Impact factors and obstetric outcomes of preeclampsia in twin pregnancies by prepregnancy body mass index: a six-year retrospective cohort study.

OBJECTIVES: Among many risk factors for preeclampsia (PE), prepregnancy body mass index (BMI) is one of few controllable factors. However, there is a lack of stratified analysis based on the prepregnancy BMI. This study aimed to determine the influencing factors for PE and assess the impact of PE on obstetric outcomes in twin pregnancies by prepregnancy BMI. METHODS: This was a retrospective cohort study between January 1, 2017, and December 31, 2022, in Southwest China. Impact factors and associations between PE and obstetric outcomes were analyzed separately for twin pregnancies with prepregnancy BMI < 24kg/m2 (non-overweight group) and BMI ≥ 24kg/m2 (overweight group). RESULTS: In total, 3602 twin pregnancies were included, of which, 672 women were allocated into the overweight group and 11.8% of them reported with PE; 2930 women were allocated into the non-overweight group, with a PE incidence of 5.6%. PE had a negative effect on birthweight and increased the incidence of neonatal intensive care unit admission in both the overweight and non-overweight groups (43.0% vs. 28.0%, p = .008; 45.7% vs. 29.1%, p < .001). Among overweight women, PE increased the proportion of postpartum hemorrhage (15.2% vs. 4.4%, p < .001). After adjustments, multivariate regression analysis showed that excessive gestational weight gain (aOR = 1.103, 95% CI: 1.056-1.152; aOR = 1.094, 95% CI: 1.064-1.126) and hypoproteinemia (aOR = 2.828, 95% CI: 1.501-5.330; aOR = 6.932, 95% CI: 4.819-9.971) were the shared risk factors for PE in both overweight and non-overweight groups. In overweight group, in vitro fertilization was the other risk factor (aOR = 2.713, 95% CI: 1.183-6.878), whereas dichorionic fertilization (aOR = 0.435, 95% CI: 0.193-0.976) and aspirin use during pregnancy (aOR = 0.456, 95% CI: 0.246-0.844) were protective factors. Additionally, anemia during pregnancy (aOR = 1.542, 95% CI: 1.090-2.180) and growth discordance in twins (aOR = 2.451, 95% CI: 1.215-4.205) were connected with an increased risk of PE only in non-overweight twin pregnancies. CONCLUSIONS: Both discrepancy and similarity of impact factors on developing PE were found between overweight and non-overweight twin pregnancies in this study. However, the dosage and initiation time of aspirin, as well as twin chorionicity on the occurrence of PE in two subgroups, are still debated.

Biogenerated Oxygen-Related Environmental Stressed Apoptotic Vesicle Targets Endothelial Cells.

The dynamic balance between hypoxia and oxidative stress constitutes the oxygen-related microenvironment in injured tissues. Due to variability, oxygen homeostasis is usually not a therapeutic target for injured tissues. It is found that when administered intravenously, mesenchymal stem cells (MSCs) and in vitro induced apoptotic vesicles (ApoVs) exhibit similar apoptotic markers in the wound microenvironment where hypoxia and oxidative stress co-existed, but MSCs exhibited better effects in promoting angiogenesis and wound healing. The derivation pathway of ApoVs by inducing hypoxia or oxidative stress in MSCs to simulate oxygen homeostasis in injured tissues is improved. Two types of oxygen-related environmental stressed ApoVs are identified that directly target endothelial cells (ECs) for the accurate regulation of vascularization. Compared to normoxic and hypoxic ones, oxidatively stressed ApoVs (Oxi-ApoVs) showed the strongest tube formation capacity. Different oxygen-stressed ApoVs deliver similar miRNAs, which leads to the broad upregulation of EC phosphokinase activity. Finally, local delivery of Oxi-ApoVs-loaded hydrogel microspheres promotes wound healing. Oxi-ApoV-loaded microspheres achieve controlled ApoV release, targeting ECs by reducing the consumption of inflammatory cells and adapting to the proliferative phase of wound healing. Thus, the biogenerated apoptotic vesicles responding to oxygen-related environmental stress can target ECs to promote vascularization.

Balancing macrophage polarization via stem cell-derived apoptotic bodies for diabetic wound healing.

