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Silu Shrestha,1 Nian Zhong,1 Sayed Mohammad Anwar Sadat,2 Siqun Zhan1 1Department of Psychology, Wuhan University, Wuhan, Hubei Province, People’s Republic of China; 2Department of Business Administration, Jahan University, Kabul, AfghanistanCorrespondence: Silu Shrestha; Siqun Zhan, Department of Psychology, School of Philosophy, Wuhan University, Bayi Road, Wuchang District, Wuhan, Hubei Province, 430072, People’s Republic of China, Tel +8618627015179, Email silushrestha@gmail.com; zhansiqun@whu.edu.cnPurpose: Adolescents living in protracted conflict areas have mostly been perceived as passive recipients of the impact of events in their surroundings who are rarely considered agents of social transformation. But a growing body of research on adolescents’ psychological development indicates that adolescents actively perceive concepts like peace and their roles and responsibilities toward creating conditions for peace. Applying the Phenomenological Variant of Ecological Systems Theory, this study focuses on understanding how adolescents from Afghanistan with lifelong exposure to intractable conflict conceptualize peace.Methods: The study was conducted in the Bagrami, Paghman and Dih Sabz districts of Kabul City in Afghanistan. A semi-structured open-ended questionnaire was used to interview 63 male and female adolescents aged 13– 19. The participants belonged to different ethnic groups, such as Pashtun, Hazara and Tajik. An inductive approach was applied to analyze the data using thematic analysis.Results: Three distinct themes about peace emerged from the data: peace based on individual emotions, social relations, and larger societal structures. Peace for adolescents had both personal and inner and social or outer dimensions. Afghan adolescents’ conceptualization of peace is primarily based on their interaction with the micro-system. Home and family provided perceived calmness and normalcy, which characterized peace as individual emotion. Social relations, often determined by good communication, community cohesiveness, and social support between family members, neighbours, and ethnic groups, constituted adolescents’ concepts about peace. Adolescents also demonstrated awareness of larger societal structures, such as the role of community leaders and government in ensuring perceived safety and security, forming their concepts of peace.Conclusion: Adolescents have meaningful voices capable of forming perceptions about peace. The microsystem of an adolescent’s environment has a significant influence in the conceptualization of peace. This study contributes to expanding the knowledge on the underpinnings of peace by relating to developmental and peace psychology.Keywords: perception of peace, thematic analysis, emotion, social relations, phenomenological variant of ecological systems theory

Shuqin Zhan,1 Hui Ye,2 Ning Li,1 Yimeng Zhang,1 Yueyang Cheng,1 Yuanqing Wang,1,3 Shimin Hu,1 Yue Hou1 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, People’s Republic of China; 2Ignis Therapeutics (Shanghai) Limited, Shanghai, 200000, People’s Republic of China; 3Department of Neurology, People’s Hospital of Rizhao, Rizhao, 276800, People’s Republic of ChinaCorrespondence: Shuqin Zhan, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, People’s Republic of China, Tel +8613801027285, Email shqzhan@hotmail.comPurpose: Narcolepsy is a rare debilitating disorder for which multiple novel pharmacological options have been approved as treatment for the past few years. The current study systematically updates the comparative efficacy and detailed safety analysis of approved wake-promoting agents in narcolepsy.Methods: Randomized controlled trials (RCTs) were searched for diagnosed narcolepsy with approved interventions. Efficacy outcomes included the Maintenance of Wakefulness Test (MWT), Epworth Sleepiness Scale (ESS), Clinical Global Impression of Change (CGI-C), and Patient Global Impression of Change (PGI-C). Safety outcomes including overall adverse event (AE) risk were measured. The study was registered at PROSPERO (CRD 42022334915).Results: The final analysis included 17 RCTs with five drug treatments: modafinil/armodafinil, sodium oxybate, pitolisant, solriamfetol, and lower-sodium oxybate (LXB). For efficacy measures, interventions included in each outcome were effective compared with placebo. Furthermore, the magnitude of solriamfetol effect on MWT (9.11 minutes; 95% CI=7.05– 11.16), ESS (− 4.79; 95% CI=− 6.56 to − 3.01), and PGI-C (9.39; 95% CI= 2.37– 37.19), and LXB effect on CGI-C (9.67; 95% CI=2.73– 34.26) was greater than that of other treatments included in each outcome compared with placebo. For safety measures, all interventions had an acceptable safety profile with LXB having least risk for overall AEs (0.56; 95% CI=0.20– 1.53), serious AEs (0.33; 95% CI=0.09– 1.20), AEs leading to treatment discontinuation (0.11; 95% CI=0.01– 2.04), and all-cause discontinuation (0.04; 95% CI=0.00– 0.67) compared to placebo. Placebo had the lowest risk for exploratory AEs.Conclusion: All approved interventions were effective in controlling the symptoms of narcolepsy at varying degrees with an acceptable safety profile.Keywords: narcolepsy, network meta-analysis, wake-promoting agents, excessive daytime sleepiness, patient-centric scores, safety

