Enhanced direct gaseous CO2 fixation into higher bio-succinic acid production and selectivity.

Utilizing CO2 for bio-succinic acid production is an attractive approach to achieve carbon capture and recycling (CCR) with simultaneous production of a useful platform chemical. Actinobacillus succinogenes and Basfia succiniciproducens were selected and investigated as microbial catalysts. Firstly, the type and concentration of inorganic carbon concentration and glucose concentration were evaluated. 6 g C/L MgCO3 and 24 g C/L glucose were found to be the optimal basic operational conditions, with succinic acid production and carbon yield of over 30 g/L and over 40%, respectively. Then, for maximum gaseous CO2 fixation, carbonate was replaced with CO2 at different ratios. The "less carbonate more CO2" condition of the inorganic carbon source was set as carbonate: CO2 = 1:9 (based on the mass of carbon). This condition presented the highest availability of CO2 by well-balanced chemical reaction equilibrium and phase equilibrium, showing the best performance with regarding CO2 fixation (about 15 mg C/(L·hr)), with suppressed lactic acid accumulation. According to key enzymes analysis, the ratio of phosphoenolpyruvate carboxykinase to lactic dehydrogenase was enhanced at high ratios of gaseous CO2, which could promote glucose conversion through the succinic acid path. To further increase gaseous CO2 fixation and succinic acid production and selectivity, stepwise CO2 addition was evaluated. 50%-65% increase in inorganic carbon utilization was obtained coupled with 20%-30% increase in succinic acid selectivity. This was due to the promotion of the succinic acid branch of the glucose metabolism, while suppressing the pyruvate branch, along with the inhibition on the conversion from glucose to lactic acid.

Simultaneous volatile fatty acids promotion and antibiotic resistance genes reduction in fluoranthene-induced sludge alkaline fermentation: Regulation of microbial consortia and cell functions.

The impact and mechanism of fluoranthene (Flr), a typical polycyclic aromatic hydrocarbon highly detected in sludge, on alkaline fermentation for volatile fatty acids (VFAs) recovery and antibiotic resistance genes (ARGs) transfer were studied. The results demonstrated that VFAs production increased from 2189 to 4272 mg COD/L with a simultaneous reduction of ARGs with Flr. The hydrolytic enzymes and genes related to glucose and amino acid metabolism were provoked. Also, Flr benefited for the enrichment of hydrolytic-acidifying consortia (i.e., Parabacteroides and Alkalibaculum) while reduced VFAs consumers (i.e., Rubrivivax) and ARGs potential hosts (i.e., Rubrivivax and Pseudomonas). Metagenomic analysis indicated that the genes related to cell wall synthesis, biofilm formation and substrate transporters to maintain high VFAs-producer activities were upregulated. Moreover, cell functions of efflux pump and Type IV secretion system were suppressed to inhibit ARGs proliferation. This study provided intrinsic mechanisms of Flr-induced VFAs promotion and ARGs reduction during alkaline fermentation.

Bacteroides methylmalonyl-CoA mutase produces propionate that promotes intestinal goblet cell differentiation and homeostasis.

Propionate is a short-chain fatty acid that is generated upon microbiome-mediated fiber fermentation in the intestine. By modulating immune and metabolic pathways, propionate exerts many health benefits. Key bacterial species, such as Bacteroides thetaiotaomicron, generate propionate, but the biochemical pathways and specific functions remain undetermined. We identified a gene operon-encoding methylmalonyl-CoA mutase (MCM) that contributes to propionate biosynthesis in B. thetaiotaomicron. Colonization of germ-free mice with wild-type or MCM-deficient strains as well as in vitro examination demonstrated that MCM-mediated propionate production promotes goblet cell differentiation and mucus-related gene expression. Intestinal organoids lacking the propionate receptor, GPR41, showed reduced goblet cell differentiation upon MCM-mediated propionate production. Furthermore, although wild-type B. thetaiotaomicron alleviated DSS-induced intestinal inflammation, this effect was abolished in mice receiving the MCM-deficient strain but restored upon propionate supplementation. These data emphasize the critical role of MCM-mediated propionate biosynthesis in goblet cell differentiation, offering potential pathways to ameliorate colitis.

Active components and mechanisms of total flavonoids from Rhizoma Drynariae in enhancing cranial bone regeneration: An investigation employing serum pharmacochemistry and network pharmacology approaches.

