Factors associated with patients' healthcare-seeking behavior and related clinical outcomes under China's hierarchical healthcare delivery system

Introduction

The hierarchical healthcare delivery system is an important measure to improve the allocation of medical resources and promote equitable distribution of basic medical and health services. It is one of the key factors in the success or failure of China's medical reform. This study aims to analyze the factors influencing patients' healthcare-seeking behaviors, including socioeconomic and clinical outcomes, under China's hierarchical healthcare delivery system, and to provide potential solutions.

Methods

Patients receiving outpatient treatment in the past 14 days and inpatient care in the past 1 year were investigated. The multivariate logistic regression was used to analyze the influencing factors of patient's medical treatment behavior selection, and to compare whether the clinical outcomes of primary medical institutions and grade A hospitals are the same.

Results

Nine thousand and ninety-eight person-times were included in the study. Of these, 4,538 patients were outpatients, 68.27% of patients were treated in primary medical institutions; 4,560 patients were hospitalized, 58.53% chose to be hospitalized in grade A hospitals. Provinces and cities, urban and rural areas, occupation, education level, medical insurance type, income, whether there are comorbid diseases, and doctors' medical behavior are the factors affecting the choice of medical treatment behavior. Patients who choose primary medical institutions and grade A hospitals have different control levels and control rate for the blood pressure, blood lipids, blood glucose.

Conclusion

Under the hierarchical diagnosis and treatment system, the patients' choice of hospital is mainly affected by their level of education, medical insurance types, and the inpatients are also affected by whether there are comorbid conditions. Clinical outcomes of choosing different levels of hospitals were different.

Mechanism of Pressure Difference Variations on Heavy Oil Start-Up and Percolation Effects

To investigate the influence of pressure difference changes on the micro start-up and percolation of heavy oil, a micro visualization displacement device was used to characterize the start-up time and oil-water percolation state of heavy oil. The mechanism of different pressure differences, as well as the frequency and amplitude of pressure difference changes, on the start-up and percolation balance of heavy oil was clarified. The results indicate that high-pressure difference and pressure difference changes can reduce the start-up time of heavy oil. A reasonable frequency of pressure difference changes effectively promotes the balance between positive and negative pressure shear and fluid-solid response. Large pressure difference changes can effectively break the viscous and adsorption resistance during heavy oil start-up; reasonable pressure difference can exert the synergistic effect of pressure difference and infiltration, achieving a balance between the water wave and the initial water film thickening process as well as the continuous percolation process of wire drawing, oil droplets, and oil columns during the medium-to-high water content period; a reasonable frequency of pressure difference variation during the high water content period can promote the superposition of inertia effects at the oil-water interface and break the balance of the oil-water interface. A large amplitude of pressure difference variation is beneficial for the strong deformation of the oil-water interface and the shear dislocation peeling of the oil-solid interface. Therefore, a relatively high amplitude of pressure difference variation and a reasonable frequency of pressure difference variation, as well as the synergistic effect of pressure difference and infiltration, are the keys to effectively start heavy oil and improving oil recovery during the ultrahigh water-cut period.

Lipid concomitant γ-oryzanol decreased oil absorbency of French fries by changing the microstructure of French fries and physical properties of frying oil

BACKGROUND

The aim of this research was to evaluate the possibility of lipid concomitant γ-oryzanol reducing oil absorbency of fried foods and the underlying mechanism. Therefore, the influence of γ-oryzanol on moisture and oil content, and distribution and micromorphology of French fries and the viscosity, fatty acid composition and total polar compounds content of rice bran oil (RBO) after frying were studied.

RESULTS

Our results showed that the incorporation of low concentration of γ-oryzanol [low addition group (LAG)] (5.754 g/kg) decreased the oil absorbency and porous structure of French fries during frying. Additionally, LAG incorporation inhibited the degradation of linoleic acid, decreased the growth rate of saturated fatty acids, total polar compounds and viscosity of frying oil.

CONCLUSIONS

Consequently, it was recommended to incorporate a small amount of γ-oryzanol in frying oil because it could inhibit oil absorption behavior of French fries. © 2023 Society of Chemical Industry.

Association of Blood Pressure With Brain Ages: A Cohort Study of Gray and White Matter Aging Discrepancy in Mid-to-Older Adults From UK Biobank

BACKGROUND

Gray matter (GM) and white matter (WM) impairments are both associated with raised blood pressure (BP), although whether elevated BP is differentially associated with the GM and WM aging process remains inadequately examined.

METHODS

We included 37 327 participants with diffusion-weighted imaging (DWI) and 39 630 participants with T1-weighted scans from UK Biobank. BP was classified into 4 categories: normal BP, high-normal BP, grade 1, and grade 2 hypertension. Brain age gaps (BAGs) for GM (BAGGM) and WM (BAGWM) were derived from diffusion-weighted imaging and T1 scans separately using 3-dimensional-convolutional neural network deep learning techniques.

