Bioinspired core-shell nanofiber drug-delivery system modulates osteogenic and osteoclast activity for bone tissue regeneration

Osteogenic-osteoclast coupling processes play a crucial role in bone regeneration. Recently, strategies that focus on multi-functionalized implant surfaces to enhance the healing of bone defects through the synergistic regulation of osteogenesis and osteoclastogenesis is still a challenging task in the field of bone tissue engineering. The aim of this study was to create a dual-drug release-based core-shell nanofibers with the intent of achieving a time-controlled release to facilitate bone regeneration. We fabricated core-shell P/PCL nanofibers using coaxial electrospinning, where alendronate (ALN) was incorporated into the core layer and hydroxyapatite (HA) into shell. The surface of the nanofiber construct was further modified with mussel-derived polydopamine (PDA) to induce hydrophilicity and enhance cell interactions. Surface characterizations confirmed the successful synthesis of PDA@PHA/PCL-ALN nanofibers endowed with excellent mechanical strength (20.02 ± 0.13 MPa) and hydrophilicity (22.56°), as well as the sustained sequential release of ALN and Ca ions. In vitro experiments demonstrated that PDA-functionalized core-shell PHA/PCL-ALN scaffolds possessed excellent cytocompatibility, enhanced cell adhesion and proliferation, alkaline phosphatase activity and osteogenesis-related genes. In addition to osteogenesis, the engineered scaffolds also significantly reduced osteoclastogenesis, such as tartrate-resistant acid phosphatase activity and osteoclastogenesis-related gene expression. After 12-week of implantation, it was observed that PDA@PHA/PCL-ALN nanofiber scaffolds, in a rat cranial defect model, significantly promoted bone repair and regeneration. Microcomputed tomography, histological examination, and immunohistochemical analysis collectively demonstrated that the PDA-functionalized core-shell PHA/PCL-ALN scaffolds exhibited exceptional osteogenesis-inducing and osteoclastogenesis-inhibiting effects. Finally, it may be concluded from our results that the bio-inspired surface-functionalized multifunctional, biomimetic and controlled release core-shell nanofiber provides a promising strategy to facilitate bone healing.

Medical expenses of patients with severe mental disorders in Beijing, China

OBJECTIVES

Mental health has become a significant public health problem that impacts both economic and social development, with severe mental disorders (SMDs) being the top priority. Over recent years, Beijing, China, has introduced several policies to reduce the economic burden on patients with mental health disorders. The aim of this study was to investigate the current status and composition of patients' medical expenses following the introduction of multiple medical policies, explore the factors that may impact the utilisation of medical services and provide a reference and basis for subsequent policy improvements.

STUDY DESIGN

Multistage sampling was used to select a representative study population. A retrospective survey was used to collect patient information and data on medical expenses in 2019.

METHODS

Descriptive statistics were applied to analyse the current status of patients' medical expenses, and a two-part model was used to examine the factors influencing healthcare utilisation and to model predicted expenses.

RESULTS

Among 4940 participants, the average outpatient expenses of patients with SMD who incurred medical expenses were 8373.61 Yuan, and the average hospitalisation expenses were 81,594.05 Yuan. The out-of-pocket expenses were 29.22% of outpatient expenses and 8.13% of inpatient expenses. Factors such as age, household status, economic status, marital status, participation in the Community Free-Medication Service (CFMS) and the type of disease diagnosed influenced the differences in medical expenses and utilisation of services.

CONCLUSIONS

The medical expenses of patients with SMD in Beijing are high, but a number of introduced policies have effectively reduced these costs for patients. Future studies should focus on the impact of factors such as age, economic status, participation in the CFMS and the type of disease diagnosed on medical expenses.

Pre-administration of human umbilical cord mesenchymal stem cells has better therapeutic efficacy in rats with D-galactosamine-induced acute liver failure

BACKGROUND

Acute liver failure (ALF) is characterized by an intense systemic inflammatory response, single or multiple organ system failure and high mortality. However, specific and effective treatments for ALF patients are still lacking. According to the current investigation, human umbilical cord mesenchymal stem cells (hUCMSCs) have shown remarkable potential to enhance the functional recovery of injured livers. We aimed to investigate the therapeutic effects of time-differentiated hUCMSCs administration regimens on ALF.

METHODS

The rat model of ALF was induced by D-galactosamine (D-gal), and hUCMSCs were administered via the tail vein 12 h before or 2 h after induction. The potential mechanisms of hUCMSCs in treatment of ALF, regulation cell subset and secretion of inflammatory factors, were verified by co-culturing with PBMCs in vitro. Liver function indicators were detected by an automatic biochemistry analyzer and inflammatory factors were obtained by ELISA detection. The distribution of hUCMSCs in rats after administration was followed by quantitative real-time fluorescence PCR.

RESULTS

The findings of the study discovered that administration of hUCMSCs 12 h prior to surgery could significantly improve the survival rate of rats, stabilize various liver function indicators in serum levels of ALT, AST, T-BIL, or ALB diminish inflammatory infiltration in liver tissue, and inhibit the secretion of inflammatory factors.

CONCLUSION

Our data showed that pre-transplantation of hUCMSCs had a better therapeutic effect on ALF rats, providing empirical evidence for preclinical studies. Thus, the timing of hUCMSCs transplantation is necessary for the optimal clinical treatment effect.

Effect of different water and organic matter content on the resistivity of loess

The pore structure and strength of loess itself will change significantly in the process of mixing organic matter, which, as the main component of solid waste at present, is of great significance for ecological vegetation restoration in loess areas. At present, the research on the internal structure and strength performance of loess through the content of organic matter is still less, this paper takes the loess mixed with different content of organic matter (0 %-6 %) and distilled water (12 %-24 %) as the object of research, and tests the electrical resistivity and pore structure of the doped organic matter loess through the LCR digital bridge test equipment and liquid nitrogen adsorption experiments. The results show that the organic matter content and water content are important factors affecting the change of resistivity of organic soil. The electrical resistivity of organic soil is correlated with its own water content and organic matter content, which is closely related to the pore type and specific surface area within the organic soil. The results of the study provide valuable references for vegetation restoration and land use and conservation strategies in ecosystems.

[Effects of Nitrogen Speciation Transformation on Microbial Community Succession in Input Rivers of Miyun Reservoir]

The Miyun Reservoir is the major source of surface drinking water in Beijing. However, the total nitrogen (TN) concentrations in the Miyun Reservoir and inflowing rivers have recently been increasing. In this study, the Mangniu River, a typical inflow river in the upper reaches of the Miyun Reservoir, was selected as the study area to investigate the spatial distribution and transformation of various nitrogen forms from the perspective of microbial community composition and predicting function, aimimg at providing a scientific reference for nitrogen pollution control of the Miyun Reservoir. The results indicated that except for TN, all the other physical and chemical water quality indicators in the upper reaches of the Miyun Reservoir met the Class II criteria of the environmental quality standards for surface water in China (GB 3838-2002). Additionally, NO3--N was the primary constituent of TN, ranging from 77.7% to 92.9%. Banchengzi Reservoir has a certain self-purification ability because its high C/N ratio promotes denitrification. Significant differences in microbial community structure were observed between the water and sediments of Mangniu River along with spatial distribution. High NO3--N concentration was the major environmental factor affecting the succession of microbial community structure. Many nitrification and denitrification microorganisms existed in Mengniu River, and the relative abundance of denitrification bacteria (DNB) was higher than that of nitrification bacteria, and that in the sediments was slightly higher than that in the water. Nitrosopumilus and Pseudomonas were the dominant nitrification and denitrification bacteria in Mengniuhe River, respectively. The results of phylogenetic investigation of communities by the reconstruction of unobserved states (PICRUSt2) showed that NO3--N reduction module was the major nitrogen metabolism module, which primarily occurred in water. The abundance of the functional genes for nitrification (i.e., narGH) was the highest in water, and the major functional gene involved in NO3--N reduction was nirBD of DNRA, which was primarily present in the sediments; however, the main functional gene involved in denitrification was nirK.

[The efficacy of muscle function training combined with occlusal inducer in the treatment of malocclusion in children with OSA]

Objective:This study aims to investigate the clinical effectiveness of muscle function training combined with occlusal inducers in the treatment for children's malocclusion after obstructive sleep apnea（OSA） surgery. Methods:A total of 40 pediatric patients who underwent surgery for OSA at Shanghai Children's Medical Center, affiliated with Shanghai Jiao Tong University School of Medicine, from January 2020 to December 2021 were involved in this study. They were divided into a treatment group（n=20） and a control group（n=20）. The treatment group received muscle function training combined with occlusal inducers, while the control group received muscle function training alone. Cephalometric measurements of hard tissues were compared between the two groups before and 12 months after surgery. Additionally, the OSA-18 questionnaire, which includes 18 items to assess the life quality of children with OSA, was filled out before surgery, 6 months after surgery, and 12 months after surgery by these patients. Results:①The scores of sleep disorders, physical symptoms, emotional status, daytime sleepiness and energy status and the degree of influence on guardians in the two groups were significantly improved at 12 months after operation（P<0.05）. The scores of sleep disorders, physical symptoms, emotional status and the degree of influence on guardians in the treatment group were better than those in the control group（P<0.05）. ②Cephalometric data at 12 months after operation showed that the upper and lower alveolar seat angle（ANB）, Overbite, upper and lower central incisor angle（U1-L1） and Overjet in the treatment group were lower than those in the control group at 12 months after operation, and the difference was statistically significant（P<0.05）. Conclusion:Children with OSA can improve the dentition irregularity by muscle function training combined with occlusal inducer after operation, and the effect is better than that of muscle function training alone.

