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Wanlan Fu,1 Yunxiang Cao,2 Jian Liu,2 Chuanbing Huang,2 Kaiyan Shu,1 Nanfei Zhu1 1First Clinical Medical College, Anhui University of Chinese Medicine, Hefei, Anhui, 230012, People’s Republic of China; 2Department of Rheumatology, First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, 230031, People’s Republic of ChinaCorrespondence: Yunxiang Cao, Department of Rheumatology, First Affiliated Hospital of Anhui University of Chinese Medicine, 117 Meishan Road, Shushan District, Hefei, Anhui, 230031, People’s Republic of China, Tel +86-13514984395 ; +0551-62838591, Email cyx800805@163.comPurpose: This study probed the mechanism of action of Xinfeng Capsule (XFC) in myocardial injury in rats with adjuvant arthritis (AA) via the growth arrest-specific transcript 5 (GAS5)/microRNA-21 (miR-21)/Toll-like receptor 4 (TLR4) axis.Methods: Rats were injected with Freund’s complete adjuvant to establish a rat model of AA. Then, some modeled rats were given normal saline or drugs only, and some modeled rats were injected with adeno-associated viruses or necrosulfonamide (NSA; a pyroptosis inhibitor) before drug administration. Toe swelling and arthritis index (AI) were calculated. Pathological and morphological changes in synovial and myocardial tissues were analyzed with hematoxylin-eosin staining, and pyroptotic vesicles and the ultrastructural changes of myocardial tissues were observed with transmission electron microscopy. The serum levels of interleukin (IL)-1β, IL-18, IL-6, and tumor necrosis factor (TNF)-α were detected, and lactate dehydrogenase (LDH) release was measured in myocardial tissues, accompanied by the examination of GAS5, miR-21, TLR4, nuclear factor-kB (NF-κB) p65, nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3), Caspase-1, and Gasdermin D (GSDMD) expression in myocardial tissues.Results: After AA modeling, rats presented with significantly increased toe swelling and AI scores, synovial and myocardial tissue damage, elevated pyroptotic vesicles, and markedly enhanced serum levels of IL-1β, IL-18, IL-6, and TNF-α, accompanied by significantly diminished GAS5 expression, substantially augmented miR-21, TLR4, NF-κB p65, NLRP3, Caspase-1, and GSDMD expression, greatly increased LDH release in myocardial tissues. XFC treatment significantly declined toe swelling, AI scores, synovial and myocardial tissue damage, and the serum levels of IL-1β, IL-18, IL-6, and TNF-α in AA rats. Additionally, XFC treatment markedly elevated GAS5 expression and substantially lowered LDH release and miR-21, TLR4, NF-κB p65, NLRP3, Caspase-1, and GSDMD expression in myocardial tissues of AA rats. Moreover, the above effects of XFC in AA rats were further promoted by GAS5 overexpression or NSA treatment.Conclusion: XFC alleviated myocardial injury in AA rats by regulating the GAS5/miR-21/TLR4 axis and inhibiting pyroptosis and pro-inflammatory cytokine secretion.Keywords: adjuvant arthritis, myocardial injury, GAS5/miR-21/TLR4 axis, pyroptosis, Xinfeng Capsule

Jing Li,1,* Na Zhu,2,* Yaqiong Wang,2 Yanlei Bao,3 Feng Xu,2 Fengjuan Liu,2 Xuefeng Zhou2 1Jilin Ginseng Academy, Changchun University of Chinese Medicine, Changchun, People’s Republic of China; 2Clinical Trial Research Center, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Central Hospital, Qingdao, People’s Republic of China; 3Department of Pharmacy, Liaoyuan People’s Hospital, Liaoyuan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xuefeng Zhou, Clinical Trial Research Center, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Central Hospital, No. 127, Siliunan Road, Shibei District, Qingdao, Shandong, 266042, People’s Republic of China, Tel +86 18561856181, Email zhouxuefeng5019@163.comAbstract: Diabetes is a major global public health problem with high incidence and case fatality rates. Traditional Chinese medicine (TCM) is used to help manage Type 2 Diabetes Mellitus (T2DM) and has steadily gained international acceptance. Despite being generally accepted in daily practice, the TCM methods and hypotheses for understanding diseases lack applicability in the current scientific characterization systems. To date, there is no systematic evaluation system for TCM in preventing and treating T2DM. Metabonomics is a powerful tool to predict the level of metabolites in vivo, reveal the potential mechanism, and diagnose the physiological state of patients in time to guide the follow-up intervention of T2DM. Notably, metabolomics is also effective in promoting TCM modernization and advancement in personalized medicine. This review provides updated knowledge on applying metabolomics to TCM syndrome differentiation, diagnosis, biomarker discovery, and treatment of T2DM by TCM. Its application in diabetic complications is discussed. The combination of multi-omics and microbiome to fully elucidate the use of TCM to treat T2DM is further envisioned.Keywords: metabolomics, traditional Chinese medicine, type 2 diabetes mellitus, diabetic complications, diagnosis

