Association between patient-reported frailty and nonhome discharge among older patients with acute stroke: A prospective study.

OBJECTIVE: To investigate the association between prestroke frailty and nonhome discharge, prolonged length of stay as well as functional outcomes. DESIGN: Prospective observational study. SETTING: Single urban teaching hospital in Guangzhou, China. PARTICIPANTS: Consecutive sample of 271 older patients admitted with acute stroke. INTERVENTION: N/A. MAIN MEASURES: A five-item FRAIL scale (0∼5 points) and the stroke severity at onset were measured. The primary outcome of interest was nonhome discharge, with secondary outcomes including prolonged length of stay and worse short-term prognosis. Multivariable logistic regression adjusting for confounding factors was used to determine the association between patient-reported frailty and nonhome discharge, prolonged length of stay, worse short-term prognosis. RESULTS: The population had a median age of 68 [interquartile range (IQR), 64∼74)]years, with 50 individuals (18.5%) identified as frail. After adjusting for age, sex, Barthel index, National Institutes of Health Stroke Scale, and Mini-Mental Status Exam score at admission, patients with self-reported frailty were significantly likely to experience nonhome discharge (Odds Ratio [OR] = 4.788; 95% confidence interval [CI] = 1.272∼18.017; p = .021), prolonged length of stay (OR = 4.76; 95% CI = 1.80∼12.56; p = .002), mRS scores at 30 days (OR = 6.72;95% CI = 1.79∼25.20; p = .005) and three months postdischarge and three-month (OR = 8.94; 95% CI = 2.10∼38.08; p = .003). CONCLUSIONS: In older adults with stroke, frailty is associated with nonhome discharge, prolonged length of stay, and worse short-term prognosis, regardless of the stroke severity, cognition, and Barthel index score at admission. FRAIL scale can be used as a practical screening tool in acute care setting by multidisciplinary team in supporting discharge process.

Machine learning decision support model for discharge planning in stroke patients.

BACKGROUND/AIM: Efficient discharge for stroke patients is crucial but challenging. The study aimed to develop early predictive models to explore which patient characteristics and variables significantly influence the discharge planning of patients, based on the data available within 24 h of admission. DESIGN: Prospective observational study. METHODS: A prospective cohort was conducted at a university hospital with 523 patients hospitalised for stroke. We built and trained six different machine learning (ML) models, followed by testing and tuning those models to find the best-suited predictor for discharge disposition, dichotomized into home and non-home. To evaluate the accuracy, reliability and interpretability of the best-performing models, we identified and analysed the features that had the greatest impact on the predictions. RESULTS: In total, 523 patients met the inclusion criteria, with a mean age of 61 years. Of the patients with stroke, 30.01% had non-home discharge. Our model predicting non-home discharge achieved an area under the receiver operating characteristic curve of 0.95 and a precision of 0.776. After threshold was moved, the model had a recall of 0.809. Top 10 variables by importance were National Institutes of Health Stroke Scale (NIHSS) score, family income, Barthel index (BI) score, FRAIL score, fall risk, pressure injury risk, feeding method, depression, age and dysphagia. CONCLUSION: The ML model identified higher NIHSS, BI, and FRAIL, family income, higher fall risk, pressure injury risk, older age, tube feeding, depression and dysphagia as the top 10 strongest risk predictors in identifying patients who required non-home discharge to higher levels of care. Modern ML techniques can support timely and appropriate clinical decision-making. RELEVANCE TO CLINICAL PRACTICE: This study illustrates the characteristics and risk factors of non-home discharge in patients with stroke, potentially contributing to the improvement of the discharge process. REPORTING METHOD: STROBE guidelines.

Detection of candidate genes and development of KASP markers for Verticillium wilt resistance by combining genome-wide association study, QTL-seq and transcriptome sequencing in cotton.

