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Zhuoran Wang,1 Xufeng Cao,2 Chunmei Jia,1 Na Mi,1 Tingting Li,1 Jingjie Wang,1 Ruiqi Fan,1 Jiayu Quan1 1School of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 2The Seventh Medical Center of the Chinese People’s Liberation, Army General Hospital, Beijing, People’s Republic of ChinaCorrespondence: Chunmei Jia, School of Medical Imaging, First Hospital of Shanxi Medical University, No. 85, South Jiefang Road, Taiyuan, 100007, Shanxi, People’s Republic of China, Tel +86 13643667836, Email jcmc6606@126.comObjective: The aim of this study is to investigate the influence of ultrasound and molybdenum target X-ray characteristics in predicting non-mass breast cancer.Methods: A retrospective analysis was conducted on the clinical data of 185 patients presenting with non-mass breast lesions between September 2019 and 2021. The non-mass lesions were categorized into benign and malignant types based on ultrasonographic findings, which included lamellar hypoechoic, ductal alteration, microcalcification, and structural disorder types. Furthermore, an examination was undertaken to discern variances in molybdenum target X-ray parameters, ultrasonographic manifestations, and characteristics among individuals diagnosed with non-mass breast lesions.Results: The ultrasonographic depiction of microcalcified lesions and the identification of suspicious malignancy through molybdenum target X-ray evaluation exhibited independent associations with non-mass breast cancer, yielding statistically significant differences (p < 0.05). Subsequently, the logistic regression model was formulated as follows: Logit (P) =− 1.757+2.194&ast; microcalcification type on ultrasound + 1.520&ast; suspicious malignancy on molybdenum target X-ray evaluation. The respective areas under the receiver operating characteristic curves for microcalcification type on ultrasound, suspicious malignancy on molybdenum target X-ray, and the integrated diagnostic model were 0.733, 0.667, and 0.827, respectively, demonstrating discriminative capacities.Conclusion: Using both ultrasound and molybdenum target X-ray diagnostics can increase the accuracy of non-mass breast cancer detection. The findings of this study have the potential to augment the detection rate of non-lumpy breast cancer and provide an imaging basis for enhancing the prognosis of individuals with breast cancer.Keywords: correlation, logistic regression, Molybdenum targeted X-ray, non-mass type, ultrasonographic manifestations

Water scarcity will increase due to climate change, especially in basins that are currently highly stressed. The Mediterranean area is one of the most vulnerable areas in the world, with a predicted natural water resource reduction of 20% to 35% at the end of the century, due to temperature increases and a 10–20% precipitation reduction. Water scarcity indices, including gross abstraction, net abstraction, and consideration of environmental requirements, can be efficiently used to analyse the effects of climate change in water resource systems and determine the main measures to adapt these systems to climate change. Increasing the reclaimed water use, seawater desalination, irrigation efficiency, and interconnecting water resource systems are the main measures to adapt basins under water stress and reduce their vulnerability to climate change. In the Júcar River Basin District (JRBD), with a 20% reduction in natural water resources, the main measures are: increasing the reclaimed water use in agriculture from 20% to 50% (91 hm3/year to 230 hm3/year), increasing seawater desalination from 30 to 55 hm3/year, increasing irrigation efficiency from 54% to 80%, and finally, fully developing the current water interconnections between water resource systems. In highly stressed basins, moving water from downstream to upstream using energy supplied by photovoltaic systems can help adapt river basins to climate change.

