The basic statistical concepts and their interrelationships in diagnostic research.

BACKGROUND: Many medical postgraduate students exhibit a lack of clarity in their understanding of relevant statistical concepts during the conduct of diagnostic studies. METHODS: This article, grounded in research practice, delves into the role of understanding statistical concepts in diagnostic research. It includes an exploration of sensitivity, specificity, types of statistical errors, and their interrelationships, as well as a discussion on statistical power-an often-overlooked but crucial concept in research. RESULTS: The article elucidates these important concepts with specific examples and illustrations, and addresses an issue of inconsistency related to the receiver operating characteristic curve in research practice. CONCLUSION: By drawing analogies between basic concepts in diagnostic tests and concepts in statistics, this article helps to enhance researchers' abilities in designing and interpreting clinical diagnostic studies, thereby improving the quality of clinical diagnostic research.

Sleep disorders among frontline nurses after the COVID-19 outbreak: a large-scale cross-sectional study.

This large-scale cross-sectional multicenter study aims to investigate the prevalence of sleep disorders among frontline nurses in China after the COVID-19 pandemic and to identify potential influencing factors contributing to these sleep disturbances. A total of 2065 frontline nurses from 27 provinces in China participated in an online survey conducted through the Wenjuan Xing platform. Data on demographic characteristics, work-related factors, and mental health assessments, including the Pittsburgh Sleep Quality Index (PSQI), Zung Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS), were collected. Statistical analyses, including chi-square tests, t-tests, binary logistic regression, and ROC analysis, were conducted to explore the relationships between various factors and sleep disorders. Over half (52.7%) of the surveyed nurses exhibited sleep disorders, reflecting a considerable post-pandemic impact on sleep quality. Factors such as nursing titles, personality traits, COVID-19 infection status, and exercise frequency showed statistically significant associations with sleep disorders. Extraverted nurses and those who had recovered from COVID-19 displayed a lower risk of sleep disorders, while anxiety was identified as an independent risk factor. The study also identified a nuanced relationship between exercise frequency and sleep quality. The study highlights a high prevalence of sleep disorders among frontline nurses post-COVID-19, emphasizing the need for targeted interventions. Factors such as nursing titles, personality traits, COVID-19 infection status, exercise habits, and anxiety levels were found to influence sleep quality. Comprehensive support strategies addressing these factors are essential for improving the overall well-being of frontline nurses and, subsequently, sustaining a resilient healthcare workforce. Further research is recommended to explore additional influencing factors and consider diverse nurse populations.

One-step cascade amplification system based on entropy-driven catalysis and DNAzyme triggered DNA walker for label-free detection of acetamiprid.

Herein, an electrochemical aptasensor for highly sensitive detection of acetamiprid (ACE) was constructed based on a one-step cascade amplification strategy. This innovative strategy integrated DNA walker containing DNAzyme sequence into entropy-driven catalysis (EDC) system. The trigger strand was released by aptamer-specific binding to ACE, initiating the EDC amplification circuit and delivering DNA walker strands. The dangling DNA walker continuously bound and cleaved hairpin substrate to form G-quadruplex fragments with the assistance of Mg2+. The G-quadruplex fragments folded and captured hemin to form multitudinous G-quadruplex/hemin complexes in the presence of K+, generating significantly enhanced current, enabling enzyme-free, label-free and highly sensitive detection of ACE, with a linear detection range of 100 fM to 50 nM and a detection limit of 68.36 fM (S/N = 3). The constructed aptasensor achieved the reliable detection of ACE in vegetable soil and cucumber samples, demonstrating its potential application prospects in environmental protection and food supervision.

The pH-sensitive chondroitin sulphate-based nanoparticles for co-delivery of doxorubicin and berberine enhance the treatment of breast cancer.

