Overtime work and Chinese workers' physical and mental health: The mediating role of social support and work value awareness.

BACKGROUND: China was once called the world's factory. Chinese workers had long weekly working hours. However, the empirical results of the relationship between overtime work and workers' health are mixed and remain inconclusive. OBJECTIVE: This study aimed to investigate how overtime work influenced workers' physical and mental health and the role of lifestyles, social support, and work value awareness. METHODS: Data from the China Labor-force Dynamics Survey 2016 (N = 14,205) was used. The instrumental variable approach was employed to overcome the endogeneity problem between overtime work and workers' health. The bootstrapping method was conducted to elicit the role of lifestyles, social support, and work value awareness. RESULTS: The results indicated that overtime work significantly and negatively influenced Chinese workers' physical and mental health. The results of the bootstrapping suggested that workers' social support and work value awareness partially mediated the relationship between overtime work and their physical and mental health. However, the mediating role of lifestyles was insignificant. CONCLUSION: Through using big data with national representativeness, this study suggests that overtime work negatively influences Chinese workers' physical and mental health. Our findings provide policy implications for improving workers' health rights and well-being in emerging economies.

Analysis of the Adsorption Behavior of Phenanthrene on Microplastics Based on Two-Dimensional Correlation Spectroscopy.

Microplastics (MPs), an emerging pollutant, widely co-occur with polycyclic aromatic hydrocarbons (PAHs) in the environment. Therefore, the interaction between MPs and PAHs has been the focus of much attention in recent years. In this study, three types of MPs, i.e., polypropylene, polystyrene, and poly(vinyl chloride), with the same main chain were selected as the adsorbents, with phenanthrene (PHE) as the representative PAHs. The adsorption mechanisms were explored from the perspective of the molecular spectral level using a combination of Fourier transform infrared spectroscopy (FT-IR) with a two-dimensional correlation technique. The adsorption kinetics results showed that the adsorption of PHE on the three MPs was dominated by chemisorption. However, the FT-IR analysis results indicated that no new covalent bond was created during the adsorption process. Based on the above research, a generalized two-dimensional (2D) correlation spectral technique was employed to investigate the sequence of functional group changes during the adsorption process for different MPs. Furthermore, the hybrid 2D correlation spectral technique explored the effect of side groups attached to the main chain molecules of MPs on adsorption. The results showed that for all three MPs, the functional groups in the side chain have a higher affinity for PHE, which is due to their higher hydrophobicity. This study provides a feasible way to analyze the adsorption of pollutants on MPs, and the results are important for understanding the adsorption interaction between PAHs and MPs in the aquatic environment.

Human exposure risk of organic UV filters: A comprehensive analysis based on primary exposure pathways.

The exposure of organic UV filters has been increasingly confirmed to induce adverse effects on humans. However, the critical exposure pathway and the vulnerable population of organic UV filters are not clearly identified. This paper attempts to evaluate the health risk of commonly used organic UV filters from various exposure routes based on comprehensive analysis strategy. The estimated daily intakes (EDI) and hazard quotient (HQ) values of organic UV filters through four pathways (dermal exposure, indoor dust, indoor air, and drinking water) for various age groups were determined. Although the total HQ values (0.01-0.4) from comprehensive exposure of organic UV filters were below risk threshold (1.0), infants were identified as the most vulnerable population, with EDI (75.71 ng/kg-bw/day) of 2-3 times higher than that of adults. Additionally, the total EDI values of individual exposure pathways were estimated and ranked as follows: indoor air (138.44 ng/kg-bw/day) > sunscreen application (37.2 ng/kg-bw/day) > drinking water (21.87 ng/kg-bw/day) > indoor dust (9.24 ng/kg-bw/day). Moreover, we successfully tailored the Sankey diagram to depict the EDI proportion of individual organic UV filters from four exposure pathways. It was noted that EHMC (ethylhexyl methoxycinnamate) and EHS (ethylhexyl salicylate) dominated the contribution of EDI (72 %) via indoor air exposure routes. This study serves as a crucial reference for enhancing public health risk awareness concerning organic UV filters, with a special focus on the vulnerable populations such as infants and children.

Analysis of the recombination and evolution of the new type mutant pseudorabies virus XJ5 in China.

