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An Wen,1,2 Er-Ling Leng,3 Wen-Feng Cao,1,2 Zheng-bing Xiang,1,2 Wei Rao,1,2 Wen Cai,1,2 Yong-Liang Zhou,1,2 Fan Hu,1,2 Ling-feng Wu,1,2 Ping Zhang,1,2 Shi-Min Liu1,2 1Department of Neurology, Jiangxi Provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, People’s Republic of China; 2Institution of Neurology, Jiangxi Provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, People’s Republic of China; 3Department of Pediatrics, Jiangxi provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, People’s Republic of ChinaCorrespondence: Shi-Min Liu, Department of Neurology, Jiangxi provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), No. 92 Aiguo Road, Nanchang, 330006, People’s Republic of China, Tel +791-8772-1401, Email aifeng420@163.comObjective: Central nervous system (CNS) infection has a high incidence and mortality worldwide. Tuberculous meningitis (TBM) accounts for approximately 5– 6% of all extrapulmonary tuberculosis (TB), and is considered an extremely lethal form of CNS TB, which has become an important threat to human health. Anemia is a common symptom of TB, and its prevalence is generally higher in patients with TBM than in other meningitis patients and healthy individuals. Anemia can increase a person’s susceptibility to common infectious diseases, including TB, by compromising the immune system. Information regarding anemia during the hospitalization of TBM is still scarce in China. This study aimed to describe in detail the prevalence of anemia in patients with TBM in Southern China and its association with the clinical forms of TB, as well as other characteristics of these patients.Methods: We conducted a retrospective analysis of patients diagnosed with TBM at two tertiary hospitals in southern China. The demographic characteristics, clinical characteristics, and laboratory results of 114 patients with TBM were collected. Multivariate logistic regression analysis was performed to explore the risk factors for anemia in patients with TBM.Results: Electronic medical record data of adult patients diagnosed with TBM from January 2004 to December 2019 were reviewed. Among 134 patients with TBM, 20 were excluded and 114 were analyzed, of whom 33 had anemic, the prevalence rate of anemia was 28.9%. Among patients with anemia, 51.5% had hypochromic microcytic anemia, 33.3% had normochromic normocytic anemia, and 15.2% had macrocytic anemia. Fever duration, TBM grade III and ESR were found to be independent predictors of anemia.Conclusion: Anemia was highly prevalent in patients with TBM, mainly hypochromic microcytic anemia. Besides, Fever duration, TBM grade III and ESR are predictors of anemia in patients with TBM.Keywords: tuberculosis, tuberculous meningitis, anemia, risk factors, prediction

Zhihui Zhang1 12 2, Wei Rao3 34 45 5 1Post-Doctoral Research Station, China Three Gorges Corporation, Beijing, 100038, People’s Republic of China; 2The Institute for the History of Natural Sciences, Chinese Academy of Sciences, Beijing, 100190, People Republic of China; 3Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, People’s Republic of China; 4Beijing Key Laboratory of CryoBiomedical Engineering, Beijing, 100190, People’s Republic of China; 5School of Future Technology, University of Chinese Academy of Sciences, Beijing, 101408, People’s Republic of ChinaCorrespondence: Wei RaoTechnical Institute of Physics and Chemistry, Chinese Academy of Sciences, 29 Zhongguancun East Road, Haidian District, Beijing, 100190, People’s Republic of ChinaTel +86-10-82543719Fax +86-10-82543766Email weirao@mail.ipc.ac.cnObjective: Sufficient amounts of basic medical materials and high-end medical equipment are required for epidemics. This study aims to investigate and determine the key risks and main factors influencing China’s high-end medical equipment innovations using a SWOT (Strengths, Weaknesses, Opportunities, Threats) matrix. Then, on the basis of findings and relevant literature concerning the development of China’s high-end medical equipment in recent years, especially during the COVID-19 period, we put forward strategies for the development of and innovations in high-end medical equipment for China, based on an analytic network process ANP–SWOT model.Methods: In this study, a comprehensive ANP–SWOT analysis model was selected to examine the current state of development of the high-end medical equipment innovation industry in China. First, a SWOT model was used to comprehensively analyze the internal and external factors influencing the development of the industry. Then, an ANP network structure was designed to accurately reflect the relationships among the influencing factors. Subsequently, weights for the influencing factors were determined according to the importance of the factors, and alternative choices for China’s strategy for high-end medical equipment innovation were presented.Results: The results revealed that the essential features of the best strategy for the innovation and development of China’s high-end medical equipment industry were as follows: first, speeding up the construction and improvement of a technological innovation system that is enterprise-dominated, market-oriented, and involves joint industry–university research; second, a greater focus on increasing the financial support for research and development and industrialization; and third, strong government support through taxes, medical insurance, promotion of talent, and appropriate land usage.Conclusion: Strong governmental support through taxes, medical insurance, promotion of talent, and land usage is required to ensure rapid development of the high-end medical equipment industry in China.Keywords: ANP–SWOT model, high-end medical equipment, innovation, risk, policies

