Toroidal micelles formed in viscoelastic aqueous solutions of a double-tailed surfactant with two quaternary ammonium head groups

Innovation in surfactant structures is an effective way to prepare new soft materials with novel applications. In this study, we synthesized a double-tailed surfactant containing two quaternary ammonium head groups (Di-C12-N2). The Di-C12-N2 solution behavior was investigated by surface tension, fluorescence, rheology, and cryo-TEM methods. Although Di-C12-N2 contained a large double-tailed hydrophobic group, the solubility of Di-C12-N2 was ∼90 mmol L-1 at 25 °C with a Krafft temperature of ∼1 °C. The increase in Di-C12-N2 concentration in the solutions led to the formation of various aggregates, including spherical micelles, worm-like micelles, multi-layered vesicles, and a rare type of small toroidal micelles. The two quaternary ammonium head groups in Di-C12-N2 led to strong electrostatic interactions between molecules, which was critical for the formation of toroidal micelles. Moreover, with an added NaCl concentration of 40 mmol L-1, the viscosity of the 5 mmol L-1Di-C12-N2 solution increased by ∼1000 times compared to the pure 5 mmol L-1Di-C12-N2 solution, revealing the high sensitivity of the unique head groups to ionic strength. This study enriches the research on the self-assembly principles of surfactants and brings new potential applications for new soft materials.

Developing screening tools to estimate the risk of diabetic kidney disease in patients with type 2 diabetes mellitus

BACKGROUND

Diabetic kidney disease (DKD) is an important microvascular complication of diabetes mellitus (DM).

OBJECTIVE

This study aimed to develop predictive nomograms to estimate the risk of DKD in patients with type 2 diabetes mellitus (T2DM).

METHODS

The medical records of patients with T2DM in our hospital from March 2022 to March 2023 were retrospectively reviewed. The enrolled patients were randomly selected for training and validation sets in a 7:3 ratio. The models for predicting risk of DKD were virtualized by the nomograms using logistic regression analysis.

RESULTS

Among the enrolled 597 patients, 418 were assigned to the training set, while 179 were assigned to the validation set. Using the predictors included glycated hemoglobin A1c (HbA1c), high density lipoprotein cholesterol (HDL-C), presence of diabetic retinopathy (DR) and duration of diabetes (DD), we constructed a full model (model 1) for predicting DKD. And using the laboratory indexes of HbA1c, HDL-C, and cystatin C (Cys-C), we developed a laboratory-based model (model 2). The C-indexes were 0.897 for model 1 and 0.867 for model 2, respectively. The calibration curves demonstrated a good agreement between prediction and observation in the two models. The decision curve analysis (DCA) curves showed that the two models achieved a net benefit across all threshold probabilities.

CONCLUSION

We successfully constructed two prediction models to evaluate the risk of DKD in patients with T2DM. The two models exhibited good predictive performance and could be recommended for DKD screening and early detection.

Role of Cisplatin in Inducing Acute Kidney Injury and Pyroptosis in Mice via the Exosome miR-122/ELAVL1 Regulatory Axis

Although cisplatin is an effective chemotherapy drug for the treatment of various cancers, its clinical use is limited due to its side effects, especially nephrotoxicity. Unfortunately, acute kidney injury (AKI) caused by cisplatin remains one of the main challenges in effective cancer treatment. Evidence increasingly suggests that renal inflammation and pyroptotic inflammatory cell death of renal tubular epithelial cells (RTECs) mainly determine the progression and outcome of cisplatin-induced AKI. However, it is not clear how cisplatin regulates the pyroptosis of RTECs cells in AKI. The current study aimed to determine the regulation mechanism of AKI induced by cisplatin. We used cisplatin to induce AKI in vivo. We performed H&E staining of mouse kidney tissue sections and evaluated serological indicators of kidney injury (including blood urea nitrogen (BUN), serum creatinine, and tumor necrosis factor-alpha (TNF-alpha)). We used immunohistochemistry and western blot to detect the important substrate protein gasdermin D (GSDMD) and key target caspase-1 of pyroptosis, respectively. Cisplatin induced mouse AKI and RTECs pyroptosis. HK2 cell-derived exosomes treated with cisplatin influenced pyroptosis of the surrounding HK2 cells. Cisplatin-treated HK2 cells exosome-derived miR-122 regulated pyroptosis in the surrounding cells. Exosome-derived miR-122 affected cisplatin-induced AKI and HK2 cells pyroptosis by regulating the expression of embryonic lethal abnormal vision (ELAVL1). These results suggest that exosome miR-122 inhibited pyroptosis and AKI by targeting ELAVL1 under cisplatin treatment, and this offers a potential target for the treatment of AKI.

Longitudinal Association Between Perceived Availability of Home- and Community-Based Services and All-Cause Mortality Among Chinese Older Adults: A National Cohort Study

Home- and community-based services (HCBS) may contribute to lowering mortality and enhancing quality of life among older adults. Limited research, however, has examined this relationship in the Chinese context. This study explored the longitudinal association between perceived availability of HCBS and all-cause mortality among Chinese older adults. This cohort study included 8,102 individuals aged 65 years and older from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. HCBS included daily life assistance, medical care services, emotional support and social services, and reconciliation and legal aid services. The association between perceived availability of HCBS and all-cause mortality was investigated using Cox proportional hazards models. Emotional support and social services were negatively associated with all-cause mortality (HR = 0.86, 95% CI: 0.78 ~ 0.95, P = .004). Daily life assistance, medical care services, and reconciliation and legal aid services were not significantly associated with all-cause mortality. Providing community-level emotional support and social services may reduce the risk of death. Focusing on the mental health and social well-being of older adults is just as important as caring for their physical health.

