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Background and AimsThe reported incidence of arterial thromboembolism (ATE) and venous thromboembolism (VTE) after cancer varies. A meta-analysis was performed to define the incidence of thromboembolism (TE) in cancer patients.MethodsArticles were searched in PubMed and Embase from inception to November 1, 2022. Studies reporting the incidence data or data from which incidence could be estimated among patients with cancer and the explicit follow-up duration were included.ResultsSeventy-four studies involving 5059134 cancer patients were identified. The incidence rate per 1000 person-years was 11.60 (95% CI 7.62-15.58) for ATE, 6.11 (95% CI 3.70-8.53) for myocardial infarction, 9.07 (95% CI 7.48-10.66) for ischemic stroke, 2.11 (95% CI 0.89-3.31) for another ATE, 26.32 (95% CI 24.46-28.18) for VTE, 12.69 (95% CI 11.51-13.87) for deep vein thrombosis, 5.94 (95% CI 5.29-6.59) for pulmonary embolism, and 13.18 (95% CI 9.93-16.42) for another VTE. In addition, the highest incidence of ATE was observed in patients with gastrointestinal cancer, while patients with pancreatic cancer had the highest incidence of VTE. The risk of ATE and VTE increased at the initial stage of cancer, and then declined and became non-significant.ConclusionThis meta-analysis provided overall estimates of ATE and VTE incidence in cancer patients, adding an important insight into the trajectory of the development of TE in cancer patients, which could help reduce the risk of TE in cancer patients in the future.

Once the sludge was directly used in the farmland, it will have a negative impact on human health through the food chain because sludge contains pollutants. Sewage sludge pyrolysis into biochar is an effective way to realize sludge harmless and resourceful utilization. This research used hydrothermal carbonization method to convert sludge into sludge biochar (SLBC) to reduce the types and contents of pharmaceuticals and personal care products (PPCPs) and available heavy metals. Furthermore, migration of the residual caffeine (Caf), acetaminophen (Ace), and heavy metals (Cr, Pb, Cu, Zn) released from the SLBC in the wheat was assessed. The results showed that the levels of Caf, Ace, Pb, Cu, and Zn accumulated in the shoots were lower than the limit regulated by Drug and Food Additive Use Standard in China (Caf: 150 mg/kg; Ace: 2.5 ~ 5 mg/kg; Pb: 0.3 mg/kg; Cu: 10 mg/kg; Zn: 20 mg/kg). The migration of Cr from roots to shoots was also significantly controlled by SBLC. SBLC delayed the germination time of wheat seeds with increasing in hydrothermal temperature, the germination rate and root length showed a decreasing trend. Evans blue and O

Background The change of cardiovascular health (CVH) status has been associated with risk of cardiovascular disease. However, no studies have explored the change patterns of CVH in relation to risk of sudden cardiac death (SCD). We aim to examine the link between baseline CVH and change of CVH over time with the risk of SCD. Methods and Results Analyses were conducted in the prospective cohort ARIC (Atherosclerosis Risk in Communities) study, started in 1987 to 1989. ARIC enrolled 15 792 individuals 45 to 64 years of age from 4 US communities (Forsyth County, North Carolina; Jackson, Mississippi; suburbs of Minneapolis, Minnesota; and Washington County, Maryland). Subjects with 0 to 2, 3 to 4, and 5 to 7 ideal metrics of CVH were categorized as having poor, intermediate, or ideal CVH, respectively. Change in CVH over 6 years between 1987 to 1989 and 1993 to 1995 was considered. The primary study outcome was physician adjudicated SCD. The study population consisted of 15 026 subjects, of whom 12 207 had data about CVH change. Over a median follow‐up of 23.0 years, 583 cases of SCD were recorded. There was a strong inverse association between baseline CVH metrics and time varying CVH metrics with risk of SCD. Compared with subjects with consistently poor CVH, risk of SCD was lower in those changed from poor to intermediate/ideal (hazard ratio [HR], 0.67 [95% CI, 0.48–0.94]), intermediate to poor (HR, 0.73 [95% CI, 0.54–0.99]), intermediate to ideal (HR, 0.49 [95% CI, 0.24–0.99]), ideal to poor/intermediate CVH (HR, 0.23 [95% CI, 0.10–0.52]), or those with consistently intermediate (HR, 0.49 [95% CI, 0.36–0.66]) or consistently ideal CVH (HR, 0.31 [95% CI, 0.13–0.76]). Similar results were also observed for non‐SCD. Conclusions Compared with consistently poor CVH, other patterns of change in CVH were associated with lower risk of SCD. These findings highlight the importance of promotion of ideal CVH in the primordial prevention of SCD.

