The value of circadian heart rate variability for the estimation of obstructive sleep apnea severity in adult males.

OBJECTIVES: Heart rate variability (HRV) is becoming more prevalent as a measurable parameter in wearable sleep-monitoring devices, which are simple and effective instruments for illness evaluation. Currently, most studies on investigating OSA severity and HRV have measured heart rates during wakefulness or sleep. Therefore, the objective of this study was to investigate the circadian rhythm of HRV in male patients with OSA and its value for the estimation of OSA severity using group-based trajectory modeling. METHODS: Patients with complaints of snoring were enrolled from the Sleep Center of Shandong Qianfoshan Hospital. Patients were divided into 3 groups according to apnea hypopnea index (AHI in events/h), as follows: (<15, 15≤AHI<30, and ≥30). HRV parameters were calculated using 24 h Holter monitoring, which included time-domain and frequency-domain indices. Circadian differences in the standard deviation of normal to normal (SDNN) were evaluated for OSA severity using analysis of variance, trajectory analysis, and multinomial logistic regression. RESULTS: A total of 228 patients were enrolled, 47 with mild OSA, 48 moderate, and 133 severe. Patients with severe OSA exhibited reduced triangular index and higher very low frequency than those in the other groups. Circadian HRV showed that nocturnal SDNN was considerably higher than daytime SDNN in patients with severe OSA. The difference among the OSA groups was significant at 23, 24, 2, and 3 o'clock sharp between the severe and moderate OSA groups (all P<0.05). The heterogeneity of circadian HRV trajectories in OSA was strongly associated with OSA severity, including sleep structure and hypoxia-related parameters. Among the low-to-low, low-to-high, high-to-low, and high-to-high groups, OSA severity in the low-to-high group was the most severe, especially compared with the low-to-low and high-to-low SDNN groups, respectively. CONCLUSIONS: Circadian HRV in patients with OSA emerged as low daytime and high nocturnal in SDNN, particularly in men with severe OSA. The heterogeneity of circadian HRV revealed that trajectories with low daytime and significantly high nighttime were more strongly associated with severe OSA. Thus, circadian HRV trajectories may be useful to identify the severity of OSA.

Prognostic value of genetic aberrations and tumor immune microenvironment in primary acral melanoma.

BACKGROUND: Acral melanoma (AM) is the most common subtype in Chinese melanoma patients with a very poor prognosis. However, our understanding of the disease pathogenesis and molecular landscape is limited by the few studies that have been conducted. Here, we profiled the clinical characteristics, mutational landscapes and tumor immune microenvironment of AM patients to gain insights into disease characteristics and potential treatment strategies. METHODS: A total of 90 AM patients were enrolled and their tissue samples were subjected to next-generation sequencing and multiplexed immunohistochemistry tests. Kaplan-Meier curves and log-rank tests were used to analyze the prognostic potential of various genetic aberrations and immune cell compositions in AM. RESULTS: The median disease-free survival was 21.3 months and estimated median overall survival (OS) was 60 months. More advanced stages, older ages and thickness of greater than 4 mm were associated with worse prognosis in AM patients (HR = 2.57, 95% CI 1.25-5.29, p = 0.01; HR = 2.77, 95% CI 1.22-6.28, p = 0.02; HR = 3.43, 95% CI 1.51-7.82, p < 0.01, respectively), while patients who received post-surgical treatments had better survival (HR = 0.36, 95% CI 0.17-0.76, p = 0.01). The most frequently altered genes included BRAF (14.5%), KIT (16.9%), NRAS (12%), NF1 (10.8%), APC (7.2%), and ARID2 (6%). Copy number variations (CNV) were commonly found in CCND1 (19.3%), CDK4 (19.3%), MDM2 (14.5%) and FGF19 (12%). CDK4 amplifications was independently associated with shorter OS in AM patients (HR = 3.61, 95% CI 1.38-9.46, p = 0.01). CD8 + T cells (p < 0.001) and M1 macrophages (p = 0.05) were more highly enriched in the invasive margin than in the tumor center. Patients with higher levels of M1 macrophage infiltration in the invasive margin derived markedly longer OS (HR = 0.43, 95% CI 0.20-0.95, p = 0.03). Interestingly, in CDK4-amplified patients, there tended to be a low level of M1 macrophage infiltration in the invasive margin (p = 0.06), which likely explains the poor prognosis in such patients. CONCLUSIONS: Our study provided a comprehensive portrait of the clinicopathological features, genetic aberrations and tumor microenvironment profiles in AM patients and identified candidate prognostic factors, which may facilitate development of additional therapeutic options and better inform clinical management of AM patients. Based on these prognostic factors, further studies should focus on enhancing the infiltration of M1 macrophages, especially in CDK4-amplified AM patients.

