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Qingbao Guo,1,2,* Manli Xie,3,* Qian-Nan Wang,4,* Jingjie Li,1,2 Simeng Liu,1,2 Xiaopeng Wang,1,2 Dan Yu,5 Zhengxing Zou,5 Gan Gao,1,2 Qian Zhang,5 Fangbin Hao,1,2 Jie Feng,5 Rimiao Yang,5 Minjie Wang,1,2 Heguan Fu,5 Xiangyang Bao,5 Lian Duan2 1Medical School of Chinese PLA, Beijing, People’s Republic of China; 2Department of Neurosurgery, First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China; 3Department of Occupational Diseases, Xi’an Central Hospital, Xi’an, Shanxi, People’s Republic of China; 4Department of Neurosurgery, Eighth Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China; 5Department of Neurosurgery, Fifth Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiangyang Bao; Lian Duan, Email bzy123@163.com; duanlian307@sina.comBackground: Moyamoya disease (MMD) signifies a cerebrovascular disorder with obscure origin and a more rapid and severe progression in children than adults. This investigation aims to uncover age-associated distinctions through proteomic and metabolomic profiling to gain insights into the underlying mechanisms of MMD.Methods: Twelve MMD patients—six children and six adults—along with six healthy controls (HC), participated, each providing a 10 mL blood sample. Serum proteomic and metabolomic analyses were conducted using ultra-performance liquid chromatography and high-resolution mass spectrometry, complemented by bioinformatics to identify differential biomolecules and their interactions. Pathway implications were ascertained using GO and KEGG enrichment analysis.Results: Notable proteomic and metabolomic discrepancies were observed between pediatric and adult MMD subjects. A total of 235 and 216 proteins varied in adult and pediatric cases compared to HCs, with 73 proteins shared. In addition, 129 and 74 anionic, plus 96 and 104 cationic metabolites, were differentially expressed in the pediatric and adult groups, respectively, with 34 anionic and 28 cationic metabolites in common. Age-specific biomolecules further characterized these distinctions. Enrichment analysis pinpointed immunity and inflammation pathways, with vitamin digestion and absorption highlighted as pivotal in pediatric MMD.Conclusion: This study unveils distinct metabolic and proteomic patterns within pediatric and adult MMD patients. The critical role of the vitamin digestion and absorption pathway in the pathogenesis of pediatric MMD offers novel insight into disease mechanisms. Keywords: proteomics, metabolomics, pediatric patients, moyamoya disease, integration analysis

Xundi Bao,1 Shuo Liang,1 Jun Li,1 Qian Ye,1 Dandan Wu,1 Shu Wang,2 Yue Li,1 Yunsheng Ding,1 Jie Liu3 1Clinical Laboratory, Anhui Provincial Chest Hospital (Provincial Institute of Tuberculosis Control), Hefei, Anhui, People’s Republic of China; 2Department of Science and Education, Anhui Provincial Chest Hospital (Provincial Institute of Tuberculosis Control), Hefei, Anhui, People’s Republic of China; 3Tuberculosis Control Institute, Anhui Provincial Chest Hospital (Provincial Institute of Tuberculosis Control), Hefei, Anhui, People’s Republic of ChinaCorrespondence: Xundi Bao, Clinical laboratory, Anhui Provincial Chest Hospital (Provincial Institute of Tuberculosis Control), No. 397, Jixi Road, Shushan District, Hefei, Anhui, People’s Republic of China, Tel +86-13866774716, Email baoxundi@163.comObjective: To preliminarily assess the prevalence and control effect of tuberculosis and drug-resistant tuberculosis (TB) in Anhui province, and analyze the trends in the changing drug resistance spectrum of Mycobacterium tuberculosis (Mtb) isolated in Anhui province from 2016 to 2022.Methods: From 2016 to 2022, a total of 2336 culture-positive tuberculosis strains were collected from four drug resistance monitoring sites. Patient demographic information was collected and drug susceptibility testing was conducted.Results: Among the 2336 Mycobacterium tuberculosis complex strains, 1788 (76.54%) were from male patients and 548 (23.46%) were from female patients. The majority were of Han ethnicity, from rural areas, and employed in agriculture, with 12.54% (285/2273) having diabetes. A total of 1893 (81.04%) strains were sensitive to all six anti-TB drugs tested, and 443 (18.96%) strains were resistant to at least one or more anti-TB drugs. The drug resistance rate for patients undergoing initial treatment was 16.80% (348/2071), and 35.85% (95/265) for those receiving retreatment. Among the six anti-TB drugs, the resistance rates from highest to lowest were: INH (10.55%, 236/2336), SM (8.18%, 183/2336), OFX (6.53%, 146/2336), RFP (5.95%, 133/2336), EMB (2.37%, 53/2336), KM (1.97%, 44/2336). Significant differences were observed in MDR strains across different ages, types, with or without diabetes, and geographical sources (χ 2=14.895,76.534,6.032,5.109, all P< 0.05).Conclusion: The tuberculosis prevention and control measures have controlled the drug resistance rate of Mycobacterium tuberculosis to a certain extent. However, there are still statistical differences in drug resistance rates among TB patients with different categories, age groups, regions, and diabetic diseases. Early detection and prompt treatment of patients with drug-resistant TB remain critical to controlling the spread of this disease.Keywords: tuberculosis, mycobacterium, drug resistance, surveillance, population distribution, characteristic analysis

