Determination of 13 potential anti-obesity agents in hair by dispersive liquid-liquid microextraction-assisted UHPLC-MS/MS

As the adulteration of dietary supplements with synthetic drugs remains a prevalent issue, the inclusion of anti-obesity agents may pose health risks, potentially leading to central nervous system or cardiovascular diseases. However, surveillance studies on the use of anti-obesity agents by the Chinese population are limited. This study aims to establish an efficient and rapid hair pretreatment method using dispersive liquid-liquid microextraction (DLLME) combined with high-speed grinding and develop a sensitive and accurate analytical method employing ultra high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) for detecting 13 potential anti-obesity agents in hair samples. Herein, hair samples were washed sequentially with 0.1% sodium dodecyl sulfate (SDS), water and acetone, and then ground at high speed using 1 mL of an extraction solution (internal standard solution-n-butanol-1.2 mol/L Na2HPO4, pH10.0, 100:400:500, v/v/v for procaterol; internal standard solution-ethyl acetate-1.2 mol/L Na2HPO4, pH8.0, 100:300:600, v/v/v for other 12 anti-obesity agents) while simultaneously performing DLLME. The developed method successfully detected 13 anti-obesity agents within 11 min, including bambuterol, clenbuterol, ractopamine, clorprenaline, formoterol, salbutamol, terbutaline, procaterol, phentermine, bupropion, sibutramine, desmethyl sibutramine, and N,N-didesmethyl sibutramine, which improved the screening efficiency. The calibration curves exhibited good linearity of 0.025-5 ng/mg, achieving correlation coefficients of r ≥ 0.99. The lower limits of quantification (LLOQs) for the analytes were 0.025 ng/mg, demonstrating acceptable levels of accuracy and precision. Recovery rates ranged between 73.30% and 107.47% across the three concentrations of 0.075, 0.375, and 3.75 ng/mg. The validated method was successfully applied to 369 real cases and detected six analytes, including bambuterol, salbutamol, terbutaline, sibutramine, desmethyl sibutramine, and N,N-didesmethyl sibutramine. This method offers several advantages, including simple pretreatment, high extraction efficiency, rapid extraction, solvent economy, and pollution mitigation, making it highly suitable for large-scale surveillance of usage of added anti-obesity agents.

[Clinical analysis of 18 children with aggressive mature B-cell lymphoma after liver transplantation]

Objective: To summarize the clinical characteristics, prognostic factors and treatment outcomes of childhood aggressive mature B-cell lymphoma after liver transplantation. Methods: This retrospective study included 18 children with newly diagnosed aggressive mature B-cell lymphoma after liver transplantation and treated from June 2018 to June 2022 in the Department of Hematology and Oncology of Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine. Clinical characteristics, treatment and outcomes of patients at last evaluation were analyzed. Overall survival (OS) and event free survival (EFS) rates were calculated by Kaplan-Meier method and Log-Rank analysis was performed to find factors of poor prognosis. Results: Among all 18 patients, there were 6 males and 12 females, and the age of onset was 40 (35, 54) months. The interval from transplant to tumor diagnosis was 21 (17, 35) months and 5 patients had early onset disease (<1 year since transplant). Seventeen patients had abdominal lesions. Diarrhea, vomiting and abdominal masses were the main clinical manifestations. All patients were Epstein-Barr virus (EBV) related posttransplant lymphoproliferative disorders (PTLD). One patient received individualized therapy due to critical sick at diagnosis, and the remaining 17 patients received CP (cyclophosphamide, methylprednisolone plus rituximab) and/or modified EPOCH (prednisone, etoposide, doxorubicin, vincristine, cyclophosphamide plus rituximab) regimens. Of all 18 patients, 15 cases got complete response, 2 cases got partial response, 1 patient died of severe infection. The 2-year OS and EFS rates of 18 patients were (94±5)% and (83±8)%, respectively. None of age, gender or early onset disease had effect on OS and EFS rates in univariate analysis (all P>0.05). Conclusions: The symptoms of PTLD were atypical. Close surveillance of EBV-DNA for patients after liver transplantation was crucial to early stage PTLD diagnosis. CP or modified EPOCH regimen was efficient for pediatric patients with aggressive mature B cell lymphoma after liver transplantation.

An antibacterial packaging film based on amylose starch with quaternary ammonium salt chitosan and its application for meat preservation

A new generation of food packaging films is gradually replacing traditional plastic packaging films because of their biodegradability, safety, and some functional properties such as anti-bacterial and oxidant resistance. In the present work, an antibacterial packing film based on amylose starch and 2-hydroxypropyl-trimethylammonium chloride chitosan (HTCC) was prepared for meat preservation. The interfacial bonding mechanism between amylose, HTCC, and glutaraldehyde (GA) was determined experimentally and through molecular dynamics (MD) simulation. The macromolecular chains of amylose starch and HTCC became entangled via inter-molecular H-bonds and then cross-linked with GA via the Schiff base reaction. The interaction of amylose starch and HTCC improved the mechanical properties of the amylose films. Compared with the amylose films, the tensile strength and elongation at break of the optimal HTCC/amylose films reached to 16.13 MPa (an increase of 206.65 %) and 53.86 % (an increase of 109.49 %). The HTCC/amylose films were found to provide obvious bacteriostatic performance, a relatively low cytotoxicity, the lower transmittance in the UV region, and thus the ability to enhance the preservation of fresh meat. These excellent characteristics therefore suggest that HTCC/amylose films might be promising candidates for application in antibacterial food packaging films.

[Intraoperative optical coherence tomography guided precise corneal suture in the treatment of acute keratoconus]

Objective: This study aimed to observe the clinical efficacy of precise suturing of posterior elastic layer fissures guided by intraoperative optical coherence tomography (OCT) in conjunction with anterior chamber puncture and drainage, and corneal thermokeratoplasty for the treatment of severe acute edematous keratoconus. Methods: Non-randomized controlled trial. Data were collected for a study involving 31 cases of acute edematous keratoconus patients who underwent surgical treatment at the Shandong Eye Hospital between June 2017 and July 2021. Among them, there were 30 male and 1 female patients, with an age range of 11 to 32 years and a mean age of (19.80±5.80) years. Eighteen patients in the study group underwent precise suturing of posterior elastic layer fissures guided by intraoperative OCT, in combination with anterior chamber puncture and drainage, and corneal thermokeratoplasty. Thirteen patients in the control group did not undergo suturing. Preoperative visual acuity, corneal edema diameter, corneal thickness, and posterior elastic layer fissure length were collected. Evaluation was performed using slit lamp microscopy, anterior segment OCT, and other methods to assess the time of initial postoperative corneal edema resolution and closure of the posterior elastic layer fissure. Deep lamellar keratoplasty was performed 2 to 4 weeks after edema resolution, and the corneal bed scar repair and visual acuity of the two groups were compared. Results: In the suturing group, the corneas of all 18 patients were accurately sutured to the deep stromal layer near the posterior elastic layer. The time for corneal edema resolution was 2.50 (1.00, 6.25) days in the suturing group and 7.00 (6.00, 10.50) days in the control group. The fissure healing time was 7.50 (7.00, 12.00) days in the suturing group and 14.00 (9.00, 14.00) days in the control group. The differences were statistically significant (all P<0.05). After 2 weeks, the central corneal thickness decreased to (529.80±174.50) μm in the suturing group and (612.00±205.12) μm in the control group. The suturing group showed accurate corneal suturing to the deep stromal layer near the posterior elastic layer, resulting in central corneal flattening, closure of voids in the stroma, and a significant decrease in corneal thickness. All 18 patients in the suturing group successfully completed deep lamellar keratoplasty, with 6 cases (6/18) experiencing mild graft bed leakage during surgery but without affecting the deep lamellar keratoplasty. One year postoperatively, the visual acuity (logarithm of the minimum resolution angle) was 0.23±0.12 in the suturing group and 0.33±0.11 in the control group, with a statistically significant difference (P<0.05). Conclusions: In the treatment of severe acute edematous keratoconus, precise suturing of posterior elastic layer fissures guided by intraoperative OCT, in conjunction with anterior chamber puncture and drainage, and corneal thermokeratoplasty, can rapidly alleviate corneal edema and promote the healing of posterior elastic layer fissures. This approach achieves better visual outcomes for subsequent lamellar keratoplasty surgeries. The use of intraoperative OCT guidance allows accurate positioning of the posterior elastic layer fissure in terms of location, direction, and depth of corneal stromal voids, thereby assisting surgeons in precise suturing.