ETHNOPHARMACOLOGICAL RELEVANCE: Rhizoma Drynariae, as the dried rhizome of Drynaria fortunei (Kunze ex Mett.) J. Sm., is a traditional Chinese medicine for treating the injury and bone broken of falling and beating. Total flavonoids is considered as the major and effective compounds for the therapeutic efficacy of Rhizoma Drynariae. AIM OF THE STUDY: To explore the effect of total flavonoids from Rhizoma Drynariae (TFRD) on bone regeneration and the underlying mechanisms. MATERIALS AND METHODS: The effect of TFRD in various doses on bone reconstruction in cranial bone defect rats was explored in vivo. The active ingredients in TFRD-medicated serum were characterized by serum pharmacochemistry and integrated by network pharmacology analysis and target prediction. To elucidate the underlying mechanism of TFRD on bone regeneration, experimental validation in vitro was executed to assess the influence of different concentrations of TFRD-medicated serum on osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs). RESULTS: Micro-CT, histological examination, immunohistochemical analysis, and ELSA demonstrated that administration of TFRD could promote bone reconstruction in a rat cranial defect model. We identified 27 active components of TFRD using ultra-high-performance liquid chromatography coupled with tandem mass spectrometry (UHPLC-MS/MS). Results from CCK8, ALP, and Alizarin Red S staining revealed that TFRD-medicated serum notably enhanced BMSCs proliferation and osteogenic differentiation. qRT-PCR and Western blot harvested results consistent with those predicted by network pharmacology, providing further evidence that TFRD activated the TGF-ß signaling pathway to benefit bone regeneration. CONCLUSION: The active components of TFRD modulate the TGF-ß signaling pathway to facilitate osteogenesis, thereby repairing cranial bone defects.

A deep learning model for predicting multidrug-resistant organism infection in critically ill patients.

BACKGROUND: This study aimed to apply the backpropagation neural network (BPNN) to develop a model for predicting multidrug-resistant organism (MDRO) infection in critically ill patients. METHODS: This study collected patient information admitted to the intensive care unit (ICU) of the Affiliated Hospital of Qingdao University from August 2021 to January 2022. All patients enrolled were divided randomly into a training set (80%) and a test set (20%). The least absolute shrinkage and selection operator and stepwise regression analysis were used to determine the independent risk factors for MDRO infection. A BPNN model was constructed based on these factors. Then, we externally validated this model in patients from May 2022 to July 2022 over the same center. The model performance was evaluated by the calibration curve, the area under the curve (AUC), sensitivity, specificity, and accuracy. RESULTS: In the primary cohort, 688 patients were enrolled, including 109 (15.84%) MDRO infection patients. Risk factors for MDRO infection, as determined by the primary cohort, included length of hospitalization, length of ICU stay, long-term bed rest, antibiotics use before ICU, acute physiology and chronic health evaluation II, invasive operation before ICU, quantity of antibiotics, chronic lung disease, and hypoproteinemia. There were 238 patients in the validation set, including 31 (13.03%) MDRO infection patients. This BPNN model yielded good calibration. The AUC of the training set, the test set and the validation set were 0.889 (95% CI 0.852-0.925), 0.919 (95% CI 0.856-0.983), and 0.811 (95% CI 0.731-0.891), respectively. CONCLUSIONS: This study confirmed nine independent risk factors for MDRO infection. The BPNN model performed well and was potentially used to predict MDRO infection in ICU patients.

Identification of urinary volatile organic compounds as a potential non-invasive biomarker for esophageal cancer.

Early diagnosis of esophageal cancer (EC) is extremely challenging. The study presented herein aimed to assess whether urinary volatile organic compounds (VOCs) may be emerging diagnostic biomarkers for EC. Urine samples were collected from EC patients and healthy controls (HCs). Gas chromatography-ion mobility spectrometry (GC-IMS) was next utilised for volatile organic compound detection and predictive models were constructed using machine learning algorithms. ROC curve analysis indicated that an 8-VOCs based machine learning model could aid the diagnosis of EC, with the Random Forests having a maximum AUC of 0.874 and sensitivities and specificities of 84.2% and 90.6%, respectively. Urine VOC analysis aids in the diagnosis of EC.

Effect of Torrefaction on the Physiochemical Characteristics and Pyrolysis of the Corn Stalk.

