Data mining and machine learning in HIV infection risk research: An overview and recommendations

In the contemporary era, the applications of data mining and machine learning have permeated extensively into medical research, significantly contributing to areas such as HIV studies. By reviewing 38 articles published in the past 15 years, the study presents a roadmap based on seven different aspects, utilizing various machine learning techniques for both novice researchers and experienced researchers seeking to comprehend the current state of the art in this area. While traditional regression modeling techniques have been commonly used, researchers are increasingly adopting more advanced fully supervised machine learning and deep learning techniques, which often outperform the traditional methods in predictive performance. Additionally, the study identifies nine new open research issues and outlines possible future research plans to enhance the outcomes of HIV infection risk research. This review is expected to be an insightful guide for researchers, illuminating current practices and suggesting advancements in the field.

Just give the contrast? Appraisal of guidelines on intravenous iodinated contrast media use in patients with kidney disease

OBJECTIVE

To appraise the quality of guidelines on intravenous iodinated contrast media (ICM) use in patients with kidney disease, and to compare the recommendations among them.

METHODS

We searched four literature databases, eight guideline libraries, and ten homepages of radiological societies to identify English and Chinese guidelines on intravenous ICM use in patients with kidney disease published between January 2018 and June 2023. The quality of the guidelines was assessed with the Scientific, Transparent, and Applicable Rankings (STAR) tool.

RESULTS

Ten guidelines were included, with a median STAR score of 46.0 (range 28.5-61.5). The guidelines performed well in "Recommendations" domain (31/40, 78%), while poor in "Registry" (0/20, 0%) and "Protocol" domains (0/20, 0%). Nine guidelines recommended estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 as the cutoff for referring patients to discuss the risk-benefit balance of ICM administration. Three guidelines further suggested that patients with an eGFR < 45 mL/min/1.73 m2 and high-risk factors also need referring. Variable recommendations were seen in the acceptable time interval between renal function test and ICM administration, and that between scan and repeated scan. Nine guidelines recommended to use iso-osmolar or low-osmolar ICM, while no consensus has been reached for the dosing of ICM. Nine guidelines supported hydration after ICM use, but their protocols varied. Drugs or blood purification therapy were not recommended as preventative means.

CONCLUSION

Guidelines on intravenous ICM use in patients with kidney disease have heterogeneous quality. The scientific societies may consider joint statements on controversial recommendations for variable timing and protocols.

CRITICAL RELEVANCE STATEMENT

The heterogeneous quality of guidelines, and their controversial recommendations, leave gaps in workflow timing, dosing, and post-administration hydration protocols of contrast-enhanced CT scans for patients with kidney diseases, calling for more evidence to establish a safer and more practicable workflow.

KEY POINTS

• Guidelines concerning iodinated contrast media use in kidney disease patients vary. • Controversy remains in workflow timing, contrast dosing, and post-administration hydration protocols. • Investigations are encouraged to establish a safer iodinated contrast media use workflow.

Role of low-density lipoprotein in mediating the effect of air pollution on coronary heart disease: a two-step multivariate Mendelian randomization study

OBJECTIVE

Air pollution is affecting the health of millions of people all over the world. The causal correlations of PM2.5, PM10, and nitrogen dioxide (NOx), as the main fine particulate matter, and coronary heart disease (CHD) are yet to be explored. Low-density lipoprotein (LDL) has been a principal factor in the pathogenesis of CHD. It is an interesting issue to consider whether LDL mediates the effect of air pollutants in CHD pathogenesis.

MATERIALS AND METHODS

A genome-wide association study (GWAS) on the European population, followed up from 2010 to 2018, involving over 400,000 participants, was based on a land-use regression model. The annual mean concentrations of major air pollutant particles, PM2.5 (n=423,796), PM10 (n=423,796), and NOx (n=456,380), were recorded. The large GWAS database of CHD covered over ten million SNPs with independent single nucleotide polymorphisms (SNPs). LDL database collected major biochemical blood parameters from over 400,000 patients (n=440,546). Taken together, we conducted independent two-sample Mendelian randomization (MR) analyses for the causality between air pollutants (PM2.5, PM10, and NOx) and CHD. Multivariate MR analysis was conducted using causal relationships to determine the direct effects of exposure on outcome. The fixed-effect inverse variance weighted (IVW2) method was mainly employed to assess this relationship, with a confidence interval of 95% for the odds ratio (OR). Also, MR-Egger, weighted median, maximum likelihood ratio method, and random-effects inverse variance-weighted (IVW1) method were adopted as supplementary methods.

RESULTS

Two-sample MR results based on the IVW2 method suggested positive correlations between PM2.5 and CHD [OR 1.875 (1.279-2.748), p=0.001], PM10 and CHD [OR 2.586 (1.479-4.523), p=0.001], and NOx and CHD [OR 2.991 (2.021-4.427), p=4.37E-08]. The direct effect and mediating proportion were calculated using multivariable Mendelian randomization (MVMR). Lastly, the mediating proportions of LDL in the regulatory roles of PM2.5, PM10, and NOx in CHD were 2.82%, 4.73%, and 9.54%, respectively.

CONCLUSIONS

PM2.5, PM10, and NOx share direct causal associations with CHD, and LDL performs a mediating role in this pathogenic process. Early prevention against air pollution (such as increasing green areas and reducing large-scale industrial dust emissions) and early lipid-lowering treatment can effectively prevent the occurrence of CHD.

Traditional Chinese medicine external treatment combined with sodium vitrate injection for the treatment of knee osteoarthritis: A meta-analysis

BACKGROUND

Osteoarthritis of the knee is a clinically common degenerative joint disease that has a high prevalence and, if left untreated, can seriously affect a patient's quality of life. The objective of this article is to systematically evaluate the efficacy and safety of the combination of traditional Chinese medicine external treatment with sodium vitrate injection in the treatment of osteoarthritis of the knee.

METHODS

By searching China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Database (WF), Chinese Biomedical Literature Database (CBM), Embase, Pubmed, Cochrane Library. The search time was set from 2010 to March 2023. Revman 5.4 software was used for data analysis. The protocol was registered in the PROSPERO database (ref. CRD42023426707).

RESULTS

A total of 3239 patients from 31 RCTs were finally included. Meta-analysis showed significant differences in the Total clinical Efficiency (mean difference (MD) = 4.62, 95% Confidence Interval (CI) = 3.52-6.08, P < .01), WOMAC score (MD = 6.57, 95% CI = 5.78-7.36, P < .01), VAS score (MD = 0.26, 95% CI = 0.14-0.37, P < .0001), Lysholm scores (MD = 5.21, 95% CI = 4.51-5.90, P < .0001), and Lequesne index (MD = 5.21, 95% CI = 4.51-5.90, P < .0001) between the Traditional Chinese Medicine External Treatment combined with sodium vitrate injection group and control group.

CONCLUSION

The efficacy of traditional Chinese external treatment combined with sodium vitrate injection for osteoarthritis of the knee was superior to that of sodium vitrate injection only in all cases. Due to the limitations of the quantity and quality of the included literature, more high-quality literature is needed to validate this conclusion at a later stage.

