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Abstract Background To investigate the quantitative vascular and structural differences in the foveal region of the eyes in retinopathy of prematurity children with or without anti-vascular endothelial growth factor (VEGF) therapy and healthy children using optical coherence tomography angiography (OCTA). Methods This cross-sectional study analyzed 75 eyes from 44 subjects, categorized into four groups: ROP children treated with Conbercept or Ranibizumab, spontaneously regressed ROP, and healthy age-matched children. Using spectral-domain OCT and OCTA, we assessed parameters like central foveal thickness (CFT), foveal avascular zone (FAZ), superficial/deep capillary plexus (SCP/DCP), and choroidal vessel density (VD) at the fovea. Correlations between foveal microvasculature, preterm status and visual acuity were evaluated. Results Significant differences were found in FAZ area, CFT, and VD-SCP (parafoveal) among the groups. The FAZ area was smaller in ROP children (with/without treatment) than in healthy counterparts(p = 0.009). CFT was higher in the Ranibizumab and spontaneously regressed groups compared to healthy ones (p = 0.043, p = 0.037), while Conbercept-treated children showed no significant difference (p = 0.886). Foveal VD trends were higher in groups A, B, and C compared to group D. FAZ area correlated negatively with CFT, VD-SCP (foveal), and VD-DCP (foveal) (p

BackgroundHypoparathyroidism is the most common complication for patients who undergo total thyroidectomy (TT) with bilateral central lymph node dissection (BCLND). The objective of this retrospective study was to investigate the relationship between parathyroid autotransplantation (PA) and postoperative hypoparathyroidism.Materials and MethodsFour hundred and sixty-five patients with papillary thyroid carcinoma (PTC) who underwent TT with BCLND (including prophylactic and therapeutic BCLND) by the same surgeon were enrolled in this retrospective study. They were divided into five groups based on the number of PAs. Group 0 was defined as no PA, while Group 1, 2, 3, and 4 were considered as 1, 2, 3, and 4 PAs during TT with BCLND, respectively.ResultsTransient and permanent hypoparathyroidism occurred in 83 (17.8%) and 2 (0.4%) patients who underwent TT and BCLND, respectively. The incidence of transient hypoparathyroidism increased gradually with an increase in the number of PAs. Compared with the previous group, Groups 2 and 3 had significantly more cases of transient hypoparathyroidism (p=0.03 and p=0.04, respectively). All cases of permanent hypoparathyroidism occurred in the patients without PA. Compared with Group 0, there were more removed central lymph nodes (RCLNs) in patients with one PA. Furthermore, Group 2 had more metastatic central lymph nodes(MCLNs) and RCLNs than Group 1.The number of PAs was the only identified risk factor for transient hypoparathyroidism after the multivariate logistic regression analysis. The median parathyroid hormone level recovered to the normal range within 1 month after surgery.ConclusionWith an increasing number of PAs, the possibility of transient hypoparathyroidism also increases in patients with PTC who undergo TT and BCLND. Considering the rapid recovery of transient hypoparathyroidism in 1 month, two PAs during TT and BCLND could be a good choice, leading to an increase in the central lymph node yield and no permanent hypoparathyroidism. However, this conclusion should be validated in future multicenter prospective studies.

Vertical gardens have become important strategies for urban heat island migration in recent years. However, the simulation tools for green façade (GF) with climbing plants coupling the shading and wind-induced effects are still lacked. This study focused on GF effects on human thermal comfort (HTC) optimization in a transitional space. The main purpose was to develop a couple method on HTC simulations. Field measurements in a hot-humid climate area were conducted to obtain the parameters of GF foliage layers. A couple simulation method with Ansys Fluent, Ladybug, and Honeybee tools was developed. Seven GFs layouts on a standard balcony model were simulated. In field measurements, the Ave. global irradiation was reduced by 73.29%, leaf area index was measured at 1.56–3.61, and foliage cover ratio was measured at 49.74–92.88%. In the simulations, the results of the Ave. wind velocity were reduced by 0.20–0.77 m s−1, the Ave. air temperature was reduced by 0.2°C, the Ave. mean radiant temperature was reduced by 0.5–7°C, and the Ave. physiological equivalent temperature was reduced by 0.3–3.2°C. The couple method could support the architectural and landscape design integrating with the GFs in future.

Milk allergy is one of the most common food allergies, in which αS-casein is the major milk allergen. Under optimized conditions, mixed starter (containing Lactobacillus plantarum 7-2 and commercial starter) effectively degraded αS-casein of skimmed milk and reduced the pressure of stomach digestion. The fermented milk prepared by mixed starter was determined by ELISA, the antigenicity of αS-casein was reduced by 77.53%. Compared with the fermented milk prepared by commercial starter, label-free quantitative proteomics demonstrated that the mixed starter more efficiently degraded the epitopes of major milk allergens and influenced the digestion pattern of the fermented milk. Therefore, L. plantarum 7-2 shows positive potential in reducing the antigenicity of αS-casein and others. In addition, this study predicted that the new epitopes produced in the fermentation process could induce immunity using molecular simulation.

Abstract Based on 22 qualitative traits, 13 quantitative traits, and 27 molecular markers (26 SSR and 1 InDel), in the current study we compared the diversity and population structure of 94 local landraces and 85 current breeding lines of pepper in China. The results showed that the Shannon Diversity indices of 9 qualitative traits and 8 quantitative traits in current breeding lines were greater than those of landraces, of which 11 were fruit organ-related traits. Compared with current breeding lines, the mean values of Gene Diversity index and Polymorphism Information content of local landraces were higher by 0.08 and 0.09, respectively. Population structure and phylogenetic tree analysis showed that the 179 germplasm resources could be divided into two taxa, dominated by local landraces and current breeding lines, respectively. The above results indicated that the diversity of quantitative traits of current breeding lines were higher than that of local landraces, especially traits related to fruit organs, but the genetic diversity based on molecular markers was lower than that of local landraces. Therefore, in the future breeding process, we should not only focus on the selection of target traits, but also strengthen the background selection based on molecular markers. Moreover, the genetic information of other domesticated species and wild species will be transferred to the breeding lines through interspecific crosses to expand the genetic background of the breeding material.

