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Xue Li,1,* Dianhui Peng,2,* Xinbo Wu,2 Xiaolin Li,2 Junwen Liang,2 Hongjun Yin,2 Le Liu,2 Qian Yang,2 Weixin Dong,2 Chunxia Lu2 1College of Sports and Art, Shandong Sport University, Jinan City, Shandong Province, People’s Republic of China; 2Department of Sport Education, Hunan Normal University, Changsha City, Hunan Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Weixin Dong; Chunxia Lu, Email dongweixin@hunnu.edu.cn; luchunxia@hunnu.edu.cnObjective: Loneliness is a prevalent issue among rural left-behind children in China, adversely affecting their physical and mental well-being, as well as social stability. However, the influencing factors and potential mechanisms of loneliness have not yet been fully clarified. This study aims to validate the mediating roles of social anxiety and psychological resilience by examining the association between affective/cognitive empathy and loneliness among Chinese rural left-behind children.Methods: This cross-sectional survey employed a convenience sampling approach among Chinese left-behind children. A total of 540 participants aged 6 to 11 years old (Average age = 8.54, SD = 1.682) from 3 primary schools in Hunan Province completed the Children’s Loneliness Scale, Social Anxiety Scale for Children, The Chinese version of Connor-Davidson Resilience Scale, and Basic Empathy Scale. Data analysis was conducted using SPSS 27.0, Origin 2020, and Mplus 8.3.Results: Pearson correlation analyses suggested strong significant correlations among affective/cognitive empathy, loneliness, social anxiety, and psychological resilience. Path analyses indicated that the chain mediation effect size of social anxiety and psychological resilience was 0.016 between affective empathy and loneliness, while the chain mediation effect size between cognitive empathy and loneliness was − 0.011.Conclusion: Affective empathy positively correlates with loneliness among Chinese left-behind children through social anxiety and resilience, while cognitive empathy negatively correlates with loneliness. These findings suggest that left-behind children should enhance their cognitive empathy and psychological resilience to reduce their social anxiety, thereby mitigating their loneliness.Keywords: left-behind children, empathy, loneliness, social anxiety, resilience

Xiang Liu,1,* Zhipeng Wei,2,* Long Ting,1,* Xuming Liu,3 Yongqiang Shu,1 Huang Ling,1 Lifeng Li,1 Yumeng Liu,1 Guojin Xia,1 Dechang Peng,1 Haijun Li1 1Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China; 2Department of Radiology, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China; 3Department of Radiology, Wenzhou People’s Hospital, Wenzhou, Zhejiang, 325000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Dechang Peng; Haijun Li, Email pengdcdoctor@163.com; haijunli1990@163.comIntroduction: Continuous positive airway pressure (CPAP) therapy improves clinical symptoms in patients with obstructive sleep apnea (OSA); however, the mechanism of this clinical improvement and how it may be associated with the restoration of white matter (WM) structures in the brain is unclear. Therefore, this study investigated the relationship between the structural recovery of brain WM and improvements in cognitive function and emotion after long-term (12 months) CPAP treatment in patients with OSA.Methods: We collected data from 17 patients with OSA before and 12 months after CPAP treatment, including sleep monitoring, clinical assessment, and diffusion tensor imaging (DTI) magnetic resonance imaging.Results: We observed a partial reversible recovery of brain WM (mean and radial diffusion coefficients) after treatment. This recovery involved the commissural fibers (cingulum, body of corpus callosum), projection fibers (retrolenticular part of the internal capsule, posterior thalamic radiation, posterior limb of the internal capsule, superior corona radiata, posterior corona radiata), association fibers (external capsule, superior longitudinal fasciculus, inferior longitudinal fasciculus), and other regions. In addition, the improvements in WM fibers in one part of the brain significantly were correlated with the Hamilton Anxiety Scale and Hamilton Depression Scale scores.Discussion: Our results suggest that reversible recovery of reduced brain WM integrity due to OSA may require longer CPAP treatment. Moreover, changes in the integrity of the commissural fibers were associated with emotion regulation. These restored WM areas may explain the cognitive and mood improvements observed after OSA treatment.Keywords: obstructive sleep apnea, continuous positive airway pressure, diffusion tensor imaging, tract-based spatial statistics

Li Zeng,1 Yongqiang Shu,1,2 Wei Xie,3 Yaping Zeng,4 Kunyao Li,5 Ting Long,1 Ling Huang,1 Xiang Liu,1 Haijun Li,1,2 Dechang Peng1,2 1Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, People’s Republic of China; 2Department of PET, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, People’s Republic of China; 3Department of Radiology, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, People’s Republic of China; 4Department of Radiology, Jiangxi Provincial People’s Hospital, Nanchang, People’s Republic of China; 5Department of Radiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, People’s Republic of ChinaCorrespondence: Dechang Peng; Haijun Li, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwai Zheng Street, Donghu District, Nanchang, Jiangxi Province, 330006, People’s Republic of China, Tel +86 79186427565, Email pengdcdoctor@163.com; haijunli1990@163.comPurpose: Previous studies demonstrated that there was abnormal functional connectivity (FC) in the amygdala subregions in obstructive sleep apnea (OSA), which was associated with cognitive function. However, it is not clear whether these abnormalities can be improved after continuous positive airway pressure (CPAP) treatment. Therefore, the aim of this research was to investigate the changes in FC of amygdala subregions with other brain regions after 6 months of CPAP treatment (post-CPAP) in patients with OSA.Patients and Methods: Fifteen OSA patients underwent Magnetic Resonance Imaging prior to CPAP treatment (pre-CPAP) and following CPAP treatment. The amygdala was divided into six subregions, including bilateral dorsal amygdala (DA), medial amygdala (MA) and ventral amygdala (VA). The FC was calculated by using the amygdala subregions as seeds. A paired sample T-test was employed to assess alterations in the amygdala subregions FC of pre-CPAP and post-CPAP OSA patients, and correlation analysis was then conducted to evaluate the association between the changed FC and clinical assessment.Results: Compared to pre-CPAP OSA patients, post-CPAP OSA patients displayed an enhanced FC between the left DA and the right posterior cingulate cortex (PCC), whereas the FC between the left MA and the right postcentral gyrus, and between the right MA and the left middle frontal gyrus, decreased. Moreover, significant correlation between the FC value of left DA-right PCC and Hamilton Anxiety Inventory scores was found in pre-CPAP OSA patients.Conclusion: Altered FC between the amygdala subregions and other brain regions in OSA patients induced by CPAP treatment was related to cognitive, emotional, and sensorimotor function. Our study found altered FC between amygdala subregions and cognitive and motor-related brain regions in post-CPAP OSA patients, providing potential neuroimaging indicators for CPAP treatment.Keywords: obstructive sleep apnea, amygdala, functional connectivity, treatment, emotion

Ruixi He, Buyun Jia, Daiyin Peng, Weidong Chen School of Pharmacy, Anhui University of Chinese Medicine, Hefei, People’s Republic of ChinaCorrespondence: Ruixi He, School of Pharmacy, Anhui University of Chinese Medicine, No. 350 Longzihu Road, Xinzhan District, Hefei, 230012, People’s Republic of China, Tel +8613637080511, Fax +8655168129099, Email heruixi@ahtcm.edu.cnAbstract: The previous phytochemical analyses of Garcinia hanburyi revealed that the main structural characteristic associated with its biological activity is the caged polyprenylated xanthones with a unique 4-oxatricyclo [4.3.1.03,7] dec-2-one scaffold, which contains a highly substituted tetrahydrofuran ring with three quaternary carbons. Based on the progress in research of the chemical constituents, pharmacological effects and modification methods of the caged polyprenylated xanthones, this paper presents a preliminary predictive analysis of their drug-like properties based on the absorption, distribution, metabolism, excretion and toxicity (ADME/T) properties. It was found out that these compounds have very similar pharmacokinetic properties because they possess the same caged xanthone structure, the 9,10-double bond in a,b-unsaturated ketones are critical for the antitumor activity. The author believes that there is an urgent need to seek new breakthroughs in the study of these caged polyprenylated xanthones. Thus, the research on the route of administration, therapeutic effect, structural modification and development of such active ingredients is of great interest. It is hoped that this paper will provide ideas for researchers to develop and utilize the active ingredients derived from natural products. Keywords: caged polyprenylated xanthones, pharmacological effects, antitumor, modification, ADME/T properties

Ling Zhou,1,&ast; Yu Gan,1,&ast; Yanjun Wu,1 Dongdong Xue,1 Jianhong Hu,1 Yilan Zhang,2 Yang Liu,3 Siyuan Ma,1 Junyi Zhou,1 Gaoxing Luo,1 Daizhi Peng,1 Wei Qian1 1Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University (Third Military Medical University), Chongqing, 400038, People’s Republic of China; 2Department of Oral and Maxillofacial Head and Neck Surgery, Army Medical Center of PLA/Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People’s Republic of China; 3Department of Urology, Urology Institute of PLA, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Daizhi Peng; Wei Qian, Email dzpengpub@126.com; weiqian87@126.comIntroduction: Indocyanine green (ICG) fluorescence imaging has been used in the resection surgery and sentinel lymph node biopsy of many tumors. The aim of the present study is to verify the feasibility and effectiveness of ICG fluorescence imaging used for guiding the biopsy and resection of skin squamous cell carcinoma (SSCC).Methods: Sixty patients were enrolled, including 18 patients of suspected SSCC and 42 patients of diagnosed SSCC on admission. The ICG fluorescence imaging-guided skin biopsy was performed preoperatively in the 18 cases of suspected SSCC. Fifty-three patients underwent ICG fluorescence imaging-guided radical excision.Results: The results showed that 138 skin tissue samples in 60 patients with preoperative or intraoperative ICG fluorescence imaging-guide biopsy were collected. For a total number of 138 biopsies, 122 specimens were squamous cell carcinoma, and the accuracy rate was 88.4%, which was significantly higher than that of the group without preoperative ICG fluorescence imaging (41/62, 66.1%, P < 0.05). Fifty-three patients underwent surgery guided with ICG fluorescence imaging. Residual fluorescent signals in 24 patients were intraoperatively found and the excision was then expanded until the signals disappeared. Follow-up to November 2022, 12 patients died, of which 5 cases died from the tumor recurrence, and the others died due to advanced ages or other reasons. The recurrence rate was 9.4%, which was not significantly different from that of the group received routine radical resection (4/35, 11.4%, P > 0.05). Moreover, sentinel lymph nodes were successfully detected under ICG fluorescence imaging in the 4 patients with suspected lymph node metastases, and the location of lymph nodes can be precisely identified.Conclusion: ICG fluorescence imaging technique can guide the pathology biopsy to improve the accuracy of pathological examination, and help to identify the boundaries of tumor tissues and sentinel lymph nodes to resect tumor radically during operation.Keywords: indocyanine green, ICG, near-infrared fluorescence imaging, skin squamous cell carcinoma, biopsy, radical resection