Senlin Zhan,1,&ast; Xiong Juan,2,&ast; Tantan Ren,1 Yuxiang Wang,1 Liang Fu,1 Guofang Deng,1 Peize Zhang1 1Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, Guangdong, People’s Republic of China; 2School of Public Health, Health Science Center, Shenzhen University, Shenzhen, Guangdong, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guofang Deng; Peize Zhang, Email jxxk1035@yeah.net; 82880246@qq.comBackground: Diabetes mellitus (DM) is believed to affect tuberculosis (TB) at multiple levels in disease control and treatment efficacy, but clinical and radiological presentation resulting from interaction of the two diseases is not known.Methods: A cross-sectional study was conducted on data obtained from medical records of 438 patients confirmed with TB-DM comorbidity at the Third people’s hospital of Shenzhen from May 01, 2014, to April 30, 2019. Their CT images were reviewed, and patients were divided into subgroups according to lung cavitation: with and without cavities, and number of segments showing pulmonary infiltration: < 4 segment, 4– 8 segment, > 8 segment infiltrates. We then compared clinical parameters between these groups.Results: The median age of the patients was 50.0 years (IQR 43.3– 56.0) and 86% (n=375) of them were male. Pulmonary cavities were found in 80.8% patients. About 42.7% and 27.2% patients were seen to have infiltration involving 4– 8 and > 8 lung segments, respectively. Patients presented with cavitation and infiltration involving a greater number of lung segments had significantly higher values of WBC, MONO%, GRA%, CRP, lower LYN% level and higher bacterial burden in sputum (P< 0.001). Higher HbA1c and FBG were only observed in patients with lung cavities (P< 0.001). There was no difference in positive ELISPOT.TB and PCT level between the groups regardless of presence or absence of lung cavity (P> 0.9 and P=0.1 respectively). Lower HGB, ALB and higher PCT were observed in patients with infiltration involving more lung segments.Conclusion: Hyper-inflammation in peripheral blood was significantly associated with cavity and the number of lung lesions. Hyperglycemia was significantly associated with the development of lung cavity. Glycemic control and inflammation influenced radiographic manifestations in patients with TB-DM.Keywords: diabetes mellitus, tuberculosis, lung cavity, lung infiltration, radiography

Peize Zhang,1,2 Wei Li,3 Miaona Liu,3 Senlin Zhan,2 Hailin Zhang,2 Guofang Deng,2 Xiaoyou Chen1 1Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, People’s Republic of China; 2Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, Guangdong, People’s Republic of China; 3Department of Pharmacy, The Third People’s Hospital of Shenzhen, Shenzhen, Guangdong, People’s Republic of ChinaCorrespondence: Guofang Deng; Xiaoyou Chen, Email jxxk1035@yeah.net; chenxy1998@hotmail.comObjective: Linezolid is one of the key drugs for the treatment of multidrug-resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB). We aimed to describe the incorporation of the Michigan Neuropathy Screening Instrument (MNSI) and serum trough concentration as screening tools for neurotoxicity in the management of MDR/XDR-TB patients receiving a linezolid-based treatment regimen in Shenzhen, China.Methods: A total of 73 patients on a linezolid-containing anti–MDR/XDR-TB regimen were prospectively enrolled. The MNSI was used for peripheral neuropathy screening. Optic neuropathy was diagnosed by ophthalmologists. Serum trough concentration was recorded and its relationship with neuropathy analyzed.Results: Of all patients, neuropathy was observed in 40% (29) during anti-TB treatment. Of these, 20 (69%) had peripheral neuritis, seven (24%) optic neuritis, and two (7%) both. Serum trough concentration > 2 mg/L was observed in 17 (59%) patients with neuropathy and 13 (30%) patients without neuropathy. There was a significant statistical difference between the two groups (P=0.013). Time to onset of neuropathy from initiation of the linezolid-containing regimen was within 2 months for eight (28%) patients, 2– 6 months for 18 (62%) patients, and > 6 months for three (10%) patients. Sixteen (55%) patients were adjusted to a lower dose of 300 mg linezolid daily. Four (14%) patients had linezolid permanently removed from their regimen.Conclusion: Neuropathy is a commonly reported adverse event associated with long-term use of linezolid. MNSI and serum trough–concentration monitoring can be adopted as simple screening tools for early detection of neuropathy to balance linezolid efficacy and tolerability.Keywords: linezolid, MDR/XDR-TB, neuropathy, MNSI, serum trough concentration

