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The effect of vitamin D (VD) on the risk of preeclampsia (PE) is uncertain. Few of previous studies focused on the relationship between dietary VD intake and PE risk. Therefore, we conducted this 1:1 matched case–control study to explore the association of dietary VD intake and serum VD concentrations with PE risk in Chinese pregnant women. A total of 440 pairs of participants were recruited during March 2016 to June 2019. Dietary information was obtained using a seventy-eight-item semi-quantitative FFQ. Serum concentrations of 25(OH)D2 and 25(OH)D3 were measured by liquid chromatography–tandem MS. Multivariate conditional logistic regression was used to estimate OR and 95 % CI. Restricted cubic splines (RCS) were plotted to evaluate the dose–response relationship of dietary VD intake and serum VD concentrations with PE risk. Compared with the lowest quartile, the OR of the highest quartile were 0·45 (95 % CI 0·29, 0·71, Ptrend = 0·001) for VD dietary intake and 0·26 (95 % CI 0·11, 0·60, Ptrend = 0·003) for serum levels after adjusting for confounders. In addition, the RCS analysis suggested a reverse J-shaped relationship between dietary VD intake and PE risk (P-nonlinearity = 0·02). A similar association was also found between serum concentrations of total 25(OH)D and PE risk (P-nonlinearity = 0·02). In conclusion, this study provides evidence that higher dietary intake and serum levels of VD are associated with the lower risk of PE in Chinese pregnant women.
This study examined the effect of a cryoprotectant with and without pentoxifylline supplementation on the motility and viability of human testicular sperm, both before and after freezing. Testicular samples were obtained from 68 patients with azoospermia who came to the Andrology Service of West China Second University Hospital, Sichuan University, for testicular biopsies from December 2019 to April 2020. All patients were assigned randomly to two groups: experimental, whose testicular sperm were added to the cryoprotectant with pentoxifylline, and the control, whose testicular sperm were added to the cryoprotectant without pentoxifylline. Both groups used the same freezing and thawing methods. Testicular sperm motility in the experimental group was significantly higher than that of the control group, both before and after cryopreservation. The recovery rate of sperm motility in the experimental group was significantly higher than that of the control group. The percentage of samples with motile testicular sperm in the experimental group was significantly higher than that of the control group after thawing. Sperm viability was unchanged between the experimental and control groups, both before and after freezing. Overall, a pentoxifylline-supplemented cryoprotectant can significantly improve the motility of testicular sperm before and after cryopreservation.
Dyslipidaemia, a significant risk factor of CVD, is threatening human health worldwide. PUFA are crucial long-chain fatty acids for TAG synthesis and removal, potentially decreasing dyslipidaemia risk. We examined dyslipidaemia prevalence among 15 244 adults aged ≥ 20 years from National Health and Nutrition Examination Survey 2009–2016. Dyslipidaemia was defined as total cholesterol ≥ 240 mg/dl, or HDL-cholesterol < 40 mg/dl/50 mg/dl for males/females, respectively, or LDL-cholesterol ≥ 160 mg/dl, or TAG ≥ 200 mg/dl, or taking lipid-modifying medications. We measured the daily PUFA intake using a 24-h dietary recall. Demographics, social economics, and lifestyle factors were collected using questionnaires/interviews. Additionally, we measured Se and Hg levels in the whole blood. Logistic regression models were used to examine the association between PUFA and dyslipidaemia. The unweighted and weighted dyslipidaemia prevalences were 72·4% and 71·0 %, respectively. When grouped into tertiles, PUFA intake above 19·524 g/d was associated with an independent 19 % decrease in dyslipidaemia risk (OR = 0·81 (95 % CI 0·71, 0·94)) compared with the lowest tertile (PUFA intake ≤ 12·349 g/d). A threshold inverse association was further determined by the restricted cubic spline analysis. When PUFA intake was increased to its turning point, that is, 19 g/d, the lower nadir risk for dyslipidaemia was obtained (OR = 0·72 (95 % CI 0·56, 0·89)). When the exposure was the sum of α-linolenic acid and octadecatetraenoic acid, the inverse linear association remained. Dietary PUFA intake is a beneficial factor for dyslipidaemia among American adults, independent of many potential confounders, including Hg and Se.
