Simultaneous segmentation and classification of 99mTc-DMSA renal scintigraphic images with a deep learning approach.

BACKGROUND: 99mTc-DMSA scan plays an important role in assessing functional abnormalities in kidneys. As a promising network for deep learning (DL), Mask R-CNN has the capability of simultaneously segmenting and classifying objects in images. In this study, we tested the feasibility and accuracy of Mask R-CNN in diagnosing acute pyelonephritis (APN) and segmenting kidneys in 99mTc-DMSA scintigraphic images. Two hundred and sixty patients with suspected APN were recruited for DMSA scan, of which 358 kidneys were diagnosed as APN. Of the recruited patients, 210 were randomly selected for training and validating Mask R-CNN, and the other 50 patients' images were used for model testing. Accuracy of the results was assessed by comparing against references from human experts. RESULTS: In the validation phase, the trained model provided segmentation masks with intersection over union (mask IoU, for segmentation accuracy) of 86.6%, and classifications with mean average precision at the bounding box IoU ≥ 50% (mAP50, for classification accuracy) of 86.2%. In testing with the 50 independent patients, mask IoU of the model's segmentation was 90.3%±2.2%, and in classifying the kidneys for APN, the trained model showed accuracy of 89.0%, sensitivity of 84.8% and specificity of 97.0%. In identifying patients with any APN kidney, 3 out of 50 patients were mis-diagnosed, achieving accuracy of 94.0%. CONCLUSIONS: Mask R-CNN, designed to perform both segmentation and classification for images, showed much promise in analyzing 99mTc-DMSA images for both accurate diagnosis of APN and kidney segmentation.

Core-shell cobalt-iron@N-doped carbon: A high-performance cathode material for lithium-sulfur batteries.

Lithium-sulfur batteries hold great promise as energy storage systems, but the shuttle effect of lithium polysulfides (LiPS) and large volume variation limit their capacity and cycle life. We have developed CoFe alloy wrapped in N-doped porous carbon spheres (e-CF@NC) with a core-shell structure through simple copolymerization and pyrolysis. The nitrogen-doped porous carbon shell provides electron and ion transport channels and more active sites for electrolyte ion adsorption. The high chemically stable carbon can limit the segregation of polysulfides, further improving the battery cycling stability. Besides, the inside CoFe alloy particles catalyze the conversion between LiPS and Li2S, speeding up reaction kinetics and reducing solvation of active sites. Consequently, lithium-sulfur batteries with e-CF@NC-2 as the cathode display a high initial specific capacity of 1146 mA h g-1 at 0.1 C, excellent rate performance (891 mA h g-1 at 1 C, 741 mA h g-1 at 2 C), and satisfied cycle stability (average capacity decay rate of 0.033% per cycle at 1 C for 300 cycles), demonstrating significant application potential.

Supramolecular polymer cross-linking gel electrolyte for highly stable quasi-solid-state lithium metal batteries.

Lithium (Li) metal batteries have the advantage of high energy density, but the Li dendrites risk piercing the separator and causing a short circuit in the battery. Replacing the liquid electrolytes with gel electrolytes is considered an effective strategy to solve the issues. Herein, a poly(vinylidene fluoride-co-hexafluoropropylene) (PVDF-HFP)-based gel electrolyte, improved with multifunctional supramolecular polymer (MSP), was prepared to enhance the cycling stability and energy density of quasi-solid-state Li metal batteries. The MSP addictive constructs a cross-linked network structure with PVDF-HFP matrix and lithium bis(trifluoromethanesulfonyl)imide (LiTFSI) through hydrogen bonding, improving the mechanical strength of the composite gel electrolyte (PH-10%MSP-GE) to against the growth of Li dendrites. Moreover, the pre-lithiated sulfonic acid groups, conductive polyether groups of MSP, and the attraction of TFSI- anions, promote the Li-ion transportation of the composite gel electrolyte. Finally, the Li||Li symmetric cell cycle stably for over 450 h. The Li||LiFePO4 full cell demonstrates a high energy density and excellent cycling stability for over 600 cycles, with a capacity retention rate of up to 98.7%. This work provides valuable insights into the preparation of multifunctional composite gel polymer electrolytes and competitive quasi-solid-state Li metal batteries.

