Conjugated molecularly imprinted polymers based on covalent organic frameworks: Fluorescent sensing platform for specific capture of urea and elimination of ethyl carbamate.

This study described the preparation of an azide covalent organic framework-embedded molecularly imprinted polymers (COFs(azide)@MIPs) platform for urea adsorption and indirect ethyl carbamate (EC) removal from Chinese yellow rice wine (Huangjiu). By modifying the pore surface of COFs using the copper-catalyzed azide-alkyne cycloaddition (CuAAC) reaction, COFs(azide) with a high fluorescence quantum yield and particular recognition ability were inventively produced. In order to selectively trap urea, the COFs(azide) were encased in an imprinted shell layer via imprinting technology. With a detection limit (LOD) of 0.016 µg L-1 (R2 = 0.9874), the COFs(azides)@MIPs demonstrated a good linear relationship with urea in the linear range of 0-5 µg L-1. Using real Huangjiu samples, the spiking recovery trials showed the viability of this sensing platform with recoveries ranging from 88.44 % to 109.26 % and an RSD of less than 3.40 %. The Huangjiu processing model system achieved 38.93 % EC reduction by COFs(azides)@MIPs. This research will open up new avenues for the treatment of health problems associated with fermented alcoholic beverages, particularly Huangjiu, while also capturing and removing hazards coming from food.

Fast detection of tryptamine in meat products with azide-functionalized covalent organic frameworks confined in molecularly imprinted polymers.

Tryptamine is a biogenic amine that affects organoleptic quality through the generation of off-odours in foods. Herein, imine-based covalent organic frameworks (COFs) were synthesized via Schiff base reactions and postmodified with click chemistry to generate azide-functionalized COFs with tunable azide units on the walls. The combination of molecular imprinting with COFs enabled the specific recognition of the targets. The resulting optosensing system (azide-functionalized COFs@MIPs) was used as a sample-to-answer analyser for detecting tryptamine (detection time within 10 min). A linear relationship was observed for the fluorescence response to tryptamine concentrations in the range of 3-120 µg L-1, with a limit of detection of 1.74 µg L-1. The recoveries for spiked samples were satisfactory, with relative standard deviations <9.90%. The optosensing system is a potential tool for the quantitative detection of tryptamine in meat products because of its lower cost, shorter processing time, and simpler processing steps compared to conventional chromatographic techniques.

Acupoint Catgut Embedding for Treatment of Chronic Pelvic Pain due to the Sequelae of Pelvic Inflammatory Disease.

Chronic pelvic pain caused by the sequelae of inflammatory pelvic disease is a common clinical condition of pelvic pain in women. At present, the main challenges in its treatment are the limited effectiveness of pain relief and the frequent recurrence of symptoms, which significantly impact patients' quality of life and impose a considerable psychological burden on them. It is a clinically challenging disease. After summarizing years of treatment experience, the author's team discovered that acupoint catgut embedding demonstrated notable clinical efficacy in managing chronic pelvic pain stemming from pelvic inflammatory disease sequelae. Compared to existing Western medicine treatment methods, acupoint catgut embedding offers advantages such as a good analgesic effect, lower recurrence rate, economic benefits, and a relatively straightforward procedure. This article provides a comprehensive guide on embedding absorbable catgut into patients' acupoints for the treatment of chronic pelvic pain in females resulting from the sequelae of pelvic inflammatory disease.

Different doses and courses of omalizumab for patients with chronic spontaneous urticaria: A systematic review with meta-analysis and trial sequential analysis.

