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Background: Angiotensin II receptor blockers (ARBs) are utilized for the management of hypertension and diabetes. Previous meta-analyses suggested that azilsartan medoxomil (AZL-M) improved blood pressure (BP) reduction, but there were no safety findings or suggestions for patients with hypertension or diabetes. Methods: We performed an efficacy and safety meta-analysis of randomized controlled trials (RCTs) evaluating AZL-M therapy for reducing BP in patients with hypertension. Patients with hypertension complicated by diabetes were analyzed. The relevant literature was searched in English and Chinese databases for RCTs involving AZL-M in hypertension. Efficacy variables included the change from baseline in the 24-h mean systolic/diastolic BP measured by ambulatory BP monitoring, the change from baseline in clinic systolic/diastolic BP, and responder rates. Safety variables included total adverse events (AEs), serious AEs, AEs leading to discontinuation, and AEs related to the study drug. The raw data from the included studies were utilized to calculate the odds ratio (OR) for dichotomous data and the mean difference (MD) for continuous data, accompanied by 95% confidence intervals (CIs). Statistical analysis was performed using R software. Results: A total of 11 RCTs met the inclusion criteria, representing 7,608 patients, 5 of whom had diabetes. Pooled analysis suggested a reduction in BP among patients randomized to 40 mg of AZL-M vs. control therapy [24-h ambulatory blood pressure monitoring (ABPM) mean systolic blood pressure (SBP) (MD: -2.85 mmHg), clinic SBP (MD: -3.48 mmHg), and clinic diastolic blood pressure (DBP) (MD: -1.96 mmHg)] and for 80 mg of AZL-M vs. control therapy [24-h ABPM mean SBP (MD: -3.59 mmHg), 24-h ABPM mean DBP (MD: -2.62 mmHg), clinic SBP (MD: -4.42 mmHg), clinic DBP (MD: -3.09 mmHg), and responder rate (OR: 1.46)]. There was no difference in the reduction of risks, except for dizziness (OR: 1.56) in the 80-mg AZL-M group or urinary tract infection (OR: 1.82) in the 40-mg AZL-M group. Analysis of patients with diabetes revealed that AZL-M can provide superior management, while safety and tolerability were similar to those of control therapy. Conclusions: AZL-M appears to reduce BP to a greater extent than dose-control therapy and does not increase the risk of adverse events in patients with hypertension and diabetes compared with placebo. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=464284, identifier PROSPERO CRD42023464284.

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Bridges may undergo structural vibration responses when exposed to seismic waves. An analysis of structural vibration characteristics is essential for evaluating the safety and stability of a bridge. In this paper, a signal time-frequency feature extraction method (NTFT-ESVD) integrating standard time-frequency transformation, singular value decomposition, and information entropy is proposed to analyze the vibration characteristics of structures under seismic excitation. First, the experiment simulates the response signal of the structure when exposed to seismic waves. The results of the time-frequency analysis indicate a maximum relative error of only 1% in frequency detection, and the maximum relative errors in amplitude and time parameters are 5.9% and 6%, respectively. These simulation results demonstrate the reliability of the NTFT-ESVD method in extracting the time-frequency characteristics of the signal and its suitability for analyzing the seismic response of the structure. Then, a real seismic wave event of the Su-Tong Yangtze River Bridge during the Hengchun earthquake in Taiwan (2006) is analyzed. The results show that the seismic waves only have a short-term impact on the bridge, with the maximum amplitude of the vibration response no greater than 1 cm, and the maximum vibration frequency no greater than 0.2 Hz in the three-dimensional direction, indicating that the earthquake in Hengchun will not have any serious impact on the stability and security of the Su-Tong Yangtze River Bridge. Additionally, the reliability of determining the arrival time of seismic waves by extracting the time-frequency information from structural vibration response signals is validated by comparing it with results from seismic stations (SSE/WHN/QZN) at similar epicenter distances published by the USGS. The results of the case study show that the combination of dynamic GNSS monitoring technology and time-frequency analysis can be used to analyze the impact of seismic waves on the bridge, which is of great help to the manager in assessing structural seismic damage.

