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Objective: To propose a scoring system based on laryngoscopic characteristics for the differential diagnosis of benign and malignant vocal fold leukoplakia. Methods: Laryngoscopic images from 200 vocal fold leukoplakia cases were retrospectively analysed. The laryngoscopic signs of benign and malignant vocal fold leukoplakia were compared, and statistically significant features were assigned and accumulated to establish the leukoplakia finding score. Results: A total of five indicators associated with malignant vocal fold leukoplakia were included to construct the leukoplakia finding score, with a possible range of 0–10 points. A score of 6 points or more was indicative of a diagnosis of malignant vocal fold leukoplakia. The sensitivity, specificity and accuracy values of the leukoplakia finding score were 93.8 per cent, 83.6 per cent and 86.0 per cent, respectively. The consistency in the leukoplakia finding score obtained by different laryngologists was strong (kappa = 0.809). Conclusion: This scoring system based on laryngoscopic characteristics has high diagnostic value for distinguishing benign and malignant vocal fold leukoplakia. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to investigate the trajectory and predictors of family function in caregivers of stroke survivors during the first 6 months after the first episode of stroke. Design: Longitudinal study. Methods: A total of 288 primary caregivers of patients with first‐time stroke were recruited from seven tertiary hospitals in China between July 2020 and March 2021. The following characteristics were assessed by caregivers at hospitalization (T0) and at 1 month (T1), 3 months (T2) and 6 months (T3) after the stroke: family function, general self‐efficacy, social support, coping style, caregiver burden, and sociodemographic and clinical data. Results: Family function scores among caregivers of stroke survivors were highest in the resolve dimension and lowest in the growth and adaptation dimensions within the first 6 months. The percentages of families with low functioning were 34.7%, 33.3%, 24.8% and 17.7% at T0, T1, T2 and T3, respectively. The generalized estimating equation model revealed that family function in caregivers increased over the first 6 months (Exp(B) = 1.415–2.689, p <.05). The following factors were identified as predictors of family functioning: caregiver's age, education, residential district, self‐efficacy, social support utilization and caregiver burden. Conclusions: Family function of caregivers of stroke survivors gradually increased during the first 6 months after stroke. However, some families demonstrated poor functioning. Caregivers' age, education, caregiver burden, self‐efficacy and social support utilization could predict family function over time. Impact: Empirical data on family function in families of stroke survivors are important for developing psychosocial interventions that can help families adapt to stroke. This study found that families of stroke survivors were likely to be dysfunctional in the first 6 months after stroke, particularly in family growth and adaptation. Therefore, reducing caregiver burden and promoting self‐efficacy and social support utilization can help restore family functioning early after stroke. Patient or Public Contribution: Stroke caregivers from seven hospitals in China were involved in this study and had the right to be informed of the main findings. A few patients were informed of the research results, who contributed to the dissemination. [ABSTRACT FROM AUTHOR]

The formation of peer attachment is vitally important for the mental health of adolescents. Additionally, converging evidences show that childhood emotional trauma leads to poor peer attachment during adolescence. However, little is known about the underlying mechanism accounting for the link between early emotional trauma and adolescent peer attachment. Therefore, the present study is intended to examine the relationship between childhood psychological maltreatment (CPM) and peer attachment among Chinese adolescents and reveal its underlying mechanism. In total, we collected data from 670 adolescents (36.5% males and 63.5% females, M age = 16.44 years, SD = 0.78) attending two Chinese high schools. These participants completed measurement scales for CPM (emotional abuse and neglect), peer attachment, and emotion regulation strategies, including cognitive reappraisal (CR) and expressive suppression (ES). The multiple mediation models showed that emotional neglect negatively predicted adolescent peer attachment but that emotional abuse did not. Furthermore, the two emotion regulation strategies, CR and ES, completely mediated the relationship between emotional abuse and peer attachment and partially mediated the relationship between emotional neglect and peer attachment. These findings extend the existing studies on adolescent peer attachment and elucidate how childhood emotional trauma negatively influences adolescent peer attachment. In addition, the present results provide implications for improving the peer attachment of adolescents. On one hand, appropriate family intervention should be implemented to reduce CPM. On the other hand, schools can focus on improving the peer attachment of adolescents by enhancing their emotion regulation. Specifically, adolescents should be taught how to use adaptive strategies, such as CR, to regulate negative emotions. [ABSTRACT FROM AUTHOR]

Background: Delirium is one of the most common complications in critically ill children. Once delirium occurs, it will cause physical and psychological distress in children and increase the length of their ICU stay and hospitalization costs. Understanding the risk factors for delirium in critically ill children can help develop targeted nursing interventions to reduce the incidence of delirium. Aims: To investigate the incidence and the risk factors of delirium in the paediatric intensive care unit (PICU). Study design: We performed a prospective observational study in critically ill patients in the PICU between February and July 2020. Delirium was diagnosed by the Cornell Assessment of Paediatric Delirium (CAPD) and the Richmond Agitation Sedation Scale and analysed via univariate analysis and multivariate logistic regression to determine the independent risk factors of delirium in critically ill children. Results: The study enrolled 315 patients ranging in age from 1–202 (65.3–54.3) months, with 56.2% (n = 177) being male. The incidence of delirium was 29.2% (n = 92) according to CAPD criteria. Among them, 33 cases (35.9%) were of hyperactive delirium, 16 cases (17.4%) were of hypoactive delirium, and 43 cases (46.7%) were of mixed delirium. By using stepwise logistic regression, the independent risk factors of delirium included mechanical ventilation (odds ratio [OR], 11.470; 95% confidence interval [CI], 4.283–30.721), nervous system disease (OR, 5.596; 95%CI, 2.445 to 12.809), developmental delay (OR, 5.157; 95% CI, 1.990–13.363), benzodiazepine (OR, 3.359; 95% CI 1.278–8.832), number of catheters (OR, 1.918; 95% CI, 1.425 to 2.582), and age (OR, 0.985; 95% confidence interval CI, 0.976–0.993). Conclusions: Delirium is a common complication in the PICU. The independent risk factors include mechanical ventilation, nervous system disease, developmental delay, benzodiazepines, higher number of catheters, and younger age. This study may help develop intervention strategies to reduce the incidence of delirium in critically ill children by targeting modifiable risk factors. Relevance to Clinical Practice: Recommendations for practice include paying attention to high‐risk children in the ICU who are prone to delirium, removing influencing factors as soon as possible, and providing targeted nursing interventions. [ABSTRACT FROM AUTHOR]