Correlation analysis between HLA-DQA1*0102/DQB1*0602 genotypes and narcolepsy patients in China.

Background and objective: At present, the etiology of narcolepsy is not fully understood, and it is generally believed to be an autoimmune reaction caused by interactions between environmental and genetic factors. Human leukocyte antigen (HLA) class II genes are strongly associated with this gene, especially HLA-DQB1*0602/DQA1*0102. In this study, we mainly analyzed the correlation between different genotypes of HLA-DQB1*0602/DQA1*0102 and clinical manifestations in Chinese patients with narcolepsy. Experimental method: Narcolepsy patients who were treated at the Department of Neurology, The First Affiliated Hospital of Shandong First Medical University from January 2021 to September 2023 were selected. General information, sleep monitoring data, cerebrospinal fluid (CSF) orexin levels, and human leukocyte antigen gene typing data were collected. The statistical analysis was performed using SPSS 26.0, and the graphs were drawn using GraphPad Prism 9.5. Main results: A total of 78 patients were included in this study. The DQA1 and DQB1 gene loci were detected in 54 patients, and only the DQB1 gene locus was detected in 24 narcoleptic patients. The most common allele at the HLA-DQB1 locus was *0602 (89.7%), and the most common genotype at this locus was *0602*0301 (19.2%), followed by *0602*0602 (17.9%). The most common phenotype of the HLA-DQA1 locus is *0102 (92.6%), and the most common genotype of this locus is *0102*0102 (27.8%), followed by *0102*0505 (14.8%). There were significant differences (p < 0.05) between HLA-DQB1*0602-positive and HLA-DQB1*0602-negative patients in terms of orexin-A levels, presence or absence of cataplexy, UNS, PSG sleep latency, REM sleep latency, N1 sleep percentage, oxygen depletion index, and average REM latency on the MSLT. The HLA-DQA1*0102-positive and HLA-DQA1*0102-negative patients showed significant differences (p < 0.05) in disease course, presence or absence of sudden onset, PSG REM sleep latency, N1 sleep percentage, and average REM latency on the MSLT. There were significant differences in the average REM latency of the MSLT between HLA-DQB1*0602/DQA1*0102 homozygous and heterozygous patients p < 0.05, and no differences were found in the baseline data, orexin-A levels, scale scores, or other sleep parameters. Conclusion: Different genotypes of HLA-DQA1*0102/DQB1*0602 are associated with symptoms of cataplexy in Chinese narcoleptic patients. Homozygous individuals have a shorter mean REM latency in the MSLT, greater genetic susceptibility, and relatively more severe sleepiness.

The mechanism of solid acid-catalyzed bamboo sawdust liquefaction under polyol systems.

Solid acid catalysts are widely used in the field of biomass catalytic conversion owing to their advantages of low environmental pollution, easy separation and reusability. Nevertheless, there are relatively few studies on the mechanism of solid acid liquefaction for biomass. In this study, the effect of acid strength and acid amount of various solid acids on the liquefaction efficiency has been investigated using waste bamboo sawdust generated from the pulp and paper industry as the raw material. In addition, the physicochemical changes of cellulose, hemicellulose and lignin during the reaction process of bamboo sawdust have been studied, and the liquefaction mechanism of bamboo sawdust under the action of various solid acids has been concluded. As a result, the liquefaction efficiency of bamboo sawdust under the polyol system of PEG400/propanetriol is mainly related to the acid strength of the solid acid, and the greater the acid strength of the solid acid, the better the catalytic effect on the bamboo sawdust, in which the residual amount of bamboo sawdust liquefaction catalyzed by the SPA catalyst is only 17.72%. Noteworthy, the most difficult component to liquefy is the crystallization of natural cellulose I into cellulose II during the reaction process, which is the primary obstacle to the complete liquefaction of bamboo sawdust by solid acid. Overall, these findings are valuable for the high value utilization of waste bamboo sawdust in the pulp and paper industry, as well as the application of solid acid catalytic technology for biomass.

Trauma plays an important role in acral melanoma: A retrospective study of 303 patients.