The endorsement of general and artificial intelligence reporting guidelines in radiological journals: a meta-research study

BACKGROUND

Complete reporting is essential for clinical research. However, the endorsement of reporting guidelines in radiological journals is still unclear. Further, as a field extensively utilizing artificial intelligence (AI), the adoption of both general and AI reporting guidelines would be necessary for enhancing quality and transparency of radiological research. This study aims to investigate the endorsement of general reporting guidelines and those for AI applications in medical imaging in radiological journals, and explore associated journal characteristic variables.

METHODS

This meta-research study screened journals from the Radiology, Nuclear Medicine & Medical Imaging category, Science Citation Index Expanded of the 2022 Journal Citation Reports, and excluded journals not publishing original research, in non-English languages, and instructions for authors unavailable. The endorsement of fifteen general reporting guidelines and ten AI reporting guidelines was rated using a five-level tool: "active strong", "active weak", "passive moderate", "passive weak", and "none". The association between endorsement and journal characteristic variables was evaluated by logistic regression analysis.

RESULTS

We included 117 journals. The top-five endorsed reporting guidelines were CONSORT (Consolidated Standards of Reporting Trials, 58.1%, 68/117), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 54.7%, 64/117), STROBE (STrengthening the Reporting of Observational Studies in Epidemiology, 51.3%, 60/117), STARD (Standards for Reporting of Diagnostic Accuracy, 50.4%, 59/117), and ARRIVE (Animal Research Reporting of In Vivo Experiments, 35.9%, 42/117). The most implemented AI reporting guideline was CLAIM (Checklist for Artificial Intelligence in Medical Imaging, 1.7%, 2/117), while other nine AI reporting guidelines were not mentioned. The Journal Impact Factor quartile and publisher were associated with endorsement of reporting guidelines in radiological journals.

CONCLUSIONS

The general reporting guideline endorsement was suboptimal in radiological journals. The implementation of reporting guidelines for AI applications in medical imaging was extremely low. Their adoption should be strengthened to facilitate quality and transparency of radiological study reporting.

Impact of COVID-19 infection experience on mental health status of intensive care unit patients' family members: a real-world study

PURPOSE

Family members of patients hospitalized in intensive care unit (ICU) are susceptible to adverse psychological outcomes. However, there is a paucity of studies specifically examining the mental health symptoms in ICU patients' family members with a prior history of coronavirus disease 2019 (COVID-19) infection.

AIM

This study aimed to investigate mental health status and its influencing factors of ICU patients' family members with previous COVID-19 infection experience in China.

DESIGN

Nationwide, cross-sectional cohort of consecutive participants of family members of ICU patients from 10 provinces randomly selected in mainland China conducted between October 2022 and May 2023.

METHODS

The basic information scale, Self-rating depression scale, Self-rating Anxiety Scale, Impact of Event Scale-Revised, Pittsburgh sleep quality index, Perceived Stress Scale, Connor-Davidson resilience scale, Simplified Coping Style Questionnaire were employed to explore mental health status among participants.

RESULTS

A total of 463 participants, comprising 156 individuals in Covid-19 family member cohort (infection group) and 307 individuals in control family member cohort (control group), met inclusion criteria. The infection group exhibited significantly higher incidence of composite mental health symptoms compared to control group (P = 0.017). Multivariable logistic regression analysis revealed that being female, engaging in physical/mental labor, residing in rural areas, and having children were identified as risk factors for the development of depression, anxiety, and post-traumatic stress disorder symptoms, while medical history of surgery was protective factor. A predictive model demonstrated a favorable discriminative ability and excellent calibration.

CONCLUSION

COVID-19 infection experience regarded as new traumatic stressors worsen mental health status of ICU patients' family members.

Biodegradation mechanism of chlortetracycline by a novel fungal Aspergillus sp. LS-1

Chlortetracycline (CTC), a widely used typical tetracycline antibiotic, has raised increasing concerns due to its potential health and environmental risks. Biodegradation is considered an effective method to reduce CTC in environment. In this study, a strain Aspergillus sp. LS-1, which can efficiently degrade CTC, was isolated from CTC-rich activated sludge. Under optimal conditions, the maximum removal efficiency of CTC could reach 95.41%. Temperature was the most significant factor affecting the degradation efficiency of LS-1. The 19 products were identified in the CTC degradation by strain LS-1, and three degradation pathways were proposed. All the degradation pathways for CTC exhibited ring-cleaving, which may accelerate the mineralization of CTC. To gain more comprehensive insights into this strain, we obtained the genome of LS-1, which had high GC content (50.1%) and completeness (99.3%). The gene annotation revealed that LS-1 contains some vital enzymes and resistance genes that may carry functional genes involved in the CTC degradation. In addition, other antibiotic resistance genes were found in the genome of LS-1, indicating that LS-1 has the potential to degrade other antibiotics. This study provides a more theoretical basis for the investigation of CTC degradation by fungi and new insights into the biodegradation of CTC.

Novel 2D carbon material T-graphene supported 3d transition metal single atoms as efficient oxygen reduction catalysts

Carbon-based support anchored 3d transition metal (TM) single atom catalysts (SACs) have been widely considered as promising candidates for the oxygen reduction reaction (ORR), and their intrinsic activity is closely related to the geometric and electronic structures of the supports. T-graphene was predicted to have high conductivity and stability, so it may be also a promising support for loading SACs for electrocatalysis. Here, we systematically evaluate the ORR activity of T-graphene supported TM single atoms (TMN4-Tgra and TMC4-Tgra, TM = Sc-Zn) and their graphene supported counterparts (TMN4-Gra and TMC4-Gra). The TM(dxz)-O(px), TM(dyz)-O(py) and TM(dz2)-O(pz + s) orbital hybridizations between the active central metal and the *OH intermediate determine the ORR activity. Compared to graphene, T-graphene increases the d-band center (especially the β-spin state) of single atoms and reduces the *OH adsorption strength, which thus improves the ORR activity of the catalysts located in the left leg of the ORR activity volcano plot. Interestingly, we found that for the catalysts with different TMs anchored on the same support, the adsorption strength of oxygen intermediates increases with the increase of the d-band center of the active site, while for the catalysts with the same metal anchored on different supports, the adsorption strength of oxygen intermediates weakens with the increase of the d-band center of the active site, which can serve as a d-band center dependence law on supports and active sites for designing ORR catalysts.

Risk factors for bloodstream infection in paediatric haematopoietic stem cell transplantation: a systematic review and meta-analysis

BACKGROUND

Haematopoietic stem cell transplantation (HSCT), a standard treatment for paediatric haematological diseases, is highly associated with bloodstream infection (BSI), which may increase mortality.

AIM

To explore the risk factors for BSI in paediatric HSCT recipients.

METHODS

Three English databases and four Chinese databases were searched from inception to March 17th, 2022. Eligible studies included randomized controlled trials, cohort studies, and case-control studies that enrolled HSCT recipients aged ≤18 years and reported BSI risk factors. Two reviewers independently screened studies, extracted data, and assessed the risk of bias. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), certainty of body of evidence was assessed.

