Exploring sleep characteristics in Chinese patients with narcolepsy: insights from the nocturnal sleep onset rapid eye movement period (nSOREMP).

STUDY OBJECTIVES: This study aims to investigate the unique characteristics and clinical significance of the nocturnal sleep onset rapid eye movement period (nSOREMP) in the Chinese population with narcolepsy, enhancing our understanding and management of the disorder globally. METHODS: This retrospective analysis investigated narcolepsy in Chinese patients from six hospitals, using International Classification of Sleep Disorders. A parallel retrospective analysis of the Chinese Clinical Sleep Database (CCSD) focused on polysomnography (PSG) records was conducted to evaluate nSOREMP prevalence in other sleep disorders. RESULTS: The study found a 2.51% nSOREMP prevalence in other sleep disorders of CCSD. Significant differences in age, N2 and rapid eye movement (REM) percentages, REM latency, and various indexes were noted among narcolepsy with/without nSOREMP, and other sleep disorders with nSOREMP of CCSD. nSOREMP prevalence in NT1 was 33.33% and in NT2, 28.30%. Noteworthy disparities in NT1 included N2 percentages, REM latency, and SOREMPs in Multiple Sleep Latency Test (MSLT). In NT2, differences were significant in age, sleep latency, N2 and REM latencies, arousal index, mean sleep latency in MSLT, and MSLT SOREMPs. CONCLUSIONS: This study highlights the distinct characteristics of nSOREMP in the Chinese population. Patients exhibiting symptoms suggestive of the onset of narcolepsy are advised to undergo an MSLT, irrespective of the occurrence of SOREMP during nocturnal PSG.

The Chinese Clinical Sleep Database: An Innovative Database System Includes Large-Scale Clinical Data of Chinese Population.

Purpose: In this study, we established the Chinese Clinical Sleep Database (CCSD), aiming to provide a safe, scalable, and user-friendly database that includes high-quality clinical data from Chinese population to facilitate sleep research. Material and Methods: We collect individual's demographic data, scales, anthropometric measurements, clinical diagnosis, and polysomnography (PSG) recordings from the routine medical process of sleep medicine centers using standardized procedures. The distributed cluster storage technology are utilized to store these data. The structured data are stored in a high-performance MySQL database, while the unstructured data are stored in an object storage service. And we have developed an online data platform to share and manage our data. Results: The data collection has been conducted in three hospitals. In the preliminary stage of data collection (from October 18, 2022 to September 4, 2023), our database included a total of 1183 patients. Among them, 56.8% were male and their ages ranged from 3 to 88 years. These patients were diagnosed with various types of sleep disorders. Conclusion: Since the CCSD's inception, it has demonstrated good stability, security, and scalability. As an public database, the CCSD also exhibits user-friendliness. The CCSD contains comprehensive clinical data, which can contribute to the advancement of the diagnosis and treatment strategies for sleep disorders, ultimately promoting sleep health.

Development of a super-hydrophilic anaerobic tube for the optimization of platelet-rich fibrin.

Horizontal platelet-rich fibrin (H-PRF) contains a variety of bioactive growth factors and cytokines that play a key role in the process of tissue healing and regeneration. The blood collection tubes used to produce Solid-PRF (plasmatrix (PM) tubes) have previously been shown to have a great impact on the morphology, strength and composition of the final H-PRF clot. Therefore, modification to PM tubes is an important step toward the future optimization of PRF. To this end, we innovatively modified the inner wall surface of the PM tubes with plasma and adjusted the gas environment inside the PM tubes to prepare super-hydrophilic anaerobic plasmatrix tubes (SHAP tubes). It was made anaerobic for the preparation of H-PRF with the aim of improving mechanical strength and bioactivity. The findings demonstrated that an anaerobic environment stimulated platelet activation within the PRF tubes. After compression, the prepared H-PRF membrane formed a fibrous cross-linked network with high fracture strength, ideal degradation characteristics, in addition to a significant increase in size. Thereafter, the H-PRF membranes prepared by the SHAP tubes significantly promoted collagen synthesis of gingival fibroblast and the mineralization of osteoblasts while maintaining excellent biocompatibility, and advantageous antibacterial properties. In conclusion, the newly modified PRF tubes had better platelet activation properties leading to better mechanical strength, a longer degradation period, and better regenerative properties in oral cell types including gingival fibroblast and alveolar osteoblasts. It also improves the success rate of H-PRF preparation in patients with coagulation dysfunction and expands the clinical application scenario.

