Search

Zhihui Jia,1 Zimin Niu,1 Jia Ji Wang,2,3 Jose Hernandez,4,5 Yu Ting Li,6,7 Harry HX Wang1,8,9 1School of Public Health, Sun Yat-Sen University, Guangzhou, People’s Republic of China; 2School of Public Health, Guangzhou Medical University, Guangzhou, People’s Republic of China; 3Centre for General Practice, The Seventh Affiliated Hospital, Southern Medical University, Foshan, People’s Republic of China; 4Faculty of Medicine and Health, EDU, Digital Education Holdings Ltd., Kalkara, Malta; 5Green Templeton College, University of Oxford, Oxford, UK; 6State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People’s Republic of China; 7Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People’s Republic of China; 8Department of General Practice, The Second Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China; 9JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, People’s Republic of ChinaCorrespondence: Yu Ting Li, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, People’s Republic of China, Email liyuting3@mail.sysu.edu.cn Harry HX Wang, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, People’s Republic of China, Email haoxiangwang@163.com; haoxiangwang@cuhk.edu.hkBackground: Treatment burden is a patient-centred, dynamic concept. However, longitudinal data on the changing pattern of treatment burden among patients with one or more long-term conditions (LTCs) are relatively scanty. We aimed to explore the longitudinal trajectories of treatment burden and associated risk factors in a large, patient population in primary care settings.Methods: We analysed data from 5573 primary care patients with long-term conditions (LTCs) recruited using a multistage sampling method in Shenzhen, southern China. The treatment burden was assessed by the Mandarin Chinese version of the Treatment Burden Questionnaire (TBQ). We used latent class growth mixture modelling (LCGMM) to determine trajectories of treatment burden across four time points, ie, at baseline, and at 6, 12, and 18 months. Predictors of trajectory classes were explored using multivariable logistic regression analysis.Results: The mean TBQ scores of patients with a single LTC (n = 2756), 2 LTCs (n = 1871), 3 LTCs (n = 699), and ≥ 4 LTCs (n = 247) were 18.17, 20.28, 21.32, and 26.10, respectively, at baseline. LCGMM identified three discrete classes of treatment burden trajectories over time, ie, a high-increasing class, a low-stable class, and a high-decreasing class. When controlling for individual-level factors including age, education, monthly household income per head, smoking, alcohol consumption, and attendance in health education, patients who had a clinical diagnosis of 3 LTCs (adjusted odds ratio [aOR] = 1.49, 95% CI = 1.21– 1.86, P < 0.001) or ≥ 4 LTCs (aOR = 1.97, 95% CI = 1.44– 2.72, P < 0.001) were more likely to belong to the high-increasing class. Sensitivity analysis using propensity score methods obtained similar results.Conclusion: Our study revealed the presence of discrete patterns of treatment burden over time in Chinese primary care patients with LTCs, providing directions for tailored interventions to optimise disease management. Patients with 3 or more LTCs should receive close attention in healthcare delivery as they tend to experience a greater treatment burden.Keywords: longitudinal trajectories, treatment burden, long-term conditions, multimorbidity, risk factors

Jia-Jie Wang, Zhichao Zheng, Ying Zhang Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of ChinaCorrespondence: Ying Zhang, Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China, Tel +86 18960810771, Email just4zhangying@hotmail.com; doctorzhangying@gdph.org.cnBackground: Metabolic dysfunction-associated steatotic liver disease (MASLD) increases the risk of cardiovascular disease and existing evidence indicates that MASLD affects the cardiovascular system through systemic inflammation. Our aim was to assess the association of hematological biomarkers of inflammation with the 10-year risk of major adverse cardiovascular events (MACE) and all-cause mortality in MASLD patients.Methods: A total of 1858 MASLD participants from the Atherosclerosis Risk in Communities cohort study at visit 2 (1990– 1992) were included. A total of 1338 non-MASLD participants were also included in the comparison. At baseline, hematological biomarkers of inflammation such as leukocytes, neutrophils, lymphocytes, monocytes, and C-reactive protein (CRP) were measured. Participants were followed up for MACE and all-cause mortality for a period of 10 years. Multivariate adjusted Cox models were used to estimate hazard ratios (HR).Results: The 10-year MACE was higher in MASLD participants than in non-MASLD participants (20.8% vs 9.3%). Monocytes (HR 1.114, [95% CI, 1.022– 1.216] per 1-SD, P=0.015) and CRP (HR 1.109 [95% CI, 1.032– 1.190] per 1-SD, P=0.005) were associated with an increased 10-year risk of MACE, independent of other cardiovascular risk factors. This association was specific to the MASLD population. None of these hematological biomarkers demonstrated a significant association with 10-year all-cause mortality.Conclusion: Increased levels of monocytes and CRP were associated with an increased 10-year risk of MACE in the MASLD population. Hematological biomarkers of inflammation may help identify MASLD populations at higher risk for cardiovascular events.Keywords: MASLD, biomarkers, inflammation, cardiovascular

Miao-Miao Hua,1 Jia Li,2 Jie Zheng,2 Jing-Jing Wang,2 Chang Liu,2 Yan Zhang,2 Zhi-Feng Zhang,2 Xiao-Li Cao,1,2 Han Shen1,2 1Department of Laboratory Medicine, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, People’s Republic of China; 2Department of Laboratory Medicine, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, People’s Republic of ChinaCorrespondence: Xiao-Li Cao; Han Shen, Email cao-xiao-li@163.com; shenhan10366@sina.comObjective: To investigate the clinical and molecular characteristics of Salmonella spp. causing bloodstream infections (BSIs) in our hospital.Methods: We studied 22 clinical Salmonella isolates from BSIs and 16 from non-BSIs, performing antimicrobial susceptibility testing (AST) and whole genome sequencing (WGS). The analysis included serovars, antibiotic resistance genes (ARGs), virulence factors (VFs), sequence types (STs), plasmid replicons, and genetic relationships. We also assessed pathogenicity of the isolates causing BSIs through growth, biofilm formation, and anti-serum killing assays.Results: WGS analysis identified 13 Salmonella serovars, with four responsible for BSIs. S. Enteritidis was the most prevalent serovar, involved in 19 (50.0%) cases. BSIs were caused by 17S. Enteritidis, two S. Typhimurium, two S. Munster and one S. Diguel. Of the 38 isolates, 27 (71.1%) exhibited high resistance to ampicillin, and 24 (63.2%) to ampicillin/sulbactam. Thirty-six types of ARGs were identified, with blaTEM-1B (n = 25, 65.8%) being the most frequent. Ten plasmid replicons were found; the combination of IncFIB(S)-IncFII(S)-IncX1 was the most common in S. Enteritidis (94.7%). Fifteen STs were identified, among which ST11 was the most prevalent and clonally disseminated, primarily responsible for BSIs. A total of 333 different VFs were detected, 177 of which were common across all strains. No significant differences were observed between the BSI and non-BSI isolates in terms of resistance rates, ARGs, plasmid replicons, and VFs, except for seven VFs. No strong pathogenicity was observed in the BSI-causing isolates.Conclusion: BSIs were predominantly caused by clonally disseminated S. Enteritidis ST11, the majority of which carried multiple ARGs, VFs and plasmid replicons. This study provides the first data on clonally disseminated S. Enteritidis ST11 causing BSIs, highlighting the urgent need for enhanced infection control measures.Keywords: Salmonella enteritidis, bloodstream infections, serovars, antibiotic-resistance genes, virulence factors, sequence type

Long-Fei Xia,1 Jing-Bo Li,2 Guo-Sheng Tian,2 Wei-Ran Jiang,3 Yao-Shuang Li,1 Chen-Ying Lin,1 Hui-Na Qiu,2 Fan Wu,4 Jun-Jia Wang,5 Chun-Jun Li,2 Jing-Na Lin2 1Tianjin Union Medical Center, Tianjin Medical University, Tianjin, 300070, People’s Republic of China; 2Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, 300121, People’s Republic of China; 3Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA; 4School of Medicine, Nankai University, Tianjin, 300071, People’s Republic of China; 5Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People’s Republic of ChinaCorrespondence: Jing-Na Lin; Chun-Jun Li, Email 13207628978@163.com; li_chunjun@126.comObjective: To investigate the impact of sarcopenia on the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) among individuals with type 2 diabetes mellitus (T2DM).Methods: This study included the clinical, laboratory, and body composition data of 1491 patients with T2DM who were admitted to the Department of Endocrinology and Metabolism at Tianjin Union Medical Center from July 2018 to July 2023. The China-PAR model was utilized to evaluate cardiovascular disease risk. Associations between ASCVD risk and various clinical parameters were analyzed, and the relationship between body composition parameters and ASCVD risk was assessed using logistic regression.Results: The analysis revealed that T2DM patients with sarcopenia had a higher 10-year ASCVD risk compared to those without sarcopenia, with reduced muscle mass independently predicting an increased risk of cardiovascular disease. This association was significant among female T2DM patients, while male T2DM patients with sarcopenia showed a marginally higher median ASCVD risk compared to their non-sarcopenic counterparts. ASCVD risk inversely correlated with body muscle parameters and positively correlated with fat content parameters. Specifically, height- and weight-adjusted fat mass (FM, FM%, FMI) were identified as risk factors for ASCVD. Conversely, muscle parameters adjusted for weight and fat (ASM%, SMM%, FFM%, ASM/FM, SMM/FM, FMM/FM) were protective against ASCVD risk. These findings highlight the critical role of sarcopenia in influencing cardiovascular disease risk among Chinese patients with T2DM, as predicted by the China-PAR model.Conclusion: This study highlights the importance of sarcopenia in T2DM patients, not only as an indicator of ASCVD risk, but possibly as an independent risk factor in this demographics.Keywords: atherosclerotic cardiovascular disease, ASCVD, type 2 diabetes, T2DM, sarcopenia, fat content, muscle mass