RESULTS

There was an increase in both BAGGM and BAGWM with raised BP (P<0.05). BAGWM was significantly larger than BAGGM at high-normal BP (0.195 years older; P=0.006), grade 1 hypertension (0.174 years older; P=0.004), and grade 2 hypertension (0.510 years older; P<0.001), but not for normal BP. Mediation analysis revealed that the association between hypertension and cognitive decline was primarily mediated by WM impairment. Mendelian randomization analysis suggested a causal relationship between hypertension and WM aging acceleration (unstandardized B, 1.780; P=0.016) but not for GM (P>0.05). Sliding-window analysis indicated the association between hypertension and brain aging acceleration was moderated by chronological age, showing stronger correlations in midlife but weaker associations in the older age.

CONCLUSIONS

Compared with GM, WM was more vulnerable to raised BP. Our study provided compelling evidence that concerted efforts should be directed towards WM damage in individuals with hypertension in clinical practice.

Asymptomatic spinal lesions in patients with AQP4-IgG-positive NMOSD: A real-world cohort study

OBJECTIVE

This study aims to explore the frequency and influencing factors of asymptomatic spinal lesions (ASLs) and their impact on subsequent relapses in patients with AQP4-IgG-positive NMOSD (AQP4-NMOSD) in a real-world setting.

METHODS

We retrospectively reviewed clinical information and spinal MRI data from AQP4-NMOSD patients who had at least one spinal cord MRI during their follow-ups. Kaplan-Meier curves and Cox proportional hazards models were employed to ascertain potential predictors of remission ASLs and to investigate factors associated with subsequent relapses.

RESULTS

In this study, we included 129 patients with AQP4-NMOSD and reviewed 173 spinal MRIs during attacks and 89 spinal MRIs during remission. Among these, 6 ASLs (3.5%) were identified during acute attacks, while 8 ASLs (9%) were found during remission. Remission ASLs were linked to the use of immunosuppressive agents, particularly conventional ones, whereas no patients using rituximab developed ASLs (p = 0.005). Kaplan-Meier curve analysis indicated that patients with ASLs had a significantly higher relapse risk (HR = 4.658, 95% CI: 1.519-14.285, p = 0.007) compared to those without. Additionally, the use of mycophenolate mofetil (HR = 0.027, 95% CI: 0.003-0.260, p = 0.002) and rituximab (HR = 0.035, 95% CI: 0.006-0.203, p < 0.001) significantly reduced the relapse risk. However, after accounting for other factors, the presence of ASLs did not exhibit a significant impact on subsequent relapses (HR = 2.297, 95% CI: 0.652-8.085, p = 0.195).

INTERPRETATION

ASLs may be observed in patients with AQP4-NMOSD. The presence of ASLs may signify an underlying inflammatory activity due to insufficient immunotherapy. The administration of immunosuppressive agents plays a key role in the presence of remission ASLs and the likelihood of subsequent relapses.

The nucleocapsid protein facilitates p53 ubiquitination-dependent proteasomal degradation via recruiting host ubiquitin ligase COP1 in PEDV infection

Porcine epidemic diarrhea virus (PEDV) is a highly contagious enteric pathogen of the coronavirus family and caused severe economic losses to the global swine industry. Previous studies have established that p53 is a host restriction factor for PEDV infection, and p53 degradation occurs in PEDV-infected cells. However, the underlying molecular mechanisms through which PEDV viral proteins regulate p53 degradation remain unclear. In this study, we found that PEDV infection or expression of the nucleocapsid protein downregulates p53 through a post-translational mechanism: increasing the ubiquitination of p53 and preventing its nuclear translocation. We also show that the PEDV N protein functions by recruiting the E3 ubiquitin ligase COP1 and suppressing COP1 self-ubiquitination and protein degradation, thereby augmenting COP1-mediated degradation of p53. Additionally, COP1 knockdown compromises N-mediated p53 degradation. Functional mapping using truncation analysis showed that the N-terminal domains of N protein were responsible for interacting with COP1 and critical for COP1 stability and p53 degradation. The results presented here suggest the COP1-dependent mechanism for PEDV N protein to abolish p53 activity. This study significantly increases our understanding of PEDV in antagonizing the host antiviral factor p53 and will help initiate novel antiviral strategies against PEDV.

