[Research progress on global health competency and its models].

At present, the research on Global Health Competencies is mainly conducted in the field of the establishment of competency models and application of indicators. This review summarizes the research progress of the Global Health Competency and its models, and focuses on cutting-edge research from the aspects of target audience, purpose, content, classical model, methods and future development. The competency model is suggested to be adjusted and updated according to the practices of different countries and regions. The research and funding of the competency model in the field of public health is suggested to be strengthened, and the global health and diplomacy are suggested to be combined to enrich and improve the competency model. Finally, this review aims to promote Global Health Competencies research in China, especially to improve the global health talent training system and relevant policies in further research.

[Analysis of factors associated with futile recanalization after endovascular treatment for acute ischemic stroke with large vessels occlusion in anterior intracranial circulation].

Objective: To analyze the related factors of futile recanalization (FR) after emergency endovascular treatment of large artery occlusion in anterior circulation. Methods: Three studies on endovascular treatment of acute anterior circulation large vessels occlusion stroke were selected, and their data were merged for retrospective analysis. Patients were divided into the FR group and favorable prognosis group according to the functional prognosis. Risk factor analysis was conducted using multivariate logistic regression. Results: A total of 1 581 patients were finally included, with 858 (48.9%) patients in favorable prognosis group and 926 (51.91%) patients in FR group. Among them, there were 939 males and 642 females, with a mean age of (65±12) years. Multivariate logistic regression analysis showed that National Institute of Health Stroke Scale (NIHSS) score (OR=1.089,95%CI:1.066-1.113), puncture to recanalization time (OR=0.756, 95%CI:0.586-0.971), age (OR=1.04,95%CI:1.029-1.051), serum glucose (OR=1.101,95%CI:1.062-1.143), systolic blood pressure (OR=1.005,95%CI:1.001-1.010), passes≥3(OR=1.941,95%CI:1.294-2.941)Alberta stroke program early CT (ASPECT) score (OR=0.919,95%CI:0.847-0.996), occlusion site (M1 segment of middle cerebral artery, OR=0.744,95%CI:0.565-0.980) and collateral circulation [(2 points, OR=0.757, 95%CI:0.581-0.985); (3-4 points, adjusted OR=0.640, 95%CI: 0.472-0.866)] were independent factors of FR. Conclusion: The incidence of FR in patients with large artery occlusion in anterior circulation who achieve satisfied reperfusion after endovascular treatment is high. Higher NIHSS score, longer puncture to recanalization time, older age, higher serum glucose and systolic blood pressure are risk factors, while lower ASPECTS, occlusion in cerebral middle M1 segment, better collateral circulation are protective factors.

Precision Measurement of Reactor Antineutrino Oscillation at Kilometer-Scale Baselines by Daya Bay.

We present a new determination of the smallest neutrino mixing angle θ_{13} and the mass-squared difference Δm_{32}^{2} using a final sample of 5.55×10^{6} inverse beta-decay (IBD) candidates with the final-state neutron captured on gadolinium. This sample is selected from the complete dataset obtained by the Daya Bay reactor neutrino experiment in 3158 days of operation. Compared to the previous Daya Bay results, selection of IBD candidates has been optimized, energy calibration refined, and treatment of backgrounds further improved. The resulting oscillation parameters are sin^{2}2θ_{13}=0.0851±0.0024, Δm_{32}^{2}=(2.466±0.060)×10^{-3} eV^{2} for the normal mass ordering or Δm_{32}^{2}=-(2.571±0.060)×10^{-3} eV^{2} for the inverted mass ordering.

[Drug resistance and genomic characteristics of a strain of O139 Vibrio cholerae isolated from human bloodstream infection].