Abstract Background Professional calling (PC) is crucial for ascertaining their professional goals and fulfilling career choices in nursing students. Thus, understanding its antecedents and helping schools improve PC among nursing students is critical. This study aims to explore whether professional identity (PI), as a crucial antecedent of PC, acts as an intermediary between career self-efficacy (CSE) and professional calling during the COVID-19 pandemic. Methods A sample of 565 nursing students were selected by a web-based survey through convenience sampling. The study was conducted from October to November 2020. Measures of CSE, PI, and PC were assessed during the COVID-19 pandemic. We analyzed demographic data and the correlation of the research variables. The significance of the mediation effect was assessed using a bootstrap method with SPSS. Results CSE during the COVID-19 pandemic outbreak (r = 0. 359, p

This paper describes protocols and experiences from a seven-year natural-experiment study in El Paso, Texas, a border city of predominantly Latino/Hispanic population. The study focuses on how Bus Rapid Transit (BRT) impacts physical activity and thus plays a role in alleviating obesity and related chronic diseases that impact healthy aging. Our protocols describe a longitudinal and case-comparison study, which compared residents exposed to new BRT stations with those who were not. This paper also introduces lessons and experiences to overcome the following challenges: delays in the BRT opening (the main intervention), the COVID-19 pandemic, methodological challenges, participant recruitment and retention, and predatory survey takers. Our transdisciplinary approach was pivotal in addressing these challenges. We also proposed and tested multi-level intervention strategies to reduce modifiable barriers to transit use. Our most important takeaway for researchers, practitioners, and policy makers is the importance of being flexible and ready to adapt to new circumstances. Future natural-experiment researchers need to become more versatile in an increasingly volatile and uncertain world.

To date, the traditional open thyroid surgery via a low collar incision remains the standard approach for patients undergoing thyroidectomy. However, this conventional approach will inevitably leave patients a neck scar and even cause a variety of complications such as paresthesia, hypesthesia, and other uncomfortable sensations. With the progress in surgical techniques, especially in endoscopic surgery, and the increasing desire for cosmetic and functional outcomes, various new approaches for thyroidectomy have been developed to avoid or decrease side effects. Some of these alternative approaches have obvious advantages compared with traditional surgery and have already been widely used in the treatment of thyroid disease, but each has its limitations. This review aims to evaluate and compare the different approaches to thyroidectomy to help surgeons make the proper treatment strategy for different individuals.

Abstract Aims/Introduction Metals play an important role in diabetes mellitus. This cross‐sectional study aimed to evaluate the overall, individual and interactive effects of multi‐metal exposure on the prevalence of diabetes mellitus, impaired fasting glucose (IFG) rate and fasting blood glucose (FBG) levels. Materials and Methods The FBG levels of a study population from a cadmium (Cd)‐polluted area (n = 250) and an unpolluted area (n = 204), and the metal levels, including magnesium, calcium (Ca), iron (Fe), zinc (Zn), arsenic (As), Cd, copper and lead (Pb) in blood and urine were detected. The study population was divided into a normal fasting glucose group, an IFG group and a diabetes mellitus group on the basis of FBG levels. Results The IFG rate and diabetes mellitus prevalence were negatively associated with blood Cd and urine Zn levels (IFG rate: odds ratio [OR] 0.780, 95% confidence interval [CI] 0.655–0.928; OR 0.622, 95% CI 0.465–0.831. Diabetes mellitus prevalence: OR 0.506, 95% CI 0.288–0.888; OR 0.609, 95% CI 0.395–0.939), the IFG rate was positively associated with urine Fe levels (OR 1.876, 95% CI 1.290–2.778), and diabetes mellitus prevalence was positively associated with urine Pb and blood Fe levels (OR 1.185, 95% CI 1.022–1.376; OR 1.008, 95% CI 1.001–1.014). A linear negative correlation was observed between FBG levels and blood Cd, and non‐linear inverted U‐shaped associations were found between FBG levels and Zn, Pb and copper in urine. Conclusions This research suggests that multi‐metal exposure, especially Cd, Fe, Zn, copper and Pb, is linked to diabetes mellitus, and the interactive effects of multiple metals require further exploration.

BackgroundSevere pneumonia due to lower respiratory tract infections (LRTIs) is a significant cause of morbidity and mortality in children. Noninfectious respiratory syndromes resembling LRTIs can complicate the diagnosis and may also make targeted therapy difficult because of the difficulty of identifying LRTI pathogens. In the present study, a highly sensitive metagenomic next-generation sequencing (mNGS) approach was used to characterize the microbiome of bronchoalveolar lavage fluid (BALF) in children with severe lower pneumonia and identify pathogenic microorganisms that may cause severe pneumonia. The purpose of this study was to use mNGS to explore the potential microbiomes of children with severe pneumonia in a PICU.MethodsWe enrolled patients meeting diagnostic criteria for severe pneumonia admitted at PICU of the Children’s Hospital of Fudan University, China, from February 2018 to February 2020. In total, 126 BALF samples were collected, and mNGS was performed at the DNA and/or RNA level. The pathogenic microorganisms in BALF were identified and correlated with serological inflammatory indicators, lymphocyte subtypes, and clinical symptoms.ResultsmNGS of BALF identified potentially pathogenic bacteria in children with severe pneumonia in the PICU. An increased BALF bacterial diversity index was positively correlated with serum inflammatory indicators and lymphocyte subtypes. Children with severe pneumonia in the PICU had the potential for coinfection with viruses including Epstein–Barr virus, Cytomegalovirus, and Human betaherpesvirus 6B, the abundance of which was positively correlated with immunodeficiency and pneumonia severity, suggesting that the virus may be reactivated in children in the PICU. There was also the potential for coinfection with fungal pathogens including Pneumocystis jirovecii and Aspergillus fumigatus in children with severe pneumonia in the PICU, and an increase in potentially pathogenic eukaryotic diversity in BALF was positively associated with the occurrence of death and sepsis.ConclusionsmNGS can be used for clinical microbiological testing of BALF samples from children in the PICU. Bacterial combined with viral or fungal infections may be present in the BALF of patients with severe pneumonia in the PICU. Viral or fungal infections are associated with greater disease severity and death.

