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Jinglong Chen,1,2,&ast; Changbin Jiang,1,&ast; Youlan Zheng,1,&ast; Dongxing Zhao,1,&ast; Fan Wu,1 Zhuxiang Zhao,3 Jun Zhao,2 Qing Li,2 Bing Li,4 Gongyong Peng,1 Yumin Zhou,1 Pixin Ran1 1National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People’s Republic of China; 2Department of Geriatrics, National Clinical Key Specialty, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, 510180, People’s Republic of China; 3The Pulmonary Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, People’s Republic of China; 4GMU-GIBH Joint School of Life Sciences, Guangzhou Medical University, Guangzhou, 511436, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Pixin RanNational Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People’s Republic of ChinaEmail pxran@gzhmu.edu.cnBackground and Objective: To determine the effects of BSE (biomass smoke exposure) on pulmonary and non-pulmonary changes in patients with COPD compared with normal individuals.Methods: Using a cohort, we recruited 16 healthy individuals with BSE (BSE normal), 19 patients with BSE+COPD, 13 healthy individuals with cigarette smoke exposure (CSE normal), 25 patients with CSE+COPD, and 25 healthy controls. Patients with GOLD stage I and II COPD were included. Baseline data (demographic data, BSE or CSE, lung function, and CT findings) and follow-up lung function data were collected. CT parameters of emphysema, pulmonary small vessels, airway remodeling, pectoralis muscles, and erector spinae muscle were measured.Results: Individuals with BSE were mainly women (32/35, 91.43%). Compared with the CSE+COPD group, the BSE+COPD group demonstrated slower lung function decline, increased lower lung emphysema, narrower airway lumen dimensions and increased airway wall thickening in the moderate and small airways (all P< 0.05). Compared with healthy controls, the CSE normal and BSE normal groups exhibited significant reductions in pulmonary small vessel area and obvious airway remodeling in small airways (P< 0.05). Compared with the BSE normal group, the BSE+COPD group showed significantly more severe emphysema and airway remodeling, as well as reduced left pectoralis major muscle area (all P< 0.05).Conclusion: Healthy individuals with BSE had reduced pulmonary small vessel area and evidence of airway remodeling; patients with BSE and COPD showed more severe emphysema, airway remodeling, and reductions in pectoralis major muscle area.Clinical Trial Registration: ChiCTR-OO-14004264.Keywords: biomass smoke, chronic obstructive pulmonary disease, computed tomography, pulmonary function

Qianye Zhao,1,2,&ast; Teng Zhang,2,&ast; Beibei Zhu,1 Ying Bi,3 Shi-Wen Jiang,4 Yifan Zhu,1 Deyu Zhao,1 Feng Liu1 1Department of Respiratory Medicine, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China; 2Department of Pediatrics, Lianyungang Maternal and Child Health Care Hospital, Lianyungang, Jiangsu, People’s Republic of China; 3Department of Respiratory Medicine, Xuzhou children’s Hospital, Xuzhou, Jiangsu, People’s Republic of China; 4Research Institute for Reproductive Health and Genetic Diseases, Center of Reproductive Medicine, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, Jiangsu, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Deyu Zhao; Feng LiuDepartment of Respiratory Medicine, Children’s Hospital of Nanjing Medical University, No. 72, Guangzhou Road, Gulou District, Nanjing, Jiangsu, 210008, People’s Republic of ChinaTel +86 189 5176 9559; +86 189 5176 8373Fax +86 025 83117376Email zhaodeyu988@126.com; axsliu@163.comPurpose: It is well known that age is related to the incidence of Mycoplasma pneumoniae pneumonia (MPP), and how age and other factors contribute to MPP remains unclear. In this study, we investigate how age affects the prognosis of MPP.Patients and Methods: A total number of 1875 hospitalized children with pneumonia were enrolled in this study, including 52 children with refractory M. pneumoniae pneumonia (RMPP) and 298 children with non-RMPP. We used multiple logistic regression analysis to further identify the risk factors of RMPP, and found that age and polymorphonuclear neutrophils (PMNs) count were the key independent risk factors for the occurrence of RMPP. In order to improve specificity, 4.5 years old was taken as the cut-off value. Then, according to the cut-off value of age, 76 participants were recruited and divided into four groups: < 4.5y MPP group, ≥ 4.5y MPP group, < 4.5y health control (< 4.5yHC) and ≥ 4.5y HC group. We explored the diverse functions of primary PMNs from children of different ages with MPP at cellular level. Besides, we studied the relationship between lung injury and PMNs in mice model with MPP of different ages.Results: We found that the age and PMNs count of RMPP group were significantly higher than those of the non-RMPP group. Importantly, there is a linear correlation between the age of patients with RMPP and the percentage of PMNs. Further analysis showed that elderly patients infected with M. pneumoniae had more active PMNs function. Meanwhile, proteomics showed that children with M. pneumoniae infection in different age groups have differences in PMNs apoptosis, nicotinamide adenine dinucleotide phosphate, mitochondrial function and oxidative stress. Finally, we found that age is also involved in the pathogenesis of mouse model with MPP.Conclusion: We speculate that age may contribute to the development of RMPP.Keywords: refractory Mycoplasma pneumoniae pneumonia, Mycoplasma pneumoniae, polymorphonuclear neutrophils, reactive oxygen species, neutrophil extracellular traps

Shuyun Chen,1,2,&ast; Xiaochen Li,1,3,&ast; Zihui Wang,1,&ast; Yumin Zhou,1 Dongxing Zhao,1 Zhuxiang Zhao,1,4 Sha Liu,1 Pixin Ran1 1State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, National Clinical Research Center for Respiratory Disease Guangzhou, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People’s Republic of China; 3The People’s Hospital of Hubei Province, Wuhan, Hubei Province, People’s Republic of China; 4The First People’s Hospital of Guangzhou City, Guangzhou, Guangdong Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Pixin RanState Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, National Clinical Research Center for Respiratory Disease Guangzhou, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, No. 195 Dongfeng Xi Road, Guangzhou, 510000, Guangdong Province, People’s Republic of ChinaTel +86 2083205187Email pxran@gzhmu.edu.cnPurpose: The use of simple and affordable screening tools for chronic obstructive pulmonary disease (COPD) is limited. We aimed to assess the validity of a handheld expiratory flowmeter (Vitalograph Ltd., COPD-6®, Ireland) for COPD screening in Chinese primary care settings.Methods: In our cross-sectional study, subjects were randomly selected in eight primary care settings. Tests with the handheld expiratory flowmeter and the conventional spirometry were sequentially performed on all participants. The correlation between the handheld expiratory flowmeter and the conventional spirometry was determined. Validity was determined by the area under the receiver operator characteristic curve (AUC) of the forced expiratory volume in one second (FEV1)/forced expiratory volume in six seconds (FEV6) that used to detect airway obstruction. The sensitivity, specificity, predictive values, and likelihood ratio were calculated according to different FEV1/FEV6 cut-off points.Results: A total of 229 subjects (15.4%) were diagnosed with airflow limitation by conventional spirometry. FEV1, FEV6, and FEV1/FEV6 measured by the handheld expiratory flowmeter were correlated with FEV1, FVC, and FEV1/FVC measured by the conventional spirometry (r=0.889, 0.835 and 0.647, p< 0.001), respectively. AUC of the FEV1/FEV6 to determine airflow obstruction was 0.857 (95% CI: 0.826 to 0.888). No significant difference of AUC was observed between the symptomatic group and the asymptomatic group (AUC=0.869 vs 0.843, P=0.425). A similar phenomenon was found in the AUC of smokers and never-smokers (AUC=0.862 vs 0.840; P=0.515). The cut-off point for FEV1/FEV6 was 0.77 and the corresponding sensitivity and specificity were 71.2% and 89.8%, respectively.Conclusion: The handheld expiratory flowmeter might be used as a screening device for COPD in Chinese primary care settings.Keywords: COPD screening, airflow limitation, FEV1, FEV6, lung function

