Relationship between circadian rhythm-related genes and extracellular matrix: implications for sleep deprivation.

BACKGROUND: Sleep deprivation (SD) can lead to the development of various pathological disorders. The extracellular matrix (ECM) compositions and circadian rhythm genes are two pivotal variables of SD. However, their relationships remain undefined during SD. METHODS: A mouse SD model was established using a modified multiplatform water environment method. The expression of nerve growth factor (NGF) in mouse hippocampus was detected by an immunofluorescence (IF) method. Protein expression was assessed by western blot, and mRNA analysis was performed by quantitative real-time PCR (qRT-PCR). The differentially expressed genes after SD, the genes associated with stromal score, and gene expression correlation were analyzed by bioinformatic analysis. RESULTS: The mouse model of SD was successfully established, as evidenced by the changed morphology, increased Bax and NGF levels, and downregulated Bcl-2 in mouse hippocampus after SD. The differentially expressed genes after SD were closely associated with the ECM compositions. The ECM composition metalloproteinase 9 (MMP9) was under-expressed in mouse hippocampus after SD. The hippocampal MMP9 expression was correlated with the expression levels of circadian genes PER2, PER3, TIMELESS, FBXL3, and NFIL3. PER2 and TIMELESS were upregulated in mouse hippocampus after SD. CONCLUSION: The current findings suggest a correlation between ECM composition MMP9 and circadian rhythm-related genes PER2 and TIMELESS in mouse hippocampus after SD, providing a novel understanding of the disorders after SD.

The effect of intrapartum prolonged oxygen exposure on fetal metabolic status: secondary analysis from a randomized controlled trial.

Objective: The aim of the study is to assess the effect of maternal prolonged oxygen exposure during labor on fetal acid-base status, fetal heart rate tracings, and umbilical cord arterial metabolites. Design: The study was conducted as a secondary analysis. Settings: The study was set in three tertiary teaching hospitals in Beijing, China. Participants: Approximately 140 women in the latent phase of labor with no complications participated in the study. Intervention: Participants were randomly allocated in a 1:1 ratio to receive either 10 L of oxygen per minute in a tight-fitting simple facemask until delivery or room air only. Main outcome measures: The primary outcome was the umbilical cord arterial lactate. Results: Baseline demographics and labor outcomes were similar between the oxygen and room air groups; the time from randomization to delivery was 322 ± 147 min. There were no differences between the two groups in the umbilical cord arterial lactate (mean difference 0.3 mmol/L, 95% confidence interval -0.2 to 0.9), the number of participants with high-risk category II fetal heart rate tracings (relative risk 0.94, 95% confidence interval 0.68 to 1.32), or the duration of those high-risk tracings (mean difference 3.6 min, 95% confidence interval -9.3 to 16.4). Prolonged oxygen exposure significantly altered 91 umbilical cord arterial metabolites, and these alterations did not appear to be related to oxidative stress. Conclusion: Maternal prolonged oxygen exposure during labor did not affect either the umbilical cord arterial lactate or high-risk category II fetal heart rate tracings but might result in alterations to the umbilical cord arterial metabolic profile. Clinical trial registration: www.clinicaltrials.gov, identifier NCT03764696.

Carbon dot decorated Co3O4 nanozymes responsive to the NIR-II window for mild photothermal-enhanced nanocatalytic therapy.

Although NIR-II laser-mediated photothermal therapy (PTT) is considered as an emerging strategy for tumor therapy, its therapeutic effects are still seriously hampered by low photothermal conversion efficacy, limited tissue penetration depth, and inevitable damage to adjoining healthy tissues. Herein, we report a mild second-near-infrared (NIR-II) photothermal-augmented nanocatalytic therapy (NCT) nanoplatform based on CD@Co3O4 heterojunctions by depositing NIR-II-responsive carbon dots (CDs) onto the surface of Co3O4 nanozymes. The as-prepared Co3O4 nanozymes possess multi-enzyme-mimicking catalytic activity including peroxidase, catalase, and glutathione-peroxidase to realize the cascade amplification of ROS levels owing to the presence of multivalent Co2+ and Co3+. CDs with a high NIR-II photothermal conversion efficiency (PCE) (51.1%) enable the realization of mild PTT (∼43 °C), which could not only avoid damage to adjoining healthy tissues but also enhance the multi-enzyme-mimic catalytic activity of Co3O4 nanozymes. More importantly, the NIR-II photothermal properties of CDs and the multi-enzyme-mimicking catalytic activity of Co3O4 nanozymes are greatly augmented by the fabrication of heterojunctions due to the induced localized surface plasmonic resonance (LSPR) and accelerated carrier transfer. On the basis of these advantages, satisfactory mild PTT-amplified NCT is accomplished. Our work presents a promising approach for mild NIR-II photothermal-amplified NCT based on semiconductor heterojunctions.

