Multisystem inflammatory syndrome in children with Kawasaki disease-like manifestations in MMA.

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Rapid and Ultrasensitive Detection of Plasmodium spp. Parasites via the RPA-CRISPR/Cas12a Platform.

Microscopic examination of thick and thin blood smears stained with Giemsa dye is considered the primary diagnostic tool for the confirmation and management of suspected clinical malaria. However, detecting gametocytes is relatively insensitive, particularly in asymptomatic individuals with low-density Plasmodium infections. To complement existing diagnostic methods, a rapid and ultrasensitive point-of-care testing (POCT) platform for malaria detection is urgently needed and necessary. A platform based on recombinase polymerase amplification (RPA) followed by CRISPR/Cas12a (referred to as RPA-CRISPR/Cas12a) was developed and optimized for the determination of Plasmodium spp. parasites, particularly Plasmodium falciparum, using a fluorescence-based assay (FBDA), lateral flow test strips (LFTS), or naked eye observation (NEO). Then, the established platform was assessed with clinical malaria isolates. Under optimal conditions, the detection threshold was 1 copy/µL for the plasmid, and the limit of detection was 3.11-7.27 parasites/µL for dried blood spots. There was no cross-reactivity against blood-borne pathogens. For the accuracies of RPA-CRISPR/Cas12a, Plasmodium spp. and P. falciparum testing were 98.68 and 94.74%, respectively. The method was consistent with nested PCR results and superior to the qPCR results. RPA-CRISPR/Cas12a is a rapid, ultrasensitive, and reliable platform for malaria diagnosis. The platform requires no or minimal instrumentation for nucleic acid amplification reactions and can be read with the naked eye. Compared with similar diagnostic methods, this platform improves the reaction speed while reducing detection requirements. Therefore, this platform has the potential to become a true POCT for malaria parasites.

A Rapid Antimicrobial Resistance Diagnostic Platform for Staphylococcus aureus Using Recombinase Polymerase Amplification.

Antimicrobial resistance (AMR) has posed a global threat to public health. The Staphylococcus aureus strains have especially developed AMR to practically all antimicrobial medications. There is an unmet need for rapid and accurate detection of the S. aureus AMR. In this study, we developed two versions of recombinase polymerase amplification (RPA), the fluorescent signal monitoring and lateral flow dipstick, for detecting the clinically relevant AMR genes retained by S. aureus isolates and simultaneously identifying such isolates at the species level. The sensitivity and specificity were validated with clinical samples. Our results showed that this RPA tool was able to detect antibiotic resistance for all the 54 collected S. aureus isolates with high sensitivity, specificity, and accuracy (all higher than 92%). Moreover, results of the RPA tool are 100% consistent with that of PCR. In sum, we successfully developed a rapid and accurate AMR diagnostic platform for S. aureus. The RPA might be used as an effective diagnostic test in clinical microbiology laboratories to improve the design and application of antibiotic therapy. IMPORTANCE Staphylococcus aureus is a species of Staphylococcus and belongs to Gram-positive. Meanwhile, S. aureus remains one of the most common nosocomial and community-acquired infections, causing blood flow, skin, soft tissue, and lower respiratory tract infections. The identification of the particular nuc gene and the other eight genes of drug-resistant S. aureus can reliably and quickly diagnose the illness, allowing doctors to prescribe treatment regimens sooner. The detection target in this work is a particular gene of S. aureus, and a POCT is built to simultaneously recognize S. aureus and analyze genes representing four common antibiotic families. We developed and assessed a rapid and on-site diagnostic platform for the specific and sensitive detection of S. aureus. This method allows the determination of S. aureus infection and 10 different AMR genes representing four different families of antibiotics within 40 min. It was easily adaptable in low-resource circumstances and professional-lacking circumstances. It should be supported in overcoming the continuous difficulty of drug-resistant S. aureus infections, which is a shortage of diagnostic tools that can swiftly detect infectious bacteria and numerous antibiotic resistance indicators.

Enhanced electrochemical performance of porous carbon from wheat straw as remolded by hydrothermal processing.

