Confusion cannot explain cooperative behavior in public goods games.

Some scholars find that behavioral variation in the public goods game is explained by variations in participants' understanding of how to maximize payoff and that confusion leads to cooperation. Their findings lead them to question the common assumption in behavioral economics experiments that choices reflect motivations. We conduct two experiments, in which we minimize confusion by providing participants with increased training. We also introduce a question that specifically assesses participants' understanding of payoff maximization choices. Our experimental results show that the distribution of behavior types is significantly different when participants play with computers versus humans. A significant increase in contributions is also observed when participants play with humans compared to when they play with computers. Moreover, social norms may be the main motive for contributions when playing with computers. Our findings suggest that social preferences, rather than confusion, play a crucial role in determining contributions in public goods games when playing with humans. We therefore argue that the assumption in behavioral economics experiments that choices reveal motivations is indeed valid.

Hydrogen peroxide sensor HPCA1 is an LRR receptor kinase in Arabidopsis.

Hydrogen peroxide (H2O2) is a major reactive oxygen species in unicellular and multicellular organisms, and is produced extracellularly in response to external stresses and internal cues1-4. H2O2 enters cells through aquaporin membrane proteins and covalently modifies cytoplasmic proteins to regulate signalling and cellular processes. However, whether sensors for H2O2 also exist on the cell surface remains unknown. In plant cells, H2O2 triggers an influx of Ca2+ ions, which is thought to be involved in H2O2 sensing and signalling. Here, by using forward genetic screens based on Ca2+ imaging, we isolated hydrogen-peroxide-induced Ca2+ increases (hpca) mutants in Arabidopsis, and identified HPCA1 as a leucine-rich-repeat receptor kinase belonging to a previously uncharacterized subfamily that features two extra pairs of cysteine residues in the extracellular domain. HPCA1 is localized to the plasma membrane and is activated by H2O2 via covalent modification of extracellular cysteine residues, which leads to autophosphorylation of HPCA1. HPCA1 mediates H2O2-induced activation of Ca2+ channels in guard cells and is required for stomatal closure. Our findings help to identify how the perception of extracellular H2O2 is integrated with responses to various external stresses and internal cues in plants, and have implications for the design of crops with enhanced fitness.

Managing the quality of primary health care in urban China: the impact of organizational and physician features.

BACKGROUND: Global health care quality improvement efforts have focussed on management practices. However, knowledge in primary care settings, especially in developing countries, such as China, is lacking. OBJECTIVE: To examine the organizational and physician features associated with health care quality in China's community health centres (CHCs). METHODS: We conducted a cross-sectional survey of 224 primary care physicians (PCPs) in 38 CHCs in Jinan, Tianjin, Shenzhen, and Shanghai. Clinical and prevention care quality with a 5-level scale (1 = never, 5 = always) reported by the PCPs were used to measure the quality of care. Two-level hierarchical linear models were estimated to examine the organization and physician-level variables associated with primary care quality. RESULTS: The average clinical care quality score was 4.08 and 3.59 for preventative care out of 5. At the organizational level, organizational culture and organizational support were the strongest predictors of physician-reported quality of care. At the physician level, professional fulfilment, psychological safety, and organizational citizenship behaviour were positively associated with care quality. CONCLUSIONS: Chinese CHCs clinical quality ranked high by PCPs, but the quality of preventative care provision required improvement. To improve primary care quality, managers of CHCs should implement optimal organizational structures, supportive organizational cultures, and strong organizational support at the organization level and cultivate high professional fulfilment, safe, and trustful relationships with colleagues at the physician level.

Fenpropathrin disrupted the gills of common carp (Cyprinus carpio L.) through oxidative stress, inflammatory responses, apoptosis, and transcriptional alterations.

