Coordinated activity of a central pathway drives associative opioid analgesic tolerance.

Opioid analgesic tolerance, a root cause of opioid overdose and misuse, can develop through an associative learning. Despite intensive research, the locus and central pathway subserving the associative opioid analgesic tolerance (AOAT) remains unclear. Using a combination of chemo/optogenetic manipulation with calcium imaging and slice physiology, here we identify neuronal ensembles in a hierarchically organized pathway essential for AOAT. The association of morphine-induced analgesia with an environmental condition drives glutamatergic signaling from ventral hippocampus (vHPC) to dorsomedial prefrontal cortex (dmPFC) cholecystokininergic (CCKergic) neurons. Excitation of CCKergic neurons, which project and release CCK to basolateral amygdala (BLA) glutamatergic neurons, relays AOAT signal through inhibition of BLA µ-opioid receptor function, thereby leading to further loss of morphine analgesic efficacy. This work provides evidence for a circuit across different brain regions distinct for opioid analgesic tolerance. The components of this pathway are potential targets to treat opioid overdose and abuse.

Acetaminophen degradation in aqueous solution by the UV-LED-EC/Cl2 process.

In this study, electrochemically generated free chlorine (EC/Cl2) was activated by UV irradiation with a light emitting diode (LED) lamp at 275 nm to degrade acetaminophen (AAP, 2 µM) in aqueous solution. The potential at a RuO2-IrO2/Ti plate anode was set at 1.5 V vs. the Ag/AgCl electrode. Chlorine was in situ generated in the presence of Cl at the anode and then it was transformed into various active species such as OH and reactive chlorine species (RCS) under UV-LED irradiation. The degradation of AAP was investigated using batch tests, evaluating the influence of different experimental conditions such as NaCl concentration, phosphate buffer saline concentration, irradiation time and solution pH, keeping constant the UV-LED power and temperature. Results show that AAP could be completely degraded by the hybrid process with a high mineralization ratio (73%), and the degradation process followed a pseudo-first-order kinetics. The value of the Electric Energy per Order (EEO) = 1.272 kWh m3 order?, which is lower than the energy consumption of some other UV-based processes for AAP degradation. Adding 1 mM HCO3 ions slightly decreased the rate of AAP degradation. Luminescent bacteria experiment revealed that the acute toxicity of the reacted solution could be greatly reduced and the ecological risk was effectively abated. The scavenging assay shows that RCS plays a key role in the AAP degradation. The intermediate products were identified, and possible degradation routes were proposed. The system can advantageously replace conventional UV mercury lamp based ones in the degradation of microorganic pollutants.

Large-scale screening and characterization of Cd accumulation and ultrastructural deformation in duckweed.

Cadmium (Cd) pollution in soil, rivers and lakes is a serious problem due to the current industrialization and urbanization in China. Duckweeds are recognized as promising species for Cd phytoremediation. However, intraspecific variations in Cd accumulation in duckweeds remain largely unknown. In this study, 16 accessions selected from 39 geographically isolated duckweed strains were chosen to investigate their Cd remediation abilities. The optimal accession Landoltia punctata named 07SGZP01 (L. punctata 0701) was identified and shown to accumulate maximal Cd in the body while maintaining the highest biomass. The dominant variety treated with different Cd concentrations showed that the biomass of L. punctata 0701 was significantly lower than that of the control group (CK). Cd contents in L. punctata 0701 were substantially increased from 2511.1 to 30,641.01 mg kg-1 with an increase in Cd treatment levels from 0.3 to 20 mg L-1. The transport coefficient (TF) increased as Cd levels increased from 0.3 to 2 mg L-1. In addition, the Cd content in leaves was greater than that in roots (TF > 1) within this Cd concentration range, whereas the Cd content in roots was greater than that in leaves (TF < 1) when the concentration of the Cd treatment was greater than 5 mg L-1. The bioaccumulation factor (BCF) decreased significantly with increasing Cd levels (P < 0.05). The rate of Cd removal in the solution gradually decreased with increasing Cd concentrations, and the removal rate achieved the highest value (75%) when the Cd concentration was 0.5 mg L-1. In addition, Cd treatment (2 mg L-1) not only damaged the ultrastructure of L. punctata 0701, as characterized by chloroplast deformation and cell vacuolation but also caused most of the stomata to close, and the leaf epidermal cells were damaged and ruptured.