We aimed to comprehensively pool the prevalence of autism spectrum disorder (ASD) diagnosis by birth weight, gestational age, and size for gestational age. PubMed, EMBASE, Web of Science, Ovid PsycINFO, and Cochrane Library were searched up to December 22, 2021. We pooled data using the random-effects model and quantified heterogeneity using the I

Sewage sludge contains a large number of nutrients and dangerous substances, when sludge was processed into sludge hydrochar that was added to the soil, which not only solve the problem of sludge disposal, but also amend the soil and fix pollutants in the soil. However, it was lack of report on the effect of the sludge hydrochar on soil compositions and soil microorganism community structures until now. In the present study, the hydrothermal carbonization method is used to prepare hydrochar from sewage sludge at temperatures of 180 ℃ and 240 ℃ at durations of 6 h and 15 h in this paper. The effects of the prepared sludge hydrochar on soil-derived dissolved organic matter (DOM), the content of total dissolved nitrogen (TDN) and NO

Blending controlled-release urea (CRU) with conventional urea has the potential to be an effective option for improving nitrogen (N) use efficiency (NUE), although determination of optimal blends in combination with a reduced N application rate has not been well studied. A field experiment was conducted to compare the effects of CRU (a mixture of polymer-coated urea and urea with N ratios of 100:00, 75:25, and 50:50 at 144 kg N ha−1, hereafter denoted as CRU1, CRU2, and CRU3, respectively), urea at 180 (U1) and 144 kg N ha−1 (U2) and a control (no N fertilizer applied, CK) on grain yield, NUE, and economic benefits in a wheat–maize rotation system. The CRU treatments were one-time applied, while for the U treatments, fertilizer N was applied in a split application. The results suggest that a one-time application of CRU prior to sowing of both crops fulfilled the demand of crop plants for N across the entire growth period. Relative to U1, the CRU treatments achieved approximately the same grain yield and 4.7–26.6% greater NUE at 20% reduced N application. Moreover, under CRU2, the yield, NUE, and economic benefits were increased by 12.2%, 9.7%, and 19.1%, respectively, for wheat, and under CRU3, they were increased by 10.9%, 20.6%, and 17.3%, respectively, for maize, compared with the U2 treatment. These results demonstrate that a mixture of CRU and urea at a ratio of 75:25 for wheat and 50:50 for maize with a 20% reduction in N application rate can maintain productivity, while enhancing NUE in the North China Plain.

A field experiment consisted of two types of N fertilizer, controlled release urea (CRU) and normal urea (U), in combination with three SAP application rates (0, 45 and 90 kg ha−1) in a split-plot ...

In this paper, a new guidance law based on time-varying terminal sliding mode is proposed to make multi-agent intercept maneuvering target simultaneously. The new approach can make more benefits as follows: (1). Distributed cooperation protocol with accurate time-to-go ensures the simultaneous attack task can be solved within finite time. (2). The disturbance observer and the composite cooperative guidance law can settle the coordinated attack problem with target acceleration unknown (that is in accordance with the unknown uncertainty upper bound). (3). The improved terminal sliding mode can maintain the continuity and stability of flight control, and it can eliminate singularity and chattering of sliding mode to some extent. (4). New guidance law is designed for multi-attackers with different interaction topology, which is suitable for the long distance information communication. By comparison, numerical simulations verify the validity and superiority of the proposed method.

In this paper, aiming to drive the unmanned aerial vehicle (UAV) to the optimal position of the vertical plane in the close formation flight, a control method that is based on extended state observ...