Effective degradation of anthraquinones in Folium Sennae with Monascus fermentation for toxicity reduce and efficacy enhancement

Folium Sennae are widely used around the world, mainly in purging and removal of endogenous active substances, such as anthraquinone and its derivatives. However, the potential toxicity of anthraquinones to the liver, kidney, and intestinal limits the application of Folium Sennae. In this study, we aimed at safe regulation of Folium Sennae to degrade anthraquinones, boosting medicinal properties and reducing toxicity and potency with Monascus fermentation. Monascus strains H1102 for Folium Sennae fermentation were selected as the initial strain which was capable of producing high yields of functional pigment and low yields of hazardous citrinin. The anthraquinone degradation rate reached 41.2%, with 212.2 U mL-1 of the pigment and approximately 0.038 mg L-1 of the citrinin under optimal fermentation conditions followed by response surface streamlining, which met the requirements of reducing toxicity, increasing efficiency of Monascus fermented Folium Sennae. Furthermore, the Monascus/Folium Sennae culture had no observable toxic effect on HK-2 and L-02 cells in vitro and further inhibited cell apoptosis and necrosis. Overall, our results showed that Monascus fermentation could provide an alternative strategy for toxicity reduction of herbal medicines as well as efficacy enhancement.

Ecofriendly Viscoelastic Solutions Formed from a Recyclable Rosin-Based Amine Oxide Surfactant

Innovations in molecular structures formed using bioresources are efficient means to prepare surfactant aggregates with unique properties. Here, a rosin-based amine oxide surfactant (R-11-3-AO) containing large hydrophobic groups was synthesized from rosin derivatives, namely, dehydroabietic acid and long-chain amino acids. Cryo-transmission electron microscopy showed that R-11-3-AO molecules formed extremely long wormlike micelles with a cross-sectional diameter of 4-5 nm at a concentration of approximately 7 mmol·L^-1. A gel-like system was obtained at approximately 30 mmol·L^-1 due to the dense entanglement of the wormlike micelles. The solutions also exhibited unique shear thickening behavior at a shear rate of approximately 10 s^-1 even at high concentrations. The large hydrophobic group contained in R-11-3-AO is the origin of the strong van der Waals interactions between the surfactant molecules, resulting in the rapid growth of wormlike micelles. This rosin-based surfactant is the first recoverable amine oxide surfactant from solutions through the salting-out effect with high recovery rates. This work demonstrates the unique capabilities of rosin-based surfactants for forming wormlike micelles and provides opportunities for the development of surfactant recovery technologies.

The Role of Contextual Factors in Shaping Urban Older Adults' Intention of Institutional Care in China: A Mixed-Methods Study

BACKGROUND

This mixed-methods study explores older people's intention of institutional care and its contributing contextual factors, and the meaning given to their intention by older adults in the transitioning Chinese society.

METHODS

Guided by the extended Anderson model and frameworks of the ecological theory of aging, survey data collected from 1937 Chinese older adults were used. Transcripts from six focus group interviews were analyzed to incorporate the voices of the participants.

RESULTS

Community environment and services, health services, financial services, and regional service organizations were related to the institutional care intention of older people. The qualitative analysis showed that the reported conflicting feelings about institutional care was driven by the lack of supporting resources and age-friendly environment. The findings of this study suggested that the reported intention of Chinese older adults for institutional care may not be an ideal choice but a compromise or, in some cases, a forced choice.

CONCLUSIONS

Rather than treating the stated institutional intention as a simple expression of older Chinese people's likes or desires, the intention of institutional care should be understood within a framework that fully considers the influence of psycho-social factors and contextual organizations.

Recyclable Nonionic-Anionic Bola Surfactant as a Stabilizer of Size-Controllable and pH-Responsive Pickering Emulsions

A novel nonionic-anionic Bola surfactant (abbreviated as CH₃O(EO)₇-R₁₁-COOH) was designed and synthesized by condensation of methyl polyoxyethylene (7) ether with 12-bromododecanoic acid. In neutral aqueous solution, the surfactant behaves as a nonionic one and can stabilize oil-in-water (O/W) conventional emulsions alone and costabilize O/W Pickering emulsions with positively charged alumina nanoparticles with n-decane as the oil. In alkaline solution, the carboxylic acid group is deprotonated, becoming anionic and the surfactant is converted to Bola form, which is an inferior emulsifier and does not adsorb on particle surfaces, resulting in demulsification of both kinds of emulsions. With strong hydrophilicity, both the Bola surfactant and the bare particles return to the aqueous phase after demulsification, which is therefore recyclable and reusable in accordance with sustainable chemistry and engineering. In acidic media between pH 3 and 6, the ethyleneoxy groups tend to desorb from particle surfaces, slightly reducing the hydrophobicity of the particles. However, Pickering emulsions are still stable but their droplet size increases on lowering the pH. The Pickering emulsions are therefore pH-responsive and size-controllable. This newly designed Bola surfactant is effective in preparing smart emulsions, which are extensively applied in heterogeneous catalysis, oil product transportation, emulsion polymerization, and new material preparation.

