The role of physical activity on healthcare utilization in China.

BACKGROUND: Evidence on the role of physical activity (PA) on healthcare utilization and expenditure is limited in China. We aimed to examine the association between the total physical activity (TPA) per week, healthcare service use and expenditure. METHODS: We extracted the data from China Health and Retirement Longitudinal Study (CHARLS) 2011, 2013, and 2015. Participants more than 50 years old who completed the follow-up for the three waves were enrolled. We converted the volume of vigorous physical activity (VPA) into an equivalent volume of moderate physical activity (MPA) and calculated the TPA per week for each participant. 12,927 of the 17,708 participants in CHARLS were included in our analysis. More than one-third of participants over 50 years old never participate in any moderate or intensity activity, and the median of self-reported moderate or intensity PA was about 525 (IQR 0-1680) MET-minutes per week in 2015. RESULTS: Compared to inactive subjects, the highest level of TPA was significantly related to the decreased risk number of inpatient visits (IRR: 0.58; 95% CI:0.50-0.67, p < 0.001), inpatient hospital days (IRR: 0.60; 95% CI: 0.42-0.84, p < 0.01), healthcare expenditure (IRR: 0.71; 95% CI: 0.65-0.79, p < 0.001) and catastrophic health expenditures (OR: 0.57; 95% CI: 0.45-0.72, p < 0.001) after adjusting for covariates. CONCLUSIONS: Engaging in moderate-to-vigorous PA may drive a potential decrease in healthcare utilization, healthcare expenditure and household financial risk with a dose-response relationship in China, and some possible policy implications in public health may be considered to promote exercise in the middle-aged and elderly to reduce the medical burden on individuals and healthcare systems.

Clinicopathological characteristics and prognostic factors of elderly small intestine adenocarcinoma using propensity score matching analysis: a study based on SEER database.

BACKGROUND: Small intestine adenocarcinoma (SIA) is a scant disease that has no adequate clinical trials, so its prognostic factors are still unclear, especially in elderly patients. In this article, we aimed to explore the clinicopathology presentation, treatments, outcomes, and predictors of small intestine adenocarcinoma patients aged 65 years or older. METHODS: We retrieved clinicopathology data of small intestine adenocarcinoma patients diagnosed between 2004 and 2015 from the Surveillance Epidemiology and End Results (SEER) database. We clarified patients into two groups: the surgery and the non-surgery group and conducted propensity score matching (PSM) to compare survival outcoming. We identified the prognostic indicators for cancer-specific survival (CSS) and overall survival (OS) by the Cox proportional hazards model. RESULTS: In total, 1018 eligible cases were enrolled, with a median survival of 16 months; the 3-year OS and CSS rates were 36% and 41.7%, and the 5-year OS and CSS rates were 26.5% and 33.3%. Multivariate analyses revealed that age, grade, tumor stage, surgery, and chemotherapy were independent prognostic factors for OS, while grade, tumor stage, surgery, radiation, and chemotherapy were independent factors for CSS. After PSM, only surgery and tumor stage (AJCC 6th) were independent prognostic factors for OS and CSS. CONCLUSION: Surgery could bring benefit to survival for elderly SIA patients, and the early stage of the disease was another significant prognostic factor.

Reference values of cardiac ventricular structure and function by steady-state free-procession MRI at 3.0T in healthy adult chinese volunteers.

PURPOSE: To establish normal reference values of left ventricular (LV) and right ventricular (RV) dimension, volume, mass, and ejection fraction in a Chinese population using cardiac magnetic resonance imaging (MRI). MATERIALS AND METHODS: A total of 120 (60 males; 60 females; 23-83 years) healthy Han Chinese subjects without cardiovascular disease or risk factors were recruited. They underwent comprehensive MRI examination at 3.0T. LV/RV morphology and function were evaluated by steady-state free-procession (SSFP) sequence. Parameters were analyzed according to a standard postprocessing protocol. RESULTS: Significant differences in LV size, mass, volume, and ejection fraction (EF) between sexes were noted (all P < 0.05). After indexing using body surface area (BSA), LV end-diastolic volume (EDV), and LV mass index were greater in males than in females (76.5 vs. 68.7 mL/m, P < 0.001; 52.9 vs. 45.1 g/m, P < 0.001; respectively). LVEF was lower in males than in females (64.6% vs. 67.1%, P = 0.007, respectively). RV volume was higher and RVEF lower in males compared with females (75.3 vs. 62.7 mL/m, P < 0.001; 59.9% vs. 62.6%, P = 0.001, respectively). Age was associated significantly with indices of LV and RV volume in females (left ventricular end-diastolic volume index: r = -0.41 P = 0.001; left ventricular end-systolic volume index: r = -0.37 P = 0.004; left ventricular end-diastolic volume index: r = -0.53 P < 0.001; right ventricular end-systolic volume index: r = -0.43 P < 0.001), but not in males (all P > 0.05). CONCLUSION: These data suggest that sex and age affect ventricular parameters in healthy Han Chinese subjects without cardiovascular disease or risk factors. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;45:1684-1692.

