination of Bisphenol A in human urine. Bisphenol A was separated by EC-C18 column (250 mm×4.6 mm, 4 μm) and was detected by VWD, with retention time for qualitative analysis and peak area for quantitation. The parameters, pH values of the urine, adsorbent dose, adsorption time and so on, were optimized to achieve the excellent extraction performance. The detection limit of Bisphenol A in human urine was 1.0 ng · mL^-1 (S/N = 3), and the standard curve was linear in the range of 5.0 ng · mL^-1˜200.0 ng · mL^-1 (r = 0.9993). The average recovery of Bisphenol A was 78.5˜96.2% at three spiked levels in the range of 5.00 ng · mL^-1˜200.00 ng·mL^-1. The method was proved simple, practical and highly sensitive, which could satisfy the request for the determination of Bisphenol A in human urine.

Prediction of response to anti-vascular endothelial growth factor treatment in diabetic macular oedema using an optical coherence tomography-based machine learning method

PURPOSE

To predict the anti-vascular endothelial growth factor (VEGF) therapeutic response of diabetic macular oedema (DME) patients from optical coherence tomography (OCT) at the initiation stage of treatment using a machine learning-based self-explainable system.

METHODS

A total of 712 DME patients were included and classified into poor and good responder groups according to central macular thickness decrease after three consecutive injections. Machine learning models were constructed to make predictions based on related features extracted automatically using deep learning algorithms from OCT scans at baseline. Five-fold cross-validation was applied to optimize and evaluate the models. The model with the best performance was then compared with two ophthalmologists. Feature importance was further investigated, and a Wilcoxon rank-sum test was performed to assess the difference of a single feature between two groups.

RESULTS

Of 712 patients, 294 were poor responders and 418 were good responders. The best performance for the prediction task was achieved by random forest (RF), with sensitivity, specificity and area under the receiver operating characteristic curve of 0.900, 0.851 and 0.923. Ophthalmologist 1 and ophthalmologist 2 reached sensitivity of 0.775 and 0.750, and specificity of 0.716 and 0.821, respectively. The sum of hyperreflective dots was found to be the most relevant feature for prediction.

CONCLUSION

An RF classifier was constructed to predict the treatment response of anti-VEGF from OCT images of DME patients with high accuracy. The algorithm contributes to predicting treatment requirements in advance and provides an optimal individualized therapeutic regimen.

Clinicopathological analysis of 5146 eyelid tumours and tumour-like lesions in an eye centre in South China, 2000-2018: a retrospective cohort study

OBJECTIVES

To describe the clinicopathological characteristics of patients with eyelid tumours and tumour-like lesions in South China, investigate possible factors affecting tumour constitution.

DESIGN

Retrospective cohort study.

SETTING

All patients diagnosed with eyelid tumours were included from a high-volume tertiary eye care centre from South China which caring for over 2000 patients per day. All biopsied specimens were reviewed by two senior pathologists and were classified according to the fourth edition of the WHO Classification of Skin Tumours.

PARTICIPANT

A total of 5146 cases of eyelid lesions were reviewed from 2000 to 2018, being classified by histogenesis and pathologic diagnosis, being compared with data from previous literature containing different races.

MAIN OUTCOME MEASURES

Age-specific and gender-specific incidence constitutions, time trends, tumour location, distribution in different age groups and relationship with Sociodmographic Index (SDI) were calculated.

RESULTS

Benign tumours accounted for 85.08% (4378) of all cases, among which, nevus was most common (33.07%). Eight of top 10 benign lesions had higher occurrence in upper eyelids. The R² value of linear regression in patient annual number of benign lesions were 0.946 (p<0.01) for male and 0.914 (p<0.01) for female. More than 33.60% (1471/4378) were made up by patients younger than 40 years. The number of patients undergoing removal of benign lesions decreased with age. Among the malignant lesions, basal cell carcinoma (BCC) was most prevalent (48.70%), followed by sebaceous gland carcinoma (34.24%) and majority (81.8%) occurred in patients above 60 years.

CONCLUSIONS

Over the past 19 years, most eyelid tumours occurred at our centre were benign lesions. The number of patients presenting with benign lesions increased in both genders, especially among young females who were more likely to request surgeries. Among malignant lesions, BCC remains the most common type, appears a higher incidence in countries with higher SDI.

