Safety and efficacy of jaktinib in the treatment of Janus kinase inhibitor-naïve patients with myelofibrosis: Results of a phase II trial.

Myelofibrosis (MF) is associated with several constitutional symptoms. Currently, there are few therapeutic options for MF. Jaktinib, a novel, small-molecule inhibitor of JAK, is currently being studied for its potential to treat MF. This phase 2 trial investigated efficacy and safety of jaktinib in the treatment of MF patients. The primary end point was the proportion of patients with ≥35% reduction in spleen volume (SVR35, proportion of patients with ≥35% reduction in spleen volume) at week 24. The secondary end points included improvement of anemia, rates of symptom response, and safety profile. Between January 8, 2019 and August 29, 2020, 118 patients were recruited and treated with either jaktinib 100 mg BID or 200 mg QD. At week 24, 54.8% (34/62) of patients in the 100 mg BID group and 31.3% (15/48) in the 200 mg QD group achieved SVR35 (p = .0199). Jaktinib treatment increased hemoglobin level to ≥20 g/L in 35.6% (21/59) of patients with hemoglobin ≤100 g/L at baseline. The proportion of patients who achieved a ≥50% improvement in total symptom score at week 24 was 69.6% (39/56) in the BID group and 57.5% (23/40) in the QD group. The most common ≥ grade 3 hematological treatment-emergent adverse events (TEAEs; ≥ 10%) were anemia (100 mg BID: 24.2%, 200 mg QD: 28.8%), thrombocytopenia (16.7%, 11.5%), and neutropenia (3.0%, 11.5%). All non-hematological TEAEs were mild. These results indicate that jaktinib can shrink the spleen, improve anemia, and other clinical symptoms with good tolerability.

Antibiotic prescriptions by medical interns in Hong Kong: influence of the hospital settings and prescription culture.

BACKGROUND: Inappropriate antibiotic prescribing practices predispose to resistance emergence. Despite the inclusion of the topic in medical school curricula worldwide, it is uncertain whether newly graduated medical interns have confidence in proper antibiotic prescription. OBJECTIVES: This study aimed to explore the antibiotic prescribing behaviours of the medical interns in Hong Kong and their barriers to appropriate antibiotic prescription. METHODS: Two focus groups were conducted among medical interns with training experiences in different public hospitals. Their prescribing behaviours and barriers were further examined with a questionnaire survey just before completion of internship. RESULTS: Focus group interviews identified a variety of hospital workplace cultures, including inappropriate empirical prescriptions and dosages, interns' passive roles in prescribing antibiotics and varied guidelines between different departments. Defensive medicine and lack of clinical experience were other barriers encountered. The interns believed that the incorrect practice learnt would perpetuate in their minds and affect their future practice. The top barriers reported by the survey respondents were adaptation to prescription culture of different hospitals (93.5%), lack of experience in antibiotic prescription (88.3%), inadequate knowledge in the choice of antibiotics (85.7%) and compliance with the seniors' instructions (80.6%). However, some focus group participants perceived weaker barriers in paediatric departments which provided close monitoring of antibiotic use. CONCLUSIONS: Inadequate knowledge and low confidence in antibiotic prescription led to the passive role of medical interns in antibiotic prescription, predisposing to future inappropriate practice. Inconsistent guidelines and prescription cultures between different hospitals and departments might further exacerbate their barriers.

[Effects of weeds on crops and their ecological control in ecological agriculture of Chinese materia medica].

Weeds is one of the important parts of agricultural ecosystem of Chinese materia medica. Weeds is a double-edged sword with advantages and disadvantages for the cultivated medicinal plants. In this study, we firstly analyzed the positive and negative effects of weeds on the yield and quality of Chinese materia medica. We then explored the possible mechanisms for the weeds' positive effects from the aspects of interspecific relationship, soil microecological environment, light environment, natural control of pests and so on. We also summarized three basic principles of weed control, that is, "making medicinal plants and weeds coexist harmoniously, achieving the overall optimum growth of medicinal plants", "prevention first, integrated control" and "preserving beneficial weeds and increasing their beneficial effects, removing harmful weeds and control their adverse effects". Finally, we introduced several common weed ecological control technology in field of the cultivated medicinal plants in China, including technology of controlling weeds by no-tillage, stral mulch, rotation, alternative herbs, competitive crops, and allelopathy. This study is aimed to apply the ecology theory to guide weed management and control, so as to achieve the goal of advantages promotion and disadvantages elimination of weeds to cultivated medicinal plants, making weeds into treasure and to promote the sustainable and healthy development of Chinese medicinal materials production and the protection of weed diversity.

