Effect of volatile versus propofol anaesthesia on major complications and mortality after cardiac surgery: a multicentre randomised trial.

BACKGROUND: The comparative effectiveness of volatile anaesthesia and total intravenous anaesthesia (TIVA) in terms of patient outcomes after cardiac surgery remains a topic of debate. METHODS: Multicentre randomised trial in 16 tertiary hospitals in China. Adult patients undergoing elective cardiac surgery were randomised in a 1:1 ratio to receive volatile anaesthesia (sevoflurane or desflurane) or propofol-based TIVA. The primary outcome was a composite of predefined major complications during hospitalisation and mortality 30 days after surgery. RESULTS: Of the 3123 randomised patients, 3083 (98.7%; mean age 55 yr; 1419 [46.0%] women) were included in the modified intention-to-treat analysis. The composite primary outcome was met by a similar number of patients in both groups (volatile group: 517 of 1531 (33.8%) patients vs TIVA group: 515 of 1552 (33.2%) patients; relative risk 1.02 [0.92-1.12]; P=0.76; adjusted odds ratio 1.05 [0.90-1.22]; P=0.57). Secondary outcomes including 6-month and 1-yr mortality, duration of mechanical ventilation, length of ICU and hospital stay, and healthcare costs, were also similar for the two groups. CONCLUSIONS: Among adults undergoing cardiac surgery, we found no difference in the clinical effectiveness of volatile anaesthesia and propofol-based TIVA. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR-IOR-17013578).

Trend on dental caries status and its risk indicators in children aged 12 years in China: a multilevel analysis based on the repeated national cross-sectional surveys in 2005 and 2015.

BACKGROUND: This study aimed to explore the trend and risk indicators for dental caries of children aged 12 years in China based on national oral health survey data in 2005 and 2015. METHODS: Research data were from the two latest national oral health surveys conducted in mainland China, including 30 and 31 provinces, autonomous regions, and municipalities in 2005 and 2015, respectively. Children aged 12 years were clinically examined for dental caries and dental fluorosis according to the World Health Organization criteria. Sociodemographic characteristics and oral health-related behaviours were collected using questionnaires. Multilevel zero-inflated negative binomial regression model was used to investigate the association between dental caries severity and dental fluorosis, sociodemographic characteristics, and oral health-related behaviours. RESULTS: The final analyses included 12,350 and 27,818 children surveyed in 2005 and 2015, respectively. The standardized prevalence of dental caries increased from 27.05% (95% confidence interval [CI], 24.25-28.85) in 2005 to 37.92% (95% CI, 34.94-40.90) in 2015, and the respective standardized mean decayed, missing, filled teeth (DMFT) index scores increased from 0.50 (standard deviation [SD], 1.04) to 0.83 (SD, 1.45) (P < 0.001). Fujian province had the highest increase in dental caries, followed by Liaoning, Heilongjiang, Hainan, and Yunnan. Results revealed that children who were girls, more frequently experienced dental pain, and had more recent dental visits, had significantly higher DMFT scores after adjusting for the survey year and other variables (all P < 0.05). CONCLUSIONS: Dental caries of 12-year-old children in China deteriorated from 2005 to 2015, particularly in the northeast and southwest regions. Dental caries was associated with sex, dental pain, and dental service utilization.

Protective effect of sevoflurane on vascular endothelial glycocalyx in patients undergoing heart valve surgery: A randomised controlled trial.

