Case report: emapalumab treatment for a pediatric Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) patient with cytokine storm enabling allogeneic hematopoietic cell transplantation.

Background: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome characterized by excessive immune activation and inflammatory response. Conventional immunotherapy and molecular targeted drugs demonstrate varying efficacy. Cytokine storm, the primary pathogenic mechanism of HLH, is driven by interferon-gamma (IFN-γ), interleukin (IL)-2, IL-18, etc., in which IFN-γ plays a critical role in the development of the disease. Emapalumab, a potent IFN-γ inhibitor, effectively reduces the occurrence of cytokine storms in refractory and relapsed HLH. Case Description: A pediatric patient, 5 years old, female, with relapsed and refractory Epstein-Barr virus-associated HLH (EBV-HLH) showed no response to conventional chemotherapy or molecular-targeted drug treatment. However, after treatment with emapalumab, the patient achieved hematological remission. Subsequently, the patient underwent allogeneic hematopoietic cell transplantation (allo-HCT) and remains without HLH to date. Conclusions: To the best of our knowledge, this is the first case report using emapalumab to control EBV-HLH before HCT in mainland China. This case highlights the potential efficacy of emapalumab for treating relapsed and refractory EBV-HLH and providing a stable physical status for HCT. Further research is necessary to confirm the efficacy and safety of emapalumab in this setting.

Initiating PeriCBD to probe perinatal influences on neurodevelopment during 3-10 years in China.

Adverse perinatal factors can interfere with the normal development of the brain, potentially resulting in long-term effects on the comprehensive development of children. Presently, the understanding of cognitive and neurodevelopmental processes under conditions of adverse perinatal factors is substantially limited. There is a critical need for an open resource that integrates various perinatal factors with the development of the brain and mental health to facilitate a deeper understanding of these developmental trajectories. In this Data Descriptor, we introduce a multicenter database containing information on perinatal factors that can potentially influence children's brain-mind development, namely, periCBD, that combines neuroimaging and behavioural phenotypes with perinatal factors at county/region/central district hospitals. PeriCBD was designed to establish a platform for the investigation of individual differences in brain-mind development associated with perinatal factors among children aged 3-10 years. Ultimately, our goal is to help understand how different adverse perinatal factors specifically impact cognitive development and neurodevelopment. Herein, we provide a systematic overview of the data acquisition/cleaning/quality control/sharing, processes of periCBD.

Lower-Temperature Nucleation and Growth of Colloidal CdTe Quantum Dots Enabled by Prenucleation Clusters with Cd-Te Bond Conservation.

The reason why heating is required remains elusive for the traditional synthesis of colloidal semiconductor quantum dots (QDs) of II-VI metal chalcogenide (ME). Using CdTe as a model system, we show that the formation of Cd-Te covalent bonds with individual Cd- and Te-containing compounds can be decoupled from the nucleation and growth of CdTe QDs. Prepared at an elevated temperature, a prenucleation-stage sample contains clusters that are the precursor compound (PC) of magic-size clusters (MSCs); the Cd-Te bond formation occurs at temperatures higher than 120 °C in the reaction. Afterward, the PC-to-QD transformation appears via monomers at lower temperatures in dispersion. Our findings suggest that the number of Cd-Te bonds broken in the PC reactant is similar to that of Cd-Te bonds formed in the QD product. For the traditional synthesis of ME QDs, heating is responsible for the M-E bond formation rather than for nucleation.

The Impact of Back Optic Zone Design in Orthokeratology on Visual Performance.