[Preventive effect of atropine premedication on vagal reflex in patients undergoing suspension laryngoscopy during anesthesia induction]

Objective: To evaluate the preventive effect of atropine premedication during anesthesia induction on vagal reflex in patients undergoing suspension laryngoscopy. Methods: A total of 342 patients (202 males and 140 females) scheduled for suspension laryngoscopy under general anesthesia in Beijing Tongren Hospital from October 2021 to March 2022 were prospectively enrolled, with a mean age of (48.1±11.9) years. The patients were randomly divided into two groups using the random number table method: the treatment group (n=171) and the control group (n=171). Patients in the treatment group were administrated with 0.5 mg atropine intravenously guttae (ivgtt) while patients in the control group were given equivalent volume of normal saline. For all patients, if heart rate (HR)<50 beats/min happened during the insertion of the suspension laryngoscope, the operation should be stopped and the laryngoscope should be removed. Patients without HR recovery after the removal of the laryngoscope should be given 0.5 mg atropine, and the operation should be continued after the HR recovered. The primary outcome was the incidence of HR fluctuation over 20% (ΔHR>20%) before and immediately after suspension laryngoscope fixation, and the secondary outcomes included HR, mean arterial pressure (MAP) of the two groups recorded before and after anesthesia induction, before and immediately after suspension laryngoscope fixation, and the incidences of sinus bradycardia, laryngoscope removal and atropine treatment during operation. Results: The incidences of ΔHR>20% and bradycardia immediately after the suspension laryngoscope fixation were 14.6% (25/171) and 12.9% (22/171) in the treatment group, which were significantly lower than those in the control group [28.1% (48/171) and 29.8% (51/171)] (both P<0.05). The HR immediately after the suspension laryngoscope fixation in the treatment group [(66.4±13.5) beats/min] and in the control group [(60.8±15.7) beats/min] was significantly lower than those before the suspension laryngoscope fixation [(74.7±11.1) beats/min and (67.6±12.8) beats/min, respectively] (both P<0.05). There were no significant differences in MAP between the two groups at each time point (all P>0.05). The incidence of laryngoscope removal once plus 0.5 mg atropine administration, laryngoscope removal twice plus 0.5 mg atropine administration and laryngoscope removal twice plus 1.0 mg atropine administration was 9.9% (17/171), 1.8% (3/171) and 0 (0) in the treatment group, respectively, which was significantly lower than those in the control group [24.0% (41/171), 5.8% (10/171) and 2.3% (4/171), respectively] (all P<0.05). Conclusion: Atropine premedication during anesthesia induction can effectively reduce the occurrence of vagal reflex in patients undergoing suspension laryngoscopy.

Emerging Polymer-Based Nanosystem Strategies in the Delivery of Antifungal Drugs

Nanosystems-based antifungal agents have emerged as an effective strategy to address issues related to drug resistance, drug release, and toxicity. Among the diverse materials employed for antifungal drug delivery, polymers, including polysaccharides, proteins, and polyesters, have gained significant attention due to their versatility. Considering the complex nature of fungal infections and their varying sites, it is crucial for researchers to carefully select appropriate polymers based on specific scenarios when designing antifungal agent delivery nanosystems. This review provides an overview of the various types of nanoparticles used in antifungal drug delivery systems, with a particular emphasis on the types of polymers used. The review focuses on the application of drug delivery systems and the release behavior of these systems. Furthermore, the review summarizes the critical physical properties and relevant information utilized in antifungal polymer nanomedicine delivery systems and briefly discusses the application prospects of these systems.

Response of prokaryotic, eukaryotic and algal communities to heavy rainfall in a reservoir supplied with reclaimed water

The global climate change made the heavy rainfall happen more frequently, and the non-point source pollution caused by it would exacerbate the risk to the water ecological environment. In this study, we took a reservoir (Shahe reservoir, Beijing, China) supplied with reclaimed water as an exapmle to investigate how spatiotemporal changes in the quantity and diversity of prokaryotic, eukaryotic, and algal communities respond to heavy rainfall. Results showed that heavy rainfall could directly impact the composition of the prokaryotic community by introducing amounts of runoff closely associated bacterium especially for the human potential pathogens such as Aliarcobacter, Aeromonas and Pseudomonas in the Shahe reservoir area. While the eukaryotic community was rather stable, and the development and changes in algal communities occurred in the last few days after heavy rainfall. The microbial source tracking through FEAST indicated that Nansha river (S) was the major contributor to the development of all the three concerned communities in the reservoir. The co-occurrence analysis showed that the modules with the highest cumulative abundance in each community were all strongly and positively connected with Chl-a, pH, turbidity, COD and TOC, but negatively correlated with NO₃-N (p < 0.01). The network analysis showed that the eukaryotes played a key role in the interaction network among the three communities, and were more likely to interact with algae and prokaryotes. It was suggested that the controlling of human potential pathogens associated with prokaryotic community should be emphasized at the beginning of the heavy rainfall, but the prevention of the eutrophication bloom should be another focus after the heavy rainfall. This study provided valuable information concerning the role of heavy rainfall on the water ecological environment from the perspective of microbial community.

Tracing Microbial Production and Consumption Sources of N2O in Rivers on the Qinghai-Tibet Plateau via Isotopocule and Functional Microbe Analyses

Nitrous oxide (N₂O), a potent greenhouse gas, is produced in rivers through a series of microbial metabolic pathways. However, the microbial source of N₂O production and the degree of N₂O reduction in river systems are not well understood and quantified. This work investigated isotopic compositions (δ¹⁵N-N₂O and δ¹⁸O-N₂O) and N₂O site preference as well as N₂O-related microbial features, thereby differentiating the importance of nitrification, denitrification, and N₂O reduction in controlling N₂O emissions from five rivers on the eastern Qinghai-Tibet Plateau (EQTP). The average N₂O concentration in overlying water (15.2 nmol L^-1) was close to that in porewater (17.5 nmol L^-1), suggesting that both overlying water and sediment are potentially important sources of N₂O. Canonical and nitrifier denitrification dominated riverine N₂O production, with contribution being approximately 90%. Nitrification is a non-negligible source of N₂O production, and N₂O concentration was positively correlated with nitrification genetic potential. The degree of N₂O reduction ranged from 78.1 to 94.1% (averaging 90%), significantly exceeding the reported values (averaging 70%) in other freshwaters, which was attributed to the higher ratios of organic carbon to nitrogen and lower ratio of (nirS + nirK)/nosZ in EQTP rivers. This study indicates that a combination of isotopic and isotopocule values with functional microbe analysis is useful for quantifying the microbial sources of N₂O in rivers, and the intense microbial reduction of N₂O significantly accounts for the low N₂O emissions observed in EQTP rivers, suggesting that both the production and consumption of N₂O in rivers should be considered in the future.

An extensive assessment of seasonal rainfall on intracellular and extracellular antibiotic resistance genes in Urban River systems

Rainfall events are responsible for the accelerated transfer of antibiotic-resistant contaminants to receiving environments. However, the specific profiles of various ARG types, including intra- and extracellular ARGs (iARGs and eARGs) responding to season rainfall needed more comprehensive assessments. Particularly, the key factors driving the distribution and transport of iARGs and eARGs have not been well characterized. Results revealed that the absolute abundance of eARGs was observed to be more than one order of magnitude greater than that of iARGs during the dry season in the reservoir. However, the absolute abundance of iARGs significantly increased after rainfall (p < 0.01). Meanwhile, seasonal rainfall significantly decreased the diversity of eARGs and the number of shared genes between iARGs and eARGs (p < 0.01). Results of structural equation models (SEM) and network analysis showed the rank and co-occurrence of influencing factors (e.g., microbial community, MGEs, environmental variables, and dissolved organic matter (DOM)) concerning the changes in iARGs and eARGs. DOM contributed majorly to eARGs in the reservoir and pathogens was responsible for eARGs in the river during the wet season. Network analysis revealed that the tnp-04 and IS613 genes-related MGEs co-occurred with eARGs in the dry and wet seasons, which were regarded as potential molecular indicators to shape eARGs profiles in urban rivers. Besides, the results demonstrated close relationships between DOM fluorescence signatures and two-typed ARGs. Specifically, humic acid was significantly and positively correlated with the eARGs in the reservoir during the wet season, while fulvic acid-like substances exhibited strong correlations of iARGs and eARGs in the river during the dry season (p < 0.01). This work provides extensive insights into the potential effect of seasonal rainfall on the dynamic distribution of iARGs and eARGs and the dominance of DOM in driving the fate of two-typed ARGs in urban river systems.

Impacts of spectral characteristics of dissolved organic matter on methylmercury contents in peatlands, Northeast China

Dissolved organic matter (DOM) plays an important role in promoting or suppressing methylmercury (MeHg) production in wetlands. However, the effects of DOM spectral characteristics on MeHg levels remain poorly understood in boreal peatlands in Northeast China, where is undergoing remarkable climate warming. In the present work, soil samples were collected from 22 peatlands in the Greater Khingan Mountains (GKM) to test the hypothesis that DOM spectral properties control MeHg levels. DOM was characterized by UV-Vis absorption and fluorescence spectroscopy; the three-dimensional fluorescence excitation-emission matrix (EEM) was used to unveil the origin of DOM. The average total mercury (THg) and MeHg contents were 112.76 µg/kg and 12.43 µg/kg across all peatlands, respectively. There was a significantly positive correlation between MeHg and the longitude spanning the range from 120 to 123°E (p < 0.05). Proportions of MeHg to THg (%MeHg), 12.3% on average, were positively correlated with DOM humification degree at p < 0.05 level. Protein-like components of DOM (P-like) were negatively related to %MeHg. DOM had positive effects on THg, and P-like components, HIX and BIX can negatively affect THg as well as MeHg. Our findings demonstrate that the spectral characteristics of DOM in soil are crucial to the content of methyl mercury in the GKM soil.