FINDINGS

Fourteen studies involving 4602 persons were included. The incidences of BSI and associated mortality in paediatric HSCT recipients were approximately 10-50% and 5-15%, respectively. Meta-analysis of all studies revealed that previous BSI before HSCT (relative effect (RE): 2.28; 95% confidence interval (CI) 1.19-4.34, moderate certainty) and receiving an umbilical cord blood transplant (RE: 1.55; 95% CI: 1.22-1.97, moderate certainty) were probably associated with an increased risk of BSI. Meta-analysis of studies with low risk of bias reassured that previous BSI before HSCT probably increased the risk of BSI (RE: 2.28; 95% CI: 1.19-4.34, moderate certainty), and revealed that steroid use (RE: 2.72; 95% CI: 1.31-5.64, moderate certainty) was likely a risk factor whereas autologous HSCT was probably a protective factor of BSI (RE: 0.65; 95% CI: 0.45-0.94, moderate certainty).

CONCLUSION

These findings could inform the management of paediatric HSCT recipients, helping identify who may benefit from prophylactic antibiotics.

Simulating nitrogen balance in Canadian agricultural soils from 1981 to 2016

Agriculture produces food, fiber and biofuels for the world's growing population, however, agriculture can be a major contributor of nitrogen (N) losses including emissions of ammonia (NH₃), nitrous oxide (N₂O) and nitrate (NO₃^-) leaching and runoff. A Canadian Agricultural Nitrogen Budget for Reactive N (CANBNr) model was developed to estimate the soil N balance in 3487 soil landscape of Canada polygons from 1981 to 2016. The CANBNr model integrates NH₃ emission from fertilizers, manure from housing, storage and field, as well as direct/indirect N₂O emissions from fertilizers, manures, crop residues and soil organic matter. The NO₃^- leaching is estimated based on the residual soil N (RSN) at harvest and drainage derived with the DeNitrification-DeComposition (DNDC) model. From 1981 to 2016, the N input from fertilizer and N fixation increased at a greater rate than N removal in harvested crops in all provinces of Canada, resulting in an increase in the RSN and N losses. In 2016, the Prairie provinces had lower N losses (11.7 kg N ha^-1) from N₂O, NH₃ and NO₃^- compared with 43.2 kg N ha^-1 in central Canada, and 76.5 kg N ha^-1 in Atlantic Canada. However, the Prairie provinces had 84.3% of the total Canadian farmland (74.3% of the total Canadian N input), while central Canada had 12.9% of Canadian farmland (21.7% of the total Canadian N input). In the Prairie provinces, the total N₂O loss from fertilizer N ranged 4.4-8.6 Gg N whereas NH₃ loss ranged from 17.1 to 44.6 Gg N and these values were influenced by both emission intensity and total land area. Total N₂O losses from manure were highest in Alberta, Ontario and Quebec resulting in 4.8, 4.4, and 3.4 Gg N and NH₃ losses from manure were also highest in these 3 provinces at 61.1, 45.2 and 40.4 Gg N, respectively. Nitrate leaching was impacted by drainage volumes, soil type and N inputs. In the non-growing season, NO₃^- leaching losses (36-yr average) were 63.3 Gg in Ontario and 57.5 Gg N in Quebec compared with 20.8 Gg N for Ontario and 35.5 Gg N for Quebec in the growing season. In contrast, the Prairie provinces showed higher NO₃^- leaching in the growing season (23.1-37.4 Gg N) than in the non-growing season (10.4-13.7 Gg N). In summary, total fertilizer N increased the most over the 36 years in the Prairies which resulted in increased RSN and N leaching losses that will require further intervention.

The safety of human embryos following long-term cryopreservation ( >6 years) on vitrification

BACKGROUND

Vitrification of embryos has become the basic means of assisted reproductive technology (ART) therapy in recent years. Concerns have also been raised about the safety of vitrification and the effect of cryopreservation time. Most of the previous studies were on the data within 6 years of cryopreservation.

OBJECTIVE

In this study, we aimed to evaluate the impact of long-term cryopreservation (>6 years) on pregnancy and neonatal outcomes.

MATERIALS AND METHODS

This research was a single-center, retrospective analysis, including 426 frozen-thawed embryo transfer (FET) cycles. Patients who participated in IVF-FET cycles between January 2013 to December 2020 were analyzed. Preferentially matched participants were divided into three groups according to storage time: group A (>72 months), group B (0-3 months, propensity score matching [PSM] according to the age of oocyte retrieval), and group C (0-3 months, PSM according to the age of embryo transfer).

RESULTS

Our results revealed that there were no significant differences in human chorionic gonadotropin [HCG] positive rate, clinical pregnancy rate, miscarriage rate, live birth rate, and neonatal outcomes when the embryo storage duration >72 months. But the proportion of high birth weight was higher in group A (>72 months) when matched according to age at embryo transfer.

CONCLUSION

The results of our study showed that long-term cryopreservation had no effect on the pregnancy and neonatal outcomes of vitrification. The results offer evidence for the safety of using long-term cryopreservation embryos after vitrification. DOI: 10.54680/fr23310110612.

Valgus-varus deformity induced abnormal tissue metabolism, inflammatory damage and apoptosis in broilers

1. This study explored the tissue metabolic status and the relationship with inflammation in valgus-valgus deformity (VVD) broilers with increasing age.2. Tissue and blood from VVD and healthy broilers were collected at two, four and five weeks old. A fully automated biochemical analyser, real-time PCR, HE staining and enzyme-linked immunosorbent assay were used to detect tissue metabolic indexes, mRNA levels of inflammation and apoptosis cytokines in immune organs, histological changes and serum inflammation and immune-related protein contents in VVD broilers.3. The results showed that VVD increased the levels of total protein, albumin, alanine aminotransferase at five weeks of age, aspartate aminotransferase, urea and creatine kinase in blood at two weeks of age. It upregulated the gene expression of inflammatory factors IL-1β, IL-6, IL-8, TNF-α, NF-κB and TGF-β and apoptotic factors FAS, Bcl-2, caspase-3 and 9 in immune organs; increased levels of serum proteins TNF-α, IL-1β and IL-6 and decreased levels of serum immunoglobulins IgY and CD3⁺.4. In addition, with increasing age, IL-10 gene expression gradually increased in the BF and decreased in the spleen.5. In conclusion, VVD broilers have disorders of liver and kidney metabolism, inflammation and apoptosis of immune organs and increased levels of serum inflammatory factor proteins.