INTRODUCTION: Acral melanoma (AM) is the most common subtype of malignant melanoma in China, with a very poor prognosis. Despite the frequent reporting of trauma events in AM cases, the precise etiology of AM remains elusive. METHODS: A retrospective analysis was conducted on a cohort of 303 AM patients at Nanjing Drum Tower Hospital. The patients were categorized into four distinct groups based on different patterns of disease onset: trauma type (Type 1), pigmented nevus type (Type 2), pigmented nevi with trauma (Type 3), and pigmented nevi with natural ulceration (Type 4). Differences in clinicopathological features, genetic alterations, and tumor immune microenvironment (TIME) were analyzed. RESULTS: Traumatic events accounted for a large proportion of AM cases. Among these categories, Type 1 patients displayed the least favorable pathological traits and an immunosuppressive TIME. Common copy number variations (CNVs) were observed in CCND1, RB1, FGF19, and IL7R, while CNVs in CDK4 and TERT occurred less frequently in patients with a history of trauma (Type 1 and Type 3). Type 2 patients exhibited the most favorable pathological characteristics and genetic profiles, and demonstrated the lowest incidence of CCDN1 and RB1 CNVs but had the highest CDK4 CNVs. In contrast, the pathological behavior of Type 3 and Type 4 patients was in between Type 1 and Type 2. And patients in Type 3 and Type 4 displayed a more favorable overall microenvironment. CONCLUSION: This study provides a clinical classification of Chinese AM based on diverse clinical onset characteristics and highlights the important role of trauma in AM. These findings may help to guide the diagnosis, treatment, and prognosis of AM patients. Further investigations are imperative to elucidate the underlying mechanisms governing the association between trauma and AM.

Single-arm study of camrelizumab plus apatinib for patients with advanced mucosal melanoma.

BACKGROUND: Previous studies have suggested the potential synergistic antitumor activity when combining immune checkpoint inhibitors with anti-angiogenic agents in various solid tumors. We aimed to assess the efficacy and safety of camrelizumab (a humanized programmed cell death-1 antibody) plus apatinib (a vascular endothelial growth factor receptor tyrosine kinase inhibitor) for patients with advanced mucosal melanoma (MM), and explore-related biomarkers. METHODS: We conducted a single-center, open-label, single-arm, phase II study. Patients with unresectable or recurrent/metastatic MM received camrelizumab and apatinib. The primary endpoint was the confirmed objective response rate (ORR). RESULTS: Between April 2019 and June 2022, 32 patients were enrolled, with 50.0% previously received systemic therapy. Among 28 patients with evaluable response, the confirmed ORR was 42.9%, the disease control rate was 82.1%, and the median progression-free survival (PFS) was 8.05 months. The confirmed ORR was 42.9% (6/14) in both treatment-naïve and previously treated patients. Notably, treatment-naïve patients had a median PFS of 11.89 months, and those with prior treatment had a median PFS of 6.47 months. Grade 3 treatment-related adverse events were transaminase elevation, rash, hyperbilirubinemia, proteinuria, hypertension, thrombocytopenia, hand-foot syndrome and diarrhea. No treatment-related deaths were observed. Higher tumor mutation burden (TMB), increased T-cell receptor (TCR) diversity, and altered receptor tyrosine kinase (RTK)/RAS pathway correlated with better tumor response. CONCLUSION: Camrelizumab plus apatinib provided promising antitumor activity with acceptable toxicity in patients with advanced MM. TMB, TCR diversity and RTK/RAS pathway genes were identified as potential predictive biomarkers and warrant further validation. TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry, ChiCTR1900023277.

FTO inhibits oxidative stress by mediating m6A demethylation of Nrf2 to alleviate cerebral ischemia/reperfusion injury.

