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Background. There is a significant role for peroxisome proliferator-activated receptors (PPARs) in the development of cancer. Nevertheless, the role of PPARs-related genes in ovarian cancer (OC) remains unclear. Methods. The open-accessed data used for analysis were downloaded from The Cancer Genome Atlas database, which was analyzed using the R software. Results. In our study, we comprehensively investigated the PPAR target genes in OC, including their biological role. Meanwhile, a prognosis signature consisting of eight PPAR target genes was established, including apolipoprotein A-V, UDP glucuronosyltransferase 2 family, polypeptide B4, TSC22 domain family, member 1, growth hormone inducible transmembrane protein, renin, dedicator of cytokinesis 4, enoyl CoA hydratase 1, peroxisomal (ECH1), and angiopoietin-like 4, which showed a good prediction efficiency. A nomogram was constructed by combining the clinical feature and risk score. Immune infiltration and biological enrichment analysis were applied to investigate the difference between high- and low-risk patients. Immunotherapy analysis indicated that low-risk patients might respond better to immunotherapy. Drug sensitivity analysis indicated that high-risk patients might respond better to bleomycin, nilotinib, pazopanib, pyrimethamine, and vinorelbine, yet worse to cisplatin and gefitinib. Furthermore, the gene ECH1 was selected for further analysis. Conclusions. Our study identified a prognosis signature that could effectively indicates patients survival. Meanwhile, our study can provide the direction for future studies focused on the PPARs in OC.

Sinomenine (SIN) is commonly used as part of rheumatoid arthritis (RA) therapy in China, but there is still no published evidence of the efficacy of SIN monotherapy. This work investigates the efficacy and safety of SIN in treating RA patients and analyzes the correlation between ornithine level and the alleviation of disease activity in RA patients. In this 24 week, randomized, placebo-controlled, double-blind clinical trial, people with mild to moderate RA were randomly assigned (1:1:1, stratified by hospital) to receive SIN (120 mg, twice daily), methotrexate (MTX) (10 mg per week), or SIN + MTX therapy. The primary outcome was the proportion of patients who achieved a 50% improvement in the American College of Rheumatology (ACR) criteria at week 24 and who showed improvement according to the clinical disease activity index (CDAI). In this prospective subgroup analysis, we also assessed whether the 24 week alterations of disease activity in the treatment group were significantly correlated to the levels of blood ornithine. Of the 135 enrolled participants, 38, 39, and 36 patients were treated with SIN, MTX, and SIN + MTX, respectively. In the SIN-treated group, 52.63% of patients achieved ACR50 after 24 weeks of treatment, which was comparable to the results in the MTX-treated and SIN + MTX-treated groups. Hepatic and gastrointestinal disorders were the main adverse events; however, the ratio of patients suffering from hepatic disorder in the SIN group (1/38) was much lower than that in the MTX (10/39) and SIN + MTX (8/36) groups. A total of 221 serum samples were collected at the four follow-up time points in the three treatments, and the levels of ornithine, citrulline, and arginine were obtained through ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UHPLC-Q-TOF/MS). The serum ornithine level decreased after the 24 week treatment along with a decrease in disease activity, and may reflect therapeutic responses with a sensitivity value of 80%. In conclusion, SIN revealed a comparable efficacy to MTX for treating RA patients, but with fewer side effects. In addition, the serum ornithine level was found for the first time to have a close correlation with the alleviation of RA, which shows the value of this measure as an assessment indicator of drugs in treating RA.

Aiming at the problem of braking shock caused by the inconsistent response time of the inner motor (IM), the outer motor (OM) and the hydraulic brake when the regenerative braking mode of dual-rotor in-wheel motor (DRIWM) is switched, this paper proposes a U-shaped transition coordinated control strategy for the DRIWM. Ensure that the total braking torque can be smoothly transitioned when any one or more of the hydraulic braking torque, the braking torque of the IM and the braking torque of the OM enter/exit braking. The dynamic model of electric vehicle (EV) with DRIWMs is established, the division of braking mode is based on the principle of optimal DRIWM system efficiency, and the U-shaped transition coordinated controller of DRIWM is designed. Finally, two cases of switching the IM single braking mode to hydraulic braking mode and OM and hydraulic coordinated braking mode switching to compound braking mode are taken as examples to verify. The results show that, compared with the braking mode switching process without transition coordinated control, the U-shaped transition coordinated control strategy of the DRIWM proposed in this paper can make the DRIWM complete switching within 0.25s on the basis of the optimal system efficiency, which reduces the impact to 2 m/s3 and ensures a smooth transition of the total braking torque when switching.

Use of cultivars with certain agronomical traits has been throughout the development history of kelp Saccharina japonica farming in China. Pursuit of high yield had been on top of all the parameters. However, in recent years, demand for better blade quality has steadily become intensive, especially in the northern farming region of this country. In this article, we report a newly bred, intraspecific hybrid E25 (as designation code), of its biological features and its applicability as a potential cultivar in the related farming region. A fully grown sporophyte of E25 could reach 4–5 m in length, 0.6–0.8 m in width, and 3–5 kg in fresh biomass depending on the farming zones and growing density within ca. 7-month cultivation period from November to May–June of next year. Unlike most of the cultivars or naturally grown sporophytes, sporophyte of E25 lacks fascia in the middle of the strip and possesses smooth blades. It has thicker ruffled undulate margins on both longitudinal sides and relatively low water content in its blade. Due to its much higher chlorophyll a content, blanched product is greener than most of the other cultivars, much favored by the processing industry. Seedling production of E25 relays on a pair of vegetatively propagated unialgal male and female gametophytes. High polymorphic microsatellite markers could accurately identify its uniformed genotype and distinguish it from other conventional cultivars. The first filial sporophytic generation of E25 (E25-F1) maintains the same yield level as its parent, reaching 23–25 kg m−1 cultivation rope, but with larger deviations in individual sizes as reflected by its higher coefficient of variations (CV).

