Medium-intensity statin with ezetimibe versus high-intensity statin in acute ischemic cerebrovascular disease (MESIA): A randomized clinical trial

BACKGROUND

High-risk stroke patients are recommended to receive high-intensity statin therapy to reduce the risk of stroke recurrence. However, doubling the dosage of statin drugs did not increase the achievement rate of LDL-C target or provide additional clinical benefits, but significantly increased the risk of adverse reactions. Statins and ezetimibe work through different mechanisms and the combined use of statins and ezetimibe significantly improves outcomes with comparable safety profiles. We tested the hypothesis that moderate-intensity statin with ezetimibe may offer advantages over the conventional high-intensity statin regimen in terms of efficacy and safety.

METHODS

We conducted a randomized controlled trial. Eligible participants were aged 18 years or older with acute ischemic cerebrovascular disease. We randomly assigned (1:1) participants within the acute phase of ischemic stroke, i.e., within 1 week after the onset of mild ischemic stroke (NIHSS score ≤ 5), within 1 month for severe cases (NIHSS score ≥ 16), and within 2 weeks for the rest, as well as patients with TIA within 1 week of symptom onset, to receive either moderate-intensity statin with ezetimibe (either 10-20 mg atorvastatin calcium tablets plus a 10 mg ezetimibe tablet, or 5-10 mg rosuvastatin calcium tablets once per day plus a 10 mg ezetimibe tablet once per day) or high-intensity statin (40 mg atorvastatin calcium tablets or 20 mg rosuvastatin calcium tablets once per day) for 3 months. Randomization was performed using a random number table method. The primary efficacy outcome was the level and achievement rate of LDL-C after 3 months of treatment, specifically LDL-C ≤ 1.8 mmol/L or a reduction in LDL-C ≥ 50 %. The secondary outcome was the incidence of new stroke or transient ischemic attack (TIA) within 3 months. The safety outcome was liver and renal function tests, and the occurrence of statin-related muscle events within 3 months.

FINDINGS

This trial took place between March 15, 2022, and March 7, 2023. Among 382 patients screened, 150 patients were randomly assigned to receive either medium-intensity statins with ezetimibe (n = 75) or high-intensity statins (n = 75). Median age was 60.0 years (IQR 52.75-70.25); 49 (36.6 %) were women and 85 (63.4 %) were men. The target achievement of LDL-C at 3 months occurred in 62 (89.86 %) of 69 patients in the medium-intensity statin with ezetimibe group and 46 (70.77 %) of 65 patients in the high-intensity statin group (P=0.005, OR=0.273, 95 % CI: 0.106, 0.705). The reduction magnitude of LDL-C in moderate-intensity statin with ezetimibe group was significantly higher (-56.540 % vs -47.995 %, P=0.001). Moderate-intensity statin with ezetimibe group showing a trend of a greater reduction in LDL-C absolute value than high-intensity statin group but without statistical significance (-1.77±0.90 vs -1.50±0.89, P=0.077). New AIS or TIA within 3 months, liver and renal function tests, and the occurrence of statin-related muscle events within 3 months were also statistically insignificant. Multivariate logistic regression analysis showed that both gender and lipid-lowering regimen as independent risk factors influencing the rate of LDL-C achievement in individuals diagnosed with acute ischemic cerebrovascular disease, but only lipid-lowering regimen had predictive value.

INTERPRETATION

Compared to guideline-recommended high-intensity statin therapy, moderate-intensity statin with ezetimibe further improved the achievement rate of LDL-C in patients with acute ischemic cerebrovascular disease, with a higher reduction magnitude in LDL-C. In terms of safety, there was no significant difference between the two regimens, suggesting that moderate-intensity statin with ezetimibe can also be considered as an initial treatment option for patients with acute ischemic cerebrovascular disease.

Expression characteristics and potential function of non-coding RNA in mouse cortical cells

Non-coding RNAs (ncRNAs) play essential regulatory functions in various physiological and pathological processes in the brain. To systematically characterize the ncRNA profile in cortical cells, we downloaded single-cell SMART-Seq v4 data of mouse cerebral cortex. Our results revealed that the ncRNAs alone are sufficient to define the identity of most cortical cell types. We identified 1,600 ncRNAs that exhibited cell type specificity, even yielding to distinguish microglia from perivascular macrophages with ncRNA. Moreover, we characterized cortical layer and region specific ncRNAs, in line with the results by spatial transcriptome (ST) data. By constructing a co-expression network of ncRNAs and protein-coding genes, we predicted the function of ncRNAs. By integrating with genome-wide association studies data, we established associations between cell type-specific ncRNAs and traits related to neurological disorders. Collectively, our study identified differentially expressed ncRNAs at multiple levels and provided the valuable resource to explore the functions and dysfunctions of ncRNAs in cortical cells.

[Comparison of the microbiota diversity between autogenous and anautogenous Culex pipiens pallens]

OBJECTIVE

To investigate the microbiota composition and diversity between autogenous and anautogenous Culex pipiens pallens, so as to provide insights into unraveling the pathogenesis of autogeny in Cx. pipiens pallens.

METHODS

Autogenous and anautogenous adult Cx. pipiens pallens samples were collected at 25 ℃, and the hypervariable regions of the microbial 16S ribosomal RNA (16S rRNA) gene was sequenced on the Illumina NovaSeq 6000 sequencing platform. The microbiota abundance and diversity were evaluated using the alpha diversity index, and the difference in the microbiota structure was examined using the beta diversity index. The microbiota with significant differences in the abundance between autogenous and anautogenous adult Cx. pipiens pallens samples was identified using the linear discriminant analysis effect size (LEfSe).

RESULTS

The microbiota in autogenous and anautogenous Cx. pipiens pallens samples belonged to 18 phyla, 28 classes, 70 orders, 113 families, and 170 genera, and the dominant phyla included Proteobacteria, Bacteroidetes, and so on. At the genus level, Wolbachia was a common dominant genus, and the relative abundance was (77.6 ± 11.3)% in autogenous Cx. pipiens pallens samples and (47.5 ± 8.5)% in anautogenous mosquito samples, while Faecalibaculum (0.4% ± 0.1%), Dubosiella (0.5% ± 0.0%) and Massilia (0.5% ± 0.1%) were specific species in autogenous Cx. pipiens pallens samples. Alpha diversity analysis showed that higher Chao1 index and ACE index in autogenous Cx. pipiens pallens samples than in anautogenous samples (both P values > 0.05), and lower Shannon index (P > 0.05) and Simpson index (P < 0.05) in autogenous Cx. pipiens pallens samples than in anautogenous samples. LEfSe analysis showed a total of 48 significantly different taxa between autogenous and anautogenous Cx. pipiens pallens samples (all P values < 0.05).

CONCLUSIONS

There is a significant difference in the microbiota diversity between autogenous and anautogenous Cx. pipiens pallens.

Clopidogrel with indobufen or aspirin in minor ischemic stroke or high-risk transient ischemic attack: a randomized controlled clinical study

BACKGROUND

Ischemic stroke and transient ischemic attack (TIA) are the most prevalent cerebrovascular diseases. The conventional antiplatelet drugs are associated with an inherent bleeding risk, while indobufen is a new antiplatelet drug and has the similar mechanism of antiplatelet aggregation as aspirin with more safety profile. However, there have been no studies evaluating the combination therapy of indobufen and clopidogrel for antiplatelet therapy in cerebrovascular diseases.

OBJECTIVE

The CARMIA study aims to investigate the effectiveness and safety of a new dual antiplatelet therapy consisting of indobufen and clopidogrel comparing with the conventional dual antiplatelet therapy consisting of aspirin and clopidogrel in patients with minor ischemic stroke or high-risk TIA.

METHODS

An open-label randomized controlled clinical trial was conducted at a clinical center. We randomly assigned patients who had experienced a minor stroke or transient ischemic attack (TIA) within 72 h of onset, or within 1 month if they had intracranial stenosis (IS), to receive either indobufen 100 mg twice daily or aspirin 100 mg once daily for 21 days. For patients with IS, the treatment duration was extended to 3 months. All patients received a loading dose of 300 mg clopidogrel orally on the first day, followed by 75 mg once daily from the second day to 1 year. We collected prospective data using paper-based case report forms, and followed up on enrolled patients was conducted to assess the incidence of recurrent ischemic stroke or TIA, mRS score, NIHSS (National Institutes of Health Stroke Scale) score, and any bleeding events occurring within 3 month after onset.