Current therapies are of limited efficacy in cerebral ischemia/reperfusion (I/R) injury. Based on the important role of oxidative stress in cerebral I/R injury, this study aimed to explore how the N6-adenosine methylation (m6A) demethylase FTO affects oxidative stress. Middle cerebral artery occlusion/reperfusion (MCAO/R)-induced rat model and oxygen and glucose deprivation/re-oxygenation (OGD/R)-induced SH-SY5Y cells were established as in vivo and in vitro model, respectively. The neurological score of rats was measured, and the volume of cerebral infarction was measured by TTC staining. The levels of FTO, nuclear factor-erythroid 2-related factor (Nrf2), and the activity of m6A demethylase FTO were detected. The m6A methylation level of Nrf2 mRNA was detected by MeRIP experiment. Flow cytometry and MTT assay were used to detect apoptosis and proliferation in vitro. TUNEL assay was used to detect apoptosis in brain tissues. FTO and Nrf2 expressions were decreased in the MCAO/R rat brain tissues and OGD/R SH-SY5Y cells, while the m6A methylation level of Nrf2 mRNA was significantly increased. Overexpression of FTO upregulated Nrf2 expression by decreasing the m6A methylation level of Nrf2 mRNA. m6A binding protein YT521-B homology (YTH) domain family protein 2 (YTHDF2) promoted the degradation of Nrf2 by promoting the m6A methylation level of Nrf2 mRNA. Furthermore, SH-SY5Y cell apoptosis was increased and cell viability was decreased after the addition of methyltransferases METTL 3/14, thus blocking FTO to protect SH-SY5Y cells from oxidative stress injury. In vivo, overexpression of FTO decreased the area of cerebral ischemia infarction and the extent of cell apoptosis. In conclusion, FTO increases Nrf2 expression by mediating m6A demethylation of Nrf2 mRNA, thereby inhibiting oxidative stress response and ultimately alleviating cerebral I/R injury.

Template-directed growth of sustainable carboxymethyl cellulose-based aerogels decorated with ZIF-67 for activation peroxymonosulfate degradation of organic dyes.

A novel 3D advanced oxidation catalyst ZIF-67@C-CMC/rGO based on carboxymethyl cellulose (CMC) and reduced graphene oxide (rGO) was successfully synthesized by facile in-situ growth of Zeolitic imidazolate framework-67 (ZIF-67). C-CMC/rGO aerogel crosslinked by poly (methyl vinyl ether-alt-maleic acid)/polyethylene glycol system (PMVEMA/PEG) as the host material was prepared through a template-directed growth model and exhibited outstanding mechanical properties. The sustainable composite was successfully used as an efficient catalyst for activating peroxymonosulfate (PMS) to generate SO4-· and ·OH, then leads to the removal of organic contaminants. As a result, almost 100 % of 10 ppm MB/RhB solution can be degraded within 5 min due to the combination of catalyst aerogel and PMS. What's more, the aerogel showed a wide pH tolerance range from 4 to 9 and maintained up to 93 % of the contaminant removal rate compared to the initial value after four cycles. The ZIF-67@C-CMC/rGO aerogel with high load rate and excellent catalytic degradation performance not only solved the problem of dispersion and recovery of ZIF-67 particles, but also provided a new idea for the compound wastewater purification in sulfate radical-based advanced oxidation processes (SR-AOPs).

AAV vectors applied to the treatment of CNS disorders: Clinical status and challenges.

In recent years, adeno-associated virus (AAV) has become the most important vector for central nervous system (CNS) gene therapy. AAV has already shown promising results in the clinic, for several CNS diseases that cannot be treated with drugs, including neurodegenerative diseases, neuromuscular diseases, and lysosomal storage disorders. Currently, three of the four commercially available AAV-based drugs focus on neurological disorders, including Upstaza for aromatic l-amino acid decarboxylase deficiency, Luxturna for hereditary retinal dystrophy, and Zolgensma for spinal muscular atrophy. All these studies have provided paradigms for AAV-based therapeutic intervention platforms. AAV gene therapy, with its dual promise of targeting disease etiology and enabling 'long-term correction' of disease processes, has the advantages of immune privilege, high delivery efficiency, tissue specificity, and cell tropism in the CNS. Although AAV-based gene therapy has been shown to be effective in most CNS clinical trials, limitations have been observed in its clinical applications, which are often associated with side effects. In this review, we summarized the therapeutic progress, challenges, limitations, and solutions for AAV-based gene therapy in 14 types of CNS diseases. We focused on viral vector technologies, delivery routes, immunosuppression, and other relevant clinical factors. We also attempted to integrate several hurdles faced in clinical and preclinical studies with their solutions, to seek the best path forward for the application of AAV-based gene therapy in the context of CNS diseases. We hope that these thoughtful recommendations will contribute to the efficient translation of preclinical studies and wide application of clinical trials.

Exercise Reduces Airway Smooth Muscle Contraction in Asthmatic Rats via Inhibition of IL-4 Secretion and Store-Operated Ca2+ Entry Pathway.