Background: The stability, efficacy, and safety of omalizumab at different doses and regimens for chronic spontaneous urticaria (CSU) are yet to be studied. Objective: A systematic review (SR) with meta-analysis (MA) and trial sequential analysis (TSA) was performed to assess the efficacy and safety of omalizumab in CSU. Methods: Randomised controlled trials (RCTs) of administering omalizumab versus placebo for CSU were searched. Random-effects MAs were performed using planned subgroup analyses. TSA was performed to control for the risk of random errors and assess the stability of our MA results. Publication bias was visually assessed using a contour-enhanced funnel plot and the trim-and-fill method. The quality of RCTs was assessed using the Cochrane Risk of Bias Tool 2. Results: Twelve studies met the inclusion criteria. Omalizumab had remarkable effects on the patient percentage of the weekly urticaria activity score is zero (UAS = 0) [RR 4.64, 95% CI (3.38, 6.37)], percentage of no angioedema-burdened days [MD 3.15, 95% CI (0.10, 6.19], patient percentage of UAS ≤6 [RR 3.05, 95% CI (2.46, 3.78)], and patient percentage of the weekly itch severity score minimally important difference (ISS7 MID) [RR 1.50, 95% CI (1.36, 1.66)]. Omalizumab was well tolerated across studies [RR 0.98, 95% CI (0.90, 1.08)]. TSA confirmed the above results, except for "the percentage of no angioedema-burdened day". Conclusion: Among the different doses and courses assessed, omalizumab (300 mg, 12 weeks) can be recommended as an effective treatment for patients with CSU. However, whether omalizumab improves angioedema requires further investigation. The clinical management of angioedema accompanying CSU requires further attention.

High-throughput visualization mutation screening technology to enhance the specificity of CadR based whole-cell cadmium biosensor.

As a heavy metal pollutant, Cd2+ often enters the human body through the food chain causing great harm to human health. Whole-cell biosensor is an emerging technology for rapid on-site detection of heavy metals with the advantages of inexpensive, fast to mass-produce, and strong in anti-interference resistance, but suffering from insatisfactory specificity. In this study, a strategy of Adjacent Site Saturation Mutation (ASSM) was designed to improve the specificity of transcription factor CadR, which acted as the recognition element and determined the specificity of whole cell Cd2+ biosensors. A specific saturated library was constructed using the strategy of adjacent mutation. After two rounds of high-throughput visual screening, a whole-cell biosensor with good response to Cd2+, and with significant weakened Hg2+ interference was obtained. The optimized whole-cell biosensor showed a linear dynamic concentration range from 500 nM to 100 µM, a detection limit of 0.079 µM, and has satisfactory specificity and anti-interference. The ASSM strategy proposed in this study can provide a new method for the application of synthetic biology in food safety detection, indicating the importance of whole-cell biosensors for the detection of heavy metals.

Fertilizer response to climate change: Evidence from corn production in China.

Corn is the third most cultivated food crop in the world, and climate change has important effects on corn production and food security. China is the top user of chemical fertilizer in the world, and analyzing how to effectively manage fertilizer application in such a developing country with resource constraints is crucial. We present empirical evidence from China to demonstrate the nonlinear impact of temperature on fertilizer usage in corn production based on a panel dataset that shows 2297 corn-growing counties during 1998-2016. Our findings indicate that fertilizer usage barely changes with increasing temperatures that are below 28 °C; however, exposure to temperatures above 28 °C leads to a sharp increase in fertilizer use. The increase in temperatures in the sample period implies that fertilizer usage per hectare for corn increased by 1.5 kg. Summer corn fertilizer application in the Yellow-Huai River Valley is more sensitive to warming than in the North region. Moreover, nitrogen, phosphorus, and potassium fertilizers have different temperature thresholds of 32 °C, 20 °C, and 20 °C, respectively, that cause significant changes.

Recent advances in molecularly imprinted polymers (MIPs) for visual recognition and inhibition of α-dicarbonyl compound-mediated Maillard reaction products.

α-Dicarbonyl compounds (α-DCs) are important intermediates and precursors of harmful Maillard reaction products (e.g., acrylamide and late glycosylation end-products), and they exist widely in thermoprocessed sugar- or fat-rich foods. α-DCs and their end-products are prone to accumulation in the human body and lead to the development of various chronic diseases. Therefore, detection of α-DCs and their associated hazards in food samples is crucial. This paper reviews the preparation of molecularly imprinted polymers (MIPs) enabling visual intelligent responses and the strategies for recognition and capture of α-DCs and their associated hazards, and provides a comprehensive summary of the development of visual MIPs, including integration strategies and applications with real food samples. The visual signal responses as well as the mechanisms for hazard recognition and capture are highlighted. Current challenges and prospects for visual MIPs with advanced applications in food, agricultural and environmental samples are also discussed. This review will open new horizons regarding visual MIPs for recognition and inhibition of hazards in food safety.