RESULTS

We enrolled 202 patients diagnosed with ischemic stroke or transient ischemic attack. After applying the criteria, 182 patients were eligible for data analysis. Endpoint events (recurrence of ischemic stroke/TIA, myocardial infarction, or death) were observed in 6 patients (6.5%) receiving aspirin and clopidogrel, including 4 (4.3%) with stroke recurrence, 1 (1.1%) with TIA recurrence, and 1 (1%) with death. In contrast, no endpoint events were reported in the indobufen and clopidogrel group (P = 0.029). The group of patients receiving indobufen and clopidogrel exhibited significantly lower modified Rankin Scale (mRS) score. (scores range from 0 to 6, with higher scores indicating more severe disability) compared to the aspirin and clopidogrel group (common odds ratio 3.629, 95% CI 1.874-7.036, P < 0.0001). Although the improvement rate of NIHSS score in the indobufen and clopidogrel group was higher than that in the aspirin and clopidogrel group, the difference was not statistically significant (P > 0.05). Bleeding events were observed in 8 patients (8.6%) receiving aspirin and clopidogrel, including 4 (4.3%) with skin bleeding, 2 (2.2%) with gingival bleeding, 1 (1.1%) with gastrointestinal bleeding, and 1 (1.1%) with urinary system bleeding. On the other hand, only 1 patient (1.1%) in the indobufen and clopidogrel group experienced skin bleeding (P = 0.035).

CONCLUSION

The combination of indobufen and clopidogrel has shown non-inferior and potentially superior effectiveness and safety compared to aspirin combined with clopidogrel in patients with minor ischemic stroke and high-risk TIA in the CARMIA study (registered under chictr.org.cn with registration number ChiCTR2100043087 in 01/02/2021).

Identification of somatic mutation-driven enhancers and their clinical utility in breast cancer

Somatic mutations contribute to cancer development by altering the activity of enhancers. In the study, a total of 135 mutation-driven enhancers, which displayed significant chromatin accessibility changes, were identified as candidate risk factors for breast cancer (BRCA). Furthermore, we identified four mutation-driven enhancers as independent prognostic factors for BRCA subtypes. In Her2 subtype, enhancer G > C mutation was associated with poorer prognosis through influencing its potential target genes FBXW9, TRIR, and WDR83. We identified aminoglutethimide and quinpirole as candidate drugs targeting the mutated enhancer. In normal subtype, enhancer G > A mutation was associated with poorer prognosis through influencing its target genes ALOX15B, LINC00324, and MPDU1. We identified eight candidate drugs such as erastin, colforsin, and STOCK1N-35874 targeting the mutated enhancer. Our findings suggest that somatic mutations contribute to breast cancer subtype progression by altering enhancer activity, which could be potential candidates for cancer therapy.

The impact of air pollutants on spontaneous abortion: a case-control study in Tongchuan City

OBJECTIVES

Studies related to air pollutants and spontaneous abortion in urban northwestern China are scarce, and the main exposure windows of pollutants acting on pregnant women are unclear.

STUDY DESIGN

Case-control study.

METHODS

Data were collected from pregnant women in Tongchuan City from 2018 to 2019. A total of 289 cases of spontaneous abortion and 1156 cases of full-term labor were included and analyzed using a case-control study. Logistic regression models were developed to explore the relationship between air pollutants and spontaneous abortion after Chi square analysis and Air pollutant description.

RESULTS

O3 (odds ratio [OR] = 1.028) is a risk factor for spontaneous abortion throughout pregnancy. PM2.5 (OR = 1.015), PM10 (OR = 1.010), SO2 (OR = 1.026), and NO2 (OR = 1.028) are risk factors for spontaneous abortion in the 30 days before the last menstrual period. PM2.5 (OR = 1.015), PM10 (OR = 1.013), SO2 (OR = 1.036), and NO2 (OR = 1.033) are risk factors for spontaneous abortion in the 30-60 days before the last menstrual period. PM2.5 (OR = 1.028), PM10 (OR = 1.013), SO2 (OR = 1.035), and NO2 (OR = 1.059) are risk factors for spontaneous abortion in the 60-90 days before the last menstrual period.

CONCLUSION

Exposure to high levels of air pollutants may be a cause of increased risk of spontaneous abortion, especially in the first trimester of the last menstrual period.

The "5Ts" screening tool: Enhancements and threshold values for effective TMD identification

OBJECTIVE

This study aimed to enhance the quintessential "five temporomandibular disorder (TMD) symptoms" (5Ts) screener by incorporating frequency options and distinguishing between TMJ and muscle pain. The diagnostic accuracy along with cut-off points for the effective identification of TMDs was also established.

METHODS

Participants, aged ≥18 years, were recruited from a university-based hospital. After completing surveys encompassing demographic data and the enhanced 5Ts (with frequency options [5Ts-F] and differentiation of TMJ/muscle pain [6Ts-F]), protocolized interviews and clinical examinations were performed following DC/TMD. The diagnostic accuracy and best cut-off points were determined with the area under the receiver operating characteristic curves (AUCs).

RESULTS

324 participants were recruited (mean age 30.0 ± 11.4 years). Among these, 86.4% had TMDs. 5Ts exhibited high diagnostic accuracy for detecting all TMDs (AUC = 0.92) with sensitivity/specificity values of 83.9%/88.6%. Both 5Ts-F and 6Ts-F had slightly better accuracy (AUCs = 0.95/0.96), comparable sensitivity, and superior specificity (97.7%) compared to 5Ts. The best cut-off points were 1.5 for 5Ts and 2.5 for 5Ts-F/6Ts-F.

CONCLUSIONS

Although all three TMD screeners presented high diagnostic accuracy, 5Ts-F/6Ts-F had notably improved specificity. 5Ts scores of >1.5 and 5Ts-F/6Ts-F scores of >2.5 are to be applied for screening the presence of TMDs.

Characterization and application of Fe-modified biochar alleviating Cr(VI) stress in pak choi seedling cultivated in Cr-polluted hydroponics

Chromium (Cr) is one of the common environmental pollutants, which causes severe health hazards on human health and environmental security. In this study, we characterized two biochars, a raw biochar (RBC) and a Fe-modified biochar (MBC) made from poplar wood chips and determined the effect of the two biochars on remediation of hexavalent chromium (Cr(VI)) in hydroponic system by monitoring Pak choi growth. Results showed the surface area, pore number and pore volume were significantly higher in MBC than in PBC, but the pore size was larger in PBC than in MBC. When compared to the control, low concentrations of Cr(VI) (≤2 mg L-1) promoted the growth and biomass production of Pak choi by 10-78%. In contrast, the high concentrations of Cr(VI) (≥4 mg L-1) showed a significantly reduction of the growth and biomass production of Pak choi by 10-28%. Fe-modified biochar (MBC) had a more significant impact than RBC on the remediation of Cr in the Cr(VI) pollution and improved growth and biomass production of Pak choi to a greater extent. Our study indicated that MBC has a better effect on degrading Cr(VI) pollution. The findings provide scientific basis and reference for the remediation of heavy metals in aquatic ecosystems by using biochar.

Particle Size Determines the Phytotoxicity of ZnO Nanoparticles in Rice (Oryza sativa L.) Revealed by Spatial Imaging Techniques

To understand the nanotoxicity effects on plants, it is necessary to systematically study the distribution of NPs in vivo. Herein, elemental and particle-imaging techniques were used to unravel the size effects of ZnO NPs on phytotoxicity. Small-sized ZnO NPs (5, 20, and 50 nm) showed an inhibitory effect on the length and biomass of rice (Oryza sativa L.) used as a model plant. ZnO NP nanotoxicity caused rice root cell membrane damage, increased the malondialdehyde content, and activated antioxidant enzymes. As a control, the same dose of Zn2+ salt did not affect the physiological and biochemical indices of rice, suggesting that the toxicity is caused by the entry of the ZnO NPs and not the dissolved Zn2+. Laser ablation inductively coupled plasma optical emission spectroscopy analysis revealed that ZnO NPs accumulated in the rice root vascular tissues of the rhizodermis and procambium. Furthermore, transmission electron microscopy confirmed that the NPs were internalized to the root tissues. These results suggest that ZnO NPs may exist in the rice root system and that their particle size could be a crucial factor in determining toxicity. This study provides evidence of the size-dependent phytotoxicity of ZnO NPs.