Why was the study done?   Direct anaerobic environment effects on fibrin formation have been insufficiently studied.The effect of hydrophilic change caused by nitrogen plasma treatment on H-PRF coagulation has not been fully studied.Optimal preparation of H-PRF in patients with poor coagulation function was needed in clinical application.What is new?  The coagulation of H-PRF correlated with the level of dissolved oxygen concentrations. Anaerobic environment significantly accelerates fibrin formation and platelet activation.Nitrogen plasma treatment can remarkably enhance the hydrophilicity of the inner surface of glass blood collecting tubes, thereby promoting the activation of platelets and the formation of fibrin network.The H-PRF prepared in the tubes with anaerobic environment and hydrophilic surface showed high fracture strength, promoted collagen synthesis of gingival fibroblast and the mineralization of osteoblasts.What is the impact?  The work is aimed at developing super-hydrophilic anaerobic plasmatrix tubes (SHAP tubes) for studying gas environment and hydrophilicity participation in fibrin formation in H-PRF preparation and investigating the influence of platelet activation in the anaerobic environment.This study provides a successful trial to convert the physiological process into biotechnological application. The SHAP tubes proposed within this article was an effective versatile H-PRF preparation device, which provided a promising alternative for tissue engineering.

Liquid platelet-rich fibrin produced via horizontal centrifugation decreases the inflammatory response and promotes chondrocyte regeneration in vitro.

Objective: Recently, liquid platelet-rich fibrin (PRF), a rich source of concentrated platelets and growth factors, has emerged as a promising agent for stimulating tissue regeneration. However, its specific efficacy in chondrocyte proliferation and cartilage regeneration remains underexplored. To address this question, we investigated liquid PRF obtained through horizontal centrifugation and compared its effects with hyaluronic acid (HA), a high molecular weight glucosamine supplement widely used in clinical practice to safeguard against chondral damage. Materials and Methods: Liquid PRF, produced using horizontal centrifugation (liquid H-PRF) at 500 g for 8 min, served as our experimental agent. We conducted cell viability and proliferation assays using PRF-conditioned medium. We assessed the chondrocyte phenotype of ATDC5 cells through toluidine blue and alcian blue staining, real-time polymerase chain reaction (RT-PCR), Western blotting, and immunofluorescence staining. Furthermore, we examined the expression of genes involved in inflammation through RT-PCR and Western blot analysis. Results: Liquid H-PRF exerted notable effects on chondrocytes, influencing proliferation, inflammatory responses, and chondrogenic differentiation. The H-PRF group displayed significantly higher expression of chondrogenic markers, including Col2a1, compared to HA-treated cells, whereas aggrecan expression was significantly higher in the HA group. PRF also demonstrated the ability to reduce inflammatory levels in chondrogenic ATDC5 cells, and this effect was further enhanced when PRF from the buffy coat zone was added. In comparison, chondrocytes cultured in the HA group produced significantly fewer inflammatory factors than those in the PRF group, as confirmed qualitatively by Western blot analysis. Conclusion: Liquid H-PRF emerged as a potent stimulator for chondrogenesis and a regulator of the inflammatory response, achieving levels similar to HA. Moreover, liquid H-PRF exhibited strong potential for enhancing the production of cartilage extracellular matrix and promoting chondrogenic regeneration with notably increased Col2a1 levels. Future research should encompass animal studies and human trials to further evaluate the comparative effectiveness of liquid PRF versus HA, potentially as an alternative or complementary strategy for future clinical applications.