In the tumor microenvironment (TME), cancer associated fibroblasts (CAFs) facilitate drug resistance and tumor metastasis. Therefore, more and more attention has been focused on the regulation of TME by preventing the cross-talk between tumor cells and CAFs in the treatment of breast cancer. In this study, we have combined the benefits of deep drug penetration, pH sensitivity, and tumor-targeting delivery to prepare chondroitin sulphate (CS)-based nanomicelles (BBR/CS-DOX) for the co-delivery of doxorubicin (DOX) and berberine (BBR). A unique MCF-7 + MRC-5 co-cultured cell model and 4 T1 + NIH3T3 co-implanted mice model, were established to simulate the TME of breast cancer (BC). As expected, BBR/CS-DOX could accumulate in tumor egion, be taken up by both tumor cells and CAFs, and improve drug absorption and retention. Compared with free drugs, BBR/CS-DOX demonstrated stonger pro-apoptotic and anti-metastatic effect in vitro and in vivo, respectively the histological studies showed that BBR/CS-DOX efficiently prevented the activation of fibroblasts, inhibited extracellular matrix (ECM) deposition, and decreased tumor angiogenesis, showing superior anti-tumor efficacy. In summary, BBR/CS-DOX has the potential to significantly enhance the therapeutic effect of breast cancer through inhibiting the "CAFs-tumor cells" crosstalk, and has promising clinical application prospects.

Continuous Covalent Organic Framework Membranes with Ordered Nanochannels as Tunable Transport Layers for Fast Butanol/Water Separation.

Polymeric membranes with high permselective performance are desirable for energy-saving bioalcohol separations. However, it remains challenging to design membrane microstructures with low-resistance channels and a thin thickness for fast alcohol transport. Herein, we demonstrate highly crystalline covalent organic framework (COF) membranes with ordered nanochannels as tunable transport layers for efficient butanol/water separation. The thickness was well-regulated by altering the concentration and molar ratio of two aldehyde monomers with different reactivity. The surface-integrated poly(dimethylsiloxane) produced defect-free and hydrophobic COF membranes. The membrane with continuous transport channels exhibited an exceptional flux of up to 18.8 kg m-2 h-1 and a pervaporation separation index of 217.7 kg m-2 h-1 for separating 5 wt % n-butanol/water. The separation efficiency exceeded that of analogous membranes. The calculated mass-transfer coefficient of butanol followed an inverse relationship with the COF membrane thickness. Consequently, this work reveals the great potential of crystalline polymeric membranes with high-density nanopores for biofuel recovery.

High-Throughput Sequencing Analysis of Microbiota and Enzyme Activities in Xiaoqu from Seven Provinces in Southern China.

Xiaoqu, a pivotal starter in baijiu fermentation, provides the most microflora and enzymes to initiate and maintain baijiu brewing. This study aims to explore the differences in microbiota and enzyme activities among Xiaoqu samples from seven provinces in southern China using high-throughput sequencing, plate isolation, and activity detection. The analyses revealed significant differences in bacterial and fungal communities across the samples. A total of 22 bacterial species and 17 target fungal species were isolated and identified. Predominant bacteria included Bacillus (Bacillus subtilis) and lactic acid bacteria (LABs), while the fungal communities were primarily composed of yeasts (Saccharomyces cerevisiae) and various molds. The activities of α-amylase and glucoamylase varied significantly among the samples, and samples from HN1 and GZ2 exhibited the highest activities. Correlation analyses highlighted the pivotal role of LABs in maintaining acidity and the importance of molds and yeasts in the saccharification and fermentation processes. These findings shed light on the microbial composition and diversity of Xiaoqu and the critical role of microbes in baijiu production. Moreover, they suggested potential microbial resources for developing artificial Xiaoqu via synthetic microbial community in the future, enhancing baijiu fermentation efficiency and overall product quality.

Catalytic hairpin assembly-driven DNA walker to develop a label-free electrochemical aptasensor for antibiotic detection.

An electrochemical aptasensor was developed by utilizing a DNA walker driven by catalytic hairpin assembly (CHA) with kanamycin as the model analyte. Kanamycin bound to the aptamer, causes the release of DNA walker, triggers the CHA reaction, leads to the cyclic movement of the walker's long arm, and results in cascade amplification of the signal. The guanine-rich sequences of the double-stranded products produced by CHA were folded to form G-quadruplex structures, with electrochemical active molecules Hemin embedded, forms G-quadruplex/Hemin complexes in situ on the electrode surface, thereby achieving sensitive, efficient, and label-free detection of kanamycin with a limit of detection (LOD) of 0.27 pM (S/N = 3). Meaningfully, the aptasensor demonstrated high sensitivity and reliability in the detection of kanamycin in milk and livestock wastewater samples, suggesting that it has great potential for application in detecting antibiotics in food products and water samples from the environment.