Adsorption properties of cellulose/guar gum/biochar composite hydrogel for Cu2+, Co2+ and methylene blue.

Herein, Typha angustifolia was used as a charcoal source and chemically modified with a strong oxidizing agent, potassium permanganate (KMnO4), to obtain modified Typha angustifolia (MTC). Then, the green, stable and efficient CMC/GG/MTC composite hydrogel was successfully prepared by compounding MTC with carboxymethyl cellulose (CMC) and guar gum (GG) by free radical polymerization. Various variables that influence adsorption performance were explored, and optimal adsorption conditions were determined. The maximum adsorption capacity calculated from the Langmuir isotherm model was 805.45, 772.52, and 598.28 mg g-1 for Cu2+, Co2+, and methylene blue (MB), respectively. The XPS results revealed that the main mechanism of removing pollutants by adsorbent is surface complexation and electrostatic attraction. After five adsorption-desorption cycles, the CMC/GG/MTC adsorbent still exhibited good adsorption and regeneration capacity. This study provides a low-cost, effective and simple method for preparation of hydrogels from modified biochar, which has excellent application potential in the removal of heavy metal ions and organic cationic dye contaminants from wastewater.

Food-water-land-ecosystem nexus in typical Chinese dryland under different future scenarios.

Healthy coupling of the food-water-land-ecosystem (FWLE) nexus is the basis for achieving sustainable development (SD), and FWLE in drylands is frontier scientific issues in the study of coupled human land systems. To comprehensively safeguard the future food, water, and ecological security of drylands, this study examined the implications for FWLE linkages in a typical Chinese dryland from the perspective of future land-use change. First, four different land-use scenarios were proposed using a land-use simulation model with a gray multi-objective algorithm, including an SD scenario. Then, the variation of three ecosystem services was explored: water yield, food production, and habitat quality. Finally, redundancy analysis was used to derive the future drivers of FWLE and explore their causes. The following results were obtained. In the future in Xinjiang, under the business as usual scenario, urbanization will continue, forest area will decrease, and water production will decline by 371 million m3. In contrast, in the SD scenario, this negative impact will be substantially offset, water scarcity will be alleviated, and food production will increase by 1.05 million tons. In terms of drivers, the anthropogenic drivers will moderate the future urbanization of Xinjiang to some extent, with natural drivers dominating the sustainable development scenario by 2030 and a potential 22 % increase in the drivers of precipitation. This study shows how spatial optimization can help protect the sustainability of the FWLE nexus in drylands and simultaneously provides clear policy recommendations for regional development.

Atmospheric dryness thresholds of grassland productivity decline in China.

Atmospheric dryness events are bound to have a broad and profound impact on the functions and structures of grassland ecosystems. Current research has confirmed that atmospheric dryness is a key moisture constraint that inhibits grassland productivity, yet the risk threshold for atmospheric dryness to initiate ecosystem productivity loss has not been explored. Based on this, we used four terrestrial ecosystem models to simulate gross primary productivity (GPP) data, analyzed the role of vapor pressure deficit (VPD) in regulating interannual variability in Chinese grasslands by focusing on the dependence structure of VPD and GPP, and then constructed a bivariate linkage function to calculate the conditional probability of ecosystem GPP loss under atmospheric dryness, and further analyzed the risk threshold of ecosystem GPP loss triggered by atmospheric dryness. The main results are as follows: we found that (1) the observed and modeled VPD of Chinese grasslands increases rapidly in both historical and future periods. VPD has a strongly negative regulation on ecosystem GPP, and atmospheric dryness is an important moisture constraint that causes deficit and even death to ecosystem GPP. (2) The probability of the enhanced atmospheric dryness that induced GPP decline in Chinese grasslands in the future period increases significantly. (3) When the VPD is higher than 40.07 and 27.65 percentile of the past and future time series, respectively, the risk threshold of slight ecosystem GPP loss can be easily initiated by atmospheric dryness. (4) When the VPD is higher than 82.57 and 65.09 percentile, respectively, the threshold of moderate ecosystem GPP loss can be exceeded by the benchmark probability. (5) The risk threshold of severe ecosystem GPP loss is not initiated by atmospheric dryness in the historical period, and the threshold of severe ecosystem GPP loss can be initiated when the future VPD is higher than 91.92 percentile. In total, a slight atmospheric dryness event is required to initiate a slight ecosystem GPP loss threshold, and a stronger atmospheric dryness event is required to initiate a severe ecosystem GPP loss. Our study enhances the understandings of past and future atmospheric dryness on grassland ecosystems, and strongly suggests that more attention be invested in improving next-generation models of vegetation dynamics processes with respect to the response of mechanisms of ecosystem to atmospheric dryness.