BACKGROUND: The glycocalyx plays an important physiological role and may be damaged during cardiopulmonary bypass. Sevoflurane can protect the glycocalyx; however, its relevance in a clinical setting is unknown. OBJECTIVE: Glycocalyx degradation during cardiopulmonary bypass in patients was investigated. On the basis of the available experimental data, we hypothesised that sevoflurane-based anaesthesia would confer additional protection against cardiopulmonary bypass-induced glycocalyx damage. DESIGN: Randomised controlled study. SETTING: Clinical study at The First Affiliated Hospital of Wenzhou Medical University between June 2018 and March 2019. PATIENTS: Fifty-one patients. INTERVENTIONS: After intubation and mechanical ventilation, patients undergoing elective heart valve surgery were maintained under general anaesthesia with either propofol or sevoflurane during surgery. MAIN OUTCOME MEASURES: Glycocalyx markers (such as syndecan-1, heparan sulphate and hyaluronan), sheddases responsible for the degradation of the endothelial glycocalyx (such as matrix metalloproteinase-9 and cathepsin-B), urine albumin-to-creatinine ratio and levels of lactic acid and myocardial enzymes were all measured. Postoperative mechanical ventilation time and length of stay in the cardiac care unit and hospital were also measured. Morbidity and mortality after 30 days and 1 year were evaluated. RESULTS: The vascular endothelial glycocalyx was damaged during cardiopulmonary bypass. The glycocalyx damage in the sevoflurane group was less extensive than that in the propofol group. The urine albumin-to-creatinine ratio increased in both groups but was lower in the sevoflurane group. Enzymes including matrix metalloproteinase-9 and cathepsin-B were positively correlated with glycocalyx marker concentrations. After operation, the sevoflurane group showed lower levels of lactic acid and myocardial enzyme, as well as shorter duration of postoperative mechanical ventilation than the propofol group. CONCLUSION: Sevoflurane can decrease glycocalyx degradation in patients undergoing heart valve surgery under cardiopulmonary bypass. TRIAL REGISTRATION: Chinese Clinical Trial Registry, chictr.org.cn, identifier: ChiCTR1800016367.

The relationship between different types of caries and periodontal disease severity in middle-aged and elderly people: findings from the 4th National Oral Health Survey of China.

BACKGROUND: The relationship between dental caries and periodontal disease is still controversial. The objective of this study was to explore the relationship between different types of caries and periodontal disease severity in middle-aged and elderly people in China. METHODS: The study population consisted of 4407 middle-aged and 4117 elderly subjects. Caries were divided into the following three types: type A, crown caries; type B, lesions involving both the crown and root, representing mixed-type caries; and type C, root caries. These three types together represent the overall caries situation, which we call type ABC. Caries were quantitated by decayed and filled teeth (DFT index). Periodontitis was evaluated by clinical attachment loss. RESULTS: Middle-aged people with periodontitis had a significant association with DFT type B (OR: 1.21, 95% CI 1.17-1.25) and type C (OR: 1.40, 95% CI 1.24-1.56). Elderly people with periodontitis had a significant association with DFT type C (OR: 1.28, 95% CI 1.21-1.35). CONCLUSIONS: In China, caries types B/C were positively correlated with periodontitis in the middle-aged group, and only caries type C was positively correlated with periodontitis in the elderly group.

Dental expenditure, progressivity and horizontal inequality in Chinese adults: based on the 4th National Oral Health Epidemiology Survey.

BACKGROUND: The financial burden of oral diseases is a growing concern as the medical expenses rise worldwide. The aim of this study was to investigate the dental expenditure, analyze its progressivity and horizontal inequality under the general health finance and insurance system, and identify the key social determinants of the inequality for Chinese adults. METHODS: A secondary analysis used the data of 13,464 adults from the 4th National Oral Health Epidemiological Survey (NOHES) in China was undertaken. The dental expenditure was collected and divided into out-of-pocket and health insurance payments. Horizontal inequality index and Kakwani index were used to analyze the horizontal inequality and progressivity, respectively. The decomposition model of the concentration index was set up to explore the associated socioeconomic determinants. RESULTS: The results showed that a mean dental expenditure per capita of Chinese adults was $20.55 (95% Confidence Interval-CI: 18.83,22.26). Among those who actually used dental service, the cost was $100.95 (95%CI: 93.22,108.68). Over 90% of dental spending was due to out-of-pocket expenses. For self-reported oral health, the horizontal inequality index was - 0.1391 and for the decayed tooth (DT), it was - 0.2252. For out-of-pocket payment, the Kakwani index was - 0.3154 and for health insurance payment it was - 0.1598. Income, residential location, educational attainment, oral hygiene practice, self-reported oral health, age difference were the main contributors to the inequality of dental expenditure. CONCLUSION: Dental expenditure for Chinese adults was at a lower level due to underutilization. The ratio of payments of dental expenditure and utilization was disproportional, whether it was out-of-pocket or insurance payment. Individuals who were more in need of oral care showed less demand for service or not required service in time. For future policy making on oral health, it is worth the effort to further promote the awareness of the importance of oral health and utilization of dental service.

Increasing the homologous recombination efficiency of eukaryotic microorganisms for enhanced genome engineering.