Purpose: To evaluate the visual performance in adolescents undergoing orthokeratology (OrthoK) treatment with two different optical zone diameters (OZDs). Methods: This randomized, double-masked, self-controlled prospective study was conducted at Tianjin Eye Hospital (Tianjin, China) in June 2022. Thirty-six eligible schoolchildren were enrolled and fitted with corneal refractive therapy lenses with two sizes of OZDs (5 mm [5OZ] and 6 mm [6OZ]). Each participant was randomized to wear the 5OZ in one eye and the 6OZ in the contralateral eye. Subjective visual quality was assessed using visual acuity, refraction, contrast sensitivity function, and visual symptoms, and the objective optical quality was assessed using ocular higher order aberrations (HOAs) and modulation transfer function (MTF). Results: Thirty-five myopic children completed a 1-month follow-up visit. The 5OZ lens induced significantly smaller treatment zone diameters than the 6OZ lens (P < 0.001). Subjective visual quality did not differ significantly between the two groups. Compared to baseline, aberrations of Z40, coma-like, spherical-like, and total HOAs in both groups increased significantly (P < 0.05). For the 3-mm pupils, spherical aberration in the 5OZ group was significantly higher than that in the 6OZ group (P < 0.05). The MTF value of the 6OZ group was significantly higher than that of 5OZ group for 0.3 and 1.5 cycles per degree for the 3-mm pupils (P = 0.006 and P = 0.026, respectively). However, HOAs or MTF did not differ significantly between the two groups for the 5-mm pupils. Conclusions: The difference induced by varying OZD was significant only in the smaller pupil condition. The selection of OZD in OrthoK designs in real-world patient management should be done while considering individual pupil size. Translational Relevance: This study revealed that the objective visual quality of small OZD lenses was only slightly affected for the small pupil size.

Analysis of Factors Influencing the Stigma Associated with Postoperative Cervical Cancer Patients and the Impact of Integrated Nursing Interventions on Stigma.

Objective: To investigate the influencing factors related to stigma and nursing interventions for patients after cervical cancer surgery. Methods: The clinical data of 158 patients with cervical cancer treated with radical cervical cancer in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from November 2016 to December 2021 were retrospectively analyzed. The patients were divided into a research group (79 cases) and a control group (79 cases) based on the random number method. In the control group, patients were given general nursing instructions during the post-operative visit. In contrast, the research group provided comprehensive nursing interventions to patients and their families based on the observation group. The Social Impact Scale (SIS) was used to assess the patients' stigma; the Self-Rating Anxiety Scale (SAS), Trait Coping Style Questionnaire (TCSQ), and Quality of Life Questionnaire for Cancer Patients (QLQ-C30) were also used to assess the patients' pre- and post-care interventions. The patients' status was assessed before and after the intervention. Results: The SIS score (49.68±8.41) and TCSQ negative coping score (30.14±7.06) of the patients in the research group after the nursing intervention were much smaller than those in the control group, and the TCSQ positive coping score (40.36±6.51) was much larger than that of the control group (P < .05). The SAS anxiety score (31.65±7.36) was much smaller, and the QLQ-C30 score (78.65±16.59) was much larger in the research group than in the control group after the nursing intervention (P < .05). Conclusion: Risk factors affecting postoperative cervical cancer patients' sense of stigma include age 18-35 years, high school and above, employed, monthly income >3000 RMB, family history of the disease, disease duration >5 years, and postoperative chemotherapy, etc. Comprehensive clinical interventions can be given to patients with these conditions to reduce the sense of stigma.

Pathway of Room-Temperature Formation of CdSeS Magic-Size Clusters from Mixtures of CdSe and CdS Samples.

The synthetic application of prenucleation-stage samples of colloidal semiconductor quantum dots (QDs) is in its infancy. It is shown that when two prenucleation-stage samples of binary CdSe and CdS are mixed, ternary CdSeS magic-size clusters (MSCs) grow at room temperature in dispersion. As the amount of the CdS sample increases, the optical absorption of the CdSeS MSCs blueshifts from ≈380 to ≈360 nm. It is proposed that the cluster in the CdSe sample reacts with the CdS monomer from the CdS sample. The monomer substitution reaction of CdSe by CdS can proceed continuously; thus, CdSeS MSCs with tunable compositions are obtained. The present study provides compelling evidence that clusters formed in the prenucleation stage of QDs. The clusters are precursor compounds (PCs) of MSCs, transforming at room temperature with the thermoneutrality principle of isodesmic reactions. The nucleation and growth of QDs follows a multi-step non-classical instead of one-step classical nucleation model.

Up-bottom assessments of nutrient supply and gaseous pollutant from Chinese wheat straw field management.

