Revascularization-first strategy versus central repair-first strategy for acute type A aortic dissection complicated with mesenteric malperfusion syndrome: A meta-analysis.

OBJECTIVE: The optimal therapeutic strategy for acute type A aortic dissection (ATAAD) accompanied by mesenteric malperfusion syndrome (mMPS) has not been fully elucidated. The intent of this meta-analysis was to analyze the effectiveness and safety of the revascularization-first strategy among patients with ATAAD complicated with mMPS through comprehensive comparisons with the central repair-first strategy. METHODS: Studies relevant to the comparison of the outcomes of early reperfusion combined with delayed proximal aortic repair and initial central repair in the treatment of ATAAD complicated with mMPS, were systematacially searched using PubMed, Cochrane Library, Web of Science and Embase up to June 30, 2022. And the primary outcome was early mortality, with mesenteric complications, adverse aortic events and hypothermic circulatory arrest (HCA) time served as the secondary outcomes. Screening of the relevant studies, data extraction, and assessment of the included studies were conducted by two authors independently. Standard statistical procedures provided in Review Manager 5.3 were used to perform all statistical analyses. RESULTS: Five studies comprising 72 patients in total were included into the quantitative synthesis. In-hospital/30-day mortality was significantly reduced in patients receiving the revascularization-first strategy than in those with the central repair-first strategy, with a pooled risk ratio (RR) of 0.46 (p = .04, 95% confidence interval [CI]: 0.22-0.95). The revascularization-first strategy resulted in a lower incidence of mesenteric complications compared with the central repair-first strategy, with a pooled RR of 0.15 (p = .0002, 95% CI: 0.05-0.41). Moreover, no significant difference was found in the comparison of the revascularization-first strategy and central repair-first strategy regarding adverse aortic events (p = .31, 95% CI: 0.44-12.78). Compared with central repair-first, a longer HCA time was observed in revascularization-first with mean difference of 9.91 (p = .02, 95% CI: 1.34-18.48). CONCLUSIONS: The revascularization-first strategy presented a lower in-hospital/30-day mortality and mesenteric complications than the central repair-first strategy without increasing the incidence of adverse aortic events. However, the revascularization-first strategy indicated a longer HCA time than the central repair-first strategy.

The impact of long-term moderate level of vaccination coverage for epidemiology of varicella in Lu'an, China: should we change immunisation strategy now?

As China implements the voluntary vaccination programme of one-dose of varicella vaccine (VarV) for decades, robust estimates of the impact of voluntary vaccination era on epidemiology of varicella are needed. We estimated the vaccination coverage (VC) of VarV by using surveillance data on immunisation. The descriptive epidemiological method was used to describe the changing epidemiology of varicella from 2007 to 2018. The screening method was used to estimate the vaccine effectiveness (VE) of VarV. The overall VC for VarV was 71.7%, ranged from 47.7% to 79.5% among 2008-2017 birth cohorts. In total, 16 660 varicella cases were reported during 2007-2018, the incidence increased from 10.0 cases per 100 000 population in 2007 to 65.2 cases per 100 000 population in 2018. A shift in age group of varicella was observed since 2012, with the age increased from 5-9 years to 10-14 years. The overall VE was 79.9%, and the VE increased from 60.1% in 2008 birth cohort to 96.2% in 2017 birth cohort. We found that the overall VE for VarV is moderate, but appears highly effective within 5 years after vaccination. In addition, a shift varicella infection to older ages has occurred at the long-term moderate level VC of one-dose VarV. Therefore, to contain the incidence of varicella and prevent any potential shift to older ages, the introduction of VarV into routine immunisation programme is likely needed in Lu'an.

Uncovering Druggable Targets in Aortic Dissection: An Association Study Integrating Mendelian Randomization, pQTL, and Protein-Protein Interaction Network.