Effects of Straw Mulching on Soil Properties and Enzyme Activities of Camellia oleifera-Cassia Intercropping Agroforestry Systems

In order to explore the influences of rice straw mulching on soil fertility in agroforestry systems, the soil C and N contents and enzyme activities were investigated in a C. oleifera-cassia intercropping ecosystem in Central Southern China. Three straw mulching application treatments were set up in this study, in 2021, namely, straw powder mulching (SPM), straw segment mulching (SSM), and non-straw mulching as the control (CK). Soil samples were collected from three soil depths (0-10 cm,10-20 cm, and 20-40 cm) in each treatment on the 90th-day after the treatments. The soil organic carbon (SOC), total nitrogen (TN), microbial carbon (MBC), soil enzyme activities (including acid phosphatase (ACP), urease (UE), cellulase (CL), and peroxidase (POD)), and soil water content (SWC) were determined. The results showed that the SOC significantly increased due to the mulching application in SPM and SSM, in the topsoil of 0-10 cm when compared to the CK. The SWC, SOC, TN, and MBC increased by 0.8 and 56.5, 3.5 and 37.5, 21.3 and 61.6, and 5.8% and 76.8% in the SPM and SSM treatments compared to the CK, respectively. The soil enzyme activities of ACP, UE, CE, and POD increased significantly due to straw mulching compared with CK throughout all soil layers. The soil enzyme activities of CL and POD were significantly higher in SSM than in SPM across the soil depth except for ACP. The enzyme activities of ACP were 14,190, 12,732, and 6490 U/g in SSM, SPM, and control, respectively. This indicated that mulching application enhanced the enzyme activity of ACP. Mulching had no significant effects on UE and CL, while the POD decreased significantly in the order of SPM > SSM > CK across all soil layers, being, on average, 6.64% and 3.14% higher in SSM and SPM, respectively, compared to the CK plots. The SOC and MBC were the key nutrient factors affecting the soil enzyme activities at the study site. The results from this study provided Important scientific insights for improving soil physicochemical properties during the management of the C. oleifera intercropping system and for the development of the C. oleifera industry.

An invasive zone in human liver cancer identified by Stereo-seq promotes hepatocyte-tumor cell crosstalk, local immunosuppression and tumor progression

Dissecting and understanding the cancer ecosystem, especially that around the tumor margins, which have strong implications for tumor cell infiltration and invasion, are essential for exploring the mechanisms of tumor metastasis and developing effective new treatments. Using a novel tumor border scanning and digitization model enabled by nanoscale resolution-SpaTial Enhanced REsolution Omics-sequencing (Stereo-seq), we identified a 500 µm-wide zone centered around the tumor border in patients with liver cancer, referred to as "the invasive zone". We detected strong immunosuppression, metabolic reprogramming, and severely damaged hepatocytes in this zone. We also identified a subpopulation of damaged hepatocytes with increased expression of serum amyloid A1 and A2 (referred to collectively as SAAs) located close to the border on the paratumor side. Overexpression of CXCL6 in adjacent malignant cells could induce activation of the JAK-STAT3 pathway in nearby hepatocytes, which subsequently caused SAAs' overexpression in these hepatocytes. Furthermore, overexpression and secretion of SAAs by hepatocytes in the invasive zone could lead to the recruitment of macrophages and M2 polarization, further promoting local immunosuppression, potentially resulting in tumor progression. Clinical association analysis in additional five independent cohorts of patients with primary and secondary liver cancer (n = 423) showed that patients with overexpression of SAAs in the invasive zone had a worse prognosis. Further in vivo experiments using mouse liver tumor models in situ confirmed that the knockdown of genes encoding SAAs in hepatocytes decreased macrophage accumulation around the tumor border and delayed tumor growth. The identification and characterization of a novel invasive zone in human cancer patients not only add an important layer of understanding regarding the mechanisms of tumor invasion and metastasis, but may also pave the way for developing novel therapeutic strategies for advanced liver cancer and other solid tumors.

Biomass Production and Carbon Stocks in Poplar-Crop Agroforestry Chronosequence in Subtropical Central China

Agroforest systems have been widely recognized as an integrated approach to sustainable land use for addressing the climate change problem because of their greater potential to sequester atmospheric CO₂ with multiple economic and ecological benefits. However, the nature and extent of the effects of an age-sequence of agroforestry systems on carbon (C) storage remain largely unknown. To reveal the influence of different aged poplar-crop systems on C stocks, we investigated the variation in biomass and C storage under four aged poplar-crop agroforest systems (3-, 9-, 13-, and 17-year-old) in the Henan province of China. The results showed that stand biomass increased with forest age, ranging from 26.9 to 121.6 t/ha in the corresponding four aged poplar-crop systems. The poplar tree biomass accounted for >80% of the total stand biomass in these poplar-crop agroforestry systems, except in the 3-year-old agroforestry system. The average stand productivity peaked in a 9-year-old poplar-crop system (11.8 t/ha/yr), the next was in 13- and 17-year-old agroforestry systems, and the minimum was found in 3-year-old poplar-crop stands (4.8 t/ha/yr). The total C stocks increased, with aging poplar-crop systems ranging from 99.7 to 189.2 t/ha in the studied agroforestry systems. The proportion of C stocks accounted for about 6, 25, and 69% of the total C stocks in the crop, poplar tree, and soil components in all studied agroforestry ecosystems, respectively. Our results suggested that the poplar-crop system, especially in productive and mature stages, is quite an effective agroforestry model to increase the study site's biomass production and C stocks. This study highlighted the importance of agroforestry systems in C storage. It recommended the poplar-crop agroforest ecosystems as a viable option for sustainable production and C mitigation in the central region of China.

Urban Microplastic Pollution Revealed by a Large-Scale Wetland Soil Survey

Microplastics (MPs), as a new persistent pollutant, can be emitted and accumulated in urban environments, but there is no detailed information on the driving factors of MP pollution. In this study, through a large-scale wetland soil survey, the features of MPs were characterized in each urban area. The results showed an average abundance to be 379 n/kg in wetland soil. Polypropylene, fiber or fragment, and black color were common composition, shape, and color, respectively. The spatial distribution information showed that MP abundance was significantly relevant to the distance from the urban economic center. Furthermore, the correlation and regression analysis revealed that MP abundance was related to soil heavy metal and atmospheric particle (PM₁₀ and PM_2.5) concentrations (P < 0.05), while the promotion of socioeconomic activities (urbanization level, population density, etc.) may aggravate the pollution degree. Additionally, by using structural equation modeling, it was found that the urbanization level was the dominant factor driving the MP pollution degree, with a total effect coefficient of 0.49. Overall, this work provides multi-sided environmental information regarding MP pollution in urban ecosystems, which is significant for follow-up studies of MP pollution control and restoration.

Soil Nutrients, Enzyme Activities, and Microbial Communities along a Chronosequence of Chinese Fir Plantations in Subtropical China

Forests undergo a long-term development process from young to mature stages, yet the variations in soil nutrients, enzyme activities, microbial diversity, and community composition related to forest ages are still unclear. In this study, the characteristics of soil bacterial and fungal communities with their corresponding soil environmental factors in the young, middle, and mature stages (7, 15, and 25-year-old) of Chinese fir plantations (CFP) in the subtropical region of China were investigated in 2021. Results showed that the alpha diversity indices (Chao1 and Shannon) of soil bacteria and fungi were higher in 15 and 25-year-old stands than in 7-year-old stand of CFP, while the soil pH, soil water content, soil organic carbon, total nitrogen, total phosphorus, sucrase, urease, acid phosphatase, catalase, and microbial biomass carbon, nitrogen, and phosphorus showed higher in 7-year-old stand than other two stands of CFP. The nonmetric multidimensional scaling analysis revealed that the soil microbial species composition was significantly different in three stand ages of CFP. The redundancy and canonical correspondence analysis indicated that the soil urease and microbial biomass nitrogen were the main factors affecting soil bacterial and fungal species composition. Our findings suggested that soil microbial diversity and community structure were inconsistent with changes in soil nutrients and enzyme activities during CFP development, and enhancing stand nurturing and soil nutrient accumulation in the mid-development stage were beneficial to the sustainable management of CFP.