BackgroundStroke has become a leading cause of mortality and adult disability in China. The key to treating acute ischemic stroke (AIS) is to open the obstructed blood vessels as soon as possible and save the ischemic penumbra. However, the thrombolytic rate in China is only 2.5%. Research has been devoted to investigating the causes of prehospital delay, but the exact controllable risk factors for prehospital delay remain uncertain, and a consensus is lacking. We aimed to develop a risk assessment tool to identify the most critical risk factors for prehospital delay for AIS patients.MethodsFrom November 2018 to July 2019, 450 patients with AIS were recruited. Both qualitative and quantitative data were collected. The Delphi technique was used to obtain expert opinions about the importance of the risk indices in two rounds of Delphi consultation. Then, we used the risk matrix to identify high-risk factors for prehospital delay for AIS patients.ResultsThe risk matrix identified the following five critical risk factors that account for prehospital delay after AIS: living in a rural area; no bystanders when stroke occurs; patients and their families lacking an understanding of the urgency of stroke treatment; patients and their families not knowing that stroke requires thrombolysis or that there is a thrombolysis time window; and the patient self-medicating, unaware of the seriousness of the symptoms, and waiting for spontaneous remission.ConclusionsThe risk analysis tool used during this study may help prevent prehospital delays for patients with AIS.

Abstract Background It has previously been established that patients who have strong barriers to their diet self-management are more likely to have weak social support; however, the key mechanisms underlying the association between these two variables have not yet been established. This study aims to examine the potential role that diet self-efficacy plays in the relationship between social support and diet behavior in patients with type 2 diabetes mellitus (T2DM). Methods It was a cross-sectional survey. Three hundred-eighty patients diagnosed with T2DM were recruited for this study from five community health centers in China. The Chronic Disease Resource Scale (CIRS), Cardiac Diet Self-efficacy Scale (CDSE), and Food Control Behavior Scale (FCBS) were used to estimate participants’ utilization of social resources, diet self-efficacy, and diet self-management, respectively. The data were analyzed utilizing structural equation modelling. Results The results suggest that both higher levels of social support and diet self-efficacy are related to higher levels of diet self-management. The mediating effect that diet self-efficacy has on the relationship between social support and diet self-management was significant (β = .30, p

BackgroundStakeholders from multiple sectors are increasingly aware of the critical need for identifying sustainable interventions that promote healthy lifestyle behaviors. Activity-friendly communities (AFCs) have been known to provide opportunities for engaging in physical activity (PA) across the life course, which is a key to healthy living and healthy aging.PurposeOur purpose is to describe the study protocol developed for a research project that examines: (a) the short- and long-term changes in total levels and spatial and temporal patterns of PA after individuals move from non-AFCs to an AFC; and (b) what built and natural environmental factors lead to changes in PA resulting from such a move, either directly or indirectly (e.g., by affecting psychosocial factors related to PA).MethodsThis protocol is for a longitudinal, case-comparison study utilizing a unique natural experiment opportunity in Austin, Texas, USA. Case participants were those adults who moved from non-AFCs to an AFC. Matching comparison participants were residents from similar non-AFCs who did not move during the study period. Recruitment venues included local businesses, social and print media, community events, and individual referrals. Objectively measured moderate-to-vigorous PA and associated spatial and temporal patterns served as the key outcomes of interest. Independent (e.g., physical environments), confounding (e.g., demographic factors), and mediating variables (e.g., psychosocial factors) were captured using a combination of objective (e.g., GIS, GPS, Tanita scale) and subjective measures (e.g., survey, travel diary). Statistical analyses will be conducted using multiple methods, including difference-in-differences models, repeated-measures linear mixed models, hierarchical marked space-time Poisson point pattern analysis, and hierarchical linear mixed models.ConclusionNatural experiment studies help investigate causal relationships between health and place. However, multiple challenges associated with participant recruitment, extensive and extended data collection activities, and unpredictable intervention schedules have discouraged many researchers from implementing such studies in community-based populations. This detailed study protocol will inform the execution of future studies to explore how AFCs impact population health across the life course.

Proteins and minerals in infant formula not only serve as nutrients, but also have important effects on the physical and chemical stability of emulsions. In this study, calcium carbonate (0 or 9.08 mM) and potassium chloride (0 or 15.96 mM), as representatives of divalent and monovalent minerals, were added to 1,3-dioleoyl-2-palmitoylglycerol (OPO) emulsions in different ratios (10:0, 9:1, 6:4, 5:5, and 0:10) of whey protein isolate (WPI) and sodium caseinate (CN). The influence of proteins and minerals on emulsion stability was investigated by analyzing particle size, zeta potential, creaming index, rheological properties, storage stability, and lipid oxidation. 1,3-dioleoyl-2-palmitoylglycerol (OPO) emulsions could be destabilized by adding Ca2+, as shown by the increase in particle size index, creaming index, and the decrease in zeta potential magnitude. Divalent ions could affect the electrostatic interactions between lipid droplets and the interactive effects of ion surface adsorption. In addition, the effect of different protein ratios on the physical stability of emulsions was not significant under the same ion-type conditions. In terms of chemical stability, higher oxidized values were found in emulsions stabilized with only CN than in those containing WPI. Our study showed that protein ratios and minerals played an important role in the stability of OPO emulsions, which might provide a reference for the development and utilization of liquid infant formula.

PurposeTo compare the efficacies and treatment outcomes of intravitreal anti-VEGF agents and laser therapy in retinopathy of prematurity (ROP).MethodsA retrospective, non-randomized, comparative study of patients diagnosed with type 1 ROP or aggressive posterior ROP (A-ROP) treated with intravitreal anti-VEGF agents or laser therapy as primary treatment at the People's Hospital of Peking University.ResultsA total of 1,627 eyes of 862 patients were included. In Group 1, 399 eyes of 204 patients were diagnosed with A-ROP or zone I type 1 ROP. The initial regression of the anti-VEGF subgroup was better than that of the laser subgroup, and the reactivation rate and rate of progression to retinal detachment were lower than those of the laser subgroup. In Group 2, 1,228 eyes of 658 patients were diagnosed with zone II type 1 ROP. The reactivation rate of the laser subgroup was lower than that of the anti-VEGF subgroup. No significant differences were found in the initial regression and the probability of developing retinal detachment. Among the anti-VEGF agents, the reactivation rate in eyes treated with conbercept was much lower than that in eyes treated with ranibizumab. The spherical power and spherical equivalents of eyes treated with laser were significantly higher than those of eyes treated with anti-VEGF agents 1 year after initial treatment.ConclusionsIn contrast to laser therapy, anti-VEGF agents as primary treatments have potential advantages for eyes with zone I type 1 ROP and A-ROP. For eyes with zone II type 1 ROP, laser photocoagulation and anti-VEGF agents therapy showed similar efficacy; however, the rate of reactivation with laser therapy was significantly lower than that with anti-VEGF agents. Among the anti-VEGF agents, the reactivation rate was much lower in eyes treated with conbercept than in eyes treated with ranibizumab. Compared to anti-VEGF agents, laser treated eyes had greater trend to myopia.