White Matter Magnetic Resonance Diffusion Measures in Multiple Sclerosis with Overactive Bladder.

BACKGROUND: Lower urinary tract (LUT) symptoms are reported in more than 80% of patients with multiple sclerosis (MS), most commonly an overactive bladder (OAB). The relationship between brain white matter (WM) changes in MS and OAB symptoms is poorly understood. OBJECTIVES: We aim to evaluate (i) microstructural WM differences across MS patients (pwMS) with OAB symptoms, patients without LUT symptoms, and healthy subjects using diffusion tensor imaging (DTI), and (ii) associations between clinical OAB symptom scores and DTI indices. METHODS: Twenty-nine female pwMS [mean age (SD) 43.3 years (9.4)], including seventeen with OAB [mean age (SD) 46.1 years (8.6)] and nine without LUT symptoms [mean age (SD) 37.5 years (8.9)], and fourteen healthy controls (HCs) [mean age (SD) 48.5 years (20)] were scanned in a 3T MRI with a DTI protocol. Additionally, clinical scans were performed for WM lesion segmentation. Group differences in fractional anisotropy (FA) were evaluated using tract-based spatial statistics. The Urinary Symptom Profile questionnaire assessed OAB severity. RESULTS: A statistically significant reduction in FA (p = 0.004) was identified in microstructural WM in pwMS, compared with HCs. An inverse correlation was found between FA in frontal and parietal WM lobes and OAB scores (p = 0.021) in pwMS. Areas of lower FA, although this did not reach statistical significance, were found in both frontal lobes and the rest of the non-dominant hemisphere in pwMS with OAB compared with pwMS without LUT symptoms (p = 0.072). CONCLUSIONS: This study identified that lesions affecting different WM tracts in MS can result in OAB symptoms and demonstrated the role of the WM in the neural control of LUT functions. By using DTI, the association between OAB symptom severity and WM changes were identified, adding knowledge to the current LUT working model. As MS is predominantly a WM disease, these findings suggest that regional WM involvement, including of the anterior corona radiata, anterior thalamic radiation, superior longitudinal fasciculus, and superior frontal-occipital fasciculus and a non-dominant prevalence in WM, can result in OAB symptoms. OAB symptoms in MS correlate with anisotropy changes in different white matter tracts as demonstrated by DTI. Structural impairment in WM tracts plays an important role in LUT symptoms in MS.

A Multi-Responsive Hydrogel Combined With Mild Heat Stimulation Promotes Diabetic Wound Healing by Regulating Inflammatory and Enhancing Angiogenesis.

The repair of diabetic wound still encounters huge challenges, such as disordered inflammatory regulation and impaired neovascularization. Here, a pH/ROS/glucose responsive and photothermal hydrogel is developed for diabetic wound healing. The hydrogel is formed through cross-linkage between phenylboronic acid-modified carboxymethyl chitosan (CMCS-PBA) and oxide dextran (OXD), utilizing Schiff base and phenylboronate ester bonds. Additionally, insulin-like growth factor 1 C domain (IGF-1C) and deferoxamine-loaded polydopamine nanoparticles (D@P) are incorporated into the hydrogel. The hydrogel demonstrates sustained drug release, excellent photo thermal effect, prominent antioxidant, antibacterial and anti-inflammatory activities, desirable mechanical and tissue adhesive properties, enhanced tube formation, and cell migration. Furthermore, the hydrogel combined with mild heat treatment can regulate chronic inflammation by promoting the transformation of macrophages from M1 phenotype to M2 phenotype and enhance angiogenesis by up-regulating the expression levels of angiogenesis-related factors such as hypoxia-inducible factor-1 alpha (HIF-1α), vascular endothelial growth factor (VEGF), CD31, and α-SMA, thus greatly accelerates the wound healing in streptozotocin (STZ)-induced diabetic mice. Therefore, this multi-responsive and multifunctional hydrogel holds potential as a therapeutic strategy for diabetic wounds.