The relationship between the degree of brain edema regression and changes in cognitive function in patients with recurrent glioma treated with bevacizumab and temozolomide.

BACKGROUND: This retrospective study aims to assess the impacts on cognitive status and quality of life in recurrent high-grade glioma patients treated with temozolomide (TMZ), either alone or in combination with bevacizumab (BEV), and explore the relationship between the brain edema regression, BEV use, and cognitive status. METHODS: A total of 125 patients with recurrent high-grade glioma were enrolled in this study, of which 65 patients were treated with BEV (5-10 mg/kg IV every 2 weeks) plus TMZ (200 mg/m2 every 28 days, d1-5), and 60 patients were treated with TMZ (200 mg/m2 every 28 days, d1-5) alone. The treatment response was evaluated using the Response Assessment in Neuro-Oncology (RANO) criteria. Tumor-associated edema was evaluated with T2WI magnetic resonance imaging (MRI) and quantitative T2 mapping sequence, and an Edema Regression Index was designed to quantify volumetric changes in edema imaging after every treatment cycle. Cognitive intelligence state and quality of life were evaluated using the Mini-Mental State Examination (MMSE) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30). RESULTS: Radiologically, the partial response rate was 78.5% in the BEV + TMZ group and 38.3% in the TMZ group. After the first cycle of treatment, the mean score of the MMSE was 21.1±2.0 and 24.1±1.4 (P<0.001) in the TMZ group and the BEV + TMZ group, respectively. In the functioning domains of the QLQ-C30, scales of physical functioning, emotional functioning and cognitive functioning were 43.0±7.0 vs. 61.7±12.5 (P<0.001), 44.5±8.8 vs. 63.4±6.9 (P<0.001) and 42.4±8.8 vs. 63.7±12.0 (P<0.001) in the TMZ group and the BEV + TMZ group, respectively. In the BEV + TMZ group, a correlation between the Edema Regression Index and improvement in cognitive status and quality of life was observed. Patients with Edema Regression Index scores higher than 50% gained a 25.6% increase in the mean MMSE score from 19.9±1.6 to 25.0±1.1 (P<0.001). In the BEV + TMZ group, physical functioning, emotional functioning, and cognitive functioning increased by 76.8%, 53.1%, and 81.5%, respectively, while scores of nausea/vomiting decreased by 40.3% to 32.1. Patients with no evident edema observed in the pre-BEV MRI scans were given a prolonged four-cycle course of BEV. No significant improvement was observed in the MMSE score and the QLQ score with additional cycles of BEV. CONCLUSIONS: A close relationship was observed between Edema Regression Index and a change in cognitive function in patients treated with BEV and TMZ. Compared with TMZ alone, the combination of TMZ and BEV could improve the cognitive function and quality of life of patients with recurrent high-grade gliomas. The Edema Regression Index could be used as a surrogate imaging biomarker to predict patients who may or may not gain cognitive benefit from the combination therapy of TMZ and BEV, which warrants further prospective clinical studies for validation.

Distribution, source identification, and health risk assessment of heavy metals in the soil-rice system of a farmland protection area in Hubei Province, Central China.