Spatiotemporal variability characteristics of extreme climate events in Xinjiang during 1960-2019.

Under the global warming, it is particularly important to explore the response of extreme climate to global climate change over the arid regions. Based on daily temperature (maximum, minimum, and average) and precipitation data from meteorological stations in Xinjiang, China, we analyzed the spatiotemporal characteristics of extreme temperature and extreme precipitation events via combining thin plate smoothing spline function interpolation, Sen's slope, and Mann-Kendall test. Our results showed that during 1960-2019, the extreme low temperature index of frost days (FD), icing days (ID), cold days (TX10p), cold nights (TN10p), and cold speel duration index (CSDI) all showed the downward trend to varying degrees, and the extreme high temperature index of summer days (SD25), warm days (TX90p), warm night (TN90p), and warm speel duration index (WSDI) all showed an upward trend to varying degrees, and the extreme low temperature index of high altitude mountains decreases more than that of the basin and plains. In addition, all the extreme temperature indices are closely related to the annual average temperature in Xinjiang (R > 0.6). Among the extreme precipitation indices, except for the consecutive dry days (CDD), the other extreme precipitation indices showed increasing trends to different degrees, but the changes in extreme precipitation in Xinjiang were mainly manifested by the increase of heavy precipitation in a short period (the increase of heavy precipitation and extreme heavy precipitation was the largest, 44.8 mm/10a and 17.6 mm/10a, respectively) and spatially concentrated in the Ili River and Altai Mountains in northern Xinjiang. Meanwhile, annual precipitation was positively correlated with the extreme precipitation index (R > 0.4), except for the CDD. This study provides theoretical support for the prevention and control of natural disasters in the dry zone.

Ovarian Auto-Transplantation of Cryopreserved Tissue on Muscle Surface Compared With Subrenal Capsular in Rats.

BACKGROUND: Fertility protection and ovarian function preservation are important to those undergoing radiation therapy to fight female reproductive cancers. The aim of this study was to explore a new ovarian transplantation position, the surface of thigh muscle, which was biceps femoris muscle in rats. METHODS: We hypothesized that this procedure was comparable to traditional subrenal capsular transplantation and realized a normal ovarian function. The ovarian tissue, after cryopreservation, were transplanted to surface of biceps femoris muscle by suturing. RESULTS: Histologic examination indicated that the transplanted tissues would survive and support a lower level of follicle growth compared with subrenal capsular (17 ± 2.6 vs 8.9 ± 4; P = .0018). According to weight gaining record, muscle surface transplantation supported appropriate weight gain although the ß-estradiol levels did not completely recover. This new procedure could support a basic normal estrous cycle. CONCLUSION: Ovarian transplantation through this procedure partly rebuilt ovarian function, which was more likely to be an alternative way for those not suitable for subrenal capsular transplantation.

Effect of long-duration oxygen vs room air during labor on umbilical cord venous partial pressure of oxygen: a randomized controlled trial.