Lin-ang Wang,1,* Bo Yang,2,* Wen Rao,2 Hualiang Xiao,3 Dong Wang,2 Jun Jiang1 1Department of Urology, Daping Hospital & Army Medical Center of PLA, Third Military Medical University (Army Medical University), Chongqing 400042, People’s Republic of China; 2Cancer Center, Daping Hospital & Army Medical Center of PLA, Third Military Medical University (Army Medical University), Chongqing 400042, People’s Republic of China; 3Department of Pathology, Daping Hospital & Army Medical Center of PLA, Third Military Medical University (Army Medical University), Chongqing 400042, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jun JiangDepartment of Urology, Daping Hospital & Army Medical Center of PLA, Third Military Medical University (Army Medical University), Chongqing 400042, People’s Republic of ChinaTel +86 236 875 7151Fax +86 236 889 4062Email jiangjun_64@163.comObjectives: Tumor-infiltrating lymphocytes (TILs) play a crucial role in anti-tumor immunity. Basic studies have found that stimulator of interferon genes (STING), activated by sensing DNA damage, plays a role in recruiting and activating TILs in tumors. However, the correlation between base excision repair (BER) pathway, STING pathway and TILS and their effect on prognosis in upper urinary tract urothelial carcinoma (UTUC) are still unclear. The aim of this study was to investigate the prognostic effect of those proteins expression for disease-free survival (DFS) and overall survival (OS) and explore the correlation between these makers.Methods: We evaluated immunohistochemical expression of BER pathway (APE1, NTH1, OGG1, XRCC1, polβ), STING pathway (STING, IRF3), TILs (CD4, CD8, CD20) and PD-L1, PD-L2 in 88 UTUC patients to determine the predictive significance in DFS, OS and the correlation between them.Results: We found that interferon regulatory factor3 (IRF3) (HR: 0.451, 95% CI 0.243–0.837, p=0.024) and CD8 (HR: 0.522, 95% CI 0.295–0.926, p=0.014) are independent prognostic factors for DFS, APE1 (HR: 1.932, 95% CI 1.005–3.714, P=0.048), polβ (HR: 2.620, 95% CI 1.373–5.000, P=0.003), CD8 (HR: 0.323, 95% CI 0.151–0.693, P=0.004) were independent prognostic factors for OS. A model consisting of stage, grade, lymphovascular invasion and expression of APE1, polβ, IRF3, CD4, CD8 that predicts 3-year OS. Furthermore, DNA damage repair protein polβ is associated with CD8+ T cells in TME.Conclusion: We found that DNA damage, IRF3 and TILs are independent predictors for prognosis. We also provided clinical evidence that DNA damage repair-activated STING pathway can induce the recruitment and activation of TILs, which is consistent with preclinical models.Keywords: BER, IRF3, tumor-infiltrating lymphocytes, prognosis

