Serine deficiency exacerbates psoriatic skin inflammation by regulating S-adenosyl methionine-dependent DNA methylation and NF-κB signalling activation in keratinocytes.

BACKGROUND: Serine metabolism is crucial for tumour oncogenesis and immune responses. S-adenosyl methionine (SAM), a methyl donor, is typically derived from serine-driven one-carbon metabolism. However, the involvement of serine metabolism in psoriatic skin inflammation remains unclear. OBJECTIVES: To investigate the association between serine metabolism and psoriatic skin inflammation. METHODS: Clinical samples were collected from patients with psoriasis and the expression of serine biosynthesis enzymes was evaluated. The HaCaT human keratinocyte cell line was transfected with small interfering RNA (siRNA) of key enzyme or treated with inhibitors. RNA sequencing and DNA methylation assays were performed to elucidate the mechanisms underlying serine metabolism-regulated psoriatic keratinocyte inflammation. An imiquimod (IMQ)-induced psoriasis mouse model was established to determine the effect of the SAM administration on psoriatic skin inflammation. RESULTS: The expression of serine synthesis pathway enzymes, including the first rate-limiting enzyme in serine biosynthesis, phosphoglycerate dehydrogenase (PHGDH), was downregulated in the epidermal lesions of patients with psoriasis compared with that in healthy controls. Suppressing PHGDH in keratinocytes promoted the production of proinflammatory cytokines and enrichment of psoriatic-related signalling pathways, including the tumour necrosis factor-alpha (TNF-α) signalling pathway, interleukin (IL)-17 signalling pathway and NF-κB signalling pathway. In particular, PHGDH inhibition markedly promoted the secretion of IL-6 in keratinocytes with or without IL-17A, IL-22, IL-1α, oncostatin M and TNF-α (mix) stimulation. Mechanistically, PHGDH inhibition upregulated the expression of IL-6 by inhibiting SAM-dependent DNA methylation at the promoter and increasing the binding of myocyte enhancer factor 2A. Furthermore, PHGDH inhibition increased the secretion of IL-6 by increasing the activation of NF-κB via SAM inhibition. SAM treatment effectively alleviated IMQ-induced psoriasis-like skin inflammation in mice. CONCLUSIONS: Our study revealed the crucial role of PHGDH in antagonising psoriatic skin inflammation and indicated that targeting serine metabolism may represent a novel therapeutic strategy for treating psoriasis.

The development and validation of a prediction model for imminent vertebral osteoporotic fracture in postmenopausal women.

PURPOSE: This study aimed to develop and validate a new model that focused on the risk of imminent vertebral fractures in women with osteoporosis. METHODS: Data from 2,048 patients were extracted from three hospitals, of which 1,720 patients passed the inclusion and exclusion screen. The patients from Nanfang Hospital (NFH) were randomized at a 2:1 ratio to create a training cohort (n = 709) and an internal validation cohort (n = 355), with the patients from the other two hospitals (n = 656) used for external validation. The risk factors included in the imminent osteoporotic vertebral compression fractures (OVCFs) prediction model (labelled TVF) were sorted by the least absolute shrinkage and selection operator and constructed by logistic regression. The area under the receiver operating characteristic curve (AUC), the decision curve, and the clinical impact curves of the optimal model were analyzed to verify the model. RESULTS: There were 138 and 161 fresh fractures in NFH and the other two hospitals, respectively. The lowest BMD T value and the history of vertebral fracture were integrated into the TVF model. The prediction power of TVF was demonstrated by the AUCs of 0.788 (95% confidence interval [CI], 0.728-0.849) in the training cohort and 0.774 (95% CI, 0.705-0.842) in the internal validation cohort, and 0.790 (95% CI, 0.742-0.839) and 0.741 (95% CI, 0.668-0.813) in the external validation cohorts. CONCLUSION: The TVF model demonstrated good discrimination to stratify the imminent risk of OVCFs. We therefore consider the model as a pertinent commencement in the search for more accurate imminent OVCFs prediction.

Promoting dewatering efficiency of sludge by bioleaching coupling chemical flocculation.

