Recurrent stroke admissions with vs without COVID-19 and associated in-hospital mortality: A United States nationwide analysis, 2020

BACKGROUND Coronavirus disease 2019(COVID-19)has been shown to increase the risk of stroke.However,the prevalence and risk of recurrent stroke in COVID-19 patients with prior stroke/transient ischemic attack(TIA),as well as its impact on mor-tality,are not established.AIM To evaluate the impact of COVID-19 on in-hospital mortality,length of stay,and healthcare costs in patients with recurrent strokes.METHODS We identified admissions of recurrent stroke(current acute ischemic stroke admissions with at least one prior TIA or stroke)in patients with and without COVID-19 using ICD-10-CM codes using the National Inpatient Sample(2020).We analyzed the impact of COVID-19 on mortality following recurrent stroke admissions by subgroups.RESULTS Of 97455 admissions with recurrent stroke,2140(2.2%)belonged to the COVID-19-positive group.The COVID-19-positive group had a higher prevalence of diabetes and chronic kidney disease vs the COVID-19 negative group(P<0.001).Among the subgroups,patients aged>65 years,patients aged 45–64 years,Asians,Hispanics,whites,and blacks in the COVID-19 positive group had higher rates of all-cause mortality than the COVID-19 negative group(P<0.01).Higher odds of in-hospital mortality were seen in the group aged 45-64(OR:8.40,95%CI:4.18-16.91)vs the group aged>65(OR:7.04,95%CI:5.24-9.44),males(OR:7.82,95%CI:5.38-11.35)compared to females(OR:6.15,95%CI:4.12-9.18),and in Hispanics(OR:15.47,95%CI:7.61-31.44)and Asians/Pacific Islanders(OR:14.93,95%CI:7.22-30.87)compared to blacks(OR:5.73,95%CI:3.08-10.68),and whites(OR:5.54,95%CI:3.79-8.09).CONCLUSION The study highlights the increased risk of all-cause in-hospital mortality in recurrent stroke patients with COVID-19,with a more pronounced increase in middle-aged patients,males,Hispanics,or Asians.

Knockdown of NADPH oxidase 4 reduces mitochondrial oxidative stress and neuronal pyroptosis following intracerebral hemorrhage

Intracerebral hemorrhage is often accompanied by oxidative stress induced by reactive oxygen species,which causes abnormal mitochondrial function and secondary reactive oxygen species generation.This creates a vicious cycle leading to reactive oxygen species accumulation,resulting in progression of the pathological process.Therefore,breaking the cycle to inhibit reactive oxygen species accumulation is critical for reducing neuronal death after intracerebral hemorrhage.Our previous study found that increased expression of nicotinamide adenine dinucleotide phosphate oxidase 4(NADPH oxidase 4,NOX4)led to neuronal apoptosis and damage to the blood-brain barrier after intracerebral hemorrhage.The purpose of this study was to investigate the role of NOX4 in the circle involving the neuronal tolerance to oxidative stress,mitochondrial reactive oxygen species and modes of neuronal death other than apoptosis after intracerebral hemorrhage.We found that NOX4 knockdown by adeno-associated virus(AAV-NOX4)in rats enhanced neuronal tolerance to oxidative stress,enabling them to better resist the oxidative stress caused by intracerebral hemorrhage.Knockdown of NOX4 also reduced the production of reactive oxygen species in the mitochondria,relieved mitochondrial damage,prevented secondary reactive oxygen species accumulation,reduced neuronal pyroptosis and contributed to relieving secondary brain injury after intracerebral hemorrhage in rats.Finally,we used a mitochondria-targeted superoxide dismutase mimetic to explore the relationship between reactive oxygen species and NOX4.The mitochondria-targeted superoxide dismutase mimetic inhibited the expression of NOX4 and neuronal pyroptosis,which is similar to the effect of AAV-NOX4.This indicates that NOX4 is likely to be an important target for inhibiting mitochondrial reactive oxygen species production,and NOX4 inhibitors can be used to alleviate oxidative stress response induced by intracerebral hemorrhage.