Photostimulus-Responsive Peptide Dot-Centered Covalent Organic Polymers: Effective Pesticide Sensing via Enhancing Accessibility.

Pesticide detection and monitoring are necessary for human health as the overapplication has serious consequences for environmental pollution. Herein, a proper modulation strategy was implemented to construct the photostimulus-responsive peptide-dot-centered covalent organic polymer (P-PCOP) nanoarchitecture for selective sensing of pesticides. The as-constructed P-PCOP was prepared at room temperature by using amino-containing peptide dots as a building block instead of common organic molecules, and the merits of P-PCOP enable it to reduce the steric hindrance of recognition, enhance the interfacial contact of the target, and facilitate the accessibility of sites, which promises to improve the sensitivity. The P-PCOF exhibited a low detection limit of 0.38 µg L-1 to cartap over the range of 1-80 µg L-1 (R2 = 0.9845), and the recoveries percentage in real samples was estimated to be 93.39-105.82%. More importantly, the DFT calculation confirmed the selective recognition ability of P-PCOP on chemical pesticides. In conjunction with a smartphone-integrated portable reading device, on-site chemical sensing is achieved. The proper modulation strategy of fixing a functional guest on the COP system contributes to the advanced structure-chemical properties that are conducive to their applications in chemical sensing.

Organic cocatalysts improved Fenton and Fenton-like processes for water pollution control: A review.

In recent times, organic compounds have been extensively utilized to mitigate the limitations associated with Fe(Ⅲ) reduction and the narrow pH range in Fenton and Fenton-like processes, which have garnered considerable attention in relevant studies. This review presents the latest advancements in the comprehensive analysis and applications of organic agents as assistant/cocatalysts during Fenton/Fenton-like reactions for water pollution control. The primary focus includes the following: Firstly, the mechanism of organic co-catalytic reactions is introduced, encompassing both complexation and reduction aspects. Secondly, these organic compounds are classified into distinct categories based on their functional group structures and applications, namely polycarboxylates, aminopolycarboxylic acids, quinones, phenolic acids, humic substances, and sulfhydryl compounds, and their co-catalytic functions and mechanisms of each category are discussed in meticulous detail. Thirdly, a comprehensive comparison is conducted among various types of organic cocatalysts, considering their relative merits, cost implications, toxicity, and other pertinent factors. Finally, the review concludes by addressing the universal challenges and development prospects associated with organic co-catalytic systems. The overarching objective of this review is to provide insights into potential avenues for the future advancement of organic co-catalytic Fenton/Fenton-like reactions in the context of water purification.

Mechanism of color change in Antarctic krill oil during storage.

Antarctic krill oil (AKO) is reddish-orange in color but undergoes changes during storage. To investigate the color deterioration and potential mechanisms involved, the changes in color, endogenous components (astaxanthin, fatty acids, and phospholipids), and reaction products (aldehydes, α-dicarbonyl compounds, and pyrroles) of AKO upon storage were determined. Although the visual color of AKO tended to darken upon storage, the colorimetric analysis and ultraviolet-visible spectrum analysis both indicated a fading in red and yellow due to the oxidative degradation of astaxanthin. During storage of AKO, lipid oxidation led to the formation of carbonyl compounds such as aldehydes and α-dicarbonyls. In addition, phosphatidylethanolamines (PEs) exhibited a faster loss rate than phosphatidylcholines. Moreover, hydrophobic pyrroles, the Maillard-like reaction products associated with primary amine groups in PEs accumulated. Therefore, it is suggested that the Maillard-like reaction between PEs and carbonyl compounds formed by lipid oxidation contributed to color darkening of AKO during storage.

Advances of nanoparticle derived from food in the control of α-dicarbonyl compounds-A review.

