Combining Tibial Cortex Transverse Transport (TTT) and Endovascular Therapy (EVT) for Limb Salvage in Chronic Limb-Threatening Ischemia.

OBJECTIVE: The clinical management of patients with chronic limb-threatening ischemia (CLTI) faces great challenges. Enhancing wound healing and limb preservation rates in this cohort is a critical objective. This study investigates the effectiveness of combining tibial cortex transverse transport (TTT) and endovascular therapy (EVT) for the treatment of patients with severe CLTI. We aim to evaluate the therapeutic results of this combined approach on the specified patient group. METHODS: We conducted a retrospective study to compare EVT with the combination of TTT and EVT in patients (Rutherford category 5 and above) with CLTI at Guangxi Medical University's First Affiliated Hospital from June 2017 to June 2023. This cohort was subjected to a follow-up period ranging from a minimum of 6 months to a maximum of 12 months. The primary outcome measures included amputation-free survival (AFS) (avoidance of above-ankle amputation or death from any cause), overall mortality, limb salvage rates, wound healing efficiency, and the technical efficacy of the applied treatments. A variety of statistical analyses including chi-square tests, Fisher's exact tests, and Pearson's and Spearman's correlation analyses. RESULTS: In this study, 131 patients with CLTI were included: 76 in the control group receiving only EVT treatment and 55 in the TTT + EVT group. The two groups were matched on demographic and clinical characteristics. In the TTT + EVT group, after more than 6 months of follow-up, 85.5% of patients achieved AFS, and wound healing was observed in 54.5% (30 of 55 patients). After more than 12 months of follow-up, 81.9% achieved AFS, with wound healing in 32 patients. Furthermore, after more than 24 months, 74.2% of patients remained amputation-free, with wound healing in all surviving patients. In the control group, after more than 6 months of follow-up, 72.4% of patients achieved AFS, and wound healing was observed in 51.3% (39 of 96 patients). After more than 12 months, 48.9% achieved AFS, with wound healing in 21 patients. CONCLUSION: We found that combining therapy of TTT and EVT is safe and can be successfully administered in patients with CLTI and it enhances wound healing and AFS.

Role of ventral tegmental area dopamine neurons in fear memory retention in post-traumatic stress disorder model rats.

Ventral tegmental area (VTA) dopamine (DA) neurons have been found to substantially associate with post-traumatic stress disorder (PTSD) pathology, however, whether and how these DA neurons affect fear memory management in PTSD individuals remains largely unknown. In this study, we utilized auditory conditioned foot-shock to evaluate the fear memory retrieval and retention characteristics in a single prolonged stress-induced PTSD rat model. We employed chemogenetic technology to specifically activate VTA DA neurons to examine the freezing behaviors responding to the conditioned stimuli. In vivo extracellular electrophysiological analyses were used to identify VTA DA neuronal firing alterations due to the chemogenetic activation. The results demonstrated that PTSD model rats showed comparable fear memory retrieval (Day 2 after the conditioned foot-shock), but significant enhancements in fear memory retention (Day 8 after the conditioned foot-shock), compared to normal control rats. Chemogenetic activation of VTA DA neurons markedly diminished the retention of fear memory in PTSD model rats, which appeared concomitantly with increases in the firing activities of the DA neurons. These findings revealed that PTSD induced the persistence of fear memory, which could be attenuated by activation of VTA DA neurons. It is presumed that VTA dopaminergic signals may serve as a prospective option for PTSD treatment.

Parenthood, spatial temporal environmental exposure, and leisure-time physical activity participation: Evidence from a micro-timescale retrospective longitudinal study.