Recent evidence for subcutaneous drains to prevent surgical site infections after abdominal surgery:A systematic review and metaanalysis

BACKGROUND Surgical site infections(SSIs)increase mortality,hospital stays,additional medical treatment,and medical costs.Subcutaneous drains prevent SSIs in gynecological and breast surgeries;however,their clinical impact in abdominal surgery remains unclear.AIM To investigate whether subcutaneous drains were beneficial in abdominal surgery using a systematic review and meta-analysis.METHODS The database search used PubMed,MEDLINE,and the Cochrane Library.The following inclusion criteria were set for the systematic review:(1)Randomized controlled trial studies comparing SSIs after abdominal surgery with or without subcutaneous drains;and(2)Studies that described clinical outcomes,such as SSIs,seroma formation,the length of hospital stays,and mortality.RESULTS Eight studies were included in this meta-analysis.The rate of total SSIs was significantly lower in the drained group(54/771,7.0%)than in the control group(89/759,11.7%),particularly in gastrointestinal surgery.Furthermore,the rate of superficial SSIs was slightly lower in the drained group(31/517,6.0%)than in the control group(49/521,9.4%).No significant differences were observed in seroma formation between the groups.Hospital stays were shorter in the drained group than in the control group.CONCLUSION Subcutaneous drains after abdominal surgery prevented SSIs and reduced hospital stays but did not significantly affect seroma formation.The timing of drain removal needs to be reconsidered in future studies.

Usefulness of duodenal biopsy during routine upper gastrointestinal endoscopy for diagnosis of celiac disease

AIM： To describe the trend in duodenal biopsy performance during routine upper gastrointestinal endoscopy in an adult Spanish population, and to analyze its value for the diagnosis of celiac disease in clinical practice. METHODS： A 15 year-trend （1990 to 2004） in duodenal biopsy performed when undertaking upper gastrointestinal endoscopy was studied. We analysed the prevalence of celiac disease in the overall group, and in the subgroups with anaemia and/or chronic diarrhoea. RESULTS： Duodenal biopsy was performed in 1033 of 13 678 upper gastrointestinal endoscopies （7.6%）; an increase in the use of such was observed over the study period （1.9% in 1990-1994, 5% in 1995-1999 and 12.8% in 2000-2004）. Celiac disease was diagnosed in 22 patients （2.2%）, this being more frequent in women than in men （3% and 1% respectively）. Fourteen out of 514 （2.7%） patients with anaemia, 12 out of 141 （8.5%） with chronic diarrhoea and 8 out of 42 （19%） with anaemia plus chronic diarrhoea had celiac disease. A classical clinical presentation was observed in 55% of the cases, 23% of the patients had associated dermatitis herpetiformis and 64% presented anaemia; 9% were diagnosed by familial screening and 5% by cryptogenetic hypertransaminasaemia. CONCLUSION： Duodenal biopsy undertaken during routine upper gastrointestinal endoscopy in adults, has been gradually incorporated into clinical practice, and is a useful tool for the diagnosis of celiac disease in high risk groups such as those with anaemia and/or chronic diarrhoea.

Laboratory test variables useful for distinguishing upper from lower gastrointestinal bleeding

AIM: To distinguish upper from lower gastrointestinal(GI) bleeding. METHODS: Patient records between April 2011 and March 2014 were analyzed retrospectively(3296 upper endoscopy, and 1520 colonoscopy). Seventysix patients had upper GI bleeding(Upper group) and 65 had lower GI bleeding(Lower group). Variables were compared between the groups using one-way analysis of variance. Logistic regression was performed to identify variables significantly associated with the diagnosis of upper vs lower GI bleeding. Receiveroperator characteristic(ROC) analysis was performed to determine the threshold value that could distinguish upper from lower GI bleeding. RESULTS: Hemoglobin(P = 0.023), total protein(P = 0.0002), and lactate dehydrogenase(P = 0.009) were significantly lower in the Upper group than in the Lower group. Blood urea nitrogen(BUN) was higher in the Upper group than in the Lower group(P = 0.0065). Logistic regression analysis revealed that BUN was most strongly associated with the diagnosis of upper vslower GI bleeding. ROC analysis revealed a threshold BUN value of 21.0 mg/d L, with a specificity of 93.0%.CONCLUSION: The threshold BUN value for distinguishing upper from lower GI bleeding was 21.0 mg/d L.

