MicroRNA analysis of medium/large placenta extracellular vesicles in normal and preeclampsia pregnancies.

Background: Preeclampsia (PE) is a hypertensive disorder of pregnancy, affecting 2%-8% of pregnancies worldwide, and is the leading cause of adverse maternal and fetal outcomes. The disease is characterized by oxidative and cellular stress and widespread endothelial dysfunction. While the precise mechanisms are not entirely understood, the pathogenesis of PE is closely linked to placental dysfunction and, to some extent, syncytiotrophoblast extracellular vesicle release (STB-EVs). These vesicles can be divided into the less well-studied medium/large EVs (220-1,000 nm) released in response to stress and small EVs (<220 nm) released as a component of intercellular communication. The previously described production of m/lSTB-EVs in response to cellular stress combined with the overwhelming occurrence of cellular and oxidative stress in PE prompted us to evaluate the microRNAome of PE m/lSTB-EVs. We hypothesized that the microRNAome profile of m/lSTB-EVs is different in PE compared to normal pregnancy (NP), which might permit the identification of potential circulating biomarkers not previously described in PE. Methods/study design: We performed small RNA sequencing on medium/large STB-EVs isolated from PE and NP placentae using dual-lobe ex vivo perfusion. The sequencing data was bioinformatically analyzed to identify differentially regulated microRNAs. Identified microRNAs were validated with quantitative PCR analysis. We completed our analysis by performing an in-silico prediction of STB-EV mechanistic pathways. Results: We identified significant differences between PE and NP in the STB-EVs micro ribonucleic acid (microRNA) profiles. We verified the differential expression of hsa-miR-193b-5p, hsa-miR-324-5p, hsa-miR-652-3p, hsa-miR-3196, hsa-miR-9-5p, hsa-miR-421, and hsa-miR-210-3p in the medium/large STB-EVs. We also confirmed the differential abundance of hsa-miR-9-5p in maternal serum extracellular vesicles (S EVs). In addition, we integrated the results of these microRNAs into the previously published messenger RNA (mRNA) data to better understand the relationship between these biomolecules. Conclusions: We identified a differentially regulated micro-RNA, hsa-miR-9-5p, that may have biomarker potential and uncovered mechanistic pathways that may be important in the pathophysiology of PE.

A cross-sectional analysis of syncytiotrophoblast membrane extracellular vesicles-derived transcriptomic biomarkers in early-onset preeclampsia.

Background: Preeclampsia (PE) is a pregnancy-specific hypertensive disorder affecting 2%-8% of pregnancies worldwide. Biomarker(s) for the disorder exists, but while these have excellent negative predictive value, their positive predictive value is poor. Extracellular vesicles released by the placenta into the maternal circulation, syncytiotrophoblast membrane extracellular vesicles (STB-EVs), have been identified as being involved in PE with the potential to act as liquid biopsies. Objective: The objective of this study was to identify the difference in the transcriptome of placenta and STB-EVs between preeclampsia and normal pregnancy (NP) and mechanistic pathways. Methods/study design: We performed RNA-sequencing on placental tissue, medium/large and small STB-EVs from PE (n = 6) and NP (n = 6), followed by bioinformatic analysis to identify targets that could be used in the future for EV-based diagnostic tests for preeclampsia. Some of the identified biomarkers were validated with real-time polymerase chain reactions. Results: Our analysis identified a difference in the transcriptomic STB-EV cargo between PE and NP. We then identified and verified the differential expression of FLNB, COL17A1, SLC45A4, LEP, HTRA4, PAPP-A2, EBI3, HSD17B1, FSTL3, INHBA, SIGLEC6, and CGB3. Our analysis also identified interesting mechanistic processes via an in silico prediction of STB-EV-based mechanistic pathways. Conclusions: In this study, using comprehensive profiling of differentially expressed/carried genes of three linked sample subtypes in PE, we identified potential biomarkers and mechanistic gene pathways that may be important in the pathophysiology of PE and could be further explored in future studies.

Ectopic and visceral fat deposition in aging, obesity, and idiopathic pulmonary fibrosis: an interconnected role.