Investigating alcohol consumption in China via wastewater-based epidemiology

Alcohol abuse and addiction is a public health issue of global concern. Wastewater-based epidemiology (WBE) is a forceful and effective complementary tool for investigating chemical consumption. This study examined alcohol consumption in major cities of China via WBE and compared WBE estimates with other data sources. A simple and valid ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was developed for the determination of two alcohol metabolites, ethyl glucuronide (EtG) and ethyl sulfate (EtS) in wastewater. The optimized method was applied to 62 sewage samples collected from wastewater treatment plants (WWTPs) in 31 provincial capital cities across China in the fourth quarter of 2020. The methodology established in this study was validated with the lower limit of quantification (LLOQ) up to 0.1 μg/L, good linearity in the range of 0.1-50 μg/L, intra-day and inter-day precision less than 5.58% and 5.55%, respectively, and the recoveries of the extracts were higher than 97.14%. The consumption range of alcohol estimated via WBE was 6.09 ± 4.56 ethanol/person/day (EPD) in the capital cities of China. Alcohol consumption varies significantly between cities in China, with WBE estimating lower alcohol consumption than WHO and lower than foreign countries. Investing in alcohol consumption based on WBE has great potential to accurately and efficiently estimate alcohol consumption.

Low-Cytotoxicity, Broad-Spectrum Corn Starch-Based Antibacterial Particles that Inhibit Multidrug-Resistant Bacteria

Antimicrobial resistance is a serious problem in biomedical applications that seriously increases the risk of medical failure. Therefore, developing highly efficient antibacterial agents that inhibit the growth of multidrug-resistant bacteria is a long-standing research goal. In this report, a low-cytotoxicity and highly efficient alternative to antibiotics was designed and prepared using edible corn starch as the scaffold and 2-hydroxypropyl-trimethylammonium chloride chitosan (HTCC) as the antimicrobial agent. The HTCC/starch particles were found to have a positively charged surface over a wide pH range and to possess broad-spectrum and highly efficient antimicrobial properties. These particles inhibited the growth of standard Gram-positive and Gram-negative bacteria from the China Pharmacopoeia and a clinical multidrug-resistant bacterial strain. Moreover, after treating the HTCC/starch particles with simulated gastric fluid (SGF, pH 1.2) for 4 h, the growth of clinical multidrug-resistant Escherichia coli (NT 2036) was inhibited effectively, indicating that these particles tolerate a gastric acid environment. Although the mass of SGF-treated HTCC/starch particles required to achieve similar antibacterial activity was ∼20-fold that of chloramphenicol or ampicillin, antibiotic-containing products require considerable amounts of pharmaceutical excipients to prepare. Therefore, the HTCC/starch particles described herein are potentially cost-effective alternatives to antibiotics that resolve the antimicrobial resistance issue, especially for inhibiting the growth of pathogenic intestinal bacteria.

Design and development of a lanthanide-labeled immunochromatographic strip for simultaneous detection of morphine, methamphetamine and ketamine in hair

Colloidal gold immunoassay is the most widely used method in the field of drug detection. However, this method often has poor quantitative identification ability and low analytical sensitivity, which is not suitable for the analysis of hair poisoning ingredients. In order to solve these limitations, we developed an immunochromatographic test strip for simultaneously screening multiple drugs in this study. This hand-held test strip used fluorescent nanoparticles loaded with lanthanide chelates as the signal carrier of fluorescence reading, and conducted quantitative testing of various drugs based on the competitive immune reaction between the analyte and antigen. Under the optimal conditions, the competition curves of morphine (MOP), methamphetamine (MET) and ketamine (KET) were obtained on a single band. The detection limit (LOD) of this analytical method was 100-1000 times lower than that of colloidal gold test strips. The detection limits of MOP, MET and KET were 0.06 ng mL-1, 0.1 ng mL-1 and 1.0 ng mL-1, respectively. No cross-reaction was observed when morphine, methamphetamine and ketamine were tested simultaneously with this method. And 184 hair samples were tested simultaneously, and the detected amount was very close to the results of LC-MS. The immunochromatographic strip showed good stability in repeated tests, and the coefficient of variation was less than 15%. Fluorescence immunochromatography strips and handheld strip readers have the characteristics of portability, speed, ease of operation and high sensitivity, and may become powerful tools for screening drug abuse in hair in forensic medicine.

Application of wastewater-based epidemiology to estimate the usage of beta-agonists in 31 cities in China

The illegal use of beta-agonists could cause severe problems to human health. In this study, the usage of beta-agonists in 31 cities across China was estimated using wastewater-based epidemiology (WBE). The proposed method is based on solid-phase extraction (SPE) and LC-MS/MS and was developed and validated to determine the concentration of seven beta-agonists in wastewater. A population model based on cotinine (COT), NH4-N and the flow volume was constructed to estimate the population equivalents for different wastewater treatment plants (WWTPs). Clenbuterol and ractopamine are banned in China for both animal husbandry and medical use, but were nevertheless detected in some wastewater samples at rates of 6.2 % and 4.7 %, respectively (n = 339). The WBE-based consumption of clenbuterol and ractopamine were compared with the acceptable daily intake (ADI) and the health risks were assessed by their hazard quotients (0.26-6.62 for clenbuterol and 9.27 × 10-4-0.05 for ractopamine). Salbutamol, clorprenaline and terbutaline were observed in practically all wastewater samples at concentrations of up to several ng/L, whereas the formoterol and bambuterol concentrations were below the detection limit in all samples. Salbutamol consumption (7.35 ± 4.14 mg/1000 inh/day) was highest among the examined beta-agonists and varied regionally. Beta-agonist consumption based on WBE was higher in some cities than that based on medical survey data, indicating potential illegal use. These results show that WBE can be a straightforward and supplementary method for monitoring beta-agonist usage at the population level and spatially.

