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Liyun Zou,1,* Qiufeng Wei,1,* Sining Pan,1,* Fei Xiao,1,2 Yage Jiang,1 Yu Zhong,1 Yubo Xie1,3 1Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China; 2Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yubo Xie; Yu Zhong, Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China, Tel +86 13977121557 ; +86 15177929679, Email xybdoctor@163.com; zzlugl@163.comBackground: Perioperative anesthetic management of patients with diabetic foot undergoing surgical treatment is challenging due to their poor cardiovascular health status. According to previous literature, general anesthesia and peripheral nerve block have their own advantages and disadvantages for such patients. We reported the effect of these two anesthesia techniques on perioperative hemodynamics and prognosis in these patients.Methods: This study employed a prospective randomized controlled design, where patients meeting the inclusion criteria were assigned to two groups: the general anesthesia group (GA group) and the peripheral nerve block group (PNB group). The primary outcomes were the differences in intraoperative hemodynamic stability and the incidence of postoperative complications between the two groups. The second outcomes were postoperative numerical rating scale scores, analgesic drug remedies, postoperative sleep conditions monitored by sleep bracelets and health status assessed by EQ-5D-5 L scores.Results: One hundred and nine subjects were enrolled in this study, including 54 in the GA group and 55 in the PNB group. The baseline parameters of the two groups were comparable. The GA group exhibited a significantly higher incidence of hypotension, and Colloid intake and total fluid intake were significantly higher in the GA group than in the PNB group. Additionally, a larger proportion of patients in the GA group. The scores of postoperative pain during the 48 hours after surgery were significantly higher, and more patients needed tramadol for postoperative analgesia during the 24 h after surgery in the GA group than in the PNB group. Patients in the PNB group slept better, first feeding time, earlier out-of-bed activity and earlier discharge from the hospital, compared to the GA group. However, there was no obvious difference in postoperative complications between the two groups except pharyngeal pain.Conclusion: Peripheral nerve block is a better option in patients with diabetes undergoing elective below-knee surgery than general anesthesia.Keywords: diabetic foot, general anesthesia, peripheral nerve block, hemodynamic, postoperative pain, postoperative complication

Xiao-Xia Sun, Jing Qian, Jia-Ming Fan, Lin Liu, Xia-Fang Jin, Fei Xiao Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing City, People’s Republic of ChinaCorrespondence: Xia-Fang Jin; Fei Xiao, Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing City, People’s Republic of China, Tel +86573-83963131, Email jxjxf@126.com; 13706587501@163.comBackground: Ondansetron reduces the median effective dose (ED50) of prophylactic phenylephrine to prevent spinal-induced hypotension (SIH) during cesarean delivery. However, the exact dose response of phenylephrine in combination with prophylactic ondansetron for preventing SIH is unknown. Therefore, this study aimed to determine the dose-response of phenylephrine to prevent SIH in cesarean delivery when 4 mg of ondansetron was used as a preventive method.Methods: A total of 80 parturients were enrolled and divided randomly into four groups (n = 20 in each group) who received either 0.2, 0.3, 0.4, or 0.5 μg/kg/min of prophylactic phenylephrine. Ten minutes before the initiation of spinal induction, 4 mg prophylactic ondansetron was administered. The effective dose of prophylactic phenylephrine was defined as the dose required to prevent hypotension after the period of intrathecal injection and up to neonatal delivery. The ED50 and ED90 of prophylactic phenylephrine and 95% confidence intervals (95% CI) were calculated using probit analysis.Results: The ED50 and ED90 for prophylactic phenylephrine to prevent SIH were 0.25 (95% CI, 0.15 to 0.30), and 0.45 (95% CI, 0.39 to 0.59) μg/kg/min, respectively. No significant differences were observed in the side effects and neonatal outcomes between the four groups.Conclusion: The administration of 4 mg of prophylactic ondansetron was associated with an ED50 of 0.25 (95% CI, 0.15~0.30) and ED90 of 0.45 (95% CI, 0.39~0.59) μg/kg/min for phenylephrine to prevent SIH.Keywords: phenylephrine, ondansetron, dose-response, hypotension, cesarean delivery, spinal