Junxian Quan1 &ast;, Xingtong Chen1 &ast;, Xi Tang,1 Xianzhe Liu,1 Jieyu Li,1 Bin Yi,1 Peng Li,2 Kaizhi Lu,1 Jianteng Gu1 1Department of Anesthesiology, The First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China; 2Department of Pharmacognosy and Traditional Chinese Medicine, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jianteng Gu; Kaizhi Lu, Department of Anesthesiology, The First Affiliated Hospital, Third Military Medical University (Army Medical University), 30 Gao Tanyan Street, Chongqing, 400038, People’s Republic of China, Tel +86 23 68766122, Fax +86 23 65463270, Email jiantenggu@hotmail.com; Lukaizhi@163.netObjective: To investigate the effects of different general anesthesia methods on the changes of serum hepatitis B virus deoxyribonucleic acid (HBV-DNA) levels in the hepatitis B virus (HBV) infected patients.Methods: This pilot prospective observational study was carried out from March 2021 to January 2022. Forty patients infected by HBV, who underwent non-hepatobiliary minimally invasive surgery, were allocated into an intravenous anesthesia group maintained with propofol (Group P, n = 20) and an inhalation anesthesia group maintained with sevoflurane (Group S, n = 20) by a random envelope method. Patient’s blood was drawn before operation (Tbaseline), at 24 hours (Tpost 24hrs) and 48 hours (Tpost 48hrs) after operation to detect the serum HBV-DNA levels and analyze the subset levels of T, B lymphocytes and NK cells (TBNK) in two groups. The serum HBV-DNA level was used as the major outcome, and it was analyzed by repeated-measures analysis of variance after natural logarithm transformation.Results: In Group P and Group S, compared with the baseline, the serum HBV-DNA levels decreased significantly at Tpost 24hrs and Tpost 48hrs, P< 0.05. The total ratio of CD4+T cells and the ratio of CD4+T to CD8+T cells (CD4+/CD8+) were lower at Tpost 24hrs, P< 0.05, and the total ratio of B cells was significantly increased at Tpost 24hrs, P< 0.05. Compared with the values at Tpost 24hrs, the total ratio of CD4+ T cells, CD4+/CD8+ T cells, and the total ratio of B cells were significantly increased at Tpost 48hrs in both groups, P< 0.05. However, there were no statistical differences between Group P and Group S.Conclusion: The levels of serum HBV-DNA decreased within 48 hours after general anesthesia. There were no significant differences between the effects of intravenous and inhalation anesthesia on the serum HBV-DNA levels.Trial Registration: This study has been prospectively registered in the Clinical Trials Registry (NCT02038088, 1/28/2015).Keywords: general anesthesia, hepatitis B virus deoxyribonucleic acid, lymphocyte subsets, immune function

Lijuan Zhang,1,&ast; Yuanjun Zhang,2,3,&ast; Juxiang Liu,2,3,&ast; Yonghong Li,4 Jinxing Quan2,3 1Department of Blood Transfusion, Gansu Provincial Hospital, Lanzhou, People’s Republic of China; 2Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, People’s Republic of China; 3Key Laboratory of Endocrine and Metabolic Diseases of Gansu Province, Lanzhou, People’s Republic of China; 4Institute of Clinical and Translational Medicine, Gansu Provincial Hospital, Lanzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jinxing Quan, Tel +18109440427, Email quanjxxt@163.comPurpose: Intestinal flora imbalance has been implicated in the activation of innate immunity in the kidneys. However, little is known about the potential links between lipopolysaccharide (LPS)-toll-like. receptor 4 (TLR4) signaling activated by intestinal barrier dysfunction and microalbuminuria in type 2 diabetes mellitus (T2DM).Patients and Methods: 61 patients with T2DM were stratified based on the absence (n=32) or presence (n=29) of microalbuminuria. There were also 28 control subjects. Urinary albumin excretion rate (UAER), serum levels of LPS, D-lactic acid (DLA), diamine oxidase (DAO), fasting blood glucose (FBG), interleukin-6 (IL-6), glycosylated hemoglobin A1 (HbA1c), and high-sensitivity C-reactive protein (hs-CRP), and TLR4 expression in peripheral blood mononuclear cells (PBMCs) were measured.Results: hs-CRP, IL-6, LPS, DLA, DAO, and TLR4 were markedly increased in subjects with T2DM compared to the controls (P < 0.05 for all). Moreover, LPS was positively correlated with FBG, HbA1c, hs-CRP, IL-6, UAER, DLA, DAO, and TLR4 (P < 0.05 for all). In addition, TLR4 was positively correlated with UAER, hs-CRP, FBG, DLA, HbA1c, and LPS (P < 0.05 for all). In regression analyses, TLR4, LPS, HbA1c, and hs-CRP were independently associated with UAER (P < 0.05 for all), while FBG, LPS, TLR4, and hs-CRP (P < 0.05 for all) were found to be risk factors for microalbuminuria in T2DM.Conclusion: Intestinal integrity is compromised in subjects with T2DM, and the activation of LPS-TLR4 signaling might play an important role in the development of microalbuminuria in T2DM.Keywords: intestinal mucosal barrier, microalbuminuria, type 2 diabetes mellitus, lipopolysaccharide, toll-like receptor 4

