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Ningkang Li,1,2,&ast; Xia Qi,2,&ast; Jiamin Bao,2 Yang Gu,1,2 Xiaohong Zhou,1,2 Ting Wang,2 Ningxiang Jiang,3 Yun Wang,2 Qingshan Ye1,2 1Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China; 2Department of Anesthesiology, People’s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China; 3Department of Breast Surgery, People’s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qingshan Ye; Yun Wang, Department of Anesthesiology, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, 750002, People’s Republic of China, Email yeqingshan@hotmail.com; wangyun10483@126.comPurpose: Minimally invasive rotary resection (MIRR) is crucial for diagnosing and treating breast tumors, but the optimal intravenous anesthesia regimen is unclear. Esketamine, an NMDA receptor antagonist with anesthetic, analgesic, and sympathomimetic properties, may provide an ideal adjunct to propofol sedation. This study aims to compare the safety and efficacy of esketamine versus sufentanil as adjuncts to propofol for analgesia and sedation during breast MIRR.Patients and Methods: A total of 90 patients undergoing elective breast MIRR were randomly assigned to receive either sufentanil-propofol or esketamine-propofol for analgesia and sedation. The primary outcome was the occurrence of hypoxia (SpO2 < 92% for > 10s or exhibiting a persistent downward trajectory). Other outcomes included incidence of subclinical respiratory depression (92% ≤ SpO2 < 95% for > 10s), number of airway interventions, awakening time, satisfaction scores, postoperative exhaust time, hemodynamic parameters, and side events.Results: Finally, 41 patients were assigned to the sufentanil group and 40 to the esketamine group. The occurrence of hypoxia was significantly lower in the esketamine group (17.5%) than in the sufentanil group (39%) (P = 0.032). Subclinical respiratory depression occurred in 32.5% of the esketamine group and 56.1% of the sufentanil group (P = 0.033). The sufentanil group required more airway interventions than the esketamine group (P = 0.032), and patients in the sufentanil group experiencing hypoxia received more mask-assisted ventilation (P = 0.029). Hemodynamic stability was better in the esketamine group. No significant differences were observed in awakening time, satisfaction score, postoperative exhaust time, or side events between groups.Conclusion: Esketamine-propofol anesthesia significantly reduces the risk of hypoxia (SpO2 < 92%) compared to sufentanil-propofol, while maintaining similar awakening time, satisfaction, postoperative exhaust time, and side events. Its hemodynamic advantages make it valuable for clinical use, especially in procedures requiring respiratory and hemodynamic stability.Keywords: esketamine, hypoxia, respiratory depression, minimally invasive rotary resection, breast tumor

Xiaosu Guo,1– 4,&ast; Huimin Shi,1,2,&ast; Yuteng Sun,1 Yuan Xing,1– 3 Xin Guo,1– 3 Zhiyuan Shen,1– 3 Mengyi Zheng,1 Yaxin Zhang,1 Yicun Jia,1 Ye Li,1 Junqiang Bao,1,2 Shujuan Tian1– 3 1Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China; 2Department of Neurology, Hebei Hospital, Xuanwu Hospital, Capital Medical University, Shijiazhuang, Hebei, People’s Republic of China; 3Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China; 4Brain Aging and Cognitive Neuroscience Laboratory of Hebei Province, Shijiazhuang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Shujuan Tian; Junqiang Bao, Department of Neurology, The First hospital of Hebei Medical University, Shijiazhuang, Hebei, 050030, People’s Republic of China, Tel +86-0311-87156309, Email 57203005@hebmu.edu.cn; 57903004@hebmu.edu.cnPurpose: To summarize the clinical manifestations, laboratory findings, and magnetic resonance imaging (MRI) characteristics of anti-leucine-rich glioma-inactivated 1 (LGI1) antibody encephalitis (anti-LGI1 antibody encephalitis) and explore the electroencephalogram (EEG) features.Patients and Methods: We retrospectively analyzed the medical history of 16 patients diagnosed with anti-LGI1 antibody encephalitis at the First Hospital of Hebei Medical University from 2021 to 2023. EEGs of patients with anti-LGI1 antibody encephalitis and healthy individuals were analyzed. Based on Video-EEG signal analysis of EEG δ, θ, α, β frequency bands, weighted phase lag index values were calculated to form brain network matrices, studying differences in coherence between brain regions of patients with anti-LGI1 antibody encephalitis and healthy individuals.Results: Patients with anti-LGI1 antibody encephalitis often presented with subacute onset seizures and cognitive decline. Routine test of cerebrospinal fluid was mostly normal. Serum testing revealed hyponatremia in 62.50% of patients, along with positive serum antinuclear antibodies, decreased vitamin B12, and abnormal cytokines such as interleukin-6. Head MRI revealed abnormal lesions related to the disease in seven cases (43.75%), mainly located in the unilateral or bilateral frontal and temporal lobes of the hippocampus. The EEG mainly showed generalized and focal slow waves, sometimes with focal discharges. Brain network functional connectivity analysis found a significant weakening of functional connections in the frontal-temporal lobe in the δ and β frequency bands. Intravenous pulse corticosteroids and intravenous immunoglobulin are first-line immunotherapies for anti-LGI1 antibody-related encephalitis. The disease recovery and cognitive decline improved in most patients.Conclusion: Anti-LGI1 antibody encephalitis is characterized by seizures and cognitive dysfunction. Serum may show abnormalities in immune indicators such as cytokines. Head MRI mainly reveals abnormal signals in the frontal-temporal lobes and the hippocampus. EEG brain network connectivity analysis reveals characteristic weakening of functional connections in the frontal-temporal lobe in the δ and β frequency bands.Keywords: anti-LGI1 antibody encephalitis, epilepsy, electroencephalogram, brain network functional connectivity, immunotherapy