In recent years, bioleaching has emerged as a cost-effective technology for enhancing the dewaterability of sludge. However, the lengthy treatment time involved in sludge bioleaching processes limits daily treatment capacity for sludge. Here, a novel approach was developed through a short time of sludge bioleaching with A. ferrooxidans LX5 (A. f) and A. thiooxidans TS6 (A. t) followed by polyferric sulfate (PFS) flocculation (A. f + A. t + PFS). After 12.5 h of the A. f + A. t + PFS treatment (30% A. f, 10% A. t, 40 mg/g DS S0, 60 mg/g DS FeSO4•7H2O, and 120 mg/g DS PFS), the reduction efficiency of specific resistance to filtration (SRF) and sludge cake moisture content reached 94.0% and 11.6%, respectively, which were comparable to the results achieved through 24 h of completed bioleaching treatment. In pilot-scale applications, the mechanical dewatering performance was notably improved following A. f + A. t + PFS treatment, with the low moisture content of the treated sludge cake (∼59.2%). This study provides new insights into the A. f + A. t + PFS process and holds potential for developing efficient and promising sludge dewatering strategies in engineering application.

Effect of a video-based exercise intervention on depression and sleep conditions of peritoneal dialysis patients.

OBJECTIVE: To evaluate the effectiveness of a video-based exercise intervention on depression and sleep conditions of peritoneal dialysis (PD) patients. MATERIALS AND METHODS: Participants satisfying the inclusion and exclusion criteria were recruited from the Peritoneal Dialysis Center, Department of Nephrology of the First Affiliated Hospital of Guangxi Medical University, and they were divided into an intervention group and a control group. The intervention group received video-based exercise intervention while the control group received routine care. Then their BDI-II and PSQI scores were collected and analyzed before and after the intervention. RESULTS: There were no significant differences in BDI-II score and the seven components of PSQI score between the two groups at the baseline measures (p > 0.05). However, after 12 weeks of intervention, the intervention group had a significantly lower score in BDI-II (p < 0.05) and in six components of PSQI (p < 0.05), with the exception of the "use of sleep medications" subscale (p > 0.05). Their depression level also improved significantly after intervention (p < 0.05), while that of the control group did not change significantly(p > 0.05). CONCLUSION: The video-based exercise intervention is safe and can remarkably improve the depression and sleep conditions of PD patients and is thus worthwhile to be applied widely.

Effectiveness of a video-based exercise program on nutritional status and quality of life of peritoneal dialysis patients: A pilot randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of a video-based exercise program on nutritional status and quality of life (QOL) of peritoneal dialysis (PD) patients. MATERIALS AND METHODS: Participants satisfying the inclusion and exclusion criteria were recruited and divided into the intervention group and the control group. The intervention group received video-based exercise based on a manual advocated by the National Kidney Foundation, while the control group received routine exercise guidance. Their nutritional indicators and the Quality of Life Scale for Peritoneal Dialysis patients (QLSPD) scores were collected and analyzed. RESULTS: No adverse events occurred during the study. Baseline data between the two groups were comparable, and there were no significant differences in body mass index (BMI) (t = 0.214, p = 0.831), triceps skin fold thickness (TSF) (t = 0.407, p = 0.685), arm muscle circumference (AMC) (t = 0.310, p = 0.757), grip strength (Gs) (t = 0.557, p = 0.579), calf circumference (Cc) (t = 0.441, p = 0.660), serum albumin (Alb) (t = 0.261, p = 0.795), prealbumin (PA) (t = 0.218, p = 0.828), hemoglobin (Hb) (t = 0.114, p = 0.909), triglyceride (TG) (t = 0.192, p = 0.848), total cholesterol (TC) (t = 0.092, p = 0.927), low-density lipoprotein (LDL) (t = 0.124, p = 0.902), high-density lipoprotein (HDL) (t = 0.265, p = 0.792), blood urea nitrogen (BUN) (t = 0.540, p = 0.590), serum creatinine (SCr) (t = 0.255, p = 0.799), total urea clearance index (Kt/V) (t = 0.958, p = 0.340), total creatinine clearance rate (Ccr) (t = 0.166, p = 0.868), protein equivalent of nitrogen appearance (nPNA) (t = 0.240, p = 0.811), and QLSPD scores (p > 0.05) between the two groups at the baseline measures. However, after 12 weeks of intervention, the AMC (t = 2.993, p = 0.003) and Cc (t = 2.811, p = 0.006) of the intervention group improved significantly compared with the control group. The BMI (t = 2.068, p = 0.041) and TSF (t = 2.578, p = 0.011) showed a trend of improvement compared with baseline. And the intervention group scored less in body physiology function (t = 7.084, p < 0.001), disease factors (t = 13.336, p < 0.001), mental state (t = 9.555, p < 0.001), and social role (t = 5.156, p < 0.001) components, while their satisfaction hardly changed (t = 0.240, p = 0.811). CONCLUSION: The video-based exercise intervention is safe and can remarkably improve the nutritional status and QOL of PD patients.