Both aldosterone and arginine vasopressin (AVP) are produced in the heart and may participate in cardiac fibrosis. However, their relationship remains unknown. This study aims to demonstrate the regulation and role of AVP in aldosterone synthesis in the heart. Rats were subjected to a sham operation or myocardial infarction (MI) by ligating the coronary artery. Cardiac function and fibrosis were assessed using echocardiography and immunohistochemical staining, respectively. In addition, the effects of AVP stimulation on cardiac microvascular endothelial cells (CMECs) were studied using ELISA, real-time PCR, and Western blotting. Compared with the rats having undergone a sham operation, the MI rats had an increased LVMI, type I collagen composition, and concentrations of aldosterone and AVP in the heart but decreased cardiac function. As the MI rats aged, the LVMI, type I collagen, aldosterone, and AVP increased, while the LVMI decreased. Furthermore, AVP time-dependently induced aldosterone secretion and CYP11B2 mRNA expression in CMECs. The p-CREB levels were significantly increased by AVP. Nevertheless, these effects were completely blocked by SR49059 or partially inhibited by KN93. This study demonstrated that AVP could induce the secretion of local cardiac aldosterone, which may involve CaMK and CREB phosphorylation and CYP11B2 upregulation through V1 receptor activation.

To understand the adsorption mechanisms of Cd

Several studies have explored the link of antenatal multivitamin supplementation with autism spectrum disorder (ASD) in offspring, but the findings are inconsistent. The purpose of the current study was to perform a systematic review and meta-analysis of published studies to evaluate the actual association between maternal multivitamin supplementation during the prenatal period and the risk of ASD in children. PubMed, EMBASE, PsycINFO, Web of Science, and Cochrane Library were searched up to August 26, 2018. The random-effects model was used to calculate the pooled results. The adjusted risk ratios (RRs) were used as the common measure of association among studies. Sensitivity and subgroup analyses were also conducted. A total of 5 articles (9 independent trials; 231 163 children encompassing 4459 cases) were included. The results of overall analysis showed that the likelihood of ASD in offspring whose mothers used multivitamin supplements during the prenatal period was significantly reduced compared with that in offspring of mothers without such supplementation (RR, 0.62; 95% CI, 0.45-0.86; P = .003). Additionally, the primary outcome of the meta-analysis was quite robust after being verified by sensitivity analyses and no publication bias was found. Furthermore, the findings of overall analysis were generally consistent with those of subgroup analyses. In conclusion, this meta-analysis supports a protective association between maternal multivitamin supplementation during the prenatal period and the subsequent risk of ASD in children. Further investigation is needed and should address the constituent(s) contributing to the protective effect of multivitamin on ASD risk and the underlying molecular mechanisms.

Dissolved humic acid (DHA) from soil can interact with multi-walled carbon nanotubes (MWCNTs) and magnetic-modified multi-walled carbon nanotubes (MMWCNTs), and subsequently alter the toxicity of MWCNTs and MMWCNTs to amaranth. This is the first study to compare the effects of MWCNTs and MMWCNTs under natural DHAs on their toxicity to amaranth. When DHAs were combined with 0.5 g/L MWCNTs, 1:2:1 MMWCNTs and 4:2:1 MMWCNTs nanomaterials, DHA1 and DHA4 both increased the pH of Hoagland's solutions. DHA1 more severely decreased the soluble protein levels in shoots than DHA4 in the 1:2:1 MMWCNT and 4:2:1 MMWCNT treatments. DHA1 and DHA4 both increased the chlorophyll concentrations of amaranth treated with MWCNTs, decreased the chlorophyll concentrations in the MMWCNT treatments. Co-exposure of DHAs and carbon-based CNTs caused further decreases in the anthocyanin level as compared to the respective CNT alone treatment. In the nanomaterial alone treatment, both 0.25 and 4:2:1 MMWCNTs greatly lowered the anthocyanin level as compared to the other two CNTs with the same exposure dose. Transmission electron microscopy images showed that the interaction between 4:2:1 MMWCNT and DHA4 had more serious effects on plant cells across all the treatments.