Tibetan lake change linked to large-scale atmospheric oscillations via hydroclimatic trajectory.

Lakes are known as sentinels of climate change, but their responses may differ from one to another leading to different strategies in lake protection. It is particularly the case in the Tibetan Plateau (TP) of multiple hydrological processes. We employed the Budyko framework to study Tibetan lakes from two lake-basins of contrasting climates for the period between 1980 and 2022: Taro Co Basin (TCB) in a sub-arid climate, and Ranwu Lake Basin (RLB) in a sub-humid climate. Our results showed that total lake area, surface air temperature, evapotranspiration, and potential evapotranspiration increased in both lake-basins, while precipitation and soil moisture increased in the TCB but decreased in the RLB. In the Budyko space, two basins had contrast hydroclimatic trajectories in terms of aridity and evaporative index. The TCB shifted from wetting to drying trend, while the RLB from drying to wetting in early 2000s. Notably, lake change was generally consistent with the drying/wetting phases in the TCB, but in contrast with that in the RLB, which can be attributed to warming-induced glacier melting. Despite of significant correlation with the large-scale atmospheric oscillations, it turned to be more plausible if lake area changes were substituted with basin's hydroclimatic trajectories. Among the large-scale oscillations, El Niño-Southern Oscillation (ENSO) is the most dominant control of lake trends and their drying/wetting shifts. Our findings offer a valuable insight into lake responses to climate change in the TP and other regions.

Lactucin reverses liver fibrosis by inhibiting TGF-ß1/STAT3 signaling pathway and regulating short-chain fatty acids metabolism.

TGF-ß1 activation of hepatic stellate cells (HSCs), transcriptional activator 3 (Stat3) activation and short chain fatty acids (SCFAs), metabolite of intestinal bacteria, is closely associated with hepatic fibrosis. Previous studies have shown that Lactucin has significant anti-inflammatory and hepatoprotective effects; however, the mechanism of Lactucin's role in liver fibrosis associated with SCFAs remains unknown. This study was intended to investigate whether effect of Lactucin on liver fibrosis was mediated by TGF-ß1/Stat3 and SCFAs. We found that Lactucin induced apoptosis in HSC-T6 cells, and inhibition of nuclear translocation of Stat3 and p-Stat3. And Smad3 and TGF-ß1 protein expression was significantly inhibited, while TLR4 and Smad7 protein expression was significantly enhanced. For in vivo experiments, we demonstrated that Lactucin alleviated liver fibrosis in mice, as evidenced by a reduction in inflammatory factors, collagen deposition, liver injury and fibrosis-related factors expression, especially the expression of Smad3 and TGF-ß1 proteins was significantly suppressed and Smad7 protein expression was significantly increased in the liver. In addition, the levels of acetic acid, butyric acid and valeric acid in the intestine of Lactucin-treated mice were significantly higher than those in the intestine of liver fibrosis mice. In conclusion, based on the results of in vivo and in vitro experiments, preventive mechanism of Lactucin against liver fibrosis in mice may be to improve the enterohepatic circulation by regulating the metabolites of intestinal microorganisms, acetic acid and butyric acid, and to further regulate the Stat3 and TGF-ß1 signaling pathway through the "gut-liver axis" to combat liver fibrosis.

Au-modified ceria nanozyme prevents and treats hypoxia-induced pulmonary hypertension with greatly improved enzymatic activity and safety.

BACKGROUND: Despite recent advances the prognosis of pulmonary hypertension remains poor and warrants novel therapeutic options. Extensive studies, including ours, have revealed that hypoxia-induced pulmonary hypertension is associated with high oxidative stress. Cerium oxide nanozyme or nanoparticles (CeNPs) have displayed catalytic activity mimicking both catalase and superoxide dismutase functions and have been widely used as an anti-oxidative stress approach. However, whether CeNPs can attenuate hypoxia-induced pulmonary vascular oxidative stress and pulmonary hypertension is unknown. RESULTS: In this study, we designed a new ceria nanozyme or nanoparticle (AuCeNPs) exhibiting enhanced enzyme activity. The AuCeNPs significantly blunted the increase of reactive oxygen species and intracellular calcium concentration while limiting proliferation of pulmonary artery smooth muscle cells and pulmonary vasoconstriction in a model of hypoxia-induced pulmonary hypertension. In addition, the inhalation of nebulized AuCeNPs, but not CeNPs, not only prevented but also blunted hypoxia-induced pulmonary hypertension in rats. The benefits of AuCeNPs were associated with limited increase of intracellular calcium concentration as well as enhancement of extracellular calcium-sensing receptor (CaSR) activity and expression in rat pulmonary artery smooth muscle cells. Nebulised AuCeNPs showed a favorable safety profile, systemic arterial pressure, liver and kidney function, plasma Ca2+ level, and blood biochemical parameters were not affected. CONCLUSION: We conclude that AuCeNPs is an improved reactive oxygen species scavenger that effectively prevents and treats hypoxia-induced pulmonary hypertension.