Junxian Xu,1 Suhong Xiao,2 Xiaoyun Xie,1 Yunqin Kang,2 Donghong Peng,2 Yanhong Lu2 1College of Medicine, Jiaxing University, Jiaxing, Zhejiang, People’s Republic of China; 2Zhejiang Veteran Hospital, Jiaxing, Zhejiang, People’s Republic of ChinaCorrespondence: Junxian Xu, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, 314000, People’s Republic of China, Tel +86-13511357431, Email xujunxian_2022@163.comIntroduction: Hypoglycemia is an acute complication that can appear in people with type 2 diabetes treated with drugs which are associated with a risk of hypoglycemia, and it may lead to individual’s fear of hypoglycemia (FoH). FoH adversely affects diabetic self-management, psychological well-being, and quality of life, and it is associated with sleep quality. Nevertheless, this problem is often underestimated. The purpose of this study was to explore the heterogeneous characteristics of FoH in middle-aged and elderly hospitalized patients with type 2 diabetes and assess its relationship with the sleeping quality.Patients and Methods: A cross-sectional study was performed on 263 middle-aged and elderly patients with type 2 diabetes hospitalized at the Zhejiang Veteran Hospital in Jiaxing, China, from May to August 2022, selected by a convenient sampling method. A questionnaire containing general information, fear of hypoglycemia scale-15 (FH-15) and the Pittsburgh sleep quality index (PSQI) was provided to the participants. Latent profile analysis was performed to examine the potential latent groups in the distribution of answers on the individual FoH items.Results: The results identified three latent classes: Class 1 – Low FoH group (33%); Class 2 – No FoH group (61%); Class 3 – High FoH group (6%). The latent FoH class was the influencing factor of sleep quality, which was better in the No FoH group than in the Low FoH group, while the sleep quality of the Low FoH group was better than that in the High FoH group.Conclusion: A heterogeneity was found in the FoH of middle-aged and elderly hospitalized patients with type 2 diabetes. Health-care providers should pay more attention to these patients with high FoH and develop intervention strategies to mitigate it and improve their sleep quality.Keywords: fear of hypoglycemia, sleeping quality, middle-aged and older adults, type 2 diabetes, latent profile analysis

Nana Ren,1,2 Ronnell D Dela Rosa,2,3 Ziyu Chen,4 Yuan Gao,1 Ling Chang,1 Mingxia Li,1 Dongqin Peng1 1Division 2 of Common Gynecological Department, Guiyang Maternal and Child Health Care Hospital, Guiyang Children’s Hospital, Gui Zhou, People’s Republic of China; 2Philippine Women’s University, School of Nursing, Manila, Philippines; 3Bataan Peninsula State University, College of Nursing and Midwifery, Balanga, Bataan, Philippines; 4Beijing University of Chemical Technology, Beijing, People’s Republic of ChinaCorrespondence: Nana Ren, Email renanan9@126.comAbstract: Ectopic pregnancy is a leading cause of death for child-bearing aged women. Most patients with ectopic pregnancy experience suffer psychological distress which seriously affects their physical and mental health. The psychological distress, influencing factors, measurement tools, and nursing interventions in patients with ectopic pregnancy in China are reviewed in this article. The results showed that the main psychological distress of patients with ectopic pregnancy is anxiety, depression, uncertainty sense of disease, and low self-esteem. The main factors affecting the psychological distress of ectopic pregnancy patients included life-threatening disease, different marital status, and reproductive needs. The main intervention methods for psychological distress in pregnant patients included: cognitive behavioral therapy, emotional therapy of traditional Chinese medicine, and family support. The majority of cross-sectional surveys in China focused on psychological conditions of the patients with ectopic pregnancy, and there are very few longitudinal studies. Large-sample, multi-center longitudinal studies should be conducted in the future to monitor the development of ectopic pregnancy. Qualitative research should be conducted on patient experience, to provide guidance and basis for the implementation of targeted nursing interventions and to further explore standardized, continuous, and generalizable psychological care protocols for distress interventions for patients with ectopic pregnancy, thereby minimizing psychological distress such as anxiety, depression, and uncertainty in patients with ectopic pregnancy.Keywords: ectopic pregnancy, psychological distress, influencing factors, nursing intervention, review

Yuncheng Zhu,1– 3,&ast; Zhiguo Wu,4,&ast; Dongmei Zhao,5 Xiaohui Wu,2 Ruoqiao He,6 Zuowei Wang,1,3 Daihui Peng,2 Yiru Fang2,7– 9 1Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai, People’s Republic of China; 2Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai JiaoTong University School of Medicine, Shanghai, People’s Republic of China; 3Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai, People’s Republic of China; 4Clinical Research Center in Mental Health, Shanghai Yangpu District Mental Health Center, Shanghai University of Medicine & Health Sciences, Shanghai, People’s Republic of China; 5Division of Psychiatry, Shanghai Changning Mental Health Center, Shanghai, People’s Republic of China; 6New York University, New York, NY, USA; 7Department of Psychiatry & Affective Disorders Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 8CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, People’s Republic of China; 9Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yiru Fang, Email yirufang@aliyun.comObjective: This survey aims to explore the current medical treatment of major depressive disorder (MDD) in China and match its degree with Canadian Network for Mood and Anxiety Treatments (CANMAT).Methods: A total of 3275 patients were recruited from 16 mental health centers and 16 general hospitals in China. Descriptive statistics presented the total number and percentage of drugs, as well as all kinds of treatments.Results: Selective serotonin reuptake inhibitors (SSRIs) accounted for the largest proportion (57.2%), followed by serotonin-noradrenaline reuptake inhibitors (SNRIs) (22.8%) and mirtazapine (7.0%) in the first therapy, while that of SNRIs (53.9%) followed by SSRIs (39.2%) and mirtazapine (9.8%) in the follow-up therapy. An average of 1.85 medications was administered to each MDD patient.Conclusion: SSRIs were the first choice in the first therapy, while the proportion of those drugs decreased during the follow-up therapy and were replaced by SNRIs. Plenty of combined pharmacotherapies were directly selected as the first trial of patients, which was inconsistent with guideline recommendations.Keywords: major depressive disorder, Chinese, guideline, antidepressants

Chenjing Qian,1,&ast; Qiuling Wu,1,&ast; Zhixuan Ruan,2 Fang Liu,1 Weiming Li,1 Wei Shi,1 Ling Ma,3 Danyue Peng,1 Hua Yin,1 Lan Yao,1 Zixuan Li,1 Mei Hong,1,4 Linghui Xia1 1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, People’s Republic of China; 2Faculty of Natural, Mathematical and Engineering Sciences, King’s College, London, UK; 3Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 4Collaborative Innovation Center of Hematology, Soochow University, Suzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Mei Hong; Linghui Xia, Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road No. 1277, Wuhan, Hubei Province, People’s Republic of China, Tel +8613037137937 ; +8618627733999, Email hmxh@hust.edu.cn; linghuixia@hust.edu.cnBackground: Bloodstream infection (BSI) due to carbapenem-resistant organisms (CROs) has emerged as a worldwide problem associated with high mortality. This study aimed to evaluate the risk factors associated with mortality in HM patients with CROs BSI and to establish a scoring model for early mortality prediction.Methods: We conducted a retrospective cohort study at our hematological department from January 2018 to December 2021, including all HM patients with CROs BSI. The outcome measured was death within 30-day of BSI onset. Survivor and non-survivor subgroups were compared to identify predictors of mortality. Univariate and multivariate Cox regression analyses were used to identify prognostic risk factors and develop a nomogram.Results: In total, 150 HM patients were included in the study showing an overall 30-day mortality rate of 56%. Klebsiella pneumonia was the dominant episode. Cox regression analysis showed that pre-infection length of stay was > 14 days (score 41), Pitt score > 4 (score 100), mucositis (score 41), CAR (The ratio of C-reactive protein to albumin) > 8.8 (score 57), early definitive therapy (score 44), and long-duration (score 78) were positive independent risk predictors associated with 30-day mortality, all of which were selected into the nomogram. Furthermore, all patients were divided into the high-risk group (≥ 160 points) or the low-risk group based on the prediction score model. The mortality of the high-risk group was 8 times more than the low-risk group. Kaplan-Meier analysis showed that empirical polymyxin B therapy was associated with a lower 30-day mortality rate, which was identified as a good prognostic factor in the high-risk group. In comparison, empirical carbapenems and tigecycline were poor prognostic factors in a low-risk group.Conclusion: Our score model can accurately predict 30-day mortality in HM patients with CROs BSI. Early administration of CROs-targeted therapy in the high-risk group is strongly recommended to decrease mortality.Keywords: carbapenem-resistant organisms, predictive model, nomogram, hematological malignancies, bloodstream infection

Wei Xie,1 Yongqiang Shu,1 Xiang Liu,1 Kunyao Li,1 Panmei Li,1 Linghong Kong,1 Pengfei Yu,2 Ling Huang,1 Ting Long,1 Li Zeng,1 Haijun Li,1,3 Dechang Peng1,3 1Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China; 2Big Data Research Center, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China; 3PET Center, The First Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of ChinaCorrespondence: Dechang Peng; Haijun Li, The First Affiliated Hospital of Nanchang University, No. 17, Yongwai Zheng Street, Donghu District, Nanchang City, Jiangxi Province, 330006, People’s Republic of China, Tel +86 79186427560 ; +86 18970025300, Email pengdcdoctor@163.com; haijunli1990@163.comPurpose: This study aimed to explore the alterations in spontaneous brain activity in obstructive sleep apnea (OSA) using percent amplitude of fluctuation (PerAF) and investigate the relationship between abnormal spontaneous brain activity and cognitive impairment in OSA.Patients and Methods: Overall, 52 patients with moderate to severe OSA and 61 healthy controls (HCs) were eventually enrolled in this study. All participants underwent resting-state functional magnetic resonance (rs-fMRI) and T1-weighted imaging. The PerAF was calculated and compared between patients with OSA and HCs, with voxel level P < 0.001 and cluster level P < 0.05 corrected with Gaussian Random Field was be considered statistically different. A partial correlation analysis was used to assess the relationship between altered PerAF and clinical assessments in patients with OSA.Results: Compared to HCs, patients with OSA had significantly lower PerAF values in the right rectal gyrus and left superior frontal gyrus, but higher PerAF values in the right cerebellum posterior lobe and left middle frontal gyrus. The PerAF values of some specific regions in patients with OSA correlated with sleep efficiency and Montreal Cognitive Assessment scores. Additionally, support vector machine analysis showed that PerAF values in all differential brain regions could differentiate patients with OSA from HCs with good accuracy.Conclusion: Specific brain areas in OSA patients may exhibit aberrant neuronal activity, and these anomalies may be linked to decreased cognitive performance. This discovery offers fresh perspectives on these patients’ neurocognition.Keywords: cerebellum, cognitive function, frontal lobe, functional magnetic resonance imaging, percent amplitude of fluctuation