Arch Expansion Efficiency of Clear Aligner on Patients with Mixed Dentition Using 3ship Digital Oral Scanner

The aim of this study to evaluate the maxillary and mandibular arch expansion efficiency of clear aligner. A total of 15 patients aged between 8–11 who were admitted from January 2020 to December 2021. The 3ship digital oral scanner was used to establish a digital oral model for the patients before and after the correction. The three-dimensional model before and after correction was established by ClinCheck software to measure and record the width of each tooth position and evaluate the efficiency of arch expansion. The dental arch width was greater after correction of the width between the maxillary and maxillary canines, the width between the first premolars, the width between the second premolars, and the width between the first molars, showing statistically significant differences (P <0.05). The arch expansion efficiency in the maxillary canine area > the maxillary first premolar efficiency > the maxillary second premolar efficiency > the maxillary first molar efficiency. Through the linear regression equation, the preset expansion amount of each tooth position was reasonably predicted.Taken together our data suggested that the clear aligner efficiency can be improved by adding accessories and torque in the base bone range when necessary.

Indirect nitrous oxide emission factors of fluvial networks can be predicted by dissolved organic carbon and nitrate from local to global scales

Streams and rivers are important sources of nitrous oxide (N₂ O), a powerful greenhouse gas. Estimating global riverine N₂ O emissions is critical for the assessment of anthropogenic N₂ O emission inventories. The indirect N₂ O emission factor (EF_5r ) model, one of the bottom-up approaches, adopts a fixed EF_5r value to estimate riverine N₂ O emissions based on IPCC methodology. However, the estimates have considerable uncertainty due to the large spatiotemporal variations in EF_5r values. Factors regulating EF_5r are poorly understood at the global scale. Here, we combine 4-year in situ observations across rivers of different land use types in China, with a global meta-analysis over six continents, to explore the spatiotemporal variations and controls on EF_5r values. Our results show that the EF_5r values in China and other regions with high N loads are lower than those for regions with lower N loads. Although the global mean EF_5r value is comparable to the IPCC default value, the global EF_5r values are highly skewed with large variations, indicating that adopting region-specific EF_5r values rather than revising the fixed default value is more appropriate for the estimation of regional and global riverine N₂ O emissions. The ratio of dissolved organic carbon to nitrate (DOC/NO₃ ^- ) and NO₃ ^- concentration are identified as the dominant predictors of region-specific EF_5r values at both regional and global scales because stoichiometry and nutrients strictly regulate denitrification and N₂ O production efficiency in rivers. A multiple linear regression model using DOC/NO₃ ^- and NO₃ ^- is proposed to predict region-specific EF_5r values. The good fit of the model associated with easily obtained water quality variables allows its widespread application. This study fills a key knowledge gap in predicting region-specific EF_5r values at the global scale and provides a pathway to estimate global riverine N₂ O emissions more accurately based on IPCC methodology.

Ambient fine particulate pollution hysteresis triggers wake-up stroke and rapidly triggers non-wake-up stroke: a case-crossover study

Atmospheric pollutants increase the risk of acute ischemic stroke (AIS) which has been widely reported. However, little is known about the relationships between air pollution and specific subsets of AIS, such as wake-up stroke (WUS) and non-wake-up stroke (non-WUS). This study aimed to explore the relationship between WUS and non-WUS and atmospheric pollutants. A total of 1432 patients (331 WUS patients and 1101 non-WUS patients) were admitted to a tertiary hospital from 2016 to 2019. A time-stratified case-crossover design and a conditional logistic regression model to study the associations of change in pollutant concentration with WUS and non-WUS events were constructed. Data analysis revealed that WUS-related risks increased 48 to 72 h after the increase in the PM_2.5 concentration (each 10 μg/m³ increase, lag 0-72 h) [threshold OR (95% CI):18 μg/m³ 1.03 (0.94-1.11), 35 μg/m³ 1.01 (0.92-1.12), 50 μg/m³ 1.04 (0.91-1.19)]; the non-WUS-related risk increased 1 to 6 h after the increase in the PM_2.5 concentration (each 10 μg/m³ increase, lag 0-1 h) [threshold OR (95% CI):18 μg/m³ 1.01 (0.98-1.03), 35 μg/m³ 1.00 (0.97-1.04), 50 μg/m³ 1.01 (0.96-1.05)] (lag 0-6 h) [threshold OR (95% CI): 18 μg/m³ 1.00 (0.97-1.03), 35 μg/m³ 1.00 (0.97-1.04), 50 μg/m³ 1.01 (0.97-1.06)]; O₃ exposure was related to WUS events, and its impact on WUS events was stronger and longer-lasting (1-96 h) than its impact on non-WUS events (1-6 h). Greater than or equal to 65 years of age, overweight (BMI ≥ 25), and diabetes had a significantly greater risk of WUS associated with increased PM_2.5 concentration in the previous 12-96 h than patients without these conditions. Patients with hypertension and smoking had a significant risk of non-WUS associated with increased PM_2.5 concentration in the previous 1-6 h. The increase in PM_2.5 concentration in the cold season increased the risk of both WUS and non-WUS events. Ambient air pollution hysteresis triggers WUS and rapidly triggers non-WUS, even if the degree of pollutant is relatively low. Patients with elderly, overweight, and diabetes appeared particularly susceptible to WUS, and patients with hypertension and smoking history were susceptible to non-WUS. We need to expand the sample for further investigation into mechanisms by which environmental pollutants trigger WUS or non-WUS.

Efficacy and safety of margetuximab plus chemotherapy vs. trastuzumab plus chemotherapy in Chinese patients with pretreated HER2-positive advanced metastatic breast cancer: results from a randomized, open-label, multicenter, phase II bridging study

Background

Trastuzumab is the recommended first-line treatment for human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) patients in China, but therapeutic resistance to trastuzumab and other early-line treatments is common and late-line treatment options are limited. Derived from the same murine precursor antibody, margetuximab has enhanced anti-tumor activity compared with trastuzumab and may be an effective late-line treatment. However, data regarding the use of margetuximab in pre-treated Chinese patients are scarce. This study aimed to evaluate the efficacy and safety of margetuximab plus chemotherapy vs. trastuzumab plus chemotherapy in Chinese patients, and to determine whether the results are consistent with the clinical benefit of margetuximab observed in the pivotal global phase III study.

Methods

In this randomized, open-label, multicenter, phase II bridging study, eligible Chinese patients pretreated with ≥2 lines of anti-HER2 therapies were randomized 1:1 by stratified block randomization to margetuximab (15 mg/kg over at least 120 minutes) or trastuzumab (6 mg/kg over at least 30 minutes), each administered intravenously once every 21-day cycle and plus chemotherapy. Disease assessment was conducted once every two treatment cycles (6 weeks ± 7 days). The primary endpoint was progression-free survival (PFS) by blinded independent central review (BICR). Secondary endpoints included overall survival (OS), investigator-assessed PFS, objective response rate (ORR), duration of response (DoR), clinical benefit rate (CBR), and the incidence and severity of treatment-emergent adverse events (TEAEs).

Results

Between February 4, 2020 and February 23, 2021, 123 patients were randomized to the margetuximab (n=62) and trastuzumab (n=61) arms. Among them, 15 and 7 patients, respectively, were still on study treatment as of data cut-off (September 3, 2021). Overall, 99.2% were female, median age was 53 years old. All patients were pretreated with trastuzumab, and 83.7% and 25.2%, respectively, were pretreated with tyrosine kinase inhibitors (TKIs) and pertuzumab. Baseline characteristics were numerically balanced between arms. BICR-assessed median PFS (mPFS) was 5.5 months in the margetuximab arm and 4.1 months in the trastuzumab arm, with a hazard ratio (HR) of 0.69 [95% confidence interval (CI): 0.43-1.12], which met the consistency criterion (HR <0.88) for bridging success. Median investigator-assessed PFS was 5.5 months in the margetuximab arm and 4.0 months in the trastuzumab arm (HR =0.63; 95% CI: 0.41-0.96). Median OS (mOS) was not yet reached. Both ORR and CBR were greater in the margetuximab arm (25.5% vs. 12.5%; 32.7% vs. 14.3%). Safety results were numerically comparable between the two arms. Anti-HER2 treatment-related infusion-related reactions (IRRs) were more common in the margetuximab arm than in the trastuzumab arm (12.9% vs. 1.7%). All IRRs could be resolved.

Conclusions

Margetuximab was effective and well-tolerated in this study, supporting its clinical use in pretreated HER2-positive MBC patients in China.

Trial Registration

ClinicalTrials.gov Identifier: NCT04262804.

Ferric chloride further simplified the horizontal gene transfer network of antibiotic resistance genes in anaerobic digestion

The role of ferric chloride (FC) on the reduction of antibiotic resistance genes (ARGs) in anaerobic digestion (AD) system was investigated from the perspective of vertical (VGT) and horizontal gene transfer (HGT) network through the high-throughput qPCR (HT-qPCR). Although FC showed limited impacts on methane production in AD of swine manure, the tetracycline and MLSB resistance genes were specifically reduced at the end, where tetQ of antibiotic target protection and ermF of antibiotic target alteration contributed the most to the reduction. Both VGT and HGT network were divided into three modules, and the complexity of HGT network was largely reduced along with AD, where the HGT connection was reduced from 683 (Module III) to 172 (Module I), and FC addition could further reduce the relative abundance of ARG hosts in Module I. The contribution of VGT and HGT to the changes of ARGs in AD was further deciphered, and although the VGT reflected by the changes of microbial community contributed the most to the dynamics of ARGs (68.0 %), the HGT contribution could further be reduced by the FC addition. This study provided a new perspective on the fate of ARGs response to the FC addition in the AD system.

