YY1 directly interacts with myocardin to repress the triad myocardin/SRF/CArG box-mediated smooth muscle gene transcription during smooth muscle phenotypic modulation.

Yin Yang 1 (YY1) regulates gene transcription in a variety of biological processes. In this study, we aim to determine the role of YY1 in vascular smooth muscle cell (VSMC) phenotypic modulation both in vivo and in vitro. Here we show that vascular injury in rodent carotid arteries induces YY1 expression along with reduced expression of smooth muscle differentiation markers in the carotids. Consistent with this finding, YY1 expression is induced in differentiated VSMCs in response to serum stimulation. To determine the underlying molecular mechanisms, we found that YY1 suppresses the transcription of CArG box-dependent SMC-specific genes including SM22α, SMα-actin and SMMHC. Interestingly, YY1 suppresses the transcriptional activity of the SM22α promoter by hindering the binding of serum response factor (SRF) to the proximal CArG box. YY1 also suppresses the transcription and the transactivation of myocardin (MYOCD), a master regulator for SMC-specific gene transcription by binding to SRF to form the MYOCD/SRF/CArG box triad (known as the ternary complex). Mechanistically, YY1 directly interacts with MYOCD to competitively displace MYOCD from SRF. This is the first evidence showing that YY1 inhibits SMC differentiation by directly targeting MYOCD. These findings provide new mechanistic insights into the regulatory mechanisms that govern SMC phenotypic modulation in the pathogenesis of vascular diseases.

Effects of graphene oxide on algal cellular stress response: Evaluating metabolic characters of carbon fixation and nutrient removal.

The effects of different concentrations of graphene oxide (GO) on intracellular metabolism in Chlorella vulgaris (C. vulgaris) and removal of nitrogen and phosphorus nutrients by C. vulgaris from synthetic wastewater were studied. The results demonstrated that cell division of Chlorella vulgaris increased at 24 h and decreased at 96 h after exposure to different concentrations of GO. The removal rates of total nitrogen (TN), ammoniacal nitrogen (NH3-N), phosphate (PO43--P), and chemical oxygen demand (COD) were 24.1%, 70.0%, 37.0%, and 39.6%, respectively, when the concentration of GO was 0.01 mg/L 10 mg/L GO induced severe plasmolysis and cytoplasmic contraction. Furthermore, the protein-like exopolysaccharide (EPS) content of algal cells exposed to 10 mg/L GO decrease to 10.8% of the control group. Simultaneously, the reactive oxygen species (ROS) level was 175.4% of control group. The biological responses to 10 mg/L GO included increase in ROS level, inhibition of saccharide metabolism, and degradation of amino acids. In addition, high concentrations of 10 mg/L GO weakened the carbon fixation process in algal cells. These stress-response behaviors increased cell permeability and oxidative stress. Overall, these findings provide new insights regarding the effects of GO on algal cellular stress responses.

Patient experience of hospital care in China: major findings from the Chinese Patient Experience Questionnaire Survey (2016-2018).

OBJECTIVES: China launched the National Healthcare Improvement Initiative (NHII) in 2015 to improve patient experiences in healthcare. This study aimed to generate evidence of hospital care quality from the patients' perspective. DESIGN: This nationwide cross-sectional study interviewed participants from 31 provinces, municipalities and autonomous regions across China. SETTING: A total of 117 tertiary hospitals in mainland China. PARTICIPANTS: 48 422 responses from outpatients and 35 957 responses from inpatients were included in this study. PRIMARY OUTCOME MEASURE: The scores of six predefined domains in the Chinese Patient Experience Questionnaire, five of which were designed to reflect specific dimensions of care, and one of which indicated the overall rating. RESULTS: More than 80% of the respondents viewed their care experiences as positive. The NHII seems to have had a positive impact, as indicated by the steady, although unremarkable, increase in the patient experience scores over the 2016-2018 period. The Chinese patients generally reported a positive experience with the clinical aspects of care, but reported a less positive experience with the environmental, interpersonal and social services aspects of care. The institutional factors, including region and type of hospital, and personal factors, such as gender, age, education and occupation, were factors affecting the patient experience in China. Humanistic care was the aspect of care with the greatest association with the overall patient experience rating in both the outpatient and inpatient settings. CONCLUSIONS: The national survey indicated an overall positive patient perspective of care in China. Older age, higher education level and formal employment status were found to be correlated with positive care experiences, as were higher levels of economic development of the region, a more generous insurance benefits package and a higher degree of coordinated care. The interpersonal-related initiatives had substantial roles in the improvement of the patient experience. In the regions where farmers and users of traditional Chinese medicine services constitute a greater proportion of the population, improvement of patient experiences for these groups deserves special policy attention.