Pseudorabies have caused enormous economic losses in China's pig industry and have recurred on many large pig farms since late 2011. The disease is caused by highly pathogenic, antigenic variant pseudorabies virus (vPRV) strains. Our laboratory isolated a pseudorabies virus in 2015 and named it XJ5. The pathogenic ability of this mutant strain was much stronger than that of the original isolate. After we sequenced its whole genome (GenBank accession number: OP512542), we found that its overall structure was not greatly changed compared with that of the previous strain Ea (KX423960.1). The whole genome alignment showed that XJ5 had a strong genetic relationship with the strains isolated in China after 2012 reported in GenBank. Based on the isolation time of XJ5 and the mutation and recombination analysis of programs, we found that the whole genome homology of XJ5 and other strains with Chinese isolates was greater than 95%, while the homology with strains outside Asia was less than 94%, which indicated that there may be some recombination and mutation patterns. We found that virulent PRV isolates emerged successively in China in 2011 and formed two different evolutionary clades from foreign isolates. At the same time, this may be due to improper immunization and the presence of wild strains in the field, and recent reports have confirmed that Bartha vaccine strains recombine with wild strains to obtain new pathogenic strains. We performed genetic evolution analysis of XJ5 isolated and sequenced in our laboratory to trace its possible mutations and recombination. We found that XJ5 may be the result of natural mutation of a virus in a branch of mutant strains widely existing in China.

Study on the impact of digital transformation on green competitive advantage: The role of green innovation and government regulation.

Digital transformation enables small and medium enterprises (SMEs) to reduce or overcome their reliance on resources and energy, thereby minimizing their environmental impact and providing them with sustainable green competitive advantages. However, the reasons for this phenomenon are not yet clear. To further investigate this issue, we selected 391 Chinese SMEs to examine the relationships among green transformation, green innovation, government regulation, and green competitive advantages. Green innovation includes green product innovation and green process innovation, while government regulation includes incentive regulation, constraint regulation, and guidance regulation. The empirical results show that digital transformation can enhance SMEs' green competitive advantages. Additionally, the hypothesized mediating effect of green product innovation and green process innovation between digital transformation and green competitive advantages is supported, while the moderating effect of incentive regulation, constraint regulation, and guidance regulation on the relationship between digital transformation and green product innovation and green process innovation is also confirmed. The findings of this study may contribute to more effective management of digital transformation and green innovation in SMEs, thereby promoting their development.

Decay of Multi-point Correlation Functions in Z d.

We prove multi-point correlation bounds in Z d for arbitrary d ≥ 1 with symmetrized distances, answering open questions proposed by Sims-Warzel (Commun Math Phys 347(3):903-931, 2016) and Aza-Bru-Siqueira Pedra (Commun Math Phys 360(2):715-726, 2018). As applications, we prove multi-point correlation bounds for the Ising model on Z d , and multi-point dynamical localization in expectation for uniformly localized disordered systems, which provides the first examples of this conjectured phenomenon by Bravyi-König (Commun Math Phys 316(3):641-692, 2012) .

Ferroptosis-Related Gene Signatures in Epilepsy: Diagnostic and Immune Insights.

Epilepsy is characterized by a multifaceted aetiology. Ferroptosis has recently been implicated in seizure pathophysiology, although its mechanistic role in epilepsy remains obscure. We examined the roles of ferroptosis-related genes (FRGs) in epilepsy cohorts from the GSE143272 dataset. We investigated the associations between gene expression and the immune response by performing CIBERSORT and MCP-counter analyses. By employing unsupervised consensus clustering and weighted gene coexpression network analysis (WGCNA), we delineated robust gene clusters across cohorts. Single-cell RNA sequencing data from the GSE201048 dataset provided insights into the interactions between pivotal ferroptosis-related genes and immune cells. Additionally, we employed qRT‒PCR technology to measure the levels of these central genes in the tissues of epileptic patients and mice. Our findings revealed seven pivotal genes (TFRC, POR, PTGS2, RELA, PGD, TRIM21, and QSOX1) at the forefront in epilepsy specimens. A diagnostic model harnessing these genes exhibited substantial efficacy (AUC = 0.913). Similarly, the qRT‒PCR analysis of samples from epileptic patients and mouse epileptic brain tissues substantiated these findings. Stratification of 91 patients with epilepsy via WGCNA, based on gene expression, revealed distinct immunological profiles. The scRNA-seq data further indicated increased expression of central genes in macrophages and microglia. Notably, these cells and those with elevated ferroptosis scores were significantly enriched in inflammation-related pathways. These findings support the strong involvement of FRGs in the pathogenesis of epilepsy, particularly neuroinflammation. These central genes hold promise as novel diagnostic biomarkers for epilepsy.