Impact of the COVID-19 pandemic and corresponding control measures on long-term care facilities: a systematic review and meta-analysis

BACKGROUND

Long-term care facilities (LTCFs) were high-risk settings for COVID-19 outbreaks.

OBJECTIVE

To assess the impacts of the COVID-19 pandemic on LTCFs, including rates of infection, hospitalisation, case fatality, and mortality, and to determine the association between control measures and SARS-CoV-2 infection rates in residents and staff.

METHOD

We conducted a systematic search of six databases for articles published between December 2019 and 5 November 2021, and performed meta-analyses and subgroup analyses to identify the impact of COVID-19 on LTCFs and the association between control measures and infection rate.

RESULTS

We included 108 studies from 19 countries. These studies included 1,902,044 residents and 255,498 staff from 81,572 LTCFs, among whom 296,024 residents and 36,807 staff were confirmed SARS-CoV-2 positive. The pooled infection rate was 32.63% (95%CI: 30.29 ~ 34.96%) for residents, whereas it was 10.33% (95%CI: 9.46 ~ 11.21%) for staff. In LTCFs that cancelled visits, new patient admissions, communal dining and group activities, and vaccinations, infection rates in residents and staff were lower than the global rate. We reported the residents' hospitalisation rate to be 29.09% (95%CI: 25.73 ~ 32.46%), with a case-fatality rate of 22.71% (95%CI: 21.31 ~ 24.11%) and mortality rate of 15.81% (95%CI: 14.32 ~ 17.30%). Significant publication biases were observed in the residents' case-fatality rate and the staff infection rate, but not in the infection, hospitalisation, or mortality rate of residents.

CONCLUSION

SARS-CoV-2 infection rates would be very high among LTCF residents and staff without appropriate control measures. Cancelling visits, communal dining and group activities, restricting new admissions, and increasing vaccination would significantly reduce the infection rates.

Substituted benzoate-anchored decanuclear titanium-oxo clusters featuring unprecedented defective double-cubane geometry

Based on DMF solvent, four titanium-oxo clusters (TOCs) [Ti10(μ3-O)12(L)6 (OiPr)10 (DMF)2] (Ti-L) (L=4-methylbenzoate(MB), 3,5-Di-tert-butylbenzoate (DTBB), 4-Methoxybenzoate (MOB) and 4-Methyl-3,5-dinitrobenzoate(MDNB) with the same coordination environments have been solvothermally synthesized with high...

APOBEC mutagenesis, kataegis, chromothripsis in EGFR-mutant osimertinib-resistant lung adenocarcinomas

BACKGROUND

Studies of targeted therapy resistance in lung cancer have primarily focused on single-gene alterations. Based on prior work implicating apolipoprotein b mRNA-editing enzyme, catalytic polypeptide-like (APOBEC) mutagenesis in histological transformation of epidermal growth factor receptor (EGFR)-mutant lung cancers, we hypothesized that mutational signature analysis may help elucidate acquired resistance to targeted therapies.

PATIENTS AND METHODS

APOBEC mutational signatures derived from an Food and Drug Administration-cleared multigene panel [Memorial Sloan Kettering Cancer Center Integrated Mutation Profiling of Actionable Cancer Targets (MSK-IMPACT)] using the Signature Multivariate Analysis (SigMA) algorithm were validated against the gold standard of mutational signatures derived from whole-exome sequencing. Mutational signatures were decomposed in 3276 unique lung adenocarcinomas (LUADs), including 93 paired osimertinib-naïve and -resistant EGFR-mutant tumors. Associations between APOBEC and mechanisms of resistance to osimertinib were investigated. Whole-genome sequencing was carried out on available EGFR-mutant lung cancer samples (10 paired, 17 unpaired) to investigate large-scale genomic alterations potentially contributing to osimertinib resistance.

RESULTS

APOBEC mutational signatures were more frequent in receptor tyrosine kinase (RTK)-driven lung cancers (EGFR, ALK, RET, and ROS1; 25%) compared to LUADs at large (20%, P < 0.001); across all subtypes, APOBEC mutational signatures were enriched in subclonal mutations (P < 0.001). In EGFR-mutant lung cancers, osimertinib-resistant samples more frequently displayed an APOBEC-dominant mutational signature compared to osimertinib-naïve samples (28% versus 14%, P = 0.03). Specifically, mutations detected in osimertinib-resistant tumors but not in pre-treatment samples significantly more frequently displayed an APOBEC-dominant mutational signature (44% versus 23%, P < 0.001). EGFR-mutant samples with APOBEC-dominant signatures had enrichment of large-scale genomic rearrangements (P = 0.01) and kataegis (P = 0.03) in areas of APOBEC mutagenesis.

CONCLUSIONS

APOBEC mutational signatures are frequent in RTK-driven LUADs and increase under the selective pressure of osimertinib in EGFR-mutant lung cancer. APOBEC mutational signature enrichment in subclonal mutations, private mutations acquired after osimertinib treatment, and areas of large-scale genomic rearrangements highlights a potentially fundamental role for APOBEC mutagenesis in the development of resistance to targeted therapies, which may be potentially exploited to overcome such resistance.