Enhancing Bone Regeneration through CDC20-Loaded ZIF-8 Nanoparticles Wrapped in Erythrocyte Membranes with Targeting Aptamer.

In the context of bone regeneration, nanoparticles harboring osteogenic factors have emerged as pivotal agents for modulating the differentiation fate of stem cells. However, persistent challenges surrounding biocompatibility, loading efficiency, and precise targeting ability warrant innovative solution. In this study, a novel nanoparticle platform founded upon the zeolitic imidazolate framework-8 (ZIF-8) is introduced. This new design, CDC20@ZIF-8@eM-Apt, involves the envelopment of ZIF-8 within an erythrocyte membrane (eM) cloak, and is coupled with a targeting aptamer. ZIF-8, distinguished by its porosity, biocompatibility, and robust cargo transport capabilities, constitutes the core framework. Cell division cycle protein 20 homolog (CDC20) is illuminated as a new target in bone regeneration. The eM plays a dual role in maintaining nanoparticle stability and facilitating fusion with target cell membranes, while the aptamer orchestrates the specific recruitment of bone marrow mesenchymal stem cells (BMSCs) within bone defect sites. Significantly, CDC20@ZIF-8@eM-Apt amplifies osteogenic differentiation of BMSCs via the inhibition of NF-κB p65, and concurrently catalyzes bone regeneration in two bone defect models. Consequently, CDC20@ZIF-8@eM-Apt introduces a pioneering strategy for tackling bone defects and associated maladies, opening novel avenues in therapeutic intervention.

Mitochondrial Transfer Regulates Cell Fate Through Metabolic Remodeling in Osteoporosis.

Mitochondria are the powerhouse of eukaryotic cells, which regulate cell metabolism and differentiation. Recently, mitochondrial transfer between cells has been shown to direct recipient cell fate. However, it is unclear whether mitochondria can translocate to stem cells and whether this transfer alters stem cell fate. Here, mesenchymal stem cell (MSC) regulation is examined by macrophages in the bone marrow environment. It is found that macrophages promote osteogenic differentiation of MSCs by delivering mitochondria to MSCs. However, under osteoporotic conditions, macrophages with altered phenotypes, and metabolic statuses release oxidatively damaged mitochondria. Increased mitochondrial transfer of M1-like macrophages to MSCs triggers a reactive oxygen species burst, which leads to metabolic remodeling. It is showed that abnormal metabolism in MSCs is caused by the abnormal succinate accumulation, which is a key factor in abnormal osteogenic differentiation. These results reveal that mitochondrial transfer from macrophages to MSCs allows metabolic crosstalk to regulate bone homeostasis. This mechanism identifies a potential target for the treatment of osteoporosis.

Low Surface Accessible Area NanoCoral TiO2 for the Reduction of Foreign Body Reaction During Implantation.

The entry of implants triggers the secretion of damage associated molecular patterns (DAMPs) that recruit dendritic cells (DCs) and results in subsequent foreign body reaction (FBR). Though several studies have illustrated that the surface accessible area (SAA) of implants plays a key role in the process of DAMPs release and absorption, the effect of SAA on the immune reaction still remains unknown. Here, a series of TiO2 plates with different SAA is fabricated to investigate the relationship between SAA and FBR. Compared with larger SAA surface, the aggregation of DC is significantly inhibited by lower SAA surface. Total internal reflection microscopy (TIRFM) and molecular dynamic (MD) simulation show that although high mobility group box 1 (HMGB1) is adsorbed more on plates with lower SAA, the exposure ratio of cysteine (CYS) residue in HMGB1 is significantly decreased in lower SAA group. The lower exposure of CYS reduces the activation of Toll-like receptors 4 (TLR4), which down-regulates the expression of myeloid differentiation factor (Myd88)-TNF receptor associated factor 6 (TRAF6) to inhibit nuclear factor kappa B (NF-κB) signaling. Generally, this study reveals the mechanism of how SAA, a nanoscale property, affects FBR from perspective of DAMPs, and provides a new direction for designing better biocompatible implants.