BackgroundExtracorporeal membrane oxygenation (ECMO) has been increasingly used as rescue therapy for severe pediatric acute respiratory distress syndrome (PARDS) over the past decade. However, a contemporary comparison of venovenous (VV) and venoarterial (VA) ECMO in PARDS has yet to be well described. Therefore, the objective of our study was to assess the difference between VV and VA ECMO in efficacy and safety for infection-associated severe PARDS patients.MethodsThis prospective multicenter cohort study included patients with infection-associated severe PARDS who received VV or VA ECMO in pediatric intensive care units (PICUs) of eight university hospitals in China between December 2018 to June 2021. The primary outcome was in-hospital mortality. Secondary outcomes included ECMO weaning rate, duration of ECMO and mechanical ventilation (MV), ECMO-related complications, and hospitalization costs.ResultsA total of 94 patients with 26 (27.66%) VV ECMO and 68 (72.34%) VA ECMO were enrolled. Compared to the VA ECMO patients, VV ECMO patients displayed a significantly lower in-hospital mortality (50 vs. 26.92%, p = 0.044) and proportion of neurologic complications, shorter duration of ECMO and MV, but the rate of successfully weaned from ECMO, bleeding, bloodstream infection complications and pump failure were similar. By contrast, oxygenator failure was more frequent in patients receiving VV ECMO. No significant intergroup difference was observed for the hospitalization costs.ConclusionThese positive findings showed the conferred survival advantage and safety of VV ECMO compared with VA ECMO, suggesting that VV ECMO may be an effective initial treatment for patients with infection-associated severe PARDS.

As the main allergens in milk, whey proteins are heat-sensitive proteins and are widespread in dairy products and items in which milk proteins are involved as food additives. The present work sought to investigate the effect of heating sterilization on the allergenicity of α-lactalbumin (α-LA) and β-lactoglobulin (β-LG), the main composite and allergen in whey protein isolate (WPI), by combining molecular dynamics with experimental techniques for detecting the spatial structure and IgE binding capacity. The structure of WPI was basically destroyed at heat sterilization conditions of 95 °C for 5 min and 65 °C for 30 min by SDS-PAGE analysis and spectroscopic analysis. In addition, α-lactalbumin (α-LA) may be more sensitive to temperature, resulting in exposure to allergic epitopes and increasing the allergic potential, while the binding capacity of β-lactoglobulin (β-LG) to IgE was reduced under 65 °C for 30 min. By the radius of gyration (Rg) and root-mean-square deviation (RMSD) plots calculated in molecular dynamics simulations, α-LA was less structurally stable at 368 K, while β-LG remained stable at higher temperatures, indicating that α-LA was more thermally sensitive. In addition, we observed that the regions significantly affected by temperatures were associated with the capacity of allergic epitopes (α-LA 80–101 and β-LG 82–93, 105–121) to bind IgE through root-mean-standard fluctuation (RMSF) plots, which may influence the two major allergens. We inferred that these regions are susceptible to structural changes after sterilization, thus affecting the allergenicity of allergens.

Summary: The biosynthesis of metal nanoparticles from precious metals has been of wide concern. Their antibacterial activity is a main bottleneck restricting the bacterial activity and reduction performance. Here, bio-electrochemical systems were used to harvest electroactive biofilms (EABs), where bacteria were naturally protected by extracellular polymeric substances to keep activity. The biofilm was further encapsulated with polydopamine (PDA) as additional shield. Silver nanoparticles (AgNPs) were biosynthesized on EABs, whose electroactivity could be fully recovered after Ag+ reduction. The PDA increased bacterial viability by 90%–105%, confirmed as an effective protection against antibacterial activity of Ag+/AgNPs. The biosynthetic process changed the component and function of the microbial community, shifting from bacterial Fe reduction to archaeal methanogenesis. These results demonstrated that the electrochemical acclimation of EABs and encapsulation with PDA were effective protective measures during the biosynthesis of AgNPs. These approaches have a bright future in the green synthesis of nanomaterials, biotoxic wastewater treatment, and sustainable bio-catalysis.

Due to their heat/cool storage characteristics, thermostatically controlled loads (TCLs) play an important role in demand response programmers. However, modeling of the heat/cool storage characteristic of large numbers of TCLs is not simple. In this paper, the heat exchange power is adopted to calculate the power instead of the average power, and the relationship between the heat exchange power and energy storage is considered to develop an equivalent storage model, based on which the time-varying power constraints and the energy storage constraints are developed, to establish the overall day-ahead scheduling model. Finally, the proposed scheduling method is verified using the simulation results of a six-bus system.

(1) Background: Cyanobacteria produce a wide range of secondary metabolites, including tumor-promoting hepatotoxins. We recently reported evidence of an independent association between oral cyanobacteria and hepatocellular carcinoma in a U.S. population. We sought to characterize the nature, sources, and health correlates of cyanotoxin exposure in the U.S. Pacific Island territory of Guam, which has a high incidence of liver cancer. (2) Methods: Seventy-four adult males and females were enrolled in a cross-sectional study to quantify cyanotoxins in saliva, urine, and blood and their correlation with health behaviors, medical history, and environmental exposures. Plant samples were collected from locations throughout the island. Microcystin/nodularin (MC/NOD), cylindrospermopsin (CYN), and anabaenopeptin (AB) were measured in biospecimens and in plant extracts by ELISA. (3) Results: Overall, among study participants MC/NOD were detected in 53.9% of saliva, 7.5% of urine, and 100% of serum.; CYN in 40.0% of saliva, 100.0% of urine, and 70.4% of serum; AB in 30.8% of saliva, 85% of urine, and 92.6% of serum. Salivary MC/NOD levels were significantly higher in individuals using municipal tap water as their primary source of drinking water; both salivary and urinary MC/NOD levels were higher in those not using store-bought/commercial water. Urine MC/NOD levels were highest among individuals consuming fruits and vegetables exclusively from local sources. Urine MC/NOD levels were elevated in individuals with hypertension and hyperlipidemia and salivary MC/NOD in those with recent alcohol consumption. Cyanotoxins were prevalent in plant samples including MC/NOD (46.6%), CYN (35.1%), and AB (51.7%). (4) Conclusions: Our study provides evidence that exposure to cyanobacterial hepatotoxins, including tumor promoters, may be prevalent in Guam and may originate from environmental sources. Population-based epidemiologic studies are needed to investigate the role of cyanotoxins in liver cancer development.