Wei Zhang,1,&ast; Yuyang Zhang,1,&ast; Jingjing Gao,1 Dangwei Peng,1 Yao Zhang,1 Xu Wu,1 Guodong Liu,1 Yutian Dai,2 Hui Jiang,3 Xiansheng Zhang1 1Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China; 2Department of Urology, Gulou Hospital of Nanjing University, Nanjing, Jiangsu Province, People’s Republic of China; 3Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiansheng Zhang; Hui Jiang, Email xiansheng-zhang@163.com; jianghui55@163.comPurpose: To determine the role of poor sleep quality as a risk factor for acquired premature ejaculation (APE) after considering the various risk factors, such as ages, lower urinary tract symptoms (LUTS), anxiety, depression, and erectile dysfunction.Methods: This study presents a multivariate analysis to identify risk factors for PE, including the covariate of age, International Prostate Symptom Score (IPSS), General Anxiety Disorder-7 (GAD-7) score, Patient Health Questionnaire-9 (PHQ-9) score, International Index of Erectile Function (IIEF) score, and Pittsburgh Sleep Quality Index (PSQI). Acquired PE was defined as self-reported intravaginal ejaculation latency time ≤ 3 minutes, and poor sleep quality was diagnosed using the Pittsburgh Sleep Quality Index tool.Results: A total of 349 men were enrolled in the study after completing the questionnaires and the medical history survey. Among 349 men, 203 individuals (58.17%) suffered from acquired PE. The IIEF-5 score, IPSS, GAD-7 score, PHQ-9 score, and PSQI score of the population with PE were significantly different from the non-PE group. Further multivariate analysis showed that erectile dysfunction, depression, severe prostatitis-like symptoms, and poor sleep quality were high-risk factors of APE. Additionally, our study showed that premature ejaculation diagnostic tool (PEDT) score was associated with IPSS/GAD-7/PHQ-9/PSQI scores positively and associated with IIEF-5 scores negatively. The stratified analysis of sleep quality showed that APE patients with different sleep qualities have different prevalence rates of anxiety, depression, prostatitis-like symptoms, and erectile function.Conclusion: In general, sleep quality may be a potential risk factor for patients with acquired premature ejaculation. Our research revealed the impact of sleep quality on premature ejaculation and provided new viewpoints for further understanding and perfecting the pathogenesis of premature ejaculation.Keywords: sleep quality, acquired premature ejaculation, multivariate analysis

Yun Wang,1 Xiaohua Liu,2,3 Daihui Peng,2 Yan Wu,2 Yun’ai Su,4 Jia Xu,5 Xiancang Ma,6 Yi Li,7 Jianfei Shi,8 Xiaojing Cheng,9 Han Rong,10 Yiru Fang1,3,11 1Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 3Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 4Department of Psychiatry, Peking University Sixth Hospital, Peking, People’s Republic of China; 5Department of Psychiatry, Harbin First Specific Hospital, Harbin, People’s Republic of China; 6Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, People’s Republic of China; 7Department of Psychiatry, Wuhan Mental Health Center, Wuhan, People’s Republic of China; 8Department of Psychiatry, Hangzhou Seventh People’s Hospital, Hangzhou, People’s Republic of China; 9Department of Psychiatry, Shandong Mental Health Center, Shandong, People’s Republic of China; 10Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, People’s Republic of China; 11CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, People’s Republic of ChinaCorrespondence: Daihui Peng; Yiru Fang Email pdhsh@126.com; yirufang@aliyun.comBackground: Despite the best treatments, about 20% of patients with major depressive disorder (MDD) receiving drugs and psychological intervention show little or no improvement. There is no trial comparing different treatment methods in patients with anxiety/somatic subtype MDD.Aim: To compare the efficacy and safety of various treatments in patients with anxiety/somatic subtype MDD.Methods: This was a preliminary multicenter randomized controlled trial at eight participating hospitals in China (09/2016-06/2019) (ClinicalTrials.gov #NCT03219008). The patients were randomized to mirtazapine/SNRIs, mirtazapine/SNRIs+cognitive behavioral therapy (CBT), mirtazapine+SNRIs, or mirtazapine+SNRIs+physical therapies (modified electroconvulsive treatment or repetitive transcranial magnetic stimulation). The primary endpoint was the 17-item Hamilton Depression Scale (HAMD-17). The Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) and Quality of Life (QOL)-6 were the secondary endpoints. The adverse events (AEs) were monitored. The patients were assessed at baseline (0 weeks), and at the end of the 2nd, 4th, 6th, 8th, and 12th week during treatment.Results: Finally, 107 patients were included: mirtazapine/SNRIs (n=36), mirtazapine/SNRIs+CBT (n=28), mirtazapine+SNRIs (n=29), and mirtazapine+SNRIs+physical therapies (n=14). The 17-HDRS and QIDS-SR scores decreased in all four groups, and the QOL-6 scores increased. There were no differences in the 17-HDRS (P=0.099), QIDS-SR (P=0.407), and QOL-6 (P=0.485) scores among the four groups. There were no differences in the occurrence of AEs among the four groups (P=0.942).Conclusion: This preliminary trial suggests that all four interventions (mirtazapine/SNRIs, mirtazapine/SNRIs+CBT, mirtazapine+SNRIs, or mirtazapine+SNRIs+physical therapies) achieved similar response and remission rates in patients with anxiety/somatic subtype MDD. The safety profile was manageable.Keywords: major depressive disorder, anxiety, mirtazapine, serotonin-norepinephrine reuptake inhibitor, cognitive behavioral therapy, Hamilton Depression Scale

Yong Cheng,1 Yu-Xi Cheng,1 Xiao-Yu Liu,1 Bing Kang,2 Wei Tao,1 Dong Peng1 1Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China; 2Department of Clinical Nutrition, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of ChinaCorrespondence: Dong PengDepartment of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of ChinaTel +86 23 89011014Email carry_dong@126.comPurpose: The purpose of the current study was to analyze the effect of type 2 diabetes mellitus (T2DM) on the short-term outcomes and prognosis of stage I–III colorectal cancer (CRC) undergoing primary surgery.Methods: Patients who underwent primary CRC surgery were retrospectively collected from Jan 2011 to Jan 2020 in a single clinical center. The short-term outcomes and prognosis were compared between T2DM group and non-T2DM group using propensity score matching (PSM) analysis.Results: A total of 4250 patients were included in this study. There were 521 patients with T2DM and 3729 patients without T2DM. After 1:1 ratio PSM, there were 519 T2DM patients and 519 non-T2DM patients left in this study. No significant difference was found in baseline information after PSM (p> 0.05). T2DM had higher overall complications (p=0.033) after PSM in terms of short-term outcomes. As for prognosis, T2DM group had worse overall survival (OS) in all stages (p=0.044), stage I (p=0.009) and stage II (p=0.021) of CRC and T2DM group had worse disease-free survival (DFS) than non-T2DM group in stage I (p=0.008) of CRC before PSM. However, T2DM did not affect the overall survival (OS) or disease-free survival (DFS) on different stages of CRC after PSM (p> 0.05). Moreover, T2DM was not an independent predictor of OS or DFS (p> 0.05).Conclusion: T2DM increased overall complications after primary CRC surgery. However, T2DM might not affect OS and DFS of stage I–III CRC patients.Keywords: colorectal cancer, type 2 diabetes mellitus, outcomes, prognosis

Haijun Li,1,2 Lan Li,3 Linghong Kong,1 Panmei Li,1 Yaping Zeng,1 Kunyao Li,1 Wei Xie,1 Yongqiang Shu,1 Xiang Liu,1 Dechang Peng1,2 1Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, People’s Republic of China; 2PET Center, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, People’s Republic of China; 3Jiangxi Provincial Institute of Parasitic Diseases Control, Nanchang City, Jiangxi Province, People’s Republic of ChinaCorrespondence: Dechang PengThe First Affiliated Hospital of Nanchang University, No. 17, Yongwai Zheng Street, Donghu District, Nanchang City, 330006, Jiangxi Province, People’s Republic of ChinaTel +86 79186427560Email pengdcdoctor@163.comPurpose: Previous studies have demonstrated abnormal local spontaneous brain activity in the conventional frequency bands (0.01– 0.08 Hz) in obstructive sleep apnea (OSA). However, it is not clear whether these abnormalities are associated with the specific frequency band of low-frequency oscillations or whether it can be improved with a continuous positive airway pressure (CPAP) treatment. This study aimed to investigate the regional homogeneity (ReHo) in specific frequency at baseline (pre-CPAP) and after one month of CPAP adherence treatment (post-CPAP) in OSA patients.Methods: Twenty-one patients with moderate-to-severe OSA and 21 age- and sex-matched healthy controls (HCs) were included in the final analysis. ReHo was calculated in three different frequency bands (typical frequency band: 0.01– 0.1 Hz; slow-5 band: 0.01– 0.027 Hz; slow-4 band: 0.027– 0.073 Hz), respectively. A partial correlational analysis was performed to assess the relationship between altered ReHo and clinical evaluation.Results: OSA patients revealed increased ReHo in the brainstem, bilateral inferior temporal gyrus (ITG)/fusiform, and right-cerebellum posterior lobe (CPL), and decreased ReHo in the bilateral inferior parietal lobule (IPL), right superior temporal gyrus (STG), and left precentral gyrus (PG) compared to HC groups in different frequency bands. Significantly changed ReHo in the bilateral middle temporal gyrus (MTG), PG, medial frontal gyrus (MFG), supplementary motor area (SMA), CPL, IPL, left superior frontal gyrus (SFG), ITG, MTG, and right STG were observed between post-CPAP and pre-CPAP OSA patients, which was associated with specific frequency bands. The altered ReHo in specific frequency bands was correlated with Montreal cognitive assessment score, Epworth sleepiness scale, and apnea hypopnea index in pre-CPAP OSA patients.Conclusion: These findings indicate that OSA has frequency-related abnormalities of spontaneous neural activity before and after short-term CPAP treatment, which might contribute to a better understanding of local neural psychopathology and may serve as potential biomarkers for clinical CPAP treatment.Keywords: obstructive sleep apnea, treatment, frequency band, local connectivity, resting-state functional magnetic resonance imaging