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In order to understand the spatial distribution and sources of heavy metals in surface sediments of MaoMing city and to reasonably evaluate the ecological risk of heavy metals in sediments of the study area, the contents of heavy metals (As, Hg, Cd, Co, Cr, Cu, Mn, Ni, Pb, and Zn) in surface sediments of eight rivers and three reservoirs were detected, and the risks of heavy metals were assessed using the geo-accumulation index (Igeo), potential ecological disk index (RI), and potential adverse biological impacts (ΣTUs). The sources of heavy metals were analyzed via correlation, principal component analysis (PCA), and positive matrix factorization (PMF). The results showed that the ω(Zn) (147.56 mg·kg-1) and ω(Hg) (0.20 mg·kg-1) were 3.72 and 2.25 times the background value, respectively, and the spatial distributions of Cd, Co, Cu, Mn, Ni, and Zn were in the order of northern>central>western>southeast. The geo-accumulation index results showed that Zn was at a moderate pollution level, 76.6% of the sampling sites of Hg were at a light-heavy pollution level, and other heavy metals were at a non-light pollution level. The results of potential ecological risk and potential adverse biological impacts indicated that the potential ecological risk index and toxicity effect of Gaozhou Reservoir were higher than those of other rivers, and Hg was the major contributor to heavy metal pollution. The three factors extracted from principal component analysis and positive matrix factorization represented natural sources, agricultural sources, and industrial sources, respectively. Therefore, in order to reduce the health hazards caused by heavy metals in sediments, a prevention and control system for the Hg element should be established.

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OBJECTIVE@#To analyze the association between exposure to second-hand smoke (SHS) and 23 diseases, categorized into four classifications, among the Chinese population.@*METHODS@#We searched the literature up to June 30, 2021, and eligible studies were identified according to the PECOS format: Participants and Competitors (Chinese population), Exposure (SHS), Outcomes (Disease or Death), and Study design (Case-control or Cohort).@*RESULTS@#In total, 53 studies were selected. The odds ratio (OR) for all types of cancer was 1.79 (1.56-2.05), and for individual cancers was 1.92 (1.42-2.59) for lung cancer, 1.57 (1.40-1.76) for breast cancer, 1.52 (1.12-2.05) for bladder cancer, and 1.37 (1.08-1.73) for liver cancer. The OR for circulatory system diseases was 1.92 (1.29-2.85), with a value of 2.29 (1.26-4.159) for stroke. The OR of respiratory system diseases was 1.76 (1.13-2.74), with a value of 1.82 (1.07-3.11) for childhood asthma. The original ORs were also shown for other diseases. Subgroup analyses were performed for lung and breast cancer. The ORs varied according to time period and were significant during exposure in the household; For lung cancer, the OR was significant in women.@*CONCLUSION@#The effect of SHS exposure in China was similar to that in Western countries, but its definition and characterization require further clarification. Studies on the association between SHS exposure and certain diseases with high incidence rates are insufficient.

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Currently,the research or publications related to the clinical comprehensive evaluation of Chinese patent medicine are increasing,which attracts the broad attention of all circles. According to the completed clinical evaluation report on Chinese patent medicine,there are still practical problems and technical difficulties such as unclear responsibility of the evaluation organization,unclear evaluation subject,miscellaneous evaluation objects,and incomplete and nonstandard evaluation process. In terms of evaluation standards and specifications,there are different types of specifications or guidelines with different emphases issued by different academic groups or relevant institutions. The professional guideline is required to guide the standardized and efficient clinical comprehensive evaluation of Chinese patent medicine and further improve the authority and quality of evaluation. In combination with the characteristics of Chinese patent medicine and the latest research achievement at home and abroad,the detailed specifications were formulated from six aspects including design,theme selection,content and index,outcome,application and appraisal,and quality control. The guideline was developed based on the guideline development requirements of China Assoication of Chinese medicine. After several rounds of expert consensus and public consultation,the current version of the guideline has been developed.

