Search

Objectives: To investigate the risk of atrial fibrillation (AF) with sodium-glucose cotransporter-2 inhibitors (SGLT2is) compared to dipeptidyl peptidase-4 inhibitor (DPP4i) use in older US adults and across diverse subgroups. Methods: We conducted a retrospective cohort analysis using claims data from 15% random samples of Medicare fee-for-service beneficiaries. Patients were adults with type 2 diabetes (T2D), no preexisting AF, and were newly initiated on SGLT2i or DPP4i. The outcome was the first incident AF. Inverse probability treatment weighting (IPTW) was used to balance the baseline covariates between the treatment groups including sociodemographics, comorbidities, and comedications. Cox regression models were used to assess the effect of SGLT2i compared to DPP4i on incident AF. Results: Of the 97,436 eligible individuals (mean age 71.2 ± 9.8 years, 54.6% women), 1.01% (n = 983) had incident AF over a median follow-up of 361 days. The adjusted incidence rate was 8.39 (95% CI: 6.67-9.99) and 11.70 (95% CI: 10.9-12.55) per 1,000 person-years in the SGLT2i and DPP4i groups, respectively. SGLT2is were associated with a significantly lower risk of incident AF (HR 0.73; 95% CI, 0.57 to 0.91; p = 0.01) than DPP4is. The risk reduction of incident AF was significant in non-Hispanic White individuals and subgroups with existing atherosclerotic cardiovascular diseases and chronic kidney disease. Conclusion: Compared to the use of DPP4i, that of SGLT2i was associated with a lower risk of AF in patients with T2D. Our findings contribute to the real-world evidence regarding the effectiveness of SGLT2i in preventing AF and support a tailored therapeutic approach to optimize treatment selection based on individual characteristics. [ABSTRACT FROM AUTHOR]

In this paper, a relaxed Newton-type matrix splitting (RNMS) iteration method is proposed for solving the generalized absolute value equations, which includes the Picard method, the modified Newton-type (MN) iteration method, the shift splitting modified Newton-type (SSMN) iteration method and the Newton-based matrix splitting (NMS) iteration method. We analyze the sufficient convergence conditions of the RNMS method. Lastly, the efficiency of the RNMS method is analyzed by numerical examples involving symmetric and non-symmetric matrices. [ABSTRACT FROM AUTHOR]

Many problems in different fields may lead to solutions of absolute value equations, such as linear programming problems, linear complementarity problems, quadratic programming, mixed integer programming, the bimatrix game and so on. In this paper, by introducing a nonnegative real parameter to the modified Newton-based iteration scheme, we present a new relaxed modified Newton-based (RMN) iteration method for solving generalized absolute value equations. The famous Picard iteration method and the modified Newton-type iteration method are the exceptional cases of the RMN iteration method. The convergence property of the new method is discussed. Finally, the validity and feasibility of the RMN iteration method are verified by experimental examples. [ABSTRACT FROM AUTHOR]

Background: COVID‐19 pandemic has caused mask‐related skin problems on health‐care professions, yet very few studies have investigated the prevalence in oriental general population. Objective: To investigate the prevalence of mask‐related adverse skin reactions in Orientals, to explore psychological influence, to identify risk factors for mask‐related acne exacerbation. Methods: We performed a survey through social media. Participant demographics, skin condition before and after COVID‐19, and the influence of adverse skin on social‐psychological conditions were collected. We compared characteristics between individuals with or without acne exacerbation, and we performed a logistic regression to identify risk factors. Results: Six hundred and six participants (62.3%) responded the survey and 23.3% complained their facial acnes become exacerbated since COVID‐19. The social‐psychological impact of acnes is more prevalent in women. Risk factors for mask‐related acne exacerbation were occupation as health‐care workers (OR = 1.861, p = 0.027), prolonged wearing of N95 masks (OR = 3.167, p = 0.001), and touching of acnes (OR = 2.65, p = 0.002). Sex, pre‐existed acnes, and prolonged wearing time per day are also associated with acne exacerbation. Conclusions: Mask‐related adverse skin reactions are common in Orientals, and could lead to negative social‐psychological effects. [ABSTRACT FROM AUTHOR]