α-Dicarbonyl compounds (α-DCs) are predominantly generated through the thermal processing of carbohydrate and protein-rich food. They are pivotal precursors to hazard formation, such as advanced glycation end products (AGEs), acrylamide, and furan. Their accumulation within the body will be genotoxicity and neurotoxicity. Recently, significant advancements have been made in nanotechnology, leading to the widespread utilization of nanomaterials as functional components in addressing the detrimental impact of α-DCs. This review focuses on the control of α-DCs through the utilization of nanoparticle-based functional factors, which were prepared by using edible components as resources. Four emerging nanoparticles are introduced including phenolic compounds-derived nanoparticle, plant-derived nanoparticle, active peptides-derived nanoparticle, and functional minerals-derived nanoparticle. The general control mechanisms as well as the recent evidence pertaining to the aforementioned aspects were also discussed, hoping to valuable helpful references for the development of innovative α-DCs scavengers and identifying the further scope of research.

Effects of calcium chloride on the gelling and digestive characteristics of myofibrillar protein in Litopenaeus vannamei.

In this study, the effects of CaCl2 (0, 25, 50, 75, and 100 mM) on the gelling and digestive properties of the myofibrillar protein (MP) in Litopenaeus vannamei were investigated. The results showed that increasing CaCl2 concentration led to changes in the tertiary structure of MP. Specifically, compared with the control group, a 64.31 % increase in surface hydrophobicity and a 45.90 % decrease in the sulfhydryl group were observed after 100 mM CaCl2 treatment. Correspondingly, the water holding capacity and strength of the MP gel increased by 24.46 % and 55.99 %, respectively. These changes were positively correlated with the rheological properties, microstructure pore size, and content of non-flowable water. The mechanical properties of MP gel were improved, and the microstructure became more compact with the increase in CaCl2 concentration. Furthermore, the particle size of the digested MP gels decreased in the presence of CaCl2, which improved the digestion characteristics of MP gels.

Replacing manual operation with bio-automation: A high-throughput evolution strategy to construct an integrated whole-cell biosensor for the simultaneous detection of methylmercury and mercury ions without manual sample digestion.

Methylmercury is primarily responsible for most food mercury pollution cases. However, most biosensors developed for mercury pollution analysis can only detect mercury ions. Although oxidative strong-acid digestion or microwave-assisted digestion can convert methylmercury into mercury ions, it is unsuitable for on-site detection. This study designed a bio-digestion gene circuit and integrated it into a mercury ion whole-cell biosensor，creating a novel on-site methylmercury detection method. Five alkyl mercury lyases from different bacterial genomes were screened via bioinformatics analysis, of which goMerB from Gordonia otitis showed the highest catalytic biological digestion efficiency. The goMerB site-specific saturation and random mutation libraries were constructed. After two rounds of high-throughput visualization screening, the catalytic activity of the mutant increased 2.5-fold. The distance between the three crucial amino acid sites and methylmercury changed in the mutant, which likely contributed to the enhanced catalytic efficiency. The optimized whole-cell biosensor showed a linear dynamic concentration range of 100 nM to 100 µM (R2 =0.991), satisfactory specificity, and interference resistance. The detection limit of the goMerBt6-MerR-RFP biosensor was 0.015 µM, while the limit of quantitation was 0.049 µM. This study demonstrated the application of synthetic biology for food safety detection and highlighted the future potential of "Lab in a Cell" for hazard analysis.

Ultrasound-mediated multifunctional magnetic microbubbles for drug delivery of celastrol in VX2 liver transplant tumors.

Celastrol (CST) has positive pharmacological effects on various cancers, but clinical application is limited because of poor water solubility and systemic toxicity. Ferric oxide (Fe3O4) has a large specific surface area and can be functionalized by inorganic modification to form complex magnetic drug delivery systems. Herein, Fe3O4 was surface-modified with citric acid and polyethylene glycol (PEG) (via) the Mitsunobu reaction and then covalently bound to CST. Finally, magnetic microbubbles (MMBs) containing perfluoropropane (C3F8) and Fe3O4-PEG2K-CST particles were constructed with poly(lactic-co-glycolic acid) (PLGA) as the shell membrane. In vitro studies showed that ultrasound-mediated MMBs exhibited improved inhibition of VX2 cell proliferation compared to inhibition achieved using MMBs without ultrasound mediation, blank MMBs, or free CST. In ultrasound mode, MMBs have favorable imaging properties. After the application of a high mechanical index, MMBs collapse through the cavitation effect, releasing their internal Fe3O4-PEG2K-CST. The CST is then delivered to the tumor microenvironment under acidic conditions. In magnetic resonance imaging T2 mode, a specific hypointense signal was observed in the tumor area compared with that before treatment, whereas no significant change occurred in the signal intensity of the surrounding organs. After treatment, pathological examination of tumor-bearing rabbit tissues showed that iron elements accumulated in several apoptosis cells in the tumor area, with no apparent abnormalities found in other areas. Thus, ultrasound-mediated MMBs could significantly improve the drug uptake of solid tumors and inhibit tumor growth with favorable biological safety.