The influence of oxidation state and crystalline structure on the dissolution mechanisms of both pure iron oxides and combusted iron particles in aqueous oxalic acid (0.5 mol/l) at 60 °C was systematically investigated. Dissolution experiments were carried out in a temperature-controlled, continuous-flow capillary reactor, allowing for the removal of reaction products and thereby suppressing the autocatalytic reaction mechanism. The non-reductive dissolution of α-Fe2O3 was observed through in situ x-ray absorption measurements. In contrast, the dissolution of spinel-type oxides such as γ-Fe2O3 and Fe3O4 proceeded reductively, indicated by gradual changes in characteristic spectral features. Given that γ-Fe2O3 and Fe3O4 share a similar crystal structure but differ in the nominal oxidation state, this implies that the phase composition is decisive for the reductive dissolution. For mixed-phase particles consisting of spinel and rhombohedral phases (maghemite and hematite), the preferential dissolution of the spinel phase was observed. Despite the similar bulk composition of spinel and rhombohedral phases in the combusted iron particles (as confirmed by Mössbauer spectroscopy and x-ray diffraction analysis), dissolution predominantly follows a non-reductive pathway, with no preferential dissolution of the γ-phase. This unique dissolution behavior of combusted iron particles arises from their layered microstructure. [ABSTRACT FROM AUTHOR]

Xiaochun Chen,1,&ast; Benhong Zhang,2,&ast; Jin He,3,&ast; Xiaohong Rui,4 Tian He,4 Lizhu Zhang,5 Junfeng Bao,6 Yanfei Jing,7 Futao Cao8 1Department of Laboratory Medicine, Taizhou Second People’s Hospital, Taizhou, People’s Republic of China; 2Department of Laboratory Medicine, Hangzhou Gongshu District Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou, People’s Republic of China; 3Department of Laboratory Medicine, Hangzhou Yuhang Jiamu Nursing Home, Hangzhou, People’s Republic of China; 4Department of Laboratory Medicine, Affiliated Wuxi Fifth Hospital of Jiangnan University, Wuxi, People’s Republic of China; 5Department of Research, Nanxin Pharm, Nanjing, People’s Republic of China; 6Department of Laboratory Medicine, Wuxi Maternal and Child Health Care Hospital, Women’s Hospital of Jiangnan University, Wuxi, People’s Republic of China; 7Department of Function, Affiliated Wuxi Fifth Hospital of Jiangnan University, Wuxi, People’s Republic of China; 8Department of Emergency, Jiangnan University Medical Center, Wuxi, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yanfei Jing, Department of Function, Affiliated Wuxi Fifth Hospital of Jiangnan University, Wuxi, Jiangsu, 214005, People’s Republic of China, Email tengfeiba0002@163.com Futao Cao, Department of Emergency, Jiangnan University Medical Center, Wuxi, Jiangsu, 214000, People’s Republic of China, Email caofutao999@163.comIntroduction: The emergence of multidrug-resistant Klebsiella pneumoniae (K. pneumoniae) and the decline of effective antibiotics lead to the urgent need for new antibacterial agents. The aim of this study is to investigate the therapeutic effect of antimicrobial peptides against gentamicin-resistant (RT) K. pneumoniae and to screen effective antimicrobial peptides.Methods: In this study, the RT strains were induced by gradient gentamicin, and the RT strains were selected by detecting the expression levels of efflux pump genes, porin genes, and biofilm formation genes of the strains combined with their effects on the cells. Then the effects of four antimicrobial peptides on the efflux pump activity, biofilm formation level and cell condition after infection were detected to explore the effects of antimicrobial peptides on RT strains. Finally, the RT strain was used to induce a mouse model of pneumonia, and the four antimicrobial peptides were used to treat pneumonia mice for in vivo experiments. The pathological changes in lung tissues in each group were detected to explore the antimicrobial peptide with the most significant effect on the RT strain in vivo.Results: The results showed that the minimal inhibitory concentrations of the RT strains (strain C and strain I) were significantly higher than those of the wild-type strain, and the expression of efflux pump, porin and biofilm formation genes was significantly increased. The antimicrobial peptides could effectively inhibit the biofilm formation and efflux pump protein function of the RT strains. In addition, the antimicrobial peptides showed promising antibacterial effects both in vitro and in vivo.Discussion: Our study provided a theoretical basis for the treatment of gentamicin resistant K. pneumoniae infection with antimicrobial peptides, and found that KLA was significantly superior to LL37, Magainin I, KLA and Dermaseptin (10 μg/mL in cells, 50 μg in mice).Keywords: Klebsiella pneumoniae, K. pneumoniae, antibiotics, antimicrobial peptide, gentamicin-resistant, RT, microenvironment