Yuting Feng, Xue Bao, Jinxuan Zhao, Lina Kang, Xuan Sun, Biao Xu Department of Cardiology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology, Medical School of Nanjing University, Nanjing, People’s Republic of ChinaCorrespondence: Xuan Sun; Biao Xu, Department of Cardiology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology, Medical School of Nanjing University, No. 321 Zhongshan Road, Nanjing, 210008, People’s Republic of China, Email sunxuan891119@163.com; xubiao62@nju.edu.cnIntroduction: Acute inflammatory storm is a major cause of myocardial ischemia/reperfusion (I/R) injury, with no effective treatment currently available. The excessive aggregation of neutrophils is correlated with an unfavorable prognosis in acute myocardial infarction (AMI) patients. Exosomes derived from mesenchymal stromal cells (MSC-Exo) have certain immunomodulatory potential and might be a therapeutic application. Therefore, we investigated the protective role of MSC-Exo in modulating neutrophil infiltration and formation of neutrophil extracellular traps (NETs) following myocardial I/R injury.Methods: Exosomes were isolated from the supernatant of MSCs using a gradient centrifugation method. We used flow cytometry, histochemistry, and immunofluorescence to detect the changes of neutrophils post-intravenous MSC-Exo injection. Additionally, cardiac magnetic resonance (CMR) and thioflavin S experiments were applied to detect microvascular obstruction (MVO). The NLR family pyrin domain containing 3 (NLRP3) inflammasome was examined for mechanism exploration. Primary neutrophils were extracted for in vitro experiment. Antibody of Ly6G was given to depleting the neutrophils in mice for verification the effect of MSC-Exo. Finally, we analyzed the MiRNA sequence of MSC-Exo and verified it in vitro.Results: MSC-Exo administration reduced neutrophil infiltration and NETs formation after myocardial I/R. MSC-Exo treatment also could attenuate the activation of NLRP3 inflammasome both in vivo and in vitro. At the same time, the infarction size and MVO following I/R injury were reduced by MSC-Exo. Moreover, systemic depletion of neutrophils partly negated the therapeutic effects of MSC-Exo. Up-regulation of miR-199 in neutrophils has been shown to decrease the expression of NETs formation after stimulation.Discussion: Our results demonstrated that MSC-Exo mitigated myocardial I/R injury in mice by modulating neutrophil infiltration and NETs formation. This study provides novel insights into the potential therapeutic application of MSC-Exo for myocardial ischemia/reperfusion injury. Keywords: myocardial ischemia/reperfusion injury, mesenchymal stromal cells, exosomes, neutrophil extracellular traps, mir-199

Lili Kang,1 Changle Li,1 Duohui Chen,2 Xinxin Bao3 1School of Health Management, Fujian Medical University, Fuzhou, People’s Republic of China; 2College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand; 3School of Foreign Language Studies, Inner Mongolia Medical University, Hohhot, People’s Republic of ChinaCorrespondence: Xinxin Bao, School of Foreign Language Studies, Inner Mongolia Medical University, Hohhot, 010110, People’s Republic of China, Email 20120027@immu.edu.cnObjective: This study was conducted to identify the factors (especially parental involvement, academic self-efficacy, and depression) associated with academic performance among Chinese K-12 students during the COVID-19 pandemic.Methods: This cross-sectional study used data from the 2020 China Family Panel Studies (CFPS). The CFPS was conducted from July to December 2020 during the COVID-19 pandemic. A multistage probability sample proportional to size was used for the survey. The final sample consisted of 1747 K-12 students. This study used the 14-item Chinese Parental Involvement and Support Scale, the Responsibility Scale, and the 8-item Center for Epidemiologic Studies Depression Scale to measure parental involvement, academic self-efficacy, and depression, respectively. An ordered probit regression and structural equation models were employed to analyze the factors associated with academic performance. A multiple imputation technique was applied to compute missing values in selected variables.Results: We found that parental involvement and academic self-efficacy were positively associated with good academic performance. In contrast, depression was negatively associated with good academic performance. Moreover, academic stress, male, rural residency, middle school, family size, high income, online gaming daily, reading, and intelligence quotient were statistically significant predictors on academic performance.Conclusion: The empirical findings suggested that parental involvement and academic self-efficacy were positively and significantly associated with good academic performance. However, depression was negatively and significantly associated with good academic performance. These results showed that policymakers and practitioners can help improve academic success and address educational inequalities among K-12 students by implementing a series of reforms.Keywords: parental involvement, academic self-efficacy, depression, academic performance, K-12, COVID-19 pandemic, China

Jia Guo,1 Xuli Bao,1 Fuquan Liu,2 Jiang Guo,3 Yifan Wu,2 Fang Xiong,1 Jun Lu1 1Hepatology and Cancer Biotherapy Ward, Beijing YouAn Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Department of Interventional Therapy, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Jun Lu, Hepatology and Cancer Biotherapy Ward, Beijing YouAn Hospital, Capital Medical University, No. 8, Xi Tou Tiao, Youan Men Wai, Fengtai District, Beijing, 10069, People’s Republic of China, Tel +86-010-83997153, Fax +86-010-83997000, Email lujun98@ccmu.edu.cnPurpose: Invariant NKT cells (iNKT) are CD1d-restricted T cells with the capacity of antitumor immunity. The safety of autologous iNKT cell treatment in hepatocellular carcinoma (HCC) has been verified. This study aimed to investigate its efficacy in advanced HCC after transarterial chemoembolization (TACE) failure.Patients and methods: This open-label, randomized, controlled, trial enrolled 60 patients with unresectable HCC after TACE failure at three centers. Transarterial embolization (TAE) was used instead of TACE to protect iNKT cell function. Patients were randomly assigned (1:1) to receive TAE therapy with (TAE–iNKT) or without (TAE) biweekly iNKT cell infusion. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), objective response rate (ORR), disease control rate (DCR), quality of life (QoL), peripheral blood cell count, and safety.Results: Fifty-four patients completed the study. Median PFS was significantly higher in TAE–iNKT patients (5.7 months [95% CI, 4.3– 7.0 months]) compared with TAE patients (2.7 months [95% CI, 2.3– 3.2 months]; hazard ratio 0.32 [95% CI, 0.16– 0.63]; P< 0.001). Higher ORR and DCR were observed in TAE–iNKT patients (52% and 85%, respectively) compared with TAE patients (11% and 33%; respectively). Five TAE–iNKT patients and 1 TAE patient achieved completed response. The median time to deterioration in QoL was longer in TAE–iNKT patients (9.2 months [95% CI, 6.0– 13.3 months]) compared with TAE patients (3.0 months [95% CI, 2.9– 3.0 months]). The mean lymphocytes were higher in the TAE-iNKT group than in the TAE group at 8 (1.48 vs 0.95× 109/L, P = 0.007) and 12 (1.49 vs 0.89× 109/L, P = 0.001) weeks. Grade 3 adverse events occurred in 1 TAE-iNKT patient (4%) and 5 TAE patients (19%). All the other adverse events were grade 1– 2.Conclusion: iNKT cell infusion significantly improved PFS, ORR, DCR, and QoL with manageable toxicity during TAE therapy in patients with HCC. Trial Registration ClinicalTrials.gov Identifier: NCT04011033.Keywords: hepatocellular carcinoma, invariant natural killer T cell, transarterial embolization, progression-free survival