Aortic dissection (AD) is a life-threatening acute aortic syndrome. There are limitations and challenges in the discovery and application of biomarkers and drug targets for AD. Mendelian randomization (MR) analysis is a reliable analytical method to identify effective therapeutic targets. We aimed to identify novel therapeutic targets for AD and investigate their potential side-effects based on MR analysis. Data from protein quantitative trait loci (pQTLs) were used for MR analyses to identify potential therapeutic targets. We probed druggable proteins involved in the pathogenesis of aortic dissection from deCODE. In this study, a two-sample MR analysis was conducted, with druggable proteins as the exposure factor and data on genome-wide association studies (GWAS) of AD as the outcome. After conducting a two-sample MR, summary data-based Mendelian randomization (SMR) analysis and colocalization analysis were performed. A protein-protein interaction (PPI) network was also constructed to delve into the interactions between identified proteins. After MR analysis and the Steiger test, we identified five proteins as potential therapeutic targets for AD. SMR analysis and colocalization analysis also confirmed our findings. Finally, we identified ASPN (OR = 1.36, 95% CI: 1.20, 1.54, p = 4.22 × 10-5) and SPOCK2 (OR = 0.57, 95% CI: 0.41, 0.78, p = 4.52 × 10-4) as the core therapeutic targets. Through PPI network analysis, we identified six druggable targets, enabling the subsequent identification of six promising drugs from DrugBank for treating AD. This discovery of specific proteins as novel therapeutic targets represents a significant advancement in AD treatment. These findings provide more effective treatment options for AD.

New-Onset Sleep Disorders before Cardiac Surgery May Indicate an Increased Risk of Postoperative Atrial Fibrillation.

PURPOSE: We aimed to determine if sleep disorders before cardiac surgery indicate an increased risk of postoperative atrial fibrillation (POAF). METHODS: In this study, 238 patients undergoing coronary artery bypass grafting in our center were included. Patients were separated into the preoperative sleep disorder group and the control group. The primary endpoint was the incidence of POAF, and the secondary endpoints were the incidence of postoperative stroke, duration of invasive ventilation, length of intensive care unit, and hospitalization stay. Propensity score matching and multivariable logistic regression were used for adjusting potential confounders. RESULTS: A total of 165 (69.3%) patients had sleep disorders before surgery, and 73 well-matched pairs were generated. A higher incidence of POAF was found in the preoperative sleep disorder group (16.4% versus 5.5%, p = 0.034). In multivariable logistic regression, preoperative sleep disorders were correlated to a higher risk of POAF (odds ratio = 4.627, 95% confidence interval: 1.181-18.123, p = 0.028). In the subgroup of patients without long-term sleep disorders, those who experienced preoperative sleep disorders had a higher incidence of POAF (16.1% versus 4.3%, p = 0.024), meanwhile, no difference was found in the subgroup of long-term sleep disorders. CONCLUSION: New-onset sleep disorders before cardiac surgery may indicate a higher incidence of POAF.

Insight into the quantum anomalous Hall states in two-dimensional kagome Cr3Se4 and Fe3S4 monolayers.

To realize the quantum anomalous Hall (QAH) effect in two-dimensional (2D) intrinsic magnetic materials, which combines insulating bulk states and metallic edge channel states, is still challenging in experiment. Here, based on first-principles calculations, we predicted two stable kagome-latticed QAH insulators: Cr3Se4 and Fe3S4 monolayers, with the Chern number C = 1. It is found that both structures exhibit a large magnetic anisotropy energy and sizable band gaps, and a topological phase transition from C = -1 to C = 1 occurs when the magnetization orientation changes from the z-axis to the -z-axis. Remarkably, the non-trivial topological properties are robust against biaxial strains of up to ±6%. Furthermore, a variable high Chern number of C = 2 or C = 3 can be observed by stacking two or three layers of the QAH monolayer with an MoS2 insulator. Our results signify that such layered kagome materials can be promising platforms for exploring novel QAH physics.

[Effect of deep needling "Tianshu" (ST25) on colonic motility in rats with slow transit constipation].