Pickering Emulsions Synergistically Stabilized by Aliphatic Primary Amines and Silica Nanoparticles

Innovation in emulsion compositions is necessary to enrich emulsion formulations and applications. Herein, Pickering emulsions were prepared using silica nanoparticles and aliphatic primary amines with an oil-water ratio of 1:1 (v/v). Contact angle experiments revealed that the in situ hydrophobization of nanoparticles was caused by the surface adsorption of amine molecules. Notably, the interactions between amine compounds and the surface of silica nanoparticles were electrostatic attractions and mutual hydrogen bonding. The existence of hydrogen bonds was further confirmed by demulsification experiments using a chaotropic agent DMF and increasing temperatures. The hydrophobicity of silica nanoparticles can be effectively improved using most commercially available aliphatic primary amines such as n-hexylamine, n-octylamine, n-decylamine, dodecylamine, and tetradecylamine. The minimum concentrations of the aforementioned amines necessary for stabilizing the emulsions with 0.3 wt % silica nanoparticles are 3, 0.6, 0.3, 0.06, and 0.03 mM, respectively, decreasing significantly with increasing alkyl chain length. With the increase of the amine concentrations, the hydrophobicity of silica particles monotonically increased and finally resulted in the inversion of emulsions. The amine concentrations for emulsion phase inversion were 150, 40, 30, 20, and 20 mM, respectively, in the presence of 0.3 wt % silica nanoparticles. In this work, silica nanoparticles were hydrophobized using aliphatic primary amines. The composite stabilizers developed are useful for developing novel stimuli-responsive Pickering emulsions, while the synergistic effects introduced herein are also helpful in expanding the hydrophobization methods available for nanoparticles.

Rheological behavior of thread-like fiber solutions formed from a rosin-based surfactant with two head groups

Wormlike micelles are conventional aggregates that exist in viscoelastic solutions. However, to achieve a solution with prominent viscoelasticity, rather high concentrations of surfactants are usually required due to the flexibility of aggregates in solution. If thread-like aggregates with rigidity can be formed by surfactants, the solutions are expected to show strong viscoelasticity at very low surfactant concentrations. Herein, A novel rosin-based quaternary ammonium surfactant with two head groups (abbreviated as R-11-3-DA) was synthesized. Cryogenic transmission electron microscopy (Cryo-TEM) images showed that flexible nanofibers with diameters of about 7-8 nm and lengths of over 1 μm were formed in the 1 : 1.5 R-11-3-DA : SL solutions. The rigidity of the aggregates seems to be inherited from the rigidity of the surfactant molecules. The novel aggregates endow the solutions with remarkable viscoelasticity at very low concentrations, with a critical overlap concentration of 0.01 wt% and a critical gelling concentration of 0.58 wt%. The rheological behavior of the solutions also shows excellent shear resistance and weak sensitivity to temperature below the critical gelation temperature (T_gel). This work reveals the advantages of viscoelastic solutions containing flexible nanofibers. The design principles of new molecular structures and system compositions can be applied to the preparation of smart soft materials based on the self-assembly of molecules.

Perceived availability of home- and community-based services and self-reported depression among Chinese older adults: A cross-sectional study

Few studies have assessed the association between perceived availability of home- and community-based services (HCBSs) and self-reported depression among Chinese older adults, which the present study attempts to rectify. This cross-sectional study enrolled 11,941 participants aged 65 and older from the Chinese Longitudinal Healthy Longevity Survey 2018 wave. The 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) was used to evaluate depression, and perceived availability was measured for four categories of HCBSs: daily life assistance, medical care services, emotional support and social services, and other. These four categories and the number of services in each were used to represent the perceived availability of service provision. Binary logistic models were used to explore the relationship between perceived availability of HCBSs and depression in older adults. Perceived daily life assistance was found to be negatively associated with depression symptoms among Chinese older adults in both urban and rural areas [rural: OR (95%CI) = 0.66 (0.55-0.78), p < 0.001; urban: OR (95% CI) = 0.69(0.60-0.79), p < 0.001], while perceived levels of medical care services, emotional support and social services, and other were not associated with depression symptoms in rural or urban areas. Our primary finding was that providing daily life assistance at the community level may help to meet more older adults' daily needs, thus potentially decreasing the risk of depression.

Water-in-Oil Emulsion Gels Stabilized by a Low-Molecular Weight Organogelator Derived from Dehydroabietic Acid

High concentrations of surfactants or gelators are usually necessary to prepare emulsions gels with unusual physicochemical properties. This situation may be improved by innovating the aggregate morphology in systems. Herein, a rosin-based molecule is designed and synthesized using dehydroabietic acid as the starting material (denoted as R-Lys-R). The molecule acts as an effective organogelator and can gelate several hydrocarbon compounds with a minimum gelation concentration of 0.2% (w/v). Analysis using atomic force microscopy (AFM) and circular dichroism (CD) reveals that in n-decane, R-Lys-R forms left-handed helical fibers with a cross-sectional diameter of approximately 15 nm. The directional hydrogen bonding of the amide group is helpful to the formation of aggregates. At concentrations of R-Lys-R above 2%, water-in-oil emulsions are transformed into emulsion gels owing to the aptitude of R-Lys-R in gelating the oil phase. The concentrations of the emulsifier can be adjusted to obtain emulsion gels with different formulations. This work reveals the potential of rosin derivatives for the formation of small molecular weight organogels and provides a novel method for the utilization of natural resources in soft materials and home care products.

