OBJECTIVE: This study aimed to identify high-risk areas for type 2 diabetes mellitus (T2DM) mortality to provide relevant evidence for interventions in emerging economies. METHODS: Empirical Bayesian Kriging and a discrete Poisson space-time scan statistic were applied to identify the spatiotemporal clusters of T2DM mortality. The relationships between economic factors, air pollutants, and the mortality risk of T2DM were assessed using regression analysis and the Poisson Log-linear Model. RESULTS: A coastal district in East Guangdong, China, had the highest risk (Relative Risk [RR] = 4.58, P < 0.01), followed by the 10 coastal districts/counties in West Guangdong, China (RR = 2.88, P < 0.01). The coastal county in the Pearl River Delta, China (RR = 2.24, P < 0.01), had the third-highest risk. The remaining risk areas were two coastal counties in East Guangdong, 16 districts/counties in the Pearl River Delta, and two counties in North Guangdong, China. Mortality due to T2DM was associated with gross domestic product per capita (GDP per capita). In pilot assessments, T2DM mortality was significantly associated with carbon monoxide. CONCLUSION High mortality from T2DM occurred in the coastal areas of East and West Guangdong, especially where the economy was progressing towards the upper middle-income level.
Diabetes Mellitus, Type 2/epidemiology* ; China/epidemiology* ; Humans ; Risk Factors ; Spatio-Temporal Analysis ; Air Pollutants/analysis* ; Socioeconomic Factors ; Bayes Theorem ; Female ; Male ; Middle Aged

As artificial intelligence technology rapidly advances, its deployment within the medical sector presents substantial ethical challenges. Consequently, it becomes crucial to create a standardized, transparent, and secure framework for processing medical data. This includes setting the ethical boundaries for medical artificial intelligence and safeguarding both patient rights and data integrity. This consensus governs every facet of medical data handling through artificial intelligence, encompassing data gathering, processing, storage, transmission, utilization, and sharing. Its purpose is to ensure the management of medical data adheres to ethical standards and legal requirements, while safeguarding patient privacy and data security. Concurrently, the principles of compliance with the law, patient privacy respect, patient interest protection, and safety and reliability are underscored. Key issues such as informed consent, data usage, intellectual property protection, conflict of interest, and benefit sharing are examined in depth. The enactment of this expert consensus is intended to foster the profound integration and sustainable advancement of artificial intelligence within the medical domain, while simultaneously ensuring that artificial intelligence adheres strictly to the relevant ethical norms and legal frameworks during the processing of medical data.
Artificial Intelligence/legislation & jurisprudence* ; Humans ; Consensus ; Computer Security/standards* ; Confidentiality/ethics* ; Informed Consent/ethics*

Objective:To retrieve, evaluate and integrate the best evidence of home exercise rehabilitation for peritoneal dialysis patients, so as to provide basis for formulating home exercise rehabilitation plan for peritoneal dialysis patients.Methods:Evidence-based problems were constructed according to the PICO (population, intervention, control and outcome) principle. The home exercise rehabilitation guideline, expert consensus, evidence summary, systematic review, and randomized controlled trial of peritoneal dialysis patients were systematically searched in the evidence-based resource databases such as UpToDate, British Medical Journal (BMJ) Best Practice, Guidelines International Network, and in the comprehensive databases such as PubMed, Embase, and Web of Science. The retrieval time limit was from the establishment of the database to November 20, 2021. Two researchers with evidence-based knowledge independently evaluated the quality of the article and the level of evidence.Results:A total of 10 articles were included, including one evidence summary, one practical suggestion, one expert consensus, two systematic reviews, and five randomized controlled trials. A total of 24 best evidences were summarized from 8 aspects, including applicable population, starting time, exercise evaluation, exercise prescription formulation, exercise type, exercise frequency and duration, exercise intensity and exercise precautions.Conclusions:The best evidence of home exercise rehabilitation for peritoneal dialysis patients provides a certain evidence-based basis for the selection of home exercise rehabilitation programs for peritoneal dialysis patients.