Torrefaction of biomass is one of the most promising pretreatment methods for deriving biofuels from biomass via thermochemical conversion processes. In this work, the changes in physicochemical properties and morphology features of the torrefied corn stalk, the changes in physicochemical properties and morphology features of the torrefied corn stalk were investigated. The results of this study showed that the elemental content and proximate analysis of the torrefied corn stalk significantly changed compared with those of the raw corn stalk. In particular, at 300 °C, the volatile content decreased to 41.79%, while the fixed carbon content and higher heating value increased to 42.22% and 21.31 MJ/kg, respectively. The H/C and O/C molar ratios of torrefied corn stalk at the 300 °C were drastically reduced to 0.99 and 0.27, respectively, which are similar to those of conventional coals in China. Numerous cracks and pores were observed in the sample surface of torrefied corn stalk at the torrefaction temperature range of 275 °C-300 °C, which could facilitate the potential application of the sample in the adsorption process and promote the release of gas products in pyrolysis. In the pyrolysis phase, the liquid products of the torrefied corn stalk decreased, but the H2/CO ratio and the lower heating value of the torrefied corn stalk increased compared with those of the raw corn stalk. This work paves a new strategy for the investigation of the effect of torrefaction on the physiochemical characteristics and pyrolysis of the corn stalk, highlighting the application potential in the conversion of biomass.

The integrated production of hydrochar and methane from lignocellulosic fermentative residue coupling hydrothermal carbonization with anaerobic digestion.

The popularization of large-scale biogas project makes the disposal of fermentative residue an urgent issue to be solved. Hydrothermal carbonization (HTC) technology is suitable for treating wet biomass to produce carbonaceous materials. In this study, the solid residue from the two-phase anaerobic digestion (AD) was hydrothermally converted in the range of 180-240 °C, and the hydrochar and aqueous components were characterized for subsequent utilization. The heating values of hydrochar were indicated to be increased by 14.2% and 16.6% at 210 °C and 240 °C as compared with feedstock, and also the specific surface areas were 34.8 m2/g and 27.1 m2/g with 17.4- and 13.3-fold enhancement, respectively. The migration of elements such as S, Cl, K to aqueous phase was beneficial for fuel application. The mesoporous pores were dominant in hydrochars with ample oxygenated functional groups. In addition, the wastewater involved organic acids, phenols, and nitrogen-containing compounds, etc. Evaluating the biodegradability by AD, it was found that when the initial concentration was ≤8 g COD/L, the maximum methane yields up to 275.9 mL CH4/g CODremoval and 277.6 mL CH4/g CODremoval were obtained. The enhanced toxicity/inhibition of representative pollutants on microorganisms was significant at higher organic loading, which could be indicated in the microbial structure and diversity. As a conclusion, the integrated production of hydrochar and methane will provide an extended route for further processing of lignocellulosic fermentative residue.

The rs1421085 variant within FTO promotes brown fat thermogenesis.

One lead genetic risk signal of obesity-the rs1421085 T>C variant within the FTO gene-is reported to be functional in vitro but lacks evidence at an organism level. Here we recapitulate the homologous human variant in mice with global and brown adipocyte-specific variant knock-in and reveal that mice carrying the C-allele show increased brown fat thermogenic capacity and resistance to high-fat diet-induced adiposity, whereas the obesity-related phenotypic changes are blunted at thermoneutrality. Both in vivo and in vitro data reveal that the C-allele in brown adipocytes enhances the transcription of the Fto gene, which is associated with stronger chromatin looping linking the enhancer region and Fto promoter. Moreover, FTO knockdown or inhibition effectively eliminates the increased thermogenic ability of brown adipocytes carrying the C-allele. Taken together, these findings identify rs1421085 T>C as a functional variant promoting brown fat thermogenesis.

Volatile organic compounds for early detection of prostate cancer from urine.

Prostate cancer (PCa) is one of the most common cancers in men worldwide. Early diagnosis of PCa is extremely challenging due to the lack of effective diagnostic methods. The study presented here aims to evaluate whether urine volatile organic compounds (VOCs) can be used as an emerging diagnostic biomarker for PCa. Gas chromatography-ion mobility spectrometry (GC-IMS) was used to detect VOCs in urine samples from 66 patients with PCa and to comparatively analyze samples from 87 patients with non-cancerous controls (NCs). A total of 86 substance peak heights were detected in urine samples from all patients. Analysis using four machine learning algorithms suggested that the diagnosis of PCa could be effectively facilitated. Ultimately, diagnostic models were constructed based on the four VOCs selected. The AUC for the RF and SVM model were 0.955 and 0.981, respectively. Both the NN and DT diagnostic models also achieved an AUC of 0.8 or more, but their sensitivity or specificity was poor compared to the RF and SVM models.