Social cognition has not previously been assessed in treatment-naive patients with chronic schizophrenia, in patients over 60 years of age, or in patients with less than 5 years of schooling.
We revised a commonly used measure of social cognition, the Reading the Mind in the Eyes Test (RMET), by expanding the instructions, using both self-completion and interviewer-completion versions (for illiterate respondents), and classifying each test administration as ‘successfully completed’ or ‘incomplete’. The revised instrument (RMET-CV-R) was administered to 233 treatment-naive patients with chronic schizophrenia (UT), 154 treated controls with chronic schizophrenia (TC), and 259 healthy controls (HC) from rural communities in China.
In bivariate and multivariate analyses, successful completion rates and RMET-CV-R scores (percent correct judgments about emotion exhibited in 70 presented slides) were highest in HC, intermediate in TC, and lowest in UT (adjusted completion rates, 97.0, 72.4, and 49.9%, respectively; adjusted RMET-CV-R scores, 45.4, 38.5, and 34.6%, respectively; all p < 0.02). Stratified analyses by the method of administration (self-completed v. interviewer-completed) and by education and age (‘educated-younger’ v. ‘undereducated-older’) show the same relationship between groups (i.e. NC>TC>UT), though not all differences remain statistically significant.
We find poorer social cognition in treatment-naive than in treated patients with chronic schizophrenia. The discriminant validity of RMET-CV-R in undereducated, older patients demonstrates the feasibility of administering revised versions of RMET to patients who may otherwise be considered ineligible due to education or age by changing the method of test administration and carefully assessing respondents' ability to complete the task successfully.
To estimate the prevalence of thinness, overweight and obesity among Tibetan adolescents aged 12–17 years.
Shigatse City of Tibet municipality, with an average altitude of more than 4000 m.
Study participants included 2642 adolescents aged 12–17 years selected from six schools using a convenient cluster sampling method.
The prevalence of thinness/overweight/obesity among Tibetan adolescents was 9·4 %/5·4 %/1·4 % (China definition), 14·7 %/4·4 %/0·7 % (International Obesity Task Force (IOTF) definition), and 2·8 %/5·7 %/0·9 % (WHO definition). The prevalence of thinness and overweight was significantly different between both sexes based on each of three BMI classification criteria (P < 0·001). There was no significant difference in the prevalence of obesity between both sexes according to each of three BMI criteria. There was no clear trend in the prevalence of thinness across ages according to the China or IOTF definition (both P > 0·05), whereas an upward trend was observed for thinness in boys according to the IOTF definition (Pfor trend <0·05). In contrast, the prevalence of thinness tended to decrease with increasing age in girls according to the IOTF definition and in total sample according to the WHO definition (Pfor trend <0·05).
Among Tibetan adolescents, the prevalence of overweight and obesity is relatively low, while the prevalence of thinness is high, especially in boys. These data suggest urgent attention is needed to control adolescent thinness in Tibet.
High fibre intake is associated with reduced mortality risk in both general and chronic kidney disease populations. However, in dialysis patients, such data are limited. Therefore, the association between dietary fibre intake (DFI) and the risk of all-cause and CVD mortality was examined in this study. A total of 1044 maintenance haemodialysis (MHD) patients from eight outpatient dialysis centres in China were included in this study. Data on DFI were collected using 24-h dietary recalls for 3 d in a week and were normalised to actual dry weight. The study outcomes included all-cause and CVD mortality. Over a median of 46 months of follow-up, 354 deaths were recorded, of which 210 (59 %) were due to CVD. On assessing DFI as tertiles, the CVD mortality risk was significantly lower in patients in tertiles 2–3 (≥0·13 g/kg per d; hazard ratio (HR) 0·71; 95 % CI 0·51, 0·97) compared with those in tertile 1 (<0·13 g/kg per d). A similar but non-significant trend was found for the association between DFI (tertiles 2–3 v. tertile 1; HR 0·83; 95 % CI 0·64, 1·07) and all-cause mortality. In summary, higher DFI was associated with lower CVD mortality risk among Chinese MHD patients. This study emphasises the significance of DFI in MHD patients and provides information that is critical for the improvement of dietary guidelines for dialysis patients.