OBJECTIVE: To observe the effect of acupuncture of "Tianshu"(ST25) at different depths on colonic transportation function, expressions of colonic substance P (SP) and interstitial cells of Cajal (ICC) in rats with slow transit constipation (STC), so as to explore its mechanisms underlying improvement of STC．. METHODS: Fifty male Wistar rats were selected and randomly divided into control，STC model，conventional acupuncture，deep needling group 1 and deep needling group 2 groups，with 10 rats in each group．The STC model was established by gavage of 1 mg/mL compound diphenoxylate suspension (10 mg/kg), once every other day for 21 days, and rats of the control group were given the same dose of distilled water by gavage．EA (2 Hz, 2 mA) was applied to "Tianshu"(ST25), with the acupuncture needle inserted to a depth of 3 mm for rats of the conventional acupuncture group, 4.5 mm for those of deep needling group 1, and 10 mm for those of the deep needling group 2. The acupuncture needle was twirled for 1 min, then retained for 15 min each time, once a day for 15 consecutive days．Following modeling, rats of the 4 groups and the control group received gavage of active carbon 2 mL (100 g/L) for observing the excretion time of the first black stool grain to assess the intestinal transit function. The colonic myoelectric activities (frequency and amplitude) were recorded by using BIOPAC multichannel physiograph. The immunoactivity of SP and c-kit (a transmembrane protein kinase for identification of ICC) of colonic musculature was detected by immunohistochemistry. RESULTS: Compared with the control group，the time of excretion of the first black stool grain, and the amplitude of colonic electromyogram (EMG) were significantly increased (P<0.01), while the frequency of EMG, expressions of SP and c-kit (ICC) were significantly decreased in the model group (P<0.01). In contrast to the model group, both deep needling group 1 and 2 had a decrease in the time of excretion of the first black stool grain, and amplitude of intestinal EMG, and an increase of frequency of intestinal EMG, and immunoactivity of SP and c-kit (P<0.01). The effect of deep needling 2 is superior to that of deep needling 1 in reducing the time of excretion of the first black stool grain (P<0.05), lowering the amplitude of EMG of the gut smooth muscle (P<0.05) and in increasing the frequency of EMG (P<0.05) and the expressions of SP and c-kit (P<0.05). No significant changes were found in the levels of frequency and amplitude of EMG, and expressions of SP and c-kit after routine needling in comparison with the model group (P>0.05), except the excretion time of the first black stool grain (P<0.05). CONCLUSION: Deep needling at ST25 at depth of 4.5 mm and 10 mm，especially at depth of 10 mm，has a significant effect in promoting gut motility to ameliorate constipation in rats with STC, which may be related to its function in up-regulating the expressions of SP and ICC activity.

Catalpol rescues cognitive deficits by attenuating amyloid ß plaques and neuroinflammation.

This study sought to investigate the anti-amyloid ß (Aß) and anti-neuroinflammatory effects of catalpol in an Alzheimer's disease (AD) mouse model. METHODS: The effects of catalpol on Aß formation were investigated by thioflavin T assay. The effect of catalpol on generating inflammatory cytokines from microglial cells and the cytotoxicity of microglial cells on HT22 hippocampal cells were assessed by real-time quantitative PCR, ELISA, redox reactions, and cell viability. APPswe/PS1ΔE9 mice were treated with catalpol, and their cognitive ability was investigated using the water maze and novel object recognition tests. Immunohistochemistry and immunofluorescence were used to probe for protein markers of microglia and astrocyte, Aß deposits, and NF-κB pathway activity. Aß peptides, neuroinflammation, and nitric oxide production were examined using ELISA and redox reactions. RESULTS: Catalpol potently inhibited Aß fibril and oligomer formation. In microglial cells stimulated by Aß, catalpol alleviated the expression of the proinflammatory cytokines tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and inducible nitric oxide synthase (iNOS) but promoted the expression of the anti-inflammatory cytokine IL-10. Catalpol alleviated the cytotoxic effects of Aß-exposed microglia on HT22 cells. Treatment with catalpol in APPswe/PS1ΔE9 mice downregulated neuroinflammation production, decreased Aß deposits in the brains and alleviated cognitive impairment. Catalpol treatment decreased the number of IBA-positive microglia and GFAP-positive astrocytes and their activities of the NF-κB pathway in the hippocampus of APPswe/PS1ΔE9 mice. CONCLUSION: The administration of catalpol protected neurons by preventing neuroinflammation and Aß deposits in an AD mouse model. Therefore, catalpol may be a promising strategy for treating AD.

Ab Initio Study of Structural, Electronic and Magnetic Properties of TM&(B@C60) (TM = V, Cr) Sandwich Clusters and Infinite Molecular Wires.

The geometrical structure, electronic and magnetic properties of B-endoped C60 (B@C60) ligand sandwich clusters, TM&(B@C60)2 (TM = V, Cr), and their one-dimensional (1D) infinite molecular wires, [TM&(B@C60)]∞, have been systematically studied using first-principles calculations. The calculations showed that the TM atoms can bond strongly to the pentagonal (η5-coordinated) or hexagonal rings (η6-coordinated) of the endoped C60 ligands, with binding energies ranging from 1.90 to 3.81 eV. Compared to the configurations with contrast-bonding characters, the η6- and η5-coordinated bonding is energetically more favorable for V-(B@C60) and Cr-(B@C60) complexes, respectively. Interestingly, 1D infinite molecular wire [V&(B@C60)-η6]∞ is an antiferromagnetic half-metal, and 1D [Cr&(B@C60)-η5]∞ molecular wire is a ferromagnetic metal. The tunable electronic and magnetic properties of 1D [TM&(B@C60)]∞ SMWs are found under compressive and tensile stains. These findings provide additional possibilities for the application of C60-based sandwich compounds in electronic and spintronic devices.

