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Ting Pan,1 Xuefeng Li,2 Xiaole Guo,3 Haili Wang,2 Xue Zhou,2 Rui Shang,4 Donge Xie,5 Xin Qian,6 Mengyao Dai,2 Enshuo Fan,2 Xinhua Chen,1 Chunhai Chen5 1College of Traditional Chinese Medicine, ChangChun University of Chinese Medicine, Changchun, Jilin, People’s Republic of China; 2School of Acupuncture-Moxibustion and Tuina, Changchun University of Chinese Medicine, Changchun, Jilin, People’s Republic of China; 3Prevention and Treatment Center, The Third Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, People’s Republic of China; 4Traditional Chinese Medicine Rehabilitation Center, Jilin Cancer Hospital, Changchun, Jilin, People’s Republic of China; 5Acupuncture and moxibustion Clinical Center, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, People’s Republic of China; 6Tuina Department, Shenzhen Traditional Chinese Medicine Hospital, ShenZhen, Guangdong, People’s Republic of ChinaCorrespondence: Xinhua Chen, ChangChun University of Chinese Medicine, No. 1035 Boshuo Road, Changchun, Jilin Province, 130117, People’s Republic of China, Tel +86 13596104290, Email 187098190@qq.com Chunhai Chen, Affiliated Hospital of Changchun University of Chinese Medicine, No. 1478 Gongnong Dalu, Changchun, Jilin Province, 130021, People’s Republic of China, Tel +86 13604404239, Email 5010841@qq.comIntroduction: Adjusting internal organs and dredging channel electroacupuncture has a definite effect on type 2 diabetes, but the specific mechanism still needs to be further clarified. This study aims to investigate the effects of electroacupuncture on the gut microbiota and bile acids in db/db mice after the intervention of “adjusting internal organs and dredging channel” and further explore its mechanism of action in treating T2DM.Methods: We used db/db mice as the animal model and db/m mice from the same litter as the blank control group, a total of 4 weeks of intervention were conducted. We evaluated the effectiveness of the “adjusting internal organs and dredging channel” treatment by detecting indicators related to glucose and lipid- metabolism. Detect changes in the gut microbiota of mice in each group using 16SrDNA sequencing technology. The content of bile acids in mouse feces was determined using liquid chromatography mass spectrometry, and the correlation analysis between different bile acids and differential bacterial communities was performed. The expression levels of TGR5 and GLP-1 proteins were measured using the Western blot method.Results: Adjusting internal organs and dredging channel electroacupuncture can improve blood glucose levels in db/db mice, increase the abundance of Firmicutes and Actinobacteria, and increase the content of fecal bile acid pool heavy CA and UDCA. At the same time, it also increased the content of TGR5/GLP1 in the small intestine.Conclusion: Adjusting internal organs and dredging channel electroacupuncture can improve the disorder of glucose and lipid metabolism in db/db mice, regulate the abundance and colony composition of intestinal microbiota in mice, and regulate bile acid metabolism in mice. The interaction between bile acid and intestinal microbiota can also be observed; Mutual influence may play a role in regulating blood sugar together.Keywords: type 2 diabetes mellitus, electroacupuncture, intestinal flora, bile acid

Ya-Ming Xie,1 Wenfeng Lu,2 Jian Cheng,1 Mugen Dai,3 Si-Yu Liu,4 Dong-Dong Wang,1 Tian-Wei Fu,1 Tai-Wei Ye,1 Jun-Wei Liu,1 Cheng-Wu Zhang,1 Dong-Sheng Huang,1 Lei Liang1 1Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, General Surgery, Cancer Center, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, People’s Republic of China; 3Department of Gastroenterology, The Fifth Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People’s Republic of China; 4Department of Laboratory Medicine, The Key Laboratory of Imaging Diagnosis and Minimally Invasive Interventional Research of Zhejiang Province, Zhejiang University Lishui Hospital, Lishui, Zhejiang, People’s Republic of ChinaCorrespondence: Lei Liang; Dong-Sheng Huang, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, General Surgery, Cancer Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310014, People’s Republic of China, Email liangl1992@hotmail.com; huangdshz88@hotmail.comBackground: Nutritional and inflammatory status has been reported to be associated with the prognosis of hepatocellular carcinoma (HCC), but many studies did not include all biomarkers simultaneously. The present study aimed to determine the impact of Naples prognostic score (NPS) on the long-term survival in patients undergoing hepatectomy for HCC.Methods: Patients with HCC after curative resection were eligible. Then, all patients were stratified into three groups according to the NPS. Clinical features and survival outcomes were compared among the three groups. Independent prognostic factors were determined by COX analysis. The time dependent receiver operating characteristic (ROC) curves were used to compare prognostic performance with other immunonutrition scoring systems.Results: A total of 476 patients were enrolled eventually. Baseline characteristics showed that patients with higher NPS had a higher proportion of poor liver function and advanced tumor features. Accordingly, Kaplan-Meier survival curves showed that patients with higher NPS had a lower rate of overall survival (OS) and recurrence-free survival (RFS). Multivariable COX analysis demonstrated that NPS was an independent risk factor of OS (NPS group 2 vs 1: HR=1.958, 95% CI: 1.038– 3.369, p = 0.038; NPS group 3 vs 1: HR=2.608, 95% CI: 1.358– 5.008, p=0.004, respectively) and RFS (NPS group 2 vs 1: HR=2.014, 95% CI: 1.299-2-3.124, p=0.002; NPS group 3 vs 1: HR=2.002, 95% CI: 1.262– 3.175, p=0.003, respectively). The time-dependent ROC curve showed that NPS was superior to other models in prognostic performance and discriminatory power for long-term survival (median AUC 0.675, 95% CI: 0.586– 0.712, P < 0.05).Conclusion: The NPS is a simple tool strongly associated with long-term survival in patients undergoing curative hepatectomy for HCC.Keywords: hepatocellular carcinoma, Naples prognostic score, nutritional indicator, inflammatory indicator, prognostic performance