[Application of intraoperative optical coherence tomography in deep lamellar keratoplasty]

Objective: To evaluate the clinical application value of intraoperative optical coherence tomography (iOCT) in deep anterior lamellar keratoplasty (DALK) using the big-bubble technique to bare Descemet's membrane. Methods: Retrospective case series. Clinical data of 92 patients (92 eyes) with monocular stromal corneal diseases who underwent big-bubble DALK in the Eye Hospital of Shandong First Medical University from January 2020 to August 2021 were collected. There were 53 males and 39 females. The average age was (53.2±16.0) years old. All patients underwent iOCT scanning to determine the location and depth of the injection needle after initial removal of the corneal lesion, to observe the integrity of the recipient bed, Descemet's membrane, after complete lesion removal, and to observe the adhesion between the corneal graft and the recipient bed and check folds on the recipient bed after suturing of the corneal graft. The intraoperative perforation of Descemet's membrane, postoperative thickness of the cornea and the recipient bed, visual acuity, and corneal astigmatism were recorded. Results: By iOCT, the thickness of the recipient bed was found to be about 1/2 of the corneal thickness and relatively uniform in all directions in 62 eyes (67.4%), so the sterile air was injected from the center of the recipient bed to separate it from the stromal layer. In 30 eyes (32.6%) with an uneven thickness of the recipient bed, the sterile air was injected from the paracentral area of the recipient bed. Under the guidance of iOCT scanning, 89 eyes (96.7%) did not experience any perforation of Descemet's membrane during surgery. The Descemet's membrane folds in the central 5-mm area of the recipient bed was observed and flattened in 20 eyes with the assistance of iOCT scanning. The postoperative corneal thickness was (578.95±108.26) μm, and the recipient bed thickness was (36.06±23.11) μm. The best corrected visual acuity of all patients at 6 months after surgery was 0.57±0.25 logMAR, which was significantly better than that before surgery (1.61±1.27 logMAR; P<0.001). The average corneal astigmatism at 6 months after surgery was (2.72±2.44) diopters. Conclusions: The application of iOCT scanning in DALK surgery assisted by the big-bubble method can provide safe guidance for surgeons to adopt correct surgical procedures, decrease the risk of Descemet's membrane perforation, reduce the recipient bed folds, and facilitate corneal interlayer adhesion, thereby improving the visual prognosis.

Hepatic retinaldehyde deficiency is involved in diabetes deterioration by enhancing PCK1- and G6PC-mediated gluconeogenesis

Type 2 diabetes (T2D) is often accompanied with an induction of retinaldehyde dehydrogenase 1 (RALDH1 or ALDH1A1) expression and a consequent decrease in hepatic retinaldehyde (Rald) levels. However, the role of hepatic Rald deficiency in T2D progression remains unclear. In this study, we demonstrated that reversing T2D-mediated hepatic Rald deficiency by Rald or citral treatments, or liver-specific Raldh1 silencing substantially lowered fasting glycemia levels, inhibited hepatic glucogenesis, and downregulated phosphoenolpyruvate carboxykinase 1 (PCK1) and glucose-6-phosphatase (G6PC) expression in diabetic db/db mice. Fasting glycemia and Pck1/G6pc mRNA expression levels were strongly negatively correlated with hepatic Rald levels, indicating the involvement of hepatic Rald depletion in T2D deterioration. A similar result that liver-specific Raldh1 silencing improved glucose metabolism was also observed in high-fat diet-fed mice. In primary human hepatocytes and oleic acid-treated HepG2 cells, Rald or Rald + RALDH1 silencing resulted in decreased glucose production and downregulated PCK1/G6PC mRNA and protein expression. Mechanistically, Rald downregulated direct repeat 1-mediated PCK1 and G6PC expression by antagonizing retinoid X receptor α, as confirmed by luciferase reporter assays and molecular docking. These results highlight the link between hepatic Rald deficiency, glucose dyshomeostasis, and the progression of T2D, whilst also suggesting RALDH1 as a potential therapeutic target for T2D.

ATR-FTIR combined with machine learning for the fast non-targeted screening of new psychoactive substances

Due to the diversity and fast evolution of new psychoactive substances (NPS), both public health and safety are threatened around the world. Attenuated total reflection-Fourier transform infrared spectroscopy (ATR-FTIR), which serves as a simple and rapid technique for targeted NPS screening, is challenging with the rapid structural modifications of NPS. To achieve the fast non-targeted screening of NPS, six machine learning (ML) models were constructed to classify eight categories of NPS, including synthetic cannabinoids, synthetic cathinones, phenethylamines, fentanyl analogues, tryptamines, phencyclidine types, benzodiazepines, and "other substances" based on the 1099 IR spectra data items of 362 types of NPS collected by one desktop ATR-FTIR and two portable FTIR spectrometers. All these six ML classification models, including k-nearest neighbor (KNN), support vector machine (SVM), random forest (RF), extra trees (ET), voting, and artificial neural networks (ANNs) were trained through cross validation, and f1-scores of 0.87-1.00 were achieved. In addition, hierarchical cluster analysis (HCA) was performed on 100 synthetic cannabinoids with the most complex structural variation to investigate the structure-spectral property relationship, which leads to a summary of eight synthetic cannabinoid sub-categories with different "linked groups". ML models were also constructed to classify eight synthetic cannabinoid sub-categories. For the first time, this study developed six ML models, which were suitable for both desktop and portable spectrometers, to classify eight categories of NPS and eight synthetic cannabinoids sub-categories. These models can be applied for the fast, accurate, cost-effective, and on-site non-targeted screening of newly emerging NPS with no reference data available.

A comprehensive analytical strategy based on characteristic fragments to detect synthetic cannabinoid analogs in seized products and hair samples

Synthetic cannabinoids, one of the most widely abused new psychoactive substances (NPS), are now placed under national control generally in China. Due to continuous modification of synthetic cannabinoid structure, an ongoing dilemma in the forensic laboratory is that newly emerging substances cannot be detected by established methods. Thus, the screening methods for simultaneous detection of known or unknown substances have become research hotspots. In this study, the ultra high performance liquid chromatography tandem triple quadrupole mass spectrometry (UPLC-QqQ-MS) with precursor ion scan (PIS) as acquisition mode was used for prescreening purposes of all possible synthetic cannabinoids-related substances. In detail, four common characteristic fragments, m/z of 144.0, 145.0, 135.1, and 109.0 corresponding to acylium-indole, acylium-indazole, adamantyl, and fluorobenzyl cation respectively, were selected for PIS mode, and their collision energies were optimized by 97 available synthetic cannabinoids standards with relevant structures. Those suspicious signals observed in the screening experiment were confirmed by ultra high performance liquid chromatography tandem quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS) via high-resolution MS and MS² data obtained by full scan (TOF MS) and product ion scan mode. After methodological validation, the integrated strategy established above was applied to the screening and identification of the seized e-liquids, herbal blends and hair samples, confirming the presence of multiple synthetic cannabinoids in these samples. In particular, a novel synthetic cannabinoid was identified as 4 F-ABUTINACA, for which no relevant high-resolution mass spectrometry (HRMS) data has been retrieved until now, making this study the first to report the cleavage pattern of this compound in electrospray ionization (ESI) mass spectrometry. In addition, four other suspected by-products of the synthetic cannabinoids were found in the herbal blends and e-liquids, and their possible structures were also deduced via the information from high-resolution mass spectra.