Covalent Inhibition of a Host-Pathogen Protein-Protein Interaction Reduces the Infectivity of Streptococcus pneumoniae.

The ever-expanding antibiotic resistance urgently calls for novel antibacterial therapeutics, especially those with a new mode of action. We report herein our exploration of protein-protein interaction (PPI) inhibition as a new mechanism to thwart bacterial pathogenesis. Specifically, we describe potent and specific inhibitors of the pneumococcal surface protein PspC, an important virulence factor that facilitates the infection of Streptococcus pneumoniae. Specifically, PspC has been documented to recruit human complement factor H (hFH) to suppress host complement activation and/or promote the bacterial attachment to host tissues. The CCP9 domain of hFH was recombinantly expressed to inhibit the PspC-hFH interaction as demonstrated on live pneumococcal cells. The inhibitor allowed for the first pharmacological intervention of the PspC-hFH interaction. This PPI inhibition reduced pneumococci's attachment to epithelial cells and also resensitized the D39 strain of S. pneumoniae for opsonization. Importantly, we have further devised covalent versions of CCP9, which afforded long-lasting PspC inhibition with low nanomolar potency. Overall, our results showcase the promise of PPI inhibition for combating bacterial infections as well as the power of covalent inhibitors.

Controllable preparation of graphene glass fiber fabric towards mass production and its application in self-adaptive thermal management.

Direct synthesis of graphene on nonmetallic substrates via chemical vapor deposition (CVD) has become a frontier research realm targeting transfer-free applications of CVD graphene. However, the stable mass production of graphene with a favorable growth rate and quality remains a grand challenge. Herein, graphene glass fiber fabric (GGFF) was successfully developed through the controllable growth of graphene on non-catalytic glass fiber fabric, employing a synergistic binary-precursor CVD strategy to alleviate the dilemma between growth rate and quality. The binary precursors consisted of acetylene and acetone, where acetylene with high decomposition efficiency fed rapid graphene growth while oxygen-containing acetone was adopted for improving the layer uniformity and quality. Notably, the bifurcating introducing-confluent premixing (BI-CP) system was self-built for the controllable introduction of gas and liquid precursors, enabling the stable production of GGFF. GGFF features solar absorption and infrared emission properties, based on which the self-adaptive dual-mode thermal management film was developed. This film can automatically switch between heating and cooling modes by spontaneously perceiving the temperature, achieving excellent thermal management performances with heating and cooling power of ∼501.2 and ∼108.6 W m-2, respectively. These findings unlock a new strategy for the large-scale batch production of graphene materials and inspire advanced possibilities for further applications.

Radiomics as a tool for prognostic prediction in transarterial chemoembolization for hepatocellular carcinoma: a systematic review and meta-analysis.

