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Xinxin Wang,1,* Shengnan Wang,1,2,* Tingting Song,1,3 Kai Feng,1,4 Yongxin Li1 1Institute of Psychology and Behaviour, Henan University, Kaifeng, Henan, People’s Republic of China; 2Mental Health Service Center, Henan University of Animal Husbandry and Economy, Zhengzhou, Henan, People’s Republic of China; 3School of Psychology, Shanghai Normal University, Shanghai, People’s Republic of China; 4Academic Affairs Office, Henan University of Animal Husbandry and Economy, Zhengzhou, Henan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yongxin Li, Email liyongxin@henu.edu.cnBackground: Adolescents’ mental health literacy is a topic of growing interest and studies have begun to explore the factors that influence adolescents’ mental health literacy. This study investigated the relationship between parents’ mental health literacy and adolescents’ mental health literacy, as well as the mediating roles of parent-child relationship, and the moderating roles of school mental health service.Methods: Questionnaires were distributed to adolescents and their parents at two time points with an interval of one month. In the first survey, 835 parents completed a mental health literacy scale and a parent-child relationship scale. In the second, 841 adolescents completed a school mental health service questionnaire and an adolescent mental health literacy assessment questionnaire. A total of 617 paired data points were matched (parents’ age: M = 40.47, SD = 5.10; adolescents’ age: M = 13.34, SD = 0.99).Results: Bootstrapping results showed that parents’ mental health literacy was positively associated with adolescents’ mental health literacy. In addition, parent-child intimacy mediated the relationship between parents’ mental health literacy and adolescents’ mental health literacy. School mental health service moderated the relationship between parents’ mental health literacy and parent-child intimacy and adolescents’ mental health literacy.Conclusion: Intergenerational transmission of mental health literacy from parents to adolescents and its conditions were revealed. These findings provide new insights for the intervention of adolescents’ mental health literacy, and may lead future research to investigate the role of parents within the family context, as well as the influence of home-school cooperation on adolescents’ mental health literacy.Keywords: mental health literacy, intergenerational transmission, parent-child relationship, school mental health service

Yu Wang,1,2 Yitong Jia,3 Zheng Wang,4 Guang Feng,3 Yanhui Ma,3 Zhen Fan,3 Miao Liu,3 Kunpeng Feng,3 Tianlong Wang3 1Department of Neurosurgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, People’s Republic of China; 2College of Rehabilitation, Capital Medical University, Beijing, People’s Republic of China; 3Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China; 4Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Tianlong Wang, Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China, Email w_tl5595@hotmail.comBackground: Neuropathic pain (NP) is recognized as one of the most difficult pain syndromes which lacks a safe, well-tolerated and effective treatment. Pulsed radiofrequency (PRF), a novel and minimally invasive interventions, has been introduced to alleviate various types of NP. Previous studies reported PRF with higher voltage could further improve the treatment efficacy. Therefore, we conducted this systematic review and meta-analysis to determine whether high-voltage PRF is superior to standard-voltage PRF for the treatment of NP patients.Methods: Databases published from the date of inception until 15 March 2022 on PubMed/MEDLINE, EMBASE, Web of Science and the Cochrane Library were searched for RCTs comparing high-voltage PRF and standard-voltage PRF in NP patients. The primary outcome measures were the efficiency rates of NP patients with high-voltage PRF or standard-voltage PRF treatment. Data analysis was conducted using the Review Manager software (RevMan V.5.3).Results: Six RCTs involving 423 patients were included in our meta-analysis. Compared with standard-voltage PRF group, the high-voltage PRF group attained a higher efficiency rate at 1 month (P = 0.04; I2 = 0%), 3 months (P = 0.04; I2 = 0%), 6 months (P = 0.002; I2 = 0%) post-procedure respectively. There was no significant difference in the complications between the two groups.Conclusion: Our study supported that high-voltage PRF attained more satisfactory efficacy than standard-voltage PRF without increased side effects. High-voltage PRF could be a promising, effective, minimally invasive technology for NP patients.Keywords: trigeminal neuralgia, pulsed radiofrequency, high-voltage, standard-voltage, efficacy

