Assessment of the Ovarian Reserve by Serum Anti-Müllerian Hormone in Rheumatoid Arthritis Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: The ovarian reserve has been reported to be diminished in patients with rheumatoid arthritis. However, these results are still controversial. Anti-Müllerian hormone (AMH) is considered a reliable biomarker for the ovarian reserve. We thus performed a meta-analysis to evaluate the AMH levels and the effect of DMARDs on the ovarian reserve in rheumatoid arthritis patients. METHODS: PubMed, EMBASE, the Cochrane Library, and 2 Chinese databases (CNKI and Wanfang database), up to September 2021, were searched for relevant studies. The Newcastle-Ottawa scale (NOS) was used to assess the quality of the included studies. Pooled standard mean difference (SMD) with 95% confidence intervals (CIs) were determined with the random-effects model. The heterogeneity was described by I2 statistic and p value from the Cochrane Q test. RESULTS: Eight eligible studies (679 patients and 1,460 controls) were included in the meta-analysis. Compared with healthy control, the AMH levels in RA patients were significantly lower with the pooled SMD of -0.40 (95% CI: -0.66 to -0.14). However, in comparison of AMH with and without DMARD treatment, there was no significant difference with the pooled SMD of -0.1 (95% CI: -0.39 to 0.19). CONCLUSION: The results indicated that there was an increased risk of ovarian failure in RA patients and which is not related to DMARD treatment.

Age differences in secular trends in black-white disparities in mortality from systemic lupus erythematosus among women in the United States from 1988 to 2017.

OBJECTIVE: To examine the age differences in secular trends in black-white disparities in mortality from systemic lupus erythematosus (SLE) among women in the United States from 1988 to 2017. METHODS: We used mortality data to calculate age-specific SLE and all-causes (as reference) mortality rates and black/white mortality rates ratios among women from 1988 to 2017. Annual percent change was estimated using joinpoint regression analysis. RESULTS: We identified 10,793 and 4,165,613 black women and 19,455 and 31,129,528 white women who died between 1988 and 2017 from SLE and all-causes, respectively. The black/white SLE mortality rate ratio according joinpoint regression model was 6.6, 7.2, 4.4, and 1.4 for decedents aged 0-24, 25-44, 45-64, and 65+ years in 1988 and was 7.2, 5.9, 4.1, and 1.9, respectively in 2017. No significant decline trend was noted and the annual percent change was 0.3%, -0.7%, -0.2%, and 1.0%, respectively. On the contrast, the black/white all-causes mortality rate ratio was 2.0, 2.5, 1.8, and 1.0, respectively in 1988 and was 1.7, 1.3, 1.5, and 0.9, respectively in 2017, a significant decline trend was noted in each age group. CONCLUSIONS: Black adults, youths and adolescents had four to seven times higher SLE mortality rates than their white counterparts and the black-white disparities persisted during the past three decades. On the contrast, black women had less than two times higher all-causes mortality rates than their white counterparts and black-white disparities significantly diminish during the past three decades.

Pentraxin 3 is more accurate than C-reactive protein for Takayasu arteritis activity assessment: A systematic review and meta-analysis.

AIMS: Whether the circulating levels of pentraxin 3 (PTX3), an acute phase reactant (APR), are higher in active Takayasu arteritis (TAK), and if so, whether PTX3 is more accurate than C-reactive protein (CRP) in TAK activity assessment has been investigated in this study. STUDY DESIGN: Research works such as PubMed, Embase, ScienceDirect, Cochrane Library, and two Chinese literature databases (CNKI and WanFang) were searched for studies conducted till August 30th, 2019. Two investigators searched the studies independently, who evaluated the quality of the study using the Newcastle-Ottawa scale (NOS) and extracted data. Pooled standard mean difference (SMD) and diagnostic indexes, with a 95% confidence interval (CI), were calculated using a random-effect model. RESULTS: Totally, 8 studies involving 473 TAK (208 active and 265 inactive TAK) patients and 252 healthy controls were eventually included in the meta-analysis. PTX3 level in the blood in active TAK patients were found to be higher than that in dormant TAK with pooled SMD of 0.761 (95% CI = 0.38-1.14, p<0.0001; I2 = 68%, p of Q test = 0.003). And there was no publication bias. Among the 8 studies, 5 studies identified active TAK with both PTX3 and CRP. The pooled sensitivity, specificity, and AUC values of PTX3 in active TAK diagnosis were higher than those of CRP (0.78 [95% CI = 0.65-0.87] vs. 0.66 [95% CI = 0.53-0.77], p = 0.012; 0.85 [95% CI = 0.77-0.90] vs. 0.77 [95% CI = 0.56-0.90], p = 0.033; 0.88 [95% CI = 0.85-0.90] vs. 0.75 [95% CI = 0.71-0.79], p < 0.0001). It showed potential publication bias using Egger's test (p of PTX3 = 0.031 and p of CRP = 0.047). CONCLUSIONS: PTX3 might be better than CRP in the assessment of TAK activity. Yet, it should be cautious before clinical use for moderate heterogeneity and potential publication bias of the meta-analysis.