[Clonality relatedness and molecular characteristics of Richter transformation]

Objective: To investigate the clinical, genetic, and clonality related aspects of individuals with Richter transformation (RT) . Methods: From January 2019 to December 2021, 18 RT patients with diagnoses at the First Affiliated Hospital of Nanjing Medical University (Pukou CLL center) were retrospectively examined. The immunoglobin heavy variable (IGHV) gene usage and IGHV-D-J rearrangement pattern of diagnosed CLL/SLL and transformed diffuse large B-cell lymphoma (DLBCL) were compared to determine the clonality relatedness. To investigate the risk factors of RT, Clinical and laboratory data from patients with newly diagnosed CLL/SLL and transformed DLBCL were gathered. Results: The median age of RT was 56.5 (41-75) years old. 17 patients transformed to DLBCL and 1 transformed to Hodgkin lymphoma (HL) . Of 17 individuals who had DLBCL transformation, 15 had CLL/SLL-related clonality and 2 had unrelated clonality. Next-generation sequencing (NGS) analysis of 11 paired initially diagnosed treatment-naive CLL/SLL and RT DLBCL found that EGR2、TP53 and NOTCH1 were among the most frequently mutated genes both in treatment-naive CLL/SLL and in RT DLBCL. In several cases, specific mutations were gained or lost throughout RT, indicating clonal evolution. Among 10 patients before exposure to BTK inhibitors before RT, four patients acquired BTK mutation. The aforementioned mutations should be considered high-risk variables for transformation; in addition, TP53 and EGR2 mutations could be linked to a poor prognosis following RT in patients receiving a cocktail of new medicines. Conclusion: Most RT DLBCL patients in our center are clonality related (15/17, 88.2% ) and we recommend all qualified centers to evaluate clonality relatedness of RT DLBCL patients. There was some variability in the mutational landscape between DLBCL that had undergone a transformation and initially diagnosed, treatment-naive CLL/SLL. The underlying molecular mechanism of RT needs more research.

MSX1 Drives Tooth Morphogenesis Through Controlling Wnt Signaling Activity

Tooth agenesis is a common structural birth defect in humans that results from failure of morphogenesis during early tooth development. The homeobox transcription factor Msx1 and the canonical Wnt signaling pathway are essential for "bud to cap" morphogenesis and are causal factors for tooth agenesis. Our recent study suggested that Msx1 regulates Wnt signaling during early tooth development by suppressing the expression of Dkk2 and Sfrp2 in the tooth bud mesenchyme, and it demonstrated partial rescue of Msx1-deficient molar teeth by a combination of DKK inhibition and genetic inactivation of SFRPs. In this study, we found that Sostdc1/Wise, another secreted Wnt antagonist, is involved in regulating the odontogenic pathway downstream of Msx1. Whereas Sostdc1 expression in the developing tooth germ was not increased in Msx1-/- embryos, genetic inactivation of Sostdc1 rescued maxillary molar, but not mandibular molar, morphogenesis in Msx1-/- mice with full penetrance. Since the Msx1-/-;Sostdc1-/- embryos exhibited ectopic Dkk2 expression in the developing dental mesenchyme, similar to Msx1-/- embryos, we generated and analyzed tooth development in Msx1-/-;Dkk2-/- double and Msx1-/-;Dkk2-/-;Sostdc1-/- triple mutant mice. The Msx1-/-;Dkk2-/- double mutants showed rescued maxillary molar morphogenesis at high penetrance, with a small percentage also exhibiting mandibular molars that transitioned to the cap stage. Furthermore, tooth development was rescued in the maxillary and mandibular molars, with full penetrance, in the Msx1-/-;Dkk2-/-;Sostdc1-/- mice. Together, these data reveal 1) that a key role of Msx1 in driving tooth development through the bud-to-cap transition is to control the expression of Dkk2 and 2) that modulation of Wnt signaling activity by Dkk2 and Sostdc1 plays a crucial role in the Msx1-dependent odontogenic pathway during early tooth morphogenesis.

Contribution of Total Screen/Online-Course Time to Asthenopia in Children During COVID-19 Pandemic via Influencing Psychological Stress

Objectives: During the coronavirus disease 2019 (COVID-19) self-quarantine period, the transition to online-course has profoundly changed the learning modes of millions of school-aged children and put them at an increased risk of asthenopia. Therefore, we aimed to determine associations of the total screen/online-course time with asthenopia prevalence among that children during the COVID-19 pandemic, and whether the associations were mediated by psychological stress.

Methods: Asthenopia was defined according to a validated computer vision syndrome questionnaire (CVS-Q). We used CVS-Q to collect the frequency and intensity of 16 asthenopia-related eye symptoms of 25,781 children. Demographic features, eye care habits, visual disorders, lifestyle, psychological and environmental factors, were also collected.

Results: The overall asthenopia prevalence was 12.1%, varying from 5.4 to 18.2% across grade/gender-classified subgroups. A 100-h increment of total screen/online-course time were associated with an increased risk of asthenopia by 9% [odds ratio (OR) = 1.09] and 11% (OR = 1.11), respectively. Mediation analysis showed that the proportions of total effects mediated by psychological stress were 23.5 and 38.1%, respectively. Age, female gender, having myopia or astigmatism, bad habits when watching screens were also risk factors. Conversely, keeping 34–65 cm between eyes and screen, increased rest time between classes, and increased eye exercise were all associated with a decreased risk.

Conclusion: Our study indicated that the influence of long total screen or online-course time on psychological stress increases asthenopia risk. The findings of this study have provided a new avenue for intervening screen-related asthenopia in addition to incorporating a reasonable schedule of online courses into educational policy.

Seasonal Variation of Zooplankton Communities and the Effects of Environmental Factors in the Seawater Near Taishan Nuclear Power Station

In the seawater near Taishan Nuclear Power Station, Zooplankton community composition and abundance, the biomass of major taxa, vertical distribution pattern, together with several environmental factors were investigated to evaluate the variation tendency as the seasons change. The structure characteristics of the zooplankton community were analyzed by Margalef species richness (d), Shannon-wiener species diversity index (H’), Pielou evenness index(J’), zooplankton dominant (Y), and dominant species replacement rate (R). There are 48 species within 11 classes of zooplankton identified, including 32 species of copepods. Zooplankton species richness changed obviously in the four seasons, Spring saw the highest (8010.00 ind.m-3), followed by winter (5100.00 ind.m-3), autumn (1713.75 ind.m-3), and summer (1196.25 ind.m-3). Similar trends were observed for the wet biomass, which was highest in spring (215.90 mg.m-3), followed by winter (181.70 mg.m-3), summer (78.56 mg.m-3), and autumn (24.69 mg.m-3), which gave an annual average of 125.21 mg.m-3. The results indicate that the abundance and biomass in spring were significantly higher than those in other seasons. Altogether 8 dominant species were identified along the whole year: Acrocalanmus gibber, Bestiolina amoyensis, Paracalanus parvus, Acartia danae, Mesocyclops leuckarti, Noctiluca scientillans, Penilla avirostris, and Lucifer penicilliger. The annual average Shannon-Wiener diversity index, Margalef diversity index, Pielou evenness index were 1.75, 1.83, and 0.74, respectively. The effects of environmental factors on the zooplankton community were studied by R and canonical correspondence analysis (CCA). According to Pearson correlation analysis and canonical correspondence analysis, the most important environmental factors influencing the changes of zooplankton species composition, abundance and distribution were water temperature, salinity, and pH in the whole year.

MicroRNA-29a May Influence Myopia Development by Regulating Collagen I

PURPOSE

The aim of this study was to characterize the regulatory role of microRNA-29a (miR-29a) in myopia, providing support for potential biomarkers and new therapeutic targets of myopia in humans.