Deciphering the microbial succession and color formation mechanism of "green-covering and red-heart" Guanyin Tuqu.

"Green-covering and red-heart" Guanyin Tuqu (GRTQ), as a type of special fermentation starter, is characterized by the "green-covering" formed on the surface of Guanyin Tuqu (SQ) and the "red-heart" in the center of Guanyin Tuqu (CQ). However, the mechanisms that promote temporal succession in the GRTQ microbial ecology and the formation of "green-covering and red-heart" characteristics remain unclear. Herein, we correlated the temporal profiles of microbial community succession with the main environmental variables (temperature, moisture, and acidity) and spatial position (center and surface) in GRTQ throughout fermentation. According to the results of high-throughput sequencing and culture-dependent methods, the microbial communities in the CQ and SQ demonstrated functional complementarity. For instance, the bacterial richness index of the CQ was greater than that of SQ, and the fungal richness index of the SQ was greater than that of CQ at the later stage of fermentation. Furthermore, Saccharomycopsis, Saccharomyces, Aspergillus, Monascus, Lactobacillus, Bacillus, Rhodanobacter, and Chitinophaga were identified as the dominant microorganisms in the center, while the surface was represented by Saccharomycopsis, Aspergillus, Monascus, Lactobacillus, Acetobacter, and Weissella. By revealing the physiological characteristics of core microorganisms at different spatial positions of GRTQ, such as Aspergillus clavatus and Monascus purpureus, as well as their interactions with environmental factors, we elucidated the color formation mechanism behind the phenomenon of "green" outside and "red" inside. This study provides fundamental information support for optimizing the production process of GRTQ.

Effects of Fermentation with Eurotium cristatum on Sensory Properties and Flavor Compounds of Mulberry Leaf Tea.

Mulberry leaf tea (MT) is a popular Chinese food with nutrition and medicinal functions. Solid-state fermentation with Eurotium cristatum of MT (FMT) can improve their quality. Differences in chromaticity, taste properties, and flavor characteristics were analyzed to evaluate the improvements of the sensory quality of FMT. After fermentation, the color of the tea infusion changed. The E-tongue evaluation results showed a significant decrease in unpleasant taste properties such as sourness, bitterness, astringency, and aftertaste-bitterness, while umami and saltiness taste properties were enhanced post-fermentation. Aroma-active compounds in MT and FMT were identified and characterized. A total of 25 key aroma-active compounds were screened in MT, and 2-pentylfuran showed the highest relative odor activity value (ROAV). A total of 26 key aroma-active compounds were identified in FMT, and the newly formed compound 1-octen-3-one showed the highest ROAV, which contributed to FMT's unique mushroom, herbal, and earthy flavor attributes. 1-octen-3-one, (E)-2-nonenal, trimethyl-pyrazine, 2-pentylfuran, and heptanal were screened as the potential markers that contributed to flavor differences between MT and FMT. E. cristatum fermentation significantly altered the sensory properties and flavor compounds of MT. This study provides valuable insights into the sensory qualities of MT and FMT, offering a theoretical basis for the development of FMT products.

Effects of sorghum varieties on microbial communities and volatile compounds in the fermentation of light-flavor Baijiu.

