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Jingjing Liu, Gaosheng Zhou, Zewen Tong, Xiaoting Wang, Dawei Liu Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of ChinaCorrespondence: Dawei Liu, Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 1&num; Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, People’s Republic of China, Tel +86-10-69152305, Email daweiliu05@163.comBackground: Metabolic changing is the significant host stress response during sepsis, but there is increasing evidence that uncontrolled metabolic reprogramming is a contributing factor to sepsis. Nevertheless, its association with outcome in patients with sepsis has been poorly investigated. As the key enzyme of metabolic reprogramming, the clinical value of PDK1 and LDH in patients with sepsis will be investigated in this study.Methods: We collected serum from 167 ICU patients within 24 hours of admission for a single-center prospective observational study. The levels of PDK1 and LDH were detected by enzyme-linked adsorption method. Pearson or Spearman coefficient for correlation analysis between PDK1, LDH and clinical indicators. Areas under the ROC curves for evaluation of mortality prediction. Kaplan–Meier survival curve analysis was performed, and Cox proportional hazards model was performed to determine the risk factors for 28-day mortality.Results: The PDK1/LDH in the septic shock group was statistically different between both the sepsis group and ICU control group, and had good correlation with ScvO2 and lactate. In predicting 28-day mortality in patients with sepsis, the best AUC was observed for PDK1/LDH, and was higher than the AUC for PDK1, lactate, and SOFA. Additionally, patients with lower PDK1/LDH had markerablely higher 28-day mortality. The multivariate Cox proportional hazards model revealed that PDK1/LDH < 0.1808 were the independent risk factors for 28-day mortality in sepsis.Conclusion: The level of PDK1/LDH at admission was markedly decreased in patients with septic shock, which can serve as a novel independent prognostic biomarker for predicting mortality.Keywords: sepsis, septic shock, PDK1/LDH, metabolic reprogramming, mortality

Guoxia Zhou,1,2,&ast; Yuecheng Yang,1,2,&ast; Yunkui Zhang,1,2,&ast; Congxia Pan,1,2 Xing Wu,1,2 Jun Zhang1,2 1Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; 2Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jun Zhang, Department of Anesthesiology, Fudan University Shanghai Cancer Center, No. 270, Dong-An Road, Shanghai, 200032, People’s Republic of China, Tel +86-021-64175590, Fax +86-021-64174774, Email snapzhang@aliyun.comObjective: To investigate the efficacy of ultrasound-guided interscalene brachial plexus block in the treatment of shoulder pain following hepatectomy.Design: A randomized controlled trial.Methods: We conducted a single-center, randomized controlled trial. Forty-four patients with shoulder pain scores of at least 5 were randomly assigned to two groups: the treatment group, which received 0.5% ropivacaine (5mL) combined with dexamethasone (5 mg) (n=22), and the control group, which received normal saline (5mL) (n=22). The intervention was performed in the postanesthesia care unit after shoulder pain was identified by using the visual analogue scale. The shoulder pain was re-evaluated 15 minutes after intervention. The incidence of effective pain relief, defined as at least 75% reduction in pain intensity, was the primary outcome. Secondary outcomes included shoulder pain intensity within 2 days after surgery, the timing of the first rescue analgesia, total additional analgesic use, arterial oxygen saturation, intervention-related adverse reactions, and patient satisfaction regarding shoulder pain.Results: The incidence of effective pain relief was significantly higher in the treatment group compared to the control group (15 (68.2%) vs 2 (9.1%), P< 0.001). The interscalene brachial plexus block not only prolonged the time to first analgesic request (P < 0.001), but also reduced the number of analgesic requests (P < 0.001). In the comparison between groups, arterial oxygen saturation was lower in the control group than that in the treatment group, attributed to the use of sufentanil for remedial analgesia (92.4% vs 94.5%, P=0.014).Conclusion: Interscalene brachial plexus block can effectively relieve post-hepatectomy shoulder pain without clinically significant hypoxemia.Keywords: interscalene brachial plexus block, hepatectomy, referred pain, phrenic nerve