Saijun Huang1,2 *,* Tao Sun1,2 *,* Yanna Zhu,3 Shanshan Song,1,2 Jie Zhang,4 Linjuan Huang,5 Qiang Chen,6 Guangyang Peng,7 Dongmei Zhao,8 Hong Yu,1,2 Jin Jing3 1Department of Child Healthcare, Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong, 528000, People’s Republic of China; 2The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, 510280, People’s Republic of China; 3Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangdong, Guangzhou, 510080, People’s Republic of China; 4Department of Child Healthcare, Xi’an Children’s Hospital, Xi’an, Shaanxi, 710003, People’s Republic of China; 5Health Management Center, Fuzhou Children’s Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, People’s Republic of China; 6Department of Child Psychological Health, Zhuhai Women and Children’s Hospital, Zhuhai, Guangdong, 519001, People’s Republic of China; 7 Department of Child Rehabilitation, Huanggang Ping’an Rehabilitation Hospital, Huanggang, Hubei, 438000, People’s Republic of China; 8Department of Child Healthcare, Jinan Children’s Hospital, Jinan, Shandong, 250022, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hong Yu; Jin Jing Email yu376@163.com; jingjin@mail.sysu.edu.cnBackground: The COVID-19 pandemic and lockdown will have short-term and long-term psychosocial and mental health implications for children. Children with autism may have some specific needs for support because of their difficulties in social communication, stereotyped behavior patterns, and other specificities brought about by autism.Purpose: The purpose of this study was to investigate the impact of the COVID-19 pandemic on ASD children and their families.Patients and Methods: A total of 406 parents of ASD children completed an online survey investigating basic information; sleep, outdoor activities, and rehabilitation training; ASD children’s frequency of abnormal behaviors; and stress and emotional status of parents.Results: 50.3% of the parents thought their children had sleep problems, and 47.3% of the parents thought their children’s outdoor activity time was reduced. About 40% of parents think that their children have improved cognitive ability, language expression, and understanding. 36.2% of the families reported that their children’s emotional and social performance became worse. 60.8% of parents reported that their children’s training intensity decreased. The most common abnormal behaviors observed in children with ASD were being easily distracted, losing temper, and crying. 81.3% of parents did not have anxiety, but 98% of parents reported that family training was under pressure.Conclusion: The main impact of the COVID-19 pandemic on children with ASD is that they do not have access to professional rehabilitation training. These families need more medical support, especially in family training, to help parents improve the social and emotional control skills of ASD children.Keywords: COVID-19, ASD, child, behavior, rehabilitation training, China

Dizhou Zhao, Jieyu Fang, Wei Xiong, Jun Lin, Wanmei Chen, Chujun Wu Department of Anesthesia, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of ChinaCorrespondence: Jieyu FangDepartment of Anesthesia, The First Affiliated Hospital of Sun Yat-Sen University, No. 56 Zhongshan Road II, Guangzhou, People’s Republic of ChinaTel + 86-13660121136Email fangjy@mail.sysu.edu.cnBackground: Sugammadex has been a revolutionary reversal of neuromuscular blockade. It is known to be highly efficient. However, a change in the coagulation profile is one of the most dangerous potential complications which is a concern for both surgeon and anesthetist. Bleeding may cause hypovolemic shock, hematoma, and so on. To investigate the effects of sugammadex on coagulation profiles in patients with thyroidectomy, we compared patients that were treated with either sugammadex or neostigmine.Patients and Methods: Eighty patients with thyroid neoplasms undergoing thyroidectomy were randomly allocated to sugammadex group (group S) or neostigmine group (group N). Induction of anesthesia was preformed using propofol, sufentanil, and rocuronium. Group S received sugammadex 2.0mg/kg after trachea intubation, similarly Group N received neostigmine 40 μg/kg, for reversal of rocuronium-induced neuromuscular blockade. The intraoperative coagulation profiles were monitored after the rocuronium injection (T0), 10 minutes after reversal (T1) and 30 minutes after reversal (T2) by testing activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (FIB), thrombin time (TT), and TEG-Haemonetics. Amount of bleeding was recorded during perioperative period.Results: There was no significant difference in the thromboelastogram, APTT, PT, FIB, or TT measurements at each time point in Group N. The reaction time (R time) and kinetics time (K time) of Group S in T1 were significantly longer than the corresponding times at T0 and T2, and the R times were significantly longer than those in Group N at the same time points (P< 0.05). Additionally, in Group S, the APTT was prolonged in T1 and returned to normal in T2.Conclusion: The result showed that sugammadex provided transient efficacy in prolonging the coagulation parameters, while neostigmine did not change the coagulation profile.Keywords: sugammadex, neostigmine, TEG-Haemonetics, coagulation, thyroidectomy

Yafeng Pan,1 Xuye Zhao,2 Dean Zhao,1 Junhua Liu1 1Department of Otolaryngology, Xiang’an Hospital of Xiamen University, Xiamen, Fujian, People’s Republic of China; 2Department of Breast and Thyroid Surgery, Xiang’an Hospital of Xiamen University, Xiamen, Fujian, People’s Republic of ChinaCorrespondence: Junhua LiuDepartment of Otolaryngology, Xiang’an Hospital of Xiamen University, Xiamen, Fujian 361101, People’s Republic of ChinaEmail xaherbihou@163.comObjective: To explore the survival value of lymph node dissection (LND) in elderly patients with T3-T4 laryngeal cancer, analyze the risk factors of lymph node metastasis, and construct a preoperative prediction model.Materials and Methods: The study included 996 patients aged ≥ 65 years with laryngectomy confirmed T3-T4 laryngeal cancer queried from Surveillance, Epidemiology and End Results (SEER) database between 2010 and 2017. Propensity score matching (PSM) was applied to balance the effects of confounding factors. Kaplan–Meier (K–M) analysis and competitive risk model were used to compare the overall survival (OS) and cancer-specific survival (CSS) between LND and no-LND (N-LND) group. Combined with risk factors of multivariate logistic regression, a nomogram was built to predict lymph node metastasis preoperatively. The performance was assessed in the training set and the validation set, and internal validation was assessed.Results: Among the cohort, 822 patients underwent LND and 410 patients had positive lymph nodes. The OS and CSS of patients who underwent LND were not better than that of N-LND patients (P> 0.05). The prognosis of patients with lymph node metastases was significantly worse than that of negative patients (P< 0.05). On multivariate logistic regression, supraglottis cancer, tumor size > 5cm and grade 3– 4 classification were associated with significantly greater odds of lymph node metastasis. The nomogram showed favorable predictive efficacy and good calibration (in the training cohort C-index=0.700; in the validation cohort C-index=0.721).Conclusion: For elderly patients with T3-T4 laryngeal cancer, LND did not bring significant survival values. Supraglottis cancer, tumor size > 5cm and grade 3– 4 classification were independent risk factors of lymph node metastasis, which means poor prognosis. The nomogram developed was an easy-to-use tool for lymph node prediction.Keywords: elderly, T3-T4 laryngeal cancer, lymph node dissection, survival, nomogram

Dahai Zhao,1,2,* Haijiang Lin,3,* Zhiruo Zhang4 1School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, People’s Republic of China; 2Shanghai Jiao Tong University-Yale University Joint Center for Health Policy, Shanghai, People’s Republic of China; 3Taizhou City Center for Disease Control and Prevention, Taizhou, Zhejiang Province, People’s Republic of China; 4School of Public Health, Shanghai Jiao Tong University, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Dahai ZhaoSchool of International and Public Affairs, Shanghai Jiao Tong University, Xinjian Building, No. 1954 Huashan Road, Shanghai 200030, People’s Republic of ChinaTel +86-139-1896-8766Email dahaizhao@sjtu.edu.cnIntroduction: In less than two months, the COVID-19 outbreak in China was controlled through the stringent strategies of screening and isolation. This article aims to use empirical data from all cases from a prefecture-level city of China to introduce and examine the feasibility and efficiency of the screening and isolation strategies and how these were essential in combatting the COVID-19 outbreak.Methods: For this retrospective study, all confirmed COVID-19 patients were recruited from the Taizhou prefecture-level city of Zhejiang province, China.Results: Of the city’s total population, 24% were screened for COVID-19 and isolated at home or designated locations for two weeks. From these, a total of 146 confirmed cases of COVID-19 were analysed. Of all cases, 51% were traced from Wuhan, and 21% of patients were in close contact with confirmed cases from outside of the city. Initially, 13% of all patients reported having no clear symptoms, while 42% of patients presented with fever and/or other symptoms. Compared with local patients, new arrivals to the city had fewer days between their exposure and the development of symptoms of COVID-19 (P< 0.001), and fewer days from the time they developed symptoms to the confirmation of COVID-19 (P< 0.001), respectively.Conclusion: This study has fully confirmed that controlling the COVID-19 outbreak through screening and isolation is effective, efficient, and essential. The evidence-based framework and implementation of China’s strategy to combat COVID-19 can explain how China contained the COVID-19 outbreak in a short time period. This study offers important references and implications for containing the COVID-19 pandemic in the global community.Keywords: COVID-19, pandemic control, screening, isolation, China

