Cachexia Index as a Predictor of Reduced Survival in Patients with Gastrointestinal Cancer: A Systematic Review and Meta-Analysis.

The cachexia index is a novel indicator of cachexia, but its prognostic implications for survival outcomes have not been systematically assessed in patients with gastrointestinal cancer. This systematic review and meta-analysis aimed to examine the association between the cachexia index and survival outcomes in gastrointestinal cancer patients. Two independent reviewers searched PubMed, Embase, and Web of Science to identify studies that evaluated the prognostic significance of the cachexia index in patients with gastrointestinal cancer. The prognostic value of the cachexia index was determined by combining the adjusted hazard ratios (HR) and 95% confidence intervals (CI). Thirteen studies were identified, including a total of 4207 patients. Meta-analysis indicated that a lower cachexia index was associated with shorter overall survival (HR 2.18; 95% CI 1.78-2.66) and disease-free survival (HR 1.72; 95% CI 1.50-1.97) in gastrointestinal cancer patients. Further stratified analysis confirmed the significant association between a lower cachexia index and shorter overall survival in different study designs, regions, patients' age, sample sizes, gastrointestinal cancer subtypes, tumor stages, and follow-up duration subgroups. The cachexia index could be utilized as a predictor of overall survival and disease-free survival in patients with gastrointestinal cancer. However, future prospective studies are required to confirm these findings.

Advances on Senescence-associated secretory phenotype regulated by circular RNAs in tumors.

The components that comprise the senescence-associated secretory phenotype (SASP) include growth factors, proteases, chemokines, cytokines, and bioactive lipids. It drives secondary aging and disrupts tissue homeostasis, ultimately leading to tissue repair and regeneration loss. It has a two-way regulatory effect on tumor cells, resisting cancer occurrence and promoting its progression. A category of single-stranded circular non-coding RNA molecules known as circular RNAs (circRNAs) carries out a series of cellular activities, including sequestering miRNAs and modulating gene editing and expression. Research has demonstrated that a large number of circRNAs exhibit aberrant expression in pathological settings, and play a part in the onset and progress of cancer via modulating SASP factors. However, the research related to SASP and circRNAs in tumors is still in its infancy at this stage. This review centers on the bidirectional modulation of SASP and the role of circRNAs in regulating SASP factors across different types of tumors. The aim is to present novel perspectives for the diagnosis and therapeutic management of malignancies.

Ceftazidime-Avibactam Combination Therapy versus Monotherapy for the Treatment Carbapenem-Resistant Gram-Negative Bacterial Infections: A Retrospective Observational Study.

Purpose: Since the introduction of ceftazidime-avibactam (CZA) in the Chinese market, accumulating clinical evidence has substantiated its efficacy in the treatment of infections caused by carbapenem-resistant gram-negative bacteria (CR-GNB). Nevertheless, an ongoing debate persists concerning the choice between monotherapy and combination therapy when devising clinical anti-infection protocols. Patients and Methods: This retrospective, single-center observational study enrolled patients with CR-GNB infections who received CZA treatment between December 2019 and August 2023. The primary outcome assessed was 30-day mortality, and the secondary outcome measured was 14-day bacterial clearance. A multivariate Cox regression model was used to identify variables that were independently associated with 30-day mortality rate. Results: Eighty-three patients were enrolled in the study; of which, 45 received CZA monotherapy, whereas 38 received combination therapy. The overall 30-day mortality rate was 31.3%, and no significant difference was observed in the 30-day mortality rates between the CZA combination therapy and monotherapy groups (31.6% vs 31.1%, p=0.963). After adjustment by propensity score matching, the 30-day mortality rate was not significantly different between the two groups (28.6% vs 31.4%, p=0.794). Multivariate COX analysis revealed that age and SOFA score were independent predictors of 30-day mortality. Conclusion: Combination therapy with CZA and other antimicrobials was not found to have an advantage over monotherapy in reducing the 30-day mortality rate.