To achieve resource efficiency, and carbon neutrality, it is vital to evaluate nutrient supply and gaseous pollutant emissions associated with field management of bio-straw resources. Previous straw yield estimates have typically relied on a constant grain-to-straw yield ratio without accounting for grain yield levels in a given region. Addressing this high-resolution data gap, our study introduces a novel empirical model for quantifying grain-to-straw yield, which has been used to gauge wheat straw field management practices at the city level during 2011-2015. Utilizing both statistical review and GIS-based methods, average nitrogen (N), phosphorus (P), and potassium (K) supplies from straw field management stood at 1510, 1229, and 61700 tons, respectively. Average emissions of PM2.5, SO2, NOx, NH3, CH4, and CO2 due to straw burning were 367, 41, 160, 18, 165, and 70,644 tons, respectively. We also reported uncertainty from Monte Carlo model as the 5th-95th percentiles of estimated nutrient supply and gaseous pollutant. These insights will provide foundational support for the sustainable and environmentally friendly management of wheat straw in China.

Increased circulating cell-free mitochondrial DNA in plasma of first-diagnosed drug-naïve bipolar disorder patients: A case-control and 4-week follow-up study.

BACKGROUND: The study of clinical biological indicators in bipolar disorder (BD) is important. In recent years, basic experiments have associated the pathophysiological mechanism of BD is related to mitochondrial dysfunction, but few clinical studies have confirmed this finding. OBJECT: The present study aimed to evaluate whether plasma circulating cell-free mitochondrial DNA (ccf-mtDNA) levels, which can represent the degree of mitochondrial damage in vivo, are altered in patients with BD in early onset and during treatment compared with controls. METHOD: A total of 75 first-diagnosed drug-naive patients with BD and 60 HCs were recruited and followed up for 1 month. The clinical symptoms were assessed using HAMD, HAMA, and YMRS, and ccf-mtDNA levels were measured by qPCR before and after drug treatment in BD. RESULT: (1) The plasma ccf-mtDNA levels in first-diagnosed drug-naive patients with BD increased compared with those in HCs (p = 0.001). (2) Drug treatment for 1 month can decrease the expression of ccf-mtDNA in BD (p < 0.001). (3) No significant correlation was observed between the changes in ccf-mtDNA levels and the improvement of clinical symptoms in BD after drug treatment. CONCLUSION: The plasma ccf-mtDNA level was increased in BD, and decreased after pharmacological treatment. These outcomes suggested that plasma ccf-mtDNA level is likely to be sensitive to the drug response in BD, and mitochondrial pathway is a potential target for further therapy.

Vaccination with Adenovirus Type 5 Vector-Based COVID-19 Vaccine as the Primary Series in Adults: A Randomized, Double-Blind, Placebo-Controlled Phase 1/2 Clinical Trial.

This randomized, double-blind, placebo-controlled phase 1/2 trial aimed at evaluating the safety and immunogenicity of Ad5-nCoV via aerosolized or intramuscular or intramuscular-aerosolized routes in SARS-CoV-2-negative adults aged over 18 years. In the phase 1 trial, participants were sequentially enrolled into one of five regimen cohorts: Low-Dose (two doses of aerosolized Ad5-nCoV with 0.5 × 1010 viral particles [vps] per dose), Middle-Dose (two doses of aerosolized Ad5-nCoV with 1.0 × 1010 vps per dose), High-Dose (two doses of aerosolized Ad5-nCoV with 2.0 × 1010 vps per dose), Mixed (intramuscular Ad5-nCoV with 5.0 × 1010 vps [first dose] and aerosolized Ad5-nCoV with 2.0 × 1010 vps [second dose]), and Single-Dose (one dose of aerosolized Ad5-nCoV with 1.0 × 1010 vps). Eligible participants in the phase 2 trial were stratified by 18-59 years old or ≥60 years old and then were sequentially enrolled into one of six regimen cohorts: Low-Dose, Middle-Dose, High-Dose, Mixed, Single-Dose, and Intramuscular (one dose of intramuscular Ad5-nCoV with 1.0 × 1010 vps). The intervals between the two doses were 56 days. Participants were randomly allocated in 3:1 (phase 1) and 5:1 (phase 2) ratios to receive either Ad5-nCoV or the placebo in each cohort. This study is registered on ClinicalTrials.gov, NCT04840992. Most adverse reactions that occurred during the solicited period were mild and moderate. One serious adverse event (myelodysplastic syndrome) was considered potentially related to the aerosolized Ad5-nCoV. The GMTs of neutralizing antibodies in the Mixed group were the highest with 57.03 (95% CI: 23.95, 135.80) and 97.37 (95% CI: 74.30, 127.59) in phase 1 and 2 trials, respectively, 28 days after the second dose (p < 0.0001), which showed significantly higher immune responses compared to other regimens with aerosolized or intramuscular Ad5-nCoV alone.