Integrating Ethics and Career Futures with Technical Learning to Promote AI Literacy for Middle School Students: An Exploratory Study.

The rapid expansion of artificial intelligence (AI) necessitates promoting AI education at the K-12 level. However, educating young learners to become AI literate citizens poses several challenges. The components of AI literacy are ill-defined and it is unclear to what extent middle school students can engage in learning about AI as a sociotechnical system with socio-political implications. In this paper we posit that students must learn three core domains of AI: technical concepts and processes, ethical and societal implications, and career futures in the AI era. This paper describes the design and implementation of the Developing AI Literacy (DAILy) workshop that aimed to integrate middle school students' learning of the three domains. We found that after the workshop, most students developed a general understanding of AI concepts and processes (e.g., supervised learning and logic systems). More importantly, they were able to identify bias, describe ways to mitigate bias in machine learning, and start to consider how AI may impact their future lives and careers. At exit, nearly half of the students explained AI as not just a technical subject, but one that has personal, career, and societal implications. Overall, this finding suggests that the approach of incorporating ethics and career futures into AI education is age appropriate and effective for developing AI literacy among middle school students. This study contributes to the field of AI Education by presenting a model of integrating ethics into the teaching of AI that is appropriate for middle school students.

The effect of resting and compression time post-centrifugation on the characteristics of platelet rich fibrin (PRF) membranes.

OBJECTIVE: To evaluate the effect of resting and compression time after centrifugation on the physical properties of platelet rich fibrin (PRF) membranes, and to provide optimal guidance regarding the clinical preparation of PRF. MATERIALS AND METHODS: A total of 12 volunteers enrolled in this study divided into 2 groups equally. For each volunteer, 6 tubes of 10 mL venous whole blood was drawn. To evaluate the influence of resting time after centrifugation, PRF clots were taken out 0, 1, 3, 5, 7, and 10 min from tubes following centrifugation, and then the weight, size, maximum stress, and maximum strain of each group were measured. To evaluate the influence of compression time on the preparation of PRF membranes, the weight ratio of PRF membranes to PRF clots was calculated by compression for 10 s, 30 s, 60 s, 90 s, 120 s, and 180 s, respectively. Scanning electron microscopy was performed to observe the cross-linking of the fibers within membranes, and the maximum stress and strain of PRF membranes were tested followed by stress-strain curve analysis. RESULTS: The weight and volume of PRF clots and PRF membranes increased in size and weight reached the top at 3 min, followed by a decrease after 7-min resting. The maximum strain of the PRF membranes after 10 min decreased significantly compared to the 3-min and 5-min groups. The maximum stress was found at 3 min followed by a statistical decrease when resting time went on. Scanning electron microscopy demonstrated that the internal fibrous structure of the PRF membranes was looser when the compression time was less than 60 s when comparing the 90-s group. The maximum stress of PRF membranes was shown using a wait period of 3 min post-centrifugation followed by compression for 120 s. CONCLUSION: The findings from the present study demonstrate that the time post-centrifugation of PRF membranes showed a maximum weight, volume, and mechanical properties after resting for 3-5 min in the tube post-centrifugation followed by a compression time of 120 s. CLINICAL RELEVANCE: Although research to date has focused primarily on centrifugation protocols, this study revealed for the first time that the resting time post-centrifugation greatly affected the mechanical properties of PRF. This study demonstrated that the resting and compression time after centrifugation influences the mechanical strength of PRF membranes, which might explain differences in PRF characteristics prepared by different clinicians that may provide a standard guide for preparation of PRF membranes.

Prevalence of dental caries and its association with body mass index among school-age children in Shenzhen, China.