Jing Huang,1,&ast; Mengmeng Dai,1,&ast; Mingxia He,1,&ast; Weicheng Bu,1 Liwen Cao,1 Jing Jing,1 Run Cao,1 Hailong Zhang,1 Ke Men2 1Joint National Laboratory for Antibody Drug Engineering, The First Affiliated Hospital, Henan University, Kaifeng, Henan Province, 475004, People’s Republic of China; 2State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610044, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hailong Zhang, Joint National Laboratory for Antibody Drug Engineering, The First Affiliated Hospital, Henan University, Kaifeng, Henan Province, 475004, People’s Republic of China, Email hailong6891@163.com Ke Men, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610044, People’s Republic of China, Email mendingbob@hotmail.comPurpose: The abnormal activation of NLRP3 inflammasome is related to the occurrence and development of ulcerative colitis (UC). However, the ideal drug and delivery system remain important factors limiting the targeting of NLRP3 inflammasome in UC therapy. Gene therapy by delivering siRNA is effective in treating various diseases. Therefore, delivering siNLRP3 using an ideal vector for UC treatment is necessary.Materials and Methods: Nanoparticles delivering siNLRP3 were developed based on cationic liposome (CLP/siNLRP3). Their ability to inhibit NLRP3 inflammasome activation was monitored using Western blot (WB) and Enzyme-linked Immunosorbent Assay (ELISA). The ASC oligomerization in LPS-primed peritoneal macrophages (PMs) was detected by WB and immunofluorescence. Moreover, we assessed the role of CLP/siNLRP3 on dextran sodium sulfate (DSS)-induced UC by examining NLRP3 levels, pro-inflammatory cytokines expression, and disease-associated index (DAI). Flow cytometry (FCM) was used to detect the contents of macrophages and T cells. Finally, we assessed the safety of CLP/siNLRP3.Results: The prepared CLP was spherical, with a small particle size (94 nm) and low permeability. The CLP could efficiently protect siNLRP3 from degradation and then deliver siNLRP3 into PMs, inhibiting NLRP3 inflammasome activation. Also, the CLP/siNLRP3 could inhibit the secretion of mature IL-1β and IL-18 from PMs, thereby achieving a favorable anti-inflammation effect. In vivo, CLP/siNLRP3 could effectively alleviate intestinal injury in UC mice, which was attributed to down-regulating levels of IL-1β and IL-18, inhibiting infiltration of macrophages and other immune cells, and the polarization of M1 macrophages. Finally, pathological testing of tissue sections and blood biochemical tests showed no significant toxic effects of CLP/siNLRP3.Conclusion: We introduced a prospective approach for the efficient delivery of siRNA in vitro and in vivo with high safety and stability, which was found to have great potential in treating NLRP3-driven diseases in an RNA-silencing manner.Keywords: cationic liposome, NLRP3, siRNA, macrophage, ulcerative colitis

Wan He,1,&ast; Changbu Wu,2,3,&ast; Guanping Chen,2– 4 Guili Zhang,2,3 Zihan Zhao,2,3 Shu’an Wen,2,3 Yuan Zhou,2,3 Xue Deng,2,3 Yu Feng,2,3 Lan-Lan Zhong,2,3 Guo-Bao Tian,2– 4 Min Dai1 1School of Laboratory Medicine, Chengdu Medical College, Chengdu, 610500, People’s Republic of China; 2Department of Immunology and Microbiology, Advanced Medical Technology Center, The First Affiliated Hospital, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China; 3Key Laboratory of Tropical Diseases Control (Sun Yat-sen University), Ministry of Education, Guangzhou, 510080, People’s Republic of China; 4Department of Immunology, School of Medicine, Sun Yat-Sen University, Shenzhen, 518107, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Min Dai, School of Laboratory Medicine, Chengdu Medical College, Chengdu, Sichuan Province, People’s Republic of China, Tel +86 28-62739128, Email daimin1015@163.com Guo-Bao Tian, Department of Immunology and Microbiology, Advanced Medical Technology Center, The First Affiliated Hospital, Zhongshan School of Medicine, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou, 510080, People’s Republic of China, Tel/Fax +86 20 87335387, Email tiangb@mail.sysu.edu.cnBackground: The emergence and spread of hypervirulent carbapenem-resistant Klebsiella pneumoniae (hv-CRKP) is a potential epidemiological threat that needs to be monitored. However, the transmission and pathogenic characteristics of hv-CRKP in China remain unclear. We investigated the epidemiological characteristics of gut colonized hv-CRKP in a hospital in Guangdong Province, China.Methods: A total of 46 gut colonized hv-CRKP isolates were collected from Sun Yat-Sen Memorial Hospital (Guangzhou, China) from August 31st to December 31st, 2021. Minimum inhibitory concentrations (MICs) were obtained for 15 antibiotics for 46 hv-CRKP isolates. BALB/C mice infection model and mucoviscosity assay was used to evaluate the virulence of the isolates. The characteristics of genome, phylogenetic relationship and the structure of the plasmid of 46 gut colonized hv-CRKP isolates were compared with pathogenic isolates from GeneBank based on whole-genome data.Results: The hv-CRKP isolation rate of all gut colonized carbapenem-resistant Klebsiella pneumoniae was 17% (46/270), and the intestinal colonization rate of hv-CRKP was irrelevant to the sex, age, department of hospitalization, and history of antibiotic use of the host. The gut colonized hv-CRKP showed pandrug resistance and hypervirulence. The gut colonized hv-CRKP and pathogenic hv-CRKP prevalent in China were mainly ST11 hv-CRKP and had two major epidemic clades. The similarities in genomic characteristics between gut colonized hv-CRKP and pathogenic hv-CRKP were consistent. The gut colonized hv-CRKP carried an incomplete structure pK2044 virulence plasmid from hypervirulent K. pneumoniae NTUH-K2044 by analyzing the virulence plasmid structure.Conclusion: Our results suggest that the gut colonized ST11 hv-CRKP may serve as a reservoir for the clinical pathogenic ST11 HV-CRKP. It is necessary to further strengthen the monitoring of gut colonized hv-CRKP and research the potential mechanism of infection caused by gut colonized hv-CRKP.Keywords: K. pneumoniae, intestinal colonization, hypervirulent, genomic characterization, carbapenemase