INTRODUCTION: Transarterial chemoembolization (TACE) is one of the predominant locoregional therapeutic modalities for addressing hepatocellular carcinoma (HCC). However, achieving precise prognostic predictions and effective patient selection remains a challenging pursuit. The primary objective of this systematic review and meta-analysis is to evaluate the efficacy of radiomics in forecasting the prognosis associated with TACE treatment. METHODS: A comprehensive exploration of pertinent original studies was undertaken, encompassing databases of PubMed, Web of Science and Embase. The studies' quality was meticulously evaluated employing the quality assessment of diagnostic accuracy studies 2 (QUADAS-2), the radiomics quality score (RQS) and the METhodological RadiomICs Score (METRICS). Pooled statistics, along with 95% confidence intervals (95% CI), were computed for sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR). Additionally, a summary receiver operating characteristic curve (sROC) was generated. To discern potential sources of heterogeneity, meta-regression and subgroup analyses were performed. RESULTS: The systematic review incorporated 29 studies, comprising a total of 5483 patients, with 14 studies involving 2691 patients qualifying for inclusion in the meta-analysis. The assessed studies exhibited commendable quality with regard to bias risk, with mean RQS of 12.90 ± 5.13 (35.82% ± 14.25%) and mean METRICS of 62.98% ± 14.58%. The pooled sensitivity was 0.83 (95% CI: 0.78-0.87), specificity was 0.86 (95% CI: 0.79-0.92), PLR was 6.13 (95% CI: 3.79-9.90), and NLR was 0.20 (95% CI: 0.15-0.27). The area under the sROC was 0.90 (95% CI: 0.87-0.93). Significant heterogeneity within all the included studies was observed, while meta-regression and subgroup analyses revealed homogeneous and promising findings in subgroups where principal methodological variables such as modeling algorithms, imaging modalities, and imaging phases were specified. CONCLUSION: Radiomics models have exhibited robust predictive capabilities concerning prognosis subsequent to TACE, thereby presenting promising prospects for clinical translation.

Esophageal cancer global burden profiles, trends, and contributors.

OBJECTIVE: This study aimed to provide a comprehensive overview of the global burden of esophageal cancer (EC) and determine the temporal trends and factors influencing changes in the global burden. METHODS: The latest incidence and mortality data for EC worldwide were obtained from GLOBALCAN 2022. The mortality and disability-adjusted life years (DALYs) rates for EC from 1990-2019 were sourced from the 2019 Global Burden of Diseases. Trends in EC mortality and DALYs attributable to 11 risk factors or clusters of risk were analyzed using the joinpoint regression model. The trends in age-related EC burden were assessed using a decomposition approach. RESULTS: An estimated 511,054 new cases of EC were diagnosed in 2022 with 445,391 deaths worldwide. Approximately 75% of cases and deaths occurred in Asia. Nearly 50% of global EC deaths and DALYs were attributed to tobacco use in men in 2019, while 20% were attributed to high body mass index (BMI) in women. From 1990-2019, EC deaths and DALYs attributable to almost all risk factors had declining trends, while EC deaths and DALYs attributed to high BMI in men had upward trends. The age-related EC burden exhibited an upward trend driven by population growth and aging, which contributed to 307.4 thousand deaths and 7.2 million DALYs due to EC. CONCLUSIONS: The EC burden remains substantial worldwide. Effective tobacco and obesity control measures are critical for addressing the risk-attributable burden of EC. Population growth and aging pose challenges for EC prevention and control efforts.

Identification of the novel allele HLA-A*02:1144 in a Chinese platelet donor.

The novel HLA-A*02:1144 allele differs from HLA-A*02:03:01:01 by 3 nucleotides in exon 7.

Advancements in atomic-scale interface engineering for flexible electronics: enhancing flexibility and durability.

Flexible electronics, such as wearable displays, implantable electronics, soft robots, and smart skin, have garnered increasing attention. Despite notable advancements in research, a bottleneck remains at the product level due to the prevalent use of polymer-based materials, requiring encapsulation films for lifespan extension and reliable performance. Multilayer composites, incorporating thin inorganic layers to maintain low permeability towards moisture, oxygen, ions, etc, exhibit potential in achieving highly flexible barriers but encounter challenges stemming from interface instability between layers. This perspective offers a succinct review of strategies and provides atomic-scale interface modulation strategy utilizing atomic layer integration technology focused on enhancing the flexibility of high-barrier films. It delves into bendable multilayers with atomic-scale interface modulation strategies, encompassing internal stress and applied stress modulation, as well as stretchable composite structural designs such as gradient/hybrid, wavy, and island. These strategies showcase significant improvements in flexibility from bendable to stretchable while maintaining high barrier properties. Besides, optimized manufacturing methods, materials, and complex structure design based on atomic-scale interface engineering are provided, better aligning with the future development of flexible electronics. By laying the groundwork for these atomic-scale strategies, this perspective contributes to the evolution of flexible electronics, enhancing their flexibility, durability, and functionality.

Nitidine chloride inhibits mTORC1 signaling through ATF4-mediated Sestrin2 induction and targets IGF2R for lysosomal degradation.