Idiopathic pulmonary fibrosis (IPF) is considered an age-related disease. Age-related changes, along with other factors such as obesity, hormonal imbalances, and various metabolic disorders, lead to ectopic fat deposition (EFD). This accumulation of fat outside of its normal storage sites is associated with detrimental effects such as lipotoxicity, oxidative stress, inflammation, and insulin resistance. This narrative review provides an overview of the connection between ectopic and visceral fat deposition in aging, obesity, and IPF. It also elucidates the mechanism by which ectopic fat deposition in the airways and lungs, pericardium, skeletal muscles, and pancreas contributes to lung injury and fibrosis in patients with IPF, directly or indirectly. Moreover, the review discusses the impact of EFD on the severity of the disease, quality of life, presence of comorbidities, and overall prognosis in IPF patients. The review provides detailed information on recent research regarding representative lipid-lowering drugs, hypoglycemic drugs, and lipid-targeting drugs in animal experiments and clinical studies. This may offer new therapeutic directions for patients with IPF.

Paper test strip for fluorescence detection of iron ion based on nitrogen, zinc and copper codoped carbon dots.

In this study, a test strip for fluorometric analysis of iron ion (Fe3+) was constructed based on nitrogen, zinc and copper codoped carbon dots (NZC-CDs) as fluorescence probes. NZC-CDs were synthesized by hydrothermal method. The morphology, size, components, crystal state and optical properties of NZC-CDs were characterized by transmission electron microscope (TEM), Fourier-transform infrared (FT-IR), x-ray photoelectron spectroscopy (XPS), x-ray diffraction (XRD), UV-vis absorption and fluorescence spectroscopy techniques, respectively. NZC-CDs exhibited bright blue fluorescence under UV lamp with a quantum yield at 17.76%. The fluorescence of NZC-CDs was quenched by Fe3+possibly due to the static quenching. The possible fluorescence quenching mechanism was also discussed. The quenching fluorescence was linear with the concentration of Fe3+in the range of 2.5-400µM with a low detection limit of 0.5µM. For the convenient detection, the test strips based on filter paper were employed for Fe3+assay. Moreover, the present approach was successfully applied in the determination of Fe3+in real samples including black fungus, duck blood and pork liver. The sensing method had the potential application in more food analysis.

ExoCounter Assays Identify Women Who May Develop Early-Onset Preeclampsia From 12.5 µL First-Trimester Serum by Characterizing Placental Small Extracellular Vesicles.

BACKGROUND: Preeclampsia is a major cause of maternal and perinatal morbidity and mortality worldwide. Identifying women with high risk of developing preeclampsia in early pregnancy remains challenging. Extracellular vesicles released from the placenta offer an attractive biomarker but have been elusive to quantify. METHODS: Here, we tested ExoCounter, a novel device that immunophenotypes size-selected small extracellular vesicles <160 nm, for its ability to perform qualitative and quantitative placental small extracellular vesicles (psEV) analysis. To investigate disease-specific and gestational age-specific changes, we analyzed psEV counts in maternal plasma samples taken at each of the 3 trimesters from women who had (1) normal pregnancy (n=3); (2) women who developed early-onset preeclampsia (EOPE; n=3); and (3) women who developed late-onset preeclampsia (n=4) using 3 antibody pairs, CD10-placental alkaline phosphatase (PLAP), CD10-CD63, and CD63-PLAP. We further validated the findings in first-trimester serum samples among normal pregnancy (n=9), women who developed EOPE (n=7), and women who developed late-onset preeclampsia (n=8). RESULTS: We confirmed that CD63 was the major tetraspanin molecule coexpressed with PLAP-a known placental extracellular vesicles marker on psEV. Higher psEV counts for all 3 antibody pairs were detected in the plasma of women who developed EOPE than the other 2 groups in the first trimester, which persisted through the second and third trimesters. Significantly higher CD10-PLAP (P<0.01) and CD63-PLAP (P<0.01) psEV counts were validated in the serum of the first trimester of women who developed EOPE compared with normal pregnancy. CONCLUSIONS: Application of the ExoCounter assay developed here could identify patients at risk of developing EOPE in the first trimester, thereby providing a window of opportunity for early intervention.