[Effect of electroacupuncture of "Tianshu"(ST25) at different frequencies on electromyography and immunoactivity of SP and VIP of colon in rats with slow transit constipation].

OBJECTIVE: To observe the effect of electroacupuncture (EA) of bilateral "Tianshu"(ST25) at different frequencies on the first black stool discharge time, colonic electromyography (EMG) and immunoactivity of vasoactive intestinal peptide (VIP) and substance P (SP) in the colon tissue in rats with slow transit constipation (STC), so as to choose a better stimulating frequency in the treatment of STC. METHODS: A total of 50 male Wistar rats were randomized into control, model, 2 Hz-EA, 100 Hz- EA, and 2 Hz/100 Hz-EA groups, with 10 rats in each group. The STC model was established by intraperitoneal injection of compound diphenoxylate suspension fluid (10 mg/kg). EA was applied to bilateral ST25 for 30 min, once a day for 14 consecutive days. The discharge time for the first black stool was recorded after gavage of mixed suspension fluid of active carbon (2 mL) for assessing the gastrointestinal motility. The colonic EMG was recorded by using a pair of silver electrodes and bioelectric amplifier. The expression of SP and VIP in the colonic tissue was detected by immunohistochemistry. RESULTS: Following mode-ling, the colonic EMG amplitude, the discharge time for the first black stool and VIP immunoactivity were significantly increased (P<0.01), and the EMG frequency and SP immunoactivity were significantly decreased （P<0.01） in the model group compared with the control group. Compared with the model group, the increase of the discharge time for the first black stool, EMG amplitude and VIP immunoactivity, the decrease of EMG frequency and SP immunoactivity were reversed in the 3 EA groups (P<0.01, P<0.05). The therapeutic effect of 100 Hz-EA was notably weaker than that of both 2 Hz-EA and 2 Hz/100 Hz-EA in up-regulating EMG frequency and SP immunoactivity and in down-regulating the discharge time for the first black stool, EMG amplitude and VIP immunoactivity (P<0.05, P<0.01). There was no significant difference between the 2 Hz/100 Hz-EA and 2 Hz-EA groups (P>0.05). CONCLUSION: EA can accelerate colonic EMG activities, which may be associated with its functions in down-regulating VIP immunoactivity and up-regulating SP immunoactivity in the colonic tissues. The therapeutic effects of 2 Hz/100 Hz-EA and 2 Hz-EA are better than that of 100 Hz-EA.

Clinical study on auricular acupoint penetration needling along the skin for treatment of a variety of pain syndrome and dysfunction.

This paper is a summary of clinical studies on auricular acupoint penetration needling along the skin for treatment of pain and dysfunction in recent 10 years. Auricular acupoint penetration needling along the skin was used to observe rapid analgesic effects and clinical efficacy on cervical spondylopathy, periarthritis of shoulder, pain in waist and lower extremities, migraine, and other peripheral neuropathic pain, and stroke sequels, soft tissue injury, and so on. Self-control method was used in the studies at the first stage, and clinically randomized control trial methodwas used for systematic comparison with other therapies at the second stage. Results indicated that the auricular acupoint penetration needling along the skin had obviously clinical effects on cervical spondylopathy, periarthritis of shoulder, pain in waist and lower extremities, migraine, soft tissue injuries and stroke sequels, with a better rapid analgesic effect as compared with ear perpendicular needling method.

Combustion Characteristics, Kinetics, and Thermodynamics of Pine Wood Through Thermogravimetric Analysis.