Hao Guo,1,* Li-Heng Li,2,* Xiao-Hong Lv,1,* Feng-Zhi Su,1,* Jie Chen,1,* Fei Xiao,1,3 Min Shi,1 Yu-Bo Xie1,3 1Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China; 2Department of Anesthesiology, The Guilin Municipal Hospital of Traditional Chinese Medicine, Guangxi, People’s Republic of China; 3Guangxi Key Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yu-Bo Xie, Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530000, People’s Republic of China, Tel +86 13977121557, Email xybdoctor@163.comPurpose: Postoperative sleep disturbance, characterized by diminished postoperative sleep quality, is a risk factor for postoperative delirium (POD); however, the association between pre-existing sleep disturbance and POD remains unclear. This study aimed to evaluate the association between preoperative sleep disturbance and POD in elderly patients after non-cardiac surgery.Patients and methods: This retrospective cohort study was conducted at a single center and enrolled 489 elderly patients who underwent surgery between May 1, 2020, and March 31, 2021. Patients were divided into the sleep disorder (SD) and non-sleep disorder (NSD) groups according to the occurrence of one or more symptoms of insomnia within one month or sleep- Numerical Rating Scale (NRS)≥ 6 before surgery. The primary outcome was the incidence of POD. Propensity score matching analysis was performed between the two groups. Multiple logistic regression analysis was performed to identify the risk factors for POD.Results: In both the unmatched cohort (16.0% vs 6.7%, P=0.003) and the matched cohort (17.0% vs 6.2%, P=0.023), the incidence of POD was higher in the SD group than in the NSD group. In addition, the postoperative sleep quality and the VAS score at postoperative 24 h were significantly lower in the SD group than in the NSD group. Multivariate logistic regression analysis indicated that age (Odds Ratio, 1.13 [95% CI: 1.04– 1.23], P=0.003) and preoperative sleep disturbance (Odds Ratio, 3.03 [95% CI: 1.09– 9.52], P=0.034) were independent risk factors for the development of POD.Conclusion: The incidence of POD was higher in patients with pre-existing sleep disturbance than those without it. Whether improving sleep quality for preoperative sleep disturbance may help prevent POD remains to be determined.Keywords: sleep disturbances, postoperative delirium, postoperative sleep quality, postoperative pain, anesthesia

Pingyang Ke,1,* Jing Liu,1,2,* Chengzhi Chen,3,* Sen Luo,3,* Huiwen Gu,3,* Juan Gu,4 Yan Liu,1 Yuanlin Ma,1 Yuan Meng,1 Liqin Hu,1 Xin Tian,1 Fei Xiao1 1Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, People’s Republic of China; 2Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, People’s Republic of China; 3Department of Occupational and Environmental Health, School of Public Health and Management, Chongqing Medical University, Chongqing, People’s Republic of China; 4Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, Sichuan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Fei Xiao; Xin Tian, Email feixiao81@126.com; xintian@cqmu.edu.cnBackground: Zinc oxide nanoparticles (ZnO NPs) has been widely used in various fields and has had an important impact on human public health. In addition, it inevitably damages human health, including neurological diseases. Therefore, this study explored the effect of ZnO NPs on epilepsy.Methods: The effect of ZnO NPs on epilepsy was observed by behavioral analysis. TLR4 expression and autophagy related pathways were detected by RNA-seq and Western blot. In addition, the cell types of autophagy were detected by immunofluorescence. Further, the electrophysiological changes of ZnO NPs induced autophagy were detected by whole-cell patch-clamp. Finally, the recovery experiment was carried out by TLR4 inhibitor (TAK-242).Results: We found that ZnO NPs enhanced epilepsy susceptibility and severity. Through RNA-seq analysis and Western blot, it was found that ZnO NPs affected the changes of TLR4 and autophagy related pathways. In addition, we found that ZnO NPs mainly affects autophagy of inhibitory neurons, resulting in excitation/inhibition imbalance. The autophagy and epileptic phenotypes were reversed with TAK-242. In general, ZnO NPs exacerbate epileptic seizures by modulating the TLR4-autophagy axis.Conclusion: ZnO NPs enhanced the susceptibility and severity of epilepsy. Mechanistically, ZnO NPs affected autophagy by changing the expression of TLR4. In particular, the ZnO NPs mainly affected the synaptic function of inhibitory neuron, leading to excitation/inhibition imbalances.Keywords: zinc oxide nanoparticles, epilepsy, excitation/inhibition balance, autophage