In recent years, eukaryotic microorganisms have been widely applied to offer many solutions for everyday life and have come to play important roles in agriculture, food, health care, and the fine-chemicals industry. However, the complex genetic background and low homologous recombination efficiency have hampered the implementation of large-scale and high-throughput gene editing in many eukaryotic microorganisms. The low efficiency of homologous recombination (HR) not only makes the modification process labor-intensive but also completely precludes the application of many otherwise very useful genome editing techniques. Thus, increasing the efficiency of HR is clearly an enabling technology for basic research and gene editing in eukaryotic microorganisms. In this review, we summarize the current strategies for enhancing the efficiency of HR in eukaryotic microorganisms (particularly yeasts and filamentous fungi), list some small molecules and candidate genes associated with homologous and non-homologous recombination, and briefly discuss the further development prospects of these strategies.

Correlation Between Flow-Mediated Dilatation of the Brachial Artery and Serum Endothelial Biomarkers in the Evaluation of Acute Endothelial Injury After Cardiopulmonary Bypass.

OBJECTIVES: The purpose of this study was to investigate the correlation between flow-mediated dilatation of the brachial artery and serum endothelial biomarkers and to discuss the feasibility of sonographic evaluation of acute endothelial injury during cardiopulmonary bypass (CPB) surgery. METHODS: Sonography was applied to determine the percentage of change in the brachial artery size during flow-mediated dilatation. Meanwhile, the plasma concentrations of endothelial-derived biomarkers, such as endothelin 1, nitric oxide, and von Willebrand factor, were measured to monitor the changes in endothelial function. We analyzed the correlation between flow-mediated dilatation and biomarkers during the perioperative period of CPB in 27 patients. RESULTS: All of the biomarkers changed dramatically, especially during the CPB period. There was a negative correlation between flow-mediated dilatation and von Willebrand factor (P = .001; R = -0.31). CONCLUSIONS: A CPB event has a substantial impact on endothelial function, and sonographic assessment of the percentage of change in the brachial artery size during flow-mediated dilatation allows early detection of acute endothelial function injury in cardiac surgery.

The prevalence, length and position of the anterior loop of the inferior alveolar nerve in Chinese, assessed by spiral computed tomography.

PURPOSE: This study used spiral computed tomography to identify the anterior loop of the inferior alveolar nerve, and to measure its length and position in Chinese. This information may be useful to safely install endosseous implants in the most distal area of the interforaminal region. METHODS: Sixty-eight Chinese patients were included in this retrospective study. Patients were scanned by 64-slice spiral computed tomography, and the prevalence, length, and position of the anterior loop were assessed using the multiplanar capabilities of software. RESULTS: An anterior loop could be identified in 83.1% of the cases, with a mean length of 2.09 mm (range 0-5.31 mm). The mean distance from the superior border of the mental foramen to the alveolar crest was 13.00 mm, and the mean distance from the superior border of the origin of the anterior loop to the alveolar crest was 17.83 mm. CONCLUSIONS: The anterior loop was highly prevalent in Chinese, and the length of the anterior loop was highly variable. Therefore, we recommend that drilling commences from a location approximately 5.5 mm mesially from the mental foramen, when installing implants in the most distal interforaminal area.

A multicenter prospective study of lateral neck lymph node mapping in papillary thyroid cancer.

Background: Despite the high incidence of lateral neck lymph node (LN) metastasis in papillary thyroid cancer (PTC), the management of the lateral neck remains controversial. We aimed to map the draining LNs in the lateral neck using carbon nanoparticles and explore its potential in neck evaluation. Methods: We conducted a multicenter, prospective study in PTC patients who had non-palpable yet suspicious metastatic lateral LNs on ultrasound and/or computed tomography (CT) but could not be confirmed by fine needle aspiration. Carbon nanoparticle suspension was injected peritumorally into the thyroid and modified lateral neck dissection was subsequently performed. Results: A total of 154 patients were enrolled for analysis. And 5,070 lateral LNs were removed, of which 1,079 (21.3%) were dyed. The median of dyed LNs was 6 per case (range, 1-33). The distribution of dyed LNs in neck compartments was IV > III > IIA > IIB/V, independent of tumor size, location, multifocality or microscopic extra-thyroidal extension (ETE). Compared with undyed LNs, the probabilities of metastasis in dyed LNs were significantly increased in compartment III, IV, V, and II-V (III: 29.3% vs. 15.4%, P<0.001; IV: 26.3% vs. 14.5%, P<0.001; V: 16.7% vs. 3.3%, P=0.005; II-V: 26.3% vs. 10.0%, P<0.001). The relative risks of metastasis in dyed LNs compared with undyed LNs were 1.90, 1.82, 5.04 and 2.62 in compartment III, IV, V, and II-V, respectively. Conclusions: It was the first prospective multicenter study to map the lateral neck LNs with carbon nanoparticles, which could help surgeons visualize the suspicious LNs during surgery. Instead of unguided LN biopsy, this method has a potential role in lateral neck assessment for indeterminate lateral LNs in PTC.