BACKGROUND: Dental caries and overweight/obesity are health problems with shared risk factors, but the relationships between caries and BMI need to be further explored. The objective was to evaluate the current status of dental caries and the association between dental caries and Body Mass Index (BMI) among primary and secondary school students in Shenzhen, China, during the 2016-2017 academic year. METHODS: A population-based, cross-sectional study that enrolled a total of 1,196,004 students was conducted in Shenzhen. Physical and dental examinations were given to all primary and secondary school students by certified physicians and dentists following the national specification for student health examinations, and dental caries was diagnosed using WHO criteria. Descriptive analysis was applied to assess current oral health status and a multifactorial, logistic regression model was employed to evaluate the relationship between dental caries and obesity. RESULTS: A total of 1,196,004 students participated in the census. Mean age of the participants was 10.3 years, ranging from 6 to 20 years. The prevalence of dental caries was 41.15% in the present study, which was higher among girls (42.88%) than that in boys (39.77%) with a p-value of < 0.001. Students in public schools showed a significantly lower (p < 0.001) caries prevalence (37.36%) compared with those in private schools (47.96%). The caries restoration rate of students in Shenzhen was only 10.30%, which means only one out of ten students with caries received restorations. The mean dmft and DMFT scores were 0.97 and 0.33, respectively. More girls (10.96%) had their teeth filled than boys (9.78%). The restoration rate was higher (p < 0.001) in public schools (11.73%) than in private ones (8.35%). Children who were overweight or obese had a lower risk of experiencing caries compared to those who were within a normal weight (OR = 0.74/0.64). Caries was inversely associated with BMI among primary and secondary school students in Shenzhen. CONCLUSIONS: The prevalence of dental caries among primary and secondary school children was found to be related to sex, type of schools, region, and BMI. Further studies and more government support are required to confirm the findings of this study and to address current oral health problems.

Spinal phantom comparability study of Cobb angle measurement of scoliosis using digital radiographic imaging.

BACKGROUND: Computed radiography (CR), digital radiography (DR) and biplanar radiography (EOS™ imaging system) are common imaging tools for radiographic evaluation of adolescent idiopathic scoliosis (AIS). The effect of imaging methods in relation to later-on Cobb angle measurements on radiographs is not yet quantified. The study aimed to examine the compatibility between CR, DR and EOS for scoliotic quantification by evaluating the reliability, agreement of different imaging methods, and assessing the prediction performance for EOS measurement from that of CR and DR. METHOD: A flexible spine phantom was used to simulate 32 different scoliotic curves ranging from 10° to 60°. Each curvature was imaged using DR, CR and EOS systems accordingly. Each of the six observers independently measured Cobb angle twice on each image at a two-week interval. Intraclass correlation coefficient (model 2 and 3), Bland-Altman plot and linear regression analysis were completed to evaluate the reliability, agreement, and the prediction of Cobb angle measurement, respectively. RESULTS: Reliability analysis showed excellent intra-observer reliability (Intraclass correlation coefficient >0.9) for each observer and good inter-observer reliability (Intraclass correlation coefficient = 0.84 for EOS; 0.739 for CR; 0.877 for DR) for each method. Bland-Altman plots demonstrated good agreement between imaging methods without fixed or proportional bias. Excellent coefficient of determination was achieved, with 0.980 for CR versus EOS measurements, and 0.973 for DR versus EOS measurements. CONCLUSIONS: Radiographs produced by all of the three methods can provide reliable and accurate Cobb angle measurements for scoliosis assessments. None of the methods systemically underestimates or overestimates the Cobb angle measurement. Additionally, all of the evaluated methods are satisfactory in obtaining images for Cobb angle measurement in AIS. However, the 3D post-processing techniques offered by EOS should also be taken into consideration as it takes a vital role in treatment and monitoring of 3D deformity in the case of scoliosis. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: In view of the limited availability of biplanar radiography (EOS™ imaging system), computed radiography and digital radiography are demonstrated to be reliable alternatives in scoliosis monitoring as evident in the reliability, agreement and prediction of Cobb angle measurement.