BACKGROUND: There are limited data to guide the duration and dose of oxygen supplementation for pregnant women undergoing labor. OBJECTIVE: To assess the effect of maternal long-duration high-concentration oxygen administration during labor on umbilical cord venous partial pressure of oxygen. STUDY DESIGN: This randomized clinical trial was conducted between January and October of 2021 in the obstetrics wards of 3 tertiary teaching hospitals in Beijing, China. Women undergoing the latent phase of labor with no existing medical conditions or obstetrical complications who were admitted for delivery were eligible. The women who met inclusion criteria with category I fetal heart rate tracings in labor were randomized in a 1:1 ratio to oxygen or room air. The oxygen group received 10 L of oxygen per minute by simple, tight-fitting face mask until delivery. The room-air group received room air only, without a face mask. The primary outcome was the umbilical cord venous partial pressure of oxygen. RESULTS: A total of 661 women were screened, and 521 were excluded; 140 participants with category I fetal heart rate tracings were enrolled and randomized to oxygen (N=70) or room air (N=70). A total of 135 women with valid paired umbilical cord venous and arterial gas values were included in the umbilical cord venous partial pressure of oxygen and arterial pH analyses. All 140 women were included in the fetal heart rate tracings analysis. Baseline characteristics were similar between the oxygen and room-air groups. The duration of oxygen exposure was approximately 322±147 minutes. There were no differences between the oxygen and room-air groups in the umbilical cord venous partial pressure of oxygen (mean difference, 1.1 mm Hg; 95% confidence interval, -1.0 to 3.2; P=.318) or the proportion of participants with category II fetal heart rate tracings (81.4% vs 78.6%; relative risk, 1.04; 95% confidence interval, 0.88-1.22; P=.672). However, the umbilical cord arterial pH was significantly lower in the oxygen group than in the room-air group (median, 7.23; interquartile range, 7.20-7.27 vs median 7.27; interquartile range, 7.20-7.30; P=.005). CONCLUSION: Maternal long-duration high-concentration oxygen administration during labor did not affect either the umbilical cord venous partial pressure of oxygen or fetal heart rate pattern distribution but resulted in a deterioration of the umbilical cord arterial pH at birth.

Compression Therapy for the Patients With Breast Cancer: A Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Compression therapy is a common method for treating breast cancer-related lymphedema. However, no specific evidence exists to guide practitioners on the morbidity of lymphedema, limb volume, and range of motion. OBJECTIVE: The aims of this study were to compare the effects of compression therapy and routine nursing during the treatment of breast cancer-related lymphedema and to provide a basis for better clinical decision-making. METHODS: The PubMed, Cochrane Library, EMBASE, Web of Science, CBM, CNKI, Wanfang, and VIP databases were searched through January 21, 2021. Meta-analysis and description of the outcomes were performed by using the RevMan 5.3 software. RESULTS: A total of 17 studies were included. A meta-analysis of 13 studies was conducted. The experimental group had a lower morbidity of lymphedema, the difference was significant, and there was no heterogeneity (P < .05; odds ratio, 0.35, I2 = 31%). There was no significant difference between the experimental group and control group in limb volume, and there was significant heterogeneity (P = .44, mean difference = 4.51, I2 = 85%). Regarding range of motion, the standardized mean difference of shoulder adduction, shoulder lift, shoulder abduction, and shoulder extension were 1.37, 0.69, 0.56, and 0.87, respectively, and the differences were significant; there was heterogeneity (P < .05, I2 = 92%). CONCLUSIONS: Compression therapy can reduce the morbidity of lymphedema and improve limb movement, but the effect on limb volume needs to be further explored. IMPLICATION FOR PRACTICE: In terms of therapeutic effectiveness and limb function, the results provide evidence that physicians can reduce the morbidity of lymphedema, reduce the degree of limb, and increase limb mobility by applying compression therapy.

Measuring the impact of the COVID-19 epidemic on university resumption and suggestions for countermeasures.

Background: During the COVID-19 pandemic, universities around the world had to find a balance between the need to resume classes and prevent the spread of the virus by ensuring the health of students. The purpose of our study was to effectively assess the overall risk of universities reopening during the COVID-19 epidemic. Design and methods: Using the pressure-state-response model, we designed a risk evaluation method from a disaster management perspective. First, we performed a literature review to find the main factors affecting the virus spread. Second, we used the pressure-state-response to represent how the considered hazards acts and interacts before grouping them as disaster and vulnerability factors. Third, we assigned to all factors a risk function ranging from 1 to 4. Fourth, we modeled the risk indexes of disaster and of system vulnerability through simple and appropriate weights and combined them in an overall risk for the university resumption. Finally, we showed how the method works by evaluating the reopening of the Hebei Province University in 2022 and highlighted the resulting advice for reducing related risks. Results: Our model included 20 risk factors, six representing exogenous hazards (disaster factors) that university can only monitor and 14 related to system vulnerability that can also control. Disaster factors included epidemic risk level of students' residence and the school's location, means of transportation back to school, size of the university population, the number of migrants on and off campus and express carrier infection. Vulnerability factors included student behaviors, routine campus activities and all the other actions the university can take to control the virus spread. The university of Baoding city (Hebei Province) showed a disaster risk of 1.880 and a vulnerability of 1.666 which combined provided a low risk of school resumption. Conclusion: Our study judged the risks involved in resuming school and put forward specific countermeasures for reducing the risk levels. This not only protects public health security but also has some practical implications for improving the evaluation and rational decision-making abilities of all parties.