Factors that facilitate recognition and management of domestic violence by primary care physicians in a Chinese context - a mixed methods study in Hong Kong.

BACKGROUND: Domestic violence is common in the community. Many of its victims present to primary care physicians (PCPs) but are not being recognized and managed. The barriers, with specific reference to a Chinese cultural context, were investigated earlier. This paper explored the factors which facilitated the process of recognizing and managing suspected cases of domestic violence by PCPs in Hong Kong. METHODS: Four focus group interviews were conducted to explore in-depth the experiences of PCPs in recognition, management and referral of domestic violence cases from which facilitators were identified. The relevant themes were then investigated in a questionnaire survey with 504 PCPs working in public and private sectors. RESULTS: The focus group participants emphasized mood symptoms as useful indicators for probable abuse and continuity of care was important to unmask issues of domestic violence. The top facilitators perceived by the respondents of the survey included: a trusting doctor-patient relationship (99.8%), good communication skills (99.0%), patients' unexplained bruises (96.3%), medical history (94.6%), and mood symptoms (94.4%). Further, the survey found that PCPs with longer years of practice, a medical degree obtained from Western countries, and postgraduate training in family counselling or psychological medicine perceived more facilitators in managing domestic violence. CONCLUSIONS: Without a local screening policy and training protocol to manage domestic violence, PCPs regarded their skills in mental healthcare and good relationships with patients as the key facilitators. While training in mental health care helps PCPs manage domestic violence, a specific protocol emphasizing medical-social collaboration is anticipated to facilitate them to take a more proactive and effective stance from screening to management.

Associations between demographic factors and psychological distress among Chinese residents in Hong Kong: beyond socioeconomic classes.

Most studies highlighted the association between psychological distress and socioeconomic status (SES). There were weaker explanations for distress found in the middle classes, especially in Asian countries. We conducted a questionnaire survey with 1626 adult Chinese primary-care attenders from 13 private and 6 public clinics in different districts of Hong Kong. Their demographic background and distress level measured by GHQ-12 were analysed. We found that respondents with younger age, better education, and lower income were more likely to be distressed. In a multiple logistic regression model, age and income, but not education, were significant predictors for distress. Highest rates of distress were found among the unemployed (45.5%) and the students (37.1%), followed by service workers and shop sales workers (33.0%), associate professionals (32.0%), and clerks (29.2%). Craftworkers (9.1%), plant and machine operators (11.5%), and retired people (12.8%) were least likely to be distressed, followed by professionals (21.0%). Apart from SES, the findings suggest that young age, academic and job stressors, and low self-esteem are significant factors for distress. These factors may be intensified in a Chinese context by peer comparison resulting in a state of relative deprivation.

Computed Tomography (CT)-Guided Percutaneous Thoracic Sympathetic Chain Radiofrequency Thermocoagulation for Raynaud Disease.

BACKGROUND We introduce a minimally invasive technique for the treatment of Raynaud disease - CT-guided percutaneous thoracic sympathetic chain radiofrequency thermocoagulation. MATERIAL AND METHODS Under CT guidance, the radiofrequency needle was punctured from the upper edge of the costotransverse joint to the anterior superior edge of the 4th capitulum costae and the lateral parietal pleura. After sensorial (1.5 mA, 50 Hz) and motorial (1.5 mA, 2Hz) testing to determine that there was no nerve innervation zone with muscle numbness and twitches, radiofrequency coagulation was set at 95°C for 300 s. RESULTS A total of 17 patients were enrolled in the treatment group. All the patients underwent CT-guided percutaneous thoracic sympathetic chain puncture of the needles to the upper edge of the 4th capitulum costae on both sides. The perfusion index (PI) of the fingers began to rise 30 s after radiofrequency thermocoagulation, and the palm temperature (T) began to rise after 90 s. At the end of treatment, PI increased by an average of 4.6-fold, and the T average rose by 3.6°C. Postoperative cold-water stimulation testing could no longer induce Raynaud disease. Follow-up was conducted for 1 to 15 months. Two patients were found to have recurrence at 9 months and 13 months, respectively. CONCLUSIONS CT-guided percutaneous thoracic sympathetic nerve chain radiofrequency coagulation can effectively treat Raynaud disease.