Identification of Rapeseed (Brassica napus L.) Plant Height-Associated QTL Using BSA-seq and RNA-seq.

Plant height (PH) is a critical agronomic trait in Brassica napus, significantly impacting yield. Consequently, identifying genes associated with plant height is a pivotal objective in oilseed rape breeding. This study employed a combination of bulk segregant analysis sequencing (BSA-seq) and RNA sequencing (RNA-seq) for analysis. A novel quantitative trait locus (QTL), qPH_C02, was identified between 63,989,634 and 64,945,122 bp on chromosome C02, from which eight candidate genes were screened. The Gene Ontology (GO) analysis revealed enrichment in peroxisomes, while the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis indicated enrichment in the oxidative phosphorylation (OP) pathway. It is hypothesized that the observed differences in plant height and silique length may be attributed to the regulation of peroxidase activity in the OP pathway, which in turn alters plant energy metabolism and controls nutrient uptake. Subsequently, we will further test this hypothesis. The results of this study will contribute to our understanding of the genetic basis for differences in plant height and provide a foundation for the selection and breeding of Brassica napus varieties with desired plant shapes.

Analysis of Vibration Characteristics of Spatial Non-Uniform Tensioned Thin-Film Structures Based on the Absolute Nodal Coordinate Formulation.

Due to their lightweight characteristics, spatial thin-film structures can generate vibrations far exceeding their film thickness when subjected to external loads, which has become a key factor limiting their performance. This study examines the vibration characteristics of tensioned membrane structures with non-uniform elements subjected to impacts in air, leveraging the Absolute Nodal Coordinate Formulation (ANCF). This model takes into account the wrinkling deformation of thin films under pre-tension and incorporates it into the dynamic equation derived using the absolute node coordinate method. A detailed discussion was conducted on the influence of non-uniform elements, situated at different locations and side lengths, on the vibration characteristics of the thin film. The analytical results obtained from the vibration model were compared with the experimental results, validating the effectiveness of the vibration model. This provides a theoretical foundation for the subsequent vibration control of thin films.

Antiviral Effectiveness, Clinical Outcomes, and Artificial Intelligence Imaging Analysis for Hospitalized COVID-19 Patients Receiving Antivirals.

INTRODUCTION: There is still a lack of clinical evidence comprehensively evaluating the effectiveness of antiviral treatments for COVID-19 hospitalized patients. METHODS: A retrospective cohort study was conducted at Beijing You'An Hospital, focusing on patients treated with nirmatrelvir/ritonavir or azvudine. The study employed a tripartite analysis-viral dynamics, survival curve analysis, and AI-based radiological analysis of pulmonary CT images-aiming to assess the severity of pneumonia. RESULTS: Of 370 patients treated with either nirmatrelvir/ritonavir or azvudine as monotherapy, those in the nirmatrelvir/ritonavir group experienced faster viral clearance than those treated with azvudine (5.4 days vs. 8.4 days, p < 0.001). No significant differences were observed in the survival curves between the two drug groups. AI-based radiological analysis revealed that patients in the nirmatrelvir group had more severe pneumonia conditions (infection ratio is 11.1 vs. 5.35, p = 0.007). Patients with an infection ratio higher than 9.2 had nearly three times the mortality rate compared to those with an infection ratio lower than 9.2. CONCLUSIONS: Our study suggests that in real-world studies regarding hospitalized patients with COVID-19 pneumonia, the antiviral effect of nirmatrelvir/ritonavir is significantly superior to azvudine, but the choice of antiviral agents is not necessarily linked to clinical outcomes; the severity of pneumonia at admission is the most important factor to determine prognosis. Additionally, our findings indicate that pulmonary AI imaging analysis can be a powerful tool for predicting patient prognosis and guiding clinical decision-making.

Identification of novel mitophagy-related biomarkers for Kawasaki disease by integrated bioinformatics and machine-learning algorithms.