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Objective:To solve international students' problems of learning difficulties and passive learning caused by language barriers in the process of biochemistry learning from the perspective of teachers in this specialty.Methods:Eighty international students were randomly divided into experimental group and control group. In the experimental group, the regional management mode was introduced in teaching, allowing students to speak mother tongues or English for group discussions on well-designed questions, and at the same time, classroom quizzes and stage tests were given, introducing formative evaluation to supervise students' learning and assess their learning performance. The control group received conventional teaching. The learning effects were assessed through a final exam and questionnaire survey. SPSS 25.0 was used to perform the Kruskal-Wallis H test and Nemenyi test. Results:Twenty-seven (75.00%) students believed that group discussion by region could deepen the discussion of questions; 27 (75.00%) no longer felt difficult, or even felt easy, to learn biochemistry; and nearly 90.00% of the students affirmed the formative evaluation mode, believing that it had positive effects on their learning attitude and behavior. In addition, the median exam score of the experimental group was 36.94% higher than that of the control class in the same year.Conclusions:Regional management combined with formative evaluation can promote international students' learning enthusiasm, improve their comprehensive achievement, and positively affect their learning behavior.

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OBJECTIVE@#No consensus exists on the relative risk ( RR) of lung cancer (LC) attributable to active smoking in China. This study aimed to evaluate the unified RR of LC attributable to active smoking among the Chinese population.@*METHODS@#A systematic literature search of seven databases was conducted to identify studies reporting active smoking among smokers versus nonsmokers in China. Primary articles on LC providing risk estimates with their 95% confidence intervals ( CIs) for "ever" "former" or "current" smokers from China were selected. Meta-analysis was used to estimate the pooled RR of active smoking.@*RESULTS@#Forty-four unique studies were included. Compared with that of nonsmokers, the pooled RR (95% CI) for "ever" "former" and "current" smokers were 3.26 (2.79-3.82), 2.95 (1.71-5.08), and 5.16 (2.58-10.34) among men, 3.18 (2.78-3.63), 2.70 (2.08-3.51), and 4.27 (3.61-5.06) among women, and 2.71 (2.12-3.46), 2.66 (2.45-2.88), and 4.21 (3.25-5.45) in both sexes combined, respectively.@*CONCLUSION@#The RR of LC has remained relatively stable (range, 2-6) over the past four decades in China. Early quitting of smoking could reduce the RR to some extent; however, completely refraining from smoking is the best way to avoid its adverse effects.

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The management of perioperative antibiotic options after lung transplantation varies widely around the world, but there is a common trend to limit antibiotic use duration. Metagenomic next-generation sequencing (mNGS) has become a hot spot in clinical pathogen detection due to its precise, rapid, and wide detection spectrum of pathogens. Thus, we defined a new antibiotic regimen adjustment strategy in the very early stage (within 7 days) after lung transplantation mainly depending on mNGS reports combined with clinical conditions to reduce the use of antibiotics. To verify the clinical effect of the strategy, we carried out this research. Thirty patients who underwent lung transplantation were finally included, whose information including etiology, antibiotic adjustment, and the effect of our strategy was recorded. Lung transplant recipients in this study were prescribed with initial antibiotic regimen immediately after surgery; their antibiotic regimens were adjusted according to the strategy. According to our study, the entire effectiveness of the strategy was 90.0% (27/30). Besides, a total of 86 samples containing donor lung tissue, recipient lung tissue, and bronchoalveolar lavage fluid (BALF) were obtained in this study; they were all sent to mNGS test, while BALF was also sent to pathogen culture. Their results showed that the positive rate of BALF samples was higher (86.67%) than that of donor's lung tissue (20.0%) or recipient's lung tissue (13.33%) by mNGS test, indicating BALF samples are more valuable than other clinical samples from early postoperative period to guide the early adjustment of antibiotics after lung transplantation. It is effective for mNGS combined with traditional methods and clinical situations to optimize antibiotic regimens in lung transplantation recipients within 7 days after surgery.

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Since the implementation of drug registration in China, the classification of Chinese medicine has greatly met the needs of public health and effectively guided the transformation, inheritance, and innovation of research achievements on traditional Chinese medicine(TCM). In the past 30 years, the development of new Chinese medicine has followed the registration transformation model of " one prescription for single drug". This model refers to the R&D and registration system of modern drugs, and approximates to the " law-abiding" medication method in TCM clinic, while it rarely reflects the sequential therapy of syndrome differentiation and comprehensive treatment with multiple measures. In 2017, Opinions on Deepening the Reform of Review and Approval System and Encouraging the Innovation of Drugs and Medical Devices released by the General Office of the CPC Central Committee and the General Office of the State Council pointed out that it is necessary to " establish and improve the registration and technical evaluation system in line with the characteristics of Chinese medicine, and handle the relationship between the traditional advantages of Chinese medicine and the requirements of modern drug research". Therefore, based on the development law and characteristics of TCM, clinical thinking should be highlighted in the current technical requirements and registration system of research and development of Chinese medicine. Based on the current situation of registration supervision of Chinese medicine and the modern drug research in China, the present study analyzed limitations and deficiency of " one prescription for single drug" in the research and development of Chinese medicine. Additionally, a new type of " series prescriptions" was proposed, which was consistent with clinical thinking and clinical reality. This study is expected to contribute to the independent innovation and high-quality development of the TCM industry.