Types of On-Screen Content and Mental Health in Kindergarten Children.

Importance: Excessive screen time has been associated with a higher risk for mental health problems, but whether the associations differ by screen content types is unclear. Objective: To examine the allocation of and longitudinal changes in screen exposure across different content types and to explore their associations with mental health in children aged 3 to 6 years. Design, Setting, and Participants: This cohort study used 3-wave, lagged generalized estimating equation models to analyze data from the Shanghai Children's Health, Education and Lifestyle Evaluation-Preschool (SCHEDULE-P) study in Shanghai, China. The cohort was a representative sample of kindergarten children. Data were collected between November 2016 and May 2019 when children were aged 3 to 4 years (wave 1), 4 to 5 years (wave 2), and 5 to 6 years (wave 3). Data analysis was performed between June 2022 and May 2023. Exposure: Screen exposure (total daily time and time with each type of content, including educational programs, entertainment programs, non-child-directed programs, electronic games, and social media) was collected when children were aged 3, 5, and 6 years. Main Outcomes and Measures: Mental health of children at age 3, 5, and 6 years was reported by parents using the Strengths and Difficulties Questionnaire. Results: Of the 15 965 children included in the representative sample, 8270 were males (51.7%) and the mean (SD) age at wave 1 was 3.73 (0.30) years. As children developed from ages 3 to 6 years, the proportion of screen exposure to educational programs (≤1 hour per day: 45.0% [95% CI, 43.5%-46.5%] to 26.8% [95% CI, 25.3%-28.3%]) and entertainment programs (≤1 hour per day: 44.4% [95% CI, 42.8%-45.9%] to 32.1% [95% CI, 30.4%-33.9%]) decreased, whereas exposure to social media increased (≤1 hour per day: 1.5% [95% CI, 1.2%-1.9%] to 27.1% [95% CI, 25.5%-28.7%]). The associations between on-screen content and mental health varied. For a given total screen time, a higher proportion of screen exposure to educational programs was associated with a lower risk for mental health problems (adjusted odds ratio [AOR], 0.73; 95% CI, 0.60-0.90), whereas non-child-directed programs were associated with a higher risk for such problems (AOR, 2.82; 95% CI, 1.91-4.18). Regardless of the content, total screen time was consistently associated with mental health problems. Conclusions and relevance: Results of this study indicated that both total screen time and different types of content were associated with mental health problems in children aged 3 to 6 years. Limiting children's screen time, prioritizing educational programs, and avoiding non-child-directed programs are recommended.

Contamination and health risks brought by arsenic, lead and cadmium in a water-soil-plant system nearby a non-ferrous metal mining area.

Heavy metal(loid)s contamination prevails in the water-soil-plant system around non-ferrous metal mining areas. The present study aimed to evaluate the heavy metal(loid)s contamination in Nandan Pb-Zn mining area (Guangxi, China). A total of 36 river water samples, 75 paired paddy soil and rice samples, and 128 paired upland soil and plant samples were collected from this area. The concentrations of arsenic (As), lead (Pb), and cadmium (Cd) in these samples were measured. Results showed that the average water quality indexes (WQIs) at the 12 sampling sites along the main river ranged from 41 to 5008, indicating the water qualities decreasing from "Excellent" to "Undrinkable". The WQIs nearby tailings or industrial park were significantly higher than those at the other sites. 34.0% and 64.5% of soil samples exceeded the risk screening values for As and Cd. The Pb and Cd concentrations in all rice samples exceeded the Chinese food safety limits by 18.7% and 82.7%, respectively. Leafy vegetables had a higher concentration of As, Pb, and Cd than other vegetables, exceeding the maximum permissible limits by 14.1%, 61.2%, and 40.0%, respectively. The biological accumulation coefficient (BAC) of Cd was the highest in rice and lettuce leaves. The hazard quotients (HQs) of As and Cd, indicating non-carcinogenic risks, were 4.15 and 1.76 in adult males, and 3.40 and 1.45 in adult females, all higher than the permitted level (1.0). The carcinogenic probabilities of As and Cd from rice and leafy vegetables consumption were all higher than 1 × 10-4. We conclude that metal(loid)s contamination of the water-soil-plant system has posed great non-carcinogenic and carcinogenic risks to the local population.