Yuanhang Pan,1,&ast; Di Zhao,1,&ast; Xinbo Zhang,1,&ast; Na Yuan,1 Lei Yang,1 Yuanyuan Jia,2 Yanzhao Guo,3 Ze Chen,1 Zezhi Wang,1 Shuyi Qu,1 Junxiang Bao,4 Yonghong Liu1 1Department of Neurology, Xijing Air Force Medical University, Xi’an, People’s Republic of China; 2Encephalopathy Department No.2, Baoji Hospital of Traditional Chinese Medicine, Baoji, People’s Republic of China; 3Encephalopathy Department No.10, Xi’an Hospital of Traditional Chinese Medicine, Xi’an, People’s Republic of China; 4Department of Aerospace Hygiene, Air Force Medical University, Xi’an, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yonghong Liu, Department of Neurology, Xijing hospital, Air Force Medical University, Xi’an, People’s Republic of China, Tel +86 13991236602, Email liuyhong@fmmu.edu.cn Junxiang Bao, Department of Aerospace Hygiene, Air Force Medical University, Xi’an, People’s Republic of China, Tel +86 02984711241, Email baojunx@fmmu.edu.cnBackground: Excessive daytime sleepiness (EDS) forms a prevalent symptom of obstructive sleep apnea (OSA) and narcolepsy type 1 (NT1), while the latter might always be overlooked. Machine learning (ML) models can enable the early detection of these conditions, which has never been applied for diagnosis of NT1.Objective: The study aimed to develop ML prediction models to help non-sleep specialist clinicians identify high probability of comorbid NT1 in patients with OSA early.Methods: Totally, clinical features of 246 patients with OSA in three sleep centers were collected and analyzed for the development of nine ML models. LASSO regression was used for feature selection. Various metrics such as the area under the receiver operating curve (AUC), calibration curve, and decision curve analysis (DCA) were employed to evaluate and compare the performance of these ML models. Model interpretability was demonstrated by Shapley Additive explanations (SHAP).Results: Based on the analysis of AUC, DCA, and calibration curves, the Gradient Boosting Machine (GBM) model demonstrated superior performance compared to other machine learning (ML) models. The top five features used in the GBM model, ranked by feature importance, were age of onset, total limb movements index, sleep latency, non-REM (Rapid Eye Movement) sleep stage 2 and severity of OSA.Conclusion: The study yielded a simple and feasible screening ML-based model for the early identification of NT1 in patients with OSA, which warrants further verification in more extensive clinical practices.Keywords: obstructive sleep apnea, narcolepsy, machine learning, prediction model, sleep disorder

Guiling Li,1– 3,&ast; Tianyang Tan,3– 5,&ast; Luting Chen,3– 5 Jiaqi Bao,3– 5 Dongsheng Han,3– 5 Fei Yu3– 5 1Department of Clinical Laboratory, Sir Run Run Shaw Hospital of Medicine Zhejiang University, Hangzhou, 310003, People’s Republic of China; 2Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Hang-zhou, 310003, People’s Republic of China; 3Institute of Laboratory Medicine, Zhejiang University, Hangzhou, 310003, People’s Republic of China; 4Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China; 5Zhejiang Key Laboratory of Clinical in vitro Diagnostic Techniques, Hangzhou, 310003, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Dongsheng Han; Fei Yu, Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China, Email 1321269@zju.edu.cn; yufeizy@zju.edu.cnPurpose: Self-collected specimens are increasingly being used as alternatives to swab-based methods for the detection of respiratory viruses. While saliva is well accepted, gargle specimens are a potential alternative with characteristics that are more favorable for laboratory handling. This study assessed the performance of gargle specimens in the detection of influenza A viruses (IAVs).Patients and Methods: We performed a prospective head-to-head comparison between combined nasopharyngeal and oropharyngeal swabs (NPS&OPS) and purified water gargle (PWG) among adult outpatients with febrile respiratory symptoms to detect IAVs using real-time RT-PCR during two influenza seasons.Results: During study periods 1 (July 13 to 26, 2022, H3N2 predominated) and 2 (February 25 to March 10, 2023, H1N1 pdm09 predominated), a total of 459 patients were recruited. The overall agreement between the NPS&OPS and PWG was 85.0% (390/459, κ = 0.697), with 88.0% in period 1 and 82.6% in period 2. The detection rate of IAVs in PWG (51.6%, 237/459) was lower than that in NPS&OPS (62.3%, 286/459) (p < 0.0001). The overall sensitivity and specificity were 96.6% (93.7– 98.3%) and 100% (97.1– 100%) in NPS&OPS and were 80.1% (75.0– 84.4%) and 100% (97.1– 100%) in PWG, respectively. Among the 227 pairs of concordant positive specimens, cycle threshold (Ct) values were significantly lower in NPS&OPS than in PWG (median Ct values: 24.2, 28.2, p < 0.0001).Conclusion: Although self-collected PWG specimens offer acceptable performance for IAVs molecular testing, NPS&OPS remain a reliable option. Given the convenience of collection, nonviscous gargles are recommended for viral detection during emergencies or under specific conditions.Keywords: gargle, nasopharyngeal swab, oropharyngeal swab, detection, influenza A virus, rRT-PCR

