Screening of the shared pathogenic genes of ulcerative colitis and colorectal cancer by integrated bioinformatics analysis.

Ulcerative colitis (UC) is one of the high-risk pathogenic factors for colorectal cancer (CRC). However, the shared gene and signalling mechanisms between UC and CRC remain unclear. The goal of this study was to delve more into the probable causal relationship between UC and CRC. CRC and UC datasets were downloaded from the Gene Expression Omnibus database. Using R software and Perl, differentially expressed genes (DEGs) in both UC and CRC tissues were re-annotated and screened. The biological activities and signalling pathways involved in DEGs were investigated using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses. The STRING database and Cytoscape software were used to construct the gene interaction network. A total of 384 DEGs were selected for further investigation, and functional analysis revealed that inflammatory and immunological responses were crucial in the development of the two diseases. Moreover, the top 15 key genes involved in the UC and CRC were screened using cytoHubba, including IL1B, CXCL10, CCL20, MMP9, ICAM1, CCL4, CXCR1, MMP3, TLR2, PTGS2, IL1RN, IL6, COL1A2, TIMP1 and CXCL1. The identification of these genes in the present study may provide a novel perspective for the prediction, prevention and personalized medicine of UC and CRC patients.

p-Phenylenediamine Antioxidants in PM2.5: The Underestimated Urban Air Pollutants.

The wide use and continuous abrasion of rubber-related products appears to be leading to an incredible release of p-phenylenediamine (PPD) antioxidants in the environment. However, no related research has been conducted on the pollution characteristics and potential health risks of PM2.5-bound PPDs. We report for the first time the ubiquitous distributions of six emerging PPDs and a quinone derivative, N-(1,3-dimethylbutyl)-N'-phenyl-p-phenylenediamine quinone (6PPDQ), in PM2.5 from urban areas of China. Atmospheric contamination levels of PM2.5-bound PPDs were found to be mostly in pg m-3 amounts between 2018 and 2019. Urban vehicle rubber tire abrasion was found to probably contribute to the PPDs in PM2.5 and accounted for their significant spatiotemporal-dependent concentration variations. Furthermore, 6PPDQ, an emerging oxidation product of 6PPD in the environment, was first quantified (pg m-3) with a total detection rate of 81% in the urban PM2.5, demonstrating its broad existence. On the basis of the determined ambient concentrations, the annual intakes of PPDs and 6PPDQ for adults were not low, indicating their possible human health risks induced by long-term exposure. This study confirms the widespread occurrence of PPDs and 6PPDQ in PM2.5, showing that the pollution of such compounds in urban air should not be underestimated.

Tris(2,4-di-tert-butylphenyl)phosphate: An Unexpected Abundant Toxic Pollutant Found in PM2.5.

A novel pollutant, tris(2,4-di-tert-butylphenyl)phosphate (I168O), was identified in urban fine particulate matter (PM2.5) samples in a nontargeted screening based on mass spectrometry for the first time. I168O was detected in all samples collected from two typical cities far away from each other in China. The concentrations of I168O reached up to 851 (median: 153) ng/m3, indicating that it was a widespread and abundant pollutant in the air. The antioxidant Irgafos 168 [I168, tris(2,4-di-tert-butylphenyl)phosphite] popularly added in plastics was the most suspected source for the detected I168O. Simulation studies indicated that heating, UV radiation, and water contact might significantly (p < 0.05) transform I168 to I168O. In particular, I168O might be magnificently evaporated into the air at high temperatures. The outdoor inhalation exposure of I168O may exert substantial health risks.

Atmospheric Photosensitization: A New Pathway for Sulfate Formation.

Northern China is regularly subjected to intense wintertime "haze events", with high levels of fine particles that threaten millions of inhabitants. While sulfate is a known major component of these fine haze particles, its formation mechanism remains unclear especially under highly polluted conditions, with state-of-the-art air quality models unable to reproduce or predict field observations. These haze conditions are generally characterized by simultaneous high emissions of SO2 and photosensitizing materials. In this study, we find that the excited triplet states of photosensitizers could induce a direct photosensitized oxidation of hydrated SO2 and bisulfite into sulfate S(VI) through energy transfer, electron transfer, or hydrogen atom abstraction. This photosensitized pathway appears to be a new and ubiquitous chemical route for atmospheric sulfate production. Compared to other aqueous-phase sulfate formation pathways with ozone, hydrogen peroxide, nitrogen dioxide, or transition-metal ions, the results also show that this photosensitized oxidation of S(IV) could make an important contribution to aerosol sulfate formation in Asian countries, particularly in China.