Jiewei Sun, Xiaojun Yu, Kan Feng, Wujun Zheng, Yong Lu, Bin Bao Department of Cardiothoracic Surgery, Fuyang First People’s Hospital, Hangzhou, Zhejiang Province, People’s Republic of ChinaCorrespondence: Xiaojun Yu, Department of Cardiothoracic Surgery, Fuyang First People’s Hospital, No. 429, Beihuan Road, Fuyang District, Hangzhou, Zhejiang Province, People’s Republic of China, Tel +8613858020606, Email yuxj1977@163.comObjective: To investigate the surgical method and efficacy of percutaneous endoscopic transforaminal discectomy (PETD) for the treatment of lumbar disc herniation (LDH) with different migration levels by introducing the strategy of foramenoplasty with the “distal nucleus pulposus as the core”.Methods: Clinical data of LDH patients who underwent single-segment PETD surgery were retrospectively analyzed. Three groups were categorized according to the degree of nucleus pulposus migration in the sagittal position: no migration group, mild migration group, and high migration group. Different sites of foramenoplasty were used for LDH with different degrees of migration. All patients were followed up for at least 12 months. The clinical and follow-up data of the three groups were compared.Results: A total of 102 patients were included, of which 46 (45.1%) were in the no migration group, 36 (35.3%) in the mild migration group, and 20 (19.6%) in the high migration group. Encouraging treatment results were obtained in all three groups.Conclusion: PETD is effective in the treatment of LDH with different degrees of migration, and the foramenoplasty concept of “distal nucleus pulposus as the core” can effectively guide the molding site of foramenoplasty and facilitate the accurate placement of the working trocar.Keywords: PETD, nuclear migration, superior articular process, foraminoplasty, 3D slicer

Jinpei Song,1,* Kai Feng,1,2,* Dian Zhang,1 Shengnan Wang,1,3 Wei Wang,1 Yongxin Li1 1Institute of Psychology and Behaviour, Henan University, Kaifeng, Henan, People’s Republic of China; 2Academic Affairs Office, Henan University of Animal Husbandry and Economy, Zhengzhou, Henan, People’s Republic of China; 3Mental Health Service Center, Henan University of Animal Husbandry and Economy, Zhengzhou, Henan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yongxin Li, Email liyongxin@henu.edu.cnBackground: Entering university is a big change in life. It can cause a lot of stress for new students. Stress can affect their mental health in a negative way. Mental health literacy is the knowledge and skills to deal with mental health issues. It can help new students cope better with stress and improve their mental health.Objective: To investigate the status of mental health literacy, overall adaptation, and mental health of university freshers, and to explore the influence of mental health literacy on the overall adaptation and mental health, as well as the mediating role of overall adaptation.Methods: The undergraduate freshers of 2022 from a comprehensive university in Henan Province were selected as the research participants using a cluster sampling method and were investigated by the general information questionnaire, mental health literacy scale (MHLS), the university student overall adaptation questionnaire (CSOAQ) and university personality inventory (UPI).Results: (1) The detection rate of mental health problems among freshers was 22.39%, and the mental health literacy (112.26 ± 9.66), overall adaptation (3.93 ± 0.93), mental health (10.90 ± 10.51) of freshers had significant differences in demographic variables. (2) Mental health literacy was significantly positively correlated with overall adaptation and mental health, and overall adaptation was significantly positively correlated with mental health. (3) Overall adaptation plays a mediating role in the impact of mental health literacy on mental health. (4) Gender plays a moderating role in the effects of overall adaptation on mental health.Conclusion: The mental health literacy of university freshers could not only directly predict their mental health but also indirectly affect their mental health through overall adaptation, which is more significant among women.Keywords: university freshers, mental health literacy, overall adaptation, mental health, gender