Identification and trichothecene genotypes of Fusarium graminearum species complex from wheat in Taiwan.

BACKGROUND: Fusarium head blight (FHB) of wheat caused by Fusarium graminearum species complex (FGSC) is a devastating disease worldwide. The pathogens not only reduce the yield of wheat, but also impact the quality of wheat by contamination with trichothecene mycotoxins. A systematic investigation on the pathogens of FHB in Taiwan is lacking. Here, molecular and morphological approaches were used to identify species of the Taiwanese FGSC isolates and determine their trichothecene genotypes. RESULTS: In this study, a total of 195 isolates of FGSC from diseased wheat were collected from 8 areas of northern and central Taiwan. All isolates were subjected to seedling inoculation for verification of pathogenicity. The pathogenic isolates were genetically characterized by sequence characterized amplified region (SCAR), PCR- restriction fragment length polymorphism (RFLP), phylogenetic analysis and fixed nucleotides to clarify their phylogenetic species, and by PCR assays of TRI genes to determine trichothecene genotypes. They were identified as F. asiaticum, F. graminearum sensu stricto, F. meridionale and an unknown species. Isolates of F. asiaticum were the major causal agents (98%) in this investigated population and were comprised of SCAR type 5 (75%), SCAR type 4 (21%) and SCAR type 3 (2%). Their trichothecene genotypes were either 15-acetyl-deoxynivalenol (15-ADON) (83%) or nivalenol (NIV) genotype (17%). These genetic characterizations indicated that F. asiaticum (15-ADON SCAR type 5) accounts for 60% of this Taiwanese population. Virulence assay on wheat heads indicated virulence of F. asiaticum isolates in subpopulations divided by SCAR types or trichothecene genotypes were comparable, suggesting other factors influence the unequal subpopulation sizes. CONCLUSIONS: This is the first study that FGSC isolates in Taiwan were systematically collected and characterized. In addition to F. graminearum sensu stricto and F. meridionale, F. asiaticum with 15-ADON genotype was identified as the predominate species in Taiwan. In contrast to Chinese and Japanese populations that F. asiaticum isolates were typically of 3-ADON or NIV genotype, the predominate 15-ADON genotype in Taiwanese population was unique among F. asiaticum populations and represented the southernmost 15-ADON genotype population in East Asia.

Technical modification of retroperitoneal laparoscopic adrenalectomy for primary hyperaldosteronism and clinical outcomes.

BACKGROUND/OBJECTIVE: Standard laparoscopic adrenalectomy requires early control of the main adrenal vein; however, the small retroperitoneal working space is challenging for beginners to perform this maneuver. We report a technical modification of retroperitoneal laparoscopic adrenalectomy (RLA) for primary hyperaldosteronism (PHA) and the clinical outcomes. METHODS: A total of 38 RLAs were performed for the patients with PHA. The patients were placed in true lateral position with mild bending to expand the surgical field. Instead of attempting to control the main adrenal vein initially, we adopted a technical modification that manipulating and freeing the gland first before controlling the main adrenal vein. RESULTS: The RLAs were successfully performed in all but one case, which was converted to open surgery due to pancreatic injury. Mean operative time was 124 minutes and estimated blood loss was 74 ml. Mean maximal fluctuation of systolic blood pressure was 29 mmHg. For the right-side RLA, less operative time (113.5 vs. 137.9 minutes) and estimated blood loss (59.5 vs. 91.2 ml) were noted compared with the left-side procedure. Postoperative complications included cerebrovascular accident in one patient, one surgical site hematoma, and two patients had postoperative fever. Potassium level returned to normal in all patients and 70% of the patients reduced their antihypertensives. CONCLUSION: Technical modification RLA for PHA without initial control of the main adrenal vein is a safe and feasible procedure. No vigorous blood pressure fluctuation was intraoperatively noted. No vascular injury occurred. Moreover, the right-side procedure became easier.