To improve the electrochemical properties of lignocellulose-derived carbon, wheat straw was hydrothermally processed at different temperatures followed by KOH activation for the preparation of porous carbons. Their physical, chemical, and electrochemical properties were analyzed to clarify the effects of hydrothermal processing. The results indicated that high-temperature hydrothermal processing fragmented the wheat straw and increased the heteroatoms content to make the hydrochars more conducive to activation, thereby improving the specific surface area, N-heteroatoms and phenolic hydroxyl groups of activated carbons. A maximum specific surface area of 2034.4 m2 g-1 was achieved by HAC-300 (the activated carbon derived from hydrothermally processed wheat straw at 300 °C) with more N-heteroatoms and phenolic hydroxyl groups. Correspondingly, the excellent electrochemical performance of the three-electrode supercapacitor device assembled by HAC-300 showed a specific capacitance of 286.95 F g-1 at 0.5 A g-1, representing an improvement of 89.5 % over than that of the original wheat straw without hydrothermally processing. Its symmetric supercapacitor also realized a good capacitance retention of 95.8 % after 10,000 cycles at 5 A g-1, suggesting the excellent cycling stability of the porous carbon from the hydrothermally processed wheat straw.

Changes in humoral immunity, myocardial damage, trace elements, and inflammatory factor levels in children with rotavirus enteritis.

OBJECTIVE: To investigate the changes and significance of humoral immunity, myocardial damage, trace elements and inflammatory factors levels in children with rotavirus enteritis. METHODS: One hundred children with rotavirus enteritis admitted to our hospital from January 2019 to December 2020 were retrospectively selected as the case group, and they were divided into a no dehydration group (33 cases), mild dehydration group (41 cases), and moderate dehydration group (26 cases). Another 100 children with rotavirus-negative enteritis during the same period were selected as the control group. Serum immunoglobulin, cardiac enzyme profile, trace elements, and interleukin-6 (IL-6) levels were compared between the two groups, and among the case groups for different degrees of dehydration. RESULTS: Serum immunoglobulin A (IgA), immunoglobulin G (IgG), immunoglobulin M (IgM), zinc, magnesium, and calcium in the case group were lower than in controls (P<0.05). Serum lactate dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (α-HBDH), creatine kinase (CK), and creatine kinase isoenzyme (CK-MB) in the case group were higher than in controls (P<0.05). Serum IL-6, interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α) were also higher in cases than controls (P<0.05). Serum IgA, IgG, IgM, zinc, magnesium, and calcium in children with rotavirus enteritis with mild dehydration were lower than those without dehydration, but higher than those with moderate dehydration (P<0.05). Serum LDH, α-HBDH, CK, and CK-MB in children with rotavirus enteritis with mild dehydration were higher than those without dehydration, but lower than those with moderate dehydration (P<0.05). Serum IL-6, IL-8, and TNF-α in children with rotavirus enteritis with mild dehydration were higher than those without dehydration, but lower than those with moderate dehydration (P<0.05). CONCLUSION: Children with rotavirus enteritis with more severe dehydration exhibited lower levels of humoral immunity and trace elements and greater myocardial damage and inflammatory response. Early detection can accurately assess the condition and provide a reference for clinical treatment.

A novel way to facilely degrade organic pollutants with the tail-gas derived from PHP (phosphoric acid plus hydrogen peroxide) pretreatment of lignocellulose.