In response to the global coronavirus disease 2019 (COVID-19) pandemic, the use of shortterm confined spaces has attracted widespread attention, and elevators have become a major pathway for pathogens. This study uses video recognition technology to develop a contactless elevator operating system, which can be operated by hand gestures of the user. This design can solve current elevator usage problems by integrating human and spatial aspects into the control mode and user interface. By observing and analyzing operational interfaces and behaviors in current hospital elevators, specifications for the new interface were developed. A video motion recognition sensory system was applied to formulate the design and planning principles of the noncontact elevator. Gesture images were combined with simulations to create experimental tasks, in which users were timed and interviewed to evaluate the acceptability and efficiency of the designed interface. The results of this study show that the planning and design of noncontact elevator control modes and user interfaces are advantageous, intuitive, and easy to learn. The control interface of the elevator was displayed in an electronic panel using colors, shapes, and sizes to show operational information, enabling a quick search and high learnability. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effect of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) therapy on the prognosis of patients with atrial fibrillation (AF). Methods A total of 1,991 AF patients from the AF registry were divided into two groups according to whether they were treated with ACEI/ARB at recruitment. Baseline characteristics were carefully collected and analyzed. Logistic regression was utilized to identify the predictors of ACEI/ARB therapy. The primary endpoint was all-cause mortality, while the secondary endpoints included cardiovascular mortality, stroke and major adverse events (MAEs) during the one-year follow-up period. Univariable and multivariable Cox regression were performed to identify the association between ACEI/ARB therapy and the one-year outcomes. Results In total, 759 AF patients (38.1%) were treated with ACEI/ARB. Compared with AF patients without ACEI/ARB therapy, patients treated with ACEI/ARB tended to be older and had a higher rate of permanent AF, hypertension, diabetes mellitus, heart failure (HF), left ventricular ejection fraction (LVEF) < 40%, coronary artery disease (CAD), prior myocardial infarction (MI), left ventricular hypertrophy, tobacco use and concomitant medications (all P < 0.05). Hypertension, HF, LVEF < 40%, CAD, prior MI and tobacco use were determined to be predictors of ACEI/ARB treatment. Multivariable analysis showed that ACEI/ARB therapy was associated with a significantly lower risk of one-year all-cause mortality [hazard ratio (HR) (95% CI): 0.682 (0.527-0.882), P = 0.003], cardiovascular mortality [HR (95% CI): 0.713 (0.514-0.988), P = 0.042] and MAEs [HR (95% CI): 0.698 (0.568-0.859), P = 0.001]. The association between ACEI/ARB therapy and reduced mortality was consistent in the subgroup analysis. Conclusions In patients with AF, ACEI/ARB was related to significantly reduced one-year all-cause mortality, cardiovascular mortality and MAEs despite the high burden of cardiovascular comorbidities. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the clinical outcomes and the toxicities associated with intensity modulated radiotherapy (IMRT) administered in combination with capecitabine for gastric cancer. This study was conducted between July 2009 and October 2011, and included 31 patients (23 female and eight male patients; mean age: 57 years old) with pathologically confirmed gastric cancer (pathological staging T3 or T4 or positive lymph node). All patients underwent D2 surgery and adjuvant chemoradiotherapy, followed by combined treatment with IMRT and capecitabine. All patients received follow-up examinations every 3-6 months by physical examination, magnetic resonance imaging (MRI), and assays for tumor markers. The Kaplan-Meier method was used to calculate the rates for locoregional control (LRC) and disease-free survival (DFS). Only two patients could not complete the planned treatment regimen. Patients treated with IMRT and capecitabine tolerated their treatment well, and displayed few significant side effects. The mean follow-up, disease-free survival (DFS) and survival times were 33.0, 27.5, and 32.9 months, respectively.This study confirmed that the combined administration of IMRT and capecitabine can be used as an adjuvant therapy for gastric cancer patients, with few toxic side effects. [ABSTRACT FROM AUTHOR]

Removal of iron from coal-series kaolinite and its kinetics by chemical leaching were investigated in this paper. The optimal removal rate of iron reaches 29.09% (the content of Fe2O3 decreased from 0.55 to 0.39%) under the conditions of 100 °C, 0.4 M C2H2O4, and liquid-to-solid ratio of 4 cm3/g for 120 min. The leaching process was successfully described by the Avrami model and mainly controlled by internal diffusion control of shrinking core model, the apparent activation energy is 18.46 kJ/mol. The experimental results were consistent with the internal diffusion control of shrinking core model, improving acid concentration and leaching temperature could promotes the removal of iron from coal-series kaolin. [ABSTRACT FROM AUTHOR]