Shiyun Lv,1,&ast; Lijun Sun,1,&ast; Tongzeng Li,1,&ast; Ruojing Bai,1 Man Dai,2,3 Ran Wang,1 Yuanyi Zhai,1 Wei Hua,1 Aixin Li,1 Ruolei Xin,2 Lili Dai1 1Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Institute for STD/AIDS Prevention and Treatment, Beijing Center for Disease Prevention and Control, Beijing, People’s Republic of China; 3School of Public Health, Chinese Medical University, Shenyang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Lili Dai, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China, Tel +86 10 83911069, Email lilydaier@ccmu.edu.cn Ruolei Xin, Institute for STD/AIDS Prevention and Treatment, Beijing Center for Disease Prevention and Control, Beijing, 100013, People’s Republic of China, Tel +86 10 64407364, Email xinruolei@sina.comObjective: To analyze the antiretroviral resistance in people living with HIV (PLWH) who developed low-level viremia (LLV) during antiretroviral therapy (ART) via sequencing of their HIV-1 proviral DNA and RNA and comparisons of their proviral DNA genotyping data with their past and synchronous RNA genotyping data.Patients and Methods: PLWH with LLV while receiving ART for 6 months or longer from January 2020 to September 2021 were included. HIV-1 proviral DNA and RNA were extracted from white-blood cells and concentrated plasma by ultracentrifugation, respectively, and HIV-1 pol gene fragments were amplified and sequenced. The concordance in the detection of resistance-associated mutations (RAMs) were examined between proviral DNA vs past RNA genotyping and proviral DNA vs synchronous RNA genotyping.Results: Of the 150 PLWH with LLV, 117 proviral DNA pol sequences detected in 105 PLWH were successfully amplified and RAMs were present in 27.6% and the rate of RAMs conferring low-level or greater resistance to antiretrovirals examined was 17.1%. Fifty-six and 57 PLWH had results of past and synchronous RNA genotyping, respectively, for comparisons with those of proviral DNA genotyping; and the concordance rates were 76.8% and 75.4%, respectively. However, proviral DNA genotyping lost than gained partial information on antiretroviral resistance compared with past or synchronous RNA genotyping.Conclusion: We found that the concordance between proviral DNA and past and synchronous RNA genotyping was moderate. Proviral DNA genotyping lost than gained more information on antiretroviral resistance compared with past or synchronous RNA genotyping. To optimize ART in PLWH with LLV, antiretroviral resistance profile should be interpreted in combination with proviral DNA and RNA genotyping and a comprehensive review of previous treatment history.Keywords: genotypic resistance testing, resistance-associated mutation, nucleoside reverse-transcriptase inhibitor, non-nucleoside reverse-transcriptase inhibitor, protease inhibitor

Jing Liu,1,&ast; Xianglu Sun,2,&ast; Qianyu Du,3 Jinghao Yao,1,4 Mengfen Dai,1 Qianqian Cheng,1 Han Xu,5 Yawei Li,6 Xiuli Liu,7 Mingliang Zhang,8 Yongchun Zhou,2 Yan Yang1 1Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233004, People’s Republic of China; 2Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233004, People’s Republic of China; 3Department of Medical Oncology, Suzhou Municipal Hospital, Suzhou, Anhui, 234000, People’s Republic of China; 4Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230000, People’s Republic of China; 5Department of Medical Oncology, The Third People’s Hospital of Bengbu, Bengbu, Anhui, 233000, People’s Republic of China; 6Department of Medical Oncology, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233040, People’s Republic of China; 7Department of Oncology, The Fifth People’s Hospital of Fuyang, Fuyang, Anhui, 236000, People’s Republic of China; 8Department of Oncology Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233004, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yan Yang, Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233004, People’s Republic of China, Tel/Fax +86 552 3086178, Email qiannianhupo@163.com Yongchun Zhou, Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233004, People’s Republic of China, Tel/Fax +86 552 3086845, Email zhouyongchun_1@hotmail.comPurpose: To explore the efficacy, safety, and potential factors influencing efficacy and outcome of pyrotinib-based therapy in human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) in complex clinical practice.Methods: Real-world data for HER2-positive MBC patients treated with pyrotinib-based regimens from 6 hospitals in Northern Anhui, China, from September 2018 to February 2022, were retrospectively collected, and clinicopathological features, efficacy, prognosis, and safety were analyzed. Potential influencing factors including baseline serum vascular endothelial growth factor-A (VEGF-A) for evaluating pyrotinib’s treatment response and outcome were also explored.Results: A total of 169 patients with HER2-positive MBC were enrolled. The objective response rate (ORR), disease control rate (DCR), and median progression-free survival (mPFS) of the overall cohort were 65.1%, 87.6%, and 12.4 months, respectively. Pyrotinib is highly beneficial as different treatment lines and appears to be a feasible strategy both in combination with chemotherapeutic drugs and alone. The mPFS values were 16.5 months, 12.4 months, and 9.3 months in the first, second, and third-or-higher lines of anti-HER2 therapy, respectively (P=0.027). The most common adverse event (AE) was diarrhea (88.2%), and patients with < grade 3 diarrhea achieved a longer mPFS than patients with ≥ grade 3 diarrhea (13.3 months vs 6.9 months, P=0.007). Among the patients with available baseline VEGF-A data, the ORR was 43.5% in patients with a high level of VEGF-A, compared to 81.5% in patients with a low level of VEGF-A (P=0.005). Moreover, patients in the VEGF-A-high group exhibited a shorter mPFS time than those in the VEGF-A-low group (7.8 months vs 19.1 months, P=0.004). Further analysis demonstrated AE of diarrhea and VEGF-A at baseline to be independent prognostic factors for PFS.Conclusion: Pyrotinib-based regimens showed promising efficacy, with manageable tolerance, and AE occurrence of severe diarrhea and baseline level of serum VEGF-A are helpful in predicting the treatment outcome of pyrotinib in HER2-positive MBC.Keywords: breast cancer, HER2, pyrotinib, efficacy, prognostic factor, vascular endothelial growth factor A