Mn substitution in the topological metal Zr2Te2P

Results are reported for Mn intercalated Zr₂Te₂P, where x-ray diffraction , energy dispersive spectroscopy, and transmission electron microscopy measurements reveal that the van der Waals bonded Te-Te layers are partially filled by Zr and Mn ions. This leads to the chemical formulas Zr_0.07Zr₂Te₂P and Mn_0.06Zr_0.03Zr₂Te₂P for the parent and substituted compounds, respectively. The impact of the Mn ions is seen in the anisotropic magnetic susceptibility, where Curie-Weiss fits to the data indicate that the Mn ions are in the divalent state. Heat capacity and electrical transport measurements reveal metallic behavior, but the electronic coefficient of the heat capacity (γ_Mn≈ 36.6 mJ (mol·K²)^-1) is enhanced by comparison to that of the parent compound. Magnetic ordering is seen atTM≈4 K, where heat capacity measurements additionally show that the phase transition is broad, likely due to the disordered Mn distribution. This transition also strongly reduces the electronic scattering seen in the normalized electrical resistance. These results show that Mn substitution simultaneously introduces magnetic interactions and tunes the electronic state, which improves prospects for inducing novel behavior in Zr₂Te₂P and the broader family of ternary tetradymites.

Ant colonization increased total mercury but reduced methylmercury contents in boreal mires, Northeast China

Soil macroinvertebrates as ecosystem engineers play significant, but largely ignored, roles in affecting mercury (Hg) cycle by altering soil physical-chemical properties. Ant is likely expanded into boreal mires with climate warming, however, its impacts on Hg cycle remained poorly understood. We compared total Hg (THg) and methylmercury (MeHg) contents in soils from antmounds (Lasius flavus) and the nearby ambient in a boreal mire in Northeast China. The present work seeks to unravel factors that controlling MeHg levels in case of ant appearance or absence. The average THg was 179 µg/kg in the ant mound and was 106.1 µg/kg in nearby soils, respectively. The average MeHg was 10.9 µg/kg in the ant mound and was 12.9 µg/kg in nearby soils, respectively. The ratios of MeHg to THg (%MeHg) were 7.61% in ant mounds and 16.75% in nearby soils, respectively. Ant colonization caused THg enrichment and MeHg depletion, and this change was obvious in the 10-20 cm depth soil layer where ants mainly inhabited. Spectrometry characteristics of soil dissolved organic matter (DOM) exert a stronger control than microorganisms on MeHg variation in soils. A structural equation model revealed that the molecular weight of DOM inhibited MeHg irrespective of ant presence or absence, while humification conducive to MeHg significantly in ant mound soils. Microorganisms mainly affected Hg methylation by altering the molecular weight and humification of DOM. We propose that the effects of ant colonization on MeHg rested on DOM feature variations caused by microorganisms in boreal mires.

Network Meta-Analysis of Perioperative Analgesic Effects of Different Interventions on Postoperative Pain After Arthroscopic Shoulder Surgery Based on Randomized Controlled Trials

Background

Shoulder arthroscopic surgery is a common surgical method used in orthopedics. However, severe postoperative pain can significantly limit the early joint movement of patients and adversely affect the impact of the surgery. At present, there is no consistent and effective analgesic scheme for the management of postoperative pain after arthroscopic surgery of the shoulder.

Purpose

The aim of this study was to search for the most effective analgesic scheme to control pain in the perioperative period of arthroscopic surgery of the shoulder.

Study Design

Network meta-analysis.

Methods

We searched 5 different databases (i.e., Medline, PubMed, Embase, Web of Science, and the Cochrane Library) from January 2011 to January 2021 for English literature. Thereafter, we sifted out randomized controlled trials (RCTs), which compared different intervention schemes for pain management after shoulder arthroscopy and selected only 12 h, 24 h, or 48 h after the patient leaves the operating room as an optimal period for administration of analgesic intervention schemes. Only patients with shoulder disease who have undergone arthroscopic shoulder surgery were included in this study. The Cochrane “risk of bias” was used for the quality assessment. Moreover, some additional tests were performed to enhance the credibility of the results.

Results

Twenty-nine RCTs involving 1,885 patients were included in this frequentist network meta-analysis (NMA). These articles mainly were divided into two distinct groups, namely, the nerve block group and the non-nerve block group. Regarding the nerve block group, at postoperative 12 h, the intervention suprascapular nerve block + interscalene nerve block (SSNB + INB) was ranked first, whereas INB + intra-articular injection (INB + IAI) was ranked first at 24 h and 48 h postoperation. In the non-nerve block group, external application (EA) was ranked first at postoperative 12 h, but oral administration (OA) exhibited a better analgesic effect at postoperative 24 h and postoperative 48 h.

Conclusion

We conclude that the analgesic effect of SSNB+INB was the best at postoperative 12 h, and INB+IAI was the best at postoperative 24 h and 48 h in the nerve block group. For the non-nerve block group, the effect of EA was the best at postoperative 12 h, and the analgesic effect of OA at postoperative 24 h and 48 h was significantly better than any other interventions.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier: CRD42021286777.

[A qualitative systematic review and enlightenment of teaching models and evaluation in the general education of epidemiology in China and abroad]

Objective: This study aims to systematically sort out the effectiveness evaluation of the general education teaching models in epidemiology at home and abroad and provide a reference for the development and reform of epidemiology education. Methods: A systematic search of English databases such as PubMed, Embase, and Web of Science and Chinese databases such as CNKI, Sinomed, Wanfang, etc., were used to screen out the literature on different general teaching models of education in epidemiology. Each literature's teaching effect will be summarized and evaluated to conduct a systematic qualitative review in the narrative integration method, Results: A total of 45 articles (28 in Chinese and 17 in English) were included in this study, involving 14 teaching models, including mixed teaching models, PBL (problem-based learning), project designing models, and CBL (case-based learning) and other teaching models. Except for some teaching models such as project design, network platform, and flipped classroom model, the teaching effect of other innovative models is better than that of the traditional model. The distribution of teaching models was different in Chinese and foreign literature. Foreign teaching models were diverse, mainly concentrated in mixed teaching models and software/network platform learning. Domestic teaching models were relatively fixed. The mixed teaching model and PBL model were the most widely used in China, and there were fewer comparative studies between different teaching models than in foreign countries. Conclusion: General education in epidemiology is still in the early exploration stage. Compared with the traditional lecture model, the effect of various innovative teaching models has been improved. According to teaching objectives and student characteristics, we encourage extensive use of different teaching strategies, combining theoretical knowledge with practical applications and integrating epidemiological knowledge with inter-professional knowledge. Thus, students who can apply what they learn are becoming interdisciplinary talents our society needs.

[Effects of topical anesthesia with 1% tetracaine on hemodynamic responses in microlaryngosurgery]

Objective: To observe the effects of topical anesthesia with 1% tetracaine on hemodynamic responses in general anesthesia patients undergoing microlaryngosurgery. Methods: From October 2021 to December 2021, 92 patients (46 males and 46 females) in Beijing Tongren Hospital, with a median age [M (Q₁, Q₃)] of 51 (42, 57) years who scheduled for microlaryngosurgery under general anesthesia, were divided into two groups (n=46 in each group) using the random number table method. Group T received topical anesthesia with 1% tetracaine at the root of the tongue and epiglottis and glottis on the basis of general intravenous anesthesia induction, with 0.5 ml at each position, while the control group (group C) received equal volume of normal saline. Heart rate (HR) and mean arterial pressure (MAP) were recorded at the time of patients entering the operating room (baseline), after induction, after intubation, immediately after suspending laryngoscopy, 1 min after suspending laryngoscopy, 3 min after suspending laryngoscopy, 5 min after suspending laryngoscopy and immediately after extubation. The recovery profiles, including time to recover breathing, time to open eyes, time to extubation and adverse reactions were evaluated during recovery period. Results: The MAP of patients in group T at baseline, after induction, after intubation, immediately after suspending laryngoscopy, 1 min after suspending laryngoscopy, 3 min after suspending laryngoscopy, 5 min after suspending laryngoscopy and immediately after extubation were (99.4±12.9), (78.5±8.8), (79.2±10.2), (100.6±17.0), (101.9±14.7), (100.8±13.9), (97.4±12.1), (107.3±16.8) mmHg (1 mmH=0.133 kPa), respectively, while in group C were (99.5±11.6), (80.9±12.8), (90.5±16.0), (109.5±20.4), (108.0±18.9), (103.7±15.5), (100.1±13.3), (114.2±17.3) mmHg, respectively. The two critical time points of MAP after intubation and immediately suspending laryngoscopy in group C were significantly higher than group T (P<0.05).The HR of patients in group T at baseline, after induction, after intubation, immediately after suspending laryngoscopy, 1 min after suspending laryngoscopy, 3 min after suspending laryngoscopy, 5 min after suspending laryngoscopy and immediately after extubation was (71.3±10.6), (66.0±10.1), (69.5±11.4), (61.3±14.2), (69.8±9.8), (71.0±10.6), (70.6±11.0), (78.8±11.6) bmp, respectively, while in group C were (73.1±10.9), (67.8±9.9), (79.5±12.9), (57.1±18.1), (69.2±12.8), (71.4±11.7), (70.7±11.5), (85.3±13.0) bmp, respectively. The two critical time points of HR after intubation and after extubation in group C were significantly higher than that of group T (P<0.05). The time to recover breathing in the two groups was (11.8±3.5) min and (11.3±4.6) min, respectively. The time to open eyes was (12.0±3.3) min and (11.5±5.0) min, respectively. The time to extubation was (13.2±3.7) min and (12.6±4.9) min, respectively. There were no statistically significant difference in time to recovery between the two groups (P>0.05). Likewise, there were no toxic reactions to local anesthetics, respiratory depression, hypoxemia, laryngospasm and cough occurred in either group. Conclusion: Topical anesthesia with 1% tetracaine can effectively reduce the hemodynamic changes without influencing patient's recovery, and does not increase the incidence of adverse reactions.