To evaluate mid-term efficacy and safety of ab externo microcatheter-assisted trabeculotomy (MAT) for early-onset glaucoma associated with Sturge-Weber syndrome (SWS) and phakomatosis pigmentovascularis (PPV).Retrospective, non-comparative, interventional case series.Medical records of consecutive SWS or PPV associated glaucoma patients who had undergone ab externo MAT between August 2017 and April 2020 at Beijing Children's hospital were reviewed. Success was defined as an intraocular pressure (IOP) of lower than 21 mmHg with (qualified success) or without (complete success) the use of antiglaucoma medication.Overall, 13 eyes (12 patients) with SWS and 9 eyes (8 patients) with PPV were included, with a mean age of 12.8±15.8 months at the time of surgery and a mean follow-up time of 39.5±10.4 months. Both the SWS (26.5±5.3 mmHg at baseline vs. 16.5±5.0 mmHg at the last visit, P0.001) and PPV (29.2±7.5 mm Hg vs. 23.4±4.7mmHg, P=0.014) subsets achieved a statistically significant fall in IOP following surgery. Kaplan-Meier survival rate of complete(qualified) success after 42 months was 76.2% (87.5%) and 22.2% (40.0%) for eyes with SWS and PPV, respectively. Complications were minimal. PPV was associated with worse surgical outcomes.Ab externo MAT is an effective and safe treatment for early-onset glaucoma associated with SWS, but a gradual increase of IOP over time was noted in some patients. Ab externo MAT has limited efficacy for early-onset glaucoma associated with PPV in the mid-term.

Oxidative stress and apoptosis play vital role in diabetic rats suffering from renal ischemia reperfusion injury (IRI). As a dipeptidyl dipeptidase-4 (DPP-4) inhibitor, Saxagliptin(SAX)has been confirmed in the regulation of inflammation and apoptosis by targeting Nrf-2/HO-1signalling. The study was designed to explore the efficacy and potential mechanisms of SAX on inflammation and apoptosis for treating of IRI in diabetic rats. Through testing the expressions of Nrf-2, HO-1, Cleaved-Caspase9, Cleaved-Caspase3, Bax, BCL-2, Bak, Apaf-1, cytochrome C (Cytc), Cystatin C (CysC), β2-microglobulin (β2-MG), creatinine (Cr), urea nitrogen (BUN), TUNEL and pathological morphology, the effects of SAX on IRI diabetic rats have been investigatedg. The results has displayed SAX treatment significantly attenuate the cell apoptosis and pathological damage of kidney as well as lessening the expression of cleaved-caspase-9, cleaved-caspase3, Bax, cytoplasmic-Cytc, MDA, Bak, and Apaf-1 molecules, and the contents of ROS, Cr, CysC, β2-MG, and BUN. Furthermore, SAX therapy also increased the expression of Nrf-2, BCL-2, HO-1 and mitochondrial cytochrome Cytc, and enhanced the activity of SOD, CAT and GPx. Therefore, our study has indicated that SAX treatment alleviated IRI in diabetic rats by suppressing oxidative stress and mitochondrial apoptotic pathways by activating the Nrf-2/HO-1 signaling.

Objective To demonstrate the rheumatoid arthritis (RA) mechanisms by determining the biochemical changes. To investigate the therapeutic mechanism of moxibustion in RA-model rats using a gas chromatography-mass spectrometry (GC–MS) metabolomics approach. Methods A total of 24 rats were divided into three groups as follows: normal control group, model group and moxibustion group. Rats in model group and moxibustion group were set up collagen-induced arthritis (CIA) model. Rats in moxibustion group were treated by moxibustion. After 3 weeks of intervention, right ankle joint, serum and articular synovium samples were collected. Right ankle joint samples were used for histopathological evaluation between 3 groups to get the pathological changes of tissues and cells. Serum and articular synovium samples were used to analyze the changed metabolites of moxibustion on RA rats by the GC–MS based metabolomics. Results Treatment of moxibustion not only significantly increased the weight of CIA rats, reduced the swelling of hind paw, arthritic scores, IL-1β, TNF-α but also improved histopathological evaluation in right ankle joint samples. Sixteen significantly altered metabolites were found in RA rats as potential biomarkers of arthritis. Thirteen metabolites, significantly adjusted by moxibustion to help relieve arthritis, were selected out as biomarkers of antiarthritic mechanism of moxibustion, which were mainly involved in phenylalanine, tyrosine and tryptophan biosynthesis, glycine, serine and threonine metabolism, phenylalanine metabolism, alanine, aspartate and glutamate metabolism, glyoxylate and dicarboxylate metabolism and aminoacyl-tRNA biosynthesis. Conclusions We have indicated moxibustion treatment is able to resist inflammation in CIA rats effectively. Using GC–MS metabolomics technique, we detect novel metabolites in the moxibustion antiarthritic process, which may aid in advanced understanding of arthritis and therapeutic mechanism of moxibustion.