Size distribution of bioaerosols from biomass burning emissions: Characteristics of bacterial and fungal communities in submicron (PM1.0) and fine (PM2.5) particles.

The North China Plain is the agricultural heartland in China. High PM2.5 levels and elevated chemical pollutants have been observed during crop harvest seasons due to open biomass burning. Biomass burning in the wheat-harvest season may significantly deteriorate the regional air quality. The harmful ingredients in smoke particles also have severe implications for toxicity and health effects. Previous studies have illustrated the potential role of bioaerosols as ice-nuclei and cloud condensation nuclei and highlighted their influence on biochemical cycles and human health effects. In a monthly field observation campaign of biomass burning conducted at the summit of Mount Tai in July 2015, we reported the composition, potential role, size distribution of microorganisms in particulate matters PM1.0, PM2.5, and estimated their contribution to particles. The wide-range particle spectrometer suggested that the predominant particles were distributed in submicron particles (PM1.0), which resulted in a similar community structure for bacteria and fungi in PM1.0 and PM2.5. Among bacteria, the predominant Pseudomonas accounted for 18.06% and 21.29% in PM1.0 and PM2.5, respectively. Alternaria covered up to 69.01% and 72.76% of the fungal community in PM1.0 and PM2.5, respectively. A disparity between bacterial communities was identified by the abundance of rare species, such as Bacilli being higher in PM1.0 (2.4%) than in PM2.5 (1.8%), and Defluviicoccus being higher in PM2.5 (2.5%) than in PM1.0 (0.5%), which may be related to cell size and cell growth patterns. Quantitative PCR revealed that microbial cell numbers in PM2.5 were higher than in PM1.0, and that the bacterial cell number was about an order of magnitude greater than the fungal cell number. However, the mass concentration and contribution of fungi to particulate matter was much higher than that of bacteria, suggesting the underestimated role of fungi in atmospheric aerosols. Airborne microorganisms in alpine areas remained less characterized. The findings presented here illustrated the potentially important impacts on air quality and bioaerosol pollution by biomass burning, which provides an essential reference for understanding the transmission and health effects of bioaerosols.

Profile of inhalable bacteria in PM2.5 at Mt. Tai, China: Abundance, community, and influence of air mass trajectories.

Bacteria are ubiquitous in the near-surface atmosphere where they constitute an important component of aerosols with the potential to affect climate change, ecosystems, atmospheric process and human health. Limitation in tracking bacterial diversity accurately has thus far prevented the knowledge of airborne bacteria and their pathogenic properties. We performed a comprehensive assessment of bacterial abundance and diverse community in PM2.5 collected at Mt. Tai, via high-throughput sequencing and real-time PCR. The samples exhibited a high microbial biodiversity and complex chemical composition. The dominating populations were gram-negative bacteria including Burkholderia, Delftia, Bradyrhizobium, and Methylobacterium. The PM mass concentration, chemical composition, bacterial concentration and community structure varied under the influence of different air-mass trajectories. The highest mass concentration of PM2.5 (61 µg m-3) and major chemical components were recorded during periods when marine southeasterly air masses were dominant. The local terrestrial air masses from Shandong peninsula and its adjacent areas harbored highest bacterial concentration loading (602 cells m-3) and more potential pathogens at the site. In contrast, samples influenced by the long-distance air flow from Siberia and Outer Mongolia were found to have a highest richness and diversity as an average, which was also marked by the increase of dust-associated bacteria (Brevibacillus and Staphylococcus). The primary research may serve as an important reference for the environmental microbiologist, health workers, and city planners.

Strong ozone production at a rural site in theNorth China Plain: Mixed effects of urban plumesand biogenic emissions.