AB1346 ULTRASOUND ASSESSMENT OF SUB-CLINICAL HAND JOINT INFLAMMATION: A COMPARATIVE STUDY BETWEEN EARLY RHEUMATOID AND PSORIATIC ARTHRITIS

Background

Ultrasound (US) detected subclinical inflammation can be present in early psoriatic arthritis (PsA) and rheumatoid arthritis (RA), and also in patients fulfilling clinical remission criteria[1-2]. Numerous evidences support that the persistence of subclinical synovitis detected by US is associated with a high risk of disease progression [2-3].

Objectives

To evaluate sub-clinical inflammation of PsA and RA at the level of small joints of the hand and wrist by B-mode and Power Doppler US.

Methods

30 patients of early PsA and 35 patients of early RA (no clinical evidence of hand joint involvement, PsA disease duration <2 years, and RA disease duration <1 year) were recruited. US [grey scale (GS) and power Doppler (PD)] was performed to assess synovitis, tenosynovitis, joint effusion, and bone erosion of bilateral wrists, metacarpophalangeal joints, proximal and distal interphalangeal joints, as well as the flexor tendons and extensor compartments.

Results

A total of 35 patients were included in the RA group, including 10 males and 25 females. A total of 30 patients were included in the PsA group, including 12 males and 18 females. There were no significant differences in gender composition, age, and duration of disease between the two groups (P>0.05) (Table 1). 19 (63.33%) PsA patients and 16 (45.71%) RA patients had sub-clinical hand joint synovitis. At the joint level, wrist joints were most commonly involved (23.08%), followed by MCP3 (15.38%) and DIP3 (13.46%) in PsA group. In RA group, wrist joints were most commonly involved (55.17%), followed by MCP3 (12.41%), and MCP2 (11.03%). Eight (26.67%) PsA patients and 16 (45.71%) RA patients were detected tenosynovitis. Tenosynovitis was most frequently presented at the extensor tendons in RA and at the flexor tendons in PsA patients (p<0.05). The two most commonly affected were the 4th and 1st extensor compartments in RA patients, and the flexor pollicis longus and flexor digitorum profundus in PsA patients. 81 (6.80%) joint recesses in the RA and 75 (7.35%) joint recesses in PsA were detected effusion. Joint effusion was most frequently detected at radiocarpal and midcarpal joints in RA (30.86%, 25.92%, respectively). Effusion in PsA was most commonly presented at the 3rd PIP joints (26.67%), followed by radiocarpal joints (24.00%). Bone erosions were uncommon, totally 2 (6.67%) PsA patients and 3 (8.57%) RA patients were detected bone erosions.

Table 1.

Demographic characteristics of RA and PsA patients

RA (n=35)PsA (n=30)PFemale, n(%)25 (71.43%)18 (60.00%)0.33Age, years, mean±SD53.20±14.5054.23±13.650.77Disease duration, years, mean±SD0.72±0.370.91±0.530.07

Conclusion

There are significant differences in the US findings of sub-clinical inflammation at the hand and wrist joints, such as the joint effusion and tenosynovitis, which may assist the identification between early RA and PsA. Simultaneously, it should be pointed out that there are some similarities in the joint involvement of sub-clinical synovitis between RA and PsA, physicians should take this into account in clinical work.

Figure 1.

Gray scale ultrasound sagittal view shows synovitis at the wrist joint in an RA patient (A) and at MCP3 in a PsA patient.

References

[1]Freeston JE, Coates LC, Nam JL, et al. Is there subclinical synovitis in early psoriatic arthritis? A clinical comparison with gray-scale and power Doppler ultrasound. Arthritis Care & Research, 2014,66:432-439.

[2]Kawashiri SY, Suzuki T, Nakashima Y, et al. Ultrasonographic examination of rheumatoid arthritis patients who are free of physical synovitis: power Doppler subclinical synovitis is associated with bone erosion. Rheumatology (Oxford), 2014,53:562-569.

[3]Vreju FA, Filippucci E, Gutierrez M, et al. Subclinical ultrasound synovitis in a particular joint is associated with ultrasound evidence of bone erosions in that same joint in rheumatoid patients in clinical remission. Clin Exp Rheumatol, 2016,34:673-678.

Acknowledgements

This work was supported by National Natural Science Foundation of China (No. 82071930).

Disclosure of Interests

None declared

POS1163 PHARMACOKINETICS OF PEGLOTICASE AND METHOTREXATE POLYGLUTAMATE(S) IN PATIENTS WITH UNCONTROLLED GOUT RECEIVING PEGLOTICASE AND CO-TREATMENT WITH METHOTREXATE

Background

In a prior open-label, single-arm trial in adults with uncontrolled gout (MIRROR open-label [OL] trial), methotrexate (MTX) co-treatment with pegloticase suggested improved efficacy of pegloticase by reducing its immunogenicity.1,2 The current randomized, controlled trial (MIRROR RCT) confirmed that pegloticase-MTX co-therapy markedly increased pegloticase response rate (response defined as serum uric acid <6 mg/dL during ≥80% of Month 6) compared to pegloticase-placebo (PBO) co-therapy (71.0% vs. 38.5%) with a decreased infusion reaction rate and no new safety signals reported.

Objectives

To evaluate systemic exposures of pegloticase and its immunogenicity in uncontrolled gout patients receiving pegloticase with and without MTX as part of the MIRROR RCT; and to determine exposure of methotrexate polyglutamate(s) (MTX-PGs) in uncontrolled gout patients through Month 6 of treatment.

Methods

In MIRROR RCT, MTX (15 mg/wk) or matching PBO was given orally 4 weeks prior to the first pegloticase dose and continued weekly, in combination with pegloticase 8 mg given intravenously every 2 weeks, over a 52-week treatment period. Pre-infusion blood samples were collected to measure MTX polyglutamates (MTX-PGs, including MTX-PG1-5) in red blood cells and pre- and post-infusion serum samples were obtained to measure trough (Cmin) and peak (Cmax) concentrations of pegloticase, respectively, at multiple visits. MTX-PG and pegloticase concentrations were summarized by visit and by treatment group. Pre-infusion serum samples for anti-polyethylene glycol (PEG) antibody (Ab) measurement were also collected at multiple pre-defined time points. Anti-PEG Ab incidence and titer were summarized by visit and by treatment group.

Results

Overall, higher Cmax and Cmin of pegloticase were observed in the pegloticase + MTX group than in the pegloticase + PBO group (Figure 1). At Week 14, median (first quartile [Q1], third quartile [Q3]) Cmin was 1.32 (0.73, 1.74) µg/mL and 0.63 (0.30, 1.28) µg/mL for the pegloticase + MTX and pegloticase + PBO groups, respectively. Median (Q1, Q3) Cmax was 3.01 (1.94, 3.94) µg/mL and 2.66 (1.45, 3.20) µg/mL for the pegloticase + MTX and pegloticase + PBO groups, respectively. Improved pegloticase response was associated with higher pegloticase concentrations. At Week 14, Cmin was below the quantitation limit (0.6 µg/mL) for 8 of 10 non-responders and 1.26 (0.72, 1.71) µg/mL for responders. MTX co-administration reduced the incidence of new anti-PEG antibody formation. The proportion of subjects with an increase from baseline in anti-PEG Ab titers or who were negative at baseline and developed an anti-PEG Ab response at ≥1 post-dose time point during pegloticase treatment was 29.5% and 51.0%, for the pegloticase + MTX and pegloticase + PBO groups, respectively. The pegloticase + MTX group had overall lower titer levels than those in the pegloticase + PBO group. Positive anti-PEG Ab status was associated with a lower pegloticase Cmin. Concentrations of MTX-PGs were maintained during the treatment course in the pegloticase + MTX group, suggesting compliance with MTX administration. There was no apparent difference in concentrations of MTX-PGs (including MTX-PG3, the predominant form of MTX-PGs4) between responders and non-responders. MTX-PG concentrations were in the same range as those reported for low-dose oral MTX use in patients with rheumatoid arthritis,3 suggesting no impact of pegloticase on MTX PK.

Conclusion

Pegloticase 8 mg IV every 2 weeks with MTX co-treatment (oral 15 mg weekly) reduced anti-PEG Ab incidence and resulted in higher pegloticase exposures compared to pegloticase administered with PBO, consistent with the increased clinical efficacy observed with pegloticase + MTX co-administration.

References

[1]Botson J, et al. J Rheumatol 2021;48:767-74

[2]Song Y, et al. Arthritis Rheum 2020;72(suppl 10)

[3]Dervieux T, et al. Ann Rheum Dis 2013;72:908-10

[4]Choi R. J Pharm Biomed Anal 2021;201:114124

Disclosure of Interests

Yan Xin Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Yang Song Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Michael E. Weinblatt Consultant of: Horizon Therapeutics, Jason Chamberlain Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Jennifer Zarzoso Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Katie Obermeyer Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Stephen Sainati Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Colleen Canavan Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Srini Ramanathan Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics

Mechanism of Self-Healing Hydrogels and Application in Tissue Engineering

Self-healing hydrogels and traditional hydrogels both have three-dimensional polymeric networks that are capable of absorbing and retaining a large amount of water. Self-healing hydrogels can heal and restore damage automatically, and they can avoid premature failure of hydrogels caused by mechanical damage after implantation. The formation mechanism of self-healing hydrogels and the factors that hydrogels can load are various. Researchers can design hydrogels to meet the needs of different tissues through the diversity of hydrogels Therefore, it is necessary to summarize different self-healing mechanisms and different factors to achieve different functions. Here, we briefly reviewed the hydrogels designed by researchers in recent years according to the self-healing mechanism of water coagulation. Then, the factors for different functions of self-healing hydrogels in different tissues were statistically analyzed. We hope our work can provide effective support for researchers in the design process of self-healing hydrogel.

