CEAC (oral semustine, etoposide, cytarabine and cyclophosphamide) vs BEAM (carmustine, etoposide, cytarabine, and melphalan) conditioning regimen of autologous stem cell transplantation for diffuse large B-cell lymphoma: a post-hoc, propensity score-matched, cohort study in Chinese patients.

Autologous stem cell transplantation (ASCT) is a salvage therapy for relapsed or refractory diffuse large B-cell lymphoma (DLBCL). We have developed a novel conditioning regimen called CEAC (oral semustine 250 mg/m2 d-6, etoposide 300 mg/m2 d-5 ~ d-2, cytarabine 500 mg/m2 d-5 ~ d-2, and cyclophosphamide 1200 mg/m2 d-5 ~ d-2) In lymphoma patients in China. Here, we conducted a study to compare the conventional BEAM regimen with the CEAC regimen in 110 DLBCL patients. Propensity-score matching was performed in a 1:4 ratio (22 patients received BEAM and 88 received CEAC). Our results showed no significant difference in the overall response rate (95% vs 97%, P = 1.000) and complete response rate (66% vs 73%, P = 0.580) between the two cohorts. The 5-year progression-free survival (PFS), 5-year overall survival (OS), and 5-year cumulative incidence of relapse (CIR) for all patients were 72% (95% CI 62%-82%), 92% (95% CI 86%-97%), and 29% (95% CI 17%-38%), respectively. There was no significant difference in the 5-year PFS (80% vs 70%, P = 0.637), 5-year OS (95% vs 91%, P = 0.496), and 5-year CIR (20% vs 30%, P = 0.733) between cohorts. In terms of safety, the CEAC cohort had a lower incidence rate of grade 1-2 gastrointestinal hemorrhage (P = 0.023) and severe nausea (P = 0.007) compared with the BEAM cohort. In conclusion, the CEAC regimen seems to be a suitable alternative to the BEAM regimen for ASCT in DLBCL patients.

Expression profiles and characterization of microRNAs responding to chitin in Arthrobotrys oligospora.

Extracellular proteases, such as chitinases secreted by Arthrobotrys oligospora (A. oligospora), play a crucial role in the process of nematode infection. However, post-transcriptional regulation of gene expression involving microRNAs (miRNAs) in A. oligospora remains scarcely described. Hereto, transcriptome sequencing was carried out to analyze the expression profiles of chitin-responsive miRNAs in A. oligospora. Based on the RNA-seq data, the differential expression of miRNAs (DEmiRNAs) in response to chitin was screened, identified and characterized in A. oligospora. Meanwhile, the potential target genes were predicted by the online tools miRanda and Targetscan, respectively. Furthermore, the interaction of DEmiRNA with it's target gene was validated by a dual-luciferase reporter assay system. Among 85 novel miRNAs identified, 25 miRNAs displayed significant differences in expression in A. oligospora in response to chitin. Gene Ontology (GO) analysis showed that the potential genes targeted by DEmiRNAs were enriched in the biological processes such as bio-degradation, extracellular components and cell cycle. KEGG analysis revealed that the target genes were mainly involved in Hippo, carbon and riboflavin metabolic pathway. Outstandingly, chitinase AOL_s00004g379, which is involved in the hydrolysis metabolic pathway of chitin, was confirmed to be a target gene of differential miR_70. These findings suggest that chitin-responsive miRNAs are involved in the regulation of cell proliferation, predator hyphae growth and chitinase expression through the mechanisms of post-transcriptional regulation, which provides a new perspective to the molecular mechanisms underlying miRNAs-mediated control of gene expression in A. oligospora.

A patient information mining network for drug recommendation.

As an important task of natural language processing, medication recommendation aims to recommend medication combinations according to the electronic health record, which can also be regarded as a multi-label classification task. But patients often have multiple diseases simultaneously, and the model must consider drug-drug interactions (DDI) of medication combinations when recommending medications, making medication recommendation more difficult. There is little existing work to explore the changes in patient conditions. However, these changes may point to future trends in patient conditions that are critical for reducing DDI rates in recommended drug combinations. In this paper, we proposed the Patient Information Mining Network (PIMNet), which models the current core medications of patient by mining the temporal and spatial changes of patient medication order and patient condition vector, and allocates some auxiliary medications as the currently recommended medication combination. The experimental results show that the proposed model greatly reduces the recommended DDI of medications while achieving results no lower than the state-of-the-art results.