METHODS

The miR-29a expression level was detected in the aqueous humor and peripheral blood plasma of 21 high myopic patients and eight cataract control patients using quantitative polymerase chain reaction. iTRAQ analysis of proteomes was conducted to show the regulatory effect of miR-29a on human scleral fibroblasts (SFs) cultured in vitro. We also assessed proliferation, migration, and collagen I synthesis in SF cells, mediated by miR-29a.

RESULTS

MiR-29a expression was significantly higher in the aqueous humor of highly myopic patients than in the cataract control patients (fold change: 4.861, p = 0.001). miR-29a inhibited the synthesis of type I collagen in human SF cells and enhanced cell migration, but had no significant effect on cell proliferation.

CONCLUSION

MiR-29a was highly expressed in aqueous humor of myopia patients and inhibited the synthesis of type I collagen in human SF cells in vivo, thereby it may play an important role in myopia development.

Development of a 19-plex short tandem repeat typing system for individual identification and parentage testing of horses (Equus caballus)

Individual identification of horses for pedigree verification and registration is important for the sustainable development of the horse industry. Horse individual identification and parentage tests commonly use the 17 short tandem repeats (STRs) recommended by the International Society for Animal Genetics (ISAG) and the locus LEX33. While many multiplex STR typing systems have been established for the horse, a sex determining marker is usually absent, and none of them can simultaneously detect all 17 ISAG recommended loci and the locus LEX33. Here, we present a 19-plex STR typing system that contains the 17 ISAG recommend loci, the locus LEX33 and amelogenin as sex determining loci. The results of our sensitivity, species specificity, stutter analysis and population data analysis, indicate that this system is a specific, sensitive, and robust tool for the identification of individuals, parentage testing and genetic research in the horse.

A simulation study of the self-assembly of ABC star terpolymers confined between two parallel surfaces

The phase behavior of ABC star terpolymers confined between two identical parallel surfaces is systematically studied using a simulated annealing method. Several phase diagrams are constructed for systems with different bulk phases or with different interfacial interaction strength ratios in the space of surface distance (D) and surface preference for different arms, or in the space of D and the arm-length ratio x. Phases, including tiling patterns [6.6.6], [8.8.4], [8.6.6; 8.6.4], [8.6.6; 8.6.4; 10.6.6; 10.6.4] and hierarchical lamellar structures of lamella + cylinders and lamella + rods, are identified both in the bulk and in the films. Our results suggest that the self-assembled structure of a phase is largely controlled by x, while an increase of the interfacial interaction strength ratio shifts the x-window for each phase to the smaller x side. The orientation of a confined phase depends on the "effective surface preference" which is a combined effect of the interfacial interaction strength ratio, the surface preference, and the entropic preference. In the case of neutral or weak "effective surface preference", phases with a perpendicular orientation are usually observed, while in the case of strong "effective surface preference" phases with a perpendicular orientation or also with outermost wetting-layers can be frequently observed under some circumstances.

Nicotinamide improves NAD+ levels to protect against acetaminophen-induced acute liver injury in mice

Acetaminophen (APAP) overdose causes acute liver injury (ALI). Nicotinamide adenine dinucleotide (NAD) is an essential coenzyme, and NAD⁺ is oxidized type which synthesized from nicotinamide (NAM). The present study aimed to investigate the role of NAD⁺ in ALI and protective property of NAM. The mice were subjected to different doses APAP. After 8 hours, the serum activities of alaninetransaminase (ALT) and aspartate aminotransferase (AST), the hepatic NAD⁺ level and nicotinamide phosphoribosyltransferase (NAMPT) expression were determined. Then, the mice were pretreated with NAM (800 mg/kg), the hepatoprotective effects and the key antioxidative molecules were evaluated. Our findings indicated that APAP resulted in remarkable NAD⁺ depletion in a dose-dependent manner accompanied by NAMPT downregulation, and NAM pretreatment significantly elevated the NAD⁺ decline due to upregulation of NAMPT. Moreover, the downregulated Kelch-like ECH-associated protein-1 (Keap1), upregulated nuclear factor erythroid 2-related factor 2 (Nrf2) and its translocation activation after NAM administration were confirmed, which were in accordance with improved superoxide dismutase (SOD) and glutathione (GSH) levels. Finally, NAM dramatically exhibited hepatoprotective effects by reducing the liver index and necrotic area. This study has suggested that APAP impairs liver NAD⁺ level and NAM is able to improve hepatic NAD⁺ to activate antioxidant pathway against APAP-induced ALI.

Controlling the chirality and number of strands of helices self-assembled from achiral block copolymers confined inside a nanopore: a simulation study

Achiral block copolymers can self-assemble into helical structures when confined inside a cylindrical nanopore. However, controlling the chirality and the number of strands of helices is challenging. We present our simulation results of the influence of a chiral patch added to the confining nanopore on the structures and chirality of helices self-assembled from achiral cylinder-forming diblock copolymers under the confinement. Our results indicate that, when the designed patch is of proper geometry, it can induce the formation of helical structures and exhibit good control over their chirality. The bottom surface of the patch can induce the formation of a characteristic local structure near and parallel to it. It is the characteristic local structure that directs the formation of helices and of their chirality consistent with that of the patch. A large patch angle or the top/bottom surface of a weakly selective pore promotes the formation of double-helices compared to single-helices by enlarging the pitch of the helices near the patch or through the entropic attraction of the top surface of the pore to the minority blocks.

LINC01116 promotes the proliferation and inhibits the apoptosis of gastric cancer cells

OBJECTIVE

To detect the relative expression of long intergenic non-protein coding ribonucleic acid (LINC) 01116 in gastric cancer (GC) tissues and cells and analyze the correlations of LINC01116 expression with the clinicopathologic characteristics of patients and investigate the biological functions of LINC01116 via in vitro experiments.

PATIENTS AND METHODS

The quantitative Real Time Fluorescence-Polymerase Chain Reaction (qRT-PCR) was applied to detect the relative expression level of LINC01116 in 73 cases of tissues and cells in GC patients. The patients were divided into LINC01116 high expression group and LINC01116 low expression group, and the correlations of LINC01116 with patient's pathological characteristics were statistically analyzed. In vitro experiments [cell counting kit-8 (CCK-8) assay, colony formation assay, and flow cytometry] were adopted to investigate the influences of LINC01116 on the biological functions of GC cells.

RESULTS

According to the results of qRT-PCR, the expression of LINC01116 was upregulated in 54 out of 73 cases of tissues (fold change >1), and it was upregulated in GC cells compared with that in the normal gastric mucosal epithelial cells (GES-1). The statistical analysis manifested that the highly expressed LINC01116 was positively correlated with the tumor-node-metastasis (TNM) stage (p=0.008), lymph node metastasis (p=0.005), and depth of invasion (p=0.007) of the GC patients. The patients with high expression of LINC01116 in the GC tissues had a shorter survival time than those with low expression (p=0.017). After interference in the expression of LINC01116, it was shown in CCK-8 assay and colony formation assay that the proliferative capacity of the cells was decreased. The results of flow cytometry indicated that the cell cycle was arrested at the G1/G0 phase, and the apoptosis rate was increased.