Unloading the infarcted heart affect MMPs-TIMPs axis in a rat cardiac heterotopic transplantation model.

Ventricular assist devices may function as a bridge to recovery or heart transplantation, however, little is known about its mechanisms. This study examined the role of matrix metalloproteinases (MMP)-tissue inhibitors of metalloproteinases (TIMP) axis in the process of recovery after unloading in a rat ischemic-induce heart failure (HF) model. Myocardial infarction model was created with the coronary artery ligation. The infarcted rats hearts were unloaded by heterotopic cardiac transplantation (n=14). 2 weeks later, the function of normal and infarcted hearts with or without loading was evaluated by Langendorff perfusion model. The hearts were then harvested and prepared for the study of expression of MMPs and TIMPs. Developed pressure in the unloading group was higher than the loading group (P=0.0074). Unloading increased the ratio of TIMP-1-MMP-1(1.38±0.11 vs. 0.76±0.09, P<0.05), TIMP-2-MMP-2 (1.06±0.10 vs. 0.33±0.07, P<0.01), TIMP-3-MMP-9(1.07±0.08 vs. 0.59±0.06, P<0.05). Although MMP-1, 2, 9 were downregulated (P<0.01, 0.01, 0.05, respectively), TIMP-2 and TIMP-3 upregulated (P<0.01, 0.05, respectively), MMP-7 and TIMP-1 was not affected significantly. The infarcted cardiac function could be improved by unloading. It was attributed to downregulation of MMP-1, 2 and 9, and upregulation of TIMP-2 and -3, and furthermore, the ratio of TIMPs to MMPs was increased, which might be more sensitive than sole MMPs or TIMPs for the judgment of myocardial matrix homeostasis.

[HPLC-MS identification of degradation products of levofloxacin].

The study aims to identify the degradation products of levofloxacin by HPLC-MS. The degradation products of levofloxacin were chromatographed on Agilent Zorbax Extend-C18 column (250 mm x 4.6 mm, 5 microm). The mobile phase was 0.1% ammonium acetate solution (using methanoic acid to adjust to pH 3.5)-acetonitrile at the flow rate of 0.5 mL x min(-1) (gradient elution), the column temperature was 40 degrees C. Descarboxyl levofloxacin, desmethyl levofloxacin and levofloxacin N-oxide were identified through comparing with the standard spectrum and the results of mass spectrometry, i.e. m/z 318.2 was descarboxyl levofloxacin, m/z 348.2 was desmethyl levofloxacin, m/z 378.1 was levofloxacin-N-oxide. This method is simple, fast, accurate and suitable for the identification of degradation products of levofloxacin.

Determining the factors associated with oral health-related quality of life in Chinese elders: Findings from the fourth national survey.

OBJECTIVE: The purpose of this study was to assess the associations between the self-reported oral health-related quality of life (OHRQoL) of older Chinese people and their socio-economic status and oral health using data collected in the 4th National Oral Health Survey. METHODS: After multistage stratified cluster sampling, 4332 adults aged 65-74 years participated in the study. After a clinical examination, the participants completed a structured questionnaire. A Mandarin version of the General Oral Health Assessment Index (GOHAI) was included in the questionnaire. Clinical examinations were carried out using the criteria recommended by the World Health Organization. Multivariate analysis was used to evaluate the associations of the clinical and socio-demographic variables with the GOHAI scores of the participants. RESULTS: The weighted mean (SE) GOHAI score was 51.6 (0.0). Female sex and having more than 10 missing teeth, unrestored tooth spaces, more than 10 decayed teeth and a periodontal pocket ≥6 mm were negatively associated with the GOHAI score, while having a higher education level and living in the Eastern region of China were positively associated with the GOHAI score. CONCLUSION: After adjustment for confounders, the OHRQoL of older Chinese individuals was mainly affected by untreated dental caries and the loss of teeth. Older Chinese individuals who were male, had a higher education level, were from the Eastern region, had no unrestored tooth spaces or deep periodontal pockets and had fewer decayed or missing teeth had higher GOHAI scores, indicating better OHRQoL.