Yun-jing Hou,1 Xin-xin Yang,1 Rui-qi Liu,2 Di Zhao,1 Chen-xu Guo,1 An-chao Zhu,1 Mei-na Wen,1 Zhao Liu,3 Guo-fan Qu,4 Hong-xue Meng1 1Department of Pathology, Harbin Medical University Cancer Hospital, Harbin, People’s Republic of China; 2Department of Radiation Oncology, Sun Yat-Sen University Cancer Hospital, Guangzhou, People’s Republic of China; 3Department of Ultrasound, Harbin Medical University, Harbin, People’s Republic of China; 4Department of Orthopedics, Harbin Medical University Cancer Hospital, Harbin, People’s Republic of ChinaCorrespondence: Hong-xue Meng Department of PathologyHarbin Medical University Cancer Hospital, 150 Haping Road, Harbin, People’s Republic of ChinaTel +86-451-85718261Email menghongxue15@163.comAbstract: The ultimate goal of phototherapy based on nanoparticles, such as photothermal therapy (PTT) which generates heat and photodynamic therapy (PDT) which not only generates reactive oxygen species (ROS) but also induces a variety of anti-tumor immunity, is to kill tumors. In addition, due to strong efficacy in clinical treatment with minimal invasion and negligible side effects, it has received extensive attention and research in recent years. In this paper, the generations of nanomaterials in PTT and PDT are described separately. In clinical application, according to the different combination pathway of nanoparticles, it can be used to treat different diseases such as tumors, melanoma, rheumatoid and so on. In this paper, the mechanism of pathological treatment is described in detail in terms of inducing apoptosis of cancer cells by ROS produced by PDT, immunogenic cell death to provoke the maturation of dendritic cells, which in turn activate production of CD4+ T cells, CD8+T cells and memory T cells, as well as inhibiting heat shock protein (HSPs), STAT3 signal pathway and so on.Keywords: pathological mechanism, nanoparticles, photothermal therapy, PTT, photodynamic therapy, PDT

Dongxing Zhao1,2 ,* Asghar Abbasi2 ,* Harry B Rossiter,2,3 Xiaofen Su,1 Heng Liu,1 Yuhong Pi,1 Li Sang,1 Weiyong Zhong,1 Qifeng Yang,1 Xiongtian Guo,1 Yanyan Zhou,1 Tianyang Li,1 Richard Casaburi,2 Nuofu Zhang1 1State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, People’s Republic of China; 2Rehabilitation Clinical Trials Center, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA; 3Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK*These authors contributed equally to this workCorrespondence: Nuofu ZhangState Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, People’s Republic of ChinaEmail nfzhanggird@163.comBackground: We sought to determine whether circulating inflammatory biomarkers were associated with the frequent exacerbator phenotype in stable COPD patients ie, those with two or more exacerbations in the previous year.Methods: Eighty-eight stable, severe, COPD patients (4 females) were assessed for exacerbation frequency, pulmonary function, fraction of expired nitric oxide (FENO); inflammatory variables were measured in venous blood. Logistic regression assessed associations between the frequent exacerbator phenotype and systemic inflammation.Results: Compared with infrequent exacerbators, frequent exacerbators (n=10; 11.4%) had greater serum concentration (median (25th-75th quartile)) of serum amyloid A (SAA; 134 (84– 178) vs 71 (38– 116) ng/mL; P=0.024), surfactant protein D (SP-D; 15.6 (9.0– 19.3) vs 8.5 (3.6– 14.9) ng/mL; P=0.049) and interleukin-4 (IL-4; 0.12 (0.08– 1.44) vs 0.03 (0.01– 0.10) pg/mL; P=0.001). SAA, SP-D and IL-4 were not significantly correlated with FEV1%predicted or FVC %predicted. After adjusting for sex, age, BMI, FEV1/FVC and smoking pack-years, only SAA remained independently associated with the frequent exacerbator phenotype (OR 1.49[1.09– 2.04]; P=0.012). The odds of being a frequent exacerbator was 18-times greater in the highest SAA quartile (≥ 124.1 ng/mL) than the lowest SAA quartile (≤ 44.1 ng/mL) (OR 18.34[1.30– 258.81]; P=0.031), and there was a significant positive trend of increasing OR with increasing SAA quartile (P=0.008). For SAA, the area under the receiver operating characteristic curve was 0.721 for identification of frequent exacerbators; an SAA cut-off of 87.0 ng/mL yielded an 80% sensitivity and 61.5% specificity.Conclusion: In stable COPD patients, SAA was independently associated with the frequent exacerbator phenotype, suggesting that SAA may be a useful serum biomarker to inform progression or management in COPD.Keywords: inflammation, surfactant protein D, interleukin-4

Weihua Hu,1,* Minglin Dong,1,* Mengqing Xiong,1,* Dong Zhao,1 Yang Zhao,1 Mengmei Wang,1 Tao Wang,1 Zhenlian Liu,2 Li Lu,3 Ke Hu1 1Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China; 2Fever Clinic, The East Campus, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China; 3Department of Respiratory Medicine, The East Campus, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ke HuDepartment of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Zhangzhidong Road No. 99, Wuhan 430060, People’s Republic of ChinaTel +86-18971035988Fax +86-027-88042292Email huke-rmhospital@163.comPurpose: In this study, we investigated the acute exacerbation and outcomes of COPD patients during the outbreak of COVID-19 and evaluated the prevalence and mortality of COPD patients with confirmed COVID-19.Methods: A prospectively recruited cohort of 489 COPD patients was retrospectively followed-up for their conditions during the COVID-19 pandemic from December 2019 to March 2020 in Hubei, China. In addition, the features of 821 discharged patients with confirmed COVID-19 were retrospectively analyzed.Results: Of the 489 followed-up enrolled COPD patients, 2 cases were diagnosed as confirmed COVID-19, and 97 cases had exacerbations, 32 cases of which were hospitalized, and 14 cases died. Compared with the 6-month follow-up results collected 1 year ago, in 307 cases of this cohort, the rates of exacerbations and hospitalization of the 489 COPD patients during the last 4 months decreased, while the mortality rate increased significantly (2.86% vs 0.65%, p=0.023). Of the 821 patients with COVID-19, 37 cases (4.5%) had pre-existing COPD. Of 180 confirmed deaths, 19 cases (10.6%) were combined with COPD. Compared to COVID-19 deaths without COPD, COVID-19 deaths with COPD had higher rates of coronary artery disease and/or cerebrovascular diseases. Old age, low BMI and low parameters of lung function were risk factors of all-cause mortality for COVID-19 patients with pre-existing COPD.Conclusion: Our findings imply that acute exacerbations and hospitalizations of COPD patients were infrequent during the COVID-19 pandemic. However, COVID-19 patients with pre-existing COPD had a higher risk of all-cause mortality.Keywords: chronic obstructive pulmonary disease, COPD, exacerbation, mortality, novel coronavirus pneumonia, COVID-19, novel coronavirus, SARS-CoV-2

Hui Zhang,1 Yayun Zhao,1 Yahong Zheng,1 Qinxiang Kong,1,2 Na Lv,1 Yanyan Liu,1,3,4 Dongmei Zhao,5 Jiabin Li,1– 4 Ying Ye1 1Department of Infectious Disease, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China; 2Department of Infectious Diseases, The Chaohu Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China; 3Anhui Center for Surveillance of Bacterial Resistance, Hefei, Anhui, People’s Republic of China; 4Institute of Bacterial Resistance, Anhui Medical University, Hefei, Anhui, People’s Republic of China; 5Department of Infectious Disease, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of ChinaCorrespondence: Ying Ye; Jiabin Li Tel +86-551-62922713Fax +86-551-62922281Email yeying2@139.com; lijiabin@ahmu.edu.cnPurpose: This study aimed to develop and validate a personalized prediction model of death risk in patients with Acinetobacter baumannii (A. baumannii) infection and thus guide clinical research and support clinical decision-making.Patients and Methods: The development group is comprised of 350 patients with A. baumannii infection admitted between January 2013 and December 2015 in The First Affiliated Hospital of Anhui Medical University. Further, 272 patients in the validation group were admitted between January 2016 and December 2018. The univariate and multivariate logistic regression analyses were used to determine the independent risk factors for death with A. baumannii infection. The nomogram prediction model was established based on the regression coefficients. The discrimination of the proposed prediction model was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curves and decision curve analysis (DCA). The calibration diagram was used to evaluate the calibration degree of this model.Results: The infectious source, carbapenem-resistant A. baumannii (CRAB), hypoalbuminemia, Charlson comorbidity index (CCI), and mechanical ventilation (MV) were independent risk factors for death. The AUC of the ROC curve of the two groups was 0.768 and 0.792, respectively. The net income was higher when the probability was between 30% and 80%, showing a strong discrimination capacity of the proposed model. The calibration curve swung around the 45° oblique line, indicating a high degree of calibration.Conclusion: The proposed model helped predict the risk of death from A. baumannii infection, improve the early identification of patients with a higher risk of death, and guide clinical treatment.Keywords: Acinetobacter baumannii, carbapenem resistance, prediction model, risk factors