The thermal conversion of woody biomass is increasingly critical for the development of the energy processing technologies and fire safety engineering. The combustion characteristics, kinetics, and thermodynamics of pine wood were characterized through a thermogravimetric analyzer in the air atmosphere. There were two apparent peaks in the derivative TG curves for pine wood. The combustion process of pine wood was divided into two stages. Therein, the first stage occurring in the conversion degree range of 0-0.6 may be considered a one-step reaction. It was easier for pine wood to decompose under air than under nitrogen. Moreover, the first stage of pine wood combustion may be characterized by the diffusion model g(α) = [1 - (1 - α)1/3]2. The kinetic modeling showed a good agreement between the predicted and experimental conversion degree curves. In addition, the high comprehensive combustion index of pine wood at 10 K min-1 (6.73 × 10-7 %2 min-2 K-3) showed its great potential for bioenergy generation. Besides, both the value of ΔH and ΔS exhibited similar patterns with the activation energy value versus conversion degree, while the ΔG value almost remained at a positive constant with conversion degree. The average ΔH, ΔG, and ΔS value was nearly equal under different heating rates.

Safety of Thread Embedding Acupuncture Therapy: A Systematic Review.

OBJECTIVE: To evaluate the safety of thread embedding acupuncture therapy (TEAT) and discuss the prevention and treatment of some adverse events (AEs). METHODS: Review of databases, including China National Knowledge Infrastructure (CNKI), CBMdisc, Wanfang, VIP databases and English literature published in PubMed, MEDLINE, EMBASE and Web of Science, were searched from their inception to January 2020, randomized controlled trials (RCTs) and case reports in which AEs with TEAT were included. Cochrane Collaboration's tool and RevMan V.5.3.3 software were used to evaluate the quality of the studies. RESULTS: A total of 61 studies (45 RCTs and 16 case reports) with 620 cases of AEs were included in this review. These studies were published in two countries: China and South Korea. Twenty eight kinds of AEs were summarized. The most common AEs were induration, bleeding and ecchymosis, redness and swelling, fever, and pain. They were accounted for 75.35% (425/564) in the review, and most of them were mild. The rarest AEs were epilepsy, irregular menstruation, skin ulcer, thread malabsorption, and fat liquefaction, with 1 case each. But not all of them had clear causal relationship with TEAT. Most of the AEs were local reactions [with incidence of 9.83% (480/4,882)] and systemic reactions accounted for only 1.27% (62/4,882). Although the included studies showed that AEs were very commonly encountered (11.09%), only 5 cases of severe AEs reported from 2013 to 2017 (0.1%) by using catgut thread, which are rarely seen nowdays with the wide use of new absorbable surgical suture. All of the severe AEs were recovered after symptomatic treatment with no sequelae. CONCLUSIONS: The evidence showed that TEAT is a relatively safe and convenient therapy especially since application of new absorbable surgical suture. Improving practitioner skills, regulating operations, and paying attention to the patients' conditions may reduce the incidence of AEs and improve safety of TEAT.

Upgrading the school entry vaccination record check strategy to improve varicella vaccination coverage: results from a quasi-experiment study.

BACKGROUND: The school entry vaccination record check strategy (SECS) is an appropriate opportunity to recommend vaccines for students to improve vaccination coverage (VC). However, it is only utilized for providing necessary catch-up vaccination for students who are missing the Expanded Program on Immunization (EPI) vaccines in China. We aimed to address that gap and quantify the relationship between the SECS policy and the increase of coverage in varicella vaccine (VarV). METHODS: We employed a pretest and posttest quasi-experimental design to examine the effect of the upgraded SECS policy on the change of VarV coverage in newly enrolled students in Lu'an, 2019-2020. RESULTS: Eight hundred participants were randomly divided into the control group (C group, 31.8%), the telephone-based intervention group (T group, 31.2%), and the written notification intervention group (W group, 37.0%). Totally, 84 students received VarV during the study period, with a VC of 10.5%. The possibility of vaccination in the T group (RR = 4.9, 95% CI:2.2-10.9) and W group (RR = 5.2, 95% CI:2.4-11.5) was significantly higher than that in the C group (p< .001). CONCLUSIONS: Our study demonstrates that the upgraded SECS produce a positive effect on improving the VC of VarV. This nudge strategy may decrease varicella outbreaks in schools in China, especially in provinces where VarV is not introduced into EPI.

Kinetics, Thermodynamics, and Volatile Products of Camphorwood Pyrolysis in Inert Atmosphere.