Etiological Analysis of Viral Encephalitis in Children in Zhejiang Province from 2018 to 2019.

OBJECTIVE: To investigate the common pathogens of viral encephalitis (VE) in children, and to provide guidance for the empirical diagnosis and treatment of patients with VE. METHODS: A total of 227 cerebrospinal fluid (CSF) samples were collected from pediatric patients with VE in Zhejiang province from January 2018 to December 2019. The samples were tested using multiplex and singleplex Reverse Transcription-Polymerase Chain Reaction (RT-PCR) with primers specific to enterovirus (EV), varicella-zoster virus (VZV), mumps virus (MuV), cytomegalovirus (CMV), herpes simplex virus type 1 (HSV-1)/type 2 (HSV-2), Epstein-Barr virus (EBV), and human herpesvirus 6 (HHV-6). The data of the two analyses were compared and then verified using Sanger sequencing. RESULTS: Of the 227 CSF samples, 90 were shown to be positive for multiplex RT-PCR with a positivity rate of 39.65% and a 95% confidence interval (33.2%, 46.1%). EV was the most common cause of VE, followed by EBV, HHV-6, MuV, CMV, VZV, and HSV-1. Most included cases occurred in summer, accounting for 49.78% of all cases. For EV, EBV, and HSV-2, multiplex RT-PCR showed a positivity rate of 34.36%, which was not statistically different from that of 30.4% shown by singleplex RT-PCR. The sequences of EV, EBV, VZV, MuV, CMV, HSV-1, HHV-6, and HSV-2 were confirmed by sequencing the PCR products obtained from multiplex and singleplex PCR. CONCLUSIONS: In children, VE is more prevalent in the summer than in other seasons in Zhejiang province, and EV may be the most common causative pathogen.

[A clinical study on the effectiveness of desensitizing toothpaste in patients with dentine hypersensitivity].

OBJECTIVE: To evaluate the effectiveness of desensitizing toothpaste containing 5.53% potassium citrate on dentine hypersensitivity. METHODS: This was a randomized, double-blinded, controlled, clinical trial. Those, who satisfied the inclusion criteria, were recruited into the study and randomized allocated into test group and control group according to gender and age group. At baseline, 67 subjects (36 in test group, 31 in control group) were recruited into the study. The dentine hypersensitivity was evaluated by a subject self-perceived short, sharp pain in visual analogue scale (VAS) in response to a blast of cold air from a triple syringe administered to a tooth surface in 1 cm. Test toothpastes, containing 5.53% potassium citrate and 0.76% sodium monofluorophosphate, and control toothpastes, containing only 0.76% sodium monofluorophosphate were delivered to the study subjects in the test and control group respectively. The subjects were asked to brush their teeth twice a day, and at least one minute each time. During the 8-week study period, a subjective evaluation of changes in the individuals overall sensitivity to everyday stimuli was also scored in VAS. RESULTS: At the end of the trial data of 57 subjects (31 in test group, 26 in control group) was used for analysis. From baseline to 8-week evaluation, the mean VAS values to cold air and subjects' self-perceived VAS values of the subjects decreased both in the test and control groups. Furthermore, the reduction in mean VAS values to cold air from baseline to 4-week of the test subjects was statistically significant higher than that of the control (1.12 vs. 0.32, P<0.05). The reduction in mean subjects' self-perceived VAS values from baseline to 8-week of the test subjects was statistically significant higher than that of the control (1.59 vs. 0.24, P<0.05). CONCLUSION: RESULTS of the clinical trial showed that toothpastes containing 5.53% potassium citrate were effective in reducing dentine hypersensitivity.