Yi Gou,1,2,* Sheng-Ming Li,1,2,* Jun-Fei Zhang,1,2 Xiao-Ping Hei,2 Bo-Hui Lv,1,2 Ke Feng2 1Department of Emergency Medical, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China; 2School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ke Feng, Department of Emergency Medical, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, People’s Republic of China, Tel +86 18709676586, Email fengkedoct@163.comObjective: To describe the clinical characteristics, treatments, and outcomes of tetanus and determine the most appropriate focus for tetanus prevention and treatment to reduce morbidity and mortality in China.Methods: Four databases, including the Chinese Bio-Medical Literature Database, Chinese National Knowledge Infrastructure, Chinese Scientific Journal Database, and Wan-fang Data, were searched from 1 January, 2000 to 30 October, 2022.Results: In total, 151 articles including 6084 tetanus patients met the inclusion criteria. Additionally, 5925 patients had their gender recorded in detail, among which 66.67% (3950/5925) were male, and 33.33% (1975/ 5925) were female. The average age in the detailed records was reported in 4773 cases, with an overall average age of 46.69. The number of patients’ places of residence was 580. Those from rural areas comprised the highest percentage with 88.62% (514 / 580). The causes of injury were recorded in 1592 cases in total; injuries caused by metals, wood, and wooden spikes accounted for the highest percentage with 54.52% (868/1592). Patient outcomes were recorded in 4305 cases, with a mortality of 9.34% (402/4305). The leading causes of death included treatment terminated by family members, asphyxia due to persistent spasms, respiratory failure, and autonomic dysfunction, family automatic abandonment and asphyxia accounted for the highest percentage, both 24.00% (54/225).Conclusion: The overall success rate of tetanus treatment in China has dramatically improved, but the prevention and control of non-neonatal tetanus is still challenging. Focus should be placed on the prevention of adult tetanus and standardizing the use of sedative and spasmolytic drugs. Additionally, medical professionals should popularize tetanus prevention and treatment knowledge among the people and strengthen training in grass-roots hospitals.Keywords: tetanus, prevention, outcome, immunization

Miao Liu,1– 3 Yuan Sun,1– 3 Lingxue Zhou,1– 3 Kunpeng Feng,1– 3 Tianlong Wang,1– 3 Xuexin Feng1– 3 1Department of Anesthesiology, Capital Medical University Xuanwu Hospital, Beijing, People’s Republic of China; 2Center for Sleep and Consciousness Disorders, Capital Medical University, Beijing, People’s Republic of China; 3Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Xuexin Feng, Department of Anesthesiology, Capital Medical University Xuanwu Hospital, No. 45 Changchun St., Xicheng District, Beijing, 100053, People’s Republic of China, Tel +86-1083798277, Email fengxuexin@xwhosp.orgPurpose: Remimazolam is a new type of ultrashort benzodiazepine drug with an unclear optimal dose for general anesthesia induction in elderly patients aged > 60 years. Therefore, this study aimed to determine the effective dose of remimazolam tosilate induction and explore its correlation with the bispectral index (BIS).Patients and Methods: A total of 42 elderly patients were divided into two age groups: 60– 69 (group A) and 70– 85 (group B) years. An initial dose of 0.1mg/kg(Group A) and 0.05 mg/kg(Group B) remimazolam tosilate was administered, and the Modified Observer’s Assessment of Alertness/Sedation scale was used to assess adequate responses. The dose was calculated using the up-and-down allocation technique based on the previous response. The sequential formula and probit regression model were used to calculate ED50 and BIS50. ED95 was determined using the probit regression model.Results: The ED50 of remimazolam tosilate for anesthesia induction were 0.088 mg/kg (95% confidence interval [CI] 0.071– 0.108) and 0.061 mg/kg (95% CI 0.053– 0.069) in groups A and B, respectively. ED95 was 0.118 mg/kg (95% CI 0.103– 0.649) and 0.090 mg/kg (95% CI 0.075– 0.199) in groups A and B, respectively. The remimazolam tosilate administration could decrease BIS. BIS50 was 86.0 (95% CI 83.7– 88.6) and 85.4 (95% CI 84.1– 86.8) in groups A and B, respectively.Conclusion: During the induction process, patients’ consciousness should be observed. The dose of remimazolam tosilate could be chosen after careful consideration of individual variations.Keywords: remimazolam, anesthesia induction, geriatric, up-and-down sequential allocation