LncRNA SND1-IT1 accelerates the proliferation and migration of osteosarcoma via sponging miRNA-665 to upregulate POU2F1

OBJECTIVE

To clarify the role of long non-coding RNA (lncRNA) SND1-IT1 in accelerating the proliferative and migratory abilities of osteosarcoma (OS) via sponging miRNA-665 to upregulate POU2F1.

PATIENTS AND METHODS

The relative level of SND1-IT1 in OS tissues was determined by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). The target gene of SND1-IT1 was predicted by bioinformatics and verified by Dual-Luciferase reporter gene assay. Similarly, the target gene of miRNA-665 was identified. Correlation among SND1-IT1, miRNA-665 and POU2F1 was evaluated through linear regression test. Regulatory effects of SND1-IT1/miRNA-665/POU2F1 on cellular behaviors of MG63 and U2OS cells were evaluated.

RESULTS

SND1-IT1 was upregulated in OS, knockdown of which attenuated proliferative and migratory abilities of OS cells. MiRNA-665 was the target gene of SND1-IT1, which was negatively correlated to SND1-IT1 in OS. POU2F1 was the target gene of miRNA-665. Its level was negatively regulated by miRNA-665 and positively regulated by SND1-IT1. Inhibited proliferative and migratory abilities of OS cells with SND1-IT1 knockdown were partially elevated by transfection of miRNA-665 inhibitor, and further downregulated by POU2F1 knockdown.

CONCLUSIONS

LncRNA SND1-IT1 accelerates proliferative and migratory abilities of OS via sponging miRNA-665 to upregulate POU2F1, thus stimulating the progression of OS.

Socioeconomic inequality in the global burden of refraction disorders: results from the Global Burden of Diseases Study 2017

PURPOSE

To explore socioeconomic inequality in global burden of refraction disorders using disability-adjusted life years (DALYs).

METHODS

World Bank categorical and national DALY numbers, crude rates and age-standardized rates caused by refraction disorders between 1990 and 2017 were obtained. Gini coefficient and concentration index were computed to assess trends in global health inequality in refraction disorders burden.

RESULTS

Lower middle-income countries had the highest burden of refraction disorders and greatest decline in age-standardized DALY rates of 15.9% (171.0 in 1990; 143.8 in 2017), followed by upper middle-income countries, with a 9.7% decline (103.7 in 1990; 93.7 in 2017). High-income countries had the lowest age-standardized DALY rates (70.4 in 1990; 65.7 in 2017), while low-income countries had the lowest DALY numbers. Between-country inequality decreased, with Gini coefficient declining from 0.203 in 1990 to 0.184 in 2017. Socioeconomic-associated inequality also decreased, with concentration index changing from -0.060 in 1990 to -0.041 in 2017. Small peaks of DALY numbers and crude rates occurred in the age group of 5-9 years in countries with different income levels. An earlier occurrence of high peaks of DALY estimates in older adults had been observed in countries with lower income.

CONCLUSION

Middle-income countries are more burdened with refraction disorders but have achieved great progress in the last few decades. The global health improvement in refraction disorders has been accompanied by narrowing inequality. Older adults in lower income countries tend to suffer from refraction disorders at an earlier age, compared with older adults in higher income countries.

MiR-21 inhibitor improves locomotor function recovery by inhibiting IL-6R/JAK-STAT pathway-mediated inflammation after spinal cord injury in model of rat

OBJECTIVE

To investigate the function of miRNA-21 and interleukin-6 receptor/Janus Kinase-Signal transducer and activator of transcription (IL-6R/JAK-STAT) pathway in microglia on inflammatory responses after spinal cord injury (SCI).