Fenpropathrin (FEN) is an extensively utilized synthetic pyrethroid insecticide frequently found in aquatic ecosystems. However, the adverse effects and potential mechanisms of FEN on aquatic species are poorly understood. In this work, common carp were treated with FEN at concentrations of 0.45 and 1.35 µg/L FEN for 14 days, after which the tissue structure, physiological alterations, and mRNA transcriptome of the gills were evaluated. Specifically, FEN exposure caused pathological damage to the gills of carp, downregulated the levels of claudin-1, occludin, and zonula occluden-1 (ZO-1), and inhibited Na+-K+-ATPase activity in the gills. In addition, FEN exposure promoted an increase in reactive oxygen species (ROS) levels and significantly upregulated the levels of malondialdehyde (MDA), 8-hydroxy-2 deoxyguanosine (8-OHdG), and protein carbonyl (PC) in the gills. Moreover, the inflammation-related indices (TNF-α, IL-1ß, and IFN-γ) and the apoptosis-related parameter caspase-3 were generally increased, especially in the 1.35 µg/L FEN group, and these indices were significantly greater than those in the control group. These findings suggest that FEN exposure can cause oxidative stress, the inflammatory response, and apoptosis in carp gills. Importantly, the results of RNA-seq analysis showed that 0.45 and 1.35 µg/L FEN could significantly interfere with multiple immune and metabolic pathways, including the phagosome, NOD-like receptor (NLR) signalling pathway, Toll-like receptor (TLR) signalling pathway, necroptosis, and arachidonic acid metabolism pathways, indicating that the effects of FEN on the gills of fish are intricate. In summary, our findings confirm the toxic effects of FEN on common carp gills and provide additional comprehensive information for evaluating the toxicity and underlying molecular mechanisms of FEN in aquatic organisms.

Fine particle trace elements at a mountain site in southern China: Source identification, transport, and health risks.

Trace elements in atmospheric particulate matter play a significant role in air quality, human health, and biogeochemical cycles. In this study, the trace elements (Ca, Al, K, Fe, Na, Mg, Zn, Pb, Mn, Ti, Cu, Cr, Sr, Ni) in PM2.5 samples collected at the summit of Mt. Lushan were analyzed to quantify their abundance, source, transport, and health risks. During the whole sampling period, the major trace elements was Ca, Al, and K. While the trace metals with the lowest concentrations were Sr, Ni, Rb, and Cd. The trace elements were influenced by air mass transport routes, exhibiting an increasing trend of crustal elements in the northwesterly airmass and anthropogenic elements (Zn, Mn, Cu, and Ni) in the easterly air masses. Construction dust, coal + biomass burning, vehicle emission, urban nitrate-rich + urban waste incineration emissions, and soil dust + industry emissions were common sources of PM2.5 on Mt. Lushan. Different air mass transport routes had various source contribution patterns. These results indicate that trace elements at Mt. Lushan are influenced by regional anthropogenic emissions and monsoon-dominated trace element transport. The total resulting cancer risk value that these elements posed were below the acceptable risk value of 1 × 10-6, while the non-carcinogenic risk value (1.72) was higher than the safety level, suggesting that non-carcinogenic effects due to these trace elements inhalation were likely to occur. Vehicle emission and coal + biomass burning were the common dominant sources of non-cancer risks posed by trace elements at Mt. Lushan.

Complete mitogenome assembly of Selenicereus monacanthus revealed its molecular features, genome evolution, and phylogenetic implications.

BACKGROUND: Mitochondria are the powerhouse of the cell and are critical for plant growth and development. Pitaya (Selenicereus or Hylocereus) is the most important economic crop in the family Cactaceae and is grown worldwide, however its mitogenome is unreported. RESULTS: This study assembled the complete mitogenome of the red skin and flesh of pitaya (Selenicereus monacanthus). It is a full-length, 2,290,019 bp circular molecule encoding 59 unique genes that only occupy 2.17% of the entire length. In addition, 4,459 pairs of dispersed repeats (≥ 50 bp) were identified, accounting for 84.78% of the total length, and three repeats (394,588, 124,827, and 13,437 bp) mediating genomic recombination were identified by long read mapping and Sanger sequencing. RNA editing events were identified in all 32 protein-coding genes (PCGs), among which four sites (nad1-2, nad4L-2, atp9-copy3-223, and ccmFC-1309) were associated with the initiation or termination of PCGs. Seventy-eight homologous fragments of the chloroplast genome were identified in the mitogenome, the longest having 4,523 bp. In addition, evolutionary analyses suggest that S. monacanthus may have undergone multiple genomic reorganization events during evolution, with the loss of at least nine PCGs (rpl2, rpl10, rps2, rps3, rps10, rps11, rps14, rps19, and sdh3). CONCLUSIONS: This study revealed the genetic basis of the S. monacanthus mitogenome, and provided a scientific basis for further research on phenotypic traits and germplasm resource development.