Objectives. Primary central nervous system lymphoma (PCNSL) usually has a poor prognosis. Cerebrospinal fluid (CSF) interleukin (IL)-10 has shown diagnostic, prognostic, and monitoring value in our previous studies. Cell-free circulating tumor DNA can be detected in the CSF of refractory/relapse cases and has also shown monitoring value. However, information about its monitoring value in newly diagnosed PCNSL patients and comparisons of CSF IL-10 and CSF cell-free DNA (cfDNA) are scarce. Methods. We performed next-generation sequencing on paraffin-embedded tissue and the serial CSF cfDNA of 10 newly diagnosed PCNSL patients and on the baseline CSF cfDNA of 11 other central nervous system lymphoma patients. We also monitored the CSF IL-10 levels of the 10 newly diagnosed PCNSL patients. Results. In seven newly diagnosed PCNSL patients with sufficient baseline CSF cfDNA, six had ≥1 mutated genes in their CSF cfDNA. The most common were MYD88(4/7), PIM1(3/7), MLL2(3/7), and ETV6(2/7). We also identified multiple somatic mutations, most commonly in PIM1. MYD88L265P can be detected in both tumor tissue and CSF cfDNA. The genomic profiles of CFS cfDNA were similar in PCNSL and PIOL patients. Newly diagnosed PCNSL patients with persistently positive cfDNA and negative IL-10 progressed quickly, while those with negative cfDNA and negative IL-10 were in maintenance therapy for more than 18 months. Two patients without cfDNA had increased CSF IL-10 concentrations before disease relapse. These results indicate that negative CSF cfDNA predicts better results, and persistently positive CSF cfDNA predicts disease progression earlier than conventional magnetic resonance imaging. Conclusion. In conclusion, CSF cfDNA is a potential predictor of relapse and progression, which complements the monitoring value of CSF IL-10 in newly diagnosed PCNSL patients. [ABSTRACT FROM AUTHOR]

Background. To evaluate the associations between long-term oral Chinese herbal medicines (CHMs) and recurrence and metastasis (R&M) in patients with stage II and III colorectal cancer (CRC). Furthermore, we aimed to determine the correlation between different syndrome patterns and prognosis and summarized the regularities among CHMs prescriptions, providing reference for clinical practice. Methods. An ambispective cohort study was conducted. All CRC patients who sought evaluation and treatment at Xiyuan Hospital and Beijing Cancer Hospital from August 2014 to August 2016 were included. In this study, "whether patients voluntarily take CHMs" was taken as the exposure factor, and the exposure degree was "the duration of CHM use." Stratification was performed according to the duration of TCM use to determine the relationship with R&M of CRC. The primary outcome was disease-free survival. Patients who had R&M of CRC after taking CHMs for ≥6 months were defined as "worst patients." R software was used for statistical analysis. The Kaplan–Meier method and Cox regression analysis were used to determine the prognosis. IBM SPSS was used to model a priori association rules; drug use rules were analyzed on this basis. Results. A total of 186 patients with stage II and III CRC after radical resection were enrolled. All patients reached the study endpoint by August 2021. The difference in disease-free survival between the two groups was most significant when the cutoff value for CHMs was 18 months (P = 0.0012). Multivariate analysis showed that 18 CHMs were independent protective factors for R&M of CRC (P = 0.001 , HR = 0.20, 95% CI = 0.08–0.53). The ratio of Pi (spleen) and Shen (kidney) deficiency in the worst cases was higher than patients without R&M (P = 0.018). Sijunzi and Liuwei Dihuang decoctions were the most frequently used prescriptions in the anti-R&M phase. Conclusion. CHMs complying with the "Jianpi Bushen" principle may attenuate the risk of R&M in patients with stage II and III CRC. Pi (spleen) and Shen (kidney) deficiency in patients receiving TCM intervention for the first time within 6 months of radical resection may be associated with a higher CRC R&M rate. Further research is warranted to validate these findings and elucidate underlying biological mechanisms. [ABSTRACT FROM AUTHOR]

