The Black Lives Matter movement mitigates bias against racial minority actors.

Watching movies is among the most popular entertainment and cultural activities. How do viewers react when a movie sequel increases racial minority actors in the main cast ("minority increase")? On the one hand, such sequels may receive better evaluations if viewers appreciate racially inclusive casting for its novel elements (the value-in-diversity perspective) and moral appeal (the fairness perspective on diversity). On the other hand, discrimination research suggests that if viewers harbor biases against racial minorities, sequels with minority increase may receive worse evaluations. To examine these competing possibilities, we analyze a unique panel dataset of movie series released from 1998 to 2021 and conduct text analysis of 312,457 reviews of these movies. Consistent with discrimination research, we find that movies with minority increase receive lower ratings and more toxic reviews. Importantly, these effects weaken after the advent of the Black Lives Matter (BLM) movement, especially when the movement's intensity is high. These results are reliable across various robustness checks (e.g., propensity score matching, random implementation test). We conceptually replicate the bias mitigation effect of BLM in a preregistered experiment: Heightening the salience of BLM increases White individuals' acceptance of racial minority increase in a movie sequel. This research demonstrates the power of social movements in fostering diversity, equality, and inclusion.

Peptide Vaccine Against ADAMTS-7 Ameliorates Atherosclerosis and Postinjury Neointima Hyperplasia.

BACKGROUND: The metalloprotease ADAMTS-7 (a disintegrin and metalloproteinase with thrombospondin type 1 motif 7) is a novel locus associated with human coronary atherosclerosis. ADAMTS-7 deletion protects against atherosclerosis and vascular restenosis in rodents. METHODS: We designed 3 potential vaccines consisting of distinct B cell epitopic peptides derived from ADAMTS-7 and conjugated with the carrier protein KLH (keyhole limpet hemocyanin) as well as aluminum hydroxide as an adjuvant. Arterial ligation or wire injury was used to induce neointima in mice, whereas ApoE-/- and LDLR-/- (LDLR [low-density lipoprotein receptor]) mice fed a high-fat diet were applied to assess atherosclerosis. In addition, coronary stent implantation was performed on vaccine-immunized Bama miniature pigs, followed by optical coherence tomography to evaluate coronary intimal hyperplasia. RESULTS: A vaccine, ATS7vac, was screened out from 3 candidates to effectively inhibit intimal thickening in murine carotid artery ligation models after vaccination. As well, immunization with ATS7vac alleviated neointima formation in murine wire injury models and mitigated atherosclerotic lesions in both hyperlipidemic ApoE-/- and LDLR-/- mice without lowering lipid levels. Preclinically, ATS7vac markedly impeded intimal hyperplasia in swine stented coronary arteries, but without significant immune-related organ injuries. Mechanistically, ATS7vac vaccination produced specific antibodies against ADAMTS-7, which markedly repressed ADAMTS-7-mediated COMP (cartilage oligomeric matrix protein) and TSP-1 (thrombospondin-1) degradation and subsequently inhibited vascular smooth muscle cell migration but promoted re-endothelialization. CONCLUSIONS: ATS7vac is a novel atherosclerosis vaccine that also alleviates in-stent restenosis. The application of ATS7vac would be a complementary therapeutic avenue to the current lipid-lowering strategy for atherosclerotic disease.

Elevated serum uric acid is a predictor of pulmonary artery involvement and subsequent prognosis in patients with Takayasu's arteritis.

OBJECTIVES: The aim of this study was to investigate the predictive value of uric acid (UA) in prognosis of pulmonary artery involvement (PAI) in patients with Takayasu's arteritis (TAK). METHODS: A total of 166 TAK patients were enrolled in the study, including 76 with PAI and 90 without. Outcomes of 144 TAK patients were followed up and recorded. The possible associations between serum UA levels and incidence of PAI in TAK and PAI-related prognosis of TAK patients were examined using different statistical models. RESULTS: The serum UA levels were significantly higher in TAK patient with PAI than TAK patients without PAI. Multivariate logistic regression analysis indicated that serum UA level ≥284.5 umol/L was associated with an increasing incidence of PAI in TAK (OR: 2.108, 95% CI: 1.063 to 4.180; p=0.033). Kaplan-Meier survival analysis showed that TAK patients with serum UA level ≥328.1 umol/L had a significantly higher cumulative incidence of PAI-related adverse events compared to TAK patients with serum UA level <328.1 umol/L (p=0.008). Multivariate Cox proportional hazard regression analysis revealed that serum UA level ≥328.1 umol/L (HR: 2.595, 95% CI: 1.198 to 5.622; p=0.016) was a PAI-related prognostic risk factor for TAK. CONCLUSIONS: Elevation of serum UA level was associated with an increasing risk of PAI and PAI-related adverse event in patients with TAK, indicating its potential as a predictor for identification of PAI onset and worsening in TAK patients.