Modification of ultrasound-pretreated montmorillonite using poly(diallyldimethylammonium chloride) for W and Mo separation and the sequential application in removal of heavy metals.

The use of a resin to selectively separate thiomolybdate from a tungsten (W) feed solution is a well-known protocol for achieve high-purity W products; however, the regeneration of saturated resin is laborious. In this study, poly(diallyl dimethyl ammonium chloride) (PDADMA) was used to modify ultrasound-pretreated montmorillonite (Mt) for W and molybdenum (Mo) separation for the first time, and the resultant tetrathiomolybdate (MoS42-)-loaded composite was further tested to remove heavy metals instead of regeneration. Among the three variables of ultrasound pretreatment, that is, Mt concentration, ultrasound power, and treatment time, the Mt concentration exhibited the most significant influence followed by ultrasound power on the separation performance of W and Mo. Compared to the distance of the interlayer space and the surface charge of the modified Mt, the PDADMA content showed a closer correlation with the W/Mo separation coefficient. Assisted by Box-Behnken design, with Mt concentration of 6.9 g/L, ultrasound power of 593.8 W, and treatment time of 13.8 min, the composite with the greatest separation coefficient was obtained. The adsorption of Cu(II) on the optimal W/Mo separation-derived composite was ascribed to the formation of Cu-S complexes, while that of Pb(II) was attributed to complexation and surface precipitation. In contrast, ion exchange with the initially loaded anions, reduction by sulfide to Cr(III), and formation of Cr(III)-S complexes accounted for Cr(VI) removal. The adsorption of Cu(II) and Pb(II) equilibrated faster and showed higher acid-resistance than that of Cr(VI). The adsorption capacities for Cu(II), Pb(II), and Cr(VI) were 0.535, 1.398, and 0.882 mmol/g, respectively. Applying PDADMA to modify Mt as a reagent for W/Mo separation was feasible, and the derived composite was capable of removing cationic and anionic heavy metals.

An evaluation of Mp1p antigen screening for talaromycosis in HIV-infected antiretroviral therapy-naïve population in Guangdong, China.

BACKGROUND: Talaromycosis is one of the most common opportunistic infections in human immunodeficiency virus (HIV) infected patients. However, few researches have explored the prevalence in Southern China and fully assessed the value of the Mp1p antigen screening for the diagnosis of talaromycosis. METHODOLOGY/PRINCIPAL FINDINGS: We performed a cross-sectional study of HIV-infected antiretroviral therapy (ART)-naïve adult patients who were seen in 2018 at Guangzhou Eighth People's Hospital, Guangzhou Medical University. Serum samples collected from all the 784 enrolled patients were tested for Mp1p antigen using double-antibody sandwich enzyme-linked immunosorbent assay. A culture of pathogen was conducted in 350 clinically suspected patients to confirm talaromycosis. The overall prevalence of talaromycosis based on the Mp1p antigen detection was 11.4% (89/784) and peaked at 32.2% (75/233) in patients with CD4+ ≤50 Nr/µl. Logistic regression analysis found Mp1p antigen positive rate decreased with the increase in CD4+ counts (OR 0.982, 95% CI 0.977-0.987, P<0.01). The optimal cut-off point of the CD4+ count was 50 Nr/µl or less. Among the 350 patients received both fungal culture and Mp1p antigen detection, 95/350 (27.1%) patients were culture-positive for a Talaromyces marneffei, 75/350 (21.4%) patients were Mp1p antigen positive. The Mp1p antigen assay showed a good agreement to the culture of pathogen, and the sensitivity, specificity, positive predictive value, negative predictive value and kappa value was 71.6% (68/95), 97.3% (248/255), 90.7% (68/75), 90.2% (248/275), and 0.737, respectively. The screening accuracy of the Mp1p antigen assay in patients with CD4+ counts of ≤50 Nr/µl was superior to that in those with higher CD4+ counts. CONCLUSIONS/SIGNIFICANCE: Mp1p antigen screening can be an effective tool for more efficient diagnosis of Talaromycosis, especially in HIV/AIDS patients with low CD4+ counts. Future validation studies are needed.