Zhengyan Liang,1 Jinqing Wang,1 Minqiang Zhang,1– 4 Yingshi He,1 Jiaxin Quan,1 Da Yi1 1School of Psychology, South China Normal University, Guangzhou, People’s Republic of China; 2Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, People’s Republic of China; 3Center for Studies of Psychological Application, School of Psychology, Guangzhou, People’s Republic of China; 4Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People’s Republic of ChinaCorrespondence: Minqiang Zhang, School of Psychology, South China Normal University, No. 55, West of Zhongshan Avenue, Tianhe District, Guangzhou, 510631, People’s Republic of China, Email zhangminqiang@m.scnu.edu.cnIntroduction: There are two types of master’s qualifications in China. One is the academic qualification that pays more attention to academic research, aiming to cultivate research-oriented talents; while the other is the application-oriented qualification that focuses more on practical ability, aiming to cultivate applied-oriented talents. The purpose of this study is to explore the impact of the COVID-19 on the learning activities of postgraduate students, as well as the differences in the extent to which the learning activities of postgraduate students of different qualification types are affected and their mental health status.Methods: A self-constructed scale for the pandemic’s impact on master’s students, the self-rating anxiety scale and the self-rating depression scale were applied in the study. The single- and multi-group latent class analyses were used to investigate the impact of the pandemic on postgraduate students of different qualification types.Results: A total of 2818 responses were collected. The single-group latent class analysis identified four classes. The multi-group latent class analysis showed that no absolute homogeneity existed between different groups. In general, the number of academic master’s students affected was greater than application-oriented master’s students. Application-oriented master’s students were more affected by course activities, while academic master’s students were more affected by academic and social activities. Results show that individuals more affected had higher levels of anxiety and depression. Compared to course activities, impacts on social activities were more likely to cause anxiety and depression.Discussion: Universities can provide a more flexible way of assistance to different qualification types of postgraduate students. Furthermore, social activities play an important role in the mental health of postgraduate students. Therefore, under the background of normalization of pandemic prevention and control, schools should pay more attention to students’ interpersonal communication activities to help relieve students’ anxiety, depression, and other negative emotions.Keywords: COVID-19 pandemic, application-oriented postgraduate students, academic postgraduate students, learning activities, multi-group latent class analysis

ObjectivePatient-provider communication about complementary health approaches can support diabetes self-management by minimizing risk and optimizing care. We sought to identify sociodemographic and communication factors associated with disclosure of complementary health approaches to providers by low-income patients with diabetes.MethodsWe used data from San Francisco Health Plan's SMARTSteps Program, a trial of diabetes self-management support for low-income patients (n=278) through multilingual automated telephone support. Interviews collected use and disclosure of complementary health approaches in the prior month, patient-physician language concordance, and quality of communication.ResultsAmong racially, linguistically diverse participants, half (47.8%) reported using complementary health practices (n=133), of whom 55.3% disclosed use to providers. Age, sex, race/ethnicity, nativity, education, income, and health literacy were not associated with disclosure. In adjusted analyses, disclosure was associated with language concordance (AOR=2.21, 95% CI: 1.05, 4.67), physicians' interpersonal communication scores (AOR=1.50, 95% CI: 1.03, 2.19), shared decision making (AOR=1.74, 95% CI: 1.33, 2.29), and explanatory-type communication (AOR=1.46, 95% CI: 1.03, 2.09).ConclusionSafety net patients with diabetes commonly use complementary health approaches and disclose to providers with higher patient-rated quality of communication.Practice implicationsPatient-provider language concordance and patient-centered communication can facilitate disclosure of complementary health approaches.