Xiaolu Li,1,* Yizhong Wang,1,2,* Rong Cao,1 Fangfei Xiao,1 Xufei Wang,1 Lin Ye,1 Yongmei Xiao,1 Dan Li,1 Ting Zhang1,2 1Department of Gastroenterology, Hepatology and Nutrition, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China; 2Gut Microbiota and Metabolic Research Center, Institute of Pediatric Infection, Immunity and Critical Care Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yizhong Wang; Ting Zhang, Department of Gastroenterology, Hepatology and Nutrition, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, 355 Luding Road, Shanghai, 200062, People’s Republic of China, Tel/Fax +86 2152976335, Email wangyz@shchildren.com.cn; zhangt@shchildren.com.cnBackground: Our previous study reported a high rate of recurrence in children with Clostridioides difficile (C. difficile) infection (CDI) after conventional antibiotic therapy. Here, we aimed to explore whether metronidazole and vancomycin resistant C. difficile isolates are circulating in pediatric CDI.Methods: Antimicrobial susceptibility testing (AST) using the agar dilution method according to the Clinical and Laboratory Standard Institute (CLSI) were performed on C. difficile isolates collected from children with CDI between 2019 and 2022 at the Shanghai Children’s Hospital. Whole-genome sequencing (WGS) was performed on all C. difficile isolates, and the presence of antibiotic resistance genes (ARGs) were identified using Resfinder and the Comprehensive Antibiotic Resistance Database (CARD). The presence of plasmid pCD-METRO was detected using SRST2 (v0.2.0) against 8 pCD-METRO coding sequences.Results: A total of 50 C. difficile isolates were collected from stools of CDI children. The overall resistance rate on all isolates was 30.00% for metronidazole, 6.00% for vancomycin, 0% for rifaximin, 2.00% for rifampin, 24.00% for meropenem, 100.00% for ceftriaxone and clindamycin, 86.00% for erythromycin, 30.0% for levofloxacin, and 50.0% for tetracycline. Multidrug-resistant (MDR) was presented in 44 isolates (88.00%). Sixteen reported potential ARGs relating with resistance to antibiotic classes of aminoglycoside (AAC(6’)-Ie-APH(2”)-Ia, aad(6), ANT(6)-Ib, APH(2”)-If, APH(3’)-IIIa), lincosamide-clindamycin-erythromycin (ErmB, ErmQ), fluoroquinolones (CdeA), glycopeptides (vanRG), nucleoside (SAT-4), tetracycline (tetM, tetA(P), tetB(P), tetO), and trimethoprim (dfrF) were identified. However, the pCD-METRO plasmid and vanA/B were not detected in any isolates.Conclusion: C. difficile isolates from children with reduced susceptibility to metronidazole and vancomycin are emerging in pediatric CDI in China. The lack of pCD-METRO plasmid and vanA/B associated with reduced antibiotic susceptibility suggests there are additional mechanisms of resistance.Keywords: Clostridioides difficile, antibiotic resistance, metronidazole, vancomycin, children

Chunmei Chen,1 Yujie Zhu,2 Fanghao Xiao,3 Mingkun Que4 1Teachers College, Jimei University, Xiamen, Fujian, 361021, People’s Republic of China; 2School of Marine Culture and Law, Jimei University, Xiamen, Fujian, 361021, People’s Republic of China; 3School of Foreign Languages, Xiamen Institute of Technology, Xiamen, Fujian, 361021, People’s Republic of China; 4College of Education, Zhejiang University, Hangzhou, Zhejiang, 310058, People’s Republic of ChinaCorrespondence: Fanghao Xiao; Mingkun Que, Email xiaofanghao@xit.edu.cn; quemingkun@zju.edu.cnBackground: The phenomenon of university students’ learning burnout has attracted the research of many scholars because of its typicality. This study aims to explore the relationship between life satisfaction, academic motivation, social support and learning burnout among university students and its underlying mechanisms.Methods: A total of 1917 university students participated in this cross-sectional study. Research instruments included the Adolescent Student Life Satisfaction Scale, University Students’ Academic Motivation Questionnaire, Adolescent Learning Burnout Scale and Adolescent Social Support Scale. The data analysis comprised descriptive statistics, correlation analyses, and assessment of multicollinearity through Variance Inflation Factor (VIF). Advanced analyses were conducted using Model 4 for mediation and Model 1 for moderation from the PROCESS macro.Results: (1) life satisfaction significantly and positively predicts academic motivation; (2) academic motivation significantly and negatively predicts learning burnout; and (3) life satisfaction significantly and negatively predicts learning burnout; (4) academic motivation partially mediates the effect of life satisfaction on learning burnout; and (5) social support plays a moderating role in the effect of academic motivation on learning burnout.Discussions: These results illuminate the complex web of relationships among life satisfaction, academic motivation, social support, and learning burnout. The partial mediating role of academic motivation underscores its significance in the link between life satisfaction and learning burnout. Additionally, the moderating impact of social support emphasizes its role in ameliorating or exacerbating the effects of academic motivation on learning burnout.Conclusion: These findings can help researchers and educators better understand the underlying mechanisms between life satisfaction and learning burnout. Meanwhile, the results of the study can provide practical and effective operational suggestions for preventing and intervening in university students’ learning burnout and improving their academic motivation.Keywords: life satisfaction, learning burnout, academic motivation, social support, mediating effect, moderating effect