Danfeng Yu, Fengfeng Jiang, Wei Xu, Pingyou He, Feng Chen, Xiaobo Liu, Xiang Bao Department of Neurosurgery, Jinhua Municipal Central Hospital, Jinhua, 321000, People’s Republic of ChinaCorrespondence: Xiang Bao, Department of Neurosurgery, Jinhua Municipal Central Hospital, Jinhua, 321000, People’s Republic of China, Email 18257012012@163.comBackground: Resolvin D1 (RvD1) possesses anti-inflammatory properties and may be neuroprotective. This study was designed to ascertain the potential role of serum RvD1 in the evaluation of aSAH severity and prognosis of human aneurysmal subarachnoid hemorrhage (aSAH).Methods: In this prospective observational study, serum RvD1 levels were measured in 123 patients with aSAH and in 123 healthy volunteers. Six-month neurological function was assessed using extended Glasgow outcome scale (GOSE). A prognostic prediction model was appraised using a series of evaluative tools, such as a nomogram, receiver operating characteristic (ROC) curve, decision curve, calibration curve, restricted cubic spline, and Hosmer-Lemeshow goodness of fit statistics.Results: Serum RvD1 levels were markedly lower in patients than in controls (median, 0.54 versus 1.47 ng/mL; P< 0.001). Serum RvD1 levels were independently correlated with Hunt-Hess scores (beta, − 0.154; 95% confidence interval [CI], − 0.198--0.109; VIF, 1.769; P=0.001), modified Fisher scores (beta, − 0.066; 95% CI, − 0.125--0.006; VIF, 1.567; P=0.031) and 6-month GOSE scores (beta, 1.864; 95% CI, 0.759– 2.970; VIF, 1.911; P=0.001) and were independently predictive of a poor prognosis (GOSE scores of 1– 4) (odds ratio, 0.137; 95% CI, 0.023– 0.817; P=0.029). Serum RvD1 levels significantly distinguished the risk of a worse prognosis, with an area under the ROC curve of 0.750 (95% CI, 0.664– 0.824). Using the Youden method, serum RvD1 levels < 0.6 ng/mL was effective in predicting worse prognosis with 84.1% sensitivity and 62.0% specificity. Moreover, the model containing serum RvD1 levels, Hunt-Hess scores and modified Fisher scores was efficient, reliable and beneficial in prognostic prediction using a series of the afore-mentioned evaluative tools.Conclusion: A decline in serum RvD1 levels following aSAH is closely correlated with illness severity and independently predicts a worse outcome in patients with aSAH, implying that serum RvD1, as a prognostic biomarker of aSAH, may be of clinical value in aSAH.Keywords: aneurysm, subarachnoid hemorrhage, resolvin D1, prognosis, severity

Yang Zheng,1 Hui Xia,1 Xundi Bao,2 Bing Zhao,1 Ping He,1 Yanlin Zhao1 1National Tuberculosis Reference Laboratory, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China; 2Laboratory Department, Anhui Chest Hospital, Anhui, People’s Republic of ChinaCorrespondence: Yanlin Zhao, National Center for TB Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155 Chang Bai Road, Changping District, Beijing, 102206, People’s Republic of China, Tel +86-10-58900517, Fax +86-10-58900556, Email zhaoyl@chinacdc.cnPurpose: The drug resistance of Mycobacterium tuberculosis constitutes a major public health threat. Existing approaches make it challenging to detect low levels of drug-resistant TB, also known as heteroresistance (HR), in a population. The recently found droplet digital PCR (ddPCR) is a sensitive method for determining the precise amount of nucleic acid in a sample. We used ddPCR to test the Mycobacterium tuberculosis heteroresistance because it delivers more exact quantitative data without the need for a reference curve.Patients and Methods: A TaqMan-MGB probe mutation detection assay was developed in order to determine the mutant and wild-type sequences of the isoniazid resistance katG (315) gene. We produced heteroresistant MTB combinations, which were subsequently identified by ddPCR, qPCR, and MeltPro/INH. In addition, 21 clinical sputum samples with positive smears were used to validate each method’s capacity to determine HR in sputum.Results: We discovered that ddPCR can detect mutant sequences in as few as 0.01% of a combination. DeepMelt TB/INH, which is less sensitive in comparison, cannot detect HR with high resolution and requires a mutation rate of 50% to identify. qPCR likewise has a high resolution of 0.02%, but unlike ddPCR, it cannot determine the exact number of mutations. Our assay is applicable to sputum as well. ddPCR found a katG 315 substitution in two sputums with extremely low values of HR (0.26% and 0.14%). In 21 samples of clinical sputum, the HR prevalence of INH was 9.5%.Conclusion: This work demonstrates that a well-designed ddPCR HR detection test can detect low levels of HR with high accuracy and consistency and gives new information for the clinical diagnosis of drug resistance.Keywords: Mycobacterium tuberculosis, drug-resistant, isoniazid, heteroresistance