Assessment of Maternal Knowledge and Confidence About Abusive Head Trauma and Coping With Infant Crying Before and After Infant Safety Education in the Neonatal Intensive Care Unit.

Infants with a history of perinatal illness are at higher risk for abusive head trauma (AHT). Crying is a common trigger for physical abuse, and education on coping with infant crying is an important component of AHT prevention. This study assesses the effects of education in the neonatal intensive care unit (NICU) on mothers' knowledge about AHT and infant crying, self-efficacy in applying the education to infant cares and providing the education to others, and the quality of AHT and infant crying education after discharge. Mothers received a standardized education program about AHT and infant crying and completed a preeducation survey, posteducation survey, and 4- to 5-month follow-up survey. Overall, there was a sustained increase in knowledge (P < .001) and confidence (P < .001). Mothers who received verbal education reported a higher increase in confidence (P = .03). Few received information from healthcare providers about crying (35%) and AHT (20%) after discharge. At follow-up survey, most felt highly confident in their ability to share information about AHT (97%) and calm their infant (95%). Most had shared the education with others (77%). Education on AHT and crying in the NICU can produce sustained increases in mothers' knowledge and confidence, but the effectiveness may be improved by addressing unique barriers to education in this population.

A Needs Assessment of Brain Death Education in Pediatric Critical Care Medicine Fellowships.

OBJECTIVES: To assess the current training in brain death examination provided during pediatric critical care medicine fellowship. DESIGN: Internet-based survey. SETTING: United States pediatric critical care medicine fellowship programs. SUBJECTS: Sixty-four pediatric critical care medicine fellowship program directors and 230 current pediatric critical care medicine fellows/recent graduates were invited to participate. INTERVENTIONS: Participants were asked demographic questions related to their fellowship programs, training currently provided at their fellowship programs, previous experience with brain death examinations (fellows/graduates), and perceptions regarding the adequacy of current training. MEASUREMENTS AND MAIN RESULTS: Twenty-nine program directors (45%) and 91 current fellows/graduates (40%) responded. Third-year fellows reported having performed a median of five examinations (interquartile range, 3-6). On a five-point Likert scale, 93% of program directors responded they "agree" or "strongly agree" that their fellows receive enough instruction on performing brain death examinations compared with 67% of fellows and graduates (p = 0.007). The responses were similar when asked about opportunity to practice brain death examinations (90% vs 54%; p < 0.001). In a regression tree analysis, number of brain death examinations performed was the strongest predictor of trainee satisfaction. Both fellows and program directors preferred bedside demonstration or simulation as educational modalities to add to the fellowship curriculum. CONCLUSIONS: Pediatric critical care medicine fellows overall perform relatively few brain death examinations during their training. Pediatric critical care medicine fellows and program directors disagree in their perceptions of the current training in brain death examination, with fellows perceiving a need for increased training. Both program directors and fellows prefer additional training using bedside demonstration or simulation. Since clinical exposure to brain death examinations is variable, adding simulated brain death examinations to the pediatric critical care medicine fellowship curriculum could help standardize the experience.

Spatiotemporal Assessment of Forest Biomass Carbon Sinks: The Relative Roles of Forest Expansion and Growth in Sichuan Province, China.

Spatiotemporal patterns of forest carbon (C) sinks and accurate estimation of such patterns are crucial to sustainable forest management. We combined individual tree biomass equations and a Random Forest algorithm to assess the spatiotemporal changes in biomass C sequestration and to further quantify the relative contributions of forest areal expansion and growth to biomass C sinks in Sichuan Province, China, over the past 25 yr. Forest area and average biomass C density increased from 10.5 million ha and 45.7 Mg C ha in 1988 to 14.2 million ha and 52.3 Mg C ha in 2012. Average C density was generally larger in the north and west of Sichuan Province compared with other regions. The expanded forest area and enhanced C density have jointly led to a rise in total C storage by 54.9% over this period in Sichuan Province. It was estimated that the forest areal expansion has been a larger contributor to C sinks than forest growth in Sichuan Province (69 vs. 31%), especially in the regions of the northwestern high mountains and the hilly country of the Sichuan basin. However, the relative contributions of areal expansion exhibited different trends in five subregions and 15 forest species groups in this province. Our study suggests that it is necessary to develop a new forestry management mode to maintain the long-term health of forest ecosystems in Sichuan Province, which should attach more importance to improving forest quality and selecting tree species in different subregions while increasing forested area in the future.