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OBJECTIVE: To evaluate the prognostic value of transthoracic lung ultrasound comet-tail and extravascular lung water index (EVLWI) in septic patients. METHODS: A prospective cohort study was conducted. Sixty septic patients admitted to department of intensive care unit (ICU) of Sichuan Provincial People's Hospital from November 2016 to October 2019 were enrolled. The EVLWI and pulmonary vascular permeability index (PVPI) were determined by pulse-indicated continuous cardiac output (PiCCO) system at 0, 24, 48 and 72 hours. At the same time, the numbers of comet tail signs in both lungs (parasternal, midclavicular, axillary to midaxillary) were collected by chest ultrasound. Moreover, arterial blood gas analysis, such as pH value, central venous-to-arterial carbon dioxide difference (Pcv-aCO2), central venous oxygen saturation (ScvO2), blood lactic acid (Lac), PaO2/FiO2 were measured. Pearson correlation analysis was performed between the number of comet-tail sign and EVLWI. Multivariate Logistic regression model was used to analyze the relationship between the number of comet-tail sign, EVLWI and prognosis. Receiver operator characteristic curve (ROC curve) was drawn to predict the prognosis. RESULTS: There were 43 males and 17 females in 60 septic patients. The average age was (64.3±15.5) years old (range: 31-83 years old). There were 35 cases with pulmonary infection, 10 cases with abdominal infection, 6 cases with urinary tract infection, 3 cases with skin and soft tissue infection, 3 cases with intestinal infection, 1 case with meningitis, 1 case with cellulitis and 1 case with multiple injury. Acute respiratory distress syndrome (ARDS) occurred with 8 patients; 40 patients (66.7%) survived and 20 patients (33.3%) died on day 28. Pearson correlation analysis showed that the number of comet-tail sign was positively correlated with EVLWI (r = 0.944, P < 0.001). There was significant difference in the number of comet-tail signs among sepsis patients with different primary infection sites (H = 17.714, P < 0.001). The number of comet-tail signs in sepsis patients with pulmonary infection [19 (13, 27)] was significantly higher than that with other infections. The number of comet-tail sign in patients with ARDS was significantly higher than that in patients without ARDS [27 (19, 30) vs. 15 (9, 24), H = 25.387, P < 0.001]. Multivariate Logistic regression analysis showed that EVLWI, the number of comet-tail signs and PVPI were independent risk factors for death in septic patients [odds ratio (OR) and 95% confidence interval (95%CI) were 10.772 (1.161-99.851), 2.360 (1.070-5.202), 2.042 (1.152-3.622), all P < 0.05]. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value of Logistic regression model based on comet-tail sign and EVLWI were 90.0%, 90.0%, 90.0%, 81.8%, 94.7%, respectively, and area under curve (AUC) were 0.926±0.018, 95%CI was 0.912-0.975, P < 0.001. CONCLUSIONS: The transthoracic lung ultrasound comet-tail in septic patients is significantly correlated with EVLWI monitored by PiCCO. The transthoracic lung ultrasound comet-tail combined with EVLWI can better improve the sensitivity, specificity and accuracy of 28-day prognosis in septic patients.