Objective: Guidelines on the standard care of diabetes recommend that glycemic treatment goals for older adults consider the patient's complications and life expectancy. In this study, we examined the influence of diabetes complications and associated life expectancies on the cost-effectiveness (CE) of HbA1c treatment goals.Research Design and Methods: We used data from the 2011-2016 National Health and Nutrition Examination Survey (NHANES) to generate nationally representative subgroups of older individuals with diabetes with various health states. We used the Centers for Disease Control and Prevention-RTI International diabetes CE model to estimate the long-term consequences of two treatment goals-a stringent control goal (HbA1c <7.5%) and a moderate control goal (HbA1c <8.5%)-on health and cost. Our simulation population represented typical patients, and all individuals in each health subgroup had average characteristics, which did not account for person-level variations. The CE study was conducted from a health system perspective and followed the study samples over a lifetime. We used $50,000 per quality-adjusted life year (QALY) as the incremental CE threshold.Results: A stringent goal was, on average, cost-effective for individuals with no complications ($10,007 per QALY) or only microvascular complications (excluding renal failure; $19,621 per QALY), but it was not cost-effective for individuals with one or more macrovascular complications (all >$82,413 per QALY). Further, a stringent goal was not cost-effective when an individual had less than 7 years of life remaining.Conclusions: Our findings support the guideline recommendation that glycemic goals for older adults should consider the complexity of their complications and their life expectancy from a CE perspective. [ABSTRACT FROM AUTHOR]

Hemicellulose was isolated from poplar powder using alkaline hydrolysis coupled with alcohol precipitation. Response surface methodology was applied to study the effects of sodium hydroxide concentration, reaction time, and temperature on the extraction yield. The optimal conditions for the extraction of the hemicellulose from poplar powder were an alkaline mass fraction of 9.5%, reaction time of 4 h and 12 min, and temperature of 78 °C. The extraction yield reached 52.8% under this optimal condition. Fourier-transform infrared spectroscopy, nuclear magnetic resonance, thermogravimetric analysis, and sugar component analyses showed that the obtained hemicellulose with excellent water absorption and heat resistance consisted mainly of 4-O-methyl-glucurono-xylan, and the molar ratio of xylose to glucuronic acid on the molecule chains was 3.95. [ABSTRACT FROM AUTHOR]

Objective : Excess postpartum weight retention (PPWR) is related to long-term weight gain. Therefore, this study was conducted to identify the risk factors for PPWR to provide guidance for preventive strategies. Methods : This cohort study surveyed 461 women who gave birth at a medical center between March 2014 and March 2016. The participants completed a questionnaire within 1 month of delivery, and their 6-month postpartum weight was tracked. Results : The results showed that the mean pre-pregnancy BMI was 21.4 ± 3.3 kg/m2,and the mean gestational weight gain (GWG) was 12.8 ± 4.1 kg. The mean PPWR was 4.6 ± 3.5 kg at 1 month and 2.1 ± 3.3 kg at 6 months. Multivariate analysis revealed that GWG (adjusted OR: 1.92 (1.70-2.17)), pre-pregnancy BMI (adjusted OR: 0.85 (0.77-0.94)), and exclusive breastfeeding (adjusted OR: 0.55 (0.32-0.94)) were significantly correlated with a 1-month PPWR higher than the median value. In addition, GWG (adjusted OR: 1.30 (1.22-1.39)) and exclusive breastfeeding (adjusted OR: 0.37 (0.24-0.58)) were significantly correlated with a 6-month PPWR higher than the median value. Conclusion : Our findings indicate that the key to reducing PPWR is to control GWG and engage in exclusive breastfeeding. [ABSTRACT FROM AUTHOR]

MeSAPO-11 molecular sieves were synthesized from attapulgite by the hydrothermal method with the addition of fluorine for the dehydration of carbohydrates to 5-hydroxymethylfurfural (HMF), where cheap attapulgite served as the single Si and Me and partial Al sources. The results showed that MeSAPO-11 (Si/Al molar ratio=0.25) had an outstanding catalytic performance, where a HMF yield of 78.2% was obtained at 170 °C within 1.5 h. XRD, SEM, and UV-Vis experiments were conducted to study the morphologies and the structure of MeSAPO-11 molecular sieves. Research results indicated that MeSAPO-11(0.25) had higher acidity and better catalytic performance due to more surface acidic sites. [ABSTRACT FROM AUTHOR]