Suwen Huang,1,&ast; Wei Xie,1,2,&ast; Yufan Gao,1,3,&ast; Yining Jin,1,3 Yilin Chen,1,2 Guoliang Zhou,1,2 Feng Chen,1,2 Qiaoqiao Jin,1,2 Zihao Wu,1,2 Lingsheng Wang,1,2 Chao Chen,4 Yiyun Weng,1 Guangyong Chen5 1Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China; 2The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, People’s Republic of China; 3The Second School of Medicine, Wenzhou Medical University, Wenzhou, People’s Republic of China; 4Department of Nutriology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China; 5Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guangyong Chen, Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China, Email gychen@wmu.edu.cn Yiyun Weng, Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China, Email wengyiyun2012@126.comBackground and Purpose: The dynamic systemic inflammation level and stroke-associated infection (SAI) are related to the prognosis of acute ischemic stroke (AIS). We aimed to explore whether the systemic inflammatory response index (SIRI), systemic immune inflammation index (SII), and their dynamic changes possess predictability for SAI and long-term prognosis.Methods: A total of 1804 AIS patients without intravenous thrombolysis in two hospitals were included. We explored the relationship between SIRI, SII, and their dynamic changes and outcomes by constructing clusters. The mediating effects of SAI between prognosis and systemic inflammation were further evaluated.Results: Each SD increase in the concentration of SIRI exhibited a significant correlation with the risk of poor functional outcome, mortality, and functional dependency. Through K-means clustering analysis, patients with dramatically elevated or decreased systemic inflammation levels of SIRI (OR: 2.293, 95% CI: 1.279– 4.109) and SII (OR: 3.165, 95% CI: 1.627– 6.156) within 7 days had a higher risk of functional outcome. Through mediation analysis, SAI mediated the association between systemic inflammation and poor prognosis (SIRI: 33.73%, SII: 16.01%).Conclusion: Dramatically changing dynamics of SIRI and SII were significantly associated with a higher risk of poor prognosis in AIS patients. SAI mediated the association between systemic inflammation and prognosis at 1 year.Keywords: AIS, inflammation, SAI, mediation analysis, clustering analysis

Yinping Feng,&ast; Jing Guo, Shuirong Luo, Guangnao Zhou&ast; Department of Tuberculosis, Lishui Hospital of traditional Chinese Medicine Affiliated to Zhejiang University of traditional Chinese Medicine, Lishui, 323000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guangnao Zhou, Email zgn198615@163.comBackground: Pulmonary tuberculosis (PTB) with tracheobronchial tuberculosis (TBTB) can lead to tracheal stenosis and atelectasis, but the specific risk factors are currently unclear. Therefore, the goal of this retrospective study is to address this issue and help with the early diagnosis of TBTB.Methods: Please include PTB hospitalized in our hospital from January 2021 to October 2023 in the study. After conducting bronchoscopy examinations, the patients were divided into two groups: the PTB group and the PTB&TBTB group. We used the propensity score matching (PSM) to align the baseline data of the two groups of patients, and then performed multiple logistic regression analysis to identify risk factors.Results: 643 patients with PTB were included in the study, 227 of whom (35.30%) were diagnosed with TBTB. A total of 204 pairs of patients were successfully matched using the PSM. After matching, there were no statistically significant differences in basic information between the two groups of patients (P> 0.05). Multivariate logistic regression analysis revealed that disease course ≥ 1 month (OR=1.85, 95% CI: 1.21– 2.83), complicated with diabetes (OR=3.00, 95% CI: 1.91– 4.70), and concomitant pulmonary cavity (OR=3.46, 95% CI: 2.23– 5.36) were risk factors for PTB accompanied by TBTB (all P< 0.05).Conclusion: After adjusting for various influencing factors using PSM, the analysis demonstrated that disease course ≥ 1 month, complicated with diabetes, and concomitant pulmonary cavity are risk factors for PTB combined with TBTB. This emphasizes the significance of improving screening and implementing early intervention measures.Keywords: pulmonary tuberculosis, tracheobronchial tuberculosis, propensity score matching, risk factors