Kejia Ma,1,2 Xuejie Chen,1,2 Xin Xiang,3 Xueyi Mao,3 Ningxin Zhu,1,2 Tianyu Wang,1,2 Shuyu Ye,1,2 Xiaoyan Wang,1,2,* Minzi Deng1,2,* 1Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China; 2Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Changsha, Hunan, People’s Republic of China; 3Xiangya Medical College of Central South University, Changsha, Hunan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiaoyan Wang; Minzi Deng, Department of Gastroenterology, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Changsha, Hunan, People’s Republic of China, Tel +86 139 7488 9301 ; +86 137 8615 2169, Email wangxiaoyan@csu.edu.cn; dengmz@csu.edu.cnPurpose: This study aimed to investigate the willingness of Chinese adults aged 40 years and older to undergo gastroscopy for gastric cancer (GC) screening during the COVID-19 pandemic in 2020. The secondary purpose was to identify factors influencing willingness to undergo gastroscopy.Methods: A cross-sectional questionnaire survey was conducted in selected cities and counties from nine provinces in China using a multi-stage sampling approach. A multivariate logistic regression model was used to determine the independent predictors of willingness to undergo gastroscopy.Results: This study included 1900 participants, and 1462 (76.95%) responded that they would undergo gastroscopy for GC screening. Participants of younger age, from the eastern region, living in an urban area, with higher educational levels, with Helicobacter pylori (H. pylori) infection, or with precancerous stomach lesions, were more willing to undergo gastroscopy. The top four reasons to reject gastroscopy were fear of pain or discomfort, worry about a possible devastating test result, no symptoms in self-feeling, and concern about the high expense. Of all those who would reject gastroscopy for GC screening, 36.76% (161/438) would be willing to accept painless gastroscopy, while 24.89% (109/438) would be willing to undergo gastroscopy screening if higher medical reimbursement rates were available. Participants considered that gastroscopy was a relatively fearful and unknown procedure, accompanied by high risks and benefits compared to all other life events.Conclusion: In general, 76.95% of participants over 40 years old were willing to undergo gastroscopy for GC screening in China during the COVID-19 pandemic. Participants’ willingness to undergo GC screening increased due to medical resource constraints and increased interest in their health. Individuals with H. pylori infection are more likely to undergo gastroscopy, whereas old age individuals, those with lower educational levels, and those living in rural areas are more likely to reject gastroscopy.Keywords: gastrointestinal tumors, endoscopy, public health, early screening, questionnaire

Na Zhu,1,&ast; WeiHua Zhang,2,&ast; Jia Huang,3 Yousong Su,3 JingFang Lu,3 Lu Yang,3 YiFan Shi,3 ShaoHua Hu,4,&ast; Jun Chen,3,5,&ast; Yiru Fang3,5,6,&ast; 1Department of Psychiatry, Shanghai Pudong New Area Mental Health Center, Tong Ji University School of Medicine, Shanghai, People’s Republic of China; 2Department of Psychiatry, Taizhou Second People’s Hospital, Taizhou, People’s Republic of China; 3Clinical Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 4Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, The Key Laboratory of Mental Disorder Management of Zhejiang Province, Hangzhou, People’s Republic of China; 5Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People’s Republic of China; 6State Key Laboratory of Neuroscience, Shanghai Institutes for Biological Sciences, CAS, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: ShaoHua Hu; Jun Chen, Email dorhushaohua@zju.edu.cn; doctorcj2010@gmail.comBackground: Cognitive impairment is one of the core features of bipolar depression. A unified, reliable, and valid assessment tool is key to screening and assessing cognitive impairment. The THINC-Integrated Tool (THINC-it) is a simple and quick battery for screening cognitive impairment in patients with major depressive disorder. However, the use of the tool has not been validated in patients with bipolar depression.Methods: The cognitive functions of 120 patients with bipolar depression and 100 healthy controls were evaluated using the THINC-it tool including Spotter, Symbol Check, Codebreaker, Trials, and the only one subjective test (PDQ-5-D) and five corresponding standard tests. A psychometric analysis of the THINC-it tool was performed.Results: The overall Cronbach’s alpha coefficient of the THINC-it tool was 0.815. The intra-group correlation coefficient (ICC) of retest reliability ranged from 0.571 to 0.854 (P< 0.001), while the correlation r of parallel validity ranged from 0.291 to 0.921 (P< 0.001). There were significant differences in the two groups Z-scores of THINC-it total score, Spotter, Codebreaker, Trails, and PDQ-5-D (P< 0.05). Construct validity was analyzed using exploratory factor analysis (EFA). The Kaiser-Meyer-Olkin (KMO) value was 0.749. Using Bartlett’s Sphericity test, the χ2 (10) value was 198.257 (P< 0.001). The factor loading coefficients of Spotter, Symbol Check, Codebreaker, and Trails on the common factor 1 were − 0.724, 0.748, 0.824, and − 0.717, respectively, and the factor loading coefficient of PDQ-5-D on the common factor 2 was 0.957. Results revealed that the correlation coefficient of the two common factors was 0.125.Conclusion: The THINC-it tool has good reliability and validity in assessing patients with bipolar depression.Keywords: bipolar disorder, cognitive impairment, reliability, THINC-it tool, validity

Jing Wu,1,&ast; Yudi Jin,2,&ast; Mei Liu,1,&ast; Ningsheng Zhu,1 Zhouhong Jing,1 Xiaohua Zeng1 1Department of Breast Center, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, 400030, People’s Republic of China; 2Department of Pathology, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, 400030, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiaohua Zeng, Department of Breast Center, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, 400030, People’s Republic of China, Email zxiaohuacqu@126.comBackground: Metaplastic breast cancer (MBC) is an extremely rare malignant breast disease that has rarely been reported. The molecular subtype of MBC is mostly triple-negative, with a high recurrence rate and a worse prognosis. Due to its low HR- and HER2-positive rate, reports on endocrine and targeted therapy are very limited.Case report: We report a case of infrequent triple-negative MBC, which, although at an early stage, quickly developed multiple recurrent lesions in the chest wall. The tumor relapsed repeatedly after comprehensive treatment, including surgery, chemotherapy and radiotherapy. However, pathological results after the third surgery suggested that the molecular subtype had changed from triple-negative to HER2-positive. The previous comprehensive treatment had not been able to effectively control the disease, but the patient achieved a long progression-free survival time through chemotherapy and trastuzumab targeted therapy after the subtype change. To date, there has been no recurrence for over eight years.Conclusion: Among repeatedly relapsed MBC patients, further investigation should be taken into consideration. As in the case presented in our study, it is possible that the HER2 status can convert from negative to overexpression. Moreover, for HER2-positive MBC patients, anti-HER2 therapy is recommended. The decision-making process requires multidisciplinary involvement.Keywords: metaplastic breast cancer, triple-negative, HER2-positive, recurrence, targeted therapy