The abundantly released tail-gas from lignocellulose pretreatment with phosphoric acid plus hydrogen peroxide (PHP) was found to accelerate the aging of latex/silicone textural accessories of the pretreatment device. Inspired by this, tail-gas was utilized to control organic pollutants. Methylene blue (MB), as a model pollutant, was rapidly decolorized by the tail-gas, and oxidative degradation was substantially proven by full-wavelength scanning with a UV-visible spectrometer. The tail-gas from six typical lignocellulosic feedstocks produced 68.0-98.3% MB degradation, suggesting its wide feedstock compatibility. Three other dyes, including rhodamine B, methyl orange and malachite green, obtained 97.5-99.5% degradation; moreover, tetracycline, resorcinol and hexachlorobenzene achieved 73.8-93.7% degradation, suggesting a superior pollutant compatibility. In a cytotoxicity assessment, the survival rate of the degraded MB was 103.5% compared with 80.4% for the untreated MB, implying almost no cytotoxicity after MB degradation. Mechanism investigations indicated that the self-exothermic reaction in PHP pretreatment drove the self-generated peroxy acids into tail-gas. Moreover, it heated the pollutant solution and thermally activated peroxy acids as free radicals for efficient pollutant degradation. Here, a brand-new technique for degrading organic pollutants with a "Win-Win-Win" concept was purposed for lignocellulose valorization, pollutant control by waste tail-gas, and biofuel production.

Paper mulberry fruit juice: a novel biomass resource for bioethanol production.

By way of broadening the use of diverse sustainable bioethanol feedstocks, the potentials of Paper mulberry fruit juice (PMFJ), as a non-food, sugar-based substrate, were evaluated for fuel ethanol production. The suitability of PMFJ was proven, as maximum ethanol concentration (56.4 g/L) and yield (0.39 g/g) were achieved within half a day of the start of fermentation, corresponding to very high ethanol productivity of 4.7 g/L/hr. The established potentials were further optimally maximized through the response surface methodology (RSM). At the optimal temperature of 30 °C, yeast concentration of 0.55 g/L, and pH of 5, ethanol concentration, productivity, and yield obtained were 73.69 g/L, 4.61 g/L/hr, and 0.48 g/g, respectively. Under these ideal conditions, diverse metal salts were afterward screened for their effects on PMFJ fermentation. Based on a two-level fractional factorial design, nutrient addition had no positive impact on ethanol production. Thus, under the optimal process conditions, and without any external nutrient supplementation, bioethanol from PMFJ compared favorably with typical sugar-based energy crops, highlighting its resourcefulness as a high-value biomass resource for fuel ethanol production.

Patients With Type 2 Diabetes Mellitus and Heart Failure Benefit More From Sodium-Glucose Cotransporter 2 Inhibitor: A Systematic Review and Meta-Analysis.

Background: Patients with type 2 diabetes mellitus (T2DM) and heart failure (HF) are at higher risk of mortality and hospitalization for heart failure (HHF). A recent study showed that sodium-glucose cotransporter 2 (SGLT-2) inhibitors may be a promising choice. Methods: We searched the PubMed, Embase, and Cochrane databases of clinical trials for randomized controlled trials investigating the long-term effects of SGLT-2 inhibitors in patients with T2DM and HF compared with placebo. The primary outcome was cardiovascular death or HHF, and the secondary outcomes included cardiovascular death (CV death), HHF, and all-cause mortality. We also conducted an exploratory analysis and tried to identify the population, which will benefit more from the treatment. Results: After the study selection, a total of 5 trials, including 4 subgroup analyses, met the eligibility criteria. The results suggested that the use of SGLT-2 inhibitors was associated with a reduction in the incidence of CV death or HHF (HR, 0.69[95%CI, 0.63-0.77], P<0.00001), CV death (HR, 0.80[95%CI, 0.69-0.92], P = 0.001), HHF (HR, 0.67[95%CI, 0.60-0.76], P < 0.00001), and all-cause mortality (HR, 0.74[95%CI, 0.64-0.86], P < 0.0001). Moreover, patients with T2DM and HF may benefit more from the treatment than those with T2DM/HF. Conclusion: The long-term use of SGLT-2 inhibitors can help reduce the risk of mortality and HHF in patients with T2DM and HF. Systematic Review Registration: PROSPERO [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021233156], identifier [CRD42021233156].

Effectiveness of combined exercise in people with type 2 diabetes and concurrent overweight/obesity: a systematic review and meta-analysis.