Endothelial progenitor cells systemic administration alleviates multi-organ senescence by down-regulating USP7/p300 pathway in chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) has impacted approximately 390 million people worldwide and the morbidity is increasing every year. However, due to the poor treatment efficacy of COPD, exploring novel treatment has become the hotpot of study on COPD. Endothelial progenitor cells (EPCs) aging is a possible molecular way for COPD development. We aimed to explore the effector whether intravenous administration of EPCs has therapeutic effects in COPD mice. METHODS: COPD mice model was induced by cigarette smoke exposure and EPCs were injected intravenously to investigate their effects on COPD mice. At day 127, heart, liver, spleen, lung and kidney tissues of mice were harvested. The histological effects of EPCs intervention on multiple organs of COPD mice were detected by morphology assay. Quantitative real-time PCR and Western blotting were used to detect the effect of EPCs intervention on the expression of multi-organ senescence-related indicators. And we explored the effect of EPCs systematically intervening on senescence-related USP7/p300 pathway. RESULTS: Compared with COPD group, senescence-associated ß-galactosidase activity was decreased, protein and mRNA expression of p16 was down-regulated, while protein and mRNA expression of cyclin D1 and TERT were up-regulated of multiple organs, including lung, heart, liver, spleen and kidney in COPD mice after EPCs system intervention. But the morphological alterations of the tissues described above in COPD mice failed to be reversed. Mechanistically, EPCs systemic administration inhibited the expression of mRNA and protein of USP7 and p300 in multiple organs of COPD mice, exerting therapeutic effects. CONCLUSIONS: EPCs administration significantly inhibited the senescence of multiple organs in COPD mice via down-regulating USP7/p300 pathway, which presents a possibility of EPCs therapy for COPD.

Organisation-level and individual-level predictors of nurse-reported quality of care in primary care: A multilevel study in China.

OBJECTIVES: Knowledge of the predictors of nursing quality and safety remains a gap in global primary care research. This study examines organisational-level and nurse-level predictors of nurse-reported quality of care from a management perspective. METHODS: We recruited 175 primary care nurses in 38 community health centres (CHCs) varying by size and ownership in Jinan, Tianjin, Shenzhen and Shanghai. Guided by the Systems Engineering Initiative for Patient Safety model, the organisation-level predictors comprised organisational structure, organisational culture, psychological safety and organisational support, while the nurse-level predictors included organisational commitment and organisational citizenship behaviour. Nurse-reported quality of care was measured by two questions: "How do you rate the quality of care that you provide?" and "Do you often receive complaints from patients or their family members at work?" Multilevel linear regression models were used to examine the predictors of nurse-reported quality of care. RESULTS: Among the four organisation-level predictors, organisational structure, psychological safety and organisational support were positive predictors of nurse-reported quality of care. Nurses working in CHCs with highly hierarchical organisational structures (Coef. = 0.196, p = 0.000), a high level of organisational support (Coef. = 0.158, p = 0.017) and a high level of psychological safety (Coef. = 0.159, p = 0.035) were more likely to report high quality of care or less likely to receive medical complaints. In terms of nurse-level predictors, nurses willing to increase their knowledge through continuous education were more likely to report good quality of care (Coef. = 0.107, p = 0.049) and less likely to receive medical complaints from patients (Coef. = 0.165, p = 0.041). CONCLUSIONS: Potential management levers to improve quality of nursing care include formalised organisational structures, strong organisational support and a psychologically safe environment as well as the provision of training to facilitate continuous education. Implementing these recommendations is likely to enhance the nursing quality in primary care.

Organizational factors associated with primary care nurses' self-efficacy in pandemic response: a multilevel study in China.