Fei-Fei Wang,1,&ast; Nan Li,1,&ast; Jing-Jing Wang,1 Nijiti Muyesai,1 Haiyan Fu2 1The People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Emergency Care Center, Urumqi, Xinjiang Uygur Autonomous Region, 830000, People’s Republic of China; 2Department of Gastroenterology, Urumqi Friendship Hospital, Urumqi, Xinjiang Uygur Autonomous Region, 830000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Haiyan Fu, Department of Gastroenterology, Urumqi Friendship Hospital, 558, Shengli Road, Urumqi, Xinjiang Uygur Autonomous Region, 830000, People’s Republic of China, Tel/Fax +8618599026892, Email fuhaiyanfhu@126.com Nijiti Muyesai, The People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Emergency Care Center, the People’s Republic of China, No. 91, Tianchi Road, Tianshan District, Urumqi, 830000, People’s Republic of China, Tel/Fax +86 13899955322, Email nijiati0a@126.comObjective: The aim of this study is to examine the distribution and features of gastroscopy in northern Xinjiang, a province in China.Methods: We included a group of 895 patients diagnosed with digestive diseases at Urumqi Friendship Hospital and analyzed their gastroscopic results and baseline data.Results: Among patients aged 12 to 86 years in the specified region, females exhibited a heightened susceptibility to esophageal-gastrointestinal and intestinal disorders compared to males. The mean age for chronic gastritis onset was determined to be 54.79 years. In the context of esophageal-gastric-intestinal disorders, the distribution across various ethnic groups manifested as follows: the Han, Uygur, Hui, and Kazakh populations comprised 53.97%, 23.91%, 7.15%, and 3.46%, respectively. Through principal component-based dimension reduction analysis, we identified chronic non-atrophic gastritis with erosive gastritis, duodenal bulb inflammation, and chronic non-atrophic gastritis (predominantly in the gastric antrum) as pivotal factors contributing to differences in hiatal hernia. Multiple linear regression models were established for different ethnic groups, duodenal bulb inflammation, and hiatal hernia by age. The results revealed a heightened risk of duodenal bulb inflammation (P < 0.01) in Han, Kazakh, Hui, Mongolian, and Uygur women, while the risk of hiatal hernia exhibited a positive correlation with age (P = 0.001).Conclusion: Among patients undergoing gastrointestinal examinations in northern Xinjiang, the most prevalent pathological condition was identified as chronic gastritis. Notably, within this subgroup, the prevalence of duodenal bulb inflammation was found to be greater in women than in men. The ethnic composition within this context encompassed patients from the Han, Kazakh, Hui, and Mongolian ethnic groups. Furthermore, a positive correlation was identified between the incidence of esophageal hiatal hernia and age.Keywords: age, ethnicity, esophageal-gastric-intestinal disease, gastroscopy, gender, northern Xinjiang

Chen-Wei Lin,1,2,&ast; Jin-Jhe Wang,2,&ast; Chien-Hsiung Lai,2– 5 Chau-Yin Chen,2,3 Ing-Chou Lai2,3,6 1Department of Medical Education, Chang Gung Memorial Hospital, Chiayi, 61363, Taiwan; 2Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, 61363, Taiwan; 3Department of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan; 4Department of Nursing, Chang Gung University of Science and Technology, Chiayi, 61363, Taiwan; 5School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan; 6Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan&ast;These authors contributed equally to this workCorrespondence: Jin-Jhe Wang, Department of Ophthalmology, Chiayi Chang Gung Memorial Hospital, No. 8, Sec. W., Jiapu Road, Puzi City, Chiayi County, 613, Taiwan, Tel +886 5 3621000, Fax +886 5 3623002, Email leo81819@gmail.comPurpose: Intraocular pressure (IOP) measurement is critical in diagnosing and managing eye conditions. This study aims to assess the comparability of three alternative devices for measuring IOP: Noncontact tonometer, Icare rebound tonometer, and Tono-Pen.Patients and Methods: A cross-sectional study included 172 adult participants (87 males and 85 females) who underwent IOP and central corneal thickness (CCT) assessments. IOP was measured using Noncontact (Canon TX-20), Icare (Icare TA01i), and Tono-Pen (Tonopen XL). CCT was measured with the built-in pachymetry of the Noncontact tonometer. Correlation coefficients and Bland-Altman analyses were conducted to assess the relationships and agreements between these tonometers. Participants were grouped based on IOP and CCT levels. The mean of the standard deviation of the three tonometer results was calculated to evaluate measurement result variability. One-way analysis of variance was conducted for comparing between the groups.Results: IOP measurements among the three devices were not significantly different, indicating their comparability. Correlation analysis revealed strong correlations between the tonometers. Bland-Altman analysis showed good agreement, with the Icare rebound tonometer and Tono-Pen exhibiting narrower limits of agreement. Furthermore, IOP levels influenced measurement result variability, with higher IOP levels associated with greater variance.Conclusion: This study demonstrates that the alternative devices examined can provide reliable IOP measurements. It highlights the potential of these alternative devices for IOP measurement. These findings have implications for clinical practice, offering practitioners additional tools for accurate IOP assessment.Keywords: intraocular pressure, tonometer, noncontact, icare, Tono-Pen

Ling-Ling Xia,1,&ast; Jun-Da Li,1,&ast; Fan Duan,1,&ast; Jing Zhang,1 Lin-Lin Mu,1 Li-Jin Wang,1 Chen-Yang Jiao,2 Xun Song,1 Ze Wang,1 Jin-Xuan Chen,1 Jing-Jing Wang,1 Yue Wang,1 Xiao-Chu Zhang,1,3 Dong-Liang Jiao1 1School of Mental Health, Bengbu Medical College, Bengbu, People’s Republic of China; 2School of Medical Imaging, Wannan Medical College, Wuhu, People’s Republic of China; 3CAS Key Laboratory of Brain Function and Disease and School of Life Sciences, University of Science and Technology of China, Hefei, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Dong-Liang Jiao; Xiao-Chu Zhang, Email jdl3925697@163.com; zxcustc@ustc.edu.cnObjective: Learner dependence on short videos has many pitfalls for learning outcomes, but the negative effects of excessive short video use have been little discussed in the learning psychology literature. Therefore, this study investigated the effects of excessive short video use on anxiety, depression, prospective memory, and academically delayed gratification (ADOG) in relation to online gaming-related behaviours, and explored the possible mechanisms by which excessive online gaming and short video use may lead to decreased ADOG, to expand our understanding of excessive short video use.Methods: Based on the whole class random sampling method, a questionnaire survey was conducted among college students in Northern Anhui, China from May 7 to July 27, 2022. The questionnaires included the Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire Scale (PHQ-9), Prospective and Retrospective Memory (PRM) Questionnaire, and ADOG Scale.Results: A total of 1016 participants completed the survey. The study found that of all the internet behaviors, 20.8% of the college students mainly played online games, 43.9% mainly played short videos, and 35.3% conducted other online behaviors. When compared with other internet behaviors, online gaming and short video behaviors can cause more serious anxiety/depression and worse PRM and ADOG scores. As time spent playing online games and short videos increased, anxiety and depression became worse, and the scores for PRM and ADOG also declined. Anxiety, depression, and PRM mediate the relationship between time spent on online gaming/short videos and ADOG.Conclusion: Excessive short videos behaviour may produce the same psychological problems and learning problems as online gaming disorder. Excessive short video and online gaming behaviors may affect ADOG performance through anxiety, depression, and prospective memory. These findings could be used as a basis for future studies on the improvement of ADOG.Keywords: short video, online games, anxiety, depression, prospective memory, academic delay of gratification

Ling-Xia Ha,1 Yu-Dong Du,2,3 Xiao-Xiao Qu,2 Jin-Juan Wang2 1Reproductive Medicine Center, General Hospital of Ningxia Medical University, Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, Ningxia Medical University, Yinchuan, Ningxia, 750004, People’s Republic of China; 2Ningxia Medical University, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, People’s Republic of China; 3Department of Reproductive Medicine, Luoyang Maternal and Child Health Hospital, Luoyang, Henan, 471000, People’s Republic of ChinaCorrespondence: Ling-Xia Ha, Reproductive Medicine Center, General Hospital of Ningxia Medical University, No. 804 of Shengli Road, Xingqing District, Yinchuan, 750004, People’s Republic of China, Tel +86 951 6744033 ; +86 13629500990, Fax +86 951 6743891, Email halingxia@126.comObjective: The purpose of this study was to explore the relationship between hemoglobin levels and metabolic disorders in patients with PCOS.Methods: A total of 573 patients were selected, based on the hemoglobin level; 342 patients with PCOS were divided into two groups as follows: Group A (normal Hb group, n = 269) and Group B (high Hb group, n = 73); 231 non-PCOS patients were divided into two groups as follows: Group C (normal Hb group, n = 199), and Group D (high Hb group, n = 32). The general information, glucose and lipid metabolism indicators, and uric acid levels of all patients were compiled for data analysis.Results: (1) Hb, HGB concentration in mean red blood cells and RDW in PCOS patients were higher than those in non-PCOS patients, and MCV was lower than that in non-PCOS patients (P < 0.05); (2) Compared with Group A, patients in Group B had higher BMI, Hb, 2-hPG, FINS, 2-hINS, HOMA-IR, LDL-C, and uric acid levels while the QUICKI was lower; in Group C, the age, FSH, HDL-C, and LDL-C were higher, and AMH, BMI, T, TG, and uric acid level were lower (P< 0.05); compared with Group D, AMH, BMI, FINS, HOMA-IR, TG, uric acid level increased, while age, FSH, and QUICKI decreased in Group B; and Hb and T decreased in Group C (P< 0.05); (3) Pearson’s correlation analysis indicated that Hb in PCOS patients was positively correlated with BMI, FPG, 2-hPG, FINS, 2-hINS, and HOMA-IR, and negatively correlated with the QUICKI (P< 0.05); (4) Multi-factor logistic regression analysis suggested that the high Hb level in PCOS patients was an independent risk factor of IR (P< 0.05).Conclusion: Hb level in patients with PCOS was associated with BMI and glucose metabolism indicators; a high Hb level may be an independent risk factor for IR.Keywords: hemoglobin, insulin resistance, metabolic disorder, polycystic ovary syndrome

Yao-Shuang Li,1,2,&ast; Yan-Lan Liu,2,&ast; Jun-Jia Wang,2,3 Nahal Haghbin,4 Xiao-He Wang,5 Wei-Ran Jiang,6 Hui-Na Qiu,2 Long-Fei Xia,1,2 Fan Wu,2,7 Chen-Ying Lin,1,2 Jing-Bo Li,2 Jing-Na Lin2 1Tianjin Union Medical Center, Tianjin Medical University, Tianjin, People’s Republic of China; 2Department of Endocrinology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, People’s Republic of China; 3Tianjin Union Medical Center, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China; 4School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 5Institute of Non-Communicable Diseases Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin, People’s Republic of China; 6Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA; 7Tianjin Union Medical Center, School of Medicine, Nankai University, Tianjin, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jing-Na Lin; Jing-Bo Li, Email 13207628978@163.com; doctorljb@aliyun.comObjective: The aim of this study was to elucidate the relationship between specific body composition and the risk of Cognitive Impairment (CI) in middle-aged Type 2 Diabetes Mellitus (T2DM) patients.Methods: This cross-sectional study included 504 hospitalized patients with T2DM from the Department of Endocrinology and Metabolism of the Tianjin Union Medical Center. Subjects were grouped by sex, and cognitive status was assessed using the Montreal Cognitive Assessment (MoCA). The relationship between body composition and cognitive ability was investigated with the use of linear regression analysis. The association between body composition and CI risk was determined by logistic regression analysis.Results: The prevalence of CI was 39.3% in middle-aged T2DM patients. After adjusting for age, education, marriage status, carotid atherosclerosis, cerebrovascular disease and hemoglobin, multiple linear regression analysis showed that lean mass index (LMI), body mass index (BMI) and appendicular skeletal muscle index (SMI) were significant predictors for the MoCA scores in men (p < 0.05). In addition, BMI (OR 0.913, 95% CI 0.840– 0.992) and LMI (OR 0.820, 95% CI 0.682– 0.916) were independent protective factors for CI in males. After adjusted for age, education, marriage status, dietary control of diabetes and cerebrovascular disease, visceral obesity (VO, OR 1.950, 95% CI 1.033– 3.684) and abdominal obesity (AO, OR 2.537, 95% CI 1.191– 5.403) were risk factors for CI in female patients.Conclusion: The results suggest that there may be different mechanisms underlying the relationship of body compositions and cognitive performance between middle-aged male and female patients with T2DM. In addition, our finding of potential determinants of cognitive impairment may facilitate the development of intervention programs for middle-aged type 2 diabetic patients. Nevertheless, more large prospective studies looking at cognition and changes in body composition over time are needed in the future to further support their association.Keywords: cognitive impairment, diabetes, middle age, body composition, sex