To analyze the prognostic value of R-ISS staging combined with "Multiple-Hits" in patients with multiple myeloma (MM), and to detected the effect of different "Multiple- Hits" combinations to the prognosis of the patients.The 220 MM patients treated in the hematology department of People's Hospital of Xinjiang Uygur Autonomous Region from April 2013 to October 2019 were enrolled and retrospective analyzed. All the patients were detected by FISH. The effects of R-ISS staging combined with "Multiple-Hits" and different "Multiple-Hits" combinations to the prognosis of the patients were compared.For the patients at R-ISS stage II and III, the median progression-free survival (PFS) time, overall survival (OS) time and duration of response (DOR) time in "Multiple-Hits" patients were all shorter than those without high-risk cytogenetic abnormality (HRCA) and those with only one type of HRCA (P0.05), while the TTR (time to response) was significantly prolonged (P0.05). For the prognosis of the patients among the three different "Multiple-Hits" combinations(1q21+ combined with del(17p), 1q21+ combined with t(14;16) and combined 1q21+ combined with t(4;14)), 1q21+ combined with del(17p) showed the worst prognosis.The patients with Different "Multiple-Hits" combinations shows different prognosis. The R-ISS staging combination with "Multiple-Hits" is more conducive to accurately judging the prognosis of MM patients.R-ISS分期联合“多重打击”在多发性骨髓瘤患者中预后的预测价值.分析R-ISS分期联合“多重打击”对多发性骨髓瘤(MM)患者的预后判断价值及不同“多重打击”组合对患者预后的影响.选取并回顾性分析2013年4月至2019年10月新疆维吾尔自治区人民医院血液科收治的初诊MM患者220例,所有患者均经过FISH检测。比较R-ISS分期联合“多重打击”以及不同“多重打击”组合对预后的影响.R-ISS II和III期中，“多重打击”患者的中位无进展生存（PFS）时间、总生存（OS）时间和持续缓解（DOR）时间均短于无高危细胞遗传学异常（HRCA）和仅包含一种HRCA的患者（P0.05），而TTR（达到反应时间）明显延长（P0.05）。不同“多重打击”组合中，1q21+合并del(17p)、1q21+合并t(14;16)及1q21+合并t(4;14) 3种“双打击”组合之间，1q21+合并del(17p)患者的预后最差.不同“多重打击”组合的患者预后不同。R-ISS分期与“多重打击”相结合更有利于精准判断MM患者预后.

Background Although silent myocardial infarction (SMI) is prognostically important, the risk of sudden cardiac death (SCD) among patients with incident SMI is not well established. Methods and Results We examined 2 community‐based cohorts: the ARIC (Atherosclerosis Risk in Communities) study (n=13 725) and the CHS (Cardiovascular Health Study) (n=5207). Incident SMI was defined as electrocardiographic evidence of new myocardial infarction during follow‐up visits that was not present at the baseline. The primary study end point was physician‐adjudicated SCD. In the ARIC study, 513 SMIs, 441 clinically recognized myocardial infarctions (CMIs), and 527 SCD events occurred during a median follow‐up of 25.4 years. The multivariable hazard ratios of SMI and CMI for SCD were 5.20 (95% CI, 3.81–7.10) and 3.80 (95% CI, 2.76–5.23), respectively. In the CHS, 1070 SMIs, 632 CMIs, and 526 SCD events occurred during a median follow‐up of 12.1 years. The multivariable hazard ratios of SMI and CMI for SCD were 1.70 (95% CI, 1.32–2.19) and 4.08 (95% CI, 3.29–5.06), respectively. The pooled hazard ratios of SMI and CMI for SCD were 2.65 (2.18–3.23) and 3.99 (3.34–4.77), respectively. The risk of SCD associated with SMI is stronger with White individuals, men, and younger age. The population‐attributable fraction of SCD was 11.1% for SMI, and SMI was associated with an absolute risk increase of 8.9 SCDs per 1000 person‐years. Addition of SMI significantly improved the predictive power for both SCD and non‐SCD. Conclusions Incident SMI is independently associated with an increased risk of SCD in the general population. Additional research should address screening for SMI and the role of standard post–myocardial infarction therapy.

Background: Methylprednisolone (MP) is a synthetic corticosteroid with potent anti-inflammatory and antioxidant properties used as therapy for a variety of diseases. The underlying mechanism of MP to reduce acute pancreatitis still needs to be elucidated.Methods: Twenty-four male C57BL/6 mice (6-8 weeks) were used to establish SAP mouse model by administering an intraperitoneal injection of Cae and LPS. Amylase expression levels of serum and PLF were measured with an amylase assay kit. The concentrations of IL-1β and TNF-α in the serum and PLF were detected by ELISA. The level of pancreatic and lung tissue damage and inflammation was assessed by H&E staining and immunofluorescence staining. Western blot and qPCR were used to detect the expression levels of NLRP3, IL-1β and TNF-αin vivo and in vitro.Results: In this study, we found MP, used in the early phase of SAP, decreased the levels of IL-1β and TNF-α in serum and peritoneal lavage fluids (PLF), reduced the level of serum amylase and the expression of MPO in lung tissue, attenuated the pathological injury of the pancreas and lungs in a dose-dependent manner. The expression of NLRP3 and IL-1β in pancreas and lungs was down-regulated significantly depending on the MP concentration. In vitro, MP reduced the levels of IL-1β and TNF-α by down-regulating the expression of NLRP3, IL-1β and p-NF-κB in isolated peritoneal macrophages. Conclusion: MP can attenuate the injury of pancreas and lungs, and the inflammatory response in SAP mice by down-regulating the activation of NF-κB and the NLRP3 inflammasome.