Zhaochen Zhu,1,2,* Renzhi Gao,1,2,* Teng Ye,1,2 Kai Feng,1,2 Juntao Zhang,2 Yu Chen,2 Zongping Xie,1 Yang Wang2 1Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China; 2Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zongping Xie, Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600# Yishan Road, Shanghai, 200233, People’s Republic of China Email x91034@qq.comBackground: Tendinopathy is a common cause of tendon pain. However, there is a lack of effective therapies for managing tendinopathy pain, despite the pain being the most common complaint of patients. This study aimed to evaluate the therapeutic effect of small extracellular vesicles released from induced pluripotent stem cell-derived mesenchymal stem cells (iMSC-sEVs) on tendinopathy pain and explore the underlying mechanisms.Methods: Rat tendinopathy model was established and underwent the injection of iMSC-sEVs to the quadriceps tendon one week after modeling. Pain-related behaviors were measured for the following four weeks. Tendon histology was assessed four weeks after the injection. To further investigate the potential mechanism, tenocytes were stimulated with IL-1β to mimic tendinopathy in vitro. The effect of iMSC-sEVs on tenocyte proliferation and the expression of proinflammatory cytokines were measured by CCK-8, RT-qPCR, and ELISA. RNA-seq was further performed to systematically analyze the related global changes and underlying mechanisms.Results: Local injection of iMSC-sEVs was effective in alleviating pain in the tendinopathy rats compared with the vehicle group. Tendon histology showed ameliorated tendinopathy characteristics. Upon iMSC-sEVs treatment, significantly increased tenocyte proliferation and less expression of proinflammatory cytokines were observed. Transcriptome analysis revealed that iMSC-sEVs treatment upregulated the expression of genes involved in cell proliferation and downregulated the expression of genes involved in inflammation and collagen degeneration.Conclusion: Collectively, this study demonstrated iMSC-sEVs protect tenocytes from inflammatory stimulation and promote cell proliferation as well as collagen synthesis, thereby relieving pain derived from tendinopathy. As a cell-free regenerative treatment, iMSC-sEVs might be a promising therapeutic candidate for tendinopathy.Keywords: tendinopathy, pain relief, extracellular vesicles, iPSC derived MSC

Xiaoxia Ding,1 Shisong Rong,2 Yu Wang,1 Dong Li,1 Liang Wen,1 Bo Zou,1 Dongxiao Zang,1 Kemi Feng,3 Yuanbo Liang,3 Fenghua Wang,4 Gang Zhai1 1Department of Ophthalmology, Fushun Eye Hospital, Fushun, Liaoning, People’s Republic of China; 2Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA; 3Department of Ophthalmology, the Affiliated Eye Hospital, School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China; 4Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Science Key Laboratory, Beijing, People’s Republic of ChinaCorrespondence: Gang Zhai, Fushun Eye Hospital, No. 1 Hupo Street, Xinfu District, Fushun, Liaoning, 113008, People’s Republic of China, Email fsgangzhai@163.comAim: To report the prevalence of depression and its association with vision-related quality of life and social support in a type 2 diabetes mellitus (T2DM) population.Methods: Patients were recruited from a community-based study, Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT), conducted between July 2012 and May 2013 in China. Depression was assessed using the Centre for Epidemiological Studies Depression Scale (CES-D). Vision-related quality of life was evaluated using the Visual Function Questionnaire-25 (VFQ-25). Social support was captured with the Social Support Rating Scale (SSRS). Generalized linear models were used to estimate the individual and joint association of VFQ-25 composite score (VFQCS) and SSRS score (SSRSS) with depression.Results: A total of 1618 subjects (60.9% female) aged 61.69 ± 8.72 years in an urban district of Jiangjun Street, Fushun City, Liaoning province, Northeast China from July 2012 to May 2013 were recruited, of which, 23.36% (95% CI: 21.30– 25.42%) were identified with depression. Every 14.1 increase in VFQ-25 composite score decreased the risk of depression by half (OR = 0.5; 95% CI: 0.4– 0.6); with the elevation of 10.0 SSRS score the risk of depression decreased by 40% (OR = 0.6; 95% CI: 0.5– 0.7). Patients with the VFQCS less than 91.3 and SSRSS less than 38.0 had 5.9 times more risk of depression (OR = 5.9; 95% CI: 3.6– 9.7). Age (over 60 years) (OR = 0.6; 95% CI: 0.4– 0.9) and medical history of cardiovascular disease (OR = 1.7; 95% CI: 1.1– 2.5) were independently correlated with depression symptom.Conclusion: The prevalence of depression is high among patients with T2DM in urban district in northeast China. Vision-related quality of life and social support scores are significantly associated with depression. Measures should be taken to screen depressive symptoms in patients with type 2 diabetes patients. These patients need to be intervened with appropriate and effective treatment as early as possible. Meanwhile, behavioral health specialists should guide the patient to get and use social support sources effectively.Keywords: diabetic retinopathy, depression, quality of vision, Visual Function Questionnaire-25, Social Support Rating Scale