The kinetics, thermodynamics, and volatile products of camphorwood pyrolysis were investigated via thermogravimetry coupled with Fourier transform infrared (FTIR) spectroscopy at multiple heating rates. The kinetic triplets and thermodynamic parameters were estimated via model free combined with the model-fitting approach. The results showed that the pyrolysis of camphorwood in the conversion rate range from 0 to 0.85 might be considered as one-step process. The mean value of the activation energy and pre-exponential factor was 192.63 kJ/mol and 2.38 × 1013 s-1, respectively. The pyrolysis process (0 ≤ α ≤ 0.85) can be described by the three-dimensional diffusion model g(α) = [(1-α)-1/3 - 1]2. Furthermore, the predicted curves of the conversion rate α showed good agreement with the experimental curves. The values of ΔH, ΔG, and ΔS varied little with α and remained positive. In addition, the major gas products released from the camphorwood waste pyrolysis were H2O, methane, CO2, CO, C=O, O-H, C-O-C, and NH3, whose concentration in the order from highest to lowest was C=O > CO2 > O-H > H2O > methane > NH3 > C-O-C > CO. The main conclusions in the present study can provide guidance for the design and optimization of industrial reactor and selection of target biofuels or chemical raw materials.

Comparative Pyrolysis Characteristics and Kinetics of Typical Hardwood in Inert and Oxygenous Atmosphere.

Combustion (pyrolysis with oxygen) and pyrolysis without oxygen are two potential methods to convert wood into biofuels or biochemicals. To evaluate which is preponderant to convert wood into biofuels or biochemicals and provide guidance for optimization of product yield, the pyrolysis characteristics and kinetics of typical hardwood (black walnut) are comparatively investigated in nitrogen and air employing thermogravimetric analysis (TGA) and differential scanning calorimeter (DSC). Two model-free methods including Flynn-Wall-Ozawa (FWO) and Kissinger-Akahira-Sunose (KAS) method are applied to obtain the kinetic parameters, and a model-fitting method called Coats-Redfern (CR) method is employed to estimate the reaction mechanism. The black walnut pyrolysis in nitrogen may be divided into two stages with the threshold of conversion rate α = 0.4, but that in air may be separated into three stages with the thresholds of α = 0.25 and 0.7. The reaction mechanism for pyrolysis in nitrogen may be assumed random nucleation and its subsequent growth, but that in air may be assumed random nucleation and its subsequent growth followed by chemical reaction. The average activation energy and natural logarithm of pre-exponential factor for the whole pyrolysis process in nitrogen and air are 211.59 and 187.73 kJ/mol and 32.33 and 28.36 min-1, respectively.

In vivo investigation on bio-markers of perimenopausal panic disorder and catgut embedding acupoints mechanism.

BACKGROUND: Panic disorder (PD), defined by repeated and unexpected panic attacks, severely affects patients' living quality and social function. Perimenopausal women are high-risk group of PD and suffer greatly from it. Modern medicine therapies for this disorder have many side reactions and poor effects, so nonpharmacological modality is an urgent need. Although acupoint catgut embedding is widely used in clinical practice, there is no persuasive evidence of its effect for perimenopausal PD. The aim of this study is to investigate the effectiveness and safety of acupoint catgut embedding for perimenopausal PD and to elucidate the correlations among brain neural activation, bio-markers (amino acids) and clinical outcomes with radiographic evidence, thus to explore its neural mechanism. METHODS: The parallel designed, exploratory randomized controlled trial will include 70 outpatients with perimenopausal PD recruited from two hospitals of Chinese Medicine. These subjects will be randomly allocated to an intervention group (Group Embedding) and a control group (Group Medication) in a 1:1 ratio. The subjects in the intervention group will receive acupoint catgut embedding treatment two weeks a time in the following predefined acupuncture points: Shenshu (BL23), Sanyinjiao (SP6), Guanyuan (RN4), Ganshu (BL18), Zusanli (ST36) and Pishu (BL20). The included women of the control group will take 0.4 mg Alprazolam tablet orally, 1 tablet a time, 3 times a day. There is a study period of 3 months and a follow-up period of 1 month for each group. The primary outcomes will be the following therapeutic indexes: the frequency of panic attack, Panic Disorder Severity Score (PDSS), and Panic-associated Symptoms Score (PASS) during the observation period and follow-up period. The changes in Hamilton Anxiety Scale (HAMA) Score and Symptom Checklist 90 (SCL-90) Score will also be compared between these two groups. Additionally, functional magnetic resonance imaging (fMRI) and proton magnetic resonance spectroscopy (1H-MRS) scans will be done before and after the observation period to show cranial neuroimaging changes. DISCUSSION: We present a study design and rationale to explore the effectiveness and neural mechanism of acupoint catgut embedding for perimenopausal PD. There are still several factors restrict our research such as no unified standard of diagnostic criteria and curative effect evaluation. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR-INR-16009724, registered in November 2016.