Parents with dependent children are at a high risk of physical inactivity. While previous studies have mostly focused on how parents' time constraints and changing social network may inhibit leisure time physical activity (LTPA) over the long-term, less is known about the integrated effects of parenting and spatial-temporal environmental exposure on the execution of LTPA during certain episodes of a day. By adopting an integrated social-spatiotemporal-environmental model (ST-ISEM) based on micro-timescale retrospective longitudinal analysis, we examine the association between LTPA participation and spatial-temporal environmental exposure at a micro-timescale, i.e., at the episode-level in working adults' workday, and specifically how parenting integrated with spatial-temporal environmental exposure can jointly influence episode-level LTPA participation. Using data from the day reconstruction method from 701 individuals in Shenzhen, China, we find that parenting may affect the participation of LTPA on workdays not only by shaping temporal environmental factors (time constraint path and social network path), but also by interacting with built environmental exposures (spatial path), both at the episode-level. This study contributes to the theorizing of an integrated social-environmental model for health and wellbeing by extending the ISEM from the life span to the micro-timescale and also by highlighting the importance of temporality in environmental exposure and health studies. It also contributes to the spatial temporal behavioral perspective of time geography literature by clarifying multiple pathways through which social and spatiotemporal environmental factors could interact and jointly affect health behaviors at a micro-timescale. This study contributes to the literature on parenting and LTPA decline by enriching and deepening the understanding of the time constraint and social network pathways through which parenting leads to LTPA change at the micro-timescale. While time constraints may decrease parents' LTPA at long-term, increasing physical activities related to childcare after work may strongly obstruct moderate-to-vigorous LTPA at a micro-timescale. This study also identifies a spatial pathway by which parenting hinders LTPA due to changing understanding and usage of urban spaces. This pathway warrants attention from social epidemiologists, health geographers, and urban planners since existing interventions promoting physical activity in urban spaces may be ineffective for parents.

Mucoepidermoid carcinoma of the lung with hemoptysis as initial symptom: A case report.

BACKGROUND: Mucoepidermoid carcinoma of the lung is a rare malignant tumor, accounting for 0.1%-0.2% of all lung malignancies. It is a primary salivary gland tumor of the lung. Surgical resection is the primary treatment for pulmonary mucoepidermoid carcinoma, for which there has been no standardized treatment strategy. This article reports a case of a young woman with pulmonary mucoepidermoid carcinoma with hemoptysis as the first symptom. CASE SUMMARY: A 24-year-old female patient presented with "4 d of hemoptysis" as the chief complaint. She had no special history and denied any smoking or drinking history. Physical examination revealed that the vital signs were stable and scattered small wet rales were heard in the left lung. After admission, the lung tumor markers were checked, and no abnormalities were found. After completing the bronchoscopy, a spherical lesion was observed at the main bronchus 1.5 cm away from the protubercle, with obvious pulsation and little blood seepage on the surface, and histopathological biopsy results showed acute and chronic inflammation. She was transferred to the Department of Thoracic Surgery for surgical treatment on the 16th day after admission. After exclusion of surgical conjunctures, the patient underwent resection of the tumor in the left main bronchus with single-pore video-assisted thoracic surgery on the 19th day after admission. The postoperative histopathological biopsy results showed mucoepidermoid carcinoma of the lung. The patient and her family refused to complete genetic testing and she was discharged from the hospital on the 8th day after surgery. During the follow-up period, the patient experienced shortness of breath after feeling active and had no special discomfort. CONCLUSION: We have documented a case of moderately differentiated mucoepidermoid lung cancer with hemoptysis as the first symptom to improve clinicians' understanding of the disease and provide a new dimension of thinking for its future diagnosis and treatment.

Neighborhood social capital and self-rated mental health: Disparities between migrants and native residents in Beijing.

Introduction: Although the impact of neighborhood social capital on mental health has long been recognized, the extent to which the impact differs between immigrants and local residents remains a puzzle. This study aims to bridge the gap by comparing internal migrants who are restricted by their household registration (hukou) status, and urban natives in China. Methods: Using self-rated mental health and social capital survey data collected in 26 neighborhoods in Beijing, this study examines the mental health outcomes of three types of neighborhood social capital, including social networks, shared norms and mutual trust, and social support. Results: The study finds that the hukou status of immigrants moderates the effect of neighborhood social capital on mental health, and that the internal migrants in China experience less mental health benefit of neighborhood social capital than urban natives. Compared with urban natives, neighborhood social networks have less positive effect on migrants' mental health than that of urban natives. Conclusion: The findings suggest that policy makers can improve the mental health of migrants through social capital building on the premise of eliminating the restrictions of hukou system on the migrants' right to participate in neighborhood activities and to access neighborhood services.