Time-dependent effects of microplastics on soil bacteriome

Microplastic threats to biodiversity, health and ecological safety are adding to concern worldwide, but the real impacts on the functioning of organisms and ecosystems are obscure owing to their inert characteristics. Here we investigated the long-lasting ecological effects of six prevalent microplastic types: polyethylene (PE), polypropylene (PP), polyamide (PA), polystyrene (PS), polyethylene terephthalate (PET), and polyvinyl chloride (PVC) on soil bacteria at a 2 % (w/w) level. Due to the inertia and lack of available nitrogen of these microplastics, their effects on bacteriome tended to converge after one year and were strongly different from their short-term effects. The soil volumes around microplastics were very specific, in which the microplastic-adapted bacteria (e.g., some genera in Actinobacteria) were enriched but the phyla Bacteroidetes and Gemmatimonadetes declined, resulting in higher microbial nitrogen requirements and reduced organic carbon mineralization. The reshaped bacteriome was specialized in the genetic potential of xenobiotic and lipid metabolism as well as related oxidation, esterification, and hydrolysis processes, but excessive oxidative damage resulted in severe weakness in community genetic information processing. According to model predictions, microplastic effects are indirectly derived from nutrients and oxidative stress, and the effects on bacterial functions are stronger than on structure, posing a heavy risk to soil ecosystems.

Detection of haemodynamic obstruction in hypertrophic cardiomyopathy using the sub-aortic complex: a cardiac MRI and Doppler study

AIM

To investigate the "sub-aortic complex (SAC)", a new cardiac magnetic resonance imaging (CMRI)-derived parameter, for the evaluation of left ventricular (LV) outflow tract (LVOT) obstruction in patients with hypertrophic cardiomyopathy (HCM), compared with conventional CMRI parameters and Doppler echocardiography.

MATERIALS AND METHODS

A total of 157 consecutive patients with HCM were recruited retrospectively. The patients were divided into two groups, 87 with LVOT obstruction and 70 without obstruction. The SAC was defined as a specific anatomical SAC affecting the LVOT, which were measured on the LV three-chamber steady-state free precession (SSFP) cine image at the end-systolic phase. The relations between the existence and severity of obstruction and SAC index (SACi) were evaluated using Pearson's correlation coefficient, receiver operating characteristic (ROC) curves, and logistic regression.

RESULTS

The SACs were significantly different between the obstructive and non-obstructive groups. The ROC curves indicated that the SACi was able to discriminate obstructive and non-obstructive patients with the best predictive accuracy (AUC = 0.949, p<0.001). The SACi was an independent predictor of LVOT obstruction and there was a significant negative correlation between resting LVOT pressure gradient and SACi (r=0.72 p<0.001). In the subgroup of patients with or without severe basal septal hypertrophy, the SACi was still able to predict LVOT obstruction with excellent diagnostic accuracy (AUC = 0.944 and 0.948, p<0.001, respectively).

CONCLUSION

The SAC is a reliable and straightforward CMRI marker for assessing LVOT obstruction. It is more effective than CMRI two-dimensional flow in diagnosing the severity of obstruction in patients with HCM.

Efficacy and Safety of Dl-3-n-Butylphthalide Combined With Human Urinary Kallidinogenase in the Treatment of Acute Ischemic Stroke

OBJECTIVES

Intravenous thrombolysis and mechanical endovascular thrombectomy are recommended for patients whose stroke onsets are within the first 6 hours; however, patients beyond this time window have very limited options. Dl-3-n-butylphthalide (NBP) and human urinary kallidinogenase (HUK) have shown potential clinical benefits in the treatment of acute ischemic stroke (AIS) patients. This research aims to investigate the efficacy and safety of NBP combined with HUK in the treatment of ischemic stroke patients.

PATIENTS AND METHODS

We reviewed the 215 AIS patients registered in the database of the Fifth Affiliated Hospital of Sun Yat-sen University from April 2019 to October 2020. Among them, 65 patients received NBP sodium chloride injection treatment, 55 patients received HUK treatment, and 95 patients received NBP sodium chloride injection combined with HUK treatment. The recovery of neural function was evaluated by the National Institutes of Health Stroke Scale (NIHSS), and the recovery of daily function was evaluated by the modified Rankin Scale (mRS). The NIHSS and mRS scores after the 7-day treatment, 6-month independency rate (6-month mRS score ≤1), and related factors were compared among the 3 groups. The safety was monitored by recording adverse events.

RESULTS

The NIHSS and mRS scores of 7-day and 6-month treatment in the NBP combined with HUK group were lower than the monotherapy ( P < 0.05). In addition, the NBP combined with HUK treatment achieved an independency rate of 82.1%, whereas NBP and HUK treatments achieved only 53.8% and 63.6%, respectively ( P < 0.001). Binary logistic regression showed that NBP combined with HUK therapy treatment could lead to a 5.28 times higher rate of patients' 6-month independency after AIS occurrence. No serious adverse events occurred in both the combined therapy and monotherapy.

CONCLUSIONS

Dl-3-n-butylphthalide combined with HUK is safe to treat AIS patients. It can significantly improve the neural function and the 6-month recovery of AIS patients.

The toxic differentiation of micro- and nanoplastics verified by gene-edited fluorescent Caenorhabditis elegans

The increased emission and accumulation of micro- or nanoplastics (M-NPs) have posed a severely threaten to organisms in the environment. Though the toxicity of M-NPs has been observed in many species, the fundamental factors determining the biotoxicity are rarely expounded on. In this work, typical polystyrene (PS) M-NPs were set up with a multiparameter variation in size gradient, surface charge contrast and concentration variant, and evaluated by the Caenorhabditis elegans (C. elegans) model. From the endpoints of body length, brood size, survival rate and lifespan, an adverse effect was found on the growth and development of C. elegans caused by PSs. In general, the toxicity of PS was found to be concentrated- and size-dependent, with 100 nm positively charged nano-PS having the highest physio-toxicity. Monitoring by fluorescent imaging, it showed that positively charged nano-PS was mainly ingested and accumulated in the intestinal tract of C. elegans. In addition, the penetrated PS induced severe biological stress reactions with the increase of reactive oxygen species (ROS) and lipofuscin. Furthermore, the following expression of antioxidation-related enzymes was activated in vivo as indicated by the GFP-labelled C. elegans. All the results supplied visually toxic parameters of M-NPs to organisms, which sheds light on the biosecurity and ecological risks of M-NPs in the future.

Arbuscular mycorrhizal fungi contribute to wheat yield in an agroforestry system with different tree ages

Intercropping achieved through agroforestry is increasingly being recognized as a sustainable form of land use. In agroforestry, the roots of trees and crops are intermingled, and their interactions and the production of exudates alter the soil environment and soil microbial community. Although tree–crop interactions vary depending on the stand age of the trees, how stand age affects beneficial microorganisms, including arbuscular mycorrhizal fungi (AMF), and whether changes in soil microorganisms feed back on crop growth in agroforestry systems are unknown. We therefore conducted a long-term field study to compare changes in the soil microbial and AMF communities in a jujube/wheat agroforestry system containing trees of different stand ages: 3-year-old jujube, 8-year-old jujube, and 13-year-old jujube. Our results showed that by changing soil moisture and available phosphorus content, the stand age of the trees had a significant effect on the soil microbial and AMF communities. Soil moisture altered the composition of soil bacteria, in particular the proportions of Gram-positive and Gram-negative species, and available phosphorus had significant effects on the AMF community. A network analysis showed that older stands of trees reduced both AMF diversity and network complexity. An ordinary least squares regression analysis indicated that AMF diversity, network complexity, and stability contributed to wheat yield. Finally, structural equation modeling showed that changes in edaphic factors induced by tree age brought about significant variation in the soil microbial and AMF communities, in turn, affecting crop growth. Our study highlights the crucial roles of soil microorganisms, in particular AMF, in supporting plant growth in agroforestry systems as well as the need to consider stand age in the establishment of these systems.