AIMS: Nitidine chloride (NC), a natural phytochemical alkaloid derived from Zanthoxylum nitidum (Roxb.) DC, exhibits multiple bioactivities, including antitumor, anti-inflammatory, and other therapeutic effects. However, the primary targets of NC and the mechanism of action (MOA) have not been explicitly defined. METHODS: We explored the effects of NC on mTORC1 signaling by immunoblotting and fluorescence microscopy in wild-type and gene knockout cell lines generated by the CRISPR/Cas9 gene editing technique. We identified IGF2R as a direct target of NC via the drug affinity-responsive target stability (DARTS) method. We investigated the antitumor effects of NC using a mouse melanoma B16 tumor xenograft model. KEY FINDINGS: NC inhibits mTORC1 activity by targeting amino acid-sensing signaling through activating transcription factor 4 (ATF4)-mediated Sestrin2 induction. NC directly binds to IGF2R and promotes its lysosomal degradation. Moreover, NC displayed potent cytotoxicity against various cancer cells and inhibited B16 tumor xenografts. SIGNIFICANCE: NC inhibits mTORC1 signaling through nutrient sensing and directly targets IGF2R for lysosomal degradation, providing mechanistic insights into the MOA of NC.

ASSOCIATIONS BETWEEN CHOROIDAL ALTERATIONS AND EARLY NEURODEGENERATION IN DIABETES WITHOUT DIABETIC RETINOPATHY: Insights From Ultra-Widefield Optical Coherence Tomography Angiography Imaging.

PURPOSE: To identify associations between choroidal alterations and the reduction of peripapillary retinal nerve fiber layer (pRNFL) thickness in diabetes without diabetic retinopathy (nondiabetic retinopathy, NDR). METHODS: This retrospective cross-sectional study included 143 eyes from 83 patients with NDR and 124 eyes from 82 matched healthy controls. Ultra-widefield swept-source optical coherence tomography angiography was used to automatically measure retinal and choroidal thickness (ChT), retinal vascular density, and choroidal vascular metrics. Data were analyzed using Student's t-tests, generalized estimating equations, and generalized linear mixed models. RESULTS: Patients with NDR exhibited significant reductions in perifoveal ChT (e.g., perifoveal inferior region: 253.42 ± 86.59 µm vs. 281.01 ± 80.25 µm, P = 0.026 in GEE test) compared with the controls. The NDR group showed a significant decrease in the choroidal vascular index (P = 0.012 in GEE test), and an increase in the choroidal stromal index (P = 0.012 in GEE test). The average pRNFL thickness significantly decreased in patients with NDR (114.58 ± 11.88 µm vs. 120.25 ± 16.36 µm, P = 0.005 in GEE test). The thickness of the outer nuclear layer and total retina significantly decreased in patients with NDR (P < 0.05). In multivariate models, ChT was significantly correlated with pRNFL thickness (ß = 0.041, P = 0.001), even after adjusting by confounding factors (ß = 0.056, P = 0.001). CONCLUSION: In NDR, there were decreases in ChT, choroidal vascular index, pRNFL thickness, and outer nuclear layer thickness. The reduction in ChT was independently associated with the reduction in pRNFL thickness, suggesting that ChT could serve as a predictor of retinal neurodegeneration in NDR.

An avian-origin internal backbone effectively increases the H5 subtype avian influenza vaccine candidate yield in both chicken embryonated eggs and MDCK cells.

Inactivated vaccines play an important role in preventing and controlling the epidemic caused by the H5 subtype avian influenza virus. The vaccine strains are updated in response to alterations in surface protein antigens, while an avian-derived vaccine internal backbone with a high replicative capacity in chicken embryonated eggs and MDCK cells is essential for vaccine development. In this study, we constructed recombinant viruses using the clade 2.3.4.4d A/chicken/Jiangsu/GY5/2017(H5N6, CkG) strain as the surface protein donor and the clade 2.3.4.4b A/duck/Jiangsu/84512/2017(H5N6, Dk8) strain with high replicative ability as an internal donor. After optimization, the integration of the M gene from the CkG into the internal genes from Dk8 (8GM) was selected as the high-yield vaccine internal backbone, as the combination improved the hemagglutinin1/nucleoprotein (HA1/NP) ratio in recombinant viruses. The r8GMΔG with attenuated hemagglutinin and neuraminidase from the CkG exhibited high-growth capacity in both chicken embryos and MDCK cell cultures. The inactivated r8GMΔG vaccine candidate also induced a higher hemagglutination inhibition antibody titer and microneutralization titer than the vaccine strain using PR8 as the internal backbone. Further, the inactivated r8GMΔG vaccine candidate provided complete protection against wild-type strain challenge. Therefore, our study provides a high-yield, easy-to-cultivate candidate donor as an internal gene backbone for vaccine development.