TaCRT3 Is a Positive Regulator of Resistance to Blumeria graminis f. sp. tritici in Wheat.

Wheat powdery mildew, caused by Blumeria graminis f. sp. tritici (Bgt), is one of the most prevalent diseases of wheat worldwide and can lead to severe yield reductions. Identifying genes involved in powdery mildew resistance will be useful for disease resistance breeding and control. Calreticulin (CRT) is a member of multigene family widely found in higher plants and is associated with a variety of plant physiological functions and defense responses. However, the role of CRT in wheat resistance to powdery mildew remains unclear. TaCRT3 was identified from the proteomic sequence of an incompatible interaction between the wheat (Triticum aestivum) cultivar Xingmin 318 and the Bgt isolate E09. Following analysis of transient expression of the GFP-TaCRT3 fusion protein in Nicotiana benthamiana leaves, TaCRT3 was localized in the nucleus, cytoplasm, and cell membrane. Transcript expression levels of TaCRT3 were significantly upregulated in the wheat-Bgt incompatible interaction. More critically, knockdown of TaCRT3 using virus-induced gene silencing resulted in attenuated resistance to Bgt in wheat. Histological analysis showed a significant increase in Bgt development in TaCRT3-silenced plants, whereas the pathogen-related gene was significantly downregulated in TaCRT3-silenced leaves. In addition, overexpression of TaCRT3 in wheat enhanced the resistance to powdery mildew, the growth of Bgt was significantly inhibited, and the area of H2O2 near the infection site and the expression of defense-related genes of the salicylic acid pathway significantly increased. These findings imply that TaCRT3 may act as a disease resistance factor that positively regulates resistance to powdery mildew, during which SA signaling is probably activated.

Dynamic Fear in Fear Appeals: Applying Fear Appeals to Environmental Communication in China.

This study investigates the role of dynamic fear in the effectiveness of communicating health threats (i.e. fear appeals) of ground-level ozone among Chinese citizens. An online survey revealed that fear appeal messages effectively enhance the audience's risk perceptions, efficacy beliefs, and acceptance of the message. Crucially, dynamic fear reduction process positively predicts engagement in protective behaviors (i.e. danger control process) and negatively predicts engagement in fear control processes, such as message denial. Presenting severity before susceptibility resulted in a more positive attitude toward the message recommendation. These findings highlight that communicating health-threats about climate pollution is effective in raising awareness and motivating protective behaviors. Furthermore, our study underscores the importance of dynamic fear, specifically fear reduction, in increasing fear appeals' effectiveness in communicating climate issues from a health perspective.

The Role of Subjective Norm in Persuasion Through the Restoration of Personal Freedom.

Human behavior is largely influenced by social norms. While the social norm approach is frequently used in public health campaigns, their effectiveness is inconsistent. This study investigated the role of normative reactance - the amplification of subjective norms as a means of restoring threatened freedom - across two health behaviors: college drinking and STD testing. A 2 (message threat: low vs. high) × 2 (health topic: college drinking vs. STD testing) between-subjects experiment was conducted with 765 participants. The results indicated that, similar to attitudes, subjective norms could also be amplified as a self-justification strategy to restore threatened freedom, which led to reduced intention to follow a message recommendation. In addition, results showed that the role of subjective norms and attitudes can vary across health behaviors and individual differences, particularly concerning an individual's degree of self-monitoring. Theoretical implications, limitations, and future directions are discussed.

Is the "avoidance" group truly defensive? The interplay between perceived risk, efficacy, and behaviors.

This study examines the inconsistent theories surrounding the roles of perceived threat and efficacy in risk communication theories, focusing on behavioral changes during a public health crisis. Utilizing a two-wave panel survey, the research found a nuanced interaction between efficacy beliefs and risk perceptions in dictating individuals' engagement in protective or defensive behaviors. Notably, those with high risk perceptions but lower efficacy beliefs were more likely to engage in future protective behaviors, contradicting previous assumptions about the avoidance group's propensity for defensive reactions. These findings initiate a complex discussion on the dynamics of risk and efficacy perceptions influencing behavior.

Lactate and Lactylation in the Brain: Current Progress and Perspectives.