MATERIALS AND METHODS

This study first detected respectively the protein level of inflammatory factor inducible nitric oxide synthase (iNOS) and tumor necrosis factor alpha (TNF-α) by Western blotting after transfection of miR-21 or administration of miR-21 inhibitor in activated microglia cells of rat in vitro. The quantitative Real-time polymerase chain reaction (qRT-PCR) was utilized to detect the expression of IL-6R under two different interventions. Next, we established a model of spinal cord injury in rat and inspected miR-21 and IL-6R in SCI rat by qRT-PCR. In addition, the protein levels of iNOS and TNF-α in SCI rat were detected by Western blotting. MiR-21 inhibitor was injected into the injured area of SCI rat to delve into the function of miR-21 down-expression on iNOS and TNF-α expression by Western blot as well as the RNA levels of IL-6R, JAK and STAT3 by qRT-PCR. Furthermore, the SCI rat with movement and coordination of hindlimbs was observed by Basso-Beattie-Bresnahan locomotor rating scale (BBB scale) after miR-21 down-expression.

RESULTS

Compared with the microglia transfected with miR-21, the execution of inhibitor in microglia effectively relieved the expression of IL-6R and the breakout of iNOS and TNF-α. Meanwhile, the increase of miR-21 was significantly observed in SCI rat along with significant improvement of inflammatory response-related factors including iNOS and TNF-α. After that, we injected SCI rat with miR-21 inhibitor into the spinal cord injury area and found the inhibition of miR-21 decreased the protein levels of iNOS and TNF-α. Simultaneously, down-expression of miR-21 evidently declined the RNA levels of IL-6R, JAK, and STAT3 in SCI rat. Compared with the sham-operated rat, the movement and coordination of hindlimbs of the SCI group displayed dramatic dysfunction. However, miR-21 down-expression elevated the movement and coordination of hindlimbs of the SCI rat than those of the only injury group.

CONCLUSIONS

Inhibition of miR-21 can promote the recovery of spinal cord injury by down-regulating IL-6R/JAK-STAT signaling pathway and inhibiting inflammation.

Intussusception in 2 Children With Severe Acute Respiratory Syndrome Coronavirus-2 Infection

We note that intussusception was likely associated with severe acute respiratory syndrome coronavirus-2 infection in 2 infants in Wuhan and London. The intussusception was reduced by enemas in Wuhan; the outcome was fatal. The intussusception was not reduced by enemas in London and required surgery; the outcome was favorable.

Activated carbon/diatomite-based magnetic nanocomposites for magnetic solid-phase extraction of S-phenylmercapturic acid from human urine

In this study, activated carbon/diatomite-based magnetic nancomposites (denoted as AC/DBMNs) were synthesized and applied as an adsorbent for magnetic solid-phase extraction of S-phenylmercapturic acid (S-PMA) from human urine prior to high-performance liquid chromatography. The surface morphologies and structures of AC/DBMNs were characterized by Fourier transform infrared spectroscopy, transmission and scanning electron microscopy, X-ray diffraction, Brunauer-Emmett-Teller surface area, vibrating sample magnetometer and ζ-potential measurements. The experimental parameters including sample volume, sample pH, adsorbent amount, extraction time, elution solvent and desorption time were investigated in detail. Under the optimum conditions, the method exhibited good linearity (r > 0.9993) within the concentration ranges of 0.03-1.0 mg/L. Moreover, the limits of detection and quantification were 0.01 and 0.03 mg/L, respectively. The enrichment factor was 5, and good recoveries (88.9-97.3%) with relative standard deviations in the range of 5.6-6.8% (n = 6) for inter-day and 6.3-8.1% (n = 6) for intra-day were achieved. The developed method was successfully applied to the analysis of S-PMA in urine samples. In addition, this accurate and sensitive method has great potential to be applied in the early screening and clinical diagnosis of the workers exposed to benzene.

[Predictive values of routine blood test results for iron deficiency in children]

