1.Effect of finite element method in treatment of developmental dysplasia of the hip in children
Xiaojun SUN ; Huaming WANG ; Dehong ZHANG ; Xuewen SONG ; Jin HUANG ; Chen ZHANG ; Shengtai PEI
Chinese Journal of Tissue Engineering Research 2025;29(9):1897-1904
BACKGROUND:Developmental dysplasia of the hip often leads to limb deformities in children,and the research related to its diagnosis and treatment has been gradually clarified.Recently,the finite element method has been paid attention to by scholars in the research related to developmental dysplasia of the hip because of its advantages. OBJECTIVE:Through literature search and review of the relevant research progress of finite element method in children's developmental dysplasia of the hip and treatment,analyze and summarize its advantages and disadvantages,and explore the direction of further research in the future. METHODS:PubMed,SCI,CBM,and CNKI were searched for relevant articles published from January 2014 to November 2023 with the key words of"developmental dysplasia(dislocation)of the hip,dysplasia of the hip,finite element analysis(method),pavlik harness,fixation in herringbone position,biomechanics,pelvic osteotomies,pemberton,salter,dega,periacetabular osteotomy,children"in Chinese and English.A small number of long-term articles were included,and 62 articles were finally included for analysis through screening. RESULTS AND CONCLUSION:(1)The mechanical environment of hip joint in children with developmental dysplasia of the hip was abnormal.The pressure in acetabulum was uneven.The stress increased and concentrated;the joint contact area decreased,and the local stress concentrated in femoral neck.(2)In the Pavlik sling and herringbone fixation,the mechanical environment of the hip was improved;the concentrated high stress area disappeared and the joint contact area increased,but the excessive abduction angle led to the increase of stress in the acetabulum and the lateral femoral head.(3)After pelvic osteotomy,the stress environment of hip joint and sacroiliac joint was improved.There was no single hinge in the three kinds of osteotomy,and the stress load position was different according to the age of the children.(4)After peri-acetabular osteotomy,the joint contact pressure was close to normal,but it was difficult to recover in patients with non-spherical femoral head.(5)The postoperative X-ray film findings could not show that the joint contact mechanics was the best.(6)It is indicated that the information that cannot be measured in the body can be obtained by using the finite element method,which can be operated in a virtual environment without the limitation of time and ethics.It can directly see the stress change area of normal and developmental dysplasia of the hip,explain the effectiveness of treatment from the point of view of mechanics,establish a specific finite element model and tailor-made operation plan for patients who need osteotomy.There is no standard or unified standard for the finite element modeling of developmental dysplasia of the hip and the material characteristic parameters of children's hip joint.Due to the inherent limitations of finite element method,it is impossible to analyze the model that contains bone,cartilage,ligament,muscle and other elements at the same time.The operation of finite element analysis is difficult,although it has advantages,it is not universal,and the current research sample size is small,which needs to be further expanded and verified.
2.A Randomized Controlled,Double-Blind Study on Huaban Jiedu Formulation (化斑解毒方) in the Treatment of Psoriasis Vulgaris with Blood-Heat Syndrome
Xuewen REN ; Yutong DENG ; Huishang FENG ; Bo HU ; Jianqing WANG ; Zhan CHEN ; Xiaodong LIU ; Xinhui YU ; Yuanwen LI
Journal of Traditional Chinese Medicine 2025;66(16):1679-1686
ObjectiveTo evaluate the clinical efficacy and safety of Huaban Jiedu Formulation (化斑解毒方, HJF) in treating psoriasis vulgaris with blood-heat syndrome. MethodsA randomized, double-blind, placebo-controlled study was conducted with 60 patients diagnosed with psoriasis vulgaris of blood-heat syndrome. Patients were randomly assigned to either a treatment group or a control group, with 30 cases in each. The treatment group received HJF granules orally, one dose a day, combined with topical Qingshi Zhiyang Ointment (青石止痒软膏), while the control group received placebo granules, one dose a day, combined with the same topical ointment. Both groups were topically treated twice daily of 28 days treatment cours. Psoriasis area and severity index (PASI), visual analogue scale for pruritus (VAS), traditional Chinese medicine (TCM) syndrome scores, dermatology life quality index (DLQI), and psoriasis life stress inventory (PLSI) were assessed before treatment and on day 14 and day 28. Response rates for PASI 50 (≥50% reduction) and PASI 75 (≥75% reduction), as well as overall clinical efficacy, were compared between groups. Serum levels of interleukin-6 (IL-6) and interleukin-17 (IL-17) were measured before and after 28 days of