Jialin Qu *, Li Wang *, Man Jiang, Deze Zhao, Yuyang Wang, Feng Zhang, Jing Li, Xiaochun Zhang Department of Medical Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiaochun Zhang Department of Medical OncologyThe Affiliated Hospital of Qingdao University, Qingdao University, 16 Jiangsu Road, Qingdao 266003, People’s Republic of ChinaTel/ Fax +86 53282913271Email zhangxiaochun9670@126.comAbstract: Lung cancer is currently the malignant tumor with the highest incidence and mortality in the world, while non-small cell lung cancer (NSCLC) is the most common pathological type of lung caner. In the past few decades, the only treatment options available for advanced NSCLC patients have been targeted therapy or chemotherapy, but these therapies are inevitably tolerated by tumors. The discovery of immune checkpints that mediate the immune escape of tumor cells have been promoting a series of immune checkpoint inhibitors to be used in cancer treatment and achieved great results. Among them, pembrolizumab is currently the only PD-1 inhibitor approved for first-line treatment of NSCLC, whether it is monotherapy or combination therapy, for creditable performance in KEYNOTE studies. In this review, we systematically integrate the latest series of clinical trial results, pharmacological mechanisms, adverse events (AEs) and predictive biomarkers in the first-line treatment of NSCLC. We hope pembrolizumab could become a better choice for more clinicians and benefit more patients with advanced NSCLC.Keywords: pembrolizumab, PD-1/PD-L1, KEYNOTE studies, first-line treatment, non-small cell lung cancer, NSCLC

Dan Zhao, Baomin Zheng, Shaowen Xiao, Weixin Liu, Xiaolong Xu, Huiming Yu, Yan Sun, Weihu Wang Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital Institute, Beijing, People’s Republic of ChinaCorrespondence: Weihu Wang; Yan SunKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Beijing Cancer Hospital & Institute, 52# Fucheng Road, Haidian District, Beijing 100142, People’s Republic of ChinaTel/ Fax +86-10-88196120; +86-10-88196217 Email wangweihu88@163.com; lisaysun@139.comPurpose: This study aimed to retrospectively analyze the failure patterns and clinical outcomes in patients with locally advanced cervical esophageal carcinoma (CEC) after definitive radiotherapy (RT), and illustrate the mapping of regional failures.Patients and Methods: We reviewed 82 patients with CEC confirmed as squamous cell carcinoma who had completed definitive RT from August 2008 to December 2017. Data on clinical characteristics were collected from the medical records system. Patterns of treatment failures and the survival follow-up were analyzed.Results: The median age was 58 (38– 78) years. In 37 patients, the lesions were limited to the cervical esophagus, while in the remaining 45 patients, the disease got beyond the cervical esophagus (pharynx or thoracic esophagus involved). While 10 patients had stage Ⅱ disease, 72 had stage III disease. The completed median dose for 95% PGTV and 95% PTV was 66 Gy and 58 Gy. While the median follow-up was 27.6 months, the median progression-free survival (PFS) and overall survival (OS) was 16.1 and 28.3 months, respectively. The 3-year PFS and OS was 30.3% and 45.3%, respectively. Treatment failures were reported in 55 patients, of which 22, 8, 7, 9, 2, 3, and 4 patients had developed local, regional, distant, local-regional, regional-distant, local-distant and local-regional-distant failure, respectively. Of the 41 relapsed nodal sites, 28 were located “in-field” whereas 1 was “marginal” and 12 were “out-field”. The most frequent regional relapses were at level VIb, IV and the upper-middle mediastinum.Conclusion: Regional recurrences focused on lower neck and upper-middle mediastinum, and mainly “in-field”, after definitive RT in patients with CEC.Keywords: esophageal neoplasms, prognosis, radiotherapy, recurrence, squamous cell carcinoma

Jingjing Yan,1 Dahai Zhao1,2 1School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, People’s Republic of China; 2Shanghai Jiao Tong University-Yale University Joint Center for Health Policy, Shanghai, People’s Republic of ChinaCorrespondence: Dahai ZhaoSchool of International and Public Affairs, Shanghai Jiao Tong University, No. 1954 Huashan Road, Shanghai 200030, People’s Republic of ChinaTel +86 139-1896-8766Email dahaizhao@sjtu.edu.cnIntroduction: From December 2019 to January 2020, a novel coronavirus disease (officially COVID-19) was reported in Wuhan and continued to spread all China. This study describes the administrative mechanism of joint participation and cooperation during the early stages of the COVID-19 outbreak in Wuhan and the rest of the country by health practitioners and administrative authorities.Methods: This study adopted a qualitative design. An analytical framework based on the theory of policy participation that included stimulus, setting, and position of policy participation was constructed. Qualitative data of policy participation by health practitioners and administrative authorities consisted of publicly available data.Results: Early during the outbreak, from December 2019 to January 2020, three main stages occurred according to the containment situation. The first stage was characterized by limited knowledge of the transmission dynamics of the virus and a consequently weak response. In the second stage, the disease spreads rapidly because of travel during a national festival. In the third stage, particularly when top Chinese leaders delivered instructions to intensify containment efforts, diverse departments initiated joint prevention and control measures to combat COVID-19.Conclusion: The administrative mechanism of joint participation and cooperation was instrumental in avoiding a substantial increase in both cases and fatalities in the initial stage of the outbreak. This joint participation provides valuable experience and initiatives for major public health emergency preparedness, and the new empirical evidence further highlights the importance of policy participation theory in epidemic prevention in other countries.Keywords: joint administration, coronavirus disease 2019, public health emergency, policy participation

Xi Fu,1 Pin Liu,1 Dingyun Zhao,2 Bo Yuan,1 Zhanwen Xiao,1 Yong Zhou,2 Xiao Yang,1 Xiangdong Zhu,1 Chongqi Tu,2 Xingdong Zhang1 1National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, People’s Republic of China; 2Department of Orthopaedics, West China Hospital of Sichuan University, Chengdu 610041, People’s Republic of ChinaCorrespondence: Xiangdong ZhuNational Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, People’s Republic of ChinaTel +86 28 8547 0770Email zhu_xd1973@scu.edu.cnChongqi TuDepartment of Orthopaedics, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, People’s Republic of ChinaTel +86 28 8542 2570Email tcqbonetumor@163.comBackground: Angiogenic and osteogenic activities are two major problems with biomedical titanium (Ti) and other orthopedic implants used to repair large bone defects.Purpose: The aim of this study is to prepare hydroxyapatite (HA) coatings on the surface of Ti by using electrochemical deposition (ED), and to evaluate the effects of nanotopography and silicon (Si) doping on the angiogenic and osteogenic activities of the coating in vitro.Materials and Methods: HA coating and Si-doped HA (HS) coatings with varying nanotopographies were fabricated using two ED modes, ie, the pulsive current (PC) and cyclic voltammetry (CV) methods. The coatings were characterized through scanning electron microscope (SEM), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), X-ray photoelectron spectrometer (XPS), and atomic force microscopy (AFM), and their in vitro bioactivity and protein adsorption were assessed. Using MC3T3-E1 pre-osteoblasts and HUVECs as cell models, the osteogenic and angiogenic capabilities of the coatings were evaluated through in vitro cellular experiments.Results: By controlling Si content in ∼ 0.8 wt.%, the coatings resulting from the PC mode (HA-PC and HS-PC) and CV mode (HA-CV and HS-CV) had nanosheet and nanorod topographies, respectively. At lower crystallinity, higher ionic dissolution, smaller contact angle, higher surface roughness, and more negative zeta potential, the HS and PC samples exhibited quicker apatite deposition and higher BSA adsorption capacity. The in vitro cell study showed that Si doping was more favorable for enhancing the viability of the MC3T3-E1 cells, but nanosheet coating increased the area for cell spreading. Of the four coatings, HS-PC with Si doping and nanosheet topography exhibited the best effect in terms of up-regulating the expressions of the osteogenic genes (ALP, Col-I, OSX, OPN and OCN) in the MC3T3-E1 cells. Moreover, all leach liquors of the surface-coated Ti disks promoted the growth of the HUVECs, and the HS samples played a more significant role in promoting cell migration and tube formation than the HA samples. Of the four leach liquors, only the two HS samples up-regulated NO content and expressions of the angiogenesis-related genes (VEGF, bFGF and eNOS) in the HUVECs, and the HS-PC yielded a better effect.Conclusion: The results show that Si doping while regulating the topography of the coating can help enhance the bone regeneration and vascularization of HA-coated Ti implants.Keywords: electrochemical deposition, hydroxyapatite, silicon, coating, morphology, MC3T3-E1 cells, HUVECs