Xiang Gao,1 BiLan Wang,1 XiaWei Wei,1 Wang Rao,2 Fang Ai,2 Fen Zhao,2 Ke Men,1 Bowen Yang,1 Xingyu Liu,1 Meijuan Huang,1 Maling Gou,1 ZhiYong Qian,1 Ning Huang,1 Yuquan Wei11Department of Pathophysiology, College of Preclinical and Forensic Medical Sciences, and State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, People's Republic of China; 2Department of Surgery, First Affiliated Hospital, Xinxiang Medical School, Xinxiang, People's Republic of ChinaAbstract: Star-shaped polymer micelles have good stability against dilution with water, showing promising application in drug delivery. In this work, biodegradable micelles made from star-shaped poly(ε-caprolactone)/poly(ethylene glycol) (PCL/PEG) copolymer were prepared and used to deliver doxorubicin (Dox) in vitro and in vivo. First, an acrylated monomethoxy poly (ethylene glycol)-poly(ε-caprolactone) (MPEG-PCL) diblock copolymer was synthesized, which then self-assembled into micelles, with a core-shell structure, in water. Then, the double bonds at the end of the PCL blocks were conjugated together by radical polymerization, forming star-shaped MPEG-PCL (SSMPEG-PCL) micelles. These SSMPEG-PCL micelles were monodispersed (polydispersity index = 0.11), with mean diameter of ≈25 nm, in water. Blank SSMPEG-PCL micelles had little cytotoxicity and did not induce obvious hemolysis in vitro. The critical micelle concentration of the SSMPEG-PCL micelles was five times lower than that of the MPEG-PCL micelles. Dox was directly loaded into SSMPEG-PCL micelles by a pH-induced self-assembly method. Dox loading did not significantly affect the particle size of SSMPEG-PCL micelles. Dox-loaded SSMPEG-PCL (Dox/SSMPEG-PCL) micelles slowly released Dox in vitro, and the Dox release at pH 5.5 was faster than that at pH 7.0. Also, encapsulation of Dox in SSMPEG-PCL micelles enhanced the anticancer activity of Dox in vitro. Furthermore, the therapeutic efficiency of Dox/SSMPEG-PCL on colon cancer mouse model was evaluated. Dox/SSMPEG-PCL caused a more significant inhibitory effect on tumor growth than did free Dox or controls (P < 0.05), which indicated that Dox/SSMPEG-PCL had enhanced anticolon cancer activity in vivo. Analysis with terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) showed that Dox/SSMPEG-PCL induced more tumor cell apoptosis than free Dox or controls. These results suggested that SSMPEG-PCL micelles have promising application in doxorubicin delivery for the enhancement of anticancer effect.Keywords: drug delivery, star-shaped polymer, MPEG-PCL, CMC

OBJECTIVE: Cone Beam Computed Tomography (CBCT) was used to observe and describe the distribution of canalis sinuosus (CS) in the Chinese population and the location of CS in the maxillary alveolar bone, so as to help oral surgeons evaluate the intraoperative risk and prognosis before maxillary surgery and reduce the complications caused by the injury of this structure in anterior surgery. PATIENTS AND METHODS: CBCT images of 600 patients admitted from 2021 to 2022 were collected to observe the anatomical structure of CS in the maxillary region. The following parameters were recorded: age, sex, number of CS, left and right distribution of CS, CS diameter, and location. Statistical analysis was performed on all of the collected data. RESULTS: The discovery rate of CS in this study was 59.75%, and it is commonly found in the lateral incisor area (64.82%). No significant difference can be found in the presence and number of CS in different gender and age groups (p>0.05). CONCLUSIONS: The use of high-resolution CBCT before implantation is of irreplaceable significance in the diagnosis and analysis of CS, which is conducive to reducing implantation complications and failure rate. The incidence of CS was independent of age or sex, while the location of CS was statistically significant. [ABSTRACT FROM AUTHOR]