treatment. Adverse reactions during treatment were recorded. ResultsAfter 28 days of treatment, both groups showed significant reductions in PASI total score, lesion area score, erythema, scaling, and infiltration scores, pruritus VAS score, TCM syndrome score, DLQI, PLSI, and serum IL-6 and IL-17 levels (P<0.05). Compared to the control group, the treatment group had significantly greater improvements in PASI total score and erythema score, TCM syndrome score, serum IL-6 and IL-17 levels, and PASI 50 response rate after 28 days (P<0.05). Between-group comparisons of score differences before and after 28-day treatment revealed that the treatment group showed significantly better improvements in PASI total, lesion area score, erythema score, TCM syndrome score, DLQI, PLSI, and inflammatory markers (P<0.05 or P<0.01). The total effective rate on day 14 and day 28 was 40.00% (12/30) and 83.33% (25/30) in the treatment group, versus 6.90% (2/29) and 41.38% (12/29) in the control group, respectively. The clinical efficacy in the treatment group was significantly superior to that in the control group (P<0.05). Mild gastric discomfort occurred in 3 patients in the treatment group and 1 in the control group. ConclusionHJF can effectively improve skin lesions and TCM symptoms relieve pruritus, enhance quality of life, and reduce inflammatory markers IL-6 and IL-17, in patients with blood-heat syndrome of psoriasis vulgaris, with a good safety profile.
3.Metabolic engineering of Escherichia coli for efficient biosynthesis of L-citrulline.
Linfeng XU ; Wenwen YU ; Xuewen ZHU ; Quanwei ZHANG ; Yaokang WU ; Jianghua LI ; Guocheng DU ; Xueqin LV ; Jian CHEN ; Long LIU
Chinese Journal of Biotechnology 2025;41(1):242-255
L-citrulline is a nonprotein amino acid that plays an important role in human health and has great market demand. Although microbial cell factories have been widely used for biosynthesis, there are still challenges such as genetic instability and low efficiency in the biosynthesis of L-citrulline. In this study, an efficient, plasmid-free, non-inducible L-citrulline-producing strain of Escherichia coli BL21(DE3) was engineered by combined strategies. Firstly, a chassis strain capable of synthesizing L-citrulline was constructed by block of L-citrulline degradation and removal of feedback inhibition, with the L-citrulline titer of 0.43 g/L. Secondly, a push-pull-restrain strategy was employed to enhance the L-citrulline biosynthesis, which realized the L-citrulline titer of 6.0 g/L. Thirdly, the NADPH synthesis and L-citrulline transport were strengthened to promote the synthesis efficiency, which achieved the L-citrulline titer of 11.6 g/L. Finally, fed-batch fermentation was performed with the engineered strain in a 3 L fermenter, in which the L-citrulline titer reached 44.9 g/L. This study lays the foundation for the industrial production of L-citrulline and provides insights for the modification of other amino acid metabolic networks.
Citrulline/biosynthesis*
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Escherichia coli/genetics*
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Metabolic Engineering/methods*
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Fermentation
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NADP/biosynthesis*
4.International cooperation in pharmacology and toxicology in China
Jinnan SUN ; Xuewen CHEN ; Zuoqi DING
Journal of China Pharmaceutical University 2025;56(6):803-810
This study aimed to analyze research hotspots as well as domestic and international collaboration trends in the field of pharmacology and toxicology in China. Articles published in this field between 2005 and 2024 by Chinese researchers were retrieved and analyzed using citation analysis and descriptive statistical methods. The results indicate that over the past two decades, China’s level of international collaboration in this field has been continuously improving. China cooperates most closely with the United States, while its collaboration with other countries remains relatively limited. However, China’s cooperation with Belt and Road Initiative((BRI) partner countries has gradually deepened. The influence of Chinese publications in pharmacology and toxicology over the past 20 years is comparable to the global average. Papers resulting from international collaboration exceed the global average in terms of the impact, whereas those based solely on domestic collaboration still have significant room for improvement. It is recommended that China adhere to the principle of “coordinating well for comprehensive advancement” in international cooperation, strengthen collaborative relationships with various countries, and uphold the ‘self-directed’ approach to enhance the global influence of the discipline. Furthermore, optimizing the layout of international research collaboration networks, promoting innovation in research models, and leveraging the advantages of a diversified funding system are essential to overcome existing spatial and technological limitations.