Kuang-Ming Liao,1 Jhi-Joung Wang,2,3 Chung-Han Ho2,4,5 1Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan; 2Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; 3Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan; 4Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan; 5Cancer Center, Wan Fang Hospital, Taipei Medical University, Taipei, TaiwanCorrespondence: Chung-Han Ho, Department of Medical Research, Chi Mei Medical Center, No. 901, Zhonghua Road, Yongkang District, Tainan, 710, Taiwan, Email ho.c.hank@gmail.comBackground: Double-blind randomized controlled trials have compared patients with chronic obstructive pulmonary disease (COPD) taking triple therapy, which can improve lung function, dyspnea, and quality of life and reduce acute exacerbation and mortality, with those taking long-acting muscarinic antagonist/long-acting β 2-agonist; however, the real-word treatment scenario may be different from that of a strict and well-designed study. The aim of our study was to assess long-term outcomes among patients with COPD who received triple therapy in real-world practice.Methods: Data from Taiwan’s National Health Insurance Research Database (NHIRD) from 2005 and 2016 were used to identify COPD patients who were over 40 years of age with diagnosis codes 490– 492, 496 (ICD-9-CM) or J41-44 (ICD-10-CM). After matching for age, sex, and COPD exacerbations, COPD patients who did and did not receive triple therapy were enrolled in this study. Cox proportional regression was used to estimate the mortality risk between smoking status and COPD patients with and without triple therapy.Results: A total of 19,358 patients with COPD who did or did not receive triple therapy were enrolled in this study. The prevalence rates of some comorbidities were higher among patients with COPD who received triple therapy than among those who did not receive triple therapy. These comorbidities included lung cancer, thoracic malignancies, bronchiectasis, and heart failure. The risk of mortality was higher among patients who received triple therapy than among those who did not receive triple therapy after matching for age, sex, and COPD exacerbations, with a crude hazard ratio, fully adjusted model hazard ratio and stepwise approach reduced hazard ratio of 1.568 (95% CI, 1.500– 1.639), 1.675 (95% CI, 1.596– 1.757), and 1.677 (95% CI, 1.599– 1.76), respectively.Conclusion: Over 5 years of observation, patients with COPD who received triple therapy did not show a survival benefit compared with those who did not receive triple therapy in a real-world scenario.Keywords: chronic obstructive pulmonary disease, mortality, real-world study, triple therapy

Qi Tian,1,2,&ast; Yi-Xin Zhang,3,&ast; Jin-Jing Wang,4,&ast; Guo-Bao Huang2 1Department of Clinical Medicine, Weifang Medical University, Weifang, People’s Republic of China; 2Department of Burns and Reconstructive Surgery, Central Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China; 3Centre for Translational Medicine, Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China; 4Department of Surgery, Central Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guo-Bao Huang, Department of Burns and Reconstructive Surgery, Central Hospital Affiliated to Shandong First Medical University, No. 105, Jiefang Road, Lixia District, Jinan, Shandong Province, 250013, People’s Republic of China, Tel +86 531-55865707, Email huangguobao@sdu.edu.cnAbstract: Traumatic scar is a disease that affected approximately tens of millions of patients worldwide. According to the histological and morphological properties of scars, the traumatic scar typically includes superficial scar, atrophic scar, hypertrophic scar, and keloid. Its formation is a natural consequence of wound healing, regardless of whether the wound was caused by trauma or surgery. However, the production of scars has considerable impacts on the physical and mental health of patients, even causing substantial aesthetic and functional impairments. Prevention or early treatment of scars is the most suitable therapeutic method, including surgical and non-surgical procedures; nevertheless, the benefits of non-operative therapies for scars are quite limited, and surgical treatments are always hard to achieve satisfying outcomes. Through the application of innovative technologies such as lasers, intense pulsed light, and radiofrequency, significant progress has been made in the treatment of traumatic scars. This review highlights the current advancements of photoelectric therapy for the prevention and treatment of various traumatic scars, which may throw light on innovative therapeutic options for scar therapies.Keywords: scars, photoelectric therapy, lasers, intense pulsed light, radiofrequency

Epidermal growth factor receptor (EGFR) mutation status differs according to ethnicity, gender, smoking history, and histology types. The present study aimed to evaluate EGFR mutation status in patients with non-small cell lung cancer (NSCLC) and further explore its association with clinical characteristics and prognosis in advanced NSCLC patients (Stage IIIB-IV). 238 NSCLC patients were enrolled in this study from October 2016 through December 2019. Patient characteristics and clinical data including age, gender, smoking history, histology types, tumor stage, survival status, and time were collected via electronic medical record system or telephone. 21 somatic mutations which spanned exons 18-21 of EGFR were detected using the amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) method, followed by analysis of links to clinical characteristics, progression-free survival (PFS) and overall survival (OS). 103 patients were detected harboring EGFR mutations among the 238 cases tested (43.3%), and exons 19 and 21 were the highest mutation frequencies, with 20.6% and 19.3% respectively. The EGFR mutation rate was much higher in female versus male (57.4% vs 31.5%, p

Chien-Cheng Huang,1– 3 Tzu-Hao Chen,3,4 Chung-Han Ho,4,5 Yi-Chen Chen,4 Rong-Jane Chen,3,6 Ying-Jan Wang,3 Chien-Chin Hsu,1 Hung-Jung Lin,1,7 Jhi-Joung Wang,8,9 Ching-Ping Chang,4 How-Ran Guo3,10,11 1Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan; 2Department of Emergency Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 4Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; 5Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan; 6Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 7Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan; 8Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan; 9Department of Anesthesiology, National Defense Medical Center, Taipei, Taiwan; 10Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; 11Occupational Safety, Health and Medicine Research Center, National Cheng Kung University Hospital, Tainan, TaiwanCorrespondence: Chien-Cheng Huang, Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, 710, Taiwan, Tel +886-6-281-2811, Fax +886-6-281-6161, Email cmher11001@mail.chimei.org.tw How-Ran Guo, Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 1 Daxue Road, Tainan, 701, Taiwan, Tel +886-6-235-3535, Fax +886-6-275-2484, Email hrguo@mail.ncku.edu.twPurpose: Carbon monoxide (CO) poisoning may damage the pancreas, but the effects of CO poisoning on the development of diabetes and on existing diabetes remain unclear. We conducted a study incorporating data from epidemiologic analyses and animal experiments to clarify these issues.Methods: Using the National Health Insurance Database of Taiwan, we identified CO poisoning patients diagnosed between 2002 and 2016 (CO poisoning cohort) together with references without CO poisoning who were matched by age, sex, and index date at a 1:3 ratio. We followed participants until 2017 and compared the risks of diabetes and hyperglycemic crisis between two cohorts using Cox proportional hazards regressions. In addition, a rat model was used to assess glucose and insulin levels in blood as well as pathological changes in the pancreas and hypothalamus following CO poisoning.Results: Among participants without diabetes history, 29,141 in the CO poisoning cohort had a higher risk for developing diabetes than the 87,423 in the comparison cohort after adjusting for potential confounders (adjusted hazard ratio [AHR]=1.23; 95% confidence interval [CI]: 1.18– 1.28). Among participants with diabetes history, 2302 in the CO poisoning cohort had a higher risk for developing hyperglycemic crisis than the 6906 in participants without CO poisoning (AHR = 2.12; 95% CI: 1.52– 2.96). In the rat model, CO poisoning led to increased glucose and decreased insulin in blood and damages to pancreas and hypothalamus.Conclusion: Our epidemiological study revealed that CO poisoning increased the risks of diabetes and hyperglycemic crisis, which might be attributable to damages in the pancreas and hypothalamus as shown in the animal experiments.Keywords: animal, carbon monoxide poisoning, diabetes, epidemiology, hypothalamus, pancreas

Xin Xu,1,2,&ast; James Jiqi Wang,1,2,&ast; Hu Zhao,1,2 Kun Miao,1,2 Guanglin Cui,1,2 Yuxuan Zhang,1,2 Xiaoyun Yang,1,2 Luyun Wang,1,2 Junfang Wu,2 Dao Wen Wang1,2 1Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 2Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Wuhan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Dao Wen Wang; Junfang Wu, Division of Cardiology, Department of Internal Medicine Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave, Wuhan, 430030, People’s Republic of China, Tel/Fax +86-278366-3280, Email dwwang@tjh.tjmu.edu.cn; junfang.wu@tjh.tjmu.edu.cnBackground: Vasospastic angina (VSA) is caused by severe diffuse or segmental coronary artery spasms. Patients with variant angina have poor clinical outcomes, although nitrates and calcium blockers help improve patient symptoms because there is no understanding of the etiology and causal treatment. The present study investigated whether VSA is associated with inflammation of the heart.Patients and Methods: A total of 109 patients with VSA diagnosed by the presence of recurrent angina pectoris, typical electrocardiography, and coronary angiography were recruited, and 61 normal participants and 61 patients with acute myocardial infarction (AMI) and coronary artery stenosis were recruited as controls. The plasma levels of 24 cytokines were measured using a magnetic Luminex assay, and endothelin-1 and histamine levels tested using enzyme-linked immunosorbent assay and mass-spectrometry, respectively, for all participants. Furthermore, four patients with VSA underwent 18-fluorine fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT).Results: The plasma levels of interleukin (IL)-12p70, IL-13, PDL-1, IL-10, IL-6, IL-15, macrophage inflammatory protein (MIP)-1α, and MIP-1β in patients with VSA were significantly higher than those in both normal controls and patients with AMI (p< 0.001) but did not differ between normal controls and patients with AMI. 18F-FDG PET/CT showed that the left ventricle, coronary perivascular tissue volume, and coronary perivascular FDG uptake were significantly increased in all four patients.Conclusion: Our findings demonstrate that VSA patients have significantly elevated plasma cytokine levels and myocardial and pericoronary inflammation, suggesting that VSA is associated with myocarditis. This study provides novel insights into the etiology and treatment of VSA.Keywords: variant angina, myocarditis, cytokines, inflammation