Advances in hyperbaric oxygen to promote immunotherapy through modulation of the tumor microenvironment.

Hyperbaric oxygen therapy is a relatively safe treatment method that has been used for a long time in the clinic. It has been proven that it can enhance the sensitivity of radiotherapy and photodynamic therapy for cancer. However, there are few studies on hyperbaric oxygen and immunotherapy. In this article, we summarize that hyperbaric oxygen therapy regulates the tumor microenvironment through various pathways such as improving tumor hypoxia, targeting hypoxia-inducing factors, and generating reactive oxygen species. The change in the tumor microenvironment ultimately affects the curative effect of immunotherapy. Therefore, hyperbaric oxygen can influence immunotherapy by regulating the tumor microenvironment, providing a direction for the future development of immunotherapy.

Fluorine removal from sodium tungstate ion exchange effluent by precipitation with addition of lanthanum chloride.

The waste water generated from the sodium tungstate ion exchange process of scheelite hydrometallurgical extraction contains a certain concentration of fluorine ion, which caused environmental pollution and harmed human health. In this study, a new method for removing fluorine from the wastewater by precipitation with addition of lanthanum chloride was proposed. In the process, fluorine was removed by from the solution as insoluble lanthanum fluoride precipitates. To explore the favourable conditions for the formation of lanthanum fluoride, thermodynamic analysis of the La-F-H2O system was conducted. Results show that lanthanum fluoride is stable when the solution pH value is between 1.0 and 10.0, and the lanthanum fluoride is gradually converted into lanthana hydroxide when the pH value is more than 10.0 at 298K. The effects of various parameters on the fluorine removal were studied, and the optimum process parameters were determined. More than 92% of the fluorine can be removed when the concentration of fluorine in the solution ranged from 60 to 400 mg/L, the dosage of lanthanum chloride was 1.3 times of the theoretical amount, the pH value was 8.0 at 60°C for 30 min. After removing fluorine from the solution, the resiual fluorine concentrtion was lower than 10 mg/L, which could meet the requirement of national wastewater discharge.

Quality evaluation of Keteling capsules based on fingerprinting, multicomponent quantification, and quantitative prediction.

The Keteling capsule (KC) is a traditional Chinese medicine (TCM) made from the dried extract of Ficus microphylla and an appropriate amount of chlorpheniramine maleate. It is widely used to treat cough and relieve asthma. Despite its extensive usage, a rapid and comprehensive quality evaluation strategy for KC remains a challenge. This study introduces an electrochemical fingerprint analysis technique, in addition to the commonly employed HPLC fingerprints, for efficient and convenient quality evaluation. Moreover, a cost-effective, rapid, and accurate multi-component quantification technique known as the "Multi-markers assay by the monolinear method (MAML)" and the "FT-IR quantitative model" were explored. The HPLC fingerprints were evaluated using a systematically quantified fingerprint method, while the electrochemical fingerprints, based on the Belousov-Zhabotinsky oscillation reaction principle, were effectively analyzed and characterized using oxidation induction times and oscillation lifetimes. Multi-component quantitative analysis was carried out through the MAML and FT-IR quantitative models. The HPLC fingerprint successfully classified the 22 samples into eight grades with excellent discrimination. Active ingredient content analysis was achieved using reliable parameters obtained from electrochemical fingerprinting. The no significant difference in the quantitative results proves the accuracy of the MAML method. Additionally, successful FT-IR quantitative prediction models were developed for chlorogenic acid, isovitexin, and chlorpheniramine maleate. This study offers a dependable and effective approach for enhancing the quality control of KC, and it can provide new insights for improving the quality analysis methods in the field of TCM.

Association between Risk of Malnutrition Defined by the Nutritional Risk Screening 2002 and Postoperative Complications and Overall Survival in Patients with Cancer: A Meta-Analysis.