5.Systematic review and Meta analysis of the effect of sleep on subsequent day physical activity among children and adolescents
Chinese Journal of School Health 2025;46(12):1781-1786
Objective:
To explore the effects of sleep on subsequent day physical activity (PA) in children and adolescents, so as to provide a reference for refining PA intervention strategies and further investigating their underlying mechanisms.
Methods:
Through searching databases including Web of Science Core Collection, PubMed, EBSCOhost, ScienceDirect, Cochrane Library, CNKI, Wanfang and VIP cross sectional, cohort and experimental studies on sleep and subsequent day PA among children and adolescents were identified, with the searching period spanning from database inception to June, 2025. Based on the characteristics of the included literature, two sleep variables[sleep duration (SD) and sleep efficiency (SE)] and three physical activity variables[moderate to vigorous physical activity (MVPA), light physical activity (LPA), and total physical activity (TPA)] were selected. The relationship between these two types of variables was analyzed for pooled effect sizes using Stata 17.0.
Results:
A total of 14 studies were included, with 64.3% published in 2018 or later, involving 11 361 children and adolescents from 17 countries. Meta analysis results showed that both SD ( ES=0.04, 95%CI =0.01-0.07) and SE ( ES=0.24, 95%CI =0.01-0.47) were positively correlated with subsequent day MVPA (both P <0.05). However, no statistically significant associations were found with LPA ( ES=-0.04, 95%CI =-0.13 to 0.06; ES=-0.02, 95%CI =-0.15 to 0.11) or TPA( ES=0.09, 95%CI =-0.02 to 0.20; ES=0.02, 95%CI = -0.03 to 0.06)(all P >0.05). Subgroup analysis revealed that in the "≤6 years" subgroup, SD and SE were positively correlated with TPA ( ES=0.22, 95%CI =0.09-0.35) and MVPA ( ES=1.19, 95%CI =1.06-1.32), respectively; in the "6-12 years" subgroup, SD was positively correlated with MVPA ( ES=0.05, 95%CI =0.02-0.08); in the "≥12 years" subgroup, SE was positively correlated with LPA ( ES=0.08, 95%CI =0.00-0.16), while SD was negatively correlated with LPA ( ES=-0.23, 95%CI = -0.31 to -0.16) (all P <0.05).
Conclusion
Adequate SD and good SE can effectively enhance subsequent day MVPA among children and adolescents, although these sleep effects vary by age group.
6.Analysis of HPV genotype differences in different stages of cervical intraepithelial neoplasia
Jingmin YU ; Yan CHEN ; Xuewen YANG
Shanghai Journal of Preventive Medicine 2024;36(11):1045-1050
ObjectiveTo explore the differences in human papillomavirus (HPV) genotype among patients with varying stages of cervical intraepithelial neoplasia (CIN). MethodsThis retrospective study included 113 patients with CIN who were treated at the Third People’s Hospital of Hangzhou from April 2020 to March 2023. The patients were divided into three groups based on the progression of CIN: CIN Ⅰ (n=30), CIN Ⅱ (n=42), and CIN Ⅲ (n=41). The influencing factors of CIN progression were analyzed, and HPV genotyping was performed logistic regression analysis was used to examine relationship between HPV genotypes and the degree of CIN progression, and the interaction between HPV genotypes and CIN progression-related factors were assessed. ResultsHPV genotype analysis revealed that HPV16, HPV58, HPV18, and HPV52 were the most common genotypes among CIN patients. The proportion of negative HPV cases in CIN I patients (53.33%) was significantly higher than that in CIN Ⅱ (33.33%) and CIN Ⅲ (0) patients. The infection rates and multiple infection rates of HPV16, HPV58, HPV18, and HPV52 (3.33%, 3.33%, 0, 0, 0.) were significantly lower in CIN Ⅰ patients compared to CIN Ⅱ (7.14%, 4.76%, 2.38%, 4.76%, 2.38%) and CIN Ⅲ patients (24.39%, 19.51%, 12.20%, 14.63%, 12.20%) (P<0.05). After adjusting for confounding factors, HPV16, HPV18, HPV52, and HPV58 remained significantly associated with the progression of CIN (P<0.05). Having ≥2 sexual partners (OR=3.529, 95%CI: 2.756~6.925, P=0.025), abnormal discharge odor (OR=5.684, 95%CI: 2.439~8.942, P=0.036), contact bleeding (OR=2.679, 95%CI: 1.627~3.192, P=0.018), and chronic cervicitis (OR=3.894, 95%CI: 1.952~4.931, P=0.031) were independent factors influencing the progression of CIN. HPV16, HPV18, HPV52, HPV58 exhibited positive interactions with the number of sexual partners, abnormal discharge odor, contact bleeding, and chronic cervicitis (P<0.05). ConclusionHPV16, HPV58, HPV18, and HPV52 are the most common genotypes of HPV infection in CIN patients, which are positively correlated with the degree of CIN progression. These genotypes are also closely related to factors influencing CIN progression.