KEY MESSAGE: Combining GWAS, QTL-seq and transcriptome sequencing detected basal defense-related genes showing gDNA sequence variation and expression difference in diverse cotton lines, which might be the molecular mechanisms of VW resistance in G. hirsutum. Verticillium wilt (VW), which is caused by the soil-borne fungus Verticillium dahliae, is a major disease in cotton (Gossypim hirsutum) worldwide. To facilitate the understanding of the genetic basis for VW resistance in cotton, a genome-wide association study (GWAS), QTL-seq and transcriptome sequencing were performed. The GWAS of VW resistance in a panel of 120 core elite cotton accessions using the Cotton 63K Illumina Infinium SNP array identified 5 QTL from 18 significant SNPs meeting the 5% false discovery rate threshold on 5 chromosomes. All QTL identified through GWAS were found to be overlapped with previously reported QTL. By combining GWAS, QTL-seq and transcriptome sequencing, we identified eight candidate genes showing both gDNA sequence variation and expression difference between resistant and susceptible lines, most related to transcription factors (TFs), flavonoid biosynthesis and those involving in the plant basal defense and broad-spectrum disease resistance. Ten KASP markers were successfully validated in diverse cotton lines and could be deployed in marker-assisted breeding to enhance VW resistance. These results supported our inference that the gDNA sequence variation or expression difference of those genes involving in the basal defense in diverse cotton lines might be the molecular mechanisms of VW resistance in G. hirsutum.

Disequilibrium evolution of the Fructose-1,6-bisphosphatase gene family leads to their functional biodiversity in Gossypium species.

BACKGROUND: Fructose-1,6-bisphosphatase (FBP) is a key enzyme in the plant sucrose synthesis pathway, in the Calvin cycle, and plays an important role in photosynthesis regulation in green plants. However, no systemic analysis of FBPs has been reported in Gossypium species. RESULTS: A total of 41 FBP genes from four Gossypium species were identified and analyzed. These FBP genes were sorted into two groups and seven subgroups. Results revealed that FBP family genes were under purifying selection pressure that rendered FBP family members as being conserved evolutionarily, and there was no tandem or fragmental DNA duplication in FBP family genes. Collinearity analysis revealed that a FBP gene was located in a translocated DNA fragment and the whole FBP gene family was under disequilibrium evolution that led to a faster evolutionary progress of the members in G. barbadense and in At subgenome than those in other Gossypium species and in the Dt subgenome, respectively, in this study. Through RNA-seq analyses and qRT-PCR verification, different FBP genes had diversified biological functions in cotton fiber development (two genes in 0 DPA and 1DPA ovules and four genes in 20-25 DPA fibers), in plant responses to Verticillium wilt onset (two genes) and to salt stress (eight genes). CONCLUSION: The FBP gene family displayed a disequilibrium evolution pattern in Gossypium species, which led to diversified functions affecting not only fiber development, but also responses to Verticillium wilt and salt stress. All of these findings provide the foundation for further study of the function of FBP genes in cotton fiber development and in environmental adaptability.

Edible plant Jiaosu: manufacturing, bioactive compounds, potential health benefits, and safety aspects.

Edible plant Jiaosu (EPJ), a type of plant-based functional food fermented by beneficial bacteria, has gained publicity in recent years for its potential benefits to health. Important progress in relevant manufacturing technology has been made in the past decade with respect to raw materials, fermentation microorganisms and fermentation conditions. Current research has revealed that EPJ contains abundant nutrients and bioactive compounds, such as minerals, amino acids, polyphenols, organic acids and polysaccharides. Thus, many studies have focused on the beneficial effects of EPJ in preventing lifestyle diseases, such as hyperglycemia, hyperlipidemia, non-alcoholic fatty liver, obesity, diabetes and some cancers, although limited studies have involved the related active compounds and their protective mechanisms. Furthermore, very few studies have investigated the potential safety risks associated with the consumption of such food. In this review, we present a brief summary of the current research progress pertaining to the manufacturing, bioactive compounds, potential health benefits and safety aspects of EPJ. However, as a result of the complex components in EPJ, further studies on the bioactive compounds with relevant beneficial effects in EPJ and the safety evaluations of EPJ consumption are needed. © 2020 Society of Chemical Industry.

Adsorption and Desorption of Carbendazim and Thiamethoxam in Five Different Agricultural Soils.