Dingyun Zhao,1,* Fan Tang,1,* Li Min,1 Minxun Lu,1 Jie Wang,1 Yuqi Zhang,1 Kun Zhao,1,2 Yong Zhou,1 Yi Luo,1 Chongqi Tu1 1Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People’s Republic of China; 2Department of Orthopeadics, Tianjin Fifth Central Hospital, Tianjin 300450, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chongqi TuDepartment of Orthopedics, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan 610041, People’s Republic of ChinaTel +86-189-8060-1387Fax +86-28-8542-2246Email tcqbonetumor@163.comPurpose: This study aimed to evaluate the early stability, limb function, and mechanical complications of 3D-printed porous prosthetic reconstruction for “ultra-critical sized bone defects” following intercalary tibial tumor resections.Methods: This study defined an “ultra-critical sized bone defect” in the tibia when the length of segmental defect in the tibia was > 15.0 cm or > 60% of the full tibia and the length of the residual fragment in proximal or distal tibia was between 0.5 cm and 4.0 cm. Thus, five patients with “ultra-critical sized bone defects” following an intercalary tibial malignant tumor resection treated with 3D-printed porous prosthesis between June 2014 and June 2018 were retrospectively reviewed. Patient information, implants design and fabrication, surgical procedures, and early clinical outcome data were collected and evaluated.Results: Among the five patients, three were male and two were female, with an average age of 30.2 years. Pathological diagnoses were two osteosarcomas, one Ewing sarcoma, one pseudo-myogenic hemangioendothelioma, and one undifferentiated pleomorphic sarcoma . The average length of the bone defects following tumor resection was 22.8cm, and the average length of ultra-short residual bone was 2.65cm (range=0.6cm– 3.8cm). The mean follow-up time was 27.6 months (range=14.0– 62.0 months). Early biological fixation was achieved in all five patients. The average time of clinical osseointegration at the bone–porous interface was 3.2 months. All patients were reported to be pain free and have no limitations in their walking distance. No prosthetic mechanical complications were observed.Conclusion: Reconstruction of the “ultra-critical sized bone defect” after an intercalary tibial tumor resection using 3D-printed porous prosthesis achieved satisfactory overall early biological fixation and limb function. Excellent primary stability and the following rigid biological fixation were key factors for success. The outcomes of this study were supposed to support further clinical application and evaluation of 3D-printed porous prosthetic reconstruction for “ultra-critical sized bone defects” in the tibia.Keywords: 3D-printed porous, prosthetic reconstruction, intercalary tibial resection, critical sized bone defect

Dehua Zhao,1 Jing Chen,1 Mingming Chu,2 Xiaoqing Long,1 Jisheng Wang1 1Department of Clinical Pharmacy, The Third Hospital of Mianyang (Sichuan Mental Health Center), Mianyang 621000, People’s Republic of China; 2Department of Clinical Pharmacy, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, People’s Republic of ChinaCorrespondence: Jisheng Wang; Dehua Zhao Email wangjishengyaoshi@163.com; zhaodehua1000@163.comAbstract: Anaplastic lymphoma kinase (ALK) inhibitors are important treatment options for non-small-cell lung cancer (NSCLC), associated with ALK gene rearrangement. Patients with ALK gene rearrangement show sensitivity to and benefit clinically from treatment with ALK tyrosine kinase inhibitors (ALK-TKIs). To date, crizotinib, ceritinib, alectinib, brigatinib, lorlatinib, and entrectinib have received approval from the US Food and Drug Administration and/or the European Medicines Agency for use during the treatment of ALK-gene-rearrangement forms of NSCLC. Although the oral route of administration is convenient and results in good compliance among patients, oral administration can be affected by many factors, such as food, intragastric pH, cytochrome P450 enzymes, transporters, and p-glycoprotein. These factors can result in increased risks for serious adverse events or can lead to reduced therapeutic effects of ALK-TKIs. This review characterizes and summarizes the pharmacokinetic parameters and drug–-drug interactions associated with ALK-TKIs to provide specific recommendations for oncologists and clinical pharmacists when prescribing ALK-TKIs.Keywords: ALK, TKIs, NSCLC, PK, drug–drug interactions

The leaching behavior of hemimorphite in neutral solution (NH4 +-Cl--H2O) was investigated at high temperature (T > 100°C) under a range of experimental conditions. Thermodynamic calculations indicate that the tendency of dehydration of silica gel is significantly enhanced with the increasing temperature. It was shown that the temperature, ammonium chloride concentration, or L/S ratio increased resulted in greater leaching efficiency. The following optimized leaching conditions were obtained: stirrer speed 400r/min, NH4Cl concentration 5.5M, L/S ratio 9mL/g at 160°C for 3h. Under these optimized conditions, the average leaching yield of zinc was 97.82%. The silicon was converted to quartz and remained in the residue. This process can be used to dispose willemite and hemimorphite as it solves the problem of silica gel dehydration.

Danyang Zhao,1,* Wenban Qin,2,* Chuanxiang Zhao,3 Jianxiong Long,4 Mujun Li1 1Department of Reproductive Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, People’s Republic of China; 2Department of Oncology, Chongzuo People’s Hospital, Nanning 530021, Guangxi Province, People’s Republic of China; 3Department of General Surgery, The Second People’s Hospital of Shenzhen, Nanning 530021, Guangxi Province, People’s Republic of China; 4School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jianxiong LongSchool of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning 530021, Guangxi Province, People’s Republic of ChinaEmail longjx12345@163.comMujun LiDepartment of Reproductive Center, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi 530021, People’s Republic of ChinaEmail sciencecid@126.comPurpose: Recent studies indicate that CXC chemokine receptor type 7 (CXCR7) is associated with tumorigenesis, progression, and metastasis of various cancers, but its roles and molecular mechanisms of action in cervical squamous cell carcinoma (CSCC) remain unclear. Our purpose was to explore the expression patterns of CXCR7 and epidermal growth factor receptor (EGFR) in CSCC and to identify possible correlations with clinical characteristics. We also tested whether CXCR7 can be a screening index for treatment options for CSCC stages IB1 and IIA1.Methods: Expression of CXCR7 and EGFR in tumors from 165 patients with CSCC was evaluated by immunohistochemistry and compared with the clinical data including survival.Results: Patients at CSCC stages IB1 and IIA1 received different treatment options, including radical hysterectomy, pelvic lymph node dissection, and para-aortic lymph node sampling (RH group, 67 patients) or pelvic external-beam radiation therapy with brachytherapy (EBRT group, 34 patients). Disease-free survival (DFS) and overall survival (OS) were compared between two groups at different CXCR7 expression levels. Immunohistochemical staining showed that CXCR7, EGFR, phospho-ERK, and phospho-AKT amounts increased from normal cervical epithelia and cervical intraepithelial neoplasia to CSCC, and CXCR7 was associated with the disease stage, lymph node metastasis, tumor size ≥40 mm, and EGFR expression. Kaplan–Meier analysis revealed that CXCR7 and EGFR expression was associated with shorter DFS and OS. Multivariate analysis suggested that CXCR7 was independently associated with DFS and OS. Prevalence of recurrence and distant metastasis was significantly lower in the EBRT group than in the RH group during CXCR7 expression. Besides, CXCR7 knockdown significantly decreased the proliferation and invasion of CSCC cells.Conclusion: CXCR7 is coexpressed with EGFR, which may be involved in ERK or AKT pathway activation. CXCR7 may be a screening index for treatment options at CSCC stages IB1 and IIA1.Keywords: CXC chemokine receptor type 7, cervical cancer, cancer treatment protocol

For the modelling and determination of the Earth’s external gravity potential as well as its second-order radial derivatives in the space near sea surface, the surface layer integral method was discussed in the paper. The reasons for the applicability of the method over sea surface were discussed. From the original integral formula of disturbing potential based on the surface layer method, the expression of the radial component of the gravity gradient tensor was derived. Furthermore, an identity relation was introduced to modify the formula in order to reduce the singularity problem. Numerical experiments carried out over the marine area of China show that, the modi-fied surface layer integral method effectively improves the accuracy and reliability of the calculation of the second-order radial gradient component of the disturbing potential near sea surface.

For the calculation of gravity disturbance in the Earth’s external gravity field, the Stokes-Pizzetti integral is a commonly used method. However, when the target point approaches the Earth’s surface, such problems as singularity and discontinuity arise due to the Stokes kernel structure itself. To settle the problems, firstly the reason for singularity and discontinuity was discussed, and then modification was made to the integral formula, by which the singularity at the surface point is eliminated. Finally the non-singular integral formulas for the calculation of disturbing gravity were derived. In numerical experiments, an area in China was selected to test the modified formula. Numerical results show that the modified formula performs much better than classical Stokes-Pizzetti integral formula when dealing with the calculation of the radial component of gravity disturbance near the Earth’s surface.