Nail analysis for the assessment of caffeine abuse in Northwest China: A population-based study

Caffeine is the most widely consumed psychoactive agent worldwide and has the potential for abuse, but studies monitoring caffeine abuse in China are scarce. This study aims to estimate the prevalence of caffeine abuse in northwest China and investigate the correlation between caffeine and other drugs in hair and nails using an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Fingernail clippings were collected from 376 participants in northwest China to detect caffeine and 13 other illicit psychoactive drugs and their metabolites. Paired hair and nail samples were collected from 39 participants to investigate the correlation between caffeine and other drugs in hair and nails. The samples were decontaminated, pulverized, and extracted by a high-throughput nail sample preparation method and analyzed by UPLC-MS/MS. The results showed a risk of caffeine abuse in northwest China, with concentrations ranging from 0.43 to 10.6 ng/mg for healthy volunteers, 0.49-246 ng/mg for caffeine abusers, and 0.25-363 ng/mg for drug addicts in community rehabilitation centers. Caffeine was detected together with other illicit psychoactive drugs and their metabolites. Furthermore, positive detection correlations were found between hair and nail samples. This study provides a current perspective on caffeine abuse in northwest China and demonstrates the practical use of UPLC-MS/MS for the simultaneous detection of caffeine and 13 illicit psychoactive drugs and their metabolites in hair and nails. The results highlight the potential of nails as a supplementary matrix when hair samples are unavailable and emphasize the need for handling caffeine carefully given its potential for abuse.

Preparation of poly(methacrylic acid-co-ethylene glycol dimethacrylate)-functionalized magnetic polydopamine nanoparticles for the extraction of six cannabinoids in wastewater followed by UHPLC-MS/MS

Phytocannabinoids and their synthetic analogs (natural and synthetic cannabinoids) are illicit drugs that are widely abused worldwide. Wastewater-based epidemiology (WBE) is an objective approach for the estimation of population-level exposure to a wide range of substances, especially drugs of abuse. However, the concentrations of cannabinoids in wastewater are extremely low (frequently at the levels of nanograms per liter), and the existing pretreatment procedures for wastewater have the disadvantages of time-consumption or low extraction recoveries. This study aimed to propose a novel poly (methacrylic acid-co-ethylene glycol dimethacrylate)-functionalized polydopamine-coated Fe₃O₄ nanoparticle (Fe₃O₄@PDA@poly (MAA-co-EGDMA)) as an adsorbent, and provide a highly sensitive quantitative analytical technique for the detection of five synthetic cannabinoids (SCs: 5 F-EDMB-PINACA, FUB-APINACA, MDMB-4en-PINACA, MDMB-FUBINACA, and PB-22) and one cannabis-related human metabolite (THC-COOH) in wastewater. The magnetic adsorbents were fully characterized by transmission electron microscopy (TEM), infrared spectroscopy (IR), vibrating sample magnetometry (VSM) and X-ray photoelectron spectroscopy (XPS). Subsequently, an MSPE-UHPLC-MS/MS method was developed and validated for the determination of six trace analytes in wastewater. The validation results showed that the method has limits of quantification as low as 0.1-1.0 ng/L. Additionally, the recoveries ranged from 62.81 to 124.02%, and the relative standard deviations (RSDs) of intraday and interday precision were less than 15%. This MSPE-UHPLC-MS/MS method was successfully applied to real wastewater samples, and the whole analytical process of one sample from pretreatment to the obtained quantitative results was completed in less than 30 min. Thus, the proposed method based on Fe₃O₄@PDA@poly (MAA-co-EGDMA) is a convenient, rapid, sensitive and reliable method for the determination of trace psychoactive drugs in wastewater.

Machine Learning-Assisted Rapid Screening of Four Types of New Psychoactive Substances in Drug Seizures

Over the past few years, new psychoactive substances (NPS) have become a global health and social problem because of their wide variety, constant structural renewal, vague legal definitions, and rapid adaptation to legal restrictions. The rapid structural modifications of NPS have posed significant challenges for the screening and identification of these new substances using traditional mass spectrometric techniques based on reference substances or a mass spectral database. Here, we propose supervised machine learning (ML) classification models such as k-nearest neighbors, support vector machine, random forest, and multigrained cascade forest for the rapid screening of NPS using mass spectrometric data. This approach utilizes ML methods to learn the statistical probability distributions of mass spectral data for NPS and non-NPS. Four classification ML models were generated and evaluated using a data set comprising 567 LC-MS and 732 GC-MS spectra. Through cross validation, we achieved an F1 score of 0.35-0.97. These algorithms were applied in conjunction with mass spectrometry techniques for the detection of six seizures including electronic cigarette oil and suspected powdered substances netted in drug trafficking cases. The models provided warning signals for synthetic cannabinoids, synthetic cathinones, and fentanyl. Thus, an early warning system was successfully established, which provided a useful method for reliable and effective identifications of unknown NPS.

Estimating the prevalence of hypertension in 164 cities in China by wastewater-based epidemiology

Hypertension is the most common chronic non-infectious disease and a severe problem for public health in China. There were 244.5 million people aged over 18 years in China who had hypertension in 2015, and hypertension-related death accounted for more than 25 % of all causes of death in China every year. To monitor the hypertension prevalence in near real-time, a wastewater-based epidemiology (WBE) approach by using metoprolol acid as a biomarker was conducted in 164 cities in China. LC-MS/MS was utilized to quantify metoprolol acid in sewage, and satisfactory method validation results were achieved. The average concentration of metoprolol acid in sewage was 943.1 ± 671.1 ng/L, and the back-calculated consumption of metoprolol based on metoprolol acid was 932.0 ± 390.5 mg/day/1000inh on average, ranging from 76.7 to 3275.7 mg/day/1000inh. The prevalence of metoprolol was estimated to be 0.83 % ± 0.35 %, and the estimated hypertension prevalence in the population aged over 15 years was ultimately assessed to be 28.56 % ± 10.44 % ranging from 14.28 % to 44.28 % and was consistent with the China Hypertension Survey result of 27.9 %. This research demonstrated that estimating hypertension prevalence by WBE with metoprolol acid as a biomarker is feasible in Chinese cities.

Bile duct ligation differently regulates protein expressions of organic cation transporters in intestine, liver and kidney of rats through activation of farnesoid X receptor by cholate and bilirubin

Body is equipped with organic cation transporters (OCTs). These OCTs mediate drug transport and are also involved in some disease process. We aimed to investigate whether liver failure alters intestinal, hepatic and renal Oct expressions using bile duct ligation (BDL) rats. Pharmacokinetic analysis demonstrates that BDL decreases plasma metformin exposure, associated with decreased intestinal absorption and increased urinary excretion. Western blot shows that BDL significantly downregulates intestinal Oct2 and hepatic Oct1 but upregulates renal and hepatic Oct2. In vitro cell experiments show that chenodeoxycholic acid (CDCA), bilirubin and farnesoid X receptor (FXR) agonist GW4064 increase OCT2/Oct2 but decrease OCT1/Oct1, which are remarkably attenuated by glycine-β-muricholic acid and silencing FXR. Significantly lowered intestinal CDCA and increased plasma bilirubin levels contribute to different Octs regulation by BDL, which are confirmed using CDCA-treated and bilirubin-treated rats. A disease-based physiologically based pharmacokinetic model characterizing intestinal, hepatic and renal Octs was successfully developed to predict metformin pharmacokinetics in rats. In conclusion, BDL remarkably downregulates expressions of intestinal Oct2 and hepatic Oct1 protein while upregulates expressions of renal and hepatic Oct2 protein in rats, finally, decreasing plasma exposure and impairing hypoglycemic effects of metformin. BDL differently regulates Oct expressions via Fxr activation by CDCA and bilirubin.