Objective: To analyze the drug resistance and genomic characteristics of a strain of serogroup O139 Vibrio cholerae producing cholera toxin isolated from the bloodstream of a person with bacteremia. Methods: The broth dilution method and automatic drug sensitivity analyzer were used to determine the antibiotic sensitivity of the strain. The complete genome sequence of the strain was obtained by using second-generation gene sequencing and nanopore sequencing. BLAST software was used for comparison and analysis with CARD, Resfinder, ISfinder, VFDB, and other databases. The drug-resistant genes, insertion sequences and virulence genes carried by the strain were identified. MEGA 5.1 software was used to construct a genetic phylogenetic tree based on the core genomic single nucleotide polymorphisms. Results: V. cholerae SH400, as the toxigenic strain, carried multiple virulence-related genes and four virulence islands. The strain was resistant to streptomycin, tetracycline and cotrimoxazole, carrying corresponding drug-resistant genes. The strain also carried IncA/C plasmid with the size of 172914 bp and contained 10 drug-resistant genes. Combined with the genomic evolutionary relationship, this study found that the drug-resistant genes and drug-resistant plasmids carried among strains showed certain aggregation. The traditional ST type of strain SH400 was ST69, and the cgMLST type was a new type highly similar to cgST-252. Conclusion: This strain of serogroup O139 V. cholerae carries the ctxAB gene, multiple drug-resistant genes and IncA/C plasmid, and there are multiple drug-resistant islands.

First Measurement of High-Energy Reactor Antineutrinos at Daya Bay.

This Letter reports the first measurement of high-energy reactor antineutrinos at Daya Bay, with nearly 9000 inverse beta decay candidates in the prompt energy region of 8-12 MeV observed over 1958 days of data collection. A multivariate analysis is used to separate 2500 signal events from background statistically. The hypothesis of no reactor antineutrinos with neutrino energy above 10 MeV is rejected with a significance of 6.2 standard deviations. A 29% antineutrino flux deficit in the prompt energy region of 8-11 MeV is observed compared to a recent model prediction. We provide the unfolded antineutrino spectrum above 7 MeV as a data-based reference for other experiments. This result provides the first direct observation of the production of antineutrinos from several high-Q_{ß} isotopes in commercial reactors.

Correlations of MMP-9 and PPARγ gene polymorphisms with occurrence of preeclampsia.

OBJECTIVE: The aim of this study was to investigate the expressions of matrix metalloproteinase-9 (MMP-9) and peroxisome proliferator-activated receptor gamma (PPARγ) in the placenta of patients with preeclampsia and to elucidate the associations of their polymorphisms with the occurrence of preeclampsia. PATIENTS AND METHODS: A total of 200 patients with preeclampsia (Preeclampsia group) and 100 pregnant women with normal delivery (Control group) were enrolled as research subjects. The expressions of MMP-9 and PPARγ in placentae of Preeclampsia group and Control group were measured by Western blotting. Conformation-difference gel electrophoresis was adopted for typing single nucleotide polymorphisms (SNPs) rs101201 and rs23102 in the promoter region of MMP-9 gene and rs201018 and rs102934 in the promoter region of PPARγ gene. Chi-square test was conducted to analyze whether the distribution frequency of MMP-9 and PPARγ genotypes was consistent with the law of genetic equilibrium. The correlations of the alleles and polymorphisms of MMP-9 and PPARγ with the occurrence of preeclampsia were analyzed. In addition, the associations of rs101201 genotype GG of MMP-9 gene and rs201018 genotype TT of PPARγ gene with the clinicopathological features of preeclampsia were analyzed. RESULTS: Compared with Control group, the protein expression level of MMP-9 was significantly down-regulated (p<0.05), while the protein expression level of PPARγ was significantly up-regulated in placental tissues of Preeclampsia group (p<0.05). Based on Hardy-Weinberg equilibrium analysis, the two polymorphisms of both MMP-9 and PPARγ were consistent with the genetic equilibrium distribution (p>0.05). Gene correlation analysis showed that rs101201 polymorphism and its alleles in the promoter region of MMP-9 gene and rs201018 polymorphism and its alleles in the promoter region of PPARγ gene were correlated with the occurrence of preeclampsia (p<0.05). Besides, body mass index (BMI) value, gestational age, systolic blood pressure, and serum creatinine level in preeclampsia patients with the genotype GG of rs101201 in the promoter region of MMP-9 gene were not statistically significantly different from those in Control group (p>0.05). Furthermore, no statistically significant differences were observed in gravidity, parity, gestational age, systolic blood pressure, serum creatinine level, and plasma albumin level between preeclampsia patients with the genotype TT of rs201018 in the promoter region of PPARγ gene and those in Control group (p>0.05). CONCLUSIONS: PPARγ and MMP-9 are abnormally expressed in the placenta of patients with preeclampsia. Moreover, rs201018 polymorphism in the promoter region of PPARγ gene and rs101201 polymorphism in the promoter region of MMP-9 gene are correlated with the occurrence of preeclampsia.