Regional ozone (O3) pollution has drawn increasing attention in China over the recent decade, but the contributions from urban pollution and biogenic emissions have not been clearly elucidated. To better understand the formation of the regional O3 problem in the North China Plain (NCP), intensive field measurements of O3 and related parameters were conducted at a rural site downwind of Ji'nan, the capital city of Shandong province, in the summer of 2013. Markedly severe O3 pollution was recorded, with the O3 mixing ratios exceeding the Chinese national ambient air quality standard on 28 days (a frequency of 78%) and with a maximum hourly value of 198 ppbv. Extensive regional transport of well-processed urban plumes to the site was identified. An observation-constrained chemical box model was deployed to evaluate in situ photochemical O3 production on two episodes. The results show that the in situ formation accounted for approximately 46% of the observed O3 accumulation, while the remainder (~54%) was contributed by regional transport of the O3-laden urban plumes. The in situ ozone production was in a mixed controlled regime that reducing either NOx or VOCs would lead to a reduction of ozone formation. Biogenic VOCs played an important role in the local ozone formation. This study demonstrates the significant mixed effects of both anthropogenic pollution from urban zones and biogenic emission in rural areas on the regional O3 pollution in the NCP region, and may have general applicability in facilitating the understanding of the formation of secondary pollution over China.

Tuberculosis prevalence in China, 1990-2010; a longitudinal analysis of national survey data.

BACKGROUND: China scaled up a tuberculosis control programme (based on the directly observed treatment, short-course [DOTS] strategy) to cover half the population during the 1990s, and to the entire population after 2000. We assessed the effect of the programme. METHODS: In this longitudinal analysis, we compared data from three national tuberculosis prevalence surveys done in 1990, 2000, and 2010. The 2010 survey screened 252,940 eligible individuals aged 15 years and older at 176 investigation points, chosen by stratified random sampling from all 31 mainland provinces. All individuals had chest radiographs taken. Those with abnormal radiographs, persistent cough, or both, were classified as having suspected tuberculosis. Tuberculosis was diagnosed by chest radiograph, sputum-smear microscopy, and culture. Trained staff interviewed each patient with tuberculosis. The 1990 and 2000 surveys were reanalysed and compared with the 2010 survey. FINDINGS: From 1990 to 2010, the prevalence of smear-positive tuberculosis decreased from 170 cases (95% CI 166-174) to 59 cases (49-72) per 100,000 population. During the 1990s, smear-positive prevalence fell only in the provinces with the DOTS programme; after 2000, prevalence decreased in all provinces. The percentage reduction in smear-positive prevalence was greater for the decade after 2000 than the decade before (57% vs 19%; p<0.0001). 70% of the total reduction in smear-positive prevalence (78 of 111 cases per 100,000 population) occurred after 2000. Of these cases, 68 (87%) were in known cases-ie, cases diagnosed with tuberculosis before the survey. Of the known cases, the proportion treated by the public health system (using the DOTS strategy) increased from 59 (15%) of 370 cases in 2000 to 79 (66%) of 123 cases in 2010, contributing to reduced proportions of treatment default (from 163 [43%] of 370 cases to 35 [22%] of 123 cases) and retreatment cases (from 312 [84%] of 374 cases to 48 [31%] of 137 cases; both p<0.0001). INTERPRETATION: In 20 years, China more than halved its tuberculosis prevalence. Marked improvement in tuberculosis treatment, driven by a major shift in treatment from hospitals to the public health centres (that implemented the DOTS strategy) was largely responsible for this epidemiological effect. FUNDING: Chinese Ministry of Health.

Inhibition mechanism of buckwheat hulls polyphenols on α-amylase and α-glucosidase using kinetics, spectroscopics and molecular docking approaches.

The work investigated the activity inhibition of phenolic compounds in buckwheat (Fagopyrum esculentum Moench) hulls (BH) on α-amylase and α-glucosidase, and clarified their possible mechanisms based on kinetics, spectroscopics and molecular docking analysis. The total polyphenols (BHP) from BH using an ultrasound-assisted alcohol extraction method was 210.50 mg GAE/g DW. The study identified a total of 33 polyphenolic compounds in the extracts of BH using UPLC-Q-Exactive Orbitrap/MS, revealing that sixteen of these were novel polyphenolic substances not previously documented in this plant. BHP demonstrated significant inhibitory effects on both α-amylase and α-glucosidase enzymes, with IC50 values recorded at 27.16 µg/mL and 7.00 µg/mL, respectively, suggesting noncompetitive and mixed-type inhibition mechanisms. The fluorescence intensity of the enzymes was effectively quenched by BHP through a combination of dynamic and static quenching mechanisms, driven predominantly by hydrophobic interactions. BHP's interaction with the enzymes resulted in conformational changes that reduced their enzymatic activities. Molecular docking further revealed that six polyphenolic components of BHP had a strong affinity for binding with the active sites nestled in the enzymes' hydrophobic cavities, inhibiting their activity and potentially contributing to a reduction in blood glucose levels. The results could provide perspective for using BHP in the functional components of sugar-controlling foods.

