Bottom-Up Synthesis of Multicompartmentalized Microreactors for Continuous Flow Catalysis.

The bottom-up assembly of biomimetic multicompartmentalized microreactors for use in continuous flow catalysis remains a grand challenge because of the structural instability or the absence of liquid microenvironments to host biocatalysts in the existing systems. Here, we address this challenge using a strategy that combines stepwise Pickering emulsification with interface-confined cross-linking. Our strategy allows for the fabrication of robust multicompartmentalized liquid-containing microreactors (MLMs), whose interior architectures can be exquisitely tuned in a bottom-up fashion. With this strategy, enzymes and metal catalysts can be separately confined in distinct subcompartments of MLMs for processing biocatalysis or chemo-enzymatic cascade reactions. As exemplified by the enzyme-catalyzed kinetic resolution of racemic alcohols, our systems exhibit a durability of 2000 h with 99% enantioselectivity. Another Pd-enzyme-cocatalyzed dynamic kinetic resolution of amines further demonstrates the versatility and long-term operational stability of our MLMs in continuous flow cascade catalysis. This study opens up a new way to design efficient biomimetic multicompartmental microreactors for practical applications.

Multi-compartmental MOF microreactors derived from Pickering double emulsions for chemo-enzymatic cascade catalysis.

Bioinspired multi-compartment architectures are desired in synthetic biology and metabolic engineering, as credited by their cell-like structures and intrinsic ability of assembling catalytic species for spatiotemporal control over cascade reactions like in living systems. Herein, we describe a general Pickering double emulsion-directed interfacial synthesis method for the fabrication of multicompartmental MOF microreactors. This approach employs multiple liquid-liquid interfaces as a controllable platform for the self-completing growth of dense MOF layers, enabling the microreactor with tailor-made inner architectures and selective permeability. Importantly, simultaneous encapsulation of incompatible functionalities, including hydrophilic enzyme and hydrophobic molecular catalyst, can be realized in a single MOF microreactor for operating chemo-enzymatic cascade reactions. As exemplified by the Grubb' catalyst/CALB lipase driven olefin metathesis/ transesterification cascade reaction and glucose oxidase (GOx)/Fe-porphyrin catalyzed oxidation reaction, the multicompartmental microreactor exhibits 2.24-5.81 folds enhancement in cascade reaction efficiency in comparison to the homogeneous counterparts or physical mixture of individual analogues, due to the restrained mutual inactivation and substrate channelling effects. Our study prompts further design of multicompartment systems and the development of artificial cells capable of complex cellular transformations.

Tri-templating Synthesis of Multilevel Mesoporous Silica Microspheres with a Complex Interior Structure for Efficient CO2 Capture and Catalysis.

Multilevel porous architectures with microscopic shape control and tailor-made complex structures offer great potential for various innovative applications, but their elaborate design and synthesis have remained a scientific and technological challenge. Herein, we report a simple and effective tri-templating method, in which microscale Pickering droplets, nanoscale polystyrene colloids (PS), and molecular cetyltrimethylammonium chloride micelles are synchronously employed, for the fabrication of such micro-nanohierarchical mesoporous silica microspheres. In this protocol, Pickering droplet-directed interfacial sol-gel growth and its spatially confined surfactant assembly-directed sol-gel coating on PS suspensions are coupled together, enabling the successful formation of structured mesoporous silica that consists of numerous nanocompartments enclosed by a permeable shell. By varying the quantity of PS colloidal templates, rational regulation of the complex interior structure is achieved. Also, ascribed to the multilevel arrangement, this peculiar architecture not only shows desirable fast mass transport of external molecules but also possesses easy handling ability. After loading with tetraethylenepentamine or enzyme species, the yielded microspherical CO2 sorbents or immobilized biocatalysts, respectively, exhibit enhanced CO2 capture capacity and enzymatic catalysis efficiency. Notably, taking advantage of their microscopic characteristics, the immobilized biocatalysts could be ideally packed in a fixed-bed reactor for long-term continuous-flow enzymatic reactions. This tri-templating strategy provides a new synthetic route to access other multilevel microscopic materials with fascinating complex structures and paves a way to promote their practical applications.

Pickering-Droplet-Derived MOF Microreactors for Continuous-Flow Biocatalysis with Size Selectivity.