Yu-Chan Yang,1 Ke Zeng,2 Wei Wang,2 Zhi-Gang Gong,1 Yi-Lei Chen,1 Jian-Ming Cheng,1 Min Zhang,1 Yan-Wen Huang,1 Xin-Bo Men,2 Jian-Wei Wang,2 Songhua Zhan,1 Wen-Li Tan1 1Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People’s Republic of China; 2Department of Massage, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People’s Republic of ChinaCorrespondence: Songhua Zhan; Wen-Li TanDepartment of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 528 Zhangheng Road, Pudong New Area, Shanghai, 201203, People’s Republic of China, Email zhansonghua@sina.com; 13764935974@163.comObjective: To investigate the changes of regional homogeneity (Reho) values before and after spinal manipulative therapy (SMT) in patients with chronic low back pain (CLBP) through rest blood-oxygen-level-dependent functional magnetic resonance imaging (BOLD fMRI).Methods: Patients with CLBP (Group 1, n = 20) and healthy control subjects (Group 2, n = 20) were recruited. The fMRI was performed three times in Group 1 before SMT (time point 1, TP1), after the first SMT (time point 2, TP2), after the sixth SMT (time point 3, TP3), and for one time in Group 2, which received no intervention. The clinical scales were finished in Group 1 every time before fMRI was performed. The Reho values were compared among Group 1 at different time points, and between Group 1 and Group 2. The correlation between Reho values with the statistical differences and the clinical scale scores were calculated.Results: The bilateral precuneus and right mid-frontal gyrus in Group 1 had different Reho values compared with Group 2 at TP1. The Reho values were increased in the left precuneus and decreased in the left superior frontal gyrus in Group 1 at TP2 compared with TP1. The Reho values were increased in the left postcentral gyrus and decreased in the left posterior cingulate cortex and the superior frontal gyrus in Group 1 at TP3 compared with TP1. The ReHo values of the left precuneus in Group 1 at TP1 were negatively correlated with the pain degree at TP1 and TP2 (r = − 0.549, − 0.453; p = 0.012, 0.045). The Reho values of the middle temporal gyrus in Group 1 at TP3 were negatively correlated with the changes of clinical scale scores between TP3 and TP1 (r = 0.454, 0.559; p = 0.044, 0.01).Conclusion: Patients with CLBP showed abnormal brain function activity, which was altered after SMT. The Reho values of the left precuneus could predict the immediate analgesic effect of SMT.Keywords: blood-oxygen-level-dependent functional magnetic resonance imaging, spinal manipulation therapy, chronic low back pain, regional homogeneity