Recyclable and re-usable smart surfactant for stabilization of various multi-responsive emulsions alone or with nanoparticles

A novel multi-responsive surfactant (abbreviated as N⁺-8P8-N) was synthesized, in which one octyl trimethylamine group (quaternary ammonium) and one octyl dimethylamine group are connected to a benzene ring through ether bonds. This novel surfactant can stabilize conventional oil-in-water (O/W) emulsions alone, and O/W Pickering emulsions and novel oil-in-dispersion emulsions together with oppositely and similarly charged nanoparticles, respectively. In all cases rapid demulsification can be achieved through either pH or CO₂/N₂ triggers, by which the surfactant is reversibly converted between a normal cationic surfactant form (N⁺-8P8-N) and a strongly hydrophilic and surface-inactive bola form (N⁺-8P8-NH⁺). Notably, the bola form N⁺-8P8-NH⁺ dissolves in the aqueous phase alone or together with nanoparticles after demulsification without contamination of the oil phase, and the aqueous phase can be recycled many times triggered by pH or CO₂/N₂ in accordance with the principle of green chemistry. This newly designed re-usable smart surfactant is significant for the development of various temporarily stable emulsions, which are extensively applied in emulsion polymerization, new material synthesis, heterogeneous catalysis and oil transportation.

Gestational bisphenol A exposure impairs hepatic lipid metabolism by altering mTOR/CRTC2/SREBP1 in male rat offspring

Lipid metabolism is an important biochemical process in the body. Recent studies have found that environmental endocrine disruptors play an important role in the regulation of lipid metabolism. Bisphenol A (BPA), a common environmental endocrine disruptor, has adverse effects on lipid metabolism, but the mechanism is still unclear. This study aimed to investigate the effects of gestational BPA exposure on hepatic lipid metabolism and its possible mechanism in male offspring. The pregnant Sprague-Dawley rats were exposed to BPA (0, 0.05, 0.5, 5 mg/kg/day) from day 5 to day 19 of gestation to investigate the levels of triglyceride (TG) and total cholesterol (TC), and the expression of liver lipid metabolism-related genes in male offspring rats. The results showed that compared with the control group, the TG and TC levels in serum and liver in BPA-exposed groups was increased. And the expressions of liver fatty acid oxidation related genes, such as peroxisome proliferators-activated receptor α (PPARα) and carnitine palmitoyl transferase 1α (CPT1α), were down-regulated. However, the expressions of fatty acid synthesis related genes, such as sterol regulatory element binding proteins 1 (SREBP-1), acetyl-CoA carboxylase 1 (ACC1), fatty acid synthase (FAS) and stearoyl-CoA desaturase 1 (SCD-1), were up-regulated. The increased protein levels of mTOR and p-CRTC2 suggested that CREB-regulated transcription coactivator 2 (CRTC2) might be an important mediator in the mTOR/SREBP-1 pathway. In conclusion, these results demonstrated that mTOR/CRTC2/SREBP-1 could be affected by gestational BPA exposure, which may involve in the lipid metabolic disorders in later life.

Formation of asymmetric belt-like aggregates from a bio-based surfactant derived from dehydroabietic acid

The morphology and physicochemical properties of ordered molecular aggregates are closely related to surfactant molecules. Herein, a rosin-based amine oxide surfactant containing a large hydrophobic group (abbreviated R-10-AO) was synthesized from dehydroabietic acid, which is an important derivative of rosin. Cryogenic transmission electron microscopy (cryo-TEM) images and small-angle X-ray scattering (SAXS) showed that at a concentration of ∼5 mM, R-10-AO molecules formed flexible nanobelts with a thickness of only 2-3 nm. The width of these nanobelts was 50-150 nm and the length was more than 1 μm. The formation of the stable nanobelts arose from the strong van der Waals forces of the bulky hydrophobic portions of R-10-AO in solution, facilitating the stability of the asymmetrical aggregates. Rheological tests showed that the formed nanobelts were thermodynamically stable. The entanglement of these nanobelts led to significant viscoelasticity of the solutions. The zero-shear viscosity (η₀) of the R-10-AO solution reached 10 Pa s at a concentration of 5 mM, which is much greater than that of most wormlike micellar solutions. This work provides the inspirations of preparing aggregates with novel properties using natural products.

Behavior of Smart Surfactants in Stabilizing pH-Responsive Emulsions

Newly structured pH-responsive smart surfactants (N⁺ -(n)-N, n=14, 16) from alkyl trimethylammonium bromides are reported. In neutral and alkaline media N⁺ -(n)-N behaves as a normal cationic surfactant and stabilizes conventional emulsions alone, as well as Pickering emulsions and oil-in-dispersion emulsions together with oppositely and similarly charged nanoparticles, respectively. In acidic media N⁺ -(n)-N becomes a hydrophilic Bola-type surfactant, N⁺ -(n)-NH⁺ , and is an inferior emulsifier either when used alone or together with charged nanoparticles, resulting in demulsification. N⁺ -(n)-NH⁺ returns to the aqueous phase alone or together with nanoparticles after demulsification without contaminating the oil phase, and the aqueous phase can be recycled when triggered by pH change. This protocol is a green process and leads to preparation of various temporarily stable emulsions which are often used in emulsion polymerization, heterogeneous catalysis, and oil transportation.

