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Objective·To assess the levels of pregnancy-related stress, pre-pregnancy health care behaviors, and coping styles among pregnant women,analyze the influencing factors of pregnancy stress and provide insights for the management of pregnancy health in expectant mothers.Methods·A total of 265 pregnant women receiving treatment at the Obstetrics Clinic of the Affiliated Hospital of Zunyi Medical University from April to August 2022 were included as participants. General information questionnaires, pre-pregnancy health care behavior questionnaires, pregnancy stress scales and simple coping style questionnaires were utilized for data collection. After obtaining the consent of the patients, assessments on pregnancy stress levels, pre-pregnancy health care behaviors, and coping styles were conducted.Results·The overall average score for pregnancy stress among pregnant women was 1.05±0.41. Multiple linear regression analysis revealed that age, number of pregnancies, history of threatened abortion, fetal gender expectations, attending prenatal education classes or reviewing relevant manuals significantly influenced pregnancy-related stresses (P

Background Gastrointestinal dysfunction is a very common complication in peritoneal dialysis patients, which not only seriously affects the appetite and mood of patients, but also induces malnutrition, dehydration, electrolyte disorders, or systemic inflammatory reactions, and even leads to a decrease in the effectiveness of peritoneal dialysis, thus increasing the difficulty of medical treatment and lowering the patients' standard of living. Objective To analyse the clinical characteristics and influencing factors of patients with peritoneal dialysis-associated gastrointestinal dysfunction, and provide reference for the clinical diagnosis and treatment of peritoneal dialysis-associated gastrointestinal dysfunction. Methods A retrospective study was conducted to select 304 uremic patients who underwent continuous ambulatory peritoneal dialysis in the Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from 2019-09-01 to 2021-09-01. The patients were divided into the gastrointestinal dysfunction group and non-gastrointestinal dysfunction according to the combination of gastrointestinal dysfunction. General data, comorbidities, laboratory test indexes, and dialysis adequacy-related indexes of the two groups of patients were collected and compared. SPSS 23.0 software was used to statistically analyze the clinical data, the clinical characteristics of peritoneal dialysis-associated gastrointestinal dysfunction, and multivariate Logistic regression analysis was used to explore the factors influencing the occurrence of peritoneal dialysis-associated gastrointestinal dysfunction in patients with uremia. Results A total of 304 peritoneal dialysis patients were included, of which 189 (62.2%) were in the gastrointestinal dysfunction group, with the median age of 62 (52, 67) years. The differences in age, proportions of primary diabetic nephropathy and combined hypertension and coronary artery disease between the two groups were statistically significant (P

ObjectiveTo evaluate the efficacy of three screening questionnaires for COPD in the community residents of Songjiang District， Shanghai， and to provide a basis for selecting COPD screening questionnaire and process that are more suitable.MethodsCommunity residents aged 40 years or over were randomly selected from the Shanghai Suburban Adult Cohort and Biobank for the study with screening questionnaires and spirometry. Questionnaires included the COPD screening questionnaire （COPD-SQ）， the COPD population screener （COPD-PS） and the revised COPD diagnostic questionnaire （revised-CDQ）. Evaluation of the efficacy of these questionnaires was based on the area under the receiver operating characteristic curve （AUC） of the subjects. DeLong test was used to compare the accuracy of different questionnaires； Z test was used to compare the accuracy of different cut-off values for the same questionnaire.ResultsAmong 3 184 community residents， a total of 259 （8.1%） COPD patients were screened by spirometry. AUC values of these 3 screening questionnaires were >0.7 indicating that they were reliable COPD screening tools. The sensitivity and specificity of the questionnaires at the recommended cut-off values were COPD-SQ （63.7% and 72.2%）， COPD-PS （12.0% and 96.1%）， and revised CDQ （78.8% and 52.7%）， with the COPD-SQ having the highest screening accuracy （AUC=0.754）. The optimal and recommended cut-off values for the three questionnaires differed in this population， but the difference in accuracy was statistically significant only for COPD-PS. The optimal cut-off values for the three questionnaires differed between male and female， and the sensitivity and accuracy of COPD-SQ and COPD-PS improved when lower cut-off values were used for women. The AUC was greater when two questionnaires were utilized simultaneously for screening， but the differences were not statistically significant.ConclusionThe COPD-SQ is recommended for primary COPD screening； a lower cut-off value for women should be considered. The COPD screening questionnaire needs to be further improved for the early diagnosis and treatment of COPD patients.

Abstract Immune thrombocytopenia (ITP), an acquired autoimmune disease, is characterized by immune-mediated platelet destruction. A biomarker is a biological entity that contributes to disease pathogenesis and reflects disease activity. Metabolic alterations are reported to be associated with the occurrence of various diseases. As metabolic biomarkers for ITP have not been identified. This study aimed to identify metabolism-related differentially expressed genes as potential biomarkers for pathogenesis of ITP using bioinformatic analyses.The microarray expression data of the peripheral blood mononuclear cells were downloaded from the Gene Expression Omnibus database (GSE112278 download link: https://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=GSE112278 ). Key module genes were intersected with metabolism-related genes to obtain the metabolism-related key candidate genes. The hub genes were screened based on the degree function in the coytoscape sofware. The key ITP-related genes were subjected to functional enrichment analysis. Immune infiltration analysis was performed using a single-sample gene set enrichment analysis algorithm to evaluate the differential infiltration levels of immune cell types between ITP patient and control. Molecular subtypes were identified based on the expression of hub genes. The expression of hub genes in the ITP patients was validated using quantitative real-time polymerase chain reaction analysis. This study identified five hub genes (ADH4, CYP7A1, CYP1A2, CYP8B1, and NR1H4), which were be associated with the pathogenesis of ITP, and two molecular subtypes of ITP. Among these hub genes, CYP7A1 and CYP8B1 involved in cholesterol metabolism,were further verified in clinical samples.