[Analysis of 42 cases of childhood superior vena cava syndrome associated with mediastinal malignancy]

Objective: To summarize the clinical features, management and outcome of superior vena cava syndrome (SVCS) associated with mediastinal malignancy in children. Methods: Clinical data of 42 children of SVSC associated with mediastinal malignancy in Shanghai Children's Medical Center from January 2015 to December 2021 were collected and analyzed retrospectively. The clinical manifestations, pathological diagnosis, disease diagnosis process, and prognosis were summarized. Results: Among 42 children of SVCS associated with mediastinal malignancy, there were 31 males and 11 females. The age at diagnosis was 8.5 (1.9, 14.9) years. Cough and wheezing (33 cases, 79%), orthopnea (19 cases, 45%) and facial edema (18 cases, 43%) occurred most commonly. T-cell lymphoblastic lymphoma (T-LBL) was the most frequent pathological diagnosis (25 cases, 60%), followed by T-cell acute lymphoblastic leukemia (T-ALL) (7 cases, 17%), anaplastic large cell lymphoma (4 cases, 10%) and diffuse large B-cell lymphoma (2 cases, 5%), peripheral T-lymphoma, Hodgkin lymphoma, Ewing's sarcoma and germ cell tumor (1 case each). Pathological diagnosis was confirmed by bone marrow aspiration or thoracentesis in 14 cases, peripheral lymph node biopsy in 6 cases, and mediastinal biopsy in 22 cases. Twenty-seven cases (64%) had local anesthesia. Respiratory complications due to mediastinal mass developed in 3 of 15 cases who received general anesthesia. Of the 42 cases, 27 cases had sustained remission, 1 case survived with second-line therapy after recurrence, and 14 cases died (2 cases died of perioperative complications and 12 cases died of recurrence or progression of primary disease). The follow-up time was 36.7 (1.2, 76.1) months for 27 cases in continuous complete remission. The 3-year overall survival (OS) and events free survival (EFS) rates of 42 children were 59% (95%CI 44%-79%) and 58% (95%CI 44%-77%) respectively. Conclusions: SVCS associated with mediastinal malignancy in children is a life-threatening tumor emergency with high mortality. The most common primary disease is T-LBL. The most common clinical symptoms and signs are cough, wheezing, orthopnea and facial edema. Clinical management should be based on the premise of stable critical condition and confirm the pathological diagnosis through minimal invasive operation.

Detection of mescaline in human hair samples by UPLC-MS/MS: Application to 19 authentic forensic cases

Mescaline, a natural alkaloid found in the peyote cactus (Lophophora williamsii) in the Americas, has gradually become a drug of abuse in China because of its psychedelic properties. Its intake may lead to hallucinations and confusion or even be life-threatening. Mescaline is classified as a class Ⅰ psychotropic drug in China, which means its use in medicine or scientific research is under strict control of the government. However, studies on surveillance of mescaline abuse in the Chinese population are lacking. A rapid and sensitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed and validated for the determination and quantification of mescaline in hair. The method had good linearity in the range from 10 to 1000 pg/mg, with the limit of detection (LOD) of 3 pg/mg and the limit of quantitation (LOQ) of 10 pg/mg. The total runtime was 5 min. Acceptable intraday and interday precision (RSD < 15%) and accuracy (bias, -11.2% ∼ 6.8%) were achieved. The recovery was 85.0-101.0%, and the matrix effect was 92.0-105.0%. The validated method was successfully applied to 19 real forensic cases. The concentrations of mescaline in hair ranged from 10 to 784 pg/mg. The method has the benefits of simple sample preparation, high sensitivity, and short running time, making it suitable for large-scale quantitative surveillance analysis of mescaline in forensic toxicology.

Automatic analytical approach for the determination of 12 illicit drugs and nicotine metabolites in wastewater using on-line SPE-UHPLC-MS/MS

In this study, we developed a novel on-line solid phase extraction (SPE)-ultra-high-performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS)-based analytical method for simultaneously quantifying 12 illicit drugs and metabolites (methamphetamine, amphetamine, morphine, codeine, 6-monoacetylmorphine, benzoylecgonine, 3,4-methylenedioxymethamphetamine, 3,4-methylenedioxyamphetamine, cocaine, ketamine, norketamine, and methcathinone) and cotinine (COT) in wastewater samples. The analysis was performed by loading 2 mL of the sample onto an Oasis hydrophilic-lipophilic balance cartridge and using a cleanup step (5% methanol) to eliminate interference with a total run time of 13 min. The isotope-labeled internal standard method was used to quantify the target substances and correct for unavoidable losses and matrix effects during the on-line SPE process. Typical analytical characteristics used for method validation were sensitivity, linearity, precision, repeatability, recovery, and matrix effects. The limit of detection (LOD) and limit of quantification (LOQ) of each target were set at 0.20 ng/L and 0.50 ng/L, respectively. The linearity was between 0.5 ng/L and 250 ng/L, except for that of COT. The intra- and inter-day precisions were <10.45% and 25.64%, respectively, and the relative recovery ranged from 83.74% to 162.26%. The method was used to analyze various wastewater samples from 33 cities in China, and the results were compared with the experimental results of identical samples analyzed using off-line SPE. The difference rate was between 19.91% and −20.44%, and the error range could be considered acceptable. These findings showed that on-line SPE is a suitable alternative to off-line SPE for the analysis of illicit drugs in samples.

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A new wastewater analysis method based on on-line SPE UHPLC-MS/MS was established.

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The on-line SPE method showed excellent performance compared with off-line SPE.

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High sensitivity and short analysis time were achieved using the on-line SPE method.

UPLC-MS/MS method for the simultaneous quantification of caffeine and illicit psychoactive drugs in hair using a single-step high-speed grinding extraction - Insights into a cut-off value for caffeine abuse

Caffeine is a commonly consumed psychoactive substance whose addictive potential has long been reported. Excessive caffeine intake may lead to severe health damage or drug addiction problems; however, studies on the surveillance of caffeine abuse by the Chinese population are lacking. This study aimed to propose a concentration value for caffeine based on hair analysis to distinguish excessive intake from normal consumption, and provide an analytical tool for forensic toxicology investigations of caffeine and other frequently abused drugs. A sensitive and accurate ultra-high performance liquid chromatography-tandem mass spectrometry method was developed to detect caffeine and 13 illicit drugs and their metabolites in hair. Thereafter, this method was employed to test 479 real samples. Briefly, the hair samples were washed with water and acetone, and subsequently extracted by one-step high-speed grinding with acetonitrile-buffer solution. The lower limit of quantifications of 0.05 ng/mg for caffeine and THC, and 0.005 ng/mg for others, were achieved for all substances. The results revealed a mean caffeine concentration of 0.78 (range 0.008-3.5 ng/mg) based on 24 healthy volunteers, 55.0 (range 3.07-292.2 ng/mg) based on 52 self-reported caffeine abuse participants, and 5.78 (range 0-140.34 ng/mg) based on 403 drug addicts. The mean caffeine concentration in hair from self-reported caffeine abusers was 70-fold higher than that in hair from healthy volunteers. A tentative cut-off level of 5.5 ng/mg as an indicator of excessive caffeine consumption was developed based on receiver operating characteristic analysis. Additionally, the assessment of 403 hair samples from drug addicts indicated that illicit drug abusers had potential for caffeine abuse, especially polydrug users. This hair analysis method serves as a useful tool for the large-scale surveillance of caffeine and illicit drug abuse.