The Nutritional Risk Screening 2002 (NRS 2002) has been applied as a nutritional screening tool in oncology patients. This meta-analysis aimed to assess the association between the risk of malnutrition defined by the NRS 2002 and adverse outcomes in patients with cancer. We comprehensively searched PubMed, Embase, and Web of Science until May 7, 2023. Studies investigating the association between the risk of malnutrition defined by the NRS 2002 and overall survival or postoperative complications in adult patients with cancer were included. Patients were grouped as being at risk of malnutrition (NRS2002 ≥ 3) and not at risk (NRS 2002 < 3). Twenty-two studies involving 9,332 patients were identified. The reported prevalence of the risk of malnutrition ranged from 12.8% to 80.8%. Meta-analysis indicated that cancer patients with a risk of malnutrition had a poor overall survival (hazard ratio 1.66; 95% confidence intervals [CI] 1.40-1.97). Furthermore, the pooled adjusted odds ratio of postoperative complications was 2.27 (95% CI 1.81-2.84) for the risk of malnutrition. The risk of malnutrition defined by the NRS 2002 is independently associated with an increased risk of postoperative complications and worse overall survival in patients with cancer. NRS 2002 can serve as a promising risk stratification tool in cancer patients.

Association of Prefrailty and Frailty With All-Cause Mortality, Acute Exacerbation, and Hospitalization in Patients With Chronic Obstructive Pulmonary Disease: A Meta-Analysis.

OBJECTIVE: To evaluate the impact of prefrailty and frailty on all-cause mortality, acute exacerbation, and all-cause hospitalization in patients with chronic obstructive pulmonary disease (COPD). DESIGN: Meta-analysis. SETTING AND PARTICIPANTS: Two authors independently searched PubMed, Web of Science, and Embase databases until December 27, 2022，to identify studies that reported the predictive value of prefrailty and frailty in COPD patients. MEASUREMENTS: All-cause mortality, acute exacerbation, and all-cause hospitalization. RESULTS: Ten studies reporting on 11 articles enrolling 13,203 patients with COPD were included. The prevalence of frailty ranged from 6.0% to 51%. When compared with nonfrailty, the pooled adjusted hazard ratio (HR) of all-cause mortality was 1.48 (95% CI 0.92-2.40) for prefrailty and 2.64 (95% CI 1.74-4.02) for frailty, respectively. The pooled adjusted odds ratio (OR) of all-cause hospitalization was 1.35 (95% CI 1.05-1.74) for prefrailty and 1.65 (95% CI 1.05-2.61) for frailty. In addition, frailty significantly predicted all acute exacerbation (OR 2.20, 95% CI 1.26-3.81) but not moderate to severe acute exacerbation (OR 1.42, 95% CI 0.94-2.17) in patients with stable COPD. However, the pooled results of all-cause hospitalization were not reliable in leave-1-out sensitivity analyses. CONCLUSIONS AND IMPLICATIONS: Frailty significantly predicts all-cause mortality in patients with COPD, even after adjustment for common confounding factors. Assessment of frail status in COPD patients may improve secondary prevention and allow early intervention. However, future studies are warranted to validate the impact of frailty defined by a standardized definition of frailty on acute exacerbation and all-cause hospitalization.

Association Between Disease-specific Health-related Quality of Life and All-cause Mortality in Patients with Heart Failure: A Meta-analysis.