Unfolding mechanism of thrombin-binding aptamer revealed by molecular dynamics simulation and Markov State Model.

Thrombin-binding aptamer (TBA) with the sequence 5'GGTTGGTGTGGTTGG3' could fold into G-quadruplex, which correlates with functionally important genomic regionsis. However, unfolding mechanism involved in the structural stability of G-quadruplex has not been satisfactorily elucidated on experiments so far. Herein, we studied the unfolding pathway of TBA by a combination of molecular dynamics simulation (MD) and Markov State Model (MSM). Our results revealed that the unfolding of TBA is not a simple two-state process but proceeds along multiple pathways with multistate intermediates. One high flux confirms some observations from NMR experiment. Another high flux exhibits a different and simpler unfolding pathway with less intermediates. Two important intermediate states were identified. One is similar to the G-triplex reported in the folding of G-quadruplex, but lack of H-bonding between guanines in the upper plane. More importantly, another intermediate state acting as a connector to link the folding region and the unfolding one, was the first time identified, which exhibits higher population and stability than the G-triplex-like intermediate. These results will provide valuable information for extending our understanding the folding landscape of G-quadruplex formation.

Regional representativeness assessment and improvement of eddy flux observations in China.

Both the amounts of data describing the site-scale carbon flux at a high temporal and spatial resolution collected in China and the number of eddy covariance flux towers have been increasing during the last decade. To correctly upscale these fluxes to the regional and global level, the representativeness of the current network of flux towers must be known. The present study quantifies the representativeness of the flux network for the regional carbon exchange. This analysis combined the total solar radiation, air temperature, vapor pressure and the enhanced vegetation index to indicate the environmental characteristics of each 1-km pixel cell and flux tower. Next, the Euclidean distance from each pixel to the tower was calculated to determine the representativeness of the existing flux towers. To improve the regional representativeness, additional tower locations were pinpointed by identifying and clustering the underrepresented areas. The existing network of flux towers performed well in representing the environmental conditions of the middle and the northeastern portions of China. The well-represented areas covered 60.9% of the total areas. The towers in croplands and grasslands represented the vegetation types well, but the wetlands and barelands were poorly represented. The representativeness of the flux network increased with the addition of nine towers located in forests, grasslands, wetlands and barelands. The representativeness of 27.5% of the land areas improved. In addition, the well-represented areas were enlarged by 15.2%. Substantial gains in representation were achieved by adding new towers on the Tibet Plateau. The representativeness of the northwest and southwest was improved less significantly, suggesting that more towers are required to capture certain ecosystem behaviors.

Effect of high pressure CO2 and mild heat processing on natural microorganisms in apple juice.

Apple juice was pasteurized by high pressure carbon dioxide (HPCD) at 20MPa with CO(2) concentration of 4.5-5.3% and mild heat (MH) at atmospheric pressure. Microbial inactivation and stability of natural microorganisms in apple juice were investigated. The temperatures were 37, 42, 47, 52, 57 and 62 degrees C, treatment time was 30min, and storage temperatures of pasteurized apple juice were 2 and 28 degrees C. The aerobic bacteria (AB) treated by MH at 62 degrees C and by HPCD at > or =52 degrees C were almost totally inactivated, the microbial counts were<10CFU/mL. The yeasts and moulds (Y&M) treated by MH at > or =57 degrees C and by HPCD at > or =42 degrees C were totally inactivated. HPCD increased the susceptibility of these natural microorganisms to temperature and enhanced their microbial inactivation. The AB in apple juice treated by HPCD at > or =52 degrees C and the Y&M treated by HPCD at > or =57 degrees C, the AB and the Y&M treated by MH at 62 degrees C showed a better stability during storage at 2 and 28 degrees C, but apple juice treated by HPCD at < or =47 degrees C was characterized with high microbial counts of the AB> or =2.75x10(3)CFU/ml. A viable but non-culturable (VBNC) state of the Y&M treated by MH at 57 degrees C and by HPCD at 42, 47 and 52 degrees C was observed during storage at 28 degrees C. Apparently the proper temperature of HPCD treatment of apple juice at 20MPa and stored at 2 and 28 degrees C was greater than or equal to 52 degrees C, while for MH treatment the proper temperature increased to 62 degrees C in this study.