Dual effects of ultrasound on fabrication of anodic aluminum oxide.

Ultrasound has been proven to enhance the mass transfer process and impact the fabrication of anodic aluminum oxide (AAO). However, the different effects of ultrasound propagating in different media make the specific target and process of ultrasound in AAO remain unclear, and the effects of ultrasound on AAO reported in previous studies are contradictory. These uncertainties have greatly limited the application of ultrasonic-assisted anodization (UAA) in practice. In this study, the bubble desorption and mass transfer enhancement effects were decoupled based on an anodizing system with focused ultrasound, such that the dual effects of ultrasound on different targets were distinguished. The results showed that ultrasound has the dual effects on AAO fabrication. Specifically, ultrasound focused on the anode has a nanopore-expansion effect on AAO, leading to a 12.24 % improvement in fabrication efficiency. This was attributed to the promotion of interfacial ion migration through ultrasonic-induced high-frequency vibrational bubble desorption. However, AAO nanopores were observed to shrink when ultrasound was focused on the electrolyte, accompanied by a 25.85 % reduction in fabrication efficiency. The effects of ultrasound on mass transfer through jet cavitation appeared to be the reason for this phenomenon. This study resolved the paradoxical phenomena of UAA in previous studies and is expected to guide AAO application in electrochemistry and surface treatments.

Emerging roles of non-coding RNAs in colorectal cancer oxaliplatin resistance and liquid biopsy potential.

Colorectal cancer (CRC) is one of the most common malignancies of the digestive tract, with the annual incidence and mortality increasing consistently. Oxaliplatin-based chemotherapy is a preferred therapeutic regimen for patients with advanced CRC. However, most patients will inevitably develop resistance to oxaliplatin. Many studies have reported that non-coding RNAs (ncRNAs), such as microRNAs, long non-coding RNAs, and circular RNAs, are extensively involved in cancer progression. Moreover, emerging evidence has revealed that ncRNAs mediate chemoresistance to oxaliplatin by transcriptional and post-transcriptional regulation, and by epigenetic modification. In this review, we summarize the mechanisms by which ncRNAs regulate the initiation and development of CRC chemoresistance to oxaliplatin. Furthermore, we investigate the clinical application of ncRNAs as promising biomarkers for liquid CRC biopsy. This review provides new insights into overcoming oxaliplatin resistance in CRC by targeting ncRNAs.

Widening or convergence, the trajectories of health inequalities induced by childhood SES across the life course: Evidence from China.

This study aims to explore the trajectories of health inequalities induced by childhood SES across the life course in China. There are two competing theories on this subject. Cumulative disadvantage theory contends that health gaps induced by childhood SES tend to widen across the life course as adulthood SES compound or multiply the negative effects of early SES disadvantage. Age-neutral theory draws the opposite inference that the physiological decline due to aging offsets the health gaps at older ages. Based on the data of the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018, a two-level mixed-effects model was used to analyze the trajectories of health inequalities induced by childhood SES among Chinese individuals aged 45 and above and further distinguished the age and cohort effects in the overall trajectories. Unlike previous studies that unilaterally supported one of these theories, our findings support both of them. In this study, health gaps induced by childhood SES gradually widened before entering old age, which supports the cumulative disadvantage theory. In contrast, the health gaps in older adults gradually converged with age, thus supporting the age-neutral theory. The age effect shows that in the same birth cohort, health gaps induced by childhood SES first increased and then decreased during the survey time. The cohort effect shows that, at the same age, childhood SES has a greater impact on the health of those with later birth cohorts than on those with earlier birth cohorts. The findings of this study support the importance of policy and practices to reduce health inequalities among adolescents for long-term healthy aging in China.

Presence of Depression Is Associated with Functional Impairment in Middle-Aged and Elderly Chinese Adults with Vascular Disease/Diabetes Mellitus-A Cross-Sectional Study.