Baicalein is a flavonoid with excellent oxidant scavenging capability. It has been reported to protect against a variety of oxidative injuries including ischemia/reperfusion (I/R). However, the optimal treatment strategy for I/R injury and the protective mechanisms are not fully understood. In this study we employed an established chick cardiomyocyte model of I/R and investigated the effects of three baicalein treatment strategies on reactive oxygen species (ROS) scavenging, nitric oxide (NO) production and cell viability. The molecular signaling pathways were also explored. Compared to the I/R control (cell death 52.2 ± 2.0%), baicalein preventive treatment (25 µM, pretreated for 72 h and continued through I/R) conferred the best protection (19.5 ± 3.9%, p < 0:001), followed by I/R treatment (treated during I/R) and reperfusion treatment (treated at reperfusion only). Preventive and I/R treatments almost completely abolished ROS generation during both ischemic and reperfusion phases, and increased NO production and Akt phosphorylation. Reperfusion treatment reduced the ROS burst in the early reperfusion phase only, and had no effect on NO production and Akt activation. Further, the phosphorylation of phosphatase and tensin homolog (PTEN), a phosphatase negatively regulating Akt activation, was significantly increased by baicalein preventive treatment and slightly by the I/R treatment. PTEN protein expression was reduced in the same trend accordingly. Baicalein reperfusion treatment had no effects on PTEN phosphorylation and expression. Our results indicate that baicalein preventive treatment confers optimal cardioprotection against I/R injury, and this protection involves effective oxidant scavenging and the activation of PTEN/Akt/NO pathway. [ABSTRACT FROM AUTHOR]

The effect of ferric ions (Fe3+) on the flotation of zircon and cassiterite using sodium oleate (NaOL) was investigated by single mineral flotation tests, adsorption density tests, zeta potential measurements, solution chemistry analyses, and FTIR analyses. It is difficult for zircon to be separated from cassiterite by using NaOL alone. Nevertheless, the flotation of zircon was activated while that of cassiterite was depressed in the presence of Fe3+. Adsorption density tests indicated that the addition of Fe3+ enhanced the adsorption of NaOL on zircon surfaces, whereas it receded on cassiterite surfaces. Zeta potential measurements and solution chemistry analyses found that H(OL)-2 was the predominant species to determine the flotation behaviors of zircon and cassiterite. Furthermore, the addition of Fe3+ at pH < 8 reduced the negative charges on the zircon and cassiterite surfaces. It was confirmed that the positive charges of zircon were caused by the positively charged species of Fe3+, including Fe3+, Fe(OH)2+, and Fe(OH)+2. Meanwhile, these results revealed that the hydroxy complex and the precipitate of Fe(OH)3(s) adsorbed onto the cassiterite surfaces caused the flotation of cassiterite to be inhibited. It can be concluded from FTIR analyses that the peaks of zircon at 894.14 cm-1 and 611.65 cm-1 were strengthened and the adsorption on zircon surfaces was found to be chemisorption due to the addition of Fe3+, whereas both chemical and physical adsorptions of NaOL on cassiterite surfaces were weakened, resulting in the different flotation behaviors of zircon and cassiterite in the presence of Fe3+. [ABSTRACT FROM AUTHOR]

Ottelia alismoides is a constitutive C4 plant and bicarbonate user, and has facultative crassulacean acid metabolism (CAM) at low CO2. Acclimation to a factorial combination of light and CO2 showed that the ratio of phosphoenolpyruvate carboxylase (PEPC) to ribulose-bisphosphate carboxylase/oxygenase (Rubisco) (>5) is in the range of that of C4 plants. This and short-term response experiments showed that the activity of PEPC and pyruvate phosphate dikinase (PPDK) was high even at the end of the night, consistent with night-time acid accumulation and daytime carbon fixation. The diel acidity change was maximal at high light and low CO2 at 17-25 μequiv g-1 FW. Decarboxylation proceeded at ~2-3 μequiv g-1 FW h-1, starting at the beginning of the photoperiod, but did not occur at high CO2; the rate was greater at high, compared with low light. There was an inverse relationship between starch formation and acidity loss. Acidity changes account for up to 21% of starch production and stimulate early morning photosynthesis, but night-time accumulation of acid traps <6% of respiratory carbon release. Ottelia alismoides is the only known species to operate CAM and C4 in the same tissue, and one of only two known aquatic species to operate CAM and bicarbonate use. [ABSTRACT FROM AUTHOR]