CONCLUSIONS

LINC01116 is highly expressed in GC tissues and cells, and highly expressed LINC01116 indicates poor prognosis of the patients, promotes the proliferation, and inhibits the apoptosis of GC cells.

A new procedure, free from human assessment, that automatically grades some facial skin signs in men from selfie pictures. Application to changes induced by a severe aerial chronic urban pollution

OBJECTIVE

These were two folds: at first, to develop an automatic grading system specifically dedicated to some facial signs of men, similar to the one previously validated on women of different ethnic ancestry and second, to assess its potential in detecting and grading the possible impacts of a severe aerial urban pollution on some facial signs of Chinese men.

METHODS

In both studies, selfie images were obtained from differently aged men. Nine facial signs were automatically graded through a specific A.I-based algorithm and clinically assessed by a panel of experts and dermatologists. Selfie pictures were taken from individual smartphones of variable optical properties. The first study, designed for developing an automatic grading system, involved three comparable cohorts of men from three different regional ancestries (African, Asian, Caucasian, 110 each) the selfie images of which were acquired under four different lighting conditions. As a second use case study, the facial signs of two cohorts of Chinese men (101 and 100, each), differently aged, regularly exposed to very different aerial urban pollution conditions (UP) were analysed by the same algorithm, selfies being taken under only one lighting condition.

RESULTS

-The new automatic grading system of facial signs suits well to men, showing comparable results than that the one dedicated to women and provides data in close agreement with experts' assessments. -In both cases (expert's or automatic methodology), the accuracy of the scores appeared ethnic-dependent. -The applied case confirmed previous results obtained clinically, that is, that many facial signs were found of an increased severity among men exposed to a severe urban pollution, as compared to those living in a less polluted city. -In both studies, statistical agreements between the automatic grading system and expert's assessments were reached. In some facial signs, the automatic grading system seems offering a slightly better accuracy than the assessments made by the experts.

CONCLUSION

Apart from some minor limitations, this A.I-based automatic grading system, free from human intervention, performed as well as the one previously developed in women, in close agreement with expert's assessments. In epidemiological studies, this system offers an easy, fast, affordable and confidential approach in the detection and quantification of male facial signs.

Effect of 0.01% atropine eye drops on choroidal thickness in myopic children

PURPOSE

To examine the effects of low-dose atropine on the choroidal thickness (CT) of young children in Shanghai, China, as well as the ocular biometrics of myopic patients.

METHODS

A total of 59 eyes of 35 myopic children had subfoveal CT and ocular biometry measurements taken before and after 2weeks, 4weeks, and 8weeks of treatment with 0.01% atropine. All eyes were measured using swept-source optical coherence tomography. CT and changes in it were also recorded.

RESULTS

The choroid exhibited significant and continuous thickening under the fovea after patients were treated with 0.01% atropine. The magnitude of change in CT varied with the location and with the duration of treatment. The greatest change was observed in the fovea. There was no significant relationship between changes in subfoveal CT and axial length.

CONCLUSIONS

Using 0.01% atropine eye drops significantly increased CT in eyes of young myopic children, by variable magnitude depending upon location.

HIF-1α Mediates Osteoclast-Induced Mandibular Condyle Growth via AMPK Signaling

During the mandibular condylar growth, the absorption of calcified cartilage matrix induced by osteoclasts is crucial for the continuous endochondral osteogenesis. Meanwhile, recent studies showed that subchondral bone resided within the low-oxygen microenvironment, and our previous study revealed that hypoxia-inducible transcription factor 1α (HIF-1α) promoted osteoclastogenesis under hypoxia. However, whether HIF-1α regulates the function of osteoclasts in the mandibular condyle cartilage remains elusive. Our study indicated that severe deformity of the mandibular condyle was displayed in 10-wk-old osteoclast-specific HIF-1α conditional knockout (CKO) mice, accompanied by shortened length of condylar process and disorganized fibrocartilage. In 1-, 2-, and 4-wk-old CKO mice, the size of the hypertrophic layer and chondrocytic layer was significantly thickened. In the chondrocytic layer, chondrocytes were atrophied, showing a form of apoptosis in 4-wk-old CKO mice. Furthermore, an increase in the thickness of the fibrous and proliferating layer was observed in 10-wk-old CKO mice, as well as a significant decrease in that of the chondrocytic and hypertrophic chondrocyte layers. Interestingly, the articular surface of the condylar process abnormally presented a horizontal concave shape, and a disk-like acellular connective tissue appeared. In addition, genetic ablation of HIF-1α blunted cartilage matrix loss by subchondral osteoclast deficiency, resulting in a high subchondral bone mass phenotype, accompanied with a decreased number of blood vessels, alkaline phosphatase staining, and vascular endothelial growth factor (VEGF) expression. Mechanistically, the number of osteoclasts in the center of the condyle in CKO mice was significantly reduced by attenuated expression of adenosine 5′-monophosphate-activated protein kinase (AMPK) signaling. These findings reveal a novel influence of HIF-1α function in osteoclasts on maintenance of osteoclast-induced resorption of calcified cartilage matrix via AMPK signaling, as well as subchondral bone formation through VEGF-dependent angiogenesis in bone marrow.

Significant Day-time Ionospheric Perturbation by Thunderstorms along the West African and Congo Sector of Equatorial Region

The equatorial Congo has been recognized as the most active lightning chimney region in the Globe. Although the perturbation of tropospheric thunderstorms on the lower ionosphere has been noticed in the middle latitudes through their transient lightning electric fields or convective gravity waves, the effects on equatorial ionosphere and the horizontal extent of this perturbation remains a mystery because of the difficulties in extracting the effects due to the sporadic nature of the equatorial ionosphere. Here we present observational results showing solid evidence of deviations in ionospheric total electron content (TEC) and its direction of propagation associated with thunderstorms using the method of polynomial filtering, by utilizing the TEC measured from equatorial Global Positioning System (GPS) Receiver stations along the West African region-Congo Basin. The TEC deviations due to the thunderstorms were found to be mostly propagated in a specific direction from the point of the event, with the highest absolute peak TEC at ~±1.5 TECUs. The internal dynamics of the equatorial ionosphere have been found to be suppressed by large thunderstorm effects during the daytime, with negligible impact at night.

Lattice self-consistent field calculations of confined symmetric block copolymers of various chain architectures

The effects of chain architecture and confinement on the structure and orientation of lamellae formed by incompressible and symmetric AB-type block copolymer melts confined between two parallel and identical surfaces are investigated using self-consistent field calculations on a simple cubic lattice. Five systems of various chain architectures (linear, ring, and star) and lengths are studied, with their bulk lamellar period L₀ chosen such that they have comparable L₀/R_g, where R_g denotes the ideal-chain radius of gyration. For thin films of thickness D = L₀ confined between two neutral surfaces, we define the rescaled volume fraction profiles of A, B, chain end, and joint segments in the parallel and perpendicular lamellae such that these profiles can be directly compared among the five systems to quantitatively reveal the interplay between the chain-end enrichment near confining surfaces and the surface-induced A-B compatibilization, and how such interplay is affected by the chain architectures (for example, the chain-crowding effects in the star block copolymers). The effects of D and surface preference for one of the blocks are also investigated.

