Shatin Hospital

STUDY OBJECTIVE: Most but not all epidemiologic evidence suggests a female predisposition of insomnia. We applied meta-analytic methods to investigate sex differences in the risk of insomnia among the published epidemiologic studies. DESIGN: Meta-analysis with Comprehensive Meta-Analysis (Englewood, NJ); 9 different analyses were performed to investigate the sex difference of insomnia among different conditions. SETTING: A comprehensive search of the medical literature databases was performed to identify epidemiologic studies of insomnia. A rolling snowball method was also used. PARTICIPANTS: General population. INTERVENTIONS: N/A. RESULT: Thirty-one related papers were found, but 2 studies only reported the subtype prevalence of insomnia. All other studies (1,265,015 participants, female/male: 718,828/546,187) were included in the overall analysis of insomnia. A risk ratio of 1.41 [95% confidence interval: 1.28-1.55] for female versus male was found. The female excess in the risk of insomnia in large and quality studies was much higher than that of small and nonquality studies. The trend of female predisposition was consistent and progressive across age, with more significance in the elderly. The use of various criteria and frequency and duration of insomnia did not influence the predisposition of female in the risk of developing insomnia. Although obvious female excess in the risk of insomnia exists among different regions, there was a relatively lower female excess in East Asia. CONCLUSION: This meta-analysis confirmed a female predisposition of insomnia. Further studies will be needed to examine the roles of different factors in leading to the sex difference of insomnia.

The CRISPR-associated protein Cas12a (previously known as Cpf1), which is an endonuclease from the type V-A CRISPR system, has been applied in both in vivo genome editing and in vitro DNA assembly. 1 , 2 , 3 Cas12a is guided by a single CRISPR RNA (crRNA) with a T-rich protospacer adjacent motif (PAM) sequence to cleave double-stranded DNA (dsDNA) targets, generating sticky ends. Different from Cas9, Cas12a cleaves both the target and non-target strands of a targeted dsDNA by a single active site in the RuvC catalytic pocket 4 , 5 , 6 (Supplementary information, Figure S12a ). Besides, Cas12a also processes precursor crRNAs to generate mature crRNAs. 7 However, the cleavage activity of Cas12a on single-stranded DNA (ssDNA) targets is less understood.

a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm's potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause.

Graphitic carbon nitride (g-C3N4) quantum dots (CNQDs) were prepared from bulk g-C3N4 directly by a thermal-chemical etching process. The CNQDs show strong blue emission as well as upconversion behavior, which can be used as universal energy-transfer components in visible-light-driven metal-free photocatalytic systems.

OBJECTIVES: There has been an increasing interest in the role of fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) in irritable bowel syndrome (IBS). We report results from the first randomized controlled trial of the low FODMAP diet in US adults with IBS and diarrhea (IBS-D). The objectives were to compare the efficacy of the low FODMAP diet vs. a diet based upon modified National Institute for Health and Care Excellence guidelines (mNICE) on overall and individual symptoms in IBS-D patients. METHODS: This was a single-center, randomized-controlled trial of adult patients with IBS-D (Rome III) which compared 2 diet interventions. After a 2-week screening period, eligible patients were randomized to a low FODMAP or mNICE diet for 4 weeks. The primary end point was the proportion of patients reporting adequate relief of IBS-D symptoms ≥50% of intervention weeks 3-4. Secondary outcomes included a composite end point which required response in both abdominal pain (≥30% reduction in mean daily pain score compared with baseline) and stool consistency (decrease in mean daily Bristol Stool Form of ≥1 compared with baseline), abdominal pain and stool consistency responders, and other key individual IBS symptoms assessed using daily questionnaires. RESULTS: After screening, 92 subjects (65 women, median age 42.6 years) were randomized. Eighty-four patients completed the study (45 low FODMAP, 39 mNICE). Baseline demographics, symptom severity, and nutrient intake were similar between groups. Fifty-two percent of the low FODMAP vs. 41% of the mNICE group reported adequate relief of their IBS-D symptoms (P=0.31). Though there was no significant difference in the proportion of composite end point responders (P=0.13), the low FODMAP diet resulted in a higher proportion of abdominal pain responders compared with the mNICE group (51% vs. 23%, P=0.008). Compared with baseline scores, the low FODMAP diet led to greater reductions in average daily scores of abdominal pain, bloating, consistency, frequency, and urgency than the mNICE diet. CONCLUSIONS: In this US trial, 40-50% of patients reported adequate relief of their IBS-D symptoms with the low FODMAP diet or a diet based on modified NICE guidelines. The low FODMAP diet led to significantly greater improvement in individual IBS symptoms, particularly pain and bloating, compared with the mNICE diet.