Study region: Australia. Study focus: We developed the Seasonally Coherent Calibration (SCC) model to post-process precipitation forecasts from numerical weather prediction (NWP) models. The SCC model is capable of generating high-quality calibrated forecasts which are coherent in climatology, including seasonality, consistent with observations, despite only a short period of forecasts being available. In this study, we post-process deterministic precipitation forecasts from the Australian Bureau of Meteorology’s Australian Community Climate and Earth System Simulator G2 version (ACCESS-G2) NWP model to generate calibrated ensemble forecasts across Australia. We evaluate the effectiveness, robustness, and computational feasibility of forecast post-processing with the SCC model at a high spatial resolution across the continental scale. New hydrological insights for the region: Inadequate representation of forecast seasonality in calibration models poses a challenge for the calibration of NWP forecasts. Through this investigation, the statistical assumptions and reparameterization algorithms of the SCC model are confirmed to be effective and robust in addressing the challenge. Calibrated precipitation forecasts could be used to support operational water balance forecasting in Australia. Post-processing of NWP precipitation forecasts with the SCC model will also benefit a broad range of forecast users in Australia by providing accurate, skillful, and reliable ensemble forecasts. Computation strategies adopted in this study will help develop effective procedures for future post-processing of NWP forecasts with sophisticated calibration models at a large spatial scale.

Tao Lv,1,* Yunbo Chen1,* Lihua Guo,1 Qiaomai Xu,1 Silan Gu,1 Ping Shen,1 Jiazheng Quan,1 Yunhui Fang,1 Lifeng Chen,2 Qiaodi Gui,3 Guangyong Ye,4 Lanjuan Li11State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China; 2Medical Engineering Department, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China; 3Department of Clinical Laboratory, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, People’s Republic of China; 4Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China*These authors contributed equally to this workBackground: The epidemic new strain NAP1/BI/027/ST-1 of Clostridioides difficile (C. difficile) causes more severe coliti and a higher mortality rate than historical strains. However, C. difficile NAP1/BI/027/ST-1 (C. difficile RT027) infections have been rarely reported in Asia, particularly in China.Purpose: The objective of this study was to strengthen the understanding of the molecular characterizations of C. difficile RT027 in China.Patients and methods: Two C. difficile NAP1/BI/027/ST-1 were detected from two patients, and no additional isolates were found. Whole genome sequencing (WGS) was used to characterize two C. difficile RT027 isolates and control strain CD6 (from Hong Kong), and comparative genomic analysis was performed to compare genomic differences between seven isolates from Mainland China, CD6, and 10 isolates from North America and Europe.Results: The comparative genomic analysis revealed that isolates obtained from Mainlan China were outside of the two epidemic lineages, FQR1 and FQR2, and might have decreased virulence and transmissibility for outbreak. Furthermore, unique SNP mutations were detected in isolates obtained from Mainland China, which may affect the biological function of C. difficile.Conclusion: We speculate that C. difficile RT027 isolates in Mainland China may have different features, compared to those in North America and Europe.Keywords: People’s Republic of China, multilocus sequence typing, Clostridioides difficile infection, whole genome sequencing