Prediction model for haematoma after tissue expander placement: A retrospective cohort study of 7080 cases over 20 years

Haematoma is an early complication of tissue expander placement and can lead to infection, capsule contracture and various complications, hindering successful reconstruction. However, no scientific models can accurately predict the risk of haematoma following tissue expansion. Therefore, this study aimed to develop and validate a prediction model for haematoma following tissue expander placement. The medical records of patients who underwent expander placement between 2001 and 2021 were obtained from the clinical database of the Department of Plastic Surgery at the Xijing Hospital. A total of 4579 consecutive patients with 7080 expanders and 179 expanded pocket haematomas were analysed. Multivariate logistic regression analysis identified adult age (P = 0.006), male sex (P < 0.001), scar reconstruction (P = 0.019), perioperative hypertension (P < 0.001), face and neck location (P = 0.002) and activated partial thromboplastin time above the normal range (P < 0.001) as risk factors for haematoma. Therefore, these were included in the prediction model, and a nomogram was constructed. The discrimination of the nomogram was robust (area under the curve: 0.78; 95% confidence interval: 0.72-0.83). Further, the prediction model had a strong fit (Hosmer-Lemeshow test, P = 0.066) and maintained similar discrimination after considering performance optimism (bootstrapped area under the curve: 0.79; 95% confidence interval: 0.73-0.84). This clinical prediction model was created using a generalisable dataset and can be utilised to obtain valid haematoma predictions after expander placement, assisting surgeons in implementing preventive measures or interventions to reduce the occurrence of haematoma.

Macrophage β-arrestin-1 deteriorates DSS-induced colitis through interaction with NF-κB signaling

β-arrestin-1 has been demonstrated to participate in the regulation of inflammatory reactions in several diseases. Thus, this study aimed to investigate the role of macrophage β-arrestin-1 in the pathogenesis and progression of ulcerative colitis (UC). A myeloid β-arrestin-1 conditional knockout mouse model was generated to explore the role of macrophage β-arrestin-1. DSS was employed for the establishment of an ulcerative colitis mouse model, using TNF-α as an inflammatory stressor in vitro. The expression level of β-arrestin-1 was detected via western blot and immunofluorescence assays, whilst disease severity was evaluated by clinical score and H&E staining in the DSS-induced colitis model. In the in vitro experiments, the levels of inflammatory cytokines were examined using real-time PCR. NF-κB activation was detected through the double luciferase reporter system, western blot, and electrophoretic mobility shift assay (EMSA). BAY11-7082 was used to inhibit NF-κB activation. Our results exposed that the level of β-arrestin-1 was increased in monocytes/macrophages derived from DSS-induced colitis mice or under the TNF-α challenge. Moreover, conditionally knocking out the expression of myeloid β-arrestin-1 alleviated disease severity, while knocking out the expression of β-arrestin-1 decreased the levels of inflammatory cytokines. Additionally, NF-κB was identified as a central regulatory element of β-arrestin-1 promoter, and using BAY11-7082 to inhibit NF-κB activation lowered the level of β-arrestin-1 under TNF-α challenge. β-arrestin-1 led to the activation of the NF-κB signaling pathway by enhancing binding to IκBα and IKK under the TNF-α challenge. Taken together, our findings demonstrated macrophage β-arrestin-1 contributes to the deterioration of DSS-induced colitis through the interaction with NF-κB signaling, thus highlighting a novel target for the treatment of UC.

Template-Free Synthesis of High Dehydration Performance CHA Zeolite Membranes with Increased Si/Al Ratio Using SSZ-13 Seeds

Pervaporation is an energy-efficient alternative to conventional distillation for water/alcohol separations. In this work, a novel CHA zeolite membrane with an increased Si/Al ratio was synthesized in the absence of organic templates for the first time. Nanosized high-silica zeolite (SSZ-13) seeds were used for the secondary growth of the membrane. The separation performance of membranes in different alcohol-aqueous mixtures was measured. The effects of water content in the feed and the temperature on the separation performance using pervaporation and vapor permeation were also studied. The best membrane showed a water/ethanol separation factor above 100,000 and a total flux of 1.2 kg/(m2 h) at 348 K in a 10 wt.% water-ethanol mixed solution. A membrane with high performance and an increased Si/Al ratio is promising for the application of alcohol dehydration.

Biochemical component analysis of human myopic corneal stroma using the Raman spectrum

PURPOSE

This study aimed to measure the Raman spectrum of the human corneal stroma lens obtained from small incision lenticule extraction surgery (SMILE) in Asian myopic eyes using a confocal Raman micro-spectrometer built in the laboratory.

METHODS

Forty-three myopic patients who underwent SMILE with equivalent diopters between - 4.00 and - 6.00 D were selected, and the right eye data were collected. Corneal stroma lenses were obtained during surgery, and the Raman spectra were measured after air drying. The complete Raman spectrum of human myopic corneal stroma lens tissue was obtained within the range of 700-4000 cm-1.

RESULTS

Thirteen characteristic peaks were found, with the stronger peaks appearing at 937 cm-1, corresponding to proline, valine, and the protein skeleton of the human myopic corneal stroma lens; 1243 cm-1, corresponding to collagen protein; 1448 cm-1, corresponding to the collagen protein and phospholipids; and 2940 cm-1, corresponding to the amino acid and lipids, which was the strongest Raman peak.

CONCLUSION

These results demonstrated that Raman spectroscopy has much potential as a fast, cost-effective, and reliable diagnostic tool in the diagnosis and treatment of eye diseases, including myopia, keratoconus, and corneal infection.