OBJECTIVE: To synthesise the available scientific evidence on the effects of combined exercise on glycaemic control, weight loss, insulin sensitivity, blood pressure and serum lipids among patients with type 2 diabetes (T2D) and concurrent overweight/obesity. DESIGN AND SAMPLE: PubMed, EMBASE, Web of Science, the Cochrane library, WANFANG, CNKI, SinoMed, OpenGrey and ClinicalTrials.gov were searched from inception through April 2020 to identify randomised controlled trials (RCTs) that reported the effects of combined exercise in individuals with T2D and concurrent overweight/obesity. METHODS: Quality assessment was performed using the Cochrane Collaboration's risk of bias tool. The mean difference (MD) with its corresponding 95% CI was used to estimate the effect size. Meta-analysis was performed using Review Manager V.5.3. RESULTS: A total of 10 RCTs with 978 participants were included in the meta-analysis. Pooled results demonstrated that combined exercise significantly reduced haemoglobin A1c (MD=-0.16%, 95% CI: -0.28 to -0.05, p=0.006); body mass index (MD=-0.98 kg/m2, 95% CI: -1.41 to -0.56, p<0.001); homeostasis model assessment of insulin resistance (MD=-1.19, 95% CI: -1.93 to -0.46, p=0.001); serum insulin (MD=-2.18 µIU/mL, 95% CI: -2.99 to -1.37, p<0.001) and diastolic blood pressure (MD=-3.24 mm Hg, 95% CI: -5.32 to -1.16, p=0.002). CONCLUSIONS: Combined exercise exerted significant effects in improving glycaemic control, influencing weight loss and enhancing insulin sensitivity among patients with T2D and concurrent overweight/obesity.

Congenital cytomegalovirus infection and the risk of hearing loss in childhood: A PRISMA-compliant meta-analysis.

BACKGROUND: Congenital cytomegalovirus (cCMV) infection is the most common cause of childhood hearing loss (HL), although the strength of this association remains limited and inconclusive. Thus, the purpose of this study was to summarize evidence regarding the strength of the relationship between cCMV and childhood HL and to determine whether this relationship differs according to patient characteristics. METHODS: The PubMed, EmBase, and Cochrane Library databases were searched for studies evaluating the relationship between cCMV and HL from inception to September 2019. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were used to calculate the investigated outcomes in a random-effects model. Sensitivity, subgroup, and publication bias analyses were also performed. RESULTS: A total of 15 studies involving 235,026 children met the inclusion criteria and were included in the final analysis. The summary results indicated that cCMV infection was associated with an increased risk of HL (odds ratio [OR]: 8.45; 95% confidence interval [CI]: 3.95-18.10; P < .001), irrespective of whether studies reported sensorineural HL (OR: 5.42; 95% CI: 1.98-14.88; P = .001), or did not evaluate HL types among their patients (OR: 11.04; 95% CI: 3.91-31.16; P < .001). However, in studies conducted in the United States (P < 0.001) and published in or after 2000 (P = 0.026), the study populations included <60% males (P < 0.001). Moreover, studies of high quality (P < .001) demonstrated a significantly greater risk of HL with cCMV infection than that in the corresponding subgroups. CONCLUSIONS: The study results suggest that cCMV infection increases the risk of HL. Further studies are required to investigate the association of cCMV infection with the risk of specific subtypes of HL.

3-D hierarchical porous carbon from oxidized lignin by one-step activation for high-performance supercapacitor.

To convert lignin into high-valued carbon materials and understand the lignin structure function, oxidized lignin, a by-product from lignocellulose PHP-pretreatment (phosphoric acid plus hydrogen peroxide), was carbonized by one-step KOH-activation; the physico-chemical characteristics and electrochemical performances of the harvested carbons were also investigated. Results indicated the resultant carbons displayed 3-dimensional hierarchical porous morphology with maximum specific surface area of 3094 m2 g-1 and pore volume of 1.72 cm3 g-1 using 3:1 KOH/lignin ratio for carbonization. Three-electrode determination achieved a specific capacitance of 352.9 F g-1 at a current of 0.5 A g-1, suggesting a superior rate performance of this carbon. Two-electrode determination obtained an excellent energy density of 9.5 W h kg-1 at power density of 25.0 W kg-1. Moreover, 5000 cycles of charge/discharge reached 88.46% retention at 5 A g-1, implying an outstanding cycle stability. Basically, low molecular weight and abundant oxygen-containing functional groups of employed lignin mainly related to the excellent porous morphology and the outstanding electrochemical performances, suggesting the oxidized lignin was an ideal precursor to facilely prepare activated carbon for high-performance supercapacitor. Overall, this work provides a new path to valorize lignin by-product derived from oxidative pretreatment techniques, which can further promote the integrality of lignocellulose biorefinery.