Enzymatic microarchitectures with spatially controlled reactivity, engineered molecular sieving ability, favorable interior environment, and industrial productivity show great potential in synthetic protocellular systems and practical biotechnology, but their construction remains a significant challenge. Here, we proposed a Pickering emulsion interface-directed synthesis method to fabricate such a microreactor, in which a robust and defect-free MOF layer was grown around silica emulsifier stabilized droplet surfaces. The compartmentalized interior droplets can provide a biomimetic microenvironment to host free enzymes, while the outer MOF layer secludes active species from the surroundings and endows the microreactor with size-selective permeability. Impressively, the thus-designed enzymatic microreactor exhibited excellent size selectivity and long-term stability, as demonstrated by a 1000 h continuous-flow reaction, while affording completely equal enantioselectivities to the free enzyme counterpart. Moreover, the catalytic efficiency of such enzymatic microreactors was conveniently regulated through engineering of the type or thickness of the outer MOF layer or interior environments for the enzymes, highlighting their superior customized specialties. This study provides new opportunities in designing MOF-based artificial cellular microreactors for practical applications.

Health-related quality of life in residents aged 18 years and older with and without disease: findings from the First Provincial Health Services Survey of Hunan, China.

OBJECTIVE: Published research has not considered acute diseases and injuries in assessing the impact of varying disease counts on health-related quality of life (HRQoL). We used Chinese value sets of EQ-5D-3L to examine the relationship between the number of diseases individuals had (including chronic diseases, acute diseases and injuries) and their HRQoL. METHODS: A total of 19 387 individuals aged 18 years and older were included in the study. Using data from the First Provincial Health Services Survey of Hunan, China, HRQoL was assessed with the EQ-5D-3L scale, a standardized instrument developed by the EuroQoL group. The EQ-5D-3L utility score was calculated using the Chinese EQ-5D-3L value set. This survey coded disease using the list of 133 conditions that was defined by the First Provincial Health Services Survey of Hunan, China, based on the 10th International Classification of Diseases. 126 conditions were disease-related and were therefore included in data analysis. RESULTS: Of 15 245 respondents, urban residents and male constituted 53.0% and 48.2%, respectively. 19.3% of respondents had one disease and 5.0% had at least two diseases. Of the five dimensions of the EQ-5D-3L, the pain/discomfort dimension had the highest proportion of moderate or serious problems among the respondents (14.4%, 95% CI 10.5% to 18.2%). The average Visual Analogue Scale (VAS) score and utility score were 78.0 (95% CI 76.9 to 79.1) and 0.958 (95% CI 0.946 to 0.970), respectively. Residents with 1 and ≥2 diseases had higher proportions of moderate or serious problems in five dimensions of the EQ-5D-3L scale during the previous 2 weeks than those without disease after controlling for location (urban/rural), sex, age, education level and household income, respectively (adjusted ORs: 3.1-3.7 and 4.4-6.6, respectively). The mean of the EQ VAS score was 8.4 and 13.6 points lower in respondents with 1 and ≥2 diseases than in respondents without disease; the corresponding mean score difference was 0.048 and 0.086 in EQ-5D-3L utility score. Disease-specific analyses were not conducted due to the inadequacy of sample size. CONCLUSIONS: The HRQoL of residents aged 18 years and older declines distinctly as the number of diseases increases. Actions should be taken to improve the HRQoL of residents with multiple diseases in China (including acute diseases, chronic diseases and injuries).

Prevalence of Breastfeeding: Findings from the First Health Service Household Interview in Hunan Province, China.

Background: With the development of economy and urbanization, methods of child-feeding have significantly changed in China over the past three decades. However, little is known about breastfeeding in China since 2009. This study aims to update information on the prevalence of breastfeeding in China. Methods: Data were obtained from the first Health Service Household Interview Survey of Hunan Province, China. Of 24,282 respondents, 1659 were aged five years or younger. We ran multivariable logistic regression to examine the impact of urban/rural setting, gender, age and household income per capita on the use of breastfeeding. Results: A total of 79.4% of children aged 5 years or younger had been breastfed at some point and 44.9% been breastfed exclusively in the first 6 months of life. After controlling for setting urban/rural setting, gender and child age, children from households with average family income were more likely to be breastfed than those from households with the lowest family income (adjusted odds ratio: 2.28). Children from households with higher and the highest family income were less likely to be exclusively breastfed in the first 6 months of life compared to those from households with the lowest family income (adjusted odds ratio: 0.51 and 0.68, respectively). Conclusions: It is encouraging that the prevalence of exclusive breastfeeding for infants in the first 6 months of life in Hunan Province, China is approaching the goal of 50% proposed by the World Health Organization (WHO). Nevertheless, more efforts are needed to further promote exclusive breastfeeding in the first 6 months after birth.