AIM: We examined the incidence and the reversibility of sarcopenia and their associated factors over a 4-year period using the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. METHODS: A total of 4000 community-dwelling older adults aged ≥ 65 years were evaluated for which detailed information regarding demographics, socioeconomic, medical history, lifestyle, and clinical factors were documented at baseline, 2 years, and 4 years later. Sarcopenia was defined according to the EWGSOP algorithm. Incident sarcopenia and its reversibility were documented at each follow-up year, and related to possible factors. RESULTS: At baseline, of the 4000 participants, 361(9.0%) had sarcopenia. Between baseline and 2-year follow-up, 6.0% of the participants without sarcopenia at baseline had developed sarcopenia, and 18.8% of the initially sarcopenic participants had reverted to normal.Between baseline and 4-year follow-up, the corresponding figures were 6.3% and 14.1%, respectively. The average annual incidence over 4 years was 3.1%. After multivariate adjustments, older age, female sex, presence of chronic obstructive pulmonary disease, presence of stroke, lower physical activity levels, presence of instrumental activities of daily living impairments, and lower body mass index were associated with incident sarcopenia, whereas younger age, female sex, higher body mass index and absence of instrumental activities of daily living impairments, but not physical activity,were associated with its reversibility. Protein and vitamin D intake were not significantly associated with sarcopenia incidence or its reversibility [corrected]. CONCLUSION: Sarcopenia incidence increases with age, but is potentially reversible in a Chinese elderly population. High body mass index is protective against sarcopenia incidence and its reversibility. Increasing physical activity and maintaining a healthy weight could be beneficial in the prevention of sarcopenia.

Swarming micro/nanorobots offer great promise in performing targeted delivery inside diverse hard-to-reach environments. However, swarm navigation in dynamic environments challenges delivery capability and real-time swarm localization. Here, we report a strategy to navigate a nanoparticle microswarm in real time under ultrasound Doppler imaging guidance for active endovascular delivery. A magnetic microswarm was formed and navigated near the boundary of vessels, where the reduced drag of blood flow and strong interactions between nanoparticles enable upstream and downstream navigation in flowing blood (mean velocity up to 40.8 mm/s). The microswarm-induced three-dimensional blood flow enables Doppler imaging from multiple viewing configurations and real-time tracking in different environments (i.e., stagnant, flowing blood, and pulsatile flow). We also demonstrate the ultrasound Doppler-guided swarm formation and navigation in the porcine coronary artery ex vivo. Our strategy presents a promising connection between swarm control and real-time imaging of microrobotic swarms for localized delivery in dynamic environments.

A new concept of exploiting bromide ions as a complexing agent to ‘free-up’ iodide ions for energy storage.

The 3D-connected BaTiO ₃ network introduced into the polymer matrix improves polarization transmission and results in significantly enhanced permittivity and discharged energy density.

OBJECTIVE: To determine the prevalence and risk factors of obstructive sleep apnoea syndrome (OSAS) in Chinese children using a two-phase community-based study design. METHODS: Children from 13 primary schools were randomly recruited. A validated OSAS screening questionnaire was completed by their parents. Children at high risk of OSAS and a randomly chosen low-risk group were invited to undergo overnight polysomnographic study and clinical examination. The the sex-specific prevalence rate was measured using different cutoffs (obstructive apnoea hypopnoea index ≥ 1, ≥ 1.5, ≥ 3 and ≥ 5 and obstructive apnoea index ≥ 5) and risk factors associated with OSAS were evaluated with logistic regression. RESULTS: 6447 completed questionnaires were returned (out of 9172 questionnaires; 70.3%). 586 children (9.1%; 405 boys and 181 girls) children belonged to the high-risk group. A total of 619 (410 and 209 from the high and low-risk group, respectively) subjects underwent overnight polysomnagraphy. Depending on the cutoffs, the prevalence rate of childhood OSAS varied from 4.8% to 40.3%. Using the International Criteria of Sleep Disorders version II, the OSAS prevalence for boys and girls was 5.8% and 3.8%, respectively. Male gender, body mass index z-score and increased adenoid and tonsil size were independently associated with OSAS. CONCLUSIONS: The prevalence rate of OSAS in children was contingent on the cutoff used. The inclusion of symptoms as a part of the diagnostic criteria greatly reduced the prevalence. A further prospective and outcome study is needed to define a clinically significant diagnostic cutoff for childhood OSAS.

Nanostructured photocatalysts have attracted ever-growing research attention in the application of solar energy for water disinfection.

We demonstrate a rational fabrication of hierarchical treated rape pollen as metal-free catalyst for visible-light-driven photocatalytic CO ₂ reduction.