7.The impact of non-HDL-C level on major adverse cardiovascular and cerebrovascular events and all-cause mortality after revascularization
Xuewen WANG ; Shihe LIU ; Xu HAN ; Qian LIU ; Shuohua CHEN ; Xiujuan ZHAO ; Lu LI ; Shouling WU ; Yuntao WU
Chinese Journal of Cardiology 2024;52(6):667-675
Objective:To investigate the impact of non-high-density lipoprotein cholesterol (non-HDL-C) level on major adverse cardiovascular and cerebrovascular events (MACCE) and all-cause mortality in the Kailuan Study cohort undergoing revascularization.Methods:This is a prospective cohort study, with participants from the Kailuan Study cohort who participated in physical examinations from 2006 to 2020 and received revascularization therapy for the first time. According to the level of non-HDL-C, the study subjects were divided into 3 groups:<2.6 mmol/L group, 2.6-<3.4 mmol/L group, and≥3.4 mmol/L group. Annual follow-up was performed, and the endpoint events were MACCE and all-cause mortality. Cox proportional regression model was implemented to estimate the impact on MACCE and all-cause mortality associated with the different non-HDL-C groups. The partial distributed risk model was used to analyze the impact of different non-HDL-C levels on MACCE event subtypes, and death was regarded as a competitive event. The restricted cubic spline regression model was used to explore the dose-response relationship between non-HDL-C level and all-cause mortality, MACCE and its subtypes.Results:A total of 2 252 subjects were enrolled in the study, including 2 019 males (89.65%), aged (62.8±8.3) years, the follow-up time was 5.72 (3.18, 8.46) years. There were 384 cases(17.05%) of MACCE and 157 cases(6.97%) of all-cause mortality. Compared with patients with non-HDL-C≥3.4 mmol/L, patients with non-HDL-C<2.6 mmol/L were associated with a 38% reduced risk of MACCE after revascularization [ HR=0.62(95% CI: 0.48-0.80)]. Every 1 mmol/L decrease in non-HDL-C was associated with a 20% reduction in the risk of MACCE [ HR=0.80(95% CI: 0.73-0.88)]. The results of restricted cubic spline also showed that non-HDL-C levels after revascularization therapy were positively correlated with MACCE events (overall association P<0.001, non-linear association P=0.808). For all-cause mortality, compared to the non-HDL-C≥3.4 mmol/L group, the HR for all-cause mortality after revascularization in non-HDL-C<2.6 mmol/L group was 0.67(95% CI: 0.46-1.01). Every 1 mmol/L decrease in non-HDL-C was associated with a 15% reduction in the risk of all-cause mortality [ HR=0.85(95% CI: 0.73-0.99)]. The restricted cubic spline results showed a linear association between non-HDL-C levels after revascularization therapy and the risk of all-cause mortality (overall association P=0.039, non-linear association P=0.174). Conclusion:The decrease in non-HDL-C levels after revascularization were significantly associated with a reduced risk of MACCE and all-cause mortality.