Despite important progress in understanding the influence of deforestation on the bacterial α diversity and community structure at local scales, little is known about deforestation impacts in terms of spatial turnover and soil bacterial community network interactions, especially at regional or global scales. To address this research gap, we examined the bacterial spatial turnover rate and the species networks in paired primary and secondary forest soils along a 3700-km north-south transect in eastern China using high-throughput 16S rRNA gene sequencing. The spatial turnover rate of bacterial communities was higher in primary forests than in secondary, suggesting deforestation increased biotic homogenization at a large geographic scale. Multiple regression on matrices analysis revealed that both geographic distance and soil properties (especially soil pH and organic matter availability) strongly affected bacterial spatial turnover. Through the phylogenetic molecular ecological network approach, we demonstrate that the bacterial network of primary forests was more intricate than in secondary forests. This suggests that microbial species have greater niche-sharing and more interactions in primary forests as compared to secondary forests. On the other hand, the bacterial network in secondary forests was more modular, and the taxa tended to co-occur, with positive correlations accounting for 82% of all potential interactions. In conclusion, our findings demonstrate that anthropogenic deforestation has clear effects on bacterial spatial turnover and network interactions, with potential for serious consequences such as microbial diversity loss in primary forests.

Micro-organisms harbouring the nosZ gene convert N2O to N2 and play a critical role in reducing global N2O emissions. As higher denitrifier diversity can result in higher denitrification rates, here we aimed to understand the diversity, composition and spatial structure of N2O-reducing microbial assemblages in forest soils across a large latitudinal and temperature gradient. We sequenced nosZ gene amplicons of 126 soil samples from six forests with mean annual soil temperatures (MAST) ranging from 3.7 to 25.3°C and tested predictions of the metabolic theory of ecology (MTE) and metabolic-niche theory (MNT). As predicted, α-diversity of nosZ communities increased with increasing MAST, within-site β-diversity decreased and two (pH and soil moisture) of the three niche widths examined were larger with increasing MAST. We calculated β-nearest taxon distance and Raup–Crick metric to quantify the relative influence of the assembly processes determining nosZ assemblage structure. Environmental selection was the primary process driving assemblage structure in all six forests. Homogenizing dispersal was also important at one site, which could be explained by the site's much lower variability in soil chemistry. We used canonical correspondence analysis and multiple regression on matrices to examine relationships between nosZ communities and environmental factors, and found that temperature and spatial distance were significant predictors of nosZ assemblage structure. Overall our results support both theories (MTE and MNT) tested, showing that higher temperatures are correlated with higher local diversity, wider niche breadths and lower within-site turnover rates. A plain language summary is available for this article.