Objective To study the effects of berberine on inflammatory factor levels and glucose and lipid metabolism in type 2 diabetes mellitus (T2DM) rats based on phosphatidylinositol-3-kinase (PI3K)/protein kinase B (Akt) pathway. Methods Forty SPF grade SD male rats were selected, of which 10 rats were randomly selected as normal group, and the other 30 rats were constructed as T2DM model rats ［divided into model group (10 rats), metformin positive control group (10 rats) and berberine group (10 rats) randomly］. The levels of inflammatory factors ［tumor necrosis factor-α (TNF-α)、 C-reactive protein (CRP), interleukin-1β (IL-1β)］, lipid metabolism indexes ［low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), total cholesterol (TC), free fatty acid (FFA)］, and glucose metabolism indexes [fasting insulin (FINS), fasting blood glucose (FBG), insulin resistance index (HOMA-IR)]. The expressions of PI3K, Akt and p-PI3Kp85 proteins in pancreatic tissue were detected. Results The levels of serum glucose metabolism indexes (FBG, FINS, HOMA-IR), lipid metabolism indexes (TC, TG, LDL-C, FFA) and inflammatory factors (TNF-α, CRP, IL-1β) in the three T2DM model groups were higher than those in the normal group (P

Objective: To explore the differential expression profiles of DNA methylation sites/regions and potential molecular mechanisms in the peripheral blood of coronary heart disease (CHD)-induced unstable angina pectoris patients with or without Qi deficiency and blood stasis syndrome, and to provide scientific evidence for the conbination of disease and syndrome. Methods: According to the pre-determined inclusion and exclusion criteria, the study subjects were enrolled and divided into two groups namely CHD-induced unstable angina group (G group) and healthy control group (J group) to conduct “disease” analysis, while G group was further divided into Qi deficiency and blood stasis syndrome group (case group) and non-Qi deficiency blood stasis syndrome group (control group) to perform “syndrome” analysis. The general data and clinical information of the study subjects were collected. The peripheral venous blood was extracted on an empty stomach, and the Illumina Infinium MethylationEPIC BeadChip (850K methylation chip) was used to detect the differential expression profiles of DNA methylation in each group, ChAMP software (V 2.14.0) was used for the differential methylation data analysis, with a threshold of the adjusted P value (adj.P.val) < 0.01. Gene Ontology (GO) and Kyoto Encyclopedia of Genomes (KEGG) were employed for the functional and pathway enrichment analyses of related mapped genes. Results: A total of 263 differentially methylated CpG positions (DMPs) were screened out between G and J groups, including 191 hypermethylated positions such as cg05845204 and cg08906898, and 72 hypomethylated positions such as cg26919182 and cg13149459. These positions were mainly mapped to 148 genes encompassing RNA binding motif protein 39 (RBM39), acetyl-CoA acyltransferase 2 (ACAA2), protein phosphatase 1 regulatory subunit 12B (PPP1R12B), and the dual-specificity tyrosine phosphorylation-regulated kinase 2 (DYRK2). GO functional enrichment analysis revealed that the genes of the DMPs were primarily enriched in protein localization to chromosomes, regulation of cell morphogenesis, negative regulation of calcium-mediated signals, etc. KEGG pathway analysis suggested that the genes were mainly enriched in fatty acid metabolism and endocytosis pathways. In addition, a total of 23 differential methylation regions (DMRs) were identified, with overlapping genes such as transmembrane protein 232 (TMEM232), ribosomal protein large P1 (RPLP1), peroxisomal biogenesis factor 10 (PEX10), and forkhead box N3 (FOXN3) recognized. It was found that GO functions were mainly enriched in the negative regulation of Ras protein signal transduction, small GTPase-mediated signal transduction, negative regulation, etc. A total of 1 703 differential methylation sites were screened out between case and control groups, including 444 increased methylation positions such as cg05573767 and 1 259 decreased methylationpositions such as cg19938535, and cg03893872. These positions were mapped to 1108 genes such as ribosomal protein S6 kinase A2 (RPS6KA2), leucine rich repeat containing 16A (LRRC16A), and hedgehog acyltransferase (HHAT). According to the GO functional enrichment analysis, the genes relating to the DMPs were mainly enriched in biological functions such as transmembrane receptor protein serine/threonine kinase signaling pathway and axonogenesis. The KEGG pathway enrichment analysis suggested the involvement of Rap1 signaling pathway, adenosine 5’-monophosphate-activated protein kinase (AMPK) signaling pathway, etc. A total of 21 DMRs were identified, including 22 overlapping genes such as mucin 4 (MUC4), three prime repair exonuclease 1 (TREX1), and LIM homeobox 6 (LHX6). GO analysis demonstrated that the genes primarily participated in molecular functions such as positive regulation of transmembrane transport, regulation of fatty acid metabolism, and copper ion binding. Conclusion: This study reveals the methylation patterns of DMPs and DMRs in patients with Qi deficiency and blood stasis syndrome caused by CHD-induced unstable angina pectoris. Potential epigenetic regulation of fatty acid metabolism, Rap1 signaling, and other molecular functions are involved in the development of CHD between the ''disease'' and ''syndrome''.

To tackle the challenge of localization failure due to traveling wave dispersion during a mid-line fault in a long high-voltage cable, this study conducts an in-depth analysis of the refraction characteristics of the cumulative three-phase sheath currents at cross commutation points and direct grounding points, facilitated by detailed theoretical derivation. We introduce the novel concept of a 'first traveling wave attenuation index,' which quantifies the peak of the initial faulted traveling wave. We strategically place distributed traveling wave detection devices solely in the first direct grounding box of each cross-interconnected main section, effectively segmenting the line into five distinct zones. These zones are identified based on the unique transient polarities exhibited by the first traveling wave of fault current at each impedance mismatch point along the cable. To overcome the issue of weak traveling wave signals collected at the first end measurement point, we propose an innovative peak detection method for the first wave. This method harnesses the power of empirical wavelet transform (EWT) and multi-resolution singular value decomposition (MRSVD), providing a significant boost in ranging accuracy compared to traditional wavelet methods. Simulation results validate the efficacy of our proposed fault location method, which accurately pinpoints the fault section by contrasting the polarity of the first wave peak of the sheath current detected at each measurement point. Notably, our method ensures safety and convenience as the equipment does not require direct contact with high voltage.