Mi Wang,1,&ast; Xian Zhao,2,&ast; Pengfei Yin,1 Xiuxia Bao,1 Hongli Tang,3 Xianhui Kang1 1Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 2Department of Anesthesiology, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, People’s Republic of China; 3Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xianhui Kang, Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, Zhejiang, People’s Republic of China, Tel +86-0571-87236169, Fax +86-21-57643271, Email kxhui66@zju.edu.cn Hongli Tang, Department of Anaesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China, Tel +86-577-87236169, Fax +86-21-57643371, Email tanghongliok@126.comAbstract: Remimazolam is a novel short-acting γ-aminobutyric acid (GABA) receptor agonist with typical characteristics of benzodiazepine sedative drugs, nonorgan-dependent metabolism, long-term infusion without accumulation, and no injection pain. It is quite different from the other current sedative drugs and has broad prospects for application. It has been established that the metabolites of remimazolam are inactive, and the interactions with other drugs are weak with slight cardiopulmonary suppressive effects, showing good effectiveness and safety. During the 2-year period that it has been on the market, remimazolam has been used in multiple clinical scenarios, such as the induction and maintenance of general anesthesia and sedation in outpatient minor procedures or examinations. However, it’s use has also prompted widespread concern around the world. Therefore, given its short- and rapid-acting, controllable characteristics remimazolam deserves in-depth study in order for it to be used in fast-track surgery, comfort diagnosis and treatment. Notably, such agents might be of great significance, especially in elderly individuals, patients with critical diseases or patients with liver and kidney insufficiency. The current study reviews recent clinical studies (2015– 2022) on remimazolam and summarizes the characteristics of its applications. Specifically, the use of remimazolam in some specific populations are described. This study attempts to provide scientific support for the clinical application of this novel sedative drug in the field of anesthesia.Keywords: remimazolam, anesthesia, sedation, benzodiazepine, clinical

Jinwen Xia,1,2 Quhui Wang,1 Fei Ju,3 Xiang Luo,3 Feng Wang,4 Youlang Zhou,3 Hua Huang,5 Hua Wang,1,2 Xingli Bao6 1Department of Breast and Thyroid Surgery, Affiliated Hospital of Nantong University, Nantong, People’s Republic of China; 2Clinical Medicine, Medical College, Nantong University, Nantong, People’s Republic of China; 3Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, People’s Republic of China; 4Department of Laboratory Medicine, Affiliated Hospital of Nantong University, Nantong, People’s Republic of China; 5Department of Pathology, Affiliated Hospital of Nantong University, Nantong, People’s Republic of China; 6Department of Medical Equipment, Affiliated Hospital of Nantong University, Nantong, People’s Republic of ChinaCorrespondence: Hua Wang, Department of Breast and Thyroid Surgery, Affiliated Hospital of Nantong University, No. 20, Xisi Road, Chongchuan District, Nantong City, Jiangsu Province, 226001, People’s Republic of China, Tel +86 137 062 92250, Email wanghua12083@163.comPurpose: Multiple reports have demonstrated that highly expressed chloride intracellular channel 1 (CLIC1) exists in a range of malignant tumors and is involved in proliferation, invasion, and migration of cancer cells. There are few studies on CLIC1 and breast cancer (BC). The purpose of this research was to evaluate the expression level of CLIC1 in BC and its impact on prognosis of BC patients.Patients and Methods: Differences in CLIC1 expression levels in 25 pairs of BC and corresponding paracancerous specimens were tested by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot (WB). Immunohistochemistry (IHC) was performed to discuss the relevance between CLIC1 expression in BC tissue chips and clinicopathological parameters of BC patients. The effect of CLIC1 expression on patient prognosis was evaluated by Kaplan–Meier survival curve and Cox regression analysis. Receiver operating characteristic (ROC) curve assessed the diagnostic performance of CLIC1 for BC.Results: The experimental results of qRT-PCR and WB demonstrated that CLIC1 was highly expressed in BC tissues. IHC results showed that overexpression of CLIC1 was strictly correlated with tumor size, TNM classification, pathological grade, lymph node metastasis and Ki67. Patients with lower CLIC1 expression had longer overall survival (OS) and progression-free survival (PFS). Cox regression analysis and ROC curve confirmed that CLIC1 could independently influence the prognosis of BC patients and might have diagnostic efficiency.Conclusion: Overexpressed CLIC1 is closely related to the progression of BC and the poor prognosis of the patients, suggesting that it may act as a potential biological diagnostic index for BC.Keywords: CLIC1, clinical pathological parameter, prognosis, diagnosis

Zhijun Pu,1– 5 Xinyu Bao,1– 5 Shengnan Xia,1– 5 Pengfei Shao,1– 5 Yun Xu1– 5 1Department of Neurology, Nanjing Drum Tower Hospital, Medical School and the State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, 210008, People’s Republic of China; 2Institute of Brain Sciences, Nanjing University, Nanjing, Jiangsu, 210093, People’s Republic of China; 3Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing, Jiangsu, 210008, People’s Republic of China; 4Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, Jiangsu, 210008, People’s Republic of China; 5Nanjing Neurology Clinic Medical Center, Nanjing, Jiangsu, 210008, People’s Republic of ChinaCorrespondence: Yun Xu, Email xuyun20042001@aliyun.comIntroduction: Peripheral neutrophil infiltration can exacerbate ischemia–reperfusion injury. We focused on the relationship between various peripheral immune cells and cerebral ischemia–reperfusion (I/R) injury.Methods: In this study, we investigated the effects of dauricine on neuronal injury induced by ischemia–reperfusion and peripheral immune cells after ischemic stroke in mouse model, and we explored the undefined mechanisms of regulating peripheral immune cells through RNA sequencing and various biochemical verification in vitro and in vivo.Results: We found that dauricine improved the neurological deficits of I/R injury, reduced the infarct volume, and improved the neurological scores. Furthermore, dauricine reduced the infiltration of neutrophils into the brain after MCAO-R and increased peripheral neutrophils but unchanged the permeability of the endotheliocyte Transwell system in an in vitro blood-brain barrier (BBB) model. RNA sequencing showed that chemotaxis factors, such as CXCL3, CXCL11, CCL20, CCL22, IL12a, IL23a, and serpine1, might play a crucial role. Overexpression of serpine1 reversed LPS-induced migration of neutrophils. Dauricine can directly bind with serpine1 in ligand–receptor docking performed with the Autodock and analyzed with PyMOL.Conclusion: We identified chemotaxis factor serpine1 played a crucial role in peripheral neutrophil infiltration, which may contribute to reduce the neuronal injury induced by ischemia–reperfusion. These findings reveal that serpine1 may act as a potential treatment target in the acute stage of ischemic stroke.Keywords: ischemia–reperfusion injury, dauricine, neutrophil recruitment, serpine1