Objectives: Limited information is known about preventive dental visits (PDVs) before seven years of age among children in China. This study aimed to examine the early PDV rate, identify the impact of PDV on dental caries and untreated dental caries, and explore the factors related to PDV among Chinese sampled children under seven years old. Methods: A cross-sectional survey was conducted in five selected primary health care facilities in Chengdu, China, from May to August 2021. Parent–child dyads during regular systematic medical management were recruited to participate. Children's dental caries were identified through dental examinations and documented as decayed, missing and filled teeth index (dmft) by trained primary care physicians. Dental-related information was collected through a questionnaire. Zero-inflated negative binomial (ZINB) regression was used to test the effect of early PDV on the dmft value, and logistic regression was used to analyse impact factors on the early PDV. Results: A total of 2028 out of 2377 parent–child dyads were qualified for analysis. Half of the children (50.4%) were male, with a mean age of 4.8 years. Among all the children, 12.1% had their first dental visit for preventive purposes, 34.4% had their first dental visit for symptomatic purposes, and more than half had never visited a dentist. The results showed that a lower dmft value (adjusted OR: 0.69, 95% CI: 0.48–0.84), a higher rate of caries-free (aOR: 6.5, 95% CI: 3.93–10.58), and a lower rate of untreated dental caries (aOR: 0.40, 95% CI: 0.21–0.76) were associated with early PDV utilization. Children who had a higher rate of PDV were positively associated with living in a family with better parental behaviours (aOR: 2.30, 95% CI: 1.71–3.08), better parental oral health perception (aOR: 1.23, 95% CI: 1.06–1.32), fathers who had no untreated caries (aOR: 0.68, 95% CI: 0.47–0.97), families with higher socioeconomic status (aOR: 1.09, 95% CI: 1.04–1.16), and dental health advice received from well-child care physicians (aOR: 1.47, 95% CI: 1.08–2.00). Conclusions: Early PDV was associated with a lower rate of dental caries prevalence and untreated dental caries among sampled children younger than seven in Western China. Underutilization and social inequities existed in PDV utilization. Public health strategies should be developed to increase preventive dental visits and eliminate social disparities that prevent dental care utilization. [ABSTRACT FROM AUTHOR]

Aim: To examine whether various aspects of adverse childhood experiences (ACEs) are associated with comorbid cardiovascular diseases (CVDs) and diabetes among middle‐aged and old adults in China. Methods: Using the 2018 China Health and Retirement Longitudinal Study survey and the 2014 Life History survey, in total, 17 115 respondents aged ≥45 years were included. Logistic regressions were applied to estimate the relationship between aspects of ACEs and diagnosis of both CVDs and diabetes while adjusting for adulthood demographics, health and health behaviors. Results: Childhood hunger (OR = 1.75, P < 0.01), childhood socioeconomic status (OR = 1.45, P < 0.05) and abuse from father (OR = 1.50, P < 0.05) were significantly associated with greater odds of comorbid CVDs and diabetes above and beyond adulthood characteristics. In addition, the effects of these ACEs on comorbidity were stronger than their effects on the single chronic condition. Conclusions: Our findings suggest that, for middle‐aged and old Chinese adults, ACEs could have long‐lasting impacts on multiple chronic conditions in later life. Public health interventions should focus on the early life stage as the protective childhood conditions might help in warning of later clustering chronic diseases. Geriatr Gerontol Int 2022; 22: 12–18. [ABSTRACT FROM AUTHOR]

Aim: Cancer patients have long been found to have multiple types of unmet needs during their survivorship. Composite psychological instruments are essential for measuring the unmet needs of cancer patients. The objective of this study was to evaluate the psychometric properties of the Short‐Form Survivor Unmet Needs Survey (SF‐SUNS)‐Chinese version. Design: A cross‐sectional survey. Methods: The Chinese version was developed using the standard Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology and 428 Chinese cancer patients participated in the survey between 2016‐2017. Inter‐rater reliability, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were calculated. Results: Confirmatory factor analysis supported the four‐factor structure with good model fit. Cronbach's alpha of 0.894 for the overall scale and intra‐class correlation coefficients (0.869–0.884) indicated that reliability was satisfactory. The EFA extracted four factors with eigenvalues greater than 1 and these factors explained 50.68% of the total variance. The Chinese version of SF‐SUNS was confirmed to have the potential to become a useful and valid instrument. It could contribute to the assessment of unmet needs among Chinese cancer patients with accuracy and with respect to Chinese culture and context. This measurement of unmet needs may help promote cancer management and nursing quality. Clinical nurses and researchers could use the simple assessment tool to target the individual needs of Chinese cancer patients and then provide more personalized care efficiently. [ABSTRACT FROM AUTHOR]

Aims: To explore the level and associated factors of perceived participation and autonomy among stroke survivors in Shanghai, China. Design: Cross‐sectional explorative study. Methods: From January to December 2018, 431 patients presenting at the neurology departments of three hospitals with a confirmed diagnosis of stroke were recruited. Impact on Participation and Autonomy Questionnaire, modified Rankin Scale, Self‐efficacy for Managing Chronic Disease six‐item Scale, Medical Coping Modes Questionnaire and Multidimensional Scale of Perceived Social Support were applied to measure their participation, physical function, self‐efficacy, coping styles, and social support. Results: The average score of perceived participation and autonomy was 41.30 (SD 21.22); and 54.3%, 46.9%, 21.6%, and 7.7% of the participants reported poor participation in social relations, family role, autonomy indoors, and autonomy outdoors. Age, physical function, self‐efficacy, friend support, and knowledge of stroke were predictors of post‐stroke participation. Physical function and self‐efficacy were the most relevant factors of nearly all domains of participation except autonomy outdoors, while predictors of autonomy outdoors were social support, resignation coping style, and knowledge of stroke. Conclusion: The stroke patients experienced insufficient participation compared with previous studies in western countries. Patients' physical function and self‐efficacy were particularly important and contributed to their participation, while the patient's age, perceived social support, coping styles, and knowledge of stroke also played a role in formulating participation. Impact: The results may be used to provide nurses with a better understanding of the participation among stroke patients and assist them in promoting the post‐stroke participation. Nurses should pay special attention to those with older age, worse physical function, lower self‐efficacy, less support, little stroke‐related knowledge, or who applied resignation coping style since those patients might experience lower participation in their daily life. It needs further studies to explore the causal effects of self‐efficacy, coping styles, and social support on post‐stroke participation. [ABSTRACT FROM AUTHOR]