Ge Du, Fangfang Liu, Xiaomin Ma, Shanshan Chen, Min Dai, Li Wei,&ast; Zishuang Liu&ast; Department of Rehabilitation Center for Elderly, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Li Wei; Zishuang Liu, Department of Rehabilitation Center for Elderly, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, 100144, People’s Republic of China, Tel/Fax + 86-010-56981582, Email weili2014@sina.com; 1774332663@qq.comPurpose: We retrospectively compared the complications, blood biochemical indexes and outcomes in patients with swallowing disturbances receiving nasogastric tube (NGT) feeding and percutaneous endoscopy gastrostomy (PEG).Methods: Among 160 patients, 72 cases received PEG and 88 cases received NGT. All patients were followed up for two years. We collected their clinical data from the medical records. Indicators, such as body mass index (BMI), white blood cell (WBC), hemoglobin (HGB), complications, including recurrent aspiration pneumonia, gastrointestinal bleeding, reflux esophagitis, and outcomes (survival or death) were compared between the two groups semi-annually.Results: SAt both six months and one year after receiving treatment, there was no statistical difference between the two groups in indicators, complications and outcomes, with all P > 0.05. It can be seen that, when the patients were followed up for one and a half years18 months, ALB was lower in the NGT group (33.81± 0.46) compared with the PEG group (36.14± 0.50) (P < 0.05). After two years of follow-up, differences between the NGT and PEG group could be seen in a variety of indicators, including BMI (20.08± 0.27 vs 21.03± 0.25), WBC (9.12± 0.56 vs 7.08± 0.29), ALB (33.11± 0.43 vs 35.75± 0.49), creatinine (55.07± 1.83 vs 63.21± 2.94), and the complications, such as aspiration pneumonia, gastrointestinal bleeding, reflux esophagitis, and electrolyte disorder, in the PEG group were significantly reduced compared to the NGT groupthan that in its counterpart, P < 0.05. In the two-year follow-up period, there were 13 and 22 patients died in the PEG group and NGT group, respectively.Conclusion: Both techniques are safe and effective in the short term. However, on a longer-term basis, PEG is shown to be superior to NGT feeding in improving nutrition and preventing common complications for patients with swallowing disturbances.Keywords: percutaneous endoscopy gastrostomy, nasogastric tube feeding, swallowing disturbances, two-year, follow-up

Limin Yan1 &ast;, Dedong Xu2 &ast;, Ying Xiao,1 Mingming Dai,1 Ting Wang,1 Xinhong Zhuang,3 Kunliang Wu4 1Department of Neurology, The Second Affiliated Hospital of Hainan Medical University, Haikou, People’s Republic of China; 2Department of Neurosurgery, The Second Affiliated Hospital of Hainan Medical University, Haikou, People’s Republic of China; 3Department of Nephrology, The Second Affiliated Hospital of Hainan Medical University, Haikou, People’s Republic of China; 4Department of Infectious Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xinhong Zhuang, Department of Nephrology, The Second Affiliated Hospital of Hainan Medical University, No. 48, Baishuitang Road, Haikou, Hainan, 570311, People’s Republic of China, Tel +86-0890-66809015, Email zhuang_xinhong@163.com Kunliang Wu, Department of Infectious Diseases, The Second Affiliated Hospital of Hainan Medical University, No. 48, Baishuitang Road, Haikou, Hainan, 570311, People’s Republic of China, Tel +86-0890-66809015, Email kun4821583@163.comPurpose: NAD(P)H: Quinone Oxidoreductase 1 gene (NQO1) polymorphism is associated with the risk of cardiovascular disease. This study was designed to investigate the relationship between NQO1 gene polymorphism and ischemic stroke susceptibility in Chinese Han nationality.Patients and Methods: One hundred and forty-one patients diagnosed with ischemic stroke and 139 matched control groups were recruited in this study. The polymorphism distribution of rsl800566 locus and rs10517 locus of NQO1 gene was genotyped via TaqMan assay, and the concentration of Oxidized low-density lipoprotein (ox-LDL) in the blood of the subjects was detected by enzyme linked immunosorbent assay (ELISA). The relationship between the polymorphism distribution and the susceptibility to ischemic stroke was evaluated.Results: The frequency distribution of the three genotypes of NQO1 rs1800566 between the case group and the control group was statistically significant, and cases carrying CT and TT genotype were less likely to suffer from ischemic stroke. Compared with individuals carrying T allele, C allele carriers have higher risk of ischemic stroke. However, there was no significant difference in frequency distribution among the three genotypes of NQO1 rs10517 between controls and patients.Conclusion: The NQO1 rs1800566 C allele may be a novel marker associated with ischemic stroke susceptibility in Chinese Han population. Polymorphism of rsl800566 locus in NQO1 gene may be protective against ischemic stroke risk.Keywords: genetic polymorphism, ischemic stroke, NQO1, oxidized low-density lipoprotein

Xiaoxue Liang,1,&ast; Ping Chen,2,&ast; Baoguo Deng,2,&ast; Feng-Hui Sun,1,&ast; Yongqiang Yang,3– 5 Yanxian Yang,3,4 Ruowen He,3,4 Mingyang Qin,2 Yiping Wu,3,4 Fan Yang,2 Guo-Bao Tian,3,4 Min Dai1 1School of Laboratory Medicine, Chengdu Medical College, Chengdu, Sichuan Province, People’s Republic of China; 2School of Basic Medical Science, Xinxiang Medical University, Xinxiang, Henan Province, People’s Republic of China; 3Department of Microbiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China; 4Key Laboratory of Tropical Diseases Control (Sun Yat-sen University), Ministry of Education, Guangzhou, Guangdong Province, People’s Republic of China; 5School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Min Dai, School of Laboratory Medicine, Chengdu Medical College, Chengdu, Sichuan Province, People’s Republic of China, Tel +86 28-62739128, Email daimin1015@163.comPurpose: To compare antimicrobial resistance, virulence, clinical characteristics, and risk factors between carbapenem-resistant K. pneumoniae (CRKP) and carbapenem-susceptible K. pneumoniae (CSKP) isolates from patients with bloodstream infections (BSIs) in China.Patients and Methods: The clinical data of 103 patients with K. pneumoniae BSI from 10 hospitals were retrospectively analyzed. The minimum inhibitory concentrations of 15 antibiotics against the bacteria were determined. A Galleria mellonella infection model was used to evaluate virulence of the isolates. Kaplan–Meier curves were calculated to evaluate the 28-day and in-hospital survival rates of the isolates. The risk factors for CRKP and CSKP infection and respective mortality rate were evaluated by univariate analysis, and independent risk factors were evaluated using the multivariate logistic regression model.Results: Our results indicated that CRKP isolates were more resistant to most tested antibiotics than CSKP isolates. The G. mellonella infection model was used to demonstrate that CRKP isolates were more virulent than CSKP isolates. We found that in-hospital deaths occurred in 39.3% (22/56) of patients with CRKP BSIs and were significantly higher than those in patients with CSKP infections (19.1%, 9/47). Patients infected with CRKP isolates had poorer outcomes than those infected with the CSKP strains. For in-hospital mortality of CRKP BSIs, the independent risk factors included carbapenem-resistant Enterobacterales bacteremia and length of hospitalization after the onset of BSI.Conclusion: Our findings confirm that CRKP isolates are more drug-resistant than CSKP isolates and are associated with poorer outcomes. To prevent CRKP infection, strict infection control strategies and active surveillance should be implemented in hospitals.Keywords: Klebsiella pneumoniae, bloodstream infections, virulence, antimicrobial resistance