Abstract Background Breast cancer (BC), a common malignant tumor originating from the terminal ductal lobular unit of the breast, poses a substantial health risk to women. Previous studies have associated cytochrome b561 (CYB561) with a poor prognosis in BC; however, its underlying mechanism of this association remains unclear. Methods We investigated the expression of CYB561 mRNA in BC using databases such as The Cancer Genome Atlas, Gene Expression Omnibus, Tumor–Normal–Metastatic plot, and Kaplan–Meier plotter databases. The prognostic value of CYB561 protein in BC was assessed in relation to its expression levels in tumor tissue samples from 158 patients with BC. The effect of CYB561 on BC progression was confirmed using in vivo and in vitro experiments. The biological functions and related signaling pathways of CYB561 in BC were explored using gene microarray, Innovative Pathway, Gene Ontology enrichment, and Kyoto Encyclopedia of Genes and Genomes enrichment analyses. The correlation between CYB561 and the BC tumor immune microenvironment was evaluated using the CIBERSORT algorithm and single-cell analysis and further validated through immunohistochemistry of serial sections. Results Our study demonstrated that upregulation of CYB561 expression predicted poor prognosis in patients with BC and that CYB561 knockdown inhibited the proliferation, migration, and invasive ability of BC cells in vitro. CYB561 knockdown inhibited BC tumor formation in vivo.CYB561 was observed to modulate downstream tropomyosin 1 expression. Furthermore, CYB561 expression was associated with macrophage M2 polarization in the BC immune microenvironment. Conclusions Elevated CYB561 expression suggests a poor prognosis for patients with BC and is associated with macrophage M2 polarization in the BC microenvironment. Therefore, CYB561 could potentially serve as a therapeutic target for BC treatment.

[Objective] To investigate the influence of rainfall energy and initial moisture content on the mechanism of soil aggregate splashing erosion. [Methods] The typical cultivated black soil in northeast China was selected as the research object. Artificial simulated rainfall experiments were conducted to explore the splashing erosion characteristics of soil aggregates with varying initial moisture content, rainfall energy, and initial particle size of aggregates. [Results] (1) The splash erosion of the four kinds of black soil aggregates with initial particle size was highest when the initial soil moisture level was 4%, and the splash erosion of the aggregates with an initial particle size

Knee osteoarthritis (KOA) is a degenerative joint disease characterized by pain, stiffness, and impaired mobility, with current therapies offering limited efficacy. This study investigates the epigenetic role of nuclear receptor-binding SET domain protein 1 (NSD1) in KOA pathogenesis. A KOA mouse model was established, and adenoviral vectors were employed to upregulate Nsd1 and inhibit SRY-box transcription factor 9 (Sox9), followed by histopathological assessments. We examined changes in cell morphology, proliferation, viability, and ferroptosis-related markers. The expression of Nsd1, Sox9, and acyl-CoA synthetase long-chain family member 4 (Acsl4) was analyzed, along with the enrichment of Nsd1 and dimethylated lysine 36 of histone 3 (H3K36me2) on the Sox9 promoter and Sox9 on the Acsl4 promoter. Additionally, the binding relationship between Sox9 and the Acsl4 promoter sequence was analyzed. Our results revealed that Nsd1 expression was reduced in KOA mouse tissues and interleukin (IL)-1β-stimulated chondrocytes. Nsd1 upregulation alleviated KOA, promoted chondrocyte proliferation and viability, and inhibited ferroptosis. Mechanistically, Nsd1 enhanced H3K36me2 to upregulate Sox9 expression, which in turn suppressed Acsl4 expression and ferroptosis. Sox9 inhibition partially reversed the protective effect of Nsd1 overexpression. In summary, Nsd1 upregulation mitigates chondrocyte ferroptosis and ameliorates KOA by modulating H3K36me2 to upregulate Sox9 and downregulate Acsl4 expression.