BACKGROUND: Adipose tissue-derived stem cell-derived apoptotic bodies (ADSC-ABs) have shown great potential for immunomodulation and regeneration, particularly in diabetic wound therapy. However, their local application has been limited by unclear regulatory mechanisms, rapid clearance, and short tissue retention times. METHODS: We analyzed the key role molecules and regulatory pathways of ADSC-ABs in regulating inflammatory macrophages by mRNA sequencing and microRNA (miRNA) sequencing and then verified them by gene knockdown. To prevent rapid clearance, we employed microfluidics technology to prepare methacrylate-anhydride gelatin (GelMA) microspheres (GMS) for controlled release of ABs. Finally, we evaluated the effectiveness of ADSC-AB-laden GMSs (ABs@GMSs) in a diabetic rat wound model. FINDINGS: Our results demonstrated that ADSC-ABs effectively balanced macrophage inflammatory polarization through the janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway, mediated by miR-20a-5p. Furthermore, we showed that AB@GMSs had good biocompatibility, significantly delayed local clearance of ABs, and ameliorated diabetic wound inflammation and promoted vascularization, thus facilitating its healing. CONCLUSIONS: Our study reveals the regulatory mechanism of ADSC-ABs in balancing macrophage inflammatory polarization and highlightsthe importance of delaying their local clearance by GMSs. These findings have important implications for the development of novel therapies for diabetic wound healing. FUNDING: This research was supported by the National Key Research and Development Program of China (2020YFA0908200), National Natural Science Foundation of China (82272263, 82002053, 32000937, and 82202467), Shanghai "Rising Stars of Medical Talents" Youth Development Program (22MC1940300), Shanghai Municipal Health Commission (20204Y0354), and Shanghai Science and Technology Development Funds (22YF1421400).

Transcriptome network analysis of inflammation and fibrosis in keloids.

BACKGROUND: Keloid (KL) is a common benign skin tumor. KL is typically characterized by significant fibrosis and an intensive inflammatory response. Therefore, a comprehensive understanding of the interactions between cellular inflammation and fibrotic cells is essential to elucidate the mechanisms driving the progression of KL and to develop therapeutics. OBJECTIVE: Investigate the transcriptome landscape of inflammation and fibrosis in keloid scars. METHODS: In this paper, we performed transcriptome sequencing and microRNA (miRNA) sequencing on unselected live cells from six human keloid tissues and normal skin tissues to elucidate a comprehensive transcriptome landscape. In addition, we used single-cell RNA sequencing (scRNA-seq) analysis to analyze intercellular communication networks and enrich fibroblast populations in two additional keloid and normal skin samples to study fibroblast diversity. RESULTS: By RNA sequencing and a miRNA-mRNA-PPI network analysis, we identified miR-615-5p and miR-122b-3p as possible miRNAs associated with keloids, as they differed most significantly in keloids. Similarly, COL3A1, COL1A2, THBS2, TNC, IGTA, THBS4, TGFB3 as genes with significant differences in keloid may be associated with keloid development. Using single-cell RNA sequencing data from 24,086 cells collected from normal or keloid, we report reconstructed intercellular signaling network analysis and aggregation to modules associated with specific cell subpopulations at the cellular level for keloid alterations. CONCLUSIONS: Our multitranscriptomic dataset delineates inflammatory and fibro heterogeneity of human keloids, underlining the importance of intercellular crosstalk between inflammatory cells and fibro cells and revealing potential therapeutic targets.

Regulation of Glucose Metabolism for Cell Energy Supply In Situ via High-Energy Intermediate Fructose Hydrogels.

The cellular functions, such as tissue-rebuilding ability, can be directly affected by the metabolism of cells. Moreover, the glucose metabolism is one of the most important processes of the metabolism. However, glucose cannot be efficiently converted into energy in cells under ischemia hypoxia conditions. In this study, a high-energy intermediate fructose hydrogel (HIFH) is developed by the dynamic coordination between sulfhydryl-functionalized bovine serum albumin (BSA-SH), the high-energy intermediate in glucose metabolism (fructose-1,6-bisphosphate, FBP), and copper ion (Cu2+ ). This hydrogel system is injectable, self-healing, and biocompatible, which can intracellularly convert energy with high efficacy by regulating the glucose metabolism in situ. Additionally, the HIFH can greatly boost cell antioxidant capacity and increase adenosine triphosphate (ATP) in the ischemia anoxic milieu by roughly 1.3 times, improving cell survival, proliferation and physiological functions in vitro. Furthermore, the ischemic skin tissue model is established in rats. The HIFH can speed up the healing of damaged tissue by promoting angiogenesis, lowering reactive oxygen species (ROS), and eventually expanding the healing area of the damaged tissue by roughly 1.4 times in vivo. Therefore, the HIFH can provide an impressive perspective on efficient in situ cell energy supply of damaged tissue.