During the coronavirus disease 2019 (COVID-19) pandemic, Fangcang shelter hospitals were opened in Wuhan, China, to isolate and care for patients with mild or moderate symptoms. The patients and staff in the hospitals faced mental health challenges. This paper reports the experiences and mental health needs from them.
Following the qualitative design, semi-structured interviews were conducted in the EastWest Lake Fangcang Shelter Hospital, Wuhan on March 2020. Data collection and analysis was based on grounded theory. Open coding was adapted and a structured codebook was developed through coding seminars. The themes and subthemes were then confirmed through thematic analysis. The findings were further explained and integrated in a theoretical framework.
A total of 10 COVID-19 patients and 13 staff, including doctors, nurses, psychiatrists, and policemen participated in the interviews. They have common needs, as well as their own needs. The perspectives from the staff also did complement for needs of the patients. The mental health needs were generalized into four themes, that is, basic needs, information and communication, emotional needs, and social support, each with several subthemes. In addition, there were some external factors that regulated the internal needs, which were summarized in a theoretical framework.
The study indicates the directions on hospital management, mental health services, policy making, and social work to meet the mental health needs of the inpatients and staff from temporary shelter hospitals like Fangcang in Wuhan during the COVID-19 pandemic.
A robotically assisted surgical system, the da Vinci surgical system (DVSS), is a sophisticated surgical platform equipped with immersive 3D visualization and dexterous articulating endoscopic instruments. Surgeons can intuitively control the surgical system to perform delicate surgical tasks. Robotic surgery has gained popularity globally ever since its birth and was approved to market by the China Food and Drug Administration in 2006. This study aims to map the current use of DVSSs in mainland China and the trends from 2009 to 2019.
A full-sample survey of all hospitals equipped with DVSSs was conducted in mainland China, collecting data on hospitals and surgical departments using DVSSs, operation volume, and time of installation. Disease classification was standardized to obtain DVSS use in each department. EXCEL software was used for logging and cleaning the data. The analysis focused on descriptive analysis to map trends of DVSS use in China and present geographical and department distribution.
The DVSSs installed have grown from seven in 2009 to 135 in 2019. By the end of 2019, twenty-eight provinces in China have been equipped with the DVSSs, among which eighty-seven in the eastern regions, twenty-seven in the central regions, and twenty-one in the western regions. The annual volume of operations grew from 339 in 2009 to 38,991 in 2019, at an annual rate of 60.7 percent. The average workload conducted by a single robot is much higher than that of their counterparts in other countries. The largest share of the volume is in department of urology (48%), followed by general surgery (25%) and thoracic surgery (13%).
The use of DVSSs in China has been growing rapidly and extensively, with certain differences between geographical regions and surgical departments. We need to further explore the factors affecting its use and operation efficiency and to evaluate the effectiveness as well as cost-effectiveness in real-world clinical practice to inform public policies on application of DVSS, for example, license and insurance.
There is growing interest globally in using real-world data (RWD) and real-world evidence (RWE) for health technology assessment (HTA). Optimal collection, analysis, and use of RWD/RWE to inform HTA requires a conceptual framework to standardize processes and ensure consistency. However, such framework is currently lacking in Asia, a region that is likely to benefit from RWD/RWE for at least two reasons. First, there is often limited Asian representation in clinical trials unless specifically conducted in Asian populations, and RWD may help to fill the evidence gap. Second, in a few Asian health systems, reimbursement decisions are not made at market entry; thus, allowing RWD/RWE to be collected to give more certainty about the effectiveness of technologies in the local setting and inform their appropriate use. Furthermore, an alignment of RWD/RWE policies across Asia would equip decision makers with context-relevant evidence, and improve timely patient access to new technologies. Using data collected from eleven health systems in Asia, this paper provides a review of the current landscape of RWD/RWE in Asia to inform HTA and explores a way forward to align policies within the region. This paper concludes with a proposal to establish an international collaboration among academics and HTA agencies in the region: the REAL World Data In ASia for HEalth Technology Assessment in Reimbursement (REALISE) working group, which seeks to develop a non-binding guidance document on the use of RWD/RWE to inform HTA for decision making in Asia.