Dongxue Chen,1,&ast; Qian Lin,2,&ast; Tiecheng Yang,3,&ast; Lushaobo Shi,1 Xiaolu Bao,1 Dong Wang1,4 1School of Health Management, Southern Medical University, Guangzhou, People’s Republic of China; 2Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China; 3The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, People’s Republic of China; 4Institute of Health Management, Southern Medical University, Guangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Dong Wang, School of Health Management, Southern Medical University, No. 1023 Shatai Road, Guangzhou, Guangdong, 510515, People’s Republic of China, Tel/Fax +0086-020-61647576, Email dongw96@smu.edu.cnBackground: Turnover of medical staff is a vital issue in the global healthcare system. Previous evidence has confirmed the critical effect of distributive justice on turnover intention, but few studies have focused on the mediating mechanism behind this relationship or the medical staff. This study aimed to examine the mediating roles of organizational commitment and work engagement in the relationship between distributive justice and turnover intention of medical staff, and explore potential occupational differences.Methods: Stratified random sampling was adopted to select qualified medical staff from each clinical department of a large general hospital in Shenzhen, China, at a physician-to-nurse ratio of 1:1.5. The medical staff were surveyed using the Distributive Justice Scale, the Organizational Commitment Scale, the Work Engagement Scale, and the Turnover Intention Scale from May to July 2020. Of the 500 medical staff sampled, 480 responded (response rate: 96.00%), and 457 were finally included for analysis (effective response rate: 95.21%). A mediation analysis was performed using Model 6 of the SPSS macro PROCESS program.Results: There were significant positive correlations among distributive justice, organizational commitment, and work engagement and significant negative correlations among distributive justice, organizational commitment, work engagement, and turnover intention. Distributive justice directly and negatively affected the turnover intention of physicians and nurses, but there were occupational differences in the underlying mechanism between distributive justice and turnover intention. Distributive justice indirectly affected turnover intention among physicians mainly through the mediating effect of organizational commitment, and indirectly among nurses through three different pathways: the mediating effect of organizational commitment, the mediating effect of work engagement, and the chain mediating effect of organizational commitment and work engagement.Conclusion: The relationship between distributive justice and turnover intention was found to be mediated by organizational commitment and work engagement among medical staff in Shenzhen, with variations between physicians and nurses. Thus, appropriately targeted interventions are needed for physicians and nurses to reduce turnover intention.Keywords: medical staff, distributive justice, turnover intention, organizational commitment, work engagement

Formation damage caused by organic contaminates is one of the most important issues that undermine well injectivity and productivity. Anionic surfactants are commonly used to mobilize the organic contaminates trapped by capillary forces. The electrostatic repulsion between anionic surfactant heads reduces the surfactant density at the oil-water interface, consequently reducing the interfacial efficiency. In this paper, a novel surfactant blend of anionic-cationic surfactants (Sa/c) was designed and showed much higher efficiency than traditional ones because of the strong electrostatic attraction between anionic and cationic surfactants. The oil-water interfacial tension (IFT) was reduced to 3 × 10−4 mN/m, and the viscosity of crude oil was reduced by 92%. In addition, the freezing point of the residual oil was decreased by 20.9%. Moreover, Sa/c altered the wettability and inhibited the clay swelling. Field applications were conducted in sandstone reservoirs at temperatures of about 120 °C and permeabilities below 10 mD. The average injection pressure drops were greater than 30%. The findings of this study can help for better understanding the advantages of Sa/c with high interfacial activity and revealed that formation damage caused by the organic contaminates in high temperature and low permeability sandstone reservoirs can be effectively remediated by this novel surfactant blend. [ABSTRACT FROM AUTHOR]

Topological insulators (TIs) are quantum materials with topologically protected surface states surrounding an insulating bulk. However, defect-induced bulk conduction often dominates transport properties in most TI materials, obscuring the Dirac surface states. In order to realize intrinsic topological insulating properties, it is thus of great significance to identify the spatial distribution of defects, understand their formation mechanism, and finally control or eliminate their influence. Here, the electronic heterogeneity in polyol-synthesized Bi2Se3 and chemical vapor deposition-grown Sb2Te3 nanocrystals is systematically investigated by multimodal atomic-to-mesoscale resolution imaging. In particular, by combining the Drude response sensitivity of infrared scattering-type scanning near-field optical microscopy with the work-function specificity of mirror electron microscopy, characteristic mesoscopic patterns are identified, which are related to carrier concentration modulation originating from the formation of defects during the crystal growth process. This correlative imaging and modeling approach thus provides the desired guidance for optimization of growth parameters, crucial for preparing TI nanomaterials to display their intrinsic exotic Dirac properties.

Xinyang Wang,1,&ast; Dandan Xue,1,&ast; Xiaoxia Zhu,2,&ast; Rui Geng,3 Xin Bao,2 Xiang Chen,2 Tiansong Xia1,4 1Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, People’s Republic of China; 2Department of Thyroid and Breast, Yixing People’s Hospital Affiliated to Jiangsu University, Yixing, People’s Republic of China; 3Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China; 4Jiangsu Key Lab of Cancer Biomarkers, Prevention, and Treatment, Jiangsu Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiang ChenDepartment of Thyroid and Breast, Yixing People’s Hospital Affiliated to Jiangsu University, 75 Zhen’guan Road, Yixing, 214200, People’s Republic of ChinaEmail staff984@yxph.comTiansong XiaDepartment of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People’s Republic of ChinaEmail xiatsswms@163.comPurpose: Breast cancer accounts for the highest incidence of tumors in women. Immune infiltrating of the tumor microenvironment positively correlates with the overall survival of breast cancer patients. PLAT can affect the development of many cancers, but its mechanism in breast cancer is unclear. We assessed the correlation between PLAT and immune infiltrating in breast cancer based on the TCGA database.Patients and Methods: The expression and DNA methylation of PLAT in breast cancer with different clinical characteristics was tested by Wilcoxon signed rank test and displayed by box plot. Sequentially, Kaplan–Meier plot was employed to compare the difference in overall survival rates between patients with different expressed levels. Univariate and multivariate Cox regression analyses were used to validate whether PLAT is an independent prognostic factor of breast cancer. After that, GO, KEGG, and gene-set enrichment analysis were employed to do functional enrichment analysis. Finally, TIMER, TISIDB database, and ssGSEA algorithm were used to assess the correlation between PLAT expression and various immune characteristics. The correlation between PLAT expression and DNA methylation was examined by Pearson correlation coefficient.Results: PLAT displays differential expression levels in breast cancer patients with various clinical characteristics. As an independent protective factor for breast cancer, PLAT may significantly correlate with the immune status of breast cancer by adjusting many immune molecules and affecting the immune infiltration in the tumor microenvironment. DNA methylation of PLAT downregulates the gene expression and affects the prognosis of breast cancer.Conclusion: PLAT can be considered a potential biomarker to predict breast cancer prognosis and might contribute to the development of immunological treatment strategies.Keywords: tPA, prognosis, immune infiltration, bioinformatic