Effectiveness of continuous home wound care on patients with diabetic foot ulcers.

AIMS: To explore the effectiveness of continuous home wound care on patients with diabetic foot ulcers (DFUs). DESIGN: A non-randomized parallel controlled non-inferiority trial. METHODS: Patients with Wagner grade I-III DFUs hospitalized in two distant campuses of the same hospital were included. All patients received infection treatment and wound bed preparation during hospitalization; after discharge, patients in one of the campuses received routine outpatient wound care, and those treated in the other received continuous home wound care. The per-protocol analysis was performed to compare ulcer healing indicators, knowledge, health belief, self-management behaviour and medical expenses of the two groups. RESULTS: Between October 2021 and December 2022, 116 patients were enrolled in the study; 107 completed. The home care was not inferior in terms of ulcer healing rate and demonstrated significant enhancements in the understanding of warning signs, health belief and self-management behaviour. Additionally, the home care saved 220.38 yuan (24.32 UK pounds) in direct medical expenses for each additional one square centimetre of ulcer healing. CONCLUSION: The continuous home wound care enhanced self-management behaviour of the patients and saved their medical expenses while not compromising ulcer healing. IMPACT: This is to date the first study to conduct continuous home wound care practice for patients with DFUs and confirmed its safety and non-inferiority in ulcer healing, and supported its superiority in improving self-management behaviour and saving medical expenses. REPORTING METHOD: We have adhered to the transparent reporting of evaluations with nonrandomized designs statements and the corresponding checklist was followed. PATIENT OR PUBLIC CONTRIBUTION: The patients and their primary caregivers were involved in intervention design, we received input from them about the factors that facilitate and hinder patient self-management behaviours to develop intervention strategies.

Effectiveness of continuous home wound care on wound healing, self-management behavior, and medical expenses of patients with diabetic foot ulcers.

OBJECTIVE: To explore the effectiveness of continuous home wound care on wound healing, self-management behavior, and medical expenses of patients with diabetic foot ulcers. MATERIALS AND METHODS: Patients were grouped by the campuses they were hospitalized. One group received home wound care, and the other one received outpatient wound care after their discharge. Non-inferiority testing was performed to compare ulcer healing. Their Diabetes-related Foot Ulcer Self-Management Behavior Scale (DFUSMBS) scores and medical expenses were compared. RESULTS: Between October 2021 and December 2022, fifty-five patients in the home wound care group and fifty-two in the outpatient wound care group completed the study. The home wound care was non-inferior concerning ulcer complete healing rate in total or stratified by Wagner grade or baseline ulcer area. Concerning wound healing time, the home wound care group was inferior for Wagner Grade Ⅲ ulcers (hazard ratio = 0.7772, 95 % CI = 0.2799-2.1581). In contrast, for ulcers with baseline area>5 cm2, the home care group was non-inferior and even can be superior, although the superiority was not statistically significant (Log-rank X2 = 0.257, p = 0.612). Moreover, the home wound care group showed significant improvement concerning timely wound treatment (t = 23.045, p < 0.001, Cohen's d = 4.460, Effect Size = 0.912) and wound care behavior (t = 33.410, p < 0.001, Cohen's d = 6.454, Effect Size = 0.955), while that of diabetes self-management was not statistically significant (t = -0.673, p = 0.502, Cohen's d = 0.128, Effect Size = 0.064). The medium direct medical expense per capita of the patients in the outpatient care group was statistically significantly heavier than that of the home wound care group (Z = -6.877, p < 0.001). CONCLUSION: The home wound care practice did not compromise ulcer healing, enhanced timely wound treatment and wound care behavior of the patients, and saved their medical expenses, hopefully providing a feasible wound care alternative with economic benefits for the physically and economically devastated patients.

Validity and reliability of Chinese version of the new diabetic foot ulcer assessment scale.

