[This corrects the article DOI: 10.1016/j.apsb.2021.10.012.].

Objective The aim of this study is to analyze the expression level of cell-free DNA(cf-DNA),a biomarker of neutrophil extracellular traps(NETs),in children with Mycoplasma pneumoniae pneumonia(MPP),and to explore the predictive efficacy of cf-DNA(as a marker of NETs)for the severity of MPP in these children.Methods A total of 115 children with MPP were prospectively selected as the MPP group.Based on the disease severity,the MPP group was categorized into the mild group(n=75)and the severe group(n=40).During the same period,50 healthy children undergoing physical examinations were selected as the control group.The levels of serum cf-DNA in the MPP group and the control group,as well as the levels of C-reactive protein(CRP),D-dimer,lactate dehydrogenase(LDH),interleukin-6(IL-6),interferon-γ(IFN-γ),and tumor necrosis factor-α(TNF-α)in the MPP group were detected.The differences in the levels of serum cf-DNA and related inflammatory factors among the groups were compared,and the role of serum cf-DNA in evaluating the severity of MPP was analyzed.Results The level of serum cf-DNA in children of the MPP group was notably higher than that in the control group,with a more significant elevation observed in the severe group(P<0.05).The levels of CRP,D-dimer,LDH,IL-6,IFN-γ,and TNF-α were all higher in the severe group than in the mild group(P<0.05).Multivariate logistic regression analysis showed that the increased levels of serum cf-DNA,CRP,and IL-6 were closely related to the severity of MPP(P<0.05).The results of receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of the combination of serum cf-DNA,CRP,and IL-6 for predicting severe MPP was 0.981,which was higher than that of each index alone(P<0.05).Conclusions Serum cf-DNA(as a marker of NETs)is closely related to the severity of MPP in children.The combined detection of cf-DNA,CRP,and IL-6 is more beneficial for assessing the severity of MPP in children.

Objective The aim of this study is to analyze the expression level of cell-free DNA(cf-DNA),a biomarker of neutrophil extracellular traps(NETs),in children with Mycoplasma pneumoniae pneumonia(MPP),and to explore the predictive efficacy of cf-DNA(as a marker of NETs)for the severity of MPP in these children.Methods A total of 115 children with MPP were prospectively selected as the MPP group.Based on the disease severity,the MPP group was categorized into the mild group(n=75)and the severe group(n=40).During the same period,50 healthy children undergoing physical examinations were selected as the control group.The levels of serum cf-DNA in the MPP group and the control group,as well as the levels of C-reactive protein(CRP),D-dimer,lactate dehydrogenase(LDH),interleukin-6(IL-6),interferon-γ(IFN-γ),and tumor necrosis factor-α(TNF-α)in the MPP group were detected.The differences in the levels of serum cf-DNA and related inflammatory factors among the groups were compared,and the role of serum cf-DNA in evaluating the severity of MPP was analyzed.Results The level of serum cf-DNA in children of the MPP group was notably higher than that in the control group,with a more significant elevation observed in the severe group(P<0.05).The levels of CRP,D-dimer,LDH,IL-6,IFN-γ,and TNF-α were all higher in the severe group than in the mild group(P<0.05).Multivariate logistic regression analysis showed that the increased levels of serum cf-DNA,CRP,and IL-6 were closely related to the severity of MPP(P<0.05).The results of receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of the combination of serum cf-DNA,CRP,and IL-6 for predicting severe MPP was 0.981,which was higher than that of each index alone(P<0.05).Conclusions Serum cf-DNA(as a marker of NETs)is closely related to the severity of MPP in children.The combined detection of cf-DNA,CRP,and IL-6 is more beneficial for assessing the severity of MPP in children.