Accuracy of stroke volume variation and pulse pressure variation to predict fluid responsiveness in patients with thoracic kyphosis.

BACKGROUND: This study aims to evaluate the ability of stroke volume variation (SVV) and pulse pressure variation (PPV) to predict fluid responsiveness in mechanically ventilated patients with thoracic kyphosis. METHODS: A total of 35 patients diagnosed with thoracic kyphosis undergoing corrective surgery were studied. For all patients, the Vigileo/FloTrac system was used for analysis. Hemodynamic data such as mean arterial pressure (MAP), heart rate (HR), stroke volume (SV), stroke volume index (SVI), cardiac output (CO), cardiac output index (CI), SVV, and PPV were recorded before and after volume expansion (VE). Fluid responsiveness was defined as an increase in SVI ≥10% (ΔSVI ≥10%). Patients were divided into responders and non-responders as determined by changes in ΔSVI ≥10% and <10%. Nonparametric Wilcoxon rank sum test was used to compare the hemodynamic parameters of Responders and Non-responders before and after VE. Pearson correlation analysis was used to analyze the values of SVV, PPV and ΔSVI. The receiver operating characteristic (ROC) curve of each hemodynamic index was drawn to determine its accuracy and threshold. RESULTS: Two patients were excluded. There was no significant difference in patients' characteristics between Responders and Non-responders. After VE, there were no significant changes in HR, MAP, and SV in both responders and non-responders, but CI were significantly changed in the two groups. SVI and CO increased significantly in responders before and after VE, but not in non-responders. VE also caused decreases of PPV and SVV in both responders and non-responders. Before VE, the SVV and PPV correlated with ΔSVI in responders (r=0.621, r=0.569, respectively, P<0.05), but neither the SVV nor PPV correlated with ΔSVI in non-responders (P>0.05). The areas under the ROC curves of patients with thoracic kyphosis were 0.872 (95% CI: 0.719-1.000) for SVV and 0.833 (95% CI: 0.667-1.000) for PPV. The threshold of the SVV of patients with thoracic kyphosis was 13.5%, and the threshold of PPV was 14.5%. CONCLUSIONS: Both SVV and PPV can be used as effective indictors to monitor volume changes in patients with thoracic kyphosis.

Effect of Physical Activity on the Association Between Dietary Fiber and Constipation:Evidence From the National Health and Nutrition Examination Survey 2005-2010

Background/Aims@#The effect of physical activity on the relationship between dietary fiber intake and constipation has not been comprehensively studied.This study aims to explore the impact of physical activity. @*Methods@#Data were obtained from 3 cycles of the National Health and Nutrition Examination Survey (NHANES) 2005-2010 and included a total of 13 941 participants aged ≥ 20 years. Multiple logistic regression analysis was used to investigate the independent associationbetween dietary fiber and constipation. Interaction analysis was also performed to analyze the relationship between dietary fiber and constipation in different physical activity groups. @*Results@#Among non-active participants, dietary fiber intake did not associate with stool consistency (OR, 1.02; 95% CI, 0.98-1.05; P = 0.407). For physically active participants, 1-gram unit increase in dietary fiber intake reduced the risk of stool consistency by 3% (OR, 0.97; 95% CI, 0.94-0.99; P = 0.020). Moreover, the relationship between dietary fiber intake and stool consistency was significantly different for groups with different levels of physical activity (P interaction = 0.044). However, dietary fiber intake was not related to stool frequency among non-active participants (OR, 0.99; 95% CI, 0.94-1.05; P = 0.767) nor physically active participants (OR, 1.01; 95% CI, 0.97-1.04; P = 0.751). @*Conclusions@#Increasing dietary fiber intake was associated with stool consistency-related constipation among physically active participants, but not among non-active participants. However, increasing dietary fiber intake is not significantly associated with stool frequency in different physical activity groups.