Jin Zhang,1 Mengyang He,2 Qiduo Yu,1 Fei Xiao,1 Yongming Zhang,3 Chaoyang Liang1 1Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, People’s Republic of China; 2Graduate School, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 3Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital; National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of ChinaCorrespondence: Yongming Zhang; Chaoyang Liang, No. 2 Yinghua East Street, Chao Yang District, Beijing, 100029, People’s Republic of China, Tel/Fax +86-10-8420 6191, Email cacpzym@163.com; liangchaoyang@zryhyy.com.cnBackground: Asthma is a public health problem requiring focused attention. This study aimed to systematically evaluate the association between dietary structure and asthma or wheezing in children.Methods: The study protocol of this meta-analysis has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration code CRD42023390191. A total of 8397 articles were retrieved, searching PubMed, Medline, Embase, Web of Science, and Scopus databases as of November 21, 2022. Two independent authors were responsible for independently conducting the literature screening process. Effect-size estimates were expressed as odds ratio (OR) in cross-sectional studies and risk ratio (RR) in cohort studies with a 95% confidence interval (CI). Summary effect estimates were evaluated with random-effect models. Meanwhile, subgroup and sensitivity analyses were performed to assess the potential sources of heterogeneity and the robustness of the pooled estimation.Results: A total of 65 studies, including 567,426 subjects had been analyzed. Overall analyses of cross-sectional studies revealed that a healthy diet was protective against asthma (adjusted OR=0.85, 95% CI: 0.80– 0.89, P < 0.001, I2=69.8%, Tau2=0.026) and wheezing (adjusted OR=0.85, 95% CI: 0.81– 0.89, P < 0.001, I2=66.8%, Tau2=0.015) in children and adolescents. Conversely, unhealthy diets can exacerbate asthma (adjusted OR=1.28, 95% CI: 1.20– 1.36, P < 0.001, I2=64.9%, Tau2=0.019) and wheeze (adjusted OR=1.09, 95% CI: 1.02– 1.16, P =0.006, I2=75.2%, Tau2=0.023) in children and adolescents. The same trend was found in cohort studies (adjusted RR=0.72, 95% CI: 0.58– 0.90, P =0.003, I2=83.5%, Tau2=0.105). A clear trend was observed between high-frequency healthy diets (OR=0.80; 95% CI: 0.71– 0.89; P < 0.001) is more protective against asthma than low-frequency healthy diets (OR=0.81; 95% CI: 0.70– 0.94; P =0.007).Conclusion: Our findings highlight the protective effects of a healthy diet on asthma and wheezing in children, including fruit, seafood, cereals, and the Mediterranean diet.Keywords: dietary habits, wheezing, asthma, children, meta-analysis

Using the particle swarm optimization algorithm, we conducted an extensive search for the high-pressure stable structure of technetium diboride (TcB2) within the pressure range of 0–400 GPa. At zero pressure, the P63/mmc (hP6-TcB2) structure is considered the ground state configuration. As the pressure increases, a structural transition from hP6-TcB2 to P6/mmm (hP3-TcB2) occurs at approximately 174.9 GPa. We discuss the bonding between the two distinct phases and analyze the contribution of different atomic bonds to maintaining their structural stability. Meanwhile, the temperature–pressure phase diagram of TcB2 was successfully determined for the first time through the quasi-harmonic approximation method. It is predicted that the transition pressure from hP6-TcB2 to hP3-TcB2 can be reduced to about 164 GPa at a room temperature of 300 K. These results provide valuable insights into the behavior of TcB2 under different temperature and pressure conditions and open up new possibilities for exploring its potential applications in a variety of environments. [ABSTRACT FROM AUTHOR]

Jiawen He,1,2,&ast; Ruixiang Song,1,&ast; Fengfeng Xiao,2 Meng Wang,3 Liewei Wen2 1Key Laboratory of Biomedical Engineering of Hainan Province, School of Biomedical Engineering, Hainan University, Haikou, People’s Republic of China; 2Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Jinan University, Zhuhai, People’s Republic of China; 3Center for Biomedical Optics and Photonics (CBOP) & College of Physics and Optoelectronic Engineering, Key Laboratory of Optoelectronic Devices and Systems of Guangdong Province and Ministry of Education, Shenzhen University, Shenzhen, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Liewei Wen, Zhuhai People’s Hospital, (Zhuhai Hospital Affiliated with Jinan University), Jinan University, Zhuhai, Guangdong, 519000, People’s Republic of China, Tel +86-756-2158358, Fax +86-756-2157515, Email wenliewei@ext.jnu.edu.cn; wenner1989@163.com Meng Wang, Center for Biomedical Optics and Photonics (CBOP) & College of Physics and Optoelectronic Engineering, Key Laboratory of Optoelectronic Devices and Systems of Guangdong Province and Ministry of Education, Shenzhen University, Shenzhen, People’s Republic of China, Email wangmengst@szu.edu.cnPurpose: Photothermal therapy (PTT) is a promising anticancer treatment that involves inducing thermal ablation and enhancing antitumor immune responses. However, it is difficult to completely eradicate tumor foci through thermal ablation alone. Additionally, the PTT elicited antitumor immune responses are often insufficient to prevent tumor recurrence or metastasis, due to the presence of an immunosuppressive microenvironment. Therefore, combining photothermal and immunotherapy is believed to be a more effective treatment approach as it can modulate the immune microenvironment and amplify the post-ablation immune response.Methods: Herein, the indoleamine 2, 3‐dioxygenase‐1 inhibitors (1-MT) loaded copper (I) phosphide nanocomposites (Cu3P/1-MT NPs) are prepared for PTT and immunotherapy. The thermal variations of the Cu3P/1-MT NPs solution under different conditions were measured. The cellular cytotoxicity and immunogenic cell death (ICD) induction efficiency of Cu3P/1-MT NPs were analyzed by cell counting kit-8 assay and flow cytometry in 4T1 cells. And the immune response and antitumor therapeutic efficacy of Cu3P/1-MT NPs were evaluated in 4T1-tumor bearing mice.Results: Even at low energy of laser irradiation, Cu3P/1-MT NPs remarkably enhanced PTT efficacy and induced immunogenic tumor cell death. Particularly, the tumor-associated antigens (TAAs) could help promote the maturation of dendritic cells (DCs) and antigen presentation, which further activates infiltration of CD8+ T cells through synergistically inhibiting the indoleamine 2, 3‐dioxygenase‐1. Additionally, Cu3P/1-MT NPs decreased the suppressive immune cells such as regulatory T cells (Tregs) and M2 macrophages, indicating an immune suppression modulation effect.Conclusion: Cu3P/1-MT nanocomposites with excellent photothermal conversion efficiency and immunomodulatory properties were prepared. In addition to enhanced the PTT efficacy and induced immunogenic tumor cell death, it also modulated the immunosuppressive microenvironment. Thereby, this study is expected to offer a practical and convenient approach to amplify the antitumor therapeutic efficiency with photothermal-immunotherapy.Keywords: copper (I) phosphide (Cu3P), photothermal therapy, IDO‐1 inhibitors, immunotherapy