Method comparison and overview of refractive measurements in children: implications for myopia management.

OBJECTIVE: This study investigated the agreement between objective wavefront-based refraction and subjective refraction in myopic children. It also assessed the impact of cyclopentolate and refraction levels on the agreement. METHODS: A total of 84 eyes of myopic children aged 6-13 years were included in the analysis. Non-cycloplegic and cycloplegic objective wavefront-based refraction were determined and cycloplegic subjective refraction was performed for each participant. The data were converted into spherical equivalent, J0 and J45, and Bland-Altman plots were used to analyse the agreement between methods. RESULTS: Linear functions were used to determine the dependency between the central myopic refractive error and the difference between the method of refraction (=bias). The influence of central myopia was not clinically relevant when analysing the agreement between wavefront results with and without cyclopentolate (comparison 1). The bias for wavefront-based minus subjective spherical equivalent refraction (comparison 2) was ≤-0.50 D (95% limits of agreement -0.010 D to -1.00 D) for myopia of -4.55 D and higher when cycloplegia was used (p<0.05). When no cyclopentolate was used for the wavefront-based refraction (comparison 3), the bias of -0.50 D (95% limits of agreement -0.020 D to -0.97 D) was already reached at a myopic error of -2.97 D. Both astigmatic components showed no clinically relevant bias. CONCLUSION: The spherical equivalent, measured without cycloplegic agents, led to more myopic measurements when wavefront-based refraction was used. The observed bias increased with the amount of myopic refractive error for comparisons 2 and 3, which needs to be considered when interpreting wavefront-refraction data. TRIAL REGISTRATION NUMBER: NCT05288335.

One-year efficacy of myopia control by the defocus distributed multipoint lens: a multicentric randomised controlled trial.

AIMS: To report the 1-year results of the efficacy of a defocus distributed multipoint (DDM) lens in controlling myopia progression in a multicentre, randomised controlled trial. METHODS: Overall, 168 children aged 6-13 years were recruited and randomly assigned to wear a DDM lens (n=84) or single-vision (SV) lens (n=84) in three centres. Cycloplegic autorefraction (spherical equivalent refraction (SER)) and axial length (AL) were measured. Linear mixed model analysis was performed to compare between-group SER and AL changes. Logistic regression analysis was used to analyse the between-group difference in rapid myopia progression (SER increase≥0.75 D per year or AL growth≥0.40 mm per year). RESULTS: After 1 year, mean changes in SER were significantly lower in the DDM group (-0.47±0.37 D) than in the SV group (-0.71±0.42 D) (p<0.001). Similarly, mean changes in AL were significantly lower in the DDM group (0.21±0.17 mm) than in the SV group (0.34±0.16 mm) (p<0.001). After adjusting for age, sex, daily wearing time and parental myopia, rapid myopia progression risk was higher in the SV group than in the DDM group (OR=3.51, 95% CI: 1.77 to 6.99), especially for children who wore a lens for >12 hours per day, boys and younger children (6-9 years) with ORs (95% CIs) of 10.82 (3.22 to 36.37), 5.34 (1.93 to 14.78) and 8.73 (2.6 to 29.33), respectively. CONCLUSIONS: After 1 year, DDM lenses effectively retarded myopia progression in children. Longer daily wearing time of DDM lens improved the efficacy of myopia control. Future long-term studies are needed for validation. TRIAL REGISTRATION NUMBER: NCT05340699.

Identification candidate genes for salt resistance through quantitative trait loci-sequencing in Brassica napus L.