Xiaoling Zhou,1,2 Jing Wu,3 Ying Liu,3 Yuzhong Yan,2 Geyao Zhou,1 Ming Li1,4 1School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, People’s Republic of China; 2Research Department, Shanghai University of Medicine&Health Sciences Affiliated Zhoupu Hospital, Shanghai, People’s Republic of China; 3School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 4Party Committee office, Tongji University Affiliated Shanghai East Hospital, Shanghai, People’s Republic of ChinaCorrespondence: Ming Li; Geyao Zhou, Email liming1070202306@163.com; zhougeyao@163.comBackground: The health status of the occupational population is critical to the development of countries and regions as it is the main force of social and economic development. However, there is a dearth of comprehensive and systematic indicators to evaluate the health of occupational groups. This study aimed to construct a multi-dimensional evaluation index system for the general population.Methods: This study combined a literature review and initially established a multidimensional health system framework for the occupational population based on health ecology theory and then used two rounds of Delphi expert consultation to construct the final multidimensional health index system for the occupational population. Fifteen experts from related fields were selected for two rounds of Delphi expert consultation.Results: The recovery rates of the two rounds of expert questionnaires were 100.00% and 93.33% respectively, the expert authority coefficient were 0.90, and the Kendall’s coordination coefficients of the first and second level indexes were 0.32 and 0.42 (P ≥ 0. 001). The final index system includes four primary indicators (individual characteristics, health knowledge, health behavior, and health skills), 13 second-level indicators, and 41 third-level indicators; the weight coefficients of the four primary health dimensions are relatively close, and the “health knowledge” is slightly higher.Conclusion: The multi-dimensional health index system of the occupational population established in this study is comprehensive and reasonable from the perspective of health ecology, which can provide a solid foundation for the further development of a comprehensive health status prediction model for the occupational population.Keywords: health ecology, delphi method, multidimensional health, index system

Diguo Zhai,1,2 Qingwei Chen,1,2 Ying Yao,3 Taotao Ru,1,2 Guofu Zhou1,2 1Guangdong Provincial Key Laboratory of Optical Information Materials and Technology, Institute of Electronic Paper Displays, South China Academy of Advanced Optoelectronics, South China Normal University, Guangzhou, 510006, People’s Republic of China; 2National Center for International Research on Green Optoelectronics, South China Normal University, Guangzhou, 510006, People’s Republic of China; 3Anhui Provincial Library, Hefei, 230000, People’s Republic of ChinaCorrespondence: Taotao Ru; Qingwei Chen, Lab of Light and Physio-Psychological Health-National Center for International Research on Green Optoelectronics-South China Academy of Advanced Optoelectronics-South China Normal University, No. 55, West Zhongshan Road, Tianhe District, Guangzhou, 510631, People’s Republic of China, Tel +86 15603063417 ; +86 15521094813, Email taotao.ru@m.scnu.edu.cn; qingwei.chen@m.scnu.edu.cnPurpose: To explore whether sleep electroencephalogram (EEG) microarousals of different standard durations predict daytime mood and attention performance in healthy individuals after mild sleep restriction.Participants and Methods: Sixteen (nine female) healthy college students were recruited to examine the correlations between nocturnal EEG microarousals of different standard durations (≥ 3 s, ≥ 5 s, ≥ 7 s, ≥ 9 s) under mild sleep restriction (1.5 h) and the following morning’s subjective alertness, mood, sustained attention, and selective attention task performance.Results: Results revealed that mild sleep restriction significantly reduced subjective alertness and positive mood, while having no significant effect on negative mood, sustained attention and selective attention performance. The number of microarousals (≥ 5 s) was negatively associated with positive mood at 6:30. The number of microarousals was significantly and positively correlated with the response time difference value of disengagement component of the selective attention task at around 7:30 (≥ 5 s and ≥ 7 s) and 9:00 (≥ 5 s). The number of microarousals (≥ 7 s) was significantly and positively correlated with the inaccuracy difference value of orientation component of the selective attention task at around 9:00.Conclusion: The number of EEG microarousals during sleep in healthy adults with mild sleep restriction was significantly and negatively related to their daytime positive affect while positively associated with the deterioration of disengagement and orientation of selective attention performance, but this link is dependent on the standard duration of microarousals, test time and the type of task.Keywords: microarousal, alertness, sustained attention, selective attention, sleep restriction