The role of peroxisome proliferator-activated receptor gamma and adiponectin in children with Kawasaki disease.

OBJECTIVE: To investigate the relationship between peroxisome proliferator-activated receptor gamma (PPARγ) mRNA, serum adiponectin (ADP) and lipids in paediatric patients with Kawasaki disease (KD). METHODS: This prospective study enrolled paediatric patients with KD and grouped them according to the presence or absence of coronary artery lesions (CAL). A group of healthy age-matched children were recruited as the control group. The levels of PPARγ mRNA, serum ADP and lipids were compared between the groups. Receiver operating characteristic (ROC) curve analysis was undertaken to determine if the PPARγ mRNA level could be used as a predictive biomarker of CAL prognosis. RESULTS: The study enrolled 42 patients with KD (18 with CAL [CAL group] and 24 without CAL [NCAL group]) and 20 age-matched controls. PPARγ mRNA levels in patients with KD were significantly higher than those in the controls; but significantly lower in the CAL group than the NCAL group. ROC curve analysis demonstrated that the PPARγ mRNA level provided good predictive accuracy for the prognosis of CAL. There was no association between PPARγ, ADP and lipid levels. CONCLUSION: There was dyslipidaemia in children with KD, but there was no correlation with PPARγ and ADP. PPARγ may be a predictor of CAL in patients with KD with good predictive accuracy.

Why can hydrothermally pretreating lignocellulose in low severities improve anaerobic digestion performances?

A lignocellulosic residue, rice straw, was hydrothermally pretreated for the whole slurry anaerobic digestion. In contrast to the unpretreated rice straw, 110-120 °C pretreatment promoted biogas yield by 35%-38%, while only 14% promotion happened on the pretreatment at 180 °C. To understand why this improvement happened at lower severities, the pretreated rice straw at 90 °C, 120 °C, and 180 °C were selected for the further investigation, in which the liquor and solid fraction were separated for digestion, and compared with the whole slurry digestion. Results indicated more methane was released from the derived liquor of 180 °C than that of 90 °C and 120 °C, however, solid fraction did not exhibit significantly different methane yields (187.77-193.91 mL/g TS). These results suggested that the released soluble fraction from pretreatment could facilitate the methanogenesis. Furthermore, the released inherent soluble fraction in rice straw was mainly responsible for higher biogas yield at lower temperatures. Pretreatment at higher temperatures disintegrated the rice straw recalcitrance more, and intensified the release of soluble fraction accordingly. Consequently, the methanogenesis of whole slurry could be promoted at the initial digestion; the hydrolysis/acidification of the solid fraction in whole slurry was weakened greatly, which resulted in a lower biogas yield. This can also be proved by the evolution of dominant bacteria and archaea in the anaerobic digestion of whole slurry, separated solid and liquor fraction.

CD14, CD163, and CCR1 are involved in heart and blood communication in ischemic cardiac diseases.

OBJECTIVE: Cardiac diseases lead to heart failure (HF), but the progression can take several years. Using blood samples to monitor changes in the heart before clinical symptoms begin may help to improve patient management. METHODS: Microarray data GSE42955 and GSE9128 were used as study datasets and GSE16499, GSE57338, and GSE59867 were used as validation groups. The "limma" package from R Language was used to identify differentially expressed genes. Functional enrichment analyses of gene ontology terms and Kyoto Encyclopedia of Genes and Genomes pathways were performed using Database for Annotation, Visualization and Integrated Discovery. We also investigated the correlation between the heart and blood using the mRNA expression level. RESULTS: Three hub genes, CD14, CD163, and CCR1, were identified. Functional enrichment analyses showed their involvement in the immune response and in the inflammatory response, which are the critical biochemical processes in ischemic HF. The mRNA expression level further demonstrated that a special model may exist to help to predict the mRNA level in the heart based on that in blood. CONCLUSIONS: Our study identified three biomarkers that can connect the heart and blood in ischemic heart diseases, which may be a new approach to help better manage ischemic cardiac disease patients.