ObjectiveTo investigate the prevalence of overweight， obesity and fatty liver disease （FLD） in adult residents in a suburban area of Shanghai， and to explore the relationship between these conditions and eating out of home （EOH）.MethodsAdult residents from Zhongshan Street， Songjiang， Shanghai， were invited to report their frequency of EOH and undergo a physical examination using B-ultrasonography from May to September 2017. Binary logistic regression analyses were conducted to examine the relationship between EOH and conditions of overweight， obesity， and FLD.ResultsAmong the final sample size of 6 608 participants， the prevalence rates of overweight， obesity， and FLD were 41.65%， 14.71% and 38.29%， respectively. After adjusting for potential confounders， logistic analyses revealed that participants with an EOH frequency > once/week had a 1.44-fold higher prevalence of obesity （P=0.006）， a 1.35-fold higher prevalence of overweight/obesity （P=0.005）， and a 1.36-fold higher prevalence of FLD （P=0.008）.ConclusionThe prevalence of overweight， obesity， and FLD is relatively high in Songjiang， Shanghai. EOH may be a risk factor for these diseases， and residents are recommended to reduce the frequency of EOH.

Online adaptive radiotherapy(OART)is considered to be a revolutionary technology after intensity-modulated radiotherapy. The first Chinese OART platform based on iterative cone beam computed tomography (iCBCT)has been applied in clinical treatment in Peking Union Medical College Hospital. This article reports the workflow and efficacy of first case with cervical cancer who received radical OART. After treatment, the patient achieved clinical complete remission with only a grade 1 radiation toxicity in the lower gastrointestinal tract. This article analyzes and discusses the clinical treatment process and follow-up data of this patient, aiming to provide clinical evidence for the subsequent large-scale application of artificial intelligence-driven iCBCT-guided OART technology.

Objective To explore the effect of magnetic resonance imaging （MRI） and contrast enhanced ultrasound （CEUS） in the grading diagnosis of glioma. MethodsA retrospective analysis was performed on the patients without glioma （control group, n=94） and with glioma （observation group, n=96） treated in No. 215 Hospital of Shaanxi Nuclear Industry from April 2017 to April 2022. All patients received CEUS and MRI examinations before surgery. Time to peak （TTP）, mean transit time （mTT）, pure water diffusion coefficient （D）, perfusion fraction （f） and quantitative indicators were compared between two groups. During six months after operation, 29 cases of residual tumor were found by histopathology examination. ResultsIn observation group, TTP, D, f were statistically higher than those in control group, mTT was lower than that in control group （P ＜ 0.05）. Compared with those in the patients with low-grade tumor, TTP, D and f increased significantly, and mTT decreased in the patients with high-grade tumor （P ＜ 0.05）. ROC curve analysis showed that the AUCs of TTP, mTT, D, f and joint prediction for glioma grading were 0.849, 0.839, 0.914, 0.893 and 0.971, respectively. ConclusionCEUS combined with MRI has a higher efficiency in predicting the grade of glioma and postoperative residual tumors, which can provide a scientific basis for prognosis evaluation.

To analyze the value of real-time shear wave elastography (SWE) multi-point measurement in the evaluation of muscle elasticity in patients with end-stage renal disease (ESRD) complicated with sarcopenia.

ObjectiveTo compare the efficacy between the Mycob.T scanner system and manual microscopy for detecting acid-fast bacilli in sputum specimens.MethodsBetween January and November 2020， a total of 1 519 sputum samples from suspected primary tuberculosis patients from 5 designated tuberculosis hospitals in Shanghai were examined by Smear and BACTEC MGIT 960 liquid culture （liquid culture） methods. Each specimen was subiected to 2 direct smear slides. One slide was stained by Z-N method and examined with manual microscopic method. Another slide was stained and scanned by the Mycob.T system. The efficacy of manual microscopy and the Mycob.T scanner system for detecting acid-fast bacilli in sputum specimens was compared based on the result of liquid culture. Results of the repetitive scanning by the Mycob.T scanner system and the recheck of the manual microscopy were analyzed.ResultsThe average positive rate by the Mycob.T scanner system was 14.4% （219/1 519） while the average positive rate by manual microscopy was 16.3% （248/1 519）. No significant difference was observed （χ2=2.13， P=0.145）. Based on liquid culture confirmation results， the sensitivity of manual microscopy （60.36%） was higher than that of the Mycob.T scanner system （52.94%）， and the difference is statistically significant （χ2=4.38， P=0.036）. Both methods had high specificity （98.94%）. The concordance of the Mycob.T scanner system and manual microscopy was 95.46%， with the kappa value of 0.826. The results of repeatability test of the Mycob.T scanner system and the recheck results of the manual microscopy showed that the coincidence rate of scanning by the Mycob.T scanner system was 99.5% （436/438）， and the recheck coincidence rate by the manual microscopy was 98.6% （432/438）.ConclusionThe Mycob.T scanner system have high specificity for detecting acid-fast bacilli in sputum samples and good consistency with the results of manual microscopy. Compared with manual microscopic examination， the Mycob.T scanner system can greatly alleviate the work intensity.

Objective To investigate the effects of irisin on the depression-like behaviors in depression mice. Methods C57BL/6 mice were randomly divided into model and healthy groups. Mice in the model group were trained by open-space forced swim (OSFS) model and then were sub-divided into “model-control” and “model-irisin”. Healthy wild mice were bred normally and sub-divided into “healthy-control” and “healthy-irisin”groups. All mice in test group and in control groups were injected with 77 pmol irisin or the solvent (PBS) into both hippocampi by brain stereotactic injection, respectively. Depression-like behaviors were examined by forced swim test (FST) and tail suspension test (TST). Results Compared with the healthy ones, the model mice showed a markedly prolonged immobility time in FST(P＜0.01) and TST(P＜0.05), which indicated that the successfully established model can simulate the despair-like behaviors of patients with depression. Compared with the “model-control”, irisin can remarkably reduce the immobility time of “model-irisin” mice in FST(P＜0.001) and TST(P＜0.05). Conclusions Irisin can significantly improve the depression-like behaviors of OSFS depression mice.