Meng Luo,1,2,&ast; Xue Han,1,2,&ast; Huan Li,1,2 Guangyue Zhou,1,2 Haoxuan Chen,1,2 Fang Gao1,2 1Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China; 2Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Fang Gao, Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou, Jiangsu, 221002, People’s Republic of China, Tel +86-18052268331, Email gaofangxz@126.comBackground: Remifentanil-induced hyperalgesia (RIH) increases the risk of persistent postoperative pain, making early postoperative analgesic therapy ineffective and affecting postoperative patient satisfaction. This study aimed to verify the effects of gradual withdrawal of remifentanil combined with postoperative pump infusion of remifentanil on postoperative hyperalgesia and pain in patients undergoing laparoscopic hysterectomy.Methods: This trial was a factorial design, double-blind, randomized controlled trial. Patients undergoing laparoscopic hysterectomy were randomly allocated to the control group, postoperative pump infusion of remifentanil group, gradual withdrawal of remifentanil group, or gradual withdrawal plus postoperative pump infusion of remifentanil group (n = 35 each). The primary outcome was postoperative mechanical pain thresholds in the medial forearm. The secondary outcomes included postoperative mechanical pain thresholds around the incision, pain numeric rating scale scores, analgesic utilization, awakening agitation or sedation scores, a 15-item quality of recovery survey, and postoperative complications.Results: Gradual withdrawal of remifentanil significantly increased postoperative pain thresholds versus abrupt discontinuation (P < 0.05), whereas postoperative infusion did not show significant differences compared to the absence of infusion (P > 0.05). The combined gradual withdrawal and postoperative infusion group exhibited the highest thresholds and had the lowest postoperative pain scores and analgesic requirements as well as the highest quality of recovery scores (P < 0.05). No significant differences were observed for agitation scores, sedation scores, or complication rates (P > 0.05).Conclusion: The novel combined gradual withdrawal and postoperative infusion of remifentanil uniquely attenuates postoperative hyperalgesia, pain severity, analgesic necessity, and improves recovery quality after laparoscopic hysterectomy.Keywords: opioid-induced hyperalgesia, remifentanil-induced hyperalgesia, laparoscopic hysterectomy, mechanical pain thresholds, postoperative recovery

Guangxin Zhou,1,2 Wei Zhao,2 Yi Zhang,2 Wenli Zhou,2 Haizhou Yan,2 Yongli Wei,1 Yuming Tang,1 Zijing Zeng,2 Hanrong Cheng1 1Department of Sleep Medicine, Institute of Respiratory Diseases, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, People’s Republic of China; 2OPPO Health, Guangdong OPPO Mobile Telecommunications Co. Ltd., Shenzhen, Guangdong, People’s Republic of ChinaCorrespondence: Hanrong Cheng, Department of Sleep Medicine, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, People’s Republic of China, Email cheng.hanrong@szhospital.comObjective: To evaluate the clinical performance of the OPPO Watch (OW) Sleep Analyzer (OWSA) on OSA screening with polysomnography reference.Methods: We recruited 350 participants using OWSA and PSG simultaneously in a sleep laboratory. The respiratory event index (REI) derived from OWSA and the apnea-hypopnea index (AHI) provided by PSG were compared. SHapley Additive exPlanation (SHAP) values were calculated to explain the model of OWSA.Results: The OWSA-REI (26.5± 18.5 events/h) correlated well with PSG-AHI (33.2± 25.7 events/h; r = 0.91, p < 0.001), with an intraclass correlation coefficient (ICC) of 0.83. Using a threshold of AHI ≥ 15 events/h, the sensitivity, specificity, accuracy, and area under the curve (AUC) were 86.1%, 86.7%, 86.3%, and 0.94, respectively. Bland-Altman analysis showed that OWSA-REI and PSG-AHI were in good agreement (Mean Difference: − 6.7, 95% CI:16.0 to − 29.3 events/h). In addition, the effectiveness of the models in OWSA were also explained by visualizing SHAP values.Conclusion: The OWSA demonstrated a reasonable performance for OSA screening in the clinical setting. In light of this, it is possible for smartwatches to become a complementary tool to PSG, which is particularly useful for larger-scale preliminary screenings.Plain Language Summary: OPPO Watch Sleep Analyzer (OWSA), an emerging sleep-tracking method based on a wearable device, uses a machine learning model to analyze physiological signals including snoring recordings, and other basic anthropometric information to estimate REI. The study evaluated the OSA screening performance of OWSA with PSG-AHI and interpreted the results of the pre-trained machine learning model.OWSA demonstrated consistent clinical diagnostic performance for OSA. The interpretive machine learning models used in OWSA highlighted the impact of multi-modal data on estimation results. Therefore, these types of models are likely to be more widely accepted and promoted in clinical practice.Keywords: obstructive sleep apnea, photoplethysmography, polysomnography, smartwatch