Clinical characteristics and risk factors associated with breakthrough varicella during varicella outbreaks.

BACKGROUND: Although a varicella vaccine has been available in China since 1998 in the private sector, varicella outbreaks and breakthrough varicella (BV) still occur. In 2018, four varicella outbreaks with high BV rate sequentially occurred in four schools in Lu'an, sparking local public health authority's concerns on the varicella vaccine. Therefore, we conducted this investigation to evaluate varicella vaccine effectiveness (VE), characterize BV, and detect potential risk factors associated with BV. METHODS: This was a three-stage study. First, a retrospective cohort study was done in each school to estimate the VEs of varicella vaccine  during outbreaks. Second, a descriptive epidemiological method was used to describe the characteristics of the four outbreaks and to compare the clinical characteristics between the BV cases and unvaccinated varicella cases. To identify the risk factors associated with BV, we conducted an unmatched case-control study in the third stage of the study. RESULTS: A total of 199 cases were identified among four outbreaks, and the overall attack rate was 14%. Of 1203 students with available vaccination information, 822 (68%) were vaccinated at least once. The overall VEs among four outbreaks ranged from 19% to 69%, whereas the VE against moderate or severe varicella ranged from 74% to 90%. Compared with unvaccinated varicella cases, the moderate or severe varicella (p < .001) and fever (p = .029) in the BV group were less common. Besides, BV cases had a shorter duration of disease (p = .007). Children vaccinated more than six years before the outbreak had a higher risk of developing BV compared with those vaccinated within the past six years (OR = 2.4, 95% CI: 1.2-4.8). The risk of developing BV differed by the exposure intensity. Compared with the presence of three or fewer varicella cases in the same class, the OR was 7.8 (95% CI: 3.6-16.9) for four to nine cases in the same class and 25.2 (95% CI: 13.5 -47.2) for that of 10 or more cases. CONCLUSIONS: The overall VE was insufficient to protect varicella infection, and the VE for moderate or severe varicella was only moderate. The manifestations of BV cases were generally milder than those seen in natural varicella infection. The time since vaccination and the intensity of exposure are risk factors for developing BV during an outbreak.

[Advance in the Treatment of Ph Chromosome Positive Acute Lymphoblastic Leukemia ---Review].

Abstract　　The curative efficacy of adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) has been improved substantially with the introduction of tyrosine kinase inhibitors (TKIs). However, there is no consensus so far on the following issues, which TKIs should be chosen in combination with chemotherapeutic regimens; which regimen of intensive chemotherapy incorporated into TKIs would be more beneficial to patients. The prognosis of the patients with Ph+ ALL has been so significantly improved by the combinatorial treatment of TKIs and chemotherapy, thus it is necessary to reevaluate the role of allogeneic hematopoietic stem cell transplantation in the management of Ph+ ALL. In addition, immunotherapy has achieved an initial success in the treatment of Ph+ ALL. In this review, the treatment paradigms for the disease are summrized briefly.

Pyrolysis Characteristics and Reaction Mechanisms of Pine Needles.

Pyrolysis has been considered as a promising method to utilize biomass by thermal cracking for energy or feedstock. In order to provide guidance for thermochemical process management of pine needle utilization by pyrolysis, the pyrolysis kinetics and reaction mechanism of one typical pine needle are investigated employing thermogravimetric analysis in nitrogen in the present study. Multi kinetics methods including model-free method and model-fitting method are adopted. Results indicate that one peak and three shoulders occur in the reaction rate curves. The maximum reaction rates decrease with the increasing of heating rates, and the average reaction rate of the whole process is 0.0021 K-1. The pyrolysis process of pine needles in nitrogen may be divided into four stages in the conversion rate range of 0~0.1, 0.1~0.5, 0.5~0.75, and 0.75~1, which may be mainly resulted by the reaction of the extractives, hemicellulose, cellulose, and lignin, respectively. The reaction mechanisms of stages I, II, and III may be regarded as random nucleation and nuclei growth, but the reaction mechanism of stage IV may be chemical reaction. The average value of activation energy and logarithm of the pre-exponential factor for the whole pyrolysis process is 215.99 kJ mol-1 and 38.75 min-1, respectively.