Painleve Analysis and Determinant Solutions of a (3+1)-Dimensional Variable-Coefficient Kadomtsev-Petviashvili Equation in Wronskian and Grammian Form

In this paper, the investigation is focused on a （3＋1）-dimensional variable-coefficient Kadomtsev- Petviashvili （vcKP） equation, which can describe the realistic nonlinear phenomena in the fluid dynamics and plasma in three spatial dimensions. In order to study the integrability property of such an equation, the Painlevé analysis is performed on it. And then, based on the truncated Painlevé expansion, the bilinear form of the （3＋1）-dimensionaJ vcKP equation is obtained under certain coefficients constraint, and its solution in the Wronskian determinant form is constructed and verified by virtue of the Wronskian technique. Besides the Wronskian determinant solution, it is shown that the （3＋1）-dimensional vcKP equation also possesses a solution in the form of the Grammian determinant.

RNA-Seq analysis and development of SSR and KASP markers in lentil(Lens culinaris Medikus subsp. culinaris)

Lentil(Lens culinaris Medikus subsp.culinaris,2 n=14)is a cool-season legume with high production potential for multiple uses.However,limited molecular research has been conducted in this species owing to its large genome,which impedes the generation of genome sequences and the development of molecular markers.In this study,more than 1.37 billion filtered clean reads were collected by RNA-Seq of six diverse lentil accessions and217,836 transcripts and 161,095 unigenes were de novo assembled,yielding respectively 257.1 and 240.6 million nucleotides.The mean transcript length was 1180 bp and the N50 and N90 lengths were respectively 2075 and 479 bp.The mean length of the unigenes was 1494 bp and their N50 and N90 values were respectively 2203 and 714 bp.The unigenes were annotated against seven databases.The FLOWERING LOCUS T(FT)gene homolog in lentil showed high protein sequence similarity to the FT gene homologs of pea and alfalfa.On the basis of the RNA-Seq analysis,26,449 EST-SSR markers were designed in silico,and 276 preliminarily screened markers were selected to evaluate polymorphism in 94 diverse lentil accessions.In total,125(45.29%)of 276 EST-SSR markers were found to be polymorphic.A total of 130,073 SNP loci were detected and 78(61.41%)of 127 SNPs were successfully converted to KASP markers.Population genetic analyses of the lentil accessions with EST-SSR and KASP markers revealed similar genetic structures,suggesting that the RNA-Seq-generated resources and the developed markers are reliable for use in molecular marker-assisted breeding of lentil.

Analysis of Metamaterial Cloaks Using Circular Split Ring Resonator Structures

A novel microwave cloak using circular split ring resonator(SRR)based metamaterial structure has been proposed in this paper.The cloak which operates at a frequency of 10.6 GHz is composed of cylindrical dielectric sheets printed with circular split ring resonators of spatially varying and anisotropic material properties.The article also focuses on the phenomenon of resonant splitting in circular SRR microwave cloak.A detailed analysis of various linear metamaterial arrays and their response has also been elucidated.