Metagenomics insights into the profiles of antibiotic resistome in combined sewage overflows from reads to metagenome assembly genomes

Combined sewage overflows (CSOs) have become an important source of antibiotic resistance genes (ARGs) in the environment, while the distribution and dynamics of antibiotic resistome in the CSOs events have not been well understood. This study deciphered the profiles of antibiotic resitome in the CSOs based on metagenomics analysis from reads to metagenome assembly genomes (MAGs), and the dynamical changes of ARGs were clarified through continuous monitoring of the CSO event. Results showed that antibiotic inactivation was the dominant resistance mechanism, and sulfonamide, aminoglycoside along with multidrug resistance were the dominant antibiotic resistance types. It was speculated that the antibiotic resistome were generally determined by sewer sediment flushed out along with the CSOs not domestic sewage in the pipes. The host range and mobility of the antibiotic resistome were determined at contigs level, and the hosts mainly belonged to the Proteobacteria with the genus of Pseudomonas, Escherichia, Enterobacter and Aeromonas being dominant. The transposase (tnpA), IS91 and integrons were mobile genetic elements (MGEs) located together with ARGs, and a MAG carrying 32 ARGs and 140 VFGs was assembled. Although microbial community contributed most to the changes of antibiotic resistome in the CSOs directly, the risks caused by the MGEs should be paid more attention.

Advances in research on the effects of platelet activation in acute lung injury (Review)

Acute lung injury (ALI) is an acute hypoxic respiratory insufficiency or failure caused by various factors inside and outside the lungs. ALI is associated with high morbidity and a poor prognosis in hospitalized patients. The lungs serve as a reservoir for platelet precursor megakaryocytes and are closely associated with platelets. Platelets not only play a central role in hemostasis, coagulation and wound healing, but can also act as inflammatory cells capable of stimulating non-hemostatic immune functions under inflammatory conditions, participating in the progression of various inflammatory diseases, and can result in tissue damage. Therefore, it was speculated that platelets may play an important role in the pathogenesis of ALI. In this review, the latest research progress on secretion of bioactive mediators from platelets, platelet activation-related signaling pathways, and the direct contact reactions between platelets and neutrophils with endothelial cells that result in ALI are described, providing evidence to support the importance of the consideration of platelets in the search for ALI interventional targets.

Cochlear implantation in a Chinese patient with a novel frameshift variant in POU3F4 gene and incomplete partition type III: a case report

Variations in the POU Class 3 Homeobox 4 ( POU3F4) gene are associated with X-linked mixed deafness. Here, the identification of a novel variant of POU3F4 in a male paediatric patient (the proband) with incomplete partition type III (IP-III) hearing impairment, is described. Clinical data were collected from the proband and his biological parents. Whole exome sequencing of the proband revealed a novel frameshift insertion mutation in POU3F4 (c.717_718ins GTGCCTTGCAG : p.Leu240Valfs*5) in a hemizygous state. This variant likely truncates the protein within the POU-specific domain, and the proband’s biological mother was found to be a carrier of this variant. After excluding all contraindications, the proband underwent cochlear implantation in the right ear in June 2020. Cerebrospinal fluid (CSF) gushing was observed during surgery, but there were no postoperative complications, such as CSF leak, meningitis, or facial nerve stimulation. A novel pathogenic frameshift variant of POU3F4 was identified, enriching the known mutation spectrum of POU3F4. Effective perioperative prevention and response measures should be taken to reduce the incidence of CSF gushing and meningitis in patients receiving IP-III cochlear implantation.

Improving the efficiency of anaerobic digestion of Molasses alcohol wastewater using Cassava alcohol wastewater as a mixed feedstock

Cassava alcohol wastewater (CAW) was utilized as a mixed feedstock to explore whether the addition of CAW could improve the anaerobic digestion of Molasses alcohol wastewater (MAW). The result showed that the rate of removal of the soluble chemical oxygen demand in the M treatment mixed with CAW was 70.13 ± 0.16%, which was significantly higher than that of the C treatment (only MAW), which was 61.23 ± 0.36%. Co-digestion in the M treatment resulted in higher methane production, achieving 23.89% increase in methane yield compared to C treatment. The addition of CAW helps to alleviate the accumulation of volatile fatty acids (397.06 ± 141.82 mg·L^-1), enhance the stability of system and promote the establishment of stable and active microbial communities. Microbial community structure analysis indicated that hydrolytic bacteria such as Bacteroidetes, Firmicutes, and Proteobacteria, and acetoclastic methanogens, including Methanosaeta and Methanosarcina were more abundant in the co-digests.

Docking protein 1 and free fatty acids are associated with insulin resistance in patients with type 2 diabetes mellitus

OBJECTIVE

Insulin resistance (IR) is a key defect in type 2 diabetes mellitus (T2DM); therefore, effective means of ameliorating IR are sought.

METHODS

We performed a retrospective cohort study of 154 patients with T2DM and 39 with pre-diabetes (pre-DM). The effects of IR and a high concentration of FFA on gene expression were determined using microarray analysis and quantitative reverse transcription polymerase chain reaction (RT-qPCR) in patients with T2DM or pre-DM.

RESULTS

Serum FFA concentration and homeostasis model assessment of IR (HOMA-IR) were significantly higher in patients with T2DM but no obesity and in those with pre-DM than in controls. HOMA-IR was significantly associated with T2DM. RT-qPCR showed that the expression of FBJ murine osteosarcoma viral oncogene homolog (FOS) and AE binding protein 1 (AEBP1) was much lower in the circulation of participants with obesity and diabetes. RT-qPCR showed that the expression of docking protein 1 (DOK1) was significantly lower in the blood of participants with diabetes but no obesity and in those with pre-DM than in controls.

CONCLUSIONS

FFA and DOK1 are associated with IR in patients with T2DM but no obesity or pre-DM. The downregulation of DOK1 might inhibit lipid synthesis and induce lipolysis, inducing or worsening IR.

[Research Progress on Touch DNA on Cartridge Cases in Forensic Field]

Abstract

Cartridge cases are crucial physical evidence in gun-related crimes. The successful identification of the touch DNA on cartridge cases can help to screen the suspects and reconstruct the gun-related crime scene. With the improvement of DNA extraction methods and the sensitivity of amplification kit, forensic examiners are expected to obtain more valuable information by testing the touch DNA on cartridge cases. In practical cases, the touch DNA detection on cartridge cases often encounters with low DNA content degradation, mixing and the gunshot residual interference, which brings more challenges to DNA examination and identification. This article reviews forensic research of touch DNA on the cartridge cases from the aspects of factors affecting touch DNA on cartridge cases, advances in the extraction and amplification methods, and the practical applications in order to provide reference for forensic identification of touch DNA on the cartridge cases in real cases.

[Cochlear implantation in a patient with Noonan syndrome caused by a variant in PTPN11: a case report]

Noonan syndrome is a multisystem disease with widespread heterogeneity regarding the genetic and clinical characteristics, which can be accompanied by distinctive facial dysmorphism, congenital heart defects, short stature, cryptorchidism, lymphatic malformations, bleeding disorders and skeletal malformations. Some patients have hearing impairment. Noonan syndrome is a rare cause of sensorineural hearing loss. The study describes a Noonan syndrome patient with profound bilateral hearing loss. He received a cochlear implantation successfully. The patient had clinical characteristics of Noonan syndrome, and the diagnosis was confirmed by the detection of pathogenic variants in PTPN11 by whole exome sequencing. According to the authors' knowledge, this is the first report regarding cochlear implantation in a Noonan syndrome patient in China.

WITHDRAWN: Urban citizen health risk assessment for epidemic pneumonia and research on innovation on economic development

Ahead of Print article withdrawn by publisher.

Coating matching recommendation based on improved fuzzy comprehensive evaluation and collaborative filtering algorithm

Coating matching design is one of the important parts of ship coating process design. The selection of coating matching is influenced by various factors such as marine corrosive environment, anti-corrosion period and working conditions. There are also differences in the coating performance requirements for different ship types and different coating parts. At present, the design of coating matching in shipyards depends on the experience of technologist, which is not conducive to the scientific management of ship painting process and the macro control of ship construction cost. Therefore, this paper proposes a hybrid algorithm of fuzzy comprehensive evaluation and collaborative filtering based on user label improvement (IFCE-CF). Based on the analytic hierarchy process (AHP), the evaluation index system of coating matching is constructed, and the weight calculation process of fuzzy comprehensive evaluation is optimized by introducing the user label weight. The collaborative filtering algorithm based on matrix decomposition is used to realize the accurate recommendation of coating matching. Historical coating process data of a shipyard between 2010 and 2020 are selected to verify the recommendation ability of the method in the paper. The results show that using the coating matching intelligent recommendation algorithm proposed in this paper, the root mean square error is < 1.02 and the mean absolute error is < 0.75, the prediction accuracy is significantly better than other research methods, which proves the effectiveness of the method.