The adsorption and desorption behaviors of carbendazim (CBD) and thiamethoxam (TMX) were systematically studied in five different agricultural soils. The adsorption and desorption isotherms of CBD and TMX in the five different soils were fitted well by the Freundlich model. The Freundlich adsorption coefficient (Kfads) and Freundlich desorption coefficient (Kfdes) of CBD in the five different soils were 1.46-19.53 and 1.81-3.33, respectively. The corresponding values of TMX were 1.19-4.03 and 2.07-6.45, respectively. The adsorption affinity and desorption ability of the five different soils for CBD and TMX depended mainly on soil organic matter content (OMC) and cation exchange capacity (CEC). Desorption hysteresis occurred in the desorption process of CBD and TMX in the five different agricultural soils, especially for TMX. It is concluded that the adsorption-desorption ability of CBD was much higher than that of TMX in the five different agricultural soils, which was attributed to soil OMC and CEC.

Rhodium-catalyzed triazole-directed C-H bond functionalization of arenes with diazo compounds.

Heterocyclic compounds bearing 1,2,3-triazole scaffolds have found wide application both in medicinal chemistry and materials science. In this paper, rhodium(iii)-catalyzed triazole-directed alkylation reactions of arenes using diazo compounds as the alkylating agents are described. A number of polysubstituted arenes were provided from easily available materials in good yields under mild conditions. The reactions proceed via triazole-directed ortho C-H bond activation and subsequent carbene insertion originating from diazo compounds.

Regional association analysis-based fine mapping of three clustered QTL for verticillium wilt resistance in cotton (G. hirsutum. L).

BACKGROUND: Verticillium wilt is one of the most destructive diseases affecting global cotton production. The most effective way to control wilt disease has been the development of new cotton varieties that are resistant to VW. VW-resistant Upland cotton cultivars have been created in both the USA and China by Gossypium barbadense introgression. More than 100 VW resistance quantitative trait loci have been detected. RESULTS: Three clustered VW resistance-related QTL were detected in a 120-line association population and assigned to a genome region of 14,653,469-55,190,112 bp in Dt_chr9. A regional association analysis-based fine-mapping strategy was developed to narrow down the confidence intervals of the above QTL. The estimated LD decay of the genome region of interest was much faster than those of the Dt_chr9 chromosome and the whole genome, suggesting the existence of a recombination hotspot. Thirty-seven haplotype blocks were detected. The confidence intervals of the three clustered QTL were narrowed down to a region of 937,906 bp involving QTL-i23734Gh and a region of 1,389,417 bp involving QTL- i10740Gh, respectively. Each region contained the strongest association signal. Comparative analysis redefined the confidence intervals of the other three QTLs, qDL52T2-c19, QTL-BNL4069, and QTL-JESPR0001. The broad-spectrum VW resistance QTL qVW-D9-1 was demonstrated to be closely linked with the three redefined QTL, QTL-i23734Gh, QTL- i10740Gh and QTL-JESPR0001. Twelve functional genes were detected to be located within the redefined confidence intervals of VW resistance QTL. The mRNA CotAD_60243, encoding E3 ubiquitin-protein ligase UPL2-like, responsible for plant innate immunity and broad-spectrum disease resistance, was found to be overlapped with the strongest association signal i10740Gh. Six mRNAs encoding putative disease-resistance proteins were within the redefined confidence interval of QTL-JESPR0001, suggesting a tandem arrangement of R genes. CONCLUSIONS: Our results proved that the VW resistance effect related to three clustered VW resistance-related QTL was actually controled by two redefined major QTL and severlal minor loci. The broad-spectrum VW resistance QTL qVW-D9-1 may be closely linked with the two redefined major QTLs. The tandem arrangement of R genes were detected in the redefined confidence interval of QTL-JESPR0001. The candidate genes obtained should be helpful in identifying and characterizing defense genes related to VW resistance QTL.

4,5-cis unsaturated α-GalCer analogues distinctly lead to CD1d-mediated Th1-biased NKT cell responses.