Room-Temperature, Solution-Processed, Robust, Transparent, and Conductive SiOx/AgNW Nanocomposite Coating.

AgNW networks show high promise as a conductive material due to excellent flexibility, low resistance, high transparency, and ease of large-scale preparation. However, the application of AgNW networks has been hindered by their inherent characteristics, such as easy oxidation degradation, chemical corrosion, and structural instability at high temperatures. In this study, a dense SiOx protective layer derived from perhydropolysilazane was introduced to fabricate a robust SiOx/AgNW nanocomposite coating through an all-solution process at room temperature. The achieved nanocomposite coating shows outstanding thermal stability up to 450 °C, resistance to ultraviolet radiation, and excellent mechanical performance by maintaining stability after 10,000 cycles of bending at a radius of 2.5 mm, 1000 cycles of peeling, and 1200 cycles of wearing. Meanwhile, the nanocomposite coating demonstrates exceptional chemical tolerance against HCl, Na2S, and organic solvents. A transparent heater based on the nanocomposite coating achieves a remarkable benchmark with a maximum temperature of 400 °C at 20 V. These features highlight the potential of the nanocomposite coating in flexible electronics, optoelectronics, touch screens, and high-performance heaters.

Clinical and Genomic Characteristics of a Clinical Listeria Monocytogenes ST120 Isolate Recovered from a Pregnant Woman.

Background: Maternal-fetal listeriosis, caused by Listeria monocytogenes, is a rare but serious infection. Herein, we report the clinical and genomic characteristics of a clinical L. monocytogenes ST120 isolate recovered from a pregnant woman. Methods: The clinical symptoms and treatment in pregnant woman were described in detail. Whole genome sequencing (WGS) was performed on the L. monocytogenes isolate SJZ_LM001, and the genomic characterization of the isolate was deeply analyzed. Results: The clinical symptoms in pregnant women were mainly fever, and the placenta experienced severe inflammation. The pregnant woman was treated with ampicillin for effective anti-infective therapy. Genomic analysis showed that isolate SJZ_LM001 is sequence type (ST) 120, belong to clonal complex (CC)8 and lineage II of L. monocytogenes. Additionally, the isolates SJZ_LM001 harbored a novel plasmid pSJZ_LM001, which carried arsenical resistance genes (arsACD and acr3), and cadmium resistance genes (cadAC). Drug susceptibility testing showed that the isolate SJZ-LM001 was susceptible to ampicillin, meropenem, penicillin, and cotrimoxazole. Conclusion: This is the first to identify a clinical case of infection in a pregnant woman caused by ST120 L. monocytogenes in China. These findings could benefit our understanding of the genomic characteristics of L. monocytogenes, and the pregnancy-related listeriosis and providing early diagnosis and effective targeted treatment.

A Photoenzymatic Pathway for Gram-Scale Synthesis of 25-Hydroxyvitamin D3.

Vitamin D and its analogues play a crucial role in promoting the well-being of both humans and animals. However, the current synthesis of this vital class of nutrients heavily relies on chemical transformations, which suffer from low step- and atom-efficiency due to lengthy synthetic pathways. To enhance sustainability in the chemical industry, it is necessary to develop alternative synthetic processes. Herein, we present a photoenzymatic approach for synthesizing 25-hydroxyvitamin D3 from 7-dehydrocholesterol. In this sequential synthesis, 7-dehydrocholesterol is initially hydroxylated at the C25 C-H bond, resulting in an 85 % conversion to 25-hydroxyl-7-dehydrocholesterol. Subsequently, by employing photo-irradiation using a monochromatic LED ultraviolet light source in a batch reactor and thermal isomerization, 25-hydroxyvitamin D3 is obtained in satisfactory yield. This photoenzymatic process significantly reduces the need for purification steps and allows for gram-scale synthesis of the target product. Our work offers a selective, efficient, and environmentally friendly method for synthesizing 25-OH-vitamin D3, addressing the limitations of current synthetic approaches.