Background3-caffeoylquinic acid (3-CQA), a member of the chlorogenic acid family, possesses diverse pharmacological properties, such as scavenging, antioxidant, and antiapoptotic activity, rendering substantial value to alimentary consumables and therapeutic substances. However, the pervasiveness of non-standard practices, notably the misuse and abuse of indigenous botanicals, coupled with the inherent susceptibility of 3-CQA to degradation under light and heat exposure, engenders discernible disparateness in the quality profiles of the same kinds of herbs. Consequently, precise quantification of 3-CQA becomes imperative.MethodsIn this context, an artificial antigen was synthesized as a specific conjugate of 3-CQA and bovine serum albumin (3-CQA-BSA), followed by the generation of a monoclonal antibody (mAb) against the conjugate. Through optimization, a mAb-based indirect competitive chemiluminescence enzyme immunoassay (ic-CLEIA) was developed.ResultsIt demonstrated an IC50 and the calibration range of 2.97 ng/mL and 0.64–13.75 ng/mL, respectively, outperforming the conventional enzyme-linked immunosorbent assay (ELISA). Notably, the ic-CLEIA displayed 10.71% cross-reactivity with 3,5-dicaffeoylquinic acid, alongside minimal cross-reactivity toward other isomeric counterparts and analogs. Validation experiments on herbs and Chinese patent medicines using ic-CLEIA, confirmed by high-performance liquid chromatography (HPLC) analysis, revealed a robust correlation coefficient of 0.9667 between the two modalities.ConclusionThese findings unequivocally demonstrated that the proposed ic-CLEIA represents a viable and reliable analytical method for 3-CQA determination. This method holds significant potential for ensuring the quality control and therapeutic efficacy germane to herbs and patent medicines, spanning diverse therapeutic milieus and applications.

ObjectivesTo synthesize qualitative evidence on the experience of lay responders performing cardiopulmonary resuscitation (CPR).MethodsQualitative evidence synthesis was performed using the Thomas and Harden method. The PubMed, Cochrane Library, Web of Science, OVID Medline, Embase, CINAHL, CNKI, and WanFang databases were systematically searched. The quality of the research was assessed by the Critical Assessment Skills Program Tool (CASP).ResultsA total of 5,610 studies were identified, and 9 studies were included in the analysis. Four analytical themes were generated: emotional ambivalence before CPR, psychological tolerance during CPR, perceived experience after CPR, and enhancing psychological resilience.ConclusionLay responders face complicated psychological experience during CPR, which may be susceptible to psychological effects such as “loss aversion,” “bystander effects” and “knowledge curse.” In addition to the timely retraining of CPR, lay responders should be instructed to manage psychological distress and improve psychological resilience. More importantly, the psychological sequelae may be long-lasting, requiring ongoing psychological intervention and follow-up based on valuing transdisciplinarity across endeavours.

BackgroundTheoretically, stress is positively correlated with posttraumatic growth (PTG). However, evidence for a correlation between fear of cancer recurrence (FCR), a cancer-specific stressor, and PTG is mixed. The present study aimed to systematically investigate the overall effect size between the two and to explore moderators that may influence this relationship.MethodsFrom the earliest available date to October 2023, a comprehensive search was conducted in seven databases. Correlation coefficients (r) were calculated using Stata software. Publication type, continent, trauma role, gender, FCR measurements, PTG measurements, sample size, age, and time since diagnosis were used to examine moderating effects. The National Heart, Lung, and Blood Institute’s (NHLBI) assessment tool was used to evaluate study quality.ResultsA total of 14 studies, involving 17 samples and 3,701 participants, were included. The studies found a small association between FCR and PTG (r = 0.161, 95% CI: 0.070–0.249, p