Wangmei Liu,&ast; Jing Guo,&ast; Qiaomin Jiang, Guangnao Zhou, Yanyu Dong, Biqing Xu, Zhongda Liu, Zunjing Zhang, Jianjun Liu Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jianjun Liu; Zunjing Zhang, Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, No. 800 Zhongshan Street, Liandu District, Lishui, 323000, People’s Republic of China, Tel +86 13757835027 ; +86 13884387661, Email jianjunliu888@126.com; zunjingzhangzj@126.comObjective: The purpose of this study is to examine the effect of quality control circle (QCC) activities on increasing the mask-wearing compliance of hospitalized patients diagnosed with tuberculosis (TB) during external examinations.Methods: To assess the mask-wearing compliance of patients diagnosed with TB admitted to a ward in our hospital in 2019, who visited other departments, we conducted activities in accordance with the ten steps of the QCC. We outlined the causes of non-compliance and developed and implemented improvement plans. We compared the results obtained before and after the implementation of the QCC to assess the enhancement in patient compliance concerning wearing masks during external examinations, particularly among individuals diagnosed with pulmonary tuberculosis.Results: The compliance rate for mask-wearing during external examinations rose from an initial 32.61% (45/138) prior to the intervention to 83.71% (149/178) following the intervention. The difference between the two groups was statistically significant (χ2 = 85.635, P

Junhui He,1,&ast; Jiaxiu Xie,1,&ast; Guili Zhou,2,&ast; Chunlian Jia,2 Dongbo Han,2 Dongmei Li,1 Jie Wei,1 Yi Li,1 Renshan Huang,1 Chunlian Li,1 Bo Wang,3 Chao Wei,3 Qibiao Su,4 Kedao Lai,1 Guining Wei1 1Department of Pharmacology, Key Laboratory of Quality Standards, Guangxi Institute of Chinese Medicine & Pharmaceutical Science, Nanning, 530022, People’s Republic of China; 2Department of Pharmacology, Guangxi Medical University, Nanning, Guangxi, 530021, People’s Republic of China; 3Guangxi Shuangyi Pharmaceutical Co., Ltd, Nanning, Guangxi, 530021, People’s Republic of China; 4College of Health Science, Guangdong Pharmaceutical University, Guangzhou, 510006, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guining Wei, Department of Pharmacology, Guangxi Institute of Chinese Medicine & Pharmaceutical Science, Nanning, 530022, People’s Republic of China, Email weiguining2013@163.com Qibiao Su, College of Health Science, Guangdong Pharmaceutical University, Guangzhou, 510006, People’s Republic of China, Tel +8618376664440, Email suqibiao@163.comPurpose: Neuroinflammation is a significant etiological factor in the development of depression. Traditional Chinese medicine (TCM) has demonstrated notable efficacy in the treatment of inflammation. Our previous study surfaces that the active fraction of Polyrhachis vicina Roger (AFPR) has antidepressant and anti-neuroinflammatory effects, but the specific mechanisms remain to be elucidated. The objective of this study was to examine the impact of AFPR on inflammation in depression via the FTO/miR-221-3p/SOCS1 axis.Methods: Chronic unpredictable stress (CUMS)-induced rats and LPS-induced BV2 cells were employed to simulate depression models in vivo and in vitro. The levels of inflammatory factors were detected using the ELISA assay. The expression of genes and proteins was detected using qRT-PCR and Western blot. Gene interactions were detected using the dual luciferase reporter gene. Protein-RNA interactions were investigated using RNA methylation immunoprecipitation (MeRIP) and RNA immunoprecipitation (RIP). Neuroinflammation in the brain was examined through H&E staining, while neuronal apoptosis was assessed using TUNEL staining.Results: The results showed that AFPR ameliorated depression induced inflammation by increasing SOCS1 expression. However, SOCS1 was identified as a target of miR-221-3p. Overexpression of miR-221-3p decreased the expression of SOCS1 and increased the levels of NF-κB, IL-7, and IL-6. In addition, we found that miR-221-3p was regulated by FTO-mediated m6A modification through MeRIP and RIP experiments. Interference with miR-221-3p and overexpression of FTO resulted in increased SOCS1 gene expression and decreased levels of NF-κB, IL-7, and IL-6, which were reversed by AFPR.Conclusion: AFPR inhibits the maturation of pri-miR-221-3p through FTO-mediated m6A modification, reduces the production of miR-221-3p, increases the expression of SOCS1, and reduces the level of inflammation, thereby improving depressive symptoms. Keywords: depression, FTO, SOCS1, inflammation, Polyrhachis vicina Roger