Objective: To explore the predictive values of routine blood test results for iron deficiency (ID) screening in children. Methods: Routine blood test results and serum ferritin (SF) levels from 1 443 healthy children (862 boys, 581 girls) aged 6 months to 18 years, who were seen for well-child visits between June 2017 and May 2019 in Children's Hospital, Zhejiang University School of Medicine, were retrospectively analyzed. ID was defined as SF<20 μg/L, iron deficiency anemia (IDA) as ID with anemia (hemoglobin(Hb)<110 g/L at 6 months-5 years of age, Hb<120 g/L at 6-18 years of age), non-anemia ID as ID without anemia, non-ID anemia as SF≥20 μg/L with anemia, and healthy control subjects as those with SF≥20 μg/L but without anemia. The blood test results including Hb, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red blood cell distribution width (RDW), and the percentage of low hemoglobin density (LHD) of healthy control, non-anemia ID, non-ID anemia, and IDA groups were compared by analysis of variance (ANOVA) or non-parametric test, quantitative data were described as x±s or M(interquartile range), and receiver operating characteristic curve (ROC) analysis was applied to assess predictive values of routine blood test results and LHD for detecting IDA and ID. Results: Among 1 443 children with median age of 2.1(3.3) years, 1 061 children were in healthy control group, 292 in non-anemia ID group, 43 in non-ID anemia group and 47 in IDA group. The prevalence of ID was much higher than that of anemia (23.5% (339/1 443) vs. 6.2% (90/1 443) , χ(2)=169.76, P<0.01). Compared with control group, non-anemia ID group showed higher LHD (0.088 (0.093) vs.0.073 (0.068), P<0.01) and RDW (0.131±0.013 vs. 0.126±0.008, P<0.01), lower MCV ((80±4) vs. (83±4) fl, P<0.01) and MCHC values ((326±9) vs. (329±8) g/L, P<0.01). IDA group showed higher LHD (0.322(0.544)) and RDW (0.151±0.018), lower MCV ((73±6) fl) and MCHC values((309±14) g/L) than non-anemia ID group (all P<0.01). The area under curve (AUC) values of MCHC, LHD, RDW and MCV for detecting ID were 0.63 (95%CI: 0.60-0.67), 0.63 (95%CI:0.60-0.67), 0.67 (95%CI: 0.63-0.70) and 0.73 (95%CI: 0.69-0.76) respectively. With cutoff limits (MCV<80.2 fl, RDW>0.131 or MCHC<322 g/L), MCV, RDW and MCHC showed higher sensitivity for screening ID than hemoglobin (0.540, 0.469 and 0.336 vs. 0.139, χ(2)=121.70, 87.47, 35.56, all P<0.01). Conclusion: MCV, RDW and MCHC can be used to screen ID in primary health care settings.

Socio-economic disparity in global burden of near vision loss: an analysis for 2017 with time trends since 1990

PURPOSE

To investigate the socio-economic disparity in global burden of near vision loss by disability-adjusted life-years (DALYs).

METHODS

The DALY numbers of country income groups by World Bank classification and the national age-standardized DALY rates caused by near vision loss were obtained from Global Burden of Disease Study 2017. Human development index (HDI) was collected from the Human Development Report. The association between age-standardized DALY rates and HDI was analysed. Additionally, the concentration index (CI) and the relative index of inequality (RII) were employed to assess the trends of socio-economic disparity in the global burden of near vision loss from 1990 to 2017.

RESULTS

The global burden of near vision loss increased from 5.3 million DALYs in 1990 to 9.8 million DALYs in 2017, corresponding to an increase of 82.4%. The highest rate of increase for 1990-2017 occurred in low-income country group (97.7%). Age-standardized DALY rates were inversely correlated with HDI (Standardized β = -0.679, P < 0.001). Lower HDI countries displayed higher age-standardized DALY rates caused by near vision loss. From 1990 to 2017, CI declined from -0.233 to -0.209, and RII increased from 0.149 to 0.247.

CONCLUSION

The total global burden of near vision loss increased greatly in the past few decades, with low-income countries showing the highest growth. The age-standardized burden was higher in countries with lower socio-economic status. Although a declining trend of socio-economic inequalities was observed, the persistence of disparities still highlights the need to provide more eye care services for developing countries.

Hyperinsulinemia promotes heterologous desensitization of β2 adrenergic receptor in airway smooth muscle in obesity