PURPOSE: Increased evidence has shown that aerobic exercise reduces airway hyperresponsiveness in asthmatic individuals. However, the underlying mechanisms of action remain elusive. This study aimed to investigate the effect of exercise on airway smooth muscle (ASM) contractile function in asthmatic rats, and uncover the possible involvement of interleukin 4 (IL-4) and the store-operated Ca2+ entry (SOCE) pathway. METHODS: In this study, chicken ovalbumin was used to induce asthma in male Sprague-Dawley rats. The exercise group received moderate-intensity aerobic exercise training for 4 weeks. IL-4 concentrations in bronchoalveolar lavage fluid (BALF) samples were evaluated by enzyme linked immunosorbent assay. The contractile function of the ASM was investigated using tracheal ring tension experiments and intracellular Ca2+ imaging techniques. Western blot analysis was used to evaluate expression levels of calcium-release activated calcium (CRAC) channel protein (Orai) and stromal interaction molecule 1 (STIM1) in ASM. RESULTS: Our data showed that the carbachol-stimulated, SOCE-mediated contraction of rat ASM was significantly increased in asthmatic rats, which could be abolished by exercise. Pharmacological studies revealed that GSK5498A and BTP-2, selective blockers of CRAC channels significantly inhibited SOCE-induced ASM contraction. In addition, exercise inhibited the up-regulation of IL-4 in BALF as well as STIM1 and Orai expression in the ASM of asthmatic rats. In line with these observations, we demonstrated that pretreatment of the ASM with IL-4 up-regulated the expression level of STIM1, Orai1 and Orai2, thereby promoting SOCE-mediated ASM contraction. CONCLUSIONS: The data in this study reveal that aerobic exercise may improve the ASM contractile function in asthmatic rats by inhibiting IL-4 secretion and by down-regulating the expression of STIM1, Orai1 and Orai2, thus decreasing excessive SOCE-mediated ASM contraction in asthmatic rats.

Tryptophan Metabolism in Central Nervous System Diseases: Pathophysiology and Potential Therapeutic Strategies.

The metabolism of L-tryptophan (TRP) regulates homeostasis, immunity, and neuronal function. Altered TRP metabolism has been implicated in the pathophysiology of various diseases of the central nervous system. TRP is metabolized through two main pathways, the kynurenine pathway and the methoxyindole pathway. First, TRP is metabolized to kynurenine, then kynurenic acid, quinolinic acid, anthranilic acid, 3-hydroxykynurenine, and finally 3-hydroxyanthranilic acid along the kynurenine pathway. Second, TRP is metabolized to serotonin and melatonin along the methoxyindole pathway. In this review, we summarize the biological properties of key metabolites and their pathogenic functions in 12 disorders of the central nervous system: schizophrenia, bipolar disorder, major depressive disorder, spinal cord injury, traumatic brain injury, ischemic stroke, intracerebral hemorrhage, multiple sclerosis, Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, and Huntington's disease. Furthermore, we summarize preclinical and clinical studies, mainly since 2015, that investigated the metabolic pathway of TRP, focusing on changes in biomarkers of these neurologic disorders, their pathogenic implications, and potential therapeutic strategies targeting this metabolic pathway. This critical, comprehensive, and up-to-date review helps identify promising directions for future preclinical, clinical, and translational research on neuropsychiatric disorders.

The Impact of Sleep Pattern in School/Work Performance During the COVID-19 Home Quarantine in Patients With Narcolepsy.

Objectives: Narcolepsy patients were observed improvements in their academic performance during the COVID-19 home quarantine. Therefore, we aim to investigate the influence of sleep behavioral changes on school/work performance in narcolepsy patients during the home quarantine. Methods: Patients admitted to Shandong Provincial Qianfoshan Hospital from Jan 1, 2017 to Jan 1, 2021 who were diagnosed with narcolepsy were studied by online questionnaires in two different periods (during and 1 year after the COVID-19 home quarantine), including five aspects: (1) changes in school/work performance (percentile ranking in class/Sheehan Disability Scale 1, SDS1); (2) daytime functions; (3) clinical symptoms; (4) psychological moods; (5) medication situations. Results: A total of 46 narcolepsy patients 34 (73.9%) narcolepsy type 1, 12 (26.1%) narcolepsy type 2 with average age of 20.76 ± 8.99 years and an equal number of age and gender matched control subjects were enrolled. During the COVID-19 home quarantine, the narcolepsy patients were found that they altered sleep patterns, including later get up time (P < 0.001), longer total sleep time (TST, P = 0.001), better sleep quality (PSQI, P = 0.001), and lower anxiety level (P = 0.005). Their school/work performance improved parallelly [with better percentile ranking (P = 0.001) and lower SDS1 scores (P = 0.002)]. The results of multiple linear stepwise regression analysis showed a linear regression relationship between TST [efficient (95%) -7.356 (-13.570 to 1.143)], SDS1 score [efficient (95%) 6.580 (2.346-10.815), P = 0.004] and the percentile ranking after adjusting for potential effects. Both the improvements of sleep behavior and school/work performance disappeared after the end of COVID-19 home quarantine. No similar fluctuation was found in the control group. Discussion: Changes in sleep pattern during the COVID-19 home quarantine, such as longer sleep time and later wake-up time, can reduce the degree of daytime sleepiness and increase the degree of daytime wakefulness of narcolepsy patients, which can alleviate the impact of the disease on school/work performance.