Background: Areca nut/betel quid (AN/BQ) chewing, a prevalent practice in parts of the Pacific and Asia, is an independent cause of cancers of the oral cavity and esophagus and may be linked to liver cancer. The mechanisms of AN/BQ-associated carcinogenesis are unclear. In a Guam population, we previously demonstrated that AN/BQ chewing alters the oral bacterial microbiome including in chewers with oral premalignant lesions. Enrichment of specific taxa, including Cyanobacteria, was observed. Objectives: We undertook an investigation to evaluate Areca catechu and/or Piper betle plants as potential sources of Cyanobacteria and cyanotoxins in AN/BQ chewers in Guam. Methods: We evaluated bacterial 16S rRNA with Illumina MiSeq in 122 oral samples and 30 Areca catechu nut and Piper betle leaf samples. Cyanobacteria sequences were interrogated using the NCBI database to identify candidate species and their reference sequences were evaluated for secondary metabolite toxins using AntiSMASH 5.0. Selected toxins were measured by ELISA in extracts from 30 plant samples and in a subset of 25 saliva samples. Results: Cyanobacteria was the predominant taxa in Areca catechu and Piper betle plants, comprising 75% of sequences. Cyanobacteria was detected at low levels in oral samples but 90-fold higher in current AN/BQ chewers compared to former/never chewers (p = 0.001). Microcystin/nodularin was detected in saliva (15 of 25 samples) and Piper betle leaves (6 of 10 samples). Cylindrospermopsin was detected in all saliva and leaf samples and 7 of 10 nut/husks. Salivary cylindrospermopsin levels were significantly higher in current chewers of betel quid (i.e., crushed Areca catechu nut wrapped in Piper betle leaf) compared to those chewing Areca nut alone. Anabaenopeptin was detected in saliva (10 of 25 samples), all leaf samples, and 7 of 10 nut/husks. Salivary anabaenopeptin concentration was weakly, albeit significantly, correlated with oral Cyanobacteria relative abundance. Discussion: Our study demonstrates that Cyanobacteria can contaminate AN/BQ plants and expose chewers to potent hepatotoxins. With worldwide increases in climate-related overgrowth of Cyanobacteria, our findings have broad implications for cancer risk across populations.

Patients with osteosarcoma (OS) usually have poor overall survival because of frequent metastasis. Long non-coding RNAs (lncRNAs) have been reported to be associated with tumorigenesis and metastasis. In this study, we investigated the expression and roles of lncRNA human histocompatibility leukocyte antigen (HLA) complex P5 (HCP5) in OS, aiming to provide a novel molecular mechanism for OS. HCP5 was up-regulated both in OS tissues and cell lines and high expression of HCP5 was associated to low survival in OS patients. Down-regulation of HCP5 inhibited cell proliferation, migration, and invasion, suggesting its carcinogenic role in OS. miR-101 was targeted by HCP5 and its expression was decreased in OS. The inhibitor of miR-101 reversed the impact of HCP5 down-regulation on cell proliferation, apoptosis, and metastasis in OS. Ephrin receptor 7 (EPHA7) was proved to be a target of miR-101 and had ability to recover the effects of miR-101 inhibitor in OS. In conclusion, lncRNA HCP5 knockdown suppressed cell proliferation, migration, and invasion, and induced apoptosis through depleting the expression of EPHA7 by binding to miR-101, providing a potential therapeutic strategy of HCP5 in OS.

Chinese spicy cabbage (CSC) is a popular special fermented food in Northeast China. The bacterial community and quality of CSC from different regions of northeastern China (Group_J: Jilin province, Group_L: Liaoning province, Group_H: Heilongjiang province) at retail (Group_P) and home-made (Group_C) were investigated in this study. The determination of the microbial community was achieved using high-throughput sequencing and the quality-related physicochemical characteristics included pH, salinity, total acid (TA), amino acid nitrogen (AAN), reducing sugar (RS), nitrite, and biogenic amines (BAs). Based on OPLS-DA analysis, there was a difference between the quality of Group_C and Group_P. No significant difference was observed in province grouping. Proteobacteria and Firmicutes were the dominant phyla, and the dominant genera were Lactobacillus, Pantoea, Weissella, and Pseudomonas. All groups had significant differences in community structure (p < 0.05). Compared with Group_C, the relative abundance of opportunistic pathogens (Pseudomonas and Serratia) in Group_P was lower. Pseudomonas and Serratia were the biomarkers in Group_H. At the genus level, Lactobacilluss and Weissella had a positive correlation with pH, Cadaverrine, and salinity (p < 0.05), however, they were negatively related to tryptamine. Pseudomonas was negatively correlated with salinity (p < 0.05). Bacterial community and physicochemical parameters of CSC, as well as the correlation between them, were discussed in this study, providing a reference for future studies on CSC inoculation and fermentation.

Abstract Objectives This study aimed to identify the influencing factors associated with long onset‐to‐door time and establish predictive models that could help to assess the probability of prehospital delay in populations with a high risk for stroke. Materials and Methods Patients who were diagnosed with acute ischemic stroke (AIS) and hospitalized between 1 November 2018 and 31 July 2019 were interviewed, and their medical records were extracted for data analysis. Two machine learning algorithms (support vector machine and Bayesian network) were applied in this study, and their predictive performance was compared with that of the classical logistic regression models after using several variable selection methods. Timely admission (onset‐to‐door time

Metal tolerance proteins (MTP) as divalent cation transporters are essential for plant metal tolerance and homeostasis. However, the characterization and the definitive phylogeny of the MTP gene family in Fagopyrum tartaricum, and their roles in response to metal stress are still unknown. In the present study, MTP genes in Fagopyrum tartaricum were identified, and their phylogenetic relationships, structural characteristics, physicochemical parameters, as well as expression profiles under five metal stresses including Fe, Mn, Cu, Zn, and Cd were also investigated. Phylogenetic relationship analysis showed that 12 Fagopyrum tartaricum MTP genes were classified into three major clusters and seven groups. All FtMTPs had typical structural features of the MTP gene family and were predicted to be located in the cell vacuole. The upstream region of FtMTPs contained abundant cis-acting elements, implying their functions in development progress and stress response. Tissue-specific expression analysis results indicated the regulation of FtMTPs in the growth and development of Fagopyrum tataricum. Besides, the expression of most FtMTP genes could be induced by multiple metals and showed different expression patterns under at least two metal stresses. These findings provide useful information for the research of the metal tolerance mechanism and genetic improvement of Fagopyrum tataricum.