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Esophageal cancer is a malignant tumor with a five-year survival rate of less than 20%. Early diagnosis and exploration of esophageal cancer pathogenesis are of great significance for the treatment and prognosis of esophageal cancer. Long non-coding RNA (lncRNA) plays a vital role in the occurrence and development of different types of tumors. However, the role of exosome LncRNA in esophageal squamous cell carcinoma (ESCC) is rarely reported. In this study, we detected high expression of lncRNA LINC01711 in ESCC tissues and was associated with poor prognosis. Silencing LINC01711 can inhibit the proliferation, migration, invasion, and growth of ESCC cell lines, and induce apoptosis. Linc01711 was identified as a competitive endogenous RNA that suppressed miR-326, and up-regulated the expression of fascin actin-bundling protein 1 (FSCN1). Besides, in vivo experiments showed that the administration of exosome-derived LINC01711 (LINC01711-Exo) promoted the growth of tumors in nude mice. In general, exosomal LINC01711 promoted the proliferation, migration, and invasion of esophageal cancer cells by up-regulating FSCN1 and down-regulating miR-326, thus improved the occurrence and development of ESCC.

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In January 2012, a serious accident polluted the Longjiang River with high concentrations of cadmium (Cd) and other concomitant metals and metalloids in the water. After emergency treatment (i.e., the addition of coagulants), these metals and metalloids were transferred from the water into the sediment through precipitation of the flocculent materials produced. In this study, the long-term distribution of six metals and metalloids in the sediment of the Longjiang River was investigated and their ecological risks were assessed. Approximately 1 year after the accident (i.e., late 2012), the average Cd content in the sediment of the affected sites decreased to 25.6 ± 19.5 mg/kg, which was 8 times higher than that of 3.16 ± 3.18 mg/kg in the upstream reference sites. In 2016 and 2017, the average Cd content in the sediment of the affected sites further decreased to 4.91 ± 2.23 and 6.27 ± 4.27 mg/kg, respectively. Compared with late 2012, the amounts of Zn, Pb, and Cu obviously decreased in 2016 and 2017, whereas there were no obvious differences in the As and Hg amounts during 3 years considered. Among metals and metalloids, the average contribution of Cd to the potential ecological risk index (RI) was 90%, 69%, and 70% in the affected areas in 2012, 2016, and 2017, respectively, suggesting that Cd was the most important factor affecting the ecological risk of metals in the Longjiang River. It should be noted that the average contribution of Hg to RI in the affected areas increased from 8% in 2012 to 25% and 23% in 2016 and 2017, respectively. The sequence of contribution of six elements was Cd > Hg > As>Pb > Cu ≈ Zn. A high ecological risk of metals and metalloids was found in the sediments of two reservoirs, probably owing to the barrier effect of the dam. This study will be useful for the environmental management of rivers affected by accidental pollution of metals and metalloids.

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Objective:To evaluate the prognostic value of transthoracic lung ultrasound comet-tail and extravascular lung water index (EVLWI) in septic patients.Methods:A prospective cohort study was conducted. Sixty septic patients admitted to department of intensive care unit (ICU) of Sichuan Provincial People's Hospital from November 2016 to October 2019 were enrolled. The EVLWI and pulmonary vascular permeability index (PVPI) were determined by pulse-indicated continuous cardiac output (PiCCO) system at 0, 24, 48 and 72 hours. At the same time, the numbers of comet tail signs in both lungs (parasternal, midclavicular, axillary to midaxillary) were collected by chest ultrasound. Moreover, arterial blood gas analysis, such as pH value, central venous-to-arterial carbon dioxide difference (Pcv-aCO 2), central venous oxygen saturation (ScvO 2), blood lactic acid (Lac), PaO 2/FiO 2 were measured. Pearson correlation analysis was performed between the number of comet-tail sign and EVLWI. Multivariate Logistic regression model was used to analyze the relationship between the number of comet-tail sign, EVLWI and prognosis. Receiver operator characteristic curve (ROC curve) was drawn to predict the prognosis. Results:There were 43 males and 17 females in 60 septic patients. The average age was (64.3±15.5) years old (range: 31-83 years old). There were 35 cases with pulmonary infection, 10 cases with abdominal infection, 6 cases with urinary tract infection, 3 cases with skin and soft tissue infection, 3 cases with intestinal infection, 1 case with meningitis, 1 case with cellulitis and 1 case with multiple injury. Acute respiratory distress syndrome (ARDS) occurred with 8 patients; 40 patients (66.7%) survived and 20 patients (33.3%) died on day 28. Pearson correlation analysis showed that the number of comet-tail sign was positively correlated with EVLWI ( r = 0.944, P < 0.001). There was significant difference in the number of comet-tail signs among sepsis patients with different primary infection sites ( H = 17.714, P < 0.001). The number of comet-tail signs in sepsis patients with pulmonary infection [19 (13, 27)] was significantly higher than that with other infections. The number of comet-tail sign in patients with ARDS was significantly higher than that in patients without ARDS [27 (19, 30) vs. 15 (9, 24), H = 25.387, P < 0.001]. Multivariate Logistic regression analysis showed that EVLWI, the number of comet-tail signs and PVPI were independent risk factors for death in septic patients [odds ratio ( OR) and 95% confidence interval (95% CI) were 10.772 (1.161-99.851), 2.360 (1.070-5.202), 2.042 (1.152-3.622), all P < 0.05]. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value of Logistic regression model based on comet-tail sign and EVLWI were 90.0%, 90.0%, 90.0%, 81.8%, 94.7%, respectively, and area under curve (AUC) were 0.926±0.018, 95% CI was 0.912-0.975, P < 0.001. Conclusions:The transthoracic lung ultrasound comet-tail in septic patients is significantly correlated with EVLWI monitored by PiCCO. The transthoracic lung ultrasound comet-tail combined with EVLWI can better improve the sensitivity, specificity and accuracy of 28-day prognosis in septic patients.