Identification of F-box gene family in Brassica oleracea and expression analysis in response to low-temperature stress.

Unfavorable climatic conditions, such as low temperatures, often hinder the growth and production of crops worldwide. The F-box protein-encoding gene family performs an essential role in plant stress resistance. However, a comprehensive analysis of the F-box gene family in cabbage (Brassica oleracea var capitata L.) has not been reported yet. In this study, genome-wide characterization of F-box proteins in cabbage yielded 303 BoFBX genes and 224 BoFBX genes unevenly distributed on 9 chromosomes of cabbage. Phylogenetic analysis of 303 BoFBX genes was classified into nine distinct subfamily groups (GI-GIX). Analysis of the gene structure of BoFBX genes indicated that most genes within the same clade are highly conserved. In addition, tissue-specific expression analysis revealed that six F-box genes in cabbage showed the highest expression in rosette leaves, followed by roots and stems and the lowest expression was observed in the BoFBX156 gene. In contrast, the expression of the other five genes, BoFBX100, BoFBX117, BoFBX136, BoFBX137 and BoFBX213 was observed to be upregulated in response to low-temperature stress. Moreover, we found that the expression level of the BoFBX gene in the cold-tolerant cultivar "ZG" was higher than that in cold-sensitive "YC" with the extension of stress duration, while expression levels of each gene in "ZG" were higher than "YC" at 24 h. Knowledge of the various functions provided by BoFBXs genes and their expression patterns provides a firm theoretical foundation for explaining the functions of BoFBXs, thereby contributing to the molecular breeding process of cabbage.

Cotton swabs decorated with Ag@BPQD for the fluorescence determination of 3-aminosalicylic and 5-aminosalicylic acid.

Novel and portable cotton swab-based fluorometry was constructed for the first time for 3-aminosalicylic acid (3-ASA) and 5-aminosalicylic acid (5-ASA) detection. It was carried out by fluorescence enhancement on silver (Ag)-doped black phosphorus quantum dots (Ag@BPQD). Ag@BPQD were prepared from AgNO3 and bulk black phosphorus in N, N-dimethylformamide (DMF) solution by solvothermal decomposition after mechanical exfoliation. Ag@BPQD show blue fluorescence with a quantum yield (QY) of 2.43%. In the presence of Ag@BPQD, 3-ASA exhibited bright blue fluorescence (λex = 328 nm, λem = 448 nm). The fluorescence of 5-ASA was also enhanced significantly and exhibited bright green emission (λex = 328 nm, λem = 484 nm). The linear range of 3-ASA is 0-90 µM with a detection limit (LOD) of 0.10 µM, relative standard deviation (RSD) ≤ 2.04%, and a recovery range of 98.0-104.3%. The linear range of 5-ASA is 0-120 µM with a LOD of 0.12 µM, RSD ≤ 1.34%, and a recovery range of 98.0-101.3%. When 3-ASA and 5-ASA were mixed in different ratios, the fluorescence showed different colors. The possible mechanism of the interaction between 3-ASA (or 5-ASA) and Ag@BPQD may be ascribed to the generation of excited-state intramolecular proton transfer. To realize convenient detection of 3-ASA and 5-ASA, a Ag@BPQD portable sensing method using cotton swabs were built. The proposed approach provides the detection of 3-ASA and 5-ASA in environmental and biological samples with high efficiency, accuracy and portability.

Preeclampsia and syncytiotrophoblast membrane extracellular vesicles (STB-EVs).