OBJECTIVE:Cold water immersion methods are not standardized in terms of operational indicators such as immersion temperature,duration and depth,leading to controversy over the efficacy of recovery from exercise fatigue in skeletal muscle.In this article,we analyze the effects of cold water immersion on muscle injury,muscle soreness and muscle strength recovery under different factors,in order to find the best immersion implementation plan,and thus provide evidence for the recovery of muscle fatigue. METHODS:A search of CNKI,WanFang Data,Web of Science,and PubMed databases was conducted for relevant literature published from January 1,2000 to August 15,2023.A total of 4 759 articles were initially retrieved,with 4 735 articles excluded through screening and 24 articles finally included.The Physical Therapy Evidence Database Scale was used to assess the methodological quality of the included literature,and Stata-MP 16 software was used to perform effect size combinations,subgroup analyses,Meta-regression,sensitivity tests,and publication bias analyses. RESULTS:(1)The article included a total of 24 randomized controlled trial studies,including 617 subjects,with overall high legal quality.(2)Meta-analysis showed that cold water immersion can significantly reduce creatine kinase blood value[standardized mean difference(SMD)=-0.17,95％confidence interval(CI):-0.29 to-0.05,P<0.01],alleviate muscle pain(SMD=-0.60,95％CI:-0.81 to-0.38,P<0.01),and promote maximum muscle strength recovery(SMD=0.17,95％CI:0.05 to 0.30,P<0.01).(3)Subgroup analysis showed that:The immersing regimen with water temperature>14 ℃(SMD=-0.48,95％CI:-0.76 to-0.20,P<0.01)and duration of 12-14 minutes(SMD=-0.38,95％CI:-0.61 to-0.15,P<0.01)had the best effect in reducing creatine kinase blood values,and had a more significant intervention effect on endurance exercise(SMD=-0.45,95％CI:-0.71 to-0.20,P<0.01),while the immersion regimen with water temperature<10 ℃(SMD=-0.61,95％CI:-0.79 to-0.43,P<0.01),duration<12 minutes(SMD=-0.76,95％CI:-0.98 to-0.53,P<0.01),and immersion depth above the iliac spine(SMD=-0.74,95％CI:-0.97 to-0.52,P<0.01)had the best effect on relieving muscle soreness,and had a more significant analgesic effect after endurance exercise(SMD=-0.42,95％CI:-0.61 to-0.22,P<0.01).(4)Meta regression showed that immersion water temperature,immersion duration,and exercise type were important regulatory factors affecting the effect size of creatine kinase;immersing water temperature and immersing depth were important regulatory factors affecting the effect size of visual analogue scale score,while exercise type was an important regulatory factor affecting the maximum isometric muscle strength effect size. CONCLUSION:(1)Evidence of extremely low to moderate strength suggests that cold water immersion can effectively reduce muscle damage,alleviate muscle soreness,and promote muscle strength recovery.(2)In terms of reducing muscle injury,immersion water temperature,immersion duration,and exercise type are significant regulatory factors that affect the efficacy of immersing.Among them,immersion water temperature>14 ℃ and duration of 12-14 minutes are the best solutions to reduce muscle injury after exercise,and the immersing effect is better for endurance exercise.(3)In terms of reducing muscle soreness,immersion water temperature and immersion depth are important regulatory factors that affect the intervention effect.Among them,immersion water temperature<10 ℃,duration<12 minutes,and immersing depth above the iliac spine are the best solutions to reduce muscle soreness,and have a better analgesic effect after endurance exercise.(4)In terms of promoting muscle strength recovery,exercise type is a key regulatory factor that affects the maximum isometric muscle strength effect.

Objective To establish an automatic review plan for coagulation tests with image recognition function,and evaluate the correctness and effectiveness of the plan.Methods Artificial intelligence software and hardware were combined to establish an image recognition system that could automatically determine the characteristics of specimens,blood volume and hematocrit.The correctness of the determination results of specimen character was compared with the visual method,the correctness of the determination results of blood volume was compared with the manual measurement method,and the correctness of hematocrit was compared with the hematology analyzer.According to the flow chart,reference interval,medical decision level,critical value range,relevant literature,work experience and historical data,the autoverification rules of coagulation tests were formulated.The autoverification rules were manually verified,and the autoverification pass rate,true positive rate,true negative rate,false positive rate,and false negative rate were calculated.The change of turnaround time in the laboratory after the implementation of the autoverification scheme was evaluated.Re-sults The accuracy rate of sample trait determination in the image recognition system was 96.72％,and the false negative rate of judging hemolytic,jaundice,and lipoid blood samples as normal samples was 0.04％.The image recognition system was compared with the blood volume data of two groups of specimens measured manually,P=0.4881.The image recognition method was not inferior to the manual measurement method.Comparing the two sets of hematocrit data from the image recognition system and the blood cell analyzer,P=0.1130,the image recognition system was not inferior to the blood cell analyzer.A total of 61 automatic re-view rules for coagulation tests had been established,including numerical abnormalities,logical abnormalities,Delta Check,sample quality abnormalities,reaction curve abnormalities,etc.The automatic review pass rate was 76.19％,true positive rate was 23.77％,true negative rate was 76.19％,false positive rate was 0.04％,and false negative rate was 0.00％.After implementing the automatic audit plan,the turnaround time of sam-ples in each quantile was shortened,with an average shortening time of 13.66 min.Conclusion The applica-tion of image recognition technology in the automatic review of coagulation tests makes the automatic review function more automated and scientific,standardizes specimen quality judgment,improves the accuracy of test results,effectively improves work efficiency and saves manpower.