Manganese(III) Phthalocyanine Complex Nanoparticle-Loaded Glucose Oxidase to Enhance Tumor Inhibition through Energy Metabolism and Macrophage Polarization

Elevated levels of reactive oxygen species (ROS) have demonstrated efficacy in eliminating tumor cells by modifying the tumor microenvironment and inducing the polarization of tumor-associated macrophages (TAMs). Nevertheless, the transient nature and limited diffusion distance inherent in ROS present significant challenges in cancer treatment. In response to these limitations, we have developed a nanoparticle (MnClPc-HSA@GOx) that not only inhibits tumor energy metabolism but also facilitates the transition of TAMs from the M2 type (anti-inflammatory type) to the M1 type (proinflammatory type). MnClPc-HSA@GOx comprises a manganese phthalocyanine complex (MnClPc) enveloped in human serum albumin (HSA), with glucose oxidase (GOx) loaded onto MnClPc@HSA nanoparticles. GOx was employed to catalyze the decomposition of glucose to produce H2O2 and gluconic acid. Additionally, in the presence of MnClPc, it catalyzes the conversion of H2O2 into •O2- and 1O2. Results indicate that the nanoparticle effectively impedes the glucose supply to tumor cells and suppresses their energy metabolism. Simultaneously, the ROS-mediated polarization of TAMs induces a shift from M2 to M1 macrophages, resulting in a potent inhibitory effect on tumors. This dual-action strategy holds promising clinical inhibition applications in the treatment of cancer.

The relationship between daytime napping and glycemic control in people with type 2 diabetes

Aim

To examine the association between napping characteristics and glycemic control in people with type 2 diabetes.

Design

This study used a cross-sectional design.

Methods

A convenience sample of people with type 2 diabetes (N=226) were included. Glycemic control was indicated by HbA1c which was measured by A1C Now®+. Napping characteristics including napping frequency, duration, timing, and type were measured by validated questionnaires. Other variables, such as insomnia, cognitive impairment, and depression were measured by the Insomnia Severity Index, Montreal Cognitive Assessment, and Patient Health Questionnaire-9, respectively. Multivariate linear regression analyses were performed.

Results

The sample consisted of 122 women (54.0%), with a median age of 67 years. Their median HbA1c was 6.8%. No significant relationship was found between napping frequency and HbA1c. Among nappers, after controlling for covariates, long napping duration (≥60 min) and morning napping were both associated with poorer glycemic control. Compared with appetitive napping, restorative napping was associated with better glycemic control.

Conclusion

Daytime napping (e.g., duration and type) is an important modifiable factor for glycemic control in people with type 2 diabetes. This study provides new insights into the relationship between napping and glucose management among people with diabetes.

A low-cost and portable fluorometer based on an optical pick-up unit for chlorophyll-a detection

Chlorophyll-a (Chl-a) fluorescence detection is an important technique for monitoring water quality. In this work, we proposed an approach that employs the mass-produced low-cost optical pick-up unit (OPU) extracted from the high-definition digital versatile disc (HD-DVD) drive as the key optical component for our chlorophyll-a fluorometer. The built-in blue-violet 405 nm laser diode of the OPU acts as the excitation light to perform laser-induced fluorescence (LIF). The laser driver and a series of intrinsic lenses within the OPU, such as an objective lens with a numerical aperture (NA) of 0.65 and a collimating lens, help reduce the size, cost, and system complexity of the fluorometer. By integrating off-the-shelf electronic components, miniaturized optical setups, and 3D-printed assemblies, we have developed a low-cost, easy-to-make, standalone, and portable fluorometer. Finally, we validated the performance of the device for chlorophyll-a fluorescence detection under laboratory and on-site conditions, which demonstrated its great potential in water monitoring applications. The limit of detection (LOD) for chlorophyll-a is 0.35 μg/L, the size of the device is 151 × 100 × 80 mm3, and the total cost of the proposed fluorometer is as low as 137.5 USD. © 2023 Elsevier Science. All rights reserved.

Association between weight change, waist circumference change, and the risk of nonalcoholic fatty liver disease in individuals with metabolically healthy overweight or obesity and metabolically unhealthy overweight or obesity

BACKGROUND

This study aimed to explore and compare the effect of weight change, and waist circumference (WC) change, on the risk of nonalcoholic fatty liver disease (NAFLD) in individuals with metabolically healthy overweight or obesity (MHOW/O) and metabolically unhealthy overweight or obesity (MUOW/O) in a health check-up cohort in China.

METHODS

5625 adults with overweight or obesity, and free from NAFLD at baseline were included. Metabolically healthy was defined as not having any components of metabolic syndrome. Weight/WC changes were calculated as the relative difference between the first and second visits of check-up. NAFLD was assessed based on abdominal ultrasound.