The accurate identification and prediction of high-cost Chronic obstructive pulmonary disease (COPD) patients is important for addressing the economic burden of COPD. The objectives of this study were to use machine learning approaches to identify and predict potential high-cost patients and explore the key variables of the forecasting model, by comparing differences in the predictive performance of different variable sets. Machine learning approaches were used to estimate the medical costs of COPD patients using the Medical Insurance Data of a large city in western China. The prediction models used were logistic regression, random forest (RF), and extreme gradient boosting (XGBoost). All three models had good predictive performance. The XGBoost model outperformed the others. The areas under the ROC curve for Logistic Regression, RF and XGBoost were 0.787, 0.792 and 0.801. The precision and accuracy metrics indicated that the methods achieved correct and reliable results. The results of this study can be used by healthcare data analysts, policy makers, insurers, and healthcare planners to improve the delivery of health services. [ABSTRACT FROM AUTHOR]

This article aims to estimate the effects of air pollutants (PM2.5, PM10, SO2, and NO2) on the hospitalization expenses of adult patients admitted due to asthma. The data is sourced from the medical health database of a city in Southwest China, which involves approximately 14 million residents. A generalized additive model using a Poisson distribution was utilized to identify the effects of air pollution on the cost of hospitalization due to asthma. Hospital admissions were stratified by sex, age, season, and type of medical insurance to specialize the results. Air pollution significantly affects hospitalization expenses for asthma. These effects were more significant in the male, non-senior subgroups than in the female, senior subgroups. The difference also significantly existed in different insurance type subgroups. Air pollution has adverse effects on hospitalization expenses for asthma. Climate change is now deeply affecting the world in the aspects of economy and health. Based on our research, policymakers can establish more effective air pollution reduction policies and measures that can control the levels of ambient air pollutants, which help save health care resources and improve the welfare of the population by easing the climate change. [ABSTRACT FROM AUTHOR]

With the development of Web 2.0 technologies, an increasing number of websites are providing online healthcare services, and they have potential to alleviate problems of overloaded medical resources in China. However, some patients are reluctant to trust and continue using online healthcare services, partly due to the immature development of healthcare websites. Previous research has argued that online trust is significantly associated with the risk or benefit perceived by users. This study aims to extend prior research and examine how perceptual factors influence patients' online trust and intention to continue using online healthcare services. We developed a model with the moderating role of purpose of use and tested it with data collected from 283 participants. The results support the validity of the model and most hypotheses. The moderating role of purpose of use between the perceived benefits/risks and patients' online trust is also highlighted. Theoretical and practical implications are also discussed. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study is to identify the role of factors influencing women's breast cancer screening (BCS) intentions in Changchun city based on the health belief model (HBM) and the theory of planned behavior (TPB). Methods: A cross‐sectional study of 422 women aged 17–75 years was conducted in Changchun, northern China, in 2018. Data were collected using a questionnaire that included three parts. We used descriptive analysis, correlation analysis and multiple regressions to analyze data in spss version 23.0. Results: Career (P = 0.004), clinical examination (P = 0.002), X‐ray examination (P = 0.026), screening costs accepted (100–300 RMB) (P = 0.001), perceived behavioral benefit (P = 0.000), self‐efficacy (P = 0.000), subjective norms (P = 0.000), behavioral attitudes (P = 0.000) and perceived behavioral control (P = 0.000) had significant associations with BCS intentions. This study tested the applicability of the HBM (adjusted R2 = 4.7%, ΔR2 = 5.6%) and the TPB (adjusted R2 = 8.3%, ΔR2 = 3.8%) in the prediction of BCS intentions. It was found that the predictive power of the integrated model (adjusted R2 = 39%, ΔR2 = 30.8%) is better than that of each of the single models. Therefore, the integrated model has better predictive power. Conclusion: An exploration of the factors affecting BCS intentions based on the HBM and the TPB is beneficial for reduced mortality and the development of measures to increase women's BCS awareness, thus providing a basis for future research on the factors affecting BCS intentions. [ABSTRACT FROM AUTHOR]

Background and objectives: Stroke commonly results in physical dysfunction and seriously affects the quality of life. We aimed to estimate the prevalence and association of resilience with the quality of life among patients at hospitalization and whether the association was independent of physical function, anxiety, depression, and other population characteristics. Methods: A cross-sectional study at a tertiary hospital included 215 individuals. The Chinese version of the Connor-Davidson Resilience Scale was used to evaluate resilience. Stroke Scale Quality of life was used to measure the quality of life. Other validated questionnaires were used to assess physical function (Functional Independency Measure), anxiety, and depression (the Hospital Anxiety and Depression Scale). Hierarchical regression analysis was applied to determine the association between psychological factors and quality of life. Multiple linear regression was also used to examine whether resilience independently affects the quality of life. Results: The mean score of 215 participants' resilience was 62.36 ± 13.965. Resilience, anxiety, and depression were separately significantly associated with quality of life. Resilience was negatively associated with anxiety and depression. Subjects with high scores of resilience showed a higher quality of life at patients' hospitalization (Standardized Coefficients = 0.275) independent of physical function, anxiety, depression, disease-related characteristics, and sociodemographic characteristics. Discussion: Resilience was an independent predictor of quality of life beyond anxiety and depression in patients with ischemic stroke. Interventions aimed at improving resilience at acute hospitalization might be a worthwhile addition to improve quality of life early after stroke. [ABSTRACT FROM AUTHOR]