Xian Zhang, Jialu Bao, Yan Zhang, Xiaodan Wang College of Traditional Chinese Veterinary Medicine, Hebei Agricultural University, Baoding, 071001, People’s Republic of ChinaCorrespondence: Xiaodan Wang, College of Traditional Chinese Veterinary Medicine, Agricultural University of Hebei Baoding, People’s Republic of China, 071001, Email wangxiaodan_wxd@126.comBackground: Obesity is a growing global problem that causes various complications such as diabetes, cognitive dysfunction, cardiovascular diseases, and hepatobiliary disease. Alpha-linolenic acid (ALA) has been reported to exhibit multiple pharmaceutical effects. This study aimed to explore the effects of ALA on obesity-induced adipose tissue accumulation, cognitive impairment, inflammation, and colonic mucosal barrier integrity.Methods: Mice were fed with high-fat diet (HFD) and were treated with ALA (60 or 100 mg/kg). Body weight, adipose tissue, serum glucose and lipid levels, glucose resistance, and insulin resistance were measured. Cognitive ability was analyzed using the behavior tests. PTP1B and IRS/p-AKT/p-GSK3β/p-Tau signaling were examined to evaluate inflammation and synaptogenesis. Colon mucosal barrier integrity was examined by Alcian blue staining and expression of the tight junction proteins. The production of pro-inflammatory cytokines and liver damages were evaluated. 3T3-L1 cells were used for in vitro experiments. Cell viability, migration and invasion were detected. The levels of ROS, iron, and ferrous ions were measured to assess ferroptosis. Metabolomic analysis of adipose tissues was performed.Results: ALA treatment prevented HFD-induced adipose tissue accumulation, improved glucose and lipid homeostasis and metabolism. Administration of ALA repressed the HFD-induced increase in insulin levels and insulin resistance index. Serum and colon levels of pro-inflammatory cytokines were decreased after ALA treatment. ALA elevated mitochondrial content in brown adipose tissues. ALA ameliorated obesity-induced cognitive impairment and hippocampal inflammation, enhanced colon mucosa integrity. ALA treatment ameliorated HFD-induced liver damage and lipid accumulation and inhibited differentiation of preadipocyte 3T3-L1 cells into mature adipocytes and induces ferroptosis. Metabolomic analysis suggested that ALA may target the glycerolipid metabolism pathway to ameliorate obesity. Knockdown of AGPAT2 abolished the protective effects of ALA.Conclusion: ALA treatment suppressed adipose accumulation in adipocytes, improved cognitive ability and colon integrity, and alleviated liver damage by modulating the 1-acylglycerol-3-phosphate O-acyltransferase 2 (AGPAT2).Keywords: alpha-linolenic acid, obesity, liver damage, cognitive recognition, colon integrity

Gengyao Hu,1,&ast; Yuanhang Pan,1,&ast; Na Yuan,1,&ast; Zhixian Yang,2 Xiuyu Shi,3 Sha Ma,4 Shan Li,4 Xiaohua Hou,5 Fei Liu,5 Dongmei Li,6 Junxiang Bao,7 Yonghong Liu1 1Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, People’s Republic of China; 2Department of Pediatrics, Peking University First Hospital, Beijing, People’s Republic of China; 3Department of Pediatrics, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China; 4Department of Neurology, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, People’s Republic of China; 5Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China; 6Department of Dentistry for Special Services, Fourth Military Medical University (Air Force Medical University), Xi’an, People’s Republic of China; 7Department of Aerospace Hygiene, Fourth Military Medical University (Air Force Medical University), Xi’an, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yonghong Liu, Email liuyhong@fmmu.edu.cnBackground: Sleep-related facial mandibular myoclonus (SRFMM) remains rare in clinical practice. The aim of this study was to provide a comprehensive understanding of the electroclinical manner, therapeutic regimen, and prognosis of SRFMM.Methods: Twenty-three patients who were diagnosed with SRFMM by clinical manifestation, video-electroencephalography (EEG) and electromyography over bilateral masseter and temporalis muscles were enrolled. Clinical and electrophysiological evaluation as well as follow-up information were recorded and analyzed.Results: The cohort involved 4 infants and 19 adults with a mean onset age of 43.5 years for SRFMM, among whom 19 were male. Twenty-one patients complained of tongue injuries and disturbed night-time sleep. SRFMM in 4 patients were ascribed to oral aripiprazole, brainstem ischemia and brain trauma. In 62 SRFMM episodes, 93.5% occurred in NREM sleep and 6.5% in REM sleep, and all events were associated with EEG arousals. In 13 patients with or without clonazepam, the motor events gradually disappeared, and the rest turned to be sporadic.Conclusion: SRFMM is a characteristic parasomnia manifested by tongue biting and accompanying facial mandibular myoclonus, leading to disrupted sleep. Besides adults, infants can also experience SRFMM with spontaneous remission. Most patients respond well to clonazepam, eventually with favorable prognosis.Keywords: sleep-related facial mandibular myoclonus, tongue biting, movement disorder, SRFMM

Yilan Hu,1,2 Jiaqi Bao,1,2 Zhicheng Gao,1,2 Lifang Ye,2 Lihong Wang1,2 1The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China; 2Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, People’s Republic of ChinaCorrespondence: Lihong Wang, Heart Center, Department of Cardiovascular Medicine, Zhejiang, Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, People’s Republic of China, Email wanglhnew@126.comAbstract: Obesity is becoming increasingly prevalent in China and worldwide and is closely related to the development of hypertension. The pathophysiology of obesity-associated hypertension is complex, including an overactive sympathetic nervous system (SNS), activation of the renin–angiotensin–aldosterone system (RAAS), insulin resistance, hyperleptinemia, renal dysfunction, inflammatory responses, and endothelial function, which complicates treatment. Sodium–glucose cotransporter protein 2 (SGLT-2) inhibitors, novel hypoglycemic agents, have been shown to reduce body weight and blood pressure and may serve as potential novel agents for the treatment of obesity-associated hypertension. This review discusses the beneficial mechanisms of SGLT-2 inhibitors for the treatment of obesity-associated hypertension. SGLT-2 inhibitors can inhibit SNS activity, reduce RAAS activation, ameliorate insulin resistance, reduce leptin secretion, improve renal function, and inhibit inflammatory responses. SGLT-2 inhibitors can, therefore, simultaneously target multiple mechanisms of obesity-associated hypertension and may serve as an effective treatment for obesity-associated hypertension.Keywords: sodium-glucose cotransporter protein 2 inhibitors, obesity-associated hypertension, metabolism, neuro-humoral regulation, inflammation