RESULTS

During a median follow-up of 2.1 (IQR: 1.1-4.3) years, 1849 participants developed NAFLD. In MHOW/O participants, the multivariable adjusted HRs (95 % CIs) for NAFLD in weight change ≤ -5.0 %, and - 4.9-- 1.0 % were 0.36 (0.23-0.59), 0.59 (0.43-0.80), respectively, compared to the weight stable group (-0.9% to 0.9 %). The corresponding HRs (95 % CIs) for the association between WC change (≤ 6.0 %, - 5.9 to -3.0 %) and NAFLD in MHOW/O participants were 0.41 (0.27-0.62), and 0.74 (0.54-1.01), respectively, compared to the WC stable group (-2.9-2.9 %). Similar patterns were observed in MUOW/O participants. A more marked gradient of cumulative incidence of NAFLD across weight/WC change categories was observed in MHOW/O than in MUOW/O individuals.

CONCLUSIONS

A more evident association between weight/WC loss and risk of NAFLD was observed in MHOW/O than in MUOW/O individuals. Our findings indicate the practical significance of encouraging all individuals with overweight and obesity to achieve a clinically relevant level of weight/WC loss to prevent NAFLD, even among metabolic healthy groups.

[Safety and efficacy of acute stent implantation during endovascular treatment for patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis]

Objective: To investigate the efficacy and safety of acute stent implantation during endovascular treatment for patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis. Methods: A retrospective analysis was carried out on 46 patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis who received endovascular treatment at the Strategic Support Force Medical Center from January 2015 to August 2022. Twenty-seven patients underwent balloon angioplasty alone and 19 patients underwent acute stent implantation. The baseline characteristics, modified thrombolysis in cerebral infarction (mTICI) score of the responsible vessels, modified Rankin scale (mRS) score 90 days after operation, incidence of symptomatic intracranial hemorrhage and mortality of the two groups were evaluated. Results: The proportion of effective recanalization of the offending vessels (mTICI≥2b) in the acute stenting group was slightly higher than that in the balloon angioplasty group (16/19 vs. 81.5%), but the difference was not statistically significant (P>0.05). Besides, there was no significant difference in the median of mRS between the acute stenting group [3.0(0, 4.0)] and the balloon angioplasty group [4.0(1.0, 5.0)] 90 days after operation (P>0.05). In terms of safety, the incidence of symptomatic intracranial hemorrhage and mortality were comparable between the two groups (P>0.05). Conclusions: The effect of acute stent implantation during endovascular treatment for patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis is not inferior to that of balloon angioplasty, and it does not increase the risk of intracranial bleeding complications.

Using anti-PD-L1 antibody conjugated gold nanoshelled poly (Lactic-co-glycolic acid) nanocapsules loaded with doxorubicin: A theranostic agent for ultrasound imaging and photothermal/chemo combination therapy of triple negative breast cancer

Triple negative breast cancer (TNBC) has the worst prognosis of all breast cancers, and it is difficult to progress through traditional chemotherapy. Therefore, the treatment of TNBC urgently requires agents with effective diagnostic and therapeutic capabilities. In this study, we obtained programmed death-ligand 1 (PD-L1) antibody conjugated gold nanoshelled poly(lactic-co-glycolic acid) (PLGA) nanocapsules (NCs) encapsulating doxorubicin (DOX) (DOX@PLGA@Au-PD-L1 NCs). PLGA NCs encapsulating DOX were prepared by a modified single-emulsion oil-in-water (O/W) solvent evaporation method, and gold nanoshells were formed on the surface by gold seed growth method, which were coupled with PD-L1 antibodies by carbodiimide method. The fabricated DOX@PLGA@Au-PD-L1 NCs exhibited promising contrast enhancement in vitro ultrasound imaging. Furthermore, DOX encapsulated in NCs displayed good pH-responsive and photo-triggered drug release properties. After irradiating 200 μg/mL NCs solution with a laser for 10 min, the solution temperature increased by nearly 23°C, indicating that the NCs had good photothermal conversion ability. The targeting experiments confirmed that the NCs had specific target binding ability to TNBC cells overexpressing PD-L1 molecules. Cell experiments exhibited that the agent significantly reduced the survival rate of TNBC cells through photochemotherapy combination therapy. As a multifunctional diagnostic agent, DOX@PLGA@Au-PD-L1 NCs could be used for ultrasound targeted contrast imaging and photochemotherapy combination therapy of TNBC cells, providing a promising idea for early diagnosis and treatment of TNBC.

Elevated c-kit expression in failed autologous arteriovenous fistulas in end-stage renal disease patients

BACKGROUND

Serum stem cell factor is elevated in end-stage renal disease (ESRD) patients. This study aimed to investigate the expression of the c-kit receptor, which is the specific membrane receptor of stem cell factor, in failed autologous arteriovenous fistulas (AVFs) in end-stage renal disease patients.