ObjectiveTo understand the health-related life quality and its influencing factors in elderly community residents in Shanghai， and to provide reference for improving their life quality.MethodsDuring April to June 2021， a cross-sectional survey was conducted in five selected community health care centers， from Baoshan District， Minhang District， Songjiang District and Pudong New District of Shanghai， respectively. The elderly residents aged 65 and over who received physical examination were face-to-face interviewed using EQ-5D-5L scale. SPSS 26.0 and Stata 16 were used for statistical analysis. Binary logistic regression， multiple linear regression and Tobit regression were used to analyze influencing factors of each dimension in EQ-5D scale， EQ-VAS score and health utility value.ResultsA total of 1302 elderly residents were included in the study， and the proportions of problems in the five dimensions of EQ-5D-5L scale were pain/discomfort （13.9%）， mobility （9.1%）， daily activity （5.8%）， self-care ability （4.8%） and anxiety/depression （3.6%）， while age was a factor influencing problems in each dimension. The average score of EQ-VAS was 84.28±10.32， and the average health utility value based on Chinese population was 0.97±0.08， which was higher than the rest of the country. Tobit regression analysis showed that female （t=-3.96， P

Objective To design a safety management system for antitumor drugs, which can intercept or warn the overdose of medical orders from the prescription source, and ensure the safety of clinical application of antitumor drugs. Methods The threshold of interception and warning strategy of 88 kinds of antitumor drugs were developed, and the safety management system of antitumor drugs was established to intercept or warn the overdose orders. The interception and warning data from January 2021 to June 2021 in the safety management system of antitumor drugs were extracted and analyzed. Results A total of 665 medical orders were intercepted or warned by the safety management system of antitumor drugs, and the majority of the intercepted or warned drugs were oral tablets(74.29%). The intercepted orders were 642 (96.54%), and the warned orders were 23(3.46%). Among the intercepted medical orders, frequency error (64.22%) has the highest proportion, followed by route error (11.73%) and dose error (9.92%). A total of 564 medical orders were intercepted, involving 28 kinds of antitumor drugs. Methotrexate tablets ranked first in overdose quantity, with an average of seven times. Pemetrexed ranked first in overdose multiples, with an average overdose of 1000 times. 78 medical orders were intercepted for over pathway, involving 5 kinds of antitumor drugs. Conclusion The safety management system of antitumor drugs can eliminate the error of overdose in prescription and guarantee the safety of antitumor drugs.

ObjectiveTo determine the epidemiological characteristics and risk factors of hypertension in residents in Songjiang District of Shanghai， and provide evidence for prevention and control of hypertension.MethodsLocal residents aged between 20 and 74 years were recruited from four towns in Songjiang District from 2016 to 2017 by using a multistage sampling strategy. Questionnaire surveys were conducted， and then physical examination， blood pressure measurement， glucose test and lipid test were performed. The data was analyzed by SPSS 16.0 software. Chi-square test was used to compare the differences in the prevalence of hypertension in residents， stratified by demographics and health conditions. Risk factors were determined by multivariate logistic regression.ResultsAmong 35 759 residents with a median age of 58 years and the proportion of male being 40.67%， crude prevalence of hypertension was 54.24% （19 395/35 759） and standardized prevalence was 31.69%. In the hypertensive patients， proportion of hypertension awareness was 61.09%， with 63.67% in male and 59.10% in female. Proportion of receiving treatment was 49.00%， with 50.91% in male and 47.51% in female. Furthermore， in the hypertensive patients with treatment， proportion of effectively controlling hypertension was 40.50%， with 44.46% in male and 37.21% in female. Multivariate logistic regression showed that male （OR=1.272）， senior age （40‒59 years old： OR=4.353， 60‒74 years old： OR=9.802）， overweight （OR=1.823）， obesity （OR=3.070）， central obesity （OR=1.380）， diabetes （OR=1.923）， dyslipidemia （OR=1.452）， and drinking （OR=1.338） were risk factors associated with hypertension.ConclusionPrevalence of hypertension is high， while the proportions of receiving treatment and effective control remain low in residents in Songjiang District. It warrants strengthening prevention and control of hypertension in targeted and young residents.

Hyperglycemia can exacerbate cerebral ischemia/reperfusion (I/R) injury, and the mechanism involves oxidative stress, apoptosis, autophagy and mitochondrial function. Our previous research showed that selenium (Se) could alleviate this injury. The aim of this study was to examine how selenium alleviates hyperglycemia-mediated exacerbation of cerebral I/R injury by regulating ferroptosis. Middle cerebral artery occlusion (MCAO) and reperfusion models were established in rats under hyperglycemic conditions. An in vitro model of hyperglycemic cerebral I/R injury was created with oxygen-glucose deprivation and reoxygenation (OGD/R) and high glucose was employed. The results showed that hyperglycemia exacerbated cerebral I/R injury, and sodium selenite pretreatment decreased infarct volume, edema and neuronal damage in the cortical penumbra. Moreover, sodium selenite pretreatment increased the survival rate of HT22 cells under OGD/R and high glucose conditions. Pretreatment with sodium selenite reduced the hyperglycemia mediated enhancement of ferroptosis. Furthermore, we observed that pretreatment with sodium selenite increased YAP and TAZ levels in the cytoplasm while decreasing YAP and TAZ levels in the nucleus. The Hippo pathway inhibitor XMU-MP-1 eliminated the inhibitory effect of sodium selenite on ferroptosis. The findings suggest that pretreatment with sodium selenite can regulate ferroptosis by activating the Hippo pathway, and minimize hyperglycemia-mediated exacerbation of cerebral I/R injury.

Radiotherapy-associated secondary cancer is an important issue for the treatment of breast cancer (BCa). This study aimed to investigate the molecular mechanism and genetic risk factors for radiation-associated secondary diseases in BCa.

BackgroundPhysical activity during pregnancy has recently been considered as an essential part of reproductive health, and pregnant women are encouraged to adopt an active lifestyle instead of traditionally restricting their activities. Studies from abroad have shown that pregnancy physical activity gradually decreases with the progress of pregnancy. Domestic studies on the patterns and changes of pregnancy physical activity are still insufficient.ObjectiveTo explore the pattern of physical activity in the first, second and third trimesters of pregnancy, and its change trajectory, providing a reference for the formulation of targeted interventions.MethodsConvenience sampling was used to select low-risk pregnant women from Obstetric Clinic, Jiangmen Wuyi Hospital of Traditional Chinese Medicine from May 2017 to May 2018. All had a health file created at 6-13+6 weeks' gestation at the first antenatal examination. A self-developed questionnaire was used to collect general demographic data. The Chinese version of the Pregnancy Physical Activity Questionnaire was used to investigate physical activity in the first, second and third trimesters of pregnancy. Patterns and changes of physical activity were analyzed by the stage of pregnancy.ResultsAmong the 312 participants, except for 48 excluded cases and 15 dropouts, the other 249 who completed the survey were finally included. The average weekly metabolic equivalent of task (MET) values for the respondents in the first, second and third trimesters of pregnancy were 201.7, 188.6, and 177.2 MET-hours, respectively. Sedentary activity, light-intensive activity, moderate-intensive activity, and vigorous-intensive activity accounted for 17%, 60%, 21.2%-24.4%, and less than 1% of the energy expenditure attributable to total activity, respectively. In terms of activity type, household/caregiving, occupational, transportation and sports/exercise accounted for 48%, 40%, 9%, and less than 3% of the energy expenditure attributable to total activity, respectively. The differences in MET values of sedentary activity, light-intensive activity, moderate-intensive activity, and vigorous-intensive activity, household activity, sports/exercise, and total activity across three stages of pregnancy were statistically significant (P