Coronary artery calcification in Takayasu's arteritis: clinical characteristics and risk factors.

OBJECTIVES: Coronary artery calcification (CAC) is frequently observed in Takayasu's arteritis (TAK). Our objective is to calculate the prevalence and severity of CAC in TAK, while evaluating the influence of traditional cardiovascular risk factors, glucocorticoid exposure, and disease activity on CAC. METHODS: This retrospective study involved 155 TAK patients. We measured the Agatston score by coronary computed tomography angiography (CCTA) and categorised all patients into groups with or without CAC (41 vs. 114) to compare clinical characteristics and ancillary findings between the two groups. RESULTS: Among the TAK patients, a total of 41 TAK patients (26.45%) exhibited CAC. Age of onset, disease duration, history of hypertension, history of hyperlipidaemia, Numano V and glucocorticoid use emerged as the independent risk factors for developing CAC in TAK (OR [95% CI] 1.084[1.028-1.142], p=0.003; 1.005 [1.001-1.010], p=0.020; 4.792 [1.713-13.411], p=0.003; 4.199 [1.087-16.219], p=0.037; 3.287 [1.070-10.100], p=0.038; 3.558[1.269-9.977], p=0.016). Nonetheless, CAC was not associated with disease activity. Moreover, the extent of calcification score in TAK showed a positive correlation with the number of traditional cardiovascular risk factors. CONCLUSIONS: We recommend CCTA screening for Numano V classified TAK patients. Glucocorticoid usage significantly escalates the risk of CAC. Therefore, in cases of effectively controlled disease, the inclusion of immunosuppressants aimed at reducing glucocorticoid dosage is advisable.

IRF1 suppresses colon cancer proliferation by reducing SPI1-mediated transcriptional activation of GPX4 and promoting ferroptosis.

IRF1 is a tumor suppressor gene in colon cancer. This study aimed to explore the potential regulation of IRF1 on the ferroptosis of colon cancer and the mechanisms underlying its regulation of GPX4 transcription. IRF1 interacting transcription factors regulating GPX4 transcription were predicted and validated. The role of the IRF1/SPI1-GPX4 axis on the ferroptosis of colon cancer cells was explored. Results showed that IRF1 overexpression reduced GPX4 transcription, increased reactive oxygen species (ROS) and lipid ROS accumulation, and enhanced erastin-induced colon cancer cell growth in vitro and in vivo. SPI1 could directly bind to the GPX4 promoter (-414 to -409) and activate its transcription. IRF1 could bind to SPI1 and suppress its transcriptional activating effects on GPX4 expression. SPI1 overexpression reduced ROS and lipid ROS accumulation and increased colon cancer cell viability and colony formation upon erastin induction. These trends were reversed by IRF1 overexpression. In conclusion, this study revealed a novel oncogenic mechanism of SPI1 by reducing erastin-induced ferroptosis in colon cancer. IRF1 interacts with SPI1 and suppresses its transcriptional activating effect on GPX4 expression. Through this mechanism, IRF1 can enhance erastin-induced ferroptosis of colon cancer. The IRF1/SPI1-GPX4 axis might play a crucial role in modulating ferroptosis in colon cancer and might serve as a potential therapeutic target in the future.

Screening of probiotic Lactobacillus to reduce peanut allergy and with potential anti-allergic activity.