Chunmei Chen,1 Yuanyi Shen,2 Yujie Zhu,3 Fanghao Xiao,4 Jiawen Zhang,5 Jianchao Ni2 1Teachers College, Jimei University, Xiamen, Fujian, People’s Republic of China; 2School of Aerospace Engineering, Xiamen University, Xiamen, Fujian, People’s Republic of China; 3School of Marine Culture and Law, Jimei University, Xiamen, Fujian, People’s Republic of China; 4College of Computer and Information Engineering, Xiamen Institute of Technology, Xiamen, Fujian, People’s Republic of China; 5Silliman University, Dumaguete City, Negros Oriental, Philippines & Xiamen Institute of Software Technology, Xiamen, Fujian, People’s Republic of ChinaCorrespondence: Fanghao Xiao; Jiawen Zhang, Email xiaofanghao@xit.edu.cn; zhangjiawen1989@gmail.comBackground: With the popularization of higher education, the problems of academic adaptability and learning burnout among college students have become increasingly prominent. The purpose of this study was to investigate the relationship between academic adaptability, learning burnout, self-esteem and self-efficacy of college students and their underlying mechanisms.Methods: The study was conducted on 2110 college students using the College Student Learning Adjustment Scale, the Learning Burnout Undergraduates Scale, the Self-Esteem Scale, and the Self-Efficacy Scale to establish a mediating model of adjustment. SPSS 26.0 was used for descriptive statistics and Pearson correlation analysis. Model 4 and Model 14 in the process plug-in prepared by Hayes (2017) were used for mediating effects analysis and moderating mediator analysis respectively, and the significance of the mediating effects was tested using the bias-corrected percentile Bootstrap method.Results: (1) academic adaptability significantly and positively predicted self-esteem; (2) self-esteem significantly and negatively predicted learning burnout; (3) academic adaptability significantly and negatively predicted learning burnout; (4) self-esteem partially mediated the effect of academic adaptability on learning burnout; and (5) self-efficacy moderated the latter half of the mediation process of academic adaptability-self-esteem-learning burnout.Conclusion: These findings are useful for college educators and related researchers to better understand the mechanisms underlying the relationship between academic adaptability and learning burnout, thus providing practical and effective operational suggestions on the prevention and intervention of learning burnout in college students.Keywords: academic adaptability, learning burnout, self-esteem, self-efficacy, moderated mediation model