The association between disease-specific health quality of life (QoL) and adverse outcomes remains controversial in patients with heart failure (HF). This meta-analysis aimed to evaluate the association of QoL measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) or Kansas City Cardiomyopathy Questionnaire (KCCQ) with all-cause mortality in patients with HF. PubMed and Embase databases were comprehensively searched until December 30, 2022 to identify studies investigating the utility of QoL measured by the MLHFQ or KCCQ in predicting all-cause mortality patients with HF. Twenty-five studies reported on 24 articles enrolling 42,414 HF patients were identified. A comparison of the top with the bottom MLHFQ score, the pooled adjusted hazard ratios (HR) of all-cause mortality was 1.56 (95% confidence intervals [CI] 1.26-1.94). When analyzed the MLHFQ as continuous variable, each 10-point MLHFQ score increase conferred a 12% (95% CI 6%-18%) higher risk of all-cause mortality, which was consistently significant for physical component (HR 1.19; 95% CI 1.09-1.30) and mental component (HR 1.21; 95% CI 1.05-1.40). A comparison of the bottom with the top KCCQ score, the pooled adjusted HR was 2.34 (95% CI 2.10-2.60) for all-cause mortality. Furthermore, each 10-point KCCQ score decrease was associated with a 12% (95% CI 7%-16%) higher risk of all-cause mortality. Worse health-related QoL defined by the higher MLHFQ or lower KCCQ score was associated with an increased risk of all-cause mortality in patients with HF. Assessment of disease-specific health QoL at baseline may provide important prognostic information in these patients.

Anti-TLR4 IgG2 Prevents Acetaminophen-induced Acute Liver Injury through the Toll-like Receptor 4/MAPKs Signaling Pathway in Mice.

BACKGROUND AND OBJECTIVE: Acetaminophen (APAP) is a widely used antipyretic and analgesic. If taken in excess, it can cause severe drug-induced acute liver injury. The purpose of this study was to investigate the effects of anti-TLR4 IgG2 on APAP-induced liver injury and its underlying mechanisms. METHODS: We injected APAP into the abdominal cavity of mice to establish a liver injury model. Mice were divided into the control group, APAP group, and APAP + anti-TLR4 IgG2 group. In order to verify the implication of the toll-like receptor4 and mitogen-activated protein kinases activation (TLR4/MAPKs) signaling pathway, mice were intraperitoneally injected with a TLR4 / MAPKs inhibitor anti-TLR4 IgG2. We evaluated the effects of TLR4 IgG2 on the antioxidant, anti-apoptotic, anti-inflammatory, and liver histopathology of APAP mice. In addition, the expression of the TLR4 / MAPKs signaling pathway was detected by Western blot. RESULTS: Our study showed that APAP mouse models were successfully established; however, pretreatment with anti-TLR4 IgG2 alleviated APAP-induced hepatic injury, as evidenced by the 24-h survival rate. Meanwhile, anti-TLR4 IgG2 prevented the elevation of serum biochemical parameters and lipid profile. Furthermore, compared with the APAP group, hepatic antioxidants, including 3- Nitrotyrosine, high mobility group protein B1, superoxide dismutase, catalase, and glutathione, were increased in APAP + anti-TLR4 IgG2 group. In contrast, a significant decrease was observed in the levels of the malondialdehyde, which is a lipid peroxidation product. Moreover, the western blotting analysis showed that anti-TLR4 IgG2 treatment inhibited the activation of the apoptotic pathway by increasing Bcl-2 and decreasing Bax, P53, and cleaving caspase-3 / caspase-3 protein expression. These results were further validated by TUNEL staining and immunohistochemical. Histopathological observation also revealed that pretreat-ment with anti-TLR4 IgG2 could significantly reverse hepatocyte inflammatory infiltration, congestion, and necrosis in liver tissues by APAP. Importantly, anti-TLR4 IgG2 effectively alleviated APAP-induced liver injury by inhibiting tolllike receptor4 and mitogen-activated protein kinases activation signaling pathways (TLR4/MAPKs). CONCLUSION: The results clearly suggest that the underlying molecular mechanisms in the hepatoprotection of anti-TLR4 IgG2 in APAP-induced hepatotoxicity may be due to its antioxidation, anti-apoptosis, and anti-inflammation effects through inhibition of the TLR4/MAPKs signaling axis.

Predictive Value of Geriatric Nutritional Risk Index in Patients with Colorectal Cancer: A Meta-Analysis.