Teachers' assessment literacy improves teaching efficacy: A view from conservation of resources theory.

Recent revisions to the Conservation of Resources theory have not only reclassified categories of resources, but have also acknowledged the conceptual importance of "gain spirals" and "resource caravans" in enriching the theoretical understanding of resources. Given that teachers' assessment literacy is a prominent yet underexplored personal constructive resource in teaching, this paper examines its role in teaching efficacy. In addition, personal energy resources (e.g., psychological capital and professional identity) are studied as antecedents to teaching efficacy. To this end, a survey based on the Chinese versions of the Teacher Assessment Literacy Scale, the Teaching Efficacy Scale, the Psychological Capital Scale, and the Teacher Professional Identity Scale was administered to secondary school teachers in Henan Province, China, and 351 completed, valid surveys were returned. The findings indicated that the teachers' assessment literacy and teaching efficacy were positively correlated, verifying that assessment literacy can influence teaching efficacy through the separate and chain mediation effects of psychological capital and professional identity. The identification of such mediating pathways has confirmed that resources owned by teachers can lead to gain spirals and full resource caravans, thus expanding the Conservation of Resources theory by positing that resources can be nested within one another. This study has theoretical implications for teaching efficacy research and the Conservation of Resources theory as well as practical implications regarding how to boost teachers' constructive and energy resources and professional development.

Activation of ventral tegmental area dopaminergic neurons ameliorates anxiety-like behaviors in single prolonged stress-induced PTSD model rats.

Post-traumatic stress disorder (PTSD) is a debilitating psychiatric condition that arises after extremely traumatic events, with clinically significant and lasting impacts on both physical and psychological health. The present study examined the role of ventral tegmental area (VTA) dopaminergic signaling in anxiety-like behaviors and the underlying mechanisms in PTSD model rats. Chemogenetic technology was employed to specifically activate VTA dopamine (DA) neurons in rats subjected to single prolonged stress (SPS), and open field and elevated plus maze tests were applied to evaluate the anxiety-like manifestations. Subsequently, in vivo extracellular electrophysiological analyses were used to examine alterations in the firing characteristics of VTA DA neurons. Chemogenetic activation enhanced the firing and burst rates of VTA DA neurons in SPS-induced PTSD model rats and concomitantly mitigated the anxiety-like behavioral phenotypes. Collectively, these findings reveal a direct association between PTSD-relevant anxiety behaviors and VTA dopaminergic activity, and further suggest that interventions designed to enhance VTA dopaminergic activity may be a potential strategy for PTSD treatment.

Ventral tegmental area dopaminergic action in music therapy for post-traumatic stress disorder: A literature review.

Post-traumatic stress disorder (PTSD) is a debilitating sequela of extraordinary traumatic sufferings that threaten personal health and dramatically attenuate the patient's quality of life. Accumulating lines of evidence suggest that functional disorders in the ventral tegmental area (VTA) dopaminergic system contribute substantially to PTSD symptomatology. Notably, music therapy has been shown to greatly ameliorate PTSD symptoms. In this literature review, we focused on whether music improved PTSD symptoms, based on VTA dopaminergic action, including the effects of music on dopamine (DA)-related gene expression, the promotion of DA release and metabolism, and the activation of VTA functional activities. In addition, the strengths and limitations of the studies concerning the results of music therapy on PTSD are discussed. Collectively, music therapy is an effective approach for PTSD intervention, in which the VTA dopaminergic system may hold an important position.