Associations of Undergoing a Routine Medical Examination or Not with Prevalence Rates of Hypertension and Diabetes Mellitus: A Cross-Sectional Study.

BACKGROUND: Undergoing a routine medical examination may be associated with the prevalence rate of chronic diseases from a population-based household interview survey. However, this important issue has not been examined so far. METHODS: Data came from the first health service household interview of Hunan province, China, in 2013. A Rao-Scott chi-square test was performed to examine the difference in prevalence rates between subgroups. Adjusted odds ratio (OR) was calculated using the PROC SURVEYLOGISTIC procedure of SAS9.1 statistical software. RESULTS: In total, 24,282 residents of 8400 households were surveyed. A higher proportion of elderly adults had undergone a medical examination within the prior 12 months compared with young adults (≥65 years, 60%; 45-64 years, 46%; 18-44 years, 37%). After controlling for location, sex, and household income per capita, undergoing a medical examination was significantly associated with high prevalence rates of hypertension (adjusted OR: 2.0, 95% CI: 1.1-3.5) and of diabetes mellitus (adjusted OR: 3.3, 95% CI: 1.7-6.5) for young adults aged 18-44 years. The associations were not statistically significant for age groups 45-64 years and 65 years or older. CONCLUSION: The prevalence rates of hypertension and diabetes mellitus may be seriously underestimated for young adults not undergoing a routine medical examination in a health household interview survey.

Large urban-rural disparity in the severity of two-week illness: updated results based on the first health service survey of Hunan Province, China.

BACKGROUND: To examine urban-rural differences in the severity of non-fatal disease and injury using the latest household interview survey data of Hunan Province, China. METHODS: Two-week illness data were from the first provincial health household interview survey of Hunan in 2013. The proportion of patients being bedridden, the average days of being bedridden and the average off-work days were calculated to measure the severity of two-week illness. Rao-Scott-adjusted chi-square test was performed to examine the significance of two-week illness severity differences from demographic variables. Multiple logistic regression and linear regression were used to control for sex, age and household income. RESULTS: The two-week illness prevalence was 22.8 % in Hunan province. Despite similar two-week ill prevalence rates between urban areas and rural areas (23.0 % vs. 22.8 %), rural residents had higher proportions of being bedridden and of being off work than urban residents after controlling for sex, age and household income, with adjusted odds ratios of 3.4 and 6.9, respectively. Similarly, the average days of being bedridden and of being off work in rural residents were 0.45 days and 1.61 days longer than in urban residents after controlling for demographic variables, respectively. CONCLUSION: The recent data shows that two-week illness in rural residents is more serious than urban residents in Hunan Province, China in spite of very similar two-week prevalence rates. The neglected urban-rural disparities in the severity of two-week illness deserve the attention of health policy-makers and researchers.

[Analysis of satisfactions for services among outpatients and inpatients at the age of equal to or more than 15 years old in Hunan province].

OBJECTIVE: To evaluate the satisfaction of service for outpatient within two weeks and for inpatient service within a year in Hunan Province in 2013 and to analyze the influential factors.
 METHODS: Using the data from the First Health Service Survey of Hunan Province, we evaluated the satisfactions for service in outpatients and inpatients based on the listed satisfaction indicators of the Fifth National Health Service Survey questionnaire. Weighted logistic regression was used to examine the influential factors for patients' satisfactions. SURVEYFREQ and SURVEYLOGISTIC procedures in SAS9.2 were used to conduct statistical analysis.
 RESULTS: The overall satisfaction proportion was 73.85% (95% CI: 68.67%-79.03%) and 66.31% (95% CI: 61.28%-71.34%) for outpatients and inpatients, respectively. After adjusting the location, gender, age and household income, high degree of satisfaction for outpatients was associated with good patience and trust in medical personnel as well as the low medical costs, with the adjusted odds ratios of 3.64, 5.38 and 3.34, respectively; high degree of satisfaction for inpatients was associated with a good attitude from medical personnel to patients' questions, high patients' trust in medical personnel and low medical costs, with the adjusted odds ratios of 2.56, 4.69 and 4.35, respectively.
 CONCLUSION: Most of outpatients and inpatients were satisfied with medical services in 2013 in Hunan province. High degree of satisfaction is associated with good attitude from medical personnel to patients' questions, good patience and trust in medical personnel, and low medical costs.

[Forecast the trend of burden from fatal road traffic injuries between 2015 and 2030 in China].