Micro‐alloying effects of lanthanum in thermo‐mechanical control process of manganese‐chromium‐molybdenum bainite rail steel are investigated through experimental simulation and microstructural characterization. The results show that the deformation strengthening effect is fully exerted by thermo‐mechanical control process in steel containing 0.015 % lanthanum. Finally a kind of multi‐layer bainite ferrite microstructure featured by 3.5 μm blocks, 0.41 μm plates and 108 nm sub‐plates with ultrafine sub‐subunits and 55 nm θ‐M3C inside is achieved, which enhances the strength and toughness synergistically. And the nanoscale refinement mechanism of bainite ferrite plates lies in the formation of massive ultrafine sub‐subunits with the average size of 20 nm ×32 nm. Besides, a large number of twinning martensite with the size of 2 nm to 20 nm and high‐density entangled dislocations can be found on the boundaries of ultrafine sub‐subunits. Further, the density of dislocation is increased by 2.92×1014 cm−2 and its contribution to the strength is calculated to be 18 MPa. Moreover, micro‐alloying effects of lanthanum in thermo‐mechanical control process are explored to be that lanthanum enhances the interaction between bainite ferrite plates and dislocations, strengthens the entanglement of carbon and θ‐M3C with dislocations, and promotes the pinning effect of θ‐M3C on ultrafine subunits. [ABSTRACT FROM AUTHOR]

Jun Dou,1,* Luoyang Li,1,* Mei Guo,1,* Feng Mei,1 Danfeng Zheng,1 Hui Xu,1 Rui Xue,1 Xueyang Bao,1 Fengshu Zhao,1 Yu Zhang2 1Department of Pathogenic Biology and Immunology, Medical College, Southeast University, Nanjing, 210009, People’s Republic of China; 2State Key Laboratory of Bioelectronics, Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210009, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jun DouDepartment of Pathogenic Biology and Immunology, Medical School, Southeast University, Nanjing, 210009, People’s Republic of ChinaEmail njdoujun@seu.edu.cnYu ZhangSchool of Biological Science and Medical Engineering, Southeast University, Nanjing, 210009, People’s Republic of ChinaEmail zhangyu@seu.edu.cnBackground and Aim: Acute myeloid leukemia (AML), initiated and maintained by leukemia stem cells (LSCs), is often relapsed or refractory to therapy. The present study aimed at assessing the effects of nanozyme-like Fe3O4 nanoparticles (IONPs) combined with cytosine arabinoside (Ara-C) on LSCs in vitro and in vivo.Methods: The CD34+CD38–LSCs, isolated from human AML cell line KG1a by a magnetic activated cell sorting method, were treated with Ara-C, IONPs, and Ara-C+ IONPs respectively in vitro. The cellular proliferation, apoptosis, reactive oxygen species (ROS), and the related molecular expression levels in LSCs were analyzed using flow cytometry, RT-qPCR, and Western blot. The nonobese diabetic/severe combined immune deficiency mice were transplanted with LSCs or non-LSCs via tail vein, and then the mice were treated with Ara-C, IONPs and IONPs plus Ara-C, respectively. The therapeutic effects on the AML bearing mice were further evaluated.Results: LSCs indicated stronger cellular proliferation, more clone formation, and more robust resistance to Ara-C than non-LSCs. Compared with LSCs treated with Ara-C alone, LSCs treated with IONPs plus Ara-C showed a significant increase in apoptosis and ROS levels that might be regulated by nanozyme-like IONPs via improving the expression of pro-oxidation molecule gp91-phox but decreasing the expression of antioxidation molecule superoxide dismutase 1. The in vivo results suggested that, compared with the AML bearing mice treated with Ara-C alone, the mice treated with IONPs plus Ara-C markedly reduced the abnormal leukocyte numbers in peripheral blood and bone marrow and significantly extended the survival of AML bearing mice.Conclusion: IONPs combined with Ara-C showed the effectiveness on reducing AML burden in the mice engrafted with LSCs and extending mouse survival by increasing LSC’s ROS level to induce LSC apoptosis. Our findings suggest that targeting LSCs could control the AML relapse by using IONPs plus Ara-C.Keywords: acute myeloid leukemia, leukemia stem cells, Fe3O4 nanoparticles, cytosine arabinoside, reactive oxygen species