[Efficacy of minimally invasive pulmonary surfactant administration in preterm infants with neonatal respiratory distress syndrome: a multicenter clinical trial]

Objective: To explore the feasibility and safety of minimally invasive surfactant administration (MISA) in preterm neonates with respiratory distress syndrome (NRDS). Methods: In this multicenter prospective randomized controlled trial, 92 preterm infants with gestation age ≤30 weeks and diagnosed with NRDS were enrolled in 8 level Ⅲ neonatal intensive care units (NICU) in Beijing-Tianjin-Hebei Region from 1(st) July 2017 to 31(st) December 2018. They were randomly assigned to minimally invasive surfactant administration (MISA) group or endotracheal intubation surfactant administration (EISA) group according to random number generated by computer. Infants in both groups received calf pulmonary surfactant preparation at a dose of 70-100 mg/kg. The data of demography, perinatal situation, medication administration, complications, clinical outcomes in the two groups were compared with Chi-square test, Student's t-test, Mann-Whitney U test or Fisher's exact test. Results: Among the 92 preterm infants, 53 were males, 39 were females; 47 were in the MISA group (25 males), and 45 were in the EISA group (28 males). The gestational age and birth weight were (29.5±1.2) weeks and (1 271±242) g in all patients, (29.5±1.4) weeks and (1 285±256) g in the MISA group, and (29.6±0.9) weeks and (1 255±227) g in the EISA group. The duration of surfactant infusion and the length of whole procedure in the MISA group were significantly longer than that in the EISA group (60 (18, 270) s vs. 50 (30, 60) s, Z=3.009, P=0.003; 90 (60, 300) s vs. 60 (44, 270) s, Z=3.365, P=0.001). For the outcomes, the incidence of hemodynamically significant patent ductus arteriosus (hsPDA) and bronchopulmonary dysplasia (BPD) were lower in the MISA group than in the EISA group (36% (17/47) vs. 67% (30/45), χ(2)=8.556, P=0.003; 26% (12/47) vs. 47% (21/45), χ(2)=4.464, P=0.035). Conclusions: Minimally invasive surfactant administration is applicable in preterm infants ≤30 weeks gestational age with NRDS. Although the length of whole procedure is longer than route endotracheal administration, the benefit of decreasing the incidences of hsPDA and BPD outweighs this demerit.

Formation and Regulation of Multicompartment Vesicles from Cyclic Diblock Copolymer Solutions: A Simulation Study

The self-assembly of a cyclic AB copolymer system with relatively long A blocks and short B blocks in B-selective solvents is investigated using a simulated annealing method. By investigating the effect of the lengths and solubilities of A and B blocks (N A and N B, εAS and εBS), the incompatibility between A and B blocks (εAB), as well as the polymer concentration (C p) and the conditions for the formation of multicompartment vesicles in cyclic diblock copolymer solutions, is predicted. The phase diagrams in terms of N B, εAS, and C p are constructed. The mechanism of the morphological transition is elucidated. It is shown that for cyclic copolymers the change in the above factors relating to the polymer and solvent properties all can lead to the transition from simple vesicles to multicompartment vesicles, but two different transition mechanisms are revealed. In addition, our simulations demonstrate that the self-assembly of cyclic copolymers could provide a powerful strategy for regulating the compartment number and the wall thickness of the multicompartment vesicles by adjusting the block solubilities and block lengths, respectively. These findings will facilitate the application of multicompartment architectures in cell mimicry, drug delivery, and nanoreactors.

Phase behavior of ABC cyclic terpolymer melts: a simulation study

The phase behavior of ABC cyclic terpolymer melts is investigated using a simulated annealing technique. A ternary phase diagram is constructed by tuning the volume fractions of the three blocks (f_A, f_B, and f_C) in the case of symmetric interactions. 11 phases are predicted, including lamellae with spheres at the interfaces, lamellae with spheres inside a domain, lamellae with spheres inside domains, cylinders in perforated lamellae, [6.6.6] tiling patterns, lamella + cylinder, hierarchical double-gyroid, columnar piled disk, patched spheres, cylinders with spheres at the interfaces and double gyroid with spheres at the interfaces. In these structures, the end segments of the three blocks tend to distribute uniformly on the A/B, B/C, or A/C interfaces, which may result in superior mechanical properties of the structures in cyclic terpolymer systems than those of the same structures formed in star or linear terpolymer systems. The physical reason for the similarities and differences between the phases formed in ABC cyclic and star terpolymer systems is investigated. Our simulation results are compared with related experimental observations and theoretical calculations.

Genome-wide Identification of Foxf2 Target Genes in Palate Development

Cleft palate is among the most common structural birth defects in humans. Previous studies have shown that mutations in FOXF2 are associated with cleft palate in humans and mice and that Foxf2 acts in a Shh-Foxf-Fgf18-Shh molecular network controlling palatal shelf growth. In this study, we combined RNA-seq and ChIP-seq approaches to identify direct transcriptional target genes mediating Foxf2 function in palate development in mice. Of 155 genes that exhibited Foxf2-dependent expression in the developing palatal mesenchyme, 88 contained or were located next to Foxf2-binding sites. Through in situ hybridization analyses, we demonstrate that expression of many of these target genes, including multiple genes encoding transcription factors and several encoding extracellular matrix-modifying proteins, were specifically upregulated in the posterior region of palatal shelves in Foxf2^-/- mouse embryos. Foxf2 occupancy at many of these putative target loci, including Fgf18, in the developing palatal tissues was verified by ChIP-polymerase chain reaction analyses. One of the Foxf2 target genes, Chst2, encodes a carbohydrate sulfotransferase integral to glycosaminoglycan sulfation. Correlating with ectopic Chst2 expression, Foxf2^-/- embryos a exhibited region-specific increase in sulfated keratan sulfate and a concomitant reduction in chondroitin sulfate accumulation in the posterior palatal mesenchyme. However, expression of the core protein of versican, a major chondroitin sulfate proteoglycan important in palatal shelf morphogenesis, was increased, whereas expression of collagen I was reduced in the corresponding region of the palatal mesenchyme. These results indicate that, in addition to regulating palatal shelf growth through the Fgf18-Shh signaling network, Foxf2 controls palatal shelf morphogenesis through regulating expression of multiple transcription factors as well as through directly controlling the synthesis and processing of extracellular matrix components in the palatal mesenchyme. Our ChIP-seq and RNA-seq data sets provide an excellent resource for comprehensive understanding of the molecular network controlling palate development.