Fat Compartment Gliding Theory - A Novel Technique for the Repositioning of Superficial Fat Compartments for Facial Rejuvenation.

Background: Facial fat compartments and their role in facial aging have gained increased recognition and are playing a significant role in facial rejuvenation. The superficial fat compartments glide inferiorly during the aging process, leading to the flattening and elongation of the face and the appearance of facial bulges, folds, and grooves. Patients and Methods: Ultrasound imaging of the facial soft tissues was performed on nine female volunteers to demonstrate the change in superficial facial fat compartments from an upright to supine position. The net suture jowl and medial cheek fat compartment repositioning technique was operated on 165 Asian patients between September 2020 and July 2021. Volume and projection change of malar and jowl regions, as well as change in elevation of malar protrusion were measured 1, 3, and 6 months postoperatively using a three-dimensional imaging system. Results: Ultrasound measurements confirmed the medial and middle cheek, nasolabial, and jowl fat compartments changed in thickness during positional changes with age-related differences. Postoperative three-dimensional imaging showed volume and projection increase in the malar region (2.23mL and 1.11mm) and decrease in the jowl region (-0.18mL and -0.52mm) by the 6-month follow-up date, and malar projection saw a superior displacement of 3.08mm. Conclusion: The superficial fat glide inferiorly within their compartments under the force of gravity and naturally reposition themselves when the effect of gravity is reversed. The net suture technique offers a minimally invasive method for lifting the jowl fat, volumizing the mid-cheek and achieving facial rejuvenation by repositioning the superficial fat compartments.

Smart and versatile biomaterials for cutaneous wound healing.

The global increase of cutaneous wounds imposes huge health and financial burdens on patients and society. Despite improved wound healing outcomes, conventional wound dressings are far from ideal, owing to the complex healing process. Smart wound dressings, which are sensitive to or interact with changes in wound condition or environment, have been proposed as appealing therapeutic platforms to effectively facilitate wound healing. In this review, the wound healing processes and features of existing biomaterials are firstly introduced, followed by summarizing the mechanisms of smart responsive materials. Afterwards, recent advances and designs in smart and versatile materials of extensive applications for cutaneous wound healing were submarined. Finally, clinical progresses, challenges and future perspectives of the smart wound dressing are discussed. Overall, by mapping the composition and intrinsic structure of smart responsive materials to their individual needs of cutaneous wounds, with particular attention to the responsive mechanisms, this review is promising to advance further progress in designing smart responsive materials for wounds and drive clinical translation.

UV-Curing-Enhanced Organic Long-Persistent Luminescence Materials.

Amorphous organic long-persistent luminescence materials (OLPLMs) can realize simpler solution processing and large-area uniform luminescence, where the luminescent properties are significantly influenced by the rigid environment. However, research on utilizing the rigidity to promote long-persistent luminescence (LPL) properties of amorphous OLPLMs is still relatively rare due to the lack of an unambiguous and effective strategy to construct the rigid environment. Here, a universal strategy is proposed to enhance the LPL performance of organic host-guest doping systems by UV curing, which utilizes the rigid environment constructed by UV curing to promote the interaction between host and guest, thus inducing a generation of materials with highly efficient LPL performance. This solution-processable, large-area, and "easy-to-realize" material fabrication strategy can make amorphous OLPLMs show broader application prospects in some fields, such as anti-counterfeiting, nondestructive detection, and pattern marking or indication.

Inhibitory effects of a maleimide compound on the virulence factors of Candida albicans.