Xiulong Ma,1 Zhongwei Wang,1 Hongtao Ren,1 Xing Bao,1 Yang Zhang,1 Baofeng Wang,1 Dongli Ruan2 1Department of Radiation Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China; 2Department of Urology, Xijing Hospital, Air Force Military Medical University, Xi’an, Shaanxi 710032, People’s Republic of ChinaCorrespondence: Dongli Ruan Tel +86-29-84775507Email gklrhq@163.comBackground: Long non-coding RNAs (lncRNAs) function as a class of significant mediators in prostate cancer (PCa), and this study mainly discussed the molecular mechanism of lncRNA growth arrest-specific 5 (GAS5) in PCa progression and radiosensitivity.Materials and Methods: GAS5 and microRNA-320a (miR-320a) levels were determined by quantitative real-time polymerase chain reaction (qRT-PCR). Cell viability and migration were severally examined through 3-(4, 5-dimethylthiazol-2-y1)-2, 5-diphenyl tetrazolium bromide (MTT) and transwell assays. PCa cells were treated with X-ray irradiation. Cell survival and apoptosis rate were assayed using colony formation assay and flow cytometry, respectively. The apoptosis-related protein and Rab GTPase 21 (RAB21) protein levels were measured by Western blot. The relation between miR-320a and GAS5 or RAB21 was assessed via the dual-luciferase reporter assay. The effect of GAS5 on radiosensitivity of PCa in vivo was evaluated by xenotransplantation assay.Results: GAS5 was down-regulated in PCa tissues and cells. GAS5 overexpression suppressed cell viability and migration while facilitated radiosensitivity of PCa cells. GAS5 was a molecular sponge of miR-320a. The effects of GAS5 up-regulation on PCa cells were accomplished by sponging miR-320a. MiR-320a targeted RAB21 and GAS5 up-regulated RAB21 expression via targeting miR-320a. RAB21 knockdown reversed the effects of miR-320a inhibition on PCa cells. GAS5 promoted the radiosensitivity of PCa by the miR-320a/RAB21 axis in vivo.Conclusion: Collectively, GAS5 restrained tumor development and expedited the radiosensitivity in PCa by the miR-320a/RAB21 axis, which provided a molecular regulatory mechanism of GAS5/miR-320a/RAB21 in PCa development and radioresistance.Keywords: GAS5, prostate cancer, radiosensitivity, miR-320a, RAB21

Xinmin Bao,1,* Yuji Huang,2,3,* Weimin Xu,2,3 Gongyou Xiong1 1No.1 People´s Hospital, Jiujiang City, Jiangxi Province, People’s Republic of China; 2Department of Colorectal Surgery, Xin‐Hua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China; 3Shanghai Colorectal Cancer Research Center, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yuji Huang; Gongyou Xiong Email yujihuangrain@163.com; 523806759@qq.comBackground: Nonsense-mediated mRNA decay (NMD) can degrade mRNAs with a premature termination codon (PTC), and undegraded mRNAs with PTC mutations can induce a genetic compensation response (GCR) by upregulating its compensatory genes. UPF3a refers to up-frame shift 3A (UPF3a) participating in NMD pathway and GCR. It inhibits the NMD pathway while it stimulates GCR. Notably, the role of UPF3a in cancer remains unclear.Purpose: The identification and discovery of prognostic markers for colorectal cancer (CRC) are of great clinical significance. The aim of this study was to investigate clinical significance of UPF3a expression in CRC.Materials and Methods: UPF3a expression was examined in fresh CRC tissues and pared distant metastatic tissues using quantitative real-time PCR, Western blotting and immunohistochemistry staining. Tissue microarray immunohistochemical staining was used to study the relationship of UPF3a with clinicopathological features in 158 CRC patient samples collected from January 2008 to December 2012, and prognosis of CRC was analyzed.Results: The expression of UPF3a was higher in metastatic tissues than that in primary sites. Moreover, high expression of UPF3a was significantly associated with TNM stage (p=0.009), liver metastasis and recurrence (p< 0.001) in CRC patients. The Cancer Genome Atlas (TCGA) database showed the same trend. In CRC cells, knockdown of UPF3a led to a decline in the migration potential. Kaplan–Meier survival analysis revealed that high UPF3a expression, TNM stage were significantly associated (all P< 0.01) with poor prognosis for patients. Furthermore, univariate and multivariate Cox analysis revealed that high UPF3a expression was independent risk factor for both overall survival and disease-free survival of CRC patients (all P< 0.01).Conclusion: Results showed that high levels of UPF3a could lead to aggressiveness and poor CRC prognosis. Targeted UPF3a can act as a novel and effective gene therapy for CRC patients to make a better prognosis.Keywords: UPF3a, colorectal cancer, TCGA, NMD pathway, genetic compensation response, metastasis

Song Yao,1,* Junwei Yan,2,* Ling Li,1 Dongchun Ma,1 Jie Liu,1 Qing Wang,1 Aimin Wang,1 Fangjin Bao,1 Zekun Zhang,1 Xundi Bao1 1Tuberculosis Prevention and Treatment Institute of Anhui Province (Anhui Chest Hospital), Hefei 230022, Anhui, People’s Republic of China; 2Affiliated Psychological Hospital of Anhui Medical University, Hefei Fourth People’s Hospital, Anhui Metal Health Center, Hefei, People’s Republic of China*These authors contributed equally to this workCorrespondence: Junwei Yan No. 316, Huangshan Road, Hefei 230022, Anhui, People’s Republic of ChinaTel/Fax +86-551-63658250Email 594347807@qq.comBackground: Multidrug-resistant tuberculosis (MDR-TB) is currently a major problem in China. The prevention and treatment work for MDR-TB patients started late in Anhui province. To determine the prevalence of MDR-TB in sputum smear-positive TB patients (SSPTBPs) and analyze the risk factors for MDR-TB in Anhui province, we conducted an investigation of drug resistance among SSPTB outpatients from September 2015 to August 2016.Methods: A stratified cluster-randomized sampling method was used to obtain a representative sample. It was estimated that 2290 new cases and 440 previously treated cases of SSPTBPs needed to be recruited from 40 survey sites. Isolates were tested for resistance to six first-line and second-line anti-TB drugs. Information from patient questionnaire survey was used to identify factors linked to MDR-TB.Results: Finally, a total of 3047 SSPTBPs were recruited from 40 survey sites; of these, 2530 specimens were successfully cultured and had drug susceptibility testing done. The proportions of rifampin resistant (RR)-TB were 11.42% (289/2530, 95% CI: 10.18– 12.66%), 7.64% (163/2133, 95% CI: 6.38– 8.62%) and 31.74% (126/397, 95% CI: 27.38– 36.60%) in all cases, new cases and previously treated cases, respectively, and the proportions of confirmed MDR-TB were 7.63% (193/2530, 95% CI: 6.59– 8.66%), 4.97% (106/2133, 95% CI: 4.05– 5.89%) and 21.91% (87/397, 95% CI: 17.83– 26.00%), respectively. The ofloxacin resistance rate in previously treated SSPTBPs reached 21.66% (95% CI: 17.33– 26.75%). Patients who had received two or more anti-TB treatment courses were significantly associated with MDR-TB compared to patients who have received one anti-TB course.Conclusion: MDR-TB prevalence was high among SSPTBPs in Anhui province, and past anti-TB treatment course was associated with MDR-TB.Keywords: drug resistance, multidrug-resistant, Mycobacterium tuberculosis, tuberculosis