Evaluation of Hydrothermal Pretreatment on Lignocellulose-Based Waste Furniture Boards for Enzymatic Hydrolysis.

Three typical waste furniture boards, including fiberboard, chipboard, and blockboard, were pretreated with conventional hydrothermal method. The responses of chemical composition, physicochemical morphology, and performances of enzymatic hydrolysis were evaluated. Results indicated the almost complete hemicellulose removal at higher pretreatment temperatures, the enhanced crystallinity index, and disordered morphology of the pretreated substrates indicated that the hydrothermal pretreatment deconstructed these boards well. However, the very low enzymatic hydrolysis (< 8% after 72 h) of the pretreated substrates showed the poor biological conversion. Three hypotheses for the weakened enzymatic hydrolysis were investigated, and results indicated that the residual adhesives and their degraded fractions were mainly responsible for poor hydrolysis. When NaOH post-pretreatment was attempted, cellulose-glucose conversion of the hydrothermally pretreated fiberboard, chipboard and blockboard can be improved to 28.5%, 24.1%, and 37.5%. Herein, the process of NaOH hydrothermal pretreatment was integrated, by which the hydrolysis of pretreated fiberboard, chipboard and blockboard was greatly promoted to 47.1%, 37.3%, and 53.8%, suggesting a possible way to pretreat these unconventional recalcitrant biomasses.

[Risk factors for cow's milk protein allergy in infants: a multicenter survey].

OBJECTIVE: To investigate the risk factors for cow's milk protein allergy (CMPA) among infants through a multicenter clinical study. METHODS: A total of 1 829 infants, aged 1-12 months, who attended the outpatient service of the pediatric department in six hospitals in Shenzhen, China from June 2016 to May 2017 were enrolled as subjects. A questionnaire survey was performed to screen out suspected cases of CMPA. Food avoidance and oral food challenge tests were used to make a confirmed diagnosis of CMPA CMPA. A multivariate logistic regression analysis was used to investigate the risk factors for CMPA. RESULTS: Among the 1 829 infants, 82 (4.48%) were diagnosed with CMPA. The multivariate logistic regression analysis showed that maternal food allergy (OR=4.91, 95%CI: 2.24-10.76, P<0.05), antibiotic exposure during pregnancy (OR=3.18, 95%CI: 1.32-7.65, P<0.05), and the introduction of complementary food at an age of <4 months (OR=3.55, 95%CI: 1.52-8.27, P<0.05) were risk factors for CMPA, while exclusive breastfeeding (OR=0.21, 95%CI: 0.08-0.58, P<0.05) and the introduction of complementary food at an age of >6 months (OR=0.38, 95%CI: 0.17-0.86, P<0.05) were protective factors. CONCLUSIONS: The introduction of complementary food at an age of <4 months, maternal food allergy, and antibiotic exposure during pregnancy are risk factors for CMPA in infants.

A novel strategy to alleviate medium acidosis for simultaneously yielding more bacterial cellulose and electricity.

Bacterial cellulose (BC), a fascinating and renewable polymer, can be applied widely in various bio-based materials. However, its synthesis is generally limited by medium acidosis. Herein, we demonstrated a built-in galvanic cell within the BC fermentation medium to alleviate the acidosis, by which BC yield was promoted by 191%, and simultaneously the yield of electrical power of 0.68 W to 8.10 W during the incubation.

The effect of dipeptidyl peptidase-4 inhibitor and glucagon-like peptide-1 receptor agonist in gestational diabetes mellitus: a systematic review.