Xiang-yu Wei, Hui Chen, Cui Guo, Wen-li Tan, Song-hua Zhan Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People’s Republic of ChinaCorrespondence: Song-hua Zhan; Hui ChenDepartment of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 528 Zhangheng Road, Pudong New Area, Shanghai, 201203, People’s Republic of ChinaEmail zhansonghua@sina.com; chenhui660245@163.comObjection: This study was a primary study to evaluate the instant and sustained effect of electroacupuncture (EA) at GV20 (Baihui) in postgraduate students with mild depression by using a special flexible head coil.Methods: A total of 20 postgraduate students with mild depression underwent EA stimulation at GV20 and 3 phases of resting-state functional magnetic resonance imaging (rs-fMRI) scanning. Phase I: Preparation (before needle insertion); Phase II: during EA; Phase III: 15 minutes after needle removal. The Rs-fMRI data were processed using DPABI and SPSS 25.Results: 1) ReHo values showed significantly differences in the right posterior cingulate cortex, right calcarine gyrus, right angular gyrus, right precuneus, right cuneus, and bilateral postcentral gyri among Phase I, Phase II and Phase III; 2) Relative to the Phase I, increased brain activity in the Phase II was observed in the bilateral postcentral gyri, right calcarine gyrus, right cuneus. Compared with the Phase II, decreased brain activity in the Phase III was observed in the right precuneus, right posterior cingulate cortex, right angular gyrus. Relative to the Phase I, Significantly increased brain activity in the Phase III was observed in the right calcarine gyrus, right cuneus, and bilateral postcentral gyri. While decreased ReHo values were found in the right posterior cingulate cortex, right angular gyrus, right precuneus; and 3) Correlation analysis showed that the ReHo values of multiple brain regions in Phase I and Phase III were significantly correlated with the VAS and HRSD-17 scores.Conclusion: This study focuses on the instant and sustained effect in postgraduate students with depression. Our study showed that instant effect produced by EA stimulation at GV20 firstly induced changes in somatosensory and visual area, and then, sustained effect (Phase III) have a higher intensity and more extensive than instant effects. Meanwhile, we provide a visualization way to study the instant effects of head acupoints by using a flexible head coil.Keywords: acupuncture, functional magnetic resonance imaging; fMRI, depression, default mode network; DMN, neuroimaging

Peize Zhang,1,* Juan Xiong,2,* Jianfeng Zeng,1,* Senlin Zhan,1 Tao Chen,1 Yuxiang Wang,1 Guofang Deng1 1Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, Guangdong, People’s Republic of China; 2School of Public Health, Health Science Center, Shenzhen University, Shenzhen, Guangdong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Guofang DengDepartment of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, No. 29, Bulan Road, Longgang District, Shenzhen, Guangdong 518112, People’s Republic of ChinaTel +86 135 300 27001Fax +86 0755 6123 8928Email jxxk1035@yeah.netObjective: The aim of this study was to assess active tuberculosis-related deaths in Shenzhen city of China to identify major causes of mortality in different age groups.Patients and Methods: Medical records of mortality cases of patients with active TB diagnosed during 2013– 2018 were reviewed. All TB deaths were classified into two broad age groups (the young group: 18– 65 years old and the elderly group: > 65 years old). Causes of death were analyzed based on medical records.Results: A total of 279 mortality cases of active TB were reviewed during the study period. Among them, mean age was 54.0± 20.5 years old; 80.6% (225/279) were male. There were 5.7% and 4.6% MDR/XDRTB patients in the young and elderly group. Newly treated TB accounted for 89.6% in the young group and 85.1% in the elderly group. Pulmonary TB was a major infection type in both groups (65.1% vs 77.0%). Advanced TB (23.4%) and HIV co-infection (20.8%) were the leading causes of deaths in the young group, but deaths in the elderly group were mostly associated with underlying diseases, including cardiovascular disease (52.9%), diabetes (33.3%), COPD (16.1%) and cancer (11.5%). Malnutrition was a significant condition in both groups (43.2% vs 35.6%). In terms of respiratory complications, bacterial infection was the leading comorbidity in both groups (27.1% vs 18.4%), followed by septic shock (18.2% vs 12.6%) and respiratory failure (12.0% vs 11.5%). There were no significant statistical differences between the two groups.Conclusion: Our findings suggest that screening for HIV co-infection and early diagnosis of TB is vital in lowering TB-related deaths in young patients. Most deaths in elderly TB patients were caused by underlying health conditions or complications other than TB.Keywords: active tuberculosis, TB-related death, tuberculosis complication, tuberculosis comorbidity, young death