Arecoline Induces an Excitatory Response in Ventral Tegmental Area Dopaminergic Neurons in Anesthetized Rats.

Arecoline is the principle psychoactive alkaloid in areca nuts. Areca nuts are chewable seeds of Areca catechu L., which are epidemic plants that grow in tropical and subtropical countries and cause dependency after long-term use. However, the mechanisms underlying such dependency remain largely unclear, and therefore, no effective interventions for its cessation have been developed. The present study aimed to examine the effects of arecoline on neurons of the ventral tegmental area (VTA). After rats were anesthetized and craniotomized, electrophysiological electrodes were lowered into the VTA to obtain extracellular recordings. The mean firing rate of dopaminergic and GABAergic neurons were then calculated and analyzed before and after arecoline treatment. The burst characteristics of the dopaminergic neurons were also analyzed. The results showed that arecoline evoked a significant enhancement of the firing rate of dopaminergic neurons, but not GABAergic neurons. Moreover, arecoline evoked remarkable burst firings in the dopaminergic neurons, including an increase in the burst rate, elongation in the burst duration, and an enhancement in the number of spikes per burst. Collectively, the findings revealed that arecoline significantly excited VTA dopaminergic neurons, which may be a mechanism underlying areca nut dependency and a potential target for areca nut cessation therapy.

"Old friend and powerful cadre": Doctor-patient relationships and multi-dimensional therapeutic landscapes in China's primary hospitals.

A positive doctor-patient relationship is believed to play a key role in the healing process in clinics. While challenges to the doctor-patient relationship are a global concern, complex social contexts which introduce familial collectivism and totalitarian bureaucracy to maintain a doctor's authority have complicated doctor-patient relationships in China. This study delineates a multi-dimensional therapeutic landscape of hospitals in China, focusing on the doctor-patient relationship performances used to improve patients' healing experiences. Based on fieldwork in two primary hospitals in Eastern China, we find that primary hospitals in China are not only professional spaces, but hybrids of professional and non-professional spaces. In these spaces, both professional and other discourses in various forms of social-environmental engagement affect therapeutic experiences. Varying time and space in hospitals allow doctors to construct multi-dimensional therapeutic landscapes vis-a-vis patients to secure patients' compliance with their recommendations, and thus improve health outcomes. We argue that these dimensions may also cause negative therapeutic experience such as unnecessary health care. This study contributes to the literature on therapeutic landscapes of health care by providing a critical view on the construction of multi-dimensional therapeutic hospital landscapes. Furthermore, it links the critical health geographies literature with China's broader social context to explicate the cultural and social transformation of health care spaces in contemporary China. Findings from this study inform both theoretical and empirical debates regarding therapeutic landscapes of health care by embedding the professional spaces of health care into broader geographical discourses. This calls for health professionals to reflect on ethical concerns in multi-dimensional health care landscapes.

The Neighborhood Food Environment and the Onset of Child-Hood Obesity: A Retrospective Time-Trend Study in a Mid-sized City in China.

Nowadays, obesity and its associated chronic diseases have become a steadily growing public health problem, spreading from the older to younger age groups. Studies have contended that the built environment, particularly the food environment and walkability, may contribute to the prevalence of childhood obesity. In Asian countries which are characterized by rapid urbanization, high population density and oriental diets, little is known about how such urban built environment affects the onset of childhood obesity. This study juxtaposes the effect of food environment, walkability, and outdoor activity spaces at the neighborhood level upon childhood body weight in a mid-sized city in China. This observational study utilizes a retrospective time-trend study design to examine the associations between neighborhood built environment and children's body weight in Zhanjiang City, a mid-sized city in Guangdong Province, China. Robust multiple linear and logistic regression models were used to estimate associations between the built environments and child BMI and weight status (i.e., overweight/obesity and obesity only). This study finds that: (1) Western-style fast food and Chinese-style fast food have divergent impacts on childhood body weight. At neighborhood level, while increased exposure to Western-style fast food may increase child BMI and the risk of overweight and obesity, increased exposure to Chinese-style fast food, on the contrary, may reduce child BMI and the risk of overweight and obesity, indicating a positive health impact of Chinese-style fast food. (2) However, the positive health impacts brought about by Chinese-style fast food, walkable environments and accessible traditional fruit/vegetable markets have gradually disappeared in recent years. This study is among the first to simultaneously consider the divergent and changing impact of food environment upon childhood body weight in urban China. The findings provide important implications for healthy city design and the management of food retail industry in addressing the obesity epidemic in younger generations living in Asian cities. As prominent differences exist in food culture between Asian and Western cities, more attention should be paid to healthy food environment in future studies and related urban planning strategies formulation.