Daofang Zhu,1 Jingjing Gao,1 Xianming Dou,2 Dangwei Peng,1 Yao Zhang,1 Xiansheng Zhang1 1Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People’s Republic of China; 2Department of Urology, Anhui No. 2 Provincial People’s Hospital, Heifei, 230041, People’s Republic of ChinaCorrespondence: Xiansheng Zhang Tel +86- 551-62922114Email xshzhang1013@126.comBackground: Benign prostatic hyperplasia (BPH) is a frequent-occurring disease in middle-aged and elderly men. This work is a prospective study and aims at exploring the incidence of post-operative depression and the potential risk factors of depression in a cohort of patients with BPH in China.Methods: In this survey, 611 men who underwent transurethral resection of the prostate (TURP) were strictly selected at our institution from January 2016 to August 2019. Zung Self-rating Depression Scale was used for evaluation of depressive symptoms. Sociodemographic, clinical and other data were also collected.Results: We found that 152/611 (24.9%) patients suffered from different degree of depression at 6 months after TURP, including mild symptoms (20.9%) and moderate/severe symptoms (3.9%). A total of 421 (68.9%) patients developed post-TURP erectile dysfunction (ED). The occurrence of depression was closely associated with marital status, education level, cigarette smoking, alcohol consumption, severity of lower urinary tract symptoms (LUTS), duration of BPH, erectile function, and comorbidities (such as diabetes, dyslipidaemia and bladder stone). The risk factors related to the severity of depression included widowed or single marital status, frequent alcohol consumption, moderate or severe LUTS, longer duration (> 5 years) of BPH, ED, urinary continence, and comorbidities such as diabetes and bladder stone.Conclusion: Many risk factors are related to the occurrence of depression in patients undergoing TURP. Widowed or single marital status, frequent alcohol consumption, moderate or severe LUTS, longer duration of BPH, ED, urinary incontinence and comorbidities such as diabetes and bladder stone are connected with the increase odds of moderate or severe depressive symptom.Keywords: benign prostate hyperplasia, BPH, transurethral resection of the prostate, TURP, depression, prevalence rate, risk factors

Yun Wang,1 Xiaohua Liu,2,3 Daihui Peng,2 Yan Wu,2 Yun’ai Su,4 Jia Xu,5 Xiancang Ma,6 Yi Li,7 Jianfei Shi,8 Xiaojing Cheng,9 Han Rong,10 Yiru Fang1,3,11 1Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 3Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 4Department of Psychiatry, Peking University Sixth Hospital, Peking, People’s Republic of China; 5Department of Psychiatry, Harbin First Specific Hospital, Harbin, People’s Republic of China; 6Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, People’s Republic of China; 7Department of Psychiatry, Wuhan Mental Health Center, Wuhan, People’s Republic of China; 8Department of Psychiatry, Hangzhou Seventh People’s Hospital, Hangzhou, People’s Republic of China; 9Department of Psychiatry, Shandong Mental Health Center, Shandong, People’s Republic of China; 10Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, People’s Republic of China; 11CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, People’s Republic of ChinaCorrespondence: Daihui Peng; Yiru Fang Email pdhsh@126.com; yirufang@aliyun.comBackground: Fluoxetine, bupropion, cognitive behavioral therapy (CBT), and physical therapies (modified electroconvulsive treatment or repetitive transcranial magnetic stimulation) can be used to manage melancholic depression.Objective: To compare the efficacy and safety of various treatments in patients with melancholic depression.Methods: This was a preliminary multicenter randomized controlled trial that included patients with depression in their first or recurrent acute episode between September 2016 and June 2019, and randomized to fluoxetine, fluoxetine+CBT, fluoxetine+bupropion, and fluoxetine+bupropion+brain stimulation. The primary endpoint was the decrease in the 17-item Hamilton Depression Rating Scale (17-HDRS). The secondary endpoint included the scores from the Quick Inventory of Depressive Symptomatology (QIDS-SR), QOL-6, and safety. Adverse events (AEs) were monitored. The follow-ups were performed at the end of the 0th, 2nd, 4th, 6th, 8th, and 12th weeks of treatment.Results: Finally, 113 patients were included in the analyses: fluoxetine (n=37), fluoxetine+CBT (n=27), fluoxetine+bupropion (n=34), and fluoxetine+bupropion+brain stimulation (n=15). The 17-HDRS and QIDS-SR scores decreased in all four groups (all P< 0.05). There were no differences in the 17-HDRS scores among the four groups at the end of treatment (P=0.779), except for fluoxetine alone showing a better response regarding self-consciousness than fluoxetine+bupropion. The QOL-6 scores increased in all four groups. The occurrence of AEs among the four groups showed no significant difference (P=0.053).Conclusion: This preliminary trial suggests that all four interventions (fluoxetine, fluoxetine+CBT, fluoxetine+bupropion, and fluoxetine+bupropion+brain stimulation) achieved similar response and remission rates in patients with melancholic depression, but that fluoxetine had a better effect on self-consciousness than fluoxetine+bupropion. The safety profile was manageable.Keywords: major depressive disorder, melancholic depression, fluoxetine, bupropion, cognitive behavioral therapy, brain stimulation

Wei Tao,* Yu-Xi Cheng,* Ying-Ying Zou, Dong Peng, Wei Zhang Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China*These authors contributed equally to this workCorrespondence: Dong PengDepartment of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of ChinaTel +86-13370754855Email carry_dong@126.comPurpose: The purpose of the present study was to evaluate whether vascular calcification is a risk factor for anastomotic leakage after gastrectomy in gastric cancer patients.Methods: Patients with confirmed gastric cancer were collected from the database of a single clinical center from January 2013 to January 2019. The calcification score and anastomotic leakage were recorded, and predictors of anastomotic leakage were analyzed.Results: A total of 856 patients were included in this study; 818 patients had no anastomotic leakage, and 38 patients had anastomotic leakage. The ratio of hypertension status (p=0.011), open gastrectomy (p=0.012), postoperative length of stay (p=0.000), aorta calcification score (p=0.000) and celiac axis calcification (p=0.000) were higher in the anastomotic leakage group than in the nonanastomotic leakage group. In multivariate analysis, aorta calcification (p=0.029, odds ratio =2.425, 95% CI=1.095– 5.491) was an independent predictor of the anastomotic leakage.Conclusion: Aorta calcification is an independent risk factor for anastomotic leakage after gastrectomy in gastric cancer patients.Keywords: calcification, leakage, gastrectomy, gastric cancer

Dan Peng, Zi-Liang Hou, Hong-Xia Zhang, Shuai Zhang, Shu-Ming Zhang, Rui-Yan Lin, Zhen-Chuan Xing, Yuan Yuan, Kai-Yuan Yang, Jin-Xiang Wang Department of Respiratory and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Jin-Xiang WangDepartment of Respiratory and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Xinhuananlu No. 82, Tongzhou District, Beijing, 101100, People’s Republic of ChinaEmail jinxiangwang@ccmu.edu.cnBackground: Pulmonary thromboembolism (PTE) is a common disease which may be a serious condition and has high mortality. Recently, it has been shown that circRNAs play an important role in the development of various diseases, including thromboembolic disease. However, circRNAs expression profiling is not clear in PTE, this study aims to identify the circRNAs expressed in PTE and to elucidate their possible role in pathophysiology of PTE.Methods: A total of 5 patients with CTPA-confirmed PTE and 5 healthy controls were recruited for the present study. The circRNAs expression profile was analyzed by microarray.Results: In total, 256 differentially expressed circRNAs (up 142, down114) and 1162 mRNA (up 446, down 716) were summarized by analyzing the circRNAs microarray data. The top 3 up-regulated and 3 down-regulated circRNAs were validated by Real-Time Polymerase Chain Reaction (qRT-PCR). Two differentially expressed circRNAs (hsa_circ_0000891, hsa_circ_0043506) were selected for further analysis. Finally, we construct a circRNA-miRNA-mRNA ceRNA network with a bioinformatic prediction tool. Pathway analysis shows that the enriched mRNAs targets take part in Protein processing in endoplasmic reticulum, Systemic lupus erythematosus, Endocytosis, Spliceosome, HTLV-I infection and Ubiquitin mediated proteolysis.Conclusion: Our findings indicated that aberrantly expressed circRNAs (hsa_circ_0000891, hsa_circ_0043506) may be involved in the development of PTE.Keywords: circRNA, gene, pulmonary thromboembolism, circRNA-miRNA-mRNA network, functional enrichment

Jun Wang,1 Weichu Liu,2 Qinghua Zhao,1 Mingzhao Xiao,3 Daomei Peng4 1Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 2Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 3Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 4The First Social Welfare Home of Chongqing, Chongqing, People’s Republic of ChinaCorrespondence: Qinghua Zhao 1 Youyi Road, Chongqing, 400016, People’s Republic of ChinaTel +8618602308866Fax +023-89012206Email qh20063@163.comPurpose: Understanding the factors that affect nursing staffs’ intention and practice of physical restraint (PR) on older adults help develop restraint-reduction programs. This study aimed to identify the relationship between the Theory of Planned Behavior (TPB) constructs and nursing staffs’ practice to use PR in long-term care (LTC) facilities.Patients and Methods: A cross-sectional survey was conducted via convenience sampling among 316 nursing staff in six Chinese LTC facilities. PR-TPB questionnaire and the practice subscale of the Chinese version of the Staff Knowledge, Attitudes and Practices Questionnaire regarding PR were used to collect the data. Structural equation modeling (SEM) was used to examine the relationship between variables.Results: The SEM fit well with the data (χ2/df =1.639, RMSEA = 0.045, CFI= 0.955, GFI=0.945). Attitude (β=0.536, P< 0.001) and perceived behavioral control (PBC) (β=0.139, P< 0.05) predicted intention (R2=0.359). PBC was a significant predictor of practice, with R2 accounting for 0.151.Conclusion: TPB provided useful insight into better understanding nursing staffs’ PR practices, although it did not support all the TPB principles significantly. Prospective studies may be conducted to design and implement multi-component interventions based on TPB and explore the effectiveness of PR reduction in LTC facilities in-depth.Keywords: physical restraints, nursing home, aged, the theory of planned behavior, nursing, China