Candidiasis caused by Candida albicans infection has long been a serious human health problem. The pathogenicity of C. albicans is mainly due to its virulence factors, which are novel targets of antifungal drugs for low risk of resistance development. In this study, we identified a maleimide compound [1-(4-methoxyphenyl)-1hydro-pyrrole-2,5-dione, MPD] that exerts effective anti-virulence activity. It could inhibit the process of adhesion, filamentation, and biofilm formation in C. albicans. In addition, it exhibited low cytotoxicity, hemolytic activity, and drug resistance development. Moreover, in Galleria mellonella-C. albicans (in vivo) infection model, the survival time of infected larvae was significantly prolonged under the treatment of MPD. Further, mechanism research revealed that MPD increased farnesol secretion by upregulating the expression of Dpp3. The increased farnesol inhibited the activity of Cdc35, which then decreased the intracellular cAMP content resulting in the inhibition of virulence factors via the Ras1-cAMP-Efg1 pathway. In all, this study evaluated the inhibitory effect of MPD on various virulence factors of C. albicans and identified the underlying mechanisms. This suggests a potential application of MPD to overcome fungal infections in clinics.

Application of the PDCA cycle for implementing the WHO Safe Childbirth Checklist in women with vaginal deliveries.

The World Health Organization Safe Childbirth Checklist (SCC) has been recommended globally. However, the results are inconsistent. The aim of this study was to investigate the effectiveness of implementing the SCC based on plan-do-check-act (PDCA) cycle management. From November 2019 to October 2020, women who were hospitalized and had vaginal deliveries were enrolled in this study. Before October 2020, the PDCA cycle was not applied for the SCC, and women who had vaginal deliveries were included in the pre-intervention group. From January 2021 to December 2021, the PDCA cycle was applied for the SCC, and women who had vaginal deliveries were included in the post-intervention group. The SCC utilization rate and the incidence of maternal and neonatal complications were compared between the 2 groups. The SCC utilization rate in the post-intervention group was higher than that in the pre-intervention group (P < .01). The postpartum infection rate in the post-intervention group was lower than that in the pre-intervention group, and the difference was statistically significant (P < .05). After the intervention, postpartum hemorrhage, neonatal mortality, and neonatal asphyxia rates were also reduced, although no significant differences were observed between the 2 groups. There was no significant difference in the third-degree perineal laceration or neonatal intensive care unit hospitalization rate between the 2 groups (P > .05). Application of the PDCA cycle can improve the SCC utilization rate, and the SCC combined with the PDCA cycle can effectively reduce the postpartum infection rate.

"Find-eat" strategy targeting endothelial cells via receptor functionalized apoptotic body nanovesicle.

Endothelial cell (EC) injury plays a key role in the chronic wound process. A long-term hypoxic microenvironment hinders the vascularization of ECs, thus delaying wound healing. In this study, CX3CL1-functionalized apoptotic body nanovesicles (nABs) were constructed. The "Find-eat" strategy was implemented through a receptor-ligand combination to target ECs that highly express CX3CR1 in the hypoxic microenvironment, therefore amplifying the "Find-eat" signal and promoting angiogenesis. Apoptotic bodies (ABs) were obtained by chemically inducing apoptosis of adipose-derived stem cells (ADSCs), and then functionalized nABs containing deferoxamine (DFO-nABs) were obtained through a series of steps, including optimized hypotonic treatment, mild ultrasound, drug mixing and extrusion treatment. In vitro experiments showed that nABs had good biocompatibility and an effective "Find-eat" signal via CX3CL1/CX3CR1 to induce ECs in the hypoxic microenvironment, thereby promoting cell proliferation, cell migration, and tube formation. In vivo experiments showed that nABs could promote the rapid closure of wounds, release the "Find-eat" signal to target ECs and realize the sustained release of angiogenic drugs to promote new blood vessel formation in diabetic wounds. These receptor-functionalized nABs, which can target ECs by releasing dual signals and achieve the sustained release of angiogenic drugs, may provide a novel strategy for chronic diabetic wound healing.

Regulated extravascular microenvironment via reversible thermosensitive hydrogel for inhibiting calcium influx and vasospasm.