Jinbo Zhao,1,&ast; Ling Hou,2,&ast; Ni Zhu,3,&ast; Rui Huang,1 Ke Su,1 Yuhua Lei,1 Yuanhong Li1 1Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China; 2Department of Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, Hubei Province, 442000, People’s Republic of China; 3Department of Pathology, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yuanhong Li, Email lyh0101@vip.comObjective: The CHA2DS2-VASc score, a system which has been initially recommended for the assessment of thromboembolic risk in patients with atrial fibrillation (AF), arouses attention in the field of adverse coronary events. The purpose of this study was to explore the predictive value of preprocedural CHA2DS2-VASc score on ISR in patients after drug-eluting stent (DES) implantation.Methods: To further investigate the relationship between CHA2DS2-VASc scores and ISR after DES, a retrospective study of DES was carried on. Additionally, the preoperative variables for the ISR and control groups were contrasted. Predictive factors were chosen using the optimal subset regression. We validate the model using internal validation. The prediction model was evaluated using the receiver operator characteristic (ROC) analysis.Results: We used a 3:7 ratio to create an experimental group and a validation group, and then ran a stepwise regression with the data from each of the two groups. The results showed that CHA2DS2-VASc score was an independent risk factor for ISR in both the experimental (p = 0.0139) and validation groups (p = 0.0014), and both had significant predictive value for ISR. The area of the ROC curve was greater than 0.5 in both groups (AUC = 0.78, 0.719, respectively) indicating that the model fit was good in both groups.Conclusion: The CHA2DS2-VASc score is a reliable predictor of in-stent restenosis (ISR) after DES implantation.Keywords: CHA2DS2-VASc score, drug-eluting stents, DES, percutaneous coronary intervention, PCI, in-stent restenosis, ISR

Li Peng,&ast; Ni Zhu,&ast; Dan Wang,&ast; Yanhong Zhou, Yifei Liu School of Stomatology and Ophthalmology, Xianning Medical College, Hubei University of Science and Technology, Xianning, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yanhong Zhou; Yifei Liu, Email zyh@hbust.edu.cn; liuyifei@hbust.edu.cnIntroduction: Nod-like receptor C4 (NLRC4) is a member of the Nod-like receptor (NLR) family, and its expression mediates the activation of caspase-1 (CASP1). Abnormal expression of NLRC4 and CASP1 is associated with multiple tumors. However, the expression differences, prognostic value and immune correlation of NLRC4 and CASP1 in colorectal cancer (CRC) remain to be determined.Methods: In this study, TCGA, CCLE, HPA, PrognoScan, STRING and GeneMANIA databases were used to analyze differences in expression, prognostic value, genetic alterations and immune cell infiltration of NLRC4 and CASP1 in CRC patients. Then, we further validated the expression of NLRC4 and CASP1 in CRC using immunohistochemistry (IHC).Results: NLRC4 and CASP1 were expressed low in CRC tissues and CRC cell lines. The expression of NLRC4 was significantly related to the patient’s gender and lymph node metastasis. NLRC4 and CASP1 down-regulated expression was observably correlated with poor survival and diverse immune cells infiltration in CRC patients. NLRC4 and CASP1 have a gene mutation alteration. NLRC4 and CASP1 had a significant positive correlation in CRC.Conclusion: This study will provide new ideas for the prognosis and treatment in CRC. NLRC4 and CASP1 are expected to be novel biomarkers and potential immunotherapy targets in CRC patients.Keywords: Nod-like receptor C4, caspase-1, colorectal cancer, bioinformatics, immunohistochemistry

Dan Wang,1,&ast; Yanhong Zhou,2,&ast; Li Hua,2 Jiaxiang Li,2 Ni Zhu,2 Yifei Liu2 1School of Pharmacy, Xianning Medical College, Hubei University of Science and Technology, Xianning, HuBei, People’s Republic of China; 2School of Stomatology and Ophthalmology, Xianning Medical College, Hubei University of Science and Technology, Xianning, HuBei, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yifei Liu, School of Stomatology and Ophthalmology, Xianning Medical College, Hubei University of Science and Technology, Xianning, HuBei, People’s Republic of China, Tel +86-715-8266030, Email liuyifei@hbust.edu.cnIntroduction: In the cell cycle, cyclin-dependent kinases (CDKs) play a positive regulatory role, which is essential for normal cell growth, but the expression pattern and prognostic significance of the CDK family in colorectal cancer (CRC) have not been systematically investigated.Methods: In our study, we analyzed and visualized the expression of CDKs in CRC using TCGA, GEPIA, GSCALite, TIMER, HPA database, and R language CDKs risk model was constructed.Results: Overall, CDKs (CDK1, CDK2, CDK3, CDK4, CDK5, CDK6, CDK7 and CDK8) were differentially expressed between normal controls and colorectal cancer. Three CDKs genes (CDK3, CDK5 and CDK8) associated with prognosis were obtained by univariate and multivariate Cox and LASSO regression analysis. In CRC, CDK3, CDK5 and CDK8 are significantly associated with expression levels of recognized immune infiltrates.Conclusion: CDK3, CDK5 and CDK8 are potential diagnostic markers for CRC; meanwhile, CDK3, CDK5 and CDK8 are potential prognostic markers for CRC; studying the relationship between CDKs and tumor immunology may be helpful for immunotherapy of CRC, and more studies are needed to confirm these results.Keywords: colorectal cancer, cyclin-dependent kinases family, mRNA expression, prognosis, risk score model