OBJECTIVE: To predict the burden caused by fatal road traffic injuries from 2015 to 2030. METHODS: We searched the websites of United Nations Population Division,United States Department of Agriculture, World Health Organization, China Energy Research Foundation and other agencies to obtain the predictive values of gross domestic product (GDP) per capita, urbanization, motorization and education from 2015 to 2030 in China. Predicted values were then applied to log-linear models to estimate the numbers and years of life lost due to road traffic injuries from 2015 to 2030. RESULTS: The mortality rate caused by road traffic injury decreased slightly, from 13.7/100 000 in 2015 to 11.8/100 000 in 2030. 191, 189, 183, 169 thousand persons were estimated to die from road traffic crashes in 2015, 2020, 2025 and 2030, respectively, showing a declining trend. Years of Life Lost (YLLs) caused by road traffic deaths were predicted to be 6 918, 6 634, 6 189, 5 513 thousand years in 2015, 2020, 2025 and 2030, respectively, also showing a gradual downward trend. But the YLLs displayed an increase among people at 55 years of age or older, between 2015 and 2030. Results from the sensitivity analysis showed a stable forecasting result. CONCLUSION: Mortality, number of deaths and YLLs from road traffic crashes were predicted to decrease slightly, between 2015 and 2030 but the number of deaths and YLLs due to road traffic injuries will continue to increase from 2015 to 2030.

[Development of forecasting models for fatal road traffic injuries].

OBJECTIVE: To develop the forecasting models for fatal road traffic injuries and to provide evidence for predicting the future trends on road traffic injuries. METHODS: Data on the mortality of road traffic injury including factors as gender and age in different countries, were obtained from the World Health Organization Mortality Database. Other information on GDP per capita, urbanization, motorization and education were collected from online resources of World Bank, WHO, the United Nations Population Division and other agencies. We fitted logarithmic models of road traffic injury mortality by gender and age group, including predictors of GDP per capita, urbanization, motorization and education. Sex- and age-specific forecasting models developed by WHO that including GDP per capita, education and time etc. were also fitted. Coefficient of determination(R(2)) was used to compare the performance between our modes and WHO models. RESULTS: 2 626 sets of data were collected from 153 countries/regions for both genders, between 1965 and 2010. The forecasting models of road traffic injury mortality based on GDP per capita, motorization, urbanization and education appeared to be statistically significant(P < 0.001), and the coefficients of determination for males at the age groups of 0-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65+ were 22.7% , 31.1%, 51.8%, 52.3%, 44.9%, 41.8%, 40.1%, 25.5%, respectively while the coefficients for these age groups in women were 22.9%, 32.6%, 51.1%, 49.3%, 41.3%, 35.9%, 30.7%, 20.1%, respectively. The WHO models that were based on the GDP per capita, education and time variables were statistically significant (P < 0.001)and the coefficients of determination were 14.9% , 22.0%, 31.5%, 33.1% , 30.7%, 28.5%, 27.7% and 17.8% for males, but 14.1%, 20.6%, 30.4%, 31.8%, 26.7%, 24.3%, 17.3% and 8.8% for females, respectively. CONCLUSION: The forecasting models that we developed seemed to be better than those developed by WHO.

Analysis of the quantity and quality of published randomised controlled trials related to injury prevention from 2001 to 2010 in China.

OBJECTIVE: To report the quantity and quality of published randomised controlled trails (RCT) on injury prevention in China. DESIGN: Bibliometric analysis. SETTING: China, 2001-2010. DATA SOURCES: The published RCTs that were indexed by four domestic electronic databases and two international databases between 1 January 2001 and 31 December 2010. MAIN OUTCOME MEASURES: Numbers and proportions of published RCTs and those that did not report or specify the quality items recommended by Cochrane Handbook for Systematic Reviews of Intervention V.5.0.0. RESULTS: Of 4834 publications of injury prevention, 25 RCTs with 55,431 participants were identified. One study had no full text. Twenty-three RCTs were published in Chinese language. All 25 studies chose education as the intervention, including 19 studies using education as single intervention and 6 studies using education as a part of combined intervention. Eighteen of 19 studies that used injury incidence rate as the primary outcome measure; 10 studies reported 24-59% reductions in injury incidence rate in the intervention group, and 8 studies reported 24-76% rate difference between the intervention group and the control group after the implementation of intervention. Only 1 study reported no significant difference. The other 6 studies only reported improvements in knowledge, attitude and practice/behaviour. None of 24 studies with full text included the information of 'allocation concealment', 'blinding' and 'free of early stopping bias'. CONCLUSIONS: The value of 25 published RCTs cannot be determined due to the lack of quality information. More high-quality RCTs need to be performed in the future.