Jia Liu,1,&ast; Jun-Fei Zhang,2,&ast; Han-Ning Ma,2 Ke Feng,2 Zhong-Wei Chen,2 Li-Shan Yang,2 Bin Mei,3 Jun-Jian Zhang4 1Medical Experimental Center, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China; 2Department of Emergency Medical, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China; 3Department of Social Medical Development, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, People’s Republic of China; 4Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhong-Wei Chen; Li-Shan Yang Email 13995390007@163.com; nyfyyls@126.comObjective: Information regarding the epidemiology and clinical features of mild to moderate patients caused by COVID-19 in Fangcang Hospital is scarce. Through a retrospective cohort study, the clinical characteristics of COVID-19 patients in Dongxihu Fangcang shelter hospitals were analyzed, and the factors that affected the disease progression of COVID-19 patients were explored.Methods: The clinical characteristics of 714 patients with COVID-19 were retrospectively analyzed at Dongxihu Fangcang Hospital between February 7 and March 8, 2020. We described the clinical characteristics and distribution of discharge or transfer times for each patient. According to the disease progression of COVID-19 patients, we divided all patients into Non-Deteriorated group and Deteriorated group. Furthermore, binary logistic regression was used for a single outcome and multiple response variables.Results: We treated 789 patients with mild and moderate COVID-19, of which 714 were included in this study, which included 326 (45.66%) deteriorated patients and 388 (54.34%) non-deteriorated patients. The mean age of the study population was 48.16± 12.44 years. Of all patients, 319 (44.7%) were men and 395 (55.3%) were women. The average length of the patient’s stay was 16.08± 5.13 days. The most common clinical feature on admission was fever (593 of 714, 83.05%). It is worth noting that 80 (11.20%) of the 714 patients were asymptomatic from exposure to admission. Multivariate logistic regression analysis showed that gender, age, diabetes, respiratory system disease, fever, dyspnea, and nasal congestion were risk factors associated with deterioration in cases with COVID-19 patients, and asymptomatic (OR: 0.058; 95% CI: 0.022– 0.155; P< 0.001) was the protective factor for deterioration of COVID-19 patients.Conclusion: Accompanied by chronic diseases, old age, fever, nasal congestion, and dyspnea were factors that influenced the aggravation of COVID-19 patients, and more attention and treatment should be given to these patients.Keywords: clinical characteristics, mild to moderate, makeshift (fangcang) hospital, influence factors

Jun-Fei Zhang,1,* Jia Liu,2,* Han-Ning Ma,1 Ke Feng,1 Zhong-Wei Chen,1 Li-Shan Yang,1 Bin Mei,3 Jun-Jian Zhang4 1Department of Emergency Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750000, People’s Republic of China; 2Medical Experiment Center, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750000, People’s Republic of China; 3Department of Social Medical Development, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, People’s Republic of China; 4Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhong-Wei Chen; Li-Shan Yang Email 13995390007@163.com; nyfyyls@126.comRationale: Currently, the “gold standard” is real-time reverse transcriptase–polymerase chain reaction (RT-PCR) amplification of the viral DNA for diagnosis of COVID-19 infection. However, early reports of test performance in the Wuhan outbreak showed variable sensitivities. Therefore, the simple use of RT-PCR as a discharge standard for COVID-19 patients may be risky. Early discussions suggested that CT should be the preferred modality for the diagnosis of COVID-19. However, the use of CT for COVID-19 discharge is controversial. In the Fangcang hospital, we performed multiple nucleic acid tests and chest CT examinations in all patients. For discharged patients, we performed multiple nucleic acid tests and chest CT scans on the basis of discharge standards to minimize the incidence of false negatives in nucleic acid tests.Patient Concerns: Two 42-year-old male patients with mild to moderate COVID-19 were treated in the Fangcang Hospital According to the treatment, one patient was cured and discharged, while the other patient was sent to a higher-level hospital for further treatment.Diagnoses: Real-time reverse transcriptase–polymerase chain reaction amplification of the viral DNA for diagnosis of COVID-19 infection.Interventions: The patients received Chinese medicine and antiviral treatment in the Fangcang Hospital.Outcomes: At follow-up, both patients were cured after treatment and returned to normal life after 2 weeks of home isolation and a negative nucleic acid test.Lessons: The use of nucleic acid testing combined with chest CT examination can quickly diagnose patients with COVID-19 infection and evaluate their treatment in the Fangcang Hospital.Keywords: case report, COVID-19, CT, Fangcang Hospital