[Genomic subtyping of nosocomial transmission of carbapenem resistant Klebsiella pneumoniae].

Objective: To analyze the genomic epidemiological subtyping of carbapenem resistant Klebsiella pneumoniae (CRKP) isolated from a Third-class A hospital in Zhengzhou. Methods: From December 4, 2019 to January 10, 2020, 67 strains of CRKP were isolated from the samples submitted by the clinical departments of a Third-class A teaching hospital in Zhengzhou for microbiological testing. Multi-locus sequence typing (MLST) and carbapenem resistance genes were identified by whole genome sequencing and sequence analysis. Based on the whole genome SNP, the phylogenetic tree was constructed, and 67 CRKP strains were divided into clonal groups. The isolation ward and date of each clone group were analyzed. Results: Sixty-seven CRKP strains were classified into four MLST types (STs), of which 64 were ST11. There were 62 ST11 strains carrying blaKPC-2 gene. Based on genome-wide SNP phylogenetic tree, 64 ST11 strains were divided into four clone groups, two of which were dominant clone groups, including 33 and 27 strains respectively; the other two clone groups only contained 2 strains respectively. There was no aggregation of the dominant clones in the isolation department and date. Conclusion: Multiple clonal groups of ST11 strain carrying blaKPC-2 gene are differentiated during spreading, and they can spread in parallel and independently in the same hospital.

[A novel tray for recording maxillomandibular relationship of edentulous patients based on dimensional surveying of complete dentures].

OBJECTIVE: To measure the dimensional data of complete dentures and to design a novel tray for recording maxillomandibular relationship of edentulous patients. METHODS: For the measurement, 100 pairs of complete dentures from the clinic were surveyed for the following parameters: a1, the distance between the middle fossa of the upper left and right first molars; a2, the anterior-posterior distance between the middle fossa of the upper first molars and the incisal edge; a3, the width of the upper denture; a4, the anterior-posterior length of the upper denture; a51, the height from the mesio-lingual cusp of the right upper first molar to the saddle surface; a52, the height from the central fossa of the right lower first molar to the saddle surface; a6, the height from the notch of the upper lip frenulum to the upper central incisor edge; a7, the least thickness of the labial saddle base in the upper central incisor region. Based on the data, the trays with different sizes were designed and fabricated, and the key parameters were: b1, the distance between the foramina of screw posts, b2, the anterior-posterior distance between the foramina of the screw posts and the incisal edge; b3, the width of the tray; b4, the anterior-posterior length of the tray; b51, the height of the posterior platform with the screw nut; b52, the height of the screw post; b6, the height of the anterior tray handle; b7, the thickness of the anterior tray handle. RESULTS: The minimum, average and maximum data for each parameter were (in millimeter): a1: 37.1, 44.5, and 59.6; a2: 22.6, 29.0, and 38.1; a3: 48.5, 58.2, and 76.6; a4: 37.4, 50.8, and 61.0; a51: 5.6, 9.5, and 14.7; a52: 3.8, 9.9, and 18.8; a6: 8.9, 16.6, and 24.7; a7: 1.2, 2.8, and 5.9. Based on the data, the trays in small, medium and large sizes were designed and fabricated. In clinical application, the putty silicone rubber impression material was used to reline the tray, meanwhile the posterior platform and anterior tray handle were set as the occlusal plane, then the screw posts were added and adjusted till the proper vertical dimension, after that, the putty silicone rubber impression material was added around the screw posts to record the horizontal maxillomandibular relationship, finally, the anterior surface of the tray handle was used to record the midline of the face and lower edge of the upper lip at rest and with smile. CONCLUSION: The dimensional data offered reference for the analysis of restoration space in edentulous patients. The tray designed and fabricated in this study may serve as a new tool for recording the maxillomandibular relationship.