As the final product of glycolysis, lactate features not only as an energy substrate, a metabolite, and a signaling molecule in a variety of diseases-such as cancer, inflammation, and sepsis-but also as a regulator of protein lactylation; this is a newly proposed epigenetic modification that is considered to be crucial for energy metabolism and signaling in brain tissues under both physiological and pathological conditions. In this review, evidence on lactylation from studies on lactate metabolism and disease has been summarized, revealing the function of lactate and its receptors in the regulation of brain function and summarizing the levels of lactylation expression in various brain diseases. Finally, the function of lactate and lactylation in the brain and the potential mechanisms of intervention in brain diseases are presented and discussed, providing optimal perspectives for future research on the role of lactylation in the brain.

Effect of riboflavin and carbon black co-modified fillers coupled with alkaline pretreatment on anaerobic digestion of waste activated sludge.

Additional various carbon and free riboflavin could improve anaerobic digestion of waste activated sludge (WAS). However, these substances were not reused. In this study, a reusable riboflavin and carbon black (RCB) co-modified filler was developed and combined with alkaline pretreatment for enhancing the production of volatile fatty acids (VFAs) and methane during anaerobic digestion of WAS. The results showed that RCB-modified fillers exhibited a promoting effect on the reduction of alkali-pretreated WAS. The amounts of the accumulated VFAs mainly containing acetate and the produced methane rose with the increased concentration of immobilized riboflavin (0-0.75 g/L) in the presence of 4 g/L carbon black. When the alkaline pretreatment time of WAS increased from 3 d to 8 d, the amount of methane production increased from 22.8% to 63.9% in the presence of 0.75 g/L riboflavin and 4 g/L carbon black compared with that without RCB-modified fillers. Moreover, 0.75 g/L riboflavin and 4 g/L carbon black had a synergetic effect on promoting methane production via broadening extracellular electron transfer pathways. During this process, microbial dehydrogenase activity, electron transport system activity and coenzyme F420 were enhanced. Microbial community analysis showed that RCB-modified filler addition promoted the enrichment of Syntrophomonas and Pseudomonas involved in direct interspecies electron transfer (DIET). These results indicated that DIET establishment was accelerated. Meanwhile, the populations of acetic acid-producing bacteria including Rikenellaceae_RC9_gut_group and Proteiniphilum, aceticlastic and acid-tolerant methanogenic archaea including Methanosarcina and Methanosaeta, RumEn_M2 were increased. These results indicate that RCB-modified fillers coupled with alkaline pretreatment is an effective method to promote the production of methane during anaerobic digestion of WAS.

Wheat Class III Peroxidase TaPOD70 Is a Potential Susceptibility Factor Negatively Regulating Wheat Resistance to Blumeria graminis f. sp. tritici.

Powdery mildew, caused by Blumeria graminis f. sp. tritici (Bgt), is one of the most important diseases on wheat worldwide and can lead to a large reduction in wheat production. Class III peroxidases (PODs), a kind of secretory enzyme and members of a multigene family in higher plants, have been linked to various plant physiological functions and defensive responses. However, the role of PODs in wheat resistance to Bgt remains unclear. TaPOD70, a class III POD gene, was identified from the proteomics sequencing of the incompatible interaction between wheat (Triticum aestivum) cultivar Xingmin 318 and Bgt isolate E09. After transient expression of the TaPOD70-GFP fusion protein in Nicotiana benthamiana leaves, TaPOD70 was located in the membrane region. Yeast secretion assay showed that TaPOD70 was a secretory protein. Furthermore, Bax-induced programmed cell death was inhibited by transient expression of TaPOD70 in N. benthamiana. The transcript expression level of TaPOD70 was significantly upregulated in the wheat-Bgt compatible interaction. More crucially, knocking down TaPOD70 using virus-induced gene silencing increased wheat resistance to Bgt compared with the control plants. In response to Bgt, histological analyses indicated that hyphal development of Bgt was significantly reduced, whereas H2O2 production was enhanced in TaPOD70-silenced leaves. These findings imply that TaPOD70 may act as a susceptibility factor, adversely regulating wheat resistance to Bgt.

The value of a dual-energy CT Iodine map radiomics model for the prediction of collagen fiber content in the ccRCC tumor microenvironment.