Sheng Chen, Min Dai Orthopedics Department, the First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, 330006, People’s Republic of ChinaCorrespondence: Min Dai, Tel +86 0791-88692748, Email mindaiNanchang@163.comBackground: LncRNA TMC3-AS1 expression is affected by lipopolysaccharide (LPS), a contributor to osteoporosis (OS). Therefore, we hypothesized that TMC3-AS1 could inhibit osteoblast apoptosis and interact with miR-708, a regulator of osteoblast apoptosis in OS.Methods: Differential expression of TMC3-AS1 and miR-708 (mature and premature) in OS patients and controls was analyzed using RT-qPCR. Subcellular location of TMC3-AS1 in osteoblasts was analyzed using subcellular fractionation assay. The direct interaction between TMC3-AS1 and premature miR-708 was analyzed using RNA pulldown assay. The role of TMC3-AS1 and miR-708 in the expression of each other was explored with overexpression assays. Cell apoptosis induced by LPS was analyzed using cell apoptosis assay.Results: TMC3-AS1 and premature miR-708 were highly expressed in OS and were upregulated by LPS in osteoblasts. In contrast, mature miR-708 was under-expressed in OS and downregulated by LPS. TMC3-AS1 directly interacted with premature miR-708 and was detected in both the nuclear and cytoplasm fractions. TMC3-AS1 decreased premature miR-708 level and increased mature miR-708 level. Moreover, TMC3-AS1 increased LPS-induced cell apoptosis and suppressed the role of miR-708 in cell apoptosis.Conclusion: TMC3-AS1 is highly expressed in OS and promotes LPS-induced osteoblast apoptosis by reducing miR-708 maturation.Keywords: osteoporosis, TMC3-AS1, miR-708, osteoblast

Bin Ji,1 Min Dai,2 Zhongwei Guo,3 Jiapeng Li,4 Yulin Cao,4 Zhenzhong Zhang,3 Yan Zhang,3 Xiaozheng Liu2 1Department of Anesthesiologyand Perioperative Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, People’s Republic of China; 2Department of Radiology of the Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, People’s Republic of China; 3The Sleep Medical Center of Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, 310012, People’s Republic of China; 4Department of Radiology of Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, 310012, People’s Republic of ChinaCorrespondence: Yan ZhangThe Sleep Medical Center of Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Hangzhou, Zhejiang, 310012, People’s Republic of ChinaEmail zhyan73@163.comXiaozheng LiuDepartment of Radiology of the Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, No. 109 Xueyuan West Road, Wenzhou, Zhejiang, 325027, People’s Republic of ChinaEmail lxz_2088@hotmail.comObjective: It is unclear whether the patterns of functional connectivity density (FCD) differ between patients with primary insomnia (PI) and healthy subjects. In the present study, we investigated the features of FCD in patients with PI using resting-state functional MRI (rsfMRI).Methods: rsfMRI datasets of 32 patients with PI and 34 healthy controls (HCs) were obtained using a 3-Tesla scanner. FCD analysis was performed to compare voxels with abnormal whole-brain functional connectivity with other voxels among patients with PI and HCs. Abnormal brain regions were then used as seed points for FC analysis.Results: Compared with HCs, patients with PI exhibited significantly decreased FCD in the left medial frontal gyrus and increased FCD in the left supplementary motor area (SMA). With the left medial frontal gyrus as the seed point, patients with PI showed decreased FC between the left medial frontal gyrus and the left fusiform gyrus compared with HCs. With the left SMA as the seed point, patients with PI exhibited increased FC between the left SMA and the right anterior cingulate gyrus. Correlation analysis revealed that the increased FCD values in the left SMA were positively correlated with sleep latency in patients with PI.Conclusion: Default-mode network and SMA dysfunctions may be related to the pathophysiology of PI.Keywords: primary insomnia, resting-state functional magnetic resonance imaging, functional connectivity density

Wentao Huang,1,&ast; Shu Cai,1,&ast; Ye Zhou,1 Jingxin Huang,1 Xibin Sun,2 Yunhui Su,3 Meifen Dai,4 Yutao Lan1 1School of Nursing, Guangdong Pharmaceutical University, Guangzhou, People’s Republic of China; 2School of Public Health, Guangdong Pharmaceutical University, Guangzhou, People’s Republic of China; 3Department of Emergency, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, People’s Republic of China; 4Department of Nursing, The Sixth Affiliated Hospital, South China University of Technology (Nanhai District People’s Hospital of Foshan), Foshan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yutao LanSchool of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310, People’s Republic of ChinaEmail lanyutao@gdpu.edu.cnMeifen DaiDepartment of Nursing, The Sixth Affiliated Hospital, South China University of Technology (Nanhai District People’s Hospital of Foshan), Foshan, 528200, People’s Republic of ChinaEmail 63015911@qq.comBackground: A high prevalence of psychological distress is observed in nurses due to multiple occupational stressors. Personality traits and personal factors are important factors that lead to psychological distress. The personality profile reflects a combination of personality traits; however, the relationship between personality profiles and personal factors that affect psychological distress among nurses has not been defined.Methods: This cross-sectional study was conducted in November 2020 in China. Convenience and snowball sampling were used to recruit participants. Latent profile analysis was used to identify personality profiles of nurses based on the big-five personality traits. Single-factor analysis and multivariate logistic regression were used to determine the factors affecting psychological distress. The structural equation model was used to verify the hypothetical model linking personality profiles, self-efficacy, psychological resilience, and coping style with psychological distress.Results: A total of 953 Chinese nurses (934 female) with a mean (S.D.) age of 32.8 (8.6) years were recruited. Personality profiles identified were negative, normative, and positive. A personality profile may predict psychological distress directly and indirectly through self-efficacy, psychological resilience, and coping style.Limitations: No complex sampling limits the representativeness of Chinese nurses. External factors affecting psychological distress were not investigated.Conclusion: Nurses with anegative personality profile had a higher prevalence of psychological distress. This study establishes the importance of personality profile assessment to identify nurses at higher risk of psychological distress. It suggests that interventions should be based on self-efficacy, psychological resilience, and coping style as potential management strategies.Keywords: psychological distress, personality profile, self-efficacy, psychological resilience, coping style, nurse