Locoregional therapy and systemic cetuximab to treat colorectal liver metastases

AIM: To investigate efficacy and safety of second-line treatment with irinotecan-loaded drug-eluting beads(DEBIRI) and cetuximab(DEBIRITUX) of unresectable colorectal liver metastases.METHODS: Patients with the following characteristics were included in the study: unresectable hepatic metastases from colorectal carcinoma(CRC-LM), progression after first line chemotherapy(any type of chemotherapeutic drug and combination was allowed), second line treatment(mandatory), which included for each patient(unregarding the KRas status) two cycles of DEBIRI(using 100-300 μm beads loaded with irinotecan at a total dose 200 mg) followed by 12 cycles of cetuximab that was administered weekly at a first dose of 400 mg/m2 and then 250 mg/m2; good performance status(0-2) and liver functionality(alanine aminotransferase and gamma-glutamyl transferase not exceeding three times the upper limit of normal, total bilirubin not exceeding 2.5 mg/m L). Data were collected retrospectively and included: tumor response(evaluated monthly for 6 mo then every 3 mo), overall response rate(ORR), KRas status, type and intensity of adverse events(G according to the Common Terminology Criteria for Adverse Events v3.0, CTCAE), overall survival(OS) and progression free survival(PFS).RESULTS: Forty consecutive cases of CRC hepatic metastases were included in the study. Median duration of DEBIRITUX was 4.4 mo(range, 4.0-6.5). Sixteen patients(40%) received the planned 2 cycles of DEBIRI and an average of 10 cetuximab cycles. ORR of the whole sample was 50%, in particular 4 patients were complete responders(10%) and 16(40%) partial responders. The most observed side effects(G2) were: post-embolization syndrome(30%), diarrhea(25%), skin rushes(38%) and asthenia(35%). The retrospective evaluation of KRas status(24 wild type, 16 mutated) showed that the group of patients with wild type KRas had ORR significantly higher than mutant KRas. Median follow-up was 29 mo(8-48 range); median PFS was 9.8 mo and OS was 20.4 mo. Future randomized trials are required in this setting to establish a role for DEBIRITUX compared with systemic chemotherapy.CONCLUSION: DEBIRITUX seems to be efficacious after first line chemotherapy for the treatment of unresectable CRC-LM.

A Cross-Sectional Study of the Causes, Effects and Management Strategies for Stress and Burnout among Nurses in the Fako Division, Cameroon

Introduction: Stress and burnout are a reality which nurses encounter and try to cope with especially in the Emergency Department (ED) so that they can provide optimal patient care. Nurses who work in ED are front line providers of immediate medical care needed to stabilize patients. With the known critical shortage of health workforce in Cameroon, nurses are overloaded with work and often experience stress and burnout. Aim: This study aimed at determining the causes, effects and management strategies of stress and burnout among nurses working in the ED in hospitals in the Fako Division, Cameroon. Methods: This study was a descriptive cross-sectional study. The sample consisted of seventy nurses from five different hospitals. A purposive sampling technique was used and data was analyzed using SPSS version 16.0. Data was collected using a structured questionnaire developed from the International Stress Management Scale. Results: The highest reported cause of stress in this study was heavy workload (12.88%) and the least was no experience in handling the challenges of the department. The leading reported effect of stress was the development of musculoskeletal disorders such as joint and back pain (16.48%) and the least effect was contemplating quitting the profession (5.99%). The major management strategy used was humour (8.27%), while the least was crying out stress to feel relieved (2.18%). Conclusion: The major cause of stress and burnout among nurses in our study setting was heavy workload, which mostly results in joint and back pain. Moreover, humour was the prime management strategy for stress and burnout among nurses in the emergency department in the study setting. Thus more nurses should be employed and the working conditions of nurses improved to reduce the workload in the study hospitals.

Electroacupuncture for abdominal pain relief in patients with acute pancreatitis:A three-arm randomized controlled trial