Systematical investigation of binding interaction between novel ruthenium(II) arene complex with curcumin analogs and ctDNA.

In this study, the interaction between a novel ruthenium(II) arene complex with curcumin analogs and calf thymus DNA (ctDNA) was investigated systematically by viscosity measurement, the DNA melting approach, multispectroscopic techniques and electrochemical methods. The absorption spectra of the ctDNA-drug complex showed a slight red shift and a weak hypochromic effect. The relative viscosity and melting temperature of ctDNA increased on addition of the drug. The evidence obtained from fluorescence competitive experiments indicated that the binding mode of the drug with ctDNA was intercalative. Using acridine orange (AO) as a fluorescence probe, the drug statically quenched the fluorescence of the ctDNA-AO complex, and hydrogen bonding and van der Waals interactions played vital roles in the binding interaction between the drug and ctDNA. The influences of ionic strength, chemical denaturants and pH on the binding interaction were also investigated. Circular dichroism and Fourier transform infrared spectra suggested that this drug might bond with the G-C base pairs of ctDNA and the right-handed B-form helicity of ctDNA remained after drug binding. The intercalative binding between the drug and ctDNA was further investigated using electrochemical techniques. All these results suggested that the biological activity of ctDNA was affected by ruthenium(II) arene complex with curcumin analogs. Copyright © 2016 John Wiley & Sons, Ltd.

An observational study of symmetrical VSD occluder for transcatheter closure of ruptured sinus of Valsalva aneurysm.

This study evaluated the immediate and 1-year postoperative outcomes of 14 patients with ruptured Valsalva aneurysmal sinus (RSVA) using symmetric ventricular septal defect (VSD) occluder for transcatheter closure (TCC). The sites of rupture were from the non-coronary sinus to the right atrium (RA) in 10 cases (71.4%), the right coronary sinus (RCS) to the RA in 3 cases (21.4%) and the RCS to the right ventricle in 1 case (7.2%). The defects (5-11 mm) were closed with a symmetrical VSD device. During the follow-up (12 months), the enlarged heart of the patients had significantly shrunk and the NYHA improved after closure. In 1 case, a moderate residual shunt was present and the patient suffered from hemolysis at 2 h after the operation, and 1 patient was transferred to surgery for aortic regurgitation 1 year after the initial treatment of RSVA. In conclusion, the TCC of RSVA with the China made symmetrical VSD occluder is safe and effective.

Diagnosis Framework for Probable Alzheimer's Disease and Mild Cognitive Impairment Based on Multi-Dimensional Emotion Features.

BACKGROUND: Emotion and cognition are intercorrelated. Impaired emotion is common in populations with Alzheimer's disease (AD) and mild cognitive impairment (MCI), showing promises as an early detection approach. OBJECTIVE: We aim to develop a novel automatic classification tool based on emotion features and machine learning. METHODS: Older adults aged 60 years or over were recruited among residents in the long-term care facilities and the community. Participants included healthy control participants with normal cognition (HC, n = 26), patients with MCI (n = 23), and patients with probable AD (n = 30). Participants watched emotional film clips while multi-dimensional emotion data were collected, including mental features of Self-Assessment Manikin (SAM), physiological features of electrodermal activity (EDA), and facial expressions. Emotional features of EDA and facial expression were abstracted by using continuous decomposition analysis and EomNet, respectively. Bidirectional long short-term memory (Bi-LSTM) was used to train classification model. Hybrid fusion was used, including early feature fusion and late decision fusion. Data from 79 participants were utilized into deep machine learning analysis and hybrid fusion method. RESULTS: By combining multiple emotion features, the model's performance of AUC value was highest in classification between HC and probable AD (AUC = 0.92), intermediate between MCI and probable AD (AUC = 0.88), and lowest between HC and MCI (AUC = 0.82). CONCLUSIONS: Our method demonstrated an excellent predictive power to differentiate HC/MCI/AD by fusion of multiple emotion features. The proposed model provides a cost-effective and automated method that can assist in detecting probable AD and MCI from normal aging.