INTRODUCTION The aim of this study was to evaluate the efficacy and safety of azithromycin (AZI) combined with glucocorticoid (GC) in the treatment of children with refractory Mycoplasma pneumoniae. METHODS Computer search for PubMed, EMbase, Cochrane Library, China Biomedical Literature Database (CBMdisc), China Knowledge Network (CNKI), Wanfang, VIP (VIP), and a randomized controlled trial (RCT) of AZI combined with GC in the treatment of children with refractory Mycoplasma pneumoniae pneumonia test (RCT), the search time limit is built until March 20, 2019. Two researchers independently performed literature screening, data extraction, and literature risk bias, and meta-analysis was performed using RevMan 5.3 software. RESULTS A total of 12 RCTs were included, including 1130 patients. Meta-analysis showed that AZI combined with GC therapy significantly improved the total effective rate of the disease compared with the conventional treatment group (odds ratio [OR] = 6.37; 95% confidence interval [CI] 4.03, 10.07; P

Seafloor observatory are becoming more and more important in multidisciplinary observations of the seabed, but real-time, long-term and fixed locations observation are still difficult to achieve. This paper describes a new technology that divides the seafloor observatory into three modules: mobile docker, scientific instrument cabin and in-situ gravity station and uses buoys or photoelectric composite cables to meet the above three requirements. After design and manufacture, the workflow of the seafloor observatory was simulated through a pool test. The handling performance of the mobile docker, the reliability of the docking between the three modules and the performance of the in-situ gravity station to adjust its attitude were proved. It has been preliminarily proved that this seafloor observatory has application value.

A novel flight control method for a fixed-wing unmanned aerial vehicle (UAV) is provided, which uses only synthetic jet actuators (SJAs) to achieve thrust vector control of the fixed-wing UAV. Firstly, the fluid model of the engine jet (or primary jet) and the SJAs are built, and the relation between the deflection angle of the primary jet and the amplitude of vibrating membrane of the SJAs is obtained. Secondly, based on the relation, a SJAs-based thrust vector control pitching motion model of the UAV is built. Thirdly, considering parameter uncertainties, unmodeled dynamics and unknown external disturbance of the system, an adaptive back-stepping sliding mode control (ABSMC) law is proposed, and pitching motion of the UAV is achieved by using only the SJAs-based thrust vector control. Finally, some simulations are conducted to analyze and verify the effectiveness of the flight control method. The results show that the thrust vector produced by the SJAs can enable the pitch control of the UAV and the ABSMC performs well in the presence of parameter uncertainties, unmodeled dynamics and unknown external disturbance of the system.

Tripterygium Glycosides Tablets has good anti-inflammatory and immunomodulatory activities,but its reproductive damage is significant. Previous studies of the research group have found that Cuscutae Semen flavonoids can improve spermatogenic cell damage caused by Tripterygium Glycosides Tablets by regulating spermatogenic cell cycle,apoptosis and related protein expression,but the mechanism of action at the gene level is still unclear. In this study,Illumina high-throughput sequencing platform was applied in transcriptional sequencing of spermatogenic cells of rats after the intervention of Cuscutae Semen flavonoids and Tripterygium Glycosides Tablets. Differentially expressed genes were screened out and the GO enrichment and KEGG pathway analysis of differentially expressed genes were conducted to explore the mechanism of Cuscutae Semen flavonoids in improving reproductive injury caused by Tripterygium Glycosides Tablets. The results showed that 794 up-regulated genes and 491 down-regulated genes were screened in Tripterygium Glycosides Tablets group compared with the blank group. Compared with Tripterygium Glycosides Tablets,440 up-regulated genes and 784 down-regulated genes were screened in the Cuscutae Semen flavonoids+Tripterygium Glycosides Tablets group. Among them,the gene closely related to reproductive function is DNMT3 L. Analysis of GO function and KEGG signaling pathway enrichment showed that the above differentially expressed genes were mainly enriched in cell,cell process,catalytic activity,binding,ovarian steroid synthesis,thyroid hormone and other functions and pathways. The thyroid hormone signaling pathway was the common enrichment pathway of the two control groups. In a word,Cuscutae Semen flavonoids has a good treatment effect on male reproductive damage caused by Tripterygium Glycosides Tablets. The mechanism may be closely related to up-regulation of DNMT3 L genes and intervention of thyroid hormone signaling pathway. At the same time,the discovery of many different genes provides valuable information for study on the mechanism of Cuscutae Semen flavonoids and Tripterygium Glycosides Tablets compatibility decreasing toxicity and increasing efficiency.