Dong Peng,* Ying-Ying Zou,* Yu-Xi Cheng, Wei Tao, Wei Zhang Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wei ZhangDepartment of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of ChinaTel +86-13808353353Email cyzhangwei@hotmail.comPurpose: The purpose of the present study was to evaluate the effect of time (season, surgical starting time in the daytime, preoperative waiting time) on patients with gastric cancer.Methods: A retrospective collection of medical records of patients who underwent gastrectomy at a single clinical center from January 2013 to December 2018 was performed. Medical records were collected, and short-term outcomes and long-term survival were analyzed by different time groups.Results: A total of 586 patients were included in this study. In terms of surgical starting time, the midday group had a shorter operation time (p=0.017) but more complications (p=0.048) than the non-midday group. No significant difference was found based on the season of gastrectomy. The long preoperative waiting group had a shorter postoperative hospital stay than the short waiting group (p=0.026). No significant difference was found between the short-waiting group and long-waiting group in overall survival for all clinical stages. Age (p=0.040, HR=1.017, 95% CI=1.001– 1.033), BMI (p< 0.001, HR=0.879, 95% CI=0.844– 0.953) and clinical stage (p< 0.001, HR=2.053, 95% CI=1.619– 2.603) were independent prognostic factors predicting overall survival; however, season of gastrectomy, surgical starting time and preoperative waiting time were not identified as independent prognostic factors.Conclusion: Surgical starting time at the midday could cause more complications, and surgeons should be careful when the surgical starting time is midday.Keywords: gastric cancer, season, waiting time, surgical starting time

Da Peng,1 Dongfeng Shan,2 Chengcheng Dai,1 Jie Li,3 Zifan Wang,1 Ziyi Huang,1 Rui Peng,1 Peng Zhao,4 Xuezhen Ma1 1Department of Oncology, Affiliated Qingdao Central Hospital, Qingdao University, Qingdao, Shandong, People’s Republic of China; 2The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China; 3Department of Oncology, Jiaozhou Central Hospital, Jiaozhou, People’s Republic of China; 4Biotherapy Center, Affiliated Qingdao Central Hospital, Qingdao University, Qingdao, Shandong, People’s Republic of ChinaCorrespondence: Xuezhen MaDepartment of Oncology, Affiliated Qingdao Central Hospital, Qingdao University, No. 127 Siliunan Road, Qingdao, Shandong, 266042, People’s Republic of ChinaTel +86-18660229289Fax +86-532-85953085Email qdlwyxpd@163.comPeng ZhaoBiotherapy Center, Affiliated Qingdao Central Hospital, Qingdao University, Qingdao, Shandong, People’s Republic of ChinaEmail zp8102@126.comPurpose: As a third-generation EGFR TKI has been taken orally, Osimertinib effectively inhibits mutant EGFR, including T790M EGFR resistance mutations. Here, we examined real-world efficacy and tolerability of Osimertinib among Chinese patients with advanced EGFR T790M-mutant NSCLC.Patients and Methods: A total of 106 advanced NSCLC patients who were taking Osimertinib following disease progression after EGFR-TKIs or other treatments were retrospectively recruited in this study. The PFS and OS after Osimertinib treatment were analyzed as the primary endpoints.Results: Osimertinib was used as a second line and ≥ 3rd line treatment in 22.6% and 77.4% of the patients, respectively. DCR and ORR were 93.4% and 57.5%, respectively. Median PFS was 12.4 12 (95% CI, 10.5– 13.5) months. The PFS was 11 (8.0, 14.0) and 12 (10.3,13.7) months (p = 0.373), in patients with and without CNS metastasis, respectively. PFS in 2nd and ≥ 3rd line treatment was 11 (9.0, 13.0) and 12.4 12 (8.9, 15.1) months (p = 0.799), respectively. In patients with EGFR exon 19 deletion and exon 21 L858 mutation, the median PFS was 11 (9.2, 12.8) and 12 (9.2, 14.8) months, respectively (p = 0.833). Median PFS in the monotherapy group and combined anti-angiogenesis group was 11 (9.9,12.1) and 14 (11.2,16.8) months, respectively. Median OS after Osimertinib initiation was 27 (19.6, 34.4) months: 15 (6.9, 23.1) and 27 (22, 32) months in patients with and without CNS metastasis (p=0.027), 27 (20.3,33.7) months and (undefined) as second line or ≥ 3rd line of treatment (p = 0.421), respectively. In patients with exon 19 deletion, the median OS was not reached, and in patients with exon 21 L858 mutations, the median OS was 23 (19.1,29.9) months (p=0.027). Median OS in the monotherapy group was 27 (21.7,32.3) months, and in combined anti-angiogenesis group was not reached (p=0.68).Conclusion: Osimertinib can effectively treat advanced NSCLC with T790M mutations independently of previous treatment lines.Keywords: osimertinib, EGFR-activating mutations, T790M EGFR mutation, tyrosine-kinase inhibitors, non-small cell lung cancer

Yongqing Cai1 *,* Bin Li1 *,* Dan Peng,1 Xianfeng Wang,1 Pan Li,2 Mingchun Huang,3 Haiyan Xing,1 Jianhong Chen1 1Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China; 2Department of Pharmacy, Fengdu Traditional Chinese Medicine Hospital, Chongqing, 408299, People’s Republic of China; 3Department of Pharmacy, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400021, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jianhong ChenDepartment of Pharmacy, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of ChinaTel +86 23 6875 7091Email chenjh-110@263.netBackground: Nrf2-Bach1 antioxidant signaling pathway is considered as one of the most important mechanisms of cellular resistance to oxidative injury. The effect of hyperoside (Hyp) on the expression and distribution of Bach1, the relationship of Hyp’s antioxidative effect and the influence of Bach1 remains unclear.Purpose: The aim of this study was to investigate the role and mechanisms of Bach1 in the protective effect of Hyp on oxidative liver injury.Methods: The protective effect of Hyp on oxidative stress injury was observed in vivo and in vitro. Next, the influence of Hyp on Bach1 expression and distribution, and competitive combination of Nrf2-Bach1 with ARE in H2O2-induced L02 cell was studied by Western blot, RT-PCR, immunofluorescence and CHIP assay. Finally, the expressions of Crm1, ERK and p38 and their roles on Hyp mediated nuclear export of Bach1 were investigated by Western blot.Results: Hyp ameliorated the pathological damage, reduced the liver index, AST, ALT and MDA activities, and increased SOD and GSH levels in the CCl4-induced acute liver injury mouse model. Hyp attenuated H2O2-induced oxidative stress injury in L02 cells. Hyp promoted the early rapid redistribution of Bach1 from nucleus to cytoplasm. CHIP analyses demonstrated that Hyp enhanced the levels of Nrf2-ARE complex, and weakened the levels of Bach1-ARE complex within three hours. In addition, Hyp enhanced transport protein Crm1 expression and ERK1/2 activity. And LMB, a Crm1 inhibitor, attenuated the effect of Hyp on Bach1 nuclear export and anti-oxidation. U0126, an ERK1/2 inhibitor, reduced the effect of Hyp on Crm1 expression and the Bach1 redistribution.Conclusion: The hepatoprotective mechanism of Hyp was related to improve Bach1 nuclear export depending on ERK1/2-Crm1 to upregulate the level of Nrf2 binding to ARE.Keywords: hyperoside, oxidative stress, Bach1, Crm1, hepatoprotective

Xiaohua Liu,1,2,* Yun Wang,3,* Daihui Peng,3 Huifeng Zhang,3,* Yanqun Zheng,1 Yan Wu,3 Yun-Ai Su,4 Ming Liu,5 Xiancang Ma,6 Yi Li,7 Jianfei Shi,8 Xiaojing Cheng,9 Han Rong,10 Yiru Fang2,3,11 1Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 3Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 4Department of Psychiatry, Peking University Sixth Hospital, Peking, People’s Republic of China; 5Department of Psychiatry, Harbin First Specific Hospital, Harbin, People’s Republic of China; 6Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, People’s Republic of China; 7Department of Psychiatry, Wuhan Mental Health Center, Wuhan, People’s Republic of China; 8Department of Psychiatry, Hangzhou Seventh People’s Hospital, Hangzhou, People’s Republic of China; 9Department of Psychiatry, Shandong Mental Health Center, Shandong, People’s Republic of China; 10Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, People’s Republic of China; 11CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yiru Fang; Daihui PengShanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wan Ping Road, Shanghai 200030, People’s Republic of ChinaEmail yirufang@aliyun.com pdhsh@126.comBackground: Major depressive disorder (MDD) is a heterogeneous mental disease that encompasses different subtypes and specifiers. Clinically targeted treatments have not been identified yet, although standardized strategies are recommended by several clinical guidelines. The main aim of this study is to respectively identify the precise treatment for three different subtypes of MDD (ie, melancholic, atypical, and anxious).Methods: An 8-to-12-week, multicenter randomized controlled trial (RCT) with a parallel group design will be conducted to determine the most effective and appropriate treatment. A total of 750 adults diagnosed with MDD will be recruited, categorized into melancholic, atypical or anxious type based on the assessment of the Inventory of Depressive Symptomatology (IDS30) and the Hamilton Anxiety Scale (HAMA), and 1:1 randomly assigned to different intervention groups. Blood draw, EEG test, and MRI scan will be performed at baseline and endpoint. Clinical symptom and side-effects will be evaluated at critical decision points (CDP) including weeks two, four, six, eight, and 12 after treatment. The primary outcome is total score and reduction rate of the 17-Hamilton Depression Rating Scale (17-HDRS). The secondary outcomes include the scores of the Quick Inventory of Depressive Symptomatology-self-report (QIDS-SR), IDS30, HAMA and the Treatment Emergent Symptom Scale (TESS). All the data will be analyzed by SAS software.Discussion: The study commenced recruitment in August 2017 and is currently ongoing.Trial Registration: ClinicalTrials.gov Identifier: NCT03219008 (July 17, 2017).Keywords: major depressive disorder, MDD, subtype, antidepressant, physical therapy, computerized cognitive behavioral treatment, cCBT, randomized controlled trial, RCT