Arterial vasospasm after microsurgery can cause severe obstruction of blood flow manifested as low tissue temperature, leading to tissue necrosis. The timely discovery and synchronized treatment become pivotal. In this study, a reversible, intelligent, responsive thermosensitive hydrogel system is constructed employing both the gel-sol transition and the sol-gel transition. The "reversible thermosensitive (RTS)" hydrogel loaded with verapamil hydrochloride is designed to dynamically and continuously regulate the extravascular microenvironment by inhibiting extracellular calcium influx. After accurate implantation and following in situ gelation, the RTS hydrogel reverses to the sol state causing massive drug release to inhibit vasospasm when the tissue temperature drops to the predetermined transition temperature. Subsequent restoration of the blood supply alleviates further tissue injury. Before the temperature drops, the RTS hydrogel maintains the gel state as a sustained-release reservoir to prevent vasospasm. The inhibition of calcium influx and vasospasm in vitro and in vivo is demonstrated using vascular smooth muscle cells, mice mesenteric arterial rings, and vascular ultrasonic Doppler detection. Subsequent animal experiments demonstrate that RTS hydrogel can promote tissue survival and alleviate tissue injury responding to temperature change. Therefore, this RTS hydrogel holds therapeutic potential for diseases requiring timely detection of temperature change.

The status quo and influencing factors of knowledge, attitude and practice of obstetric staff on the safe childbirth checklist.

Practical Guidelines for Safe Childbirth Checklist has not been widely used in medical institutions at all levels in China. This study aims to understand the current status of knowledge, attitude and practice of obstetric medical staff toward the Safe Childbirth Checklist and analyze its influencing factors to provide a reference for establishing the promotion of the checklist. Convenience sampling was used in a cross-sectional survey of 685 obstetric medical staff in Chongqing using a self-designed questionnaire to analyze their knowledge, attitude and practice of the checklist. The scores of knowledge, attitude and practice of obstetric medical staff on the checklist were 29.96 ±â€…5.44, 62.87 ±â€…9.11, and 37.74 ±â€…6.82, respectively. Occupation and hospital level were influencing factors of the knowledge and practice scores, while length of service was the only influencing factor of the knowledge score. Education was the influencing factor of attitude score. The total effects of the knowledge, facilitation and inhibition dimensions on practice were 0.671, 0.263 and -0.135, respectively. Mediating effects presented in the facilitation and inhibition of attitude in safe childbirth. Obstetrics medical staff know the checklist well, however, their attitudes and practices need to be improved. Managers should take targeted measures to strengthen the attitudes and practices of obstetric medical staff toward safe childbirth and promote the use of the checklist, thus providing a powerful safeguard for higher delivery quality and safer delivery.

Present situation and analysis of factors affecting perimenopausal syndrome among clinical nurses-a cross-sectional survey.

BACKGROUND: The quality of life of women is seriously affected by perimenopausal symptoms and related diseases. Clinical nurses often suffer from job burnout due to high pressure and intensity of work and life, which is easy to induce and aggravate perimenopausal syndrome. Nursing occupational environment varies greatly in different economic regions, but relevant studies are limited to northern cities, and are often confined to the second and third grade hospitals or a hospital in a certain region, lacking multi-center studies on hospitals of different grades. Therefore, it is necessary to understand the occurrence of perimenopausal syndrome in clinical nurses in Chongqing and its influencing factors, so as to provide reference for managers to take targeted intervention measures. METHODS: The investigation was conducted using the method of stratified random cluster sampling. A questionnaire survey was conducted among 933 clinical nurses aged from 40 to 55 in primary, secondary and tertiary hospitals. Kupperman's total symptom score ranged from 0 to 63, while a score of ≥7 can determine the existence of perimenopausal syndrome. RESULTS: Among the 933 clinical nurses surveyed, 662 (70.95%) had perimenopausal syndrome, the results of the multivariate unconditional logistic regression analysis showed that The age ranges from 51 to 55 (OR =2.035, 95% CI: 1.070-3.872), the presence of chronic diseases (OR =1.659, 95% CI: 1.095-2.512), menopause (OR =1.989, 95% CI: 1.198-3.303), moderate family function impairment (OR =1.940, 95% CI: 1.356-2.776), severe family dysfunction weekly (OR =2.309, 95% CI: 1.178-4.524), never participation in sports (OR =3.328, 95% CI: 1.657-6.684) and exercising 1-5 times per week (OR =2.689, 95% CI: 1.516-4.768) were risk factors for perimenopausal syndrome in clinical nurses, basic security (OR =0.939, 95% CI: 0.887-0.994), and sufficient manpower (OR =0.915, 95% CI: 0.855-0.979) were protective factors for perimenopausal syndrome in clinical nurses. CONCLUSIONS: The incidence of perimenopausal syndrome in clinical nurses at all levels of hospitals situated in Chongqing is relatively high. It is suggested that nursing managers should attach great importance to the physical and mental condition of this population and timely take targeted intervention measures to prevent or alleviate the occurrence and development of perimenopausal syndrome in clinical nurses.