Guoshuai Shi,1 Ni Zhu,2 Lin Qiu,3 Hong Yan,1,4 Lingxia Zeng,1 Duolao Wang,5 Shaonong Dang,1 Zhaoqing Li,1 Yijun Kang,1 Tao Chen,6 Chao Li1 1Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, People’s Republic of China; 2Department of Communicable Disease Control and Prevention, Shaanxi Provincial Center for Disease Control and Prevention, Xi’an, Shaanxi, People’s Republic of China; 3Department of Chronic and Noncommunicable Disease Control and Prevention, Shaanxi Provincial Center for Disease Control and Prevention, Xi’an, Shaanxi, People’s Republic of China; 4Nutrition and Food Safety Engineering Research Center of Shaanxi Province, Xi’an, Shaanxi, People’s Republic of China; 5Department of Clinical Sciences, Liverpool School of Tropical Medicine Pembroke Place, Liverpool, Merseyside, L3 5QA, UK; 6Department of Public Health, Policy & Systems, Institute of Population Health, The University of Liverpool, Liverpool, L69 3GB, UKCorrespondence: Chao LiDepartment of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, People’s Republic of ChinaEmail lcxjtu@xjtu.edu.cnTao ChenDepartment of Public Health, Policy & Systems, Institute of Population Health, The University of Liverpool, Whelan Building, Quadrangle, Liverpool, L 69 3GB, UKEmail Tao.chen@liverpool.ac.ukPurpose: This study aimed to estimate the impact of the 2020 China Diabetes Society’s (CDS) guideline on the prevalence of diabetes mellitus and eligibility for antidiabetic treatment in China.Material and Methods: Baseline data from the China Health and Retirement Longitudinal Study (CHARLS, 2011– 2012) were used to estimate the prevalence of diabetes mellitus and compare the recommendations for antidiabetic medication and intensification of therapy between the 2017 and 2020 CDS guidelines.Results: According to the 2017 CDS guideline, the prevalence of diabetes mellitus was 12.56% among Chinese adults who were ≥ 45 years of age. However, according to the 2020 CDS guideline, 0.65% (0.35%, 1.20%), or 3.54 (2.50, 4.57) million Chinese adults who were ≥ 45 years would additionally be diagnosed with diabetes mellitus. Among Chinese adults not taking antidiabetic medications, 1.06% (0.87%, 1.28%), or 5.37 (4.36, 6.38) million Chinese adults with diabetes mellitus were recommended to start antidiabetic medication according to the 2017 CDS guideline, while 1.27% (1.01%, 1.58%), or 6.44 (5.29, 7.60) million Chinese adults with diabetes would be recommended to initiate antidiabetic medication according to the 2020 CDS guideline. Among Chinese adults taking antidiabetic medication, 51.59% (44.19%, 58.93%), or 18.35 (15.58, 21.12) million Chinese adults with diabetes received antidiabetic treatment but had a hemoglobin A1c (HbA1c) level higher than that mentioned in the 2017 and 2020 CDS guidelines.Conclusion: The addition of HbA1c in the 2020 CDS guideline will result in a modest increase in the number of Chinese adults who are diagnosed with diabetes and diabetes patients recommended for antidiabetic medication; however, the 2020 CDS guideline does not affect the number of diabetes patients eligible for intensification of treatment.Keywords: China Diabetes Society, diabetes, glycated hemoglobin A1c

Tao Yang,1,2 Raymond W Lam,2 Jia Huang,1 Yousong Su,1 Jing Liu,2 Xiaorui Yang,1 Lu Yang,1 Na Zhu,3 Guoqing Zhao,4 Ruizhi Mao,1 Rubai Zhou,1 Weiping Xia,5 Hongmei Liu,1 Zuowei Wang,6 Jun Chen,1 Yiru Fang1,7,8 1Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; 3Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, People’s Republic of China; 4Department of Psychology, Provincial Hospital Affiliated to Shandong University, Jinan, People’s Republic of China; 5Department of Medical Psychology, Xinhua Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, People’s Republic of China; 6Division of Mood Disorders, Shanghai Hongkou District Mental Health Center, Shanghai, People’s Republic of China; 7CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, People’s Republic of China; 8Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People’s Republic of ChinaCorrespondence: Yiru FangClinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Room B2409, Building 2, 600 South Wan Ping Road, Shanghai 200030, People’s Republic of ChinaTel +86 139 0199 7089Email yirufang@aliyun.comJun ChenClinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Room B2411, Building 2, 600 South Wan Ping Road, Shanghai 200030, People’s Republic of ChinaTel +86 180 1731 1373Email doctorcj2010@gmail.comBackground: Patients with bipolar disorder (BD) and patients with major depressive disorder (MDD) have relatively specific temperament and structural abnormalities of brain regions related to emotion and cognition. However, the effects of temperament factors on the structure of frontal and temporal cortex is still unclear. The aims of this study were to explore the differences and relationships between temperament characteristics and the gray matter volume of frontal and temporal cortex in patients with BD or MDD.Methods: T1-weighted magnetic resonance imaging (MRI) data, demographic and clinical information were obtained from 279 depressed patients (90 patients with BD, 189 patients with MDD) and 162 healthy controls (HC). Temperament was assessed with the Chinese short version of Temperament Evaluation of Memphis, Pisa and San Diego – Auto questionnaire (TEMPS-A). The Desikan-Killiany atlas was used for yielding gray matter volume by FreeSurfer 6.0 software suite. A total of 22 frontal and temporal regions were chosen as regions of interest (ROIs).Results: Compared with patients with MDD, patients with BD had higher TEMPS-A total scores and scores on cyclothymic, irritable and hyperthymic subscales. The gray matter volume in bilateral rostral middle frontal gyrus (RMFG), left temporal pole and right superior frontal gyrus were reduced in patients with BD. Patients with MDD only had lower gray matter volume in bilateral temporal pole. In the pooled patients, there were negative associations between hyperthymia and gray matter volume in right RMFG.Conclusion: Patients with BD and MDD had different temperament characteristics. The prominent temperament subscales in patients with BD were cyclothymia, irritable and hyperthymia. Patients with greater hyperthymia had lower gray matter volume in right frontal gyrus. Temperament may reflect an endophenotype in patients with mood disorders, especially in BD.Keywords: bipolar disorder, major depressive disorder, temperament, gray matter volume