Analysis of risk factors for vasovagal syncope in children / 中国学校卫生

Objective@#To analyze the related factors of the onset of vasovagal syncope (VVS) in children, and to provide basis for the early prevention, early diagnosis and early treatment of VVS.@*Methods@#A total of 126 children with syncope admitted to Department of Pediatric Cardiology, Second Hospital of Lanzhou University from October 2018 to September 2019 were invited in the study. Totally 73 cases of children diagnosed with VVS by HUTT were selected as VVS group, and 53 HUTT negative children were selected as control group. Related factors were retrospectively investigated, and risk factors for VVS were analyzed by univariate and multivariate regression.@*Results@#The VVS group showed statistically significant difference in age distribution with the control group ( χ 2=19.22, P <0.05). The VVS group showed statistically significant differences of proportion in family history, syncope history, prolonged standing, electrocardiogram abnormalities, and vitamin D deficiency (43.84%，31.51%，47.95%，34.25%， 30.14 %) compared with the control group (15.09%，13.21%，20.75%，15.09%，9.43%) ( χ 2=11.71,5.67,9.79,5.83,7.82, P < 0.05 ). Multivariate Logistic regression analysis showed that age and family historywere risk factors for VVS( χ 2=3.13, 11.06, P < 0.05 ).@*Conclusion@#Age and family history may be risk factors for the onset of VVS. Active attention should be paid to the high risk factors of child patient, early identification and diagnosis can prevent the occurrence and development of VVS in children.

Preliminary application and efficacy analysis of transumbilical single-incision plus one port robotic total mesorectal excision / 中华胃肠外科杂志

Objective: To investigate the feasibility of transumbilical single-incision plus one port (SIPOP) robotic total mesorectal excision. Methods: Clinical data of a 70-year-old male patient with BMI 22.1 kg/m(2) who successfully underwent transumbilical single-incision plus 1 port robotic total mesorectal resection of upper rectal cancer at the General Surgery Department of Daping Hospital of Army Military Medical University on September 18, 2019 were retrospectively analyzed. Preoperative colonoscopy revealed that the distance of upper rectal cancer to anal edge was 14 cm, and the tumor size was 2.5 cm×1.5 cm×1 cm. Pathological result confirmed rectal moderately differentiated adenocarcinoma. The preoperative abdominal CT showed thickened bowel-wall of upper rectum and the blurred perirectal fat, suggesting tumor infiltration. Results: The operation was successful. There were no conversion to laparotomy or abdominal auxiliary incision, and the mesorectum of the specimen was intact. The operation time was 165 minutes, the blood loss was about 20 ml, and there were no complications such as injury to peripheral organs. Postoperative pathology showed ulcerative moderately differentiated adenocarcinoma of the upper rectum with TNM stage IVA (T4N2b). The postoperative recovery was smooth. Patient ambulated on the 1st day, the catheter was removed on the 7th day, and discharged from the hospital on the 8th day. Conclusion: The transumbilical SIPOP robotic total mesorectal excision is safe, effective and feasible.

Incidence and risk factors of anastomotic leak after transanal total mesorectal excision in China: a retrospective analysis based on national database / 中华胃肠外科杂志

Objective: Transanal total mesorectal excision (taTME) was a very hot topic in the first few years since its appearance, but now more introspections and controversies on this procedure have emerged. One of the reasons why the Norwegian Ministry of Health stopped taTME was the high incidence of postoperative anastomotic leak. In current study, the incidence and risk factors of anastomotic leak after taTME were analyzed based on the data registered in the Chinese taTME Registry Collaborative (CTRC). Methods: A case-control study was carried out. Between November 15, 2017 and December 31, 2020, clinical data of 1668 patients undergoing taTME procedure registered in the CTRC database from 43 domestic centers were collected retrospectively. After excluding 98 cases without anastomosis and 109 cases without complete postoperative complication data, 1461 patients were finally enrolled for analysis. There were 1036 males (70.9%) and 425 females (29.1%) with mean age of (58.2±15.6) years and mean body mass index of (23.6±3.8) kg/m(2). Anastomotic leak was diagnosed and classified according to the International Study Group of Rectal Cancer (ISREC) criteria. The risk factors associated with postoperative anastomotic leak cases were analyzed. The impact of the cumulative number of taTME surgeries in a single center on the incidence of anastomotic leak was evaluated. As for those centers with the number of taTME surgery ≥ 40 cases, incidence of anastomic leak between 20 cases of taTME surgery in the early and later phases was compared. Results: Of 1461 patients undergoing taTME, 103(7.0%) developed anastomotic leak, including 71 (68.9%) males and 32 (31.1%) females with mean age of (59.0±13.9) years and mean body mass index of (24.5±5.7) kg/m(2). The mean distance between anastomosis site and anal verge was (2.6±1.4) cm. Thirty-nine cases (37.9%) were classified as ISREC grade A, 30 cases (29.1%) as grade B and 34 cases (33.0%) as grade C. Anastomotic leak occurred in 89 cases (7.0%,89/1263) in the laparoscopic taTME group and 14 cases (7.1%, 14/198) in the pure taTME group. Multivariate analysis showed that hand-sewn anastomosis (P=0.004) and the absence of defunctioning stoma (P=0.013) were independently associated with anastomotic leak after taTME. In the 16 centers (37.2%) which performed ≥ 30 taTME surgeries with cumulative number of 1317 taTME surgeries, 86 cases developed anastomotic leak (6.5%, 86/1317). And in the 27 centers which performed less than 30 taTME surgeries with cumulative number of 144 taTME surgeries, 17 cases developed anastomotic leak (11.8%, 17/144). There was significant difference between two kinds of center (χ(2)=5.513, P=0.019). Thirteen centers performed ≥ 40 taTME surgeries. In the early phase (the first 20 cases in each center), 29 cases (11.2%, 29/260) developed anastomotic leak, and in the later phase, 12 cases (4.6%, 12/260) developed anastomotic leak. The difference between the early phase and the later phase was statistically significant (χ(2)=7.652, P=0.006). Conclusion: The incidence of anastomotic leak after taTME may be reduced by using stapler and defunctioning stoma, or by accumulating experience.