Objective::To use fetal heart quantification ( fetal HQ) technology to compare the coarctation of the aorta (CoA) and normal fetal heart structure and systolic function and to assess whether there are abnormalities in the fetal heart structure and systolic function associated with CoA. Methods::This prospective cohort study was conducted from May 2020 to December 2022 and involved 18-40-week-old singleton pregnancies and 30 fetuses diagnosed with CoA using fetal echocardiography at the General Hospital of Ningxia Medical University and Peking University First Hospital Ningxia Women’s and Children’s Hospital, China. The control group contained 60 normal fetuses. The following parameters were recorded and analyzed statistically: four-chamber view (4CV) end-diastolic long diameter, 4CV epicardial-contralateral epicardial transverse maximum diameter, 4CV global sphericity index (GSI), left ventricular (LV) and right ventricular (RV) 24-segment end-diastolic diameter (EDD), 24-segment sphericity index (SI), LV-fractional area change (LV-FAC), LV-longitudinal strain (LV-LS), RV-fractional area change (RV-FAC), RV-longitudinal strain (RV-LS), and LV and RV 24-segment transverse fractional shortening (FS). Measurement data were compared between the two groups using an independent sample t test, with P < 0.05 indicating statistically significant differences. Moreover, the correlation between gestational age and GSI, LV-FAC, LV-LS, RV-FAC, and RV-LS was assessed. Results::Within and between observer comparisons of the parameters associated with major cardiac function revealed an intragroup correlation coefficient of >0.9, indicating high consistency, and a coefficient of variable of <1 %, indicating low variability. Correlation analysis revealed no obvious correlation between gestational age and GSI, LV-FAC, LV-LS, RV-FAC, and RV-LS. A comparison of the four-chamber morphological structural parameters of the hearts in the two groups revealed that when compared with the control group, the 4CV end-diastolic long diameter was shortened in fetuses in the CoA group and the epicardial-contralateral epicardial transverse maximum diameter was wider, while the GSI was lower ( P < 0.05). A comparison of the LV and RV morphological structure parameters between the two groups revealed that when compared with the control group, the LV’s 24-segment EDD was smaller in the CoA group, the RV’s 24-segment EDD was greater in the control group, the SI of the LV’s segments 16-24 was greater than in the control group, and the SI of the RV’s segments 7-24 was less than in the control group (all P < 0.05). When compared with fetuses in the control group, the LV’s segments 16-24 were greater in the CoA group, whereas the RV’s segment 6-24 was smaller ( P < 0.05). When compared with the control group, LV-FAC, RV-FAC, and LS were lower in the CoA group ( P < 0.05). The FS of the LV segments 1-24 and the FS of the RV segments 1-16 were smaller in the CoA group than in the normal group ( P < 0.05). Conclusion::Fetal HQ, a new simple technique that offers rapid analysis and high repeatability, can quantitatively evaluate structural and systolic function changes in fetuses with CoA.