Background Turner syndrome (TS) has a variety of different karyotypes, with a wide range of phenotypic features, but the specific karyotype may not always predict the phenotype. TS with Y chromosome mosaicism may have mixed gonadal dysgenesis, and the mosaicism is related to the potential for gonadoblastoma. Case summary In this case report, we report two cases of TS with different karyotypes and gonadal dysgenesis. Patient 1 had obvious virilization, and was positive for the SRY gene, but her karyotype in peripheral blood lymphocytes was 45X. Patient 2 had a mosaic karyotype, 45X/46X, dic (Y:Y) (p11.3:p11.2), and the proportion of Y-bearing cells was 50% in peripheral blood lymphocytes, but the patient had normal female external genitalia and streaky gonads, with no genital virilism. Different tissues in the same TS individual may exhibit different ratios of mosaicism. The gonadal determination and differentiation of mosaic TS are primarily dependent on the predominant cell line in the gonads. Conclusion In TS patients with virilization, it is necessary to test at least two to three tissues to search for cryptic Y material.

Objective A systematic review and analysis of data from several rheumatoid arthritis metabolomics studies attempts to determine which metabolites can be used as potential biomarkers for the diagnosis of rheumatoid arthritis and to explore the pathogenesis of rheumatoid arthritis. Methods We searched all the subject-related documents published by EMBASE, PubMed, Web of Science, and Cochrane Library from the database to the September 2019 publication. Two researchers independently screened the literature and extracted the data. QUADOMICS tool was used to assess the quality of studies included in this systematic review. Results A total of 10 studies met the inclusion criteria of systematic review, including 502 patients with rheumatoid arthritis and 373 healthy people. Among them, the biological samples utilised for metabolomic analysis include: serum (n = 8), urine (n = 1) and synovial fluid (n = 1). Some metabolites play an important role in rheumatoid arthritis: glucose, lactic acid, citric acid, leucine, methionine, isoleucine, valine, phenylalanine, threonine, serine, proline, glutamate, histidine, alanine, cholesterol, glycerol, and ribose. Conclusions Metabolomics provides important new opportunities for further research in rheumatoid arthritis and is expected to elucidate the pathogenesis of rheumatoid arthritis that has not been fully understood before.

Vibrio vulnificus is a Gram-negative bacterium that belongs to the Vibrionaceae family. It represents a deadly opportunistic human pathogen which grows in water with the proper temperature and salinity, and is mostly acquired from seafood eating or direct contact. In susceptible individuals, a traumatic infection could be fatal, causing severe wound infection and even septic shock, and may require amputation. Global warming plays an important role in the geographical area expanding of Vibrio disease. The pathogenesis of Vibrio vulnificus-associated sepsis is very complex, including iron intake, cell injury, and adhesion-related protein and virulence regulation. Vibrio vulnificus infection mainly manifests clinical subtypes such as primary sepsis, traumatic infection, and gastroenteritis, with rapid symptom progression and signs of multiple organ dysfunction syndrome (MODS). It is important to assess these pathogenetic mechanisms in order to select more appropriate measures to prevent and treat Vibrio vulnificus infections, including antibiotic usage and surgical intervention. In this work, we report a typical case of successful treatment of necrotizing fasciitis caused by Vibrio vulnificus, and review the epidemiology, pathogenetic mechanism, clinical characteristics, and treatment of Vibrio vulnificus infection.

Background. Low back pain (LBP) is considered the leading cause of people living with years of disability worldwide. Notably, thunder-fire moxibustion (TFM) is a new type of moxibustion, which has been widely applied to treat pain syndromes for thousands of years. This study aims to provide evidence to evaluate the effect and safety of TFM in treating LBP. Methods. A systematic search of PubMed, Web of Science, the Cochrane Library, Embase, EBSCO, CNKI, Wanfang Data, CBM, and VIP (until April 2021) was used to identify studies reporting pain intensity, disability, Japanese Orthopedic Association (JOA) score, and quality of life in patients with LBP. Randomized controlled trials (RCTs), which compared TFM and other therapies in LBP, were included. Meanwhile, methodological quality was evaluated using the Cochrane criteria for risk of bias, and the level of evidence was rated utilizing the GRADE approach. Results. Twenty-one RCTs, including 2198 patients, satisfied the inclusion criteria. Compared with other therapies, the effect of TFM was statistically significant, pain intensity decreased (SMD = 0.94; 95% CI (0.74, 1.14); p < 0.00001 ), disability improved (SMD = 1.39; 95% CI (0.19, 2.59); p = 0.02 ), and the JOA score increased (SMD = −1.34; 95% CI (−1.88, −0.80); p < 0.00001 ). It was also reported that the patient’s quality of life improved after treatment for a period of 4 weeks (SMD = −0.29; 95% CI (−0.42, −0.16); p < 0.0001 ) and after a follow-up of 1 month (SMD = −0.20; 95% CI (−0.34, −0.07); p = 0.003 ). The evidence level of the results was determined to be very low to low. Conclusions. Based on the existing evidence, it can be concluded that TFM may have a better effect than other treatments on LBP. However, it is not yet possible to assess the safety level of TFM therapy. Due to the universal low quality of the eligible trials and low evidence level, rigorously designed large-scale RCTs must be conducted in order to further confirm the results in this review.