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BackgroundFalse negative results of SARS-CoV-2 nucleic acid detection pose threats to COVID-19 patients and medical workers alike. ObjectiveTo develop multivariate models to determine clinical characteristics that contribute to false negative results of SARS-CoV-2 nucleic acid detection, and use them to predict false negative results as well as time windows for testing positive. DesignRetrospective Cohort Study (Ethics number of Tongji Hospital: No. IRBID: TJ-20200320) SettingA database of outpatients in Tongji Hospital (University Hospital) from 15 January 2020 to 19 February 2020. Patients1,324 outpatients with COVID-19 MeasurementsClinical information on CT imaging reports, blood routine tests, and clinic symptoms were collected. A multivariate logistic regression was used to explain and predict false negative testing results of SARS-CoV-2 detection. A multivariate accelerated failure model was used to analyze and predict delayed time windows for testing positive. ResultsOf the 1,324 outpatients who diagnosed of COVID-19, 633 patients tested positive in their first SARS-CoV-2 nucleic acid test (47.8%), with a mean age of 51 years (SD=14.9); the rest, which had a mean age of 47 years (SD=15.4), tested negative in the first test. "Ground glass opacity" in a CT imaging report was associated with a lower chance of false negatives (aOR, 0.56), and reduced the length of time window for testing positive by 26%. "Consolidation" was associated with a higher chance of false negatives (aOR, 1.57), and extended the length of time window for testing positive by 44%. In blood routine tests, basophils (aOR, 1.28) and eosinophils (aOR, 1.29) were associated with a higher chance of false negatives, and were found to extend the time window for testing positive by 23% and 41%, respectively. Age and gender also affected the significantly. LimitationData were generated in a large single-center study. ConclusionTesting outcome and positive window of SARS-CoV-2 detection for COVID-19 patients were associated with CT imaging results, blood routine tests, and clinical symptoms. Taking into account relevant information in CT imaging reports, blood routine tests, and clinical symptoms helped reduce a false negative testing outcome. The predictive AFT model, what we believe to be one of the first statistical models for predicting time window of SARS-CoV-2 detection, could help clinicians improve the accuracy and efficiency of the diagnosis, and hence, optimizes the timing of nucleic acid detection and alleviates the shortage of nucleic acid detection kits around the world. Primary Funding SourceNone.