Extraction of the

This Letter reports the first extraction of individual antineutrino spectra from ^{235}U and ^{239}Pu fission and an improved measurement of the prompt energy spectrum of reactor antineutrinos at Daya Bay. The analysis uses 3.5×10^{6} inverse beta-decay candidates in four near antineutrino detectors in 1958 days. The individual antineutrino spectra of the two dominant isotopes, ^{235}U and ^{239}Pu, are extracted using the evolution of the prompt spectrum as a function of the isotope fission fractions. In the energy window of 4-6 MeV, a 7% (9%) excess of events is observed for the ^{235}U (^{239}Pu) spectrum compared with the normalized Huber-Mueller model prediction. The significance of discrepancy is 4.0σ for ^{235}U spectral shape compared with the Huber-Mueller model prediction. The shape of the measured inverse beta-decay prompt energy spectrum disagrees with the prediction of the Huber-Mueller model at 5.3σ. In the energy range of 4-6 MeV, a maximal local discrepancy of 6.3σ is observed.

Correction to: Neurological Symptoms in Hypophosphatasia.

Due to a typesetting error the title of the article was published wrongly.

Neurological symptoms in Hypophosphatasia.

Hypophosphatasia (HPP) typically manifests with fractures, tooth loss, and muscle pain. Although mental health diagnoses and neurological symptoms have not been previously well documented in HPP, they occur commonly. The recognition of non-traditional symptoms may improve patient satisfaction, preempt costly evaluation and misdiagnosis, and lead to further treatment options. INTRODUCTION: Hypophosphatasia (HPP) is an inborn error of metabolism due to deficiency of tissue non-specific alkaline phosphatase (TNSALP). It is traditionally characterized by rickets in children and osteomalacia in adults, along with fractures, tooth loss, and muscle pain. Neurological symptoms and mental health diagnoses have not been widely reported, and we therefore report their prevalence in a cohort of patients with HPP. METHODS: A retrospective chart review was performed on a series of 82 HPP patients. Patient charts were reviewed to identify the possible presence and onset of 13 common neurological symptoms. RESULTS: Median age was 36 years (2 to 79). Seventeen had adult onset HPP (> 18 years) and 65 had pediatric onset HPP (< 18 years). Median time from symptom onset to HPP diagnosis was 8 years (0 to 67). Seventy-four percent had a family history of bone disease, while 17% had a family history of neurologic disease. Bone problems occurred in 89%, dental problems in 77%, and muscle problems in 66%. Fatigue occurred in 66%, headache in 61%, sleep disturbance in 51%, gait change in 44%, vertigo in 43%, depression in 39%, anxiety in 35%, neuropathy in 35%, and hearing loss in 33%. CONCLUSIONS: The extra-skeletal manifestations of HPP, specifically neurological symptoms, have not been previously well documented. However, mental health diagnoses and neurological symptoms such as headache and sleep disturbance occur commonly in patients with HPP. The recognition of non-traditional symptoms in HPP may improve patient satisfaction, preempt costly evaluation and misdiagnosis, and may lead to further treatment options.

Measurement of the Electron Antineutrino Oscillation with 1958 Days of Operation at Daya Bay.

We report a measurement of electron antineutrino oscillation from the Daya Bay Reactor Neutrino Experiment with nearly 4 million reactor ν[over ¯]_{e} inverse ß decay candidates observed over 1958 days of data collection. The installation of a flash analog-to-digital converter readout system and a special calibration campaign using different source enclosures reduce uncertainties in the absolute energy calibration to less than 0.5% for visible energies larger than 2 MeV. The uncertainty in the cosmogenic ^{9}Li and ^{8}He background is reduced from 45% to 30% in the near detectors. A detailed investigation of the spent nuclear fuel history improves its uncertainty from 100% to 30%. Analysis of the relative ν[over ¯]_{e} rates and energy spectra among detectors yields sin^{2}2θ_{13}=0.0856±0.0029 and Δm_{32}^{2}=(2.471_{-0.070}^{+0.068})×10^{-3} eV^{2} assuming the normal hierarchy, and Δm_{32}^{2}=-(2.575_{-0.070}^{+0.068})×10^{-3} eV^{2} assuming the inverted hierarchy.