Rapeseed (Brassica napus L.) is one of the most important oil crops worldwide. However, its yield is greatly limited by salt stress, one of the primary abiotic stresses. Identification of salt-tolerance genes and breeding salt-tolerant varieties is an effective approach to address this issue. Unfortunately, little is known about the salt-tolerance quantitative trait locus (QTL) and the identification of salt tolerance genes in rapeseed. In this study, high-throughput quantitative trait locus sequencing (QTL-seq) was applied to identifying salt-tolerant major QTLs based on two DNA pools from an F2:3 population of a cross between rapeseed line 2205 (salt tolerant) and 1423 (salt sensitive). A total of twelve major QTLs related to the salt tolerance rating (STR) were detected on chromosomes A03, A08, C02, C03, C04, C06, C07 and C09. To further enhance our understanding, we integrated QTL-seq data with transcriptome analysis of the two parental rapeseed plants subjected to salt stress, through which ten candidate genes for salt tolerance were identified within the major QTLs by gene differential expression, variation and annotated functions analysis. The marker SNP820 linked to salt tolerance was successfully validated and would be useful as a diagnostic marker in marker-assisted breeding. These findings provide valuable insights for future breeding programs aimed at developing rapeseed cultivars resistant to salt stresses.

External Voltage-Induced Restructuring of the Solid-State Electrode/Electrolyte Interface Revealed by X-ray Photoelectron Spectroscopy Depth Profiling Analysis.

Solid/solid interfaces between electrodes and electrolytes play an important role in all-solid-state energy devices, while microscopic investigations of the buried interfaces remain challenging. Here, we construct metal|yttria-stabilized zirconia (YSZ)|Au model cells consisting of a metal film cathode (metal (M) = Au, Ni, and Ag), a single crystalline YSZ electrolyte, and a Au film anode, and use quasi in situ X-ray photoelectron spectroscopy depth profiling analysis to investigate the restructuring of buried interfaces between metal cathodes and YSZ. After applying 2.9 V at 500 °C, interfacial Zr4+ ions in the electrolyte are reduced and then interdiffuse with metal cathode overlayers, forming a miscible ZrM alloy interlayer. The interface restructuring degree follows the sequence of Au|YSZ|Au > Ni|YSZ|Au > Ag|YSZ|Au. Meanwhile, surface segregation of Zr on the cathode surface is also observed, whose degree follows the sequence of Ag|YSZ|Au > Ni|YSZ|Au > Au|YSZ|Au. Notably, the strong ZrM alloy formation enhances the interface restructuring but suppresses the Zr surface segregation. This work provides a fundamental understanding of the interfacial reaction at the buried electrode/electrolyte interface.

Formation and Transformation of CdS Clusters during the Prenucleation Stage and in a Dilute Dispersion at Room Temperature.

The formation and transformation of colloidal semiconductor clusters remain poorly understood. With CdS as a model system, we show that, in the reaction of cadmium myristate (Cd(MA)2) and S powder in 1-octadecene (ODE), clusters form in the prenucleation stage of quantum dots (QDs). Called precursor compounds (PCs), the clusters can transform to magic-size clusters (MSCs) in reaction at a relatively high temperature (MSC-322 displaying optical absorption peaking at 322 nm) or in a dispersion at room temperature (MSC-360). When the reaction temperature is increased, PC-360 forms at 140 °C, while PC-322 and MSC-322 form at 180 °C. In a dispersion of cyclohexane and octylamine, MSC-322 transforms to MSC-360 via MSC-345. The MSC-345 to MSC-360 transformation displays continuous and discontinuous shifts in the optical absorption. The PCs and MSCs are a group of isomers. The present findings bring insight into the cluster formation and isomerization in the prenucleation stage of QDs and in a dispersion.

Osteoporosis and low bone mass among schizophrenia and bipolar disorder: A cross-sectional study with newly diagnosed, drug-naïve subjects.

BACKGROUND: A growing body of data shows that schizophrenia (SCZ) and bipolar disorder (BD) have substantial metabolic risks; however, few studies have focused on bone metabolism. This study aimed to assess the prevalence and associated influencing factors of low bone mass and osteoporosis in SCZ and BD before pharmacological effects occur. METHODS: 108 healthy controls (HCs) and drug-naïve individuals with SCZ (n = 56) and BD (n = 130) had their lumbar spine (L1-L4) and left femur (Neck/Trochanter/Ward's triangle) bone mineral density (BMD) determined using dual-energy X-ray absorptiometry. Besides, we measured bone turnover markers (BTMs) levels, including procollagen I N-terminal propeptide, osteocalcin, and C-terminal cross-linking telopeptide of type I collagen in different groups. RESULTS: Individuals with SCZ and BD had significantly lower BMD and significantly higher prevalence of low bone mass and osteoporosis compared with HCs. In the main observation regions of the total lumbar (F = 18.368, p < 0.001) and left femur (F = 14.790, p < 0.001), BMD was lower in individuals with SCZ and BD than HCs, with SCZ showing lower BMD than BD. The osteocalcin (H = 11.421, p = 0.003) levels were significantly higher in SCZ and BD than HCs. Binary regression analysis showed that SCZ or BD was an independent risk factor for low bone mass and osteoporosis. In addition, sex, age, and BTMs also influenced the occurrence of low bone mass and osteoporosis. LIMITATIONS: Cross-sectional study. CONCLUSION: The results findings of the study might contribute to our understanding of the increased risk of bone metabolism in SCZ and BD. CLINICAL TRIAL REGISTRATION: www.chictr.org.cn, identifier ChiCTR1900021379.