HOXB-AS3 is a long non-coding RNA and recent studies have shown that the HOXB-AS3-encoded micro-peptide was associated with the progression of colon cancer tumorigenesis; however, the biofunction of HOXB-AS3 varies in different types of cancer and the potential function in oral squamous cell carcinoma (OSCC) is still unknown. The Cancer Genome Atlas (TCGA) database was searched and the expression patterns of HOXB-AS3 in head and neck carcinoma were analyzed. Reverse transcription-quantitative PCR and western blot analysis was used to measure the mRNA and protein expression level of HOXB-AS3 in patients with OSCC, respectively. Next, HOXB-AS3 was knocked down in 2 OSCC cell lines to investigate the biological function of the HOXB-AS3-encoded protein using a Cell Counting Kit-8 and colony formation assays. To further identify the potential mechanism of the HOXB-AS3-encoded protein, co-immunoprecipitation was also used to detect the interaction between HOXB-AS3 and IGF2BP2, while HOXB-AS3 was re-expressed to determine whether the HOXB-AS3-encoded protein and not HOXB-AS3 exerted its function in OSCC. HOXB-AS3 was upregulated in OSCC tissues, in both TCGA database and in patients with OSCC recruited into the present study. HOXB-AS3 was associated with poor prognosis in OSCC. The proliferation and viability decreased in the 2 OSCC cell lines following knock down of HOXB-AS3. HOXB-AS3 was also found to encode a protein that directly interacted with IGF2BP2 and thereby promoted the stability of c-myc. Taken together, the results from the present study indicated that increased HOXB-AS3 expression was associated with poor prognosis in OSCC. This indicated that HOXB-AS3 and its encoded protein promoted OSCC cell proliferation and viability by maintaining c-Myc mRNA stability by directly binding to IGF2BP2.

ObjectivesTo evaluate the clinical and economic consequences of continuous subcutaneous insulin infusion (CSII) vs. multiple daily injections (MDI) in children and adolescents with type 1 diabetes mellitus (T1DM) from a public health care system in developed areas of developing country, considering changes in glycemic Control, daily insulin requirements, lipid profile, body mass index (BMI), frequency of severe hypoglycemia and Diabetic Ketoacidosis (DKA) and diabetic complications.MethodsThis was a retrospective cohort study of children and adolescents with T1DM. Data were collected at baseline and the end of every year including glycated hemoglobin (HbA1c), insulin dose, lipid profile, blood pressure, and adverse events (severe hypoglycemia and DKA). The Cost-effectiveness analysis was performed using the IQVIA CORE Diabetes Model (CDM) to simulate diabetes progression by utilizing the clinical data obtained from the two groups. The main outcome measures were Life Expectancy, Quality adjusted life years (QALYs), Total Costs and Incremental Costs and Effectiveness Ratio (ICER) of CSII compared with MDI in Chinese pediatric patients with T1DM in Qingdao City (60 years).ResultsMean HbA1c values and daily insulin doses were significantly lower in those receiving CSII therapy throughout follow-up. Mean direct lifetime costs were ¥ 67,137 higher with CSII treatment than with MDI for pediatric patients. Treatment with CSII was associated with an improvement in life expectancy of 0.41 years for pediatric patients compared with MDI based on CORE diabetes model simulation. The corresponding gains in QALYs were 0.42. These data produced corresponding ICER is ¥ 161,815 per QALY for pediatric T1DM patients in Qingdao. Sensitivity analyses suggested that our base-case assumptions were mostly robust.ConclusionsCSII is associated with improved long‐term clinical outcomes compared with MDI. Based on this model analysis, CSII appears to be more cost-effective for the Qingdao TIDM pediatric population and health care system.

OBJECTIVE: To study the clinical effect of continuous subcutaneous insulin infusion (CSⅡ) versus multiple daily injection (MDI) on blood glucose control in children with type 1 diabetes mellitus (T1DM). METHODS: A retrospective analysis was performed on the medical data of 91 children with T1DM who were treated with CSⅡ for more than 1 year and 75 children with T1DM who were treated with MDI. The two groups were compared in terms of glycosylated hemoglobin (HbA1C) and the recurrence of diabetic ketoacidosis (DKA) to evaluate the difference in the efficacy during the 3-year follow-up. A survey was conducted for the children in the CSⅡ group and their family members to investigate the degree of satisfaction with insulin pump. RESULTS: There was no significant difference in age, sex, and course of diabetes between the CSⅡ and MDI groups at disease onset and in the first year, the second year, and the third year of follow-up (P > 0.05). There was no significant difference in the HbA1C level between the two groups at disease onset (P > 0.05), but in the first year of follow-up, the CSⅡ group had a significantly lower HbA1C level than the MDI group (P=0.04). There was no significant difference in the HbA1C level between the two groups in the second year and the third year of follow-up (P > 0.05). The CSⅡ group had a higher proportion of children with HbA1C < 7.5% than the MDI group in the first year, the second year, and the third year of follow-up (P > 0.05). Within the 3 years of follow-up, 2 children in the CSⅡ group and 8 in the MDI group experienced the recurrence of DKA. In the third year of follow-up, there was no significant difference in blood pressure and blood lipids between the CSⅡ and MDI groups (P > 0.05). Most children and their family members (87%) were satisfied with CSⅡ treatment. CONCLUSIONS: Children with T1DM treated with CSⅡ have a better control of blood glucose than those treated with MDI, and children and their family members are satisfied with CSⅡ treatment. Therefore, it holds promise for clinical application.