BACKGROUND: Building primary care nurses' self-efficacy in the pandemic response has great potential to improve their well-being and work performance. We identified the organizational factors associated with their self-efficacy in pandemic response and propose potential management levers to guide primary care response for the pandemic. METHODS: We conducted a cross-sectional survey with 175 nurses working in 38 community health centres varying in size and ownership in Shanghai, Shenzhen, Tianjin, and Jinan. Guided by self-efficacy theory, 4 nurse-level factors and 2 organization-level factors were selected, and a linear regression model accounting for the cluster-robust standard errors was built to examine their association with primary care nurses' self-efficacy in the pandemic response. RESULTS: Primary care nurses exhibited a high level of self-efficacy in responding to the pandemic (mean = 4.34, range: 0-5). For nurse-level factors, with a 1-point increase in job skill variety, job autonomy, work stress and perceived organizational support, primary care nurses' pandemic response self-efficacy increased by 0.193 points, 0.127 points, 0.156 points, and 0.107 points, respectively. Concerning organization-level factors, each point of improvement in organizational structure, representing higher mechanical organizational structure, was associated with a 0.145-point increase in nurses' self-efficacy. CONCLUSIONS: Our study added the knowledge of organizational factors' impact on the pandemic response self-efficacy among primary care nurses and identified the potential management levers for frontline primary care managers to build primary care nurses' self-efficacy in the pandemic response.

Primary care physicians' work conditions and their confidence in managing multimorbidity: a quantitative analysis using Job Demands-Resources Model.

BACKGROUND: Multimorbidity is a global issue that presents complex challenges for physicians, patients, and health systems. However, there is a lack of research on the factors that influence physicians' confidence in managing multimorbidity within primary care settings, particularly regarding physicians' work conditions. OBJECTIVES: Drawing on the Job Demands-Resources Model, this study aims to investigate the level of confidence among Chinese primary care physicians in managing multimorbidity and examine the predictors related to their confidence. METHODS: Data were collected from 224 physicians working in 38 Community Healthcare Centres (CHCs) in Shanghai, Shenzhen, Tianjin, and Jinan, China. Work-family conflict (WFC) perceived organizational support (POS), self-directed learning (SDL), and burnout were measured. Physicians' confidence was assessed using a single item. Mediation effect analysis was conducted using the Baron and Kenny method. RESULTS: The results showed that the mean confidence score for physicians managing multimorbidity was 3.63 out of 5, only 20.10% rating their confidence level as 5. WFC negatively related physicians' confidence and POS positively related physicians' confidence in multimorbid diagnosis and treatment. Burnout fully mediated the relationship between WFC and physicians' confidence, and SDL partially mediated the relationship between POS and physicians' confidence. CONCLUSIONS: The confidence level of Chinese primary care physicians in managing multimorbidity needs improvement. To enhance physicians' confidence in managing multimorbid patients, CHCs in China should address WFC and burnout and promote POS and SDL.

Propofol Inhibits Biological Function of Hepatocellular Carcinoma Cells through LINC00475-Mediated Sonic Hedgehog Pathway.

INTRODUCTION: Hepatocellular carcinoma (HCC) is the most deadly cancer. Many signal pathways are implicated in HCC development, including sonic hedgehog (SHH). Propofol is an anesthetic commonly used in surgery. Recent studies have reported that propofol inhibits tumorigenesis and the development of HCC in a dose-dependent manner. The study aimed to identify the mechanism of how the propofol-mediated SHH-signaling molecule works in HCC. METHODS: Cell proliferation, apoptosis, and invasion were examined, respectively, through colony formation, TUNEL, caspase-3 activity, and transwell assays. Protein levels of SHH, Ptch1, Smo, and Gli1 were determined via Western blot. RESULTS: Propofol could inhibit cell proliferation, migration, and invasion and induce apoptosis via suppression on SHH to inactivate the SHH pathway. By mechanistic assays, miR-340-5p was identified to target SHH and negatively regulate SHH. Long intergenic non-protein coding RNA 475 (LINC00475) was the endogenous sponge of miR-340-5p to upregulate SHH. Finally, the rescue assays were implemented. The activator of the SHH pathway completely rescued the effects of LINC00475 and SHH in propofol-induced HCC cells. CONCLUSION: Propofol inhibits HCC cell malignant behaviors via repressing LINC00475 to suppress SHH, thus inactivating the SHH pathway. These new findings might contribute to the understanding and application of propofol in HCC.