Preeclampsia (PE) is a hypertensive complication of pregnancy that affects 2-8% of women worldwide and is one of the leading causes of maternal deaths and premature birth. PE can occur early in pregnancy (<34 weeks gestation) or late in pregnancy (>34 weeks gestation). Whilst the placenta is clearly implicated in early onset PE (EOPE), late onset PE (LOPE) is less clear with some believing the disease is entirely maternal whilst others believe that there is an interplay between maternal systems and the placenta. In both types of PE, the syncytiotrophoblast (STB), the layer of the placenta in direct contact with maternal blood, is stressed. In EOPE, the STB is oxidatively stressed in early pregnancy (leading to PE later in gestation- the two-stage model) whilst in LOPE the STB is stressed because of villous overcrowding and senescence later in pregnancy. It is this stress that perturbs maternal systems leading to the clinical manifestations of PE. Whilst some of the molecular species driving this stress have been identified, none completely explain the multisystem nature of PE. Syncytiotrophoblast membrane vesicles (STB-EVs) are a potential contributor to this multisystem disorder. STB-EVs are released into the maternal circulation in increasing amounts with advancing gestational age, and this release is further exacerbated with stress. There are good in vitro evidence that STB-EVs are taken up by macrophages and liver cells with additional evidence supporting endothelial cell uptake. STB-EV targeting remains in the early stages of discovery. In this review, we highlight the role of STB-EVs in PE. In relation to current research, we discuss different protocols for ex vivo isolation of STB-EVs, as well as specific issues involving tissue preparation, isolation (some of which may be unique to STB-EVs), and methods for their analysis. We suggest potential solutions for these challenges.

Real-world association of self-reported sleep duration and quality with falls among older adults: A representative nationwide study of China.

INTRODUCTION: Falls are the leading cause of injury-related morbidity and mortality among older adults (aged ≥65 years) worldwide. However, previous studies examining sleep and falls were confined to community subpopulations, and few studies included both sleep quality and sleep duration when discussing risk factors of falls. This nationwide representative study aimed to examine the links between sleep duration, sleep quality and falls among Chinese community-dwelling older adults. METHOD: Cross-sectional analyses were conducted with 14,681 older individuals (aged ≥65 years) from 23 Chinese provinces from the Chinese Longitudinal Healthy and Longevity Study (CLHLS) in 2018. Individual variables, including sociodemographic factors, lifestyle, and behavioral factors, were measured using a self-reported questionnaire. Falls were confirmed through face-to-face interviews. Three multivariate logistic regression models were conducted to assess the association between sleep duration and sleep quality with falls. RESULTS: There were 21.7% (95%CI: 21.0-22.4%) participants who had experienced falls in the past year. After controlling demographic and individual variables, falls in older adults were associated with self-reported sleep quality and self-reported sleep duration. Those who reported poor sleep quality were more likely to fall (OR = 1.149; 95%CI = 1.004,1.316). Participants who reported sleep duration that was too short (<5) (OR = 1.349; 95% CI = 1.191 to 1.528) or too long (>8) (OR = 1.267; 95% CI = 1.151 to 1.394) were both associated with higher fall prevalence. CONCLUSION: Nearly one-fifth of older adults in this study had experienced falls in the past year. The study found that falls were significantly associated with less sleep duration, longer sleep duration, and overall poor sleep quality among the old Chinese population.

Family influences on older adults' problem drinking: A representative nationwide study of China.

Aim: It is reported that problem drinking is severe among the elderly. The family environment has been regarded as a significant effecting factor in alcohol consumption of the drinker. With the increasing number of older people, paying more attention to this vulnerable group's drinking status and its' influencing factors is substantial for improving older adults' health and the quality of health services. Methods: This study used data from the Chinese Longitudinal Healthy and Longevity Study (CLHLS), which was a representative survey covering 23 provinces in mainland China. Cross-sectional analyses were conducted with 15,142 older individuals (aged ≥65 years). Three self-reported questions about drinking behavior were examined to calculate alcohol consumption and categorize problem drinkers. Three multi-level models were utilized while adjusting for numerous socio-demographic and self-reported health factors to analyze the effect of family factors associated with problem drinking among the elderly. Results: A total of 1,800 problem drinkers (12%) were identified in the sample. Key factors for the problem drinker were assessed such as Hukou (governmental household registration system), current marital status, years of schooling, primary caregivers, and financial sources of living were associated with problem drinking. The older population who live in rural areas (OR = 1.702, CI = 1.453, 1.994), with advanced years of education (OR = 1.496, CI = 1.284, 1.744), and making life by themselves (OR = 1.330, CI = 1.139, 1.552) were more likely to engage in problem drinking while those participants who are widowed (OR = 0.678, CI = 0.574, 0.801), cared for by children or other relatives (OR = 0.748, CI = 0.642, 0.871), adult care giver (OR = 0.348, CI = 0.209, 0.578) or by no one (OR = 0.539, CI = 0.348, 0.835), provided with financial support from their children (OR = 0.698, CI = 0.605, 0.806), other relatives (OR = 0.442, CI = 0.332, 0.587), or the government/community (OR = 0.771, CI = 0.650, 0.915), with insufficient financial support (OR = 0.728, CI = 0.608, 0.872) were at lower risk of problem drinking. Conclusions: This study provides a strong correlation of various family factors that were associated with problem drinking among the elderly. The findings underscore the effort to promote healthy behaviors, including the importance of positive family factors and appropriate levels of alcohol consumption.