Secretory Fluid-Aggregated Janus Electrospun Short Fiber Scaffold for Wound Healing.

Exudate management is critical to improve chronic wound healing. Herein, inspired by a Janus-structured lotus leaf with asymmetric wettability, a Janus electrospun short fiber scaffold is fabricated via electrospinning technologies and short fiber modeling. This scaffold is composed of hydrophilic 2D curcumin-loaded electrospun fiber and hydrophobic 3D short fiber via layer-by-layer assembly and electrostatic interactions which can aggregate the wound exudate by pumping from the hydrophobic layer to the hydrophilic via multiple contact points between hydrophilic and hydrophobic fibers, and simultaneously trigger the cascade release of curcumin in the upper 2D electrospun fiber. The 3D short fiber with high porosity and hydrophobicity can quickly aggregate exudate within 30 s after compounding with hydrophilic 2D electrospun fiber via a spontaneous pump. In vitro experiments show that Janus electrospun short fiber has good biocompatibility, and the cascade release of curcumin can significantly promote the proliferation and migration of fibroblasts. In vivo experiments show that it can trigger cascade release of curcumin by aggregating wound exudate, so as to accelerate wound healing process and promote collagen deposition and vascularization. Hence, this unique biometric Janus scaffold provides an alternative for chronic wound healing.

Factors influencing perimenopausal syndrome in clinical nurses: a qualitative study.

BACKGROUND: The quality of life of women is seriously affected by perimenopausal symptoms and related diseases. The work of female clinical nurses is often stressful and job burnout is not uncommon. Under such conditions, perimenopausal syndrome can be easily induced or aggravated. The health of nurses is positively correlated with nursing quality, residents' health, patients' quality of life and human resource cost in health care institutions. The physical and mental health of perimenopausal nurses is an important issue worth paying attention to. METHODS: Clinical nurses were selected from tertiary and secondary hospitals in Chongqing province by purposive sampling from September to November 2020. Front-line nurses diagnosed with perimenopausal syndrome were recruited from different clinical departments and interviewed using a semi-structured method. The interview results were processed using thematic analysis. RESULTS: Finally, 16 nurses were included in the present study. Analysis of the interview transcriptions identified four themes: patient factors, work environment factors, personal factors, and family social support factors. CONCLUSIONS: The themes influencing perimenopausal syndrome in clinical nurses include aspects of patient factors, working environment factors, personal factors, and family social support factors. Our findings provide an important reference for policy makers to develop management programs that benefit nurses and ensure the safety of patients.

Demand analysis of an intelligent medication administration system for older adults with chronic diseases based on the Kano model.

OBJECTIVES: Gerontechnology has great potential in promoting older adults' well-being. With the accelerated aging process, gerontechnology has a promising market prospect. However, most technological developers and healthcare professionals attached importance to products' effectiveness, and ignored older adults' demands and user experience, which reduced older adults' adoption intention of gerontechnology use. The inclusion of older adults in the design process of technologies is essential to maximize the effect. This study explored older adults' demands for a self-developed intelligent medication administration system and proposed optimization schemes, thus providing reference to developing geriatric-friendly technologies and products. METHODS: A cross-sectional survey was conducted to explore older adults' technological demands for the self-developed intelligent medication administration system, and data were analyzed based on the Kano model. A self-made questionnaire was administered from July 2020 to October 2020 after participants used this system for two weeks. The study was registered with the Chinese Clinical Trial Registry (ChiCTR2000040644). RESULTS: A total of 354 older adults participated in the survey. Four items, namely larger font size, simpler operation process, scheduled medication reminders and reliable hardware, were classified as must-be attributes; three items, namely searching drug instructions through WeChat, more sensitive system and longer battery life, as attractive attributes; one item, viewing disease-related information through WeChat, as the one-dimensional attribute; and the rest were indifferent attributes, including simple and beautiful displays, blocking advertisements automatically, providing user privacy protection protocol, viewing personal medical information only by logged-in users, recording all the medications, ordering medications through WeChat. The satisfaction values were between 0.24 and 0.69, and dissatisfaction values were between 0.06 and 0.94. CONCLUSION: This study suggested that older adults had personalized technology demands. Including their technological demands and desire may assist in decreasing the digital divide and promoting the satisfaction of e-health and/or m-health. Based on older adults' demands, our study proposed optimization schemes of the intelligent medication administration system, which may help developers design geriatric-friendly intelligent products and nurses to perform older adults-centered and efficient medication management.