Gestational diabetes mellitus (GDM) is the most common complication in pregnancy and affects 13% pregnant women around the world. GDM has both short-term and long-term negative effect on mother and offspring. Dipeptidyl peptidase-4 (DPP-4) inhibitor and glucagon-like peptide-1 receptor agonist (GLP-1 Ra) have shown many extra-benefits in diabetes patients, and may be a promising choice to GDM. Here, we conducted a systematic review of randomized controlled trials to investigate the effect of DPP-4 inhibitor and GLP-1 Ra in GDM. This project was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement. We searched PubMed, EMBASE and Cochrane library up to November 8 2019 for eligible trials. A total of 982 records were identified and 4 trials (516 participants) met the criteria in the end. The results suggested that DPP-4 inhibitor and GLP-1 Ra can reduce the rate of developing postpartum diabetes, help to normalization of blood glucose and improve insulin resistance and ß-cell function. Although the treatments showed beneficial effects in GDM patients, but the present data could not prove it use in GDM. Further clinical trials will be needed.

Targeting the DPP-4-GLP-1 pathway improves exercise tolerance in heart failure patients: a systematic review and meta-analysis.

BACKGROUND: The most significant manifestation of heart failure is exercise intolerance. This systematic review and meta-analysis was performed to investigate whether dipeptidyl peptidase-4 (DPP-4) inhibitors or glucagon-like peptide 1 receptor agonists (GLP-1 RAs), widely used anti-diabetic drugs, could improve exercise tolerance in heart failure patients with or without type 2 diabetes mellitus. METHODS: An electronic search of PubMed, EMBASE and the Cochrane Library was carried out through March 8th, 2019, for eligible trials. Only randomized controlled studies were included. The primary outcome was exercise tolerance [6-min walk test (6MWT) and peak O2 consumption], and the secondary outcomes included quality of life (QoL), adverse events (AEs) and all-cause death. RESULT: After the literature was screened by two reviewers independently, four trials (659 patients) conducted with heart failure patients with or without type 2 diabetes met the eligibility criteria. The results suggested that targeting the DPP-4-GLP-1 pathway can improve exercise tolerance in heart failure patients [MD 24.88 (95% CI 5.45, 44.31), P = 0.01] without decreasing QoL [SMD -0.51 (95% CI -1.13, 0.10), P = 0.10]; additionally, targeting the DPP-4-GLP-1 pathway did not show signs of increasing the incidence of serious AEs or mortality. CONCLUSION: Our results suggest that DPP-4 inhibitors or GLP-1 RAs improve exercise tolerance in heart failure patients. Although the use of these drugs for heart failure has not been approved by any organization, they may be a better choice for type 2 diabetes mellitus patients with heart failure. Furthermore, as this pathway contributes to the improvement of exercise tolerance, it may be worth further investigation in exercise-intolerant patients with other diseases.

Pretreatment of Wheat Straw with Phosphoric Acid and Hydrogen Peroxide to Simultaneously Facilitate Cellulose Digestibility and Modify Lignin as Adsorbents.

Effective valorization of lignin is crucial to achieve a sustainable, economic and competitive biorefinery of lignocellulosic biomass. In this work, an integrated process was proposed based on a concentrated phosphoric acid plus hydrogen peroxide (PHP) pretreatment to simultaneously facilitate cellulose digestibility and modify lignin as adsorbent. As a dominant constitutor of PHP pretreatment, H2O2 input and its influence on the overall fractionation/lignin modification performance was thoroughly investigated. Results indicated that wheat straw was fractionated more efficiently by increasing the H2O2 input. H2O2 input had a significant influence on the digestibility of the obtained cellulose-rich fraction whereby almost 100.0% cellulose-glucose conversion can be achieved even with only 0.88% H2O2 input. Besides, the adsorption capacity of lignin on MB was improved (74.3 to 210.1 mg g-1) due to the oxidative-modification in PHP pretreatment with H2O2 inputs. Regression analysis indicated that -COOH groups mainly governed the lignin adsorption (R2 = 0.946), which displayed the considerable adsorption capacities for typical cationic substances. This work shows a promising way to integrate the lignin modification concept into the emerging PHP pretreatment process with the dual goal of both cellulose utilization and lignin valorization.