Background: Electroacupuncture(EA) may reduce the severity of acute pancreatitis(AP) and provide additional pain relief in patients with chronic pancreatitis. However, the ability of EA to relieve pain in patients with AP has not been well documented.Objective: This study was undertaken to compare the pain-relieving effects of EA and conventional treatment in patients with AP.Design, setting, participants and interventions: This study was conducted using a randomized, controlled,three-arm, parallel-group and multi-center design. Patients diagnosed with AP were randomly and equally assigned to EA1, EA2 or control groups. All participants received conventional standard-of-care therapy for AP. Local EA alone was administered in EA1, and local plus distal EA was given in EA2.Local EA included two abdominal acupoints, while distal EA included twelve peripheral acupoints. EA groups underwent one session of EA daily for 4 days(days 1–4), or until pain was resolved or discharged.Main outcome measures: The primary outcome measure was the change in the visual analogue scale(VAS;0–100) pain score between baseline and day 5.Results: Eighty-nine participants were randomized into EA1, EA2 and control groups, and 88(EA1, 30;EA2, 29;control, 29) were included in the full-analysis set. VAS score change(median [interquartile range]) on day 5 was(12.3 ± 22.5) in the EA1 group,(10.3 ± 21.5) in the EA2 group, and(8.9 ± 15.2) in the control group. There were not significant differences in the change in VAS score among treatments(P = 0.983). However, time to food intake was significantly shorter in the EA group(EA1 + EA2) than in the control group(median 2.0 days vs 3.0 days), with a hazard ratio of 0.581(P = 0.022;95% CI,0.366–0.924). No significant adverse events occurred.Conclusion: EA treatment did not significantly reduce pain after 4 days of treatment in patients with AP-associated abdominal pain but significantly reduced time to first food intake.

Structural and functional imaging of brains

Analyzing the complex structures and functions of brain is the key issue to understanding the physiological and pathological processes.Although neuronal morphology and local distribution of neurons/blood vessels in the brain have been known,the subcellular structures of cells remain challenging,especially in the live brain.In addition,the complicated brain functions involve numerous functional molecules,but the concentrations,distributions and interactions of these molecules in the brain are still poorly understood.In this review,frontier techniques available for multiscale structure imaging from organelles to the whole brain are first overviewed,including magnetic resonance imaging(MRI),computed tomography(CT),positron emission tomography(PET),serial-section electron microscopy(ss EM),light microscopy(LM)and synchrotron-based X-ray microscopy(XRM).Specially,XRM for three-dimensional(3D)imaging of large-scale brain tissue with high resolution and fast imaging speed is highlighted.Additionally,the development of elegant methods for acquisition of brain functions from electrical/chemical signals in the brain is outlined.In particular,the new electrophysiology technologies for neural recordings at the single-neuron level and in the brain are also summarized.We also focus on the construction of electrochemical probes based on dual-recognition strategy and surface/interface chemistry for determination of chemical species in the brain with high selectivity and long-term stability,as well as electrochemophysiological microarray for simultaneously recording of electrochemical and electrophysiological signals in the brain.Moreover,the recent development of brain MRI probes with high contrast-to-noise ratio(CNR)and sensitivity based on hyperpolarized techniques and multi-nuclear chemistry is introduced.Furthermore,multiple optical probes and instruments,especially the optophysiological Raman probes and fiber Raman photometry,for imaging and biosensing in live brain are emphasized.Finally,a brief perspective on existing challenges and further research development is provided.

Geochemical fingerprints and hydrocarbon potential of Paleocene mudrocks in the Tano Basin, Ghana: insights from biomarkers and stable carbon isotopes

