Experience of the Eliava Institute in bacteriophage therapy

The rapid propagation of multidrug resistant bacterial strains is leading to renewed interest in bacteriophage therapy.With challenges in the treatment of bacterial infections,it is essential for people worldwide to understand how alternative approaches,such as bacteriophages,could be used to combat antibiotic resistant bacteria.The Eliava Institute

Piezotronic neuromorphic devices:principle,manufacture,and applications

With the arrival of the era of artificial intelligence(AI)and big data,the explosive growth of data has raised higher demands on computer hardware and systems.Neuromorphic techniques inspired by biological nervous systems are expected to be one of the approaches to breaking the von Neumann bottleneck.Piezotronic neuromorphic devices modulate electrical transport characteristics by piezopotential and directly associate external mechanical motion with electrical output signals in an active manner,with the capability to sense/store/process information of external stimuli.In this review,we have presented the piezotronic neuromorphic devices(which are classified into strain-gated piezotronic transistors and piezoelectric nanogenerator-gated field effect transistors based on device structure)and discussed their operating mechanisms and related manufacture techniques.Secondly,we summarized the research progress of piezotronic neuromorphic devices in recent years and provided a detailed discussion on multifunctional applications,including bionic sensing,information storage,logic computing,and electrical/optical artificial synapses.Finally,in the context of future development,challenges,and perspectives,we have discussed how to modulate novel neuromorphic devices with piezotronic effects more effectively.It is believed that the piezotronic neuromorphic devices have great potential for the next generation of interactive sensation/memory/computation to facilitate the development of the Internet of Things,AI,biomedical engineering,etc.

混合方法研究评价工具的介绍--MMAT

混合方法研究(MMR)作为第三种研究范式,是指将定量和定性研究混合或结合到一个单一的研究中。近年来,MMR在医疗领域的应用已成为一种趋势。与单独使用定性或定量研究相比,MMR可以用来说明某一特定现象的不同方面或从不同的角度阐明问题,获得各种不同类型的信息。而MMR系统综述(MMSR)也被研究者青睐,因为通过MMSR可以综合与特定主题相关的大量信息,并产生指导决策的证据。严格评价工具使MMSR研究人员能够评估所纳入原始研究的可信度和相关性。混合方法评价工具(MMAT)为MMSR严格评价阶段的一种工具,可以对定性研究、随机对照试验、非随机研究、定量描述研究和MMR 5类研究的方法学质量进行评价。针对每个纳入的研究,在回答两个筛选问题后,选择适当的研究类别进行评估,然后依照所选类别的标准进行评分。本文全面介绍新版MMAT,以进一步规范和完善MMR和MMSR在我国的应用。

Prevalence of Atrial Fibrillation in China and Its Risk Factors

Objective To study the prevalence of atrial fibrillation （AF） and the relation with its risk factors in China. Methods A total of 19 363 participants （8635 males and 10 728 females） aged 〉35 years in geographically dispersed urban and rural regions of China were included in this cross-sectional survey. All participants received questionnaire, physical and blood examination. Echocardiography were performed for AF patients found in the survey. Results Of the 19 363 participants, 199 were diagnosed with AF. The estimated age-standardized prevalence of AF was 0.78% in men and 0.76% in women. The prevalence of AF in participants aged 〈60 years was 0.41% in men and 0.43% in women, and was 1.83% in both men and women aged 〉_60 years. About 19.0% of males and 30.9% of females with AF were diagnosed with valve disease. Age- and sex-adjusted multivariable logistic regression analysis revealed that myocardial infarction, left ventricular hypertrophy （LVH）, obesity, and alcohol consumption were associated with a increased risk of AF（P〈0.05）. Conclusion The age standardized prevalence of AF is 0.77% in the participants enrolled in the present study. The number of AF cases aged 〉35 years is 5.26 million according to 2010 Chinese Census. Most risk factors for AF, identified mainly in Western countries, are also detected in China.