To preliminarily investigate the effect of Tripterygium Glycosides Tablets( TGT) combined with traditional Chinese medicine( TCM) on the fertility and female menstruation on persons who have took during childhood. The children with henoch-schonlein purpura( HSP) or henoch-schonlein purpura nephritis( HSPN) who treated with TGT under 18 years old and now older than 18 years old( including 18 years old) during January 1998 to December 2010 were selected in our research. The content of follow-up visit included marriage,marriage age,fertility and child health; and unmarried female patients were asked whether they had menstrual abnormalities. The data of the unmarried female patients,including age,clinical classification,TCM syndrome type,initial dose and other related factors that may affect menstrual cycle,was analyzed by using binary logistic regression analysis. A total of 195 patients who met the criteria were followed up in this study,and 26 patients married for more than 1 year. Among the 26 married patients,1 HSP patient had no birth planning due to rheumatoid arthritis,and the remaining 25 patients all had given birth or were pregnant. The 169 unmarried patients included 89 female patients. Among the 89 female patients,4 cases refused to tell the menstrual situations,72 cases had normal menstruation( 84. 7%),13 cases had abnormal menstruation( 15. 3%),and there was no case of amenorrhea. Logistic regression analysis results showed that the age,clinical classification,TCM syndrome type and initial dose had no correlation with abnormal menstruation. Our results demonstrated that TGT has no effect on adulthood fertility among patients who took TGT combined with traditional Chinese medicine during childhood.

We carried out the 70-day remediation process for soil contaminated polybrominated diphenyl ethers (PBDEs) using a novel technology, a tourmaline catalyzed Fenton-like reaction (TCFR) combined with Phanerochaete chrysosporium (TCFR + P) in field soil microcosms. The results showed that the TCFR is more efficient in removing PBDE compounds with lower numbers of bromine (Br) atoms such as BDE-28, BDE-47, BDE-99, BDE-100, while the TCFR + P is a good method to remove the PBDEs with greater number of Br atoms. For the total PBDE removal from soil, the TCFR was more efficient than that in the soil added TCFR + P . SEM analysis showed that lower PBDE removal using TCFR + P may be due to the mycelium produced by P. chrysosporium covering the humin (HM) surface, thereby decreasing the effective contact between hydroxyl radicals ( OH) and PBDEs. Moreover, a systemic series of experiments on the effects of the TCFR and TCFR + P on soil pH, soil organic matter (SOM) content, humic acid (HA) and HM compositions and structure, soil fungi, and degradation pathways were designed to discuss the removal mechanisms of the TCFR and the TCFR + P. Both of the TCFR and the TCFR + P caused a decrease in the SOM contents, a decline in aromaticity, an increase in surface hydrophilicity, an improvement in the polarity index of HA and HM, and an unexpected increased ergosterol content, compared to that of the soil added H 2 O 2 , tourmaline or P. chrysosporium alone, which in turn, enhanced the removal of PBDEs. Additionally, the five and nine oxidation degradation products of BDE-47, -153, respectively, were analyzed by LC–MS/MS. To the best of our knowledge, this study is the first report demonstrating that PBDEs in soil can be removed through TCFR oxidization.