A specific assessment tool is urgently needed to guide effective wound care for diabetic foot ulcers. However, the tool has not been available in Chinese. We aimed to culturally translate and verify the validity and reliability of the new Diabetic Foot Ulcer Assessment Scale (DFUAS). The original scale was translated into Chinese according to the Brislin guidelines. Patients satisfying the inclusion and exclusion criteria were recruited. Each of the included foot ulcers was evaluated independently by two wound care specialists using the new DFUAS and by the third wound care specialists at the same time using the Bates-Jensen Wound Assessment Tool according to per guidelines. 210 diabetic foot ulcers were included for data analysis. The S-CVI of the Chinese version of the DFUAS was 0.96, and the I-CVIs ranged from 0.89 to 0.98. The total Cronbach's Alpha of the scale was 0.709, and the corrected item-total correlation of the items ranged from 0.4 to 0.872. The DFUAS had high inter-observer reliability of 0.997, and there were weak, moderate, and strong correlations between each pair of the items. The Bland-Altman plots showed a good agreement between the scale and the Bates-Jensen Wound Assessment Tool. We concluded that the Chinese version of the DFUAS showed good validity and reliability and is a reliable instrument for the assessment of diabetic foot ulcers.

Structural variation of mitochondrial genomes sheds light on evolutionary history of soybeans.

The architecture and genetic diversity of mitogenome (mtDNA) are largely unknown in cultivated soybean (Glycine max), which is domesticated from the wild progenitor, Glycine soja, 5000 years ago. Here, we de novo assembled the mitogenome of the cultivar 'Williams 82' (Wm82_mtDNA) with Illumina PE300 deep sequencing data, and verified it with polymerase chain reaction (PCR) and Southern blot analyses. Wm82_mtDNA maps as two autonomous circular chromosomes (370 871-bp Chr-m1 and 62 661-bp Chr-m2). Its structure is extensively divergent from that of the mono-chromosomal mitogenome reported in the landrace 'Aiganhuang' (AGH_mtDNA). Synteny analysis showed that the structural variations (SVs) between two genomes are mainly attributed to ectopic and illegitimate recombination. Moreover, Wm82_mtDNA and AGH_mtDNA each possess six and four specific regions, which are absent in their counterparts and likely result from differential sequence-loss events. Mitogenome SV was further studied in 39 wild and 182 cultivated soybean accessions distributed world-widely with PCR/Southern analyses or a comparable in silico analysis. The results classified both wild and cultivated soybeans into five cytoplasmic groups, named as GSa-GSe and G1-G5; 'Williams 82' and 'Aiganhuang' belong to G1 and G5, respectively. Notably, except for members in GSe and G5, all accessions carry a bi-chromosomal mitogenome with a common Chr-m2. Phylogenetic analyses based on mtDNA structures and chloroplast gene sequences both inferred that G1-G3, representing >90% of cultigens, likely inherited cytoplasm from the ancestor of domestic soybean, while G4 and G5 likely inherited cytoplasm from wild soybeans carrying GSa- and GSe-like cytoplasm through interspecific hybridization, offering new insights into soybean cultivation history.

Neutrophil extracellular traps contribute to immune dysregulation in bullous pemphigoid via inducing B-cell differentiation and antibody production.

Bullous pemphigoid (BP), an autoimmune skin disease, is characterized by autoantibodies against hemidesmosomal proteins in the skin and mucous membranes. Neutrophils infiltrate BP skin lesions, however, their role in immune dysregulation remains unclear. We investigated whether BP involves aberrant neutrophil extracellular traps (NETs) formation in skin lesions and circulation; and examined the triggers and deleterious immuno-inflammatory consequences. In the present study, we found that circulating NET-related biomarker levels increased in serum and blister fluid of BP patients and significantly correlated with disease severity. Additionally, circulating neutrophils from BP patients displayed enhanced spontaneous NETs formation than healthy controls. In vitro, BP180-NC16A immune complexes-induced NETosis in neutrophils from BP patients, which was abrogated by Fcγ receptor and/or NADPH pathway blockade. Furthermore, the elevated levels of NETs from BP patients boosted autoantibody production by inducing B-cell differentiation into plasma cells, mediated by MAPK P38 cascade activation. Together, our findings provide strong evidence that NETs are involved in a pathogenic loop, causing excessive differentiation of B cells and promotion of autoantibody production. Hence, targeting aberrant neutrophil responses will provide novel potential targets for the treatment of BP.

Validation of the functional assessment of anorexia/cachexia therapy instrument to assess quality of life in maintenance hemodialysis patients with cachexia.