Thyroid Nodules in Type 2 Diabetes Mellitus

The present analysis aims to investigate the prevalence of thyroid nodules in type 2 diabetes mellitus (T2DM) population.We searched PubMed,EMBASE,and Web of Science from inception to the March 1,2018.The studies were selected to estimate the prevalence of thyroid nodules in T2DM subjects and to compare the prevalence of thyroid nodules in different glucose tolerance status.The random effects model was used,and the outcome was presented as a pooled prevalence proportion with 95% confidence interval (95% CI) or a summary odds ratio (OR) with 95% CI.In the end,9 studies met the inclusion criteria and were included in the analysis.The pooled prevalence of thyroid nodules was 60%(95% CI:0.52,0.68) for T2DM 2 diabetes patients,50%(95% CI:0.4& 0.51) for pre-diabetes,and 43%(95% CI:0.34,0.52) for normal glucose tolerance population.Compared with patients without diabetes,diabetes subjects are more likely to develop thyroid nodules,adjusted OR for thyroid nodule was 1.78 (95% CI:1.25,2.55).Insulin resistance might be involved in thyroid nodule development.

Incidence and mortality of oral and oropharyngeal cancer in China, 2015

Objective: To report the incidence and mortality rates of oral and oropharyngeal cancer in Chinese population.Methods: Data were taken from a population-based cancer registry collected by the National Central Cancer Registry of China(NCCRC) in 2015. The data collected from 501 local cancer registries in China were assessed using NCCRC screening methods and criteria. Incidence and mortality rates of oral and oropharyngeal cancer were stratified by age group, gender, and area. Age-standardized incidence and mortality rates were adjusted using the Chinese standard population in 2000 and Segi’s world population.Results: In 2015, it was estimated that there were 51,765 oral and oropharyngeal cancer incident cases and 23,830 deaths in China. The crude incidence rate of oral and oropharyngeal cancer was 3.77/100,000, and the agestandardized incidence rate by Chinese standard population and by Segi’s world standard population were 2.55/100,000 and 2.49/100,000, respectively. The crude mortality rate and the age-standardized mortality rates by Chinese standard population and by Segi’s world standard population were 1.73/100,000, 1.09/100,000 and1.08/100,000, respectively. Both incidence and mortality rates of oral and oropharyngeal cancer were higher in males and in urban areas. Residents in eastern areas had the highest incidence and mortality rates, followed by those from middle areas and western areas. The rates of oral and oropharyngeal cancer increased greatly with age,especially after the age of 40 years.Conclusions: This study reports the latest incidence and mortality rates of oral and oropharyngeal cancer in China. Prevention intervention including early detection, treatment, and regular follow-ups is encouraged to be set up to reduce incidence and mortality rates of oral and oropharyngeal cancer in the future.

Catheter ablation for atrial fibrillation is associated with reduced risk of mortality in the elderly:a prospective cohort study and propensity score analysis

Background It is unclear whether catheter ablation(CA)for atrial fibrillation(AF)affects the long-term prognosis in the elderly.This study aims to evaluate the relationship between CA and long-term outcomes in elderly patients with AF.Methods Patients more than 75 years old with non-valvular AF were prospectively enrolled between August 2011 and December 2017 in the Chinese Atrial Fibrillation Registry Study.Participants who underwent CA at baseline were propensity score matched(1:1)with those who did not receive CA.The outcome events included all-cause mortality,cardiovascular mortality,stroke/transient ischemic attack(TIA),and cardiovascular hospitalization.Results Overall,this cohort included 571 ablated patients and 571 non-ablated patients with similar characteristics on 18 dimensions.During a mean follow-up of 39.75±19.98 months(minimum six months),24 patients died in the ablation group,compared with 60 deaths in the non-ablation group[hazard ratio(HR)=0.49,95%confidence interval(CI):0.30-0.79,P=0.0024].Besides,6 ablated and 29 non-ablated subjects died of cardiovascular disease(HR=0.25,95%CI:0.11-0.61,P=0.0022).A total of 27 ablated and 40 non-ablated patients suffered stroke/TIA(HR=0.79,95%CI:0.48-1.28,P=0.3431).In addition,140 ablated and 194 non-ablated participants suffered cardiovascular hospitalization(HR=0.84,95%CI:0.67-1.04,P=0.1084).Subgroup analyses according to gender,type of AF,time since onset of AF,and anticoagulants exposure in initiation did not show significant heterogeneity.Conclusions In elderly patients with AF,CA may be associated with a lower incidence of all-cause and cardiovascular mortality.