Haitao Li,1 Yi Li,2 Chao Song,2 Yongbin Hu,3 Minhui Dai,2 Ben Liu,4 Pinhua Pan2 1First Department of Thoracic Medicine, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha City, Hunan Province, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, National Key Clinical Specialty, Xiangya Hospital, Central South University, Changsha City, Hunan Province, People’s Republic of China; 3Department of Pathology, Xiangya Hospital, Central South University, Changsha City, Hunan Province, People’s Republic of China; 4Department of Emergency, Xiangya Hospital, Central South University, Changsha City, Hunan Province, People’s Republic of ChinaCorrespondence: Pinhua PanDepartment of Respiratory and Critical Care Medicine, National Key Clinical Specialty, Xiangya Hospital, Central South University, Changsha City, Hunan Province, People’s Republic of ChinaEmail pinhuapan668@csu.edu.cnBackground: Uncontrollable inflammation is a critical feature of gram-negative bacterial pneumonia-induced acute respiratory distress syndrome (ARDS). Both neutrophils and alveolar macrophages participate in inflammation, but how their interaction augments inflammation and triggers ARDS is unclear. The authors hypothesize that neutrophil extracellular traps (NETs), which are formed during neutrophil NETosis, partly cause alveolar macrophage pyroptosis and worsen the severity of ARDS.Methods: The authors first analysed whether NETs and caspase-1 are involved in clinical cases of ARDS. Then, the authors employed a lipopolysaccharide (LPS)-induced ARDS model to investigate whether targeting NETs or alveolar macrophages is protective. The AIM2 sensor can bind to DNA to promote AIM2 inflammasome activation, so the authors studied whether degradation of NET DNA or silencing of the AIM2 gene could protect alveolar macrophages from pyroptosis in vitro.Results: Analysis of aspirate supernatants from ARDS patients showed that NET and caspase-1 levels were correlated with the severity of ARDS and that the levels of NETs and caspase-1 were higher in nonsurvivors than in survivors. In vivo, the NET level and proportion of pyroptotic alveolar macrophages in bronchoalveolar lavage fluid (BALF) were obviously higher in LPS-challenged mice than in control mice 24 h after injury. Administration of DNase I (a NET DNA-degrading agent) and BB-Cl-amidine (a NET formation inhibitor) alleviated alveolar macrophage pyroptosis, and Ac-YVAD-cmk (a pyroptosis inhibitor) attenuated NET levels in BALF and neutrophil infiltration in alveoli. All treatments markedly attenuated the severity of ARDS. Notably, LPS causes NETs to induce alveolar macrophage pyroptosis, and degradation of NET DNA or silencing of the AIM2 gene protected against alveolar macrophage pyroptosis.Conclusion: These findings shed light on the proinflammatory role of NETs in mediating the neutrophil–alveolar macrophage interaction, which influences the progression of ARDS.Keywords: ALI/ARDS, NETs, macrophage pyroptosis, AIM2 inflammation

Lin Lin,1,2,&ast; Nana Long,1,2,&ast; Min Qiu,1,2 Yao Liu,1 Fenghui Sun,1,2 Min Dai1,2 1School of Laboratory Medicine, Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China; 2Sichuan Provincial Engineering Laboratory for Prevention and Control Technology of Veterinary Drug Residue in Animal-origin Food, Chengdu Medical College, Chengdu, 610500, Sichuan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Min Dai; Fenghui SunSchool of Laboratory Medicine, Chengdu Medical College, Chengdu, Sichuan, People’s Republic of ChinaEmail daimin1015@cmc.edu.cn; sunfenghui@cmc.edu.cnIntroduction: Antibiotics wee widely used as feed additives in animal husbandry. With the increase of drug resistance of bacteria, there is an urgent need to find alternatives to antibiotics. Clinically, methicillin-resistant Staphylococcus aureus (MRSA) infections account for about 25% to 50% of Staphylococcus aureus infections worldwide. Similarly, it is also one of the pathogens that cause serious animal infections.Methods: We established a mouse model of systemic infection of MRSA to study the preventive effect of geraniol on MRSA and the immunomodulatory effect of geraniol. The mice in the experiment were injected with geraniol by intramuscular injection and were fed intraperitoneally with minimum lethal dose of MRSA. Then, the survival rate, inflammatory cytokines, oxidative stress factors in serum were measured. These values were used to estimate the bacterial load in different organs and to assess histopathological changes in the lungs, liver and kidneys.Results: The above-mentioned two ways of using geraniol could prevent MRSA infection in vivo in mice and showed a significant dose–response relationship. In other words, geraniol significantly decreased the concentrations of inflammatory cytokines and oxidative stress factors in MRSA-infected mice. At the same time, the level of glutathione peroxidase also increased in a dose–proportional relationship. In the group of mice treated with geraniol, their superoxide dismutase levels were significantly higher than those in the vancomycin. After treatment with geraniol, the burden of MRSA decreased. No obvious histopathological abnormalities were found in the liver and kidney of MRSA-infected mice. In addition, geraniol improved the inflammatory changes in the lungs.Conclusion: The results indicated that geraniol was a natural substance that could be used as an anti-inflammatory, antioxidant and antibacterial substance to protect mice from MRSA systemic infection. Generally, the research shows that as a natural medicine, geraniol has broad potential in the development and application of antibiotic substitutes.Keywords: MRSA, geraniol, antibacterial activity, inflammatory cytokines, in vivo