Freshwater habitats in China are potentially suitable for invasive alien turtle species and, consequently, raising turtles in aquaculture facilities and the trade in turtles this supplies pose risks to habitats and native wetland communities when exotic turtles escape or are released deliberately. Online trade (e-commerce) is making an increasing contribution to turtle sales in China, seemingly driving demand and thus potentially exacerbating the risk of release. We document the scale and spatial pattern of online sales of non-native turtles over 90 days on China's Taobao.com e-commerce site. The majority of sales were in the ecologically sensitive middle and lower Yangtze river basin (82.35% of > 840,000 slider turtles Trachemys scripta elegans, and 68.26% of > 100,000 snapping turtles, Chelydridae spp.). These species are native to the Americas. Concurrently, over 2008–2018, we found 104 mentions of feral turtle issues listed on Baidu News where, among the 53 prefectures mentioned, issues with invasive turtle populations also focused predominantly in the middle and lower Yangtze river basin. Although circumstantial, this association suggests that the substantial online sale of alien turtles could be having detrimental effects in China's Yangtze river basin. It is important to safeguard these wetland habitats, which are of global importance, by improving policies for detecting and regulating invasive alien turtle issues and by warning consumers about the ecological hazard of their purchases.
Maintenance haemodialysis (MHD) is the use of a machine to filter wastes, salts and fluid from blood for at least 3 months to prolong the life of patients with advanced kidney failure. Although low dietary energy intake (DEI) has been observed in MHD patients, few studies have related DEI to the risk of mortality. To explore this relationship, a study included 1039 MHD patients from eight centres was conducted. DEI was assessed by three 24-h diet recalls and was normalised to ideal body weight (IBW). All-cause mortality and CVD mortality were the primary and secondary outcomes, respectively. During a median follow-up of 28 months, a U-shaped relationship was observed between DEI and all-cause or CVD mortality. The risk of all-cause mortality decreased significantly with the increase of DEI in participants with DEI <167·4 kJ/kg IBW per d (hazard ratio (HR) 0·98; 95 % CI 0·96, 1·00) and increased significantly with the increase of DEI in those with DEI ≥167·4 kJ/kg IBW per d (HR 1·12; 95 % CI 1·04, 1·20). Similarly, the risk of CVD mortality decreased with the increase of DEI in participants with DEI <152·7 kJ/kg IBW per d (HR 0·96; 95 % CI 0·93, 0·99) and increased with the increase of DEI in participants with DEI ≥152·7 kJ/kg IBW per d (HR 1·11; 95 % CI 1·04, 1·18). In summary, there was a U-shaped association between DEI and all-cause or CVD mortality, with a turning point at about 167·4 and 152·7 kJ/kg IBW per d, respectively, in MHD patients.
The microbiota–gut–brain axis, especially the microbial tryptophan (Trp) biosynthesis and metabolism pathway (MiTBamp), may play a critical role in the pathogenesis of major depressive disorder (MDD). However, studies on the MiTBamp in MDD are lacking. The aim of the present study was to analyze the gut microbiota composition and the MiTBamp in MDD patients.
We performed shotgun metagenomic sequencing of stool samples from 26 MDD patients and 29 healthy controls (HCs). In addition to the microbiota community and the MiTBamp analyses, we also built a classification based on the Random Forests (RF) and Boruta algorithm to identify the gut microbiota as biomarkers for MDD.
The Bacteroidetes abundance was strongly reduced whereas that of Actinobacteria was significantly increased in the MDD patients compared with the abundance in the HCs. Most noteworthy, the MDD patients had increased levels of Bifidobacterium, which is commonly used as a probiotic. Four Kyoto Encyclopedia of Genes and Genomes (KEGG) orthologies (KOs) (K01817, K11358, K01626, K01667) abundances in the MiTBamp were significantly lower in the MDD group. Furthermore, we found a negative correlation between the K01626 abundance and the HAMD scores in the MDD group. Finally, RF classification at the genus level can achieve an area under the receiver operating characteristic curve of 0.890.