Gefitinib (an EGFR tyrosine kinase inhibitor) plus anlotinib (an multikinase inhibitor) for untreated, EGFR-mutated, advanced non-small cell lung cancer (FL-ALTER): a multicenter phase III trial.

Dual inhibition of vascular endothelial growth factor and epidermal growth factor receptor (EGFR) signaling pathways offers the prospect of improving the effectiveness of EFGR-targeted therapy. In this phase 3 study (ClinicalTrial.gov: NCT04028778), 315 patients with treatment-naïve, EGFR-mutated, advanced non-small cell lung cancer (NSCLC) were randomized (1:1) to receive anlotinib or placebo plus gefitinib once daily on days 1-14 per a 3-week cycle. At the prespecified final analysis of progression-free survival (PFS), a significant improvement in PFS was observed for the anlotinib arm over the placebo arm (hazards ratio [HR] = 0.64, 95% CI, 0.48-0.80, P = 0.003). Particularly, patients with brain metastasis and those harboring EGFR amplification or high tumor mutation load gained significant more benefits in PFS from gefitinib plus anlotinib. The incidence of grade 3 or higher treatment-emergent adverse events was 49.7% of the patients receiving gefitinib plus anlotinib versus 31.0% of the patients receiving gefitinib plus placebo. Anlotinib plus gefitinib significantly improves PFS in patients with treatment-naïve, EGFR-mutated, advanced NSCLC, with a manageable safety profile.

Synthesis, characterization, and anticancer activity of a series of ketone-N(4)-substituted thiosemicarbazones and their ruthenium(II) arene complexes.

A series of ketone-N(4)-substituted thiosemicarbazone (TSC) compounds (L1-L9) and their corresponding [(η(6)-p-cymene)Ru(II)(TSC)Cl](+/0) complexes (1-9) were synthesized and characterized by NMR, IR, elemental analysis, and HR-ESI-mass spectrometry. The molecular structures of L4, L9, 1-6, and 9 were determined by single-crystal X-ray diffraction analysis. The compounds were further evaluated for their in vitro antiproliferative activities against the SGC-7901 human gastric cancer, BEL-7404 human liver cancer, and HEK-293T noncancerous cell lines. Furthermore, the interactions of the compounds with DNA were followed by electrophoretic mobility spectrometry studies.

Synchronal pulmonary sarcomatoid carcinoma and lung adenocarcinoma EML4-ALK fusion: A case report.

Pulmonary sarcomatoid carcinoma (PSC) is a rare form of poorly differentiated non-small-cell lung cancer that is prone to distant metastases. PSC is therapeutically challenging, with low sensitivity to conventional radiotherapy and a poor overall prognosis. The present study reported on the case of a 29-year-old male non-smoker diagnosed with both PSC and lung adenocarcinoma; the cancer had a complex etiology and rapidly metastasized after surgery. The patient presented with an EML4-ALK gene fusion in both tumors with high programmed death ligand-1 (PD-L1) expression. After initial treatment failure, Alectinib, Anlotinib and Tirelizumab were combined, which rapidly resolved the patient's symptoms and led to partial remission of disease at 6 weeks and effective control of the disease 7 months into the treatment. This case exemplifies the efficacy of combining targeted chemotherapy with immunotherapy for patients with PSC. Furthermore, this outcome suggests the usefulness of genetic testing and monitoring PD-L1 expression to identify patients with PSC who may be candidates likely to respond to this combined therapeutic regimen. The present study provides evidence of the success of a novel therapeutic strategy for patients with PSC.

Application of 3D-print silica bolus for nasal NK/T-cell lymphoma radiation therapy.

The aim of the study was to evaluate the clinical feasibility of a 3D-print silica bolus for nasal NK/T-cell lymphoma radiation therapy. Intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) plans were designed using an anthropomorphic head phantom with a 3D-print silica bolus and other kinds of bolus used clinically, and the surface dose was measured by a metal oxide semiconductor field-effect transistor (MOSFET) dosimeter. Four nasal NK/T patients with or without 3D-print silica bolus were treated and the nose surface dose was measured using a MOSFET dosimeter during the first treatment. Plans for the anthropomorphic head phantom with 3D-print bolus have more uniform dose and higher conformity of the planning target volume (PTV) compared to other boluses; the homogeneity index (HI) and conformity index (CI) of the VMAT plan were 0.0589 and 0.7022, respectively, and the HI and CI of the IMRT plan were 0.0550 and 0.7324, respectively. The MOSFET measurement results showed that the surface dose of the phantom with 3D-print bolus was >180 cGy, and that of patients with 3D-print bolus was higher than patients without bolus. The air gap volume between the 3D-print bolus and the surface of patients was <0.3 cc. The 3D-print silica bolus fitted well on the patient's skin, effectively reducing air gaps between bolus and patient surface. Meanwhile, the 3D-print silica bolus provided patients with higher individuation, and improved the conformity and uniformity of the PTV compared to other kinds of boluses.