Objectives: The association between chronic diseases and depression has received increasing attention, and are both considered to increase the risk of functional impairment. However, previous research evidence is controversial. Our study aimed to investigate the association between depression, three types of vascular disease (i.e., hypertension, myocardial infarction, stroke), diabetes mellitus, and functional impairment in middle-aged and elderly Chinese people. Methods: We designed a cross sectional study. Data were collected from the China Health and Retirement Longitudinal Study (CHARLS) in 2018. Logistic regression models were used to explore the association between independent variables and functional status. Results: Lower functional status was significantly associated with comorbid depression and vascular disease/diabetes mellitus (Activity of Daily Living/Instrumental Activity of Daily Living: Adjusted OR of Hypertension, Diabetes mellitus, Myocardial infarction, Stroke is 3.86/4.30, 3.80/4.38, 3.60/4.14, 6.62/7.72, respectively; all p < 0.001). Conclusions: Depression is associated with functional decline in middle-aged and elderly Chinese individuals with vascular disease/diabetes mellitus. Identifying mediational factors and preventative strategies to reduce concurrent depression in persons with vascular diseases should be a priority therapeutic vista.

Energy recovery from high ash-containing sewage sludge: Focusing on performance evaluation of bio-fuel production.

Hydrothermal liquefaction (HTL) has shown great potential to convert sewage sludge (SS) with high moisture into bio-crude. However, the disposal and reutilization of hydrothermal liquefaction wastewater (HTLWW) is a critical issue. Anaerobic digestion (AD) is proven to be an alternative to treat organic wastewater. Therefore, energy recovery from high ash-containing SS was studied by integrating AD with HTL. The effect of temperature on HTL efficiency was investigated and then methane production from HTLWW was conducted by AD with organic loading increasing from 2 g COD/L to 6 g COD/L. Results showed that the maximum bio-crude yield of 23.5 % was obtained at 350 °C. Methane yield of 309.4 mL CH4/g CODremoved was achieved at 2 g COD/L with COD removal rate of 72.5 %. Meanwhile, the microbial structure and abundance showed great shifts resulting from the adaptation to complex compounds. JGI-000079-D21, Aminicenantales, and Bacteroidetes_ vadinHA17 predominated in the bacterial community. Due to the presence of the toxic substances in HTLWW, such as phenolic and nitrogenous heterocyclic compounds, there was a decrease in methane yield when the organic loading was higher than 4 g COD/L. The organic matters in extracellular polymeric substances (EPS) were rich in fulvic acid-like and humic acid-like substances due to the attack and stimulation of toxicants. Under the condition of unstable fermentation, Advenella and Bacillus first appeared as phenol and pyridine degrading bacteria, respectively. The microbial diversity declined sharply to demonstrate the toxic effect of the refractory organics existing at high organic loading. The enrichment of Methanosaeta in methanogens meant that acetotrophic metabolism is the dominant pathway in methanogenesis. In this study, the profile of bio-fuel production from high ash-containing SS would provide an integrated reference to treat wet biomass and recover energy simultaneously.

The psychological factors mediating/moderating the association between childhood adversity and depression: A systematic review.

Accumulating evidence suggests that individuals with a history of childhood adversity are at greater risk for developing depression. Potential psychological mechanisms have not been well-established. Our study aims to identify psychological variables consistently mediating/moderating the link between childhood adversity to depression. We systematically searched articles from 1990 to October 2021 on online databases including PubMed, Web of Science and PsycINFO. Studies that examined a mediating/moderating role of psychological variables between childhood adversities and depression were included. Totally, 33 records were included. The review identified maladaptive schema, negative automatic thoughts, and avoidance as mediators of the relationship between childhood adversity and depression. Additionally, resilience was identified as both a mediator and moderator of the association between childhood adversity and depression. In general, cognitive dysfunction, avoidance behaviors and impaired resilience may be a by-product of childhood adversity and may contribute to increased risk for depression. Interventions that target at challenging negative cognition and improving resilience may be effective to prevent or treat depression in individuals with a history of childhood adversity.

CD36 regulates LPS-induced acute lung injury by promoting macrophages M1 polarization.