β-Adrenergic receptor (β-AR) agonists are the most common clinical bronchodilators for asthma. Obesity influences asthma severity and may impair response to β-AR agonists. Previous studies show that in obese mice, hyperinsulinemia plays a crucial role in β-AR desensitization in the heart. We therefore investigated whether insulin promotes β-AR desensitization in airway smooth muscle (ASM) and compromises airway relaxation responsiveness to β-AR agonists. We found that human ASM cells and mouse airway tissues exposed to insulin exhibit impaired β₂ AR-induced cAMP accumulation and airway relaxation. This impaired relaxation is associated with insulin-induced phosphorylation and expression of phosphodiesterase 4D (PDE4D) through transactivation of a G protein-coupled receptor kinase 2 (GRK2)-dependent β₂ AR-G_i -ERK1/2 cascade. Both acute and chronic pharmacological inhibition of PDE4 effectively reversed impaired β₂ AR-mediated ASM relaxation in an obesity mouse model induced by a high fat diet. Collectively, these findings reveal that cross talk between insulin and β₂ AR signaling promotes ASM β₂ AR desensitization in obesity through upregulation of PDE4D phosphorylation and expression. Our results identify a novel pathway of asthma pathogenesis in patients with obesity/metabolic syndrome, in which the GRK2-mediated signaling can be a potential therapeutic modality to prevent or treat β₂ AR desensitization in ASM. Moreover, PDE4 inhibitors may be used as efficacious therapeutic agents for asthma in obese and diabetic subjects.

Ageing affects the proliferation and mineralization of rat dental pulp stem cells under inflammatory conditions

AIM

To comparatively evaluate changes in the proliferation and mineralization abilities of dental pulp stem cells (DPSCs) from juvenile and adult rats in a lipopolysaccharide (LPS)-induced inflammatory microenvironment to provide a theoretical basis for the age-related differences observed in DPSCs during repair of inflammatory injuries.

METHODOLOGY

DPSCs were isolated from juvenile (JDPSCs) and adult rats (ADPSCs), and senescence-associated β-galactosidase staining was used to compare senescence between JDPSCs and ADPSCs. Effects of LPS on JDPSCs and ADPSCs proliferation were investigated by cell counting kit-8 assays and flow cytometry. Alizarin red staining, quantitative reverse transcription polymerase chain reaction and Western blot assay were used to examine the effects of LPS on mineralization-related genes and proteins in JDPSCs and ADPSCs. Immunohistochemistry was used to compare interleukin-1β (IL-1β) and osteocalcin (OCN) expression in the pulpitis model. Unpaired Student's t-tests and one-way anova were used for statistical analysis.

RESULTS

DPSCs were isolated from juvenile and adult rat dental pulp tissues. At low concentrations (0.1-1 μg mL^-1 ), LPS significantly promoted the proliferation of JDPSCs (P < 0.01) and ADPSCs (P < 0.01 or P < 0.05), with the effect being stronger in JDPSCs than in ADPSCs. In addition, mineralized nodules and the expression of mineralization-related genes (OCN, DSPP, ALP, BSP) increased significantly after stimulation with LPS (0.5 μg mL^-1 ) in JDPSCs and ADPSCs (P < 0.01 or P < 0.05), and JDPSCs displayed a more obvious increase than ADPSCs. Western blots revealed OCN and ALP expression levels in JDPSCs treated with LPS were significantly upregulated (P < 0.05); meanwhile, ALP expression in ADPSCs increased slightly but significantly (P < 0.05), and OCN expression was not affected. Finally, IL-1β expression was significantly higher (P < 0.05) and OCN expression was significantly lower (P < 0.05) in the inflamed dental pulp of adult rats than in juvenile rats.

CONCLUSIONS

A certain degree of inflammatory stimulation promoted the proliferation and mineralization of DPSCs; however, this effect declined with age. The DPSCs of adult donors in an inflammatory microenvironment have a weaker repair ability than that of juvenile donors, who are better candidates for tissues damage repair.

First Detection of Photons with Energy beyond 100 TeV from an Astrophysical Source

We report on the highest energy photons from the Crab Nebula observed by the Tibet air shower array with the underground water-Cherenkov-type muon detector array. Based on the criterion of a muon number measured in an air shower, we successfully suppress 99.92% of the cosmic-ray background events with energies E>100  TeV. As a result, we observed 24 photonlike events with E>100  TeV against 5.5 background events, which corresponds to a 5.6σ statistical significance. This is the first detection of photons with E>100  TeV from an astrophysical source.