Background: Kawasaki disease (KD) is a systemic vasculitis primarily affecting the coronary arteries in children. Despite growing attention to its symptoms and pathogenesis, the exact mechanisms of KD remain unclear. Mitophagy plays a critical role in inflammation regulation, however, its significance in KD has only been minimally explored. This study sought to identify crucial mitophagy-related biomarkers and their mechanisms in KD, focusing on their association with immune cells in peripheral blood. Methods: This research used four datasets from the Gene Expression Omnibus (GEO) database that were categorized as the merged and validation datasets. Screening for differentially expressed mitophagy-related genes (DE-MRGs) was conducted, followed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. A weighted gene co-expression network analysis (WGCNA) identified the hub module, while machine-learning algorithms [random forest-recursive feature elimination (RF-RFE) and support vector machine-recursive feature elimination (SVM-RFE)] pinpointed the hub genes. Receiver operating characteristic (ROC) curves were generated for these genes. Additionally, the CIBERSORT algorithm was used to assess the infiltration of 22 immune cell types to explore their correlations with hub genes. Interactions between transcription factors (TFs), genes, and Gene-microRNAs (miRNAs) of hub genes were mapped using the NetworkAnalyst platform. The expression difference of the hub genes was validated using quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). Results: Initially, 306 DE-MRGs were identified between the KD patients and healthy controls. The enrichment analysis linked these MRGs to autophagy, mitochondrial function, and inflammation. The WGCNA revealed a hub module of 47 KD-associated DE-MRGs. The machine-learning algorithms identified cytoskeleton-associated protein 4 (CKAP4) and serine-arginine protein kinase 1 (SRPK1) as critical hub genes. In the merged dataset, the area under the curve (AUC) values for CKAP4 and SRPK1 were 0.933 [95% confidence interval (CI): 0.901 to 0.964] and 0.936 (95% CI: 0.906 to 0.966), respectively, indicating high diagnostic potential. The validation dataset results corroborated these findings with AUC values of 0.872 (95% CI: 0.741 to 1.000) for CKAP4 and 0.878 (95% CI: 0.750 to 1.000) for SRPK1. The CIBERSORT analysis connected CKAP4 and SRPK1 with specific immune cells, including activated cluster of differentiation 4 (CD4) memory T cells. TFs such as MAZ, SAP30, PHF8, KDM5B, miRNAs like hsa-mir-7-5p play essential roles in regulating these hub genes. The qRT-PCR results confirmed the differential expression of these genes between the KD patients and healthy controls. Conclusions: CKAP4 and SRPK1 emerged as promising diagnostic biomarkers for KD. These genes potentially influence the progression of KD through mitophagy regulation.

Chemical vapor deposition growth of high-quality 2D ultrathin hexagonal CoSb crystals.

CoSb has emerged as an important two-dimensional (2D) atomic crystal for its potential application in energy conversion and superconductivity. Controllable growth in terms of thickness and structural phase is necessary to elucidate its intrinsic properties at the 2D limit. Here we demonstrate the chemical vapour deposition of ultrathin hexagonal CoSb crystals on the mica substrate. The thickness could be controlled by growth time and the structural phase could be tuned by the precursor's supply ratio. Electrical transport measurements show that the chemical vapor deposition-grown ultrathin hexagonal CoSb is a good metal with non-Fermi liquid behavior. No apparent superconductivity has been observed down to 2.8 K.

Genetic association analyses highlight apolipoprotein B as a determinant of chronic kidney disease in patients with type 2 diabetes.