Guiying Yang, Xiaohang Bao, Jing Peng, Jie Li, Guangming Yan, Sheng Jing, Hong Li, Guangyou Duan Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing 400037, People’s Republic of ChinaCorrespondence: Hong Li; Guangyou DuanDepartment of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, People’s Republic of ChinaTel +8618323376014Fax +862368774997Email lh78553@163.com; dgy1986anesthesia@126.comPurpose: This study aimed to compare the analgesic outcomes between primary and repeated cesarean delivery.Patients and Methods: We performed a retrospective analysis based on the medical records of a teaching hospital in China from January 2018 to March 2019. We collected data on demographic characteristics, perioperative complications, anesthesia, and surgical factors for cesarean delivery patients. We also recorded the postoperative analgesic strategy, pain intensity (assessed by the number rating scale) during the first 48 hrs after surgery, hospital cost, and hospital stay. Postoperative inadequate analgesia was defined by a score of ≥ 4 in the number rating scale. Analgesic outcomes after cesarean delivery between primiparas and multiparas were compared using propensity score matching analysis. Moreover, subgroup logistic analysis for different age groups (≥ 35 and < 35 years) was performed to investigate the effect of the maternal category on postoperative inadequate analgesia.Results: A total of 1543 patients were included in the analysis and 571 pairs (1142 patients) were matched in the primiparas and multiparaparas group according to their propensity score. In both the non-matched and matched cohort, the incidence of inadequate analgesia in the primiparas group was lower than that in the multiparas group (16.7% vs. 24.0%, P < 0.001 and 16.1% vs. 23.5%, P = 0.002; respectively). The multiparas group was identified as being at risk of inadequate analgesia after cesarean delivery in both age groups (age ≥ 35 years, odds ratio: 2.18, 95% confidence interval: 1.20– 3.95; age < 35 years, odds ratio: 1.43, 95% confidence interval 1.08– 1.89).Conclusion: Multiparas that undergo a repeat cesarean delivery had a significantly higher risk of inadequate postoperative pain treatment than primiparas. The maternal category should be considered when formulating the postoperative analgesia strategy after cesarean delivery.Keywords: cesarean delivery, analgesia, primipara, multipara

Guangyou Duan,1,* Xiaohang Bao,1,* Guiying Yang,1 Jing Peng,1 Zhuoxi Wu,1 Peng Zhao,1 Zhiyi Zuo,2 Hong Li1 1Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China; 2Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA *These authors contributed equally to this work Introduction: This study aimed to compare the postoperative analgesic effects of tramadol and hydromorphone for secondary cesarean delivery (CD) as well as their anti-anxiety and anti-depression properties.Methods: A total of 106 patients receiving secondary CD under spinal anesthesia were randomly allocated to the tramadol group (n=53) and the hydromorphone group (n=53). Each group received patient-controlled intravenous analgesia using flurbiprofen 4 mg/kg combined with tramadol (4 mg/kg) or hydromorphone (0.04 mg/kg) immediately after the surgery. Postoperative pain numerical rating scale (NRS) for incision and visceral pain, hospital anxiety and depression scale (HADS), early walking time and length of hospital stay were assessed.Results: Patients in the tramadol and hydromorphone groups exhibited equivalent incision pain NRS at different time points (P>0.05). Visceral pain in the tramadol group was higher than that in the hydromorphone group at postoperative 4 hours (2.9 [1.2] vs 2.3 [1.4], P=0.011) and 8 hours (2.4 [1.1] vs 1.8 [1.1], P=0.028). One week after the surgery, the patients in the tramadol group, as compared to the hydromorphone group, had lower anxiety scores (1.9 [3.5] vs 3.6 [4.1], P=0.033) and depression scores (0.8 [1.3] vs 2.7 [4.1], P=0.023). In addition, early walking time (25.3 [7.0] hours vs 29.3 [9.6] hours, P=0.016) and length of hospital stay (2.9 [0.8] days vs 3.3 [0.8] days, P= 0.008) after the surgery in the tramadol group were less than those in the hydromorphone group.Conclusion: Postoperative intravenous analgesia with tramadol or hydromorphone for secondary CD provides comparable analgesic effects on incision pain. Tramadol is less effective in controlling visceral pain compared to hydromorphone. However, tramadol can help to alleviate anxiety and depression in the early postpartum period, improve patients’ early mobilization and shorten their hospital stay.Clinical trial number and registry URL: No: ChiCTR-IIR-17011043; URL: www.chictr.org.cn. Keywords: anxiety, caesarean section, depression, postoperative pain, tramadol

Decision making ability has been reported to be impaired in schizophrenia patients, but no research has examined the genetic bases of this impairment. This study investigated how decision making was affected by the genetic variants in the serotonin transporter gene (triallelic 5- HTTLPR) and serotonin receptor 1A gene (rs6295) and their interaction in 465 schizophrenia patients and 448 healthy controls. The Iowa Gambling Task (IGT) was used to evaluate decision making under ambiguity (the first 40 trials) and decision making under risk (the last 60 trials). Results showed that, among the patients, the main effects of 5- HTTLPR (F(2) (,16) = 6.54, P = 0.002) and HTR1A rs6295 (F(2) (,16) = 3.87, P = 0.021) polymorphisms and their interaction effect (F(4) (,16) = 3.32, P = 0.005) were significant for the first 40 trials, with the GG genotype of HTR1A rs6295, the L'L' genotype of 5- HTTLPR and the GG-L'L' combination showing poorer IGT performance than their counterparts. Results for the healthy controls showed a similar pattern but did not reach statistical significance. No significant effects were found for the last 60 trials. These results are discussed in terms of their implications for our understanding of the genetic mechanisms of decision making in schizophrenia patients as well as healthy adults.