Weihua Zhang,1,2,* Na Zhu,3,* Jianbo Lai,1,4 Jingjing Liu,1,5 Chee H Ng,6 Jun Chen,3 Chao Qian,1,7 Yanli Du,1 Chanchan Hu,1,4 Jingkai Chen,1,4 Jianbo Hu,1,4 Zhong Wang,1,4 Hetong Zhou,1,4 Yi Xu,1,4 Yiru Fang,3 Chuan Shi,8– 11 Shaohua Hu1,4 1Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, People’s Republic of China; 2Department of Psychiatry, Taizhou Second People’s Hospital, Taizhou 317200, People’s Republic of China; 3Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, People’s Republic of China; 4The Key Laboratory of Mental Disorder Management of Zhejiang Province, Hangzhou 310003, People’s Republic of China; 5Department of Psychiatry, Wenzhou Kangning Hospital, Wenzhou 325000, People’s Republic of China; 6The Melbourne Clinic Department of Psychiatry, University of Melbourne, Melbourne, Victoria 3052, Australia; 7Department of Psychiatry, The Seventh Shaoxing People’s Hospital, Shaoxing 312000, People’s Republic of China; 8Department of Psychological Assesssment, Peking University Sixth Hospital, Beijing 100191, People’s Republic of China; 9Peking University Institute of Mental Health, Beijing 100191, People’s Republic of China; 10NHC Key Laboratory of Mental Health, Beijing 100191, People’s Republic of China; 11National Clinical Research Center for Mental Disorders, Beijing 100191, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yiru FangShanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, People’s Republic of ChinaEmail yirufang@aliyun.comShaohua HuDepartment of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, The Key Laboratory of Mental Disorder Management of Zhejiang Province, 79 Qing Chun Road, Hangzhou 310003, People’s Republic of ChinaEmail dorhushaohua@zju.edu.cnPurpose: The THINC-integrated tool (THINC-it) as a brief screening tool can assesses cognitive impairment in patients with major depressive depression (MDD). Here, we aim to evaluate the reliability and validity of the THINC-it in a bipolar depression (BD-D) group in comparison with a healthy control (HC) group.Materials and Methods: Both groups were matched according to age, gender, years of education, and IQ. All participants completed the THINC-it test, including Spotter, Symbol Check, Codebreaker, Trails, and the Perceived Deficits Questionnaire for Depression-5-item (PDQ-5-D). The concurrent validity and internal consistency of the THINC-it test were analyzed, and 30 healthy controls were randomly sampled to retest THINC-it to verify the reliability of the THINC-it retest. The correlation between THINC-it and Hamilton Depression Scale (HAMD-17) and Sheehan Disability Scale (SDS) was also analyzed.Results: Fifty-eight patients with BD-D and 61 HCs were included for final analysis. There were significant mean difference (MD) standard errors (SE) between two groups in PDQ-5-D, Spotter and Codebreaker (all P< 0.01), Trails (P=0.015). There was no significant difference in Symbol Check (MD (SE)=− 0.01 (0.18), P=0.938; 95% CI=− 0.38 to 0.35). The Cronbach’s α of PDQ-5-D was 0.640. The intraclass correlation coefficient (ICC) was between 0.440 and 0.757. The highest concurrent validity was PDQ-5-D (r=0.812, P< 0.001). PDQ-5-D was positively correlated with HAMD-17 and SDS score (P< 0.01). The objective test had no significant correlation with HAMD-17 and SDS scores (P> 0.05).Conclusion: This study found that THINC-it can accurately present the cognitive impairment of patients with BD-D. It can be potentially applied in assessing the cognitive function of patients with BD-D although Symbol Check may not accurately reflect the level of cognitive function. The concurrent validity and retest reliability are lower than expected, we need to further increase the sample size to study.Keywords: bipolar depression, BD-D, major depressive depression, MDD, THINC-it, cognitive function, reliability, validity

Ning Zhu, Xue Yan, Hongli Li, Huiqin Wang Department 1 of Cardiology, Baoding First Center Hospital, Baoding 071002, Hebei, People’s Republic of ChinaCorrespondence: Ning ZhuDepartment 1 of Cardiology, Baoding First Center Hospital, 320 Changchengbeidajie, Baoding 071002, Hebei, People’s Republic of ChinaTel +86-312-5096409Email zhuning_my@21cn.comBackground: In this study, we explored the clinical significance of serum peroxisome proliferator-activated receptor gamma co-activator 1 (PGC-1) alpha levels in diabetes mellitus with myocardial infarction (DMMI) patients and investigated the possible mechanism.Materials and Methods: Serum samples were obtained from patients with DMMI or normal volunteer in Baoding First Center Hospital. C57BL/6 mice were induced by a single intraperitoneal (i.p.) injection of 100 mg/kg STZ (streptozocin) for in vivo model. Human myocardial cell lines H9C2 cells were induced with high glucose medium (33 mmol/L glucose) for in vitro model. Western blot was used to analyze the protein expressions in this study.Results: Serum PGC-1 alpha levels were down-regulated in patients with DMMI. There was negative correlation between serum PGC-1 alpha levels and glycated hemoglobin, blood glucose or glucagon in DMMI patients. Recombination of PGC-1 alpha protein decreased the levels of glycated hemoglobin, blood glucose and glucagon, and inhibited oxidative stress and myocardial damage in mice of DMMI. Over-expression of PGC-1 alpha reduced reactive oxygen species (ROS)-oxidative stress, while down-regulation of PGC-1 alpha promoted ROS-oxidative stress via regulation of hemeoxygenase− 1 (HO-1) expression in in vitro model of DMMI. The inhibition of HO-1 expression attenuated the anti-oxidation effects of PGC-1 alpha in vitro.Conclusion: PGC-1 alpha attenuated ROS-oxidative stress in diabetic cardiomyopathy model, and PGC-1 alpha served as a potential intervention to alleviate DMMI in clinical applications.Keywords: PGC-1 alpha, ROS, oxidative stress, diabetes mellitus with myocardial infarction