[To observe the effect of "Fangfenggubenkeli" on IL-4, IL-5, IL-10 and IFN-γ cytokines in PBMC supernatant of allergic rhinitis patients with lung depression and spleen efficiency].

Objective:To observe the effect of "Fangfenggubenkeli" on IL-4, IL-5, IL-10 and IFN-γ cytokines in PBMC supernatant of allergic rhinitis' patients with lung depression and spleen deficiency.Method:One hundred patients were randomly divided into two groups. The treatment group of 50 cases, was given to ancient side of the "Fangfenggubenkeli". The control group of 50 patients, was given to cetirizine hydrochloride, oral treatment. The levels of IL-4, IL-5, IL-10 and IFN-γ in the two groups were measured before and after treatment of 1 month. The changes of the laboratory indexes were compared between the two groups before and after treatment.Result:The levels of IL-4 in the two groups were significantly lower than those before treatment (P < 0.01), and the levels of IFN-γ were significantly higher than those before treatment (P < 0.01), there was a statistically significant difference.Conclusion:The mechanism of "Fangfenggubenkeli" in patients with allergic rhinitis with lung depression may be related to the IFN-γ level, lower IL-4 level. Thereby Fangfenggubenkeli would improved the Th1/Th2 imbalance state as a whole.

[Prevalence of obstructive sleep apnea hypopnea syndrome in professional drivers and the relationship with traffic accidents].

Objective: To study the prevalence of obstructive sleep apnea hypopnea syndrome (OSAHS) and its relationship with traffic accidents in the professional drivers. Methods: Questionnaires of OSAHS were sent to 950 professional drivers who had annual physical examination at the Central Hospital of Jiading District in Shanghai from October 2014 to September 2015. Those with moderate to severe snoring and/or Epworth Sleepiness Scale (ESS)≥9 performed the home sleep testing. All drivers were divided into OSAHS and non-OSAHS according to the survey and monitoring. The following parameters were compared such as driving ages, neck circumference, body mass index (BMI), average night sleep time, ESS, hypertension, diabetes, hypertrophy of tonsil and the incidence of traffic accidents. The risk factors of traffic accidents were analyzed by multivariate Logistic regression. Results: Totally 826 responses were eligible, including 578 (70.0%) with self-reported snoring. There was measurement failure involving 3 of 233 the home sleep testing due to sensor off, 823 subjects were included in the study. The prevalence of OSAHS was 13.5% (111/823). The mild, moderate and severe OSAHS were 47, 38 and 26 cases respectively. There were 712 drives without OSAHS. The neck circumference[(39.8±3.8) vs (39.0±3.0) cm]and BMI[(26.7±4.2) vs (24.4±3.8) kg/m2]were significantly higher in the drivers suffering from OSAHS (all P<0.05). The percentage of ESS≥ 9 (57.7% vs 12.6%), hypertension (27.9% vs 5.9%), diabetes (4.5% vs 1.1%), hypertrophy of tonsil (7.2% vs 2.3%) were higher in the drivers with OSAHS (all P<0.05). There were no significant difference in driving ages and average night sleep time between two groups (all P>0.05). The overall incidence of traffic accidents was 5.8% (48/823) in a year. The percentage was respectively 17.1% (19/111) in OSAHS and 4.1% (29/712) in non-OSAHS (P<0.001). Multiple logistic regression analysis showed that sleepiness (OR=30.578, 95%CI: 10.699-87.394; P<0.001), OSAHS (OR=14.062, 95%CI: 4.791-41.269; P<0.001) and vehicle years (OR=2.345, 95%CI: 1.183-4.646; P<0.05)were the risk factors, while the average night sleep time (OR=0.037, 95%CI: 0.014-0.098; P<0.001) was the protective factor. Conclusion: Professional drivers have higher prevalence of OSAHS, which contributes to the increased risk of traffic accidents.

