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BackgroundThe last decade has witnessed many achievements in China’s health care industry, but the industry still faces major challenges among which the uneven distribution of medical resources and the imbalance between supply and demand are the most pressing problems. Although mobile health (mHealth) services play a significant role in mitigating problems associated with health care delivery, their adoption rates have been low. ObjectiveThe objective of this study was to explore the impact of resource scarcity and resource accessibility on the adoption of mHealth from the perspective of resource competition, to examine the concerning factors, and to provide a theoretical basis for promoting mHealth in China. MethodsWe used 229,516 original registration records of outpatients to conduct an empirical analysis to examine the adoption of mHealth services from the perspective of resource competition. ResultsThe adoption rate of mobile services for outpatients was low, accounting for only 31.5% (N=71,707). The empirical results indicated that resource scarcity (beta=.435, P=.01) and accessibility (beta=−.134, P=.02) have a significant impact on the adoption of mHealth. In addition, gender (beta=.073, P=.01) and age (beta=−.009, P

Objective To investigate the effect of resveratrol (RSV) in the treatment of peri-implantitis in a murine model and its effect on nuclear factor kappa-B (NF-κB) signaling and mitogen-activated protein kinase (MAPKs) signaling. Methods This study has been reviewed and approved by the Ethics. After extracting the right maxillary molars of 40 C57BL/6 mice and allowing them to heal naturally for 8 weeks, implants were implanted at the site of the first molar. The mice were randomly divided into a control group, a mouse peri implantitis model group, a low-dose group of 20 mg/kg resveratrol (RSV-L), and a high-dose group of 40 mg/kg resveratrol (RSV-H). After 4 weeks of implant implantation, a silk thread ligation induced peri implantitis model was established in all mice except for the control group. The model group received intervention with physiological saline by gavage, while the drug group received intervention with resveratrol by gavage for 6 consecutive weeks. After 6-week treatment, observe the swelling of the gums around the implant and measure the bone resorption around the mouse implant using micro CT. Enzyme linked immunosorbent assay (ELISA) was used to detect the levels of tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) in gingival crevicular fluid. HE staining was used to observe the infiltration of inflammatory cells in the surrounding tissues of mouse implants. Protein expression level and phosphorylation level of extracellular regulated protein kinases (ERK), p-ERK, c-Jun N-terminal kinase (JNK), p-JNK, p38 mitogen activated protein kinase (p38 MAPK), p-p38MAPK, nuclear factor kappa-B (NF-κB), p-NF-κB, nuclear factor-κB inhibitory protein (IκΒα), p-IκBα in MAPKs/NF-κB signaling pathway were detected by Western blot (WB). Results Resveratrol group showed reduced tissue edema and decreased alveolar bone resorption. Among them, the high-dose resveratrol group had lighter tissue edema and weaker bone resorption compared to the low-dose group. The micro CT results showed that significant changes in the bone level around the implant were observed in the model group mice at four sites: proximal, distal, buccal, and palatal. High dose resveratrol intervention reduced alveolar bone resorption (PPP>0.05). The ELISA results showed that compared with the model group, the levels of TNF - α and IL-6 in the gingival crevicular fluid of mice in the low-dose and high-dose resveratrol groups were lower (PPPP

Multimodal public transport network (MPTN) plays an important role in relieving road traffic pressure for metropolitan area. Nevertheless, the impact of an accident happened in an individual station may not only disrupt the station itself or the single lines that go through the station but also spread over the whole network. Therefore, identifying the vulnerable stations is essential for improving the MPTN management against the systematic risk caused by accidents. In this paper, we proposed a route diversity-based approach to measure the vulnerability of stations in MPTN based on the complex network theory. The route constraint parameters were established to reflect the travel time restriction in constructing the set of passengers' acceptable routes. In addition, an algorithm was formulated to rapidly calculate the route diversity index and meanwhile avoid the “overlapping routes” problem. A simple virtual network was used as a numerical example to compare the proposed approach with the vulnerability evaluation approaches based on degree centrality and betweenness centrality. Finally, the proposed approach was applied to the MPTN of Beijing to explain its effectiveness and potential applications. The results show that the proposed method can efficaciously estimate vulnerable nodes compared with degree centrality and betweenness centrality. Meanwhile, the acceptable routes between any OD pairs in the MPTN are 1-10 according to the constrained parameter. In addition, the average number of acceptable routes between OD pairs of Beijing MPTN is 3.649. By ranking the stations according to their vulnerability, it can be found that the top 5 vulnerable stations are all external traffic hubs or the stations around famous commercial areas. The results suggest that these stations are significant for external transport as well as crucial for internal urban transportation systems. The research output could contribute to the MPTN management in accident prevention and emergency handling., Author(s): Jianlin Jia (corresponding author) [1]; Yuwen Huang [1]; Wanting Zhang [1]; Yanyan Chen [2]; Zhuo Liu [2] 1. Introduction Due to the rapid urbanization all over the world, a [...]