Retrospective cohort study of neonatal blood transfusion in China.

BACKGROUND: Blood transfusion therapy is extremely important for certain neonatal diseases, but the threshold for neonatal blood transfusion is not the same in different countries. Until now, clinical studies to determine the suitable threshold for newborns in China are lacking. Therefore, it is of high importance to establish a multi-center cohort study to explore appropriate transfusion thresholds for newborns in China. METHODS: This retrospective cohort study investigated neonatal blood transfusion therapy administered from January 1, 2017 to June 30, 2018, with the aim of evaluating the effect of restricted and nonrestricted blood transfusion on neonatal health. The subjects were enrolled in 46 hospitals in China. A total of 5669 neonatal cases were included in the study. Clinical diagnosis and transfusion treatment of these neonates were collected and the data were retrospectively analyzed. The neonates were followed up 1 week and 1 month after leaving the hospital. The newborns' and their mothers' data were collected containing 280 variables in the database. The primary outcome of the study was mortality, and the secondary outcomes were complications, hospital stays, NICU hospital stays and hospital costs. RESULTS: Results from the < 1500 g group showed that there was a higher mortality rate in the restricted transfusion group (11.41%) when compared with the non-restricted transfusion group (5.12%) (P = 0.000). Among the secondary outcomes, the restricted transfusion group had fewer costs. Results from the 1500-2500 g group showed that the mortality rates of the restricted and non-restricted transfusion groups were 3.53% and 4.71%, respectively, however there was no statistical significance between the two groups (P = 0.345). Among the secondary outcomes, the restricted transfusion group had fewer hospital stays, NICU hospital stays and hospital costs. The incidence of necrotizing enterocolitis was lower in the restricted transfusion group (OR, 2.626; 95% confidence interval [CI], 1.445 to 4.773; P = 0.003). The results from the ≥ 2500 g restricted transfusion group suggested that the mortality rate of (3.02%) was significantly lower than that of non-restricted transfusion group (9.55%) (P = 0.000). Among the secondary outcomes, the restricted transfusion group had fewer hospital stays and hospital costs. The incidence of retinopathy of prematurity was lower in the restricted transfusion group (OR, 4.624; 95% confidence interval [CI], 2.32 to 9.216; P = 0.000). CONCLUSIONS: Current transfusion protocols for newborns weighing less than 1500 g may be inappropriate and lead to higher mortality. The current transfusion threshold performed better for the other two weight groups.

SDR-Based 28 GHz mmWave Channel Modeling of Railway Marshaling Yard.

Compared with railway communication service requirements on the mainline, requirements in hotspots such as stations and yards are more complicated in terms of service types as well as bandwidth, of which railway-dedicated mobile communication systems such as 5G-R facilitated with dedicated frequency support cannot meet the entire communication requirements. Therefore, other radio-communication technologies need to be adopted as a supplement, among which the mmWave communication system is a promising technology, especially for large bandwidth communication between train and trackside. However, there is a lack of evaluation of the 28 GHz mmWave channel characteristics for the railway marshaling yard scenario. In this paper, the railway marshaling yard mmWave propagation scenario is deeply analyzed and classified into three typical categories, based on which, a measurement campaign is conducted using an SDR channel sounding system equipped with a 28 GHz mmWave phased-array antenna. A self-developed software under the LabVIEW platform is used to derive the channel parameters. Conclusions on the relationship between the parameters of MPC numbers, time-spread, and received power and position, as well as the impact of typical obstructions such as the Catenary, adjacent locomotives, and buildings are drawn. The statistical results and conclusions of this paper are helpful for facilitating the design and performance evaluation of future mmWave communication systems for railway marshaling yards and can also be further extended and applied to the research of mmWave utilization in 6G and other future communication technologies for more scenarios.

Nutrient released characteristics of struvite-biochar fertilizer produced from concentrated sludge supernatant by fluidized bed reactor.