BACKGROUND AND PURPOSE: Renal cell carcinoma (RCC) is a heterogeneous group of cancers. The collagen fiber content in the tumor microenvironment of renal cancer has an important role in tumor progression and prognosis. A radiomics model was developed from dual-energy CT iodine maps to assess collagen fiber content in the tumor microenvironment of ccRCC. METHODS: A total of 87 patients with ccRCC admitted to our hospital were included in this retrospective study. Among them, 59 cases contained large amounts of collagen fibers and 28 cases contained a small amount of collagen fibers. We established a radiomics model using preoperative dual-energy CT scan Iodine map (IV) imaging to distinguish patients with multiple collagen fibers from those with few collagen fibers in the tumor microenvironment of ccRCC. We extracted features from dual-energy CT Iodine map images to evaluate the effects of six classifiers, namely k-nearest neighbor (KNN), support vector machine (SVM), extreme gradient boosting (XGBoost), random forest (RF), logistic regression (LR), and decision tree (DT). The effects of the models built based on the dynamic and venous phases are also compared. Model performance was evaluated using quintuple cross-validation and area under the receiver operating characteristic curve (AUC). In addition, a clinical model was developed to assess the clinical factors affecting collagen fiber content. RESULTS: Compared to KNN, SVM, and LR classifiers, RF, DT, and XGBoost classifiers trained with higher AUC values, with training sets of 0.997, 1.0, and 1.0, respectively. In the validation set, the highest AUC was found in the SVM classifier with a size of 0.722. In the comparative test of the active and intravenous phase models, the SVM classifier had the best effect with its validation set AUC of 0.698 and 0.741. In addition, there was a statistically significant effect of patient age and maximum tumor diameter on the collagen fiber content in the tumor microenvironment of kidney cancer. CONCLUSION: Radionics features based on preoperative dual-energy CT IV can be used to predict the amount of collagen fibers in the tumor microenvironment of renal cancer. This study better informs clinical prognosis and patient management. Iodograms may add additional value to dual-energy CTs.

The Role of Media in Addressing Opioid Use Disorder: Examining Causal Attributions and Emotions as Mediators of Media Influence on Stigma and Policy Support.

This study examined the influence of media on stigma and public support for policy interventions that address opioid-related problems. Data from a survey of 997 U.S. adults indicate that media exposure to opioids and relevant topics significantly influenced stigma and support for punitive and public health-oriented policies, even after direct and indirect experiences with opioid misuse were controlled for. However, differences emerged in terms of what led people to endorse each type of policy intervention. When people attributed opioid misuse to individual-oriented causes after media exposure, they were more likely to support punitive policies. When people recognized pharmaceutical-oriented causes, they tended to support public health-related policies.In addition to causal attributions, emotions (fear, anger, and sympathy) served as mediators with different effects on stigma and policy support. Although exposure to opioid-related stories positively influenced all three emotions, media influence was most likely to elicit sympathy, which was negatively associated with social stigma. However, people who felt anger tended to stigmatize individuals with opioid use disorder and not to support either of the policy interventions. The overall findings suggest that communication efforts addressing the opioid situation should find frames that reduce social stigma and encourage support for public health-related policies.

The Need for Systems Approaches for Precision Communications in Public Health.

A major challenge in communicating health-related information is the involvement of multiple complex systems from the creation of the information to the sources and channels of dispersion to the information users themselves. To date, public health communications approaches have often not adequately accounted for the complexities of these systems to the degree necessary to have maximum impact. The virality of COVID-19 misinformation and disinformation has brought to light the need to consider these system complexities more extensively. Unaided, it is difficult for humans to see and fully understand complex systems. Luckily, there are a range of systems approaches and methods, such as systems mapping and systems modeling, that can help better elucidate complex systems. Using these methods to better characterize the various systems involved in communicating public health-related information can lead to the development of more tailored, precise, and proactive communications. Proceeding in an iterative manner to help design, implement, and adjust such communications strategies can increase impact and leave less opportunity for misinformation and disinformation to spread.

TITE-BOIN12: A Bayesian phase I/II trial design to find the optimal biological dose with late-onset toxicity and efficacy.

In the era of immunotherapies and targeted therapies, the focus of early phase clinical trials has shifted from finding the maximum tolerated dose to identifying the optimal biological dose (OBD), which maximizes the toxicity-efficacy trade-off. One major impediment to using adaptive designs to find OBD is that efficacy or/and toxicity are often late-onset, hampering the designs' real-time decision rules for treating new patients. To address this issue, we propose the model-assisted TITE-BOIN12 design to find OBD with late-onset toxicity and efficacy. As an extension of the BOIN12 design, the TITE-BOIN12 design also uses utility to quantify the toxicity-efficacy trade-off. We consider two approaches, Bayesian data augmentation and an approximated likelihood method, to enable real-time decision making when some patients' toxicity and efficacy outcomes are pending. Extensive simulations show that, compared to some existing designs, TITE-BOIN12 significantly shortens the trial duration while having comparable or higher accuracy to identify OBD and a lower risk of overdosing patients. To facilitate the use of the TITE-BOIN12 design, we develop a user-friendly software freely available at http://www.trialdesign.org.