Objective: This paper aims to explore the determinants of the online health information seeking (OHIS) and usage (OHIU) behaviours of consumers based on the perceived benefits and costs of such activities. Methods: This study applies questionnaires and empirical research methods. A questionnaire is designed according to the hypothesis model. A total of 282 questionnaires are obtained from patients and their accompanying families in two large hospitals, and the SPSS 17.0 and AMOS 17.0 (IBM, Almond, NY, USA) software are used to analyse the sample data and to test the research models. Results: Three key findings are obtained from the analysis. Firstly, functional, learning, social and personal integrative benefits positively affect the OHIS intent of consumers. Secondly, cognitive costs negatively influence the OHIU behaviour of consumers. Thirdly, personal integrative benefits and OHIS behaviour significantly influence the OHIU behaviour of consumers. Conclusion: This paper highlights the differences between OHIS and OHIU based on their impact factors and applies social exchange theory to understand such factors. Online health information providers must improve the ease of use of their websites or applications, enhance the quality of their health information and focus on their functionality. [ABSTRACT FROM AUTHOR]

Aim: This investigation aimed to study the general self‐efficacy level and its influential factors of breast cancer screening for the female college students in Changchun city of China. Methods: A three‐part questionnaire was designed to investigate 220 female college students' general self‐efficacy for breast cancer screening and its associated factors and knowledge of breast cancer screening. The data were analyzed with spss 23.0 using descriptive statistics, independent sample t‐tests and multiple regression analysis. Results: The mean total score of general self‐efficacy for breast cancer screening was 22.2 ± 5.213 (average ± standard deviation [SD])). About 37.7% of participants had lower level of general self‐efficacy for breast cancer screening. The average score of knowledge about breast cancer and screening was 5.26 ± 3.974 (average ± SD). About half (48.6%) of the students had poor breast cancer screening knowledge. Multivariate logistic regression analysis demonstrated that the level of breast cancer knowledge (P = 0.011) and sleep satisfaction (P = 0.008) were two predictive factors of good general self‐efficacy for breast cancer screening in female college students. Conclusion: Female college students in Changchun did not have enough knowledge and self‐efficacy to cope with the breast cancer screening through this survey. Therefore, primary healthcare professionals have the responsibility to improve their awareness of breast cancer screening by delivering enough breast cancer knowledge and implementing effective health promotion strategies to keep better health status and have satisfied sleep. [ABSTRACT FROM AUTHOR]

Charcot-Marie-Tooth 1A (CMT1A) caused by peripheral myelin protein 22 (PMP22) gene duplication is the most common form of hereditary polyneuropathy. Twenty-four genetically confirmed CMT1A patients with sural nerve biopsies were enrolled in this study. The clinical picture included a great variability of phenotype with mean onset age of 22.2±14.5 years (1–55 years). Pathologically, we observed a severe reduction in myelinated fiber density showing three types of changes: pure onion bulb formation in 3 cases (12.5%), onion bulb formation with axonal sprouts in 10 cases (41.7%), and focally thickened myelin with onion bulb formation or/and axonal sprouts in 11 cases (45.8%). We observed no significant correlation between nerve fiber density and disease duration. There was no significant difference between the 3 pathological types in terms of clinical manifestations, nerve fiber density, and g-ratio. Our study indicates that there is marked variability in the age of onset of CMT1A, as well as significant pathological changes without deterioration with the development of the disease. Focally thickened myelin is another common morphological feature of demyelination. [ABSTRACT FROM AUTHOR]

Expedited bone tissue engineering employs the biological stimuli to harness the intrinsic regenerative potential of skeletal muscle to trigger the reparative process in situ to improve or replace biological functions. When genetically modified with adenovirus mediated BMP2 gene transfer, muscle biopsies from animals have demonstrated success in regenerating bone within rat bony defects. However, it is uncertain whether the human adult skeletal muscle displays an osteogenic potential in vitro when a suitable biological trigger is applied. In present study, human skeletal muscle cultured in a standard osteogenic medium supplemented with dexamethasone demonstrated significant increase in alkaline phosphatase activity approximately 24-fold over control at 2-week time point. More interestingly, measurement of mRNA levels revealed the dramatic results for osteoblast transcripts of alkaline phosphatase, bone sialoproteins, transcription factor CBFA1, collagen type I, and osteocalcin. Calcified mineral deposits were demonstrated on superficial layers of muscle discs after an extended 8-week osteogenic induction. Taken together, these are the first data supporting human skeletal muscle tissue as a promising potential target for expedited bone regeneration, which of the technologies is a valuable method for tissue repair, being not only effective but also inexpensive and clinically expeditious. [ABSTRACT FROM AUTHOR]

Autophagy exists in vascular endothelial cells, but the relationship between autophagy and blood vessel dysfunction in hypertension remains elusive. This study aimed to investigate role of autophagy in vascular endothelial dysfunction in prehypertension and hypertension and the underlying mechanisms involved. Furthermore, we sought to determine if and how tetrahydroxystilbene glucoside (TSG), a resveratrol analogue and active ingredient of Polygonum multiflorum Thunb used for its cardiovascular protective properties in traditional Chinese medicine, influences vascular endothelial function. Male spontaneously hypertensive rats (SHRs) aged 4 weeks (young) and 12 weeks (adult) were studied and the vascular function of isolated aorta and mesenteric artery was assessed in vitro. Compared with Wistar Kyoto rats (WKY), young and adult SHRs showed endothelial dysfunction of the aorta and mesenteric artery, along with decreased pAkt, pmTOR, and autophagic marker protein p62 and increased LC3 II/I in microvascular but not aortic tissues. TSG administration for 14 days significantly improved mesenteric vascular endothelial function, increased levels of pAkt and pmTOR, and decreased autophagy. Pretreatment of young SHRs with the mTOR inhibitor rapamycin blocked the antiautophagic and vasodilative effects of TSG. Moreover, TSG significantly activated Akt-mTOR signaling in HUVECs and reduced the autophagic levels in vitro, which were almost completely blocked by rapamycin. In summary, mesenteric endothelial dysfunction in prehypertensive SHRs was at least partly attributable to excessive autophagy in vascular tissues. TSG partly restored microvascular endothelial dysfunction through activating the Akt/mTOR pathway, which consequently suppressed autophagy, indicating that TSG could be potentially applied to protect vascular function against subclinical changes in prehypertension. [ABSTRACT FROM AUTHOR]