A chain mediation model of inclusive leadership and voice behavior among university teachers: evidence from China.

As a vital mode in which teachers can participate in university management, voice behavior is an important way of enhancing the efficiency of organizational decision-making, promoting democratic management, and facilitating sustainable development in universities. Although previous studies have confirmed the positive impact of inclusive leadership on employees' voice behavior, the mechanism underlying this effect remains unclear. Therefore, based on the cognitive-affective system theory of personality, this study aims to examine the mediating effects of psychological empowerment and organizational identification on the relationship between inclusive leadership and voice behavior among university teachers. A total of 517 valid questionnaires were administered to university teachers in mainland China using a convenience sampling approach. Structural equation modeling and bootstrap testing were used to analyze the data, and the results reveal that inclusive leadership is positively related to teachers' promotive and prohibitive voice behavior. This relationship is mediated by psychological empowerment and organizational identification, in which context a partial mediating effect is observed in the relationship between inclusive leadership and promotive voice and a full mediating effect is observed in the relationship between inclusive leadership and prohibitive voice. These findings can enrich the extant research on the impact of inclusive leadership in the field of higher education to a certain extent. Moreover, they provide a new perspective that can support an in-depth analysis of the mechanism underlying the effect of inclusive leadership and generate valuable practical insights into ways of stimulating voice behavior among university teachers.

Targeting P21-activated kinase suppresses proliferation and enhances chemosensitivity in T-cell lymphoblastic lymphoma.

T-cell lymphoblastic lymphoma (T-LBL) is a highly aggressive non-Hodgkin lymphoma with a poor prognosis. P21-activated kinase (PAK) is a component of the gene expression-based classifier that can predict the prognosis of T-LBL. However, the role of PAK in T-LBL progression and survival remains poorly understood. Herein, we found that the expression of PAK1 was significantly higher in T-LBL cell lines (Jurkat, SUP-T1, and CCRF-CEM) compared to the human T-lymphoid cell line. Moreover, PAK2 mRNA level of 32 relapsed T-LBL patients was significantly higher than that of 37 cases without relapse (P = .012). T-LBL patients with high PAK1 and PAK2 expression had significantly shorter median RFS than those with low PAK1 and PAK2 expression (PAK1, P = .028; PAK2, P = .027; PAK1/2, P = .032). PAK inhibitors, PF3758309 (PF) and FRAX597, could suppress the proliferation of T-LBL cells by blocking the G1/S cell cycle phase transition. Besides, PF could enhance the chemosensitivity to doxorubicin in vitro and in vivo. Mechanistically, through western blotting and RNA sequencing, we identified that PF could inhibit the phosphorylation of PAK1/2 and downregulate the expression of cyclin D1, NF-κB and cell adhesion signaling pathways in T-LBL cell lines. These findings suggest that PAK might be associated with T-LBL recurrence and further found that PAK inhibitors could suppress proliferation and enhance chemosensitivity of T-LBL cells treated with doxorubicin. Collectively, our present study underscores the potential therapeutic effect of inhibiting PAK in T-LBL therapy.

Efficacy of Acupuncture for Chronic Spontaneous Urticaria : A Randomized Controlled Trial.