IntroductionThe ancient ivories unearthed from the Sanxingdui Ruins site are valuable cultural relics, however, the microbial biodeterioration on ivories during temporary cold storage poses a great threat to their later long-term preservation.MethodsHere, the combination of high-throughput sequencing and biochemical assays was applied for the in-depth investigation of the key deteriorative microorganisms colonizing on the ivories and the tracing of their origin, as well as the assessment of the ethanol disinfection impact on the microbial communities on ivories.ResultsIt was observed that the surfaces of ivories were scattered by the fungal patches of white, dark grey, and hedge green colors during cold storage. The high-throughput sequencing results showed that the genera Mortierella (38.51%), Ilyonectria (14.43%), Penicillium (1.15%), and Aspergillus (1.09%) were the dominant fungi, while Pseudomonas (22.63%), Sphingopyxis (3.06%), and Perlucidibaca (2.92%) were the dominant bacteria on ivories. The isolated Aspergillus A-2 resulted in the highest amount of calcium releasing from the degradation of hydroxyapatite (HAP), the main component of ivory, by the organic acids produced, including oxalic acid and citric acid. The fast expectation-maximization for microbial source tracking (FEAST) analysis revealed that the majority of the fungi (57.45%) and bacteria (71.84%) colonizing on the ivories were derived from the soils surrounding ivories in the sacrifice pits, indicating soils as the primary source for the spoilage microbes growing on ivories. The dominant strains could degrade cellulose, the key components of wet cotton towels commonly applied on ivories for moisture maintenance, aiding the spoilage microbes colonizing on ivories. Notably, the ivory disinfection with 75% ethanol during the cleansing significantly decreased the relative abundance of the dominant genera of Ilyonectria, Aspergillus, and Pseudomonas, with Mortierella becoming the dominant one on ivories.DiscussionTogether, the fungi, particularly Aspergillus and Penicillium, played a significant role in the microbial biodeterioration of unearthed ancient ivories by producing the organic acids. These results may improve the control of the microbial biodeterioration and develop more efficient strategies for the long-time conservation of unearthed ancient ivories and other cultural relics.

BackgroundHome-based intervention occupies a prominent place in the treatment of autism spectrum disorder （ASD） in children， whereas previous studies on the effect of home-based early intensive behavioral intervention on verbal ability of children with ASD are somewhat inadequate.ObjectiveTo study the effects of intensive family behavioral of intervention based on Verbal Behavior Milestones Assessment and Placement Program （VB-MAPP） on the language ability of children with ASD， so as to provide references for the development of family intervention strategies for children with ASD.MethodsChildren aged 2 to 3 years old who attended the Children's Rehabilitation Department of the Second Affiliated Hospital of Shantou University Medical College from September 2020 to December 2021 and met the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） diagnostic criteria for ASD were selected as the study objects. A non-randomized concurrent control trial was conducted to compare a study group （n=24） receiving home-based early intensive behavioral intervention using VB-MAPP with a control group （n=14） receiving training from other special institutions or early childhood education institutions. The intervention lasted for 6 months in both groups. Before and after the intervention， the VB-MAPP milestone assessment was performed in the two groups， and the VB-MAPP milestone score， mand， trac and listener responds were selected as the study indicators. Then the intervention effect was compared between two groups， and the multiple linear regression was performed to screen the related influencing factors.ResultsAfter intervention， the total milestone assessment score， mand， tact and listener responds scores of study group were higher than those of control group， with statistical difference （Z=-4.339~-2.195， P

Zhu-Quan Su,&ast; Wan-Yuan Rao,&ast; Xiao-Yi Pan, Jia-Xin Tang, Ming-Yue Fan, Xiao-Bo Chen, Shi-Yue Li State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Shi-Yue Li; Xiao-Bo Chen, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, People’s Republic of China, Tel +86 20 8306 2896, Email lishiyue@188.com; xiaobo-win@163.comAbstract: Disseminated infection caused by Streptococcus constellatus was seldom occurred. We reported a case of Streptococcus constellatus infection, presenting as multiple pulmonary cavities, thoracic wall abscess and vertebral destruction. The 37-year-old male had recurrent fever, chest wall swelling and pain, and lower limb numbness, he had weak physical condition and previously suffered from poorly controlled diabetes and severe periodontal disease for 3 years. Definite diagnosis of Streptococcus constellatus infection was made by metagenomic next‑generation sequencing (mNGS) in abscess drainage fluid. Systemic antibiotics and thoracic wall drainage were given, and the pulmonary cavity and the thoracic intermuscular abscess were significantly decreased. Few to no study reported the disseminated infection (pulmonary cavities, thoracic wall abscess and vertebral destruction) caused by Streptococcus constellatus. This case report highlighted the importance of mNGS for accurate diagnosis, as well as the timely drainage and antibiotics for effective treatment of Streptococcus constellatus infection.Keywords: Streptococcus constellatus, pulmonary cavity, thoracic wall abscess, vertebral destruction, metagenomic next‑generation sequencing