BACKGROUND: Peanut is a significant source of nutrition and a valuable oilseed crop. It is also a serious allergy source, which poses a threat to 1.1% of the population. This study aimed to screen lactic acid bacteria (LAB) with the capacity to alleviate peanut allergenicity and exhibit anti-allergic properties. RESULT: The results show that LAB can make use of substances in peanuts to reduce the pH of peanut milk from 6.603 to 3.593-4.500 by acid production and that it can utilize the protein in peanuts to reduce the allergenic content (especially Ara h 1) and improve biological activity in peanut pulp. The content of Ara h 1 peanut-sensitizing protein was reduced by 74.65% after fermentation. The protein extracted from fermented peanut pulp is more readily digestible by gastrointestinal juices. The inhibitory activity assay of hyaluronidase (an enzyme with strong correlation to allergy) increased from 46.65% to a maximum of 90.57% to reveal that LAB fermentation of peanut pulp exhibited a robust anti-allergic response. CONCLUSION: The strains identified in this study exhibited the ability to mitigate peanut allergenicity partially and to possess potential anti-allergic properties. Lactobacillus plantarum P1 and Lactobacillus salivarius C24 were identified as the most promising strains and were selected for further research. © 2023 Society of Chemical Industry.

The adaptive evolution of cancer driver genes.

BACKGROUND: Cancer is a life-threatening disease in humans; yet, cancer genes are frequently reported to be under positive selection. This suggests an evolutionary-genetic paradox in which cancer evolves as a secondary product of selection in human beings. However, systematic investigation of the evolution of cancer driver genes is sparse. RESULTS: Using comparative genomics analysis, population genetics analysis and computational molecular evolutionary analysis, the evolution of 568 cancer driver genes of 66 cancer types were evaluated at two levels, selection on the early evolution of humans (long timescale selection in the human lineage during primate evolution, i.e., millions of years), and recent selection in modern human populations (~ 100,000 years). Results showed that eight cancer genes covering 11 cancer types were under positive selection in the human lineage (long timescale selection). And 35 cancer genes covering 47 cancer types were under positive selection in modern human populations (recent selection). Moreover, SNPs associated with thyroid cancer in three thyroid cancer driver genes (CUX1, HERC2 and RGPD3) were under positive selection in East Asian and European populations, consistent with the high incidence of thyroid cancer in these populations. CONCLUSIONS: These findings suggest that cancer can be evolved, in part, as a by-product of adaptive changes in humans. Different SNPs at the same locus can be under different selection pressures in different populations, and thus should be under consideration during precision medicine, especially for targeted medicine in specific populations.

High Curvature PEDOT:PSS Transport Layer Toward Enhanced Perovskite Light-Emitting Diodes.

The rapidly developed metal halide perovskite light-emitting diodes (PeLEDs) are considered as a promising candidate for next-generation display and illumination, but the unbalanced charge transport is still a hard-treat case to restrict its efficiency and operational stability. Here, a high curvature PEDOT:PSS transport layer is demonstrated via the self-assembly island-like structures by the incorporation of alkali metal salts. Benefiting from the dielectric confinement effect of the high curvature surface, the modified CsPbBr3 -based PeLEDs present a 2.1 times peak external quantum efficiency (EQE) from 6.75% to 14.23% and a 3.3 times half lifetime (T50 ) from 3.96 to 13.01 h. Besides, the PeLEDs show high luminance up to 44834 cd m-2 . Evidently, this work may provide a deep insight into the structure-activity relationship between the micro-structures at the PEDOT:PSS/perovskite interface and the performance of PeLEDs, and crack the codes for ameliorating the performance of PeLEDs via interfacial micro-structured regulation.

Surveying Public Perceptions of Artificial Intelligence in Health Care in the United States: Systematic Review.