The total synthesis of 4,5-cis unsaturated α-GalCer analogues was achieved, and their immune-response altering activity was assessed in vitro as well as in vivo in mice. Using glycosyl iodide as a glycosyl donor, construction of the sphingosine unit was shortened by four steps and single α-stereoselectivity was achieved in good yield (67%). With regard to the therapeutic use of α-GalCer, the novel analogues (1b and 1c) distinctly induced a Th1-biased cytokine response, avoiding induction of a contradictory response and overstimulation.

Self supervised learning based emotion recognition using physiological signals.

Introduction: The significant role of emotional recognition in the field of human-machine interaction has garnered the attention of many researchers. Emotion recognition based on physiological signals can objectively reflect the most authentic emotional states of humans. However, existing labeled Electroencephalogram (EEG) datasets are often of small scale. Methods: In practical scenarios, a large number of unlabeled EEG signals are easier to obtain. Therefore, this paper adopts self-supervised learning methods to study emotion recognition based on EEG. Specifically, experiments employ three pre-defined tasks to define pseudo-labels and extract features from the inherent structure of the data. Results and discussion: Experimental results indicate that self-supervised learning methods have the capability to learn effective feature representations for downstream tasks without any manual labels.

Transition experiences of patients with post stroke dysphagia and family caregivers: A longitudinal, qualitative study.

BACKGROUND: Stroke patients with dysphagia and family caregivers will experience multiple transitions during the whole process of the disease and various nursing needs will be generated. There is a lack of knowledge about their experiences at different transition stages. Thus, we aimed to explore the transition experiences of patients with post stroke dysphagia and family caregivers from admission to discharge home. METHODS: A semi-structured interview based on Meleis's transition theory was used during hospitalization and telephone follow-up interviews were conducted in the first, third, and sixth month after the diagnosis of dysphagia. Interview transcripts were analyzed using the conventional content analysis method. RESULTS: A total of 17 participants enrolled in the first face-to-face interview, 16 participants took part in the first month's telephone follow-up interview, 14 participants in the third month, and 12 participants in the sixth month. The transition experiences of patients with post stroke dysphagia and family caregivers could be summarized into three themes: (1)transition from onset to admission; (2)transition from discharge to other rehabilitation institutions; and (3)transition from discharge to home. Each theme had identified interrelated subthemes. CONCLUSIONS: The experiences of patients with post stroke dysphagia and family caregivers during transition are a dynamic process with enormous challenges in each phase. Collaboration with health care professionals, follow-up support after discharge, and available community and social support should be integrated into transitional nursing to help patients facilitate their transition.

Ortho C-H Bond Activations in an Atmospheric Microwave Plasma Ion Source.

C-H bond ortho-substitution reaction has always been a significant and challenging topic in organic chemistry. We proposed a synthesis method based on microwave plasma torches. High-resolution mass spectrometry was used to monitor rapid reaction products. 2-Alkylbenzimidazole can be formed through the reaction of phenylnitrenium ion and nitriles on a millisecond scale. This reaction can achieve the one-step formation of benzimidazoles from benzene ring single-substituted compounds without the addition of external oxidants or catalysts. A similar C-H bond activation reaction can be accomplished with ketones. Meanwhile, the microwave plasma reactor was modified, and the resulting 2-methylbenzimidazole was successfully collected, indicating the device has good application potential in organic reactions such as C-H bond activation reaction.

2-Acetyl-amino-1,3,4,6-tetra-O-(tri-methyl-silyl)-2-de-oxy-α-d-gluco-pyran-ose.

The title compound, C20H47NO6Si4, was synthesized by per-O-tri-methyl-silylation of N-acetyl-d-glucosa-mine using chloro-tri-methyl-silane in the presence of hexa-methyl-disiloxane. The tri-methyl-silyl group and acetamido group are located on the same side of the pyran ring, showing an α-configuration glycoside. One of the tri-methyl-silyl groups is disordered over two orientations, with site-occupancy factors of 0.625 (9) and 0.375 (9). In the crystal, N-H⋯O hydrogen bonds link the mol-ecules into supra-molecular chains along the a-axis direction.

pH-responsive in situ gelling properties of thiolated citrus high-methoxyl pectin and its potential gel mechanism.