With the exacerbating water eutrophication globally, it is important to recover nitrogen (N) and phosphorus (P) from sewage for recycle. In this study, coconut shell biochar and ethylene diamine tetraacetic acid (EDTA) were added into the designed fluidized bed reactor (FBR) to create struvite-biochar. N and P released from struvite-biochar and the recovery efficiency of N and P from concentrated sludge supernatant were analyzed. Results showed that the optimal operation condition for hydraulic retention time (HRT), pH, Mg/P molar ration, and addition amount EDTA were 90 min, 9.5, 1.2, and 0.2 g/L, respectively. The recovery efficiency of NH4+-N and PO43--P, and purity struvite for FBR were 34.41%-38.05%, 64.95-68.40%, and 84.15%, respectively. The recovery efficiency of NH4+-N and PO43--P were respectively increased by 7.23% and 5.36% when FBR with addition of 0.33 g/L coconut shell biochar, but purity struvite from struvite-biochar decreased by 45.70%. Contents of As, Cd, Pb, and Cr in struvite and struvite-biochar were all lower than Chinese Standard Limits of Fertilizer. Compared to commercial chemical fertilizer, such as superphosphate and urea, struvite-biochar and struvite have slowly released N and P. The amounts of released P, NO3--N and NH4+-N from struvite-biochar were higher than struvite during the five leaching times. Compared with struvite, the total amounts of released P, NO3--N and NH4+-N from struvite-biochar increased by 4.9%, 3.5% and 8.3%, respectively. Therefore, it is valuable to add biochar into FBR to recovery N and P from concentrated sludge supernatant and make struvite-biochar as a slow-release fertilizer.

Orelabrutinib-bruton tyrosine kinase inhibitor-based regimens in the treatment of central nervous system lymphoma: a retrospective study.

BACKGROUND: Central nervous system lymphoma (CNSL) is an aggressive lymphoma. Orelabrutinib, an oral Bruton tyrosine kinase inhibitor, is a new treatment strategy for CNSL. This study aims to evaluate the efficacy and safety of orelabrutinib-based regimens in the treatment of patients with CNSL. METHODS: Twenty-three patients with CNSL were included in this retrospective study. All patients received the orelabrutinib-based regimen. Efficacy was evaluated based on investigators' assessment of overall response rate (ORR), complete response/unconfirmed complete response (CR/CRu), partial response (PR), stable disease (SD), progressive disease (PD), duration of response (DOR), progression-free survival (PFS) and overall survival (OS). The safety of orelabrutinib-based regimens has also been evaluated. RESULTS: A total of 17.39% of patients received orelabrutinib-based regimens for consolidation therapy, and 82.61% of patients for induction therapy (4 newly diagnosed CNSL, 15 relapsed/refractory CNSL). In the newly diagnosed CNSL group, the ORR was 100% (1 CR, 1 CRu, 2 PR). The 6-month DOR rate, 6-month PFS rate, and 6-month OS rate were 100%, 100%, and 100%, respectively. Of the 15 relapsed/refractory CNSL patients, five therapy regimens were applied (orelabrutinib, n = 3; orelabrutinib/immunotherapy, n = 3; orelabrutinib/chemotherapy, n = 2; orelabrutinib/immunochemotherapy, n = 6; orelabrutinib/radiotherapy, n = 1). The ORR was 60.00% (4 CR, 5 PR). The 6-month DOR rate, 6-month PFS rate, and 6-month OS rate were 92.30%, 67.70%, and 70.00%, respectively. Twenty-one patients reported adverse events (AEs), and 6 patients experienced grade ≥ 3 AEs. CONCLUSION: Orelabrutinib-based regimens were efficacious and well-tolerated in patients with CNSL. These combined therapies offer a new potential therapeutic strategy for patients with CNSL.

Public expectations of good primary health care in China: a national qualitative study.