Inhibiting Hh Signaling in Gli1+ Osteogenic Progenitors Alleviates TMJOA

The increased prevalence of temporomandibular joint osteoarthritis (TMJOA) in children and adolescents has drawn considerable attention as it may interfere with mandibular condyle growth, resulting in dento-maxillofacial deformities. However, treatments for osteoarthritis have been ineffective at restoring the damaged bone and cartilage structures due to poor understanding of the underlying degenerative mechanism. In this study, we demonstrate that Gli1+ cells residing in the subchondral bone contribute to bone formation and homeostasis in the mandibular condyle, identifying them as osteogenic progenitors in vivo. Furthermore, we show that, in a TMJOA mouse model, derivatives of Gli1+ cells undergo excessive expansion along with increased but uneven distribution of osteogenic differentiation in the subchondral bone, which leads to abnormal subchondral bone remodeling via Hedgehog (Hh) signaling activation and to the development of TMJOA. The selective pharmacological inhibition and specific genetic inhibition of Hh signaling in Gli1+ osteogenic progenitors result in improved subchondral bone microstructure, attenuated local immune inflammatory response in the subchondral bone, and reduced degeneration of the articular cartilage, providing in vivo functional evidence that targeting Hh signaling in Gli1+ osteogenic progenitors can modulate bone homeostasis in osteoarthritis and provide a potential approach for treating TMJOA.

Cell transcriptomic atlas of the non-human primate Macaca fascicularis

Studying tissue composition and function in non-human primates (NHPs) is crucial to understand the nature of our own species. Here we present a large-scale cell transcriptomic atlas that encompasses over 1 million cells from 45 tissues of the adult NHP Macaca fascicularis. This dataset provides a vast annotated resource to study a species phylogenetically close to humans. To demonstrate the utility of the atlas, we have reconstructed the cell-cell interaction networks that drive Wnt signalling across the body, mapped the distribution of receptors and co-receptors for viruses causing human infectious diseases, and intersected our data with human genetic disease orthologues to establish potential clinical associations. Our M. fascicularis cell atlas constitutes an essential reference for future studies in humans and NHPs.

[Clinical effects of in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage in the treatment of hypertrophic scar in non-functional sites after burns]

Objective: To investigate the clinical effects of in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage in the treatment of hypertrophic scar in non-functional sites after burns. Methods: A retrospective observational study was used. From June 2017 to June 2019, 33 patients (24 males and 9 females, aged 8-50 years) who met the inclusion criteria with hypertrophic scars in non-functional sites outside the face after burns were treated in General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University). All patients underwent scalp transplantation after perforation of retained split scar matrix in situ (with scar thinning area of 90-500 cm2), and then the vacuum sealing drainage was performed. The hematoma and infection of wounds were observed on the 7th day after operation. At the same time, the survival rate of skin grafting was observed and calculated. The flatness and thickness of the scar in the operative area were observed in 12 months after operation, and the itching and pain of the patients were recorded. Vancouver Scar Scale was used to score the scar of patients before operation and at 3, 6 and 12 months after operation. The healing time and hair growth of donor site were observed. Data were statistically analyzed with repeated analysis of variance, paired sample t test and bonferroni correction. Results: On the 7th day after operation, local subcutaneous hematoma appeared in the wound of 2 patients, which healed after dressing change; no infection occurred. On the 7th day after operation, the survival rate of skin grafting of patients was 94.6%-99.0%(96.8±1.2)%. Scar flatness was well, the thickness of scar was not significantly higher than that of normal skin in 12 months after operation, and the symptoms of itching pain of patients disappeared or significantly relieved. Vancouver Scar Scale scores of patients before operation and at 3, 6, and 12 months after operation were 12.1±2.8, 8.5±1.5, 7.6±1.6, 6.7±1.3, respectively, and the scores of 3, 6, and 12 months after operation were all significantly lower than that before operation (with t values of 4.48, 4.06, and 3.97, respectively, P<0.01). All the donor sites of the head healed well in 4-7 days after operation. By 3-6 months after operation, all patients had good hair growth in the donor site and achieved no scar healing. Conclusions: The treatment of hypertrophic scar in non-functional sites outside the face after burns by in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage can effectively improve the appearance of hypertrophic scar in non-functional areas after burn and reduce its degree of hyperplasia, with scar-free donor site healing.

[Analysis of molecular and clinical characteristics of carbapenem-resistant hypervirulent Klebsiella pneumoniae in the intensive care unit]

To investigate the carbapenemases distribution of carbapenem-resistant Klebsiella pneumoniae (CRKP) in the intensive care unit, and the clinical characteristics between carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) and carbapenem-resistant non-hypervirulent Klebsiella pneumoniae (CR-non-hvKP) were compared. A total of 53 non-repetitive CRKP strains isolated from 49 patients in the intensive care unit of the Second Affiliated Hospital of Xi'an Jiaotong University from May 2020 to March 2021 were retrospectively studied. The carbapenemase inhibitor enhancement test was used for screening carbapenemase-producing strains, and the string test was carried out to screen the hypermucoviscosity phenotype. Using PCR to detect five main carbapenemase genes (bla_KPC-2, bla_NDM, bla_IMP , bla_VIM and bla_OXA-48-like), common serotype (K1 and K2) and virulence gene (rmpA and iutA). Treated the strains with both rmpA and iutA genes as hypervirulent Klebsiella pneumonia (hvKP), and the whole genome sequencing of CR-hvKP was completed. At the same time, the clinical data of 49 patients were sorted out, and the differences in clinical characteristics of CR-hvKP and CR-non-hvKP infected patients were compared using the independent sample t test, Mann-Whitney U test, chi-square test or Fisher's exact probability test. CRKP isolated from the intensive care unit were extensively drug resistance and still had a good sensitivity to polymyxin B and tigecycline. Producing carbapenemases were the main resistance mechanism of CRKP (52/53, 98.1%). Of the 53 CRKP strains, except for 1strain that did not detect carbapenemase, at least one carbapenemase resistance gene was detected in the remaining 52 CRKP strains, of which 45 strains carried an enzyme, including 36 bla_KPC-2 (36/53, 67.9%), 8 bla_NDM (8/53, 15.1%), 1 bla_IMP (1/53, 1.9%), and 7 strains carried with both bla_KPC-2 and bla_NDM (7/53, 13.2%). String test and virulence gene showed that 7 CR-hvKP strains (13.2%) were detected in 53 CRKP strains, and two of which were hypermucoviscosity phenotype. Sequencing results revealed that CR-hvKP were mainly ST11 type. Almost all patients with CR-hvKP infection were over 60 years old (7/7), with invasive treatment (7/7), pulmonary infection with hypermucoviscosity phenotype (2/7) and high mortality (5/7); and the percentage of neutrophils in patients with CR-hvKP infection (86.44±4.70) % was higher than those patients with CR-non-hvKP infection (78.90±19.15) %, the difference was statistically significant (t=-2.225, P=0.032). The CR-hvKP strains in the intensive care unit mainly produced KPC-2 enzyme, with K2 capsular serotype and ST11 type. It is necessary to strengthen the monitoring and control of the CR-hvKP strain to prevent the co-evolution of drug-resistant and hypervirulent strains.

Systematical review of interactions between microplastics and microorganisms in the soil environment

Terrestrial ecosystems are widely contaminated by microplastics due to extensive usage and poor handling of plastic materials, but the subsequent fate and remediate strategy of these pollutants are far from fully understood. In soil environments, microplastics pose a potential threat to the survival, growth, and reproduction of soil microbiota that in turn threaten the biodiversity, function, and services of terrestrial ecosystems. Meanwhile, microorganisms are sensitive to microplastics due to the adaptability to changes in substrates and soil properties. Through the metabolic and mineralization processes, microorganisms are also crucial participator to the plastic biodegradation. In this review, we present current knowledges and research results of interactions between microplastics and microorganisms (both fungi and bacteria) in soil environments and mainly discuss the following: (1) effects of microplastics on microbial habitats via changes in soil physical, chemical, and biological properties; (2) effects of microplastics on soil microbial communities and functions; and (3) soil microbial-mediated plastic degradation with the likely mechanisms and potential remediation strategies. We aim to analyze the mechanisms driving these interactions and subsequent ecological effects, propose future directives for the study of microplastic in soils, and provide valuable information on the plastic bioremediation in contaminated soils.