Geriatric Nutritional Risk Index (GNRI) has been used as a predictor of adverse prognosis in patients with colorectal cancer (CRC). This meta-analysis sought to evaluate the prognostic role of GNRI in CRC patients. Two authors comprehensively searched the studies indexed in PubMed and Embase databases until March 15, 2022. Only observational studies evaluating the association between GNRI and adverse outcomes in patients with CRC were eligible. The prognostic value of GNRI was expressed by pooling the adjusted hazard ratio (HR) with 95% confidence intervals (CI) for the low vs. high GNRI group. Eight retrospective studies enrolling 3239 CRC patients were included. When comparing the low with the high GNRI group, the pooled HR was 2.40 (95% CI 1.71-3.39) for overall survival, 1.63 (95% CI 1.35-1.96) for disease-free survival, and 1.85 (95% CI 1.21-1.83) for ≥ 2 Clavien-Dindo Grade postoperative complications, respectively. Moreover, malnutrition defined by the cutoff GNRI at 98 was associated with a reduced overall survival (HR 1.66; 95% CI 1.37-2.02). Low GNRI score may be a promising predictor of postoperative complications and long-term poor survival in Asian patients with CRC. Malnutrition defined by the GNRI can be applied to improve risk stratification of CRC.

Utility of Fibrinogen Levels for Predicting Survival and Functional Outcomes in Patients with Acute Ischemic Stroke: A Meta-Analysis.

BACKGROUND AND OBJECTIVE: Studies on the association between blood fibrinogen levels and adverse outcomes in patients with acute ischemic stroke have produced controversial results. This meta-analysis aimed to examine the association of elevated fibrinogen levels with adverse outcomes in acute ischemic stroke patients. METHODS: Two authors comprehensively searched the articles indexed in PubMed and Embase databases until December 31, 2021. All cohort studies that assessed the value of fibrinogen level in predicting poor functional outcomes or all-cause mortality in acute ischemic stroke patients were included. RESULTS: Nine studies reporting on ten articles involving 16,998 patients met the inclusion criteria. For the highest versus lowest fibrinogen group, the pooled adjusted risk ratio (RR) was 1.48 (95% confidence intervals [CI] 1.17-1.87) for poor functional outcomes defined by the modified Rankin Scale ≥ 3. In addition, elevated fibrinogen was not significantly associated with an increased risk of all-cause mortality (RR 1.76; 95% CI 1.42-2.20). Subgroup analysis suggested that there was no clear association between elevated fibrinogen levels and PFO in younger acute ischemic stroke patients (RR 1.16; 95% CI 0.87-1.53). CONCLUSION: Elevated fibrinogen level at baseline is possibly an independent predictor of short-term poor functional outcome and long-term all-cause mortality, particularly in elderly acute ischemic stroke patients. Blood fibrinogen level may serve as a useful biomarker for risk classification of acute ischemic stroke patients.

Exploring facilitators and barriers to self-management engagement of Chinese people with type 2 diabetes mellitus and poor blood glucose control: a descriptive qualitative study.

AIMS: To explore facilitators and barriers to self-management engagement of Chinese people with poorly controlled type 2 diabetes. METHODS: Purposive sampling method was used for recruitment. Semi-structured interview and thematic analysis was used for data collection and analysis. RESULTS: Twenty-six semi-structured interviews were conducted. Poor blood glucose control introduced awareness of susceptibility to complications, while mental disorders could be concomitant. General knowledge about healthy lifestyle and unhealthy habits impeded lifestyle management. Temporary remission of hyperglycemia and no perceived symptoms interfered engagement of medication therapy and regular blood glucose monitoring. Family and work environments could impact self-management engagement. Accessibility to reliable diabetes-related information influenced self-management engagement. CONCLUSIONS: Awareness of susceptibility to complications motivated self-management engagement, while the awareness could cause mental disorders that need to be addressed. Customized lifestyle plans and behavior change technologies were crucial for lifestyle management. The progression of diabetes, importance of continuity of medication therapy, and the value of blood glucose monitoring should be clarified in diabetes education. Building diabetes-friendly social environments and providing reliable diabetes-related information were essential.