Zhicheng Gao,1,2,&ast; Jiaqi Bao,1,2,&ast; Liuyang Wu,2 Kaiyu Shen,1 Qiqi Yan,2 Lifang Ye,2 Lihong Wang2 1The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China; 2Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Lihong Wang, Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China, Tel +86 85894275, Email wanglhnew@126.comPurpose: Lymphocyte to C-reactive protein ratio (LCR) is a recognized systemic inflammatory marker and novel prognostic indicator for several cancers. This study investigated the relationship between preoperative LCR and new-onset atrial fibrillation (NOAF) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).Patients and Methods: Patients with AMI (n=662) with no history of atrial fibrillation (AF) were enrolled and classified into NOAF and non-NOAF groups based on the occurrence of postoperative NOAF during hospitalization. Logistic regression models were used to analyze NOAF risk factors and to assess the association between preoperative LCR and NOAF incidence. We constructed a new nomogram from the selected NOAF risk factors, and tested its predictive performance, degree of calibration, and clinical utility using receiver operating characteristic and calibration curves, decision curve analysis, and clinical impact curves.Results: Overall, 84 (12.7%) patients developed NOAF during hospitalization. The LCR was significantly lower in the NOAF group. Preoperative LCR accurately predicted NOAF after AMI and was correlated with increased NOAF risk. Age, body mass index, diabetes, serum albumin levels, uric acid levels, left atrium (LA) diameter, left ventricular ejection fraction, left circumflex artery stenosis > 50%, and Killip class II status were independent predictors of NOAF after AMI. In addition, a new nomogram combined with LCR was constructed to stratify the risk of NOAF in patients with AMI. The performance of the new nomogram was satisfactory, as shown by the receiver operating characteristic curve, calibration curve, decision curve analysis and clinical impact curve.Conclusion: Preoperative LCR was an independent predictor of NOAF in patients with AMI after PCI. The novel nomogram combined with LCR could rapidly and individually identify and treat patients at a high risk of NOAF.Keywords: C-reactive protein, acute myocardial infarction, atrial fibrillation, nomogram, left ventricular ejection fraction

Xin Jiang,&ast; Lijie Gao,&ast; Jian Wang, Jiajia Bao, Jinghuan Fang, Li He Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jinghuan Fang; Li He, Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, People’s Republic of China, Email jinghuan_fang@126.com; heli2003new@126.comBackground: Blood pressure variation and collateral status have been reported to be associated with clinical outcome in patients with acute ischemic stroke who received endovascular treatment; however, the relationship between blood pressure variation within 72 hours after EVT and clinical outcome in different collateral status remains unclear.Methods: Acute ischemic stroke patients due to large vessel occlusion with EVT were retrospectively enrolled. We classified participants into poor collateral (ASITN/SIR grade < 2) and good collateral subgroups (ASITN/SIR grade ≥ 2). The primary outcome was unfavorable neurological outcome defined as a 3-month modified Rankin Scale (mRS) score ≥ 2. The interactive effect was tested to determine the influence of collateral status on the association between BP variation and clinical outcome.Results: A total of 545 patients were included. The poor collateral subgroup was detected in 198 patients with an average age of 70.2 years. The association between BP variation and primary outcome did not differ under different collateral status (P for interaction > 0.05). However, the association between the mean and coefficient of variation (CV) values of DBP and 3-month mortality was significantly discrepant under different collateral status (P for interaction < 0.05). In the good collateral subgroup, higher mean DBP was associated with a lower risk of 3-month mortality (OR 0.95, 95% CI 0.91– 1, P = 0.033) compared with the poor subgroup (OR 1.04, 95% CI 0.97– 1.1, P = 0.286). In addition, a higher CV of DBP was associated with a higher risk of 3-month mortality (OR 1.24, 95% CI 1.13– 1.36, P < 0.01) compared with poor status (OR 1.08, 95% CI 0.94– 1.23, P=0.275).Conclusion: For patients who received EVT with good collateral status, increased CV of DBP was significantly associated with higher 3-month mortality, while higher mean DBP within 72 h after EVT was associated with a decrease in 3-month mortality.Keywords: acute ischemic stroke, blood pressure variability, clinical outcome, collateral status, endovascular treatment