Two new cadmium(II) coordination polymers based on imidazole-containing ligands: synthesis, structural characterization and fluorescence properties.

The judicious selection of suitable ligands is vitally important in the construction of novel metal-organic frameworks (MOFs) with fascinating structures and interesting properties. Recently, imidazole-containing multidentate ligands have received much attention. Two new CdII coordination frameworks, namely, poly[tris{µ-1,4-bis[(1H-imidazol-1-yl)methyl]benzene-κ2N3:N3'}tetrakis(nitrato-κ2O,O')dicadmium], [Cd2(NO3)4(C14H14N4)3]n, (I), and poly[[bis{µ3-1,3,5-tris[(1H-imidazol-1-yl)methyl]benzene-κ3N3:N3':N3''}cadmium] hexafluorosilicate], {[Cd(C18H18N6)2](SiF6)}n, (II), have been synthesized and characterized by elemental analysis, IR spectroscopy and single-crystal X-ray diffraction. In polymer (I), the 1,4-bis[(1H-imidazol-1-yl)methyl]benzene ligand bridges Cd2+ ions with a distorted seven-coordinated pentagonal bipyramidal geometry, forming a one-dimensional ladder chain, and the nitrate anions coordinate to the Cd2+ ions in a terminal bidentate fashion. In the crystal, adjacent chains are further connected by C-H...O hydrogen bonds to generate a two-dimensional (2D) supramolecular structure. Polymer (II) exhibits a 2D layered structure in which 1,3,5-tris[(1H-imidazol-1-yl)methyl] benzene ligands join Cd2+ centres having a six-coordinated octahedral structure. The layers are connected by hexafluorosilicate anions via C-H...F hydrogen-bond interactions, giving rise to a three-dimensional supramolecular network structure in the solid state. In addition, powder X-ray diffraction (PXRD) patterns were recorded, thermogravimetric analyses (TGA) carried out and fluorescence properties investigated.

Vitamin D deficiency as a risk factor for dementia and Alzheimer's disease: an updated meta-analysis.

BACKGROUND: We aimed to comprehensively explore the associations between serum 25(OH)D deficiency and risk of dementia and Alzheimer's disease(AD). METHODS: We systematically searched Pubmed, the Cochrane Library, Embase and the reference lists of pertinent review articles for relevant articles published from database inception up until January 2019. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated with random effects models using the Stata 12.0 statistical software package. RESULTS: Twelve prospective cohort studies and four cross-sectional studies were included in this meta-analysis. The pooled HRs of dementia and AD, respectively, were 1.32 (95%CI: 1.16, 1.52) and 1.34 (95%CI: 1.13, 1.60) for vitamin D deficiency (< 20 ng/ml). In the subgroup analyses, the pooled HRs of dementia and AD, respectively, were 1.48 (95%CI: 1.19, 1.85) and 1.51 (95%CI: 1.04, 2.18) for moderate vitamin D deficiency (10-20 ng/ml) and 1.20 (95%CI: 0.99, 1.44) and 1.36 (95%CI: 1.01, 1.84) for severe vitamin D deficiency (< 10 ng/ml). CONCLUSION: There are significant associations between vitamin D deficiency and both dementia and AD. There are stronger associations between severe vitamin D deficiency (< 10 ng/ml) and both dementia and AD compared to moderate vitamin D deficiency (10-20 ng/ml).

Effectiveness of rituximab in neuromyelitis optica: a meta-analysis.