Mengxiang Zhao,1,* Liang Ding,1,* Yan Yang,2 Sheng Chen,2 Nisha Zhu,1 Yong Fu,1 Yanhong Ni,1 Zhiyong Wang2 1Central Laboratory of Stomatology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210093, People’s Republic of China; 2Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhiyong WangDepartment of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, 30 Zhongyang Road, Nanjing 210008, Jiangsu, People’s Republic of ChinaTel +86 137 709 2448Email wangzhiyong67@163.comYanhong NiCentral Laboratory of Stomatology, Nanjing Stomatological Hospital, Medical School of Nanjing University, 22 Hankou Road, Nanjing, Jiangsu 210093, People’s Republic of ChinaTel +86 138 1451 6225Email niyanhong12@163.comBackground: Programmed cell death 4 (PDCD4) as a tumor suppressor gene inhibits growth and metastasis of cancer cells, which involved with eIF4A1, the inhibitor of translation initiation. Although the prognosis of early-stage oral squamous cell carcinoma (OSCC) is generally better, but many patients occur recurrence after surgery. Understanding the clinical expression pattern of PDCD4/eIF4A1 signal would provide diagnostic biomarker and target therapy premise for early-stage OSCC patients.Methods: Immunohistochemical analysis was performed on 69 early-stage (T1/2N0M0) OSCC samples to evaluate temporal expression and prognostic value of eIF4A1 and PDCD4 in early-stage OSCC according to cell types and microlocalization. The correlations between PDCD4/eIF4A1 signal and Ki-67, postoperative recurrence and metastasis were determined.Results: We found that PDCD4 was presented in tumor cells (TCs) and tumor-infiltrating lymphocytes (TILs) but absent in fibroblast-like cells (FLCs). eIF4A1 was only presented in TCs. PDCD4TCs was negative associated with eIF4A1TCs in tumor center, and patients with low PDCD4TCs or high eIF4A1TCs had poorer differentiation. Moreover, aberrant PDCD4/eIF4A1 signal led to higher Ki-67 level. Interestingly, patients with low expressed PDCD4TILs had better prognosis, indicating the function heterogeneity of PDCD4 in different cell types. Furthermore, low PDCD4 TCs and high eIF4A1TCs predicted higher postoperative recurrence rate and are significant independent risk factors for early-stage OSCC.Conclusion: Patients with low PDCD4TCs and high eIF4A1TCs have higher recurrence rate and poor clinical outcome. Of note, PDCD4TILs exerts contradictory function. Thus, PDCD4/eIF4A1 targeting therapeutics should consider the function heterogeneity of PDCD4.Keywords: PDCD4, eIF4A1, early-stage OSCC, prognosis, diagnosis

Peng Cui,1,2 Jichun Su,1 Qingmin Li,1 Guangming Xu,3 Ningxi Zhu1 1Department of Neurosurgery, Taian Center Hospital, Taian 271000, People’s Republic of China; 2School of Medicine, Shandong University, Jinan 250000, People’s Republic of China; 3Department of Neurosurgery, Shandong Provincial Hospital, Jinan 250021, People’s Republic of ChinaCorrespondence: Guangming XuDepartment of Neurosurgery, Shandong Provincial Hospital, No.324 Jingwuweiqi Road, Jinan 250021, People’s Republic of ChinaTel +86 531 87938911Email azhe610@163.comIntroduction: Glioma arises from the proliferation of neuroglial cells differentiated from the ectoderm. Evidence has confirmed that differentially expressed long non-coding RNAs (lncRNAs) may be involved in the development and progression of various tumors. The present study aimed to explore the biological function of lncRNA RHPN1-AS1 in glioma.Materials and methods: The expressions of RHPN1-AS1 in glioma tissues and cells were examined using RT-PCR. Colony formation assay, MTT assay, wound healing assay and transwell assay were performed to detect cell cloning efficiency, proliferation, migration and invasion of glioma cells, respectively. Western blot was applied to assess the expression levels of migration-related and invasion-related proteins. Online bioinformatic tools and luciferase reporter assay were, respectively, employed to predict and verify the downstream target microRNA/gene of RHPN1-AS1.Results: RHPN1-AS1 was up-regulated in glioma tissues and cells. The cell proliferation, migration and invasion of glioma were inhibited when the expression of RHPN1-AS1 was down-regulated in glioma cells. The expressions of migration-related and invasion-related proteins were also suppressed in siRHPN1-AS1 groups. Furthermore, we predicted and verified that RHPN1-AS1 was directly targeted to miR-625-5p/REG3A. Our study demonstrated that the knockdown of RHPN1-AS1 inhibited the proliferation, migration and invasion activity of glioma cells via regulating miR-625-5p/REG3A expression.Conclusion: The results revealed that the lncRNA RHPN1-AS1 may be a molecular target in glioma therapy.Keywords: glioma, LncRNA, RHPN1-AS1, proliferation, migration, invasion