Exploring the impact of GSTM1 as a novel molecular determinant of survival in head and neck cancer patients of African descent.

BACKGROUND: Blacks/African American (BAA) patients diagnosed with head and neck squamous cell carcinoma (HNSCC) have worse survival outcomes than White patients. However, the mechanisms underlying racial disparities in HNSCC have not been thoroughly characterized. METHODS: Data on gene expression, copy number variants (CNVs), gene mutations, and methylation were obtained from 6 head and neck cancer datasets. Comparative bioinformatics analysis of the above genomic features was performed between BAAs and Whites. The expression pattern of GSTM1 was validated by immunohistochemistry using tumor tissue microarray (TMA). Effect of GSTM1 knockdown were assessed by cell proliferation, colony formation, and tumor development in an orthotopic mouse model. The changes in protein kinases were determined using the Proteome Profiler Human Phospho-Kinase Array Kit in HNSCC cells with or without GSTM1 knockdown. RESULTS: We identified ancestry-related differential genomic profiles in HNSCC. Specifically, in BAA HNSCC, FAT1 mutations were associated with its gene expression, SALL3 gene expression correlated with its gene CNVs, and RTP4 gene expression showed an inverse correlation with its methylation. Notably, GSTM1 emerged as a prognostic risk factor for BAA HNSCC, with high gene CNVs and expression levels correlating with poor overall survival in BAA patients. Immunohistochemistry results from newly developed in-house TMA validated the expression pattern of GSTM1 between BAA HNSCC and White HNSCC. In an orthotopic mouse model, GSTM1 knockdown significantly inhibited malignant progression in tumors derived from BAAs. In contrast, loss of GSTM1 did not affect the development of HNSCC originating in Whites. Mechanistically, GSTM1 knockdown suppressed HSP27 phosphorylation and ß-catenin in BAA HNSCC cells, but not in White HNSCC cells. This differential effect at least partially contributes to tumor development in BAA patients. CONCLUSION: This study identifies GSTM1 as a novel molecular determinant of survival in HNSCC patients of African descent. It also provides a molecular basis for future research focused on identifying molecular determinants and developing therapeutic interventions to improve outcomes for BAA patients with HNSCC.

Predictors of return to work among postoperative patients with colorectal cancer.

OBJECTIVE: To describe the status of return to work and identify predictors of return to work among Chinese postoperative patients with colorectal cancer. DESIGN: A cross-sectional study. SETTING: Conducted in two tertiary hospitals in China. PARTICIPANTS: A total of 210 postoperative patients with colorectal cancer were included in the study. MAIN MEASURES: Two hundred and ten postoperative patients with colorectal cancer who were working at the time of their diagnosis were assessed with the Perceived Social Support Scale, the Return-To-Work Self-Efficacy Questionnaire, Kessler Psychological Distress Scale, Cancer Fatigue Scale, and Social Impact Scale. Descriptive statistics, univariate logistic regression analysis, and multivariate logistic regression analysis were used for data analysis in SPSS 26.0. RESULTS: Around a third of participants (n = 74, 35.2%) returned to work after surgery. Multiple stepwise regression analysis indicated that more family income (odds ratio (OR) = 5.769, 95% confidence interval (CI) = 1.666-19.972), time span after surgery 5-10 months, and ≥10 months (OR = 3.546, 95% CI = 1.084-11.598; OR = 3.077, 95% CI = 1.074-8.818), with a stoma (OR = 0.221, 95% CI = 0.075-0.653), psychological distress (OR = 0.912, 95% CI = 0.843-0.987), cancer fatigue (OR = 0.924, 95% CI = 0.872-0.978), and stigma (OR = 0.928, 95% CI = 0.886-0.971) were significantly associated with return to work. CONCLUSIONS: A high proportion of patients with colorectal cancer did not return to work within 1 year after diagnosis. Those with shorter postoperative time, lower family income, stoma, greater psychological stress, higher level of cancer fatigue, and more stigma may have a higher risk in delayed work resumption.