Early vs late fracture fixation in severe head and orthopedic injuries.

BACKGROUND: Patients suffered from craniocerebral trauma with extermities fracture is one of the most common multiple injuries.Actually there is no comparative study demonstrating advantages of early or delayed treatment of skeletal injuries. PURPOSES: To conduct a meta-analysis with studies published in full text to demonstrate database to show the associations of perioperative, postoperative outcomes of early fracture fixation(EFF) and late fracture fixation(LFF) for patients with severe head and orthopedic injuries to provide the predictive diagnosis for clinic. PATIENTS AND METHODS: Literature search was performed in PubMed, Embase, Web of Science and Cochrane Library for information from the earliest date of data collection to October 2017. Studies comparing the perioperative, postoperative outcomes of EFF with those of LFF patients with severe head and orthopedic injuries were included. Statistical heterogeneity was quantitatively evaluated by ×2 test with the significance set P<0.10 or I2>50%. RESULTS: Thirteen papers consisting of 2941 patients were included (1224EFF patients; 1717 LFF patients). The results showed that EFF was related to a greater increase in blood loss, intraoperative blood infusion, crystalloid, hypotension, hypoxia, length of surgery, non-neurologic complications and mortality(P<0.1). No differences in ICU days, hospital days, neurologic complications and GCS on discharge scores (P>0.1). CONCLUSIONS: Compared with LFF patients, EFF patients demonstrated an increased risk of perioperative and postoperative complications and clear difference about complications between EFF and LFF about patients with severe head and orthopedic injuries. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Regulation of Lipolysis in Adipose Tissue and Clinical Significance.

Lipolysis is a critical process to hydrolyze triglyceride in adipose tissue, thereby breaking down the stored lipid and maintaining energy homeostasis. Recent studies have made significant progress in understanding the steps of lipolysis. This chapter discusses the major pathways that regulate lipolysis in adipose tissue. Specifically we focus on the mechanisms by which the activities of critical lipolytic enzymes are regulated. We further discuss how the lipolysis is regulated by other factors, including insulin and neurotransmitters, in particular catecholamines and the role of sympathetic nervous system in the whole process. Finally we provide clinical perspectives about the novel therapeutic strategies to target or promote adipose tissue lipolysis for treatment/prevention of obesity and type 2 diabetes.

[Progress in researches on pathogens, epidemiology and integrated control of diseases on Salvia miltiorrhiza in China].

Danshen (Salvia miltiorrhiza) is a perennial herbal plant as a bulk commodity of traditional Chinese medicinal material. With the growing market demand, the planting scale of Danshen has been fast enlarged. The occurance of diseases on Danshen has become as a major threaten of its production. Root diseases are most devastated on Danshen. Rootrot is the most important disease, and Fusarium wilt comes second. Leaf spot occurs most on aerial part of Danshen. In the Danshen industry, the chemical control is most commonly used, with biological agents as supplements. This review summarized the symptom, pathogen, epidemiology, and control method of 7 diseases on Danshen (rootrot, Fusarium wilt, southern blight, root knot nematode, leaf spot, leaf red and virus diseases), providing guidelines for disease diagnostics, pathogen isolation and identification, proper pesticide application and integrated control.

A Chinese help-seeking model for psychological distress in primary care: An adaptation of Andersen's Behavioral Model of Health Services Use.