Haibin Guo,* Yanqing Xia,* Ke Feng, Xiaowei Qu, Cuilian Zhang, Feng Wan Henan Provincial People’s Hospital, Henan Provincial Reproductive Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan 450003, People’s Republic of China*These authors contributed equally to this workCorrespondence: Feng Wan; Cuilian ZhangHenan Provincial People’s Hospital, Henan Provincial Reproductive Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan 450003, People’s Republic of ChinaTel +86 371 87160762Email fengwanscholar@163.com; zhangcuilian@henu.edu.cnBackground: Metal–organic frameworks (MOFs) have attracted intensive research interest in the biomedical field because of their unique properties. However, in order to realize the high loading capacity and therapeutic efficacy, it is still urgent to develop a multifunctional MOFs-based nanoplatform.Materials and Methods: Herein, a pH/near-infrared (NIR) dual-responsive drug delivery system based on zeolitic imidazolate framework-8 (ZIF-8) is constructed for synergistic chemo-photothermal therapy and dual-modal magnetic resonance (MR)/photoacoustic (PA) imaging. The doxorubicin hydrochloride (DOX) is embedded into ZIF-8 through one-pot method, and the resultant ZIF-8/DOX is then successively modified with polydopamine, Mn ions and poly(ethylene glycol). The obtained ZIF-8/DMPP is systematically characterized, and both its in vitro and in vivo biological effects are evaluated in detail.Results: The ZIF-8/DMPP possesses a high drug-loading content of 18.9% and displays appropriate size and morphology. The pH-dependent degradation and drug release behavior of prepared ZIF-8/DMPP are confirmed. Importantly, the results demonstrate that the photothermal effect of ZIF-8/DMPP under NIR laser irradiation can significantly accelerate its drug releasing rate, further improving the intracellular drug concentrations. Thereafter, the augmented chemotherapeutic efficiency by photothermal effect against cancer cells is verified both in vitro and in vivo. Besides, the favorable MR and PA imaging capacity of ZIF-8/DMPP is also evidenced on the tumor model.Conclusion: Taken together, the surface engineering of ZIF-8-based nanocarrier in this work offers a promising strategy for the multifunctional MOFs-based drug delivery system.Keywords: zeolitic imidazolate framework-8, pH/NIR responsive, chemo-photothermal therapy, dual-modal imaging

Recent studies have shown that the high standard of living enjoyed by people in the richest countries often comes at the expense of CO2 emissions produced with technologies of low efficiency in less affluent, developing countries. Less apparent is that this relationship between developed and developing can exist within a single country’s borders, with rich regions consuming and exporting high-value goods and services that depend upon production of low-cost and emission-intensive goods and services from poorer regions in the same country. As the world’s largest emitter of CO2, China is a prominent and important example, struggling to balance rapid economic growth and environmental sustainability across provinces that are in very different stages of development. In this study, we track CO2 emissions embodied in products traded among Chinese provinces and internationally. We find that 57% of China’s emissions are related to goods that are consumed outside of the province where they are produced. For instance, up to 80% of the emissions related to goods consumed in the highly developed coastal provinces are imported from less developed provinces in central and western China where many low–value-added but high–carbon-intensive goods are produced. Without policy attention to this sort of interprovincial carbon leakage, the less developed provinces will struggle to meet their emissions intensity targets, whereas the more developed provinces might achieve their own targets by further outsourcing. Consumption-based accounting of emissions can thus inform effective and equitable climate policy within China.