Genome-Wide Study of Hsp90 Gene Family in Cabbage (Brassica oleracea var. capitata L.) and Their Imperative Roles in Response to Cold Stress.

Heat shock protein 90 (Hsp90) plays an important role in plant developmental regulation and defensive reactions. Several plant species have been examined for the Hsp90 family gene. However, the Hsp90 gene family in cabbage has not been well investigated to date. In this study, we have been discovered 12 BoHsp90 genes in cabbage (Brassica oleracea var. capitata L.). These B. oleracea Hsp90 genes were classified into five groups based on phylogenetic analysis. Among the five groups, group one contains five Hsp90 genes, including BoHsp90-1, BoHsp90-2, BoHsp90-6, BoHsp90-10, and BoHsp90-12. Group two contains three Hsp90 genes, including BoHsp90-3, BoHsp90-4, and BoHsp90. Group three only includes one Hsp90 gene, including BoHsp90-9. Group four were consisting of three Hsp90 genes including BoHsp90-5, BoHsp90-7, and BoHsp90-8, and there is no Hsp90 gene from B. oleracea in the fifth group. Synteny analysis showed that a total of 12 BoHsp90 genes have a collinearity relationship with 5 Arabidopsis genes and 10 Brassica rapa genes. The promoter evaluation revealed that the promoters of B. oleracea Hsp90 genes included environmental stress-related and hormone-responsive cis-elements. RNA-seq data analysis indicates that tissue-specific expression of BoHsp90-9 and BoHsp90-5 were highly expressed in stems, leaves, silique, and flowers. Furthermore, the expression pattern of B. oleracea BoHsp90 exhibited that BoHsp90-2, BoHsp90-3, BoHsp90-7, BoHsp90-9, BoHsp90-10, and BoHsp90-11 were induced under cold stress, which indicates these Hsp90 genes perform a vital role in cold acclimation and supports in the continual of normal growth and development process. The cabbage Hsp90 gene family was found to be differentially expressed in response to cold stress, suggesting that these genes play an important role in cabbage growth and development under cold conditions.

Regional Internet Access and Mental Stress Among University Students: A Representative Nationwide Study of China.

Background: The Internet changed the lives of average citizens in the early part of the twenty-first century, and it has now become an essential part of daily life. Many studies reported that accessibility of Internet use is associated with mental health. However, previous studies examining this association were confined to local and community subpopulations and limited at the individual level, which increases the potential bias from the selection effect at a different level. Regional variables would be a stable estimate of people's socioeconomic and cultural environments and how these variables affect mental health needed to be studied. The objective of this study was to evaluate the association between regional Internet access, and mental stress among university students. Methods: Participants were 11,954 students, who were identified through a multistage survey sampling process conducted in 50 Chinese universities. Regional Internet access was retrieved from a national database, and mental stress was measured using the Perceived Stress Scale (Chinese Version) (CPSS). Both unadjusted and adjusted methods were considered in the analyses. Results: More than one-third 36.9% (95% CI: 24.4-49.5%) of university students in this study suffered from severe mental stress (SMR). The multilevel logistic regression model found that university students studied in low-level universities had 2.52 (95% C.I. 1.17 to 6.37) times the prevalence of SMR than those in high-level universities. Compared with small cities, students in a large city had a lower prevalence of SMR (OR 0.25; 95%C.I. 0.06 to 0.77). Most importantly, regional Internet access was negatively associated with students' SMR (OR 0.25; 95%C.I. 0.08 to 0.76). Conclusions: This study indicated that regional Internet access and other environmental factors including city size and type of universities contribute to students' mental health. The findings underscore that efforts to control excessive mental stress among students in China should pay greater attention to environmental determinants of stress and particularly to improve internet access.