The physiological and biochemical responses to dark pericarp disease induced by excess manganese in litchi.

Dark pericarp disease (DPD), a physiological disorder induced by excess Manganese (Mn) in litchi, severely impacts the appearance and its economic value. To elucidate the underlying mechanisms of DPD, this study investigated the variations of phenolic compound, antioxidant defense system, subcellular structure, and transcriptome profiles in both normal fruit and dark pericarp fruit (DPF) at three developmental stages (green, turning, and maturity) of 'Guiwei' litchi. The results reveal that excess Mn in DPF pericarp resulted in a significant increase in reactive oxygen species, especially H2O2, and subsequent alterations in antioxidant enzyme activities. Notably, SOD (EC 1.15.1.1) activity at the green stage, along with POD (EC 1.11.1.7) and APX (EC 1.11.1.11) activities at the turning and the maturity stages, and GST (EC 2.5.1.18) activity during fruit development, were markedly higher in DPF. Cell injury was observed in pericarp, facilitating the formation of dark materials in DPF. Transcriptome profiling further reveals that genes involved in flavonoid and anthocyanin synthesis were up-regulated during the green stage but down-regulated during the turning and maturity stages. In contrast, PAL (EC 4.3.1.24), C4H (EC 1.14.14.91), 4CL (EC 6.2.1.12), CAD (EC 1.1.1.195), and particularly POD, were up-regulated, leading to reduced flavonoid and anthocyanin accumulation and increased lignin content in DPF pericarp. The above suggests that the antioxidant system and phenolic metabolism jointly resisted the oxidative stress induced by Mn stress. We speculate that phenols, terpenes, or their complexes might be the substrates of the dark substances in DPF pericarp, but more investigations are needed to identify them.

The gut microbiome and metabolites are altered and interrelated in patients with functional constipation.

Introduction: Gut microbiota and metabolites have been identified to contribute to the pathogenesis of functional constipation (FC); however, the underlying mechanism(s) have not been elucidated, and the relationship between the gut microbiota and metabolites in FC has received limited attention in the literature. Methods: 16S rDNA sequencing and non-targeted metabolomic detection based on liquid chromatography-mass spectrometry (LC-MS/MS) technologies were combined to analyze the altered gut microbiome and metabolic profile of fecal samples from FC patients and healthy individuals (healthy control; HC). Results: The richness and diversity of gut microbiota significantly (p < 0.01) increased in FC patients. Compared to the HC group, 18 genera, including Intestinibacter, Klebsiella, and Akkermansia, exhibited statistically significant changes (p < 0.05). Metabolic analysis showed that metabolic profiles were also markedly altered with 79 metabolites, such as (-)-caryophyllene oxide, chenodeoxycholic acid, and biliverdin, indicating significant inter-group differences (p < 0.05). Besides, the primary bile acid biosynthesis, as well as the metabolic profile of porphyrin and chlorophyll, were the most dominant enriched pathways (FDR < 0.01), in which chenodeoxycholic acid and biliverdin were significantly enriched, respectively. Correlation analysis demonstrated a strong relationship between 10 genera and 19 metabolites (r > 0.6, FDR < 0.05), and notably, Intestinibacter showed a negative correlation with biliverdin (FDR < 0.001), which highlighted the interplay of the gut microbiota and metabolites in the pathogenesis of FC. Conclusion: Our research describes the characteristics of the gut microbiota and metabolic profiles and the correlation between the gut microbiota and metabolites in FC patients. This may contribute to the understanding of the underlying mechanisms involved in FC pathogenesis and may provide novel insights into therapeutic interventions.