Objective::To use fetal heart quantification ( fetal HQ) technology to compare the coarctation of the aorta (CoA) and normal fetal heart structure and systolic function and to assess whether there are abnormalities in the fetal heart structure and systolic function associated with CoA. Methods::This prospective cohort study was conducted from May 2020 to December 2022 and involved 18-40-week-old singleton pregnancies and 30 fetuses diagnosed with CoA using fetal echocardiography at the General Hospital of Ningxia Medical University and Peking University First Hospital Ningxia Women’s and Children’s Hospital, China. The control group contained 60 normal fetuses. The following parameters were recorded and analyzed statistically: four-chamber view (4CV) end-diastolic long diameter, 4CV epicardial-contralateral epicardial transverse maximum diameter, 4CV global sphericity index (GSI), left ventricular (LV) and right ventricular (RV) 24-segment end-diastolic diameter (EDD), 24-segment sphericity index (SI), LV-fractional area change (LV-FAC), LV-longitudinal strain (LV-LS), RV-fractional area change (RV-FAC), RV-longitudinal strain (RV-LS), and LV and RV 24-segment transverse fractional shortening (FS). Measurement data were compared between the two groups using an independent sample t test, with P < 0.05 indicating statistically significant differences. Moreover, the correlation between gestational age and GSI, LV-FAC, LV-LS, RV-FAC, and RV-LS was assessed. Results::Within and between observer comparisons of the parameters associated with major cardiac function revealed an intragroup correlation coefficient of >0.9, indicating high consistency, and a coefficient of variable of <1 %, indicating low variability. Correlation analysis revealed no obvious correlation between gestational age and GSI, LV-FAC, LV-LS, RV-FAC, and RV-LS. A comparison of the four-chamber morphological structural parameters of the hearts in the two groups revealed that when compared with the control group, the 4CV end-diastolic long diameter was shortened in fetuses in the CoA group and the epicardial-contralateral epicardial transverse maximum diameter was wider, while the GSI was lower ( P < 0.05). A comparison of the LV and RV morphological structure parameters between the two groups revealed that when compared with the control group, the LV’s 24-segment EDD was smaller in the CoA group, the RV’s 24-segment EDD was greater in the control group, the SI of the LV’s segments 16-24 was greater than in the control group, and the SI of the RV’s segments 7-24 was less than in the control group (all P < 0.05). When compared with fetuses in the control group, the LV’s segments 16-24 were greater in the CoA group, whereas the RV’s segment 6-24 was smaller ( P < 0.05). When compared with the control group, LV-FAC, RV-FAC, and LS were lower in the CoA group ( P < 0.05). The FS of the LV segments 1-24 and the FS of the RV segments 1-16 were smaller in the CoA group than in the normal group ( P < 0.05). Conclusion::Fetal HQ, a new simple technique that offers rapid analysis and high repeatability, can quantitatively evaluate structural and systolic function changes in fetuses with CoA.

Objective : The purpose of this study was to clarify the regulatory effect and mechanism of Src homology-2 domain containing protein tyrosine phosphatase-2 (SHP2) on human periodontal ligament stem cell (hPDLSC) proliferation and osteogenic differentiation under inflammatory environment and to provide a new target for the treatment of periodontitis. Methods: SHP2 was knocked down in hPDLSCs, and the transfection efficiency of SHP2 was detected by RT-qPCR and Western blot. An in vitro inflammatory environment was created using tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β). The effect of SHP2 knockdown on hPDLSC viability under normal and inflammatory conditions was detected by CCK-8, and the osteogenic capacity of hPDLSCs under normal and inflammatory conditions was detected by ALP staining, ALP activity, ARS staining, RT-qPCR and Western blot. The mechanism by which SHP2 knockdown affected the MAPK pathway and its downstream NF-κB pathway under inflammatory conditions was assessed by Western blot. Results: Green fluorescence was observed after transfection for 72 h, and the titer of SHP2 shRNA recombinant lentivirus was 2.9×108 TU/mL. SHP2 expression was significantly downregulated in lentivirus-transfected cells, as demonstrated by Western blot and RT-qPCR (P<0.001). SHP2 knockdown inhibited hPDLSC proliferation to a certain extent and increased the expression of early osteogenic markers under normal conditions, including increased ALP activity and increased ALP and COL-1 expression (P<0.05). However, SHP2 knockdown exerted no effect on mineralized nodule formation. In the TNF-α- and IL-1β-induced inflammatory environment, SHP2 knockdown exerted no effect on hPDLSC proliferation (P>0.05). Osteogenic markers were upregulated (P<0.05), and mineralized nodules were significantly increased (P<0.05) after SHP2 knockdown. Western blot analysis showed that p65 phosphorylation and IκB-α degradation were reduced in SHP2-knockdown hPDLSCs in the inflammatory environment. Moreover, SHP2 knockdown significantly inhibited the expression of p-p38 and p-JNK MAPK, which represent pathways upstream of the NF-κB pathway (P<0.05). Conclusion SHP2 knockdown did not affect cell viability but promoted the osteogenic potential of hPDLSCs by inhibiting the MAPK/NF-κB-mediated signaling pathway under inflammatory environment.