Yuxuan Qiu,1,* Yuan Fei,1,* Jingyan Liu,2 Chang Liu,3 Xin He,4 Ning Zhu,5 Wan-jun Zhao,1 Jing-qiang Zhu1 1Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 2Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 3Public Policy and Administration, Department of Government, London School of Economics and Political Science, London, UK; 4West China School of Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 5Library and Information Science, School of Information Management, Nanjing University, Nanjing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jing-qiang ZhuDepartment of Thyroid & Parathyroid surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan 610041, People’s Republic of ChinaTel/Fax +86-28-85422467Email zjq-wkys@163.comBackground: Skip metastasis is a special type in cervical lymph node metastasis (LNM) of patients diagnosed with papillary thyroid carcinoma (PTC) which induced poor prognosis. There are few studies about skip metastasis and conclusions remained uncertain. Therefore, this study aims to explore the frequency and to investigate risk factors of skip metastasis in PTC.Methods: Through searching the keyword by PubMed and Embase databases which articles published up to 1st August 2018 about skip metastasis in papillary thyroid carcinoma, we extract data in order to assure whether those materials meet the criteria.Results: The prevalence of skip metastasis is 12.02% in light of our meta-analysis of 18 studies with 2165 patients. The upper pole location (RR = 3.35, 95% CI =1.65–6.79, P = 0.0008) and tumors size ≤1 cm (RR = 2.65, 95% CI =1.50–4.70, P = 0.0008) are significantly associated with skip metastasis, whereas lymphovascular invasion (RR = 0.33, 95% CI =0.15–0.75, P = 0.0083) exists lower rate of skip metastasis. Multifocality, gender, age, bilaterality, thyroiditis and Extrathyroidal extension (ETE) are insignificantly associated with skip metastasis. Level II and level III are the most frequently affected areas.Conclusion: The lateral compartment should be carefully examined especially for those PTC patients who present primary tumors in the upper lobe with a primary tumor size ≤10 mm which could be detected with skip metastasis.Keywords: papillary thyroid carcinoma, skip metastasis, lateral neck dissection, meta-analysis

The autogenous bone ring technique is among the approaches for vertical alveolar ridge augmentation, and this technique can enable simultaneous implantation. However, the outcomes can be compromised due to donor site morbidity, shifting of the bone ring graft positioning, and inaccurate implant placement. In recent decades, dynamic navigation systems have been introduced into the field of implantology, allowing the accuracy of outcomes to be improved. This Technical Note describes the use of dynamic navigation to guide bone ring surgery, which is expected to enable more precise and predictable bone augmentation and implantation procedures, reduce the risk of injuries to the adjacent anatomical structures, and achieve better treatment outcomes. [ABSTRACT FROM AUTHOR]

Accurate occupancy prediction can improve facility control and energy efficiency of buildings. In recent years, buildings’ exiting WiFi infrastructures have been widely studied in the research of occupancy and energy conservation. However, using WiFi to assess occupancy is challenging due to that occupancy information is often characterized stochastically and varies with time and easily disturbed by building components. To overcome such limitations, this study utilizes WiFi probe technology to actively scan WiFi connection requests and responses between access points and network devices of building occupants. With captured signals, this study proposed a Markov based feedback recurrent neural network (M-FRNN) algorithm to model and predict the occupancy profiles. One on-site experiment was conducted to collect ground truth data using camera-based video analysis and the results were used to validate the M-FRNN occupancy prediction model over a 9-day measurement period. From the results, the M-FRNN based occupancy model using WiFi probes shows best accuracies can reach 80.9%, 89.6%, and 93.9% with a tolerance of 2, 3, and 4 occupants respectively. This study demonstrated that WiFi data coupled with stochastic machine learning system can provide a viable alternative to determine a building's occupancy profile.

The establishment of an eco-industrial demonstration park is based on the principles of sustainable development and aims to achieve social progress and economic growth before ultimately evolving into a fully developed industrial ecosystem. This study explores the relationship between the ecological environment and socioeconomic development in Zhengzhou Economic Development Zone (area of 158.7 km2), China. By analyzing the landscape patterns and changes in ecosystem service values over the periods of 2010, 2015, and 2019, results revealed a remarkable shift in land use in this area from 2010 to 2019. Particularly noteworthy was the remarkable growth in forest lands, which expanded from 0.98 km2 in 2010 to 23.42 km2 in 2019, whereas cultivated and bare lands decreased by 47.55% and 73.81%, respectively. The value of ecosystem services experienced a continuous increase and reached 13.3009 billion yuan in 2019. This study also examined the coordination degree of socioeconomic development and ecological environment coupling and found considerable progress from 2010 to 2019. The coupling degree values of 0.129, 0.809, and 0.960 for the aforementioned years indicated a remarkable improvement in synergistic and integrated development between the socioeconomic system and the ecosystem in this area. The landscape patterns in this area underwent noteworthy transformations. [ABSTRACT FROM AUTHOR]

Mandatory civil building energy efficiency codes strictly govern the energy consumption of new buildings in China. As the promotion of building energy efficiency in China has increased in recent years, compliance with mandatory civil building energy efficiency codes has also improved, increasing from less than 10% in 2000 to nearly 100% in 2012, a remarkable achievement. However, because the promotion of energy efficiency strategies in China has followed a unique pattern, some researchers doubt these statistics. In response to these doubts, this paper summarises and analyses the framework of measures implemented by the Chinese government to enforce mandatory building energy efficiency codes. First, the development and implementation of China's mandatory civil building energy efficiency code system is summarised. Second, the building supervision and inspection systems used to assess energy efficiency are introduced and analysed in detail in order to provide a framework for the development of energy policies in other countries. Third, the assessment and reporting processes used to determine compliance rates are reviewed. Finally, the improvement of compliance rates and its impact on building energy savings in China are discussed. Along with the increase in compliance rates in the construction stage from 71% in 2007 to 100% in 2012, the energy savings of new buildings per increased floor area per year increased from 20.4 kWh/m2 to 28.4 kWh/m2. The supervision and inspection systems reported in this paper are the keys to enforcing building energy efficiency codes.