The Paleocene mudrocks in Ghana’s Tano Basin have received limited attention despite ongoing efforts to explore hydrocarbon resources.A thorough geochemical analysis is imperative to assess these mudrocks’petroleum generation potential and formulate effective exploration strategies.In this study,a comprehensive geochemical analysis was carried out on ten Paleocene rock cuttings extracted from TP-1,a discovery well within the Tano Basin.Various analytical techniques,including total organic carbon(TOC)analysis,Rock–Eval pyrolysis,gas chromatography-mass spectrometry,and isotope ratio-mass spectrometry,were employed to elucidate their hydrocar-bon potential and organic facies.Thefindings in this study were subsequently compared to existing geochemical data on Paleocene source rocks in the South Atlantic marginal basins.The results indicated that the Paleocene samples have TOC content ranging from 0.68 to 2.93 wt%.The prevalent kerogen types identified in these samples were Type Ⅱ and Type Ⅲ.Molecular and isotope data suggest that the organic matter found in the Paleocene mudrocks can be traced back to land plants and lower aquatic organisms.These mudrocks were deposited in a transi-tional environment withfluctuating water salinity,charac-terized by sub-oxic redox conditions.Maturity indices,both bulk and molecular,indicated a spectrum of maturity levels within the Paleocene mudrocks,spanning from immature to marginally mature,with increasing maturity observed with greater depth.In comparison,the organic composition and depositional environments of Paleocene source rocks in the Tano Basin closely resemble those found in the Niger Delta Basin,Douala,and Kribi-Campo Basins,the Kwanza Formation in Angola,and certain Brazilian marginal basins.However,it is worth noting that Paleocene source rocks in some of the basins,such as the Niger Delta and Brazilian marginal basins,exhibit rela-tively higher thermal maturity levels compared to those observed in the current Paleocene samples from the Tano Basin.In conclusion,the comprehensive geochemical analysis of Paleocene mudrocks within Ghana’s Tano Basin has unveiled their marginal hydrocarbon generation potential.The shared geochemical characteristics between the Paleocene mudrocks in the Tano Basin and those in the nearby South Atlantic marginal basins offer valuable insights into source rock quality,which is crucial for shaping future strategies in petroleum exploration in this region.

云边端协同驱动的陶瓷制造过程能效调度方法

陶瓷制造企业作为典型的多品种小批量高能耗制造企业,面临着能耗高、生产周期长、品种繁多、生产工艺复杂等问题,因此如何提高陶瓷制造的能源和资源利用效率,并进一步实现节能降耗,已经成为陶瓷企业亟需解决的重要问题。针对这一目标,提出了一种云边端协同驱动的陶瓷制造过程能效调度架构,该架构依赖于云边端协同技术来支持陶瓷制造过程的调度优化。以最小化最大完工时间和最小化总能耗为优化目标,建立陶瓷制造过程柔性流水车间调度模型。利用灰狼优化算法具有较强的全局搜索能力的特性,使用灰狼优化算法求解调度模型。结合陶瓷工厂实际情况设计算例,并以其作为实验数据,验证了灰狼优化算法在陶瓷制造过程中柔性流水车间调度优化的有效性。

魔芋葡甘聚糖接枝聚丙烯酸敷料对糖尿病皮损治疗作用的研究

目的探究魔芋葡甘聚糖(KGM)接枝聚丙烯酸(AA)敷料对糖尿病皮肤损伤的修复作用。方法采用自由基聚合方法制备(KGM-AA)敷料,进行吸水性实验检测KGM-AA敷料的吸水性能与黏性;通过扫描电子显微镜观察材料冻干后结构及形态。将KGM-AA水凝胶与小鼠成纤维细胞L929体外共培养24 h后,进行细胞活死染色及CCK-8检测,探究细胞的活性及生长状况。将血管内皮细胞接种到KGM、KGM-AA和空白对照上,于接种后第2、4、6、8小时时间点观察血管形成情况。通过小鼠腹腔注射STZ造糖尿病模型,当随机血糖连续2次大于11.1 mmol/L即造模成功。将所获得的高血糖糖尿病小鼠于颈后处制造直径为1 cm圆形伤口并随机分为3组,一组为不做处理空白对照组,另2组分别用KGM及KGM-AA敷料对小鼠创面进行治疗,观察伤口的愈合情况。于创伤后第7、14天时取伤口处皮肤进行苏木精-伊红(HE)染色,观察伤口愈合及炎症、增生等情况。结果KGM-AA敷料具有良好的吸水能力,吸水后的KGM-AA呈现均匀的多孔结构,孔径均大于10μm。与小鼠L929共培养后发现,细胞成功进入吸水形成的凝胶内部,细胞存活率大于95%,可以为细胞附着提供良好的环境且对细胞生长及活性无显著影响。成管实验结果显示,与KGM相比,接种6 h左右KGM-AA组血管数量明显多于KGM组,差异有显著性统计学意义(P<0.01),该差异一直维持到接种后的第10小时。体内实验表明,与对照组相比,创口用KGM-AA敷料处理过的高血糖小鼠在治疗7 d时创面皮肤比未接受治疗组更加完整。结论KGM-AA敷料吸水性及生物相容性良好,吸水后形成均匀多孔结构,形成保护膜的同时为细胞附着提供了良好生长条件,同时表现出良好的促进血管生成特性和潜在的调节皮肤损伤能力,是理想的伤口敷料和细胞递送材料。