Antifungal Agents/therapeutic use* ; Child ; Fusariosis/drug therapy* ; Humans ; Leukemia, Myeloid, Acute/drug therapy*

ObjectiveTo explore the effect of arsenic trioxide （ATO） on the expression of DNA methyltransferase 1 （DNMT1） and its anti-leukemia mechanism in acute T-lymphocytic leukemia （T-ALL） cells. MethodsT-ALL cell lines （Jurkat， CCRF-CEM， Molt-4） were cultured in vitro and divided into control （0 μmol/L）， low concentration （3 μmol/L） and high concentration （6 μmol/L） groups according to the dose of ATO， and the expression of DNMT1 and cleaved-caspase-3 were investigated by RT-qPCR and western blot after ATO treatment for 24 h （0， 3 and 6 μmol/L） intervention； Flow cytometry was applied to detect cell death in T-ALL cell lines （Jurkat， CCRF-CEM， MOLT-4）； The expression of DNMT1 and cleaved-caspase-3 and cell death were detected after applying ATO and Z-DEVD-FMK （caspase-3 specific inhibitor）； T-ALL cell death was detected after overexpressing DNMT1 under ATO intervention. ResultsWith the dose of ATO increasing， the expression level of DNMT1 in T-ALL cells decreased， the expression level of cleaved-caspase-3 protein increased， and the cell mortality increased （P<0.05）； The application of Z-DEVD-FMK specifically inhibited cleaved-caspase-3， diminished the inhibitory effect of ATO on DNMT1 expression， and decreased the cell mortality （P<0.05）；Overexpression of DNMT1 in T-ALL cells significantly reduced cell death induced by ATO treatment （P<0.05）. ConclusionWithin a certain concentration range， ATO effectively down-regulates the expression of DNMT1 via the activation of caspase-3 in a dose-dependent manner， thus inducing cell death in T-ALL cells， which provides a theoretical basis for the future application of ATO as a demethylating drug to improve the clinical treatment of T-ALL.

Objectives:To investigate the risk factors of sarcopenia in patients receiving maintenance peritoneal dialysis (MPD).Methods:One hundred and thirteen patients receiving maintenance MPD for ≥3 months during January and December 2017 were enrolled in this study. According to the Asian Working Group for Sarcopenia(AWGS)algorithm, there were 26 patients with sarcopenia accounting for 23.0% of all MPD patients. Demographic and anthropometric data were collected; laboratory tests were conducted, Kt/V urea and normalized protein equivalent of total nitrogen appearance were calculated; the bioelectrical impedance analysis (BIA) was performed and grip strength was tested. The nutritional status was evaluated with Subjective Global Assessment (SGA). Logistic regression was used to analyze the risk factors of sarcopenia in MPD patients. Results:BMI and dialysis dose of patients with sarcopenia were significantly lower than those without sarcopenia [(20.35±2.35) kg/m 2vs. (23.81±3.14) kg/m 2, t=-5.181, P<0.01; (5.57±1.83) L/d vs. (6.66±1.71) L/d, t=-2.795, P<0.01]. The bioelectrical impedance analysis showed that the total water content of patients with sarcopenia was higher than that of patients without sarcopenia [(35.44±6.40) kg vs. (28.52±4.89) kg, t=5.077, P<0.01]; while the protein content[(7.46±1.31) kg vs. (9.24±1.63) kg, t=-5.080, P<0.01] and skeletal muscle content [(20.54±4.18) kg vs. (25.88±4.95) kg, t=-4.980, P<0.01] of patients with sarcopenia were lower than those without sarcopenia. Multivariate analysis showed that decreased BMI( OR=0.934, 95 %CI: 0.723-0.998, P<0.01) and body protein ( OR=0.927, 95 %CI: 0.698-0.996, P<0.01), increased total body water( OR=1.382, 95 %CI: 1.053-1.813, P=0.02) were independent risk factors for sarcopenia in MPD patients. Conclusion:The incidence of sarcopenia in MPD patients is high, which is associated with the excessive volume load and malnutrition of patients.