Lysophosphatidic acid receptor 6 regulated by miR-27a-3p attenuates tumor proliferation in breast cancer

Purpose

Lysophosphatidic acid (LPA) is a bioactive molecule which participates in many physical and pathological processes. Although LPA receptor 6 (LPAR6), the last identified LPA receptor, has been reported to have diverse effects in multiple cancers, including breast cancer, its effects and functioning mechanisms are not fully known.

Methods

Multiple public databases were used to investigate the mRNA expression of LPAR6, its prognostic value, and potential mechanisms in breast cancer. Western blotting was performed to validate the differential expression of LPAR6 in breast cancer tissues and their adjacent tissues. Furthermore, in vitro experiments were used to explore the effects of LPAR6 on breast cancer. Additionally, TargetScan and miRWalk were used to identify potential upstream regulating miRNAs and validated the relationship between miR-27a-3p and LPAR6 via real-time polymerase chain reaction and an in vitro rescue assay.

Results

LPAR6 was significantly downregulated in breast cancer at transcriptional and translational levels. Decreased LPAR6 expression in breast cancer is significantly correlated with poor overall survival, disease-free survival, and distal metastasis-free survival, particularly for hormone receptor-positive patients, regardless of lymph node metastatic status. In vitro gain and loss-of-function assays indicated that LPAR6 attenuated breast cancer cell proliferation. The analyses of TCGA and METABRIC datasets revealed that LPAR6 may regulate the cell cycle signal pathway. Furthermore, the expression of LPAR6 could be positively regulated by miR-27a-3p. The knockdown of miR-27a-3p increased cell proliferation, and ectopic expression of LPAR6 could partly rescue this phenotype.

Conclusion

LPAR6 acts as a tumor suppressor in breast cancer and is positively regulated by miR-27a-3p.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12094-021-02704-8.

Early Clinical Outcomes of Short versus Long Proximal Femoral Nail Anti-rotation (PFNA) in the Treatment of Intertrochanteric Fractures

INTRODUCTION

Both short and long PFNA are employed to treat intertrochanteric fractures. Controversy exists in the choice between the two nails as each implant has specific characteristics and theoretical advantages. This retrospective study seeks to examine the operative complication rates and clinical outcomes of short versus long (Proximal Femoral Nail Antirotation) PFNA in the treatment of intertrochanteric fractures.

MATERIAL AND METHODS

Between July 2011 and February 2015, 155 patients underwent PFNA insertion. The decision on whether to use a short or long PFNA nail, locked or unlocked, was determined by the attending operating surgeon. Visual Analogue Pain Score (VAS) Harris Hip Scores (HHS), Short-form 36 Health Questionnaire (SF-36) and Parker Mobility Scores (PMS) were collected at six weeks, six months and one year post-operatively.

RESULTS

A total of 137 (88.4%) patients were successfully followed-up. Forty-two (30.7%) patients received a short PFNA. The patients were similar in baseline characteristics of age, gender, and comorbidities. Operative time was significantly longer in the short PFNA group (62 ±17 mins) versus the long PFNA group (56±17). While the patients in both groups achieved improvement in all outcome measures, there was no significant difference between the groups in terms of HHS (61.0 ±16.0 vs 63.0 ±16.8, p=0.443), PMS (2.3±1.5 vs 2.7±2.1, p=0.545) and VAS (1.7±2.9 vs 1.8 ±2.2 p=0.454). There were 3 (7.1%) and 7 (7.4%) complications in the short versus long PFNA group, respectively.

CONCLUSION

Both short and long PFNA had similar clinical outcomes and complication rates in the treatment of intertrochanteric fractures in an Asian population.

[Construction and effect evaluation of tuberculosis information platform in Ningxia]

Objective: To explore the value of information technology in management of tuberculosis patients. Methods: The data comes from the case reports of Ningxia tuberculosis patients in the national tuberculosis special report system from March to December 2019 and the data of Ningxia tuberculosis information management platform. Using the computer Information and communication technologies and the Internet platform, unified data collection and data interface standards,Hospital Information System(HIS) of 18 (90%)TB specific Hospitals in Ningxia 22 counties are linked together, forming a closed loop management System, to realize Information interconnection, compare the patients' diagnostic rate before and after the application, and standardize treatment differences. Results: The system automatically collected and uploaded valid data for 2 918 times, and the consistency rate of uploaded data was 94.8%.The clinical diagnostic rate was 18.23% (1 154/6 332) before and 39.1% (914/2 335) after using the AI imaging screening subsystem (χ²=235.56, P<0.001).The regular medication rate of patients after system use was 86.89% (510/587), which was higher than that before [73.72% (544/738)] (χ²=3.94, P<0.05).The cure rate of etiologically positive tuberculosis patients (2019) was 86.03% (788/916), which was higher than that of 83.45% (1 008/1 208) before the use of the system (2018) (χ²=435.43, P<0.001). Conclusion: The tuberculosis information management platform in Ningxia has achieved tuberculosis information interconnection, significantly improving the standard diagnosis, treatment and management level of tuberculosis.

Estimation of leaf water content from hyperspectral data of different plant species by using three new spectral absorption indices

The leaf equivalent water thickness (EWT, g cm-2) and fuel moisture content (FMC, %) are key variables in ecological and environmental monitoring. Although a variety of hyperspectral vegetation indices have been developed to estimate the leaf EWT and FMC, most of these indices are defined considered two or three specific bands for a specific plant species, which limits their applicability. In this study, we proposed three new spectral absorption indices (SAI970, SAI1200, and SAI1660) for various plant types by considering the symmetry of the spectral absorption at 970 nm, 1200 nm and 1660 nm and spectral heterogeneity of different leaves. The indices were calculated considering the absorption peak and shoulder bands of each leaf instead of the same specific bands for all leaves. A pooled dataset of three tree species (camphor (VX), capricorn (VJ), and red-leaf plum (VL)) was used to test the performance of the SAIs in terms of the leaf EWT and FMC estimation. The results indicated that, first, SAI1200 was more suitable for estimating the EWT than FMC, whereas SAI970 and SAI1660 were more suitable for estimating the FMC. Second, SAI1200 achieved the most accurate estimation of the EWT with a cross-validation coefficient of determination (Rcv2) of 0.845 and relative cross-validation root mean square error (rRMSEcv) of 8.90%. Third, SAI1660 outperformed the other indices in estimating the FMC at the leaf level, with an Rcv2 of 0.637 and rRMSEcv of 8.56%. Fourth, SAI970 achieved a moderate accuracy in estimating the EWT (Rcv2 of 0.25 and rRMSEcv of 19.68%) and FMC (Rcv2 of 0.275 and rRMSEcv of 12.10%) at the leaf level. These results can enrich the application of the SAIs and demonstrate the potential of using SAI1200 to determine the leaf EWT and SAI1660 to obtain the leaf FMC among various plant types.