妊娠期糖尿病患者血清胱抑素⁃C、CTRP5、CTRP9与HbA1c的相关性及对围产儿不良结局的预测价值

目的探讨妊娠期糖尿病(GDM)患者血清胱抑素-C、补体C1q/肿瘤坏死因子相关蛋白5(CTRP5)、补体C1q/肿瘤坏死因子相关蛋白9(CTRP9)与糖化血红蛋白(HbA1c)的相关性及预测围产儿不良结局的价值。方法选取2022年1月至2023年12月150例GDM患者为研究对象,根据围产儿结局分为不良结局组(n=41)、良好结局组(n=109)。比较2组基线资料及血清胱抑素-C、CTRP5、CTRP9、HbA1c水平,多因素Logistic回归分析GDM患者围产儿不良结局影响因素,Pearson法分析胱抑素-C、CTRP5、CTRP9与HbA1c的相关性,受试者工作特征曲线分析各指标对不良结局的预测价值,并比较各预测方案效能。结果不良结局组年龄、孕前体质量指数(BMI)、分娩前BMI、孕中期口服葡萄糖耐量试验结果及血清胱抑素-C、CTRP5、CTRP9、HbA1c水平与良好结局组比较有差异(P<0.05)。校正其他相关因素后,血清胱抑素-C、CTRP5、CTRP9、HbA1c仍是GDM患者围产儿不良结局的影响因素(P<0.05)。GDM患者血清胱抑素-C、CTRP5与HbA1c呈正相关,CTRP9与HbA1c呈负相关(P<0.05)。血清胱抑素-C、CTRP5、CTRP9联合预测GDM患者围产儿不良结局的曲线下面积为0.936(95%CI:0.885,0.970),优于各指标单独及两两组合预测价值。结论胱抑素-C、CTRP5在GDM患者血清中表达上调,CTRP9表达下调,各指标与HbA1c具有相关性,三者联合检测对围产儿不良结局具有一定预测价值,可作为临床评估血糖控制情况、预测围产儿结局的辅助指标。

Novel synthetic opioids-toxicological aspects and analysis

Over the past few years,there has been an emerging number of new psychoactive drugs.These drugs are frequently mentioned as“legal highs”,“herbal highs”,“bath salts”and“research chemicals”.They are mostly sold and advertised on online forums and on the dark web.The emerging new psychoactive substances are designed to mimic the effects of psychoactive groups,which are often abused drugs.Novel synthetic opioids are a new trend in this context and represent an alarming threat to public health.Given the wide number of fatalities related to these compounds reported within the last few years,it is an important task to accurately identify these compounds in biologic matrices in order to administer an effective treatment and reverse the respiratory depression caused by opioid related substances.Clinicians dealing with fentanyl intoxication cases should consider that it could,in fact,be a fentanyl analogue.For this reason,it is a helpful recommendation to include synthetic opioids in the routine toxicological screening procedures,including analysis in alternative matrices,if available,to investigate poly-drug use and possible tolerance to opioids.To address this public health problem,better international collaboration,effective legislation,effective investigation,control of suspicious“research chemicals”online forums and continuous community alertness are required.This article aims to review diverse reported fatalities associated with new synthetic opioids describing them in terms of pharmacology,metabolism,posology,available forms,as well as their toxic effects,highlighting the sample procedures and analytical techniques available for their detection and quantification in biological matrices.