Zhexue Xu,1,2,* Tao Han,1,2,* Tian Li,3 Xiaodong Zhang,3 Zhaoyang Huang,1,2 Shuqin Zhan,1,2 Chunyan Liu,1,2 Jinping Xu,3 Yuping Wang1,2 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, People’s Republic of China; 2Beijing Key Laboratory of Neuromodulation, Beijing 100053, People’s Republic of China; 3Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chunyan LiuDepartment of Neurology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing 100053, People’s Republic of ChinaEmail lcy_e_mail@163.comJinping XuInstitute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People’s Republic of ChinaEmail jp.xu@siat.ac.cnBackground: Neurophysiological and radiological studies provide accumulating evidence for the involvement of the brainstem in the pathogenesis of restless legs syndrome (RLS). The analysis of the various subregions of the brainstem may help us better understand the pathophysiological mechanisms underlying the disorder. In this study, we investigated the structural and functional changes in the various subregions of the brainstem in RLS patients.Methods: The subregional changes in gray matter density and functional connectivity in the brainstem were analyzed in 20 drug-naive idiopathic RLS patients, as well as 18 normal control (NC) subjects for comparison. Correlation analyses and multivariate pattern analyses using linear support vector machine (SVM) were conducted.Results: We found significantly increased gray matter density in two clusters in the pons (designated pons_1 and pons_2) and in one cluster in the midbrain in RLS patients compared with NC subjects. Further functional connectivity analyses revealed significantly decreased functional connectivity between the midbrain and the right middle occipital gyrus, between pons_1 and the right orbital part of the superior frontal gyrus, and between pons_2 and the right parahippocampus in RLS compared with NC. Moreover, the functional connectivity between pons_2 and the right supplementary motor area (SMA) was significantly increased in RLS compared with NC. This change in RLS was marginally correlated with RS_RLS scores in the RLS patients. SVM-based classification showed an AUC of 0.955 using gray matter density of pons_2, and functional connectivity between pons_2 and SMA as features.Conclusion: Collectively, our findings suggest that changes in gray matter density and functional connectivity in the pons may play a pathologic role in RLS. Furthermore, these abnormal changes in the pons might help to discriminate RLS from healthy subjects.Keywords: restless legs syndrome, gray matter density, brainstem, multivariate pattern analysis

Hailong Li,1 Hongbo Lin,2 Houyu Zhao,1 Yang Xu,1 Yinchu Cheng,1 Peng Shen,2 Siyan Zhan1 1Department of Epidemiology and Bio-statistics, School of Public Health, Peking University Health Science Centre, Beijing, People’s Republic of China; 2Department of Chronic Diseases and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, People’s Republic of China Background: Reports have suggested that statin use is associated with an increased incidence of type 2 diabetes mellitus (T2DM). Guidelines suggested that statins should be prescribed in hypertensive patients for primary prevention. However, there were very few studies on the risk of T2DM associated with statin use among patients with hypertension in mainland People’s Republic of China. Purpose: To determine the association between statin use and new-onset diabetes mellitus among patients with hypertension in mainland People’s Republic of China. Patients and methods: We performed a retrospective cohort study of hypertensive patients using the Yinzhou regional health care database from January 1, 2010, to August 31, 2016. Patients aged 30–90 years old without T2DM were eligible for inclusion. We identified new statin initiators and nonusers by using prescription records of inpatients and outpatients. Multivariate Cox model and propensity score methods were used to adjust potential confounders, including age, sex, body mass index, comorbidities, lifestyle characteristics, and baseline antihypertensive drug use. The risk of incident T2DM among statin initiators compared to nonusers was estimated by the Cox proportional hazards model. Propensity scores for statin use were then developed using logistic regression, statin initiators were matched 1:1 with nonusers according to propensity scores with the nearest neighbor matching method within 0.2 caliper width, and Cox regression was again conducted. Results: Among 67,993 patients (21,551 statin initiators; 46,442 nonusers), the unadjusted incidence rate of incident T2DM was higher in statin initiators than nonusers (25.68 versus 14.19 events/1,000 person-years; adjusted hazard ratio: 1.55; 95% confidence interval: 1.44–1.66). After propensity score 1:1 matching (19,818 statin initiators; 19,818 nonusers), baseline characteristics between 2 groups were balanced except that the nonusers group was 0.53 years older on average (P

Jing Zhang,1,* Tao Wang,1,* Chen-cheng Zhang,1 Kristina Zeljic,2 Shikun Zhan,1 Bo-min Sun,1 Dian-you Li1 1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 2Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China *These authors contributed equally to this work Introduction: Deep brain stimulation (DBS) is a well-established therapy for the treatment of advanced Parkinson’s disease (PD) in patients experiencing motor fluctuations and medication-refractory tremor. Despite the relative tolerability and safety of this procedure, associated complications and unnatural deaths are still unavoidable.Methods: In this study, hardware-related complications and the causes of unnatural death were retrospectively analyzed in 478 patients with PD who were treated with DBS.Results: The results showed a 3-year survival rate of 98.6% and a 5-year survival rate of 96.4% for patients with PD who underwent DBS treatment at the study center. Pneumonia was the cause of death with the highest frequency. Prophylactic antibiotics and steroids or antihistamine drugs were adopted to reduce the risk of infection. Twenty-two patients (4.6%) experienced hardware-related complications.Conclusion: Deaths of PD patients who receive DBS are typically unrelated to the disease itself or complications associated with the surgery. Pneumonia, malignant tumors, asphyxia, and multiple-organ failure are the common causes of death. Swallowing-related problems may be the most important clinical symptom in late-stage PD, as they cannot be stabilized or improved by DBS alone, and are potentially lethal. Although prophylactic antibiotics and steroids or antihistamine drugs may reduce the risk of infection, it is imperative to identify high-risk patients for whom a therapeutic approach not requiring an implantable device is more suitable, for example, pallidotomy and potentially transcranial ultrasound. Keywords: motor fluctuations, tolerability, death, survival, antibiotics, steroids