Comprehensive landscape of epigenetic-dysregulated lncRNAs reveals a profound role of enhancers in carcinogenesis in BC subtypes

Aberrant expression of long non-coding RNAs (lncRNA) is associated with altered DNA methylation and histone modifications during carcinogenesis. However, identifying epigenetically dysregulated lncRNAs and characterizing their functional mechanisms in different cancer subtypes are still major challenges for cancer studies. In this study, we systematically analyzed the epigenetic alterations of lncRNAs at important regulatory elements in three breast cancer subtypes. We identified 87, 691, and 1,197 epigenetically dysregulated lncRNAs in luminal, basal, and claudin-low subtypes of breast cancer, respectively. The landscape of epigenetically dysregulated lncRNAs at enhancer elements revealed that epigenetic changes of the majority of lncRNAs occurred in a subtype-specific manner and contributed to subtype-specific biological functions. We identified six acetylation of lysine 27 on histone H3 (H3K27ac)-dysregulated lncRNAs and three DNA methylation-dysregulated lncRNAs (CTC-303L1.2, RP11-738B7.1, and SLC26A4-AS1) as prognostic biomarkers of basal subtype. These lncRNAs were involved in immune response-related biological functions. Treatment of the basal breast cancer cell line MDA-MB-468 with CREBBP/EP300 bromodomain inhibitors downregulated H3K27 acetylation levels and caused a decrease in the expression of five H3K27ac-dysregulated lncRNAs (LINC00393, KB-1836B5.1, RP1-140K8.5, AC005162.1, and AC020916.2) and inhibition of the growth of breast cancer cells. One epigenetically dysregulated lncRNA (LINC01983) and four lncRNA regulators (UCA1, RP11-221J22.2, RP11-221J22.1, and RP1-212P9.3) were identified as prognostic biomarkers of the luminal molecular subtype of breast cancer by controlling the tumor necrosis factor (TNF) signaling pathway, T helper (Th)17 cell differentiation, and T cell migration. Finally, our results highlighted a profound role of enhancer-related H3K27ac-dysregulated lncRNAs, DNA methylation-dysregulated lncRNAs, and lncRNA regulators in breast cancer subtype carcinogenesis and their potential prognostic value.

The impact of new modes of electronic communication in the treatment of severe acute respiratory syndrome coronavirus 2 infection

Background

More than 26,760,000 cases of SARS-CoV-2 infection have been reported globally to date. This study aimed to analyze the impact of new electronic communication tools in the diagnosis and treatment of patients with SARS-CoV-2 infection.

Methods

From January 20 to February 26, 2020, adult patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were treated in The Fifth Affiliated Hospital, Sun Yat-sen University, in Zhuhai, China, were recruited. Forty-seven eligible patients were enrolled and randomly classified into either the test group or the control group. All of the patients received the standard therapeutic regimen and routine ward rounds. The test group was subdivided into three subgroups: the first subgroup (5-minute group) was given an extra 5-minute ward round by WeChat voice call once daily for basic disease communication; the second subgroup (10-minute group) received an extra 10-minute ward round by WeChat voice call once daily for further detail; and the third subgroup (20-minute group) was given an extra 10-minute ward round via WeChat voice call once daily, as well as an extra 10 minutes every 3 days. The primary outcome was the duration of positive-to-negative conversion of SARS-CoV-2 nucleic acid diagnosed by the NAT (nucleic acid testing).

Results

In the test groups, the median time from diagnosis to the endpoint was 7.0 days [interquartile range (IQR), 3.8–10.8], compared with 10.0 days (IQR, 6.5–14.5) in the control group. It showed significant reduced the duration time of virus from positive to negative by the NAT (nucleic acid testing), (P=0.032) especially between the 10-minute subgroup (3.0 days; IQR, 3.0–7.5) and the control group (P=0.0065).

Conclusions

The use of new modes of electronic communication can benefit patients during the COVID-19 pandemic and could be extremely valuable in addressing the shortage of medical protective equipment and reducing occupational risk of exposure to infection.

[Three-dimensional quantitative evaluation of condylar bone remodeling of temporomandibular joint based on cone-beam CT imaging]

Objective: To establish a three-dimensional （3D） quantitative measurement and evaluate the condylar bone remodeling of temporomandibular joint (TMJ). Methods: Pre-and post-treatment cone-beam CT (CBCT) data were obtained from 41 patients ［10 males, 31 females, mean age of (19.7±4.4) years (12-30 years old)］, who visited the Center for TMD and Orofacial Pain, Peking University School and Hospital of Stomatology from November 2014 to August 2019, and diagnosed with acute disc displacement without reduction or disc displacement with reduction, with intermittent locking and treated by manual disc reduction followed by anterior repositioning splint. First, condylar bone remodeling was evaluated according to the number of "double contour image" and qualitatively classified as no remodeling (no double contour image), partial remodeling (1-4 double contour images) and remarkable remodeling (5-6 double contour images). Then, condylar bone remodeling was quantitatively evaluated by CBCT based 3D measurement: segmenting condylar images using a semi-automatic method of the manually preliminary mark combined with watershed algorithm, reconstructing the surface models, superimposing the pre-and post-treatment condylar images and finally calculating the volumetric differences of condyle and condylar head, respectively. Results: The Kappa values of two-dimensional (2D) qualitative evaluation were 0.66-0.87, and 3D quantitative measurements of condyle and condylar head volume were also reliable, with the intraclass correlation coefficient (ICC) values of intra-observer 0.998/0.941 and inter-observer 0.999/0.942 respectively. The volumetric increment of the condyle and condylar head after treatment was (41.7±90.2) mm³ and (62.8±70.9) mm³, respectively. Eighty-two condyles were divided into three sub-groups: no remodeling (21), partial remodeling (20) and remarkable remodeling (41). Ranking of the volumetric increment of the condyle and condylar head after treatment was as follows: remarkable remodeling group>partial remodeling group>no remodeling group (P<0.05). Conclusions: The 3D quantitative measurement for evaluating condylar bone remodeling had excellent consistency and reliability, which was consistent with the qualitative classification for condylar bone remodeling. The condylar head as a region of interest was more sensitive to the volumetric changes.

LncTarD: a manually-curated database of experimentally-supported functional lncRNA-target regulations in human diseases

Long non-coding RNAs (lncRNAs) are associated with human diseases. Although lncRNA–disease associations have received significant attention, no online repository is available to collect lncRNA-mediated regulatory mechanisms, key downstream targets, and important biological functions driven by disease-related lncRNAs in human diseases. We thus developed LncTarD (http://biocc.hrbmu.edu.cn/LncTarD/ or http://bio-bigdata.hrbmu.edu.cn/LncTarD), a manually-curated database that provides a comprehensive resource of key lncRNA–target regulations, lncRNA-influenced functions, and lncRNA-mediated regulatory mechanisms in human diseases. LncTarD offers (i) 2822 key lncRNA–target regulations involving 475 lncRNAs and 1039 targets associated with 177 human diseases; (ii) 1613 experimentally-supported functional regulations and 1209 expression associations in human diseases; (iii) important biological functions driven by disease-related lncRNAs in human diseases; (iv) lncRNA–target regulations responsible for drug resistance or sensitivity in human diseases and (v) lncRNA microarray, lncRNA sequence data and transcriptome data of an 11 373 pan-cancer patient cohort from TCGA to help characterize the functional dynamics of these lncRNA–target regulations. LncTarD also provides a user-friendly interface to conveniently browse, search, and download data. LncTarD will be a useful resource platform for the further understanding of functions and molecular mechanisms of lncRNA deregulation in human disease, which will help to identify novel and sensitive biomarkers and therapeutic targets.

[Reflections on the orientation of public health physicians]

Public health physician is one of the four statutory types of physicians in China, but there is no consensus on their connotation. The main problems are that public health physician is confused with those who perform public health tasks, the relationship between public health physician and clinician and the connotation of prescription right is not clear, and there is limitation in public health education and relevant laws and regulations. Public health physician is positioned as professionals who monitor, investigate, evaluate, and intervene in population health-related issues. It is suggested to retain the practicing qualification of public health physicians and highlight the attribute of public health physicians' prescribing the prescriptions for community health. Encourage public health physicians to obtain qualification for clinicians to individual prescription, Encourage clinicians to access to public health physician qualification. Improve public health school education, take the pilot of public health physician standardization training, cultivate "prevention and treatment combined" physician.

Eicosapentaenoic acid prevents inflammation induced by acute cerebral infarction through inhibition of NLRP3 inflammasome activation

OBJECTIVE

Acute cerebral infarction (ACI) is the most common type of acute cerebrovascular diseases resulting in high rate of death and disability. Numerous evidences show that inflammation is the leading cause of ischemic brain injury, thus anti-inflammatory therapy is an attractive candidate for ischemic brain damage. Eicosapentaenoic acid (EPA) exerts anti-inflammatory activity in lots of human inflammatory diseases, whereas its effect in ACI is left to elucidate.