Heavy metal contamination in farmland soil is of great concern due to the threat to food security arising from the bioaccumulation of heavy metals in crops planted in contaminated soil, such as rice, corn, and vegetables. Cd is the main contaminant in both paddy soils and rice. The purpose of this study was to reveal the spatial distribution of 8 heavy metals (Cd, Cr, Ni, Cu, Pb, Zn, As, and Hg) in the farmland protection areas in northwestern Hubei Province and to evaluate their pollution status, sources, and health risks. The total amounts of these 8 heavy metal elements in the samples were measured, and the health risk posed by their accumulation in rice was evaluated using the health risk evaluation model recommended by the US Environmental Protection Agency (US EPA). The mean contents of Cd, Ni, Cu, Zn, Hg, and As in soil exceeded the background levels (0.17, 37.3, 30.7, 83.6, 0.077, and 12.3 mg kg-1, respectively) of Hubei Province, and Cd showed the highest enrichment coefficient. The concentration of Cd in 89.1% of samples exceeded the limit values stipulated in the Soil Environmental Quality Risk Control Standard for Soil Contamination of Agricultural Land (Trial) (GB15618-2018). The contents of heavy metals showed dissimilar geographical distribution patterns. The principal component analysis (PCA) results indicated that Cd, Zn, Ni, As, and Cu mainly originated from the application of pesticides and fertilizers; Cr mainly originated from soil texture and pedogenesis; exhaust gas generated during transportation was the point pollution source of Pb; livestock wastewater, manure irrigation, and atmospheric deposition were the main pollution source of Hg. The contents of Ni and Cd in 52.2% and 58.7% of the rice samples, respectively, exceeded the limit values stipulated in the Food Safety National Standards for Contaminants in Foods (GB2762-2017), and the average effective Cd content accounted for 81.9% of the total Cd. The average bioconcentration factor of each heavy metal in rice followed the order Cd >Zn >Hg >As >Ni >Cr >Pb. Cd and As were the main noncarcinogenic contributing factors, accounting for 80.8% of the total noncarcinogenic risk. The carcinogenic risk indexes of Cd, As, and Cr exceeded the risk index threshold of 10-4, indicating a carcinogenic risk to the human body. The highest risks to local residents from heavy metals were found in rice. Cd and As were the main noncarcinogenic and carcinogenic factors and should receive greater attention in risk decision management.

Effects of organic selenium on absorption and bioaccessibility of arsenic in radish under arsenic stress.

Arsenic (As) exposure poses a serious threat to human health. The present study investigated the effects of organic Se on As accumulation, migration, and As bioaccessibility in As-stressed radish. The results showed that organic Se can effectively block the accumulation of As in radish, reduce As bioaccessibility, and promote the conversion of As from inorganic to organic form. The total As content decreased with increasing Se application in raw radish roots, the gastric fraction and the gastrointestinal fraction. Compared to the control (CK) group, the As bioaccessibility in the 24Se treatment of the yeast Se and malt Se groups decreased by 26% and 37%, respectively. These findings provide new comprehensive information for the application of organic Se to alleviate the toxicological effects of As and reduce the health risks of As in edible plants. In the future, it is necessary to carry out a deeper study of the interaction between Se and As through advanced analytical methods.

Chemical forms governing Cd tolerance and detoxification in duckweed (Landoltia punctata).

Duckweed (Landoltia punctata) is an ideal species to restore cadmium (Cd)-polluted waters due to its fast growth and easy harvesting. To understand its tolerance and detoxification mechanism, the Cd stress responses, subcellular Cd distribution and chemically bound Cd forms (especially protein-bound Cd) were surveyed in this study. L. punctata, a potential Cd bioremediation plant, was cultured hydroponically with Cd concentrations of 0.0, 0.5, 2.0, and 5.0 mg L-1 for 5 days. The results showed that the Cd content in L. punctata increased significantly as the Cd content increased. The majority of Cd was localized in the soluble fraction (23-55%) and the cell wall fraction (21-54%), and only 14-23% of Cd was located in cell organelles. Analysis of the Cd chemical forms demonstrated that the largest portion of Cd was found in 1 M NaCl extracts, followed by d-H2O and 2% HAc extracts, indicating that Cd was mainly bound to different proteins. Albumin- and globulin-bound Cd forms were predominant, together accounting for over 80% of the total protein-bound Cd in L. punctata. These results indicate that cell wall immobilization and vacuolar dissociation of Cd are possible primary strategies for Cd biosorption and detoxification in L. punctata, which occur mainly through chemical forms changes, especially the binding of Cd to proteins.

Machine Learning Based on a Multiparametric and Multiregional Radiomics Signature Predicts Radiotherapeutic Response in Patients with Glioblastoma.