Adherence to preventive treatment for latent tuberculosis infection in close contacts of pulmonary tuberculosis patients: A cluster-randomized controlled trial in China.

OBJECTIVES: This study examined adherence rates to tuberculosis preventive treatment (TPT) among close contacts of individuals with pulmonary tuberculosis (PTB) and identified factors associated with TPT adherence in China. METHODS: A multicenter, cluster-randomized, open-label control trial was carried out across three sites involving 34 counties in China. Close contacts of bacteriologically confirmed rifampin and isoniazid-susceptible PTB cases were identified and screened for latent tuberculosis infection (LTBI). Eligible participants were randomly assigned to either the 3H2P2 group, which consisted of a 3-month, twice-weekly regimen of rifapentine and isoniazid, or the 6H group, which entailed a 6-month daily regimen of isoniazid. To assess the factors influencing adherence, a two-level logistic regression model was utilized. RESULTS: Out of the 2434 close contacts who initiated TPT, 2121 (87.1%) completed the regimen. Of the 313 individuals who did not complete TPT, 60.1% refused to continue, and 27.8% discontinued due to adverse effects. The two-level logistic regression model revealed several factors associated with enhanced TPT adherence: enrollment in the 3H2P2 group (odds ratio [OR] = 2.09), management by a TB dispensary responsible for TPT (OR = 2.55), supervision by healthcare workers (OR = 6.40), and clinician incentives (OR = 2.49). Conversely, the occurrence of any adverse effects (OR = 0.08) was identified as a risk factor for nonadherence. CONCLUSION: Administering TPT to individuals with LTBI is feasible among close contacts. Adherence to TPT can be enhanced through shorter, safer treatment regimens and supportive interventions, such as directly supervised therapy for TPT recipients and incentives for healthcare providers managing TPT.

Tuberculosis infection among close contacts of patients with pulmonary tuberculosis in China: a population-based, multicentered study.

OBJECTIVES: Limited information is currently available on the prevalence of and risk factors for tuberculosis infection (TBI) among close contacts of patients with pulmonary TB (PTB) in China. In this study, we estimated the burden of TBI among close contacts using QuantiFERON-TB Gold In-Tube assay (QFT) and identified factors associated with TB transmission among this high-risk population. METHODS: From January 1, 2018 to August 31, 2020, we identified laboratory-confirmed patients with PTB from a population-based, multicentered, cluster-randomized control trial for tuberculosis preventive treatment. Close contacts of these patients were identified, interviewed, and tested using the QFT assay. We estimated TBI prevalence and calculated ORs and 95% CIs for TBI risk factors. RESULTS: A total of 3138 index cases and 8117 close contacts were identified. Of these contacts, 36 had PTB (a prevalence of 443.51 cases/100 000 population). Among the remaining 7986 close contacts; 3124 (39.12%) reported a positive QFT result. QFT positivity was significantly associated with older age (adjusted OR, 1.77; [95% CI, 1.27-2.47], 2.20; [95% CI, 1.59-3.05], and 2.74; [95% CI, 1.96-3.82]) for age groups: 35-44, 45-54, and 55-64, respectively) when compared with a younger age group: 5-14; longer contact duration (adjusted OR, 1.44; 95% CI, 1.22-1.69); and sharing of a bedroom (adjusted OR, 1.39; 95% CI, 1.18-1.65). DISCUSSION: Our findings indicate a high TBI burden among the close contacts of PTB. The results also highlighted that contact tracing and investigation for TBI are necessary and beneficial, particularly for those who are older, have had a longer contact duration, and share a bedroom.

Association between phthalate metabolite mixture in neonatal cord serum and birth outcomes.