Background Virtual reality (VR) is the use of computer technology to create an interactive three-dimensional (3D) world, which gives users a sense of spatial presence. In nursing education, VR has been used to help optimize teaching and learning processes. Objective The purpose of this study was to evaluate the effectiveness of VR in nursing education in the areas of knowledge, skills, satisfaction, confidence, and performance time. Methods We conducted a meta-analysis of the effectiveness of VR in nursing education based on the Cochrane methodology. An electronic literature search using the Cochrane Library, Web of Science, PubMed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature), up to December 2019 was conducted to identify studies that reported the effectiveness of VR on knowledge, skills, satisfaction, confidence, and performance time. The study selection and data extraction were carried out by two independent reviewers. The methodological quality of the selected studies was determined using the Cochrane criteria for risk-of-bias assessment. Results A total of 12 studies, including 821 participants, were selected for the final analysis. We found that VR was more effective than the control conditions in improving knowledge (standard mean difference [SMD]=0.58, 95% CI 0.41-0.75, P Conclusions The results of this study suggest that VR can effectively improve knowledge in nursing education, but it was not more effective than other education methods in areas of skills, satisfaction, confidence, and performance time. Further rigorous studies with a larger sample size are warranted to confirm these results.

Graphical abstract, Genome-wide association studies (GWAS) have contributed significantly to predisposing the disease etiology by associating single nucleotide polymorphisms (SNPs) with complex diseases. However, most GWAS-SNPs are in the noncoding regions that may affect distal genes via long range enhancer-promoter interactions. Thus, the common practice on GWAS discoveries cannot fully reveal the molecular mechanisms underpinning complex diseases. It is known that perturbations of topological associated domains (TADs) lead to long range interactions which underlie disease etiology. To identify the probable long range interactions in noncoding regions via GWAS and TADs perturbed by deletions, we integrated datasets from GWAS-SNPs, enhancers, TADs, and deletions. After ranking and clustering, we prioritized 201,132 high confident pairs of GWAS-SNPs and target genes. In this study, we performed a systematic inference on noncoding regions via GWAS-SNPs and deletion-perturbed TADs to boost GWAS discovery power. The high confident pairs of GWAS-SNPs and target genes (SE-Gs) provide the promising candidates to understand the molecular mechanisms underlying complex diseases with emphasis on the three-dimensional genome.

The hydrological regimes of many freshwater lakes have been dramatically changed by human activity. Nevertheless, few studies have reported the effects of human water management on the formation mechanisms of lakeshore plant communities. In this study, we investigated the effects of flooding and soil nutrients on the plant diversity of lakeshore Carex communities fringing a pristine lake (Poyang Lake) and a human managed lake (Shengjin Lake), two adjacent floodplain lakes in the middle and lower reaches of the Yangtze River. Over time, the Carex meadow at Shengjin Lake experienced a lower flooding frequency and a smaller amplitude of water level fluctuations in comparison with those obtained at Poyang Lake, but similar flooding durations were found for both sites. Soil total nitrogen (TN), total phosphorus (TP) and the ratio of TN to TP in study plots at Shengjin Lake tended to be higher than those in the plots at Poyang Lake at the 0–100 cm soil depth except for soil TP at the 0–10 cm soil depth. A total of 23 plant species were recorded in the Carex communities at the two lakes. Artificial water management increased plant diversity but had no effect on plant biomass in the Carex community. The primary factor in determining plant diversity changed from the flooding regime to the concentrations of soil nutrients as the water regime underwent management. Flooding regimes had strong direct impacts on the plant communities, while imposing few indirect effects on plants by changing soil nutrients in the pristine lake. Our results represent essential information for enhancing the robustness of management efforts for these large and important freshwater lakes.

Nitrogen-doped carbon dots (CDs) have attracted great interest due to their extraordinary properties, especially their enhanced emission efficiency, and thus a facile synthesis of nitrogen-doped CDs with high emission efficiency is critical for practical applications. To improve the emission efficiency of CDs, herein we employed Bombyx mori silk, which has high nitrogen content, as a raw material to prepare photoluminescent nitrogen-doped carbon dots through one-pot hydrothermal synthesis, and found that the as-prepared CDs have a photoluminescence (PL) quantum yield of 13.9%, and display amphoteric properties depending on the pH, are highly photostable, have low toxicity and are suitable for bioimaging.

Background Limited data is available on retinal vessel morphology in the north China. The study aimed to evaluate the prevalence of retinal vascular abnormalities (RVAs) and investigate their associations with the self-reported diagnosis of cardiovascular and cerebrovascsular diseases (CCVds) in a rural adult population of northeast China. Methods A population-based, cross-sectional study was conducted, using the cluster random sampling method. One eye of each participant was photographed with a non-mydriatic fundus camera. RVAs including focal and general arteriolar narrowing (FAN and GAN), arteriovenous nicking (AVN), arteriolar sheathing (AS), and retinopathy were evaluated. Data on self-reported diagnosis of cardiovascular and cerebrovascular diseases and status of smoking and alcohol drinking were obtained from questionnaires. Results Among the 6267 participants with an age ≥ 50 years, photographs were obtained of 99.2%, with quality sufficient to perform retinal evaluations in 82.5%. The prevalence of FAN, AVN, AS, retinopathy and GAN were 9.1, 8.9, 5.0, 6.6 and 6.2%, respectively. All the retinal lesions were associated with hypertension (all P Conclusions The overall prevalence of retinal microvascular abnormalities in this population was relatively higher than that reported in other regions of the world. Retinopathy is associated with the self-reported diagnosis of stroke while AVN was associated with the self-reported diagnosis of CHD, but the remaining retinal lesions were not consistently associated with CCVds. Thus, an examination of retinal microvascular characteristics may offer clues to CCVds and could be a potentially novel biomarkers for CCVds risk.