Chien-An Chen,1,2,&ast; Chung-Han Ho,3– 5,&ast; Yu-Cih Wu,3 Yi-Chen Chen,3 Jhi-Joung Wang,3 Kuang-Ming Liao6 1Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, 71004, Taiwan; 2Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, 71004, Taiwan; 3Department of Medical Research, Chi Mei Medical Center, Tainan, 71004, Taiwan; 4Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, 71005, Taiwan; 5Cancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, 11696, Taiwan; 6Department of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan, 72263, Taiwan&ast;These authors contributed equally to this workCorrespondence: Kuang-Ming Liao, Department of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan, 72263, Taiwan, Tel +886 6 726 3333, Email abc8870@yahoo.com.twPurpose: The incidence of aspergillosis is increasing, and the risk factors for infection include cancer, admission to the intensive care unit, chronic pulmonary diseases, immunocompromised status, and taking immunomodulatory drugs. There are limited data about the incidence of aspergillosis in patients with different types of cancer. The aim of our study was to survey the incidence of aspergillosis in different cancer types from 2006 to 2017.Patients and Methods: Data were collected from the Taiwan Cancer Registry database and International Classification of Diseases, 9th, 10th Revision, and Clinical Modification codes for diagnosing aspergillosis. Patients with a history of aspergillosis before cancer were excluded, and the secondary outcome was the risk of mortality in cancer patients with and without aspergillosis after 1 year.Results: Among 951 cancer patients with a diagnosis of aspergillosis, there were 614 hematopoietic and reticuloendothelial system patients, 100 lung cancer patients, and 73 lymphoma cancer patients. The overall incidence rates of aspergillosis tended to increase significantly from 2006 to 2017 (from 3.50 to 13.37 per 10,000 person-years, p value: < 0.0001). Regarding sex, the incidence rates of aspergillosis in males and females were 12.52 and 7.53 per 10,000 person-years, respectively. Patients with a diagnosis of aspergillosis had a 2.30-fold (95% CI: 2.14– 2.48, p value: < 0.0001) higher risk of mortality than those without aspergillosis.Conclusion: The incidence of aspergillosis was increased in cancer patients, and cancer patients with aspergillosis had a significantly higher risk of mortality than those without aspergillosis.Keywords: aspergillosis, cancer patients, Taiwan Cancer Registry, incidence rate

Yi Wang,1,&ast; Xiao-Ya Wu,2,&ast; Harry HX Wang,1,3 Yu-Ting Li,4 Yu Fu,1,5 Jia-Ji Wang,6,7 Jose Hernandez,8,9 Martin CS Wong3,10,11 1School of Public Health, Sun Yat-Sen University, Guangzhou, People’s Republic of China; 2Shipai Community Health Centre, Tianhe District, Guangzhou, People’s Republic of China; 3JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong Special Administrative Region; 4State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People’s Republic of China; 5Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; 6Guangdong-Provincial Primary Healthcare Association, Guangdong, People’s Republic of China; 7School of Public Health, Guangzhou Medical University, Guangzhou, People’s Republic of China; 8Faculty of Medicine and Health, EDU, Digital Education Holdings Ltd., Kalkara, Malta; 9Green Templeton College, University of Oxford, Oxford, UK; 10School of Public Health, Peking University, Beijing, People’s Republic of China; 11School of Public Health, The Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Harry HX WangSchool of Public Health, Sun Yat-Sen University, No. 74 Zhongshan Road 2, Guangzhou, 510080, People’s Republic of ChinaEmail wanghx27@mail.sysu.edu.cn; haoxiangwang@cuhk.edu.hkBackground: Adherence to lifestyle recommendations remains insufficient in cardiovascular (CV) health management globally. Body constitution, from the perspective of traditional Chinese medicine, is primarily influenced by an individual’s internal metabolism and susceptibility to external pathogenic factors. Nevertheless, less is known about whether body constitutions may play a role in the presence of unhealthy lifestyles. We aimed to explore the associations between body constitutions and unhealthy lifestyles among Chinese individuals at high CV risk.Methods: Computerised data were retrieved from a primary care population-based health record for all 1739 eligible individuals at high CV risk who attended routine check-up in an urbanised, medium-size district in Guangzhou, China. Unhealthy lifestyles were determined in accordance with guideline recommendations. The body constitution was assessed on the basis of physical signs, personality, body symptoms, and the susceptibility to environmental changes, following nationally standard procedure. Binary logistic regression analyses were performed using marginal standardisation method.Results: The participants ranged in age from 20 to 96 years, with a mean age of 69.55 years. There were slightly more females than males (52.3% vs 47.7%). Current smoking, regular drinking, and physical inactivity were most common. Participants with a body constitution of phlegm-and-dampness type (adjusted odds ratio [aOR]=1.999, 95% confidence interval [CI]=1.003– 3.984; p=0.049) tended to be current smokers, and those assessed with special diathesis type (aOR=2.166, 95% CI=1.029– 4.559; p=0.042) had a higher likelihood of being regular drinkers. Having a body constitution type of blood stasis (aOR=1.375, 95% CI=1.029– 1.838; p=0.031) or qi deficient (aOR=1.711, 95% CI=1.080– 2.709; p=0.022) was associated with physical inactivity.Conclusion: Our findings add to current evidence suggesting that an individual’s body constitution is closely related to the presence of unhealthy lifestyles. This offers new insights for health management through body constitution-based strategies to target those at high CV risk who need tailor-made attention in lifestyle modifications during routine primary care.Keywords: body constitution, unhealthy lifestyles, association, primary care, cardiovascular health management

Jia-Jie Wang Medical College, Soochow University, Suzhou, Jiangsu Province, People’s Republic of ChinaCorrespondence: Jia-Jie WangMedical College, Soochow University, No. 199 Ren Ai Road, Industrial Park, Suzhou, Jiangsu Province, People’s Republic of ChinaTel +86 18960810771Email 364352199@qq.comBackground: Patients with chronic obstructive pulmonary disease complicated with coronary heart disease are a major public health problem, but it has not been widely accepted by the public or health professionals, the purpose of this study is to conduct a meta-analysis of the literature reports on the risk of coronary heart disease in patients with chronic obstructive pulmonary disease.Methods: Data sources are PubMed and Web of Science searched up to August 2021. Design is meta-analysis.Results: Literature searches yielded 8877 records, meta-analysis showed that the risk of coronary heart disease in chronic obstructive pulmonary disease patients was 1.24 times higher than that in non-chronic obstructive pulmonary disease patients (HR=1.24,95% CL 1.16– 1.32).Conclusion: The findings suggest that patients with chronic obstructive pulmonary disease are at a higher risk of developing coronary heart disease than non-chronic obstructive pulmonary disease patients.Keywords: meta-analytic methods, coronary heart disease risk, chronic obstructive pulmonary disease, COPD

Yao-Cheng Yang,1,2,* Jun-Jie Wang,3,4,* Yun Huang,1,2 Wei-Xin Cai,1,2 Qian Tao1,2 1Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, 510055, People’s Republic of China; 2Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, 510086, People’s Republic of China; 3Department of Stomatology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, People’s Republic of China; 4School of Stomatology, Jinan University, Guangzhou, 510632, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qian TaoDepartment of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, 56 Lingyuanxi Road, Guangzhou, Guangdong, 510055, People’s Republic of ChinaTel/Fax +86 20-83846030Email taoqian@mail.sysu.edu.cnPurpose: Ameloblastoma is a benign odontogenic neoplasm with a high local recurrence rate if the operation is not thorough. However, a useful clinical tool for the quantitative assessment of the prognosis and risk of postoperative recurrence of ameloblastoma has not yet been constructed. This study aims to develop a prognostic nomogram model for ameloblastoma of the jaw to assist surgeons in surgical decision-making.Patients and Methods: Patients who underwent initial surgery for ameloblastoma in our department from October 2004 to March 2020 were enrolled and randomly divided into training and validation sets. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify the independent prognostic factors, from which a nomogram for predicting 3-, 5- and 10-year recurrence-free survival (RFS) of ameloblastoma was constructed using the training set and internally validated using the validation set. The model performance was assessed by Harrell’s concordance index (C-index) and calibration curves.Results: A total of 302 eligible patients with ameloblastoma were enrolled, 54 of whom were confirmed to relapse during the follow-up period of 6 to 191 months. Four independent predictors, including cortical bone perforation, root(s) resorption, WHO classification, and treatment pattern, were identified and included in the construction of a nomogram for recurrence-free survival (RFS), which showed promising calibration performance and discrimination in the training set (C-index 0.790, 95% confidence interval [CI] 0.735– 0.845) and the validation set (C-index 0.734, 95% CI 0.599– 0.869).Conclusion: A favorable nomogram was developed that accurately predicted the RFS of patients with ameloblastoma based on individual characteristics. Risk stratification using the nomogram could optimize tailored therapy and follow-up.Keywords: ameloblastoma, nomogram, prognosis, recurrence, recurrence-free survival

Le Qiu,* Xu Jin,* Jun-Jie Wang,* Xu-Dong Tang,* Xiao Fang, Shi-Ji Li, Fei Wang, Xu-Lin Chen Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xu-Lin ChenDepartment of Burns, The First Affiliated Hospital of Anhui Medical University, 120 Wanshui Road, Hefei, Anhui, 230088, People’s Republic of ChinaTel +86-551-65908495 Email okcxl@126.comIntroduction: Neutrophil-to-lymphocyte ratio (NLR) is a marker of inflammation. This study aimed to evaluate the potential role of NLR to predict 90-day mortality.Methods: Data of 577 patients with burns over 30% of total body surface area were collected and retrospectively analyzed. The risk factors for 90-day mortality were evaluated using logistic regression analyses. Receiver operating characteristic (ROC) curve analysis of the 3rd day NLR was performed and the optimal cut-off value was calculated. The 90-day mortality rates were compared between high and low NLR groups using Kaplan-Meier analysis.Results: Age, mechanical ventilation, burn index, 3rd day NLR, and 7th day red blood cell and platelet (PLT) counts were found to be independent predictive values for 90-day mortality. In contrast, percentage of total body surface area burned, inhalation injury, 1st day white blood cell and neutrophil counts, the 3rd day lymphocytes and PLT counts, and 7th day hemoglobin level were not independently associated with 90-day mortality. The area under the ROC curve of the 3rd day NLR for severe burn–delayed death prediction was 0.665 (95% confidence interval, 0.591– 0.739), and the optimal cut-off value of the 3rd day NLR was 10.50. The 90-day mortality rates differed significantly between the NLR > 10.5 group and the NLR ≤ 10.5 group (17.03% vs 5.92%, respectively; P < 0.01).Conclusion: These results suggested that the 3rd day NLR was associated with an increased risk of death in severely burned patients; thus, it can provide useful information to predict 90-day mortality.Keywords: burns, neutrophil-to-lymphocyte ratio, 90-day mortality