METHOD

Nlpr3^-/- mice, Gpr40^-/-; Gpr120^-/- mice and mice with right middle cerebral artery occlusion (MCAO) were used to detect NLR family pyrin domain containing 3 (NLRP3) inflammasome activation by Western Blot and the release of proinflammatory cytokines by ELISA. To estimate the acute ischemic condition in vitro, oxygen-glucose deprivation (OGD) was induced in BV2 microglia cells. Transfection of the shRNA targeting GPR40 and GPR120 mRNA into BV2 cells was also assessed. Apoptosis in ischemic cerebral tissues and BV2 cells was detected by terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (TUNEL) assay and flow cytometry.

RESULT

Here we show that EPA suppresses ACI-induced inflammatory responses through blocking NLRP3 inflammasome activation. In addition, EPA inhibits NLRP3 inflammasome activation through G protein-coupled receptor 40 (GPR40) and GPR120. Importantly, EPA ameliorates ACI-induced apoptosis.

CONCLUSION

EPA exerts beneficial effect on ACI-induced inflammation through blocking NLRP3 inflammasome activation by GPR40 and GPR120. Our findings suggest the potential clinical use of EPA in ACI.

Cerebral Damage after Carbon Monoxide Poisoning: A Longitudinal Diffusional Kurtosis Imaging Study

BACKGROUND AND PURPOSE

Previous DTI cross-sectional studies have showed the cerebral damage feature was different in the three clinical stages after carbon monoxide poisoning. Diffusional kurtosis imaging (DKI) is an advanced diffusion imaging model and considered to better provide microstructural contrast in comparison with DTI parameters. The primary aim of this study was to assess microstructural changes in gray and white matter with diffusional kurtosis imaging in the acute, delayed neuropsychiatric, and chronic phases after acute carbon monoxide (CO) poisoning. The secondary aim was to relate diffusional kurtosis imaging measures to neuropsychiatric outcomes of acute carbon monoxide poisoning.

MATERIALS AND METHODS

In all, 17 patients with acute carbon monoxide poisoning and 30 sex- and age-matched healthy volunteers were enrolled in the study. Patients were scanned within 1 week, 3-8 weeks, and 6 months after acute carbon monoxide poisoning. Diffusional kurtosis imaging metrics including mean kurtosis, mean diffusivity, fractional anisotropy, and kurtosis fractional anisotropy were measured in 11 ROIs and then further correlated with neuropsychiatric scores.

RESULTS

In WM, mean kurtosis tended to increase from the acute-to-delayed neuropsychiatric phases and then decrease in the chronic phase, while in GM mean kurtosis showed a constant decline. Contrary to mean kurtosis, mean diffusivity first decreased then tended to increase in WM, while in GM, from the acute to chronic phases, mean diffusivity showed a constant increase. In both WM and GM, the fractional anisotropy and kurtosis fractional anisotropy values progressively declined with time. Kurtosis fractional anisotropy showed the best diagnostic efficiency with an area under the curve of 0.812 (P = .000). Along with neuropsychiatric scores, kurtosis fractional anisotropy of the centrum semiovale and Digit Span Backward were most relevant (r = 0.476, P = .000).

CONCLUSIONS

Longitudinally, microstructural changes were inconsistent in WM and GM with time after acute carbon monoxide poisoning. Diffusional kurtosis imaging metrics provided important complementary information to quantify the damage to cognitive impairment.

Fast exact conformalization of the lasso using piecewise linear homotopy

Conformal prediction is a general method that converts almost any point predictor to a prediction set. The resulting set retains the good statistical properties of the original estimator under standard assumptions, and guarantees valid average coverage even when the model is mis-specified. A main challenge in applying conformal prediction in modern applications is efficient computation, as it generally requires an exhaustive search over the entire output space. In this paper we develop an exact and computationally efficient conformalization of the lasso and elastic net. The method makes use of a novel piecewise linear homotopy of the lasso solution under perturbation of a single input sample point. As a by-product, we provide a simpler and better-justified online lasso algorithm, which may be of independent interest. Our derivation also reveals an interesting accuracy-stability trade-off in conformal inference, which is analogous to the bias-variance trade-off in traditional parameter estimation. The practical performance of the new algorithm is demonstrated in both synthetic and real data examples.

Association between hypoplastic condyles and temporomandibular joint disc displacements: a cone beam computed tomography and magnetic resonance imaging metrical analysis

This study investigated the association between hypoplastic condyles and disc displacements without reduction (DDw/oR). Consecutive patients with non-syndromic unilateral condylar hypoplasia were recruited and clinical, cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) data were acquired. Linear measurements including condylar head width, depth, height and condyle length were determined with CBCT while MRI was used to assess disc position, morphology and displacement. A total of 43 patients were enrolled of which 93.02% had a history of temporomandibular disorders (TMDs) and 83.72% presented with TMD signs and symptoms. Depth and height of the condylar head along with condyle length of hypoplastic joints (6.68±1.67mm, 4.97±1.25mm and 14.49±3.02mm, respectively) were significantly lesser than normal joints (7.77±1.26mm, 6.35±1.45mm and 18.20±3.18mm) (P<0.001). The prevalence of DDw/oR was significantly higher in hypoplastic joints (79.07% versus 13.95%) (P<0.001). Joints with hypoplastic condyles had shorter disc lengths (6.99 ± 2.16 mm vs, 8.45 ± 2.26 mm) (P=0.007). Furthermore, disc displacements were significantly more advanced (8.52 ± 2.84 mm) and severe (76.74% with severe translations) when compared to the contralateral side (4.77 ± 2.97 mm and 32.56%) (P<0.05). A significant association was observed between condylar hypoplasia and temporomandibular joint DDw/oR with hypoplastic joints exhibiting more severely displaced and deformed discs. DDw/oR coupled with repaired degenerative joint disease may mimic condylar hypoplasia radiographically.

[Characteristics of MRI and associated pathological features of the condylar cyst like lesions in temporomandibular joint]

Objective: To analyze the MRI characteristics and pathological features of the condylar cyst like lesions in temporomandibular joint (TMJ). Methods: The study was conducted retrospectively on TMJ images from 14 patients (2 males, 12 females, aged 10-71) who underwent MRI examinations, from January 2015 to December 2017 at Center for TMD and Orofacial Pain, Peking University School and Hospital of Stomatology including 2 patients with pathological results. The signals of the lesion, condylar bone and disc-condyle relationship were evaluated. Results: Cyst like lesions of 15 condyles from 14 patients were analyzed. All of the lesions showed hypersignal on T2WI (12/12), while most of them showed hypersignal on T1WI (8/11) and PDWI (11/12). Mostly the lesions were surrounded by hyposignal linear margin (12/15), with normal condylar bone signal (13/15). Disk displacement with reduction was discovered in 3 joints, while disk displacement without reduction was discovered in 8 joints and 4 joints had normal disk-condyle relationships. The pathological components of cyst like lesions included cartilage, loose connective tissue, hemorrhage and bone tissue. Conclusions: Differed from those of large joints like hips or knees, MRI characteristics of cyst like lesions of condyle in TMJ exhibited hypersignal imaging in both T1WI and T2WI, indicating that the components of cyst like lesions included granulation tissue, not fluid.

Evaluating the risk of post-extraction inferior alveolar nerve injury through the relative position of the lower third molar root and inferior alveolar canal

The aim of this study was to introduce a method to evaluate the risk of inferior alveolar nerve (IAN) injury following the extraction of impacted lower third molars. Two hundred impacted lower third molars adjacent to the IAN were evaluated. These were divided into four classification groups according to preoperative cone beam computed tomography (CBCT) findings: AR, apical region; LT, lateral region of the tapered root; LE, lateral region of the enlarged root; AE, adjacent to the enlarged root. All teeth were dislocated along the long axis or arc of the root by tooth sectioning technique and extracted by a single surgeon. The primary outcome variable was postoperative neurosensory impairment of the IAN. The χ² test was used to evaluate differences in postoperative IAN injury between the classifications. Logistic regression analysis was used to evaluate the risk factors for postoperative IAN injury. The overall incidence of postoperative IAN injury was 7%. Specifically, most injuries involved classification AE (AE 36%, LE 8.6%, LT 3.6%, AR 0%), and the difference was statistically significant (P< 0.05). Logistic regression showed that classification AE was the only risk factor for postoperative IAN injury (P< 0.001). According to preoperative CBCT, the risk of postoperative IAN injury is higher when the IAN is adjacent to the enlarged part of the root.