Influence of Verapamil on Pharmacokinetics of Triptolide in Rats.

The aim of this study was to investigate the role of P-glycoprotein (P-gp) in the intestinal absorption of triptolide. In this research, the bidirectional transport of triptolide across Caco-2 cells was studied in vitro. Moreover, the pharmacokinetic profiles of orally administered triptolide with and without pretreatment with verapamil were determined in rats. A markedly higher transport of triptolide across Caco-2 cells was observed in the basolateral-to-apical direction and was abrogated in the presence of the P-gp inhibitor, verapamil. The result indicated that P-gp might be involved in the absorption of triptolide. When the rats were pretreated with verapamil, the C max of triptolide increased from 423.01 ± 19.59 to 565.33 ± 20.27 ng/mL (33.6 %), and the AUC0-6 h increased by approximately 57 % when co-administered with verapamil. It was demonstrated that P-gp was involved in the transport of triptolide, which might exhibit a role in limiting its absorption and attenuating the toxicity of triptolide.

Multispectroscopic Investigation of the Interaction Between two Ruthenium(II) Arene Complexes of Curcumin Analogs and Human Serum Albumin.

The interaction between two ruthenium(II) arene complexes of curcumin analogs and human serum albumin (HSA) was systematically investigated by multispectroscopic techniques. The fluorescence spectral results indicated that two complexes quenched the intrinsic fluorescence of HSA through static quenching mode. The quenching constants and the corresponding thermodynamic parameters at different temperatures were calculated. The binding interactions of two complexes with HSA resulted in the complex formation of complex-HSA, and the van der Waals interactions and hydrogen bond interactions played major roles in the complex stabilization. The distances between HSA and two complexes were obtained according to fluorescence resonance energy transfer theory. The site competitive replacement experiments illustrated that two complexes mainly bounded with HSA on site I. The results of synchronous fluorescence spectra, three-dimensional fluorescence spectra, FT-IR spectra, and circular dichroism spectra indicated that the secondary structure of HSA was changed at the present of two complexes. The results of mass spectrometry further validated the binding interaction and the binding number between two complexes and HSA.

[Applying grading methods of synthesizing multiple guidelines to optimizing extracting technology for Radix Panacis Quinquefolii].

OBJECTIVE: To optimize the best extracting procedure for Radix Panacis Quinquefolii. METHODS: (1) The optimum alcohol extracting procedure was selected with the content and extraction efficiency of ginsenoside Rg, Re, Rb, from Radix Panacis Quinquefolii by orthogonal test design and synthesizing multiple guidelines method. (2) The content of three ginsenoides Rg1, Re and Rb1 in Radix Panacis Quinquefolii was determined by gradient elution method in RP-HPLC. RESULTS: The optimum alcohol-extracting procedure was determined as 12 times of 70% alcohol refluxing and extracting 3 h for 2 times. CONCLUSIONS: The optimum extracting procedure can increase extraction efficiency of Radix Panacis Quinquefolii.

Estimation of type i collagen structure dissolved in inorganical acids from circular dichroism spectra / Estimativa da estrutura de colágeno tipo i dissolvida em ácidos inorgânicos a partir de espectros de dicroísmo circular

Usually, weak inorganic acids have been used to disperse collagen as green solvents for fabricating kinds of biomaterials all the time. However, it is an open question how much the dissolving process preserves or alters the native structure of collagen till now. Herein, we have examined the effect of three different solvents (HAc, HCl, H3PO4) on the secondary structures of collagen, based on circular dichroism (CD) spectra of collagen from 185 to 260 nm together with CDNN programs. We have found that collagen almost completely preserved its triple helical structure in the three inorganic acids at pH=3.0 or so, which demonstrated that it was the concentration of free H+ in the above three solutions whose pH was fixed at 3.0 that can maintain an proper amount of surface charge on the collagen colloidal particles and appropriately loose the three-helix structure, which can not only lead to a better dispersion behavior, but also maximize the preservation of the integrity of the collagen structure. Although the fractions of kinds of secondary structures in collagen were different from all the three solvents based on CDNN data, which gave very similar results for each other. These results was tested for the first time in this work to estimate the secondary structures for collagen in the different common inorganic acids, which provides a new avenue for green collagen solvents to prepare collagen-based composite with well triple-helical structure for tissue engineering.