Background: Data regarding the treatment efficacy of integrative treatment of Traditional Chinese Medicine (TCM) and Western Medicine (WM) in treating patients with (SARS) are conflicting. The effects of integrative TCM/WM treatment have not been fully quantified. Objectives: To systematically asses the treatment effects of integrated TCM with WM versus WM alone in patients with SARS, incorporating data from recently published studies. Methods: A meta-analysis was conducted, using published randomized and nonrandomized controlled clinical studies that compared the treatment effects of integrative TCM/WM with WM alone from 2002 to 2006.The outcome measurements included mortality rate, cure rate, resolution of pulmonary infiltrate, use of corticosteroid, and time to defervescence. The effect sizes were presented as risk ratio (RR), rate difference (RD), and weighted mean difference (WMD).The pooled effect sizes were calculated by both fixed-effects and random-effects models. Results: A total of 1,678 patients with a diagnosis of SARS were identified, including 866 patients from 16 randomized controlled studies and 812 patients from 8 nonrandomized controlled studies. There were no differences detected in mortality rate or cure rate between treatments. Compared with patients receiving WM treatment alone, patients receiving integrative treatment were more likely to have complete or partial resolution of pulmonary infiltrate (RD=0.18, 95%CI; 0.07 to 0.30), lower average daily dosage (mg) of corticosteroid (WMD=-60.27, 95% CI; -70.58 to -49.96), higher CD4+ counts (cells/uL) (WMD=167.96, 95% CI; 109.68 to 226.24), and shorter time to defervescence (days) (WMD= -1.06, 95%CI;-1.60 to -0.53).Conclusions: The experience of integrative TCM/WM in the treatment of SARS is encouraging. The use of TCM as an adjunctive therapy in the treatment of SARS should be further investigated.

T cell immunoglobulin and mucin domain-containing protein 3 (Tim-3) is a newly identified negative immunomodulator that is up-regulated on dysfunctional T cells during viral infections. The expression and function of Tim-3 on human innate immune responses during HCV infection, however, remains poorly characterized. In this study, we report that Tim-3 is constitutively expressed on human resting CD14(+) monocyte/macrophages (M/M(Ø)) and functions as a cap to block IL-12, a key pro-inflammatory cytokine linking innate and adaptive immune responses. Tim-3 expression is significantly reduced and IL-12 expression increased upon stimulation with Toll-like receptor 4 (TLR4) ligand--lipopolysaccharide (LPS) and TLR7/8 ligand--R848. Notably, Tim-3 is over-expressed on un-stimulated as well as TLR-stimulated M/M(Ø), which is inversely associated with the diminished IL-12 expression in chronically HCV-infected individuals when compared to healthy subjects. Up-regulation of Tim-3 and inhibition of IL-12 are also observed in M/M(Ø) incubated with HCV-expressing hepatocytes, as well as in primary M/M(Ø) or monocytic THP-1 cells incubated with HCV core protein, an effect that mimics the function of complement C1q and is reversible by blocking the HCV core/gC1qR interaction. Importantly, blockade of Tim-3 signaling significantly rescues HCV-mediated inhibition of IL-12, which is primarily expressed by Tim-3 negative M/M(Ø). Tim-3 blockade reduces HCV core-mediated expression of the negative immunoregulators PD-1 and SOCS-1 and increases STAT-1 phosphorylation. Conversely, blocking PD-1 or silencing SOCS-1 gene expression also decreases Tim-3 expression and enhances IL-12 secretion and STAT-1 phosphorylation. These findings suggest that Tim-3 plays a crucial role in negative regulation of innate immune responses, through crosstalk with PD-1 and SOCS-1 and limiting STAT-1 phosphorylation, and may be a novel target for immunotherapy to HCV infection.