Xiaofeng Li,1,&ast; Cha Chen,1,&ast; Luyuan Tong,1 Qun Gao,1 Wenxian Chen,2 Guangde Zhou,3 Zhaowei Tong,1 Weihong Wang1,4 1Department of Infectious Diseases, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang Province, People’s Republic of China; 2Department of Ultrasonography, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang Province, People’s Republic of China; 3Department of Pathology, Affiliated Beijing You An Hospital, Capital Medical University, Beijing, People’s Republic of China; 4Huzhou Key Laboratory of Precision Medicine Research and Translation for Infectious Diseases, Huzhou, Zhejiang Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Weihong Wang, Email hzwwh0606@163.comBackground: Amoebiasis, an infectious disease caused by the parasitic protozoan E. histolytica, is easily misdiagnosed due to its declining incidence and atypical symptoms.Case Presentation: A 31-year-old male presented to the hospital with dyspnea and inability to lie flat. Imaging studies indicated a large amount of pleural effusion on the right side and multiple huge cysts in the liver. The patient underwent liver tumor resection surgery at another hospital due to suspected malignancy, but no evidence of relevant malignant tumors was found in the pathological examination. Subsequently, we performed metagenomic next-generation sequencing on the liver drainage fluid and obtained liver pathology slides from the hospital where the surgery was performed at that time. Both of them confirmed the diagnosis of amoebic infection. Empirical treatment with metronidazole was initiated before the diagnosis was confirmed, along with symptomatic treatments such as thoracic drainage and liver drainage. Eventually, the patient’s condition improved and he was discharged smoothly.Conclusion: In order to avoid misdiagnosis of amoebiasis, thoroughly inquiring about the patient’s medical history, shifting perspectives and continuing investigating are necessary when one diagnostic approach proves ineffective. Besides, interdisciplinary collaboration and persistent efforts are crucial for accurate diagnosis.Keywords: amebiasis, amoebic abscess, diagnosis, HIV, metagenomic next-generation sequencing, metronidazole