It is largely unknown how invading autoreactive T cells initiate the pathogenic process inside the diseased organ in organ-specific autoimmune diseases. In experimental autoimmune uveitis (EAU) induced by uveitogenic, interphotoreceptor retinoid-binding protein (IRBP)-specific T cells (tEAU) in mice, we have previously reported that high mobility group box 1 (HMGB1) released as a consequence of the direct interaction between IRBP-specific T cells and retinal parenchymal cells is an early and critical mediator in induction of intraocular inflammation. Our present study explored the roles of HMGB1 in intraocular inflammation, focusing on its role in recruiting inflammatory cells into the eye. Our results showed that supernatants from retinal explants either stimulated with HMGB1 or cocultured with IRBP-specific T cells attracted leukocytes. Notably, HMGB1 antagonists blocked supernatant-induced chemoattraction when present from the start of coculture, but not when added to the culture supernatants after coculture, indicating that molecules released by HMGB1-treated retinal cells are chemoattractive. Moreover, CXCL12 levels in the coculture supernatants were dependent on HMGB1, since they were increased in the cocultures and reduced when HMGB1 antagonists were added at the beginning of the coculture. When either anti-CXCL12 Ab was added to the supernatants after coculture or the responding lymphocytes were pretreated with Ab against CXCL12 specific receptor, CXCR4, chemoattraction by the coculture supernatants was decreased. Finally, induction of tEAU was significantly inhibited by a CXCR4 antagonist, AMD3100, at the time of autoreactive T cell transfer. Our study demonstrates that, at a very early stage of intraocular inflammation initiated by uveitogenic autoreactive T cells, synergism between HMGB1 and CXCL12 is crucial for the infiltration of inflammatory cells. [ABSTRACT FROM AUTHOR]

Objective: To evaluate cluster of differentiation (CD)127 expression in T cells of patients with HIV-1 and the relationship of CD127 expression with disease progression. Methods: We divided 139 patients infected with human immunodeficiency virus type 1 (HIV-1) who had undergone highly active antiretroviral therapy (HAART) into 3 groups: patients with poor recovery (CD4+T<350/mL, patients with general recovery (CD4+ T= 350 - ~600/µL) and patients with good recovery (CD4+ T>600/µL). Counts and percentages of naïve (CD45RA+) and memory (CD45RO+) T cells and CD127 expression were determined using flow cytometry. Results: CD4+ CD45RO+, CD4+ CD45RA+, CD4+ CD45RO+ CD127+, and CD4+ CD45RA+ CD127+ T-cell counts in patients with good recovery were higher than in patients with poor recovery and those with general recovery patients (P <.05). Percentages of CD45RO+ were increased, and percentages of CD45RA+ and CD127 in T cells were decreased in patients with poor and general recovery (P <.05). CD127 values were positively correlated with CD4+ T-cell counts and percentages of CD45RA+ subsets (P <.05). Conclusion: CD127 expression in T cells is decreased in patients with HIV-1 and is related to recovery of CD4+ T-cell counts and to naïve subsets. [ABSTRACT FROM AUTHOR]

Epileptogenic focus resection is less effective for the treatment of frontal lobe epilepsy compared with temporal lobe epilepsy. However, there is currently a lack of effective therapeutic options for patients with frontal lobe epilepsy who are unsuitable for epileptogenic focus resection (such patients with epileptogenic foci in one frontal lobe in which the precise epileptic foci cannot be determined), or who experience recurrent epilepsy following epileptogenic focus resection. The present study reports a patient with frontal lobe epilepsy who underwent successful frontal lobe isolation surgery following a previous unsuccessful epileptogenic focus resection surgery. To ensure complete isolation of the prefrontal lobe, the surgery included division of the anterior commissure and the anterior part of the corpus callosum. The patient was followed-up for 16 months. Although the follow-up electroencephalogram presented a number of sharp waves on the affected side, the patient did not experience any seizures. The results suggest that prefrontal lobe isolation is an effective method of treating frontal lobe epilepsy, as division of the anterior commissure and the anterior part of the corpus callosum ensures disconnection of the prefrontal lobe from other regions of the brain. [ABSTRACT FROM AUTHOR]

The article discusses the bridging research to operations through transitioning of an operational data assimilation system into community-based code management framework. Topics discussed include the operational capabilities for the research community, code management frameworks for the development and operational applications.