Transcriptome Analysis of Peripheral Blood Mononuclear Cells Response in Patients with Severe COVID-19 Reveals Crucial Genes Regulating Protein Ubiquitination.

BACKGROUND We sought to further our understanding of the biological characteristics underlying severe COVID-19. MATERIAL AND METHODS RNA sequencing (RNA-Seq) analysis was used to evaluate peripheral blood mononuclear cells from 4 patients with severe COVID-19 and 4 healthy controls. We performed gene expression analyses to detect differentially expressed genes (DEGs). Enrichment analyses were performed to identify their molecular processes and signaling pathways, and the protein-protein interaction network was constructed to extract the core gene cluster. The investigation of protein-chemical interactions and regulatory signatures for specific regulatory checkpoints and powerful chemical agents was then conducted for these essential genes. Finally, we used single-cell RNA-Seq analysis from an online platform to show how these genes were expressed differently, depending on the kind of cell. RESULTS A total of 268 DEGs were found. The biological process of protein ubiquitination was later discovered to be highly influenced by the core gene cluster (ITCH, TRIM21, RNF130, FBXO11, UBE2J1, and ASB16) at the transcriptome level. Six transcription factors, FNIC, FOXA1, YY1, GATA2, MET2A, and FOXC1, as well as miRNAs hsa-miR-1-3p and hsa-miR-27a-3p were identified. We found a potent chemical agent, copper sulfate, may regulate protein ubiquitination genes cooperatively, and the genes regulating protein ubiquitination could be expressed highly on the macrophages. CONCLUSIONS Taken together, we suggest that protein ubiquitination is a crucial functional process in patients with severe COVID-19. This study will give a deeper insight into biological characteristics and progression of COVID-19 and facilitate development of novel therapeutics, leading to significant advancements in the COVID-19 pandemic.

Fear of COVID-19: What Causes Fear and How Individuals Cope with It.

The public's fear of COVID-19 may cause severe consequences. The current project explored what caused U.S. adults' fear of COVID-19 and how they regulated fear using a longitudinal two-wave survey on a national-representative sample (N = 315). Results showed that participants' media exposure frequency and their perceived valence of interpersonal communication predicted their fear of COVID-19 at both waves, and fear at wave 1 further motivated higher frequency of media and interpersonal communication as well as strengthened perceptions that their interpersonal conversations emphasized the danger aspect of COVID-19 at wave 2. Counterarguing was effective in down-regulating individuals' fear, which in turn further encouraged more subsequent use of such strategy. Avoidance used in wave 1 predicted counterarguing at wave 2, while counterarguing employed in wave 1 predicted the subsequent use of reappraisal. Individuals may choose to use counterarguing as a maladaptive coping strategy to control their fear, and they tend to shift from one emotion regulation strategy to another as the pandemic progresses.

Can Interactive Media Attenuate Psychological Reactance to Health Messages? A Study of the Role Played by User Commenting and Audience Metrics in Persuasion.

Health advocacy messages can generate psychological reactance and lead to message rejection. Could we offset this negative outcome by providing more agency and interactivity to message receivers? Are individuals more likely to be receptive if health campaigns provided them an opportunity to comment on the advocacy messages? Will they be more likely to follow the advocated behavior if a lot of other receivers have expressed approval of those messages, i.e., will they follow the bandwagon and show lesser reactance? We investigated these questions by conducting a 2 (bandwagon cue: strong vs. weak) X 2 (comment action: presence vs. absence) X 2 (message threat: high vs. low) between-subjects experiment (N = 179) with an online health message. Findings suggest that strong bandwagon cues can reduce reactance and improve persuasion by eliciting bandwagon perceptions. Comment action is associated with a strong sense of agency, which positively predicts intention to follow the message recommendation. Technological affordances interact with threat level of the message and with each other in influencing users' evaluation and acceptance of persuasive health messages.

Molecular Mapping of a Recessive Gene for Stripe Rust Resistance at the YrCf75 Locus Using Bulked Segregant Analysis Combined with Single Nucleotide Polymorphism Genotyping Arrays and Bulked Segregant RNA-Sequencing.