BACKGROUND: China is currently making efforts to transform the current hospital-centric service delivery system to people-centred primary health care (PHC)-based delivery system, with service delivery organized around the health needs and expectations of people. To help direct China's PHC reform efforts, a profile of high-quality PHC from the public's perspective is required. OBJECTIVES: To profile high-quality PHC from the perspective of the Chinese public. METHODS: Semistructured interviews were conducted in 6 provinces (Henan, Shandong, Zhejiang, Shaanxi, Shanxi, and Heilongjiang) in China. In total, 58 interviewees completed the recorded interview. For transcription, trained research assistant listened to the recording of the interviews, summarizing each 30-s segment in English. Next, thematic analysis was performed on the narrative summaries to identify thematic families. RESULTS: Seven themes and 16 subthemes were generated from the analysis of our interview data. In order of their frequency, the interviewees expressed a high expectation for interpersonal communication and technical quality; followed by access, comprehensive care, cost, continuity, and coordination. CONCLUSIONS: Using qualitative data from 6 provinces in China, knowledge was generated to reveal the public's views and expectations for high-quality PHC. Our results confirm the urgent need for quality improvement efforts to improve patient experience and technical quality. The government also needs to further improve the delivery system and medical training programme to better meet public expectation in these areas, especially in establishing an innovative integrated primary care model, and strengthening interpersonal and clinical competency training for family doctors.

Serum Creatinine/Cystatin C Ratio as a Predictor of In-hospital Mortality in Patients Hospitalized with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

PURPOSE: Low serum creatinine/cystatin C ratio (CCR) is associated with unfavorable characteristics in patients with chronic obstructive pulmonary disease (COPD); however, the relationship between CCR and in-hospital mortality of patients with acute exacerbation of COPD (AECOPD) is unexplored. Our objective was to assess the value of CCR for predicting in-hospital mortality of patients hospitalized with AECOPD. METHODS: Patients with AECOPD (n = 597) were retrospectively enrolled. Patient's clinical characteristics and laboratory tests, including serum cystatin C and creatinine, were reviewed. The prediction value of CCR was evaluated using area under the receiver operating characteristic curve (AUC) values. Factors potentially impacting in-hospital mortality were investigated using univariate and multivariate logistic regression analyses. RESULTS: Mortality rate during hospitalization was 10.05%. CCR was lower in non-surviving vs. survived patients (41.67 vs. 61.52, P < 0.001). AUC value for CCR for in-hospital mortality prediction was 0.79 [95% confidence interval (CI) 0.73-0.85]. On multivariate logistic regression analysis, in-hospital mortality was strongly associated with CCR < 52.27 [odds ratio (OR) 6.23, 95% CI (3.00-12.92), P < 0.001], age ≥ 81 years [OR 2.97, 95% CI (1.20-7.37), P = 0.019], oxygenation index < 300 [OR 3.28, 95% CI (1.27-8.44), P = 0.014], CRP > 8 mg/L [OR 1.84, 95% CI (1.15-2.95), P = 0.012], and D-dimer > 500 ng/L [OR 5.19, 95% CI (1.51-17.79), P = 0.009]. CONCLUSIONS: CCR was significantly lower, and is a potential prognostic indicator, in patients with AECOPD who died during hospitalization.

Determinants of choice of usual source of care among older people with cardiovascular diseases in China: evidence from the Study on Global Ageing and Adult Health.

BACKGROUND: Cardiovascular diseases (CVD) are emerging as the leading contributor to death globally. The usual source of care (USC) has been proven to generate significant benefits for the elderly with CVD. Understanding the choice of USC would generate important knowledge to guide the ongoing primary care-based integrated health system building in China. This study aimed to analyze the individual-level determinants of USC choices among the Chinese elderly with CVD and to generate two exemplary patient profiles: one who is most likely to choose a public hospital as the USC, the other one who is most likely to choose a public primary care facility as the USC. METHODS: This study was a secondary analysis using data from the World Health Organization's Study on Global AGEing and Adult Health (SAGE) Wave 1 in China. 3,309 individuals aged 50 years old and over living with CVD were included in our final analysis. Multivariable logistic regression was built to analyze the determinants of USC choice. Nomogram was used to predict the probability of patients' choice of USC. RESULTS: Most of the elderly suffering from CVD had a preference for public hospitals as their USC compared with primary care facilities. The elderly with CVD aged 50 years old, being illiterate, residing in rural areas, within the poorest income quintile, having functional deficiencies in instrumental activities of daily living and suffering one chronic condition were found to be more likely to choose primary care facilities as their USC with the probability of 0.85. Among those choosing primary care facilities as their USC, older CVD patients with the following characteristics had the highest probability of choosing public primary care facilities as their USC, with the probability of 0.77: aged 95 years old, being married, residing in urban areas, being in the richest income quintile, being insured, having a high school or above level of education, and being able to manage activities living. CONCLUSIONS: Whilst public primary care facilities are the optimal USC for the elderly with CVD in China, most of them preferred to receive health care in public hospitals. This study suggests that the choice of USC for the elderly living with CVD was determined by different individual characteristics. It provides evidence regarding the choice of USC among older Chinese patients living with CVD.