The clinical medical postdoctoral project is a complex elite national project of post-graduation supported by the Ministry of Human Resources and Social Security. Since the 2016 academic year, the department of internal medicine at Peking Union Medical College Hospital has launched, modified and developed this project on multiple aspects, including the stratified training mode, 360 degree evaluating system, system of evaluation and feedback for progressive training, and program of simulation. During the process of implementing this project, we continued the improving process according to the feedback from multiple aspects. In this article, we demonstrated the innovation of this project and summarized our experience during the implementing process, hopefully to provide reference for cultivating a complex medical elite with international vision.

Deoxycytidine triphosphate pyrophosphatase 1(dCTP pyrophosphatase 1, DCTPP1) is a newly discovered pyrophosphatase targeting deoxycytidine triphosphate (dCTP). It regulates cytosine metabolism by not only hydrolyzing conventional and modified dCTP, but also participating in the steady-state regulation of other pyrimidine nucleotides. In the process of tumor cells, the high expression of DCTPP1 is facilitate to stabilize the balance of deoxynucleoside triphosphate pool (dNTP pool),methylation of the genome, and maintainance of stability of the tumor cell genome. Besides, DCTPP1 promotes malignant phenotypes such as tumor cell proliferation and metastasis through different signal pathways, and it is related to tumor drug resistance and poor clinical prognosis. DCTPP1 may become a “star” target for the development of anti-tumor drugs. In-depth research on its regulatory mechanism is expected to provide a new strategy for the development of targeted inhibitors of tumor nucleotide metabolism.

Objective To isolate and identify Rhodococcus equi(R.equi) from clinical specimens for potential relationship between antibiotic sensitivity and efficacy of antibiotic chemotherapy. Methods From April 2019 to April 2020, 17 cases patients with positive isolation of R. equi were grouped as test one and and 17 cases of patients underwent empirical treatment only were collected as the control group. Results The efficacy of antibiotic chemotherapy with sensitivity test (test group) showed significantly better than that of the control group. Conclusions Rational use of antibiotics chemotherapy supported by sensitivity test can significantly improve the effect of chemotherapy.

Previous studies reported that sex and age could influence urine metabolomics, which should be considered in biomarker discovery. As a consequence, for the baseline of urine metabolomics characteristics, it becomes critical to avoid confounding effects in clinical cohort studies. In this study, we provided a comprehensive lifespan characterization of urine metabolomics in a cohort of 348 healthy children and 315 adults, aged 1 to 78 years, using liquid chromatography coupled with high resolution mass spectrometry. Our results suggest that sex-dependent urine metabolites are much greater in adults than in children. The pantothenate and CoA biosynthesis and alanine metabolism pathways were enriched in early life. Androgen and estrogen metabolism showed high activity during adolescence and youth stages. Pyrimidine metabolism was enriched in the geriatric stage. Based on the above analysis, metabolomic characteristics of each age stage were provided. This work could help us understand the baseline of urine metabolism characteristics and contribute to further studies of clinical disease biomarker discovery.

Long noncoding RNA OPA-interacting protein 5 antisense transcript 1 (OIP5-AS1) was confirmed to involve in the malignancy of breast cancer. However, whether exosomal OIP5-AS1 is implicated in trastuzumab resistance remains unclear.

Objective: To evaluate the clinical efficacy of infusion of gemcitabine (GEM) and fluorouracil (5-FU)through the celiac artery and superior mesenteric artery in the treatment of pancreatic carcinoma (PC). Methods: We analyzed 20 patients diagnosed clinically or pathologically with PC, without metastases, who had an estimated survival duration of >3 months in our department from May 2009 to December 2014. Nine patients were treated directly without surgical resection of the tumor, while the other 11 patients were treated after surgery. In all patients, the femoral artery was punctured using the Seldinger technique, and a catheter was placed in the opening of the celiac artery or the superior mesenteric artery. We administered 500 ​mg/m2 GEM and 500 ​mg/m2 5-FU. Observational data included data on clinical efficacy and survival rates during the follow-up period of 3–72 months. Results: Twenty patients were treated 85 times with transcatheter arterial infusion chemotherapy (TAI). The survival rates were 80%, 40%, 35%, 20%, 10%, and 5% at 3, 6, 12, 24, and 72 months, respectively. Conclusion: TAI chemotherapy with GEM and 5-FU may be a therapeutic option for the treatment of PC.

Promoting the social integration of ecological migrants and identifying the key constraints to their integration are significant issues for social governance and transformation. Most previous studies have not systematically analyzed the level of social integration of migrants from the perspective of spatial ternary dialectics or systematically analyzed physical, social, and spiritual spaces. Based on space production theory, this study used principal component analyses to evaluate the ternary spatial integration level of physical, social, and spiritual spaces of ecological migrants in a specific resettlement area in Yinchuan City, China, and the Tobit regression model was used to identify the key constraint factors. The results demonstrate that the overall socio-spatial integration levels of ecological migrants in Yinchuan City are lower than that of the overall migrant population nationwide, and the levels of their spatial adaptation and spatial practice integration lag behind that of spatial belonging and spatial identity integration. Meanwhile, length of residency, occupation type, monthly income, and household type have facilitating effects on the ecological migrants’ social integration, while gender, age, ethnicity, and education levels have insignificant effects. In particular, occupation type is a key factor in promoting social integration and improving employment among ecological migrants. It is concluded that upgrading production skills and raising employment for ecological migrants can foster sustainable social space production patterns, facilitate virtuous cycles, and eliminate inhibiting factors such as lagging spatial practices, regional cultural differences, and socio-spatial deprivation.