Background The association between years of non-diabetes status after diagnosis of impaired glucose tolerance (IGT) and the risk of long-term death and cardiovascular outcomes needed to be clarified. Methods and findings In this post hoc analysis, we included 540 individuals with IGT who participated in the original Da Qing Diabetes Prevention Study (DQDPS). In the DQDPS, all participants were diagnosed with IGT by a 75 g oral glucose tolerance test and randomized to intervention or control groups with a 6-year lifestyle intervention trial. After the completion of the trial, death, cardiovascular events, and microvascular complications were monitored over a 30-year follow-up. In this post hoc analysis, the Cox analysis assessed the extended risk of these outcomes in individuals who either remained non-diabetes status or progressed to diabetes at the end of 2, 4, and 6 years after diagnosis of IGT. In all participants, the difference in the cumulative incidence rate of the outcomes between the diabetes and non-diabetes group gradually increased over 30 years. Compared with the diabetes group, a significantly lower risk of all-cause death (hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.57 to 0.97, p = 0.026), cardiovascular events (HR: 0.63; 95% CI: 0.49 to 0.82, p < 0.001), and microvascular complications (HR: 0.62; 95% CI: 0.45 to 0.86, p = 0.004) first emerged in individuals who remained non-diabetes at the 4 years visit, whereas the significant risk reduction in cardiovascular death was first observed at the end of 6 years (HR: 0.56; 95% CI: 0.39 to 0.81, p = 0.002) after adjustment for age, sex, smoking status, BMI, systolic blood pressure, blood glucose, total cholesterol, intervention, and medications (including insulin plus oral hypoglycaemics, antihypertensives, and lipid-lowering agents). The results in the original intervention group alone were similar to the whole group. The main limitations of our study are the limited number of participants and the sole ethnicity of the Chinese population. Conclusions In this study, we observed that maintaining several years of non-diabetes status after IGT diagnosis was associated with a significant reduction in long-term risk of death and vascular complications, and for most of these outcomes, maintaining at least 4 years of non-diabetes status may be needed to achieve a significant risk reduction., Author(s): Xin Qian 1, Jinping Wang 2, Qiuhong Gong 1, Yali An 1, Xinxing Feng 1, Siyao He 1, Xiaoping Chen 3, Wenjuan Wang 4, Lihong Zhang 1, Yuanchi Hui [...]

Drivers' fault emergency response behavior can easily lead to crashes, resulting in significant economic and property losses. Exploring the causes of improper emergency response behavior is crucial for regulating driver behavior and preventing crash. Therefore, based on crashes data between commercial motor vehicles (CMVs) and noncommercial motor vehicles (NCMVs) that occurred in China from 2014 to 2018, this study established a binary logistic regression model. It systematically analyzed the key factors influencing drivers' fault emergency response behaviors in terms of individuals, vehicles, road conditions, environment, and corporate management. Additionally, it compared the differences in the influencing factors of fault emergency response behaviors between drivers of CMV and NCMV. The results indicate that the model fits well. The presence of faulty emergency response behavior in drivers is significantly correlated with five factors: age, gender, fatigue driving, speeding, and weather conditions. Moreover, these factors have different impacts on CMV drivers and NCMV drivers. Fatigue driving and speeding have a more significant impact on CMV drivers, while other factors are more pronounced for NCMV drivers. This study can provide valuable insights for the development of measures aimed at reducing the severity of CMV-NCMV crashes., Author(s): Panyi Wei [1,2,3,4]; Jianling Huang [5]; Yanyan Chen (corresponding author) [1,2]; Jianming Ma [6]; Yunchao Zhang [1,2]; Shaohua Wang [7]; Ning Chen [1,2] 1. Introduction In recent years, crashes [...]

Objective To investigate the correlation between serum leptin level and body mass index (BMI) in infants with cyanosis congenital heart disease, and the relationship between leptin and Ob gene receptor (Ob-R) and hypoxia-inducible factor 1α (HIF-1α) in myocardium. Methods A total of 52 children under 6 months of age with congenital heart disease who underwent surgical treatment in the Department of Congenital Heart Surgery, Fuwai Hospital from January 2019 to October 2020 were included in this study. According to the arterial partial pressure of oxygen (PaO2) of 90 mmHg, they were divided into cyanotic group (n=30) and acyanotic group (n=22). Their height and weight were collected to calculate BMI. The serum leptin level was measured by ELISA. The expressions of HIF-1α and Ob-R in myocardial tissue were detected by RT-PCR and Western blot. In animal model, SD rats were divided into normoxia group and hypoxia intervention group, which were subjected to continuous hypoxia (10% O2) for 4 weeks. The hypoxia intervention group received intraperitoneal injection of HIF-1α inhibitor digoxin (2 mg/kg) daily from the 14 th to 21st day of hypoxia, respectively. The body weight of rats was recorded, and the expressions of HIF-1α and Ob-R were detected by RT-qPCR and Western blot. Results Compared with the acyanosis group, the cyanosis group had a significantly lower BMI (P＜0.05) and a lower leptin/BMI ratio (leptin /BMI) (P＜0.05). Spearman correlation analysis confirmed that serum leptin in the circulatory system was positively correlated with BMI (P＜0.05). In the cyanosis group, the expression of Ob-R increased with the upregulation of HIF-1α,showing a positive correlation. In animal model, with the down-regulation of HIF-1α expression in digoxin injection, the Ob-R level was significantly lower than that in the control group(P＜0.05), the trend of weight loss was significantly inhibited(P＜0.05). The right ventricular hypertrophy index was significantly lower than that in the control group (P＜0.05). Conclusions HIF-1α regulates the expression of Ob-R in myocardial tissue, and the mechanism of its association with leptin and Ob-R may help to find new therapeutic target for improving the prognosis of infants with congenital heart disease.