Comparative Study on Temperature Response of Hydropower Development in the Dry-Hot Valley

Due to the specific hydrothermal conditions of dry-hot valleys, temperature changes caused by the development of large-scale hydropower projects may be more extreme than they are in other regions. In this study, we analyzed these temperature changes at four hydropower stations in both dry-hot and non-dry-hot valleys. Based on the calculated relative temperatures of the downstream river and the areas surrounding the reservoirs, we employed two indices to quantify the influence of the reservoirs on the temperatures of these two regions: the downstream river temperature change and the reservoir effect change intensity. Our results are as follows: (a) In the downstream rivers, the temperature regulation effect was more pronounced in the wet season; in the regions surrounding the reservoirs, the temperature regulation effect was more pronounced in the dry season. (b) The downstream river temperature in both the dry-hot and wet-hot valleys exhibited noticeable warming in both the wet and dry seasons, while the cold-dry valley was characterized by cooling in the dry season and warming in the wet season. With the exception of the Liyuan station (where the influence of the reservoir on the downstream temperatures only extended to a distance of 9 km from the dam) during the dry season, the existence of the hydropower stations affected the temperatures of the entire downstream region. (c) For the areas surrounding the reservoir, the presence of a hydropower station mainly caused the temperatures in the dry-hot valleys to rise and the temperatures in the non-dry-hot valleys to decrease.

Thiamethoxam induces nonalcoholic fatty liver disease in mice via methionine metabolism disturb via nicotinamide N-methyltransferase overexpression

Thiamethoxam (TMX) is one of the major compounds of neonicotinoids, the most widely used class of insecticides worldwide. Previously, TMX was considered a non-toxic neonicotinoid insecticide to mammals. However, the genotoxicity, cytotoxicity, and hepatotoxicity of TMX in mammals were recently reported. Thus far, the effects of TMX on the mouse liver and its detailed mechanism remain unclear. NNMT, strongly expressed in the liver, plays a critical role in body energy expenditure. To confirm the potential pathogenesis of liver dysfunction induced by TMX, ICR mice were exposed to TMX at a dose of 4 mg/kg and 20 mg/kg by gavage administration for 12 weeks. The data showed that chronic TMX exposure caused dyslipidemia and nonalcoholic fatty liver disease (NAFLD) in mice. Moreover, aggravated oxidative stress, dysfunction, and disorganized structure were also observed in TMX-treated mouse livers. In addition, increases of PPARγ, fatty acid synthase, and NNMT expression, as well as decreases of PPARα and GNMT expression, S-adenosylmethionine deficiency, and methionine metabolism disorder were also observed in TMX-treated mouse livers. These results suggest that chronic TMX exposure induces dyslipidemia and NAFLD in mice. Moreover, inhibition of NNMT in hepatocytes significantly reversed the effects of TMX. The molecular mechanism of TMX-induced NAFLD is mostly through NNMT-mediated methionine metabolism and methyl donor balance, which ultimately regulates PPARα signaling pathway. Inhibition of NNMT could be a potentially novel strategy for blocking the progression of NAFLD induced by TMX.

POS1136 PHARMACOKINETICS OF PEGLOTICASE AND METHOTREXATE POLYGLUTAMATE(S) IN PATIENTS WITH UNCONTROLLED GOUT RECEIVING PEGLOTICASE AND CO-TREATMENT OF METHOTREXATE

Background:

In an open-label, single-arm trial in adult patients with uncontrolled gout (MIRROR open-label [OL] trial) evaluating pegloticase co-treatment with methotrexate (MTX); 78.6% patients were responders, defined as maintenance of serum uric acid <6 mg/dL for at least 80% of the time during month 6 [weeks 20, 22, and 24]. In comparison, 42% patients achieved a response during month 3 and 6 in historical Phase 3 monotherapy trials of pegloticase (C0405 and C0406)1. MTX co-treatment is shown to improve the pharmacokinetics (PK) of biologics by attenuating the formation of anti-drug antibodies2.

Objectives:

To determine the systemic exposures of pegloticase and methotrexate polyglutamate(s) (MTX-PGs) in uncontrolled gout patients receiving pegloticase and MTX; to evaluate the effect of MTX on the PK of pegloticase in comparison to historical pegloticase monotherapy trials (C0405 and C0406)3, 4; and to evaluate the immunogenicity of pegloticase in co-treatment with MTX.

Methods:

In the MIRROR OL trial, MTX (15 mg/week) was given orally 4 weeks prior to the first pegloticase dose and continued weekly, in combination with pegloticase 8 mg given intravenously every 2 weeks, for a treatment duration of up to 52 weeks. Pre-infusion samples were collected to measure MTX-PGs in red blood cells. Pre- and post-infusion blood samples were obtained to measure the peak (Cmax) and trough (Cmin) concentrations of pegloticase at multiple visits. Anti-drug antibody blood samples were collected at multiple visits. The impact of MTX on pegloticase PK was evaluated by comparing pegloticase exposures with MTX from this trial to historical monotherapy data (C0405 and C0406)3, 4. The observed pegloticase concentrations with MTX were also overlaid with the 90% prediction interval based on the population PK model5 from C0405 and C0406.

Results:

Pegloticase and MTX-PG levels were determined in 14 patients. The 11 responders were generally associated with higher pegloticase exposures than the non-responders, especially Cmin (Figure 1). Concomitant treatment of MTX resulted in fewer patients with Cmin below quantitation limit (BQL) (5/14 [36%] with MTX vs 63/82 [77%] without MTX), and higher overall Cmin (median: 1.03 µg/ml with MTX vs BQL without MTX); Cmax was slightly higher (median [Q1, Q3]: 2.11 [1.65, 2.59] µg/mL with MTX vs 1.51 [BQL, 2.48] µg/mL without MTX). Pegloticase co-treatment with MTX resulted in more concentrations above the predicted median value of pegloticase, compared to monotherapy. ADA data is consistent with pegloticase PK and efficacy. Significant increase in ADA titers were only observed in 2 subjects (both were non-responders) at time corresponding to the loss of pegloticase exposure and increases in sUA levels. Concentrations of MTX-PGs were maintained during the treatment course, suggesting compliance of MTX administration. There was no apparent difference in concentrations of MTX-PGs between responders and non-responders.

Conclusion:

Pegloticase 8 mg IV every 2 weeks co-treatment with MTX 15 mg weekly resulted in fewer patients with pegloticase Cmin below the quantification limit (BQL) and gave higher overall trough concentrations (Cmin) compared to pegloticase monotherapy in the phase 3 studies.

Pegloticase 8 mg IV every 2 weeks co-treatment with MTX 15 mg weekly was associated with an improved response rate for pegloticase in association with improved drug levels in these patients with uncontrolled gout compared to pegloticase monotherapy in the phase 3 studies.

References:

[1]Botson J., et al. J Rheumatol. 2020; doi: 10.3899/jrheum.200460

[2]Goss S. L., et al. Clin Ther;2018, 40 (2).

[3]Lipsky P. E., et al. Arthritis Res Ther;2014, 16 (2).

[4]Sundy J. S., et al. JAMA;2011, 306 (7).

[5]Yue C. S., et al. ASCPT, Atlanta, 2010.

Disclosure of Interests:

Yang Song Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc, Yan Xin Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc, Michael E. Weinblatt Shareholder of: Canfite, Inmedix, Lycera, Vorso, Scipher, Grant/research support from: Crescendo Bioscience, Bristol Myers Squibb, Sanofi, Eli Lilly, Amgen, Jason Chamberlain Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc, Katie Obermeyer Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc, Lin Zhao Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc, Colleen Canavan Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc, Paul M. Peloso Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc, Srini Ramanathan Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc.

POS1062 ULTRASOUND ASSESSMENT OF SUB-CLINICAL HAND JOINT SYNOVITIS: A COMPARATIVE STUDY BETWEEN PSORIATIC AND RHEUMATOID ARTHRITIS

Background:

Ultrasound (US) detected subclinical synovitis can be present in early psoriatic arthritis (PsA) and rheumatoid arthritis (RA), and also in patients fulfilling clinical remission criteria[1-2]. Numerous evidences support that the persistence of subclinical synovitis detected by US is associated with a high risk of disease progression [2-3].

Objectives:

To evaluate sub-clinical synovitis of PsA and RA at the level of small joints of the hand and wrist by B-mode and Power Doppler US.

Methods:

21 patients of early PsA and 25 patients of early RA (no clinical evidence of hand joint involvement, PsA disease duration <2 years, and RA disease duration <1 year) were recruited. DAS28 and DAPSA score used for assessment of articular disease activity for RA and PsA, respectively. US [grey scale (GS) and power Doppler (PD)] was performed to assess synovitis of bilateral wrists, metacarpophalangeal joints, proximal and distal interphalangeal joints, altogether 30 joints. A GS score ≥2 and/or a PD score ≥1 were used to identify US detected synovitis.

Results:

A total of 25 patients were included in the RA group, including 5 males and 20 females. A total of 21 patients were included in the PsA group, including 7 males and 14 females. There were no significant differences in gender composition, age, and duration of disease between the two groups (P>0.05) (Table 1). 14 (66.67%) PsA patients and 12 (48%) RA patients had sub-clinical hand joint synovitis. Among 630 hand joints scanned in PsA group, 49 (7.78%) joints showed evidence of sub-clinical synovitis. Wrist joint was most commonly involved (24.49%), followed by MCP3 (14.29%), MCP1 (12.24%) and DIP3 (10.20%). Among 750 hand joints scanned in RA group, 110 (14.67%) joints showed evidence of sub-clinical synovitis. Wrist joint was most commonly involved (60.00%), followed by MCP3 (8.24%), MCP1 (8.24%) and MCP2 (7.06%). No correlation noted between numbers of joints with subclinical synovitis with DAPSA and DAS28 score. There was no correlation between number of joints with sub-clinical synovitis and disease activity indices.

Conclusion:

Almost two-thirds patients with PsA and half patients with RA had US evidence of sub-clinical synovitis in wrist and hand joints, most commonly in wrist. There are some similarities in the joint involvement of sub-clinical synovitis between RA and PsA, physicians should take this into account in clinical work.