Associated Factors of Oral Health-related Quality of Life in Chinese Adolescents Aged 12-15 Years.

adolescents aged 12 to 15 years based on the 4th National Oral Health Survey and to explore its associated factors. METHODS: Students aged 12 to 15 years were recruited using to a multistage stratified random sampling method. All the subjects received oral examination and completed a questionnaire. Information relating to OHRQoL was collected through a Mandarin version of the child oral impacts on daily performances (Child-OIDP) questionnaire. The relationship between the Child-OIDP scores and independent variables was assessed using a Mann-Whitney U-test, Kruskal-Wallis test and a multivariate Poisson regression. RESULTS: A total of 89,582 subjects were included in the analysis, of whom 76.6% reported oral impacts in the last 6 months. Eating was the most affected daily performance. The results of the regression analysis showed that factors associated with adolescents' OHRQoL included sex, location of residence, region, only child status, parents' level of education, frequency of sugar consumption, self-perception of general/oral health, dental appointments in the past 12 months, oral health knowledge status, age, decayed, missing and filled teeth (DMFT) index and number of teeth with gingival bleeding. CONCLUSION: Oral impacts were common among Chinese adolescents, although most were not so severe. Eating was the most commonly affected performance. Sex, location of residence, region, only child status, parents' level of education, frequency of sugar consumption, selfperception of general/oral health status, dental appointments in the previous 12 months, oral health knowledge status, age, DMFT index and number of teeth with gingival bleeding were found to be associated with OHRQoL.

Draft genome sequence of tetracycline-resistant Klebsiella oxytoca CCTCC M207023 producing 2,3-butanediol isolated from China.

OBJECTIVES: Recently, the Gram-negative bacterium Klebsiella oxytoca has been identified as an emerging pathogen. Here we report the draft genome of a 2,3-butanediol-producing strain, K. oxytoca CCTCC M207023, isolated from soil in Nanjing, China. The tetracycline-resistant phenotype and the high yield of 2,3-butanediol was demonstrated. METHODS: The draft genome of K. oxytoca CCTCC M207023 was determined using an Illumina NovaSeq™ 6000 next-generation DNA sequencing platform. Clean sequencing data were subsequently assembled using SOAPdenovo. RESULTS: The draft genome of K. oxytoca CCTCC M207023, comprising 5 658 144bp and with a GC content of 56.50%, was assembled into 5262 open-reading frames (ORFs). Antimicrobial resistance genes were also annotated. CONCLUSIONS: The draft genome sequence of K. oxytoca CCTCC M207023 reported here will be a reference for comparative analysis with the antimicrobial resistance mechanisms for the safety of 2,3-butanediol industrial production.

[Prevention effect of transcutaneous electrical acupoint stimulation for chemotherapy-related myelosuppression in non-small cell lung cancer].

OBJECTIVE: To observe the prevention effect of transcutaneous electrical acupoint stimulation (TEAS) for chemotherapy-related myelosuppression in non-small cell lung cancer. METHODS: A total of 102 patients with non-small cell lung cancer who received initial chemotherapy were randomly divided into a conventional group, a medication group and a TEAS group, 34 cases in each one. The conventional group was treated with chemotherapy of gemcitabine combined with cisplatin and given routine care. On the basis of conventional group's treatment, the medication group was given Diyu Shengbai tablets before chemotherapy, 2-3 tablets each time, 3 times a day. In the TEAS group, on the basis of conventional group's treatment, TEAS was applied at Dazhui (GV 14), Geshu (BL 17), Hegu (LI 4), Zusanli (ST 36) and Sanyinjiao (SP 6) on day 1, 2, 3, 5, 8, 14, 21 and 28 of chemotherapy. The treatment was given 30 min each time and once a day. In the three groups, the treatment for 28 days was as one course and one course of treatment was required. The changes of leukocytes, platelets, erythrocyte, hemoglobin indexes in patients of the three groups were observed one day before chemotherapy and on day 5, 8, 11, 14, 21 and 28 of chemotherapy. The comfort situation of patients was observed one day before chemotherapy and on the 5th, 11th and 21st day of chemotherapy. RESULTS: Compared with before chemotherapy, the leukocyte counts of three groups were decreased at various time points after chemotherapy (P<0.05). Compared with the conventional group, the leukocyte counts were higher on day 8 and 14 in the TEAS group and on day 14 in the medication group (P<0.05). Compared with before chemotherapy, the platelet count decreased on the day 5, 8, 11 and 14 of chemotherapy in the conventional group (P<0.05), and the platelet counts all decreased at each time point after chemotherapy in the medication group (P<0.05). The platelet counts of the TEAS group on day 5, 8, 11 and 14 of chemotherapy were higher than those of the conventional group (P<0.05), and the platelet counts of the TEAS group on day 5, 8, 11 and 21 of chemotherapy were higher than those of the medication group (P<0.05). Compared with the conventional group, the comfort situation scores of the TEAS group were higher on the 5th and 11th days of chemotherapy (P<0.05). CONCLUSION: Transcutaneous electrical acupoint stimulation can prevent chemotherapy-induced myelosuppression (leukocyte, platelets) in patients with non-small cell lung cancer and improve patient comfort situation.