Cigarette sharing and gifting in China: Patterns, associated factors, and behavioral outcomes.

INTRODUCTION: The purpose of this study was to investigate the patterns and factors associated with cigarette sharing and gifting, and to explore whether smoking can be predicted by these social practices. METHODS: A cross-sectional survey using a multi-stage sampling design was conducted online from 30 April to 30 July 2020 in China. A sample of 982 household heads from Guangdong Province and 530 household heads from Shaanxi province were involved in the data analysis. Demographic characteristics, social participation, beliefs and behaviors related to cigarette sharing and gifting were assessed. Chi-squared analysis and multiple logistic regression analysis were used to explore the key factors associated with cigarette sharing and gifting, and to identify their relationship with smoking. RESULTS: The shared and gift cigarettes were both mainly offered to friends, and receiving gift cigarettes mostly occurred during the holidays. Gender and province were associated with cigarette sharing, and marital status and social participation were associated with cigarette gifting. Cigarette gifting beliefs and smoking status were prominent predictors for both sharing and gifting cigarettes. Cigarette gifting beliefs were significantly higher among smokers than non-smokers, and people with high cigarette gifting beliefs were 1.68 (adjusted odds ratio, AOR=19.17; 95% CI: 13.31-27.61) times more likely to be a smoker. Offering shared cigarettes has been found to significantly predict tobacco use (AOR=19.17; 95% CI: 13.31-27.61), while people who received shared and gift cigarettes were 1.50 (95% CI: 1.08-2.09) and 2.58 (95% CI: 1.66-4.00) times more likely to be a current smoker than those who did not receive cigarettes, respectively. CONCLUSIONS: Cigarette sharing and gifting were especially pervasive among male smokers and married people in Shaanxi Province. Offering shared cigarettes and receiving shared/gift cigarettes might facilitate cigarette use. This study provides evidence-based data to support the design and implementation of tobacco control programs for the denormalization of gifting and sharing cigarettes.

Uncertainty stress, social capital, and suicidal ideation among Chinese medical students: Findings from a 22-university survey.

Respective associations between uncertainty stress and three dimensions of social capital with suicidal ideation were assessed among 4446 undergraduates from 22 Chinese universities in a cross-sectional study. Multiple logistic regression model and structural equation modeling were used to examine these relationships. Uncertainty stress was more strongly and uniquely associated with suicidal ideation than with life stress. Social capital, especially social networks, shared a dual role as a correlate of suicidal ideation and means to reduce the impact of uncertainty stress. School-based gender- and age-specific suicidal ideation interventions should emphasize social capital enhancement and uncertainty stress coping.

Associations Between Uncertainty Stress, Life Stress and Internet Addiction Among Medical Students.

OBJECTIVES: Internet Addiction (IA) is a growing issue predominate in adolescents and young adults. Although the effects of diverse stressors on IA have been highlighted, there is little consensus about the specific underpinnings of IA. The current study aims to investigate associations between uncertainty stress, life stress and IA among Chinese university medical students. METHODS: A cross-sectional survey employing multi-stage sampling was used. Data were collected from 6,061 students from 27 university medical programs across China. Associations between uncertainty stress, life stress, and IA were examined by means of multivariate logistic regression. RESULTS: The findings indicated that the overall IA prevalence was 12.6% (95% CI 11.7-13.5), life stress prevalence was 8.1% (95% CI 7.4-8.8), and uncertainty stress prevalence was 19.1% (95% CI 18.1-20.1). Multivariate logistic regression showed that uncertainty stress [adjusted OR 2.60 (95% CI 2.14-3.15), P < 0.001] and life stress [adjusted OR 1.71 (95% CI 1.32-2.23), P < 0.001] were positively associated with IA. Population Attributable Risk (PAR) of uncertainty stress associated with IA was 29%, and that of life stress was 15%. CONCLUSIONS: The contribution of uncertainty stress to IA is significantly higher than that of life stress. High uncertainty stress, being male and born in a region of higher economic status were associated with excessive Internet use and IA.