Chen Zhang,1– 3 Daihui Peng,1– 3 Lu Lv,4 Kaiming Zhuo,1,3 Kai Yu,5 Tian Shen,4 Yifeng Xu,1,2 Zhen Wang1– 3 1Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 3Shanghai Psychological Medical Team Supporting Hubei, Shanghai, People’s Republic of China; 4School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 5MoE Key Laboratory of Artificial Intelligence, AI Institute Shanghai Jiao Tong University, Shanghai, People’s Republic of ChinaCorrespondence: Zhen Wang Email wangzhen@smhc.org.cnYifeng Xu Email xuyifeng@smhc.org.cnBackground: Since the novel coronavirus disease (COVID-19) outbreak in Wuhan, thousands of medical workers have been dispatched to support Wuhan against the virus. The purpose of this study was to identify the independent risk factors for psychological distress in order to develop a more effective strategy and precise evidence-based psychological intervention for medical workers.Methods: This multisite cross-sectional survey recruited doctors and nurses from local and nonlocal medical teams working at 16 hospitals in Wuhan to complete this online survey from February to March, 2020. Psychological status was evaluated through Perceived Stress Scales (PSS), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder Scale (GAD-7) and Acute Stress Disorder Scale (ASDS).Results: Of 966 participants, the prevalence of stress (95.9%), depression (46.0%) and anxiety (39.3%) were high. Local medical workers exhibited even higher scores of PSS, PHQ-9, GAD-7 and ASDS than those from outside Hubei (P< 0.001). Females had more severe perceived stress, depression and anxiety than males (P< 0.001). Multiple logistic regression showed that perceived stress is associated with increased odds of depression (OR=1.413; 95% CI: 1.338– 1.493; P< 0.001) and anxiety (OR=1.515; 95% CI: 1.407– 1.631; P< 0.001).Conclusion: Our findings demonstrated a high prevalence of stress, depression, anxiety and acute distress among medical workers on the front-line during the COVID-19 outbreak in Wuhan. The level of psychological impact may be mediated by individual perceptions of stressful events.Keywords: COVID-19, stress, anxiety, depression, Wuhan

Lijuan Sheng,1 Lihong Yin,1 Dezhen Peng,1 Liping Zhao2 1Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, People’s Republic of China; 2Department of Nursing, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, People’s Republic of ChinaCorrespondence: Liping ZhaoDepartment of Nursing, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, People’s Republic of ChinaTel/ Fax +86 731-8529-4072Email zhaolp0818@csu.edu.cnBackground: Best evidence regarding enteral nutrition from continuous nasal feeding in stroke patients is limited. The aim of this study was to explore the best evidence of continuous nasal feeding in stroke patients and translate the evidence into clinical practice.Methods: This study utilized the standard procedures of the Joanna Briggs Institute (JBI) evidence-based nursing centers’ clinical evidence-practice application system. The baseline assessment of stroke patients in the neurology ward was conducted. A pre- and post-implementation audit approach was used in this study and adopted the Getting Research into Practice program. We analyzed the compliance of nurses with best practice and its impact on patients’ gastrointestinal function and complications, aspiration, aspiration pneumonia, nurses’ daily workload of nasal feeding, and the length of hospitalization before and after implementing the evidence-based strategies.Results: After application of the evidence-based strategies, nurses’ compliance with best practice was improved. The incidence of patients’ gastrointestinal complications including vomit (χ 2 = 5.195, P=0.023), palirrhea (χ 2 = 4.216, P=0.039), diarrhea (χ 2 = 4.514, P=0.042), constipation (χ 2 = 5.535, P=0.035) and gastric retention (χ 2 = 4.541, P=0.042) decreased significantly after the application of the best evidence. The working time of nurses undergoing nasal feeding decreased from 23.71 ± 3.22 min to 7.73 ± 1.14 min (P =0.000) and the length of patient’s hospitalization decreased from 35.63 ± 4.45 days to 35.00 ± 3.70 days (P=0.534). The rate of aspiration, aspiration pneumonia did not show a significant difference after implementation of the evidence-based strategies.Conclusion: The results revealed that the evidence-based practice of continuous nasal feeding in stroke patients is an effective method to improve nursing quality and reduce gastrointestinal complications, which was worthy of clinical application.Keywords: stroke, nasal feeding, evidence-based nursing, best evidence, complications

Dong Peng,* Yu-Xi Cheng,* Wei Tao, Ying-Ying Zou, Kun Qian, Wei Zhang Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wei Zhang; Kun QianDepartment of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People’s Republic of ChinaEmail cyzhangwei@hotmail.com; hxjsqk@hotmail.comPurpose: The purpose of this study was to explore the changes in blood pressure in patients with concurrent gastric cancer and hypertension after gastrectomy, and to identify the factors that affect the changes in blood pressure.Materials and Methods: Patients with concurrent gastric cancer and hypertension who underwent gastrectomy were retrospectively analyzed from January 2013 to December 2018. The pre- and 6-month postoperative medical records were compared. Predictors for the remission of hypertension were analyzed.Results: A total of 143 patients with concurrent gastric cancer and hypertension were included in this study. The number of patients with complete remission, partial remission and no remission were 67 (46.9%), 12 (8.4%) and 64 (44.7%), respectively. The average of weight and BMI (body mass index) before gastrectomy were 63.0 ± 9.7 kg and 23.4 ± 2.9 kg/m2, respectively, which were significantly higher than those 6-month postgastrectomy: 54.8 ± 9.8 kg and 20.4 ± 3.1 kg/m2, respectively (p< 0.001). The average number of antihypertensive medications before gastrectomy was 1.5 ± 0.6, while it was 0.8 ± 0.8 6-month postgastrectomy (p< 0.001). Age (p< 0.05) and the surgical techniques used (p< 0.05) were significantly different between partial remission and no remission patients. Furthermore, age (p< 0.05) and the surgical techniques used (p< 0.05) were significantly different between complete remission and no remission patients. Age (p< 0.05, odds ratio =0.933, 95% CI=0.890– 0.978) and the surgical techniques used (p< 0.05, odds ratio =2.749, 95% CI=1.132– 6.677) are predictors for remission of hypertension.Conclusion: Total gastrectomy is an onco-metabolic surgery that can cure younger patients with concurrent gastric cancer and hypertension. Age and the surgical techniques used can predict the remission of hypertension 6 months after gastrectomy.Keywords: gastric cancer, age, hypertension, gastrectomy, remission

Economic growth and convergence issues arise in humanity continually, especially in developing countries. With Rwandan and Peruvian common vital economic variables from 1960 to 2017, we analyze their economic growth, causality, and convergence. The cointegration shows the long-run equilibrium correlation among the explained and explanatory variables, indicating the causality occurrence. The causality direction is defined by the Error Correction Model (ECM) using the Chi-square (χ2) short-run test, long-run T-test, and joint F-test statistics. The estimated values support a generalized Broadwell model equation with linear and quadratic terms. Through ANOVA with the F test, the economic convergence scenario for the two countries is testified. Thus, joint countries' strategies for economic improvement are suggested with the reduction of unnecessary losses.

Yujie Shi,1,* Dong Peng,2,* Dan Wang,1 Zongmin Zhao,3 Binlong Chen,1 Bing He,1 Yukun Zhu,2 Kun Wang,2 Jie Tian,2 Qiang Zhang1 1Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems, School of Pharmaceutical Sciences, Peking University, Beijing 100191, People’s Republic of China; 2CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, People’s Republic of China; 3School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA*These authors contributed equally to this workCorrespondence: Jie TianCAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, People’s Republic of ChinaTel +86-10-82618465Email tian@ieee.orgQiang ZhangBeijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems, School of Pharmaceutical Sciences, Peking University, Beijing 100191, People’s Republic of ChinaTel/Fax +86-10-82802791Email zqdodo@bjmu.edu.cnIntroduction: Though widely studied for biomedical applications, the lack of current systemic studies on the in vivo fate of single-walled carbon nanohorns (SWCNHs) largely restricts their further applications, as real-time monitoring of their biodistribution remains a big challenge. Here, we aim to customize a label-free multispectral optoacoustic tomography (MSOT) method and systematically survey the fate of oxidized SWCNHs (SWCNHox) following different exposure routes by whole body imaging.Methods: Mice were given a suspension of SWCNHox with an average size of 136.4 nm via four different administration routes, and then imaged by MSOT.Results: After oral gavage, SWCNHox were mainly distributed in the gastrointestinal tract then excreted through the gut. Compared with the observation post first dosing, the accumulation of SWCNHox in the gastrointestinal tract was not obvious even after four-time oral gavage. Almost no SWCNHox were found at detectable levels in kidney, liver, blood and spleen. Following intravenous (iv) injection, SWCNHox were mainly presented and persisted in the spleen and liver, while very little in the kidney and almost none detectable in the intestine. SWCNHox accumulated significantly in the liver and spleen after four IV administrations. Following hypodermic and intramuscular injections, almost no SWCNHox could cross biological barriers and transport to the spleen, kidney or liver, likely due to their very low absorption rate. Almost all SWCNHox remained around the injection sites. For the first time, we have systematically investigated the in vivo fate of SWCNHs in a label-free and real-time manner.Conclusion: The findings of this study provide insights into the selection of appropriate exposure routes for potential biomedical applications of carbon nanomaterials.Keywords: MSOT imaging, SWCNHox, exposure routes, biodistribution, in vivo fate