Wenhui Zhang,1,2 Shourong Liu,1 Liangbin Miao,3 Ai Fu,3 Jianfeng Bao,4 Liping Zheng,2 Er Li,2 Jianhua Yu,1,&ast; Yi Wang1,3,&ast; 1Department of Infection, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 2Department of Nursing, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 3Institute of Hepatology and Epidemiology, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 4Department of Hepatology, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jianhua Yu, Department of Infection, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China, Email yujhmc@126.com Yi Wang, Institute of Hepatology and Epidemiology, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China, Email wangyi_xixi@126.comBackground: Comprehensive characterization of safety and immune responses to vaccines is crucial for the prevention and treatment of COVID-19 among people living with HIV (PLWH). This study aimed to investigate the dynamic changes in SARS-CoV-2-specific CD4+ T-cell subsets and neutralizing antibody after three consecutive doses of inactivated COVID-19 vaccines (BBIBP-CorV) among PLWH.Methods: The blood samples were collected from 165 PLWH, including 66 PLWH in the 3-month interval between the second and third dose (cohort 1) and 99 PLWH in the 5-month interval (cohort 2). Blood collection for immunogenicity analysis was performed at 1-month post-2nd vaccination, pre-3rd vaccination, and within 2-month post-3rd vaccination. Wilcoxon matched-pairs signed-rank test was applied to compare the SARS-CoV-2-specific CD4+ T cell subsets and neutralizing antibody level at different time points. The relationship among CD4+ T-cells, Tregs subpopulations and SARS-CoV-2-specific neutralizing antibody level were evaluated with Spearman non-parametric correlation test.Results: No serious adverse reactions were found among PLWH. After two-dose or three-dose inactivated COVID-19 vaccination, the absolute counts of CD4+ T-cells and Tregs subpopulations (CD4+CD25HighCD127Low Tregs, CD45RA+ rTregs and CD45RO+ eTregs) increased in two cohorts. Satisfactory SARS-CoV-2-specific neutralizing antibody responses to the third-dose vaccination were found in two cohorts, including significantly enhanced neutralizing antibody level and high neutralizing antibody seroconversion rate. In addition, SARS-CoV-2-specific neutralizing antibody level were positively associated with the absolute counts of CD4+ T-cells and Tregs subpopulations as well as the frequency of CD45RO+ eTregs in PLWH after three doses of vaccinations.Conclusion: The three doses of inactivated COVID-19 vaccination were both safe and effective to increase SARS-CoV-2-specific CD4+ T-cells and neutralizing antibody in two PLWH cohorts with different inoculation intervals.Keywords: CD4+ T-cells, neutralizing antibody, inactivated COVID-19 vaccines, PLWH

Dan Li,1 Liwen Ma,1 Jun Bao,1 Lei Cao,2 Wei Min3 1Department of Dermatology, the Affiliated Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China; 2Clinical Immunology Laboratory, the First Affiliated Hospital of Soochow University, Soochow University, Suzhou, People’s Republic of China; 3Department of Dermatology, the First Affiliated Hospital of Soochow University, Soochow University, Suzhou, People’s Republic of ChinaCorrespondence: Wei Min, Email minwei@suda.edu.cnBackground: Increasing evidence has indicated that several B7 family members play critical roles in the progress of many cancers. However, the clinical significance of the B7 family in cutaneous squamous cell carcinoma (cSCC) is still elusive. The purpose of this study is to investigate the potential role of B7-H1 biomolecules (PD-L1) in regulating the tumorigenesis and progression of cSCC, the most common non-melanoma skin cancer.Methods: We collected transcriptome data of cSCC patients from TCGA databases (n = 496) and subjected the transcription data to bioinformatical analysis. Differential expression of B7-H1 genes with a grade-dependent pattern was identified. We collected paraffin sections of skin squamous carcinoma and analyzed by immunohistochemical staining. We further examined the PD-L1 levels of CD14+ cells in peripheral blood of each cSCC patient and normal subjects by flow cytometry.Results: It was found that higher expression of PD-L1 was associated with poor prognosis of cSCC patients and shorter overall survival. These observations were further verified in the clinical paraffin sections and in peripheral blood T cells.Conclusion: Our study reveals that PD-L1 is a potential prognostic marker in clinical prognosis for cSCC patients and could be valuable for cSCC treatment.Keywords: PD-L1, cutaneous squamous cell carcinoma, tumour progression, immunotherapy

Jian Gong,1,2,&ast; Weiwei Wu,3,&ast; Liguo Qiu,1,2 Xi Wang,1,2 Jianwei Bao,1,2 Jinjing Wang,4 Lifang Cheng,1,2 Zhiyuan Fu,1,5 Fengming Hu1,2 1Department of Integrated Traditional Chinese and Western Medicine of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China; 2Jiangxi Provincial Clinical Research Center for Skin Diseases, Nanchang, Jiangxi, People’s Republic of China; 3Department of Plastic and Dermatological Surgery, The Fifth People’s Hospital of Hainan Province, Haikou, Hainan, People’s Republic of China; 4Clinical School of Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, People’s Republic of China; 5Department of Pharmacy, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhiyuan Fu, Department of Pharmacy, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China, Tel +86 13970827820, Fax +86-0791-85207512, Email 1074586168@qq.com Fengming Hu, Department of Integrated Traditional Chinese and Western Medicine of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China, Tel +86 13970935828, Fax +86-0791-85207512, Email 18970802429@163.comAbstract: Psoriasis is an immune-mediated chronic inflammatory dermatosis influenced by hereditary and environmental factors. Human immunodeficiency virus (HIV) infection affects the immune system and exacerbates psoriatic lesions. We report the case of a 33-year-old male patient diagnosed with psoriasis vulgaris, psoriatic arthritis and HIV infection. Acitretin capsules, etanercept and high-active antiretroviral therapy (HAART) were effective. Two months after etanercept was discontinued, his condition worsened. After switching to secukinumab combined with HAART, the symptoms of psoriatic arthritis resolved rapidly after four weeks, with a Disease Activity Index for Psoriatic Arthritis score of 0. The time to achieve psoriasis area and severity index 40, 75, 90, and 100 were 2, 4, 8, and 29 weeks. The treatment was maintained for 1 year with no adverse reactions. Regarding the stable CD4+ T lymphocyte count and the viral load, administering anti-IL-17 monoclonal antibodies is an effective treatment option for psoriasis patients.Keywords: psoriasis, HIV, etanercept, secukinumab, biologics