Kangfu Dai,1,2 Jing Quan,1 Fangli Yan,1 Xinghan Jin,1 Xiang Pan,1 Xiaorui Song,1 Shijie Zhang,1 Qingqi Ren,2 Jikui Liu,1,2 Xiaoping Liu1,2 1Clinical College, Peking University Shenzhen Hospital, Anhui Medical University, Hefei, Anhui, 230032, P.R. China; 2Department of HepatoBiliary and Pancreatic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, China Background: Cholangiocarcinoma (CCA) is the second most common fatal primary hepatobiliary malignant carcinoma, characterized by early invasion and extremely poor outcomes. It is therefore necessary to identify a novel biomarker to better diagnose CAA and predict its prognosis. Recently, emerging evidence has revealed that some lncRNAs play an important role in the tumorigenesis and progression of CAA. In order to support this search for novel diagnostic and prognostic biomarkers for CAA, we conducted a meta-analysis to analyze the published association between lncRNA expression and its clinical value in CAA. Methods: Eligible studies were pooled and analyzed according to our inclusion and exclusion criteria after a comprehensive literature search. Stata 14.0 software was used to analyze the data from relevant studies and to construct a forest plot. Different effect sizes were selected for the meta-analysis. Results: In total, 24 publications were included in this meta-analysis. After review of their full-text, 16 articles studied the association between lncRNAs and clinicopathological characteristics, 2 discussing diagnosis and 16 discussing prognosis. Our results showed that overexpression of CCAT1 was significantly correlated with tumor stage (I + II vs III + IV) (OR, 4.99; 95% CI 2.77–8.99; P

Jun Lu,1,* Jingjing Quan,2,3,* Dongdong Zhao,2 Yanfei Wang,2,3 Yunsong Yu,2,3 Jin Zhu1 1Department of Laboratory, Quzhou People’s Hospital, Quzhou, Zhejiang, China; 2Department of Infectious Diseases, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China; 3Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China *These authors contributed equally to this work Objectives: mcr-1 gene has been widely reported in the world. This study aimed to analyze the prevalence and molecular characteristics of mcr-1 gene in Salmonella typhimurium from Quzhou People’s Hospital. Materials and methods: A total of 62 S. typhimurium isolates were isolated and preserved in our laboratory from 2007 to 2016. PCR was used to screen plasmid-mediated colistin resistance gene, mcr-1. For mcr-1-positive isolates, susceptibilities to colistin and other antibiotics were assessed using broth microdilution or agar dilution methods. The genetic location of mcr-1 was determined by analysis of pulsed-field gel electrophoresis profiles of S1-digested genomic DNA and subsequent Southern blot hybridization. The multi-locus sequence type and other drug resistance genes found in the mcr-1-positive isolates were analyzed by performing whole genome sequencing. Genetic environment of mcr-1 gene was analyzed by RAST and Easyfig. Results: A total of three S. typhimurium isolates were identified to be mcr-1 positive, with the prevalence rate of 4.8% (3/62). The minimum inhibitory concentration values of colistin for all these isolates were 8 µg/mL. The three mcr-1-positive isolates carried mcr-1 gene on two different types of plasmids having the sizes of ~54.7–78.2 kb and 310.1 kb, respectively. All the three isolates belonged to ST34 and carried various resistant genes. Conclusion: Colistin-resistant, mcr-1-positive S. typhimurium isolates belonging to ST34 have been isolated from Quzhou People’s Hospital. Surveillance needs to be strengthened to identify colistin resistance and prevent the spread of drug-resistant bacteria in the hospital. Keywords: Salmonella typhimurium, colistin, mcr-1

Jing Quan,1,2 Xiang Pan,1,2 Liwen Zhao,1,2 Zuwei Li,1 Kangfu Dai,2 Fangli Yan,2 Suyue Liu,2 Hongfei Ma,2 Yongqing Lai1,2 1Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, China; 2Graduate school, Anhui Medical University, Hefei, Anhui 230032, China Background: Bladder cancer is one of the most common urinary malignancies, and has a high recurrence rate and poor outcomes. In order to identify novel diagnostic and prognostic biomarkers for bladder cancer, we conducted a meta-analysis to analyze the association between long non-coding RNA (lncRNA) expression and survival in bladder cancer.Materials and methods: We searched literature from databases using our inclusion and exclusion criteria. STATA 14.0 software was used to analyze the data from collected studies and to construct the forest plots. A different effect size was selected for each meta-analysis.Results: After selection, 30 articles were found to be eligible. The present meta-analysis contains data from 13 articles about clinicopathological characteristics, six articles about diagnosis, and 16 articles about prognosis. In the present study, we found that many lncRNAs could function as potential diagnostic and prognostic markers in bladder cancer. Among these findings, UCA1 was expected to be a diagnostic biomarker for bladder cancer, while the aberrant expression of HOTAIR and GAS5 was associated with poor disease-free survival/recurrence-free survival/disease-specific survival.Conclusion: Overall, the present study is the first meta-analysis to assess the association between expression of lncRNAs and clinical value in patients with bladder cancer. LncRNAs hold promise as novel diagnostic and prognostic markers in bladder cancer. Keywords: lncRNA, bladder cancer, clinicopathological characteristics, prognosis