Orexin dual receptor antagonists, zolpidem, zopiclone, eszopiclone, and cognitive research: A comprehensive dose-response meta-analysis.

Background: About one-third of adults have trouble sleeping, ranging from occasional difficulty to chronic insomnia, along with difficulty maintaining sleep. Many studies reported that the long-term use of hypnotics can cause brain dysfunction and damage cognition. Objective: The objective of the study is to evaluate whether low, medium, and high doses of orexin dual receptor antagonists (DORA), zopiclone (ZOP), eszopiclone (ESZ), and zolpidem (ZST) can impair cognition. Methods: From the beginning through September 20, 2022, PubMed, Embase, Scopus, the Cochrane Library, and Google Scholar were searched. Randomized controlled trials (RCTs) assessing the therapeutic effects of DORA, eszopiclone, and zopiclone for sleep and cognitive function were included. The primary outcomes were indices related to the cognitive profile, including memory, alertness, execution and control function, and attention and orientation. The secondary outcomes were indices related to sleep and adverse events. The standard mean difference (SMD) was generated for continuous variables. Certain data were captured from figures by GetData 2.26 and analyzed using RStudio 4.2. Results: Finally, a total of 8,702 subjects were included in 29 studies. Compared with the placebo, the DSST (Digit Symbol Substitution Test) scores of low, medium, and high doses of DORA were SMD = 0.77; 95% CI: 0.33-1.20; SMD = 1.58; 95% CI: 1.11-2.05; and SMD = 0.85; 95% CI: 0.33-1.36, respectively. The DSST scores of zolpidem at low, medium, and high doses were SMD = -0.39; 95% CI: 0.85-0.07; SMD = -0.88, 95% CI: -2.34-0.58; and SMD = -0.12, 95% CI: -0.85-0.60, respectively. Zopiclone's DSST scale score was SMD = -0.18; 95% CI: -0.54-0.18. In addition, the total sleep time (TST) of low, medium, and high doses of DORA was SMD = 0.28, 95% CI: -0.15-0.70; SMD = 1.36, 95% CI: 0.87-1.86; and SMD = 2.59, 95% CI: 1.89-3.30, respectively. The TST of zolpidem with low, medium, and high doses was SMD = 1.01, 95% CI: 0.18-1.83; SMD = 1.94, 95% CI: 0.46-3.43; and SMD = 1.71, 95% CI: 0.86-2.56, respectively. The TST of low, medium, and high doses of eszopiclone was relatively SMD = 2.03, 95% CI: -0.21-4.27; SMD = 2.38, 95% CI: 1.35-3.42; and SMD = 1.71, 95% CI: 0.60-2.82. Zopiclone's TST was SMD = 2.47, 95% CI: 1.36-3.58. Conclusion: We recommend DORA as the best intervention for insomnia because it is highly effective in inducing and maintaining sleep without impairing cognition. Although zolpidem has a more pronounced effect on maintaining sleep, it is best to reduce its use because of its side effects. Eszopiclone and zopiclone improved sleep quality, but their safety in cognition remains to be verified.

Effect of thermal activation and particle size on cementitious activity of bauxite tailings.