Wan-Yi Rao,1,&ast; Fang Xu,1,&ast; Shao-Bing Dai,1 Zhong Mei,2 Xiao-Ping Chen,1 Chang-Cheng Lv,1 Chun-Lei Liu,1 Warwick Ngan Kee,1 Xin-Zhong Chen1 1Department of Anesthesia, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 2Department of Anesthesiology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xin-Zhong Chen, Department of Anesthesia, Women’s Hospital, Zhejiang University School of Medicine, No. 1 Bachelor’s Road, Hangzhou, 310000, People’s Republic of China, Email chenxinz@zju.edu.cnPurpose: Catheter-based techniques such as combined spinal-epidural (CSE) anesthesia which are sometimes indicated for obstetric anesthesia have a complex mechanism of action. The application of the dural puncture epidural (DPE) anesthesia for cesarean section (CS) has not been well investigated. The present study compared the relatively novel DPE technique with epidural (EA) and CSE anesthesia.Patients and Methods: We randomly assigned 150 parturients who underwent elective CS to receive DPE, EA or CSE anesthesia. The primary outcome was the onset of sensory anesthesia to the T5 dermatome assessed using the Cox proportional hazards model. Secondary outcomes included median time to sensory block, quality of block, patient and surgeon satisfaction, APGAR scores and other side effects.Results: For DPE anesthesia versus EA anesthesia, the onset of anesthesia was faster (hazard ratio 2.47 [95% CI 1.56 to 3.90], adjusted P < 0.001) and the median time to surgical level was shorter (16 [IQR 14– 18] min versus 19 [15.5– 21] min, adjusted P < 0.001); the incidence of intraoperative pain was lower (7/48 versus 17/47, adjusted P = 0.046) and the median patient satisfaction score was higher (9 [IQR 9– 10] versus 8 [8– 9.5], adjusted P = 0.004). In the CSE group, the onset of anesthesia was faster than in the other two but the incidence of hypotension was higher (P < 0.001) and the phenylephrine requirement was greater (P < 0.001).Conclusion: DPE anesthesia had a faster onset and better quality of block than EA anesthesia and provided less influence to maternal hemodynamic parameters than CSE anesthesia for CS. These results suggest that the dural puncture plays a significant role in enhancing the effectiveness of epidural top-ups during CSE anesthesia and indicates enlightenment that contributes to the satisfaction of anesthetic effect in DPE technique labor analgesia transferred to CS.Keywords: anesthesia, dural puncture epidural, anesthesia, epidural, cesarean section