Quantification of Cathinone Analogues without Reference Standard Using 1H Quantitative NMR

Synthetic cathinones are a type of new psychoactive substances (NPS) that have been seriously abused. Owing to the rapid variation in their structures, the absence of reference standards poses a challenge in quantitative investigations. In this study, a ¹H quantitative nuclear magnetic resonance (¹H qNMR) method was established using maleic acid as the internal standard and the shared signal (i.e., the methylidyne hydrogen) on the parent synthetic cathinones structure as the quantitative peak. Taking 3-methoxy-2-(methylamino)-1-(4-methylphenyl)propan-1-one (mexedrone) as an example, this study optimized the acquisition parameters and conducted method validation, including an evaluation of the specificity, linearity, accuracy, precision, and robustness. Using this ¹H qNMR method, the contents of mexedrone and its analogues, including 1-(3-chlorophenyl)-2-(ethylamino)-propan-1-one (3-CEC), 4-chloro-α-pyrroli-dinopropiophenone (4-Cl-α-PVP), 1-(3,4-methylenedioxy-phenyl)-2-propylamino-propan-1-one (propylone), and methcathinone, were obtained. The obtained results showed that the method was accurate, rapid, versatile, and can be used to address the qualitative and quantitative issues related to similar substances.

Using dual exonucleases to finely distinguish structural adjustment of aptamers for small-molecule detection

The binding of small molecules to their DNA aptamers can modulate their susceptibility to digestion by exonucleases, however, absolute differentiation between digestion and inhibition has never been reported. Here, we show that the digestion of aptamers by T7 exonuclease can be completely inhibited upon binding of small-molecule targets and exploit this finding for the first time to achieve sensitive, label-free small-molecule detection. We use a quinine-binding aptamer to show that target binding entirely halts T7 exonuclease digestion, leaving behind an intact double-stranded product that retains strong target affinity. On the contrary, digestion of nontarget-bound aptamer produces a single-stranded product incapable of target binding. Exonuclease I efficiently eliminates these single-stranded products but is unable to digest the target-bound double-stranded product. The remaining products can be fluorescently quantified with SYBR Gold to determine target concentrations, giving a limit of detection of 100 nM with the linear range from 0 to 8 μM. We demonstrate the first example of a dual-exonuclease-mediated approach capable of producing a concentration-dependent response in terms of aptamer digestion modules, therefore improving performance of the current aptamer-based assay for small-molecule detection.

Dual exonucleases to finely distinguish structural adjustment of aptamers to produce absolute differentiation between digestion and inhibition.

[Proximal incisal edge length and recent clinical observation of Siewert type Ⅱ advanced esophagogastric junction adenocarcinoma]

Objective: To investigate the clinical effect of the radical resection with a proximal incisal edge length of 20-25 mm and 30-35 mm in Siewert type Ⅱ advanced esophagogastric junction adenocarcinoma, to shorten the minimum safe distance of the proximal incisal edge to 20-25 mm. Methods: A retrospective cohort study method was used. The clinical data of 166 patients with Siewert type Ⅱ advanced esophagogastric junction adenocarcinoma who underwent total gastrectomy from January 2017 to August 2020 in the Department of Gastrointestinal Surgery, Heji Hospital Affiliated to Changzhi Medical College were retrospectively collected. According to the proximal incisal edge length, the patients were divided into two groups: the proximal incisal edge length of 20-25 mm group (69 cases) and 30-35 mm group (97 cases). The perioperative conditions and the 6-month follow-up after the operation were compared between the two groups. Results: There was no statistically significant difference in baseline information between the patients in the two groups (P>0.05). The operations of both groups were completed. The intraoperative operation time of the proximal incisal edge length of 20-25 mm group was shorter than that in the proximal incisal edge length of 30-35 mm group ((172±24)and(206±27)min, P<0.001). There were no significant differences in the amount of intraoperative blood loss, the treatment of the diaphragm during the operation and the positive rate of intraoperative freezing of the upper incisal edge between the patients in the two groups (all P>0.05). And there was no significant differences in the first exhaust time, gastric tube removal time, first feeding time and hospital stay after the operation of the two groups (all P>0.05). There was no significant differences in the incidence of anastomotic leakage, anastomotic stenosis, reflux esophagitis and intestinal obstruction after the operation between the patients in the two groups (all P>0.05). And there was no anastomotic leakage case among the 69 cases in the proximal incisal edge length of 20-25 mm group. Postoperative pathological treatment showed no significant differences in the vascular tumor thrombus and nerve infiltration between the two groups (both P>0.05). During the 6-month follow-up, there was no death or tumor recurrence in the two groups, and there was no significant difference in body weight loss at 6 months after the operation between the two groups (P=0.178). Conclusion: When radical resection of Siewert type Ⅱ advanced esophagogastric junction adenocarcinoma is performed, it is feasible to shorten the minimum safe distance of the proximal incisal edge to 20-25 mm under the premise of ensuring R0 resection. The operation time is shortened. Due to the shortening the incisal edge distance, the anastomotic tension is decreased, and the incidence of postoperative anastomotic leakage is also reduced.

Development of Acid-Neutralization and in Vitro Dissolution to Evaluate the Overall Quality of Compound Aluminum Hydroxide Tablets

Background:

Compound aluminum hydroxide tablets (CAHTs) are widely used in the Chinese domestic market, and strict quality control is required to ensure their clinical efficacy.

Purpose:

In this study, we established a comprehensive strategy of acid-neutralization, in vitro dissolution and an assay of magnesium trisilicate to evaluate the overall quality and monitor the consistency of CAHTs.

Methods:

The acid-neutralization profiles of 38 batches of CAHTs were generated using the dissolution and release method III (the cup method, the Chinese pharmacopeia) combined with potentiometric titration. To directly reflect the disintegration and release process of the preparation, we optimized the sample pretreatment method by omitting the grinding step to determine the profiles of complete tablets. In addition, in vitro dissolution was conducted in the hydrochloric acid medium at pH 1.0 by using the assay of magnesium trisilicate through a validated approach of flame atomic absorption spectrophotometry (FAAS) to evaluate the similarity of the dissolution profiles.

Results:

Acid-neutralization tests showed that the quality of the samples from manufacturers B and F was poor. In vitro dissolution experiments showed that the samples from manufacturer A had the highest similarity with the reference preparation, which indicated their good quality consistency. Besides, the optimized acid-neutralization method had the advantage of simple operation and enabled direct characterization of pharmacodynamics in the quality consistency evaluation of antacids.