Light-flavor Baijiu (LFB) fermentation is a representative spontaneous mixed-culture solid-state fermentation process in which sorghum is used as the raw material. Raw materials and microorganisms are crucial to the flavor formation and quality of LFB. However, the microbial and physicochemical dynamics of different sorghum varieties during LFB fermentation, as well as their impact on flavor compounds are still largely unknown. Herein, PacBio single-molecule real-time (SMRT) sequencing and headspace solid-phase microextraction coupled with gas chromatography-mass spectrometry (HS-SPME-GC-MS) were applied to investigate microbial community succession and volatile flavor formation in glutinous/non-glutinous sorghum-based fermented grains during LFB fermentation. Fermented grains made of glutinous sorghum Liangnuo No. 1 (GLN) had higher bacterial α-diversity and lower fungal α-diversity than those with fermented grains prepared with non-glutinous red sorghum (NRS) (p < 0.05). The dominant microbial species were Saccharomyces cerevisiae, Acetobacter pasteurinus, and Lactobacillus helveticus, the latter two of which were the predominant bacteria observed at the end of fermentation in GLN and NRS, respectively. Moisture content and reducing sugar had a more significant impact on the microorganisms in GLN, while amino acid nitrogen, total free amino acids, and residual starch were the main driving factors driving the microbial community in NRS. The correlation network and discriminant analysis indicated that a relatively high content of 4-vinylguaiacol showed a significant positive association with significant differential microbial species in GLN. These results provided valuable insights for improving the quality of LFB.

Clinical and genetic analysis of 23 Chinese children with epilepsy associated with KCNQ2 gene mutations.

OBJECTIVE: To summarize the clinical features and genetic mutation characteristics of Chinese children with KCNQ2-related epilepsy. METHODS: A cohort of children with genetically caused epilepsy was evaluated at Linyi People's Hospital from January 2017 to December 2023. After next-generation sequencing and pathogenicity analysis, we summarized the medical records and genetic testing data of the children who had KCNQ2 gene mutations. RESULTS: We identified 23 KCNQ2 gene mutations. 73.9% (n = 17) of the mutation sites were located in S5-S6 segments and the C-terminal region. In addition to the common phenotypes, 2 new phenotypes were identified: infantile convulsion with paroxysmal choreoathetosis (ICCA) and febrile seizure plus (FS+). Of all the cases with abnormal video-electro-encephalography, three cases with self-limited familial infantile epilepsy (SeLNE) exhibited a small number of multifocal discharges. Of the patients who have taken a particular antiepileptic drug, the statistics on the number of patients who have responded to the drug are as follows: oxcarbazepine (8/9, 88.9%), levetiracetam (5/7, 71.4%), phenobarbital (9/16, 56.3%), and topiramate (2/5, 40.0%). However, the efficacy of phenobarbital varied widely in treating SeLNE and KCNQ2-DEE. At the final follow-up, 1 case with SeLNE had a transient developmental regression and 7 cases with KCNQ2-DEE had mild to severe developmental backwardness. SIGNIFICANCE: Although clinically rare, we report 10 new KCNQ2 mutations and two new phenotypes: ICCA and FS+. This further expands genetic and phenotypic spectrum of KCNQ2-related epilepsy. The gene mutation sites are mostly located in S5-S6 segments and the C-terminal region, and the former is usually associated with KCNQ2-DEE. Sodium channel blockers (including oxcarbazepine and topiramate) and levetiracetam should be prioritized over phenobarbital for KCNQ2-DEE. Some cases with KCNQ2-related epilepsy may have transient developmental regression during periods of frequent seizures. Early treatment and early seizure control may be beneficial for willing outcomes in children with KCNQ2-DEE. PLAIN LANGUAGE SUMMARY: This article reports 23 cases of children with KCNQ2-related epilepsy, including 10 new mutation sites and 2 new phenotypes. It further expands the genetic and phenotypic spectrum of KCNQ2-related epilepsy. In addition, the article summarizes the gene mutation characteristics and clinical manifestations of children with KCNQ2-related epilepsy, with the expectation of providing a certain theoretical basis for the diagnosis and treatment of such patients.

Consensus for antifungal stewardship in China (2024 edition).