Impact of frailty on survival and readmission in patients with gastric cancer undergoing gastrectomy: A meta-analysis.

Background: Frailty as a common geriatric syndrome can affect the clinical outcomes in patients with gastric cancer. However, the impact of frailty on survival and readmission patients with gastric cancer has not been well-characterised. Objectives: To investigate the impact of frailty on survival and readmission in patients with gastric cancer undergoing gastrectomy by conducting a meta-analysis. Methods: Eligible studies were identified by searching the PubMed, Web of Science, Cochrane Library, and Embase databases until 2 September 2022. Observational studies that evaluated the value of frailty in predicting adverse outcomes in gastric cancer patients undergoing gastrectomy were included. The outcomes of interest were overall survival, disease-specific survival (death from gastric cancer), and readmission. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) were pooled to calculate the association of frailty with adverse outcomes. Results: Eight studies reported on nine articles with 2,792 patients with gastric cancer were included. A fixed-effect meta-analysis indicated that frailty was associated with a reduced in-hospital overall survival (HR 2.08; 95% CI 1.46-2.95), long-term overall survival (HR 1.84; 95% CI 1.37-2.47), and disease-specific survival (HR 1.94; 95% CI 1.34-2.83). In addition, frailty was associated with increased risk of readmission within 1 year (HR 3.63; 95% CI 1.87-7.06). Conclusions: Frailty was associated with a reduced overall survival and disease-specific survival and an increased risk of readmission in patients with gastric cancer undergoing gastrectomy. Frail status may play an important role in the risk stratification of gastric cancer after gastrectomy.

Co-creation using crowdsourcing to promote PrEP adherence in China: study protocol for a stepped-wedge randomized controlled trial.

BACKGROUND: Adherent pre-exposure prophylaxis (PrEP) uptake can prevent HIV infections. Despite the high HIV incidence, Chinese key populations have low PrEP uptake and adherence. New interventions are needed to increase PrEP adherence among key populations in China. Co-creation methods are helpful to solicit ideas from the community to solve public health problems. The study protocol aims to describe the design of a stepped-wedge trial and to evaluate the efficacy of co-created interventions to facilitate PrEP adherence among key populations in China. METHODS: The study will develop intervention packages to facilitate PrEP adherence among Chinese key populations using co-creation methods. The study will then evaluate the efficacy of the co-created intervention packages using a stepped-wedge randomized controlled trial. This four-phased closed cohort stepped-wedge design will have four clusters. Each cluster will start intervention at three-month intervals. Seven hundred participants who initiated PrEP will be recruited. Participants will be randomized to the clusters using block randomization. The intervention condition includes receiving co-created interventions in addition to standard of care. The control condition is the standard of care that includes routine clinical assessment every 3 months. All participants will also receive an online follow-up survey every 3 months to record medication adherence and will be encouraged to use a WeChat mini-app for sexual and mental health education throughout the study. The primary outcomes are PrEP adherence and retention in PrEP care throughout the study period. We will examine a hypothesis that a co-created intervention can facilitate PrEP adherence. Generalized linear mixed models will be used for the primary outcome analysis. DISCUSSION: Developing PrEP adherence interventions in China faces barriers including suboptimal PrEP uptake among key populations, the lack of effective PrEP service delivery models, and insufficient community engagement in PrEP initiatives. Our study design addresses these obstacles by using co-creation to generate social media-based intervention materials and embedding the study design in the local healthcare system. The study outcomes may have implications for policy and intervention practices among CBOs and the medical system to facilitate PrEP adherence among key populations. TRIAL REGISTRATION: The study is registered in Clinical Trial databases in China (ChiCTR2100048981, July 19, 2021) and the US (NCT04754139, February 11, 2021).