Mei Mei,1 Ligang Ye,2 Juan Quan,1 Pintong Huang1 1Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China; 2Department of Emergency, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China Purpose: Contrast-enhanced ultrasound (CEUS) is a new technique used to distinguish benign from metastatic superficial lymph nodes (LNs) with variable accuracy. The objective of this meta-analysis was to evaluate the accuracy of CEUS for the diagnosis of superficial metastatic LNs.Methods: A comprehensive literature search of PubMed, Web of Science, Medline, Embase, and the Cochrane Library was performed until April 2018. Nine articles reporting the diagnosis of 436 LNs by CEUS were investigated. The Mantel–Haenszel and DerSimonian–Laird methods were used to analyze pooled sensitivity, specificity, diagnostic OR, positive likelihood ratio (LR), and negative LR, and a summary receiver operating characteristic (SROC) curve was also evaluated.Results: The pooled sensitivity and specificity of CEUS for the differential diagnosis of benign and metastatic superficial LNs were 0.88 (95% CI, 0.83–0.92) and 0.80 (95% CI, 0.74–0.85), respectively. The pooled positive LR, negative LR, and diagnostic OR were 4.36 (95% CI, 2.38–7.99), 0.17 (95% CI, 0.10–0.31), and 32.75 (95% CI, 11.08–96.84), respectively. SROC area under the curve (AUC) was 0.9288. The subgroup analysis excluding outliers implied that the heterogeneity was almost eliminated, and the pooled sensitivity and specificity were 0.87 (95% CI, 0.81–0.92) and 0.79 (95% CI, 0.71–0.85), respectively. The SROC AUC was 0.8950.Conclusion: CEUS, a novel imaging modality for the characterization of superficial LNs, shows a high sensitivity and specificity in the diagnosis of superficial metastatic LNs. The different diagnostic standards, contrast agents, and contrast modes contribute to a considerable level of heterogeneity among studies. A uniform standard for distinguishing between benign and metastatic LNs is needed for further clinical application. Keywords: contrast-enhanced ultrasound, benign, metastatic, lymph nodes, meta-analysis

Fast and accurate modelling of flood inundation has gained increasing attention in recent years. One approach gaining popularity recently is the development of emulation models using data driven methods, such as artificial neural networks. These emulation models are often developed to model flood depth for each grid cell in the modelling domain in order to maintain accurate spatial representation of the flood inundation surface. This leads to redundancy in modelling, as well as difficulties in achieving good model performance across floodplains where there are limited data available. In this paper, a spatial reduction and reconstruction (SRR) method is developed to (1) identify representative locations within the model domain where water levels can be used to represent flood inundation surface using deep learning models; and (2) reconstruct the flood inundation surface based on water levels simulated at these representative locations. The SRR method is part of the SRR-Deep-Learning framework for flood inundation modelling and therefore, it needs to be used together with data driven models. The SRR method is programmed using the Python programming language and is freely available from https://github.com/yuerongz/SRR-method. • The SRR method identifies locations which are representative of flood inundation behavior in surrounding areas. • The representative locations selected following the SRR method have sufficient flood data for developing emulation models. • Flood inundation surfaces can be reconstructed using the SRR method with a detection rate of above 99%.