BACKGROUND: Blood lipid levels were associated with chronic kidney disease (CKD) in patients with type 2 diabetes (T2D), but the genetic basis and causal nature remains unclear. OBJECTIVE: This study aimed to investigate the relationships of lipids and their fractions with CKD in patients with T2D. METHODS: Our prospective analysis involved 8,607 White participants with T2D but no CKD at baseline from the UK Biobank. Five common lipid traits were included as exposures. Weighted genetic risk scores (GRSs) for these lipid traits were developed. The causal associations between lipid traits, as well as lipid fractions, and CKD were explored using linear or nonlinear Mendelian randomization (MR). The 10-year predicted probabilities of CKD were evaluated via integrating MR and Cox models. RESUTLS: Higher GRS of apolipoprotein B (ApoB) was associated with an increased CKD risk (HR[95 % CI]:1.07[1.02,1.13] per SD;P = 0.008) after adjusting for potential confounders. Linear MR indicated a positive association between genetically predicted ApoB levels and CKD (HR[95 % CI]:1.53[1.12,2.09];P = 0.008), but no evidence of associations was found between other lipid traits and CKD in T2D. Regarding 12 ApoB-contained lipid fractions, a significant causal association was found between medium very-low-density lipoprotein particles and CKD (HR[95 % CI]:1.16[1.02,1.32];P = 0.020). Nonlinear MR did not support nonlinearity in these causal associations. The 10-year probability curve showed that ApoB levels was positively associated with the risk of CKD in patients with T2D. CONCLUSION: Lower ApoB levels were causally associated with a reduced risk of CKD in patients with T2D, positioning ApoB as a potential therapeutic target for CKD prevention in this population.

Microplastics' vector effect on Co-bioaccumulation of it and polychlorinated biphenyls in Crassostrea hongkongensis.

Microplastics (MPs) and polychlorinated biphenyls (PCBs) are known with high persistence and toxicity, posing urgent threats to food safety and human health. However, little is known about the synergistic effect of MPs on PCBs bioaccumulation on Crassostrea hongkongensis. In the present study, diverse types of MPs were analyzed on sea water and C. hongkongensis sampled from three distinct estuary sites, and film-shaped MPs were discovered to be preferentially ingested by the oysters. Interestingly, the content of MPs and PCBs showed negative correlation (R2 = 0.452, p< 0.001) in the oysters sampled from site 2. Upon MPs and PCBs co-treatment, the in vivo accumulation of PCBs in C. hongkongensis was inhibited by 25.90 % when compared to the group treated with PCBs solely. PCBs stresses significantly induced the expression of genes of CYP2C31, GST, SOD and HSP70 in C. hongkongensis, while, the elevated state was compromised when co-treated with PCBs. The present research alleviates concerns about the potential effects of MPs on promoting PCBs bioaccumulation and provide a better understanding of the combined impact of MPs and PCBs on C. hongkongensis.

Exercise-induced changes in intramuscular total creatine concentration measured with 1H magnetic resonance spectroscopy: A pilot study.

Total amount of creatine (Cr) and phosphocreatine, or total creatine (tCr), may have a significant impact on the performance of skeletal muscles. In sports such as bodybuilding, it is popular to take Cr supplements to maintain tCr level. However, no study has explored the quantitative relationship between exercise intensity and the induced change in muscle's tCr. In this well-controlled study, straight-leg plantar flexion with specific load and duration was performed by 10 healthy subjects inside an MRI scanner, immediately followed by 1H MR spectroscopy (MRS) for measuring tCr concentration in gastrocnemius. For repeatability assessment, the experiment was repeated for each subject on two different days. Across all the subjects, baseline tCr was 46.6 ± 2.4 mM, ranging from 40.6 to 50.1 mM; with exercise, tCr significantly decreased by 10.9% ± 1.0% with 6-lb load and 21.0% ± 1.3% with 12-lb load (p < 0.0001). Between two different days, baseline tCr, percentage decrease induced by exercise with a 6-lb and 12-lb load differed by 2.2% ± 2.3%, 11.7% ± 6.0% and 4.9% ± 3.2%, respectively. In conclusion, the proposed protocol of controlled exercise stimulation and MRS acquisition can reproducibly monitor tCr level and its exercise-induced change in skeletal muscles. The measured tCr level is sensitive to exercise intensity, so can be used to quantitatively assess muscle performance or fatigue.

In the Acute Phase of Anterior Cruciate Ligament Rupture: Quantitative Assessment of Matrix Changes and Correlation between Different States of Meniscus and Adjacent Cartilage.