Chien-Cheng Huang,1– 3 Chung-Han Ho,4,5 Yi-Chen Chen,4 Chien-Chin Hsu,1,6 Hung-Jung Lin,1,7 Jhi-Joung Wang,4,8 How-Ran Guo2,9,10 1Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan; 2Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 3Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan; 4Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; 5Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan; 6Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan; 7Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan; 8Allied AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan, Taiwan; 9Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; 10Occupational Safety, Health and Medicine Research Center, National Cheng Kung University Hospital, Tainan, TaiwanCorrespondence: How-Ran GuoDepartment of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 1 Daxue Road, East District, Tainan City 701, TaiwanTel +886-6-235-3535Fax +886-6-275-2484Email hrguo@mail.ncku.edu.twBackground: In addition to hypoxia, oxidative stress and inflammation due to carbon monoxide (CO) poisoning cause adverse health effects. These mechanisms are related to the occurrence of autoimmune connective tissue disease, but studies on the association between CO poisoning and autoimmune connective tissue disease are limited. We conducted a study to evaluate the occurrence of autoimmune connective tissue disease following CO poisoning.Methods: We identified participants with CO poisoning diagnosed between 1999 and 2012 from the Nationwide Poisoning Database and selected participants without CO poisoning from the Taiwan National Health Insurance Research Database with matching age and index dates at a 1:3 ratio. Sex, underlying comorbidities, and monthly income were also included in the analyses. We followed up the participants until 2013 and made comparison of the risk of autoimmune connective tissue disease between participants with and without CO poisoning.Results: The 23,877 participants with CO poisoning had a higher risk for autoimmune connective tissue disease than the 71,631 participants without CO poisoning (adjusted hazard ratio [AHR], 3.5; 95% confidence interval [CI], 3.1– 3.9) after adjustment for sex, diabetes, Lyme disease, herpes zoster, infectious mononucleosis, hepatitis, HIV infection, liver disease, renal disease, non-CO poisoning or drug abuse, malignancy, hypertension, hyperlipidemia, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, and monthly income. An increased risk was observed even after 4 years of follow-up (AHR, 3.6; 95% CI, 3.0– 4.4).Conclusion: The risk of autoimmune connective tissue disease increased following CO poisoning. Close follow-up of the patients with CO poisoning for the development of connective tissue disease is recommended, and further investigation of the detailed mechanisms is warranted.Keywords: autoimmune, carbon monoxide poisoning, connective tissue disease, hypoxia, inflammation, oxidative stress

Weakly interacting massive particles (WIMPs) may interact with a virtual pion that is exchanged between nucleons. This interaction channel is important to consider in models where the spin-independent isoscalar channel is suppressed. Using data from the first science run of the LUX-ZEPLIN dark matter experiment, containing 60 live days of data in a 5.5 tonne fiducial mass of liquid xenon, we report the results on a search for WIMP-pion interactions. We observe no significant excess and set an upper limit of 1.5 × 10−46 cm2 at a 90% confidence level for a WIMP mass of 33 GeV/c2 for this interaction.

Kuang-Ming Liao,1 Chien-Jen Tseng,2 Yi-Chen Chen,3 Jhi-Joung Wang,3,4 Chung-Han Ho3,51Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan; 2Department of Surgery, Chi Mei Medical Center, Chiali, Taiwan; 3Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; 4Allied AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan, Taiwan; 5Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, TaiwanObjective: The aim of this study was to investigate the outcomes of patients with COPD after laparoscopic cholecystectomy (LC).Patients and methods: All COPD patients who underwent LC from 2000 to 2010 were identified from the Taiwanese National Health Insurance Research Database. The outcomes of hospital stay, intensive care unit (ICU) stay, and use of mechanical ventilation and life support measures in COPD and non-COPD populations were compared.Results: A total of 3,954 COPD patients who underwent LC were enrolled in our study. There were significant differences in the hospitalization period, ICU stay, and use of mechanical ventilation and life support measures between the COPD and non-COPD populations. The mean hospital stay, ICU stay and number of mechanical ventilation days in the COPD and non-COPD groups were 7.81 vs 6.01 days, 5.5 vs 4.5 days and 6.40 vs 4.74 days, respectively. The use of life support measures, including vasopressors and hemodialysis, and the rates of hospital mortality, acute respiratory failure and pneumonia were also increased in COPD patients compared with those in non-COPD patients.Conclusion: COPD increased the risk of mortality, lengths of hospital and ICU stays, ventilator days and poor outcomes after LC in this study.Keywords: COPD, laparoscopic cholecystectomy, outcome

Kuang-Ming Liao,1 Yi-Chen Chen,2 Kuo-Chen Cheng,3 Jhi-Joung Wang,2 Chung-Han Ho2,4 1Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan; 2Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; 3Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 4Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan Objective: The objective of this study was to investigate the trends in COPD patients admitted to the intensive care unit (ICU) in Taiwan from 2003 to 2013. Patients and methods: A retrospective study was conducted to analyze the available data in the National Health Insurance Research Database compiled by the Taiwan Department of Health. We selected patients admitted to the ICU nationwide from 2003 to 2013. Patients older than 40 years with a diagnosis of COPD were enrolled. The ICU admission date was used as the index date. Baseline comorbidities existing before the index date were identified. The comorbidities of interest included diabetes, hypertension, diabetes mellitus, coronary artery disease, stroke, dyslipidemia, cancer, and end-stage renal disease. Results: The number of COPD patients in the ICU increased from 12,384 in 2003 to 13,308 in 2013 (P

Xianzhu Tu,1 Juanjuan Wang,2 Xuming Liu,3 Jiyong Zheng4 1Department of Psychiatry, Seventh People’s Hospital of Wenzhou City, Wenzhou, Zhejiang, People’s Republic of China; 2Department of Neurology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China; 3Department of Radiology, The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China; 4Department of Medical Imaging, The Affiliated Huai’an No 1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, People’s Republic of China Objective: Whether moderate alcohol consumption has health benefits remains controversial, but the harmful effects of excessive alcohol consumption on behavior and brain function are well recognized. The aim of this study was to investigate alcohol-induced regional brain activities and their relationships with behavioral factors. Subjects and methods: A total of 29 alcohol-dependent subjects (9 females and 20 males) and 29 status-matched healthy controls (11 females and 18 males) were recruited. Severity of alcohol dependence questionnaire (SADQ) and alcohol use disorders identification test (AUDIT) were used to evaluate the severity of alcohol craving. Regional homogeneity (ReHo) analysis was used to explore the alcohol-induced regional brain changes. Receiver operating characteristic (ROC) curve was used to investigate the ability of regional brain activities to distinguish alcohol-dependent subjects from healthy controls. Pearson correlations were used to investigate the relationships between alcohol-induced ReHo differences and behavioral factors. Results: Alcohol-dependent subjects related to healthy controls showed higher ReHo areas in the right superior frontal gyrus (SFG), bilateral medial frontal gyrus (MFG), left precentral gyrus (PG), bilateral middle temporal gyrus (MTG), and right inferior temporal gyrus (ITG) and lower ReHo areas in the right cerebellum posterior lobe (CPL), left rectal gyrus (RG), and right cluster of pons and cerebellum anterior lobe (CAL). ROC curve revealed high area under the curve (AUC) values (mean ± SD: 0.864 ± 0.028; range: 0.828–0.911) of ReHo differences. Diagnostic analysis showed that these areas alone discriminated alcohol-dependent subjects from healthy controls with high degree of sensitivities (mean ± SD: 81.25% ± 11.49%; range: 62.5%–100%) and specificities (mean ± SD: 81.75% ± 12.36%; range: 67.5%–100%). Years of drink showed negative correlation with left RG (r = -0.493, p = 0.007), the same finding was shown between AUDIT and right CPL (r = -0.52, p = 0.004). Conclusion: Alcohol dependence is associated with aberrant regional activities in multiple brain areas. ReHo analysis may be a useful biological indicator for the detection of regional brain activities in individuals with alcohol dependence. Keywords: alcohol dependence, regional homogeneity, receiver operating characteristic

Xiang-Jun Tang,1,* Kuan-Ming Huang,1,* Hui Gui,1,* Jun-Jie Wang,2 Jun-Ti Lu,1 Long-Jun Dai,1,3 Li Zhang,1 Gang Wang2 1Department of Neurosurgery, TaiHe Hospital, Hubei University of Medicine, Shiyan, 2Department of Pharmaceutics, Shanghai Eighth People’s Hospital, Jiangsu University, Shanghai, People’s Republic of China; 3Department of Surgery, University of British Columbia, Vancouver, BC, Canada *These authors contributed equally to this work Abstract: As one of the natural herbal flavonoids, myricetin has attracted much research interest, mainly owing to its remarkable anticancer properties and negligible side effects. It holds great potential to be developed as an ideal anticancer drug through improving its bioavailability. This study was performed to investigate the effects of Pluronic-based micelle encapsulation on myricetin-induced cytotoxicity and the mechanisms underlying its anticancer properties in human glioblastoma cells. Cell viability was assessed using a methylthiazol tetrazolium assay and a real-time cell analyzer. Immunoblotting and quantitative reverse transcriptase polymerase chain reaction techniques were used for determining the expression levels of related molecules in protein and mRNA. The results indicated that myricetin-induced cytotoxicity was highly potentiated by the encapsulation of myricetin. Mitochondrial apoptotic pathway was demonstrated to be involved in myricetin-induced glioblastoma cell death. The epidermal growth factor receptor (EGFR)/PI3K/Akt pathway located in the plasma membrane and cytosol and the RAS-ERK pathway located in mitochondria served as upstream and downstream targets, respectively, in myricetin-induced apoptosis. MiR-21 inhibitors interrupted the expression of EGFR, p-Akt, and K-Ras in the same fashion as myricetin-loaded mixed micelles (MYR-MCs) and miR-21 expression were dose-dependently inhibited by MYR-MCs, indicating the interaction of miR-21 with MYR-MCs. This study provided evidence supportive of further development of MYR-MC formulation for preferentially targeting mitochondria of glioblastoma cells. Keywords: myricetin, glioblastoma, EGFR, miR-21, mitochondrial apoptosis, mixed micelles, anticancer, drug delivery