Table 1.

Demographic characteristics of RA and PsA patients

RA (n=25)PsA (n=21)PFemale, n(%)20 (80.00%)14 (66.67%)0.305Age, years, mean±SD56.32±12.1854.31±15.820.637Disease duration, years, mean±SD1.06±0.590.90±0.580.363

References:

[1]Freeston JE, Coates LC, Nam JL, Moverley AR, Hensor EM, Wakefield RJ, et al. Is there subclinical synovitis in early psoriatic arthritis? A clinical comparison with gray-scale and power Doppler ultrasound. Arthritis care & research 2014, 66:432-439.

[2]Kawashiri SY, Suzuki T, Nakashima Y, Horai Y, Okada A, Iwamoto N, et al. Ultrasonographic examination of rheumatoid arthritis patients who are free of physical synovitis: Power doppler subclinical synovitis is associated with bone erosion. Rheumatology (Oxford), 2014, 53:562-569.

[3]Vreju FA, Filippucci E, Gutierrez M, Di Geso L, Ciapetti A, Ciurea ME, et al. Subclinical ultrasound synovitis in a particular joint is associated with ultrasound evidence of bone erosions in that same joint in rheumatoid patients in clinical remission. Clinical and experimental rheumatology, 2016, 34:673-678.

Acknowledgements:

This work was supported by National Natural Science Foundation of China (No. 82071930 and 81571684).

Disclosure of Interests:

None declared.

Expression of lncRNA TUG1 in hypertensive patients and its relationship with change state of an illness

OBJECTIVE

To investigate the expression of LncRNA TUG1 in hypertensive patients and its relationship with the change state of illness.

PATIENTS AND METHODS

A prospective analysis was carried out. Eighty-two patients with hypertension admitted to our hospital from March 2016 to February 2019 were regarded as a research group, and 79 healthy people admitted to our hospital during the same period were regarded as a control group. The serum LncRNA TUG1, platelet activating factor (PAF), endothelin-1 (ET-1), serum tumor necrosis factor-α (TNF-α), high sensitive C-reactive protein (hsCRP), and the relationship between the expression of LncRNA TUG1 and the clinicopathological characteristics of patients with hypertension in the two groups were detected, and finally, the risk factors of hypertension were analyzed.

RESULTS

The expression levels of LncRNA TUG1, PAF, ET-1, TNF-α, and hsCRP in the serum of patients in research group were significantly higher than those in control group (p<0.05). LncRNA TUG1 has a positive correlation with the severity of an illness of hypertensive patients (r=0.881, p<0.001), and also has a positive correlation with the expression levels of PAF, ET-1, TNF-α, and hsCRP (r=0.735, p<0.001; r=0.756, p<0.001; r=0.712, p<0.05; r=0.723, p<0.05). The expression of LncRNA TUG1 in the serum of patients with hypertension was related to hypertension mode, severity of disease, hyperlipidemia, and obesity (p<0.05). Obesity (OR: 3.469, 95% CI: 2.175-4.095), drinking (OR: 3.677, 95% CI: 1.695-4.892), hyperlipidemia (OR: 3.374, 95% CI: 1.759-6.988), and the high expression of TUG1 (OR: 2.693, 95% CI: 1.679-7.472) are independent risk factors for the attack of hypertension.

CONCLUSIONS

LncRNA TUG1 is highly expressed in the serum of hypertensive patients and it is closely related to the progression of hypertension. Also, it may be one of the independent risk factors for hypertension and a new molecular target for hypertension treatment.

[The study of the protection function of the sphingosine kinase 1 in the nerve cell damage caused by acrylamide]

Objective: To study the protective effect and effect of SphK1 overexpression on the injury of nerve cells induced by acrylamide. Methods: ACR with 99% purity was prepared into 1.25 mmol/L and 2.5 mmol/L solutions. SH-SY5Y cells were divided into control group (NC group) , experimental group and SphK1 activator group. The experimental group was given ACR solution with final concentration of 1.25 mmol/L and 2.5 mmol/L respectively for 24 h. In the SphK1 activator group, on the basis of the exposure concentration of the experimental group, the SphK1 specific activator (12-) phorbol tetradecanoate (-13-) acetate (PMA) solution[prepared by dimethyl sulfoxide (DMSO) , the final concentration was 100 nmol/l], and other treatments were the same as the experimental group. Control group (NC group) added PMA solution into normal cells. Western blot was used to detect the expression of SphK1 protein; CCK-8 was used to detect the proliferation of SH-SY5Y cells; hoechst33342 method was used to observe the morphological changes of nerve cells; flow cytometry was used to analyze the apoptosis of cells. Results: Compared with NC group, the expression of SphK1 protein in the experimental group and the SphK1 activator group was significantly lower (P<0.05) . Compared with the experimental group, the expression of SphK1 protein in each concentration of SphK1 activator group was increased, and the difference was statistically significant (P<0.05) . In addition to 1.25 mmol/L SphK1 activator group, compared with NC group, the relative growth survival rate of experimental group and 2.5 mmol/L SphK1 activator group were lower, the difference was statistically significant (P<0.05) . Compared with the experimental group, the relative survival rate of cells in the SphK1 activator group was higher, and the difference was statistically significant (P<0.05) . With the increase of exposure concentration, the cells in the experimental group showed the morphological characteristics of early apoptosis at ACR 1.25 mmol/L and late apoptosis at ACR 2.5 mmol/L. Compared with NC group, the apoptosis rate of experimental group and SphK1 activator group at ACR 2.5 mmol/L was significantly different (P<0.05) ; compared with experimental group, the apoptosis rate of SphK1 activator group at ACR 2.5 mmol/L was lower, the difference was statistically significant (P<0.05) . Conclusion: The SphK1 excessive expression plays the protective function to the nerve cell damage caused by acrylamide.

Mental Health of Parents and Preschool-Aged Children During the COVID-19 Pandemic: The Mediating Role of Harsh Parenting and Child Sleep Disturbances

In the context of the coronavirus disease-2019 (COVID-19) pandemic, mental health problems of parents and children have become a public issue. Herein, we explored the association between parental well-being index and child mental health problems during the pandemic and the mediating role of harsh parenting and child sleep disturbances. An online survey was conducted among 16,398 parents of children aged 3-6 years (48.1% girls, M_age = 4.69 years, SD_age = 0.75 years) from March 15 to 29, 2020. Child mental health (Strengths and Difficulties Questionnaire, SDQ), sleep problems (Children's Sleep Habits Questionnaire, CSHQ), and parental well-being index (World Health Organization-Five Well-Being Index, WHO-5), and harsh parenting were reported by parents. The results revealed that a higher parental well-being index was associated with lower child mental health problems. Harsh parenting and child sleep problems were significant mediators within the association. This study indicates the association between parental well-being index and child mental health during the pandemic and underlying mechanism, and has important implications for reducing parental and child mental health problems.

Effects of early nutritional intervention on oral mucositis in patients with radiotherapy for head and neck cancer

BACKGROUND

To observe the effect of early nutritional intervention on radiation-induced oral mucositis and nutritional status in patients with head and neck cancer (HNC).

METHODS

A total of 54 HNC patients were divided into early (28 cases) and late (26 cases) nutritional intervention groups. The early group received enteral nutrition at the beginning of radiotherapy (RT), while the late group received enteral nutrition after restricted feeding. Operators reported and assessed the timing and extent of oral mucositis and nutritional status during treatment. The nutritional status assessment indicators included body weight; body mass index (BMI); Patient-Generated-Subjective Global Assessment (PG-SGA) score; levels of albumin, hemoglobin and pre-albumin and total lymphocyte count.

RESULTS

The incidence of high-grade oral mucositis was significantly lower in the early group than that in the late group (P < 0.05). Nutritional status assessments showed more significant weight and BMI losses in the late group than in the early group at weeks 4 and 7 after RT (P < 0.01). The albumin decreased in the late group at week 7 after RT was more significant than that in the early group (P < 0.05). Albumin, hemoglobin and pre-albumin levels and total lymphocyte count decreased significantly in both groups (P > 0.05). During therapy, more patients in the early group were well-nourished and fewer were malnourished according to PG-SGA scores (P < 0.05).

CONCLUSION

Early nutritional intervention can reduce the incidence of high-grade oral mucositis during RT in patients with HNC and improve the nutritional status during treatment, which has important clinical significance.

Development and validation of a nomogram to predict the risk of occult cervical lymph node metastases in cN0 squamous cell carcinoma of the tongue

We have explored the relations between clinicopathological features and cervical lymph node metastases (LNM) in patients with cN0 squamous cell carcinoma (SCC) of the tongue, and developed and validated a nomogram for predicting the risk of their development. Clinical data on 230 patients with cN0 SCC of the tongue who had had primary extended excision and lymph node dissection of the neck were collected retrospectively. They were divided into a development cohort and a validation cohort in a 4:1 ratio. Logistic regression analysis was used to assess the risk factors of cervical LNM in patients in the development cohort, and a nomogram was established to predict the risk of such nodes. In the validation cohort, the predictive performance and compliance of the model were evaluated using the consistency index (C-index) and calibration curve, and the clinical value was evaluated by decision curve analysis. Of the 230 patients, 60 had cervical LNM, of which 60 were invaded (26%). Analysis of the development cohort showed that the site of the primary lesion, depth of invasion, size of the tumour, and histopathological grade were included in the prediction model, which was validated in the validation cohort. Consistency was high (C-index=0.846), calibration good, and it was clinically valuable. The nomogram could be used to predict the probability of occult cervical LNM before operation in patients with stage cN0 SCC of the tongue. It could also be used as a reference tool for dissection of cervical nodes and a communication tool between the doctor and the patient.