Seong Yong Lim1,*, Di Zhao2,*, Eliseo Guallar2, Yoosoo Chang3, Seungho Ryu3, Juhee Cho4, Jung Yeon Shim5 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; 2Department of Epidemiology and Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; 3Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; 4Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea; 5Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea*These authors contributed equally to this workCorrespondence: Jung Yeon ShimDepartment of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunanro, Jongro-ku, Seoul 03181, South KoreaTel +82 22 001 2200Fax +82 22 001 1922Email jy7.shim@samsung.comPurpose: Chronic obstructive pulmonary disease (COPD) is associated with systemic inflammation. We investigated whether elevated baseline serum C-reactive protein (CRP) levels in healthy individuals are associated with the risk of incident COPD by smoking status.Patients and methods: This was a cohort study of 63,260 adult men and women who were older than 40 years, free of COPD at baseline, and underwent health screening from 2002 to 2016 with at least one follow-up visit through December 2016. We investigated the association between baseline high-sensitivity CRP (hsCRP) levels and incident COPD by smoking status, using flexible parametric proportional hazards models and pooled logistic regression analyses.Results: The multivariable-adjusted hazard ratio (95% confidence interval) comparing participants in the 90th to those in the 10th percentile of hsCRP was 1.19 (1.08, 1.31). The corresponding hazard ratio in never, former, and current smokers were 1.07 (0.89, 1.29), 1.22 (1.05, 1.42), and 1.22 (1.05, 1.41), respectively. The association between hsCRP levels and incident COPD had a similar dose–response pattern in former and current smokers, but not in never smokers.Conclusion: Higher baseline hsCRP is associated with an increased risk to develop COPD in ever smokers but not in never smokers.Keywords: smokers, C-reactive protein, systemic inflammation, COPD, cohort studies

Xin-Yu Liao,1,* Yang Lei,2,* Song-Feng Chen,2 Jing Cheng,3 Dan Zhao,4 Zhi-Feng Zhang,2 Xin Han,5 Ya Zhang,2 Hua-Bao Liao,2 Yang Zhuang,2 Juan Chen,6 Hai-Bing Zhou,5 Qi Wan,7 Ying-Ying Zou,11Department of Pathology and Pathophysiology, Faculty of Basic Medical Sciences, Kunming Medical University, Kunming 650500, People’s Republic of China; 2Department of Physiology, School of Basic Medical Sciences, Wuhan University School of Medicine, Wuhan 430071, People’s Republic of China; 3Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan 430060, People’s Republic of China; 4Department of Physiology, School of Basic Medical Sciences, Hubei University of Medicine, Shiyan, Hubei 442000, People’s Republic of China; 5School of Pharmacy, Wuhan University, Wuhan 430071, People’s Republic of China; 6Department of Neurology, The Central Hospital of Wuhan, Tongji Medical College of Huazhong University of Science & Technology, Wuhan 430013, People’s Republic of China; 7Institute of Neuroregeneration & Neurorehabilitation, Collaborative Innovation Center for Brain Science, Department of Neurosurgery of the Affiliated Hospital, Qingdao University, Qingdao 266071, People’s Republic of China*These authors contributed equally to this work Background: The authors have recently designed a new compound bisperoxovandium (pyridin-2-squaramide) [bpV(pis)] and verified that bpV(pis) confers neuroprotection through suppressing PTEN and activating ERK1/2, respectively. Intracerebral hemorrhage (ICH) is the second most common cause of stroke and has severe clinical outcome. In this study, we investigate the effect of bpV(pis) in ICH model both in vivo and in vitro.Materials and methods: The novel drug bpV(pis) was synthesized in the Faculty of Pharmacy, Wuhan University School of Medicine. An ICH model was generated on both SD rats and cells. bpV(pis) was injected into intracerebroventricular or culture media. Western blotting was applied to test the signal pathway. To determine the effect of bpV(pis) on PTEN inhibition and ERK1/2 activation, we measured the phosphorylation level of AKT (a direct downstream target of PTEN that negatively regulates AKT) and ERK1/2. FJC, MTT, and LDH were applied to measure the cell viability. Neurobehavioral tests were performed to measure the effect of bpV(pis).Results: The in vivo results showed that intracerebroventricular administration of bpV(pis) significantly alleviates hematoma, the damage of brain–blood barrier and brain edema. The in vitro results demonstrated that bpV(pis) treatment reduces ICH-induced neuronal injury. Western blotting results identified that bpV(pis) exerts a neuroprotective effect by significantly increasing the phosphorylation level of AKT and ERK1/2 after experimental ICH. Neurobehavioral tests indicate that bpV(pis) promotes functional recovery in ICH animals.Conclusion: This study provides first and direct evidence for a potential role of bpV(pis) in ICH therapy.Keywords: bpV(pis), intracerebral hemorrhage, PTEN, AKT, ERK1/2, neuroprotection

Jin Zhang,1,* Donghui Zhao,1,* Qingjun Li,2 Xiuluan Du,1 Yanxiang Liu,1 Xin Dai,1 Lianqing Hong3 1Department of Pathology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, P.R. China; 2Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, P.R. China; 3Department of Pathology, Nanjing Integrated Traditional Chinese and Western Medicine Hospital Affiliated with Nanjing University of Chinese Medicine, Nanjing, P.R. China *These authors contributed equally to this work Background: Gastric cancer (GC) is a common malignant tumor of the digestive system. In addition, GC metastasis is an extremely complicated process. A previous study has found that lysine-specific demethylase 1 (LSD1) is abnormal expression in a variety of cancers and its overexpression correlates with aggressive disease and poor outcome. Methods: qRT-PCR and Western blot assays were used to assess the expression of LSD1 in GC tissue samples and cell lines. Colony formation assay, CCK-8 assay, scratch-wound assay and transwell invasion, were performed to determine the effect of LSD1 on cell proliferation and migration as well as invasion in GC. Results: Our results show that LSD1 was up-regulated in GC tumor tissues and cell lines, and high expression level of LSD1 was found to be positively correlated with tumor size, lymph node metastasis and pathological grade. Moreover, LSD1 promoted cell proliferation, migration and invasion of GC. In addition, LSD1 regulated E-cadherin expression through demethylating H3K4me2, thereby promoting EMT in GC. Conclusion: Our work indicated that LSD1 may be used as a potential target of gastric cancer. Keywords: LSD1, EMT, E-cadherin, H3K4me2, gastric cancer

Ti–Al based alloys have been widely used in the aeronautics and aerospace. Adding alloying element Zr can significantly improve their high-temperature endurance and corrosion resistance. To investigate the influence of the addition of element Zr on the properties of the Ti–Al system, ab initio calculations and the CALPHAD (CALculation of PHAse Diagrams) method were used to evaluate the Ti–Al–Zr ternary system. Ab initio calculations were carried out to calculate the formation enthalpies of intermetallic compounds and end-members. CALPHAD approach was employed to optimize the thermodynamic parameters based on experiments. The experimental data of phase equilibria at 1073, 1273, 1473, and 1573 K, as well as a vertical section of the Ti3Al–Ti + 5 wt.% Zr were used to assess this system. The thermodynamic parameters of the binary Ti–Al, Al–Zr and Ti–Zr systems were acquired from recent assessments, and the ternary ones were evaluated in the present work. The Ti–Al–Zr ternary dataset has been established and the calculated results are in close agreement with the experimental data on both thermodynamics and phase equilibria.

Jun Lu,1,* Jingjing Quan,2,3,* Dongdong Zhao,2 Yanfei Wang,2,3 Yunsong Yu,2,3 Jin Zhu1 1Department of Laboratory, Quzhou People’s Hospital, Quzhou, Zhejiang, China; 2Department of Infectious Diseases, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China; 3Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China *These authors contributed equally to this work Objectives: mcr-1 gene has been widely reported in the world. This study aimed to analyze the prevalence and molecular characteristics of mcr-1 gene in Salmonella typhimurium from Quzhou People’s Hospital. Materials and methods: A total of 62 S. typhimurium isolates were isolated and preserved in our laboratory from 2007 to 2016. PCR was used to screen plasmid-mediated colistin resistance gene, mcr-1. For mcr-1-positive isolates, susceptibilities to colistin and other antibiotics were assessed using broth microdilution or agar dilution methods. The genetic location of mcr-1 was determined by analysis of pulsed-field gel electrophoresis profiles of S1-digested genomic DNA and subsequent Southern blot hybridization. The multi-locus sequence type and other drug resistance genes found in the mcr-1-positive isolates were analyzed by performing whole genome sequencing. Genetic environment of mcr-1 gene was analyzed by RAST and Easyfig. Results: A total of three S. typhimurium isolates were identified to be mcr-1 positive, with the prevalence rate of 4.8% (3/62). The minimum inhibitory concentration values of colistin for all these isolates were 8 µg/mL. The three mcr-1-positive isolates carried mcr-1 gene on two different types of plasmids having the sizes of ~54.7–78.2 kb and 310.1 kb, respectively. All the three isolates belonged to ST34 and carried various resistant genes. Conclusion: Colistin-resistant, mcr-1-positive S. typhimurium isolates belonging to ST34 have been isolated from Quzhou People’s Hospital. Surveillance needs to be strengthened to identify colistin resistance and prevent the spread of drug-resistant bacteria in the hospital. Keywords: Salmonella typhimurium, colistin, mcr-1