Waste printed circuit boards (WPCBs) are attracting increasing concerns because the recovery of its content of valuable metallic resources is hampered by the presence of hazardous substances. In this study, we used ionic liquids (IL) to leach copper from WPCBs. [BSO3HPy]OTf, [BSO3HMIm]OTf, [BSO4HPy]HSO4, [BSO4HMim]HSO4 and [MIm]HSO4 were selected. Factors that affect copper leaching rate were investigated in detail and their leaching kinetics were also examined with the comparison of [Bmim]HSO4. The results showed that all six IL acids could successfully leach copper out, with near 100% recovery. WPCB particle size and leaching time had similar influences on copper leaching performance, while IL acid concentration, hydrogen peroxide addition, solid to liquid ratio, temperature, showed different influences. Moreover, IL acid with HSO4- was more efficient than IL acid with CF3SO3-. These six IL acids indicate a similar behavior with common inorganic acids, except temperature since copper leaching rate of some IL acids decreases with its increase. The results of leaching kinetics studies showed that diffusion plays a more important role than surface reaction, whereas copper leaching by inorganic acids is usually controlled by surface reaction. This innovation provides a new option for recovering valuable materials such as copper from WPCBs.

BackgroundPreserving cognitive function is an important public health issue. We investigated whether dietary pattern associates with cognitive function in middle-age.MethodsWe studied 2435 participants in the community-based Coronary Artery Risk Development in Young Adults (CARDIA) study of black and white men and women aged 18-30 in 1985-86 (year 0, Y0). We hypothesized that a higher A Priori Diet Quality Score, measured at Y0 and Y20, is associated with better cognitive function measured at Y25. The diet score incorporated 46 food groups (each in servings/day) as the sum of quintile ranks of food groups rated beneficial, 0 for food groups rated neutral, and reversed quintile ranks for food groups rated adverse; higher score indicated better diet quality. Y25 cognitive testing included verbal memory (Rey Auditory-Verbal Learning Test (RAVLT)), psychomotor speed (Digit Symbol Substitution Test (DSST)) and executive function (Stroop).ResultsPer 10-unit higher diet score at Y20, the RAVLT was 0.32 words recalled higher, the DSST was 1.76 digits higher, and the Stroop was 1.00 seconds+errors lower (better performance) after adjusting for race, sex, age, clinic, and energy intake. Further adjustment for physical activity, smoking, education, and body mass index attenuated the association slightly. Diet score at Y0 and increase in diet score over 20 years were also positively associated with each cognitive test.ConclusionsA higher quality dietary pattern was associated with better cognitive function 5 years and even 25 years later in apparently healthy middle-aged adults.

OBJECTIVE: The aim of this study was to investigate the hemoglobin variability in patients undergoing maintenance hemodialysis during the application of erythropoietin (EPO) and roxadustat. PATIENTS AND METHODS: For this retrospective study, we analyzed the clinical records of 80 patients with renal anemia on maintenance hemodialysis (MHD) admitted to our hospital between January 2017 and December 2022. We adopted a self-control design comparing the hemoglobin variability of the values before and after roxadustat administration in each patient. The patients received EPO from January 2017 to December 2019 and roxadustat from January 2020 to December 2022. We compared the levels of serum ferritin, transferrin saturation, and hemoglobin and calculated the hemoglobin variabilities by comparing values before and after roxadustat treatments. RESULTS: We found higher transferrin saturation levels at different time points after the roxadustat treatments (p<0.01); meanwhile, the serum ferritin and hemoglobin levels were significantly higher after the roxadustat treatment (p<0.001). During the treatments with EPO and roxadustat, the transferrin saturation, serum ferritin, and hemoglobin levels differed significantly at different time points for each patient (p<0.05). After roxadustat administration, the hemoglobin levels were significantly higher than after EPO administration (p<0.001) and changed more rapidly after roxadustat administration than after EPO administration (p<0.05). The hemoglobin variability after roxadustat administration was significantly lower than that after EPO administration (p<0.05). CONCLUSIONS: Treatment with roxadustat led to higher hemoglobin levels and less hemoglobin variability than the treatment with EPO, with high transferrin saturation and higher ferritin levels in patients with renal anemia on MHD. [ABSTRACT FROM AUTHOR]

Ecological functions and environmental characteristics were examined by taking Huangshan City, China, as the research object in this study. On the basis of the evaluated ecological function importance, a method for identifying the dominant ecological function of towns was determined. Then, the towns were divided into groups in terms of their dominant ecological functions, and the differences in the environmental suitability of human settlements in these town groups were explored. The results showed that (1) the most important degrees of biodiversity, water conservation, soil and water conservation functions in Huangshan City were 70.57%, 51.28%, and 39.87%, respectively. (2) Among the 108 towns in Huangshan City, 67 towns with water conservation as the dominant ecological function (TWC group); 33 towns with biodiversity as the dominant ecological function (TBD group); and 8 towns with soil and water conservation as the dominant ecological function (TSW group). (3) The largest proportion was low suitability areas in the TSW group (39.38%), the smallest proportion was high suitability areas in the TWC group (1.13%). A reasonable identification of dominant ecological functions can provide a reference for regional environmental planning and management of human settlements. [ABSTRACT FROM AUTHOR]