The microRNA is a kind of small non-coding RNA, which can cause target mRNA degradation or translation inhibition. Reactive oxygen species(ROS)represent the main active product of redox. It has been reported that ROS are involved in different signaling pathways to keep cell stability. The imbalance of ROS in cell is closely related to tumorigenesis. In the progress of occurrence and development of human glioma, microRNAs and ROS can affect cell proliferation, apoptosis, invasion, migration, and resistance to chemotherapy as well as radiotherapy. Therefore, to understand the mechanism of miRNA on ROS may lead to a potential strategy for glioma treatment.

The colonization of microorganisms planted on the surface of teeth and restoration materials is the main cause of oral disease and treatment failure. How to improve the antibacterial properties of dental materials is a hot topic in dentistry. Nano-sized antibacterial materials have attracted much attention. Among them, metal and metal oxide nanoparticles are prominent due to their strong and broad-spectrum antibacterial activity. Thus, in recent years, many studies have used metal and metal oxide nanoparticles to develop antimicrobial dental materials for resin restoration, root canal therapy, orthodontic treatment, and implant surface and removable denture repair and have found that the antibacterial properties of nano-sized materials are significantly enhanced. However, the mechanical properties and esthetic properties of the modified materials are affected, so it is still necessary to explore appropriate modification methods. In addition, most of the experiments are carried out in vitro, which cannot accurately simulate the oral environment. Therefore, the antibacterial effect, cytotoxicity and immune response of these materials in vivo still need further research and exploration. This paper reviewed the potential antibacterial mechanisms and the safety of those nanoparticles and their applications in dentistry.

Objective: To explore the possible preventive mechanism of Hunan expert group recommended Chinese medicine prescription of No. 2 (Pre-No. 2) against coronavirus disease 2019 (COVID-19) by network pharmacology method. Methods: The target proteins of effective components and active compounds in Pre-No. 2 were screened by searching the Tradi-tional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP). A component-target-disease interac-tion network of Pre-No. 2 was constructed by Cytoscape 3.7.2, gene ontology (GO) analysis, and Kyoto encyclopedia of genes and genomes (KEGG) analysis of target protein pathway by DAVID. Results: A total of 163 compounds and 278 target protein targets in Pre-No. 2 were collected from the TCMSP database. Kaempferol, wogonin, 7-methoxy-2-methyl isoflavone, formononetin, isorhamnetin, and licochalcone A were the most frequent targets in the regulatory network. GO enrichment analysis showed that Pre-No. 2 regulated response to virus, viral processes, humoral immune responses, defense responses to virus and viral entry into host cells. KEGG enrichment analysis showed that the formula regulated the NF-κB signaling pathway, B cell receptor signaling pathway, viral carcinogenesis, T cell signaling pathway and FcγR-mediated phagocytosis signaling pathway. Conclusions: Pre-No. 2 may play a preventive role against COVID-19 through regulation of the Toll-like signaling, T cell signaling, B cell signaling and other signaling pathways. It may re-gulate the immune system to protect against anti-influenza virus.

Objective To investigate the effect of centrifugal speed and temperature on urine proteome after acetone precipitation and the individual variation of urine proteome in normal people. Methods Human urine samples precipitated by acetone were centrifuged at different centrifugation speeds (4 000×g and 12 000×g) and temperatures (4 ℃ and 20 ℃). Urine proteins were extracted for mass spectrum analysis. The identification results of different methods were compared to determine the best conditions of urine protein centrifugation after acetone precipitation. The above methods were used to analyze the urine proteome of 36 normal people (male∶female =1∶1). Results Under the condition of low temperature and high speed (4 ℃,12 000×g), the identification effect was the best and the individual variation of the normal urine proteome was 0.635. Conclusions After acetone precipitation, the extraction effect of urine protein at low temperature and high speed (4 ℃, 12 000×g) is good. The individual variation of urine protein is similar to that of plasma proteome, which can be used for large-scale clinical analysis because of stability.

Objective: Natural language processing (NLP) was used to excavate and visualize the core content of syndrome element syndrome differentiation (SESD). Methods: The first step was to build a text mining and analysis environment based on Python language, and built a corpus based on the core chapters of SESD. The second step was to digitalize the corpus. The main steps included word segmentation, information cleaning and merging, document-entry matrix, dictionary compilation and information conversion. The third step was to mine and display the internal information of SESD corpus by means of word cloud, keyword extraction and visualization. Results: NLP played a positive role in computer recognition and comprehension of SESD. Different chapters had different keywords and weights. Deficiency syndrome elements were an important component of SESD, such as “Qi deficiency” “Yang deficiency” and “Yin deficiency”. The important syndrome elements of substantiality included “Blood stasis” “Qi stagnation”, etc. Core syndrome elements were closely related. Conclusions: Syndrome differentiation and treatment was the core of SESD. Using NLP to excavate syndromes differentiation could help reveal the internal relationship between syndromes differentiation and provide basis for artificial intelligence to learn syndromes differentiation. Keywords: Syndrome element syndrome differentiation (SESD), Natural language processing (NLP), Diagnostics of TCM, Artificial intelligence, Text mining

Objective: To investigate the potential molecular mechanism of Xin Hui Tong Formula (XHTF) in the treatment of coronary heart disease (CHD) by using network pharmacology and bioinformatics. Methods: The targets network of CHD was constructed through Therapeutic Targets Database (TTD) and Drugbank database; The XHTF pharmacodynamic molecule-targets network and the XHTF pharmacodynamic molecule-CHD targets network were explored by the traditional Chinese medicine systems pharmacology database and analysis platform (TCMSP). And the multi-targets mechanism and molecular regulation network of XHTF in the treatment of CHD were explored from multiple perspectives by Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) database pathway enrichment analysis. Results: A total of 88 CHD targets were screened out through the Therapeutic Targets and the Drugbank database. 393 compounds and corresponding 205 drug targets of XHTF were retrieved from TCMSP. A total of 13 known targets directly related to the development of CHD were retrieved from the disease-related databases: TP53, MAPK14, NFKB1, HSPA5, PLG, PTGS2, ADRB1, NOS2, CYP3A4, GRIA2, CYP2A6, GRIA1, PTGS1. XHTF also contained 118 drug targets that directly interact with CHD targets. GO enrichment analysis showed that the biological processes of 13 direct targets proteins were found to be mainly enriched in response to drug, cellular response to biotic stimulus, long-chain fatty acid metabolic process, fatty acid metabolic process and regulation of blood pressure. KEGG pathway enrichment analysis found that XHTF participated in the CHD pathological process mainly through retrograde endocannabinoid signaling, regulation of lipolysis in adipocytes, cAMP signaling pathway, chemical carcinogenesis and other pathways. Conclusions: XHTF plays a role in the treatment of CHD through multiple targets and multiple pathways, and provides a scientific basis for the theory of “virtual standard” in the treatment of CHD. Keywords: Xin Hui Tong Formula (XHTF), Coronary heart disease, Network pharmacology, Network analysis, Bioinformatics