Transition between a Pickering Emulsion and an Oil-in-Dispersion Emulsion Costabilized by Alumina Nanoparticles and a Cationic Surfactant

The transition between a novel oil-in-dispersion emulsion and an oil-in-water (O/W) Pickering emulsion triggered by pH was achieved using alumina nanoparticles in combination with a cationic surfactant. In acidic and neutral aqueous media, positively charged particles and the surfactant both at very low concentrations costabilize an oil-in-dispersion emulsion with the surfactant adsorbed at droplet interfaces and particles dispersed in the aqueous phase between the droplets. In alkaline media, however, particles become negatively charged and are hydrophobized in situ by adsorption of the surfactant to become surface-active and stabilize an O/W Pickering emulsion. The transition between the two is also possible by lowering the pH. The transformation can be achieved several times in a mixture of 0.1 wt % nanoparticles and 0.01 mM surfactant. This transition is significant, since particles can be made to either adsorb at the oil-water interface, which is beneficial for applications like biphasic catalysis, or remain dispersed in the aqueous phase, which is favorable for their recovery and reuse.

Covalent Immobilization of L-Asparaginase and Optimization of Its Enzyme Reactor for Reducing Acrylamide Formation in a Heated Food Model System

Acrylamide is a potent carcinogen and neurotoxin that is mainly formed by the Maillard reaction of asparagine with starch at high temperatures. In this work, a food safety immobilization system for L-asparaginase (L-ASNase) consisting of food-grade agarose (Aga) spheres and N-hydroxysuccinimide esters was developed to decrease the formation of acrylamide in a fluid food model system. L-asparaginase was successfully immobilized with a maximum immobilization efficiency of 68.43%. The immobilized enzymes exhibited superior storage stability and reusability with 93.21 and 72.25% of the initial activity retained after six consecutive cycles and storage for 28 days, indicating its high industrial application potential. Meanwhile, a simplified mathematical model of the enzyme reactor was developed and verified with experiments, which demonstrated its auxiliary role in the design and optimization of reactors. In addition, simulated fluidized food components were continuously catalyzed in the designed packed bed reactor, achieving a reduction rate of nearly 89%.

Supramolecular Hydrogels with Chiral Nanofibril Structures Formed from β-Cyclodextrin and a Rosin-Based Amino Acid Surfactant

The rational combination of natural molecules is expected to provide new soft material building blocks. Herein, a rosin-based amino acid surfactant was synthesized using dehydroabietic acid and l-serine as the starting materials (denoted as R-6-Ser). Supramolecular hydrogels were formed when β-cyclodextrin (β-CD) was mixed with R-6-Ser at molar ratios of over 0.5:1 and above certain concentrations. The hydrogels were investigated using rheometry, small-angle X-ray scattering, CD spectroscopy, and cryo-transmission electron microscopy (cryo-TEM). The β-CD associated with the isopropyl benzyl group of the dehydroabietic acid unit in R-6-Ser and formed R-6-Ser@β-CD complexes. The complexes and R-6-Ser self-assembled to form elongated right-handed rigid fibers with a diameter of approximately 7-8 nm, which were responsible for the elasticity of the hydrogels. This work demonstrated the feasibility of preparing supramolecular hydrogels from a diterpenoid-based surfactant and β-CD and provides a new means of utilizing the secretions of pine trees.

An Investigation of the Relationship Between COMLEX-USA Licensure Examination Performance and State Licensing Board Disciplinary Actions

PURPOSE

Passing the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) serves as a licensing requirement, yet there is limited understanding between this high-stakes exam and performance outcomes. This study examined the relationship between COMLEX-USA scores and disciplinary actions received by osteopathic physicians.

METHOD

Data for osteopathic physicians (N = 26,383) who graduated from medical school between 2004 and 2013 were analyzed using multinomial logistic regression to assess the relationship between COMLEX-USA scores and placement into one of 3 disciplinary action categories relative to no action received, controlling for years in practice and gender.

RESULTS

Less than 1% of physicians in this study (n = 187) had a disciplinary action(s). Controlling for all COMLEX-USA levels, years in practice, and gender, higher Level 3 scores were associated with significant decreased odds for all action categories: revoked licensed (odds ratio [OR] = 0.51, 95% confidence interval [CI] 0.36, 0.72; P < .001), imposed limitations to practice (OR = 0.59, 95% CI 0.41, 0.84; P < .01), and other action imposed (OR = 0.48, 95% CI 0.33, 0.69; P < .001), relative to not receiving an action. In these same models, higher Level 2 Performance Evaluation Biomedical/Biomechanical Domain scores decreased the odds for an action that revoked a license (OR = 0.75, 95% CI 0.58, 0.98; P < .05) and imposed limitations to practice (OR = 0.64, 95% CI 0.49, 0.84; P < .001).

CONCLUSIONS

These findings provide evidence that the COMLEX-USA delivers useful information regarding the likelihood of a practitioner receiving state board disciplinary actions.

Association Between American Board of Surgery Initial Certification and Risk of Receiving Severe Disciplinary Actions Against Medical Licenses

Importance

Board certification is used as a marker of surgeon quality and professionalism. Although some research has linked certification in surgery to outcomes, more research is needed.

Objective

To measure associations between surgeons obtaining American Board of Surgery (ABS) certification and examination performance with receiving future severe disciplinary actions against their medical licenses.

