Deletion of the mitochondrial calcium uniporter in adipose tissue promotes energy expenditure and alleviates diet-induced obesity.

OBJECTIVE: Studies have shown a correlation between obesity and mitochondrial calcium homeostasis, yet it is unclear whether and how Mcu regulates adipocyte lipid deposition. This study aims to provide new potential target for the treatment of obesity and related metabolic diseases, and to explore the function of Mcu in adipose tissue. METHODS: We firstly investigated the role of mitoxantrone, an Mcu inhibitor, in the regulation of glucose and lipid metabolism in mouse adipocytes (3T3-L1 cells). Secondly, C57BL/6J mice were used as a research model to investigate the effects of Mcu inhibitors on fat accumulation and glucose metabolism in mice on a high-fat diet (HFD), and by using CRISPR/Cas9 technology, adipose tissue-specific Mcu knockdown mice (Mcufl/+ AKO) and Mcu knockout of mice (Mcufl/fl AKO) were obtained, to further investigate the direct effects of Mcu on fat deposition, glucose tolerance and insulin sensitivity in mice on a high-fat diet. RESULTS: We found the Mcu inhibitor reduced adipocytes lipid accumulation and adipose tissues mass in mice fed an HFD. Both Mcufl/+ AKO mice and Mcufl/fl AKO mice were resistant to HFD-induced obesity, compared to control mice. Mice with Mcufl/fl AKO showed improved glucose tolerance and insulin sensitivity as well as reduced hepatic lipid accumulation. Mechanistically, inhibition of Mcu promoted mitochondrial biogenesis and adipocyte browning, increase energy expenditure and alleviates diet-induced obesity. CONCLUSIONS: Our study demonstrates a link between adipocyte lipid accumulation and mCa2+ levels, suggesting that adipose-specific Mcu deficiency alleviates HFD-induced obesity and ameliorates metabolic disorders such as insulin resistance and hepatic steatosis. These effects may be achieved by increasing mitochondrial biosynthesis, promoting white fat browning and enhancing energy metabolism.

Leaching experiments and risk assessment to explore the migration and risk of potentially toxic elements in soil from black shale.

Black shale is rich in potentially toxic elements (PTEs) that migrate through rock weathering or rainfall, adversely affecting human health and the environment. In this study, simulated rainfall leaching experiments were used to investigate the migration patterns and leaching kinetics of PTEs in black shale from the Lower Cambrian Hetang Formation and to analyze the water quality index (WQI) of PTEs in the leachate. A comparison between the risk of PTEs in the leachate and those in the soil was also made to determine the risk sources, risk status, and distribution characteristics of PTEs in the study area. The WQI of the indoor column experimental leachate indicated the highest As contamination. The geo-accumulation index (Igeo) and potential ecological risk (Er) of soils in the entire region revealed that the risk of Cd was the highest. Furthermore, by mapping the distribution of Igeo and Er in soils, the risk level in the region where black shale is located was found to be significantly higher than that in other areas. Comparing the leaching rate of PTEs with the WQI from leaching experiments, the risk associated with As in soil can be inferred to originate mainly from the leaching of black shale. Previous studies on PTEs in black shale in the study area tended to focus on Cd; however, this study found that the risk of As was not negligible. The health risk assessment also showed that the risk at the location of black shale was beyond the accepted range. Overall, this study provided a new and important evaluation law for the level of pollution by PTEs and health risks in typical black shale regions.

Hospital volume and outcomes for inpatients with acute myocardial infarction in Shanxi, China: A cross-sectional study.

In this cross-sectional study, we assessed the relationship between hospital volume and clinical outcomes for inpatients with acute myocardial infarction (AMI) in tertiary A hospitals in Shanxi, China (N = 12 931). In-hospital mortality, length of stay (LOS), and total cost were measured. The crude in-hospital mortality rate was 1.69%. Adjusted in-hospital mortality was significantly lower for medium-volume hospitals (odds ratio (OR) = 0.605, 95% confidence interval (CI) = 0.411-0.900) compared with low-volume hospitals. LOS in medium- and high-volume hospitals were 0.915 (95% CI = 0.880-0.951) and 1.069 (95% CI = 1.041-1.098) days longer than in low-volume hospitals, respectively. The cost of inpatients attending low- and high-volume hospitals (OR = 1.180, 95% CI = 1.140-1.221) was higher than that of medium-volume hospitals (OR = 0.897, 95% CI = 0.868-0.926). These results inform health care policy in countries with strained medical resources.

Does Hospital Competition Harm Inpatient Quality? Empirical Evidence from Shanxi, China.

This study aimed to determine whether hospital competition is associated with improved in-hospital mortality in Shanxi, China. We included a total of 46,959 hospitalizations for acute myocardial infarction (AMI) and 44,063 hospitalizations for pneumonia from 2015 to 2017. Hospital competition was measured as Herfindahl⁻Hirschman Index based on the patient predicted flow approach. Two-level random-intercept logistic models were applied to explore the effects of hospital competition on quality for both AMI and pneumonia diagnoses. Hospital competition exerts negative or negligible effects on inpatient quality of care, and the pattern of competition effects on quality varies by specific diseases. While hospital competition is insignificantly correlated with lower AMI in-hospital mortality (odds ratio (OR): 0.94, 95% confidence interval (CI): 0.77⁻1.11), high hospital competition was, in fact, associated with higher in-hospital mortality for pneumonia patients (OR: 1.99, 95% CI: 1.51⁻2.64). Our study suggests that simply encouraging hospital competition may not provide effective channels to improve inpatient quality of health care in China's current health care system.

Insurance status, inhospital mortality and length of stay in hospitalised patients in Shanxi, China: a cross-sectional study.

OBJECTIVES: To determine insurance-related disparities in hospital care for patients with acute myocardial infarction (AMI), heart failure (HF) and pneumonia. SETTING AND PARTICIPANTS: A total of 22 392 patients with AMI, 8056 patients with HF and 17 161 patients with pneumonia were selected from 31 tertiary hospitals in Shanxi, China, from 2014 to 2015 using the International Classification of Diseases, Tenth Revision codes. Patients were stratified by health insurance status, namely, urban employee-based basic medical insurance (UEBMI), urban resident-based basic medical insurance (URBMI), new cooperative medical scheme (NCMS) and self-payment. OUTCOME MEASURES: Inhospital mortality and length of stay (LOS). RESULTS: The highest unadjusted inhospital mortality rate was detected in NCMS patients independent of medical conditions (4.7%, 4.4% and 11.1% for AMI, HF and pneumonia, respectively). The lowest unadjusted inhospital mortality rate and the longest LOS were observed in UEBMI patients. After controlling patient-level and hospital-level covariates, the adjusted inhospital mortality was significantly higher for NCMS and self-payment among patients with AMI, for NCMS among patients with HF and for URBMI, NCMS and self-payment among patients with pneumonia compared with UEBMI. The LOS of the URBMI, NCMS and self-payment groups was significantly shorter than that of the UEBMI group. CONCLUSION: Insurance-related disparities in hospital care for patients with three common medical conditions were observed in this study. NCMS patients had significantly higher adjusted inhospital mortality and shorter LOS compared with UEBMI patients. Policies on minimising the disparities among different insurance schemes should be established by the government.