BACKGROUND: This paper reviews nationally representative public opinion surveys on artificial intelligence (AI) in the United States, with a focus on areas related to health care. The potential health applications of AI continue to gain attention owing to their promise as well as challenges. For AI to fulfill its potential, it must not only be adopted by physicians and health providers but also by patients and other members of the public. OBJECTIVE: This study reviews the existing survey research on the United States' public attitudes toward AI in health care and reveals the challenges and opportunities for more effective and inclusive engagement on the use of AI in health settings. METHODS: We conducted a systematic review of public opinion surveys, reports, and peer-reviewed journal articles published on Web of Science, PubMed, and Roper iPoll between January 2010 and January 2022. We include studies that are nationally representative US public opinion surveys and include at least one or more questions about attitudes toward AI in health care contexts. Two members of the research team independently screened the included studies. The reviewers screened study titles, abstracts, and methods for Web of Science and PubMed search results. For the Roper iPoll search results, individual survey items were assessed for relevance to the AI health focus, and survey details were screened to determine a nationally representative US sample. We reported the descriptive statistics available for the relevant survey questions. In addition, we performed secondary analyses on 4 data sets to further explore the findings on attitudes across different demographic groups. RESULTS: This review includes 11 nationally representative surveys. The search identified 175 records, 39 of which were assessed for inclusion. Surveys include questions related to familiarity and experience with AI; applications, benefits, and risks of AI in health care settings; the use of AI in disease diagnosis, treatment, and robotic caregiving; and related issues of data privacy and surveillance. Although most Americans have heard of AI, they are less aware of its specific health applications. Americans anticipate that medicine is likely to benefit from advances in AI; however, the anticipated benefits vary depending on the type of application. Specific application goals, such as disease prediction, diagnosis, and treatment, matter for the attitudes toward AI in health care among Americans. Most Americans reported wanting control over their personal health data. The willingness to share personal health information largely depends on the institutional actor collecting the data and the intended use. CONCLUSIONS: Americans in general report seeing health care as an area in which AI applications could be particularly beneficial. However, they have substantial levels of concern regarding specific applications, especially those in which AI is involved in decision-making and regarding the privacy of health information.

In Situ Implantation of Bi2S3 Nanorods into Porous Quasi-Bi-MOF Architectures: Enabling Synergistic Dissociation of Borohydride for an Efficient and Fast Catalytic Reduction of 4-Nitrophenol.

Catalytic hydrogenation reduction based on sodium borohydride (NaBH4) has gained attention as an appealing "one-stone-two-birds" approach for the simultaneous elimination of nitroaromatic pollutants and the production of high-value aminoaromatics under mild conditions. However, the slow kinetics of NaBH4 dissociation on the surface of catalysts restrict the catalytic hydrogenation reduction efficiency. Herein, we report an intelligent localized sulfidation strategy for an in situ implantation of Bi2S3 nanorods within quasi-Bi-MOF architectures (Bi2S3@quasi-Bi-MOF) by fine-tuning the pyrolysis temperature. In this novel Bi2S3@quasi-Bi-MOF, the porous quasi-Bi-MOF enables efficient adsorption of BH4- and 4-nitrophenol (4-NP), while Bi2S3 facilitates the BH4- dissociation to form Hads* species adsorbed on the catalyst surface. Benefiting from the synergistic structure, Bi2S3@quasi-Bi-MOF exhibits excellent performance for the catalytic reduction of 4-NP, delivering a high turnover frequency (TOF) of 1.67 × 10-4 mmol mg-1 min-1 and an extremely high normalized rate constant (knor) of 435298 s-1 g-1. The kinetic analysis and electrochemical tests indicate that this catalytic hydrogenation reduction follows the Langmuir-Hinshelwood mechanism. This study enriches the synthetic strategy of MOF-based derivatives and offers a new catalytic platform for hydrogenation reduction reactions.

Roles of calpain in the apoptosis of Eimeria tenella host cells at the middle and late developmental stages.

This study investigated the role of calpain in Eimeria tenella-induced host cell apoptosis. Chick embryo cecal epithelial cell culture technology, flow cytometry, enzyme-linked immunosorbent assays, and fluorescence quantitative PCR were used to detect the E. tenella host cell apoptotic rate, Bax and Bid expression levels, and calpain activity. The results demonstrated that Bax, Bid, and calpain levels were upregulated and apoptosis was increased following E. tenella infection at 24-120 h. Calpain levels were reduced by pharmacological inhibition of calpain using SJA6017 or by blocking Ca2+ entry into the cell using BAPTA/AM at 24-120 h. The mRNA and protein levels of Bax and Bid, the E. tenella infection rate, and the early apoptotic and late apoptotic (necrosis) rates were decreased by using SJA6017 at 24-120 h. These results indicated that E. tenella-promoted host cell apoptosis is regulated by calpain via Bid and Bax at 24-120 h. Thus, manipulation of calpain levels could be used to manage E. tenella infection in chickens in the middle and late developmental stages.