BACKGROUND: Neuromyelitis optica (NMO) is a severe inflammatory autoimmune disorder of the central nervous system and often results in paralysis or blindness. Rituximab (RTX) is a mouse-human chimeric monoclonal antibody specific for the CD20 antigen on B lymphocytes and used to treat many autoimmune diseases. Disability and relapses were measured using the Expanded Disability Status Scale (EDSS) and annualized relapse rate (ARR) ratio to evaluate the effectiveness of RTX. This review performed a meta-analysis of the efficacy of RTX in NMO. METHODS: We searched through the databases of PubMed, Embase, and Cochrane Library. We compiled 26 studies, in which 18 used ARR ratio, 22 used EDSS score, and 14 used both variables. Differences in the ARR ratio and EDSS score before and after RTX therapy were used as the main efficacy measures. Publication bias was evaluated after the consistency test, and a sensitivity analysis was performed with mean difference (MD) of the efficacy of RTX. RESULTS: A meta-analysis of 26 studies with 577 participants was conducted. Antibodies against aquaporin-4 autoantibody were recorded in 435 of 577 (75.39%) patients with NMO. RTX therapy resulted in a mean (WMD) - 1.56 (95% CI, - 1.82 to - 1.29) reduction in the mean ARR ratio and a mean (WMD) - 1.16 (95% CI, - 1.36 to - 0.96) reduction in the mean EDSS score. A total of 330 of 528 patients (62.9%) reached the relapse-free state. A total of 95 of 577 (16.46%) patients had adverse reactions. CONCLUSIONS: RTX has acceptable tolerance, reduces the relapse frequency, and improves disability in most patients with NMO. Future studies should focus on reducing the health-care costs, improving the functional outcomes, and reducing the adverse effects associated with RTX treatment.

A study on role and mechanism of TLR4/NF-κB pathway in cognitive impairment induced by cerebral small vascular disease.

OBJECTIVE: To investigate the role and potential mechanism of Toll-like receptor 4 (TLR4)/nuclear factor-kappa B (NF-κB) signaling pathway in cognitive impairment induced by cerebral small vascular disease (CSVD), so as to provide a reference for the clinical treatment of CSVD-induced cognitive impairment. METHODS: Mice with TLR4 gene knockout (n = 20) and those with wild-type TLR4 gene (n = 40) aged 8-10 weeks old were divided into blank control group (Control group, n = 20), wild-type + CSVD group (WT + CSVD group, n = 20) and TLR4 gene knockout + CSVD group (TLR4 KO + CSVD group, n = 20). Allogeneic thrombosis (particle diameter: 50-70 mm) was injected to the mouse's external carotid artery to create a model of learning and memory dysfunction. Step-down test and Y-type maze test were utilized to examine the learning and memory abilities of the mice. Reverse transcription-polymerase chain reaction (RT-PCR) and immunoblotting techniques were adopted to measure the levels of apoptosis-related genes [B-cell lymphoma/leukemia-2 (Bcl-2), Bcl-2-associated X protein (Bax), C-caspase-3 and T-caspase-3] in the brain tissues of mice. Terminal dexynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (TUNEL) method was applied to detect the apoptosis of neuronal cells in the brain tissues. Meanwhile, the levels of oxidative stress markers, including superoxide dismutase (SOD), gp91 and malondialdehyde (MDA), were measured. Finally, the expression level of TLR4/NF-κB pathway was detected. RESULTS: The latency in the step-down test in the WT + CSVD group was remarkably longer than that in the Control group, and the number of errors was evidently larger than that in the Control group (p < 0.05). At the same time, in the WT + CSVD group, the expression levels of pro-apoptotic genes Bax and C-caspase-3 were up-regulated markedly, while the expression level of anti-apoptotic gene Bcl-2 declined notably (p < 0.05). TUNEL results showed that the number of apoptotic cells in the brain tissues in the WT + CSVD group was about 12 times that in the Control group (p < 0.05). Meanwhile, the SOD expression level was lowered, and the MDA expression level was elevated in the brain tissues in the WT + CSVD group. In addition, the TLR4/NF-κB pathway was prominently activated in the mice in the WT + CSVD group (p < 0.05). After TLR4 gene knockout, the cognitive functions of the mice were improved markedly, and the apoptosis of neuronal cells and oxidative stress in the brain tissues were suppressed significantly in the meantime. Moreover, the activation of the TLR4/NF-κB signaling pathway was also inhibited. CONCLUSION: The TLR4/NF-κB pathway is involved in the occurrence and development of CSVD-induced cognitive impairment through regulating oxidative stress and cell apoptosis.