Background: Invasive fungal disease (IFD) has become a serious threat to human health in China and around the world, with high mortality and morbidity. Currently, the misdiagnosis rate of IFD is extremely high, compounded with the low quality of prescription antifungals and the high incidence of adverse events associated with IFD treatment, resulting in lengthy hospitalization, low clinical response, and high disease burden, which have become serious challenges in clinical practice. Antifungal stewardship (AFS) can not only significantly increase the early diagnosis rate of IFD, reduce inappropriate utilization of antifungal drugs, improve patient prognosis, but can also improve therapeutic safety and reduce healthcare expenses. Thus, it is urgent to identify key AFS metrics suitable for China's current situation. Methods: Based on metrics recommended by international AFS consensuses, combined with the current situation of China and the clinical experience of authoritative experts in various fields, several metrics were selected, and experts in the fields of respiratory diseases, hematology, intensive care units (ICUs), dermatology, infectious diseases, microbiology laboratory and pharmacy were invited to assess AFS metrics by the Delphi method. Consensus was considered to be reached with an agreement level of ≥80% for the metric. Results: Consensus was reached for 24 metrics, including right patient metrics (n=4), right time metrics (n=3), and right use metrics (n=17). Right use metrics were further subdivided into drug choice (n=8), drug dosage (n=4), drug de-escalation (n=1), drug duration (n=2), and drug consumption (n=2) metrics. Forty-six authoritative experts assessed and reviewed the above metrics, and a consensus was reached with a final agreement level of ≥80% for 22 metrics. Conclusions: This consensus is the first to propose a set of AFS metrics suitable for China, which helps to establish AFS standards in China and is also the first AFS consensus in Asia, and may improve the standard of clinical diagnosis and treatment of IFD, and guide hospitals to implement AFS, ultimately promoting the rational use of antifungal drugs and improving patient prognosis.

Changes in the rumen development, rumen fermentation, and rumen microbiota community in weaned calves during steviol glycosides treatment.

Early weaning leads to weaning stress in calves, which hinders healthy growth and development. As an excellent sweetener applied in food, steviol glycosides (STE) has also been shown to exhibit positive biological activity in monogastric animals. Therefore, this study aimed to evaluate the impact of incorporating STE as a dietary supplement on rumen development, fermentation, and microbiota of rumen in weaned calves. This study selected 24 healthy Holstein bull calves and randomly allocated them into two groups (CON and STE). The results indicated that supplementation STE group improved rumen development in weaned calves, as demonstrated by a marked increase in the weight of the rumen, as well as the length and surface area of the rumen papilla. Compared with the CON group, the concentrations of total volatile fatty acids (TVFA), propionate, butyrate, and valerate were higher in the STE group. Moreover, STE treatment increased the relative abundance of Firmicutes and Actinobacteria at the phylum level. At the genus level, the STE group showed a significantly increased relative abundance of Succiniclasticum, Lachnospiraceae_NK3A20_group, and Olsenella, and a decreased relative abundance of Acinetobacter compared to the CON group. Pusillimonas, Lachnospiraceae_NK3A20_group, Olsenella, and Succiniclasticum were significantly enriched in rumen chyme after supplementation with STE, as demonstrated by LEfSe analysis. Overall, our findings revealed that rumen bacterial communities altered in response to the dietary supplementation with STE, and some bacterial taxa in these communities may have positive effects on rumen development during this period.

Renshen Yangrong decoction for secondary malaise and fatigue: network pharmacology and Mendelian randomization study.

Background: Renshen Yangrong decoction (RSYRD) has been shown therapeutic effects on secondary malaise and fatigue (SMF). However, to date, its bioactive ingredients and potential targets remain unclear. Purpose: The purpose of this study is to assess the potential ingredients and targets of RSYRD on SMF through a comprehensive strategy integrating network pharmacology, Mendelian randomization as well as molecular docking verification. Methods: Search for potential active ingredients and corresponding protein targets of RSYRD on TCMSP and BATMAN-TCM for network pharmacology analysis. Mendelian randomization (MR) was performed to find therapeutic targets for SMF. The eQTLGen Consortium (sample sizes: 31,684) provided data on cis-expression quantitative trait loci (cis-eQTL, exposure). The summary data on SMF (outcome) from genome-wide association studies (GWAS) were gathered from the MRC-IEU Consortium (sample sizes: 463,010). We built a target interaction network between the probable active ingredient targets of RSYRD and the therapeutic targets of SMF. We next used drug prediction and molecular docking to confirm the therapeutic value of the therapeutic targets. Results: In RSYRD, network pharmacology investigations revealed 193 possible active compounds and 234 associated protein targets. The genetically predicted amounts of 176 proteins were related to SMF risk in the MR analysis. Thirty-seven overlapping targets for RSYRD in treating SMF, among which six (NOS3, GAA, IMPA1, P4HTM, RB1, and SLC16A1) were prioritized with the most convincing evidence. Finally, the 14 active ingredients of RSYRD were identified as potential drug molecules. The strong affinity between active components and putative protein targets was established by molecular docking. Conclusion: This study revealed several active components and possible RSYRD protein targets for the therapy of SMF and provided novel insights into the feasibility of using Mendelian randomization for causal inference between Chinese medical formula and disease.