To explore the influence of thermal activation and particle size on cementitious activity of bauxite tailings, in this study, the raw bauxite tailings were classified into coarse bauxite tailings (CBT) and fine bauxite tailings (FBT) by a powder separator, and then the effect of activation temperature on cementitious activity of CBT and FBT was investigated. XRD, TG, and FTIR were used to study the phase and structure changes of CBT and FBT during the process of thermal activation. The results show that the main mineral phases of CBT and FBT, diaspore and kaolinite, begin to remove a large amount of hydroxyl groups at 500 ℃ and convert into corundum and metakaolin, respectively. The diaspore and kaolinite have completely removed the hydroxyl groups at 600 °C and 700 °C, respectively. With the increase of activation temperature, the particle size of CBT and FBT are first gradually decreased, when the activation temperature exceeds 700 ℃, as the activation temperature continues to arise, the particle size of CBT and FBT are gradually increased due to the occurrence of sintering. The activity index of bauxite tailings is increased with the increase of fineness, and the optimum activation temperature of CBT and FBT is 700 °C. When the activation temperature is the same, FBT has higher pozzolanic activity than CBT.

Developing stacking ensemble models for multivariate contamination detection in water distribution systems.

This study presents a new stacking ensemble model for contamination event detection using multiple water quality parameters. The stacking model consists of a number of machine learning base predictors and a meta-predictor, and it is trained using cross-validation to capture different features in multiple water quality parameters and then used for water quality predictions. For each water quality parameter, the residuals between predicted and measured data are classified to identify anomalies with thresholds derived from the sequential model-based optimization method and detection probabilities updated using Bayesian analysis. Alarms derived from individual water quality parameters are fused to enhance the anomaly signals and improve the detection accuracy. The proposed stacking-based method is evaluated using a data set of six water quality parameters from a real water distribution system with randomly simulated events. The stacking-based method could detect 2496 events out of a total 2500 events without a false alarm. The results show that the stacking method outperforms an artificial neural network (ANN) benchmark method in contamination event detection. The stacking method has a higher true positive rate, lower false positive rate and higher F1 score than the ANN method. This implies that the stacking method has great promise of detecting contamination events in the water distribution system.

Pilot study on the treatment of low carbon and nitrogen ratio municipal sewage by A1/O2/A3/A4/O5 sludge-membrane coupling process with multi-point inflow.

A new multi-point inflow pre-anoxic/oxic/anaerobic/anoxic/oxic (A1/O2/A3/A4/O5) sludge-membrane coupling process and pilot plant were developed and designed to solve the problem of nitrogen and phosphorus removal of low carbon and nitrogen (C/N) ratio domestic sewage in southern China. The removal effect and transformation rule of organic matter, nitrogen, and phosphorus in the system were studied by changing the distribution ratio of multi-point influent. The average C/N ratio of the influent was 2.09 and the influent distribution ratio was 1:1. When the temperature was 16-25 °C, the average concentrations of chemical oxygen demand (COD), ammonia nitrogen (NH4+- N), total nitrogen (TN), and total phosphorus (TP) in the effluent were 21.31 (±2.65), 0.60 (±0.24), 12.76 (±1.09), and 0.34 (±0.05) mg/L, respectively, and their average removals are 87.3 (±1.2)%, 98.7 (±0.4)%, 74.1 (±1.3)%, and 88.1 (±0.4)% respectively. When the low temperature was 12-15 °C, the average removals were 78.6 (±1.1)%, 90.5 (±1.3)%, 73.7 (±1.13)%, and 86.6 (±1.7)%, respectively. Compared with the traditional anaerobic/anoxic/aerobic (A2O) process under the same conditions, the TN removal was increased by 15.4%, and the TP removal was increased by 22.2%. This system has obvious advantages in treating wastewater with low C/N ratio, thereby solving the problem wherein the effluent of biological phosphorus removal from low C/N ratio domestic sewage was difficult when it was lower than 0.5 mg/L.

Directionally-Grown Carboxymethyl Cellulose/Reduced Graphene Oxide Aerogel with Excellent Structure Stability and Adsorption Capacity.

A novel three-dimensional carboxymethyl cellulose (CMC)/reduced graphene oxide (rGO) composite aerogel crosslinked by poly (methyl vinyl ether-co-maleic acid)/poly (ethylene glycol) system via a directional freezing technique exhibits high structure stability while simultaneously maintaining its excellent adsorption capacity to remove organic dyes from liquid. A series of crosslinked aerogels with different amounts of GO were investigated for their adsorption capacity of methylene blue (MB), which were found to be superb adsorbents, and the maximum adsorption capacity reached 520.67 mg/g with the incorporation of rGO. The adsorption kinetics and isotherm studies revealed that the adsorption process followed the pseudo-second-order model and the Langmuir adsorption model, and the adsorption was a spontaneous process. Furthermore, the crosslinked aerogel can be easily recycled after washing with dilute HCl solution, which could retain over 97% of the adsorption capacity after recycling five times. These excellent properties endow the crosslinked CMC/rGO aerogel's potential in wastewater treatment and environment protection.