Qian Wang,1 Ping Zhang,2,3 Dongdong Zhao,2 Yan Jiang,2,3 Feng Zhao,4 Yanfei Wang,3 Xi Li,5 Xiaoxing Du,2 Yunsong Yu2,3 1Department of General Practice, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China; 2Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China; 3Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China; 4Department of Clinical Laboratory, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China; 5Centre of Laboratory Medicine, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China Objective: Here, we report a case of severe infection caused by Escherichia coli that harbored mcr-1, bla NDM-5, and acquired resistance to tigecycline during tigecycline salvage therapy. Methods: Antimicrobial susceptibility testing, Southern blot hybridization, and complete genome sequence of the strains were carried out. The genetic characteristics of the mcr-1 and bla NDM-5 plasmids were analyzed. The whole genome sequencing of mcr-1-containing plasmid was completed. Finally, putative single nucleotide polymorphisms and deletion mutations in the tigecycline-resistant strain were predicted. Results: Three E. coli isolates were obtained from ascites, pleural effusion, and stool of a patient; they were resistant to almost all the tested antibiotics. The first two strains separated from ascites (E-FQ) and hydrothorax (E-XS) were susceptible to amikacin and tigecycline; however, the third strain from stool (E-DB) was resistant to tigecycline after nearly 3 weeks’ treatment with tigecycline. All three isolates possessed both mcr-1 and bla NDM-5. The bla NDM-5 gene was found on the IncX3 plasmid, whereas the mcr-1, fosA3 and blaCTX-M-14 were located on the IncHI2 plasmid. Mutations in acrB and lon were the reason for the resistance to tigecycline. Conclusion: This is the first report of a colistin-, carbapenem-, and tigecycline-resistant E. coli in China. Tigecycline resistance acquired during tigecycline therapy is of great concern for us because tigecycline is a drug of last resort to treat carbapenem-resistant Gram-negative bacterial infections. Furthermore, the transmission of such extensively drug-resistant isolates may pose a great threat to public health. Keywords: mcr-1, blaNDM-5, tigecycline-resistance, acrB, lon

Xi Li,1,* Xinli Mu,2,* Ping Zhang,2 Dongdong Zhao,2 Jingshu Ji,3 Jingjing Quan,2 Yongze Zhu,1 Yunsong Yu2 1Centre of Laboratory Medicine, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, China; 2Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China; 3Department of Clinical Laboratory, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China *These authors contributed equally to this work Objectives: A plasmid-mediated colistin resistance gene, mcr-1, has been reported worldwide and has caused concern regarding a major therapeutic challenge. Alarmingly, mcr-1 has spread into clinical carbapenem-resistant Enterobacteriaceae isolates, resulting in extensively drug-resistant and even pan drug-resistant isolates that can cause untreatable infections. In this study, we report isolation of an extensively drug-resistant Escherichia coli strain EC1188 that coproduces NDM-16 and MCR-1 from a urine sample taken from a patient with craniocerebral injury. Materials and methods: E. coli strain EC1188 was identified and subjected to genotyping, susceptibility testing and conjugation experiments. The genetic locations of blaNDM-16 and mcr-1 were established with southern blot hybridization. The complete genome sequence of this strain was obtained and the genetic characteristics of the mcr-1- and blaNDM-16-harboring plasmids were analyzed. In addition, comparative genetic analyses of mcr-1 and blaNDM-16 with closely related plasmids were also carried out. Results: Whole-genome sequencing revealed that strain EC1188 possess various resistance genes and virulence genes. S1-pulsed-field gel electrophoresis and southern blot suggested that the blaNDM-16 and mcr-1 genes were located on an ~65 kb plasmid and an ~80 kb plasmid, respectively. Moreover, the two genes could successfully transfer their resistance phenotype to E. coli strain C600. Sequence analysis showed that these two plasmids possessed high sequence similarity to previously reported blaNDM-5-harboring and mcr-1-harboring plasmids in China. Conclusion: To the best of our knowledge, this is the first report to isolate an E. coli strain that coproduces NDM-16 and MCR-1. In addition, we characterized the blaNDM-16-harboring plasmid for the first time. Our study further emphasizes that the co-occurrence of the two prevalent transferrable resistance plasmids in a single isolate is highly significant because infections caused by MCR-1–producing carbapenem-resistant Enterobacteriaceae isolates are increasing each year. It is imperative to perform active surveillance to prevent further dissemination of MCR-1–producing CRE isolates. Keywords: E. coli, mcr-1, NDM-16, CRE, colistin resistance, extensively drug-resistant bacteria

Zhaoxia Zhang,* Dong Zhao,* Mei Lin, Dongxue Zhang, Ruijuan Bai, Jing Fan, Zuomin Wang Department of Stomatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China *These authors contributed equally to this work Objectives: Based on the concept of health quotient (HQ), we designed and facilitated personalized plans to improve patients’ compliance and oral health. The study aims to increase HQ level of patients with chronic periodontitis from four aspects, namely self-care, health knowledge, lifestyle, and mental health, and evaluate the effects of HQ training in maintaining oral health.Method: In total, 105 patients with chronic periodontitis were recruited from Capital Medical University-Affiliated Beijing Chaoyang Hospital from January 2015 to January 2017. The patients were randomly split into two groups (control versus test). All the patients received standard periodontal treatments. In addition, patients in the control group received conventional oral health instructions, and patients in the test group received the HQ training. At the end of the training, oral health status of both groups was evaluated and recorded.Results: The oral health status and the HQ scores were significantly better in the test group than the control group (P

Yang K, Zhao N, Zhao D, Chen D, Li Y. Drug Des Devel Ther. 2013;7:511—517. The authors have advised due to an error at the time of figure assembly, Figure 1 on page 514 is incorrect. The correct Figure 1 is shown below. The authors apologize for this error and advise it does not affect the results of the paper. Read the original article

Yan Hu,1 Lei Ke,2 Hao Chen,1 Ma Zhuo,1 Xinzhou Yang,1 Dan Zhao,1 Suying Zeng,1 Xincai Xiao1 1Department of Pharmaceutics, School of Pharmaceutical Science, South-Central University for Nationalities, 2Department of Medicinal Chemistry, School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China Abstract: To avoid the side effects caused by nonspecific targeting, premature release, weak selectivity, and poor therapeutic efficacy of current nanoparticle-based systems used for drug delivery, we fabricated natural material-decorated nanoparticles as a multifunctional, membrane-controlled targeted drug delivery system. The nanocomposite material coated with a membrane was biocompatible and integrated both specific tumor targeting and responsiveness to stimulation, which improved transmission efficacy and controlled drug release. Mesoporous silica nanoparticles (MSNs), which are known for their biocompatibility and high drug-loading capacity, were selected as a model drug container and carrier. The membrane was established by the polyelectrolyte composite method from chitosan (CS) which was sensitive to the acidic tumor microenvironment, folic acid-modified CS which recognizes the folate receptor expressed on the tumor cell surface, and a CD44 receptor-targeted polysaccharide hyaluronic acid. We characterized the structure of the nanocomposite as well as the drug release behavior under the control of the pH-sensitive membrane switch and evaluated the antitumor efficacy of the system in vitro. Our results provide a basis for the design and fabrication of novel membrane-controlled nanoparticles with improved tumor-targeting therapy. Keywords: multifunctional, membrane-controlled, natural materials, mesoporous silica nanoparticles, targeted drug delivery

Background. Human-machine interaction technology has greatly evolved during the last decades, but manual and speech modalities remain single output channels with their typical constraints imposed by the motor system’s information transfer limits. Will brain-computer interfaces (BCIs) and gaze-based control be able to convey human commands or even intentions to machines in the near future? We provide an overview of basic approaches in this new area of applied cognitive research. Objective. We test the hypothesis that the use of communication paradigms and a combination of eye tracking with unobtrusive forms of registering brain activity can improve human-machine interaction. Methods and Results. Three groups of ongoing experiments at the Kurchatov Institute are reported. First, we discuss the communicative nature of human-robot interaction, and approaches to building a more e cient technology. Specifically, “communicative” patterns of interaction can be based on joint attention paradigms from developmental psychology, including a mutual “eye-to-eye” exchange of looks between human and robot. Further, we provide an example of “eye mouse” superiority over the computer mouse, here in emulating the task of selecting a moving robot from a swarm. Finally, we demonstrate a passive, noninvasive BCI that uses EEG correlates of expectation. This may become an important lter to separate intentional gaze dwells from non-intentional ones. Conclusion. The current noninvasive BCIs are not well suited for human-robot interaction, and their performance, when they are employed by healthy users, is critically dependent on the impact of the gaze on selection of spatial locations. The new approaches discussed show a high potential for creating alternative output pathways for the human brain. When support from passive BCIs becomes mature, the hybrid technology of the eye-brain-computer (EBCI) interface will have a chance to enable natural, fluent, and the effortless interaction with machines in various fields of application.