Yang Yang,1 Jun Zhang,2 Fang Han,3 Fulong Xiao4 1Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People’s Republic of China; 2Department of Neurology, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China; 3Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China; 4Department of General Internal Medicine, Peking University People’s Hospital, Beijing, 100044, People’s Republic of ChinaCorrespondence: Fang Han; Fulong Xiao, Peking University People’s Hospital, No. 11, South Avenue, Beijing, People’s Republic of China, Email hanfang1@hotmail.com; xiaofulong1681@163.comObjective: To detect the factors associated with total and subscales impulsivity scores in narcolepsy and further explore the non-linear relationship between these factors and impulsivity score.Methods: One hundred and fifty-eight narcolepsy type 1 (NT1) patients were involved in this cross-sectional study. Patients completed questionnaires evaluating impulsivity symptoms (Barratt impulse scale-11, BIS-11), depression symptoms (Center for Epidemiologic Studies Depression Scale for Children, CES-DC or Self-Rating Depression Scale, SDS) and sleepiness (Epworth Sleepiness Scale, ESS). Parameters from polysomnography and multiple sleep latency test were also collected. Linear regression analysis was performed to detect the factors associated with total and subscales impulsivity scores. Then, generalized additive models and smooth curve fitting were performed to explore the non-linear relationship between chronological age and impulsivity scores.Results: Factors associated with higher total impulsivity score were higher ESS, older onset and adolescents. Factors associated with higher attentional impulsivity score were higher ESS, older onset and adolescents. Factors associated with higher motor impulsivity score were higher ESS, younger onset and depression symptoms. Factors associated with higher non-planning impulsivity score were adolescents, older onset and depression symptoms. A non-linear relationship between age and impulsivity scores (total impulsivity score, attentional impulsivity score and non-planning impulsivity score) was detected in NT1 patients.Conclusion: Not only excessive daytime sleepiness but also onset-age, depression symptoms and chronological age were associated with impulsivity in NT1 patients. The non-linear relationship between age and impulsivity scores suggested brain and mental development alterations in NT1 patients.Keywords: narcolepsy, impulsivity, excessive daytime sleepiness, depression, smooth curve fitting

Li-Ying Liu,1,&ast; Zi-Lei Tian,1,&ast; Fu-Ting Zhu,1 Han Yang,1 Fang Xiao,1 Rong-Rong Wang,1 Ling Chen,1 Zhi-Yong Xiao,1 Si-Yi Yu,1 Fan-Rong Liang,1 Wen-Hui Hu,2 Jie Yang1,2 1Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People’s Republic of China; 2Clinical Research Center for Acupuncture and Moxibustion in Sichuan province, Chengdu Xinan Gynecological Hospital, Chengdu, Sichuan Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jie Yang No. 37 Shi’er Qiao Road, Chengdu, Sichuan, 610023, People’s Republic of ChinaTel +86 138 82296714Email jenny_yang_jie@126.comWen-Hui Hu No. 66 Bisheng Road, Chengdu, Sichuan, 610023, People’s Republic of ChinaTel +86 130 56699956Email 642926505@qq.comObjective: To obtain evidence-based conclusions about the effect of acupuncture on pain relief in women undergoing oocyte retrieval, the results of randomized controlled trials (RCTs) that met the criteria were assessed on the Pain Assessment Scale and pregnancy indicators.Search Methods: References were retrieved in MEDLINE, EMBASE, CNKI database, CBM database, VIP database, and Wanfang database from inception to June 26, 2021. Unpublished ongoing trials were searched in the Clinical Trials Registries. This review included RCTs that investigated the acupuncture analgesic effects during oocyte retrieval in women undergoing in vitro fertilization.Results: Fourteen RCTs (2503 women in total) with six types of comparisons were finally included. The quality of concluding evidence was generally low or very low. Performance bias and outcome assessment bias was the main risk of bias of the included studies. Acupuncture combined with conscious sedation and analgesia (CSA) was associated with less intraoperative (SMD=− 1.03; 95% CI: − 1.71 to − 0.36) and postoperative (SMD = − 1.11; 95% CI: − 1.51 to − 0.71) pain compared to receive CSA alone in oocyte retrieval. Acupuncture with non-steroidal anti-inflammatory drugs (NSAIDs) was more effective than using NSAIDs alone for postoperative analgesia (MD = − 1.76; 95% CI: − 2.08 to − 1.44).Conclusion: Acupuncture complex analgesic therapy is more effective than utilizing CSA or NSAIDs alone. Furthermore, there is no significant consensus on whether there is an analgesic effect of applying acupuncture alone during oocyte retrievals, which needs further research. The overall results should be interpreted with caution due to the high risk of bias/low-GRADE scores among these studies.Protocol and Registration: PROSPERO registration number: CRD42020170095.Keywords: acupuncture, analgesia, oocyte retrieval, meta-analysis, systematic review

Feng Xiao, Jianrong Zhou School of Nursing, Chongqing Medical University, Chongqing, 400016, People’s Republic of ChinaCorrespondence: Jianrong ZhouSchool of Nursing, Chongqing Medical University, No. 1 Changda Road, Jiulongpo District, Chongqing, 400016, People’s Republic of ChinaEmail jianrong_zhou@21cn.comBackground: Nasopharyngeal carcinoma (NPC) is mainly concentrated in East and Southeast Asia. This study aims to elucidate the potential associations of functional SNPs in the fat mass and obesity associated gene (FTO) with NPC risk and radiotherapy outcomes in a Chinese population.Methods: Functional SNP rs1477196 G>A, rs9939609 T>A, rs7206790 C>G, and rs8047395 A>G were genotyped and evaluated for their associations with NPC risk and radiotherapy outcomes.Results: Both rs9939609 (allele A versus allele T: OR=1.59; 95% CI=1.17– 2.17; P-value=0.003) and rs8047395 (allele G versus allele A: OR=0.76; 95% CI=0.64– 0.9; P-value=0.002) were significantly associated with risk of NPC. GTEx showed risk allele A of rs9939609 and rs8047395 were significantly associated with higher FTO mRNA levels in skeletal muscle tissue, which also corroborated our findings. Meanwhile, both rs1477196 (allele A versus allele G: OR=1.64; 95% CI=1.09– 2.49; P-value=0.019) and rs9939609 (allele A versus allele T: OR=0.61; 95% CI=0.43– 0.87; P-value=0.006) were significantly associated with complete remission (CR) of NPC.Conclusion: Our study identified that FTO polymorphisms contributed to the susceptibility and radiotherapy efficacy of NPC. These results shed light on the potential of establishing markers for predicting risk and personalized treatment of NPC.Keywords: nasopharyngeal carcinoma, FTO, predisposition, radiotherapy