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BackgroundThe recent outbreak of the novel coronavirus in December 2019 (COVID-19) has activated top-level response nationwide. We developed a new treatment model based on the online-to-offline (O2O) model for the home isolated patients, because in the early stages the medical staff were insufficient to cope with so many patients. MethodsIn this single-centered, retrospective study, we enrolled 48 confirmed/suspected COVID-19 patients who underwent home isolation in Wuhan between January 6 and January 31, 2020. By WeChat and online document editing all patients were treated with medical observation scale. The clinical indications such as Fever, Muscle soreness, Dyspnea and Lack of strength were collected with this system led by medical staff in management, medicine, nursing, rehabilitation and psychology. FindingsThe mean age of 48 patients was 39{middle dot}08{+/-}13{middle dot}88 years, 35(72{middle dot}9%) were women. Compared with non-hospitalized patients, inpatients were older([≥]70years, 2{middle dot}4% vs 33{middle dot}3%, P<0{middle dot}04). All inpatients had fever, 50% inpatients had coughs and showed infiltration in both lungs at the time of diagnosis. 33{middle dot}3% inpatients exhibited negative changes in their CT results at initial diagnosis. The body temperature of non-hospitalized patients with mild symptoms returned to normal by day 4-5. While dyspnea peaked on day 6 for non-hospitalized patients with mild symptoms, it persisted in hospitalized patients and exacerbated over time. The lack of strength and muscle soreness were both back to normal by day 4 for non-hospitalized patients. InterpretationMonitoring the trends of symptoms is more important for identifying severe cases. Excessive laboratory data and physical examination are not necessary for the evaluation of patients with mild symptoms. The system we developed is the first to convert the subjective symptoms of patients into objective scores. This type of O2O, subjective-to-objective strategy may be used in regions with similar highly infectious diseases to minimize the possibility of infection among medical staff.

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Background: Tumor necrosis factor-alpha (TNF-α) is a major proinflammatory cytokine that has been posited to be involved in the development of chronic pancreatitis (CP). Several studies have been carried out that explored the association between the TNF-α -308A/G polymorphism and CP; however, conflicting results have emerged. The aim of this study was to perform a meta-analysis to provide a more precise assessment of the relationship between the TNF-α -308A/G polymorphism and CP risk. Methods: Case-control studies were identified using PubMed, Embase, Web of Science, Cochrane Library, and Chinese National Knowledge Infrastructure through January 2019 from which seven were identified that met all inclusion criteria. Results: This meta-analysis included 695 CP cases and 742 controls. A positive association was found between the A allele and the risk of CP using the additive model (OR [odds ratio] = 1.83, 95% CI [confidence interval] = 1.08-3.10). We also found, after excluding the Hardy-Weinberg equilibrium-violating studies, that the AA genotype was significantly associated with CP in both the additive and recessive models (OR = 2.28, 95% CI = 1.27-4.07; OR = 2.19, 95% CI = 1.26-3.81). Conclusion: This meta-analysis indicates that the A allele of the TNF-α -308A/G polymorphism increases the risk of CP.

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Emergent cadmium pollution can cause water quality deterioration in rivers, which destroys the aquatic eco-environment and poses threats to human health. Fish species in these aquatic systems are prone to such pollution incidents and act as important indicators of the pollution level. Because cadmium enters the systematic circulation of fish and is non-biodegradable, the investigation of cadmium accumulation in fish bodies provides insights into the detrimental effects of cadmium pollution on the aquatic biological system. This research aims to validate the eco-environmental risks associated with emergent cadmium pollution incidents based on the investigation of the different tissues and organs of diverse fish species. The investigation was conducted six times along the Longjiang River using sampling methods during which all fish species were also classified and analyzed based on the water layer they reside in and their feeding habits. The results show that the cadmium concentration in the fish tissues is significantly higher in the former three investigations compared with that of the latter three analyses. For herbivorous, carnivorous, and omnivorous fish species, the cadmium concentration of their different tissues and organs follows the order:kidney > liver > gut > gill > egg > scale ≈ muscle. The cadmium concentration in the kidney is significantly higher (P<0.05) than that in any other organs of the fish species. This agrees with the fact that the kidney intensively metabolizes and accumulates heavy metals. The cadmium concentration in the same tissues or organs of the fish species living in different water layers follows the trend:demersal fish species > middle lower-layer species > middle upper-layer species. The sequence of the cadmium bioaccumulation factors in the muscles of different fish species is omnivore > carnivorous > herbivorous, that is, 8.32, 6.33, and 5.15, respectively, while the bioaccumulation factors in the muscles of the fish species in different water layers decrease in the following sequence:demersal fish species (8.18) > middle bottom-layer fish species (7.70) > middle upper-layer fish species (4.99). These experimental results indicate the biomagnification effects in heavy metal-polluted aquatic environments, where the bioaccumulation of heavy metals by fish is related to both the overall pollution level and local residential environment.