BACKGROUND Sulfur is an active element with multiple chemical forms, which plays a vital role in the regulation of redox chemistry. Reduced inorganic sulfur (RIS) including acid volatile sulfur (AVS), elemental sulfur (ES) and pyrite sulfur (CRS) is the most active part of sulfur species in sediments and plays an important role in controlling the geochemical behavior of iron, phosphorus and heavy metals in sediments. Separation and determination of reduced inorganic sulfur in anoxic sediments are critical to ecological and geological studies of sulfur cycles.Both distillation and diffusion methods can be effectively used to separate AVS, ES, and CRS in sediments. However, the current methods for extracting sulfur species are difficult to adapt to the large number of samples in geological and environmental research. Due to the reaction time, requirements of 24h for single sulfur species in the diffusion method limits the number of samples that can be processed on a timely basis. This limitation presents a problem for analyzing fresh anoxic sediment samples which have to be processed immediately to minimize the risk of sulfide re-oxidation. The detection method has the disadvantages of having a cumbersome testing process, long analysis time, and easy loss of sulfur components. OBJECTIVES To achieve efficient and continuous determination of reduced inorganic sulfur forms in bulk sediment samples. METHODS The method used in this experiment was improved based on the thermal distillation method, which was used to continuously extract the reduced inorganic sulfur from sediments. The reaction flask used in the experiment was a three-head round-bottom flask. A nitrogen flushing pipe, a condenser tube and two injection tubes were connected to each of the small necks. For the AVS procedure, 1.00g sediment sample reacted with 10mL of 6mol/L HCl under nitrogen gas at an elevated temperature (90℃) to convert reduced sulfur species into hydrogen sulfide which was subsequently carried by a nitrogen gas stream into a trap. For the CRS procedure, 20mL of CrCl2 solution was added to the sediment in the distillation flask after the AVS procedure, and 10mL of 6mol/L HCl was immediately placed in the flask at an elevated temperature (90℃), flushed with nitrogen. For the ES procedure, 20mL DMF were poured into the sample flask which contained acid and CrCl2 solutions from the previous procedure. 20mL of CrCl2 solution and 10mL of 6mol/L HCl were injected into the flask, and the reaction was allowed to take place at 90℃ purging with nitrogen. During the entire distillation process, H2S gas was absorbed by NaOH solution, and then oxidized by H2O2 to SO42-. The concentrations of SO42- were obtained by ion chromatography. RESULTS Repeatability experiments (n=3) were conducted on sediment samples from the Three Gorges Reservoir area and the mean values of acid volatile sulfur, elemental sulfur and pyrite sulfur were obtained as 0.19, 0.37 and 3.10μmol/g, respectively. The relative standard deviations (RSD) of the experimental results were 5.26%, 1.22% and 3.09%, respectively. In order to test the effectiveness of the distillation procedures, Na2S·9H2O, pyrite and S were added in the sediment to reveal the corresponding standard recoveries. An average of 92.8% of the added Na2S·9H2O was recovered by the AVS diffusion method. An average of 93.6% of the added pyrite was recovered by the CRS diffusion method. An average of 94.1% of the added elemental sulfur was recovered by the ES diffusion method. In the literature, recovery of AVS by the improved diffusion method ranged from 82.01% to 108.71%, and recovery of ES ranged from 92.25% to 98.08% (n=3), respectively.The modified apparatus presented in this paper was an economic version which uses rubber and glass parts. The method provided the advantages of lower sample weighing, and simple operation. Compared with the diffusion method (24h), the extraction time for individual sulfur forms by our distillation method was just 1.5h. The recoveries achieved by the method are comparable to those reported for earlier methods. In addition, the results are more like the data on reduced inorganic sulfur content obtained by Hongbin Yin after measuring sediment samples from Taihu Lake using the modified cold diffusion method, indicating that the method designed in this study has a high degree of confidence.Geochemical processes of sulfur in river aquatic systems play a crucial role in environmental evolution. In this study, the distributions and seasonal variation of reduced inorganic sulfur (RIS) in the Three Gorges Reservoir area surface sediments were investigated. Surface sediment samples were collected from 8 points in the section from Yunyang to Zigui in the Three Gorges Reservoir area in August and December 2017. The result showed that the AVS and ES contents were higher in summer than in winter, and the trend of RIS in the section from Yunyang to Zigui was roughly decreasing, with obvious seasonal and spatial changes. Low sulfur pollution in the Three Gorges Reservoir area was observed. CONCLUSIONS The improved thermal distillation method and apparatus in this study have significant advantages in the extraction efficiency of reduced inorganic sulfur from sediments. The extraction time of this study for individual sulfur form is 1.5h, less than the diffusion method. The established analytical method has good precision and accuracy, which is suitable for investigation studies with large numbers of samples such as environmental research and geological surveys.