Help-seeking for depression and anxiety disorders from primary care physicians in Western countries is at three times the rate of China. Western help-seeking models for common mental disorders have limitations in the Chinese settings. This article argues that an adapted model based on Andersen's Behavioral Model of Health Services Use could be an appropriate tool to better understand patients' help-seeking behaviors and improve outcomes. We applied a narrative review approach to integrate research findings from China into Andersen's model to generate a model that fits the Chinese context. We found 39 relevant articles in PubMed, MEDLINE, and Chinese journal databases from 1999 to 2022. Findings were mapped onto predisposing, enabling, and need factors of the model. This model emphasizes that predisposing factors including demographics, social norms, and health beliefs influence help-seeking preferences. Mental health service users in China tend to be older and female. Chinese generally have high concern about psychotropic medications, and social norms that consider psychological distress a personal weakness may discourage help-seeking. However, help-seeking can be enhanced by enabling factors in the health system, including training of primary care physicians, longer consultation time, and continuity of care. Need factors for treatment increase with the severity of distress symptoms, and doctor's skills and attitudes in recognizing psychosomatic symptoms. While predisposing factors are relatively hard to change, enabling factors in the health system and need factors for treatment can be targeted by enhancing the role of family doctors and training in mental health.

Exolaccase Propels Humification to Decontaminate Bisphenol A and Create Humic-like Biostimulants.

Exolaccase-propelled humification (E-PH) helps eliminate phenolic pollutants and produce macromolecular precipitates. Herein, we investigated the influencing mechanism of 12 humic precursors (HPs) on exolaccase-enabled bisphenol A (BPA) decontamination and humification. Catechol, vanillic acid, caffeic acid, and gentian acid not only expedited BPA removal but also created large amounts of copolymeric precipitates. These precipitates had rich functional groups similar to natural humic substances, which presented great aromatic and acidic characteristics. The releasing amounts of BPA monomer from four precipitates were 0.08-12.87% at pH 2.0-11.0, suggesting that BPA-HP copolymers had pH stability. More excitingly, certain copolymeric precipitates could stimulate the growth and development of radish seedlings. The radish growth-promotion mechanisms of copolymers were involved in two aspects: (1) Copolymers interacted with root exudates to accelerate nutrient uptake; (2) Copolymers released auxins to provoke radish growth. These results may provide an innovative strategy for decontaminating phenolic pollutants and yielding humic-like biostimulants in E-PH.

Family Facilitators of, Barriers to and Strategies for Healthy Eating among Chinese Adolescents: Qualitative Interviews with Parent-Adolescent Dyads.

Healthy eating is vital in preventing obesity and long-term non-communicable diseases. This study explores potential family facilitators of, barriers to and strategies for healthy eating among adolescents in Chinese families to guide the development of effective interventions in the future. Parent-adolescent dyads were purposively sampled by age, gender, fruit and vegetable intake and household income. Key family factors were identified by thematic analysis. Fourteen themes under five domains were identified: family health with (1) illness experienced in the family; parental knowledge of (2) dietary recommendations, (3) the preparation of healthy food and (4) healthy food choice; parental attitudes towards (5) the importance of healthy eating and (6) the priority of family health; socioeconomic factors of (7) time concerns and (8) cost concerns; and food parenting practices in (9) nutritional education, (10) role modeling, (11) food provision, (12) child involvement, (13) parental supervision and (14) the cultivation of food preference. Useful strategies included incorporating healthy ingredients in adolescents' favorite recipes and providing a variety of fruit and vegetables at home. There is a need to empower parents with practical nutrition knowledge, to be more authoritative in food parenting practices, to discuss healthy eating with children and to acquire practical skills related to time- and cost-saving healthy cooking.

Extracellular laccase-activated humification of phenolic pollutants and its application in plant growth.

Humification processes of phenolic pollutants may play a profound role in environment purification and plant growth. However, little literature is performed to explore exoenzyme-driven humification to polymerize 17ß-estradiol (E2) and humic constituents (HCs), and the effects of their polymeric precipitates on plant growth are usually overlooked. Herein, E2 conversion and radish (Raphanus sativus L.) growth were systematically investigated under humification mediated by extracellular laccase (EL) of Trametes versicolor. Results disclosed that EL-assisted humification achieved a wonderful E2 conversion efficiency (>99%) within 2-h, but the presence of HCs such as humic acid (HA), vanillic acid (VA), and ferulic acid (FA) impeded E2 elimination significantly. Compared with HC-free, the kinetics constants declined by 2.84-, 5.72-, and 5.22-fold with HA, VA, and FA present, respectively. Intriguingly, three close-knit self/cross-linked precipitates (i.e., E2-HA, E2-VA, and E2-FA hybrid precipitates) in dark gray, dark brown, and deep yellow were created after a continuous humification by phenolic radical-initiated polymerization mechanisms. The formation of these humified precipitates was extremely effective on circumventing phytotoxicity caused by monomeric E2, VA, or FA. Furthermore, they acted as humic-like organic fertilizers, accelerating seed germination, root elongation, and enhancing NaCl-tolerance of radish through the combination of oxygen-contained functional components and auxin structural analogues with unstable and stubborn carbon skeletons. This is the first study reporting the pollution purification and plant growth promotion in EL-activated humification. Our findings frame valuable perspectives regarding the natural detoxification and carbon sequestration of phenolic pollutants and the application of their polymeric precipitates in global crop production.