METHODS

A total of 14 ESRD patients with initial AVFs creation and 16 ESRD patients with reconstruction were enrolled in this study. Hematoxylin and eosin (H&E) and elastic Verhoeff-Van Gieson (EVG) staining were used for histomorphometric analyses. Immunohistochemistry was used to examine the expression of c-kit in the intima, and a correlation analysis was performed with the intimal area and the percentage of area stenosis. A double-label immunofluorescence method was used to explore the colocalization of c-kit with α-smooth muscle actin (α-SMA) and CD31. The expression of c-kit and the related PI3K/Akt signaling axis, including PI3K, P-PI3K, Akt, P-Akt473, P-Akt308, and mTOR, was measured by western blotting.

RESULTS

Internal elastic lamina (IEL) area, intimal area, percentage of area stenosis, and average optical density (AOD) of c-kit in the intima were significantly higher in the failed group than in the preoperative group (p ⩽ 0.001). The AOD of c-kit in the intima was positively correlated with the intimal area and the percentage of stenosis (intimal area: R = 0.744, p < 0.001; the percentage of stenosis: R = 0.923, p < 0.001). C-kit colocalized with α-SMA but not with CD31 in studies of c-kit target cells. Moreover, the levels of c-kit and P-PI3K, P-Akt473 and mTOR in the PI3K/Akt axis were also higher in the failed group than in the initial group (p < 0.05).

CONCLUSIONS

C-kit and related proteins associated with the PI3K/Akt pathway were elevated in failed AVFs among ESRD patients and that the expression level of c-kit in the intima correlates with the degree of AVF stenosis.

Persistently short or long sleep duration increases the risk of sensory impairment in Chinese older adults

Background

Cross-sectional evidence suggests that persistently short or long sleep duration is associated with sensory impairment. Thus, this study was conducted to investigate the associations between sleep duration and altered sleep duration with sensory impairment in Chinese older adults.

Methods

Longitudinal data (2008-2014) obtained through the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were analyzed. Sleep duration was classified as normal (7-8 h), short (<7 h), or long (≥9 h). Sensory impairment was assessed using individuals' self-reported data on visual and hearing functions. Cox regression was performed to evaluate the effects of sleep duration and altered sleep duration on sensory impairment, including visual impairment (VI) and hearing impairment (HI).

Results

This study included 3,578 older adults (mean age: 78.12 ± 9.59 years). Among them, 2,690 (75.2%) were aged 65-84 years and 1798 (50.3%) were women. The risks of VI (hazard ratio [HR]: 1.14; 95% confidence interval [CI]: 1.02-1.29), HI (HR: 1.14; 95% CI: 1.00-1.30), and dual sensory impairment (both VI and HI; HR: 1.26; 95% CI: 1.03-1.55) were high in older adults with long sleep duration. In addition, the risks of VI, HI, and dual sensory impairment were high in individuals whose sleep duration changed from normal to short or long (HR: 1.20 [95% CI: 1.02-1.42], 1.26 [95% CI: 1.03-1.53], and 1.54 [95% CI: 1.11-2.12], respectively) and those with persistently short or long sleep duration (HR: 1.25 [95% CI: 1.07-1.46], 1.34 [95% CI: 1.11-1.61], and 1.67 [95% CI: 1.22-2.27], respectively).

Conclusion

A prospective association was identified between altered sleep duration and sensory impairment in Chinese older adults. Our findings highlight the importance of optimal sleep duration and healthy sleep habits in preventing sensory impairment in older adults.

White matter brain age as a biomarker of cerebrovascular burden in the ageing brain

As the brain ages, it almost invariably accumulates vascular pathology, which differentially affects the cerebral white matter. A rich body of research has investigated the link between vascular risk factors and the brain. One of the less studied questions is that among various modifiable vascular risk factors, which is the most debilitating one for white matter health? A white matter specific brain age was developed to evaluate the overall white matter health from diffusion weighted imaging, using a three-dimensional convolutional neural network deep learning model in both cross-sectional UK biobank participants (n = 37,327) and a longitudinal subset (n = 1409). White matter brain age gap (WMBAG) was the difference between the white matter age and the chronological age. Participants with one, two, and three or more vascular risk factors, compared to those without any, showed an elevated WMBAG of 0.54, 1.23, and 1.94 years, respectively. Diabetes was most strongly associated with an increased WMBAG (1.39 years, p < 0.001) among all risk factors followed by hypertension (0.87 years, p < 0.001) and smoking (0.69 years, p < 0.001). Baseline WMBAG was associated significantly with processing speed, executive and global cognition. Significant associations of diabetes and hypertension with poor processing speed and executive function were found to be mediated through the WMBAG. White matter specific brain age can be successfully targeted for the examination of the most relevant risk factors and cognition, and for tracking an individual's cerebrovascular ageing process. It also provides clinical basis for the better management of specific risk factors.

Quercetin Protects Against Global Cerebral ischemia‒reperfusion Injury by Inhibiting Microglial Activation and Polarization

Background

This study aims to investigate the protective effect of quercetin against global cerebral ischemia‒reperfusion (GCI/R) injury in rats and elucidate the underlying mechanism.