The present findings enabled a better understanding of the changes in gut microbiota and the related Trp pathway in MDD. Alterations of the gut microbiota may have the potential as biomarkers for distinguishing MDD patients form HCs.
The regeneration of human tissues with complex anatomy such as gastrointestinal (GI) tract remains greatly challenging since it requires appropriate cell microenvironments with well-defined structural and biochemical cues. In this investigation, bilayer scaffolds consisting of different polymer nanofibers with orthogonal fiber orientations were prepared, in which vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) were encapsulated separately. The bilayer scaffolds have similar architecture to the anatomy of the GI tract and can achieve dual releases of VEGF and PDGF in sequential and sustained manners, which hold promise as appropriate cell microenvironments for promoting the regeneration of the GI tract.
There is growing evidence that suggests the association of vitamin D status with the development and progression of heart failure (HF). The objective of the present study is to assess the impact of concentration of serum 25-hydroxyvitamin D (25(OH)D) on cardiac prognosis in patients with HF. Between 1 January 2015 and 31 December 2016, we consecutively recruited patients with HF. Patients were followed prospectively for a median duration of 1 year. Serum concentration of 25(OH)D was measured with competitive chemiluminescent immunoassay. The endpoints were cardiac events, including CVD death and rehospitalisation for worsening HF. Univariate and multivariable adjustments were performed with Cox proportional-hazard regression analyses. The 25(OH)D concentration was obtained in 343 patients with a median value of 17·4 (interquartile range 12·6–23·4) ng/ml. There were 102 cardiac events, including forty-three deaths and fifty-nine rehospitalisations. Multivariate Cox hazard analysis found that the serum concentration 25(OH)D was independently associated with cardiac events (hazard ratio 0·93, 95 % CI 0·88, 0·97) and CVD mortality (hazard ratio 0·83; 95 % CI 0·77, 0·89) after adjustment for confounding factors. We divided the HF patients into four groups according to the 25(OH)D quartiles. Kaplan–Meier analysis found that the patients with lower serum 25(OH)D concentration had a higher risk of cardiac events or CVD mortality than those with high serum 25(OH)D concentration (log-rank test P < 0·001 and P = 0·032). Decreased serum concentrations of 25(OH)D were associated with cardiac prognosis and CVD mortality in a Chinese population with HF independent of other baseline HF markers.
Biochar conversion from corn stover was evaluated under various process conditions, and the absorption capacity of biochar was investigated for the removal of oxytetracycline in wastewater. Biochar was prepared at lower carbonization temperatures (200–500 °C) and was used in three different concentrations of chemical oxygen wastewater. The results showed that the biochar prepared at the temperature range of 200–500 °C had a faster sorption rate and shorter sorption equilibrium time compared to biochar produced at higher temperatures. The longest time to reach sorption equilibrium was 9 h for biochar obtained at 200 °C. However, the biochar prepared at 500 °C required only 0.5 h to reach the sorption equilibrium. The corn stover-biochar had the highest sorption capacity of 246.3 mg/g for oxytetracycline at 30 °C. The adsorption kinetics was consistent with pseudo–second-order kinetics. This study provides a theoretical basis for the conversion of corn stover into biochar as efficient sorbents.
Existing data on folate status and hepatocellular carcinoma (HCC) prognosis are scarce. We prospectively examined whether serum folate concentrations at diagnosis were associated with liver cancer-specific survival (LCSS) and overall survival (OS) among 982 patients with newly diagnosed, previously untreated HCC, who were enrolled in the Guangdong Liver Cancer Cohort (GLCC) study between September 2013 and February 2017. Serum folate concentrations were measured using chemiluminescent microparticle immunoassay. Cox proportional hazards models were performed to estimate hazard ratios (HR) and 95 % CI by sex-specific quartile of serum folate. Compared with patients in the third quartile of serum folate, patients in the lowest quartile had significantly inferior LCSS (HR = 1·48; 95 % CI 1·05, 2·09) and OS (HR = 1·43; 95 % CI 1·03, 1·99) after adjustment for non-clinical and clinical prognostic factors. The associations were not significantly modified by sex, age at diagnosis, alcohol drinking status and Barcelona Clinic Liver Cancer (BCLC) stage. However, there were statistically significant interactions on both multiplicative and additive scale between serum folate and C-reactive protein (CRP) levels or smoking status and the associations of lower serum folate with worse LCSS and OS were only evident among patients with CRP > 3·0 mg/l or current smokers. An inverse association with LCSS were also observed among patients with liver damage score ≥3. These results suggest that lower serum folate concentrations at diagnosis are independently associated with worse HCC survival, most prominently among patients with systemic inflammation and current smokers. A future trial of folate supplementation seems to be promising in HCC patients with lower folate status.