Insights into the mechanism underlying crystalline silica-induced pulmonary fibrosis via transcriptome-wide m6A methylation profile.

Silicosis is one of the most severe interstitial lung fibrosis diseases worldwide, caused by crystalline silica exposure. While the mechanisms and pathogenesis underlying silicosis remained unknown. N6-methyladenosine (m6A) methylation has received significant attention in a variety of human diseases. However, whether m6A methylation is involved in silicosis has not been clarified. In this study, we conducted methylated RNA immunoprecipitation sequencing (MeRIP-Seq) and transcriptome sequencing (RNA-Seq) to profile the m6A modification in normal and silicosis mouse models (n = 3 pairs). The global levels of m6A methylation were further assessed by m6A RNA methylation quantification kits, and the major regulators of m6A RNA methylation were verified by qRT-PCR. Our results showed that long-term exposure to crystalline silica led to silicosis, accompanied by increasing levels of m6A methylation. Upregulation of METTL3 and downregulation of ALKBH5, FTO, YTHDF1, and YTHDF3 might contribute to aberrant m6A modification. Compared with controls, 359 genes showed differential m6A methylation peaks in silicosis (P < 0.05 and FC ≥ 2). Among them, 307 genes were hypermethylated, and 52 genes were hypomethylated. RNA-Seq analysis revealed 1091 differentially expressed genes between the two groups, 789 genes were upregulated and 302 genes were downregulated in the lungs of silicosis mice (P < 0.05 and FC ≥ 2). In the conjoint analysis of MeRIP-Seq and RNA-Seq, we identified that 18 genes showed significant changes in both m6A modification and mRNA expression. The functional analysis further noted that these 18 m6A-mediated mRNAs regulated pathways that were closely related to "phagosome", "antigen processing and presentation", and "apoptosis". All findings suggested that m6A methylation played an essential role in the formation of silicosis. Our discovery with multi-omics approaches not only gives clues for the epigenetic mechanisms underlying the pathogenesis of silicosis but also provides novel and viable strategies for the prevention and treatment of silicosis.

A Highly Efficient Biomass Compound Aerosol Suppressant in Purifying Radioactive Cesium Droplet Aerosols.

Nuclear accidents and decommissioning in the nuclear industry would release a large number of radioactive aerosols which endangers the natural environment and the health of workers. Therefore, there is an urgent need for environment-friendly aerosol suppressants to control and handle environmental pollution problems caused by radioactive aerosols. In this paper, sodium alginate (SA), a type of polyphenol material (TP), and alkyl glycosides (APGs) were selected as the components of the compound aerosol suppressant and the optimal proportion was generated via the method of D-optimal mixture design. Furthermore, the cesium aerosol sedimentation effect of the optimized compound aerosol suppressants was evaluated via sedimentation efficiency, the change in particle concentration cumulative concentration fraction of the cesium aerosol sedimentation process. The results showed that the aerosol sedimentation efficiency was 99.82% which was much higher than nature settlement, 18.6% and water spraying sedimentation, 43.3%. Moreover, after spraying the compound suppressant, it displayed a good effect on settling the cesium aerosol particles with a diameter of less than 1 µm, as the concentration of particles was reduced from 55.49% to 44.53%. Finally, the sedimentation mechanism of the compound aerosol suppressant and cesium aerosol particles, such as the coagulation effect, was analyzed using the particle size distribution.

Violence in the first millennium BCE Eurasian steppe: Cranial trauma in three Turpan Basin populations from Xinjiang, China.