Yang Yang,1,&ast; Chenyang Li,2,&ast; Long Zhao,2 Jing Li,2 Fang Han,2 Fulong Xiao3 1Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China; 2Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China; 3Department of General Internal Medicine, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Fang Han; Fulong XiaoPeking University People’s Hospital, No. 11, South Avenue, Beijing, People’s Republic of ChinaEmail hanfang1@hotmail.com; xiaofulong1681@163.comObjective: We evaluate the association between depression symptoms, clinical features (disease onset-age, disease duration, sleep-related hallucination), sleepiness, and polysomnography parameters in adolescent narcolepsy type 1 patients.Methods: Eighty-three adolescent narcolepsy type 1 patients were involved in this cross-sectional study. Patients completed questionnaires evaluating depression symptoms (Center for Epidemiologic Studies Depression Scale) and sleepiness (Epworth Sleepiness Scale). Parameters from polysomnography and multiple sleep latency test were also collected.Results: Patients with depression symptoms (62.7%) have later disease onset-age. Depression symptoms were associated with sleep-related hallucination (OR = 2.75). Six independent variables were associated with sub-dimensional depression symptoms, including sleep latency, sleep efficiency, sleep-related hallucination, Epworth sleepiness scale, disease duration, and disease onset-age.Conclusion: Sleep-related hallucination is associated with total depression symptoms in adolescent narcolepsy. Subjective sleepiness is associated with depressed affect, somatic symptoms, and interpersonal problems. Lower sleep efficiency is associated with a lack of positive affect.Keywords: narcolepsy, adolescents, depression symptoms, hypnagogic/hypnopompic hallucination

Guoshuai Cai, 1,* Zhu Xia, 2,* Leigh Charvet, 3 Feifei Xiao, 4 Abhishek Datta, 5, 6 X Michelle Androulakis 7, 8,* 1Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA; 2Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, People’s Republic of China; 3Department of Neurology, NYU Grossman School of Medicine, New York City, NY, USA; 4Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA; 5Research and Development, Soterix Medical, New York, NY, USA; 6Department of Biomedical Engineering, City College of New York, New York, NY, USA; 7Neurology, Columbia VA Health System, Columbia, SC, USA; 8School of Medicine, University of South Carolina, Columbia, SC, USA*These authors contributed equally to this workCorrespondence: X Michelle AndroulakisColumbia VA Health System, 6439 Garners Ferry Road, Columbia, SC, 29209, USAEmail Xiao.androulakis@va.govPurpose: Transcranial direct current stimulation (tDCS) may have therapeutic potential in the management of migraine. However, studies to date have yielded conflicting results. We reviewed studies using repeated tDCS for longer than 4 weeks in migraine treatment, and performed meta-analysis on the efficacy of tDCS in migraine.Methods: In this meta-analysis, we included the common outcome measurements reported across randomized controlled trials (RCTs). Subgroup analysis was performed at different post-treatment endpoints, and with different stimulation intensities and polarities.Results: Five RCTs were included in the quantitative meta-analysis with a total of 104 migraine patients. We found a significant reduction of migraine pain intensity (MD: − 1.44; CI: [− 2.13, − 0.76]) in active vs sham tDCS treated patients. Within active treatment groups, pain intensity and duration were significantly improved from baseline after tDCS treatment (intensity MD: − 1.86; CI: [− 3.30, − 0.43]; duration MD: − 4.42; CI: [− 8.11, − 0.74]) and during a follow-up period (intensity MD: − 1.52; CI: [− 1.84, − 1.20]; duration MD: − 1.94; CI: [− 3.10, − 0.77]). There was a significant reduction of pain intensity by both anodal (MD: − 1.74; CI: [− 2.80, − 0.68]) and cathodal (MD: − 1.49; CI: [− 1.89, − 1.09]) stimulation conditions.Conclusion: tDCS treatment repeated over days for a period of 4 weeks or more is effective in reducing migraine pain intensity and duration of migraine episode. The benefit of tDCS can persist for at least 4 weeks after the completion of last tDCS session. Both anodal and cathodal stimulation are effective for reducing migraine pain intensity.Keywords: transcranial direct current stimulation (tDCS), neuromodulation, migraine, meta-analysis