Biomimic Binding Affinity Gradients Triggered GSH-Response of Core-Shell Nanoparticles for Cascade Chemo/Chemodynamic Therapy.

In eukaryotes and prokaryotes, some copper transportations driven by gradient copper-binding affinities exhibit typical glutathione (GSH)-responsive features. Inspired by these delicate endogenous processes, a biomimic copper-ion mediated GSH-responsive nanomedicine is designed based on the gradient copper-binding strengths between polydopamine (PDA) species and GSH. The nanomedicine is constructed as core-shell nanoparticles with copper-polydopamine (Cu-PDA) coordinated shell and micellar core encapsulating chemotherapeutic drug of ß-lapachone (ß-lapa). In tumor cells, the excess intracellular GSH will reduce and extract the Cu(II) from the Cu-PDA network, triggered by the binding affinity gradients between Cu-PDA and Cu-GSH, resulting in the breaking of the shell and the releasing of ß-lapa and Fenton agent copper. The additional Fenton reaction of copper ions induces excess oxidative damage of tumor cells assisted by the abundant H2 O2 amplified by ß-lapa, achieving cascade anticancer effects combining chemodynamic therapy with chemotherapy. This multilevel anticancer system exhibits an efficient tumor inhibitory rate and a negligible systematic toxicity for normal organs in vivo, presenting a new bioinspired GSH-responsive strategie to develop stimuli-responsive structures.

Transcriptomic analyses show that 24-epibrassinolide (EBR) promotes cold tolerance in cotton seedlings.

In plants, brassinosteroids (BRs) are a class of steroidal hormones that are involved in numerous physiological responses. However, the function of BRs in cold tolerance in cotton has not been explored. In this study, cotton seedlings were treated with five concentrations (0, 0.05, 0.1, 0.2, 0.5 and 1.0 mg/L) of 24-Epibrassinolide (EBR) at 4°C. We measured the electrolyte leakage, malondialdehyde (MDA) content, proline content, and net photosynthesis rate (Pn) of the seedlings, which showed that EBR treatment increased cold tolerance in cotton in a dose-dependent manner, and that 0.2 mg/L is an optimum concentration for enhancing cold tolerance. The function of EBR in cotton cotyledons was investigated in the control 0 mg/L (Cold+water) and 0.2 mg/L (Cold+EBR) treatments using RNA-Seq. A total of 4,001 differentially expressed genes (DEGs), including 2,591 up-regulated genes and 1,409 down-regulated genes were identified. Gene Ontology (GO) and biochemical pathway enrichment analyses showed that EBR is involved in the genetic information process, secondary metabolism, and also inhibits abscisic acid (ABA) and ethylene (ETH) signal transduction. In this study, physiological experiments showed that EBR can increase cold tolerance in cotton seedlings, and the comprehensive RNA-seq data shed light on the mechanisms through which EBR increases cold tolerance in cotton seedlings.

Development and validation of two aspiration prediction models in patients receiving nasogastric feeding.

AIM: To develop and validate two aspiration prediction models in patients receiving nasogastric feeding. BACKGROUND: Aspiration is one of the most serious complications of nasogastric feeding. However, there is a lack of aspiration prediction models for nasogastric feeding. METHODS: A total of 515 patients receiving nasogastric feeding were randomly selected for this unmatched case-control study, with 103 patients in the case group and 412 patients in the control group. Logistic regression was used to develop nomogram and Classification And Regression Tree (CART) models. The performances of the models were internally validated using 1,000 bootstrapped samples. RESULTS: The predictive accuracy of the CART model (94.5%) was higher than that of the nomogram model (89.1%). The area under the receiver operating characteristic curve of the CART model (0.96) was slightly higher than that of the nomogram model (0.93). CONCLUSIONS: The intubation depth, number of comorbidities, aspiration history, indwelling days, food type and the use of sedative-hypnotics may be used to identify aspiration risk. IMPLICATIONS FOR NURSING MANAGEMENT: Two aspiration prediction models are provided for nurses to evaluate aspiration risk and increase the quality of nursing management.