The Effects of Residential Built Environment on Supporting Physical Activity Diversity in High-Density Cities: A Case Study in Shenzhen, China.

In high-density cities, physical activity (PA) diversity is an essential indicator of public health and urban vitality, and how to meet the demands of diverse PA in a limited residential built environment is critical for promoting public health. This study selected Shenzhen, China, as a representative case; combined the diversity of PA participants, types, and occurrence times to generate a comprehensive understanding of PA diversity; fully used data from multiple sources to measure and analyze PA diversity and residential built environment; analyzed the relationships between the built environment and PA diversity; and explored the different effects in clustered and sprawled high-density urban forms. PAs in clustered areas were two times more diverse than those in sprawled areas. Accessibility, inclusiveness, and landscape attractiveness of residential built environment jointly improved PA diversity. Clustered areas had significant advantages in supporting PA diversity since they could keep the balance between dense residence and landscape reservation with an accessible and inclusive public space system. The residential built environment with dense street networks, public traffic and service, multi-functional public space system, and attractive landscapes is crucial to improve the diverse PA to achieve more public health outputs in high-density cities. To promote health-oriented urban development, clustered urban form is advocated, and step-forward strategies should be carried out.

Affordable and enjoyable health shopping: Commodified therapeutic landscapes for older people in China's urban open spaces.

The complex influences of the commodification of therapeutic landscapes on sense of health are not fully understood. This study investigates how commodification affects the healing sense of urban open spaces for older people from a relational approach. Drawing on eight months of fieldwork in two Chinese cities, it demonstrates that (1) China's social and cultural backgrounds shape older people's consumer values and redefine their whole-person sense of health; (2) the consumption landscape, especially retailers, enhances the therapeutic components of the spaces for older people by providing new health products to increase their self-care capacity, and by providing an affordable and enjoyable purchasing experience to help them construct positive social identities; and (3) the dichotomy between consumers' demands that are created and met by an array of marketing activities, and the healing sense of those same spaces that stem from consumers' actual needs may be the main risk of a sustainable therapeutic consumption space. These findings expand the meanings of health for the geographies of aging and health in non-Western contexts. This study contributes to the relational thinking of the commodification of therapeutic landscapes and geography of aging by proposing a reciprocal benefit between older individuals and the consumption landscape. Based on these findings, scholars and policymakers should consider consumption activities in non-Western contexts as important determinants of health of the older population vis-a-vis an overwhelming market of health products, services, and activities.

Ventral Tegmental Area Dysfunction and Disruption of Dopaminergic Homeostasis: Implications for Post-traumatic Stress Disorder.

Post-traumatic stress disorder (PTSD) is a debilitating psychiatric condition characterized by intrusive recollections of the traumatic event, avoidance behaviors, hyper-arousal to event-related cues, cognitive disruption, and mood dysregulation. Accumulating preclinical and clinical evidence implicates dysfunction of the ventral tegmental area (VTA) dopaminergic system in PTSD pathogenesis. This article reviews recent advances in our knowledge of the relationship between dopaminergic dyshomeostasis and PTSD, including the contributions of specific dopaminergic gene variants to disease susceptibility, alterations in VTA dopamine neuron activity, dysregulation of dopaminergic transmission, and potential pharmacological and psychological interventions for PTSD targeting the dopaminergic system. An in-depth understanding of PTSD etiology is crucial for the development of innovative risk assessment, diagnostic, and treatment strategies following traumatic events.