Neglected increases in rural road traffic mortality in China: findings based on health data from 2005 to 2010.

BACKGROUND: Recent changes in rural road traffic mortality have not been examined in China although rural residents were reported as having greater risk of road traffic injury than urban residents. We aimed to examine changes in urban and rural road traffic mortality rates between 2005 and 2010 in China. METHODS: Mortality rates came from the publicly available health data of the Ministry of Health-Vital Registration System that is based on a national representative sample (about 10% of total population), including 41 surveillance points in urban areas (15 large cities and 21 middle/small cities) and 85 surveillance points in rural areas. The causes of deaths were coded using the Tenth International Classification of Diseases (ICD-10). Linear regression was used to test the statistical significance of changes in mortality rates. We calculated the percent change in rates to quantify the change between 2005 and 2010, which was calculated as regression coefficient * 100 * 5 divided by the rate in 2005. RESULTS: In rural areas, road traffic mortality increased by 70%, changing from 13.3 per 100,000 population in 2005 to 22.7 per 100,000 population in 2010. In contrast, the road traffic mortality merely increased by 4% in the study time period, rising from 13.1 to 13.9 per 100,000 population in urban areas. Both the increases in road traffic mortality from motor vehicle crashes and from non-motor vehicle crashes were larger in rural areas than in urban areas (106% vs. 4%; 29% vs. 3%). CONCLUSION: The tremendous increase in road traffic mortality in rural areas calls for urgent actions to reduce road traffic injuries to motor vehicle occupants, motorcyclists, bicyclists and pedestrians in in rural areas.

[An investigation into perception of preventability of injuries and knowledge needs on injury prevention among 684 among undergraduates of a university].

OBJECTIVE: To examine the perception of the preventability of injury and needs on injury prevention knowledge among undergraduates. METHODS: Stratified sampling and cluster sampling were used to select undergraduate students from 12 classes of three specialized fields of Central South University. A survey was carried out to understand beliefs of the preventability of injuries and knowledge needs on injury prevention. RESULTS: Over 80% of students believed that drowning (605/684), road traffic injuries (601/684), burns and suicide/self-harm (591/684) are most preventable, while merely 59.6% (408/684) and 56.4% (386/684) of students considered cut/pierce and homicide/assault most preventable. The beliefs of preventability of common injuries were not statistically significant between non-public-health medical students, public health students, and non-medical students (P > 0.05), with an exception for poisoning. 18.1% of students (124) reported to received short-term injury training or take lecture for injury prevention, and 27.9% of students (191) had ever read injury-related books. There were 60% (410/684) and 56% (383/684) of students respectively reporting needs for prevention knowledge about poisoning and road traffic injuries. CONCLUSION: Many undergraduates hold incorrect perception on the preventability of injuries, quite a few report knowledge needs for injury prevention.

[Analysis of the incidence of short-term illness in four counties of Hunan Province].

OBJECTIVE: To determine the prevalence and incidence of illness of two-week duration, and the factors influencing these, among residents 15 years and older in four counties of Hunan Province. METHODS: Data were sampled from four counties of Hunan Province for the Fourth National Health Service Survey. Incidence and two-week prevalence of disease were used to assess the health service needs of residents. A non-conditional, stepwise logistic regression was employed to explore the influencing factors. RESULTS: The two-week prevalence and incidence were 11.5% and 3.9%, respectively, in four counties of Hunan. The three leading diseases of two-week prevalence were: respiratory diseases, digestive diseases, and musculoskeletal diseases. Non-conditional stepwise logistic regression showed that urban residents had 0.64 times the risk of two-week illness compared with the rural residents (P< 0.05); residents in the 45-59 year age group and the 60+ year age group had 1.69 and 2.62 times the risk of two-week illness compared with residents in the 15-44 year age group, respectively (P<0.05). The widowed had 1.91 times the risk of prevalence of two-week illness contrasted to singles (P<0.05); the students had 0.29 times the risk of two-week illness contrasted to the workers (P<0.05); urban residents had 0.63 times the risk of two-week illness compared with the rural (P<0.05); the widowed had 2.37 times the risk of incidence of two-week illness compared with singles (P<0.05). CONCLUSION: The majority of health service needs of residents of four counties is generated by three diseases: respiratory diseases, digestive diseases, and musculoskeletal diseases. Relatively, rural residents, the elderly, employed persons and the widowed have higher health service needs than others and deserve specific attention.