Jijo Jizhou Wang,1 Jennifer M Koterwas,2 Edward H Bedrossian Jr,2 William J Foster2,3 1Lewis Katz School of Medicine, 2Department of Ophthalmology, Lewis Katz School of Medicine, 3Department of Bioengineering, College of Engineering, Temple University, Philadelphia, PA, USA Purpose: The purpose of this study was to analyze the practice management patterns of the current members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) and to determine the use of oral prophylactic antibiotics in an attempt to prevent orbital cellulitis following nonoperative orbital fractures.Patients and methods: A cross-sectional web-based survey was emailed to all the members of ASOPRS regarding their current management of nonsurgical orbital fractures and their experience with orbital cellulitis following nonoperative orbital fractures.Results: The majority of practicing oculoplastic surgeon members of ASOPRS do not routinely prescribe prophylactic antibiotics for patients with nonoperative orbital fractures or patients with orbital fractures whom the physicians are observing and who might potentially need surgical intervention. Among the reported cases of orbital cellulitis following a nonoperative orbital fracture in this survey, more than a quarter of the patients had received prophylactic antibiotics. Furthermore, among physicians who have managed orbital cellulitis following nonoperative fracture, 75% (33 out of 44 physicians) report that

Gang Wang,1,2,* Jun Jie Wang,1,2,* Tony SS To,3 Hua Fu Zhao,3 Jing Wang3 1Department of Pharmaceutics, Shanghai Eighth People’s Hospital, Shanghai, People’s Republic of China; 2College of Pharmacy, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China; 3Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, People’s Republic of China *These authors contributed equally to this work Abstract: Flavonoids, the major polyphenol components in Cotinus coggygria (CC), have been found to show an anticancer effect in our previous study; however, the exact mechanisms of inducing human glioblastoma (GBM) cell death remain to be resolved. In this study, a novel polyvinylpyrrolidone K-30/sodium dodecyl sulfate and polyethyleneglycol-coated liposome loaded with CC flavonoids (CCFs) was developed to enhance solubility and the antibrain tumor effect, and the molecular mechanism regarding how CCF nanoliposomes (CCF-NLs) induce apoptotic cell death in vitro was investigated. DBTRG-05MG GBM cell lines treated with CCF-NLs showed potential antiproliferative effects. Regarding the underlying mechanisms of inducing apoptosis in DBTRG-05MG GBM cells, CCF-NLs were shown to downregulate the expression of antiapoptotic B-cell lymphoma/leukemia 2 (Bcl-2), an apoptosis-related protein family member, but the expression of proapoptotic Bcl-2-associated X protein was enhanced compared with that in controls. CCF-NLs also inhibited the activity of caspase-3 and -9, which is the initiator caspase of the extrinsic and intrinsic apoptotic pathways. Blockade of caspase activation consistently induced apoptosis and inhibited growth in CCF-NL-treated DBTRG-05MG cells. This study further investigated the role of the Akt pathway in the apoptotic cell death by CCF-NLs, showing that CCF-NLs deactivated Akt. Specifically, CCF-NLs downregulated the expression of p-Akt and SIRT1 as well as the level of phosphorylated p53. Together, these results indicated SIRT1/p53-mediated cell death was induced by CCF-NLs, but not by extracellular signal-regulated kinase, in DBTRG-05MG cells. Overall, this study suggested caspase-dependent activation of both the intrinsic and extrinsic signaling pathways, probably through blockade of the SIRT1/p53-mediated mitochondrial and Akt pathways to exert the proapoptotic effect of CCF-NLs in DBTRG-05MG GBM cells. Keywords: Cotinus coggygria flavonoid nanoliposomes, cell death, SIRT1, mitochondrial, PI3K/Akt pathway

TianHong Zhang,1 HuiJun Li,2,3 Kristen A Woodberry,3 Larry J Seidman,3 Annabelle Chow,4 ZePing Xiao,1 JiJun Wang1 1Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Department of Psychology, Florida A&M University, Tallahassee, FL, USA; 3Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA; 4Department of Psychological Medicine, Changi General Hospital, Singapore Abstract: Clinical high risk of psychosis is defined as the period in which the first signs of psychotic symptoms begin to appear. During this period, there is an increased probability of developing frank psychosis. It is crucial to investigate the interaction between psychotic symptoms and the individual’s personality and life experiences in order to effectively prevent, or delay the development of psychosis. This paper presents case reports of three Chinese female subjects with attenuated positive symptoms, attending their initial outpatient assessment in a mental health service, and their longitudinal clinical outcomes. Information regarding each subject’s symptoms and life stressors was collected at 2-month intervals over a 6-month period. The assessments indicated that these women were suffering from the recent onset of symptoms in different ways. However, all three hid their symptoms from others in their school or workplace, and experienced a decline in performance related to their social roles and in their daily functioning. They were often excluded from the social groups to which they had previously belonged. A decline in social activities may be a risk factor in the development of psychosis and a mediator of functional sequelae in psychosis. Effective treatment strategies may include those that teach individuals to gain insights related to their symptoms and a service that provides a context in which individuals can discuss their psychotic symptoms. Keywords: prodromal psychosis, ultra high risk, follow-up, functional sequelae, transition

Sheng Chen,1,* Jin-Jun Wang,2,* Qin-Qin Wang,1 Jun-Wei Hu,1 Shuang Dong,1 Li-Juan Hu,1 Yi-Cheng Jian,1 Xin-Yan Liu,2 Gen-Mei Yang,2 Wu-Jun Xiong1 1Department of Hepatology, Tongji University School of Medicine, Shanghai East Hospital, 2Department of Gerontology, Shanghai Traditional Chinese Medicine University, Shanghai Putuo Central Hospital, Shanghai, People’s Republic of China *These authors contributed equally to this workPurpose: Several randomized controlled clinical trials have been conducted to investigate the role of carvedilol and propranolol on the effect of portal pressure in patients with cirrhosis, leading to controversial results. Current meta-analysis was performed to compare the efficacy of the two drugs on portal pressure.Patients and methods: Two-hundred and ninety eligible patients were recruited. Published studies were selected based on PubMed, the Cochrane Library, Chinese Journal Full-text Database, and Wanfang Database. The outcome measurements included the mean difference (MD) in the percentage of hepatic vein pressure gradient reduction (%HVPG reduction), the risk ratio (RR) of nonresponders in hemodynamic assessment, and the percentage of mean arterial pressure reduction (%MAP reduction). Subgroup analysis was performed.Results: Seven trials were identified (including five acute and three long-term drug administration randomized controlled trials). A summary of pooled MD between the %HVPG reduction is as follows: overall -8.62 (confidence interval [CI] -11.76, -5.48, P

Lung-Shuo Wang,1–4 Chih-Yu Wang,2 Chih-Hui Yang,5 Chen-Ling Hsieh,3,5 Szu-Yu Chen,3,5 Chi-Yen Shen,1 Jia-Jung Wang,2 Keng-Shiang Huang3 1Department of Electrical Engineering, I-Shou University, Kaohsiung, Taiwan; 2Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan; 3The School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan; 4Department of Chinese Medicine, E-Da Hospital, Kaohsiung, Taiwan; 5Department of Biological Science and Technology, I-Shou University, Kaohsiung, Taiwan Abstract: Silver nanoparticles have been used in various fields, and several synthesis processes have been developed. The stability and dispersion of the synthesized nanoparticles is vital. The present article describes a novel approach for one-step synthesis of silver nanoparticles–embedded chitosan particles. The proposed approach was applied to simultaneously obtain and stabilize silver nanoparticles in a chitosan polymer matrix in-situ. The diameter of the synthesized chitosan composite particles ranged from 1.7 mm to 2.5 mm, and the embedded silver nanoparticles were measured to be 15±3.3 nm. Further, the analyses of ultraviolet-visible spectroscopy, energy dispersive spectroscopy, and X-ray diffraction were employed to characterize the prepared composites. The results show that the silver nanoparticles were distributed over the surface and interior of the chitosan spheres. The fabricated spheres had macroporous property, and could be used for many applications such as fungicidal agents in the future. Keywords: silver, nanoparticles, chitosan, anti-fungal

Gang Wang1,2, Jun Jie Wang1, Guang Yi Yang1, Shi Ming Du1, Nan Zeng2, Dong Sheng Li3, Rui Ming Li3, Ji Yan Chen1, Jin Bo Feng3, Shen Hao Yuan1, Fang Ye11Department of Pharmacy, Taihe Hospital, Hubei University of Medicine, Shiyan City, Hubei Province, 2Department of Pharmacy, Chendu Traditional Chinese Medical University, Chendu City, Sichuan Province, 3Hubei Provincial Key Laboratory of Embryo Stem Cells, Shiyan City, Hubei Province, People's Republic of ChinaBackground: Quercetin has been shown to induce apoptosis in a number of cancer cell lines, but a quercetin-loaded nanoliposomal formulation with enhanced antitumor activity in C6 glioma cells and its effect on cancer cell death has not been well studied. The aim of this study was to examine if quercetin-loaded liposomes (QUE-NL) has enhanced cytotoxic effects and if such effects involve type III programmed cell death in C6 glioma cells.Methods: C6 glioma cells were treated with QUE-NL and assayed for cell survival, apoptosis, and necrosis. Levels of reactive oxygen species production and loss of mitochondrial membrane potential (ΔΨm) were also determined by flow cytometry assay to assess the effects of QUE-NL. ATP levels and lactate dehydrogenase activity were measured, and Western blotting was used to assay cytochrome C release and caspase expression.Results: QUE-NL induced type III (necrotic) programmed cell death in C6 glioma cells in a dose-dependent and time-dependent manner. High concentrations of QUE-NL induced cell necrosis, which is distinct from apoptosis and autophagy, whereas liposomes administered alone induced neither significant apoptosis nor necrosis in C6 glioma cells. QUE-NL-induced ΔΨm loss and cytochrome C release had no effect on caspase activation, but decreased ATP levels and increased lactate dehydrogenase activity indicated that QUE-NL stimulated necrotic cell death.Conclusion: C6 glioma cells treated with QUE-NL showed a cellular pattern associated with necrosis without apoptosis and was independent of caspase activity. Nonapoptotic cell death induced by high concentrations of QUE-NL for controlling caspase-independent type III programmed cell death may provide the basis for novel therapeutic approaches to overcome avoidance of apoptosis by malignant cells.Keywords: quercetin, liposome, type III programmed cell death, reactive oxygen species, ATP, mitochondria, C6 glioma cells

Deterministic creation of multiple ferroelectric states with intermediate values of polarization remains challenging due to the inherent bi-stability of ferroelectric switching. Here we show the ability to select any desired intermediate polarization value via control of the switching pathway in (111)-oriented PbZr0.2Ti0.8O3 films. Such switching phenomena are driven by kinetic control of the volume fraction of two geometrically different domain structures which are generated by two distinct switching pathways: one direct, bipolar-like switching and another multi-step switching process with the formation of a thermodynamically-stable intermediate twinning structure. Such control of switching pathways is enabled by the competition between elastic and electrostatic energies which favors different types of ferroelastic switching that can occur. Overall, our work demonstrates an alternative approach that transcends the inherent bi-stability of ferroelectrics to create non-volatile, deterministic, and repeatedly obtainable multi-state polarization without compromising other important properties, and holds promise for non-volatile multi-state functional applications.