Multiplexed fluorometric determination for three microRNAs in acute myocardial infarction by using duplex-specific nuclease and MoS2 nanosheets.

Circulating microRNAs are of diagnostic value for acute myocardial infarction (AMI). This study describes a fluorometric assay for multiplexed detection of the AMI biomarkers microRNA-499, microRNA-133a and microRNA-1. The assay involves the following two steps: (a) duplex-specific nuclease (DSN)-mediated signal amplification using aptamer-based sensor; (b) MoS2 nanosheets-based multiplexed fluorometric signal detection, and fluorometric signals have excitation/emission maxima at 492/518 nm for microRNA-499, 565/580 nm for microRNA-133a and 649/663 nm for microRNA-1. The assay has detection limits of around 100 fM for all three microRNAs. The assay is highly specific and rapid. It demonstrates that the expressions of microRNA-499, microRNA-133a and microRNA-1 are significantly higher in AMI patients. The ROC curves allow a clear distinction to be made between AMI group and non-AMI group. Graphical abstractSchematic representation of a multiplexed fluorometric method based on duplex-specific nuclease (DSN)-mediated signal amplification and MoS2 nanosheets-based fluorometric signal detection (DSN-MoS2) for rapid, sensitive and specific detection of microRNAs in AMI.

A faster detection method for high-sensitivity cardiac troponin-POCT quantum dot fluorescence immunoassay.

BACKGROUND: High-sensitivity cardiac troponin (hs-cTn) is a significant biomarker of myocardial injury and necrosis, and has momentous clinical significance for the diagnosis and risk stratification of acute myocardial infarction (AMI). The purpose of this study is to determine the accuracy and sensitivity of hs-cTn detection in whole blood samples with a new faster method-Point of Care Testing (POCT) quantum dot fluorescence immunoassay. METHODS: Blood samples from 415 patients with chest pain suggestive of AMI from August to November 2017 in The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University were analyzed. We first performed hs-cTnI test with anticoagulated whole blood by POCT quantum dot fluorescence immunoassay. After the sample was centrifuged, the plasma sample was taken for detection of hs-cTnT by electrochemiluminescence immunoassay. The final diagnosis was determined by two independent cardiologists. RESULTS: Firstly, by measuring the receiver operating characteristic curve (ROC curve) and the area under the curve (AUC) of 32 patients with AMI, it was found that the measurement accuracy of the POCT quantum dot fluorescence immunoassay was relative high (AUC was 0.866, 95% confidence interval is 0.783 to 0.949). There was no statistical difference between POCT quantum dot fluorescence immunoassay and electrochemiluminescence troponin assay [Z value =1.527, P value =(0.063, 0.064)]. In addition, the study also calculated the performance evaluation index of POCT quantum dot fluorescence immunoassay (critical value 0.04 ng/mL) and analyzed the ROC curve to compare the diagnostic accuracy of both for cardiogenic diseases and the diagnostic efficacy of patients with AMI. Our study found that the new method-POCT quantum dot fluorescence immunoassay had high diagnostic efficiency, which was similar to the traditional electrochemiluminescence method. CONCLUSIONS: The measurements of hs-cTn by the method of Vazyme POCT quantum dot immunofluorescence and Roche electrochemiluminescence method have a good correlation (Y=37.419+131.009X, r=0.935), and also have a good consistency in the diagnosis of AMI. In addition, compared with the traditional electrochemiluminescence method, quantum dot immunofluorescence is faster and more suitable for clinical needs.

Physical activity and chronic diseases among older people in a mid-size city in China: a longitudinal investigation of bipolar effects.