The efficacy and safety of oral microecological agents as add-on therapy for atopic dermatitis: A systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: Atopic dermatitis (AD) is a common skin disease that is hard to completely cure in a short time. Guidelines recommend the use of topical corticosteroids (TCS) as first-line anti-inflammatory therapy for AD, but long-term use has significant side effects. Microecological agents (MA), including probiotics, prebiotics and synbiotics, have been widely reported as a potential adjunctive therapy of AD, but whether MA can contribute to AD treatment is currently controversial. Therefore, we conducted a systematic review and meta-analysis to investigate whether MA as an add-on therapy for AD has synergistic and attenuated effects and to further understand the role of MA in clinical interventions for AD. METHODS: We systematically searched Medline, Embase, Web of Science, Cochrane Library and PsycINFO databases up to Apr 11, 2023, and bibliographies were also manually searched, for potentially relevant studies regarding MA as additional therapy of AD. The Cochrane Risk of Bias Tool for assessing risk of bias was used to assess the quality of randomized controlled trials (RCTs). Two reviewers screened studies, extracted data, and evaluated the risk of bias independently. The primary outcomes (SCORAD scores and the number of adverse events) and the secondary outcomes (pruritus scores, the quality of life and the frequency of TCS) were extracted from each article. The data were combined and analyzed to quantify the safety and efficacy of the treatment. R (V4.4.3) software was used for data synthesis. The certainty of the evidence was evaluated with the Grade of Recommendation, Assessment, Development and Evaluation (GRADE) system. We also performed a trial sequential analysis to assess the reliability of the evidence. RESULTS: A total of 21 studies, including 1230 individuals, were identified, 20 of which met the eligibility criteria for the meta-analysis. Our pooled meta-analyses showed that compared with controls, oral MA as an add-on therapy was associated with significantly lower SCORAD scores (MD = -5.30, 95% CI -8.50, -1.55, p < 0.01, I2  = 81%). However, adverse events, pruritus scores, quality of life, and frequency of TCS use showed no significant difference in this meta-analysis study (p > 0.05). CONCLUSIONS: This meta-analysis showed that MA plus TCS could be an effective and safe treatment for patients with AD to relieve relevant symptoms, which might be used as an add-on therapy in the treatment of AD. However, due to the limited number of studies, results should be interpreted with caution. Further studies with a larger sample size are needed to explore the optimal protocol of MA plus TCS.

Development and Internal Validation of a Nomogram for Predicting Postoperative Cardiac Events in Elderly Hip Fracture Patients.

Purpose: Postoperative cardiac events (PCEs) are among the main adverse events after hip fracture surgery in the elderly. Existing cardiac risk assessment tools have some limitations and are not specifically designed for elderly patients undergoing hip fracture surgery. This study aimed to develop and internally validate a nomogram for prediction of PCEs in these patients. Patients and Methods: We performed a retrospective study of 992 patients aged ≥65 years undergoing hip fracture surgery in our hospital from July 2015 to December 2021. Patients' demographics and clinical data were collected. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to select predictors, and multivariate logistic regression was employed to construct a nomogram. Internal validation was performed by bootstrapping. The discriminatory ability of the model was determined by the area under the receiver operating characteristic curve (AUC). The calibration and clinical utility of the model were assessed. The predictive power and clinical benefit of the nomogram were compared with the Revised Cardiac Risk Index (RCRI). Results: The nomogram was constructed including seven variables: general anesthesia, the American Society of Anesthesiologists (ASA) classification, history of heart failure, history of severe arrhythmia, history of coronary artery disease, preoperative platelet count, and serum creatinine. The nomogram had an excellent predictive ability (AUC = 0.875, 95% confidence interval [CI]: 0.828-0.918). Satisfactory calibration was shown by calibration plots and the Hosmer-Lemeshow goodness-of-fit test (P = 0.520). Clinical usefulness was confirmed by decision curve analysis and clinical impact curve. The predictive power and clinical utility of the nomogram were superior to RCRI. Conclusion: We developed an easy-to-use nomogram for prediction of PCEs in elderly hip fracture patients. This prediction model could effectively identify patients at high risk of PCEs and may be useful for perioperative management optimization.