Real-world unassisted quit success and related contextual factors: a population-based study of Chinese male smokers.

OBJECTIVES: To examine the association of exposure to secondhand smoke (SHS) and tobacco advertising with unassisted smoking cessation among Chinese male smokers. METHODS: A questionnaire was administered to 6500 male adult smokers from six cities in China selected in a cross-sectional multistage sampling design. The survey collected self-reported demographic characteristics, smoking and cessation status, SHS exposure and tobacco advertising exposure, with 5782 valid questionnaires included in this study. Multiple logistic regression analysis was used to assess the association of unassisted smoking cessation with exposure to SHS and tobacco advertising. RESULTS: 42.1% of smokers who made unassisted quit attempts achieved abstinence (95% CI 32.5% to 51.7%). SHS (adjusted OR (aOR) 0.36; 95% CI 0.18 to 0.71; p=0.033) and tobacco advertising exposure (aOR 0.63; 95% CI 0.37 to 0.95; p=0.039) were negatively associated with unassisted smoking cessation. CONCLUSION: The vast majority of Chinese male smokers rely on unassisted methods to quit smoking. Success prevalence is high, which is very beneficial to health. This study suggests that exposure to secondhand smoking and tobacco advertising hinders the success of unassisted cessation. These findings speak to the need for environmental tobacco control measures to promote unassisted smoking cessation among Chinese adult male smokers.

The Impacts of Uncertainty Stress on Mental Disorders of Chinese College Students: Evidence From a Nationwide Study.

Objectives: This study aimed to examine the relationships between the types of stress and students' mental health, to distinguish the effects of stressors on mental health problems, and to explore the important role of uncertainty stress on the development of mental disorders in a nationally representative sample of Chinese college students. Methods: A cross-sectional multistage study was conducted. Participants were 11,954 students, who were recruited from 50 Chinese universities located in 43 cities covering 23 provinces, autonomous regions, and municipalities across China. The Student Daily Stress Questionnaire (SDSQ) was applied to measure the different types of stress, and mental health status was measured using the 12-item Chinese Health Questionnaire (CHQ). Both unadjusted and adjusted logistic regression models were utilized in the statistical analyses. Multilevel analyses were performed to examine the variation of mental disorder at both the individual and university levels. Results: The prevalence of mental disorders was 22.8% (95% CI: 22.0-23.5%). The unadjusted models showed that age, gender, grade, major, and university location and type were the correlates of mental disorders among students. The unadjusted models developed in this research found that study stress, life stress, and uncertainty stress were positively associated with mental disorder. The multilevel logistic regression models showed that uncertainty stress was far more likely to result in students' mental disorders than study or life stress after controlling for university level. The greater the perceived uncertainty stress, the higher the prevalence of mental disorders. Conclusion: This study provides robust evidence of the impact of uncertainty stress on mental disorders among college students. Compared with life and study stress, more attention should be given to uncertainty stress. The information from this study should be helpful when considering effective mental health policies and interventions among college students in China.

Susceptibility to smoking and determinants among medical students: A representative nationwide study in China.

INTRODUCTION: The rationale behind why the majority of medical students are non-smokers, but some initiate smoking after becoming physicians is not fully understood in China. Exploring factors that may increase susceptibility to smoking initiation among medical students is an essential first step in assessing preventative actions. METHODS: Participants were 11954 students, who were identified through a multistage survey sampling process that included 50 universities in China. Subsequent analysis focused on 8916 non-smokers among medical students. Both unadjusted and adjusted logistic methods were considered in the data analyses. RESULTS: The prevalence of susceptibility to smoking was 23.0%. Multivariate logistic regression analyses found that exposure to secondhand smoke (SHS) in domestic places (OR= 1.63) and in public places (OR=1.78), cigarette advertising (OR=1.91) and promotional activities on campus (OR=1.90) were positively associated with susceptibility to smoking. In contrast, positive attitudes toward tobacco control on the part of health professionals, HPs, (OR=0.52) were negatively associated with susceptibility to smoking. Those who received information about the dangers of smoking (OR=0.75) and did not agree that light cigarettes are less harmful to health (OR=0.79) were less susceptible to smoke. Caring about exposure to secondhand smoke (OR=0.68 care, and OR=0.33 very) and advising family members to stop smoking (OR=0.81) were negatively associated with susceptibility to smoking. CONCLUSIONS: These findings underscore the importance of tobacco control training and establishing smoke-free campuses for reducing susceptibility to smoking among medical students.