METHODS: The MRI images, genetic data, and clinical data of 152 patients with GBM were analyzed. 122 patients from the TCIA dataset (training set: n = 82; validation set: n = 40) and 30 patients from local hospitals were used as an independent test dataset. Radiomics features were extracted from multiple regions of multiparameter MRI. Kaplan-Meier survival analysis was used to verify the ability of the imaging signature to predict the response of GBM patients to radiotherapy before an operation. Multivariate Cox regression including radiomics signature and preoperative clinical risk factors was used to further improve the ability to predict the overall survival (OS) of individual GBM patients, which was presented in the form of a nomogram. RESULTS: The radiomics signature was built by eight selected features. The C-index of the radiomics signature in the TCIA and independent test cohorts was 0.703 (P < 0.001) and 0.757 (P = 0.001), respectively. Multivariate Cox regression analysis confirmed that the radiomics signature (HR: 0.290, P < 0.001), age (HR: 1.023, P = 0.01), and KPS (HR: 0.968, P < 0.001) were independent risk factors for OS in GBM patients before surgery. When the radiomics signature and preoperative clinical risk factors were combined, the radiomics nomogram further improved the performance of OS prediction in individual patients (C-index = 0.764 and 0.758 in the TCIA and test cohorts, respectively). CONCLUSION: This study developed a radiomics signature that can predict the response of individual GBM patients to radiotherapy and may be a new supplement for precise GBM radiotherapy.

Effects of selenium on antioxidant enzyme activity and bioaccessibility of arsenic in arsenic-stressed radish.

Consuming arsenic (As)-contaminated vegetables is the main route of As exposure in humans. The present study focused on the alterations in antioxidant enzymatic activities and As bioaccessibility in As-contaminated radish subjected to Se. Compared to the CK group, the total As content in raw radish was reduced by 27.5 ± 1.3%, and the bioaccessibility of As was reduced by 21.9 ± 2.3% in the 6 mg Se kg-1 treatment group. The total As content in the treatment groups decreased first but then increased with increasing Se application in raw radish, gastric (G) fraction and gastrointestinal (GI) fraction, while the antioxidant activity exhibited the opposite trend. The results revealed that a low amount of Se effectively blocks the accumulation of As in radish, improves the antioxidant activity in radish and reduces the bioaccessibility of As. These findings provide new ideas for effectively alleviating the spread of As to the human body through the food chain.

[Measurements of Bacterial Community and Biodiversity from Activated Sludge for a Wastewater Treatment Containing Starch].

This study analyzes the microbial community and diversity composition of activated sludge in anoxic/oxic (A/O) treatment systems at different operation stages using Illumina MiSeq high-throughput sequencing to investigate the microbial community structure and diversity in activated sludge for starch wastewater treatment. The experimental results showed that the microbial community structure of activated sludge for starch production wastewater treatment in A/O systems was quite stable under the same wastewater condition, and that the dominant bacteria of the activated sludge were Proteobacteria, Bacteroidetes, Chloroflexi, Firmicutes, and Actinobacteria. The most important dominant bacterial group was Proteobacteria (45.66%-66.30%), of which γ-subclass bacteria were the main member and occupied 36.38%-66.65%. The proportion of Sphingobacteria, the main member of the Bacteroidetes, decreased when the sludge settling performance was better, but the proportion of Anaerolineae, the main member of Chloroflexi, increased significantly when the sludge sedimentation performance was better. These changes may have been closely related to the behavior of sludge settleability. There were a large number of functional bacteria in the activated sludge, which played an important role in the degradation of pollutants and in nitrogen and/or phosphorus removal.

Correlations between slow pyrolysis characteristics and organic carbon structure of aquatic plant biomass.

Thermal analysis techniques have been widely used to characterize natural organic matter; in particular, thermal oxidation has been used to examine soil and sediment organic matter. However, few studies have characterized natural organic matter (NOM) by using slow thermal degradation under a N2 atmosphere. 13C nuclear magnetic resonance (NMR) spectroscopy, UV-Vis spectroscopy, and three-dimensional excitation and emission matrix (EEM) fluorescence spectroscopy were used to characterize aquatic plant biomass for the detailed interpretation of the structures of organic carbon during slow pyrolysis. There was a significant linear correlation between the absorption of heat (99-110 °C) and the loss of mass (110-160 °C) (r2 = 0.507, p = 0.01), which indicates that the initial slight loss in mass of the plant materials was due to the loss of less thermally stable components. The release of heat (277-311 °C) and the ratio of the specific absorbances at 253 and 203 nm (A253/203) were also correlated (r2 = 0.388, p = 0.008), which suggests that the release of plant biomass upon heating was associated with the proportion of substituent groups on aromatic rings and that the release of heat increased with the amount of substitution. The coefficient of determination (r2) between fulvic acid-like fluorescence peaks and the loss of mass (230-340 °C) was 0.236 (p = 0.048). This result indicates that the loss of mass in the plant material samples was related to fulvic acid-like substances. More specifically, the reason for this result was the splitting of some aromatic functional groups, such as ether bonds, carbonyl groups, and oxygen heterocycles. In conclusion, these results suggest that the developed correlations between slow pyrolysis characteristics and organic carbon structures contribute to the investigation of the inner chemical structures of natural organic matter.