Design, Setting, and Participants

Retrospective analysis of severe license action rates for surgeons who attempted ABS certification based on certification status and examination performance. Surgeons who attempted to become certified were classified as certified or failing to obtain certification. Additionally, groups were further categorized based on whether the surgeon had to repeat examinations and whether they ultimately passed. The study included surgeons who initially attempted certification between 1976 and 2017 (n = 44 290). Severe license actions from 1976 to 2018 were obtained from the Federation of State Medical Boards, and certification data were obtained from the ABS database. Data were analyzed between 1978 and 2008.

Main Outcomes and Measures

Severe license action rates were analyzed across certified surgeons and those failing to obtain certification, as well as across examination performance groups.

Results

The final dataset included 36 197 men (81.7%) and 8093 women (18.3%). The incidence of severe license actions was significantly greater for surgeons who attempted and failed to obtain certification (incidence rate per 1000 person-years = 2.49; 95% CI, 2.13-2.85) than surgeons who were certified (incidence rate per 1000 person years = 0.77; 95% CI, 0.71-0.83). Adjusting for sex and international medical graduate status, the risk of receiving a severe license action across time was also significantly greater for surgeons who failed to obtain certification. Surgeons who progressed further in the certification examination sequence and had fewer repeated examinations had a lower incidence and less risk over time of receiving severe license actions.

Conclusions and Relevance

Obtaining board certification was associated with a lower rate of receiving severe license actions from a state medical board. Passing examinations in the certification examination process on the first attempt was also associated with lower severe license action rates. This study provides supporting evidence that board certification is 1 marker of surgeon quality and professionalism.

Highly wet aqueous foams stabilized by an amphiphilic bio-based hydrogelator derived from dehydroabietic acid

Exploration of novel molecular aggregates that stabilize foam systems is helpful to optimize foam properties. Herein, solutions of a rosin-based low-molecular-weight hydrogelator, abbreviated as R-6-AO, were used to generate foams above the critical gelation temperature (Tgel). The foams with R-6-AO concentrations above the critical gelation concentration were very stable below Tgel. The high stability of the foams under such conditions was attributed to the self-assembly of nanoscale fibers of R-6-AO in the liquid films of the foams, leading to extremely slow drainage of water. The foams showed strong water retention and were classified as very wet foams. For example, the foams generated from 10 mM (0.44 wt%) R-6-AO solution subjected to a fast cooling process contained about 45 vol% trapped water after 2000 min. In comparison, the water volume fraction of a 10 mM sodium dodecyl sulfate (SDS) foam decreased from 20 vol% to 1 vol% within 18 min. Because the growth, elongation, and cross-linking of the assembled nanofibers in the liquid films were affected by the cooling process, the stability of these foams also depended on the initial preparation temperature. The present system reveals the importance of microstructures in regulating foam behavior and serves as a new type of condition-sensitive intelligent foam.

Widely Adaptable Oil-in-Water Gel Emulsions Stabilized by an Amphiphilic Hydrogelator Derived from Dehydroabietic Acid

A surfactant, R-6-AO, derived from dehydroabietic acid has been synthesized. It behaves as a highly efficient low-molecular-weight hydrogelator with an extremely low critical gelation concentration (CGC) of 0.18 wt % (4 mm). R-6-AO not only stabilizes oil-in-water (O/W) emulsions at concentrations above its critical micelle concentration (cmc) of 0.6 mm, but also forms gel emulsions at concentrations beyond the CGC with the oil volume fraction freely adjustable between 2 % and 95 %. Cryo-TEM images reveal that R-6-AO molecules self-assemble into left-handed helical fibers with cross-sectional diameters of about 10 nm in pure water, which can be turned to very stable hydrogels at concentrations above the CGC. The gel emulsions stabilized by R-6-AO can be prepared with different oils (n-dodecane, n-decane, n-octane, soybean oil, olive oil, tricaprylin) owing to the tricyclic diterpene hydrophobic structure in their molecules that enables them to adopt a unique arrangement in the fibers.

Body mass index cut-off points for predicting chronic non-communicable disease should differ by gender and age group

OBJECTIVES

The objective of this study to determine whether body mass index (BMI) in different genders and age groups need different thresholds when predicting chronic non-communicable diseases (CNCDs).

STUDY DESIGN

This is a cross-sectional study.

METHODS

Data were obtained from the China Health and Nutrition Survey conducted in 2009. Sequential sample cluster analysis was used to group age according to BMI. Propensity score matching was used to eliminate the influence of age. Receiver operating characteristic curve based on gender and age group was used to evaluate the cut-off values and efficiency of BMI in each group.

RESULTS

A total of 8469 individuals were enrolled in this study. Results of sequential sample cluster analyses showed age was divided into three groups: 18-39, 40-59 and 60-99 years. There were significant differences in the distribution of BMI among the three groups for both males and females (P < 0.001). Statistical differences were observed in the distribution of BMI between genders in the 18-39- and 60-99-year-old age groups (P < 0.001). For men, the cut-off values of BMI were ≥25 kg/m², ≥24 kg/m² and ≥23 kg/m² in the 18-39, 40-59 and 60-99 years old groups, respectively; for women, the corresponding cut-off points were ≥25 kg/m², ≥23 kg/m² and ≥25 kg/m² in groups.

CONCLUSIONS

The thresholds for BMI might be different between gender and age group. In addition, it might not be suitable to determine cut-off values of BMI to predict CNCDs for people aged ≥60 years.