Tobacco Advertising, Anti-Tobacco Information Exposure, Environmental Smoking Restrictions, and Unassisted Smoking Cessation Among Chinese Male Smokers: A Population-Based Study.

The study examined the prevalence of unassisted smoking cessation among Chinese urban male smokers and factors important in the decision to quit. A cross-sectional survey employing multistage sampling involving 5,782 participants in six cities in China was conducted. Survey respondents reported their smoking cessation status and related individual and environmental variables. Among current smokers 1,112 or 35.0% (95% CI [31.0%, 40.8%]) had attempted to quit and of those who had made such an attempt 87.6% reported that they had done so without assistance. Of all former smokers (3,389), most (97.6%; 95% CI [96.7%, 98.5%]) quit without assistance. Logistic regression analysis showed those who engaged in physical exercise and who had more belief in their ability to quit were more than twice as likely to make a quit attempt and be successful than those in comparable reference groups. Exposure to tobacco advertising was negatively associated with both unassisted quit attempts and success. By contrast, exposure to anti-tobacco information was positively associated with unassisted quit attempts while household and workplace smoking restrictions were negatively associated with unassisted attempts to quit. Most attempts to quit smoking among Chinese males are unassisted. Unassisted attempts to quit smoking and success rates are highly influenced by the presence of environmental smoking restrictions, tobacco advertising, and exposure to anti-tobacco information. Smoking cessation programs and policies in China need to pay greater attention to the social and cultural norms, which perpetuate high levels of smoking.

Systematic bias between blinded independent central review and local assessment: literature review and analyses of 76 phase III randomised controlled trials in 45 688 patients with advanced solid tumour.

OBJECTIVE: Unbiased assessment of tumour response is crucial in randomised controlled trials (RCTs). Blinded independent central review is usually used as a supplemental or monitor to local assessment but is costly. The aim of this study is to investigate whether systematic bias existed in RCTs by comparing the treatment effects of efficacy endpoints between central and local assessments. DESIGN: Literature review, pooling analysis and correlation analysis. DATA SOURCES: PubMed, from 1 January 2010 to 30 June 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Eligible articles are phase III RCTs comparing anticancer agents for advanced solid tumours. Additionally, the articles should report objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) or time to progression (TTP); the treatment effect of these endpoints, OR or HR, should be based on central and local assessments. RESULTS: Of 76 included trials involving 45 688 patients, 17 (22%) trials reported their endpoints with statistically inconsistent inferences (p value lower/higher than the probability of type I error) between central and local assessments; among them, 9 (53%) trials had statistically significant inference based on central assessment. Pooling analysis presented no systematic bias when comparing treatment effects of both assessments (ORR: OR=1.02 (95% CI 0.97 to 1.07), p=0.42, I2=0%; DCR: OR=0.97 (95% CI 0.92 to 1.03), p=0.32, I2=0%); PFS: HR=1.01 (95% CI 0.99 to 1.02), p=0.32, I2=0%; TTP: HR=1.04 (95% CI 0.95 to 1.14), p=0.37, I2=0%), regardless of funding source, mask, region, tumour type, study design, number of enrolled patients, response assessment criteria, primary endpoint and trials with statistically consistent/inconsistent inferences. Correlation analysis also presented no sign of systematic bias between central and local assessments (ORR, DCR, PFS: r>0.90, p<0.01; TTP: r=0.90, p=0.29). CONCLUSIONS: No systematic bias could be found between local and central assessments in phase III RCTs on solid tumours. However, statistically inconsistent inferences could be made in many trials between both assessments.