Quality identification of multi-component mixtures is essential for production process control. Artificial sensory evaluation is a conventional quality evaluation method of multi-component mixture, which is easily affected by human subjective factors, and its results are inaccurate and unstable. This study developed a near-infrared (NIR) spectral characteristic extraction method based on a three-dimensional analysis space and establishes a high-accuracy qualitative identification model. First, the Norris derivative filtering algorithm was used in the pre-processing of the NIR spectrum to obtain a smooth main absorption peak. Then, the third-order tensor robust principal component analysis (TRPCA) algorithm was used for characteristic extraction, which effectively reduced the dimensionality of the raw NIR spectral data. Finally, on this basis, a qualitative identification model based on support vector machines (SVM) was constructed, and the classification accuracy reached 98.94%. Therefore, it is possible to develop a non-destructive, rapid qualitative detection system based on NIR spectroscopy to mine the subtle differences between classes and to use low-dimensional characteristic wavebands to detect the quality of complex multi-component mixtures. This method can be a key component of automatic quality control in the production of multi-component products.

α-Casein (α-CN) is considered the main allergen in bovine milk. Lactic acid bacteria (LAB) fermentation can hydrolyze milk protein and therefore reduce the antigenicity. In this paper, a LAB reducing the antigenicity of casein, identified as LactiplantibacillusPlantarum 7-2 (L. plantarum 7-2), was primarily identified by screening for protein hydrolysis ability using a method involving the determination of released free amino acid with further selection for the ideal antigenicity-reducing capability by enzyme-linked immunosorbent assay (ELISA). In order to verify the capability of L. plantarum 7-2 in inhibiting antigenicity, the standard milk proteins α-LA, β-LG, α-CN, β-CN and κ-CN were cultured with L. plantarum 7-2 for 18 h; The results of SDS-PAGE show that all the bands corresponding to the full length tested proteins became unclear or completely disappeared indicating that these proteins were hydrolyzed by L. plantarum 7-2. Correspondingly, the antigenicities of α-CN and β-LG were significantly reduced. L. plantarum 7-2 demonstrated negative hemolysis and nitrate reductase capabilities and was sensitive to the commonly used antibiotics ampicillin clindamycin tetracycline chloramphenicol, and erythromycin, demonstrating that L. plantarum 7-2 could be used in dairy product fermentation to reduce the antigenicity of milk protein.

Buckwheat is a promising pseudo cereal and its cultivation history can be traced back to thousands of years ago in China. Nowadays, buckwheat is not only an ordinary crop but also a symbol of healthy life because of its rich nutritional and pharmacological properties. In this research, the current suitable areas of 19 wild buckwheat species were analyzed by the MaxEnt model, which proved that southwestern China was the diversity center of buckwheat. Their morphological characteristics and geographical distribution were analyzed for the first time. In addition, it was found that the change of buckwheat cultivation in three periods might be related to the green revolution of main crops and national policies. Meanwhile, the Sustainable Yield Index (SYI) value of buckwheat in China was the lowest from 1959 to 2016. Through the MaxEnt model, the potentially suitable areas of wild buckwheat would contract while cultivated buckwheat would expand under climate change. Accordingly, the diversity of wild buckwheat will decrease. Therefore, it is necessary to protect buckwheat resources as much as possible to strengthen the development and utilization of buckwheat resources. Moreover, the promotion of buckwheat diversity will be an important trade-off between food security, population growth, and land use under climate change.

This study aimed to evaluate the beneficial effects of novel hydrolysates produced by limited enzymatic broken rice (HEBR) on the growth performance, intestinal morphology, and gut microbiota of weaned piglets. During the enzymatic hydrolysis, the primary component of HEBR was maltooligosaccharides (significantly increased to 85.15% at 105 min). Compared to that of the Control group, the average daily gain and feed efficiency, and the villus height in the jejunum and ileum of weaned piglets, was significantly higher in the HEBR group. An increase in Bifidobacterium and Streptococcus was observed in the duodenum and ileum, while a decrease in Escherichia-Shigella was detected in the duodenum, jejunum, ileum and cecum of the weaned piglets with consumption of HEBR. Collectively, supplemental HEBR in the diet helps regulate the gut microbiota and improve the growth performance and intestinal morphology of weaned piglets. Hence, HEBR has the potential to be used as a functional food.

Fluid catalytic cracking (FCC) spent catalysts are the most common catalysts produced by the petroleum refining industry in China. The National Hazardous Waste List (2016 edition) lists FCC spent catalysts as hazardous waste, but this listing is very controversial in the petroleum refining industry. This study collects samples of waste catalysts from seven domestic catalytic cracking units without antimony-based passivation agents and identifies their hazardous characteristics. FCC spent catalysts do not have the characteristics of flammability, corrosiveness, reactivity, or infectivity. Based on our analysis of the components and production process of the FCC spent catalysts, we focused on the hazardous characteristic of toxicity. Our results show that the leaching toxicity of the heavy metal pollutants nickel, copper, lead, and zinc in the FCC spent catalyst samples did not exceed the hazardous waste identification standards. Assuming that the standards for antimony and vanadium leachate are 100 times higher than that of the surface water and groundwater environmental quality standards, the leaching concentration of antimony and vanadium in the FCC spent catalyst of the G set of installations exceeds the standard, which may affect the environmental quality of surface water or groundwater. The quantities of toxic substances in all spent FCC catalysts, except those from G2, does not exceed the standard. The acute toxicity of FCC spent catalysts in all installations does not exceed the standard. Therefore, we exclude “waste catalysts from catalytic cracking units without antimony-based passivating agent passivation nickel agent” from the “National Hazardous Waste List.”