8.Effects of Yishen Jiangu Pills on AMPK/Cyclin Y/CDK16 Pathway Expressions and Chondrocyte Autophagy and Apoptosis in Cartilage Tissue of Knee Osteoarthritis Rats
Xiping CHAI ; Shenghua LI ; Mingwang ZHOU ; Wei CHEN ; Xuewen SONG ; Yingying CHAI
Chinese Journal of Information on Traditional Chinese Medicine 2024;31(10):89-95
Objective To investigate the effects of Yishen Jiangu Pills on the expressions of AMPK/Cyclin Y/CDK16 pathway and autophagy and apoptosis-related proteins in cartilage tissue of rats with knee osteoarthritis(KOA);To discuss its mechanism for the treatment of KOA.Methods Totally 60 2-month-old SD rats were selected and randomly divided into sham-operation group,model group,agonist group,and TCM low-,medium-and high-dosage groups,with 10 rats in each group.Except for the sham-operation group,each group underwent medial meniscectomy and cruciate ligamentotomy to establish the KOA rat model,and the corresponding interventions were given for 14 d.Lequesne MG score was used to evaluate rat behavior,morphology of cartilage tissue was observed by HE and Safranin O-fixed green staining,and Mankin score was performed,Western blot was performed to detect expression of AMPK/Cyclin Y/CDK16 pathway proteins and autophagy proteins such as ULK-1,Beclin-1,LC3B,p62 and apoptotic proteins such as Bcl-2,Bax,Caspase-3,Caspase-9 in cartilage tissue,and autophagosome were observed using transmission electron microscopy.Results Compared with the sham-operation group,Lequesne MG score significantly increased in the model group(P<0.01),there was a significant defect in the surface layer of cartilage,thinning of the cartilage layer,disordered arrangement and irregular morphology of chondrocytes,and a significant increase in Mankin score(P<0.01),the expressions of AMPK,Cyclin Y,CDK16,ULK1,Beclin-1,LC3BⅡ/Ⅰ and Bcl-2 protein in cartilage tissue decreased,while the expressions of p62,Bax,Caspase-3 and Caspase-9 protein increased(P<0.01).Compared with the model group,the Lequesne MG scores of rats in the agonist group and TCM high-dosage group were significantly decreased(P<0.01),the TCM high-dosage group showed smoother cartilage surface,more regular arrangement of chondrocytes,basic integrity of cartilage layer structure,weakened cartilage tissue proliferation,and significantly decreased Mankin score(P<0.01),the expressions of AMPK,Cyclin Y,CDK16,ULK1,Beclin-1,LC3BⅡ/Ⅰ and Bcl-2 protein in cartilage tissue of rats in the agonist group and TCM medium-and high-dosage groups significantly increased(P<0.05,P<0.01),while the expressions of p62,Bax,Caspase-3 and Caspase-9 protein significantly decreased(P<0.05,P<0.01).Conclusion Yishen Jiangu Pills may promote chondrocyte autophagy and inhibit cell apoptosis by activating the AMPK/Cyclin Y/CDK16 pathway in cartilage tissue of KOA model rats,thus reduce cartilage damage.
9.Clinical efficacy of IDH1 mutation in temozolomide chemotherapy for glioma patients and its impact on immune cytokines and prognosis
Xuewen ZHANG ; Yu WANG ; Jie WU ; Chen WANG
Chinese Journal of Immunology 2024;40(11):2373-2379
Objective:To study clinical efficacy of isocitrate dehydrogenase 1(IDH1)mutation on temozolomide chemotherapy for glioma patients and its impact on immune cytokines and prognosis.Methods:A total of 134 patients with glioma who underwent surgical resection and were confirmed by pathology in Dushu Lake Hospital Affiliated to Soochow University from October 2021 to October 2022 were selected as research subjects.IDH1 mutation status was measured by direct sequencing method,and IDH1 expres-sion rate in glioma tissue was determined by immunohistochemistry.All patients with brain glioma were treated with temozolomide chemotherapy.Effects of IDH1 mutation on clinical efficacy,immune cytokines(IFN-γ,IL-2,IL-4,IL-10)and prognosis of glioma were analyzed.Results:Seventy-nine cases out of 134 cases of glioma tissue had IDH1 mutations,mostly at R132,with a mutation rate of 58.96%,significantly higher than normal brain tissue(χ2=48.066,P<0.05).Immunohistochemistry showed strong positive expression of IDH1 in 56 out of 134 glioma tissues.Proportion of WHO