OBJECTIVE: Cartilage and meniscus are important structures that maintain the health of the knee joint. Early detection of changes in the internal components of cartilage and meniscus before morphological changes occur is essential to prevent and delay the development of osteoarthritis (OA). This study was designed to determine the changes in the matrix composition of morphologically intact cartilage and meniscus during the acute phase of an anterior cruciate ligament (ACL) rupture, as well as the effect of different states of meniscus (intact or tear) on adjacent cartilage during the acute phase. METHODS: This cross-sectional study compared and analyzed 50 patients in the acute phase of ACL rupture who underwent surgical treatment and 66 age-, weight- and height-matched healthy volunteers from May 2022 to May 2023 at our institution. Mean T2 relaxation times and effect sizes in different regions of tibiofemoral articular cartilage and meniscus were compared between the two groups using the Mann-Whitney nonparametric t-test, and correlations between different meniscal states and adjacent cartilage were analyzed. RESULTS: Both in the lateral and medial compartments of the knee, T2 relaxation times were significantly higher in all subregions of cartilage and meniscus in the ACL rupture group (p < 0.05), and the site of injury was predominantly centered in the medial compartment (femur, p = 0.000; tibia, p = 0.000; anterior horn, p = 0.000). In the respective compartments, the posterior horn of the lateral meniscus showed a significant positive correlation with the mid-cartilage of the femoral and tibial (r = 0.566, p = 0.035; r = 0.611, p = 0.02); and the posterior horn of the medial meniscus showed a significant positive correlation with the posterior tibial cartilage (r = 0.668, p = 0.018). CONCLUSION: During the acute phase of ACL rupture, the internal composition of the cartilage and meniscus undergoes significant changes, even if the morphology is intact. More importantly, the state of the meniscus significantly affects the internal composition of the adjacent cartilage. This is an early warning sign of OA, which should be closely monitored and carefully managed in clinical practice.

Poly(Photosensitizer-Prodrug) Unimolecular Micelles for Chemo-Photodynamic Synergistic Therapy of Antitumor and Antibacteria.

It is crucial to use simple methods to prepare stable polymeric micelles with multiple functions for cancer treatment. Herein, via a "bottom-up" strategy, we reported the fabrication of ß-CD-(PEOSMA-PCPTMA-PPEGMA)21 (ßPECP) unimolecular micelles that could simultaneously treat tumors and bacteria with chemotherapy and photodynamic therapy (PDT). The unimolecular micelles consisted of a 21-arm ß-cyclodextrin (ß-CD) core as a macromolecular initiator, photosensitizer eosin Y (EOS-Y) monomer EOSMA, anticancer drug camptothecin (CPT) monomer, and a hydrophilic shell PEGMA. Camptothecin monomer (CPTMA) could achieve controlled release of the CPT due to the presence of responsively broken disulfide bonds. PEGMA enhanced the biocompatibility of micelles as a hydrophilic shell. Two ßPECP with different lengths were synthesized by modulating reaction conditions and the proportion of monomers, which both were self-assembled to unimolecular micelles in water. ßPECP unimolecular micelles with higher EOS-Y/CPT content exhibited more excellent 1O2 production, in vitro drug release efficiency, higher cytotoxicity, and superior antibacterial activity. Also, we carried out simulations of the self-assembly and CPT release process of micelles, which agreed with the experiments. This nanosystem, which combines antimicrobial and antitumor functions, provides new ideas for bacteria-mediated tumor clinical chemoresistance.

Antimony-assisted controlled growth of PtSe2ribbon arrays for enhanced hydrogen evolution reaction.

In this study, we report the successful synthesis of few-layer parallel PtSe2ribbons on an Au foil employing a surface melting strategyviathe chemical vapor deposition growth method at 650 °C. The controlled formation of parallel ribbons was directed by the Au steps generated through antimony treatment. These ribbons exhibit an average length of exceeding 100µm and a width of approximately 100 nm across a substantial area. Electrocatalysis measurements showcase the catalytic performance of PtSe2ribbons grown on Au foil, which can be further augmented through subsequent oxidation treatment. This investigation introduces an effective growth method for few-layer ribbons at low temperatures and broadens the scope of employing the substrate-guided strategies for the synthesis of one-dimensional materials. Additionally, it underscores the potential of PtSe2ribbons as an electrocatalyst for hydrogen evolution.