Biological control and plant growth promotion properties of Streptomyces albidoflavus St-220 isolated from Salvia miltiorrhiza rhizosphere.

Root rot disease caused by Fusarium oxysporum is a devastating disease of Salvia miltiorrhiza and dramatically affected the production and quality of Sa. miltiorrhiza. Besides the agricultural and chemical control, biocontrol agents can be utilized as an additional solution. In the present study, an actinomycete that highly inhibited F. oxysporum was isolated from rhizosphere soil and identified as based on morphological and molecular characteristics. Greenhouse assay proved that the strain had significant biological control effect against Sa. miltiorrhiza root rot disease and growth-promoting properties on Sa. miltiorrhiza seedlings. To elucidate the biocontrol and plant growth-promoting properties of St-220, we employed an analysis combining genome mining and metabolites detection. Our analyses based on genome sequence and bioassays revealed that the inhibitory activity of St-220 against F. oxysporum was associated with the production of enzymes targeting fungal cell wall and metabolites with antifungal activities. Strain St-220 possesses phosphate solubilization activity, nitrogen fixation activity, siderophore and indole-3-acetic acid production activity in vitro, which may promote the growth of Sa. miltiorrhiza seedlings. These results suggest that St. albidoflavus St-220 is a promising biocontrol agent and also a biofertilizer that could be used in the production of Sa. miltiorrhiza.

Critical role of tetracycline's self-promotion effects in its visible-light driven photocatalytic degradation over ZnO nanorods.

Zinc oxide (ZnO), which is widely applied for ultraviolet-light driven photocatalysis, has no activity in visible-light photocatalytic process due to its large band gap of ∼3.2 eV. Herein, however, we demonstrated the multiple self-promotion effects of tetracycline as band adjuster, photo-sensitizer, and charge transfer promoter for ZnO nanorods, realizing its visible-light photocatalytic degradation with an excellent removal efficiency up to 91.1% within only 2 h. Besides, the influence of complex realistic factors on this unique process was evaluated together with tests with realistic water matrices. Furthermore, the active species and degradation products were identified. Both acute and developmental toxicities were found to be reduced as the degradation proceeds. These results pave the path for the brand-new self-driven visible-light photocatalysis.

Effectiveness of different types and levels of social distancing measures: a scoping review of global evidence from earlier stage of COVID-19 pandemic.

OBJECTIVE: Social distancing is one of the main non-pharmaceutical interventions used in the control of the COVID-19 pandemic. This scoping review aims to synthesise research findings on the effectiveness of different types and levels of social distancing measures in the earlier stage of COVID-19 pandemic without the confounding effect of mass vaccination. DESIGN: Scoping review. DATA SOURCES: MEDLINE, Embase, Global Health and four other databases were searched for eligible studies on social distancing for COVID-19 published from inception of the databases to 30 September 2020. STUDY SELECTION AND DATA EXTRACTION: Effectiveness studies on social distancing between individuals, school closures, workplace/business closures, public transport restrictions and partial/full lockdown were included. Non-English articles, studies in healthcare settings or not based on empirical data were excluded. RESULTS: After screening 1638 abstracts and 8 additional articles from other sources, 41 studies were included for synthesis of findings. The review found that the outcomes of social distancing measures were mainly indicated by changes in Rt , incidence and mortality, along with indirect indicators such as daily contact frequency and travel distance. There was adequate empirical evidence for the effect of social distancing at the individual level, and for partial or full lockdown at the community level. However, at the level of social settings, the evidence was moderate for school closure, and was limited for workplace/business closures as single targeted interventions. There was no evidence for a separate effect of public transport restriction. CONCLUSIONS: In the community setting, there was stronger evidence for the combined effect of different social distancing interventions than for a single intervention. As fatigue of preventive behaviours is an issue in public health agenda, future studies should analyse the risks in specific settings such as eateries and entertainment to implement and evaluate measures which are proportionate to the risk.