A gene-based risk score model for predicting recurrence-free survival in patients with hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) remains the most frequent liver cancer, accounting for approximately 90% of primary liver cancers worldwide. The recurrence-free survival (RFS) of HCC patients is a critical factor in devising a personal treatment plan. Thus, it is necessary to accurately forecast the prognosis of HCC patients in clinical practice. METHODS: Using The Cancer Genome Atlas (TCGA) dataset, we identified genes associated with RFS. A robust likelihood-based survival modeling approach was used to select the best genes for the prognostic model. Then, the GSE76427 dataset was used to evaluate the prognostic model's effectiveness. RESULTS: We identified 1331 differentially expressed genes associated with RFS. Seven of these genes were selected to generate the prognostic model. The validation in both the TCGA cohort and GEO cohort demonstrated that the 7-gene prognostic model can predict the RFS of HCC patients. Meanwhile, the results of the multivariate Cox regression analysis showed that the 7-gene risk score model could function as an independent prognostic factor. In addition, according to the time-dependent ROC curve, the 7-gene risk score model performed better in predicting the RFS of the training set and the external validation dataset than the classical TNM staging and BCLC. Furthermore, these seven genes were found to be related to the occurrence and development of liver cancer by exploring three other databases. CONCLUSION: Our study identified a seven-gene signature for HCC RFS prediction that can be used as a novel and convenient prognostic tool. These seven genes might be potential target genes for metabolic therapy and the treatment of HCC.

Nomogram based on autophagy related genes for predicting the survival in melanoma.

BACKGROUND: Autophagy, a highly conserved lysosomal degradation pathway, is associated with the prognosis of melanoma. However, prognostic prediction models based on autophagy related genes (ARGs) have never been recognized in melanoma. In the present study, we aimed to establish a novel nomogram to predict the prognosis of melanoma based on ARGs signature and clinical parameters. METHODS: Data from The Cancer Genome Atlas (TCGA) and the Genotype-Tissue Expression (GTEx) databases were extracted to identify the differentially expressed ARGs. Univariate, least absolute shrinkage and selection operator (LASSO) and multivariate analysis were used to select the prognostic ARGs. ARGs signature, age and stage were then enrolled to establish a nomogram to predict the survival probabilities of melanoma. The nomogram was evaluated by concordance index (C-index), receiver operating characteristic (ROC) curve and calibration curve. Decision curve analysis (DCA) was performed to assess the clinical benefits of the nomogram and TNM stage model. The nomogram was validated in GEO cohorts. RESULTS: Five prognostic ARGs were selected to construct ARGs signature model and validated in the GEO cohort. Kaplan-Meier survival analysis suggested that patients in high-risk group had significantly worse overall survival than those in low-risk group in TCGA cohort (P = 5.859 × 10-9) and GEO cohort (P = 3.075 × 10-9). We then established and validated a novel promising prognostic nomogram through combining ARGs signature and clinical parameters. The C-index of the nomogram was 0.717 in TCGA training cohort and 0.738 in GEO validation cohort. TCGA/GEO-based ROC curve and decision curve analysis (DCA) demonstrated that the nomogram was better than traditional TNM staging system for melanoma prognosis. CONCLUSION: We firstly developed and validated an ARGs signature based-nomogram for individualized prognosis prediction in melanoma patients, which could assist with decision making for clinicians.