Habitualmente, os ácidos inorgânicos fracos têm sido usados para dispersar colágeno como solventes verdes para fabricar tipos de biomateriais o tempo todo. No entanto, é uma questão aberta quanto o processo de dissolução preserva ou altera a estrutura nativa do colágeno até agora. Aqui, examinamos o efeito de três solventes diferentes (HAc, HCl, H3PO4) nas estruturas secundárias de colágeno, com base em espectros de dicroísmo circular (CD) de colágeno de 185 a 260 nm em conjunto com programas CDNN. Descobrimos que o colágeno preservou quase completamente sua estrutura helicoidal tripla nos três ácidos inorgânicos a pH = 3,0 ou mais, o que demonstrou que foi a concentração de H+ livre nas três soluções acima cujo pH foi fixado em 3,0 que pode manter uma boa quantidade de carga superficial sobre as partículas coloidais de colágeno e destrói adequadamente a estrutura de três hélices, o que não só pode levar a um melhor comportamento de dispersão, mas também maximizar a preservação da integridade da estrutura de colágeno. Embora as frações de tipos de estruturas secundárias em colágeno fossem diferentes de todos os três solventes com base em dados CDNN, que deram resultados muito semelhantes entre si. Estes resultados foram testados pela primeira vez neste trabalho para estimar as estruturas secundárias para o colágeno nos diferentes ácidos inorgânicos comuns, o que fornece uma nova alternativa para solventes de colágeno verdes para preparar compósitos à base de colágeno com a estrutura helicoidal tripla para engenharia de tecidos.

[Molecular mechanism of Wulongdan for improving the learning and memory abilities of rats with chronic cerebral ischemia].

OBJECTIVE: To evaluate the effect of Wulongdan on the learning and memory abilities of rats with chronic cerebral ischemia and explore the mechanisms. METHODS: Male SD Rat models of chronic cerebral ischemia were established by permanent ligation of the bilateral carotid arteries. Three weeks after the operation, the rats were randomly divided into sham-operated group, chronic cerebral ischemia group (model group), high-dose drug group, low-dose drug group and Yinxingye group and received the corresponding treatments on a daily basis for 5 consecutive weeks. Morris water maze was used to assess the learning and memory abilities of the rats, and Western blotting was carried out for detecting the expressions of NR1 and NR2B in the hippocampus and cerebral cortex. RESULTS: Compared with the model group, the rats in high-dose drug, low-dose drug and Yinxingye groups showed significantly shorter time of finding platform in Morris water maze test (P<0.05 or 0.01). The rats in the model group showed significantly lowered expressions of NR1 and NR2B of the cortex and hippocampus than those in the sham-operated group (P<0.01). In comparison with the model group, the high-dose Wulongdan group and Yinxingye group both showed significantly increase expressions of NR1 and NR2B (P<0.01), but their expression levels still remained significantly lower than those in the sham-operated group (P<0.01). CONCLUSION: Wulongdan can enhance the learning and memory abilities of rats with chronic cerebral ischemia, the mechanisms of which may involve increased expressions of NR1 and NR2B in the hippocampus and cortex.

[Effects of Wulongdan on learning and memory abilities of rats with chronic cerebral ischemia].

OBJECTIVE: To evaluate the effect of Wulongdan, a tradition Chinese medicinal preparation, on the learning and memory abilities of rats with chronic cerebral ischemia and explore the mechanisms. METHODS: Male rats with chronic cerebral ischemia induced by permanent ligation of the bilateral carotid arteries were randomized into sham-operated group, chronic cerebral ischemia (model) group, and high-, middle-, and low-dose Wulongdan groups and Yinxingye group. The corresponding treatments were administered in the rats 24 h after the operation once daily for 8 consecutive weeks. Morris water maze and step-through tests were performed after 7 weeks of drug administration. The brain tissues were then taken to observe the morphological changes in the hippocampal neurons with Nissl staining by transmission electron microscopy. RESULTS: Compared with the model group, the latency of finding the platform in Morris water maze test was significantly shortened (P<0.05 or 0.01), and that in step-through test significantly prolonged (P<0.05 or 0.01) in high-, middle-, and low-dose Wulongdan groups and Yinxingye group. In the model group, Nissl staining of the hippocampal CA1 region visualized obvious pathological changes in the neurons, showing a significant difference from the sham-operated and high-dose Wulongdan groups. CONCLUSION: Wulongdan can enhance the learning and memory abilities of rats with chronic cerebral ischemia possibly through a mechanism in relation to neuronal protection in the hippocampus CA1 region.