Being the target of peer victimization contributes to alcohol and cigarette use during early adolescence. This 1-year longitudinal study extended the current literature by investigating the potential links between peer victimization and alcohol and cigarette initiation among a sample of 723 youths recruited from three middle schools in Southern China. We proposed a moderated mediation model to examine whether peer victimization is indirectly related to substance use via deviant peer affiliation, and whether the strength of this mediation is moderated by the level of parental knowledge for both genders. All participants self-reported using questionnaires to assess peer victimization, deviant peer affiliation, parental knowledge, and substance use. The results revealed that peer victimization was indirectly associated with increased alcohol use via deviant peer affiliation for both genders. However, deviant peer affiliation mediated the impact of peer victimization on trying cigarettes for only boys. Moreover, parental knowledge acted as a protective role for increases in alcohol use for girls, but not for boys. These findings highlight the potential role of deviant peer affiliation to explain the relationship between peer victimization and substance use, and provide important implications for addressing the adverse consequences of peer victimization. [ABSTRACT FROM AUTHOR]

The retrospective cohort epidemiological study was to investigate the characteristics of women who underwent induced abortion. Data were retrospectively collected from women who underwent induced abortions (n=19,655) at the Xiamen Maternity and Child Health Care Hospital (2010–2013). The characteristics of women who underwent induced abortions included mean age, unmarried status, no previous deliveries, first pregnancy, ≥2 abortions including the current one, and a history of caesarian section. From 2010 to 2013, mean age increased and declines were observed in the ratio of induced abortions to live births, the proportion of induced abortions among women of 15–24 years, those who were unmarried, had their first pregnancy, or had no history of delivery. However, the rates of induced abortions increased among women who were lactating, had a history of caesarian section, or had an interpregnancy interval of <6 months. This snapshot of induced abortions in China might suggest that the numbers are increasing but the ratio to live births has fallen. Methods should be improved to prevent unwanted pregnancies and reduce the number of induced abortions in China. It must be emphasized that differences in mentality and culture between countries might limit the representativeness of these results. [ABSTRACT FROM AUTHOR]

Background. Aberrant promoter methylation has been considered as a potential molecular marker for gastric cancer (GC). However, the role of methylation of FLNC, THBS1, and UCHL1 in the development and progression of GC has not been explored. Methods. The promoter methylation status of UCHL1, FLNC, THBS1, and DLEC1 was assessed by quantitative methylation-specific PCR (QMSP) in the serum of 82 GC patients, 46 chronic atrophic gastritis (CAG) subjects, and 40 healthy controls. Results. All four genes had significantly higher methylation levels in GC patients than in CAG and control subjects. However, only UCHL1 methylation was significantly correlated with the tumor stage and lymph node metastasis. While THBS1 methylation was altered in an age-dependent manner, FLNC methylation was correlated with differentiation and Helicobacter pylori infection. DLEC1 methylation was only associated with tumor size. Moreover, methylated UCHL1 with or without THBS1 in the serum was found to be significantly associated with a poor prognosis. Conclusion. The promoter methylation degree of FLNC, THBS1, UCHL1, and DLEC1 in serum could tell the existence of GC and only UCHL1 in the serum was also associated with poor prognosis of GC. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of 2,3,4′,5-tetrahydroxystilbene-2-O-β-D-glucoside (TSG), an active component extracted from the root of Polygonum multiflorum, on angiotensin II (Ang II)-induced proliferation of cultured rat vascular smooth muscle cells (VSMCs) and to identify the potential mechanism. Methods: Cell proliferation and cell cycle were determined by cell counting, 5-bromo-2′-deoxyuridine incorporation assay, proliferating cell nuclear antigen protein expression and flow cytometry. Levels of phosphorylated extracellular signal-regulated kinase 1/2 (ERK1/2), mitogenic extracellular kinase 1/2 (MEK1/2) and Src in VSMCs were measured by Western blot. The expression of c-fos, c-jun and c-myc mRNA were measured by reverse transcription polymerase chain reaction (RT-PCR). Intracellular reactive oxygen species (ROS) was measured by fluorescence assay. Results: TSG significantly inhibited Ang II-induced VSMCs proliferation and arrested cells in the G /S checkpoint ( P<0.05 or P<0.01). TSG decreased the levels of phosphorylated ERK1/2, MEK1/2 and Src in VSMCs ( P<0.05 or P<0.01). TSG also suppressed c-fos, c-jun and c-myc mRNA expression <0.05 or P<0.01). In addition, the intracellular ROS was reduced by TSG ( P<0.01). Conclusions: TSG inhibited Ang II-induced VSMCs proliferation. Its antiproliferative effect might be associated with down-regulation of intracellular ROS, followed by the suppression of the Src-MEK1/2-ERK1/2 signal pathway, and hence, blocking cell cycle progression. [ABSTRACT FROM AUTHOR]