BACKGROUND: Many patients on maintenance hemodialysis (MHD) eventually suffer from cachexia. The Functional Assessment of Anorexia/Cachexia Therapy (FAACT) is a tool used to evaluate the quality of life of patients with cachexia related to various diseases, but its suitability for use in MHD patients has yet to be verified. This study aimed to explore the validation of the FAACT in MHD patients by conducting reliability and validity tests. METHODS: Qualified MHD patients were selected to complete the FAACT and Kidney Disease Quality of Life Short Form 36 (KDQOL-36) questionnaires, and their demographic data and biochemical test results were collected from electronic medical records. Next, the Cronbach's alpha coefficient, paired sample t test and ICC were used to analyze the scale consistency. Additionally, the association between the KDQOL-36 and FAACT was analyzed using Bland-Altman plots and Pearson correlation analysis. Finally, the patients were divided into groups to evaluate discriminant validity. RESULTS: A total of 299 patients were included in this study. The Cronbach's alpha coefficients of the FAACT and its anorexia-cachexia subscale (ACS) were 0.904 and 0.842, respectively, and their ICC exceeded 0.90. The correlation coefficients between the FAACT and its items ranged from 0.146 to 0.631, and the correlation coefficients between the FAACT and KDQOL-36 dimensions ranged from 0.446 to 0.617. The Bland-Altman plots between the FAACT and KDQOL-36 showed that only 3.3% of the points were outside the 95% limits of agreement. The effects of cachexia status (present or absent) on FAACT and ACS scores had effect sizes of 0.54 (P < 0.001) and 0.60 (P < 0.001), respectively. The FAACT and ACS also significantly discriminated between patients with and without inflammation (P < 0.001). CONCLUSIONS: The FAACT and ACS have acceptable reliability and validity in MHD patients and are suitable for measuring the quality of life of MHD patients with cachexia.

Effectiveness of silver dressings in the treatment of diabetic foot ulcers: a systematic review and meta-analysis.

OBJECTIVE: Silver dressings have been used in the treatment of diabetic foot ulcers (DFUs). However, meta-analyses examining their effectiveness is lacking. Therefore, this meta-analysis evaluates the effectiveness of silver dressings on DFU healing. METHOD: Various databases were searched for randomised controlled trials (RCTs) of silver dressing applied to DFUs. RESULTS: A total of seven studies involving 650 patients were identified for inclusion in the meta-analysis. The odds ratio (OR) for silver dressing improving wound healing rate, complete healing time, ulcer-related in-hospital time and infection resolution rate were: 4.02 (95% confidence interval [CI]: 2.25-7.17; p<0.01); 2.81 (95% CI: -3.33--2.29; p<0.01); 12.13 (95% CI:-20.64--3.62; p<0.01); and 7.36 (95% CI: 1.58-34.22; p=0.01), respectively. The OR on ulcer area reduction was 8.60 (95% CI:-8.93-26.12; p=0.34) indicating no significant effect. CONCLUSION: The results of this meta-analysis showed that silver dressings enhance DFU healing rate, shorten the time to complete healing, shorten in-hospital duration, and improve infection resolution rate, while having no significant effect on reduction of ulcer area. Large-scale, multicentre, rigorously designed RCTs are recommended for future investigation to justify the beneficial effects of silver dressings on DFU healing.

Photoinduced Copper-Catalyzed Asymmetric C(sp3 )-H Alkynylation of Cyclic Amines by Intramolecular 1,5-Hydrogen Atom Transfer.

The development of a mild and general method for C(sp3 )-H functionalization of cyclic amines has been an ongoing challenge. In this work, we describe the copper-catalyzed enantioselective C(sp3 )-H alkynylation of unactivated cyclic 2-iodo-benzamide under photo-irradiation by intramolecular 1,5-hydrogen atom transfer (HAT). The employment of a new bisoxazoline diphenylamine ligand, in conjunction with 1,1'-bi-2-naphthol, which significantly improved the reduction potential of the copper complex, was the key to success of this chemistry. Mechanistic and computational studies supported that the new copper complex served the dual role as a photoredox and coupling catalyst, the reaction went through a radical process, and the intramolecular 1,5-HAT process was involved in the rate-limiting step. Apart from the broad substrate scope including unprecedented benzocyclic amines, this method also showed excellent diastereoselectivity in 2-monosubstituted cyclic amines via substrate control.