The multiferroic Y-type hexaferrites BaxSr2−xMe2Fe12−yAlyO22 (Me = Zn2+, Co2+, Mg2+, etc.) have attracted much attention due to their giant magnetoelectric (ME) effect up to room temperature and low modulated magnetic field by the chemical doping control of the complex magnetic phases. However, the research of substitution between the Me ions is rare. As doping at the Me ion site can combine the advantages of both, e.g., higher magnetic ordering temperature in Co2 and stronger ME coefficient in Mg2 Y-type hexaferrites, herein, we report the stability and switching of magnetoelectric states in the Y-type hexaferrites Ba0.5Sr1.5CoMgFe11AlO22 single crystals. Our results demonstrate that substituting half of the Mg2+ with Co2+ enhances the transition temperature of the alternating longitudinal conical phase to proper screw spin order up to room temperature compared to those Mg2 Y-type hexaferrites. Simultaneous occurrence of in-plane and out-of-plane ferroelectric polarization is observed, alongside comparable spontaneous magnetization. It was found that the in-plane spin-driven polarization can be reversible below 50 K with a substantial ME coefficient α = −8000 ps/m but becomes irreversible at 100 K. This reversal in the sign of the ME coefficient signifies the transition between two distinct ME states at high temperature. The reversibility and irreversibility of spin-induced polarization are discussed within the framework of free energy based on the ferroelectric phase, which prevail in numerous Y-type hexaferrites. Our results provide insights into understanding the role of the Me ions in the magnetoelectric coupling in Y-type hexaferrites. [ABSTRACT FROM AUTHOR]

Guiling Zhou,1 Stijn de Vos,1 Catharina CM Schuiling-Veninga,1 Jens Bos,1 Katrien Oude Rengerink,2 Anna Maria Gerdina Pasmooij,2 Peter GM Mol,2,3 Geertruida H de Bock,4 Eelko Hak1 1Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, the Netherlands; 2Medicines Evaluation Board, Utrecht, the Netherlands; 3Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 4Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the NetherlandsCorrespondence: Guiling Zhou, Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Antonius Deusinglaan 1, Groningen, 9713 AV, the Netherlands, Tel +31 503638707, Fax +31 503632772, Email g.zhou@rug.nlBackground: Repurposing registered drugs could reduce coronavirus disease (COVID-19) burden before novel drugs are authorized. Little is known about how the pandemic and imposed restrictions changed their dispensing. We aimed to investigate the impact of COVID-19 pandemic on repurposed drugs dispensing in the Netherlands.Methods: We performed interrupted time-series study using University of Groningen prescription database IADB.nl to evaluate dispensing trends of 24 repurposed drugs before (2017-February 2020) and after (March 2020– 2021) the pandemic’ start. Primary outcomes were monthly prevalence and incidence rates. An autoregressive integrated moving average model assessed the effect of pandemic and stringency index (measuring strictness of government’s restriction policies).Results: Annual number of IADB.nl population ranged from 919,697 to 952,400. Generally, dispensing of common long-term-used drugs was not significantly affected by pandemic. The prevalence of antibacterials (− 4.20 users per 1000 people), antivirals (− 0.04), corticosteroids (− 1.29), prednisolone (− 1.32), calcium channel blocker (− 0.41), and diuretics (− 1.29) was lower than expected after the pandemic’s start, while the prevalence of ivermectin (0.07), sulfonylureas (0.15), sodium-glucose co-transporter-2 (SGLT2) inhibitor (0.17), and anticoagulants (1.95) was higher than expected. The pandemic was associated with statistically significant decreases in the incidence of antibacterials (− 1.21), corticosteroids (− 0.60), prednisolone (− 0.64) and anticoagulants (− 0.02), and increases in ivermectin (0.02), aggregated antidiabetic drugs (0.13), and SGLT2 inhibitors (0.06). These trends were positively associated with pandemic and negatively associated with stringency index.Conclusion: Dispensing of most drugs was not significantly associated with pandemic and government’s response. Despite some statistically significant disruptions, these were not necessarily clinically relevant due to small absolute differences observed.Keywords: COVID-19, drug utilization, repurposed drug, stringency index