M1 polarization of macrophages works as a promoter in pathogenesis of acute lung injury / acute respiratory distress syndrome (ALI/ARDS) by the secretion of pro-inflammatory cytokines and recruiting other inflammatory cells. Lipopolysaccharide (LPS), a critical component of the wall of gram-negative bacteria, can induce M1 polarization and ALI. Recently, cluster of differentiation 36 (CD36) has been reported to be associated with inflammatory responses. However, it has not yet been clarified whether CD36 in macrophages is involved in LPS-induced ALI. Herein, we demonstrated that in macrophages, LPS-induced ALI was regulated by CD36. Loss of CD36 attenuated LPS-induced ALI by reducing M1 polarization. Mechanistically, CD36 promoted macrophage M1 polarization by regulating CD14 associated with TLR4 during LPS stimulation. The findings of this study, clarified the mechanism of LPS-induced ALI through CD36 in macrophages, which provides a potential target for the prevention and treatment of ALI.

Application of computerized cognitive test battery in major depressive disorder: a narrative literature review.

BACKGROUND: Major depressive disorder (MDD) is a chronic and debilitating relapsing-remitting mood disorder, characterized by psychological, cognitive, and behavioral disturbances. The assessment of cognitive dysfunction in individuals with MDD has increasingly become a topic of concern in recent years. AIMS: To pool and compare the characteristics of various cognition evaluation tools. METHOD: Overview of recent research in application of computerized cognitive test battery in MDD. RESULTS: With recent technological advances in mobile health technologies and the ubiquity of smartphones, the use of traditional tools is no longer sufficient to monitor the dynamic changes of an individual's cognitive performance, which may be influenced by many factors, including, but not limited to, disease course and medications. Computerized tests have many advantages over traditional neuropsychological testing, chiefly in terms of time and cost savings, accurate recording of multiple response components, and the ability to automatically store and compare performance between testing sessions. In the following review, we summarized cognitive impairment characteristics of MDD, introduced traditional assessment tools of cognitive function in MDD, and reviewed the development of the current computerized cognitive test batteries for MDD. The comparisons among cognitive function evaluation tools were also performed. CONCLUSIONS: It is our belief that the improvement of existing novel computerized cognitive test batteries, the development of more comprehensive and easy-to-operate scales, verification techniques and multiple follow-up surveys among large sample populations may provide valuable clues for the evaluation and tracking of cognitive function in individuals with MDD.

Anaerobic digestion of wood vinegar wastewater using domesticated sludge: Focusing on the relationship between organic degradation and microbial communities (archaea, bacteria, and fungi).

Thermochemical process of biomass is one of the promising renewable energy technologies; however, the by-product (wood vinegar wastewater) is rich in refractory organics, which is harmful to the environment and inhibits the conversion efficiency of microorganisms. Consequently, the dominant functional microbial communities corresponding to the various substrate were obtained through the continuous domestication, and the relationship between the dominant functional communities and the degradation of organic compounds was comprehensively analyzed. The bacterial community was absolutely dominant (approximately 85%), while archaea and fungi had similar relative abundance. The diversity showed that glucose was not conducive to the development of microbial diversity, while the substrate containing wood vinegar wastewater showed the opposite trend. The functional analysis revealed that the enrichment of bacteria associated with the hydrolysis and acidification of organics increased in the domestication process. Glucose facilitated hydrogen-trophic methanogenesis as the main methanogenic pathway in the methanogenic stage.

The impact of medical financial assistance on healthcare expenses and the medical financial burden: Evidence from rural China.

Background: The medical financial burden has become a key limitation to accessing healthcare in rural areas of China as healthcare expenses continue to rise. To ensure that low-income people have access to basic healthcare services, China has implemented medical financial assistance (MFA) policy, which provides social health insurance and medical cash assistance for low-income people. Methods: Using data from the 2014 China Family Panel Studies (CFPS), the propensity score matching (PSM) method was applied to estimate the impact of MFA on healthcare expenses and the medical financial burden. Results: Empirical results showed that the total annual healthcare expenditure of MFA beneficiaries is significantly higher than that of non-beneficiaries after matching. Although low-income individuals are now covered by MFA, neither the out-of-pocket expenditure to per capita household non-food expenditure ratio nor the likelihood of catastrophic healthcare expenditure (CHE) decrease significantly. Conclusion: Medical financial assistance (MFA) has reduced the inequality in healthcare utilization to a certain extent by improving access to healthcare for low-income people. However, people with low income still face a heavy medical financial burden even when they are covered by MFA. Policymakers should pay attention to raising the standards of MFA in rural areas and providing higher subsidies for the reasonable healthcare expenditures of low-income people.