Jing-Jing Sun,1,2 Xiao-Min Liu,2 Chen-Yu Shen,2 Kun Feng,1,2 Po-Zi Liu2 1School of Clinical Medicine, Medicine Institute, Tsinghua University, Beijing, China; 2Yu Quan Hospital, Clinical Neuroscience Institute, Tsinghua University, Beijing, China Purpose: Bipolar disorder (BD) patients with psychotic symptoms (BDp) worsens prognosis and decreases rates of recovery. The study investigated cognitive performance and brain function between BD patients in depressive episode with and without psychotic symptoms to find potential neurobiological markers associated with psychotic features of BD patients in depressive episode. Patients and methods: Thirty-one patients without psychotic symptoms and 29 patients with psychotic symptoms diagnosed with bipolar I disorder with a current depressive episode were included in the present study. The neural function of prefrontal cortex (PFC) and cognitive performance among BDp, BD patients without psychotic symptoms, and 23 healthy controls (HC) were examined using near-infrared spectroscopy during verbal fluency task (VFT). Results: 1) Both the BD groups exhibited significantly worse performance of VFT and lower activation of oxygenated hemoglobin (oxy-Hb) changes in the bilateral ventrolateral PFC compared with the HC group. 2) Within the BD group, VFT performance was not significantly different. 3) The prefrontal activation of oxy-Hb changes in the BDp patients was significantly lower than that in the BD patients without psychotic symptoms in the right dorsolateral PFC. 4) Activation of oxy-Hb changes in right dorsolateral PFC was negatively correlated with the severity of psychotic symptoms in BDp patients. Conclusion: The prefrontal function differs between BD patients in depressive episode with or without psychotic symptoms measured with near-infrared spectroscopy. Keywords: bipolar disorder, depressive, psychotic symptoms, near-infrared spectroscopy, verbal fluency task

Jing-Jing Sun,1,2 Xiao-Min Liu,2 Chen-Yu Shen,2 Xiao-Qian Zhang,1,2 Gao-Xiang Sun,2 Kun Feng,2 Bo Xu,2 Xia-Jin Ren,1,2 Xiang-Yun Ma,1,2 Po-Zi Liu2 1Medical Center, Tsinghua University, Beijing, China, 2Department of Psychiatry, YuQuan Hospital, Tsinghua University, Beijing, China Purpose: Daytime complaints such as memory and attention deficits and failure to accomplish daily tasks are common in insomnia patients. However, objective psychological tests to detect cognitive impairment are equivocal. Neural function associated with cognitive performance may explain the discrepancy. The aim of this study was to investigate the hemodynamic response patterns of patients with chronic insomnia disorder (CID) using the noninvasive and low-cost functional neuroimaging technique of multichannel near-infrared spectroscopy (NIRS) in order to identify changes of neural function associated with cognitive performance.Patients and methods: Twenty-four CID patients and twenty-five healthy controls matched for age, right-hand dominance, educational level, and gender were examined during verbal fluency tasks (VFT) using NIRS. A covariance analysis was conducted to analyze differences of oxygenated hemoglobin (oxy-Hb) changes in prefrontal cortex (PFC) between the two groups and reduce the influence of the severity of depression. Pearson correlation coeffcients were calculated to examine the relationship between the oxy-Hb changes, with the severity of insomnia and depressive symptoms assessed by the Pittsburgh Sleep Quality Index (PSQI) and the Hamilton Rating Scale for Depression (HAMD).Results: The number of words generated during the VFT in CID groups showed no statistical differences with healthy controls. CID patients showed hypoactivation in the PFC during the cognitive task. In addition, we found that the function of left orbitofrontal cortex (OFC) during the VFT was significantly negatively correlated with the PSQI scores and the function of right dorsolateral PFC (DLPFC) was significantly negatively correlated with the HAMD scores.Conclusion: The present study detected dysfunctions in PFC in spite of intact performance which indicates the role of PFC in the neurophysiological underpinnings. Left OFC function is associated with insomnia symptoms and right DLPFC function is associated with depressive symptoms. Keywords: chronic insomnia disorder, near-infrared spectroscopy, NIRS, prefrontal cortex, verbal fluency task, depressive symptoms