Fengqin Zhu,1,2 Zongjing Hu,1 Wei Yu,1 Fengxian Dai,1 Dehuai Jing,1 Guangxi Zhou1 1Department of Gastroenterology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, 272000, People’s Republic of China; 2Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250355, People’s Republic of ChinaCorrespondence: Guangxi Zhou, Department of Gastroenterology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, 272000, People’s Republic of China, Email zgx_viola@126.comBackground: Ulcerative colitis (UC) is a chronic, relapsing progressive inflammatory immune disease. There is still no cure for it. Even worse, UC may predispose patients to opportunistic infections, and several extra-intestinal manifestations (EIMs) and comorbidities may antedate, occur with, or postdate the onset of UC, which may increase the mortality risk. But case reports of UC patients simultaneously concomitant with opportunistic infection, EIM, and comorbidity are extremely rare.Case Presentation: We report a case of 51-year-old male patient with incipient UC accompanied by cytomegalovirus (CMV) infection and bullous Sweet’s syndrome (bSS, a cutaneous EIM of UC) after treatment with oral mesalazine and prednisolone for 3 weeks. After clearance of the CMV infection by using ganciclovir, the patient was administered two cycles of infliximab to cure UC and bSS; however, he developed acute myeloid leukemia (AML) a month later and died after two cycles of chemotherapy.Conclusion: Based on this rare case of UC concomitant with CMV infection, bSS and AML, we recommend that it is important to distinguish between an acute UC flare and opportunistic infections, especially in patients receiving immunosuppressive therapy, and monitor EIMs and comorbidities timely. Particular attention should be paid to cancer surveillance. Clinicians should be mindful of these facts to adopt optimal therapeutic options to address all aspects of UC. Early initiation of biological therapy may be of benefit to patients with newly diagnosed severe UC.Keywords: ulcerative colitis, cytomegalovirus, bullous Sweet’s syndrome, acute myeloid leukemia

Ying Wang,1,&ast; Xuanzhi Huang,1,&ast; Gaoshi Zhou,1 Jing Han,1 Zhuo Xie,1 Mudan Zhang,1 Xiaoling Li,1 Qi-rui Wu,1 Li Li,1 Ziyin Ye,2 Minhu Chen,1 Yun Qiu,1 Shenghong Zhang1 1Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China; 2Department of Pathology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Shenghong Zhang; Yun Qiu, Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou Province, 510080, People’s Republic of China, Tel/Fax +86-20-87332916, Email zhshh3@mail.sysu.edu.cn; qyun@mail2.sysu.edu.cnBackground: Treatment failures (TFs) generally exist in the course of ulcerative colitis (UC), while early reliable predictors of TFs are still lacking. We aimed to generate nomograms for the prediction of TFs.Methods: In this retrospective case–control study, the endpoint was the occurrence of TFs, which included medically associated treatment failures and surgery-associated treatment failures (colectomy). Clinical features and mucus integrity evident by goblet cells (GCs) number, expression levels of MUC2 and SLC26A3 were enrolled in the univariate analysis. Nomogram performance was evaluated by discrimination and calibration.Results: We identified 256 UC patients at our center from January 2010 to June 2022. Fourteen variables for TFs and 9 for colectomy were identified by univariate analysis. Five baseline indices were incorporated into the nomogram for the prediction of TFs: area of GCs, age at diagnosis, disease duration, hemoglobin, and Mayo score. The model was presented with decent discrimination (C index of 0.822) and well calibration. In addition, the colectomy predictive nomogram was built using MUC2 intensity, age at onset, and Mayo score with a good discrimination (C index of 0.92).Conclusion: Nomograms based on comprehensive factors including mucus barrier function were developed to predict TFs in UC patients with great discrimination, which may serve as practical tools aiming to identify high-risk subgroups warrant timely intervention.Keywords: ulcerative colitis, treatment failure, nomogram, mucus barrier

Electrochemical conversion of small molecules such as carbon dioxide (CO2) and carbon monoxide (CO) to high-value multi-carbon products (C2+) offers a chemical upgrade approach for fuels and chemical feedstock production using renewable energy, in the possible absence of the petrochemical industry under the new energy system such as hydrogen economy. Identifying robust and efficient electrocatalysts to selectively produce C2+ products remains a challenge. Herein, we report a synthetic strategy of atomically dispersing copper atoms on nitrogen-rich porous carbon (Cu–N–C) through pyrolysis of a supramolecular assembly. Benefitting from the unsaturated coordination structure, in KOH electrolyte, the Cu–N–C with a Cu content of 6.9 wt% exhibits a maximum acetate Faradaic efficiency (FE) of 30% with an acetate partial current density as high as 48 mA cm−2 in electrochemical CO reduction. Different from the C–C coupling mechanism on metallic copper, we propose a CO insertion mechanism for the acetate production on the single site copper catalyst.