Prenatal exposure to phthalates (PAEs) is ubiquitous among Chinese neonates. PAEs entering the body will be transformed to various hydrolyzed and oxidated PAE metabolites (mPAEs). PAEs and mPAEs exposure may lead to adverse birth outcomes through disruption of multiple hormone signaling pathways, induction of oxidative stress, and alterations in intracellular signaling processes. In this study, the concentrations of 11 mPAEs in 318 umbilical cord serum samples from neonates in Jinan were quantified with HPLC-ESI-MS. Multiple linear regression, Bayesian kernel machine regression, and quantile g-computation models were utilized to investigate the effects of both individual mPAE and mPAE mixture on birth outcomes. Stratified analysis was performed to explore whether these effects were gender-specific. mPAE mixture was negatively associated with birth length (BL) z-score, birth weight (BW) z-score, head circumference (HC) z-score, and ponderal index (PI). Mono(2-ethylhexyl) phthalate (MEHP) manifested negative associations with BL(z-score), BW(z-score), HC(z-score), and PI, whereas mono(2-carboxymethylhexyl) phthalate (MCMHP) was negatively associated with BW(z-score) and PI within the mPAE mixture. Stratified analysis revealed that the negative associations between mPAE mixture and four birth outcomes were attenuated in female infants, while the positive impact of mono(2-ethyl-5carboxypentyl) phthalate (MECPP) on BL(z-score) and BW(z-score) could be detected only in females. In summary, our findings suggest that prenatal exposure to phthalates may be associated with intrauterine growth restriction, and these effects vary according to the gender of the infant.

Financial Burden of Tuberculosis Patients - China, 2020.

What is already known about this topic?: Tuberculosis (TB) is often referred to as "a disease of poverty," yet the information regarding the financial burden of TB care is limited and regionally representative. What is added by this report?: This manuscript reported the national representative total and breakdown costs associated with TB care in China. The total cost per patient was 1,185 USD, of which 88% was direct cost and 37% was incurred prior to TB treatment. What are the implications for public health practice?: TB patients experience a significant financial burden, and disparities exist among different regions and populations. Current TB care policies and packages are not sufficient to address this issue.

Inorganic-Organic Silica/PDMS Nanocomposite Antiadhesive Coating with Ultrahigh Hardness and Thermal Stability.

Antiadhesive surfaces have been gaining continuous attention, because of the scientific and industrial significance. Slippery surfaces and antismudge coatings with antiadhesive behavior have been readily designed and prepared. However, improving robustness of the surfaces, especially the simultaneous demonstration of features of high hardness, excellent adhesion to different substrates, and high thermal stability, is constantly challenging. Herein, we present a silica/polydimethylsiloxane (PDMS) nanocomposite coating (SPNC), wherein silica acts as a consecutive phase and nanophased PDMS is covalently embedded. The nanoconfined PDMS phase exhibits enhanced thermal stability and endows SPNC with slippery behavior; meanwhile, enrichment of PDMS on the surface renders a gradient composition of the coating. Accordingly, the inorganic-organic SPNC simultaneously displays a high nanoindentation hardness of 3.07 GPa and a pencil hardness over 9H, outstanding thermal stability of the slippery performance up to 400 °C, and excellent adhesion strength to different substrates. Additionally, SPNC exhibits high optical transparency, flexibility, resistance to bacterial clone, and chemical corrosion. With the scalable fabrication process, it can be envisioned that the antiadhesive coating with unprecedented comprehensive merits in this work has significant potentials for large-area applications, especially under severe service environments.

Effect of the hospital-community-family (HCF) nutritional management on patients with esophageal and head and neck cancers undergoing radiotherapy: a randomized control trial.