Geographic Variations in the Prevalence,Awareness,Treatment,and Control of Dyslipidemia among Chinese Adults in 2018–2019:A Cross-sectional Study

Objective To investigate the spatial patterns of the prevalence,awareness,treatment,and control rates of dyslipidemia at the provincial level in China.Methods A national and provincial representative cross-sectional survey was conducted among 178,558 Chinese adults in 31 provinces in China's Mainland in 2018–2019,using a multi-stage,stratified,cluster-randomized sampling design.Subjects,as households,were selected,followed by a home visit to collect information.Both descriptive and linear regression procedures were applied in the analyses.Results The overall prevalence of dyslipidemia was 35.6%,and wide geographic variations of prevalence,treatment,and control rates of dyslipidemia were identified among 178,558 eligible participants with a mean age of 55.1±13.8 years.The highest-lowest difference regarding the provincial level prevalence rates were 19.7%vs.2.1%for high low-density lipoprotein cholesterol,16.7%vs.2.5%for high total cholesterol,35.9%vs.5.4%for high triglycerides,and 31.4%vs.10.5%for low high-density lipoprotein cholesterol.The treatment rate of dyslipidemia was correlated with the socio-demographic index(P<0.001),urbanization rate(P=0.01),and affordable basic technologies and essential medicines(P<0.001).Conclusion Prevailing dyslipidemia among the Chinese population and its wide geographic variations in prevalence,treatment,and control suggest that China needs both integrated and localized public health strategies across provinces to improve lipid management.

Evaluation of IGL-1 preservation solution using an orthotopic liver transplantation model

AIM： To compare, in a pig the protective effect of UW liver transplantation model, with that of IGL-1, a highsodium preservation solution containing polyethylene glycol （PEG） as an oncotic supply. METHODS： All livers were harvested and grafted orthotopically according to standard techniques. The livers were washed out and preserved for 7 h in IGL-1 （n = 6） or in UW solution （n = 7） at 4℃. In a sham group （n = 4）, the livers underwent a 60-min warm ischemia at 37℃. The hepatocellular injury was assessed in organ preservation solution washed out from the graft at the end of ischemic storage （before revascularization）, and in serum 2 h after reperfusion and daily for up to 6 d. RESULTS： Livers preserved in IGL-1 solution released markedly less AST than that preserved in the UW solution before and after revascularization （P 〈 0.05）. Besides, the activity of creatine kinase-BB, a marker of sinusoidal lining cells injury, was higher in the UW group than in the IGL-1 group （P 〈 0.05）. Histological results showed less necrotic regions in livers preserved in IGL-1 solution; however, no difference was observed for inflammation. CONCLUSION： IGL-1 liquid effectively protects parenchymal and non-parenchymal cells against preservation-reperfusion injuries.

Subclinical atherosclerosis in northern and southern China： the Chinese paradox

Background The incidence of coronary heart disease （CHD） is higher in Northern than that in Southern China, however differences in traditional CHD risk factors do not fully explain this. No study has examined the differences in subclinical atherosclerosis that may help explain the differences in incidence. This study examined these differences in subclinical atherosclerosis using coronary computed tomography （CT） for calcification between the Northern and Southern China. Methods We selected a random sample of participants in a large multi-center ongoing epidemiologic study for coronary calcium scanning in one northern city （North） （Beijing, n = 49） and in two southern cities （South） （Shanghai, n = 50, and Guangzhou, n = 50）. Participants from the three field centers （mean age 67 years） underwent coronary risk factor evaluation and cardiac CT scanning for coronary calcium measurement using the Multi-Ethnic Study of Atherosclerosis scanning protocol. Results Adjusted log-transformed coronary artery calcium score in North China （Beijing） was 3.1 ±0.4 and in South China （Shanghai and Guangzhou） was 2.2 ＋_ 0.3 （P = 0.04）. Mean calcium score for the northern city of Beijing was three times higher than that of the southern city of Guangzhou （P = 0.01） and 2.5 times higher than for the southern city of Shanghai （P = 0.03）. Conclusions The extent of subclinical atherosclerosis is significantly higher in the northern city of Beijing than that in the two southern cities of Guangzhou and Shanghai, even after adjusting for standard cardiac risk factors. This finding suggests that standard risk factors do not fully explain north south differences in clinical CHD incidence.