Dewei Peng,1,2 Jing Dong,1,2 Yunping Zhao,1,2 Xiaomei Peng,1,2 Jingjing Tang,1,2 Xiaoyan Chen,1,2 Lihua Wang,1,2 Dan-Ning Hu,2,3 Peter S Reinach,1,2 Jia Qu,1,2 Dongsheng Yan1,21School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China; 2State Key Laboratory of Ophthalmology, Optometry and Visual Science, Wenzhou, Zhejiang, People’s Republic of China; 3Tissue Culture Center, New York Eye and Ear Infirmary, New York Medical College, New York, NY, USAPurpose: Uveal melanoma (UM) is the most frequent metastatic ocular tumor in adults. Therapeutic intervention remains ineffective since none of the novel procedures used to treat this disease increased survival rates. To deal with this limitation, additional studies are required to clarify its pathogenesis. The current study focused on describing how epigenetic modulation by miR-142-3p affects changes in some cellular functions underlying UM pathogenesis.Methods and results: Microarray analysis identified 374 miRNAs which were differentially expressed between UM cells and uveal melanocytes. miR-142-3p was one of the 10 most downregulated miRNAs. Quantitative RT-PCR analysis confirmed that miR-142-3p expression levels were significantly decreased in both UM cell lines and clinical specimens. The results of the MTS, clone formation, scratch wound, transwell assays, and in vivo biofluorescence imaging showed that miR-142-3p overexpression significantly inhibited cell proliferation, migration, and invasiveness. Nevertheless, miR-142-3p did not affect cell apoptotic activity or sensitivity to doxorubicin. Cell cycle and EdU analysis showed that miR-142-3p overexpression induced G1/G2 cell cycle arrest and reduced DNA synthesis in UM cells. Microarray analysis showed that miR-142-3p mainly regulates the TGFβ signaling pathway, and those in which MAPK and PI3K-Akt are constituents. Functional interactions between miR-142-3p and CDC25C, TGFβR1, GNAQ, WASL, and RAC1 target genes were confirmed based on the results of the luciferase reporter assay and Western blot analysis. CDC25C or RAC1 downregulation is in agreement with cell cycle arrest and DNA synthesis disorder induction, while downregulation of TGFβR1, GNAQ, WASL, or RAC1 accounts for declines in cell migration.Conclusion: miR-143-3p is a potential therapeutic target to treat UM since overriding its declines in expression that occur in this disease reversed the pathogenesis of this disease. Such insight reveals novel biomarker for decreasing UM vitality and for improved tracking of tumor progression.Keywords: miR-142-3p, uveal melanoma, tumor suppressor, molecular mechanisms

Honghui Yu,1 Liting Chen,2 Haijun Li,1 Huizhen Xin,1 Juan Zhang,1 Zhipeng Wei,1 Dechang Peng11Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People’s Republic of China; 2Department of Radiology, the First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, People’s Republic of ChinaBackground: The amygdala is one of the core areas of the emotional circuits. Previous neuroimaging studies have revealed that patients with obstructive sleep apnea (OSA) have aberrant structure and function in several brain areas (including the amygdala). However, the resting-state functional connectivity (rs-FC) of amgydala subregions remains uncertain.Objective: To determine whether aberrant rs-FC exists between the amygdala subregions and other brain areas and whether such abnormalities are related to emotional disorders and cognitive impairment in OSA.Methods: The resting-state functional magnetic resonance imaging (rs-fMRI) data of 40 male severe OSA patients and 40 matched healthy controls (HCs) were collected. The rs-FC between the amygdala subregions and other brain areas was compared between the two groups. The correlations between aberrant rs-FC and clinical variables and neuropsychological assessments were evaluated.Results: Compared with the HCs, the OSA patients showed significantly increased rs-FC between the left dorsal amygdala (DA) and the anterior lobe of the cerebellum, among the left ventrolateral amygdala (VA), the left inferior frontal gyrus (IFG) and the left superior temporal gyrus (STG), and between the right VA and the left IFG. However, significantly decreased rs-FC was observed between the right DA and the right prefrontal cortex (PFC) in OSA patients. No regional differences in rs-FC were found between the OSA patients and HCs in the bilateral medial amygdala (MA).Conclusion: In this study, male severe OSA patients showed complex rs-FC patterns in the amygdala subregions, which may be the result of OSA-related selective damage to the amygdala, and abnormal rs-FC between the amygdala subregions and brain regions associated with emotional, cognitive and executive functions may partly explain the affective deficits and cognitive impairment observed in male severe OSA patients.Keywords: obstructive sleep apnea, amygdala subregion, resting-state functional connectivity, functional magnetic resonance imaging, blood oxygen-level-dependent

Huizhen Xin,1,* Haijun Li,1,* Honghui Yu,1 Jingjing Yu,2 Juan Zhang,1 Wenjing Wang,2 Dechang Peng1 1Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, People’s Republic of China; 2Department of Respiratory, The First Affiliated Hospital, Nanchang University, Nanchang, People’s Republic of China *These authors contributed equally to this work Introduction and aim: Abnormal brain structure and function in COPD has been reported on MRI. However, the deficit in local synchronization of spontaneous activity in patients with stable COPD remains unknown. The main aim of the present study was to explore spontaneous brain activity in patients with COPD compared with normal controls using the regional homogeneity (ReHo) method based on resting-state functional MRI. Methods: Nineteen patients with stable COPD and 20 well-matched (including age, sex, and number of years of education) normal controls who were recruited for the present study underwent resting-state functional MRI examinations and a series of neuropsychological and clinical assessments. The ReHo method was used to assess the strength of local brain signal synchrony. The mean ReHo values in brain areas with abnormal ReHo were evaluated with a receiver operating characteristic curve. The relationships between the brain regions with altered ReHo values and the clinical and neuropsychological parameters in COPD patients were assessed using Pearson’s correlation. Results: Patients with COPD showed significantly lower ReHo values in the left occipital lobe and the right lingual, bilateral precuneus, and right precentral gyrus. The result of receiver operating characteristic curve analysis showed that the altered average ReHo values have high efficacy for distinguishing function. The mean lower ReHo values in the precuneus gyrus showed a significant positive correlation with FEV1%, FEV1/FVC, and orientation function but a significant negative correlation with arterial partial pressure of carbon dioxide. Conclusion: The COPD patients demonstrated abnormal synchrony of regional spontaneous activity, and the regions with abnormal activity were all correlated with visual processing pathways, which might provide us with a new perspective to further understand the underlying pathophysiology of cognitive impairment in patients with COPD. Keywords: chronic obstructive pulmonary disease, regional homogeneity, resting-state functional magnetic resonance imaging, visual processing pathways, blood oxygen-level-dependent

Wenjing Wang,1,* Haijun Li,2,* Dechang Peng,2 Juan Luo,1 Huizhen Xin,2 Honghui Yu,2 Jingjing Yu1 1Department of Respiratory, The First Affiliated Hospital of Nanchang University, Nanchang, China; 2Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China *These authors contributed equally to this work Objective: The majority of previous neuroimaging studies have reported both structural and functional changes in COPD, whereas the intrinsic low-frequency oscillations changes and the relationship between the abnormal brain regions and the clinical performances remain unknown. The present study was conducted with the aim of evaluating the intrinsic brain activity in COPD patients using the amplitude of low-frequency fluctuation (ALFF) method.Methods: All participants, including 19 stable patients with COPD and 20 normal controls (NCs) matched in age, sex, and education, underwent resting-state functional MRI scans and performed cognitive function tests and respiratory functions tests. The local spontaneous brain activity was examined using the voxel-wise ALFF. Pearson’s correlation analysis was used to investigate the relationships between the brain regions with altered ALFF signal values and the clinical features in COPD patients.Results: Compared with the NCs, COPD patients showed significantly lower cognitive function scores. Also, lower ALFF areas in the cluster of the posterior cingulate cortex (PCC) and precuneus, as well as a higher ALFF area in the brainstem were also found in COPD patients. The mean ALFF values in the PCC, precuneus, and brainstem showed high sensitivity and specificity in operating characteristic curves analysis, which might have the ability to distinguish COPD from NCs. Meanwhile, the mean signal values of the lower ALFF cluster displayed significant positive correlations with FEV1/FVC proportion and significant negative correlation with PaCO2; the higher ALFF cluster showed significant positive correlation with FEV1 proportion in COPD.Conclusion: According to the results of the present study, the COPD patients showed abnormal intrinsic brain activities in the precuneus, PCC, and brainstem, which might provide useful information to better understand the underlying pathophysiology of cognitive impairment. Keywords: chronic obstructive pulmonary disease, amplitude of low-frequency fluctuation, functional magnetic resonance imaging, spontaneous brain activity, blood-oxygen-level dependent

Can Liu,1 Huiqing Xie,2 Jingang Yu,3 Xiaoqing Chen,3 Shijie Tang,4 Lichun Sun,5 Xiang Chen,6 Defei Peng,7,* Xiangyan Zhang,8,* Jianda Zhou1,* 1Department of Plastic Surgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China; 2Department of Rehabilitation, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China; 3School of Chemistry and Chemical Engineering, Central South University, Changsha, Hunan, 410013, China; 4Cleft Lip and Palate Treatment Center, The Second Affliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041,China; 5Department of Medicine, School of Medicine, Tulane Health Sciences Center, New Orleans, LA, USA; 6Department of Dermatology, The Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China; 7Department of Burns and Plastic Surgery, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, 550002, China; 8Department of Nursing, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China *These authors contributed equally to this work Background: Nowadays, the combination of microRNA (miR) is attracting increased attention in clinical cancer trials. However, the clinical use of miR is highly limited because of certain properties such as instability, low-specificity distribution, and metabolic toxicity. Methods: In order to improve the anti-tumor efficacy and reduce the side effects of miR in treating melanoma, a combination of graphene oxide (GO), chitosan (CS), and a cellular penetrating peptide, MPG, was prepared with solid dispersion method in this research. The research has analyzed the specific components of nano drug-loading complexes GO-CS and GO-CS-MPG through characterization research and confirmed the bio-safety of the carrier material GO-CS-MPG. Results: The GO-CS-MPG-miR33a/miR199a nano drug-loading complex was successfully constructed and its medical effectiveness was verified. Through the subcutaneous tumor implantation experiment, an evident effect of the drug-loading complex in inhibiting melanoma cells was proven. Conclusion: Results suggest that GO-CS-MPG may have potential applications in melanoma therapy. Keywords: melanoma, graphene oxide, chitosan, cellular penetrating peptide, microRNA