Methotrexate can prevent cardiovascular events in patients with rheumatoid arthritis: An updated meta-analysis.

AIMS: The incidence of cardiovascular events (CVEs) in patients with rheumatoid arthritis (RA) is higher than that in people without RA. This may be because inflammation promotes the progression of atherosclerosis. Anti-inflammatory drugs might reduce the occurrence of CVEs in patients with RA. Methotrexate (MTX) is a conventional synthetic anti-rheumatic drug that is widely used in the treatment of RA. We performed a meta-analysis to determine whether MTX can prevent CVEs in RA patients. Then, we discussed the possibility of using MTX to prevent recurred CVEs in patients with coronary heart disease (CHD). METHODS: We searched PubMed, Embase, Web of Science, and the Cochrane Library using the key words "methotrexate," "cardiovascular," "acute coronary syndrome," "coronary heart disease," "myocardial infarction," "angina pectoris," and "rheumatoid arthritis." The efficacy outcome was defined as a composite of CVEs, including stable angina, acute coronary syndrome, stroke, heart failure, and cardiac death. RESULTS: A total of 10 studies and 195,416 RA patients were included in our meta-analysis, and the effect size of relative risk (RR) was pooled using a fixed effect model. The results showed that MTX prevented CVEs in RA patients (RR: 0.798, 95% CI 0.726-0.876, P = .001, I2 = 27. 9%). CONCLUSION: MTX can prevent CVEs in RA patients, but there is not sufficient evidence for using MTX to treat patients with CHD.

Comparison of Short-Term Quality of Life between Percutaneous Device Closure and Surgical Repair via Median Sternotomy for Atrial Septal Defect in Adult Patients.

OBJECTIVE: To compare the quality of life and psychological state of patients after receiving different closure treatments for atrial septal defect (ASD) and to explore some factors affecting the quality of life of patients after ASD closure. METHODS: Fifty-five patients who underwent percutaneous device closure of ASD (group A) and fifty-five patients who underwent surgical repair via median sternotomy of ASD (group B) were followed up from before to one year after surgery to assess their quality of life. We used the Medical Outcomes Study 36-Item Short-Form (SF-36) and the Hospital Anxiety and Depression Scale (HADS) to evaluate the quality of life of patients. RESULTS: Both groups had improved HADS scores after operation. In the comparison of the postoperative quality of life between the two groups, group A was superior to group B on some dimensions of the SF-36, and there was a significant difference in HADS scores. Age was negatively correlated with quality of life. CONCLUSIONS: In adults over 18 years of age, the quality of life after surgical repair or percutaneous device closure of ASD improved significantly. Compared with surgical repair via median sternotomy, percutaneous device closure has a more significant effect on the improvement in some aspects of people's quality of life.

Acute promyelocytic leukemia with myelofibrosis: A case report and literature review.

RATIONALE: Acute promyelocytic leukemia (APL) with myelofibrosis (MF) is rare, and only 14 cases have been reported in the literature to date. PATIENT CONCERNS: A 42-year-old woman was admitted to the hospital with easy bruising and excessive bleeding. With the remission of the primary disease during treatment, the degree of fibrosis did not decrease, but worsened progressively. DIAGNOSIS: The woman was diagnosed with acute promyelocytic leukemia with secondary myelofibrosis. INTERVENTIONS: All-trans retinoic acid (ATRA) was discontinued after 6 months of complete remission of APL. Arsenic trioxide (ATO) was discontinued because of supraventricular tachycardia 9 months after complete remission of APL. OUTCOMES: After withdrawal of ATRA for 2 months, the degree of fibrosis was significantly alleviated, and after withdrawal of ATRA for 8 months and ATO for 5 months, bone marrow biopsy showed no reticular fiber deposition. LESSONS: In this case report and review of an additional 14 cases of APL with MF, we highlighted the importance of the degree of MF to be evaluated by bone marrow biopsy at the time of bone marrow aspiration when APL is suspected. If MF is present, the type of MF should be determined in a timely manner, and appropriate intervention measures should be taken accordingly.