FSMB Census of Licensed Physicians in the United States, 2018

There are 985,026 physicians with Doctor of Medicine (MD) and Doctor of Osteopathic Medicine (DO) degrees licensed to practice medicine in the United States and the District of Columbia, according to physician census data compiled by the Federation of State Medical Boards (FSMB). These qualified physicians graduated from 2,089 medical schools in 167 countries and are available to serve a U.S. national population of 327,167,434. While the percentage of physicians who are international medical graduates have remained relatively stable over the last eight years, the percentage of physicians who are women, possess a DO degree, have three or more licenses, or are graduates of a medical school in the Caribbean have increased by varying degrees during that same period.

This report marks the fifth biennial physician census that the FSMB has published, highlighting key characteristics of the nation's available physician workforce, including numbers of licensees by geographic region and state, type of medical degree, location of medical school, age, gender, specialty certification and number of active licenses per physician. The number of licensed physicians in the United States has been growing steadily, due in part to an expansion in the number of medical schools and students during the past two decades, even as concerns of a physician shortage to meet health care demands persist. The average age of licensed physicians continues to increase, and more licensed physicians appear to be specialty certified, though the latter finding may reflect more comprehensive reporting. This census was compiled using the FSMB's Physician Data Center (PDC), which collects, collates and analyzes physician data directly from the nation's state medical and osteopathic boards and is uniquely positioned to provide a comprehensive snapshot of information about licensed physicians. A periodic national census of this type offers useful demographic and licensure information about the available physician workforce that may be useful to policy makers, researchers and related health care organizations to better understand and address the nation's health care needs.

The Relationship Between Board Certification and Disciplinary Actions Against Board-Eligible Family Physicians

PURPOSE

Lack of specialty board certification has been reported as a significant physician-level predictor of receiving a disciplinary action from a state medical board. This study investigated the association between family physicians receiving a disciplinary action from a state medical board and certification by the American Board of Family Medicine (ABFM).

METHOD

Three datasets were merged and a series of logistic regressions were conducted examining the relationship between certification status and disciplinary actions when adjusting for covariates. Data were available from 1976 to 2017. Predictor variables were gender, age, medical training degree type, medical school location, and the severity of the action.

RESULTS

Of the family physicians in this sample, 95% (114,454/120,443) had never received any disciplinary action. Having ever been certified was associated with a reduced likelihood of ever receiving an action (odds ratio [OR] = 0.35; 95% confidence interval [CI] = 0.30, 0.40; P < .001), and having held a prior but not current certification at the time of the action was associated with an increase in receiving the most severe type of action (OR = 3.71; 95% CI = 2.24, 6.13; P < .001).

CONCLUSIONS

Disciplinary actions are uncommon events. Family physicians who had ever been ABFM certified were less likely to receive an action. The most severe actions were associated with decreased odds of being board certified at the time of the action. Receiving the most severe action type increased the likelihood of physicians holding a prior but not current certification.

Viscoelastic lyotropic liquid crystals formed in a bio-based trimeric surfactant system

Exploring the self-assembly of oligomeric surfactants is expected to bridge the gap between conventional and polymeric surfactants. Using the natural resource rosin as the starting material, a bio-based star-shaped trimeric quaternary ammonium surfactant (abbreviated tri-R-4-Phe) was synthesized. With three bulky dehydroabietic acid units in the hydrophobic group, tri-R-4-Phe has a molecular weight of 1684.9 and shows strong affinity towards both water and nonpolar organic compounds. In the presence of tri-R-4-Phe, C12EO3 was able to form lamellar lyotropic liquid crystals over a wide concentration range in water. The tri-R-4-Phe/C12EO3/water tertiary system was investigated by polarizing optical microscopy (POM), small angle X-ray scattering (SAXS) and rheological measurements. The investigated samples with different formulations all showed strong viscoelasticity, and the viscosity increased with the surfactant content. All samples showed interesting shear banding phenomena due to the shear induced mesoscale phase transition in tri-R-4-Phe/C12EO3/water systems. The present work reveals the unique behaviour of trimeric surfactant involved LLC systems and the result may be helpful in investigating delicate molecular self-assembly using natural resources.

Switchable Oil-in-Water Emulsions Stabilized by Like-Charged Surfactants and Particles at Very Low Concentrations

A novel CO₂/N₂ switchable n-decane-in-water emulsion was prepared, which is stabilized by a CO₂/N₂ switchable surfactant [ N'-dodecyl- N, N-dimethylacetamidine (DDMA)] in cationic form in combination with positively charged alumina nanoparticles at concentrations as low as 0.01 mM and 0.001 wt %, respectively. The particles do not adsorb at the oil-water interface but remain dispersed in the aqueous phase between surfactant-coated droplets. A critical zeta potential of the particles of ca. +18 mV is necessary for the stabilization of the novel emulsions, suggesting that the electrical double-layer repulsions between particles and between particles and oil droplets are responsible for their stability. By bubbling N₂ into the emulsions, demulsification occurs following transformation of DDMA molecules from the surface-active cationic form to the surface-inactive neutral form and desorption from the oil-water interface. Bubbling CO₂ into the demulsified mixtures, cationic DDMA molecules are re-formed, which adsorb to the droplet interfaces, ensuring stable emulsions after homogenization. Compared with Pickering emulsions and traditional emulsions, the amount of switchable surfactant and number of like-charged particles required for stabilization are significantly reduced, which is economically and environmentally benign for practical applications.