Conclusion:

A successful synthetic evaluation strategy was established to assess the overall quality of CAHTs, which demonstrated that the improvement in the quality of this formulation is imperative.

Measurement of the Cosmic Ray Helium Energy Spectrum from 70 GeV to 80 TeV with the DAMPE Space Mission

The measurement of the energy spectrum of cosmic ray helium nuclei from 70 GeV to 80 TeV using 4.5 years of data recorded by the Dark Matter Particle Explorer (DAMPE) is reported in this work. A hardening of the spectrum is observed at an energy of about 1.3 TeV, similar to previous observations. In addition, a spectral softening at about 34 TeV is revealed for the first time with large statistics and well controlled systematic uncertainties, with an overall significance of 4.3σ. The DAMPE spectral measurements of both cosmic protons and helium nuclei suggest a particle charge dependent softening energy, although with current uncertainties a dependence on the number of nucleons cannot be ruled out.

[Predictive value of platelet aggregation rate in hemodynamically significant patent ductus arteriosus in preterm infants]

Objective: To explore the predictive value of platelet aggregation rate in patent ductus arteriosus in preterm infants. Methods: This prospective nested case-control study enrolled 72 preterm infants with gestational age<32 weeks, who were admitted to Neonatal Intensive Care Unit of Xuzhou Central Hospital from August 2017 to October 2019. The echocardiography was performed on the 4^th to 5^th day after birth, and the preterm infants who met the diagnostic criteria of hemodynamically significant patent ductus arteriosus (hsPDA) were included into hsPDA group, and the control group was comprised of matched preterm infants with non-hsPDA according to the proportion of 1∶2. The basic characteristics of the preterm infants were recorded, and their complete blood counts and platelet aggregation function were examined. Clinical data were compared by student's t test and chi-square test between the two groups. The risk factors and their predictive values were analyzed by binary logistic regression analysis and receiver operating characteristic curve. Results: There were 24 preterm infants (16 boys) in the hsPDA group, and 48 (30 boys) in the control group. The incidence of neonatal respiratory distress syndrome (NRDS) grade II-IV in the hsPDA group was higher than that in the control group (67% (16/24) vs. 27% (13/48), χ²=10.422, P=0.001). The thrombocytocrit and adenosine diphosphate-induced platelet aggregation rate in the hsPDA group were lower than those in the control group (0.002 1±0.000 9 vs. 0.002 8±0.000 9, 0.21±0.10 vs. 0.32±0.07, t=-3.043 and -5.093, P=0.004 and <0.01, respectively); while the platelet volume in the hsPDA group was greater than that in the control group ((10.3±2.4) vs. (9.2±2.0) fl, t = 2.713, P = 0.033). The other platelet parameters (platelet count, platelet distribution width, and large platelet ratio) and platelet aggregation rate induced by other inducers (collagen, epinephrine and arachidonic acid) were not significantly different between the two groups (all P>0.05). The low platelet aggregation rate induced by adenosine diphosphate and low thrombocytocrit were independent risk factors for hsPDA in preterm infants (OR=4.525 and 3.994, 95%CI: 1.305-15.689 and 1.143-13.958, respectively). And the adenosine diphosphate-induced platelet aggregation rate had moderate predictive value for hsPDA in preterm infants, as the area under the receiver operating characteristic curve was 0.809, and the cutoff value was 0.245 with 0.67 sensitivity and 0.86 specificity. Conclusions: Poor platelet aggregation function and low thrombocytocrit are independent risk factors for hsPDA in preterm infants with gestational age<32 weeks. Low platelet aggregation rate induced by adenosine diphosphate has moderate predictive value for hsPDA patency.

Nosocomial infection by Klebsiella pneumoniae among neonates: a molecular epidemiological study

BACKGROUND

Nosocomial infection by Klebsiella pneumoniae (Kp) and drug resistance of Kp among neonates is a major concern. Hypervirulent K. pneumoniae (hvKp) infections are gradually increasing worldwide. Carbapenem-resistant hvKp infection has brought challenges to clinical treatment.

AIM

To evaluate the changes in drug resistance trends of Kp strains in neonatal intensive care unit (NICU) nosocomial infections, to analyse drug resistance genes and virulence genes of carbapenem-resistant K. pneumoniae (CRKP) and to identify whether these CRKP strains are hvKp.

METHODS

A total of 80 neonates with Kp nosocomial infections from 2013 to 2018 were retrospectively studied. Drug susceptibility testing was performed on 80 Kp strains, among which the 12 CRKP strains were further studied.

FINDINGS

Kp accounted for 26.9% of nosocomial infections in the NICU. CRKP strains accounted for 15.0%. Among the 80 nosocomial infection Kp strains, CRKP strains accounted for 33.3% and 53.3% in 2017 and 2018 respectively. One of the 12 CRKP strains was positive in the drawing test. The 12 CRKP strains were divided into four complete genome sequence types: cgST1 (N = 2), cgST2 (N = 1), cgST3 (N = 1), and cgST4 (N = 8). Among genes that mediated carbapenem resistance, strains of cgST4 carried NDM-5, strains of cgST2 and cgST3 carried NDM-1, and strains of cgST1 carried IMP-4. None of the 12 CRKP strains carried rmpA/rmpA2 (highly related with hvKp).

CONCLUSION

Nosocomial infections of CRKP among neonates are becoming common, but no hvKp was found among the CRKP strains in this study.

Multi-linear antenna microwave plasma assisted large-area growth of 6 × 6 in.2 vertically oriented graphenes with high growth rate

Vertically oriented graphenes (VGs) are promising for many emerging energy and environmental applications, while their mass production still remains a critical challenge. This note reports a multi-linear antenna microwave plasma device for fabricating VGs on a large-scale. Eight coaxial linear plasma antennas are parallelly arrayed to produce large-area plasma, depositing 6 × 6 in.² VGs on nickel foil at a high rate of 160 nm min^-1. In supercapacitor applications, the potential of VGs for AC line filtering (an RC time of 0.43 ms) and decreasing the interfacial contact resistance within commercial activated carbon supercapacitors is demonstrated.

[HIV early infant diagnosis test in HIV-exposed children in China, 2015-2017]

Objective: To understand the early infant diagnosis (EID) test rate and associated factors in HIV-exposed children in China during 2015-2017. Methods: The follow-up information cards of 12 096 HIV-exposed children for 18 months after birth during 2015-2017 were collected from the Management Information System of China's Prevention of Mother-to-Child Transmission of HIV for a retrospective analysis. The EID test characteristics of HIV exposed children and associated factors were analyzed. Results: From 2015 to 2017, the EID test rate in HIV exposed children increased from 65.6% to 83.4% in China (trend χ(2) P<0.001). The EID test rate within 8 weeks after birth increased from 61.1% to 76.8% (trend χ(2) P<0.001), but the EID positive rate decreased from 8.7% to 3.4% (trend χ(2) P<0.001). The EID positive rate in fatal HIV-exposed children was 47.7%, 36.9% and 36.3% during 2015-2017, respectively, the differences were not significant. EID test rate was associated with ethnic group, living area, survival status and the year reaching 18-month-old of the children. Conclusions: The performance of EID test has been standardized step by step in China. The positive rate of EID test decreased gradually with year. However, the EID test rates in children who were from minority ethnic groups, lived in areas with lower prevalence of HIV infection and died within 18 months after birth were relatively low.