Objective. To evaluate the efficacy and safety of traditional Chinese medicine in preventing kidney damage caused by Henoch-Schonlein Purpura (HSP) in Children by meta-analysis. Methods. We systematically searched the main Chinese and English electronic databases and collected randomized controlled trials of Chinese herbs in children with HSP until July 2018. Then we used the bias risk assessment tool in Cochrane Handbook 5. 1. 0 to complete the risk assessment of the included studies. We utilized STATA12.0 and RevMan 5.3 for meta-analysis and GRADE pro. for quality evaluation of evidence. Result. (1) Meta-analysis: data from 39 studies, representing 3643 individuals, were included in the analysis. Thirty-seven studies were treated with traditional Chinese medicine for clearing away heat and cooling blood, which were combined. On this basis, subgroup analysis was conducted according to the bias risk of the original study. It showed that Chinese herbs can significantly improve the treatment effect (OR: 4.31, 95% CI [3.34, 5.57], P < 0.01) and reduce the risk of renal damage (RR: 0.36; 95% CI [0.21, 0.61], P < 0.01) and the risk of recurrence (RR: 0.43, 95% CI [0.34, 0.54], P P=0.572, the relapse rate Egger’s test was P=0.175, the efficiency was combined with the low-risk original study, and the bias risk Egger’s test was P=0.175. There was not any significant publication bias based on the funnel plot and Egger’s test. (4) GRADE evaluation: GRADE evaluation showed that the quality of evidence in the risk of renal damage and recurrence rate was moderate. Conclusion. Chinese medicine treatment can prevent the occurrence of renal damage in children with HSP and can reduce the recurrence rate, the incidence of adverse reactions, and the effect in terms of efficiency. However, the quality of the included studies in the meta-analysis and the quality of the evidence of outcomes were not high; the clinical use of the evidence needs to be cautious.

Background A number of studies have explored the link of antenatal folic acid (FA) intake with autism spectrum disorder (ASD) in children, with inconsistent findings. Therefore, we conducted a systematic review and meta-analysis of relevant studies to elucidate the actual association between maternal FA intake during the prenatal period and the risk of ASD in offspring. Methods PubMed, EMBASE, PsycINFO, Scopus, Web of Science, and Cochrane Library were searched up to June 7, 2018, without language restriction. The random-effects model was applied to summarize results. The adjusted odds ratios (ORs) and hazard ratios (HRs) were pooled separately. Results Eight observational studies (a total of 13 reports; 840,776 children and 7127 cases) were included. FA intake was mainly estimated from self-report of mothers or available databases. The results of overall analysis from 6 studies (9 reports) combined by OR and 2 studies (4 reports) presenting HR showed that the likelihoods of ASD in offspring whose mothers were prenatally exposed to FA did not vary significantly compared with those in offspring of mothers without such exposure (OR = 0.91, 95% CI: 0.73–1.13 and HR = 0.66, 95% CI: 0.38–1.17, respectively). Further analysis revealed that the primary outcome of the meta-analysis was stable regardless of the study design, and not unduly affected by any single report. Additionally, no publication bias was observed, and the findings of overall analysis were in agreement with those of subgroup analyses. Conclusions This study does not provide support for the association between maternal FA intake during the prenatal period and the reduced risk of ASD in children. However, in view of the types and limited number of studies in the literature, more investigation is needed to confirm the findings of this meta-analysis.

The endocapillary proliferative (EP) lesion is not included in the International Study of Kidney Disease in Children (ISKDC) pathological classification of Henoch-Schonlein purpura nephritis (HSPN). The main objective of the study was to determine the pathological importance of EP in the development of proteinuria in children with Henoch-Schonlein purpura nephritis (HSPN). The pathological features of 148 HSPN children with nephrotic-range proteinuria were investigated retrospectively. Urinary IgG, transferrin, and albumin levels were measured by immunonephelometry. The correlations between EP lesion and 24-h proteinuria, urinary IgG, urinary transferrin, and urinary albumin were analyzed. Renal biopsy specimens were immunohistochemically stained for nephrin and podocalyxin. Of the total 581 cases of children with HSPN who underwent renal biopsy, 148 cases (25.5%) presented with nephrotic-range proteinuria. The pathological types of HSPN with nephrotic-range proteinuria were categorized as IIb, IIIa, IIIb, IIIb with diffuse EP, IVb, pure focal EP type, and pure diffuse EP type. Among these types, pure diffuse EP type accounted for 7.4%. The levels of 24-h proteinuria and urinary albumin were the highest in pure diffuse EP type among all pathological types, and the percentage of EP correlated with 24-h proteinuria and urinary albumin levels. 24-h proteinuria was significantly higher in pure diffuse EP type relative to HSPN IIb type, and significantly higher in IIIb with EP, compared with HSPN IIIb. Nephrin, but not podocalyxin, was downregulated in EP segment. EP is an independent pathogenic factor in HSPN with nephrotic-range proteinuria. Downregulation of nephrin in EP segment is a potential molecular mechanism of nephrotic-range proteinuria. Albumin is the major urinary protein component in HSPN with EP.