From Esters to Ketones via a Photoredox-Assisted Reductive Acyl Cross-Coupling Strategy.

A method was developed for ketone synthesis via a photoredox-assisted reductive acyl cross-coupling (PARAC) using a nickel/photoredox dual-catalyzed cross-electrophile coupling of two different carboxylic acid esters. A variety of aryl, 1°, 2°, 3°-alkyl 2-pyridyl esters can act as acyl electrophiles while N-(acyloxy)phthalimides (NHPI esters) act as 1°, 2°, 3°-radical precursors. Our PARAC strategy provides an alternative and reliable way to synthesize various sterically congested 3°-3°, 3°-2°, and aryl-3° ketones under mild and highly unified conditions, which have been otherwise difficult to access. The combined experimental and computational studies identified a Ni0 /NiI /NiIII pathway for ketone formation.

Desymmetrization of 1,3-Diones by Catalytic Enantioselective Condensation with Hydrazine.

We present herein an unprecedented desymmetrization of meso 1,3-diones by enantioselective intermolecular condensation. Under the catalysis by a chiral phosphoric acid, a range of readily available 1,3-diones undergo reaction with hydrazines to produce cyclic and acyclic keto-hydrazones bearing an all-carbon quaternary center in high efficiency and enantioselectivity. These compounds are also highly versatile for the preparation of multifunctional building blocks and heterocycles in excellent stereoselectivity.

Application of a nurse-led multidisciplinary health problem assessment tool on patients undergoing peritoneal dialysis at home: A cross-sectional study.

OBJECTIVE: To identify and analyze the most prominent problems of peritoneal dialysis (PD) patients by applying a nurse-led multidisciplinary health problem assessment tool. METHODS: 170 PD patients were recruited from the PD center of the First Affiliated Hospital of GuangXi Medical University from January 2019 to June 2019, and their information was collected from July 2019 to June 2020 through telephone interviews, Wechat interviews, outpatient visits, and home visits; their health problems were classified and analyzed with regard to physiological, psychosocial, health-related behavior, and environment categories based on the Omaha Problem Classification System, and their knowledge, behavior, and status related to these problems were evaluated by the Omaha Knowledge-Behavior-Status Scale. RESULTS: 165 of the eligible patients completed the follow-up, and their ten most prominent health problems were "Income", "Social contact", "Pain", "Neuro-musculo-skeletal function", "Digestion-hydration" and "Edema", "Nutrition", "Physical activity", "Fluid and diet restriction", and "Symptom management". As for the Knowledge-Behavior-Status scale, they got the lowest scores in knowledge of "Symptom management", behavior of "Fluid and diet restriction" and Status of "Nutrition", while they scored the best in knowledge of "Nutrition" and "Edema", behavior of "Income" and "Pain", and Status of "Pain" and "Edema". CONCLUSION: The multidisciplinary problem assessment tool based on the Omaha Problem Classification System serves as an effective and instructive tool to identify the prominent health problems of PD patients and provides a basis for the development of subsequent targeted interventions.

Chemoselective Union of Olefins, Organohalides, and Redox-Active Esters Enables Regioselective Alkene Dialkylation.

Multicomponent catalytic processes that can generate multiple C(sp3)-C(sp3) bonds in a single step under mild conditions, particularly those that employ inexpensive catalysts and substrates, are highly sought-after in chemistry research for complex molecule synthesis. Here, we disclose an efficient Ni-catalyzed reductive protocol that chemoselectively merges alkenyl amides with two different aliphatic electrophiles. Starting materials are readily accessible from stable and abundant feedstock, and products are furnished in up to >98:2 regioisomeric ratios. The present strategy eliminates the use of sensitive organometallic reagents, tolerates a wide array of complex functionalities, and enables regiodivergent addition of two primary alkyl groups bearing similar electronic and steric attributes across aliphatic C═C bonds with exquisite control of site selectivity. Utility is underscored by the concise synthesis of bioactive compounds and postreaction functionalizations leading to structurally diverse scaffolds. DFT studies revealed that the regiochemical outcome originates from the orthogonal reactivity and chemoselectivity profiles of in situ generated organonickel species.

Effect of nurse-led food exchange intervention for patients undergoing peritoneal dialysis
.