Multifunctional scaffolds with dual release of small molecular drugs and biomacromolecules have potential in many applications such as cancer postoperative care, which require appropriate administration of anticancer drugs and biomacromolecules in a spatiotemporal manner. Herein, a systematic investigation into the dual release of anticancer drugs and biomacromolecules from the bicomponent nanofibrous scaffolds is performed. Their release behavior is affected by different fabrication techniques and different polymers used. We show that the bicomponent scaffold fabricated by dual-source dual-power emulsion electrospinning enables dual release of anticancer drugs and biomacromolecules in a controlled manner, holding promise for combinational cancer postoperative care.
Carbon nanotubes (CNTs) were added to carbon nanofibers (CNFs) as additives to improve their electrochemical properties. In the present work, CNFs were prepared by using pressurized gyration with polyacrylonitrile as the precursor. The microstructure and electrochemical properties of samples were investigated by scanning electron microscopy and electrochemical workstation, respectively. The results showed that the network structure formed in the fiber, and the fiber diameter decreased with the increase of working pressure. The integral area of cyclic voltammetry curve reached the maximum and the charge/discharge time of constant current charge/discharge curve reached the longest in the case of the CNT concentration is 0.50 wt% and working pressure is 0.2 MPa. At the same time, it exhibited the best electrochemical performance with a specific capacitance of 79 F/g at a current density of 100 mA/g. Compared with the specific capacitance of pure CNFs, the specific capacitance of CNFs with the concentration of CNTs 0.50 wt% increased by about 40%.
The hydrogen embrittlement of 12Cr2Mo1R(H) steel at different strain rates were investigated after hydrogen precharging for 4 h in a 0.5 M H2SO4 solution with 2 g/L ammonium thiocyanate. Results showed that the embrittlement index increased and gradually reached a relative stable value of about 20% at the strain rate of 5 × 10−5 s−1 with the decrease of strain rates. SEM images depicted small and deep flakes at high strain rates, while flakes grew larger at slow strain rates. Most hydrogen-induced cracks (HICs) were transgranular fracture through lath grain of bainitic ferrite. High strain field surrounds the crack tips, which makes the crack tips of two close and parallel cracks deflect toward each another and even form crack coalescence. The electron backscatter diffraction technique was used to investigate the effects of grain boundaries, recrystallization fraction, kernel average misorientation map, texture component, and coincidence site lattice boundaries on the HIC propagation. High densities of dislocations and strain concentrations were found around the cracks, where grains are highly sensitive to HIC.
Flower-like AgI/Bi5O7I hybrid photocatalysts were fabricated via a hydrothermal method and the subsequent heating process with AgI/Bi4O5I2 as the intermediate. X-ray powder diffraction, Raman, X-ray photoelectron spectroscopy, diffuse reflectance spectra, scanning electron microscopy, transmission electron microscopy, photoluminescence, and electrochemical methods were used to reveal the structure, elemental content, morphology, and charge separation capabilities of the as-prepared samples. The photocatalytic test showed that the AgI/Bi5O7I composites own much higher photoactivity than pure AgI and Bi5O7I. Based on the result of XPS analysis, the composite is believed to be the Ag/AgI/Bi5O7I system. Due to the suitable band potentials of AgI and Bi5O7I, the ternary system can form a heterojunction structure which works in a Z-scheme mechanism with Ag nanoparticles as the transfer media. The guided charge transfer in the composite prolongs the life time of charge carriers and eventually leads to the high photocatalytic activity of AgI/Bi5O7I. Additionally, the flower-like structure of the composite also contributes to the photocatalytic reaction.