BACKGROUND: While previous studies have shown that regular physical activity can delay the onset of certain chronic diseases; less is known about the changes in physical activity practices following chronic disease diagnoses. China is experiencing a rapid aging transition, with physical activity an important routine in many older people's lives. This study utilizes the Health Belief Model to better understand the bidirectional relationships and bipolar effects between physical activity and chronic disease burden in Huainan City, a mid-sized city in China. METHODS: Longitudinal health survey data (2010-2015) from annual clinic visits for 3198 older people were obtained from a local hospital, representing 97% of the older population in three contiguous neighborhoods in Huainan City. The chronic diseases studied included obesity, hypertension, diabetes, hyperlipidemia, cardiovascular diseases, liver and biliary system diseases, and poor kidney function. Multilevel logistic regression was used to examine differences in physical activity levels across socio-demographic groups. Cox proportional hazards models were used to examine the impacts of physical activity practice levels on chronic disease onsets. Logistic regression was used to estimate the effects of chronic disease diagnosis on physical activity practice levels. RESULTS: The prevalence of chronic diseases increased with increasing age, among men, and those with a lower education. Older people who were physically active experienced a later onset of chronic disease compared to their sedentary counterparts, particularly for obesity and diabetes. Following diagnosis of a chronic disease, physically active older people were more likely to increase their physical activity levels, while sedentary older people were less likely to initiate physical activity, demonstrating bipolar health trajectory effects. CONCLUSIONS: Health disparities among older people may widen as the sedentary experience earlier onsets of chronic diseases and worse health trajectories, compared to physically active people. Future health education communication and programmatic interventions should focus on sedentary and less healthy older populations to encourage healthy aging. These lessons from China may be applied to other countries also experiencing an increasing aging population.

Cholinergic tone in ventral tegmental area: Functional organization and behavioral implications.

The ventral tegmental area (VTA), a pivotal brain region of the mesocorticolimbic dopaminergic system, is substantially innervated and modulated by cholinergic projections from the pedunculopontine tegmental nucleus and laterodorsal tegmental nucleus. In this review, we focus mainly on the current findings on VTA cholinergic compositions and functions, including VTA cholinergic innervations and synaptic connectivity, acetylcholine receptor expression and functional characteristics, cholinergic modulation of neuronal activity and dopamine efflux, cholinergic modulation of VTA-mediated behaviors such as reward and addiction, stress and depression, locomotion, etc. Taken together, these findings indicate that cholinergic transmission to the VTA plays an important role in modulation of the VTA circuit, which is implicated in regulation of multiple behaviors.

How the built environment affects change in older people's physical activity: A mixed- methods approach using longitudinal health survey data in urban China.

Although the general population in China is physically active, only 45% of older adults meet the World Health Organization's recommendation for weekly moderate-to-vigorous exercise, to achieve health benefits. This percentage is even lower (9.8%) in urban China. It is, therefore, important to understand the pathways by which physical activity behaviors are impacted by the built environment. This study utilized a mixed methods approach-interviews (n = 42) and longitudinal (2010-2015) health survey data (n = 3094) for older people residing in three neighborhoods in Huainan, a mid-sized city in Anhui Province, central eastern China. First, a content analysis of interview data was used to identify individual and built environment factors (motivators and barriers) that impacted physical activity within older people's activity spaces. Second, a multilevel path analysis was conducted using the health survey data to demonstrate the pathways by which these motivators and barriers contributed to the initiation, regulation, and maintenance of physical activity. This study found (a) that the liveliness of an apartment building and its proximity to functional spaces (fast-food stores, farmer's markets, supermarkets, pharmacies, schools, hospitals, PA facilities and natural and man-made water bodies) were important factors in attracting sedentary older people to initiate physical activity; (b) the social networks of apartment neighbors helped to initiate, regulate, and maintain physical activity; and housing closeness to functional spaces was important in maintaining physical activity, particularly for those older people with chronic diseases. To increase older people's overall physical activity, future interventions should focus on residential form and access to functional spaces, prior to investing in large-scale urban design interventions.