grade Ⅳ in IDH1 mutant group was lower than IDHI wild type group[11.39%(9/79)vs 63.64%(35/55),Z=41.020,P<0.05].Proportion of low differentiation in IDH1 mutant group was higher than IDHI wild type group[50.63%(40/79)vs 20.00%(11/55),χ2=12.907,P<0.05].Total effective rate in IDH1 mutant group was higher than IDH1 wild type group[91.14%(72/79)vs 76.36%(42/55),χ2=5.575,P<0.05],IFN-γ and IL-2 levels were higher than IDH1 wild type group[(28.98±3.25)pg/ml vs(20.15±2.54)pg/ml,(33.42±4.25)pg/ml vs(25.23±3.52)pg/ml,t=16.870,11.750,P<0.05],IL-4 and IL-10 levels were lower than IDH1 wild type group[(7.90±1.02)pg/ml vs(12.38±1.66)pg/ml,(8.79±1.00)pg/ml vs(15.26±1.23)pg/ml,t=19.330,33.500,P<0.05].IDH1 mutation was positively correlated with IFN-γ and IL-2 levels after temozolo-mide chemotherapy(r=0.845,0.772,P<0.05),and negatively correlated with IL-4 and IL-10 levels after temozolomide chemotherapy(r=-0.786,-0.685,P<0.05).Survival rate after chemotherapy in IDH1 mutant group was higher than IDH1 wild type group[89.87%(71/79)vs 72.70%(40/55),Log Rank test χ2=5.208,P<0.05].Cox regression analysis found that WHO grade Ⅲ(RR=1.342),poorly differentiated(RR=1.783),IFN-γ(RR=1.808),IL-2(RR=2.112),IL-4(RR=2.342),IL-10(RR=1.342)as risk factors,temozolo-mide chemotherapy efficacy(RR=0.653),IDH1 mutation(RR=0.895)as protective factors affect prognosis of temozolomide chemo-therapy in glioma patients(P<0.05).Conclusion:IDH1 mutation is related to disease grade and differentiation degree of glioma patients,and can affect efficacy of temozolomide chemotherapy and expressions of immune cytokines,which is a protective factor for prognosis and survival after temozolomide chemotherapy.
10.Special application of stone extractor balloon catheter in ERCP for anastomotic biliary stenosis after liver transplantation
Xuan WANG ; Xuewen CHEN ; Jinxin HUANG ; Jiajun CHEN ; Yan QU ; Hao GAO ; Biao GONG ; Xiwen ZHANG ; Fu LI
China Journal of Endoscopy 2024;30(3):7-13
Objective To discuss the application effect of using a stone extractor balloon catheter to assist in crossing the anastomotic stenosis in treatment of anastomotic biliary stenosis after liver transplantation using endoscopic retrograde cholangiopancreatography(ERCP).Methods Clinical data of 48 patients who developed anastomotic biliary stenosis after liver transplantation and underwent ERCP treatment were collected.Upon unsuccessful use of a dilation catheter to cross the stricture,attempts were made to cross the anastomotic biliary stenosis by using a stone extractor balloon catheter.The success rate of the procedure was recorded,intraoperative conditions were observed,treatment outcomes and complications were analyzed.Results The main presenting symptoms in the 48 patients on admission were abdominal discomfort(32 patients),fever(7 patients),pruritus(4 patients),jaundice(3 patients),and no obvious symptoms(2 patients).Preoperative magnetic resonance cholangiopancreatography(MRCP)examination revealed isolated stricture of the anastomotic site in 35 cases,and stricture associated with stones in 13 cases.Using the stone extractor balloon catheter as a guide,guidewire crossing of the anastomotic stenosis was successful in 26 cases,resulting in a success rate of 54.17%(26/48).Through statistical analysis of the successful group and the failed group,there was a significant difference in whether the distal biliary dilatation between the two groups,and the difference was statistically significant(χ2 = 8.39,P = 0.004).In the 26 successfully treated cases,alanine transaminase(ALT),aspartate transaminase(AST),γ-glutamyl transpeptidase(γ-GT),alkaline phosphatase(ALP),and total bilirubin(TBiL)levels decreased significantly 48 hours after the procedure(P<0.05),and no serious complications occurred.Conclusion The use of a stone extractor balloon catheter significantly increases the success rate of crossing anastomotic stenosis in the treatment of anastomotic biliary stenosis after liver transplantation,especially in cases with distal dilatation of the common bile duct.This approach is safe and worth promoting.


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