Assessing bioaccessibility of Se and I in dual biofortified radish seedlings using simulated in vitro digestion.

Selenium (Se) and iodine (I) are essential elements for humans, and biofortification of vegetables with these elements is an effective way to amend their deficiencies in the diet. In this study, the distribution and transformation of Se and I species were investigated in radish seedlings that were simultaneously supplemented with these two elements; the fate and the bioaccessibility of Se and I species were dynamically surveyed in the oral, gastric and intestinal phases using a simulated in vitro digestion method. The radish seedlings were cultivated in hydroponic conditions with Se (IV), Se (VI), I- and IO3- (each 1 mg L-1). The results revealed that Se-methylselenocysteine (MeSeCys), selenocystine (SeCys2), selenomethionine (SeMet) and Se (VI) were present in radish, and MeSeCys was the dominant species in both gastric and intestinal extracts, comprising 32.7 ±â€¯1.5% and 39.6 ±â€¯1.1% of the total content, respectively. I- was also the dominant species, which accounted for 57.1 ±â€¯2.1%, 46.6 ±â€¯1.5% and 68.8 ±â€¯1.8% of the total digested content respectively in the oral, gastric and intestinal extracts. Meanwhile, IO3- was absent and organic I accounted for approximately 20%. The bioaccessibility of Se and I in the intestinal phase reached 95.5 ±â€¯2.5% and 85.8 ±â€¯0.9%, respectively; although after dialysis through membranes, the data reduced to 60.1 ±â€¯2.8% and 39.6 ±â€¯0.8%, respectively. Contents of MeSeCys and I- increased from the oral to intestinal phase and the bioaccessibility of both Se and I in radish was above 85%. So radish is suitable as a potential dietary source of Se and I with biofortification.

Combination of Pre-Treatment DWI-Signal Intensity and S-1 Treatment: A Predictor of Survival in Patients with Locally Advanced Pancreatic Cancer Receiving Stereotactic Body Radiation Therapy and Sequential S-1.

OBJECTIVE: To identify whether the combination of pre-treatment radiological and clinical factors can predict the overall survival (OS) in patients with locally advanced pancreatic cancer (LAPC) treated with stereotactic body radiation and sequential S-1 (a prodrug of 5-FU combined with two modulators) therapy with improved accuracy compared with that of established clinical and radiologic risk models. METHODS: Patients admitted with LAPC underwent diffusion weighted imaging (DWI) scan at 3.0-T (b = 600 s/mm2). The mean signal intensity (SIb = 600) of region-of-interest (ROI) was measured. The Log-rank test was done for tumor location, biliary stent, S-1, and other treatments and the Cox regression analysis was done to identify independent prognostic factors for OS. Prediction error curves (PEC) were used to assess potential errors in prediction of survival. The accuracy of prediction was evaluated by Integrated Brier Score (IBS) and C index. RESULTS: 41 patients were included in this study. The median OS was 11.7 months (2.8-23.23 months). The 1-year OS was 46%. Multivariate analysis showed that pre-treatment SIb = 600 value and administration of S-1 were independent predictors for OS. The performance of pre-treatment SIb = 600 and S-1 treatment in combination was better than that of SIb = 600 or S-1 treatment alone. CONCLUSION: The combination of pre-treatment SIb = 600 and S-1 treatment could predict the OS in patients with LAPC undergoing SBRT and sequential S-1 therapy with improved accuracy compared with that of established clinical and radiologic risk models.

18 F-Fluoromisonidazole positron emission tomography/CT-guided volumetric-modulated arc therapy-based dose escalation for hypoxic subvolume in nasopharyngeal carcinomas: A feasibility study.