China is experiencing one of the fastest growing human immunodeficiency virus (HIV) epidemics in the world. Condom use is consistently low among Chinese college students. The purpose of this study was to identify the predictors that determine the intention to use condoms among Chinese college students applying the theory of planned behavior (TPB). A non-probability convenience sample of 433 participants was drawn from three universities in Central, Eastern, and Southwestern China, respectively. An anonymous written questionnaire was self-administered. Data were collected and analyzed descriptively and statistically using Predictive Analytical Software 19.0. Multiple linear regression was performed to identify the predictors among 402 participants with non-missing data. Eighteen percent (78/433) of the participants reported being sexually active in the past 6 months. The percentage of times these individuals reported using condoms during intercourse was 38.19 %. Intention to use condoms was statistically significantly (R = 50.4 %) predicted by attitudes (β = 0.213), subjective norms (β = 0.259), and perceived behavior control (PBC) (β = 0.332). All predictors were statistically significant at the 0.001 level ( p < 0.001). PBC was the strongest predictor of intention to use condoms. The study findings indicated that the TPB could be used as a framework to determine the predictors of intention to use condoms among the Chinese college students. It is recommended that the HIV education programs should increase the intention to use condoms through promoting positive attitudes, subjective norms and PBC of condom use in Chinese college students. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to evaluate the therapeutic effect of laser vaporization for vaginal intraepithelial neoplasia ( VAIN) after hysterectomy in Chinese women and to identify factors affecting persistence/recurrence. Material and Methods Twenty-eight VAIN patients after hysterectomy due to cervical intraepithelial neoplasia (group 1) and 11 VAIN patients due to cervical cancer (group 2) were reviewed retrospectively. All patients were treated with at least one episode of laser vaporization between 2010 and 2011, and then followed up every 3 months for at least 1 year. Cox regression analysis was used to identify independent factors predicting persistence/recurrence. Results All VAIN patients achieved remission after two episodes of laser treatment, with 85.7% complete regression in group 1 and 54.5% in group 2. The first episode of the treatment had a significantly higher success rate in group 1 than in group 2 (46.2% vs 0.0%). All patients had no recurrence during a mean follow-up time of 22.8-27.8 months (range 12-39 months). However, infection persisted in 21 (61.8%) of 34 human-papillomavirus-positive patients after laser vaporization. Severity of VAIN was the only significant independent predictor of persistence/recurrence after one episode of the treatment (adjusted odds ratio, 4.08; 95% confidence interval, 1.28-12.96; P = 0.017). Laser treatments were well tolerated with no major side-effects. Conclusion Laser vaporization may be a useful option for the treatment of VAIN after hysterectomy. However, a follow-up is required to assess the long-term efficacy of laser treatment. [ABSTRACT FROM AUTHOR]

Purpose: As an inhibitor of HMG-CoA reductase that catalyses the first step of cholesterol synthesis, pitavastatin undergoes little hepatic metabolism; however, it is a substrate of uptake and efflux transporters. Since pitavastatin is potentially co-administered with agents that affect transporter activities, the pharmacokinetics of pitavastatin was investigated on the effects of a single-dose rifampin in healthy volunteers. Methods: Twelve Chinese healthy male volunteers took 4 mg pitavastatin orally with 150 ml water or with a single dose of 600 mg rifampin on separate occasions and the plasma concentrations of pitavastatin were measured over 48 h by HPLC-MS/MS. Results: A single dose of rifampin significantly increased the mean area under the plasma concentration-time curve(AUC) and C of pitavastatin by 573.5 %(95%CI, 373.3-773.7 %, p < 0.001) and 819.2 %(95 % CI, 515.4-1123.0 %, p < 0.001) respectively, while significantly decreased the t and CL/F of pitavastatin by 38.8 % (95 % CI, 18.2-59.4 %, p < 0.001) and 81.4 % (95 % CI, 75.0-87.7 %, p < 0.001) respectively. Conclusions: Co-administration of pitavastatin with a single dose of rifampin resulted in a significant increase in plasma levels of pitavastatin in Chinese healthy subjects. [ABSTRACT FROM AUTHOR]

Background: To evaluate the conditions of palliative chemotherapy in terminally ill patients with advanced non-small cell lung cancer (NSCLC), and to discuss the potential factors that affect the prognosis of these patients. Methods: All 205 terminally ill patients with advanced NSCLC, who died in our hospital during the period from 2006 to 2010, were included in the study. Basic information was collected and details for the treatment of patients, related to overall survival, were evaluated. Results: One hundred and fifty-nine out of 205 patients (77.6%) were treated with palliative chemotherapy. Of these, 59.7% patients were treated with palliative chemotherapy in the last three months and 27.7% patients in the last one-month, prior to their expiration, respectively. In addition, 22.0% of the 159 patients were treated with palliative chemotherapy for the first time in the last three months and 10.1% in the last month of their final days. We have shown that patients treated with palliative chemotherapy in their last three and final month had a shorter overall survival rate than those patients who were not treated with palliative chemotherapy. Conclusion: A large proportion of patients with advanced NSCLC received palliative chemotherapy near the end of their life. However, our results were not in favor of palliative chemotherapy in the last three or final month of life. [ABSTRACT FROM AUTHOR]

Purpose: Nateglinide is commonly used in the treatment of patients with type 2 diabetes mellitus. Our objective was to assess the association between CYP2C9 and SLCO1B1 polymorphisms and the metabolism of nateglinide in healthy Chinese male volunteers. Methods: A total of 35 healthy Chinese male volunteers with different CYP2C9 and SLCO1B1 genotypes were given a single oral dose of 120 mg nateglinide. Plasma concentrations of nateglinide and blood glucose level were measured up to 8 h. Results: In subjects with the CYP2C9*1/*3 & 521TT, CYP2C9*1/*1 & 521TC/CC and CYP2C9*1/*3 & 521TC genotype, AUC of nateglinide was 56 %, 34 % and 56 % higher ( P = 0.002, P = 0.041 and P = 0.013, respectively), and the CL/F of nateglinide was 35 %, 11 % and 36 % lower ( P = 0.000, P = 0.003 and P = 0.002, respectively) than that in the reference group. When only considering 521 T>C polymorphism, it had no significant association with the pharmacokinetics of nateglinide. CYP2C9*3 and 521 T>C polymorphisms were the significant predictors of the AUC and CL/F of nateglinide (adjusted multiple R = 34 % and 43 %, respectively) according to multiple linear regression analyses, but they have no significant association with changes in the blood glucose-lowering effect of nateglinide. Conclusions: Both SLCO1B1 521 T>C and the CYP2C9*3 polymorphisms can significantly affect the pharmacokinetics of nateglinide, but they could only partially explain the interindividual variability of plasma concentration of nateglinide. Moreover, 521 T>C and the CYP2C9*3 polymorphisms have no effect on pharmacodynamics of nateglinide in healthy Chinese male subjects. [ABSTRACT FROM AUTHOR]