Methods

A GCI/R injury rat model was established using a four-vessel occlusion (4-VO) method. An oxygen-glucose deprivation/reoxygenation (OGD/R) injury model was induced in BV2 cells. The extent of injury was assessed by evaluating neurological deficit scores (NDS) and brain water content and conducting behavioral tests. Pathomorphological changes in the prefrontal cortex were examined. Additionally, the study measured the levels of inflammatory cytokines, the degree of microglial activation and polarization, and the protein expression of Toll-like receptor 4 (TLR4) and TIR-domain-containing adaptor inducing interferon-β (TRIF).

Results

Quercetin pretreatment significantly ameliorated neurological impairment, improved learning and memory abilities, and reduced anxiety in rats subjected to GCI/R injury. Furthermore, quercetin administration effectively mitigated neuronal injury and brain edema. Notably, it suppressed microglial activation and hindered polarization toward the M1 phenotype. Simultaneously, quercetin downregulated the expression of TLR4 and TRIF proteins and attenuated the release of IL-1β and TNF-α.

Conclusion

This study highlights the novel therapeutic potential of quercetin in alleviating GCI/R injury. Quercetin demonstrates its neuroprotective effects by inhibiting neuroinflammation and microglial activation while impeding their transformation into the M1 phenotype through modulation of the TLR4/TRIF pathway.

Clinical practice guidelines for the nutrition of colorectal cancer patients: a systematic review

PURPOSE

The aim of this study is to rigorously assess the methodological quality of published clinical practice guidelines (CPGs) related to nutrition among colorectal cancer patients, to compile consensus recommendations, and to evaluate the quality of the included CPGs.

METHODS

The systematic search covered eight electronic databases, two relevant professional association websites, and six guideline websites from their inception up to January 22, 2023. The methodological quality of the eligible guidelines was evaluated using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument, and then, consensus recommendations were synthesized. The scores for each domain were expressed as the mean ± standard deviation (SD). Using the mean score as the benchmark for comparison, they were subsequently ranked from highest to lowest. The included guidelines were then categorized as having "high," "moderate," or "low" quality based on their scores.

RESULTS

The literature search yielded ten guidelines. The findings indicated that the "Clarity of presentation" domain had the highest mean score (65.2 ± 7.7). This demonstrates how the guidelines effectively articulate recommendations. Additionally, the "Scope and purpose" domain achieved a mean score of 60.7 ± 10.9, followed by "Rigor of development" (51.7 ± 15.7), "Editorial independence" (51.1 ± 21), "Stakeholder involvement" (48 ± 16.8), and "Applicability" domains (47.5 ± 17.3). Two CPGs received an overall rating of "high quality" and were recommended; four CPGs received an overall rating of "moderate" and were recommended with modifications; and four CPGs received an overall rating of "low quality" and were not recommended. Furthermore, this study compiled twenty consensus recommendations related to nine distinct clinical issues.

CONCLUSION

This study identified disparities in the methodological quality of the included CPGs, particularly in the "Applicability" domain, thus emphasizing the need for advancement in clinical feasibility and implementation. Notably, there is few guidelines specifically targeting colorectal cancer nutrition. These synthesized findings provided an intuitive, convenient, and comprehensive reference for evaluating nutrition among colorectal cancer patients. When applying these results, users should make careful decisions based on their specific situations.

Probucol protects against brain damage caused by intra-neural pyroptosis in rats with vascular dementia through inhibition of the Syk/Ros pathway

BACKGROUND

Neuronal injury in chronic cerebral hypoperfusion (CCH) is the main pathogenic factor of vascular dementia (VD). Clinically, there isn't a drug specifically for VD; instead, the majority of medications used to treat Alzheimer's disease (AD) are also used to treat VD. Based on the proven anti-inflammatory and antioxidant effects of Probucol, we hypothesized that it may have therapeutic effects on VD, but more research is required to determine its exact mechanism of action.

METHODS

In vivo experiment: We used SD rats and most commonly used bilateral carotid artery occlusion (2-VO) in VD for modeling. After successful modeling, SD rats were given Probucol 3.5 mg/kg/day for 8 weeks to evaluate the therapeutic effect. In vitro experiment: BV-2 microglia of rats were cultured and divided into Control group and Probucol group. Each group was treated with hypoxia-hypoglycemia, hypoxia-hypoglycemia hydrogen peroxide and hypoxia-hypoglycemia hydrogen peroxide Syk inhibitor respectively.

RESULTS

The results of immunofluorescence and Western blot showed that Probucol could significantly improve the cognitive impairment induced by CCH, and the neuronal damage was also attenuated. On the one hand, the underlying mechanism of Probucol was to reduce oxidative stress and cell apoptosis of hippocampal neurons by inhibiting the expression of phosphorylated spleen tyrosine kinase (P-Syk); On the other hand, it exerted a protective effect by reducing NLRP3-dependent cell pyroptosis and inhibiting neuroinflammation induced by microglia activation.

CONCLUSION

Probucol could reduce oxidative stress and cell apoptosis by inhibiting the Syk/ROS signaling pathway, thereby improving CCH-induced cognitive impairment in vitro and in vivo.