MicroRNA (miRNA) is an endogenous, non-coding single-stranded RNA that regulates a variety of signal pathways or cytokines.Recent studies have confirmed that miRNA can affect alkaline phosphatase activity and matrix mineralization in bone formation, and plays an important role in osteogenic differentiation and cartilage differentiation.Abnormalities in the osteogenesis process can lead to osteogenesis imperfecta, Feingold syndrome, and femoral head necrosis.This review summarizes the specific mechanism of osteogenic differentiation and cartilage differentiation regulated by miRNA, suggesting the new clue for the future research about the underlying mechanism of bone development and clinical treatment of bone dysplasia from epigenetics.

Objective To compare the efficacy and safety of tacrolimus with those of cyclosporine in treating idiopathic membranous nephropathy (IMN) via network meta-analysis. Methods Databases including PubMed,Embase,CENTRAL (Cochrane),Wanfang Database,CNKI,and VIP citation database were searched for relevant studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Package Meta 4.5.0 and Gemtc 0.8.1 in R 3.3.1 were used to analyze the included studies. Results In this network meta-analysis,the complete remission rate (RR=0.98,95% CI:0.70-1.40)and the total remission rate (RR=1.00,95% CI:0.90-1.20)of idiopathic membranous nephropathy did not differ significantly between IMN patients treated with cyclosporine A or tacrolimusand,nor did the incidences of hepatic dysfunction(RR=1.40,95% CI:0.52-4.00),infection(RR=0.75,95% CI:0.18-3.10),or gastrointestinal syndrome(RR=2.1,95% CI:0.36-28.00). Conclusion Cyclosporine A seems to have similar effectiveness and safety to tacrolimus in treating IMN.

Objective To establish a liquid biopsy technique of KRAS gene G12D mutation and to assess its diagnostic value. Methods KRAS G12D mutation was analyzed by ddPCR in plasma DNA from 52 colorectal cancer patients and compared that of to 80 healthy subjects. KRAS gene sequencing in cancerous tissue of colorectal cancer patient being set as a golden standard, we evaluated the accuracy of ddPCR and analyzed the correlation between G12D mutation rate, plasma concentration;and their clinical manifestations in CRC. Results ddPCR indicated that KRAS G12D mutation rate and concentration(26.92％, 81.5 copies/mL) in the plasma samples of colorectal cancer patients were significantly higher than that of healthy subjects (8.75％, 16 copies/mL). Colorectal cancer patients with highly differentiated adenocarcinoma showed a significantly higher number of mutant copies than medium and low differentiated adenocarcinoma(P＜0.05);M2 patients had a significantly higher number of mutant copies than N1 and NO patients (P＜0.05);The concordance rate of KRAS gene mutation between cancerous tissue and plasma ctDNA was 87.50％ in CRC.Conclusions ddPCR is a fast, noninvasive and accurate method for plasma testing of ctDNA, and the test results could be used to monitor the course of the disease and as clinical guidelines.

Objective To develop a detergent for decontamination of Co2+ and Mn2+ on skin.Methods Single-factor experimental and orthogonal experimental designs were performed to study the formula composition of the decontaminant.The skin irritation experiment was performed and assessed according to the standard method.The detergent was prepared according the conventional process of showering gel.The pH,ethylenediaminetetraacetic acid (EDTA) level,total active substances of the detergent,and its stability were evaluated according to the chemical method recommended in the national standard GB/T 13173-2008.The decontamination efficiency on stable isotopes of Co2+ and Mn2+ contamination was measured on the back of hand skin of volunteers.Results The formula composition of the decontaminant was obtained through the orthogonal experiment.The pH value of the detergent was 6.99,total active substance was 20.49％ and the content of EDTA was 5.99％.After being kept at-5 ℃ and 40℃℃ for 24h,the decontaminant showed no strange smell,no precipitation,no discoloration and still kept transparent.The decontamination effects on Co2+ and Mn2+ contaminated on hand skin were 103.13％ ± 0.05％ and 100.62％ ± 0.09％,respectively,which was significantly higher than that of distilled water (81.77％ ± 0.23％ and 79.63％ ± 0.23％,P＜0.01,respectively).Conclusion The decontaminant has a high effect on decontamination of Co2+ and Mn2+ polluted on skin,and is hopeful to be developed as an effective detergent on radioactive isotopes contamination.