IntroductionRheumatoid arthritis (RA) has a huge societal impact due to the high prevalence, irreversible joint damage and systemic complications. Gut microbiota plays an important role in the pathogenesis and progression of RA by regulating the host immune system. Restoring intestinal homeostasis by altering the microbiota could be an attractive strategy for the prevention and treatment of RA. However, the signature features of microbial dysbiosis in RA are still controversial. Therefore, we aim to elucidate the characteristic change in the diversity and composition of gut microbiota in RA.Methods and analysisWe will systematically search through PubMed, EMBASE, Web of Science and Cochrane Library, as well as dissertations and conference proceedings. The reference lists of all included studies will be also reviewed to retrieve additional relevant studies. The case-control studies that reported either the relative abundance of bacteria at the phylum or genus level or at least one of the alpha-diversity, beta-diversity indexes in both RA and healthy controls will be included. Eligible studies will be screened independently by two reviewers according to the inclusion criteria. The Newcastle-Ottawa Quality Assessment Scale will be used to assess the quality of the included studies. Data extraction, qualitative and quantitative analysis will be performed within the gut microbial dysbiosis in RA. The expected outcomes will be the identification of the specific changes in composition and diversity of the gut microbiota in patients with RA. The quality of evidence will be assessed by the Grading of Recommendations Assessment, Development and Evaluation framework.Ethics and disseminationEthical approval is unnecessary as this review does not address the data and privacy of patients. The results will be published in a peer-reviewed scientific journal and conference presentations.PROSPERO registration numberCRD42021225229.

It is common knowledge that financial sector bonds underperformed on a relative basis immediately following the financial crisis of 2008. We use the portfolio Sharpe ratio and factor regression models to gauge the relative performance of the financial, industrial and utility sectors on a risk-adjusted basis. As the data demonstrate, the underperformance of financial-sector bonds relative to other sectors exists not just for the post-crisis period of 2008–2015 but for the entire sample period of 1996–2015. In our sample of corporate bonds, the utility sector has the best relative performance during 1996–2015. Industrial sector bonds have similar performance to financials in the pre-crisis period and only outperform them post 2008. We find that the underperformance of financial-sector bonds during our sample period is largely attributable to their high relative volatility.

Kennedy’s disease (KD), also known as X-linked spinal and bulbar muscular atrophy (SBMA), is caused by the expansion of cytosine-adenine-guanine (CAG) repeats in the first exon of the androgen receptor (AR) gene. KD is a late-onset neural-endocrinal disease that is characterized by the degeneration of motor neurons in the brainstem and spinal cord. In addition, partial androgen insensitivity is an important manifestation of KD. Here, we report two Chinese KD pedigrees that reveal the clinical and genetic manifestations and fully elaborate the endocrinal characteristics of KD patients. The proband in pedigree 1 was referred to an endocrinologist for gynaecomastia and sexual dysfunction. A gene analysis of this patient revealed that there were 53 CAG repeats in the AR gene. A family survey identified an additional two KD patients in pedigree 1. The proband in pedigree 2 was diagnosed by a neurologist and did not have gynaecomastia or sexual dysfunction. A family survey identified an additional subclinical patient, and both patients exhibited partial androgen insensitivity at a hormonal level. We therefore suggest that a family survey and hormone tests should be routinely performed in KD patients and that physicians should increase their understanding of the different symptoms of KD to achieve correct diagnoses in affected patients.

We report the clinical features, treatments, and outcomes of 9 infants with glaucoma secondary to congenital fibrovascular pupillary membrane. The clinical features included unilateral low vision, high intraocular pressure (IOP), enlarged and cloudy cornea, loss of anterior chamber, and pupillary membrane. All patients underwent membranectomy, peripheral iridectomy, pupilloplasty, and goniosynechialysis as primary treatment. The membranes were posterior to the iris in all 9 eyes. In 5 eyes, the membrane covered the ciliary processes, and in 1 eye the membrane reached the posterior lens capsule. Following primary surgery, 3 patients developed membrane recurrence, 4 had refractory elevated IOP, and 2 developed lens opacities. All 4 eyes with poor postoperative IOP control had iris root insertion anterior to the scleral spur. Five patients received additional surgeries including membranectomy, pupilloplasty, goniosynechialysis, cyclocryotherapy, ciliary photocoagulation, Amhed valve implantation, and lensectomy. One patient had refractory elevated IOP at last follow-up. IOP in the other 8 eyes was well controlled. None of the affected eyes was able to fix and follow at last follow-up.

Endothelial dysfunction is associated with the risk of cardiovascular complications in diabetic patients. Endothelial progenitor cells (EPCs) and flow-mediated dilation (FMD) are common markers of endothelial function. In this study, we aim to investigate whether the DPP-4 inhibitor saxagliptin modulate EPCs number and FMD in newly diagnosed, treatment-naive type 2 diabetic patients. This was a controlled, randomized, open-label clinical trial. Saxagliptin group and metformin group consumed either saxagliptin 5 mg per day or metformin 1 500 mg per day respectively for 12 weeks. Changes of FMD and EPCs number after 12-week intervention were the primary endpoints. 31 patients were initially enrolled and randomized to saxagliptin group (n=16) and metformin group (n=15). 27 patients completed the trial (saxagliptin group n=14 and metformin group n=13), and 4 patients dropped out during the study. FMD and EPCs number increased significantly in both saxagliptin group and metformin group, and there was no significant difference between groups. 2-h postprandial plasma glucose, HbA1c and diastolic blood pressure improved significantly in both groups, and there was no significant difference between groups. Saxagliptin and metformin had comparable beneficial effects on endothelial function.