mHealth as a health system strengthening tool in China

Over the past 70 years,there was a rapid epidemiological transition in disease burden in China,from infectious disease to non-communicable diseases(NCDs),which requires long-term prevention and management.Rapid growth in mobile phone use,internet connectivity and digital health technology,presents new opportunities for improvement in NCD healthcare delivery and population-based outcomes.Although there were a growing number of research to evaluate the feasibility and effectiveness of the mobile health(mHealth)interventions for NCD management,the extent to which mHealth contributes towards the health system strengthening in China remains unknown.In this paper,we provided a high-level overview of mHealth in China and its role for Chinese health system strengthening.We conclude with several recommendations for the future of mHealth research in China based on existing evidence identified.

Non-Communicable Diseases During the COVID-19 Pandemic and Beyond

1.Introduction The coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has swept the globe as a pandemic[1].As of 1 April 2021,there were about 129.5 million confirmed cases of COVID-19,and 2.8 million deaths attributable to COVID-19[2].While some countries have suppressed COVID-19,most governments worldwide are still mobilizing available resources to contain the spread of SARS-CoV-2 in communities,facilitate COVID-19 treatments in hospitals,expand COVID-19 vaccination,and accelerate drug and vaccine development[3].

印度乡村345例成年人中的心血管疾病和危险因素:安得拉邦乡村健康行动

背景：心脏病发作和卒中是印度一些城市人群已然面临的问题，但是目前对乡村心血管疾病和危险因素的了解较少。本研究旨在观察印度乡村安得拉邦的两个村庄中主要心血管危险因素的水平和处理情况以及心血管疾病的患病率。方法：在2002年搜集的人口普查名单中，从每个村庄选择根据年龄和性别分层的随机样本进行横断面调查。对各研究对象，由经培训的研究人员负责对调查表进行泰卢固语翻译，完成简要的体格检查，并采集空腹静脉血样。计算人群的平均（或百分数）危险因素水平加权估计值，并报告可信区间，除非有其他特殊说明。结果：收集了来自345例年龄20～90岁成人的数据。家庭平均大小为4．2人，平均家庭收入为约25454印度卢比（580美元）／年。

Sex differences in the association between marital status and the risk of cardiovascular,cancer,and all-cause mortality:a systematic review and metaanalysis of 7,881,040 individuals

Purpose:To ascertain whether sex differences exist in the relationship between marital status and cardiovascular diseases(CVD),coronary heart disease(CHD),cancer and all-cause mortality in the general population and to explore the potential effect of age,location,the duration of follow-up and publication years on these outcomes.Methods:A systematic search was performed in PubMed and EMBASE from inception through to April 2018 and review of references to obtain sex-specific relative risks and their 95%confidence intervals.These were used to derive the women-to-men ratio of RRs(RRR)and 95%CI for each study.RRs and RRRs for each outcome were then pooled using random effects inverse-variance weighted meta-analysis.Results:Twenty-one studies with 7,891,623 individuals and 1,888,752 deaths were included in the meta-analysis.Compared with married individuals,being unmarried was significantly associated with all-cause,cancer,CVD and coronary heart disease mortalities for both sexes.However,the association with CVD and all-cause mortality was stronger in men.Being divorced/separated was associated with a higher risk of all-cause mortality in men and a stronger risk of cancer and CVD mortality.The pooled ratio for women versus men showed 31 and 9%greater risk of stroke mortality and all-cause mortality associated with never married in men than in women.Conclusions:Being unmarried conferred higher risk of stroke and all-cause mortality for men than women.Moreover,divorced/separated men had higher risk of cancer mortality and CVD mortality.Further studies are warranted to clarify the biological,behavioral,and/or social mechanisms involved in sex differences by these associations.