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20(S)-protopanaxadiol (PPD)-type ginsenosides are generally believed to be the most pharmacologically active components of Panax ginseng. These compounds induce apoptotic cell death in various cancer cells, which suggests that they have anti-cancer activity. Anti-angiogenesis is a promising therapeutic approach for controlling angiogenesis-related diseases such as malignant tumors, age-related macular degeneration, and atherosclerosis. Studies showed that 20(S)-PPD at low concentrations induces endothelial cell growth, but in our present study, we found 20(S)-PPD at high concentrations inhibited cell growth and mediated apoptosis in human umbilical vein endothelial cells (HUVECs). The mechanism by which high concentrations of 20(S)-PPD mediate endothelial cell apoptosis remains elusive. The present current study investigated how 20(S)-PPD induces apoptosis in HUVECs for the first time. We found that caspase-9 and its downstream caspase, caspase-3, were cleaved into their active forms after 20(S)-PPD treatment. Treatment with 20(S)-PPD decreased the level of Bcl-2 expression but did not change the level of Bax expression. 20(S)-PPD induced endoplasmic reticulum stress in HUVECs and stimulated UPR signaling, initiated by protein kinase R-like endoplasmic reticulum kinase (PERK) activation. Total protein expression and ATF4 nuclear import were increased, and CEBP-homologous protein (CHOP) expression increased after treatment with 20(S)-PPD. Furthermore, siRNA-mediated knockdown of PERK or ATF4 inhibited the induction of CHOP expression and 20(s)-PPD-induced apoptosis. Collectively, our findings show that 20(S)-PPD inhibits HUVEC growth by inducing apoptosis and that ATF4 expression activated by the PERK-eIF2α signaling pathway is essential for this process. These findings suggest that high concentrations of 20(S)-PPD could be used to treat angiogenesis-related diseases.

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During typhoon "Mujigae" in October 2015, water samples and surface sediments were collected from Gaozhou Reservoir, a drinking water reservoir, for simulation and analysis of the kinetics of suspended solids adsorption to nitrogen and phosphorus and the adsorption isotherms of suspended solids with different particle sizes and different concentrations. The results showed no obvious nitrogen adsorption of suspended solids of Gaozhou Reservoir. However, the adsorption effect to phosphorus by suspended solids was significant and the equilibrium time of phosphorus adsorption was 10 hours. The adsorption capacity of phosphorus increased with the decrease of sediment particle size when particle sizes were less than 0.25 mm, whereas it increased with the increase of suspended solids concentration when the concentration was in the range of 0.2-2.0 kg·m-3. The adsorption isotherm of suspended solids to phosphorus conformed to the Langmuir and Freundlich models, and the maximum adsorption capacity increased with the decrease of suspended solids particle sizes, which increased with the increase of suspended solids concentrations. The maximum adsorption capacity of suspended solids to phosphorus was 0.073-1.776 mg·g-1. These results indicated that the increase of suspended solids concentration due to the heavy rainfall of the typhoon promoted the adsorption of suspended solids to phosphorus, which reduced eutrophication in Gaozhou Reservoir.

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RESUMEN

In early January 2012, the Longjiang River was subjected to a serious cadmium (Cd) pollution accident, which led to negatively environmental and social impacts. A series of measures of emergency treatment were subsequently taken to reduce water Cd level. However, little information was available about the change of Cd level in environmental matrices and long-term effect of this pollution accident to aquatic ecosystem. Thus, this study investigated the distribution of Cd in water and sediment of this river for two years since pollution accident, as well as assessed its ecological risk to aquatic ecosystem of Longjiang River. The results showed that it was efficient for taking emergency treatment measures to decrease water Cd concentration to below the threshold value of national drinking water quality standard of China. There was high risk (HQ > 1) to aquatic ecosystem in some of reaches between February and July 2012, but low or no risk (HQ < 1) between December 2012 to December 2013. Cd concentration in sediment in polluted reaches increased after pollution accident and emergency treatments in 2012, but decreased in 2013. During flood period, the sediment containing high concentration of Cd in Longjiang River was migrated to downstream Liujiang River. Cd content in sediment was reduced to background level after two years of the pollution accident occurrence. The study provides basic information about Cd levels in different media after pollution accident, which is helpful in evaluating the effectiveness of emergency treatments and the variation of ecological risk, as well as in conducting water management and conservation.

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