Size-Controlled and Super Long-Term Stable Lignin Nanospheres through a Facile Self-Assembly Strategy from Kraft Lignin.

In diverse fields, much attention has been concentrated on the preparation of lignin nanospheres with various structures. Here we report a facile self-assembly strategy for preparing super long-term stable hollow and solid nanospheres based on lignin fractionation. We found that different lignins obtained at different pHs during fractionation can form nanospheres with different particle sizes and structures. The self-assembled and formation mechanisms of the nanospheres were surveyed by dynamic light scattering (DLS), elemental analysis, transmission electron microscopy (TEM), scanning electron microscopy (SEM), and Fourier transform infrared spectroscopy (FTIR). The analysis results showed that the phenolic hydroxyl groups and the intermolecular π-π interaction play a decisive effect in the formation of nanospheres. This study can not only facilitate the advance of lignin-based nanotechnologies but also provide a broad prospect for the use of black liquor.

Effectively reducing the bioavailability and leachability of heavy metals in sediment and improving sediment properties with a low-cost composite.

Heavy metal-contaminated sediment is a common environmental problem. In situ stabilization is an effective and low-cost method to remediate heavy metal-contaminated sediment. In this study, a red mud-based low-cost composite (RMM) was used to stabilize heavy metal-contaminated sediment. RMM was mixed with heavy metal-contaminated sediment at the doses of 0%, 1%, 3% and 5%. The CaCl2-extractable, DTPA-extractable, leachability (TCLP) and heavy metal fractions were analysed to evaluate the stabilization efficiency of RMM for heavy metals. The selected properties and microbial activities of the sediment were analysed to verify the safety of RMM to sediment. The results showed that RMM reduced the DTPA-, CaCl2- and TCLP-extractable heavy metals in sediment. At an RMM dose of 5%, DTPA-, CaCl2- and TCLP- extractable heavy metals were reduced by 7.60%, 72.34% and 69.24% for Pb; 18.20%, 76.7% and 23.57% for Cd; 32.7%, 96.50% and 49.64% for Zn; and 35.0%, 61.20% and 55.27% for Ni, respectively. TCLP- and DTPA-extractable Cu was reduced by 71.15% and 12.90%, respectively. In contrast, CaCl2-extractable Cu increased obviously after the application of RMM. RMM reduced the acid-soluble fraction of Zn by 6.99% and increased the residual fraction of Ni by 4.28%. However, the influence of RMM on the fractions of Pb, Cd and Cu was nonsignificant. In addition, the application of RMM increased the pH values of the sediment, and the microbial activity in the sediment was also obviously enhanced. These results indicated that RMM has great potential in the remediation of heavy metal-contaminated sediment.

Comparative Evaluation of Organic Acid Pretreatment of Eucalyptus for Kraft Dissolving Pulp Production.

Pretreatment is an essential process for the extensive utilization of lignocellulose materials. The effect of four common organic acid pretreatments for Kraft dissolving pulp production was comparatively investigated. It was found that under acidic conditions, hemicellulose can be effectively removed and more reducing sugars can be recovered. During acetic acid pretreatment, lignin that was dissolved in acetic acid could form a lignin-related film which would alleviate cellulose hydrolysis, while other organic acids caused severe cellulose degradation. Scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR) and X-ray diffractometry (XRD) were used to characterize the pretreated chips in the process. Lignin droplets were attached to the surface of the treated wood chips according to the SEM results. The FTIR spectrum showed that the lignin peak signal becomes stronger, and the hemicellulose peak signal becomes weaker with acid pretreatment. The XRD spectrum demonstrated that the crystallinity index of the wood chips increased. The acetic acid pretreatment process-assisted Kraft process achieved higher yield (31.66%) and higher α-cellulose (98.28%) than any other organic acid pretreatment. Furthermore, extensive utilization of biomass was evaluated with the acetic acid pretreatment-assisted Kraft process. 43.8% polysaccharide (12.14% reducing sugar and 31.66% dissolving pulp) and 22.24% lignin (0.29% acetic acid lignin and 21.95% sulfate lignin) were recovered during the process. Biomass utilization could reach 66.04%. Acetic acid pretreatment is a promising process for extensive biomass utilization.