Severe obstructive sleep apnea and long distance truck driving: A case report

Introduction: Untreated sleep disorders can increase driver crash risk by up to 7 fold, and truck drivers have a variety of risk factors for sleep disorders. Measures currently used to identify drivers at risk depend predominantly on the ability of the driver to identify and report themselves as sleepy. Methods: This case report presents a 54 year old long distance truck driver who participated in a case-control study, underwent at home breathing monitoring and was followed up with an in-depth interview. Results: Self-reported measures did not identify this driver as at risk of sleepiness or sleep apnea;yet he was subsequently diagnosed with severe sleep apnea using an at home monitor and polysomnography. Conclusions: Self-assessment of risk factors is insufficient as a screen for sleep apnea. General practitioners are in an ideal position to identify potential sleep apnea sufferers and can initiate the enquiry process that leads to diagnostic testing.

What paradigm shifts occurred in the management of acute diverticulitis during the COVID-19 pandemic?A scoping review

BACKGROUND Acute colonic diverticulitis(ACD)is common in Western countries,with its prevalence increasing throughout the world.As a result of the coronavirus disease 2019(COVID-19),elective surgery and in-patients’visits have been cancelled or postponed worldwide.AIM To systematically explore the impact of the pandemic in the management of ACD.METHODS MEDLINE,Embase,Scopus,MedxRiv,and the Cochrane Library databases were searched to 22 December 2020.Studies which reported on the management of patients with ACD during the COVID-19 pandemic were eligible.For cross sectional studies,outcomes of interest included the number of hospital admission for ACD,as well as key features of disease severity(complicated or not)across two time periods(pre-and during lockdown).RESULTS A total of 69 papers were inspected,and 21 were eligible for inclusion.Ten papers were cross sectional studies from seven world countries;six were case reports;three were qualitative studies,and two review articles.A 56%overall decrease in admissions for ACD was observed during lockdown,peaking 67%in the largest series.A 4%-8%decrease in the rate of uncomplicated diverticulitis was also noted during the lockdown phase.An initial non-operative management was recommended for complicated diverticulitis,and encouraged to an out-of-hospital regimen.Despite initial concerns on the use of laparoscopy for Hinchey 3 and 4 patients to avoid aerosolized contamination,societal bodies have progressively mitigated their initial recommendations as actual risks are yet to be ascertained.CONCLUSION During the COVID-19 pandemic,fewer patients presented and were diagnosed with ACD.Such decline may have likely affected the spectrum of uncomplicated disease.Established outpatient management and follow up for selected cases may unburden healthcare resources in time of crisis.

Experiences of Adults Using Feedback-Based Technology to Improve Physical Function in Rehabilitation: Study Protocol for a Qualitative Systematic Review

Question: What are the experiences of adults using feedback-based technology to improve their physical function during rehabilitation? Design: A systematic review with meta-synthesis of qualitative studies is proposed. Participants: Adults (aged ≥ 15 years) participating in neurological or aged care rehabilitation. Intervention: Feedback-based technology (technology providing feedback to the user about task performance or dose of practice) used as an intervention to improve physical function or physical activity levels. Outcomes: Experiences of using feedback-based technology (learning, accepting, adopting, practicing and progressing), as well as barriers and facilitators to use. Methods: Meta-synthesis of qualitative studies involving the following steps: 1) a systematic search of 10 electronic databases and grey literature, and hand-searching of reference lists of included studies, 2) screening of search results and abstracts for study selection, 3) data extraction, 4) quality appraisal of included studies using the Critical Appraisal Skills Programme (CASP) checklist, and 5) qualitative synthesis to identify common themes and concepts across studies. The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement will be used to report study methods and results. Discussion: This meta-synthesis will provide new knowledge about how feedback-based technologies are currently being used in rehabilitation, and describe users’ experiences. Review registration: PROSPERO International prospective register of systematic reviews Registration No. CRD42015017119.