AIM: We aimed to apply nurse-led food exchange model intervention to peritoneal dialysis (PD) patients and verify its effectiveness. BACKGROUND: Protein-energy malnutrition is a prominent problem in patients on PD, and it has been estimated that 40% of PD patients suffer from malnutrition to some extent. INTRODUCTION: The rate of malnutrition among PD patients has been relatively high in recent years. Although a lot of effort has been made to alter the situation, an effective method has yet to be implemented. MATERIALS AND METHODS: We recruited 142 patients according to the inclusion and exclusion criteria and divided them into study group (n = 71) and control group (n = 71) using a random-number table generated by SPSS22.0. The control group received routine dietary guidance and instruction while the study group received nurse-led food exchange intervention. The subjective global assessment (SGA) scale scores, nutrition parameter, and dialysis efficacy indicators between the two groups were compared at baseline and after 12 months of intervention. RESULTS: There were no significant differences between the two groups in all dimensions at the baseline measures (p > 0.05). However, after 12 months of intervention, the study group represented a higher score of SGA while the control group declined, which was significantly different (p = 0.022). The study group had an improved level of body mass index, triceps skinfold thickness, middle-arm muscle circumference, serum albumin, prealbumin, and normalized protein catabolic rate, while the control group showed decreased levels, and these results were significantly different (p = 0.001, p = 0.019, p = 0.001, p < 0.001, p = 0.043, respectively). Moreover, blood urea nitrogen declined in the study group and increased in the control group, which was significantly different (p = 0.004). CONCLUSION: Nurse-led food exchange model intervention improved nutrition condition of PD patients dramatically. Implications for nursing and/or health policy: Our study provides a basis for health policy designers to develop nutrition programs and encourage clinical nurses to participate in PD patients' diet management.

Effects of Multidisciplinary Team Care Based on 5E's Renal Rehabilitation for Peritoneal Dialysis Patients in Guangxi Zhuang Autonomous Region of China: A Randomized Controlled Trial.

BACKGROUND: The number of patients with peritoneal dialysis (PD) in China has been increasing year after year, but there are still some challenge in the management of PD patients, and the efficient and effective method has yet to be developed. Multidisciplinary team (MDT) is to create a standardized, individualized, and continuous integrated treatment program for the patients, to ensure the best efficacy and improve patient outcomes. 5E's renal rehabilitation was originally developed by the Life Options Rehabilitation Advisory Council in 1997 to achieve better management of PD patients. However, there is still no relevant study combining these 2 methods and applying to PD patients so far. METHODS: A randomized controlled trial was undertaken in the nephrology department of the First Affiliated Hospital of Guangxi Medical University. We recruited 146 patients according to inclusion and exclusion criteria and divided them into study group (n = 73) and control group (n = 73) using SPSS random number. The control group received routine care and follow-up, while the study group received MDT care based on 5E's renal rehabilitation. The self-management scale for PD patients and the incidence of dialysis-related peritonitis were compared before discharge and 12 months after discharge. RESULTS: T tests showed that there were no significant differences between the 2 groups in the 5 subscales of Self-management Scale for PD patients at the baseline measures (p > 0.05). However, after 12 months of intervention, the study group gained higher scores in the 5 subscales while the control group declined. And the study group improved statistically significant compared with the control group on "Solution bag replacement (t = 3.103, p = 0.002)," "Troubleshooting during operation (t = 3.978, p ≤ 0.001)," "Diet management (t = 3.201, p = 0.002),"and "Emotion management and return to social life (t = 3.552, p = 0.001)" subscales. Moreover, the peritonitis occurrence rate of the study group (1/68.1 patient month) was statistically significantly lower than that of control group (1/29.4 patient month; p = 0.047). CONCLUSIONS: MDT care based on 5E's renal rehabilitation is beneficial for patients undergoing PD and helpful to improve self-management ability and reduce the incidence of peritonitis.

Palladium-Catalyzed Intermolecular Ditrifluoromethoxylation of Unactivated Alkenes: CF3O-Palladation Initiated by Pd(IV).

A novel palladium-catalyzed intermolecular ditrifluoromethoxylation of unactivated alkenes has been developed, using a new electrophilic reagent, SelectfluorCN, as a strong oxidant, and AgOCF3 as a trifluoromethoxide source. Preliminary mechanistic studies revealed that the reaction was possibly initiated by Pd(IV) species, and an unusual cis-addition of CF3O-Pd(IV) into the double bond leads to the formation of the first C-OCF3 bond; in addition, the second C-OCF3 bond was produced through reductive elimination at high-valent palladium center.