pH-responsive in situ gelling properties of thiolated citrus high-methoxyl pectin (TCHMP) were investigated in this study. The gelation capacity results revealed that the in situ gelation behavior of TCHMP only occurred when the pH value was higher than 6.25. The gel strength increased from 26.63 g to 42.77 g as the pH value increased from 7.4 to 8.9. Rheological measurements confirmed that the apparent viscosity and viscoelasticity of TCHMP were highly dependent on pH value and dialysis time. Compared with the control group, the apparent viscosity of TCHMP dialyzed in phosphate-buffered saline (PBS) of pH 8.9 for 180 min increased 695-fold. During the dialysis process of TCHMP at different pH values (7.4-8.9), the final thiol groups content decreased and the final disulfide bonds content increased with the increase in pH value. This illustrates that the mechanism of in situ gelation is mainly the oxidation of thiol-thiol groups to form disulfide bonds. These results can put forward new insights into the pH-responsive in situ gelling properties of TCHMP and provide a theoretical basis for the application of TCHMP in neutral and alkaline gel systems.

Compound treatment of thiolated citrus high-methoxyl pectin and sodium phosphate dibasic anhydrous improved gluten network structure.

The effects of pectin or thiolated pectin alone and combined with sodium phosphate dibasic anhydrous (Na2HPO4) on the performances of gluten were studied. Results showed that compared with pectin treated gluten, the thiols of thiolated pectin treated gluten increased by 8.7 times. Analysis of the extensibility and rheological properties revealed that pectin reduced gluten strength, whereas thiolated pectin improved the strength and viscoelasticity of gluten, especially with the assistance of Na2HPO4. Furthermore, thiolated pectin and Na2HPO4 compound increased enthalpy (ΔH, from 150.42 to 168.60 J/g) and decreased Imax (from 5255.33 to 2775.33) markedly, indicating gluten aggregation. The highest ß-sheet (76.47%) and the lowest α-helix/ß-sheet ratio (0.11) were found in gluten treated with thiolated pectin and Na2HPO4 and suggested gluten stability was enhanced. SEM observation confirmed that thiolated pectin and Na2HPO4 compound strengthened the gluten structure. These results are of great significance for the supplementation of pectin in wheat products.

Zinc phthalocyanine labelled polyethylene glycol: preparation, characterization, interaction with bovine serum albumin and near infrared fluorescence imaging in vivo.

Zinc phthalocyanine labelled polyethylene glycol was prepared to track and monitor the in vivo fate of polyethylene glycol. The chemical structures were characterized by nuclear magnetic resonance and infrared spectroscopy. Their light stability and fluorescence quantum yield were evaluated by UV-Visible and fluorescence spectroscopy methods. The interaction of zinc phthalocyanine labelled polyethylene glycol with bovine serum albumin was evaluated by fluorescence titration and isothermal titration calorimetry methods. Optical imaging in vivo, organ aggregation as well as distribution of fluorescence experiments for tracking polyethylene glycol were performed with zinc phthalocyanine labelled polyethylene glycol as fluorescent agent. Results show that zinc phthalocyanine labelled polyethylene glycol has good optical stability and high emission ability in the near infrared region. Imaging results demonstrate that zinc phthalocyanine labelled polyethylene glycol can track and monitor the in vivo process by near infrared fluorescence imaging, which implies its potential in biomaterials evaluation in vivo by a real-time noninvasive method.

2,3,4,6-Tetra-O-acetyl-ß-d-galacto-pyrano-syl butyrate.

The title compound, C(18)H(26)O(11), was synthesized by a condensation reaction of 2,3,4,6-tetra-O-acetyl-α-d-galactopyranosyl bromide and butyric acid. The acet-oxy-methyl and butyrate groups are located on the same side of the pyran ring, showing the ß configuration for the d-glycosyl ester; the butyl group adopts an extend conformation, the C-C-C-C torsion angle being 179.1 (7)°. In the crystal, the mol-ecules are linked by weak C-H⋯O hydrogen bonds.