Free-electron lasers (FELs) are fourth-generation light sources that deliver extremely high intensity, ultrashort light pulses over a broad wavelength range from far-infrared to hard x ray. FELs based on the self-amplified spontaneous emission principle have been successfully operated with ultrahigh brightness and a broad wavelengths tuning range with good transverse coherence but poor temporal coherence. In contrast, the laser-seeded FELs have provided full coherence but at selected central wavelengths, usually the harmonics of the laser seeds, with relatively narrower tuning range. We report the experimental demonstration of a high-gain harmonic-generation (HGHG) FEL that is continuously tunable over a wide range using the combination of optical parametrical amplification, variable-gap undulator, and harmonic selection, where the temporal coherence is preserved as confirmed with the Michelson interferometry. In order to achieve higher photon energies, the first try of cascaded HGHG with a fresh-bunch technique is also made at the Shanghai Deep Ultraviolet Free-electron Laser test facility.

The emerging literature on multinational migration highlights migratory journeys that involve more than one country of destination. This article focuses on the lived experiences of new Chinese and Indian migrants in Singapore and Los Angeles. We conduct a novel three-way comparison to examine personal choices to engage in additional migration(s) and to consider the reasons behind such moves. Drawing on in-depth interviews and analyses of policy documents, we find that new, especially skilled, migrants from China and India actively participate in multinational migration. However, variations exist between these two national origin groups and between the two global cities. Factors affecting decisions about whether and where to further migrate include immigration policy of the host country, job opportunities, homeland economic development, and migration networks. Singapore regulates migrants' long-term settlement more tightly than does the United States; thus, migrants in the former are more likely than the latter to move onward to another country. Due to a more robust economy in the homeland, Chinese migrants are more likely to return and are thus less likely to migrate to a third country than their Indian counterparts. Job opportunities and migration networks also have strong effects on personal decisions concerning additional migration(s).

This paper examines the challenges that highly skilled immigrant workers face and their strategies of adaptation. We employ the term “precarious talent” to capture an often neglected aspect of skilled migration. Using both survey data and interviews on skilled Chinese and Indian immigrants in Singapore, we find that these migrants confront varying degrees of employment insecurity and settlement uncertainty in an era of neoliberal globalization, contrary to the common perception of “foreign talent” as a privileged group. We also find that skilled immigrants actively use Information and Communication Technologies (ICTs) to mitigate precarity: they use the Internet and social media to access timely job information, sustain social contacts across national borders, and adapt to life and work in the host society. However, the ability to effectively cope with precarity depends on their own socioeconomic status, context of reception, and homeland development. We discuss theoretical implications of our findings.

OBJECTIVE: This study aimed to determine the minimum interaction between different antiepileptic drugs (AEDs) and meropenem (MEPM) for clinical treatment. PATIENTS AND METHODS: The data of 91 patients enrolled in the neurology department from January 2020 to March 2023 for clinical trials were measured and observed. Self-controlled studies were conducted to monitor the trough concentrations of valproic acid (VPA), carbamazepine (CBZ) and levotiracetam (LEV) before and after MEPM usage. Relevant indicators of liver and kidney function were also monitored. RESULTS: The serum VPA trough concentrations were 36.25±8.22 μg/ml at 24±12 h and 34.99±11.17 μg/ml at 96±12 h after MEPM use; the difference was significant (p<0.05). Decreased CBZ trough concentrations were also identi- fied after MEPM usage (96±12 h), whereas LEV trough concentrations were not affected. An increased liver injury rate (χ² =8.744, p<0.05) and a decreased kidney injury rate (χ² =5.393, p<0.05) were found in the VPA group only. CONCLUSIONS: The interaction between VPA and MEPM decreased serum VPA concentrations, increased liver injury rates, and decreased kidney injury rates. In addition, the co-administration of MEPM and CBZ reduced serum CBZ concentrations. Clinicians should be aware of this potential interaction and closely monitor the relevant biochemical indices and number of seizures. [ABSTRACT FROM AUTHOR]