出生体重和随后胆固醇水平关系:“胎源性”假说的探究

Context: Inverse associations between birth weight and subsequent blood cholesterol levels have been used to support the “fetal origins”hypothesis of the relevance of fetal nutrition to adult disease. Objectives: To perform a systematic review of the association between birth weight and total blood cholesterol levels, and to explore the impact of including unpublished results, adjusting for potential confounders. Data Sources and Study Selection: Relevant studies published by September 30, 2004, were identified through literature searches using EMBASE and MEDLINE and MeSH heading search strategy(using terms such as birth weight, intrauterine growth retardation, fetal growth retardation and cholesterol, lipoprotein, lipid). Studies that reported qualitative or quantitative estimates of the association between birth weight and total blood cholesterol, or had recorded both measures but not reported on their associations, were included. Data Extraction: A total of 79 relevant studies involving a total of 74122 individuals were identified; 65 had reported on the direction of the association between birth weight and total blood cholesterol. Although regression coefficients were published for only 11 studies and other quantitative estimates for 3 other studies, regression coefficients(published or unpublished)were obtained for 58 studies among 68974 individuals. Data Synthesis: Inverse associations were observed in 11 of 14 studies that had previously published quantitative estimates but in only 18 of the remaining 51 that had reported on the direction of this association(heterogeneity P=.004). Similarly, the weighted estimate for the 11 studies was -1.89 mg/dL(-0.049 mmol/L)total cholesterol per kilogram birth weight compared with -0.69 mg/dL(-0.018 mmol/L)per kilogram for 47 studies that provided unpublished regression coefficients(heterogeneity P=.009). Overall, the weighted estimate from the 58 contributing studies was-1.39 mg/dL(-0.036 mmol/L)per kilogram(95%confidence interval, -1.81 to -0.97 mg/dL [-0.047 to -0.025 mmol/L]), but there was significant heterogeneity between their separate results(P< .001). Part of this heterogeneity appears to reflect stronger associations reported from smaller studies and studies of cholesterol levels in infants. Conclusion: These findings suggest that impaired fetal growth does not have effects on blood cholesterol levels that would have a material impact on vascular disease risk.

培哚普利降压治疗可降低心房纤颤及以前有卒中或短暂缺血性发作患者大血管事件的发生

Background and Purpose -Patients with atrial fibrillation have a high risk of stroke and other vascular events even if anticoagulated. The primary objective here is to determine whether routine blood pressure-lowering provides additional protection for this high-risk patient group. Methods -This study was a subsidiary analysis of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS)-a randomized, placebocontrolled trial that established the beneficial effects of blood pressure-lowering in a heterogeneous group of patients with cerebrovascular disease. A total of 6105 patients were randomly assigned to either active treatment (2 to 4 mg perindopril for all participants plus 2.0 to 2.5 mg i ndapamide for those without an indication for or a contraindication to a diuretic) or matching placebo(s). Outcomes are total major vascular events, causespecific vascular outcomes, and death from any cause. Results -There were 476 patient s with atrial fibrillation at baseline, of whom 51%were taking anticoagulants. In these patients, active treatment lowered mean blood pressure by 7.3/3.4 mm Hg and was associated with a 38%(95%confidence interval [CI], 6 to 59) reduction in major vascular eve nt s and 34%(95%CI, -13 to 61) reduction in stroke. The benefits of blood pressu re-lowering in patients with atrial fibrillation were achieved irrespective of the use of anticoagulant therapy (P homogeneity=0.8) or the presence of hyperten sion (P homogeneity=0.4). Conclusions -For most patients with atrial fibrillati on, routine blood pressurelowering is likely to provide protection against major vascular events additional to that conferred by anticoagulation.

Transfer or tailor?Implementing a technology-supported intervention for noncommunicable diseases across contexts

In May 2022,the 75th World Health Assembly recognized the need to accelerate national responses to the growing burden of noncommunicable diseases(NCDs)to achieve the goals of the Global Action Plan(GAP)for the Prevention and Control of NCDs.To facilitate this,an implementation roadmap was adopted that urges countries to prioritize the implementation of NCD interventions that are most appropriate to their specific local and regional context.The roadmap will act as an overarching guide for countries to tackle NCDs via three approaches:(i)Accelerate national responses based on local NCD epidemiology,risk factors and identified barriers and enablers;(ii)Prioritize and scale up the implementation of most impactful and feasible interventions according to the local context;and(iii)Ensure timely,reliable and sustained national data on NCD risk factors and mortality for data driven actions and to strengthen accountability[1].