The gyrokinetic toroidal code has been upgraded for global simulations by coupling the core and scrape-off layer regions across the separatrix with field-aligned particle-grid interpolations. A fully kinetic particle pusher for high frequency waves (ion cyclotron frequency and beyond) and a guiding center pusher for low frequency waves have been implemented using cylindrical coordinates in a global toroidal geometry. The two integrators correctly capture the particle orbits and agree well with each other, conserving energy and canonical angular momentum. As a verification and application of this new capability, ion guiding center simulations have been carried out to study ion orbit losses at the edge of the DIII-D tokamak for single null magnetic separatrix discharges. The ion loss conditions are examined as a function of the pitch angle for cases without and with a radial electric field. The simulations show good agreement with past theoretical results and with the experimentally observed feature in which high energy ions flow out along the ion drift orbits and then hit the divertor plates. A measure of the ion direct orbit loss fraction shows that the loss fraction increases with the ion energy for DIII-D in the initial velocity space. Finally, as a further verification of the capability of the new code, self-consistent simulations of zonal flows in the core region of the DIII-D tokamak were carried out. All DIII-D simulations were performed in the absence of turbulence.

Jie Bao,1,&ast; Lifeng Wang,2,&ast; Peng Hu,3,&ast; Jie Liu,2,4– 6 Jun Tu,2,4– 6 Jinghua Wang,2,4– 6 Jidong Li,2,7 Xianjia Ning2,4– 6 1Department of Rehabilitation Medicine, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China; 2Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People’s Hospital, Tianjin, 301900, People’s Republic of China; 3Department of Acupuncture Encephalopathy, Binhai New Area Hospital of TCM, Tianjin, 300451, People’s Republic of China; 4Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China; 5Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People’s Republic of China; 6Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People’s Republic of China; 7Department of Neurosurgery, Tianjin Jizhou People’s Hospital, Tianjin, 301900, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xianjia Ning, Laboratory of Epidemiology, Tianjin Neurological Institute & Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People’s Republic of China, Tel +86-22-60817505, Fax +86-22-60817448, Email xning@tmu.edu.cn Jidong Li, Department of Neurosurgery, Tianjin Jizhou People’s Hospital, Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People’s Hospital, 18 Nanhuan Road, Jizhou District, Tianjin, 301900, People’s Republic of China, Tel/Fax +86-22- 60733586, Email jd_li_doctor@163.comIntroduction: Metabolic syndrome (MetS) is a chronic and complex disease associated with all-cause mortality, cardiovascular disease, and type 2 diabetes. The present study aimed to evaluate the prevalence of MetS and its risk factors among middle-aged and older adults in low-income, low-education rural areas with a high incidence of stroke.Methods: This cross-sectional study of the general population was performed from April 2019 to June 2019 in rural areas of Tianjin, China. All eligible residents aged ≥ 45 years and without active malignant tumors, hepatic failure, and severe renal disease underwent routine medical examinations, which included a questionnaire, physical examination, and routine blood and biochemical tests. The modified International Diabetes Federation criteria for the Asian population was used to identify patients with MetS.Results: A total of 3175 individuals (44.8% men, 55.2% women) were included in the final analysis. The prevalence of MetS was 52.8%, with higher prevalence in women than in men (62.4%and 40.9%, respectively). Of the five MetS components, high blood pressure and abdominal obesity were the two most prevalent in both women and men, accounting for 89.3% and 62.0%, respectively, followed by elevated fasting plasma glucose, low high-density lipoprotein cholesterol, and elevated triglycerides. Multivariate logistic regression analysis revealed the following traits to be risk factors for MetS: female sex, self-reported smoking, self-reported snoring, high body mass index, high waist-to-hip ratio, and high serum urate level.Conclusion: The prevalence of MetS was quite high in rural areas with a low-income, low-education population. Implementing preventive and therapeutic interventions based on these risk factors is essential to prevent metabolic abnormalities.Keywords: metabolic syndrome, epidemiology, risk factors, population-based, cross-sectional study

Chuanlong Zhou,1,&ast; Jie Bao,2,&ast; Hantong Hu,1 Siting Ye,3 Xiaomei Shao,4 Yi Liang,4 Jianqiao Fang4 1Department of Acupuncture, the Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China; 2School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China; 3Department of Tuina, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China; 4Key Laboratory of Acupuncture and Neurology of Zhejiang Province, the Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Chuanlong Zhou, Department of Acupuncture, the Third Affiliated Hospital of Zhejiang Chinese Medical University, No. 219 Moganshan Road, XiHu District, Hangzhou, 310005, People’s Republic of China, Email zhouchuanlong6255@163.comBackground: Migraine without aura (MWoA) is a nervous system disease, which is closely related to autonomic nerves dysfunction. As a popular non-pharmacological alternative treatment for preventing migraine, it remains unclear whether the acupuncture can prevent MWoA. Thus, this trial aims to evaluate the preventive effect and safety of the acupuncture method of stimulating acupoints that regulate autonomic nerves in MWoA patients.Methods: This is a single-center, prospective, double-dummy, randomized controlled clinical trial. A total of ninety-six patients with MWoA are randomly allocated to acupuncture combined with the placebo group and sham acupuncture combined with the medication group in a 1:1 ratio. All subjects will receive intervention for 8 weeks and follow-up assessments three times (one month, three months, and six months in follow-up visiting). The frequency of acupuncture in both groups is three times a week for eight weeks. The primary outcome will be evaluated using a visual analog scale (VAS) and the number of migraine attacks per four weeks. The secondary outcome measures will include the migraine-specific quality of life (MSQOL) scale and headache needs assessment survey (HANA) questionnaire scale.Results: The acupoint selection of this clinical trial is based on the combination of traditional Chinese medicine theory with modern medicine, thereby evaluating the efficacy and safety of the acupuncture method of stimulating acupoints that regulate autonomic nerves in the prevention of MWoA. The results may provide evidence of the beneficial effects of acupuncture on the prevention of MWoA by regulating autonomic nerves dysfunction.Trial Registration: ClinicalTrials.gov NCT04766762.Keywords: acupuncture, migraine without aura, autonomic nerves, randomized controlled clinical trial, protocol