Abstract Background Short term results of the change of center of rotation (COR) after Bryan cervical disc replacement (CDR) have been reported. However, there is a lack of long-term studies focusing on the COR and its influences on facet joint degeneration. Objective To evaluate the long-term clinical and radiographic results of Bryan CDR, and to explore the influence of deviated COR on facet joint degeneration at index level. Methods It is a retrospective follow up study conducted in China. Eighty-three consecutive patients who received single-level Bryan CDR were retrospectively reviewed. Clinical evaluation included Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and Odom’s scale. Radiographic evaluation underwent before surgery, at early follow-up (3 months) and last follow-up (10 years). The radiographic parameters included range of motion (ROM), location of COR presented by the coordinates (COR-x, COR-y), and facet joint degeneration score. Correlation analysis was conducted between changes of COR and facet joint degeneration score. Results Fifty-nine patients were included, with an average age of 44.6 ± 7.4 years. The mean follow-up time was 135.7 ± 12.4 (120–155) months. JOA score, NDI and Odom’s scale showed significant improvements at last follow-up. The ROM was well preserved through follow-up. 33 patients (55.9%) showed deterioration of facet joint degeneration at index level. The increment of facet joint degeneration score at index level was strongly correlated with the change of COR-x (r = 0.758, P

Abstract Background TOBAMOVIRUS MULTIPLICATION 1 (TOM1) and its homolog TOBAMOVIRUS MULTIPLICATION 3 (TOM3) play a prominent role in the multiplication of tobacco mosaic virus (TMV) in higher plants. Although homologs of NtTOM1/TOM3 genes have been identified in several plant species, little is known about the characteristics and functions of NtTOM1/TOM3 at the genome-wide level in tobacco (Nicotiana tabacum L.). Results In this study, we performed genome-wide identification and expression pattern analysis of the tobacco NtTOM1/TOM3 gene family. Twelve NtTOM1/TOM3 genes were identified and classified into four groups based on phylogenetic analysis. Sequence and conserved domain analyses showed that all these genes contained a specific DUF1084 domain. Expression pattern analysis showed that NtTOM1a, NtTOM1b, NtTOM1d, NtTOM3a, NtTOM3b, and NtTOM3d were induced by TMV at 1-, 3-, and 9 dpi, whereas the expression of other genes was not responsive to TMV at the early infection stage. TMV virion accumulation showed no obvious difference in either nttom1a or nttom3a mutants compared with the wild type. However, the virus propagation was significantly, but not completely, inhibited in the nttom1atom3a double mutant, indicating that other gene family members may function redundantly, such as NtTOM1b and NtTOM1d. In addition, overexpression of NtTOM1a or NtTOM3a also inhibited the TMV replication to some extent. Conclusions The present study performed genome-wide analysis of the NtTOM1/TOM3 gene family in tobacco, and identified NtTOM1a and NtTOM3a as important genes involved in TMV multiplication based on functional analysis. These results provide a theoretical basis for further improving TMV resistance in tobacco.

Abstract Objectives To establish superb microvascular imaging (SMI) based thyroid imaging reporting and data system (SMI TI-RADS) for risk stratification of malignancy in thyroid nodules. Methods In total, 471 patients, comprising 643 thyroid nodules, who received conventional ultrasound (US), SMI, and a final diagnosis were extensively analyzed. A qualitative assessment of US features of the nodules was performed followed by univariable and multivariable logistic regression analyses, leading to the construction of the SMI TI-RADS, which was further verified using internal and external validation cohorts. Results Among the stand-alone US, predictive factors were the shape and margins of the nodules, echogenicity and echogenic foci, vascularity, extrathyroidal extension, ring-SMI patterns, penetrating vascularity, flow-signal enlarged, and vascularity area ratio. SMI TI-RADS depicted an enhanced area under the receiver operating characteristic curve (AUC) of 0.94 (95% CI: 0.92, 0.96; p

Abstract A high efficiency simulation method for propagation-based phase-contrast imaging, called directional macro-wavefront (DMWF), is developed with the aim of simulating high-energy phase-contrast imaging. This method takes both Monte Carlo and wave optical propagation into consideration. Traditional wave-optics-based simulation methods for phase-contrast imaging encounter unacceptable computational complexity when high-energy radiation is used. In contrast, this method effectively addresses this issue by using macro-wavefront integration. Several simulation examples using typical parameters of inverse Compton scattering sources are presented to illustrate the excellent energy adaptability and efficiency of the DMWF method. This method provides a more efficient approach for phase-contrast imaging simulations, which will drive the advancement of high-energy phase-contrast imaging.