Objective:To dynamically monitor the prevalence and trend of dental fluorosis in children in Shandong Province, and to evaluate the prevention and control measures for drinking water-borne endemic fluorosis (referred to as drinking water-borne fluorosis), and to provide scientific basis for the next step.Methods:Totally 40 counties (cities, districts) were selected as project counties (cities, districts) from drinking water-borne fluorosis areas in Shandong Province in 2018, and all counties (cities, districts) were selected in 2019 and 2020, to investigate the situation of water improvement, detect water fluoride content, and investigate the prevalence of dental fluorosis in children aged 8 - 12 years.Results:From 2018 to 2020, the detection rates of dental fluorosis in children aged 8 - 12 years were 10.30% (503/4 884), 8.94% (25 895/289 539) and 8.66% (24 061/277 689), respectively, with statistically significant differences (χ 2 = 27.10, P < 0.001), and the dental fluorosis indexes were 0.21, 0.18 and 0.17, respectively. The total detection rates of dental fluorosis in children of different age groups in the 3 years were 7.26% (6 590/90 775), 7.97% (9 303/116 680), 9.29% (12 167/130 915), 9.29% (12 238/131 670) and 9.95% (10 161/102 072), the differences were statistically significant (χ 2 = 615.71, P < 0.001). In the 3 years, the total detection rate of dental fluorosis was 8.93% (28 101/314 737) in boys and 8.69% (22 358/257 375) in girls, the difference was statistically significant (χ 2 = 10.27, P = 0.001). In 2018 and 2019, the detection rates of dental fluorosis of children aged 8 - 12 years in water fluoride qualified villages [5.74% (235/4 095) and 7.98% (20 200/253 082)] were significantly lower than those in villages with excessive water fluoride [33.97% (268/789) and 15.62% (5 695/36 457), χ 2 = 570.61, 2 283.76, P < 0.001]. Conclusions:The prevalence of dental fluorosis among children aged 8 - 12 years has been effectively controlled, and remarkable results have been achieved in prevention and treatment of drinking water-borne fluorosis in Shandong Province. However, the detection rate of dental fluorosis among children in a few endemic villages is high, so it is necessary to continue to strengthen the monitoring of fluoride content in drinking water and the condition of dental fluorosis among children.

Background::Whether anesthetic depth affects postoperative outcomes remains controversial. This meta-analysis aimed to evaluate the effects of deep vs. light anesthesia on postoperative pain, cognitive function, recovery from anesthesia, complications, and mortality. Methods::PubMed, EMBASE, and Cochrane CENTRAL databases were searched until January 2022 for randomized controlled trials comparing deep and light anesthesia in adult surgical patients. The co-primary outcomes were postoperative pain and delirium (assessed using the confusion assessment method). We conducted a meta-analysis using a random-effects model. We assessed publication bias using the Begg’s rank correlation test and Egger’s linear regression. We evaluated the evidence using the trial sequential analysis and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. We conducted subgroup analyses for pain scores at different postoperative time points and delirium according to cardiac or non-cardiac surgery.Results::A total of 26 trials with 10,743 patients were included. Deep anesthesia compared with light anesthesia (a mean difference in bispectral index of -12 to -11) was associated with lower pain scores at rest at 0 to 1 h postoperatively (weighted mean difference = -0.72, 95% confidence interval [CI] = -1.25 to -0.18, P= 0.009; moderate-quality evidence) and an increased incidence of postoperative delirium (24.95% vs. 15.92%; risk ratio = 1.57, 95% CI = 1.28-1.91, P < 0.0001; high-quality evidence). No publication bias was detected. For the exploratory secondary outcomes, deep anesthesia was associated with prolonged postoperative recovery, without affecting neurocognitive outcomes, major complications, or mortality. In the subgroup analyses, the deep anesthesia group had lower pain scores at rest and on movement during 24 h postoperatively, without statistically significant subgroup differences, and deep anesthesia was associated with an increased incidence of delirium after non-cardiac and cardiac surgeries, without statistically significant subgroup differences. Conclusions::Deep anesthesia reduced early postoperative pain but increased postoperative delirium. The current evidence does not support the use of deep anesthesia in clinical practice.