We present a statistical analysis of the first 300 stars observed by the Gemini Planet Imager Exoplanet Survey. This subsample includes six detected planets and three brown dwarfs; from these detections and our contrast curves we infer the underlying distributions of substellar companions with respect to their mass, semimajor axis, and host stellar mass. We uncover a strong correlation between planet occurrence rate and host star mass, with stars M ∗ >1.5 M o more likely to host planets with masses between 2 and 13M Jup and semimajor axes of 3-100 au at 99.92% confidence. We fit a double power-law model in planet mass (m) and semimajor axis (a) for planet populations around high-mass stars (M ∗ >1.5 M o) of the form , finding α = -2.4 +0.8 and β = -2.0 +0.5, and an integrated occurrence rate of % between 5-13M Jup and 10-100 au. A significantly lower occurrence rate is obtained for brown dwarfs around all stars, with % of stars hosting a brown dwarf companion between 13-80M Jup and 10-100 au. Brown dwarfs also appear to be distributed differently in mass and semimajor axis compared to giant planets; whereas giant planets follow a bottom-heavy mass distribution and favor smaller semimajor axes, brown dwarfs exhibit just the opposite behaviors. Comparing to studies of short-period giant planets from the radial velocity method, our results are consistent with a peak in occurrence of giant planets between ∼1 and 10 au. We discuss how these trends, including the preference of giant planets for high-mass host stars, point to formation of giant planets by core/pebble accretion, and formation of brown dwarfs by gravitational instability.

Wildfire-altered soil may be an important source of polycyclic aromatic hydrocarbons (PAHs) in the environment. With projected increase of wildfire frequency and intensity due to changing global climate, understanding the quantity and speciation of PAHs, including halogenated PAHs (XPAHs), resulting from different burn intensities has important ramifications for environmental quality concerns and global soil carbon dynamics. Here, we quantified levels of 16 U.S. Environmental Protection Agency regulated PAHs, 3 chlorinated PAHs, and 6 brominated PAHs in nonburned forest soils and burned ash/soil samples covered with black ash (B-Ash; moderate burn intensity) or white ash (W-Ash; severe burn intensity) from the 2013 Rim Fire (1,041 km 2 ) in California. The - 16 PAH concentrations follow (mean ± standard deviation; μg/kg) B-Ash (893 ± 285) > W-Ash (515 ± 333) ≈ nonburned soils (247 ± 58). Moreover, the - 16 PAH profiles were altered by both moderate and severe burn conditions with the size of aromatic structures following B-Ash > W-Ash > nonburned soils. Neither chlorinated nor brominated PAH concentration was significantly elevated by moderate or severe wildfire. Overall, fire intensity is critical in regulating soil PAH concentrations and profiles. Given the high erodibility of wildfire ash, these PAHs can be easily transported to rivers and reservoirs where they could impact the aquatic food web and drinking source water.

We present new high resolution imaging of a light-scattering dust ring and halo around the young star HD 35841. Using spectroscopic and polarimetric data from the Gemini Planet Imager in H-band (1.6 μm), we detect the highly inclined (i = 85°) ring of debris down to a projected separation of ∼12 au (∼0.″12) for the first time. Optical imaging from HST/STIS shows a smooth dust halo extending outward from the ring to >140 au (>1.″4). We measure the ring's scattering phase function and polarization fraction over scattering angles of 22°-125°, showing a preference for forward scattering and a polarization fraction that peaks at ∼30% near the ansae. Modeling of the scattered-light disk indicates that the ring spans radii of ∼60-220 au, has a vertical thickness similar to that of other resolved dust rings, and contains grains as small as 1.5 μm in diameter. These models also suggest the grains have a low porosity, are more likely to consist of carbon than astrosilicates, and contain significant water ice. The halo has a surface brightness profile consistent with that expected from grains pushed by radiation pressure from the main ring onto highly eccentric but still bound orbits. We also briefly investigate arrangements of a possible inner disk component implied by our spectral energy distribution models, and speculate about the limitations of Mie theory for doing detailed analyses of debris disk dust populations.

We explore KLIP forward modeling spectral extraction on Gemini Planet Imager coronagraphic data of HR 8799, using PyKLIP, and show algorithm stability with varying KLIP parameters. We report new and re-reduced spectrophotometry of HR 8799 c, d, and e in the H and K bands. We discuss a strategy for choosing optimal KLIP PSF subtraction parameters by injecting simulated sources and recovering them over a range of parameters. The K1/K2 spectra for HR 8799 c and d are similar to previously published results from the same data set. We also present a K-band spectrum of HR 8799 e for the first time and show that our H-band spectra agree well with previously published spectra from the VLT/SPHERE instrument. We show that HR 8799 c and d show significant differences in their H and K spectra, but do not find any conclusive differences between d and e, nor between c and e, likely due to large error bars in the recovered spectrum of e. Compared to M-, L-, and T-type field brown dwarfs, all three planets are most consistent with mid- and late-L spectral types. All objects are consistent with low gravity, but a lack of standard spectra for low gravity limit the ability to fit the best spectral type. We discuss how dedicated modeling efforts can better fit HR 8799 planets' near-IR flux, as well as how differences between the properties of these planets can be further explored.

The Gemini Planet Imager Exoplanet Survey (GPIES) is a multiyear direct imaging survey of 600 stars to discover and characterize young Jovian exoplanets and their environments. We have developed an automated data architecture to process and index all data related to the survey uniformly. An automated and flexible data processing framework, which we term the Data Cruncher, combines multiple data reduction pipelines (DRPs) together to process all spectroscopic, polarimetric, and calibration data taken with GPIES. With no human intervention, fully reduced and calibrated data products are available less than an hour after the data are taken to expedite follow up on potential objects of interest. The Data Cruncher can run on a supercomputer to reprocess all GPIES data in a single day as improvements are made to our DRPs. A backend MySQL database indexes all files, which are synced to the cloud, and a front-end web server allows for easy browsing of all files associated with GPIES. To help observers, quicklook displays show reduced data as they are processed in real time, and chatbots on Slack post observing information as well as reduced data products. Together, the GPIES automated data processing architecture reduces our workload, provides real-Time data reduction, optimizes our observing strategy, and maintains a homogeneously reduced dataset to study planet occurrence and instrument performance.

We present evidence that the recently discovered, directly imaged planet HD 131399 Ab is a background star with nonzero proper motion. From new JHK1L′ photometry and spectroscopy obtained with the Gemini Planet Imager, VLT/SPHERE, and Keck/NIRC2, and a reanalysis of the discovery data obtained with VLT/SPHERE, we derive colors, spectra, and astrometry for HD 131399 Ab. The broader wavelength coverage and higher data quality allow us to reinvestigate its status. Its near-infrared spectral energy distribution excludes spectral types later than L0 and is consistent with a K or M dwarf, which are the most likely candidates for a background object in this direction at the apparent magnitude observed. If it were a physically associated object, the projected velocity of HD 131399 Ab would exceed escape velocity given the mass and distance to HD 131399 A. We show that HD 131399 Ab is also not following the expected track for a stationary background star at infinite distance. Solving for the proper motion and parallax required to explain the relative motion of HD 131399 Ab, we find a proper motion of 12.3 mas yr-1. When compared to predicted background objects drawn from a galactic model, we find this proper motion to be high but consistent with the top 4% fastest-moving background stars. From our analysis, we conclude that HD 131399 Ab is a background K or M dwarf.

We present spectrophotometry spanning 1-5 μm of 51 Eridani b, a 2-10 planet discovered by the Gemini Planet Imager Exoplanet Survey. In this study, we present new K1 (1.90-2.19 μm) and K2 (2.10-2.40 μm) spectra taken with the Gemini Planet Imager as well as an updated L P (3.76 μm) and new M S (4.67 μm) photometry from the NIRC2 Narrow camera. The new data were combined with J (1.13-1.35 μm) and H (1.50-1.80 μm) spectra from the discovery epoch with the goal of better characterizing the planet properties. The 51 Eri b photometry is redder than field brown dwarfs as well as known young T-dwarfs with similar spectral type (between T4 and T8), and we propose that 51 Eri b might be in the process of undergoing the transition from L-type to T-type. We used two complementary atmosphere model grids including either deep iron/silicate clouds or sulfide/salt clouds in the photosphere, spanning a range of cloud properties, including fully cloudy, cloud-free, and patchy/intermediate-opacity clouds. The model fits suggest that 51 Eri b has an effective temperature ranging between 605 and 737 K, a solar metallicity, and a surface gravity of log(g) = 3.5-4.0 dex, and the atmosphere requires a patchy cloud atmosphere to model the spectral energy distribution (SED). From the model atmospheres, we infer a luminosity for the planet of -5.83 to -5.93 (logL/L⊙), leaving 51 Eri b in the unique position of being one of the only directly imaged planets consistent with having formed via a cold-start scenario. Comparisons of the planet SED against warm-start models indicate that the planet luminosity is best reproduced by a planet formed via core accretion with a core mass between 15 and 127 M⊕.

We present a new matched-filter algorithm for direct detection of point sources in the immediate vicinity of bright stars. The stellar point-spread function (PSF) is first subtracted using a Karhunen-Loéve image processing (KLIP) algorithm with angular and spectral differential imaging (ADI and SDI). The KLIP-induced distortion of the astrophysical signal is included in the matched-filter template by computing a forward model of the PSF at every position in the image. To optimize the performance of the algorithm, we conduct extensive planet injection and recovery tests and tune the exoplanet spectra template and KLIP reduction aggressiveness to maximize the signal-to-noise ratio (S/N) of the recovered planets. We show that only two spectral templates are necessary to recover any young Jovian exoplanets with minimal S/N loss. We also developed a complete pipeline for the automated detection of point-source candidates, the calculation of receiver operating characteristics (ROC), contrast curves based on false positives, and completeness contours. We process in a uniform manner more than 330 data sets from the Gemini Planet Imager Exoplanet Survey and assess GPI typical sensitivity as a function of the star and the hypothetical companion spectral type. This work allows for the first time a comparison of different detection algorithms at a survey scale accounting for both planet completeness and false-positive rate. We show that the new forward model matched filter allows the detection of 50% fainter objects than a conventional cross-correlation technique with a Gaussian PSF template for the same false-positive rate.