Conclusion: The deficient regulatory T cells may play a role in the development of allergic rhinitis. Objective: A subpopulation of regulatory T cell that produce IL-17a were proved to show an apparent duality of regulatory T cell and effector T helper-17 cells. We studied this subpopulation in patients with allergic rhinitis. Methods: Fresh whole blood from 20 patients with allergic rhinitis and 19 healthy donors was used to investigate the frequencies of CD4+IFN-γ+ T cells (effector T helper-1), CD4+IL-4+ T cells (effector T helper-2) and CD4+IL-17a+ T cells (effector T helper-17) by flow cytometry after stimulation for 4-6 h. Simultaneously, CD4+ T lymphocytes were isolated from peripheral blood mononuclear cells and then the frequencies of regulatory T cells and IL-17a-producing regulatory T cells in the allergic rhinitis group were compared with healthy controls after T-cell antigen receptor stimulation for 48 h. The suppressive capacity of CD4+CD25highCD127low regulatory T cells that were stimulated by Dermatophagoides pteronyssinus in both groups was isolated and assessed. Results: The frequencies of effector T helper-17 and effector T helper-2 cells were higher in the allergic group compared with healthy controls. Regulatory T cells were similar in both groups, but IL-17a-producing regulatory T cells were increased in the allergic group. In addition, the capacity of regulatory T cells to suppress effector T helper-17 cytokine production was significantly decreased in the allergic group. [ABSTRACT FROM AUTHOR]

Background: Traditional Chinese medicine (TCM) has been used to treat chronic obstructive pulmonary disease (COPD) for many years. This study aimed to evaluate the efficacy and safety of the comprehensive therapy based on the three common TCM patterns in stable COPD patients.Methods: A four-center, open-label randomized controlled method was conducted. A total of 352 patients were divided into the trial group (n = 176, treated with conventional Western medicine and Bu-Fei Jian-Pi granules, Bu-Fei Yi-Shen granules, and Yi-Qi Zi-Shen granules based on the TCM patterns respectively) and the control group (n = 176, treated with conventional Western medicine). The frequency and duration of acute exacerbation, lung function, clinical symptoms, 6-minute walking distance (6MWD), dyspnea scale and quality of life were observed during a 6-month treatment period and at a further 12-month follow-up. Results: A total of 306 patients completed the study fully. The full analysis set (FAS) population was 350 and the per-protocol analysis set (PPS) population was 306. After the 6-month treatment and 12-month follow-up, there were significant differences between the trial and control group in the following: frequency of acute exacerbation (FAS: P = 0.000; PPS: P = 0.000); duration of acute exacerbation (FAS: P = 0.000; PPS: P = 0.001); FEV1 (FAS: P = 0.007;PPS: P = 0.008); symptoms (FAS: P = 0.001; PPS: P = 0.001); 6MWD (FAS: P = 0.045; PPS: P = 0.042); dyspnea scale (FAS: P = 0.002; PPS: P = 0.004); and physical domain (FAS: P = 0.000; PPS: P = 0.000), psychological domain (FAS: P = 0.008; PPS: P = 0.011), social domain (FAS: P = 0.001; PPS: P = 0.000) and environment domain (FAS: P = 0.015; PPS: P = 0.009) of the WHOQOL-BREF questionnaire. There were no differences between the trial and control group in FVC, FEV1% and adverse events. Conclusions: Based on the TCM patterns, Bu-Fei Jian-Pi granules, Bu-Fei Yi-Shen granules and Yi-Qi Zi-Shen granules have beneficial effects on measured outcomes in stable COPD patients over the 6-month treatment and 12-month follow-up, with no relevant between-group differences in adverse events. Trial Registration: This trial was registered at Chinese Clinical Trial Register Center, ChiCTR-TRC-11001406. [ABSTRACT FROM AUTHOR]

Being victimized online and through social media is a prevailing phenomenon among adolescents, and has been shown to be associated with later internalizing and externalizing problems. However, there is insufficient understanding of how the experience of cybervictimization is associated with these problems and when these associations are strongest. Guided by general strain theory, we proposed that cybervictimization is associated with internalizing and externalizing problems through different mechanisms, and that emotion regulation strategies moderate these processes. Questionnaire data were collected from 810 high school students in southern China (54.3% girls, mean age = 16.8, SD = 0.79). As hypothesized, path analysis results showed that the positive association between cybervictimization and internalizing problems was mediated by psychological insecurity, whereas the positive association between cybervictimization and externalizing problems was mediated by moral disengagement. In addition, adolescents' emotion regulation strategies moderated these mediation processes. Cognitive reappraisal buffered the effect of psychological insecurity on internalizing problems but aggravated the effect of cybervictimization on moral disengagement. Expressive suppression buffered the effect of moral disengagement on externalizing problems. Our results provide a novel perspective for understanding the negative impacts of cybervictimization on adolescents, and have practical implications for interventions to reduce these impacts. • Cybervictimization is associated with adolescents' internalizing and externalizing problems. • Moral disengagement and psychological insecurity mediated these two pathways, respectively. • Cognitive reappraisal and expressive suppression play a moderating role in the above relationships. • The results have practical implications for developing targeted prevention and intervention programson cybervictimization. [ABSTRACT FROM AUTHOR]