Timing of immunotherapeutic strategies for first-episode Isolated Anti-Myelin Oligodendrocyte Glycoprotein-IgG Associated Optic Neuritis: A single-centre retrospective study.

Background: There is no consensus on the timing of immunotherapeutic strategies for the first-episode anti-myelin oligodendrocyte glycoprotein-IgG (MOG-IgG) associated disorders (MOGAD) presenting with isolated optic neuritis (ON). Objective: To investigate the optimal timing of intravenous methylprednisolone therapy (IVMP) and necessity of immunosuppressive therapy for the first-episode isolated MOG-IgG associated ON (iMOG-ON). Methods: Adult patients with the first-episode iMOG-ON were enrolled. Primary outcomes were best-corrected visual acuity (BCVA) at last follow-up (i.e. final BCVA) and relapse, and their predictors were assessed by multivariate analysis. Results: 62 patients were included. Logistic regression analysis revealed BCVA at the time of IVMP (odds ratio: 0.463 (95 % confidence interval (CI) 0.310-0.714) was a factor predictive of regaining a final BCVA of 0.0 logMAR vision, and its Youden optimal criterion was <0.175 logMAR by plotting the receiver operating characteristic curve. The time-dependent cox proportional hazards model exhibited MMF therapy was not associated with a high likelihood of relapse-free survival (HR = 1.099, 95 % CI 0.892-1.354, P = 0.376) after adjusting for age of onset, gender, and baseline MOG serum titers. Similar analysis exhibited evidently negative association between high MOG-IgG serum titers at baseline and relapse-free survival after adjusting for age of onset, gender, and MMF therapy (HR = 0.339, 95 % CI 0.155-0.741, P = 0.007). Conclusions: During the first episode of iMOG-ON, the optimal timing of IVMP may be a short timeframe before visual acuity decreasing to 0.175 logMAR, and MMF therapy may not be recommended for patients with low MOG-IgG serum titers. Further long-term follow-up studies are required to validate these findings.

High thermodynamical sensitivity of CO2 emissions from a large oligotrophic-hardwater lake (Nam Co) on the Tibetan Plateau.

The Tibetan Plateau (TP) has the world's largest distribution of high-alpine and saline (generally hardwater) lakes, which are expected to affect regional carbon cycling profoundly. However, the variability, and especially underlying factors controlling CO2 dynamics, across widespread hardwater lakes is poorly understood on the TP. Here, we present year-round records of surface water pCO2 from a representative hardwater lake (Nam Co) on the TP, and analyze relationships between ambient variables and pCO2 during open water (i.e., ice-free) and ice-covered months. Surface pCO2 (233.3 µatm on average) was a little oversaturated to atmosphere (219 µatm on average) during the open water season. As a CO2 source, Nam Co emitted 8.73 ± 1.06 Gg C annually, but this flux only accounted for 0.53 ± 0.06 ‰ of its total dissolved inorganic carbon pool (1.64 × 1013 g C). Regression results indicate that, during open water months, both seasonal and diurnal varying patterns of surface pCO2 were influenced predominantly by water temperature, in a quasi-marine mode, by controlling gas solubility and dissolved carbonate equilibria. Therefore, CO2 evasion was elevated during summer months, despite the lake being autotrophic (i.e., CO2 consumption via photosynthesis). By contrast, during ice-covered months the surface pCO2 was strongly related to under-ice thermodynamics, and declined nonlinear with increased inversed stratification. In the hypolimnion, as a result of extremely weak metabolism (as indicated by low dissolved oxygen depletion rates) and a combined high carbonate buffering effect, accumulation of CO2 was negligible, leading to an absence of peak effluxes of CO2 during turnover periods, compared to eutrophic freshwater lakes. We argue that, under future global warming scenarios, consideration of the impact of gradually warming lake water on thermodynamics and dissolved carbonate equilibria are vital in order to understand the future CO2 dynamics of these widespread high-altitude oligotrophic-hardwater lakes situated across the TP.