The gelation behavior of thiolated citrus high-methoxyl pectin induced by sodium phosphate dibasic dodecahydrate.

The present study found that sodium phosphate dibasic dodecahydrate (Na2HPO4) was capable of inducing the gelation of thiolated citrus high-methoxyl pectin (TCHMP). TCHMP was synthesized by amidation of citrus high-methoxyl pectin. The gel formation exhibited an obvious concentration-dependence, including TCHMP and Na2HPO4 concentration. For Na2HPO4-induced TCHMP gels (TCHMPGs), gel strength and water holding capacity (WHC) increased, while the microcellular network structure was more compact with the increase of TCHMP and Na2HPO4 concentration. Dynamic viscoelastic experiment showed when Na2HPO4 concentration was more than or equal to 0.5 mol/L, TCHMP sols could be transferred into gels within 30 min. Crystal property was not changed while thermal stability was improved after phase transition. Gelling forces analysis indicated that disulfide bonds were the main interaction forces in TCHMPGs. Consequently, TCHMPGs were covalently crosslinked and exhibited satisfactory gel performance. The results provide a theoretical basis for the formation of gels by Na2HPO4 induced TCHMP.

The downward referral experiences of stroke caregivers in the regional medical alliance in China: A phenomenological study.

The downward referral platform in the regional medical alliance has provided more possibilities to follow-up rehabilitation and transitional care for increasing stroke survivors, which also has the most contributions in the rational use of resources and health promotion of stroke survivors. However the downward referral rate is low compared to upward referral. At present, no scholars have explored the downward referral experiences of medical demanders from the perspective of qualitative study, and these experiences may also most truly reflect the influencing factors of their unwillingness to downward referral. Therefore, this study explored the subjective experiences of stroke caregivers who had experienced the downward referral, because stroke attacks often lead to lack of autonomy of patients themselves, making it difficult to complete interviews with them. A descriptive phenomenological study was adopted. A purposive sampling strategy was used to recruit 13 stroke caregivers. Interviews were guided by a semi-structured interview-guide encouraging interviewees to reflect on their experiences with downward referral. Coliazzi's data analysis process was applied. The analysis of the data revealed 4 themes: coping challenges; disrupted information; gaps in medical and nursing transition, and potential enabling factors. The results of this study showed that the lack of knowledge of medical alliance, non-sharing of medical information and non-homogeneousness of medical quality were identified to be impeding positive attitude towards downward referral and be factors of bad experiences. Of course, the interviewees had positive experiences such as smooth referral and comfortable environment. These may be potential enabling factors to their attitude towards downward referral. The challenges and needs of medical demanders after downward referral are worthy of attention, and these should be solved by corresponding measures to improve the downward referral rate and referral experiences.

Long noncoding RNA NEAT1 inhibits the acetylation of PTEN through the miR-524-5p /HDAC1 axis to promote the proliferation and invasion of laryngeal cancer cells.

Long noncoding RNA nuclear paraspeckle assembly transcript 1 (lncRNA NEAT1) is abnormally expressed in numerous tumors and functions as an oncogene, but the role of NEAT1 in laryngocarcinoma is largely unknown. Our study validated that NEAT1 expression was markedly upregulated in laryngocarcinoma tissues and cells. Downregulation of NEAT1 dramatically suppressed cell proliferation and invasion through inhibiting miR-524-5p expression. Additionally, NEAT1 overexpression promoted cell growth and metastasis, while overexpression of miR-524-5p could reverse the effect. NEAT1 increased the expression of histone deacetylase 1 gene (HDAC1) via sponging miR-524-5p. Mechanistically, overexpression of HDAC1 recovered the cancer-inhibiting effects of miR-524-5p mimic or NEAT1 silence by deacetylation of tensin homolog deleted on chromosome ten (PTEN) and inhibiting AKT signal pathway. Moreover, in vivo experiments indicated that silence of NEAT1 signally suppressed tumor growth. Taken together, knockdown of NEAT1 suppressed laryngocarcinoma cell growth and metastasis by miR-524-5p/HDAC1/PTEN/AKT signal pathway, which provided a potential therapeutic target for laryngocarcinoma.