Effects of Retrograde Colonic Enema Based Fecal Microbiota Transplantation in the Treatment of Childhood Constipation: A Randomized, Double-blind Controlled Trial.

OBJECTIVE: Management of intractable childhood constipation is still challenging. The efficacy of retrograde colonic enema (RCE) with fecal microbiota transplantation (FMT) in intractable childhood constipation has not been established although both have demonstrated potential in gastrointestinal diseases. The aim of the current study was to determine the safety and efficacy of RCE-based FMT in the treatment of intractable constipation in children. METHODS: A randomized, double-blind, controlled trial with 110 children was conducted. The subjects were randomly assigned to the FMT with RCE group or the placebo with RCE group. All participants received a daily RCE followed by a 4-week FMT treatment (twice a week) and a 12-week follow-up period. Spontaneous bowel movements (SBMs) ≥ 3 per week were the main outcomes and the risk ratio (RR) with 95% CI was calculated. Changes in the intestinal bacterial profile were analyzed by BOX-PCR-based DNA fingerprinting and sequencing. The adverse effects were assessed based on symptoms. RESULTS: At the end of the follow-up period, 22 patients (40.0%) in the FMT with RCE group and 10 patients (18.2%) in the placebo with RCE group had ≥ 3 SBMs per week (net difference = 21.8%, 95% CI: 13.2%-30.4%; RR: 1.364, 95% CI: 1.063-1.749; P<0.05). Both RCE and FMT enriched the intestinal bacterial diversity of patients with constipation. The adverse events were all mild self-limiting gastrointestinal symptoms. CONCLUSIONS: FMT enhances the efficacy of RCE and the use of RCE-based FMT is a safe and effective method in the treatment of intractable constipation in children.

Thickened photoreceptor outer segment layer in children with hyperopic anisometropic amblyopia.

PURPOSE: To quantitatively investigate the reflectivity and structure of the outer retinal layers in children with hyperopic anisometropic amblyopia by using swept-source optical coherence tomography (SS-OCT). METHODS: Seventy-eight patients with amblyopia and 64 age-matched children with normal vision were included in this study. All participants underwent SS-OCT and detailed ophthalmic examinations. Longitudinal reflectance profile measurements were measured using Image J. The reflectivity of outer retinal layers was measured at the three selected positions: subfovea, 1 mm nasal to the fovea, and 1 mm temporal to the fovea. The reflectivity ratios were calculated by outer retinal layers divided by the nuclear layer (ONL) for normalization. Photoreceptor outer segment layer thickness was also measured. The results were compared between the amblyopia and normal controls. The possible effects of age, sex, and axial length on results were adjusted by generalized estimating equations. RESULTS: Photoreceptor outer segment layer thickness was significantly greater in amblyopic eyes than in normal control eyes at all three regions (18.41 ± 1.83 vs. 16.84 ± 1.39, P < 0.001 at the fovea; 14.78 ± 1.34 vs. 14.19 ± 1.40, P = 0.030 at 1 mm nasal to the foveal; 14.92 ± 1.48 vs. 14.41 ± 1.32, P = 0.049 at 1 mm temporal to the fovea). The reflectivity ratio of outer segment/ONL was higher only at 1 mm nasal to the fovea (2.94 ± 0.61 vs. 2.70 ± 0.42, P = 0.02). Subfoveal OS thickness was positively correlated with choroidal thickness (r = 0.248, P = 0.018) but was not correlated with spherical equivalent, age, axial length, or logMAR visual acuity. CONCLUSION: Quantitative measurement of SS-OCT images revealed greater photoreceptor outer segments in both eyes of children with amblyopia than in normal control eyes. A thicker OS thickness is somehow related to amblyopia, and this may be a new useful diagnostic parameter for amblyopia.