OBJECTIVES: Violence affected daily life in prehistoric societies, especially at conflict zones where different peoples fought over resources and for other reasons. In this study, cranial trauma was analyzed to discuss the pattern of violence experienced by three Bronze to early Iron Age populations (1,000-100 BCE) that belonged to the Subeixi culture. These populations lived in the Turpan Basin, a conflict zone in the middle of the Eurasian Steppe. METHODS: The injuries on 129 complete crania unearthed from the Subeixi cemeteries were examined for crude prevalence rate (CPR), trauma type, time of occurrence, possible weapon, and direction of the blow. Thirty-three injuries identified from poorly preserved crania were also included in the analyses except for the CPR. Data was also compared between the samples and with four other populations that had violence-related backgrounds. RESULTS: Overall, 16.3% (21/129) of the individuals showed violence-induced traumatic lesions. Results also indicated that most of the injuries were perimortem (81.6%), and that women and children were more involved in conflict than the other comparative populations. Wounds from weapons accounted for 42.1% of the identified cranial injuries. Distribution analysis suggested no dominant handedness of the attackers, and that blows came from all directions including the top (17.1%). Wounds caused by arrowheads and a special type of battle-ax popular in middle and eastern Eurasian Steppe were also recognized. DISCUSSION: A comprehensive analysis of the skeletal evidence, historical records, and archeological background would suggest that the raiding to be the most possible conflict pattern reflected by the samples. The attackers were likely to have been nomadic invaders from the steppe (such as the Xiongnu from historical records), who attacked the residents in the basin more likely for their resources rather than territory or labor force.

Glucocerebrosidase activity, cathepsin D and monomeric α-synuclein interactions in a stem cell derived neuronal model of a PD associated GBA1 mutation.

The presence of GBA1 gene mutations increases risk for Parkinson's disease (PD), but the pathogenic mechanisms of GBA1 associated PD remain unknown. Given that impaired α-synuclein turnover is a hallmark of PD pathogenesis and cathepsin D is a key enzyme involved in α-synuclein degradation in neuronal cells, we have examined the relationship of glucocerebrosidase (GCase), cathepsin D and monomeric α-synuclein in human neural crest stem cell derived dopaminergic neurons. We found that normal activity of GCase is necessary for cathepsin D to perform its function of monomeric α-synuclein removal from neurons. GBA1 mutations lead to a lower level of cathepsin D protein and activity, and higher level of monomeric α-synuclein in neurons. When GBA1 mutant neurons were treated with GCase replacement or chaperone therapy; cathepsin D protein levels and activity were restored, and monomeric α-synuclein decreased. When cathepsin D was inhibited, GCase replacement failed to reduce monomeric α-synuclein levels in GBA1 mutant neurons. These data indicate that GBA1 gene mutations increase monomeric α-synuclein levels via an effect on lysosomal cathepsin D in neurons.

Multipotent stem cells with neural crest stem cells characteristics exist in bovine adipose tissue.

Neural crest stem cells (NCSCs) often referred to as the fourth germ layer, comprise a migratory, stem and progenitor cell population and are synonymous with vertebrate evolution and development. The cells follow specific paths to migrate to different locations of the body where they generate a diverse array of cell types and tissues. There are NCSCs which are maintained in an undifferentiated state throughout the life in the animal tissues. Based on some cells migratory property, we successfully developed a separation strategy to isolate and identify a population of adipose-derived stem cells with neural crest stem cell features in adult bovine adipose tissues within minimally-invasive surgical procedures. The cells have a high degree of multi-potency and self-renewal capabilities, can be cultured and maintained in feeder-free adhesion conditions as monolayer cells, and also be able to grow in the suspension condition in the form of neurosphere. For the purpose of simple description, we name this type cell as bovine adipose-derived neural crest stem cell (baNCSC). Taken together our study describes a readily accessible source of multipotent baNCSC for autologous tissue engineer and cell-based therapeutic researches.

Phosphine-Based Covalent Organic Framework for the Controlled Synthesis of Broad-Scope Ultrafine Nanoparticles.

In this work, a phosphine-based covalent organic framework (Phos-COF-1) is successfully synthesized and employed as a template for the confined growth of broad-scope nanoparticles (NPs). Ascribed to the ordered distribution of phosphine coordination sites in the well-defined pores, various stable and well-dispersed ultrafine metal NPs including Pd, Pt, Au, and bimetallic PdAuNPs with narrow size distributions are successfully prepared as determined by transmission electron microscopy, X-ray photoelectron spectroscopy, inductively coupled plasma, and powder X-ray diffraction analyses. It is also demonstrated that the as-prepared Phos-COF-1-supported ultrafine NPs exhibit excellent catalytic activities and recyclability toward the Suzuki-Miyaura coupling reaction, reduction of nitro-phenol and 1-bromo-4-nitrobenzene, and even tandem coupling and reduction of p-nitroiodobenzene. This work will open many new possibilities for preparing COF-supported ultrafine NPs with good dispersity and stability for a broad range of applications.