High performance liquid chromatography three-wavelength fusion fingerprint combined with electrochemical fingerprint and antioxidant method to evaluate the quality consistency of Mingmu Dihuang Pill.

In this paper, three-wavelength fusion fingerprint (TWFFP) combined with electrochemical fingerprint (ECFP) and antioxidant methods were used to jointly explore the quality consistency of Mingmu Dihuang Pill (MMDHP). The TWFFP fully demonstrated the maximum ultraviolet absorption characteristics at multiple wavelengths, supplemented the defects brought by the single-wavelength evaluation. ECFP was established to analyze the characteristic parameters in more depth, and all samples had inhibitory effects on the electrochemical oscillation system. Using 2,2-diaza-bis(3-ethylbenzothiazole-6-sulfonic acid) antioxidant test, combined with ECFP, the fingerprint-efficacy relationship was established with the peak areas of the TWFFP. As a result, 15 of the 36 common peaks made important contributions to both efficacy relationships at the same time. The TWFFP and ECFP were evaluated by a systematically quantified fingerprint method, and the ability of HPLC and electrochemical to distinguish samples was discussed by hierarchical clustering analysis. Content percentage was introduced to calculate the relationship between marker components and macro quantitative similarity. The method of quantitative analysis of multi-components by single marker was explored to analyze the accuracy of evaluating the marker components. This study provided a comprehensive and reliable method for the quality consistency control of complex Traditional Chinese Medicine and its compound preparations.

Solventing out crystallization-basic magnesium carbonate percipitation for thorough phosphorus removal from ammonium tungstate solution.

The ammonium tungstate solution obtained by leaching scheelite with phosphate contains a large amount of phosphorus. For production of qualified ammonium paratungstate products, phosphorus must be deeply removed from the ammonium tungstate solution. In this study, a novel process for ammonium phosphate recovery and deep phosphorus removal from the solution was proposed. First, ammonium phosphate was crystallized and separated from the ammonium tungstate solution by blowing ammonia and cooling. Results showed that the crystallization ratio of phosphorus was above 95% under the conditions of an ammonia concentration of 4.18 mol/L, an initial phosphorus concentration ranging from 15 g/L to 30 g/L, a holding time of 60 min and the temperature of 20°C. Then, the small portion of phosphorus remaining in the ammonium tungstate solution was further deeply removed by basic magnesium carbonate percipitation. The phosphorus removal efficiency was above 99% and tungsten loss was less than 0.22% under the following conditions: the basic magnesium carbonate stoichiometric ratio was 1.5, the initial phosphorus concentration was ranging from 0.5 to 4 g/L, the reaction time was 120 min and temperature was 25°C. After phosphorus removal, the concentration of phosphorus in the ammonium tungstate solution was below 10 ppm, which meant deep phosphorus removal was achieved.

Association of Cognitive Impairment With Mortality and Readmission in Patients With Heart Failure: A Meta-analysis.

Cognitive impairment is a frequent condition in patients with heart failure (HF). This meta-analysis aimed to evaluate the prognostic impact of cognitive impairment on all-cause mortality and readmission among HF patients. We systematically searched articles indexing in PubMed and Embase databases until August 5, 2022. Original studies investigating the association of cognitive impairment with mortality and/or readmission for more than 3-month follow-up in patients with HF were selected. Twelve studies including 9556 patients were eligible. The prevalence of cognitive impairment ranged from 13.5% to 63.4% in HF patients. For patients with cognitive impairment vs those without, the pooled adjusted risk ratio (RR) was 1.88 (95% confidence intervals [CI] 1.42-2.48) for all-cause mortality, 1.48 (95% CI 1.19-1.84) for readmission, and 1.53 (95% CI 1.35-1.73) for combined endpoints of all-cause mortality/readmission, respectively. Cognitive impairment is a significant predictor of all-cause mortality/readmission in patients with HF, even after adjustment for the conventional confounding. Evaluation of cognitive function may help to improve risk classification of HF patients.