Tongtong Zhou,1,2,&ast; Li Tan,1,&ast; Yang Gui,1 Jing Zhang,1 Xueqi Chen,1 Menghua Dai,3 Mengsu Xiao,1 Qing Zhang,1 Xiaoyan Chang,4 Qun Xu,5 Chunmei Bai,6 Yuejuan Cheng,6 Qiang Xu,3 Xue Wang,7 Hua Meng,1 Wanying Jia,1 Ke Lv,1 Yuxin Jiang1 1Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 2Department of Ultrasound, China-Japan Friendship Hospital, Beijing, People’s Republic of China; 3Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 4Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 5Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, People’s Republic of China; 6Department of Medical Oncology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 7Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ke Lv; Yuxin JiangDepartment of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of ChinaTel/Fax +86 10-69155493; +86 10-69155491Email lvke@163.com; yuxinjiangxh@163.comObjective: Investigate the CEUS enhancement patterns of PDAC and analyse correlations between the CEUS enhancement pattern and both the degree of tumour tissue differentiation and overall survival (OS).Methods: The study included 56 patients with locally advanced PDAC, performed conventional ultrasound and CEUS, and analysed characteristics of the CEUS enhancement patterns. In addition, clinical data, such as serum level of CA19-9, TNM stage were collected, and patients’ survival times were followed up. TICs of dynamic CEUS images were acquired using image processing software to obtain the peak, TP, sharpness, and AUC. Correlations of the CEUS enhancement patterns of PDAC with the degree of differentiation of tumour tissue and OS were quantitatively analysed, as were the correlations of the TIC parameters and CEUS enhancement patterns with OS.Results: Enhancement in the arterial phase included iso-enhancement (30.3%) and hypo-enhancement (69.6%), and was not significantly correlated with sex, age at disease onset, or lesion size. Also was not significantly correlated with tumour tissue differentiation. Clear survival times were obtained for 50 patients during follow-up, and the median survival time was significantly longer for the patients with iso-enhancement than hypo-enhancement. Among the TIC parameters, peaktumour, sharpnesstumour, AEsharpness, and REsharpness differed significantly between the group with iso-enhancement and hypo-enhancement (p < 0.05).Conclusion: The CEUS enhancement patterns of PDAC in the arterial phase include iso-enhancement and hypo-enhancement. Enhancement pattern was not significantly correlated with the degree of differentiation of tumour tissue, but patient survival time differed significantly between the two enhancement patterns, with longer survival for patients with iso-enhancement.Keywords: contrast-enhanced ultrasound, pancreatic ductal adenocarcinoma, survival time, enhancement pattern, time-intensity curve

Ruellia tuberosa (family Acanthaceae) is widely known in traditional medicine in Asian countries for the treatment of diabetes and other diseases. Its roots were demonstrated to possess a hypoglycemic ability in diabetic animal models. In this study, an original induced procedure was investigated to establish hairy root (HR) from R. tuberosa. With the aim of increasing the transformation rate, some induced factors (acetosyringone (AS) dosage, type of explant, age, infection time, bacterial density, co-cultivation duration) were individually examined. As a result, an improved procedure was implemented: ten-day-old in vitro cotyledon explants were injured and then immersed in the bacterial suspension (OD600 nm = 0.4) added 200 µM AS during 10 min. The infected explants were co-cultivated for 4 days in the Murashige & Skoog (MS) medium before transferring to the medium containing cefotaxime for bacterial elimination. After thirty days of culture, the improved procedure revealed a synergistic effect by enhancing the rooting rate and number of secondary roots per explant up to 4.4- and 8.0-fold, respectively, in comparison with the original procedure. The R. tuberosa HR was then cultured in liquid MS medium and achieved the highest biomass production at the late exponential growth phase (3rd week). Its ethanol extract was also higher 2.0-fold in α-glucosidase inhibitory activity than that of the natural root. In conclusion, the α-glucosidase inhibitory activity of HR inducing by the improved procedure may offer an effective and reliable substitute for the utilization of this herbal plant.

Cheng Xing, Yatong Li, Cheng Ding, Shunda Wang, Hanyu Zhang, Lixin Chen, Pengyu Li, Menghua Dai Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of ChinaCorrespondence: Menghua DaiDepartment of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1, Shuai Fu Yuan, Dongcheng District, Beijing, 100730, People’s Republic of ChinaTel +86-10-69152600Email daimh@pumch.cnBackground: Circulating tumor endothelial cells (CTECs) are cells that originate from tumor endothelial cells (TECs) of blood vessels and are shed into peripheral blood. Some studies have shown that CTECs are associated with tumor angiogenesis, growth and indicate prognosis in patients with malignant solid tumor. However, the role of CTECs especially the phenotype of CTECs in pancreatic adenocarcinoma (PDAC) is still not clear. We investigated the relationship between CTECs and patients’ prognosis.Methods: A total of 73 patients with resectable PDAC were enrolled in our research and underwent radical surgery. Peripheral venous blood samples were collected before surgery, on postoperative day (POD) 7 and on postoperative month (POM) 1, respectively. We used integrated subtraction enrichment and immunostaining-fluorescence in situ hybridization (SE-iFISH) platform to identify and enumerate CTECs. Immunofluorescence was used to identify CTECs expressing CD44 and vimentin.Results: In patients with early tumor recurrence (DFS< 6 months), the preoperative CD44+ CTEC levels showed significantly higher (P = 0.023). Univariate and multivariate analysis showed that history of diabetes [HR 2.656 (1.194– 5.908), P = 0.017], numbers of positive lymph nodes [HR 1.871 (1.388– 2.522), P < 0.001], preoperative numbers of CD44+ CTECs [HR 1.216 (1.064– 1.390), P = 0.004], and POM1 CA19-9 level [HR 1.002 (1.001– 1.002), P < 0.001] were independent prognostic factors for DFS.Conclusion: The detection of CD44+CTECs in patients with resectable PDAC preoperatively could be an independent predictor of shorter DFS after radical surgery.Keywords: circulating tumor endothelial cells, pancreatic adenocarcinoma, prognostic factor, CD44