The nitrogen (N) nutrition index (NNI) is a reliable indicator of crop N status and there is an urgent need to develop efficient technologies for non-destructive estimation of NNI to support the practical applications of precision N management strategies. The objectives of this study were to: (i) validate a newly established critical N dilution curve for spring maize in Northeast China; (ii) determine the potential of using the GreenSeeker active optical sensor to non-destructively estimate NNI; and (iii) evaluate the performance of different N status diagnostic approaches based on estimated NNI via the GreenSeeker sensor measurements. Four field experiments involving six N rates (0, 60, 120,180, 240, and 300 kg·ha-1) were conducted in 2014 and 2015 in Lishu County, Jilin Province in Northeast China. The results indicated that the newly established critical N dilution curve was suitable for spring maize N status diagnosis in the study region. Across site-years and growth stages (V5-V10), GreenSeeker sensor-based vegetation indices (VIs) explained 87%-90%, 87%-89% and 83%-84% variability of leaf area index (LAI), aboveground biomass (AGB) and plant N uptake (PNU), respectively. However, normalized difference vegetation index (NDVI) became saturated when LAI > 2 m²·m-2, AGB > 3 t·ha-1 or PNU > 80 kg·ha-1. The GreenSeeker-based VIs performed better for estimating LAI, AGB and PNU at V5-V6 and V7-V8 than the V9-V10 growth stages, but were very weakly related to plant N concentration. The response index calculated with GreenSeeker NDVI (RI-NDVI) and ratio vegetation index (R² = 0.56-0.68) performed consistently better than the original VIs (R² = 0.33-0.55) for estimating NNI. The N status diagnosis accuracy rate using RI-NDVI was 81% and 71% at V7-V8 and V9-V10 growth stages, respectively. We conclude that the response indices calculated with the GreenSeeker-based vegetation indices can be used to estimate spring maize NNI non-destructively and for in-season N status diagnosis between V7 and V10 growth stages under experimental conditions with variable N supplies. More studies are needed to further evaluate different approaches under diverse on-farm conditions and develop side-dressing N recommendation algorithms. [ABSTRACT FROM AUTHOR]

Background: Platycodon grandiflorum is the only species in the genus Platycodon of the family Campanulaceae, which has been traditionally used as a medicinal plant for its lung-heat-clearing, antitussive, and expectorant properties in China, Japanese, and Korean. Oleanane-type triterpenoid saponins were the main chemical components of P. grandiflorum and platycodin D was the abundant and main bioactive component, but little is known about their biosynthesis in plants. Hence, P. grandiflorum is an ideal medicinal plant for studying the biosynthesis of Oleanane-type saponins. In addition, the genomic information of this important herbal plant is unavailable. Principal findings: A total of 58,580,566 clean reads were obtained, which were assembled into 34,053 unigenes, with an average length of 936 bp and N50 of 1,661 bp by analyzing the transcriptome data of P. grandiflorum. Among these 34,053 unigenes, 22,409 unigenes (65.80%) were annotated based on the information available from public databases, including Nr, NCBI, Swiss-Prot, KOG, and KEGG. Furthermore, 21 candidate cytochrome P450 genes and 17 candidate UDP-glycosyltransferase genes most likely involved in triterpenoid saponins biosynthesis pathway were discovered from the transcriptome sequencing of P. grandiflorum. In addition, 10,626 SSRs were identified based on the transcriptome data, which would provide abundant candidates of molecular markers for genetic diversity and genetic map for this medicinal plant. Conclusion: The genomic data obtained from P. grandiflorum, especially the identification of putative genes involved in triterpenoid saponins biosynthesis pathway, will facilitate our understanding of the biosynthesis of triterpenoid saponins at molecular level. [ABSTRACT FROM AUTHOR]