BACKGROUND Virtual reality (VR) is the use of computer technology to create an interactive three-dimensional (3D) world, which gives users a sense of spatial presence. In nursing education, VR has been used to help optimize teaching and learning processes. OBJECTIVE The purpose of this study was to evaluate the effectiveness of VR in nursing education in the areas of knowledge, skills, satisfaction, confidence, and performance time. METHODS We conducted a meta-analysis of the effectiveness of VR in nursing education based on the Cochrane methodology. An electronic literature search using the Cochrane Library, Web of Science, PubMed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature), up to December 2019 was conducted to identify studies that reported the effectiveness of VR on knowledge, skills, satisfaction, confidence, and performance time. The study selection and data extraction were carried out by two independent reviewers. The methodological quality of the selected studies was determined using the Cochrane criteria for risk-of-bias assessment. RESULTS A total of 12 studies, including 821 participants, were selected for the final analysis. We found that VR was more effective than the control conditions in improving knowledge (standard mean difference [SMD]=0.58, 95% CI 0.41-0.75, PI2=47%). However, there was no difference between VR and the control conditions in skills (SMD=0.01, 95% CI –0.24 to 0.26, P=.93, I2=37%), satisfaction (SMD=0.01, 95% CI –0.79 to 0.80, P=.99, I2=86%), confidence (SMD=0.00, 95% CI –0.28 to 0.27, P=.99, I2=0%), and performance time (SMD=–0.55, 95% CI –2.04 to 0.94, P=.47, I2=97%). CONCLUSIONS The results of this study suggest that VR can effectively improve knowledge in nursing education, but it was not more effective than other education methods in areas of skills, satisfaction, confidence, and performance time. Further rigorous studies with a larger sample size are warranted to confirm these results.

ABSTRAT Background: Limited data is available on retinal vessel morphology in the north China. The study aimed to evaluate the prevalence of retinal vascular abnormalities (RVAs) and investigate their associations with the self-reported diagnosis of cardiovascular and cerebrovascsular diseases (CCVds) in a rural adult population of northeast China. Methods: A population-based, cross-sectional study was conducted, using the cluster random sampling method. One eye of each participant was photographed with a non-mydriatic fundus camera. RVAs including focal and general arteriolar narrowing (FAN and GAN), arteriovenous nicking (AVN), arteriolar sheathing (AS), and retinopathy were evaluated. Data on self-reported diagnosis of cardiovascular and cerebrovascular diseases and status of smoking and alcohol drinking were obtained from questionnaires. Results: Among the 6 267 participants with an age ≥50 years, photographs were obtained of 99.2%, with quality sufficient to perform retinal evaluations in 82.5%. The prevalence of FAN, AVN, AS, retinopathy and GAN were 9.1%, 8.9%, 5.0%, 6.6% and 6.2%, respectively. All the retinal lesions were associated with hypertension (all P

Background: Data on the retinal vessel morphology in the north China are still scarce so far. The study aimed to evaluate retinal vascular abnormalities and their associations with self-reported diagnosis of cardiovascular and cerebrovascsular diseases in a rural adult population of northeast China. Methods: A population-based, cross-sectional study was conducted, using the cluster random sampling method. two 40° non-mydriatic retinal photographs of one eye from each participant was taken using a fundus camera. The main Outcome measures: the prevalence of focal and general arteriolar narrowing, arteriovenous nicking, arteriolar sheathing, and retinopathy. Clinical data including general parameters and system diseases were collected by physical and laboratory examination and standard questionnaires.The association between retinal vascular abnormalities and cardiovascular and cerebrovascsular diseases and their risk factors was determined using logistic regressions. Results: Among 6 267 participants with an age ≥50 years, photographs were obtained of 99.2%, with quality sufficient to perform retinal evaluations in 82.5% (from 5172 participants). Among them, 432 subjects had diabetes. The average age was 61.25±7.37 years. The prevalence of focal arteriolar narrowing, arteriovenous nicking, arteriolar sheathing, retinopathy and general arteriolar narrowing were 9.1%, 8.9 %, 5.0 %, 6.6 % and 6.2% respectively. All the retinal lesions were associated with hypertension (all P0.05). After adjusting for age, gender and left/right eyes, hypertension, hyperlipidemia, diabetes mellitus, habits of past or current smoking and alcohol drinking, arteriovenous nicking was strongly associated with the self-reported histories of coronary heart diseases (OR, 1.44; 95% CI, 1.09, 1.89) and retinopathy was significantly associated with self-reported histories of stroke (OR, 2.05; 95% CI, 1.18, 3.57). Conclusions: Retinopathy is associated with self-reported diagnosis stroke while arteriovenous nicking is associated with the self-reported diagnosis of coronary heart diseases, but the rest retinal lesions are not consistently related to the self-reported diagnosis of coronary heart diseases. Thus, an examination of retinal microvascular characteristics may offer clues to the cardiovascular and cerebrovascsular diseases and could be a potentially novel risk marker.

The hydrogen peroxide generation system was used to analyze the scavenging activity of hydrogen peroxide by Liropes Radix from different origins by HPLC-UV-CL. The UV-CL fingerprints of Liropes Radix from different origins were evaluated,and the HPLC-UV and LC-CL fingerprints were systematically analyzed and evaluated. The results showed that the ether fractions of Liriope spicata var. prolifera and L. muscari had good scavenging activity of hydrogen peroxide,and the total activity of different origins varied greatly,while the similar samples had similar activities. The total antioxidant activity of L. muscari is higher than that of L. spicata var.prolifera. The similarity analysis of the two fingerprints was carried out by two different analytical methods. The chemical fingerprints and the active fingerprints have different characteristics. The contribution of each fingerprint to the total peak area and total activity is also different. There are significant differences between the two different fingerprint clustering results.