Zhuxiang Zhao,1,2 Changbin Jiang,1 Dongxing Zhao,1 Yujun Li,2 Chunxiao Liang,1 Weifeng Liu,2 Shuquan Wei,2 Yumin Zhou,1 Ziwen Zhao,2 Pixin Ran1 1The State Key Laboratory of Respiratory Diseases, The First Affliated Hospital, Guangzhou Medical University, Guangzhou, 2The Pulmonary Medicine,Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China Abstract: Quantitative computed tomography (CT) measures of emphysema have been shown to be associated with increased mortality in humans, but genetic variants affecting the quantitative parameters of chest CT that measure degree of emphysema have not yet been examined. In this study, using available chest CT data from a total of 344 emphysema patients, we assessed the correlations between five chronic obstructive pulmonary disease (COPD) susceptibility variants in the cholinergic receptor nicotinic (CHRN) genes and the degree of emphysema and chest CT manifestations. We verified that most of the parameters were significantly correlated with the degree of emphysema. Compared to rs76071148AA and TT genotype carriers, the rs76071148AT genotype carriers exhibited a decreased probability of having severe emphysema (odds ratio [OR] =0.63, 95% confidence interval [CI] =0.40–0.99), whereas the variant rs8040868C allele was negatively correlated with the emphysema index (P=0.002). Interestingly, further stratification analysis grouped by spirometry-diagnosed COPD status revealed that the variant rs8040868C (CT + CC) genotypes exerted a protective effect against severe emphysema with borderline significance (OR =0.41, 95% CI =0.16–1.05) and affected the mean lung density, emphysema index, ratio of airway wall thickness to airway dimensions (AWT/AD), and AWT grade in spirometry-diagnosed non-COPD subjects. The rs76071148 variant was also significantly associated with AWT/AD and AWT grade in those individuals. In summary, we determined that rs8040868 and rs76071148 are promising indicators of the degree of emphysema and chest CT manifestations, especially in spirometry-diagnosed non-COPD subjects. Keywords: COPD, CHRN variant, CT manifestation, emphysema

We take a unified approach to study the open set lattices of various subspaces of the spectrum of a multiplicative lattice L. The main aim is to establish the order isomorphism between the open set lattice of the respective subspace and a sub-poset of L. The motivating result is the well known fact that the topology of the spectrum of a commutative ring R with identity is isomorphic to the lattice of all radical ideals of R. The main results are as follows: (i) for a given nonempty set S of prime elements of a multiplicative lattice L, we define the S-semiprime elements and prove that the open set lattice of the subspace S of Spec(L) is isomorphic to the lattice of all S-semiprime elements of L; (ii) if L is a continuous lattice, then the open set lattice of the prime spectrum of L is isomorphic to the lattice of all m-semiprime elements of L; (iii) we define the pure elements, a generalization of the notion of pure ideals in a multiplicative lattice and prove that for certain types of multiplicative lattices, the sub-poset of pure elements of L is isomorphic to the open set lattice of the subspace Max(L) consisting of all maximal elements of L.

Li X, Mu X, Zhang P, et al. Infect Drug Resist. 2018;11:1189–1195.On page 1192, Table 2, in sub-column “Incompatibility and size of mcr-1”, the data in fourth NDM-1 gene was IncHI2, ~60 kb but should be IncI2, ~60 kb. The data in second NDM-5 gene was IncHI2, ~60 kb but should be IncX4, ~33 kb. In sub-column “Incompatibility and size of carbapenemases”, the data in third NDM-5 gene was IncX3, - but should be IncX3, ~45 kb.In sub-column “Incompatibility and size of mcr-1”, the data in first KPC-2 gene was IncHI2, ~60 kb but should be IncI2, ~60 kb. In sub-column “Incompatibility and size of carbapenemases” was IncR, ~104.5kb but should be IncR, ~107.7 kb. In subcolumn “Incompatibility and size of mcr-1” in second KPC-2 gene was IncI2, - but should be IncHI2, -. Finally, in sub-column of “Sample” for second OXA-48 gene was Urine but should be Blood. On page 1193, Figure 2 Linear plasmid characterization of NDM-16 and MCR-1-bearing plasmids with closely related plasmids should be replaced as follows: Read the original article

Ying Gao,1,* Fei Gao,2,* Jin-lu Ma,1,* Xiao-zhi Zhang,1 Yi Li,1 Li-ping Song,1 Dong-li Zhao1 1Department of Radiotherapy Oncology, First Affiliated Hospital of Xi’an Jiaotong University, 2Department of Neurology, First Affiliated Hospital of Xi’an Medical University, Xi’an, People’s Republic of China *These authors contributed equally to this work Objective: Lung cancer is still the leading cause of cancer-related deaths worldwide. However, most elderly patients with advanced non-small-cell lung cancer (NSCLC) have been undertreated and the outcome related to age is controversial. A retrospective analysis was conducted for advanced NSCLC in order to investigate the characteristics and prognosis of older patients. Methods: Medical records were collected from 165 patients with NSCLC (stages IIIA–IIIB) who had been treated with concurrent chemoradiotherapy (CRT) or radiotherapy from January 2009 to January 2011. The cases were divided into two age groups 1) patients ≥70 years old; 2) patients 0.05). In the patients with adenocarcinoma, more cases were found in group II than that in group I; the more squamous cell carcinoma and the more smokers with squamous cell carcinoma were seen in older group (P0.05). The therapy-related toxicities in group I seem to be similar to the group II (P>0.05). Conclusion: More adenocarcinoma patients were found in youthful lung cancer and the more smokers with squamous cell carcinoma were seen in older group. Age is not the important factor for the selection and allocation of treatment in advanced NSCLC. The same prognosis and toxicities had been shown in older and young. Age may not be an independent increased risk of death in advanced NSCLC. Keywords: advanced non-small-cell lung cancer, age, prognosis

Di Zhao,1,* Jian Song,2,* Xuan Gao,3 Fei Gao,4 Yupeng Wu,2 Yingying Lu,5 Kai Hou1 1Department of Neurosurgery, The First Hospital of Hebei Medical University, 2Department of Neurosurgery, 3Department of Neurology, The Second Hospital of Hebei Medical University, 4Hebei Provincial Procurement Centers for Medical Drugs and Devices, 5Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang People’s Republic of China *These authors contributed equally to this work Background: Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) are associated with reduced mortality and infection rates among patients in intensive care units (ICUs); however, whether SOD has a superior effect than SDD remains uncertain. Hence, we conducted a meta-analysis of randomized controlled trials (RCTs) to compare SOD with SDD in terms of clinical outcomes and antimicrobial resistance rates in patients who were critically ill. Methods: RCTs published in PubMed, Embase, and Web of Science were systematically reviewed to compare the effects of SOD and SDD in patients who were critically ill. Outcomes included day-28 mortality, length of ICU stay, length of hospital stay, duration of mechanical ventilation, ICU-acquired bacteremia, and prevalence of antibiotic-resistant Gram-negative bacteria. Results were expressed as risk ratio (RR) with 95% confidence intervals (CIs), and weighted mean differences (WMDs) with 95% CIs. Pooled estimates were performed using a fixed-effects model or random-effects model, depending on the heterogeneity among studies. Results: A total of four RCTs involving 23,822 patients met the inclusion criteria and were included in this meta-analysis. Among patients whose admitting specialty was surgery, cardiothoracic surgery (57.3%) and neurosurgery (29.7%) were the two main types of surgery being performed. Pooled results showed that SOD had similar effects as SDD in day-28 mortality (RR =1.03; 95% CI: 0.98, 1.08; P=0.253), length of ICU stay (WMD =0.00 days; 95% CI: -0.2, 0.2; P=1.00), length of hospital stay (WMD =0.00 days; 95% CI: -0.65, 0.65; P=1.00), and duration of mechanical ventilation (WMD =1.01 days; 95% CI: -0.01, 2.02; P=0.053). On the other hand, compared with SOD, SDD had a lower day-28 mortality in surgical patients (RR =1.11; 95% CI: 1.00, 1.22; P=0.050), lower incidence of ICU-acquired bacteremia (RR =1.38; 95% CI: 1.24, 1.54; P=0.000), and lower rectal carriage of aminoglycosides (RR =2.08; 95% CI: 1.68, 2.58; P=0.000), ciprofloxacin-resistant Gram-negative bacteria (RR =1.84; 95% CI: 1.48, 2.29; P=0.000), and respiratory carriage of third-generation cephalosporin-resistant Gram-negative bacteria (RR =2.50; 95% CI: 1.78, 3.5; P=0.000). Conclusion: SOD has similar effects as SDD in clinical outcomes, but has higher incidence of ICU-acquired bacteremia, and higher carriage of antibiotic-resistant Gram-negative bacteria. However, due to the high cost of SDD and the increased risk of development of antibiotic resistance with the widespread use of cephalosporins in SDD, we would recommend SOD as prophylactic antibiotic regimens in patients in the ICU. More well-designed, large-scale RCTs are needed to confirm our findings. Keywords: selective digestive decontamination, selective oropharyngeal decontamination, intensive care units, meta-analysis