A two-stage, pH- and temperature-controlled wheat bran fermentation method using Aureobasidium pullulans was investigated for feruloyl oligosaccharides (FOs) production and the activities of xylanase, xylosidase, and ferulic acid esterase (FAE). A. pullulans secreted xylanase, xylosidase, and FAE at high levels in the initial pH of 4.0 to 5.0 and a fermentation liquid temperature of 31 °C to 33 °C. FOs production via two-stage fermentation (FOs 2) reached 1123 nmol/L after fermentation for 96 h, by controlling the initial pH at 4.0 and the initial temperature at 33 °C, and then changing the pH to 6.0 and the temperature to 29 °C at the same time at 36 h. This process was 12 h shorter and 219 nmol/L higher than a one-stage fermentation for producing FOs 1. Xylanase, xylosidase, and FAE activities were highly correlated with controlled pH and temperature and FOs biosynthesis rate. Thus, the combination of two-stage controlled pH and temperature could support mass production of FOs.

# Background Non-invasive, self-collection sampling methods for human papillomavirus (HPV) DNA detection have the potential to address logistical and cultural barriers to Pap screening, particularly in under resourced settings such as Yap state in the Federated States of Micronesia -- a population with low levels of screening and high incidence of cervical cancer. # Methods A randomized controlled trial was conducted among adult women in Yap to compare cervical HPV DNA in self-collected urine and clinician-collected liquid cytology. Adult women aged 21-65 (n=217) were randomized by the order of sample collection. Concordance of HPV DNA, evaluated by the Roche Linear Array, was compared in paired self-collected urine and clinician-collected liquid cytology samples. The sensitivity and specificity of urine HPV DNA for prediction of cervical HPV and abnormal cytology was also evaluated. p16 in urine cytology samples was additionally assessed. # Results Overall, HPV DNA detection was significantly lower in urine than cervical samples for any HPV (27.8% and 38.3%, respectively) and high-risk HPV (15.1% and 23.8%, respectively). For paired samples, there was moderate agreement for the overall study population (Kappa=0.54, 95% confidence interval CI=0.40-0.68) and substantial agreement for women ≥40 years (Kappa=0.65, 95% CI=0.46-0.85). The sensitivity and specificity of urine for the detection of cervical high-risk HPV was 51.0% and 96.2%, respectively. The sensitivities of HPV DNA in urine and liquid cytology for prediction of abnormal cytology (ASCUS/LSIL/HSIL) were 47.4% (95% CI=31.0-64.2) and 57.9% (95% CI=40.8-73.7), respectively; specificities were 92.0% (95% CI=86.9%-95.5%) and 83.5% (95% CI=77.2-88.7). Urine p16 was poorly correlated with urine HPV DNA positivity. # Conclusions Urine is less sensitive but more specific than directed cervical sampling for detection of cytologic abnormalities and may have utility for screening in older populations within low-resource communities when clinically-collected samples cannot be obtained.

This study aimed to assess the effects of a psychological intervention programme on the mental stress, coping style and cortisol and IL-2 levels of patients undergoing percutaneous coronary intervention (PCI).A total of sixty cardiovascular patients scheduled for PCI with clear anxiety and depression screened by the Hospital Anxiety and Depression Scale were randomly divided into an experimental (n = 30) and control (n = 30) group. The participants in the experimental group received cognitive therapy, relaxation therapy and emotional support. Self-reported questionnaires, including the Self-Report Symptom Checklist (SCL-90) and the Medical Coping Mode Questionnaire (MCMQ), and levels of IL-2 and cortisol were collected at baseline and the day before discharge.Compared with the controls, patients in the intervention group had a better mental state and coping style (confrontation), higher levels of IL-2 and lower levels of cortisol (all P

The antioxidant functions of two feruloyl oligosaccharide (FO1 and FO2) were investigated in vivo and in vitro. Effects of FO1 and FO2 on hemolysis of rat red blood cell (RBC) and malondialdehyde (MDA) formation in rat liver homogenate and rat liver mitochondria in vitro were studied. Hemolysis of rat RBC and MDA formation in rat liver homogenate and rat liver mitochondria were inhibited in a dosage-dependent manner by FO1 and FO2 in the tested concentration range of 0.5 to 10 mg/mL. The results showed that FO1 and FO2 had antioxidative activity in vitro, and the effect of FO2 was better than that of FO1. With increasing dosage, FO1 and FO2 could increase the activity of SOD and GSH-Px in serum of S180 tumor-bearing mice, reduce the level of MDA, and thus improve the activity of the antioxidant in vivo. When the dosage reached 250 mg/kg/d, FO2 was more likely to improve the capabilities of the antioxidants of tumor-burdened mice than were 5-FU and FO1 in vivo. Thus, these oligosaccharides may be used as functional biological materials produced from fermented lignocellulose of WB.

Oral cancers are attributed to a number of causal agents including tobacco, alcohol, human papillomavirus (HPV), and areca (betel) nut. Although betel nut chewing has been established as an independent cause of oral cancer, the mechanisms of carcinogenesis are poorly understood. An investigation was undertaken to evaluate the influence of betel nut chewing on the oral microbiome and oral premalignant lesions. Study participants were recruited from a dental clinic in Guam. Structured interviews and oral examinations were performed. Oral swabbing and saliva samples were evaluated by 454 pyrosequencing of the V3- V5 region of the 16S rRNA bacterial gene and genotyped for HPV. One hundred twenty-two adults were enrolled including 64 current betel nut chewers, 37 former chewers, and 21 with no history of betel nut use. Oral premalignant lesions, including leukoplakia and submucous fibrosis, were observed in 10 chewers. Within-sample bacterial diversity was significantly lower in long-term (≥10 years) chewers vs. never chewers and in current chewers with oral lesions vs. individuals without lesions. Between-sample bacterial diversity based on Unifrac distances significantly differed by chewing status and oral lesion status. Current chewers had significantly elevated levels of Streptococcus infantis and higher and lower levels of distinct taxa of the Actinomyces and Streptococcus genera. Long-term chewers had reduced levels of Parascardovia and Streptococcus. Chewers with oral lesions had significantly elevated levels of Oribacterium, Actinomyces, and Streptococcus, including Streptococcus anginosus. In multivariate analyses, controlling for smoking, oral HPV, S.anginosus, and S. infantis levels, current betel nut chewing remained the only predictor of oral premalignant lesions. Our study provides evidence that betel nut chewing alters the oral bacterial microbiome including that of chewers who develop oral premalignant lesions. Nonetheless, whether microbial changes are involved in betel nut-induced oral carcinogenesis is only speculative. Further research is needed to discern the clinical significance of an altered oral microbiome and the mechanisms of oral cancer development in betel nut chewers.