The glycan profile is a critical quality attribute for pharmaceutical monoclonal antibodies due to the potential physiological impact of the glycan composition when used as a drug product. Monoclonal antibody reference standards are useful as system suitability samples for glycan profile testing. The development of future glycan profiling techniques could be better evaluated by testing well-characterized reference standards. The USP has introduced monoclonal antibody reference standards (i.e., USP mAb 001 RS, USP mAb 002 RS, and USP mAb 003 RS) with the glycan profiles reported herein that can be used to assess the analytical testing of monoclonal antibody glycan profiles. Comparison of the USP reference standards to other available reference standards (NISTmAb) is presented. The glycan profile of the USP monoclonal antibody reference standards covers a range of glycan species that complements other available reference standards. The USP mAb reference standards are a valuable tool that can be used to verify the glycan structure and provide the system suitability of analytical methods.

Objective To investigate the effect and potential molecular mechanisms of isorhamnetin (ISO) extracted from Ginkgo biloba on the differentiation of osteoclasts. Methods Osteoclast precursor RAW264.7 cells were induced with RANKL to differentiate into mature osteoclasts. Different concentrations of ISO were added to RAW264.7 cells to determine its effect on osteoclast differentiation. CCK8 was used to evaluate the effect of ISO on cytotoxicity. The im⁃ pact of ISO on the osteoclast differentiation process was investigated by analyzing tartrate resistance and bone resorption lacuna. Real⁃time PCR was performed to analyze the levels of differentiation marker genes, including tartrate resistant acid phosphatase (Trap), cathepsin K (Ctsk), and matrix metalloproteinase 9 (MMP⁃9); differentiation⁃related transcription factors, including the proto⁃oncogene protein c⁃Fos, nuclear factor of activated T⁃cells cytoplasmic 1(NFATc1); and the levels of downstream NF⁃κB p65 signaling pathway phosphorylation. Using the above⁃described method, we verified that ISO exerted an inhibitory effect on osteoclast differentiation and explored related molecular mechanisms. Results Dif⁃ ferent concentrations of ISO (1⁃10 μM) had no cytotoxic effects on RAW264.7 cells, inhibited TRAP activity and decreased the number of bone resorption lacuna during osteoclast differentiation. When applied at a concentration of 10 μM, its inhibitory effect was significant. In addition, ISO significantly reduced the expression levels of Trap, Ctsk, MMP⁃9, c⁃Fos, NFATc1 and NF⁃ κB p65 mRNA. Conclusion ISO extracted from Ginkgo biloba extract exerted an inhibitory effect on osteoclast differentiation, and the mechanism underlying its activity may involve the inhibition of the classical NF⁃κB pathway.

Objective To investigate the association between interleukin⁃6 ⁃572 gene polymorphism and aggressive periodontitis. Methods A case⁃control study involved 83 patients with aggressive periodontitis (AgP) and 69 health con⁃ trols was held, and the genotype and allele distributions of interleukin⁃6 ⁃572 gene polymorphism were analyzed by PCR⁃ RFLP. Results There was statistically significant differences in the genotype distribution by the chi⁃square test in the two groups (c2 = 13.710, P＝0.001). The distribution of allele frequencies in AgP group was statistically different (c2 ＝ 13.213, P < 0.001) from the healthy control group, and the OR for the G allele is 2.988 (95%CI: 1.634⁃5.465) when com⁃ pared with the C allele. Conclusion IL⁃6 ⁃572 gene polymorphism is associated with the susceptibility to AgP in Chi⁃ nese Han population of Guangdong, and the IL⁃6 ⁃572 G allele might be a risk factor of the genetic susceptibility to AgP.

Abstract The chloroplast genome originated from photosynthetic organisms and has retained the core genes that mainly encode components of photosynthesis. However, the causes of variations in chloroplast genome size in seed plants have only been thoroughly analyzed within small subsets of spermatophytes. In this study, we conducted the first comparative analysis on a large scale to examine the relationship between sequence characteristics and genome size in 272 seed plants based on cross-species and phylogenetic signal analysis. Our results showed that inverted repeat regions, large or small single copies, intergenic regions, and gene number can be attributed to the variations in chloroplast genome size among closely related species. However, chloroplast gene length underwent evolution affecting chloroplast genome size in seed plants irrespective of whether phylogenetic information was incorporated. Among chloroplast genes, atpA, accD and ycf1 account for 13% of the variation in genome size, and the average Ka/Ks values of homologous pairs of the three genes are larger than 1. The relationship between chloroplast genome size and gene length might be affected by selection during the evolution of spermatophytes. The variation in chloroplast genome size may influence energy generation and ecological strategy in seed plants.

Children’s fear and anxiety and dental behavioral management problems are relatively usual in dental settings, and it is a barrier to dental care. Many factors associated with these problems will be reviewed from the aspects of doctor, patient and guardian, in order to reduce the incidence of dental fear and anxiety/dental behavioral management problem in dental departments.

Deer antler, as the only mammalian regenerative appendage, provides an optimal model to study regenerative medicine. Antler harvested from red deer or sika deer were mainly study objects used to disclose the mechanism underlying antler regeneration over past decades. A previous study used proteomic technology to reveal the signaling pathways of antler stem cell derived from red deer. Moreover, transcriptome of antler tip from sika deer provide us with the essential genes, which regulated antler development and regeneration. However, antler comparison between red deer and sika deer has not been well studied. In our current study, proteomics were employed to analyze the biological difference of antler regeneration between sika deer and red deer. The proteomics profile was completed by searching the UniProt database, and differentially expressed proteins were identified by bioinformatic software. Thirty-six proteins were highly expressed in red deer antler, while 144 proteins were abundant in sika deer. GO and KEGG analysis revealed that differentially expressed proteins participated in the regulation of several pathways including oxidative phosphorylation, ribosome, extracellular matrix interaction, and PI3K-Akt pathway.