Wheat stripe rust, caused by Puccinia striiformis f. sp. tritici (Pst), is one of the most important diseases in wheat worldwide. Planting resistant varieties is the most economical, effective, and environment-friendly measure to control wheat stripe rust. Changfeng 75, a Chinese winter wheat variety, shows high stripe rust resistance in both seedling and adult-plant stages. The seedling tests of F1, F2, and F2:3 populations derived from Mingxian 169/Changfeng 75 inoculated with Chinese predominant Pst race CYR34 showed that the stripe rust resistance of Changfeng 75 was controlled by a single recessive gene. The locus was temporarily designated as YrCf75. Bulked segregant analysis (BSA) combined with the wheat 660K single-nucleotide polymorphism (SNP) array and bulked segregant RNA-sequencing indicated that the proportion of polymorphic SNPs on wheat chromosome 2A was the highest, which suggested that YrCf75 was likely located on chromosome 2A. Two hundred and twenty-five Kompetitive allele-specific PCR (KASP) and 75 simple sequence repeat (SSR) markers on chromosome 2A were used to map YrCf75 using the BSA approach. Linkage analysis indicated that 31 KASP markers and one SSR marker were linked to YrCf75, and the genetic distances of the two closest flanking KASP markers, AX-1110060462 and AX-111004763, were 1.2 and 2.7 cM, respectively. YrCf75 was located on wheat chromosome 2AL. The molecular detection, resistance specificity, and chromosome location showed that YrCf75 is likely a new gene that is different from the known stripe rust resistance genes (Yr1 and Yr32) on wheat chromosome 2AL.

Genome-Wide Association Mapping of Resistance to Powdery Mildew in Regional Trials of Wheat Mainly from China.

Wheat powdery mildew (Blumeria graminis f. sp. tritici [Bgt]) is a widespread disease that causes significant economic losses to common wheat (Triticum aestivum L.) crops worldwide. To identify effective resistance genes, we evaluated 120 common wheat accessions mainly from different wheat producing regions in China for responses to different Bgt isolates in the seedling stage and to natural infection in three field trials and genotyped them with a wheat 55K iSelect single-nucleotide polymorphism array for a genome-wide association study. A total of 26 loci were identified, which explained 6.6 to 26.2% of the phenotypic variation depending on individual locus. Of the 26 loci, 10 were detected in the A genomes, 10 in the B genomes, and only 6 in the D genome. Sixteen loci overlapped with known powdery mildew resistance genes or quantitative trait loci, and the remaining 10 loci were potentially novel. This study improves the understanding of the genetic structure of wheat powdery mildew resistance and provides germplasms and information on genes and markers for breeding new wheat cultivars with effective resistance to powdery mildew.

Induction of labour in mid-trimester pregnancy using double-balloon catheter placement within 12 h versus within 12-24 h.

BACKGROUND: This study aims to evaluate the efficacy and safety of the induction of labour in mid-trimester pregnancy using a double-balloon catheter (DBC) within 12 h versus within 12-24 h. METHODS: In this retrospective study, a total of 58 pregnant women at 14 + 0 weeks to 27 + 6 weeks of gestation were enrolled as research subjects, and they underwent the intended termination of pregnancy at our birth centre from January 1, 2017, to June 31, 2019. Based on the duration of DBC, the patients were divided into two groups, namely, the DBC group within 12 h and the DBC group within 12-24 h. RESULTS: All 58 cases were successful vaginal deliveries, and no one chose to undergo caesarean section. The success rate of induction (successful abortion of the foetus and placenta without the implementation of dilation and evacuation) was higher in the DBC group within 12-24 h (96.3%, 29/31) than in the DBC group within 12 h (71.0%, 18/27) (p < 0.05). Additionally, the time from DBC removal to delivery in the DBC group within 12-24 h was significantly shorter than that in the DBC group within 12 h (3.0 h versus 17.8 h) (p < 0.05), and the degree of cervical dilation after DBC removal in the DBC group within 12-24 h was larger than that in the DBC group within 12 h (p < 0.05). CONCLUSION: In the clinic, the placement time of DBC generally lasts for approximately 12 h. However, considering that the cervical condition is immature in the mid-trimester, properly extending the placement time of DBC to 24 h will benefit cervical ripening and reduce the chance of dilation and evacuation.