A nosocomial cluster induced by co-infections with avian influenza A(H7N9) and A(H1N1)pdm09 (pH1N1) viruses occurred in 2 patients at a hospital in Zhejiang Province, China, in January 2014. The index case-patient was a 57-year-old man with chronic lymphocytic leukemia who had been occupationally exposed to poultry. He had co-infection with H7N9 and pH1N1 viruses. A 71-year-old man with polycythemia vera who was in the same ward as the index case-patient for 6 days acquired infection with H7N9 and pH1N1 viruses. The incubation period for the second case-patient was estimated to be <4 days. Both case-patients died of multiple organ failure. Virus genetic sequences from the 2 case-patients were identical. Of 103 close contacts, none had acute respiratory symptoms; all were negative for H7N9 virus. Serum samples from both case-patients demonstrated strong proinflammatory cytokine secretion but incompetent protective immune responses. These findings strongly suggest limited nosocomial co-transmission of H7N9 and pH1N1 viruses from 1 immunocompromised patient to another. [ABSTRACT FROM AUTHOR]

Background: The strategy of health policy has been changed for improving the performances to meeting the increasing healthcare demands. However, limited evidences were found to prove that the bundled payment was valid for service delivering in public sector. This study was designed to evaluate the effectiveness of a bundled policy on strengthening the county-village communication and improving the quality of chronic disease management. Methods: This is a retrospective cohort study using the data collected in 2011, 2012 and 2014 from the Rural Health Development Project in China. The policy intervention included performance-related contract with health facilities, developing technical guideline for doctors and nurses, routine monitoring of performance, and efforts to increase public awareness about the services. There were two intervention counties in Henan Province, China, while one county with similar characteristics in Henan was selected as control. Funding allocation, work load and salary for health care workers, volume of township-to-village technical assistance were reported before and after the policy was implemented. Our study also examined the policy impacts on improving treatment outcomes of diabetes and hypertension care. Results: There were substantial increases in the provision of the basic package of services including 96.6 % of patients with hypertension, 91.2 % of patients with diabetes under the health management system. After the intervention, there were 34.3 % (hypertension) and 42.0 % (diabetes) increase in regular follow-up visit rates, 24.6 and 17.2 % increase in blood pressure and blood glucose control rates, respectively. The family health records system covered 96 % of the rural families. Technical assistance between township health centres and village clinics were enhanced. Compared with baseline, the monthly training meeting and field supervision & guidance between township health centres and village clinics increased 1.0 meeting, 1.5 field visits, respectively, while the increases in the control county were only 0.3 meeting and 0.3 field visits. At the end of this study, 93.8 % of health workers achieved their performance goals. More patients were referred to appropriate levels of care. Conclusion: This bundled policy intervention effectively improved rural health care delivery. The result of our study can be used for local governments to implement performance-based health system management in developing country. [ABSTRACT FROM AUTHOR]

Infection is one of the most severe complications of total knee prosthesis implantation. The present study reported the case of a 74-year-old female that developed a Staphylococcus epidermidis infection following a cemented total knee arthroplasty. A routine blood test revealed neutropenia and anemia, while S. epidermidis was detected in the peripheral blood and bone marrow. In the present case, S. epidermidis infection led to acute arrest of hematopoiesis (AAH), also known as aplastic crisis, which is the temporary cessation of red cell production. The development of AAH secondary to S. epidermidis infection is rare and, to the best of our knowledge, this is the first case reported in the literature. The present study increased our knowledge of this rare disease and its characteristics, which will enable physicians to be aware of the development of AAH as a rare complication of S. epidermidis infection. [ABSTRACT FROM AUTHOR]

The article presents the discussion on examining factors associated with the use of the two new drug classes and estimating the contributions of the factors for the use of drugs. Topics include commercially insured population due to the older age and longer diabetes duration benefiting more from the new drug classes; and lower utilization rates having a larger gain in health benefits such as Medicare beneficiaries.

Malignant obstructive jaundice comprises a group of diseases that can be caused by primary biliary and extra-biliary carcinomas. Generally, surgical resection is the primary treatment for malignant obstructive jaundice; however, for the patients that are unable to undergo surgery, urgent treatment is required to improve hepatic function. Percutaneous transhepatic biliary drainage (PTBD) and stenting are emerging alternative treatments for malignant obstructive jaundice. PTBD and stenting have exhibited good efficacy for the treatment of malignant obstructive jaundice, with few complications and reduced associated pain. [ABSTRACT FROM AUTHOR]