White adipose tissue (WAT) plays a significant role in energy metabolism and the obesity epidemic. In this study, we sought to (1) profile the mouse WAT proteome with advanced 2DLC/MS/MS approach, (2) provide insight into WAT function based on protein functional annotation, and (3) predict potentially secreted proteins. A label-free 2DLC/MS/MS proteomic approach was used to identify the WAT proteome from female mouse WAT. A total of 6,039 proteins in WAT were identified, among which 5,160 were quantified (spanning a magnitude of 106) using an intensity-based absolute quantification algorithm, and 3,117 proteins were reported by proteomics technology for the first time in WAT. To comprehensively analyze the function of WAT, the proteins were divided into three quantiles based on abundance and we found that proteins of different abundance performed different functions. High-abundance proteins (the top 90%, 1,219 proteins) were involved in energy metabolism; middle-abundance proteins (90–99%, 2,273 proteins) were involved in the regulation of protein synthesis; and low-abundance proteins (99–100%, 1,668 proteins) were associated with lipid metabolism and WAT beiging. Furthermore, 800 proteins were predicted by SignalP4.0 to have signal peptides, 265 proteins had never been reported, and five have been reported as adipokines. The above results provide a large dataset of the normal mouse WAT proteome, which might be useful for WAT function research.

Objective. In our previous study, we found that some miRNAs were deregulated in hepatocellular carcinoma (HCC), including miR-183. However, the expression of miR-183 in the progression of benign liver diseases to HCC and its correlation with clinicopathologic factors remain undefined. Methods. MiR-183 expression was measured in normal controls (NC) (n=21), chronic viral hepatitis B or C (CH) tissues (n=10), liver cirrhosis (LC) tissues (n=18), HCC tissues (n=92), and adjacent nontumor tissues (NT) (n=92) by quantitative real-time reverse-transcription polymerase chain reaction (qRT-PCR). Results. The expression levels of miR-183 were significantly higher in HCC than in NT, LC, CH, and NL (P=0.001, P

Isoniazid (INH) and Rifampicin (RFP) are widely used in the world for the treatment of tuberculosis, but the hepatotoxicity is a major concern during clinical therapy. Previous studies showed that these drugs induced oxidative stress in liver, and several antioxidants abated this effect. Metallothionein (MT), a member of cysteine-rich protein, has been proposed as a potent antioxidant. This study attempts to determine whether endogenous expression of MT protects against INH and RFP-induced hepatic oxidative stress in mice. Wild type (MT+/+) and MT-null (MT-/-) mice were treated intragastrically with INH (150 mg/kg), RFP (300 mg/kg), or the combination (150 mg/kg INH +300 mg/kg RFP) for 21 days. The results showed that MT-/- mice were more sensitive than MT+/+ mice to INH and RFP-induced hepatic injuries as evidenced by hepatic histopathological alterations, increased serum AST levels and liver index, and hepatic oxidative stress as evidenced by the increase of MDA production and the change of liver antioxidant status. Furthermore, INH increased the protein expression of hepatic CYP2E1 and INH/RFP (alone or in combination) decreased the expression of hepatic CYP1A2. These findings clearly demonstrate that basal MT provides protection against INH and RFP-induced toxicity in hepatocytes. The CYP2E1 and CYP1A2 were involved in the pathogenesis of INH and RFP-induced hepatotoxicity.

Abstract Background To reduce harm caused by health care is a global priority. Medical students should be able to recognize unsafe conditions, systematically report errors and near misses, investigate and improve such systems with a thorough understanding of human fallibility, and disclose errors to patients. Incorporating the knowledge of how to do this into the medical student curriculum is an urgent necessity. This paper aims to systematically review the literature about patient safety education for undergraduate medical students in terms of its content, teaching strategies, faculty availability and resources provided so as to identify evidence on how to promote patient safety in the curriculum for medical schools. This paper includes a perspective from the faculty of a medical school, a major hospital and an Evidence Based Medicine Centre in Sichuan Province, China. Methods We searched MEDLINE, ERIC, Academic Source Premier(ASP), EMBASE and three Chinese Databases (Chinese Biomedical Literature Database, CBM; China National Knowledge Infrastructure, CNKI; Wangfang Data) from 1980 to Dec. 2009. The pre-specified form of inclusion and exclusion criteria were developed for literature screening. The quality of included studies was assessed using Darcy Reed and Gemma Flores-Mateo criteria. Two reviewers selected the studies, undertook quality assessment, and data extraction independently. Differing opinions were resolved by consensus or with help from the third person. Results This was a descriptive study of a total of seven studies that met the selection criteria. There were no relevant Chinese studies to be included. Only one study included patient safety education in the medical curriculum and the remaining studies integrated patient safety into clinical rotations or medical clerkships. Seven studies were of a pre and post study design, of which there was only one controlled study. There was considerable variation in relation to contents, teaching strategies, faculty knowledge and background in patient safety, other resources and outcome evaluation in these reports. The outcomes from including patient safety in the curriculum as measured by medical students' knowledge, skills, and attitudes varied between the studies. Conclusions There are only a few relevant published studies on the inclusion of patient safety education into the undergraduate curriculum in medical schools either as a selective course, a lecture program, or by being integrated into the existing curriculum even in developed countries with advanced health and education systems. The integration of patient safety education into the existing curriculum in medical schools internationally, provides significant challenges.

ObjectiveTo establish a method using ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) for the detection of six common trichothecene toxins in oats.MethodsOats were selected as the research subject in this study. Response surface design was used to optimize the QuEChERS extraction method. Additionally, a rapid and efficient strategy for sample extraction and purification was developed. Combined with UHPLC-MS/MS, six commonly co-occurring trichothecene toxins in oats were quantitatively analyzed simultaneously.ResultsThis method demonstrated good analytical performance for each analyte across the corresponding concentration ranges (r>0.99), with accuracy ranging from 87.26% to 99.64%. The inter-day and intra-day relative standard deviations were less than 6.8% and 5.5%, respectively, indicating its potential for practical application. This method was used to detect mycotoxins in 12 oat samples from China, and it was found that one sample exceeded the standard limits for deoxynivalenol (DON), and the co-contamination of trichothecene toxin was prevalent.ConclusionThe risk posed by these toxins has been underestimated. Ongoing, extensive monitoring is necessary to provide contamination data to assess the consumer risk.