People-centered primary care measures in health equity: a perspective of urban-rural comparison in Beijing, China.

Person-centered primary care measures (PCPCM) facilitate high-quality and culturally appropriate primary care. Access to PCPCM remains unequal between rural and urban areas, and the available evidence on rural PCPCM is still lacking. A cross-sectional survey was conducted with stratified sampling by regions, and four districts (Xicheng, Fengtai, Huairou, and Daxing) in Beijing were selected to test the performance of PCPCM in both urban and rural areas. Descriptive statistical methods were used to compare the urban-rural differences in the demographic characteristics of PCPCM. Correlation and regression analyses were performed to determine the associations between PCPCM in demographics and utilization of primary care. The PCPCM showed good reliability and validity in both urban and rural areas (P < .001), slightly lower in rural areas, but scores of rural PCPCM (R-PCPCM) in all items were lower than urban PCPCM (U-PCPCM). Patients in either the preferred urban or rural health centers all showed the highest PCPCM scores, with U-PCPCM= 3.31 for CHCs and R-PCPCM= 3.10 for RHCs, respectively. Patients in urban areas were more likely to receive higher-quality primary care than in rural areas (P < .001). Patients who preferred hospitals (ß = 2.61, P < .001) or CHCs (ß = 0.71, P = .003) as providers was a significant positive predictor of U-PCPCM but it was the preference for hospitals (ß = 2.95, P < .001) for R-PCPCM. Urban-rural differences existed in the performance of PCPCM, with rural areas typically more difficult to access better PCPCM. To promote health equity in rural areas, healthcare providers should strive to minimize urban-rural differences in the quality and utilization of primary care services as much as feasible.

A Case of Spontaneous Recovery in an Infant with Nail Candidiasis Probably Related to Nail Trauma During Vaginal Delivery.

Onychomycosis in infants is a rare fungal infection. The condition is frequently linked to congenital or secondary immunodeficiency, as well as exposure to contaminated environments. In this report, we present a case of infant onychomycosis, likely infected during birth delivery from the mother with vaginal candidiasis. However, both the infant and the mother recovered spontaneously without any treatment over several months.

Community-dwelling older adults' perspectives on health risks: a qualitative study exploring anxieties, priorities, and expectations in ageing.

BACKGROUND: With the conflict between the promise of ageing in health and longevity and the limited availability of health resources and social support, older adults in China inevitably experience anxieties surrounding health risks. This study aims to investigate how older adults perceive the health risks that come with getting older, explore the degree to which health risks affect older adults, and advocate for active engagement in practices for managing health risks. METHODS: Using purposive sampling, three districts of Beijing (Xicheng District, Fengtai District, and Daxing District, respectively) were selected for the research. Qualitative semi-structured and in-depth interviews were conducted with 70 community-dwelling older adults who participated in the study. Data were extracted and analyzed based on a thematic framework approach. RESULTS: Three main themes were identified: (i) the anxieties of older adults concerning health risks in ageing; (ii) the priorities of older adults for health risk management in ageing; (iii) the expectations of older adults for health risk management in ageing. The primary health concerns among older adults included disease incidence and function decline. It was found that basic health management emerged as a critical need for older adults to mitigate health risks. Moreover, it was observed that healthcare support for older adults from familial, institutional, and governmental levels exhibited varying degrees of inadequacy. CONCLUSIONS: The primary source of anxieties among older adults regarding health risks predominantly stems from a perceived sense of health deprivation. It is often compounded by persistent barriers to primary care of priorities in managing health risks among older adults. In addition, the expectations of older adults for health risk management emphasize the necessity for integrated care approaches. Therefore, further research should give priority to the prevention and management of health risks, aim to reduce anxieties, provide integrated care to meet the primary needs and expectations of older adults, and ultimately strive toward the overarching goal of promoting health and longevity.