We examined the transmission of human papillomavirus (HPV) in 25 heterosexual, monogamous couples (25 men, 25 women), followed up over an average of 7.5 months. A total of 53 heterosexual transmission events were observed among 16 couples (14 male-to-female and 39 female-to-male). Sexual transmission involved 13 different oncogenic and nononcogenic HPV types; 8% were vaccine-covered types transmitted between partners. The overall rate of HPV transmission from the penis to the cervix was 4.9/100 person-months, which was substantially lower than that from the cervix to the penis (17.4/100 person-months). Transmission between the hands and genitals, as well as apparent self-inoculation events (primarily in men), were also observed. Couples who transmitted HPV were more sexually active and used condoms less frequently. These results have implications for HPV prevention and control strategies, including the targeting of prophylactic vaccines.

Walking is an affordable and environmentally clean mode of transportation that can bring additional benefits as healthy physical activity. This cross-sectional study examines the prevalence and correlates of walking to or from school in eight elementary schools in Austin, Texas, which have high percentages of low-income, Hispanic students. A survey of 1,281 parents was conducted, including questions about personal, social, and environmental factors that may influence their decisions on the children's school transportation. Binary logistic regressions were used to estimate the odds of choosing walking as the children's typical school travel mode. The results showed that walking was a typical mode for 28 and 34% of trips to and from school, respectively, and mostly accompanied by an adult. Parents' education level, family's car ownership, children's and parents' personal barriers, and having the school bus service reduced the likelihood of walking, while positive peer influences encouraged walking. Among the physical environmental factors, living close to school was the strongest positive predictor; safety concerns and the presence of highway or freeway en route were negative correlates. We concluded that the location of school is a key, as it determines the travel distance and the presence of highway or freeway en route. In addition to environmental improvements, educational and other assistance programs are needed for both parents and children to overcome their personal barriers and safety concerns. Health and disparity issues require further attention, as many underprivileged children have no other means of school transportation but walking in unsafe and poor environments.

Pleiotrophin (PTN), a secreted, multifunctional cytokine, is involved in angiogenic, fibrotic and neurodegenerative diseases. However, little is known about its effects on diabetic retinopathy, a neurovascular disease. To investigate the role of PTN in proliferative diabetic retinopathy (PDR), PTN concentration in the vitreous was evaluated in PDR patients and non-diabetic controls. PTN expression was observed in epiretinal membranes from patients. PTN knockdown was performed using small interfering (si)RNA, and the effects on retinal pigment epithelium (RPE) cells and human umbilical vascular endothelia cells (HUVECs) were observed in vitro under hyperglycemic and hypoxic conditions. Cell attachment, proliferation, migration, tube formation, cell cycle, apoptosis, extracellular signal-regulated kinase 1/2 (ERK 1/2) phosphorylation, and VEGF levels were studied. The vitreous PTN concentration in PDR patients was higher than that in non-diabetic controls, and PTN was highly expressed in the fibrovascular membranes of PDR patients. Under hyperglycemic and hypoxic conditions, PTN knockdown reduced cell attachment, proliferation, migration, and tube formation and induced cell cycle arrest and apoptosis in vitro. Mechanically, PTN depletion decreased ERK 1/2 phosphorylation. Recombinant PTN up regulated the concentration of VEGF in vitro, which can be attenuated by the ERK 1/2 inhibitor. Taken together, our results implied that elevated PTN in PDR patients might participate in the critical processes of the development of PDR, most likely playing roles in angiogenesis and proliferation, possibly by activating the ERK 1/2 pathway and regulating VEGF secretion. These findings provide new insight into the roles of PTN in PDR and suggest that PTN may become a new target for therapeutic intervention in PDR.

BACKGROUND AND PURPOSE: Measures of specific knowledge of coping with pre-hospital stroke symptoms can help educate high-risk patients and family caregivers. This study aimed to develop and validate the Pre-hospital Stroke Symptoms Coping Test (PSSCT). MATERIALS AND METHODS: Reliability and validity were analyzed using multiple data sources. The Delphi expert consultation method was applied to assess the test's surface validity and content validity index. The final edition of the 19-item PSSCT contained 3 sections assessing coping with typical symptoms and symptoms associated with vomiting and twitching. Its psychometric properties were investigated in a community sample of 300 high-risk patients and family members. RESULTS: The PSSCT was readily accepted by participants. It demonstrated adequate surface validity and content validity, and good internal consistency (KR20 = 0.822) and test-retest reliability (0.769), with difficulty (P) and degree of differentiation (D) ranges of 0.28-0.83 and 0.15-0.66, respectively. It was also able to distinguish between individuals who had/had not experienced a stroke. Experienced individuals scored significantly higher overall and on coping with typical symptoms and twitching (P

Background and Purpose. Nurse managers are in an excellent position for providing leadership and support within the institutions they serve and are often responsible for accessing information that is vital to the improvement of health facility processes and patients’ outcomes. Therefore, competency in informatics is essential. The purposes of this study are to examine current informatics competency levels of nurse managers and to identify the variables that influence these competencies. Methods. A questionnaire designed to assess demographic information and nursing informatics competency was completed by 68 nurse managers. Multiple linear regression analysis was conducted to analyze the factors influencing informatics competency. Results. Descriptive analysis of the data revealed that informatics competency of these nurse managers was in the moderate range 77.65±8.14. Multiple linear regression analysis indicated that level of education, nursing administration experience, and informatics education/training were significant factors affecting competency levels. Conclusion. The factors identified in this study can serve as a reference for nurse managers who were wishing to improve their informatics competency, hospital administrators seeking to provide appropriate training, and nursing educators who were making decisions about nursing informatics curricula. These findings suggest that efforts to enhance the informatics competency of nurse managers have marked potential benefits.

Based on analyzing principle about the smart car’s speed control system, the system mathematical model is built. Considering the control optimization, a novel control scheme is proposed based on internal model control, and the internal model controller of speed control system is established. Regarding this subject, the internal control theory is introduced to verify the control performance; the traditional PID control method is employed in the experiment. The experiment indicates that the proposed method based on internal model control is easier to determine parameter and has a well robust and good control result of smart car’s speed.