miR-30a-5p modulates traits of cutaneous squamous cell carcinoma (cSCC) via forkhead box protein G1 (FOXG1)

miRNA has shown its potential in the regulation of squamous cell carcinoma (SCC). However, the mechanism of such an effect was not quite clear. Therefore, we aimed to investigate whether miR-30a-5p participated in the regulation of cutaneous SCC (cSCC) and the possible mechanism involved. 5-Ethynyl-2'-deoxyuridine (EdU) and cell cycle were measured using flow cytometry. The formation of cell colony was tested by colony formation assay. The capacities of migration and invasion were tested by wound healing assay and Transwell invasion assay, respectively. The target of miR-30a-5p was predicted by bioinformatics and identified by luciferase assay. Western blot was used for the determination of proteins and qPCR was for mRNA levels. miR-30a-5p expression was lowered in SCL-1 and A431 cells, and its upregulation suppressed EdU positive cells, colony numbers, migration, invasion and Bcl-2 expression, and elevated Bcl-2-associated X protein (Bax) and cleaved Caspase-3 expressions, arresting cell cycle in G1 phase. Moreover, forkhead box protein G1 (FOXG1) was proved to be the target of miR-30a-5p, and FOXG1 overexpression partially offsets the decreased colony numbers, migration and invasion rates due to miR-30a-5p overexpression in SCL-1 and A431 cells. miR-30a-5p showed a regulatory role on the expression of FOXG1 and further modulated the progressing of cSCC cells, which could be a novel pathway intervening the development of cSCC.

Systematic identification of lncRNAs and circRNAs-associated ceRNA networks in human lumbar disc degeneration

Lumbar disc degeneration (LDD) is a common cause of low back and neck pain. The molecular mechanisms underlying LDD, however, are unclear. Noncoding RNAs have been reported to participate in human diseases. We investigated a series of public datasets (GSE67566, GSE56081 and GSE63492) and identified 568 mRNAs, 55 microRNAs (miRNAs), 765 long noncoding RNAs (lncRNAs), and 586 circular RNAs (circRNAs) that were expressed differently in LDD than in normal discs. We constructed lncRNAs and circRNAs regulated competing endogenous RNAs (ceRNA) networks in LDD. Four lncRNAs, DANCR, CASK-AS1, SCARNA2, and LINC00638), and three circRNAs, hsa_circ_0005139, hsa_circ_0037858, and hsa_circ_0087890, were identified as key regulators of LDD progression. We found that hsa-miR-486-5p regulated the crosstalk among circRNA hsa_circ_0000189, lncRNA DANCR and 6 mRNAs, PYCR2, TOB1, ARHGAP5, RBPJ, CD247, SLC34A1. Gene ontology (GO) analysis demonstrated that these differently expressed lncRNAs and circRNAs were involved in cellular component organization or biogenesis, gene expression and negative regulation of metabolic processes. Our findings provide useful information for exploring new mechanisms for LDD and candidates for therapeutic targets.

Multidisciplinary care of breast cancer patients: a scoping review of multidisciplinary styles, processes, and outcomes

Background

Clinical practice guidelines recommend a multidisciplinary approach to cancer care that brings together all relevant disciplines to discuss optimal disease management. However, the literature is characterized by heterogeneous definitions and few reviews about the processes and outcomes of multidisciplinary care. The objective of this scoping review was to identify and classify the definitions and characteristics of multidisciplinary care, as well as outcomes and interventions for patients with breast cancer.

Methods

A systematic search for quantitative and qualitative studies about multidisciplinary care for patients with breast cancer was conducted for January 2001 to December 2017 in the following electronic databases: medline, embase, PsycInfo, and cinahl. Two reviewers independently applied our eligibility criteria at level 1 (title/abstract) and level 2 (full-text) screening. Data were extracted and synthesized descriptively.

Results

The search yielded 9537 unique results, of which 191 were included in the final analysis. Two main types of multidisciplinary care were identified: conferences and clinics. Most studies focused on outcomes of multidisciplinary care that could be variously grouped at the patient, provider, and system levels. Research into processes tended to focus on processes that facilitate implementation: team-working, meeting logistics, infrastructure, quality audit, and barriers and facilitators.

Summary

Approaches to multidisciplinary care using conferences and clinics are well described. However, studies vary by design, clinical context, patient population, and study outcome. The heterogeneity of the literature, including the patient populations studied, warrants further specification of multidisciplinary care practice and systematic reviews of the processes or contexts that make the implementation and operation of multidisciplinary care effective.