Structure-Property Effects in the Generation of Transient Aqueous Benzoic Acid Anhydrides by Carbodiimide Fuels

The design of dissipative systems, which operate out-of-equilibrium by consuming chemical fuels, is challenging. As yet, there are a few examples of privileged fuel chemistries that can be broadly applied in abiotic systems in the same way that ATP hydrolysis is exploited throughout biochemistry. The key issue is that designing nonequilibrium systems is inherently about balancing the relative rates of coupled reactions. The use of carbodiimides as fuels to generate transient aqueous carboxylic anhydrides has recently been used in examples of new nonequilibrium materials and supramolecular assemblies. Here, we explore the kinetics of formation and decomposition of a series of benzoic anhydrides generated from the corresponding acids and EDC under typical conditions (EDC = N-(3-dimethylaminopropyl)-N'-ethylcarbodiimide hydrochloride). The reactions can be described by a simple mechanism that merges known behavior for the two processes independently. Structure-property effects in these systems are dominated by differences in the anhydride decomposition rate. The kinetic parameters allow trends in concentration-dependent properties to be simulated, such as reaction lifetimes, peak anhydride concentrations, and yields. For key properties, there are diminishing returns with the addition of increasing amounts of fuel. These results should provide useful guidelines for the design of functional systems making use of this chemistry.

Rapid Identification of Four New Synthetic Cannabinoids in Whole Blood

Objective To establish accurate and rapid methods to identify four new synthetic cannabinoids （JWH-203, JWH-122, 5F-APINACA and AB-CHMINACA） in blood samples. Methods The whole blood samples were extracted by acetonitrile and methanol, screened by gas chromatography-mass spectrometry （GC-MS） then confirmed by liquid chromatography-tandem mass spectrometry （LC-MS/MS） method, and multiple reaction monitoring （MRM） mode was used for quantitative analysis. Results The GC-MS method needed 21 min to complete the analysis, while the LC-MS/MS method needed 5 min. The AB-CHMINACA, JWH-203, 5F-APINACA and JWH-122 all used quasi molecular ion peak as a parent ion. The precursor-product ion combinations were m/z 357.4→312.2, m/z 340.2→125.0, m/z 384.1→135.1 and m/z 356.4→169.2. The four synthetic cannabinoids in blood samples had good linearity in the 1-250 ng/mL mass concentration range （r>0.99）. The limits of detection （LODs） were in the range of 0.1-0.5 ng/mL, the recovery rate was 85.4%-95.2%, the RSD less than 10.0%, and the matrix effect was 80.3%-92.8%. Conclusion The GC-MS and LC-MS/MS chromatographic behaviors and mass spectrometry analysis information of four synthetic cannabinoids were obtained in this study, and the possible causes of differences in chromatographic behaviors were discussed preliminarily. Therefore this study has a suggestive effect on judging the development trend of synthetic cannabinoids. This method can be used for rapid identification of four synthetic cannabinoids in blood, which can provide reference for identification of new synthetic cannabinoids when they are proliferating at present.

Requirement of Hyaluronan Synthase-2 in Craniofacial and Palate Development

Cleft palate is a common major birth defect resulting from disruption of palatal shelf growth, elevation, or fusion during fetal palatogenesis. Whereas the molecular mechanism controlling palatal shelf elevation is not well understood, a prevailing hypothesis is that region-specific accumulation of hyaluronan, a predominant extracellular glycosaminoglycan in developing palatal mesenchyme, plays a major role in palatal shelf elevation. However, direct genetic evidence for a requirement of hyaluronan in palate development is still lacking. In this study, we show that Has2, 1 of 3 hyaluronan synthases in mammals, plays a major role in hyaluronan synthesis in the neural crest-derived craniofacial mesenchyme during palatogenesis in mice. We analyzed developmental defects caused by tissue-specific inactivation of Has2 throughout the cranial neural crest lineage or specifically in developing palatal or mandibular mesenchyme, respectively, using Wnt1-Cre, Osr2-Cre, and Hand2-Cre transgenic mice. Inactivation of Has2 either throughout the neural crest lineage or specifically in the developing palatal mesenchyme caused reduced palatal shelf size and increased palatal mesenchyme cell density prior to the time of normal palatal shelf elevation. Whereas both Has2f/f;Wnt1-Cre and Has2f/f;Osr2-Cre mutant mice exhibit cleft palate at complete penetrance, the Has2f/f; Wnt1-Cre fetuses showed dramatically reduced mandible size and complete failure of palatal shelf elevation, whereas Has2f/f;Osr2-Cre fetuses had normal mandibles and delayed palatal shelf elevation. All Has2f/f;Hand2-Cre pups showed reduced mandible size and about 50% of them had cleft palate with disruption of palatal shelf elevation. Results from explant culture assays indicate that disruption of palatal shelf elevation in Has2f/f;Hand2-Cre mutant fetuses resulted from physical obstruction by the malformed mandible and tongue. Together, these data indicate that hyaluronan plays a crucial intrinsic role in palatal shelf expansion and timely reorientation to the horizontal position above the tongue as well as an important role in mandibular morphogenesis that secondarily affects palatal shelf elevation.

P3623Integrating depression and acute coronary syndrome care in low-resource hospitals in china: primary results from the I-Care randomised clinical trial

Background

Depression and acute coronary syndromes (ACS) are significant public health challenges. Patients with ACS often experience depression, which adversely affects prognosis. Low-cost, sustainable, and effective service models that integrate depression care into the management of ACS patients to reduce depression and improve ACS outcomes are critically needed.

Purpose

I-CARE study is a multi-center, randomised clinical trial (RCT) to evaluate the efficacy of an 11-month integrated care (IC) intervention compared to usual care (UC) in the management of ACS patients.

Methods

The I-CARE RCT was conducted between October 2014 and March 2018 in 16 rural Chinese hospitals. A total of 4041 patients with ACS were consecutively enrolled and randomly assigned in a 1:1 ratio to an IC intervention consisting of nurse-led risk factor management, group-based counseling supplemented by individual problem solving therapy and antidepressant medications as needed, or UC. The primary outcome was change in Patient Health Questionnaire-9 (PHQ-9) scores from baseline to 6 and 12 months. Secondary outcomes included incidence of major adverse events (MAEs) after discharge, quality of life (EQ5D), and adherence to ACS secondary prevention medications. Data analysis used a multilevel mixed-effects model with hospital-level and subject-level random-effect intercepts and hospital-level random slope incorporated to adjust for clustering effect. Primary analyses followed the intent-to-treat principle.

Results

The mean age of the patients was 61±10 years and 63% were men; however, only 3.3% were classified as depressed based upon a cutoff of ≥10 on the PHQ-9, and 26.9% had PHQ-9 scores between 5 to 9 at the baseline. There were no significant differences in patients' clinical characteristics between IC and UC groups. Changes in PHQ-9 scores from baseline to 6- and 12-months did not differ between treatment groups (−1.47 in IC group vs −1.40 in UC group; adjusted mean difference, −0.04; 95% CI, −0.17 to 0.08 at 6-months; −1.62 in IC group vs −1.54 in UC group; adjusted mean difference, −0.06; 95% CI: −0.19 to 0.06 at 12-months).The risk of MAEs after discharge between IC and UC groups also did not differ significantly (42.1% vs 43.1%; p=0.307).

Conclusions

Results from the I-CARE trial showed that a nurse-coordinated ACS and depression IC intervention did not reduce depression or improve clinical outcomes among patients with ACS compared to usual care controls. The low prevalence of depression was unexpected and may have minimized the potential added benefits of the IC intervention on depression and clinical outcomes compared to UC.

Acknowledgement/Funding

This study is supported by a grant from the National Institute of Mental Health (R01MH100332).