The objective of this meta-analysis was to assess the effects of mobile learning for nursing students in clinical nursing education. Five electronic databases including PubMed, CINAHL, EMBASE, the Cochrane library and Web of Science were searched for English language articles published on or before February 10, 2020. Two reviewers retrieved articles, evaluated quality and extracted data independently. Review Manager (RevMan) version 5.3 software was used to perform meta-analysis. A total of 9 studies including 580 nursing students receiving clinical nursing education met the inclusion criteria. The mobile learning intervention led to significant improvements in nursing students' skills (SMD = 1.22, 95% CI [0.29, 2.14], P = 0.009), knowledge (SMD = 0.43, 95% CI [0.11, 0.76], P = 0.009), satisfaction (SMD = 0.31, 95% CI [0.05, 0.56], P = 0.020), and confidence (SMD = 0.4, 95% CI [0.16, 0.63], P 0.001) compared with the control group. Due to differences in experimental design among studies and limited data availability, we cautiously conclude that mobile learning has a beneficial effect on clinical nursing education for nursing students compared with conventional methods.

Introduction Rheumatoid arthritis (RA) is a global disease with a high disability rate. Moxibustion, a well-known traditional Chinese medicine (TCM) therapy that has a long history in the treatment of RA, has attracted increasing clinical attention. However, little is known about its therapeutic mechanism. This study aimed to investigate the mechanism of moxibustion in the treatment of RA in rats through metabolomics. Methods In this study, rats with collagen-induced arthritis (CIA) were treated with moxibustion daily for three weeks at the Shenshu (BL 23) and the Zusanli acupoints (ST 36). Their weight, swelling of the hind paw, arthritic scores, histopathological parameters, and inflammatory factors were assessed. The urine samples of the rats in each group were collected after each course of moxibustion treatment. Gas chromatography–mass spectrometry was used to explore the changes in the urine metabolism spectrum at different courses of moxibustion treatment and analyze the relevant targeted metabolic pathways. Results Results showed that moxibustion alleviated the severity of arthritis and changed 33 metabolites in the urine of rats. These metabolites are involved in glycolysis/gluconeogenesis; tricarboxylic acid (TCA) cycle; and phenylalanine, tryptophan, butanoate, and purine metabolism. The levels of these metabolites in the moxibustion group showed trends similar to those in the control group. Conclusion Moxibustion treatment effectively inhibited inflammation in rats with CIA by regulating glycolysis/gluconeogenesis; TCA cycle; phenylalanine, tryptophan, purine and butanoate metabolism; and other biological pathways. Metabolomics may be an effective way to explain the mechanisms of moxibustion for RA.

In aquaculture of the kelp Saccharina japonica, hybrid cultivars could improve both the yield and quality of the farmed products. Hybrid cultivars refer to the diploid macroscopic offspring resulted from crossing a pair of haploid vegetative gametophyte cell lines. When these two cell lines are derived from individuals that are geographically isolated, the adult sporophytic offspring mostly remain immature in their second year of growth from June to September in the sea. The absence of sori in the adult sporophytes of the hybrid during this period prevents them from being used as parental ones for releasing spores to produce “summer seedlings” in hatchery. This is due to the seasonal restriction of hatchery operation which requires the availability of matured sori exclusively in August in the temperate zone in the northern hemisphere. The reasons for appearance of non-sporulating adult individuals has never been investigated although raising adult sporophyte in land-based tank filled with recirculated cold water at 10 °C has been a routine operation in hatchery enterprises in the subtropical zone in the south region of China for more than 20 years. While in the north region of China, parental sporophytes have been always raised in the sea until they are used for hatchery. From 2017 to 2019, we have conducted a series of culture experiments, both in beakers with isolated thallus in incubators and in large concrete tanks with intact individuals, trying to understand this phenomenon and look for a solution. The results showed that, (1) the hybrid cultivars demonstrated a feature of photoperiodic short-day plant and that it could form sorus within 25 days when exposed to SD at higher temperature (18 °C); (2) the hybrid cultivar maintains unique genetic structures different from the conventional ones as revealed by use of ten polymorphic microsatellite markers; (3) the sensitivity of the hybrids to the shortening of day-length differs in at least 10 days among individuals and could be inherited to its offspring; (4) sori induction in the intact adult sporophytes could be achieved within a month when supplied with SD, applicable to all current cultivars including the hybrids. The discovery and solution presented in this article has opened a gateway to utilization of hybrid cultivars in the giant kelp farming industry in China.

A green, highly efficient, and porous copper-ferrite heterogeneous catalyst (Fe-Cu-400) with good magnetism was synthesized via a coprecipitation method. The catalysts were characterized using XRD, BET, FESEM, and EDS. The performance of Fe-Cu-400 as a catalyst was evaluated by activating peroxymonosulfate (PMS) for degradation of tetracycline (TC) in aqueous solution and investigating the influence of several water parameters. The Fe-Cu-400/PMS system showed a greater TC degradation ability, and the degradation rate of TC was enhanced with an increase in the PMS concentration and the initial pH of the coupled Fe-Cu-400/PMS system. Anions including H