达格列净治疗早期糖尿病肾病的临床效果分析

目的探究达格列净治疗早期糖尿病肾病的临床效果。方法选取2022年7月—2023年7月连江县医院收治的82例早期糖尿病肾病患者为研究对象,应用随机数表法分成对照组与观察组,各41例。对照组采用阿卡波糖降糖及厄贝沙坦治疗,观察组在对照组基础上加用达格列净治疗。治疗12周,比较两组的治疗总有效率、治疗前后血糖指标[空腹血糖(Fasting Plasma Glucose,FPG)、餐后2 h血糖(2-hour Postprandial Plasma Glucose,2 hPG)]、肾功能[尿素氮(Blood Urea Nitrogen,BUN)、血肌酐(Serum Creatinine,SCr)]变化以及药物不良事件发生率。结果观察组的治疗总有效率为95.12%,高于对照组的78.05%,差异有统计学意义(χ^(2)=5.145,P=0.023)。治疗12周后,观察组的FPG(6.94±1.20)mmol/L、2 hPG(8.13±0.62)mmol/L、BUN(6.07±0.45)mmol/L、SCr(68.40±3.39)μmol/L较对照组低,差异有统计学意义(P均<0.05)。两组药物不良事件发生率对比,差异无统计学意义(P>0.05)。结论达格列净治疗早期糖尿病肾病能够更好改善患者的肾功能和血糖,提高疗效。

Subtropical forest macro-decomposers rapidly transfer litter carbon and nitrogen into soil mineral-associated organic matter

Background:Forest soils in tropical and subtropical areas store a significant amount of carbon.Recent framework to assess soil organic matter(SOM)dynamics under evolving global conditions suggest that dividing bulk SOM into particulate and mineral-associated organic matter(POM vs.MAOM)is a promising method for identifying how SOM contributes to reducing global warming.Soil macrofauna,earthworms,and millipedes have been found to play an important role in facilitating SOM processes.However,how these two co-existing macrofaunae impac the litter decomposition process and directly impact the formation of POM and MAOM remains unclear.Methods:Here,we set up a microcosm experiment,which consisted of 20 microcosms with four treatments earthworm and litter addition(E),millipedes and litter addition(M),earthworm,millipedes,and litter addition(E+M),and control(only litter addition)in five replicates.The soil and litter were sterilized prior to beginning the incubation experiment to remove any existing microbes.After incubating the samples for 42 days,the litte properties(mass,C,and N contents),soil physicochemical properties,as well as the C and N contents,and POM and MAOM^(13)C abundance in the 0–5 and 5–10 cm soil layers were measured.Finally,the relative influences o soil physicochemical and microbial properties on the distribution of C and N in the soil fractions were analyzed Results:The litter mass,C,and N associated with all four treatments significantly decreased after incubation especially under treatment E+M(litter mass:-58.8%,litter C:-57.0%,litter N:-75.1%,respectively),while earthworm biomass significantly decreased under treatment E.Earthworm or millipede addition alone showed no significant effects on the organic carbon(OC)and total nitrogen(TN)content in the POM fraction,but join addition of both significantly increased OC and TN regardless of soil depth.Importantly,all three macrofauna treatments increased the OC and TN content and decreased the^(13)C abundance in the MAOM fraction.More than65%of the total variations in the distribution of OC and TN throughout the two fractions can be explained by a combination of soil physicochemical and microbial properties.Changes in the OC distribution in the 0–5 cm soi layer are likely due to a decrease in soil pH and an increase in arbuscular mycorrhizal fungi(AMF),while those in the 5–10 cm layer are probably caused by increases in soil exchangeable Ca and Mg,in addition to fungi and gram-negative(GN)bacteria.The observed TN distribution changes in the 0–5 cm soil likely resulted from a decrease in soil pH and increases in AMF,GN,and gram-negative(GP)bacteria,while TN distribution changes in the 5–10 cm soil could be explained by increases in exchangeable Mg and GN bacteria.Conclusions:The results indicate that the coexistence of earthworms and millipedes can accelerate the litte decomposition process and store more C in the MAOM fractions.This novel finding helps to unlock the processe by which complex SOM systems serve as C sinks in tropical forests and addresses the importance of soil mac rofauna in maintaining C-neutral atmospheric conditions under global climate change.