Weiping Xia,1,2 Rubai Zhou,1 Guoqing Zhao,1 Fan Wang,1 Ruizhi Mao,1 Daihui Peng,1 Tao Yang,1 Zuowei Wang,1,3 Jun Chen,1 Yiru Fang1,4,5 1Division of Mood Disorders, Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China; 2Department of Medical Psychology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China; 3Mood Disorder Department, Hongkou District Mental Health Center of Shanghai, Shanghai, People’s Republic of China; 4State Key Laboratory of Neuroscience, Shanghai Institutes for Biological Sciences, CAS, Shanghai, People’s Republic of China; 5Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People’s Republic of China Background: Almost half of patients with major depressive disorder (MDD) also have clinically meaningful levels of anxiety. Anxious depression is a distinct clinical subtype of MDD, which has poor response to pharmacotherapy; however, the neural mechanisms behind are largely unknown. In the present study, we explored the white matter (WM) integrity traits of anxious depression in first-episode and medication-free (medication-naïve and medication washout) Chinese young adult patients by detecting differences in diffusion tensor imaging (DTI) with the tract-based spatial statistics (TBSS) method.Subjects and methods: DTI was obtained from 39 first-episode, medication-free anxious depressive patients, 45 nonanxious depressive patients, and 50 demographically similar healthy controls. All subjects underwent clinical assessments. TBSS was carried out to investigate the difference in WM integrity among three groups within DTI parameter maps. WM integrity was measured using fractional anisotropy (FA), mean diffusivity, axial diffusivity, and radial diffusivity (RD). The correlations between WM integrity and clinical features were also computed.Results: When compared with nonanxious patients, lower FA values in anxious depressive patients were found in multiple regions of the brain, mainly involving left uncinate fasciculus (UF), superior longitudinal fasciculus (SLF), and forceps major and minor. Higher RD in forceps major and minor and SLF were also detected. The decreased FA values and increased RD values correlated with both anxiety level and depression level in the pooled depressive group.Conclusion: The anxious depressive patients had more abnormalities in WM integrity at the early phase than the nonanxious group. Alternations in WM integrity in fiber pathways, including SLF, UF, and forceps major and minor, may play a critical role in the neuropathology of anxious depression and might help to identify anxious MDD from nonanxious MDD. Further study with larger sample size, larger age range, and longitudinal design is needed to confer a robust inference to better understand the dynamic neurological change and neuropathology of WM integrity in anxious MDD. Keywords: diffusion tensor imaging, anxious depression, tract-based spatial statistics, micro-structure of whiter matter

Li-Ting Chen,1,* Xiao-Le Fan,2,* Hai-Jun Li,1 Cheng-Long Ye,1 Hong-Hui Yu,1 Hui-Zhen Xin,1 Hong-Han Gong,1 De-Chang Peng,1 Li-Ping Yan3 1Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China; 2Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China; 3Department of Cardiology, People’s Hospital of Jiangxi Province, Nanchang, Jiangxi Province, China *These authors contributed equally to this work Objective: Obstructive sleep apnea (OSA) is accompanied by widespread abnormal spontaneous regional activity related to cognitive deficits. However, little is known about the topological properties of the functional brain connectome of patients with OSA. This study aimed to use the graph theory approaches to investigate the topological properties and functional connectivity (FC) of the functional connectome in patients with OSA, based on resting-state functional magnetic resonance imaging (rs-fMRI). Methods: Forty-five male patients with newly diagnosed untreated severe OSA and 45 male good sleepers (GSs) underwent a polysomnography (PSG), clinical evaluations, and rs-fMRI scans. The automated anatomical labeling (AAL) atlas was used to construct the functional brain connectome. The topological organization and FC of brain functional networks in patients with OSA were characterized using graph theory methods and investigated the relationship between functional network topology and clinical variables. Results: Both the patients with OSA and the GSs exhibited high-efficiency “small-world” network attributes. However, the patients with OSA exhibited decreased σ, γ, Eglob; increased Lp, λ; and abnormal nodal centralities in several default-mode network (DMN), salience network (SN), and central executive network (CEN) regions. However, the patients with OSA exhibited abnormal functional connections between the DMN, SN, and CEN. The disrupted FC was significantly positive correlations with the global network metrics γ and σ. The global network metrics were significantly correlated with the Epworth Sleepiness Scale (ESS) score, Montreal Cognitive Assessment (MoCA) score, and oxygen desaturation index. Conclusion: The findings suggest that the functional connectome of patients with OSA exhibited disrupted functional integration and segregation, and functional disconnections of the DMN, SN, and CEN. The aberrant topological attributes may be associated with disrupted FC and cognitive functions. These topological abnormalities and disconnections might be potential biomarkers of cognitive impairments in patients with OSA. Keywords: obstructive sleep apnea, graph theory, functional connectome, cognitive function, resting-state fMRI

Yujie Shi,1 Zujin Shi,2 Suxin Li,1 Yuan Zhang,3 Bing He,1 Dong Peng,4 Jie Tian,4 Ming Zhao,5 Xueqing Wang,1 Qiang Zhang1 1Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems, School of Pharmaceutical Sciences, 2Beijing National Laboratory for Molecular Sciences, State Key Lab of Rare Earth Materials Chemistry and Applications, College of Chemistry and Molecular Engineering, Peking University, Beijing, People’s Republic of China; 3Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI, USA; 4Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, 5Department of Chemical Biology, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China Abstract: Single-wall carbon nanohorns (SWCNHs), which have multitudes of horn interstices, an extensive surface area, and a spherical aggregate structure, offer many advantages over other carbon nanomaterials being used as a drug nanovector. The previous studies on the interaction between SWCNHs and cells have mostly emphasized on cellular uptake and intracellular trafficking, but seldom on epithelial cells. Polar epithelium as a typical biological barrier constitutes the prime obstacle for the transport of therapeutic agents to target site. This work tried to explore the permeability of SWCNHs through polar epithelium and their abilities to modulate transcellular transport, and evaluate the potential of SWCNHs in drug delivery. Madin-Darby canine kidney (MDCK) cell monolayer was used as a polar epithelial cell model, and as-grown SWCNHs, together with oxidized and fluorescein isothiocyanate-conjugated bovine serum albumin-labeled forms, were constructed and comprehensively investigated in vitro and in vivo. Various methods such as transmission electron microscopy and confocal imaging were used to visualize their intracellular uptake and localization, as well as to investigate the potential transcytotic process. The related mechanism was explored by specific inhibitors. Additionally, fast multispectral optoacoustic tomography imaging was used for monitoring the distribution and transport process of SWCNHs in vivo after oral administration in nude mice, as an evidence for their interaction with the intestinal epithelium. The results showed that SWCNHs had a strong bioadhesion property, and parts of them could be uptaken and transcytosed across the MDCK monolayer. Multiple mechanisms were involved in the uptake and transcytosis of SWCNHs with varying degrees. After oral administration, oxidized SWCNHs were distributed in the gastrointestinal tract and retained in the intestine for up to 36 h probably due to their surface adhesion and endocytosis into the intestinal epithelium. Overall, this comprehensive investigation demonstrated that SWCNHs can serve as a promising nanovector that can cross the barrier of polar epithelial cells and deliver drugs effectively. Keywords: carbon nanohorns, epithelial cells, transport mechanisms, nanocarriers, MSOT imaging

Li-Ting Chen,1,* Xiao-Le Fan,2,* Hai-Jun Li,1 Si Nie,1 Hong-Han Gong,1 Wei Zhang,3 Xian-Jun Zeng,1 Ping Long,4 De-Chang Peng1 1Department of Radiology, 2Department of General Surgery, 3Department of Pneumology, 4Department of Otolaryngology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China *These authors contributed equally to this work Purpose: Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder that can damage cognitive function. However, the functional network organization remains poorly understood. The aim of this study was to investigate the topological properties of OSA patients using a graph theoretical analysis.Patients and methods: A total of 30 male patients with untreated severe OSA and 25 male education- and age-matched good sleepers (GSs) underwent functional magnetic resonance imaging (MRI) examinations. Clinical and cognitive evaluations were conducted by an experienced psychologist. GRETNA (a toolbox for topological analysis of imaging connectomics) was used to construct the brain functional network and calculate the small-world properties (γ, λ, σ, Eglob, and Eloc). Relationships between these small-world properties and clinical and neuropsychological assessments were investigated in OSA patients.Results: The networks of both OSA patients and GSs exhibited efficient small-world topology over the sparsity range of 0.05–0.40. Compared with GSs, the OSA group had significantly decreased γ, but significantly increased λ and σ. The OSA group’s brain network showed significantly decreased Eglob (P

Jinsong Zhang1, Ethan W Taylor2, Xiaochun Wan1, Dungeng Peng31School of Tea and Food Science, Anhui Agricultural University, Anhui, People's Republic of China; 2Department of Nanoscience, Joint School of Nanoscience and Nanoengineering, University of North Carolina at Greensboro, Greensboro, NC, 3Department of Biochemistry, Vanderbilt University, Nashville, TN, USABackground: Elemental selenium nanoparticles have emerged as a novel selenium source with the advantage of reduced risk of selenium toxicity. The present work investigated whether heat treatment affects the size, structure, and bioactivity of selenium nanoparticles.Methods and results: After a one-hour incubation of solution containing 80 nm selenium particles in a 90°C water bath, the nanoparticles aggregated into larger 110 nm particles and nanorods (290 nm × 70 nm), leading to significantly reduced bioavailability and phase II enzyme induction in selenium-deficient mice. When a solution containing 40 nm selenium nanoparticles was treated under the same conditions, the nanoparticles aggregated into larger 72 nm particles but did not transform into nanorods, demonstrating that the thermostability of selenium nanoparticles is size-dependent, smaller selenium nanoparticles being more resistant than larger selenium nanoparticles to transformation into nanorods during heat treatment.Conclusion: The present results suggest that temperature and duration of the heat process, as well as the original nanoparticle size, should be carefully selected when a solution containing selenium nanoparticles is added to functional foods.Keywords: nanoparticle, selenium, bioactivity, heat treatment

Background: Nutritional status in pediatric patients undergoing heart transplantation (HT) is frequently a focus of clinical management and requires high resource utilization. Pre‐operative nutrition status has been shown to affect post‐operative mortality but no studies have been performed to assess how nutritional status may change and the risk of developing nutritional comorbidities long‐term in the post‐transplant period. Methods: A single‐center retrospective chart review of patients ≥2 years of age who underwent heart transplantation between 1/1/2005 and 4/30/2020 was performed. Patient data were collected at listing, time of transplant, 1‐year, and 3‐year follow‐up post‐transplant. Nutrition status was classified based on body mass index (BMI) percentile in the primary analysis. Alternative nutritional indices, namely the nutrition risk index (NRI), prognostic nutrition index (PNI), and BMI z‐score, were utilized in secondary analyses. Results: Of the 63 patients included, the proportion of patients with overweight/obese status increased from 21% at listing to 41% at 3‐year follow‐up. No underweight patients at listing became overweight/obese at follow‐up. Of patients who were overweight/obese at listing, 88% maintained that status at 3‐year follow‐up. Overweight/obese status at listing, 1‐year, and 3‐year post‐transplantation were significantly associated with developing metabolic syndrome. In comparison to the alternative nutritional indices, BMI percentile best predicted post‐transplant metabolic syndrome. Conclusions: The results suggest that pediatric patients who undergo heart transplantation are at risk of developing overweight/obesity and related nutritional sequelae (ie, metabolic syndrome). Improved surveillance and interventions targeted toward overweight/obese HT patients should be investigated to reduce the burden of associated comorbidities. [ABSTRACT FROM AUTHOR]