Ting-Ting Chen,* Feng Xiao,* Nan Li, Shan Shan, Meng Qi, Zi-Ying Wang, Sheng-Nan Zhang, Wei Wei, Wu-Yi Sun Institute of Clinical Pharmacology, Anhui Medical University, Key Laboratory of Anti-Inflammatory and Immune Medicine, Ministry of Education, Anhui Collaborative Innovation Center of Anti-Inflammatory and Immune Medicine, Hefei, Anhui Province, 230032, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wu-Yi Sun; Wei WeiInstitute of Clinical Pharmacology, Anhui Medical University, Key Laboratory of Anti-Inflammatory and Immune Medicine, Ministry of Education, Anhui Collaborative Innovation Center of Anti-Inflammatory and Immune Medicine, 81 Meishan Road, Hefei, Anhui Province, 230032, People’s Republic of ChinaTel/Fax +86 551 65161209Email sunwuyi51@aliyun.com; wwei@ahmu.edu.cnAbstract: Fibrosis is the final stage of the development of chronic inflammation. It is characterized by excessive deposition of the extracellular matrix, leading to tissue structure damage and organ dysfunction, which is a serious threat to human health and life. However, the molecular mechanism of fibrosis is still unclear. Inflammasome is a molecular complex of proteins that has been becoming a key innate sensor for host immunity and is involved in pyroptosis, pathogen infection, metabolic syndrome, cellular stress, and tumor metastasis. Inflammasome signaling and downstream cytokine responses mediated by the inflammasome have been found to play an important role in fibrosis. The inflammasome regulates the secretion of IL-1β and IL-18, which are both critical for the process of fibrosis. Recently, researches on the function of inflammasome have attracted extensive attention, and data derived from these researches have increased our understanding of the effects and regulation of inflammasome during fibrosis. In this review, we emphasize the growing evidence for both indirect and direct effects of inflammasomes in triggering fibrosis as well as potential novel targets for antifibrotic therapies.Keywords: inflammasome, fibrosis, NLRP3, AIM2, caspase-1

Yi Zhang,1 Xiujin Shi,1 Jialun Han,1 Wenxing Peng,1 Zhenwei Fang,1 Yang Zhou,1 Xiaoyu Xu,1 Jie Lin,2,3 Fucheng Xiao,4 Limin Zhao,3 Yang Lin1 1Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China; 2Department of Endocrinology and Metabolism, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China; 3Department of Atherosclerosis, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, People’s Republic of China; 4Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of ChinaCorrespondence: Yang LinDepartment of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, 100029, People’s Republic of ChinaTel/Fax +86-10-64456045Email linyang3623@outlook.comIntroduction: As the primary immune cells, macrophages play a key role in atherosclerotic progression. M2 macrophage polarization has been reported to promote tissue repair and attenuate plaque formation upon the expression of anti-inflammatory factors. Convallatoxin (CNT) is a natural cardiac glycoside with anti-inflammatory pharmacological properties. However, whether CNT protects against atherosclerosis (AS) and underlying mechanisms is unknown. This work was designed to explore the potential effects of CNT on atherosclerosis.Methods: In this study, Apolipoprotein E deficiency (ApoE−/-) mice fed with high-fat diet were established, and CNT (50 or 100 μg/kg) were intragastrically administrated for 12 weeks every day. In vitro, RAW264.7 macrophages stimulated with ox-LDL were treated with CNT (50 or 100 nM) for 24 h. The specific PPARγ antagonist, GW9662, was used to block the PPARγ signaling pathway in vitro. Then, the atherosclerotic lesions, macrophage polarization markers, inflammatory cytokines and PPARγ signaling pathway were examined in further examinations.Results: Our results showed that the atherosclerotic lesions were reduced by CNT, as demonstrated by the downregulation of serum lipid level and aortic plaque area in AS mice. Furthermore, we found that CNT treatment promoted the expression of M2 macrophage markers (Arg1, Mrc1, Retnla and Chi3l3), and decreased the levels of pro-inflammatory cytokines (IL-6 and TNF-α), accompanied by the increase of anti-inflammatory factor (IL-10) in aortic vessels of AS mice. In ox-LDL-induced RAW264.7 cells, CNT administration also facilitated macrophages polarizing towards M2 subtype and inhibited inflammatory responses. Furthermore, both the in vivo and in vitro experiments showed CNT could increase the expression of PPARγ, Integrin αv and Integrin β5, and GW9662 could block CNT-induced M2 macrophage polarization.Conclusion: Taken together, these data suggest that CNT may promote M2 macrophage polarization to exert an anti-atherosclerotic effect, partially through activating PPARγ-Integrin αvβ5 signaling pathway.Keywords: atherosclerosis, convallatoxin, macrophage polarization, ox-LDL, PPARγ-Integrin αvβ5 signaling pathway