Cholesterol imbalance in adipocytes: a possible mechanism of adipocytes dysfunction in obesity.

Studies of the past decade have increased our understanding of the role of adipose tissue dysfunction in obesity and obesity-related insulin resistance and type 2 diabetes. Although adipose tissue is the body's largest pool of free cholesterol, adipocytes have limited activity in cholesterol synthetic pathway. Thus, the majority of adipocyte cholesterol originates from circulating lipoproteins. To maintain cholesterol homeostasis, adipocytes have developed multiple pathways for cholesterol efflux. Several transcriptional factors, such as sterol regulatory element-binding proteins and liver X receptors may be responsible for the regulation of cholesterol homeostasis in adipocytes. Most notably, because altering cholesterol balance profoundly modifies adipocyte metabolism in a way resembling that seen in hypertrophied adipocytes, cholesterol imbalance is recognized as a characteristic for enlarged adipocytes per se in the obese state. In addition, plasma membrane cholesterol normalization by chromium picolinate can fully restore insulin-stimulated glucose transport, further supporting the role of the adipocyte cholesterol imbalance in obesity and insulin resistance.

Screening for fractions of Oxytropis falcata Bunge with antibacterial activity.

Preliminary studies with the four extracts of Oxytropis falcate Bunge exhibited that the chloroform and ethyl acetate extracts showed stronger antibacterial activities against the nine tested Gram-positive and Gram-negative bacteria. The HPLC-scanned and bioassay-guided fractionation led to the isolation and identification of the main flavonoid compounds, i.e. rhamnocitrin, kaempferol, rhamnetin, 2',4'-dihydroxychalcone and 2',4',beta-trihydroxy-dihydrochalcon. Except 2',4',beta-trihydroxy-dihydrochalcon, four other compounds had good antibacterial activities. The minimal inhibitory concentrations (MICs) and minimal bactericidal concentrations (MBCs) of the four compounds ranged between 125 and 515 microg mL(-1). Staphylococcus aureus was the most susceptible to these compounds, with MIC and MBC values from 125 to 130 microg mL(-1). This is the first report of antibacterial activity in O. falcate Bunge. In this study, evidence to evaluate the biological functions of O. falcate Bunge is provided, which promote the rational use of this herb.

[The calculation-improving of stress amplification coefficient and the checking of its trouble-shooting model].

Through mechanical analysis, it is discovered that the twined structure decides the amplification coefficient of the catgut tension. Many troubles of production can be explained with this mechanics model, and it could be used as a reference for medical sutures. The paper gives an accurate calculating formula for catgut design and its direct tensile strength through improving mechanics model. It can raise the material strength from 10 to over 31% depending on its twined structure.

[Pharmacodynamics and clinical therapeutic effects of aerosol and injection of shuanghuanglian].

The results show that both aerosol and injection of shuanghuanglian can increase the activity of NK cells in peripheral blood of the human body as well as the ability of lymphocyte to produce alpha-interferon. Their broad-spectrum antiseptic and virus-inhibiting actions have also been confirmed. The absolute bioavailability of aerosol was 96.88% (baicalin) and 90.69% (chlorogeniacid). The significant response rate of aerosol and injection was 84% and 83% respectively. The total response rate was 92% and 93% respectively.

Growth-related changes in familial resemblance of maxillofacial morphology.

We investigated changes in resemblance between Japanese parents and their growing children with regard to maxillofacial morphology. Lateral roentgenographic cephalograms taken from 963 children (336 male and 627 female) over 6 years of age and their parents were used as samples. Based on the age of the children, there were six groups--I: 6-7 years of age; II: 8-9; III: 10-11; IV: 12-13; V: 14-15; and VI: over 16. Parent-offspring heritabilities (h2) were computed for 35 variables representing maxillofacial and dentoalveolar traits, and group comparisons were also made. The following results were obtained: (1) there were more significant heritabilities for maxillofacial variables than those for dentoalveolar ones; (2) in general, additive genetic effects were more prominent in controlling maxillofacial and dentoalveolar structure of on-growing children, with increasing age.