The influence of coronavirus disease 2019 on emergency department visits in Nanjing, China: A multicentre cross-sectional study.

INTRODUCTION: Influenza has been linked to the crowding in emergency departments (ED) across the world. The impact of the Coronavirus Disease 2019 (COVID-19) pandemic on China EDs has been quite different from those during past influenza outbreaks. Our objective was to determine if COVID-19 changed ED visit disease severity during the pandemic. METHODS: This was a retrospective cross sectional study conducted in Nanjing, China. We captured ED visit data from 28 hospitals. We then compared visit numbers from October 2019 to February 2020 for a month-to-month analysis and every February from 2017 to 2020 for a year-to-year analysis. Inter-group chi-square test and time series trend tests were performed to compare visit numbers. The primary outcome was the proportion of severe disease visits in the EDs. RESULTS: Through February 29 th 2020, there were 93 laboratory-confirmed COVID-19 patients in Nanjing, of which 40 cases (43.01%) were first seen in the ED. The total number of ED visits in Nanjing in February 2020, were dramatically decreased (n = 99,949) in compared to January 2020 (n = 313,125) and February 2019 (n = 262,503). Except for poisoning, the severe diseases in EDs all decreased in absolute number, but increased in proportion both in year-to-year and month-to-month analyses. This increase in proportional ED disease severity was greater in higher-level referral hospitals when compared year by year. CONCLUSION: The COVID-19 outbreak has been associated with decreases in ED visits in Nanjing, China, but increases in the proportion of severe ED visits.

"A community system": A critical foundation for the epidemic prevention and control of SARS-CoV-2.

In response to COVID-19 that has constituted a global pandemic, countries around the world have successively adopted a myriad of prevention and control measures. As the first country with the COVID-19 outbreak, the Chinese government has adopted a series of timely and strict prevention and control measures against the spread of the SARS-CoV-2, which has effectively slowed down the spread of the SARS-CoV-2 and created a valuable window for the international community to overcome the epidemic. China's experience in combating the COVID-19 has shown that building a community prevention and control system is essential to control the spread of coronavirus. As the backbone of the epidemic prevention and control system, the community prevention and control system plays an important role in improving the pattern of disorderly medical treatment, screening suspected patients, preventing the input of pathogens, ensuring residents' medical needs, stabilizing public sentiment, reducing disease fear, and maintaining residents' national security. At the same time, it also exposed the problems of the community prevention and control epidemic system in terms of infrastructure, human resources, and internal systems. Based on this, this article suggests that we should improve the hardware facilities of community, improve the internal mechanism of the community, strengthen the stability of the community talent team, improve the level of linkage between the community and other departments to prevent and control the spread of SARS-CoV-2, effectively use information technology and actively mobilize social forces to help community prevention and control COVID-19.

Total per-visit medical expenses incurred by outpatients with diabetes-Evidence from six provinces in eastern China.

BACKGROUND: Chronic diseases associated with diabetes threaten the health of Chinese people and contribute to poverty. METHODS: Medical service utilization records of 78 124 visits by outpatients with diabetes to medical institutions in China's eastern region between 2013 and 2015 were randomly selected from the Medical Insurance Department (MID) database. One-way analysis of variance (ANOVA) was used to compare the average total per-visit, out-of-pocket (OOP), and medical insurance (MI) fund expenses between variables. Multiple linear regression analysis was performed to identify possible risk factors affecting total per-visit medical expenses. RESULTS: Average total per-visit medical expenses were 244.59, 285.56, and 435.33 yuan in primary, secondary, and tertiary medical institutions, respectively. Significant differences were found for average total per-visit medical expenses by year of visit, age, type of medical insurance, and levels of medical institutions. No significant differences were found for average total per-visit medical expenses by gender. CONCLUSION: The functions of medical networks at all levels should be clarified and the Urban Resident Basic Medical Insurance (URBMI) reimbursement ratio improved to ensure equal access to medical services irrespective of medical insurance type. Patients with chronic diseases should be encouraged to visit primary medical institutions to reduce medical expenses.