Background: Malnutrition is particularly common in patients undergoing radiotherapy for head and neck cancers (HNC) and esophageal cancers (EC). Proper nutritional management plays an important role in improving the nutritional status and reducing complications in patients undergoing radiotherapy for malignancy. With most nutrition studies limited to the nutritional management of patients during hospitalization or after discharge, there is a lack of research evidence on the nutritional management of patients in combination with out-of-hospital. The aim of this study was to evaluate the effect of the hospital-community-family (HCF) nutritional management model on nutritional status and radiotherapy complications in EC and HNC radiotherapy patients. Methods: Between October 2019 and October 2021, a total of 116 EC and HNC radiotherapy patients were randomized into control group (conventional nutritional support) and experimental group (HCF-model nutritional management), and assessed weekly for 3 months. The primary endpoint was the patient's Nutrition Risk Screening 2002 (NRS2002) score, Scored Patient-Generated Subjective Global Assessment (PG-SGA), weight change, and Eastern Cooperative Oncology Group (ECOG) score from baseline level to 3 months after the end of treatment. The secondary endpoints were the incidence of albumin, hemoglobin, hematological parameters, and radiotherapy complications. Results: A total of 95 patients (47 in the control group and 48 in the experimental group) completed the study. At 3 months after treatment, NRS2002 (P=0.028) and PG-SGA (P=0.022) decreased, and albumin was higher (P=0.001) than at the beginning of treatment in HCF group. Weight decreased (P<0.001) and PG-SGA was higher after 3 months of treatment (P=0.012) in the control group. PG-SGA (P<0.001), NRS2002 (P<0.001), and ECOG (P=0.006) in the HCF group at the end of the 3-month treatment period were lower in the conventional group (P<0.05). The incidence of radiation mucositis (P=0.018)and radiation dermatitis (P=0.028) in the HCF nutrition management group was significantly reduced (P<0.05). Conclusions: HCF-model nutritional management significantly improved the nutritional status and reduced the incidence and severity of radiation mucositis and dermatitis for EC and HNC radiotherapy patients. These findings suggest that HCF-model nutritional management is a promising nutritional management model. Trial Registration: Chinese Clinical Trial Registry identifier: ChiCTR2300068399.

Digital adherence technologies to improve tuberculosis treatment outcomes in China: a cluster-randomised superiority trial.

BACKGROUND: Drug-sensitive tuberculosis treatment requires 6 months of therapy, so adherence problems are common. Digital adherence technologies might improve tuberculosis treatment outcomes. We aimed to evaluate the effect of a daily reminder medication monitor, monthly review of adherence data by the health-care provider, and differentiated care for patients with adherence issues, on tuberculosis treatment adherence and outcomes. METHODS: We did a cluster-randomised superiority trial across four prefectures in China. 24 counties or districts (clusters) were randomly assigned (1:1) to intervention or control groups. We enrolled patients aged 18 years or older with GeneXpert-positive, rifampicin-sensitive pulmonary tuberculosis, who were receiving daily fixed-dose combination treatment. Patients in the intervention group received a medication monitor for daily drug-dosing reminders, monthly review of adherence data by health-care provider, and management of poor adherence; and patients in the control group received routine care (silent-mode monitor-measured adherence). Only the independent endpoints review committee who assessed endpoint data for some participants were masked to study group assignment. Patients were followed up (with sputum solid culture) at 12 and 18 months. The primary outcome was a composite of death, loss to follow-up, treatment failure, switch to multidrug-resistant tuberculosis treatment, or tuberculosis recurrence by 18 months from treatment start, analysed in the intention-to-treat population. Analysis accounted for study design with multiple imputation for the primary outcome. This trial is now complete and is registered with ISRCTN, 35812455. FINDINGS: Between Jan 26, 2017, and April 3, 2019, 15 257 patients were assessed for eligibility and 3074 were enrolled, 2686 (87%) of whom were included in the intention-to-treat population. 1909 (71%) of 2686 patients were male, 777 (29%) were female, and the median age was 44 years (IQR 29-58). By 18 months from treatment start, using multiple imputation for missing outcomes, 239 (16% [geometric mean of cluster-level proportion]) of 1388 patients in the control group and 224 (16%) of 1298 in the intervention group had a primary composite outcome event (289 [62%] of 463 events were loss to follow-up during treatment and 42 [9%] were tuberculosis recurrence). The intervention had no effect on risk of the primary composite outcome (adjusted risk ratio 1·01, 95% CI 0·73-1·40). INTERPRETATION: Our digital medication monitor intervention had no effect on unfavourable outcomes, which included loss to follow-up during treatment, tuberculosis recurrence, death, and treatment failure. There was a failure to change patient management following identification of treatment non-adherence at monthly reviews. A better understanding of adherence patterns and how they relate to poor outcomes, coupled with a more timely review of adherence data and improved implementation of differentiated care, may be required. FUNDING: Bill & Melinda Gates Foundation.