Advances in the metabolic engineering of Yarrowia lipolytica for the production of terpenoids.

Terpenoids are a large class of natural compounds based on the C5 isoprene unit, with many biological effects such activity against cancer and allergies, while some also have an agreeable aroma. Consequently, they have received extensive attention in the food, pharmaceutical and cosmetic fields. With the identification and analysis of the underlying natural product synthesis pathways, current microbial-based metabolic engineering approaches have yielded new strategies for the production of highly valuable terpenoids. Yarrowia lipolytica is a non-conventional oleaginous yeast that is rapidly emerging as a valuable host for the production of terpenoids due to its own endogenous mevalonate pathway and high oil production capacity. This review aims to summarize the status and strategies of metabolic engineering for the heterologous synthesis of terpenoids in Y. lipolytica in recent years and proposes new methods aiming towards further improvement of terpenoid production.

CRISPR/Cas9-Based Genome Editing in the Filamentous Fungus Fusarium fujikuroi and Its Application in Strain Engineering for Gibberellic Acid Production.

The filamentous fungus Fusarium fujikuroi is well-known for its production of natural plant growth hormones: a series of gibberellic acids (GAs). Some GAs, including GA1, GA3, GA4, and GA7, are biologically active and have been widely applied in agriculture. However, the low efficiency of traditional genetic tools limits the further research toward making this fungus more efficient and able to produce tailor-made GAs. Here, we established an efficient CRISPR/Cas9-based genome editing tool for F. fujikuroi. First, we compared three different nuclear localization signals (NLS) and selected an efficient NLS from histone H2B (HTBNLS) to enable the import of the Cas9 protein into the fungal nucleus. Then, different sgRNA expression strategies, both in vitro and different promoter-based in vivo strategies, were explored. The promoters of the U6 small nuclear RNA and 5S rRNA, which were identified in F. fujikuroi, had the highest editing efficiency. The 5S rRNA-promoter-driven genome editing efficiency reached up to 79.2%. What's more, multigene editing was also explored and showed good results. Finally, we used the developed genome editing tool to engineer the metabolic pathways responsible for the accumulation of a series GAs in the filamentous fungus F. fujikuroi, and successfully changed its GA product profile, from GA3 to tailor-made GA4 and GA7 mixtures. Since these mixtures are more efficient for agricultural use, especially for fruit growth, the developed strains will greatly improve industrial GA production.

Tongue Image Database Construction Based on the Expert Opinions: Assessment for Individual Agreement and Methods for Expert Selection.

This study aims at introducing a method for individual agreement evaluation to identify the discordant raters from the experts' group. We exclude those experts and decide the best experts selection method, so as to improve the reliability of the constructed tongue image database based on experts' opinions. Fifty experienced experts from the TCM diagnostic field all over China were invited to give ratings for 300 randomly selected tongue images. Gwet's AC1 (first-order agreement coefficient) was used to calculate the interrater and intrarater agreement. The optimization of the interrater agreement and the disagreement score were put forward to evaluate the external consistency for individual expert. The proposed method could successfully optimize the interrater agreement. By comparing three experts' selection methods, the interrater agreement was, respectively, increased from 0.53 [0.32-0.75] for original one to 0.64 [0.39-0.80] using method A (inclusion of experts whose intrarater agreement>0.6), 0.69 [0.63-0.81] using method B (inclusion of experts whose disagreement score="0"), and 0.76 [0.67-0.83] using method C (inclusion of experts whose intrarater agreement>0.6& disagreement score="0"). In this study, we provide an estimate of external consistency for individual expert, and the comprehensive consideration of both the internal consistency and the external consistency for each expert would be superior to either one in the tongue image construction based on expert opinions.