We present H band spectroscopic and Hμ photometric observations of HD 100546 obtained with the Gemini Planet Imager and the Magellan Visible AO camera. We detect H band emission at the location of the protoplanet HD 100546 b, but show that the choice of data processing parameters strongly affects the morphology of this source. It appears point-like in some aggressive reductions, but rejoins an extended disk structure in the majority of the others. Furthermore, we demonstrate that this emission appears stationary on a timescale of 4.6 years, inconsistent at the 2σ level with a Keplerian clockwise orbit at 59 au in the disk plane. The H band spectrum of the emission is inconsistent with any type of low effective temperature object or accreting protoplanetary disk. It strongly suggests a scattered-light origin, as this is consistent with the spectrum of the star and the spectra extracted at other locations in the disk. A non-detection at the 5σ level of HD 100546 b in differential Hμ imaging places an upper limit, assuming the protoplanet lies in a gap free of extinction, on the accretion luminosity of 1.7 ? 10-4 L o and for 1 R Jup. These limits are comparable to the accretion luminosity and accretion rate of T-Tauri stars or LkCa 15 b. Taken together, these lines of evidence suggest that the H band source at the location of HD 100546 b is not emitted by a planetary photosphere or an accreting circumplanetary disk but is a disk feature enhanced by the point-spread function subtraction process. This non-detection is consistent with the non-detection in the K band reported in an earlier study but does not exclude the possibility that HD 100546 b is deeply embedded.

We present new observations of the low-mass companion to HD 984 taken with the Gemini Planet Imager (GPI) as a part of the GPI Exoplanet Survey campaign. Images of HD 984 B were obtained in the J (1.12-1.3 μm) and H (1.50-1.80 μm) bands. Combined with archival epochs from 2012 and 2014, we fit the first orbit to the companion to find an 18 au (70-year) orbit with a 68% confidence interval between 14 and 28 au, an eccentricity of 0.18 with a 68% confidence interval between 0.05 and 0.47, and an inclination of 119°with a 68% confidence interval between 114°and 125°. To address the considerable spectral covariance in both spectra, we present a method of splitting the spectra into low and high frequencies to analyze the spectral structure at different spatial frequencies with the proper spectral noise correlation. Using the split spectra, we compare them to known spectral types using field brown dwarf and low-mass star spectra and find a best-fit match of a field gravity M6.5 ±1.5 spectral type with a corresponding temperature of K. Photometry of the companion yields a luminosity of log(Lbol/L⊙)=2.88 ± 0.07 dex with DUSTY models. Mass estimates, again from DUSTY models, find an age-dependent mass of 34 ±1 to 95 ±4 M Jup. These results are consistent with previous measurements of the object.

Using the Gemini Planet Imager located at Gemini South, we measured the near-infrared (1.0-2.4 μm) spectrum of the planetary companion to the nearby, young star β Pictoris. We compare the spectrum obtained with currently published model grids and with known substellar objects and present the best matching models as well as the best matching observed objects. Comparing the empirical measurement of the bolometric luminosity to evolutionary models, we find a mass of 12.9 ±0.2 , an effective temperature of 1724 ±15 K, a radius of 1.46 ±0.01 , and a surface gravity of [dex] (cgs). The stated uncertainties are statistical errors only, and do not incorporate any uncertainty on the evolutionary models. Using atmospheric models, we find an effective temperature of 1700-1800 K and a surface gravity of -4.0 [dex] depending upon the model. These values agree well with other publications and with "hot-start" predictions from planetary evolution models. Further, we find that the spectrum of β Pic b best matches a low surface gravity L2 ±1 brown dwarf. Finally, comparing the spectrum to field brown dwarfs, we find the the spectrum best matches 2MASS J04062677-381210 and 2MASS J03552337+1133437.

We present H-band near-infrared polarimetric imaging observations of the F5V star HD 157587 obtained with the Gemini Planet Imager (GPI) that reveal the debris disk as a bright ring structure at a separation of ∼80-100 au. The new GPI data complement recent Hubble Space Telescope/STIS observations that show the disk extending out to over 500 au. The GPI image displays a strong asymmetry along the projected minor axis as well as a fainter asymmetry along the projected major axis. We associate the minor and major axis asymmetries with polarized forward scattering and a possible stellocentric offset, respectively. To constrain the disk geometry, we fit two separate disk models to the polarized image, each using a different scattering phase function. Both models favor a disk inclination of ∼70° and a 1.5 ± 0.6 au stellar offset in the plane of the sky along the projected major axis of the disk. We find that the stellar offset in the disk plane, perpendicular to the projected major axis is degenerate with the form of the scattering phase function and remains poorly constrained. The disk is not recovered in total intensity due in part to strong adaptive optics residuals, but we recover three point sources. Considering the system's proximity to the galactic plane and the point sources' positions relative to the disk, we consider it likely that they are background objects and unrelated to the disk's offset from the star.

A principal scientific goal of the Gemini Planet Imager (GPI) is obtaining milliarcsecond astrometry to constrain exoplanet orbits. However, astrometry of directly imaged exoplanets is subject to biases, systematic errors, and speckle noise. Here, we describe an analytical procedure to forward model the signal of an exoplanet that accounts for both the observing strategy (angular and spectral differential imaging) and the data reduction method (Karhunen-Loève Image Projection algorithm). We use this forward model to measure the position of an exoplanet in a Bayesian framework employing Gaussian processes and Markov-chain Monte Carlo to account for correlated noise. In the case of GPI data on β Pic b, this technique, which we call Bayesian KLIP-FM Astrometry (BKA), outperforms previous techniques and yields 1σ errors at or below the one milliarcsecond level. We validate BKA by fitting a Keplerian orbit to 12 GPI observations along with previous astrometry from other instruments. The statistical properties of the residuals confirm that BKA is accurate and correctly estimates astrometric errors. Our constraints on the orbit of β Pic b firmly rule out the possibility of a transit of the planet at 10-σ significance. However, we confirm that the Hill sphere of β Pic b will transit, giving us a rare chance to probe the circumplanetary environment of a young, evolving exoplanet. We provide an ephemeris for photometric monitoring of the Hill sphere transit event, which will begin at the start of April in 2017 and finish at the end of January in 2018.

We present the discovery of a brown dwarf companion to the debris disk host star HR 2562. This object, discovered with the Gemini Planet Imager (GPI), has a projected separation of 20.3 ± 0.3 au (0.″618 ± 0. ″004) from the star. With the high astrometric precision afforded by GPI, we have confirmed, to more than 5?, the common proper motion of HR 2562B with the star, with only a month-long time baseline between observations. Spectral data in the J-, H-, and K-bands show a morphological similarity to L/T transition objects. We assign a spectral type of L7 ± 3 to HR 2562Band derive a luminosity of log(Lbol/L⊙) = -4.62 ± 0.12, corresponding to a mass of 30 ± 15 MJup from evolutionary models at an estimated age of the system of 300-900 Myr. Although the uncertainty in the age of the host star is significant, the spectra and photometry exhibit several indications of youth for HR 2562B. The source has a position angle that is consistent with an orbit in the same plane as the debris disk recently resolved with Herschel. Additionally, it appears to be interior to the debris disk. Though the extent of the inner hole is currently too uncertain to place limits on the mass of HR 2562B, future observations of the disk with higher spatial resolution may be able to provide mass constraints. This is the first brown-dwarf-mass object found to reside in the inner hole of a debris disk, offering the opportunity to search for evidence of formation above the deuterium burning limit in a circumstellar disk.

Using the Gemini Planet Imager, we have resolved the circumstellar debris disk around HD 111520 at a projected range of ∼30-100 AU in both total and polarized H-band intensity. The disk is seen edge-on at a position angle of 165° along the spine of emission. A slight inclination and asymmetric warp are covariant and alter the interpretation of the observed disk emission. We employ three point-spread function subtraction methods to reduce the stellar glare and instrumental artifacts to confirm that there is a roughly 2:1 brightness asymmetry between the NW and SE extension. This specific feature makes HD 111520 the most extreme example of asymmetric debris disks observed in scattered light among similar highly inclined systems, such as HD 15115 and HD 106906. We further identify a tentative localized brightness enhancement and scale height enhancement associated with the disk at ∼40 AU away from the star on the SE extension. We also find that the fractional polarization rises from 10% to 40% from 0.″5 to 0.″8 from the star. The combination of large brightness asymmetry and symmetric polarization fraction leads us to believe that an azimuthal dust density variation is causing the observed asymmetry.

We present the first scattered-light image of the debris disk around HD 131835 in the H band using the Gemini Planet Imager. HD 131835 is a ∼15 Myr old A2IV star at a distance of ∼120 pc in the Sco-Cen OB association. We detect the disk only in polarized light and place an upper limit on the peak total intensity. No point sources resembling exoplanets were identified. Compared to its mid-infrared thermal emission, in scattered light the disk shows similar orientation but different morphology. The scattered-light disk extends from ∼75 to ∼210 AU in the disk plane with roughly flat surface density. Our Monte Carlo radiative transfer model can describe the observations with a model disk composed of a mixture of silicates and amorphous carbon. In addition to the obvious brightness asymmetry due to stronger forward scattering, we discover a weak brightness asymmetry along the major axis, with the northeast side being 1.3 times brighter than the southwest side at a 3σ level.

We present the first scattered light detections of the HD 106906 debris disk using the Gemini/Gemini Planet Imager in the infrared and Hubble Space Telescope (HST)/Advanced Camera for Surveys in the optical. HD 106906 is a 13 Myr old F5V star in the Sco-Cen association, with a previously detected planet-mass candidate HD 106906b projected 650 AU from the host star. Our observations reveal a near edge-on debris disk that has a central cleared region with radius ∼50 AU, and an outer extent >500 AU. The HST data show that the outer regions are highly asymmetric, resembling the "needle" morphology seen for the HD 15115 debris disk. The planet candidate is oriented ∼21° away from the position angle of the primary's debris disk, strongly suggesting non-coplanarity with the system. We hypothesize that HD 106906b could be dynamically involved in the perturbation of the primary's disk, and investigate whether or not there is evidence for a circumplanetary dust disk or cloud that is either primordial or captured from the primary. We show that both the existing optical properties and near-infrared colors of HD 106906b are weakly consistent with this possibility, motivating future work to test for the observational signatures of dust surrounding the planet.

We present new Gemini Planet Imager observations of the young exoplanet 51 Eridani b that provide further evidence that the companion is physically associated with 51 Eridani. Combining this new astrometric measurement with those reported in the literature, we significantly reduce the posterior probability that 51 Eridani b is an unbound foreground or background T-dwarf in a chance alignment with 51 Eridani to 2 × 10-7, an order of magnitude lower than previously reported. If 51 Eridani b is indeed a bound object, then we have detected orbital motion of the planet between the discovery epoch and the latest epoch. By implementing a computationally efficient Monte Carlo technique, preliminary constraints are placed on the orbital parameters of the system. The current set of astrometric measurements suggest an orbital semimajor axis of AU, corresponding to a period of years (assuming a mass of 1.75 Mo for the central star), and an inclination of deg. The remaining orbital elements are only marginally constrained by the current measurements. These preliminary values suggest an orbit that does not share the same inclination as the orbit of the distant M-dwarf binary, GJ 3305, which is a wide physically bound companion to 51 Eridani.