BACKGROUND: Unlike the adult sleep related disordered breathing (SDB) patients who are typically obese, the relation between obesity and childhood SDB is not clear. AIMS: To investigate whether obese children are more at risk of obstructive SDB when compared to normal population, and whether this risk is potentiated by the presence of pharyngeal lymphoid tissue. METHODS: Forty six obese children (age 10.8 (SD 2.3) years; BMI 27.4 (SD 5.1)), and 44 sex and age matched normal weight children (age 11.7 (SD 2.1) years; BMI 18 (SD 1.8)) were studied. All children underwent a set of physical examinations (including the upper airways) and sleep studies. RESULTS: The obese children were different from the normal weight children in terms of type (predominantly obstructive), frequency, and severity of respiratory disturbances. Depending on the criteria used, 26% or 32.6% of obese children had SDB; 2.3% of normal controls had OAI > or =1 and 4.5% had RDI > or =5. Presence of SDB was related to presence of tonsils (size >2; range 0-4) (OR 12.67, 95% CI 2.14 to 75.17) and BMI (OR 1.20, 95% CI 1.08 to 1.33). CONCLUSIONS: Results suggest that obese children are at increased risk of obstructive SDB; the presence of any pharyngeal lymphoid tissue enlargement in obese children should therefore be aggressively managed.

Oxygen vacancies induced exciton dissociation of flexible BiOCl nanosheets for effective photocatalytic CO ₂ conversion <italic>via</italic> the CO ₂ hydrogenation pathway.

A perovskite/CIGS tandem configuration is an attractive and viable approach to achieve an ultra-high efficiency and cost-effective all-thin-film solar cell.

A new single elemental heterostructure of black–red phosphorus was prepared, which exhibited high visible-light-driven photocatalytic activity comparable to that of CdS.

BACKGROUND: Childhood obstructive sleep apnoea (OSA) is increasingly being recognised. Its effects on blood pressure (BP) elevation and hypertension are still controversial. OBJECTIVE: To evaluate the association between OSA and ambulatory BP in children. METHODS: Children aged 6-13 years from randomly selected schools were invited to undergo overnight sleep study and ambulatory BP monitoring after completing a validated OSA questionnaire. OSA was diagnosed if the obstructive apnoea-hypopnoea index (AHI) was >1, and normal controls had AHI <1 and snoring <3 nights per week. Children with OSA were subdivided into a mild group (AHI 1-5) and moderate to severe group (AHI >5). RESULTS: 306 subjects had valid sleep and daytime BP data. Children with OSA had significantly higher BP than normal healthy children during both sleep and wakefulness. BP levels increased with the severity of OSA, and children with moderate to severe disease (AHI >5) were at significantly higher risk for nocturnal systolic (OR 3.9 (95% CI 1.4 to 10.5)) and diastolic (OR 3.3 (95% CI 1.4 to 8.1)) hypertension. Multiple linear regression revealed a significant association between oxygen desaturation index and AHI with daytime and nocturnal BP, respectively, independent of obesity. CONCLUSIONS: OSA was associated with elevated daytime and nocturnal BP, and is an independent predictor of nocturnal hypertension. This has important clinical implications as childhood elevated BP predicts future cardiovascular risks. Future studies should examine the effect of therapy for OSA on changes in BP.

A mediator strategy is proposed to facilitate MnO ₂ dissolution and recover ‘lost’ capacity from exfoliated MnO ₂ , which improves the cycling stability at high areal capacity of Zn–Mn ²⁺ /MnO ₂ batteries.

Gene vectors are nucleic acids that carry genetic materials or gene editing devices into cells to exert the sustained production of therapeutic proteins or to correct erroneous genes of the cells. However, the cell membrane sets a barrier for the entry of nucleic acid molecules, and nucleic acids are easily degraded or neutralized when they are externally administered into the body. Carriers to encapsulate, protect and deliver nucleic acid molecules therefore are essential for clinical applications of gene therapy. The secreted organelles, exosomes, which naturally mediate the communications between cells, have been engineered to encapsulate and deliver nucleic acids to the desired tissues and cells. The fusion of exosomes with liposomes can increase the loading capacity and also retain the targeting capability of exosomes. Altogether, this review summarizes the most recent designs of exosome-based applications for gene delivery and their future perspectives in gene therapy.

The recent outbreak of severe acute respiratory syndrome (SARS) provided an opportunity to study the antibody response of infected individuals to the causative virus, SARS coronavirus. We examined serum samples obtained from 46 patients with SARS, 40 patients with non-SARS pneumonia, and 38 healthy individuals, by use of Western blotting (WB), enzyme-linked immunoassay (ELISA), and immunofluorescence assay, using both native and bacterially produced antigens of the virus. We found a highly restricted, immunoglobulin G-dominated antibody response in patients with SARS, directed most frequently (89% by ELISA) and predominantly at the nucleocapsid. Almost all of the subjects without SARS had no antinucleocapsid antibodies. The spike protein was the next most frequently targeted, but only 63% of the patients (by ELISA) responded. Other targets of the response identified by use of WB included antigens of 80 and 60 kDa. Several nonstructural proteins cloned were not antigenic, and the culture-derived nucleocapsid appeared to be specifically degraded.