BACKGROUND: The effectiveness of acupuncture for patients with chronic spontaneous urticaria (CSU), reported in a few small-scale studies, is not convincing. OBJECTIVE: To investigate whether acupuncture leads to better effects on CSU than sham acupuncture or waitlist control. DESIGN: A multicenter, randomized, sham-controlled trial. (Chinese Clinical Trial Registry: ChiCTR1900022994). SETTING: Three teaching hospitals in China from 27 May 2019 to 30 July 2022. PARTICIPANTS: 330 participants diagnosed with CSU. INTERVENTION: Participants were randomly assigned in a 1:1:1 ratio to receive acupuncture, sham acupuncture, or waitlist control over an 8-week study period (4 weeks for treatment and another 4 weeks for follow-up). MEASUREMENTS: The primary outcome was the mean change from baseline in the Weekly Urticaria Activity Score (UAS7) at week 4. Secondary outcomes included itch severity scores, self-rated improvement, and Dermatology Life Quality Index scores. RESULTS: The mean change in UAS7 (range, 0 to 42) for acupuncture from baseline (mean score, 23.5 [95% CI, 21.8 to 25.2]) to week 4 (mean score, 15.3 [CI, 13.6 to 16.9]) was -8.2 (CI, -9.9 to -6.6). The mean changes in UAS7 for sham acupuncture and waitlist control from baseline (mean scores, 21.9 [CI, 20.2 to 23.6] and 22.1 [CI, 20.4 to 23.8], respectively) to week 4 (mean scores, 17.8 [CI, 16.1 to 19.5] and 20.0 [CI, 18.3 to 21.6], respectively) were -4.1 (CI, -5.8 to -2.4) and -2.2 (CI, -3.8 to -0.5), respectively. The mean differences between acupuncture and sham acupuncture and waitlist control were -4.1 (CI, -6.5 to -1.8) and -6.1 (CI, -8.4 to -3.7), respectively, which did not meet the threshold for minimal clinically important difference. Fifteen participants (13.6%) in the acupuncture group and none in the other groups reported adverse events. Adverse events were mild or transient. LIMITATION: Lack of complete blinding, self-reported outcomes, limited generalizability because antihistamine use was disallowed, and short follow-up period. CONCLUSION: Compared with sham acupuncture and waitlist control, acupuncture produced a greater improvement in UAS7, although the difference from control was not clinically significant. Increased adverse events were mild or transient. PRIMARY FUNDING SOURCE: The National Key R&D Program of China and the Science and Technology Department of Sichuan Province.

Global evaluation of key factors influencing nitrogen fertilization efficiency in wheat: a recent meta-analysis (2000-2022).

Improving nitrogen use efficiency (NUE) without compromising yield remains a crucial agroecological challenge in theory and practice. Some meta-analyses conducted in recent years investigated the impact of nitrogen (N) fertilizer on crop yield and gaseous emissions, but most are region-specific and focused on N sources and application methods. However, various factors affecting yield and N fertilizer efficiency in wheat crops on a global scale are not extensively studied, thus highlighting the need for a comprehensive meta-analysis. Using 109 peer-reviewed research studies (published between 2000 and 2022) from 156 experimental sites (covering 36.8, 38.6 and 24.6% of coarse, medium, and fine texture soils, respectively), we conducted a global meta-analysis to elucidate suitable N management practices and the key factors influencing N fertilization efficiency in wheat as a function of yield and recovery efficiency and also explained future perspectives for efficient N management in wheat crop. Overall, N fertilization had a significant impact on wheat yield. A curvilinear relationship was found between N rates and grain yield, whereas maximum yield improvement was illustrated at 150-300 kg N ha-1. In addition, N increased yield by 92.18% under direct soil incorporation, 87.55% under combined chemical and organic fertilizers application, and 72.86% under split application. Site-specific covariates (climatic conditions and soil properties) had a pronounced impact on N fertilization efficiency. A significantly higher yield response was observed in regions with MAP > 800 mm, and where MAT remained < 15 °C. Additionally, the highest yield response was observed with initial AN, AP and AK concentrations at < 20, < 10 and 100-150 mg kg-1, respectively, and yield response considerably declined with increasing these threshold values. Nevertheless, regression analysis revealed a declining trend in N recovery efficiency (REN) and the addition of N in already fertile soils may affect plant uptake and RE. Global REN in wheat remained at 49.78% and followed a negative trend with the further increase of N supply and improvement in soil properties. Finally, an advanced N management approach such as "root zone targeted fertilization" is suggested to reduce fertilizer application rate and save time and labor costs while achieving high yield and NUE.