Regulation of NCOA4-mediated iron recycling ameliorates paraquat-induced lung injury by inhibiting ferroptosis

Paraquat (PQ) is an irreplaceable insecticide in many countries for the advantage of fast-acting and broad-spectrum. However, PQ was classified as the most prevailing poisoning substance for suicide with no specific antidote. Therefore, it is imperative to develop more effective therapeutic agents for the treatment of PQ poisoning. In the present study, both the RNA-Seq and the application of various cell death inhibitors reflected that ferroptosis exerts a crucial regulatory role in PQ poisoning. Moreover, we found PQ strengthens lipid peroxidation as evidenced by different experimental approaches. Of note, pretreatment of iron chelation agent DFO could ameliorate the ferroptotic cell death and alleviate the ferroptosis-related events. Mechanistically, PQ treatment intensively impaired mitochondrial homeostasis, enhanced phosphorylation of AMPK, accelerated the autophagy flux and triggered the activation of Nuclear receptor coactivator 4-ferritin heavy chain (NCOA4-FTH) axis. Importantly, the activation of autophagy was observed prior to the degradation of ferritin, and inhibition of autophagy could inhibit the accumulation of iron caused by the ferritinophagy process. Genetic and pharmacological inhibition of ferritinophagy could alleviate the lethal oxidative events, and rescue the ferroptotic cell death. Excitingly, in the mouse models of PQ poisoning, both the administration of DFO and adeno-associated virus-mediated FTH overexpression significantly reduced PQ-induced ferroptosis and improved the pathological characteristics of pulmonary fibrosis. In summary, the current work provides an in-depth study on the mechanism of PQ intoxication, describes a framework for the further understanding of ferroptosis in PQ-associated biological processes, and demonstrates modulation of iron metabolism may act as a promising therapeutic agent for the management of PQ toxicity.

Sensory manipulation as a countermeasure to robot teleoperation delays: system and evidence

In the realm of robotics and automation, robot teleoperation, which facilitates human-machine interaction in distant or hazardous settings, has surged in significance. A persistent issue in this domain is the delays between command issuance and action execution, causing negative repercussions on operator situational awareness, performance, and cognitive load. These delays, particularly in long-distance operations, are difficult to mitigate even with the most advanced computing advancements. Current solutions mainly revolve around machine-based adjustments to combat these delays. However, a notable lacuna remains in harnessing human perceptions for an enhanced subjective teleoperation experience. This paper introduces a novel approach of sensory manipulation for induced human adaptation in delayed teleoperation. Drawing from motor learning and rehabilitation principles, it is posited that strategic sensory manipulation, via altered sensory stimuli, can mitigate the subjective feeling of these delays. The focus is not on introducing new skills or adapting to novel conditions; rather, it leverages prior motor coordination experience in the context of delays. The objective is to reduce the need for extensive training or sophisticated automation designs. A human-centered experiment involving 41 participants was conducted to examine the effects of modified haptic cues in teleoperations with delays. These cues were generated from high-fidelity physics engines using parameters from robot-end sensors or physics engine simulations. The results underscored several benefits, notably the considerable reduction in task time and enhanced user perceptions about visual delays. Real-time haptic feedback, or the anchoring method, emerged as a significant contributor to these benefits, showcasing reduced cognitive load, bolstered self-confidence, and minimized frustration. Beyond the prevalent methods of automation design and training, this research underscores induced human adaptation as a pivotal avenue in robot teleoperation. It seeks to enhance teleoperation efficacy through rapid human adaptation, offering insights beyond just optimizing robotic systems for delay compensations.

Novel quality control strategies for the determination of 25-hydroxyvitamin D by LC-MS/MS

Mass spectrometry analysis has been applied in many important diagnostic fields of laboratory medicine. However, there is little literature to guide quality management systems for LC-MS/MS methods. In this study, LC-MS/MS 25-hydroxyvitamin D (25(OH)D) was used as an example to establish internal quality control strategies to ensure the accuracy of clinical vitamin D results. A total of 141 batches of samples were analyzed. Sample internal standard peak area variability, ion pair ratio, and physical examination population data were monitored as quality control strategies for 25(OH)D results. The analytical performance was evaluated by calculated Sigma metrics. Applying our quality control strategies, several abnormal data were monitored in the routine analysis. The daily peak area CV of 25(OH)D fluctuated within a certain range. By selecting P99 CV as the control target, two abnormal batches were found. The ratio of 25(OH)VD3 ion pairs was relatively stable. Among them, batch20230120 had a high CV value, which may be due to the bias caused by the limited number. According to the physical examination data, batch20220913 and batch20220919 exceeded the alarm limit. Sigma level of 25(OH)VD3 in the laboratory was 6.52, which achieved "excellent" performance. In conclusion, we established comprehensive quality control strategies for the determination of 25(OH)D by LC-MS/MS, which has high analytical performance and can provide more accurate reports for the clinic.