BACKGROUND: The purpose of this study is to investigate the feasibility of a simultaneously integrated boost to the hypoxic subvolume of nasopharyngeal carcinomas (NCPs) under the guidance of 18 F-fluoromisonidazole (FMISO) positron emission tomography (PET)/CT using volumetric-modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) techniques. METHODS: Eight patients with NPC were treated with simultaneous integrated boost-IMRT (treatment plan named IMRT70) with dose prescriptions of 70 Gy, 66 Gy, 60 Gy, and 54 Gy to the gross tumor volume (GTV), positive neck nodes, the planning target volume (PTV), and the clinically negative neck, respectively. Based on the same datasets, experimental plans with the same dose prescription plus a dose boost of 14 Gy (an escalation of 20% of the prescription dose) to the hypoxic volume target contoured on the pretreatment 18 F-FMISO PET/CT imaging were generated using IMRT and VMAT techniques, respectively (represented by IMRT84 and VMAT84). Two or more arcs (approximately 2-2.5 arcs, totally rotating angle <1000 degrees) were used in VMAT plans and 9 equally separated fields in IMRT plans. Dosimetric parameters, total monitor units, and delivery time were calculated for comparative study of plan quality and delivery efficiency between IMRT84 and VMAT84. RESULTS: In experimental plans, hypoxic target volumes successfully received the prescribed dose of 84 Gy in compliance with other dose constraints with either the IMRT technique or the VMAT technique. In terms of the target coverage, dose homogeneity, and organs at risk (OAR) sparing, there was no statistically significant difference between the actual treatment plan of IMRT70 and experimental plans. The total monitor unit of VMAT84 (525.7 ± 39.8) was significantly less than IMRT70 (1171.5 ± 167; P = .001) and IMRT84 (1388.3 ± 151.0; P = .001) per fraction, with 55.1% and 62.1% reduction. The average machine delivery time was 3.5 minutes for VMAT plans in comparison with approximately 8 minutes for IMRT plans, resulting in a reduction factor of 56.2%. For experimental plans, the 3D gamma index average was over 98.0% with no statistical significant difference when a 3%/3 mm gamma passing rate criteria was used. CONCLUSION: With the guidance of 18 F-FMISO PET/CT imaging, dose escalation to hypoxic zones within NPC could be achieved and delivered efficiently with the VMAT technique in comparison with the IMRT technique.

[Efficacy of MVP chemotherapy combined with concurrent radiotherapy for advanced non-small cell lung cancer].

BACKGROUND: To observe the effects of MVP chemotherapy combined with concurrent radiotherapy for stage IIIB-IV non-small cell lung cancer. METHODS: Sixty-two patients with stage IIIB-IV non-small cell lung cancer were randomized into two groups, concurrent radiochemotherapy group and MVP che-motherapy group. All patients in two groups were treated with MVP regimen (mitomycin C 6 mg/m² on day 1, vindesine 2 mg/m² on days 1, 8, and cisplatin 80-100 mg/m²). Patients in concurrent radiochemotherapy group received concurrent radiotherapy (46-56 Gy in 5-6 weeks). RESULTS: All patients received 2-4 cycles of MVP chemotherapy. The response rate was 48.4% and 19.4% in concurrent radiochemotherapy group and MVP group respectively (P < 0.05), the 1-year survival rate was 54.8% and 22.6% respectively (P < 0.05), median time to progression was 8 months and 4 months respectively (P < 0.05), and median survival duration was 10 months and 6 months respectively (P < 0.05). Incidence of grade II-III leukopenia in concurrent radiochemotherapy group was remarkably higher than those in MVP group.. CONCLUSIONS: The results show that efficacy of MVP chemotherapy combined with concurrent radiotherapy is significantly higher than that of MVP chemotherapy alone for advanced non-small cell lung cancer.

Changing knowledge, behavior, and practice related to universal precautions among hospital nurses in China.

PURPOSE: To evaluate the effect of an educational training program for hospital nurses on universal precautions in Changsha, Hunan Province, People's Republic of China. METHOD: Using a quasi-experimental design, 50 of 100 randomly selected hospital nurses were randomly assigned to receive an educational intervention. Questionnaires were administered to the 100 nurses prior to and 4 months after the training. FINDINGS: Knowledge, practice, and behaviors related to universal precautions and the prevalence of hepatitis B immunization improved among nurses in the group who received training. No significant change in the frequency of glove use was found. Underreporting of sharps injuries to hospital authorities continued in both groups. CONCLUSION: Although educational training significantly improved Chinese nurses' knowledge, practice, and behavior related to universal precautions, there remains room for improvement in glove use and needlestick injury reporting.