Tao Liu,&ast; Chaofan Wang,&ast; Jie Yin, Lili Wang, Haochen Xuan, Yan Yan, Junhong Chen, Jieli Bao, Dongye Li, Tongda Xu Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Tongda Xu; Dongye Li, Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China, Email xutongda3004@163.com; dongyeli@xzhmu.edu.cnBackground: Coronary microvascular obstruction (CMVO) is closely associated with poor prognosis of ST-segment elevation myocardial infarction (STEMI) patients. However, data showing the comparison between cardiac magnetic resonance feature tracking (CMR-FT) and speckle tracking echocardiography (STE) combined with low-dose dobutamine stress echocardiography (LDDSE) in evaluating CMVO was scarcely available. We aimed to explore and compare the predictive value between CMR-FT and STE+LDDSE in detecting CMVO.Methods: Sixty-one STEMI patients were executed cardiac magnetic resonance and echocardiography within the first 5– 7 days after primary percutaneous coronary intervention (PCI). The myocardial strain analysis was performed in STE, STE+LDDSE, and CMR-FT, and strain parameters included radial strain (RS), circumferential strain (CS), and longitudinal strain (LS). ROC curves were performed to predict infarcted myocardium segments with CMVO.Results: Finally, 324 infarcted myocardium segments were analyzed, including 100 infarcted segments with CMVO and 224 segments without CMVO by the gold standard assessment of late gadolinium-enhancement cardiac magnetic resonance imaging (LGE-CMR). The results showed that CS was generally superior to RS and LS in identifying CMVO. CS in CMR-FT facilitated the detection of CMVO, with a sensitivity, specificity, and accuracy of 78.00%, 81.25%, and 80.25%, respectively. The sensitivity, specificity, and accuracy of CS in STE combined with LDDSE were better than STE alone (76.00% vs 60.00%, 79.91% vs 64.29%, and 78.70% vs 62.96%, P < 0.05). In addition, CMR-FT is not superior to STE+LDDSE for detection of CMVO (P > 0.05).Conclusion: Low-dose dobutamine can improve the clinical value of STE for evaluating CMVO in STEMI patients. Compared with CMR-FT, STE+LDDSE might be a better choice for STEMI patients because of its safety, convenience, and low-cost.Keywords: ST-segment elevation myocardial infarction, magnetic resonance feature tracking, speckle tracking echocardiography, low-dose dobutamine, coronary microvascular obstruction

Jiaqi Bao,1,&ast; Yanlong Wu,2,&ast; Kun Zhang,3 Huijuan Qi4 1Department of Thoracic Surgery, Affiliated Hospital of Chifeng University, Chifeng, People’s Republic of China; 2Department of Urology, Affiliated Hospital of Chifeng University, Chifeng, People’s Republic of China; 3Department of Radiology, Huhhot First Hospital, Huhhot, People’s Republic of China; 4Department of Gynecology, Affiliated Hospital of Chifeng University, Chifeng, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Huijuan Qi, Department of Gynecology, Affiliated Hospital of Chifeng University, Chifeng, People’s Republic of China, Email cfxyqihuijuan1968@163.comBackground: TKI-acquired resistance markedly interferes with treatment of lung cancer patients with EGFR mutant features. Long non-coding RNAs (lncRNAs) modify EGFR-TKI resistance during tumor progression. Non-structural maintenance of chromosomes condensin I complex subunit G (NCAPG) is a mitosis-related protein that is involved in tumorigenesis. We investigated the potential regulatory lncRNAs of NCAPG in lung adenocarcinoma (LUAD) and assessed their roles in EGFR-TKI resistance.Methods: Data for 1678 lung cancer patients were retrieved from TCGA and GEO databases and used to evaluate NCAPG and lncRNAs expressions, as well as their prognostic significance in LUAD. Protein levels of NCAPG in LUAD were validated by immuno-histochemistry. To assess the relationship between NCAPG levels and EGFR-TKIs sensitivity, a cohort of 57 LUAD patients administered with EGFR-TKIs was used.Results: Both NCAPG and lncRNA AC099850.3 were over-expressed in LUAD tissues, and correlated with tumor progression and poor prognosis in LUAD. LncRNA AC099850.3 was identified as a potential regulator of NCAPG expressions. The AC099850.3/NCAGP axis was markedly correlated with EGFR mutations and IC50 of EGFR-TKIs. Besides, elevated NCAPG levels were associated with EGFR-TKIs resistance in 57 LUAD patients undergoing TKIs treatment. Gene set enrichment analysis revealed that both AC099850.3 and NCAGP were abundant in the cell cycle and the p53 signaling pathway.Conclusion: The AC099850.3/NCAPG axis is a potential prognostic predictor and therapeutic biomarker for EGFR-TKIs in LUAD.Keywords: lung cancer, biomarker, NCAPG, lncRNA, EGFR