P834Secondary prevention medications of cardiovascular diseases in China: findings from China PEACE million persons project

Background

Cardiovascular diseases (CVD) is the leading cause of death in China. Secondary prevention medications can improve the prognosis of CVD, yet little is known about the current use, variation and associated factors of these therapies in China.

Purpose

The aim of this study was to describe the current use of secondary prevention medications among patients with established CVD in the community setting in China, assess variations across population subgroups, and identify the individual characteristics associated with these therapies.

Methods

We studied 2.6 million participants aged 35–75 years from all 31 provinces in the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project, a government-funded public health program conducted from 2014 to 2018. Participants self-reported their history of ischemic heart disease (IHD) or ischemic stroke (IS) and medication use in an interview. Among participants with IHD and/or IS, we assessed the reported use of secondary prevention medications (anti-platelet drugs and statins) in the overall population and in 1,530,408 population subgroups, defined by all possible combinations of 16 factors (age, sex, urbanity, geographic region, ethnicity, occupation, annual household income, education, marital status, medical insurance, current smoker, current drinker, history of hypertension, history of diabetes, body mass index and years since diagnosis). Multivariable mixed models with a logit link function and community-specific random intercepts were fitted to assess the associations of demographic, socioeconomic and health behavior factors with the reported use of secondary prevention mediations.

Results

Among 2,613,035 screened participants, 2.9% (74,830) had history of IHD and/or IS (1.2% for IHD, 2.4% for IS). Overall, the reported use rate either anti-platelet drugs or statins was 21.9% (18.3% anti-platelet drugs, 11.0% statins, and 7.4% both). Among the 1,530,408 population subgroups, the use of secondary prevention medications varied substantially (3.4% to 52.0%). Multivariable analyses found that that younger people, women, those living in rural areas, current smokers, current drinkers, people without hypertension or diabetes, and those with established CVD for more than 2 years were less likely to take anti-platelet drugs or statins (Figure).

Forest plot of multivariable mixed model

Conclusions

The current use of secondary prevention drugs is suboptimal and varies substantially across population subgroups in China. Our study identifies target populations for interventions to improve secondary prevention of CVD.

Acknowledgement/Funding

This study was supported by the Ministry of Finance of China and National Health Commission of China

[Efficacy of magnetic levitation elastic mandibular elevator in treatment of mild or moderate obstructive sleep apnea]

Objectives: To investigate the clinical efficacy of magnetic levitation elastic mandibular elevator (MLEME) in treatment of mild obstructive sleep apnea (OSA). Methods: Twenty one patients with mild or moderate OSA confirmed by polysomnographic (PSG) examination were recruited from the First Affiliated Hospital with Nanjing Medical University between June of 2016 and June of 2017. Their PSG parameters, daytime Epworth sleepiness score (ESS) were compared before and on treatment of MLEME. In addition, any side effects and discomfort were observed during MLEME treatment. Results: Comparison of parameters during and before MLEME treatment revealed a significant decrease (all P<0.05) in apnea hypopnea index [(9.3±6.2) vs (15.6±7.8)/h], arousal index [(6.2±3.4) vs (10.3±5.4)/h], percentage of sleep time with less than 90% oxygen saturation (3.9%±2.7% vs 9.8%±3.5%), daytime ESS (6.3±2.3 vs 11.2±2.8); but a remarkable increase (all P<0.05) in mean and minimal pulse oxygen saturation (97.2%±0.9% vs 94.7%±1.1% and 87.6%±2.8% vs 81.7%±4.6% respectively). All patients could tolerate MLEME treatment well with no complain of discomfort. Following wearing of MLEME, X-ray lateral film of head and neck revealed a significantly longer distance than that before MLEME treatment from tip of uvula to posterior pharyngeal wall [(11.9±1.8) vs (9.6±1.5) mm](P<0.05). Conclusions: MLEME could significantly improve sleep respiratory parameters and daytime sleepiness of OSA without side effects. Its long-term efficacy for OSA remains to be further explored.

Measurement of the cosmic ray proton spectrum from 40 GeV to 100 TeV with the DAMPE satellite

The precise measurement of the spectrum of protons, the most abundant component of the cosmic radiation, is necessary to understand the source and acceleration of cosmic rays in the Milky Way. This work reports the measurement of the cosmic ray proton fluxes with kinetic energies from 40 GeV to 100 TeV, with 2 ¹/₂ years of data recorded by the DArk Matter Particle Explorer (DAMPE). This is the first time that an experiment directly measures the cosmic ray protons up to ~100 TeV with high statistics. The measured spectrum confirms the spectral hardening at ~300 GeV found by previous experiments and reveals a softening at ~13.6 TeV, with the spectral index changing from ~2.60 to ~2.85. Our result suggests the existence of a new spectral feature of cosmic rays at energies lower than the so-called knee and sheds new light on the origin of Galactic cosmic rays.

[International incidence trend of coal workers' pneumoconiosis and silicosis]

Pneumoconiosis is a group of occupational disease that seriously threaten the health of workers, which was regard as incurable for the irreversibility of pulmonary fibrotic lesions. It was successfully controlled in a few countries but resurgent in resent years. At the same time, the silicosis in the emerging industries has gradually appeared in many countries. In this article, the process aforementioned were described and the lessons were summarized to give some suggestions for promoting the prevention of pneumoconiosis in our country.

Clinicopathologic charcterization of sorafenib-induced endoplasmic reticulum stress in human liver cancer cells

Sorafenib (Sor) is clinical standard therapy for advanced hepatocellular carcinoma (HCC). However, detailed molecular mechanism behind Sor-exerted pharmacological effect remains unknown. In this study, sera samples, staged hepatic cancer tissues from Sor-treated patients with advanced HCC were harvested for a group of biochemical tests and immunoassays. Compared to non-treated control, blood contents of alanine transaminase (ALT), aspartate transaminase (AST), alphafetoprotein (AFP), fibroblast growth factor 21 (FGF21) were decreased in Sor-treated HCC patients, while the level of interleukin 10 (IL-10) were increased. As well, reduced triglyceride (TG), total cholesterol (T-CHOL), interferon gamma (IFN-γ), and tumor necrosis factor alpha (TNF-α) levels in sera were checked in Sor-treated HCC patients. In comparison with non-treated cancer sections, Sor-treated HCC cells showed decreased positive cells of proliferative marker for proliferating cell nuclear antigen (PCNA) and metastasized biomarker for cytokeratin 19 (CK19). In addition, elevated immunofluorescence-labeled cells of endoplasmic reticulum (ER)-stress markers of activating transcription factor 6 (ATF6), eukaryotic initiation factor 2α kinase (eIF2α), glucose-regulated protein (GRP-78), X-box binding protein 1 (XBP1) were observed in Sor-treated HCC livers. Further, validated data from Western blot assay exhibited that hepatocellular expressions of ATF6, eIF2α, GRP78, XBP1 in Sor-treated HCC liver cells were up-regulated. Briefly, our present clinicopathologic findings indicate that Sor-induced ER stress may be responsible for therapeutic mechanism against advanced HCC. In addition, induction of intracellular ER stress functions as a promising strategy for treating advanced HCC.