Huijun Qiu,1,* Rui Zheng,1,* Xinyue Wang,1,* Zhuanggui Chen,2,3 Peiying Feng,2,4 Xuekun Huang,1,2 Yuqi Zhou,2,5 Jin Tao,2,6 Min Dai,2,7 Lianxiong Yuan,8 Xiangdong Wang,9 Luo Zhang,9 Qintai Yang1,2 1Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China; 2Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China; 3Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China; 4Department of Dermatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China; 5Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China; 6Department of Gastroenterol, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China; 7Department of Traditional Chinese Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China; 8Department of Science and Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China; 9Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qintai YangDepartment of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, People’s Republic of ChinaTel +86-20-85252252Fax +86-20-85253336Email yangqint@mail.sysu.edu.cnLuo ZhangDepartment of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 16 Hougou Hutong, Chongnei Street, Donghuamen Street, Dongcheng District, Beijing, 100730, People’s Republic of ChinaTel +86-10-65141136Fax +86-10-85115988Email dr.luozhang@139.comBackground: To explore the epidemiological characteristics of allergic rhinitis (AR) and allergic conjunctivitis (AC) based on the Internet big data.Methods: The Baidu index (BDI) of keywords “allergic rhinitis” and “allergic conjunctivitis” in Mandarin, the daily pollen concentration (PC) released by the Beijing Meteorological Bureau and the volumes of outpatient visits (OV) of the Beijing Tongren Hospital (Beijing) and the Third Affiliated Hospital of Sun Yat-sen University (Guangzhou) from 2017 to 2020 were obtained. The temporal and spatial changes of AR and AC were discussed. The correlations between BDI and PC/OV were analyzed by Spearman correlation analysis.Results: The trends of BDI of “AR”/“AC” in Beijing showed obvious seasonal variations, but not in Guangzhou. The BDI of “AR” and “AC” was consistent with the OV in both cities (r1AR-BJ=0.580, P< 0.001; r1AR-GZ=0.360, P=0.031; r1AC-BJ=0.885, P< 0.001; r1AC-GZ=0.694, P< 0.001). The BDI of “AR” and “AC” was highly consistent with the change of the PC in Beijing (r AR-Pollen=0.826, P< 0.001; r AC-Pollen=0.564, P< 0.001). The OV of AR in Beijing and Guangzhou decreased significantly in the first half of 2020, but there was no significant change in AC. In the first half of 2020, the OV of AC in Beijing was significantly higher than that of AR, while that of AC in Guangzhou was slightly higher than that of AR.Conclusion: The BDI could reflect the real-world situation to some extent and has the potential to predict the epidemiological characteristics of AR and AC. The BDI and OV of AR decreased significantly, but those of AC were still at a high level, during the COVID-19 pandemic, in the environment where most people in Beijing and Guangzhou wore masks without eye protection.Keywords: allergic rhinitis, allergic conjunctivitis, Internet, Baidu, big data, COVID-19

Yuying Shi,1– 3,* Mengyuan Dai,1– 3,* Yaxing Zhang,1– 3 Yuwen Qi,1– 3 Zhen Li,1– 3 Hongbing Cai1– 3 1Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China; 2Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, Hubei, People’s Republic of China; 3Hubei Cancer Clinical Study Center, Wuhan, Hubei, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hongbing CaiZhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of ChinaTel +86-1-339-716-8990Email chb21051@163.comIntroduction: Ovarian clear cell carcinoma (OCCC) is a subtype of ovarian cancer characterized by highly aggressive and poor prognosis. However, it is unclear what factors are associated with OCCC recurrence and death. The study aimed to evaluate whether residual tumor diameter after primary debulking surgery, or other clinicopathological features play roles in predicting survival outcome in stage II–IV OCCC patients.Material and Methods: We present a retrospective study of OCCC patients with stage II–IV in our department from 2010 to 2015. Kaplan–Meier method was used to draw a survival curve. Survival analysis was performed using Log-rank test for univariate analysis and COX proportional risk regression model for multivariate analysis.Results: In this cohort of 78 patients who underwent primary debulking surgery, 47 patients had disease recurrence and 32 cases died. On univariate analysis, FIGO stage, residual tumor diameter and ascites were significant predictors of 3-year PFS (P values< 0.05) and OS (P values< 0.05). On multivariate analysis, the residual tumor diameter was an independent prognostic factor for 3-year PFS and OS (P values< 0.05). The outcomes of patients in residual-free group were significantly better than those in the residual tumor diameter 0– 1cm and > 1cm group (PFS: P=0.000, OS: P=0.001), but there was no significant difference in prognosis between 0– 1cm and > 1cm group (P values > 0.05). Greater residual tumor diameter predicted progression on cox analysis in patients with stage III, but not for patients with stage IV.Conclusion: Residual tumor diameter is prognostic after surgery for OCCC. Achieving no residual disease will significantly improve the prognosis in advanced OCCC patients.Keywords: ovarian clear cell carcinoma, residual tumor diameter, progression

He Liu,1,2,* Mingsheng Dai,1,3,* Huilian Guan,1 Xing Gao,1 Yang Zhou,1 Xun Sun,1 Jian Zhou,1 Xiaoyi Hu,1 Xiang Li,1 Yu Song,1 Yuan Han,4 Junli Cao1,2 1Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City 221002, Jiangsu Province, People’s Republic of China; 2Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou City 221004, Jiangsu Province, People’s Republic of China; 3Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China; 4Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai 20031, People’s Republic of China*These authors contributed equally to this workCorrespondence: Junli CaoJiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, NO. 209 Tongshan Road, Yunlong District, Xuzhou City 221004, Jiangsu Province, People’s Republic of ChinaTel/Fax +86-0516-83262686Email caojl0310@aliyun.comYuan HanDepartment of Anesthesiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai 200031, People’s Republic of ChinaEmail hanyuan2002@163.comPurpose: Malnutrition has been considered as a risk factor for postoperative delirium (POD). The Prognostic Nutritional Index (PNI) is a validated tool for assessing nutritional status. This study aimed to investigate the association between preoperative PNI values and the occurrence of POD in elderly surgical patients.Methods: The retrospective cohort study included 361 elderly individuals who underwent noncardiac surgery between 2018 and 2019. Perioperative data were collected from the patients’ medical records. PNI was used to evaluate preoperative nutritional status. The primary outcome was the occurrence of POD. Univariate and multivariate logistic regression analyses were used to identify key factors associated with POD and assess the relationship between PNI values and the occurrence of POD. Receiver operating characteristic (ROC) curve analysis was used to assess the predictive value of PNI for POD.Results: Seventy-two (19.9%) individuals developed postoperative delirium after surgery. Compared with patients of normal nutrition status (PNI ≥ 50), mild malnutrition (PNI 45– 50) did not increase the risk of POD, while patients with moderate to severe malnutrition (PNI 40– 45) (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.31– 6.50) and serious malnutrition (PNI < 40) (OR, 3.15; 95% CI, 1.12– 8.83) were more likely to develop POD. The cut-off value of PNI was 46.05 by ROC curve analysis, the area under the curve (AUC) was 0.69 (95% CI 0.62– 0.77).Conclusion: Preoperative PNI value is related to postoperative delirium in elderly patients after noncardiac surgery.Keywords: noncardiac surgery, elderly patients, nutritional status, prognostic nutritional index, postoperative delirium