Background In recent years, studies have demonstrated the use of ultrasound speckle tracking techniques for the early evaluation of subclinical left ventricular (LV) systolic function in patients with type 2 diabetes mellitus (T2DM). In addition, long-term exposure to hyperglycemia severely damages the microvascular system. However, the interaction between diabetic microvascular complications and subclinical LV systolic function has not been fully understood. Objective To investigate the relationship between subclinical LV systolic function and diabetic microvascular complications in patients with T2DM. Methods A total of 150 patients with T2DM who were admitted to the Department of Endocrinology, the First Affiliated Hospital of Air Force Medical University from June to December 2021 were selected in the cross-sectional study and all underwent conventional echocardiography, pulsed tissue Doppler echocardiography and two-dimensional speckle tracking echocardiography (2D STE). The 2D global longitudinal strain (GLS) of LV was obtained to assess the subclinical LV systolic function. Diabetic microvascular complications were defined as combined diabetic retinopathy, diabetic kidney disease or peripheral neuropathy. The subjects were divided into the T2DM alone group (T2DM alone group, n=76), the T2DM with 1 complication group〔T2DM+C (1) group, n=37〕 and the T2DM with 2 to 3 complications group〔T2DM+C (2 to 3) group, n=37〕 according to the cumulative number of microvascular complications. The general demographic characteristics and biochemical indices of patients in the three groups were compared. The relationship between microvascular complications and subclinical LV systolic function was assessed by using Spearman correlation analysis and Logistic regression analysis. Results GLS was lower in the T2DM+C (1) and T2DM+C (2 to 3) groups than in the T2DM alone group (P

Background The incidence of diabetic kidney disease (DKD) and the proportion of its related end-stage renal disease in dialysis patients in China are increasing. So it is urgent to take measures to prevent and control DKD. Intensified multifactorial interventions may prevent or delay the progression of DKD. Therefore, developing a personalized risk prediction model can effectively delay or even prevent the progression of DKD and be useful for the prevention and treatment of DKD. Objective The purpose of this study was to develop and validate a nomogram for the risk prediction of the progression from microalbuminuria (MAU) to macroalbuminuria (CAU) in type 2 diabetes mellitus (T2DM) patients. Methods A total of 1 263 T2DM patients with albuminuria who were hospitalized in Department of Endocrinology, the First Affiliated Hospital of Air Force Medical University from October 2016 to March 2020 were retrospectively recruited and divided into a development cohort of 906 cases and a validation cohort of 357 cases, according to the admission time. LASSO regression was used to screen the optimized variables measured at baseline for CAU. A Nomogram was constructed based on selected predictive factors identified by the multivariate logistic regression model of the development sub-cohort. The receiver operating characteristic (ROC) curve, calibration curve and Hosmer-Lemeshow (H-L) test were employed to assess the calibration and discrimination of the model. Decision curve analysis (DCA) was performed to evaluate the net clinical benefit of the Nomogram. Results The diabetes duration, systolic blood pressure (SBP), glycosylated hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), cystatin C (Cys-C), estimated glomerular filtration rate (eGFR), and diabetic retinopathy (DR) were screened as predictive factors for progression from MAU to CAU by LASSO penalty regression. Multivariable Logistic regression analysis using these factors indicated that seven of those potential predictors were present in the final model, diabetes duration≥10 years, SBP≥140 mmHg, HbA1c≥7.0 mmol/L, LDL-C≥1.8 mmol/L, Cys-C>1.09 mg/L, and DR were risk factors for the progression from MAU to CAU in T2DM patients (P0.05). External and internal validations of the nomogram indicated a good predictive performance. The AUC of the model was 0.814〔95%CI (0.782, 0.846) 〕 in the development cohort, and was 0.768〔95%CI (0.713, 0.823) 〕 in the validation cohort. The model was well fit according to the calibration curve and the H-L goodness of fit test (internal validation: P=0.065; external validation: P=0.451). DCA curve showed that the Nomogram's net benefit was higher than both extreme curves when the threshold probability set between 0.08 and 0.74 in the development cohort, and between 0.14 and 0.70 in the external validation cohort, suggesting potential clinical benefits provided by this Nomogram. Conclusion This study finally constructed a prediction model with seven indicators containing diabetes duration, SBP, HbA1c, LDL-C, Cys-C, eGFR, and DR, and will be a useful clinical predictive tool for the risk of progression from MAU to CAU in T2DM patients.